C.7 Common Composite Image IOD Modules
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## C.7 Common Composite Image IOD Modules

This Section defines the Modules that are common to all Composite Image IODs.

### C.7.1 Common Patient IE Modules

The following Patient IE Module is common to all Composite Image IODs that reference the Patient IE.

#### C.7.1.1 Patient Module

Table C.7-1 specifies the Attributes of the Patient that describe and identify the Patient who is the subject of a diagnostic Study. This Module contains Attributes of the patient that are needed for diagnostic interpretation of the Image and are common for all studies performed on the patient. It contains Attributes that are also included in the Patient Modules in Section C.2.

Table C.7-1. Patient Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Patient's Name | (0010,0010) | 2 | Patient's full name.
Patient ID | (0010,0020) | 2 | Primary hospital identification number or code for the patient.
Include Table 10-18 “Issuer of Patient ID Macro Attributes” |
Patient's Birth Date | (0010,0030) | 2 | Birth date of the patient.
Patient's Sex | (0010,0040) | 2 | Sex of the named patient. Enumerated Values: M male F female O other
Referenced Patient Photo Sequence | (0010,1100) | 3 | A photo to confirm the identity of a patient. Only a single Item is permitted in this Sequence. See C.2.2.1.1.
>Include Table 10-3b “Referenced Instances and Access Macro Attributes” |
Quality Control Subject | (0010,0200) | 3 | Indicates whether or not the subject is a quality control phantom. Enumerated Values: YES NO If this Attribute is absent, then the subject may or may not be a phantom. This attribute describes a characteristic of the Imaging Subject. It is distinct from Quality Control Image (0028,0300) in the General Image Module, which is used to describe an image acquired.
Referenced Patient Sequence | (0008,1120) | 3 | A sequence that provides reference to a Patient SOP Class/Instance pair. Only a single Item is permitted in this Sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
Patient's Birth Time | (0010,0032) | 3 | Birth time of the Patient.
Other Patient IDs | (0010,1000) | 3 | Other identification numbers or codes used to identify the patient.
Other Patient IDs Sequence | (0010,1002) | 3 | A sequence of identification numbers or codes used to identify the patient, which may or may not be human readable, and may or may not have been obtained from an implanted or attached device such as an RFID or barcode. One or more Items are permitted in this sequence.
>Patient ID | (0010,0020) | 1 | An identification number or code used to identify the patient.
>Include Table 10-18 “Issuer of Patient ID Macro Attributes” |
>Type of Patient ID | (0010,0022) | 1 | The type of identifier in this item. Defined Terms: TEXT RFID BARCODE ### Note The identifier is coded as a string regardless of the type, not as a binary value.
Other Patient Names | (0010,1001) | 3 | Other names used to identify the patient.
Ethnic Group | (0010,2160) | 3 | Ethnic group or race of the patient.
Patient Comments | (0010,4000) | 3 | User-defined additional information about the patient.
Patient Species Description | (0010,2201) | 1C | The species of the patient. Required if the patient is an animal and if Patient Species Code Sequence (0010,2202) is not present. May be present otherwise.
Patient Species Code Sequence | (0010,2202) | 1C | The species of the patient. Only a single Item shall be included in this sequence. Required if the patient is an animal and if Patient Species Description (0010,2201) is not present. May be present otherwise.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7454 “Species”.
Patient Breed Description | (0010,2292) | 2C | The breed of the patient. See Section C.7.1.1.1.1. Required if the patient is an animal and if Patient Breed Code Sequence (0010,2293) is empty. May be present otherwise.
Patient Breed Code Sequence | (0010,2293) | 2C | The breed of the patient. See Section C.7.1.1.1.1. Zero or more Items shall be included in this sequence. Required if the patient is an animal.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7480 “Breed”.
Breed Registration Sequence | (0010,2294) | 2C | Information identifying an animal within a breed registry. Zero or more Items shall be included in this sequence. Required if the patient is an animal.
>Breed Registration Number | (0010,2295) | 1 | Identification number of an animal within the registry.
>Breed Registry Code Sequence | (0010,2296) | 1 | Identification of the organization with which an animal is registered. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7481 “Breed Registry”.
Responsible Person | (0010,2297) | 2C | Name of person with medical decision making authority for the patient. Required if the patient is an animal. May be present otherwise.
Responsible Person Role | (0010,2298) | 1C | Relationship of Responsible Person to the patient. See Section C.7.1.1.1.2 for Defined Terms. Required if Responsible Person is present and has a value.
Responsible Organization | (0010,2299) | 2C | Name of organization with medical decision making authority for the patient. Required if patient is an animal. May be present otherwise.
Patient Identity Removed | (0012,0062) | 3 | The true identity of the patient has been removed from the Attributes and the Pixel Data Enumerated Values: YES NO
De-identification Method | (0012,0063) | 1C | A description or label of the mechanism or method use to remove the patient's identity. May be multi-valued if successive de-identification steps have been performed. ### Note This may be used to describe the extent or thoroughness of the de-identification, for example whether or not the de-identification is for a "Limited Data Set" (as per HIPAA Privacy Rule). The characteristics of the de-identifying equipment and/or the responsible operator of that equipment may be recorded as an additional item of the Contributing Equipment Sequence (0018,A001) in the SOP Common Module. De-identifying equipment may use a Purpose of Reference of (109104,DCM,"De-identifying Equipment"). Required if Patient Identity Removed (0012,0062) is present and has a value of YES and De-identification Method Code Sequence (0012,0064) is not present. May be present otherwise.
De-identification Method Code Sequence | (0012,0064) | 1C | A code describing the mechanism or method use to remove the patient's identity. One or more Items shall be included in this sequence. Multiple items are used if successive de-identification steps have been performed or to describe options of a defined profile. Required if Patient Identity Removed (0012,0062) is present and has a value of YES and De-identification Method (0012,0063) is not present. May be present otherwise.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7050 “De-identification Method”.

##### C.7.1.1.1 Patient Module Attributes

###### C.7.1.1.1.1 Patient Breed Description and Code Sequence

The breed of an animal, if known, shall be encoded in either Patient Breed Description (0010,2292) or Patient Breed Code Sequence (0010,2293) or both.

In the case of a mixed breed, it shall be either:

1. described in plain text in Patient Breed Description (0010,2292), e.g., "Border Collie American Bulldog mix", or just "Mixed", or

2. coded as multiple specific breeds by composing the mix as multiple items of Patient Breed Code Sequence (0010,2293), e.g., (L-809A2,SRT,"Border Collie dog breed") followed by (L-80974,SRT, "American Bulldog breed"), or

3. encoded non-specifically with a code that means "mixed breed" of the appropriate species, as defined in CID 7482 “DX Anatomy Imaged for Animals”, which is included in CID 7480 “Breed”, e.g., (L-809DF,SRT,"Mixed breed dog").

### Note

The absence of a value for both Patient Breed Description (0010,2292) and Patient Breed Code Sequence (0010,2293) implies that the breed is unknown, not that it is mixed.

###### C.7.1.1.1.2 Responsible Person Role

Defined Terms:

OWNER

PARENT

CHILD

SPOUSE

SIBLING

RELATIVE

GUARDIAN

CUSTODIAN

AGENT

#### C.7.1.2 Specimen Identification Module

Retired. See PS3.3-2008.

### Note

The functionality of the Specimen Identification Module has been replaced by the Specimen Module. See Section C.7.6.22.

#### C.7.1.3 Clinical Trial Subject Module

Table C.7-2b contains attributes that identify a Patient as a clinical trial Subject.

Table C.7-2b. Clinical Trial Subject Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Clinical Trial Sponsor Name | (0012,0010) | 1 | The name of the clinical trial sponsor. See Section C.7.1.3.1.1.
Clinical Trial Protocol ID | (0012,0020) | 1 | Identifier for the noted protocol. See Section C.7.1.3.1.2.
Clinical Trial Protocol Name | (0012,0021) | 2 | The name of the clinical trial protocol. See Section C.7.1.3.1.3.
Clinical Trial Site ID | (0012,0030) | 2 | The identifier of the site responsible for submitting clinical trial data. See Section C.7.1.3.1.4.
Clinical Trial Site Name | (0012,0031) | 2 | Name of the site responsible for submitting clinical trial data. See Section C.7.1.3.1.5
Clinical Trial Subject ID | (0012,0040) | 1C | The assigned identifier for the clinical trial subject. See Section C.7.1.3.1.6. Shall be present if Clinical Trial Subject Reading ID (0012,0042) is absent. May be present otherwise.
Clinical Trial Subject Reading ID | (0012,0042) | 1C | Identifies the subject for blinded evaluations. Shall be present if Clinical Trial Subject ID (0012,0040) is absent. May be present otherwise. See Section C.7.1.3.1.7.
Clinical Trial Protocol Ethics Committee Name | (0012,0081) | 1C | Name of the Ethics Committee or Institutional Review Board (IRB) responsible for approval of the Clinical Trial. Required if Clinical Trial Protocol Ethics Committee Approval Number (0012,0082) is present.
Clinical Trial Protocol Ethics Committee Approval Number | (0012,0082) | 3 | Approval number issued by committee described in Clinical Trial Protocol Ethics Committee Name (0012,0081).

##### C.7.1.3.1 Clinical Trial Subject Attribute Descriptions

Identification of subjects in clinical trials generally requires a combination of the following four attributes:

1. Clinical Trial Sponsor Name (0012,0010),

2. Clinical Trial Protocol ID (0012,0020),

3. Clinical Trial Subject ID (0012,0040) (or Clinical Trial Subject Reading ID (0012,0042) for blinded evaluations), and

4. Clinical Trial Site ID (0012,0030).

For trials in which subject identifiers are unique within the scope of the Clinical Trial Protocol (e.g., if subject identifiers are centrally assigned or contain the site identifier) the Clinical Trial Site ID (0012,0030) is not required to identify subjects.

###### C.7.1.3.1.1 Clinical Trial Sponsor Name

The Clinical Trial Sponsor Name (0012,0010) identifies the entity responsible for conducting the clinical trial and for defining the Clinical Trial Protocol ID (0012,0020).

###### C.7.1.3.1.2 Clinical Trial Protocol ID

The Clinical Trial Protocol ID (0012,0020) is the number or character sequence used by the Clinical Trial Sponsor to uniquely identify the investigational protocol in which the subject has been enrolled.

###### C.7.1.3.1.3 Clinical Trial Protocol Name

The Clinical Trial Protocol Name (0012,0021) contains the title of the investigational protocol in which the subject has been enrolled.

### Note

It is recommended that the phase of the clinical trial be noted in the Clinical Trial Protocol Name, if applicable.

###### C.7.1.3.1.4 Clinical Trial Site ID

The Clinical Trial Site ID (0012,0030) is the identification number or character string (issued by the entity identified by the Clinical Trial Sponsor Name (0012,0010)) used to identify the site responsible for submitting clinical trial data.

###### C.7.1.3.1.5 Clinical Trial Site Name

The Clinical Trial Site Name (0012,0031) is a character string used to identify the site responsible for submitting clinical trial data.

###### C.7.1.3.1.6 Clinical Trial Subject ID

The Clinical Trial Subject ID (0012,0040) identifies the subject within the investigational protocol specified by Clinical Trial Protocol ID (0012,0020).

###### C.7.1.3.1.7 Clinical Trial Subject Reading ID

The Clinical Trial Subject Reading ID (0012,0042) identifies the subject in the context of blinded evaluations.

### C.7.2 Common Study IE Modules

The following Study IE Modules are common to all Composite Image IODs that reference the Study IE. These Modules contain Attributes of the patient and study that are needed for diagnostic interpretation of the image. They contain Attributes that are also in the Patient Modules in Section C.2 and Study Modules in Section C.4.

#### C.7.2.1 General Study Module

Table C.7-3 specifies the Attributes that describe and identify the Study performed upon the Patient.

Table C.7-3. General Study Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Study Instance UID | (0020,000D) | 1 | Unique identifier for the Study.
Study Date | (0008,0020) | 2 | Date the Study started.
Study Time | (0008,0030) | 2 | Time the Study started.
Referring Physician's Name | (0008,0090) | 2 | Name of the patient's referring physician
Referring Physician Identification Sequence | (0008,0096) | 3 | Identification of the patient's referring physician. Only a single item is permitted in this sequence.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Study ID | (0020,0010) | 2 | User or equipment generated Study identifier.
Accession Number | (0008,0050) | 2 | A RIS generated number that identifies the order for the Study.
Issuer of Accession Number Sequence | (0008,0051) | 3 | Identifier of the Assigning Authority that issued the Accession Number. Only a single Item is permitted in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Study Description | (0008,1030) | 3 | Institution-generated description or classification of the Study (component) performed.
Physician(s) of Record | (0008,1048) | 3 | Names of the physician(s) who are responsible for overall patient care at time of Study (see Section C.7.3.1 for Performing Physician)
Physician(s) of Record Identification Sequence | (0008,1049) | 3 | Identification of the physician(s) who are responsible for overall patient care at time of Study. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Physician(s) of Record (0008,1048), if present.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Name of Physician(s) Reading Study | (0008,1060) | 3 | Names of the physician(s) reading the Study.
Physician(s) Reading Study Identification Sequence | (0008,1062) | 3 | Identification of the physician(s) reading the Study. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Name of Physician(s) Reading Study (0008,1060), if present.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Requesting Service Code Sequence | (0032,1034) | 3 | Institutional department where the request initiated. Only a single item is permitted in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7030 “Institutional Departments, Units and Services”.
Referenced Study Sequence | (0008,1110) | 3 | A sequence that provides reference to a Study SOP Class/Instance pair. One or more Items are permitted in this Sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
Procedure Code Sequence | (0008,1032) | 3 | A Sequence that conveys the type of procedure performed. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Reason For Performed Procedure Code Sequence | (0040,1012) | 3 | Coded reason(s) for performing this procedure. ### Note May differ from the values in Reason for the Requested Procedure (0040,100A) in Request Attribute Sequence (0040,0275), for example if what was performed differs from what was requested. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.

##### C.7.2.1.1 General Study Attribute Descriptions

###### C.7.2.1.1.1 Referring Physician, Physician of Record, Physician Reading Study

The model used for application of attributes related to different functions of Physicians involved in the care of a patient is shown in Figure C.7.2-1. Figure C.7.2-1 shows some of the relationships and information flows between physician roles that might be present in some healthcare business models.

Figure C.7.2-1. Functions of Physicians

There can be an overlap of functions provided by any given physician. In this case, the various attributes specifying the different roles would convey the same physician name.

#### C.7.2.2 Patient Study Module

Table C.7-4a defines Attributes that provide information about the Patient at the time the Study started.

Table C.7-4a. Patient Study Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Admitting Diagnoses Description | (0008,1080) | 3 | Description of the admitting diagnosis (diagnoses)
Admitting Diagnoses Code Sequence | (0008,1084) | 3 | A sequence that conveys the admitting diagnosis (diagnoses). One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Patient's Age | (0010,1010) | 3 | Age of the Patient.
Patient's Size | (0010,1020) | 3 | Length or size of the Patient, in meters.
Patient's Weight | (0010,1030) | 3 | Weight of the Patient, in kilograms.
Patient's Size Code Sequence | (0010,1021) | 3 | Patient's size category code One or more Items are permitted in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID is CID 7040 “Broselow-Luten Pediatric Size Categories” for pediatric patients Baseline CID is CID 7042 “Calcium Scoring Patient Size Categories” for CT calcium scoring
Occupation | (0010,2180) | 3 | Occupation of the Patient.
Additional Patient History | (0010,21B0) | 3 | Additional information about the Patient's medical history.
Admission ID | (0038,0010) | 3 | Identifier of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence | (0038,0014) | 3 | Identifier of the Assigning Authority that issued Admission ID (0038,0010). Only a single Item is permitted in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Service Episode ID | (0038,0060) | 3 | Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence | (0038,0064) | 3 | Identifier of the Assigning Authority that issued the Service Episode ID (0038,0060). Only a single Item is permitted in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Service Episode Description | (0038,0062) | 3 | Description of the type of service episode.
Patient's Sex Neutered | (0010,2203) | 2C | Whether or not a procedure has been performed in an effort to render the patient sterile. Enumerated Values: ALTERED Altered/Neutered UNALTERED Unaltered/intact ### Note If this Attribute is present but has no value then the status is unknown. Required if patient is an animal. May be present otherwise.

#### C.7.2.3 Clinical Trial Study Module

Table C.7-4b contains attributes that identify a Study in the context of a clinical trial.

Table C.7-4b. Clinical Trial Study Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Clinical Trial Time Point ID | (0012,0050) | 2 | An identifier specifying the one or more studies that are grouped together as a clinical time point or submission in a clinical trial. See Section C.7.2.3.1.1.
Clinical Trial Time Point Description | (0012,0051) | 3 | A description of a set of one or more studies that are grouped together to represent a clinical time point or submission in a clinical trial. See Section C.7.2.3.1.1.
Consent for Clinical Trial Use Sequence | (0012,0083) | 3 | A Sequence that conveys information about consent for Clinical Trial use of the composite instances within this Study. One or more Items are permitted in this sequence. See Section C.7.2.3.1.2.
>Distribution Type | (0012,0084) | 1C | The type of distribution for which consent to distribute has been granted. Defined Terms: NAMED_PROTOCOL RESTRICTED_REUSE PUBLIC_RELEASE See Section C.7.2.3.1.2. Required if Consent for Distribution Flag (0012,0085) equals YES or WITHDRAWN.
>Clinical Trial Protocol ID | (0012,0020) | 1C | The identifier of the protocol for which consent to distribute has been granted. Required if Distribution Type (0012,0084) is NAMED_PROTOCOL and the protocol is not that which is specified in Clinical Trial Protocol ID (0012,0020) in the Clinical Trial Subject Module.
>Consent for Distribution Flag | (0012,0085) | 1 | Whether or not consent to distribute has been granted for the purpose described in Distribution Type (0012,0084). Enumerated Values: NO YES WITHDRAWN See Section C.7.2.3.1.2. ### Note Under some circumstances, consent may be withdrawn. The purpose of encoding this is to warn receiving systems that further distribution may not be appropriate, but no semantics are defined by the Standard for what action is appropriate under such circumstances, such as what to do with previously received images that had a value of YES.

##### C.7.2.3.1 Clinical Trial Study Attribute Descriptions

###### C.7.2.3.1.1 Clinical Trial Time Point

The Clinical Trial Time Point ID (0012,0050) attribute identifies an imaging study within the context of an investigational protocol. This attribute is used to define a set of studies that are grouped together as a clinical time point or data submission in a clinical trial. The Clinical Trial Time Point Description (0012,0051) attribute can be used to give a description of the Clinical Trial Time Point to which the set of studies belongs.

###### C.7.2.3.1.2 Consent For Clinical Trial Use Sequence

For applications such as clinical trials, the distribution of composite instances in Studies, whether containing identifying information or partially or completely de-identified, may need to be controlled. Permission for distribution is usually granted under the control of the patient (through informed consent), the ethics committee or institutional review board responsible for the study, and the sponsor of the study through contractual means. The Consent for Clinical Trial Use Sequence (0012,0083) is intended to encode the result of the consent process to allow appropriate subsequent handling of the instances.

The Defined Terms for Distribution Type (0012,0084) mean that consent has been issued to distribute for the following purposes:

Defined Terms:

NAMED_PROTOCOL

  conducting the protocol named in Clinical Trial Protocol ID (0012,0020)

RESTRICTED_REUSE

  re-use for restricted purposes (not specified here) other than those for which the instances were originally created

PUBLIC_RELEASE

  release to the general public for re-use without restriction

### Note

1. There is no intent to convey in this sequence further details of the often complex consent and approval process. Further information about the protocol and ethics committee may be found in the Clinical Trials modules, if present.

2. There is no identification of an individual responsible for the approval or granting consent, since in the case of a clinical trial subject granting informed consent, the presence of this information would breach de-identification requirements.

3. Multiple sequence items may be present; for example a Study may be approved for distribution for conducting multiple explicitly named protocols.

4. Whether or not the instances have been adequately de-identified for any particular purpose of distribution is not defined by the Attributes in the Consent for Clinical Trial Use Sequence (0012,0083). Other Attributes address this, such as Patient Identity Removed (0012,0062), De-identification Method (0012,0063), De-identification Method Code Sequence (0012,0064) and Burned In Annotation (0028,0301). See also Annex E “Attribute Confidentiality Profiles” in PS3.15.

5. It is possible that the list of Defined Terms for Distribution Type (0012,0084) may be extended in future for other purposes, not necessarily related to the conduct of clinical trials.

### C.7.3 Common Series IE Modules

The following Series IE Modules are common to all Composite Image IODs that reference the Series IE.

#### C.7.3.1 General Series Module

Table C.7-5a specifies the Attributes that identify and describe general information about the Series within a Study.

Table C.7-5a. General Series Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Modality | (0008,0060) | 1 | Type of equipment that originally acquired the data used to create the images in this Series. See Section C.7.3.1.1.1 for Defined Terms.
Series Instance UID | (0020,000E) | 1 | Unique identifier of the Series.
Series Number | (0020,0011) | 2 | A number that identifies this Series.
Laterality | (0020,0060) | 2C | Laterality of (paired) body part examined. Required if the body part examined is a paired structure and Image Laterality (0020,0062) or Frame Laterality (0020,9072) are not sent. Enumerated Values: R right L left ### Note Some IODs support Image Laterality (0020,0062) at the Image level or Frame Laterality (0020,9072) at the Frame level in the Frame Anatomy functional group macro or Measurement Laterality (0024,0113) at the Measurement level, which can provide a more comprehensive mechanism for specifying the laterality of the body part(s) being examined.
Series Date | (0008,0021) | 3 | Date the Series started.
Series Time | (0008,0031) | 3 | Time the Series started.
Performing Physician's Name | (0008,1050) | 3 | Name of the physician(s) administering the Series.
Performing Physician Identification Sequence | (0008,1052) | 3 | Identification of the physician(s) administering the Series. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Performing Physician's Name (0008,1050), if present.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Protocol Name | (0018,1030) | 3 | User-defined description of the conditions under which the Series was performed. ### Note This attribute conveys series-specific protocol identification and may or may not be identical to the one presented in the Performed Protocol Code Sequence (0040,0260).
Series Description | (0008,103E) | 3 | Description of the Series
Series Description Code Sequence | (0008,103F) | 3 | A coded description of the Series. Only a single Item is permitted in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Operators' Name | (0008,1070) | 3 | Name(s) of the operator(s) supporting the Series.
Operator Identification Sequence | (0008,1072) | 3 | Identification of the operator(s) supporting the Series. One or more items are permitted in this sequence. If more than one Item, the number and order shall correspond to the value of Operators' Name (0008,1070), if present.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Referenced Performed Procedure Step Sequence | (0008,1111) | 3 | Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related. Only a single Item is permitted in this sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
Related Series Sequence | (0008,1250) | 3 | Identification of Series significantly related to this Series. One or more Items are permitted in this Sequence. ### Note For example, for a combined CT and PET acquisition, the CT images and PET images would be in separate series that could cross-reference each other with multiple purpose of reference codes meaning same anatomy, simultaneously acquired and same indication. The related series may have different Frames of Reference and hence require some sort of registration before spatial coordinates can be directly compared. This attribute is not intended for conveying localizer reference information, for which Referenced Image Sequence (0008,1140) should be used.
>Study Instance UID | (0020,000D) | 1 | Instance UID of Study to which the related Series belongs
>Series Instance UID | (0020,000E) | 1 | Instance UID of Related Series
>Purpose of Reference Code Sequence | (0040,A170) | 2 | Describes the purpose for which the reference is made. Zero or more Items shall be included in this sequence. When absent, implies that the reason for the reference is unknown.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7210 “Related Series Purposes of Reference”.
Body Part Examined | (0018,0015) | 3 | Text description of the part of the body examined. See Annex L “Correspondence of Anatomic Region Codes and Body Part Examined Defined Terms” in PS3.16 for Defined Terms ### Note Some IODs support the Anatomic Region Sequence (0008,2218), which can provide a more comprehensive mechanism for specifying the body part being examined.
Patient Position | (0018,5100) | 2C | Patient position descriptor relative to the equipment. Required for images where Patient Orientation Code Sequence (0054,0410) is not present and whose SOP Class is one of the following: CT ("1.2.840.10008.5.1.4.1.1.2") or MR ("1.2.840.10008.5.1.4.1.1.4") or Enhanced CT ("1.2.840.10008.5.1.4.1.1.2.1") or Enhanced MR Image ("1.2.840.10008.5.1.4.1.1.4.1") or Enhanced Color MR Image ("1.2.840.10008.5.1.4.1.1.4.3") or MR Spectroscopy ("1.2.840.10008.5.1.4.1.1.4.2") Storage SOP Classes. May be present for other SOP Classes if Patient Orientation Code Sequence (0054,0410) is not present. See Section C.7.3.1.1.2 for Defined Terms and further explanation.
Smallest Pixel Value in Series | (0028,0108) | 3 | The minimum value of all images in this Series.
Largest Pixel Value in Series | (0028,0109) | 3 | The maximum value of all images in this Series.
Request Attributes Sequence | (0040,0275) | 3 | Sequence that contains attributes from the Imaging Service Request. One or more Items are permitted in this sequence.
>Include Table 10-9 “Request Attributes Macro Attributes” | No Baseline CID is defined.
Include Table 10-16 “Performed Procedure Step Summary Macro Attributes” | No Baseline CID is defined.
Anatomical Orientation Type | (0010,2210) | 1C | The anatomical orientation type used in instances generated by this equipment. Enumerated Values: BIPED QUADRUPED Required if the patient is an animal and the anatomical frame of reference is not bipedal. May be present otherwise. See Section C.7.6.1.1.1 and Section C.7.6.2.1.1. ### Note If this Attribute is not present, the default human standard anatomical position is used to define the patient orientation of projection images and the patient coordinate system of cross-sectional images.

### Note

1. If any Performed Procedure Step SOP Class is supported as an SCU by a Storage SCU, the SCU is strongly encouraged to support the attribute Referenced Performed Procedure Step Sequence (0008,1111). This attribute references the Performed Procedure Step SOP Instance, and extraction of this Attribute from a Composite Instance may allow retrieval of the Performed Procedure Step SOP Instance.

2. If the Storage SCU does not conform to any Performed Procedure Step SOP Class, it is still advisable to include the attributes Performed Procedure Step Start Date (0040,0244), Performed Procedure Step Start Time (0040,0245) and Performed Procedure Step Description (0040,0254) into the Composite Instances.

##### C.7.3.1.1 General Series Attribute Descriptions

###### C.7.3.1.1.1 Modality

Defined Terms:

AR

  Autorefraction

AU

  Audio

BDUS

  Bone Densitometry (ultrasound)

BI

  Biomagnetic imaging

BMD

  Bone Densitometry (X-Ray)

CR

  Computed Radiography

CT

  Computed Tomography

DG

  Diaphanography

DOC

  Document

DX

  Digital Radiography

ECG

  Electrocardiography

EPS

  Cardiac Electrophysiology

ES

  Endoscopy

FID

  Fiducials

GM

  General Microscopy

HC

  Hard Copy

HD

  Hemodynamic Waveform

IO

  Intra-Oral Radiography

IOL

  Intraocular Lens Data

IVOCT

  Intravascular Optical Coherence Tomography

IVUS

  Intravascular Ultrasound

KER

  Keratometry

KO

  Key Object Selection

LEN

  Lensometry

LS

  Laser surface scan

MG

  Mammography

MR

  Magnetic Resonance

NM

  Nuclear Medicine

OAM

  Ophthalmic Axial Measurements

OCT

  Optical Coherence Tomography (non-Ophthalmic)

OPM

  Ophthalmic Mapping

OP

  Ophthalmic Photography

OPT

  Ophthalmic Tomography

OPV

  Ophthalmic Visual Field

OSS

  Optical Surface Scan

OT

  Other

PLAN

  Plan

PR

  Presentation State

PT

  Positron emission tomography (PET)

PX

  Panoramic X-Ray

REG

  Registration

RESP

  Respiratory Waveform

RF

  Radio Fluoroscopy

RG

  Radiographic imaging (conventional film/screen)

RTDOSE

  Radiotherapy Dose

RTIMAGE

  Radiotherapy Image

RTPLAN

  Radiotherapy Plan

RTRECORD

  RT Treatment Record

RTSTRUCT

  Radiotherapy Structure Set

RWV

  Real World Value Map

SEG

  Segmentation

SMR

  Stereometric Relationship

SM

  Slide Microscopy

SRF

  Subjective Refraction

SR

  SR Document

STAIN

  Automated Slide Stainer

TG

  Thermography

US

  Ultrasound

VA

  Visual Acuity

XA

  X-Ray Angiography

XC

  External-camera Photography

Retired Defined Terms:

AS

  Angioscopy

CD

  Color flow Doppler

CF

  Cinefluorography

CP

  Culposcopy

CS

  Cystoscopy

DD

  Duplex Doppler

DF

  Digital fluoroscopy

DM

  Digital microscopy

DS

  Digital Subtraction Angiography

EC

  Echocardiography

FA

  Fluorescein angiography

FS

  Fundoscopy

LP

  Laparoscopy

MA

  Magnetic resonance angiography

MS

  Magnetic resonance spectroscopy

OPR

  Ophthalmic Refraction

ST

  Single-photon emission computed tomography (SPECT)

VF

  Videofluorography

### Note

1. The XA modality incorporates the retired modality DS.

2. The RF modality incorporates the retired modalities CF, DF, VF.

3. The modality listed in the Modality Data Element (0008,0060) may not match the name of the IOD in which it appears. For example, a SOP instance from XA IOD may list the RF modality when an RF implementation produces an XA object.

4. The MR modality incorporates the retired modalities MA and MS.

5. The US modality incorporates the retired modalities EC, CD, and DD.

6. The NM modality incorporates the retired modality ST.

###### C.7.3.1.1.2 Patient Position

Patient Position (0018,5100) specifies the position of the patient relative to the imaging equipment space. This attribute is intended for annotation purposes only. It does not provide an exact mathematical relationship of the patient to the imaging equipment.

When facing the front of the imaging equipment, Head First is defined as the patient's head being positioned toward the front of the imaging equipment. Feet First is defined as the patient's feet being positioned toward the front of the imaging equipment. Prone is defined as the patient's face being positioned in a downward (gravity) direction. Supine is defined as the patient's face being in an upward direction. Decubitus Right is defined as the patient's right side being in a downward direction. Decubitus Left is defined as the patient's left side being in a downward direction.

Defined Terms:

HFP

  Head First-Prone

HFS

  Head First-Supine

HFDR

  Head First-Decubitus Right

HFDL

  Head First-Decubitus Left

FFDR

  Feet First-Decubitus Right

FFDL

  Feet First-Decubitus Left

FFP

  Feet First-Prone

FFS

  Feet First-Supine

The Figure C.7.3.1.1.2-1 illustrates these Defined Terms for imaging equipment with a table, such as in X-Ray Angiography. The orientation of the patient related to gravity is always recumbent.

Figure C.7.3.1.1.2-1. Representation of the Eight Different Patient Positions on the X-Ray Table

#### C.7.3.2 Clinical Trial Series Module

Table C.7-5b contains attributes that identify a Series in the context of a clinical trial.

Table C.7-5b. Clinical Trial Series Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Clinical Trial Coordinating Center Name | (0012,0060) | 2 | The name of the institution that is responsible for coordinating the medical imaging data for the clinical trial. See Section C.7.3.2.1.1.
Clinical Trial Series ID | (0012,0071) | 3 | An identifier of the series in the context of a clinical trial. See Section C.7.3.2.1.2.
Clinical Trial Series Description | (0012,0072) | 3 | A description of the series in the context of a clinical trial. See Section C.7.3.2.1.2.

##### C.7.3.2.1 Clinical Trial Series Attribute Descriptions

###### C.7.3.2.1.1 Clinical Trial Coordinating Center Name

The Clinical Trial Coordinating Center Name (0012,0060) identifies the institution responsible for coordinating the collection of images and associated data for subjects enrolled in the clinical trial.

###### C.7.3.2.1.2 Clinical Trial Series Identifier and Description

The Clinical Trial Series ID (0012,0071) and Clinical Trial Series Description (0012,0072) attributes can be used to identify and describe a Series within the context of a clinical trial without requiring the replacement of the values in Series Number (0020,0011) and Series Description (0008,103E) attributes in the General Series Module, whose manufacturer or user provided values may be relevant and important to retain.

#### C.7.3.3 Enhanced Series Module

Table C.7-5c Table specifies the Attributes that identify and describe general information about the Series within a Study.

### Note

This table contains a subset of the attributes of General Series Module (Table C.7-5a) but the Type designation is changed into Type 1. Including this module in an IOD overwrites the Type designation of the General Series Module.

Table C.7-5c. Enhanced Series Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Series Number | (0020,0011) | 1 | A number that identifies this Series. ### Note The value of this attribute should be unique for all series in a study created on the same equipment. Because series can be created on more than one equipment, it can not be guaranteed that the value of Series Number (0020,0011) is unique in a study.
Referenced Performed Procedure Step Sequence | (0008,1111) | 1C | Uniquely identifies the Performed Procedure Step SOP Instance to which the Series is related. Only a single Item shall be included in this sequence. Required if a Performed Procedure Step SOP Class was involved in the creation of this Series.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |

### C.7.4 Common Frame of Reference Information Entity Modules

#### C.7.4.1 Frame of Reference Module

Table C.7-6 specifies the Attributes necessary to uniquely identify a frame of reference that ensures the spatial relationship of Images within a Series. It also allows Images across multiple Series to share the same Frame Of Reference. This Frame Of Reference (or coordinate system) shall be constant for all Images related to a specific Frame Of Reference.

When a Frame of Reference is identified, it is not important how the imaging target (Patient, specimen, or phantom) is positioned relative to the imaging equipment or where the origin of the Frame Of Reference is located. It is important that the position of the imaging target and the origin are constant in relationship to a specific Frame Of Reference.

### Note

Since the criteria used to group images into a Series is application specific, it is possible for imaging applications to define multiple Series within a Study that share the same imaging space. Previous versions of the DICOM Standard specified that all images within the Series must be spatially related. However, insufficient information was available to determine if multiple Series within a Study were spatially related.

Table C.7-6. Frame of Reference Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame of Reference UID | (0020,0052) | 1 | Uniquely identifies the frame of reference for a Series. See Section C.7.4.1.1.1 for further explanation.
Position Reference Indicator | (0020,1040) | 2 | Part of the imaging target used as a reference. See Section C.7.4.1.1.2 for further explanation.

##### C.7.4.1.1 Frame of Reference Attribute Descriptions

###### C.7.4.1.1.1 Frame of Reference UID

The Frame of Reference UID (0020,0052) shall be used to uniquely identify a frame of reference for a series. Each series shall have a single Frame of Reference UID. However, multiple Series within a Study may share a Frame of Reference UID. All images in a Series that share the same Frame of Reference UID shall be spatially related to each other.

### Note

1. Previous versions of this Standard defined a Data Element "Location", which has been retired. Frame of Reference UID provides a completely unambiguous identification of the image location reference used to indicate position.

2. A common Frame of Reference UID may be used to spatially relate localizer images with a set of transverse images. However, in some cases (e.g., multiple localizer images being related to a single set of transverse images) a common Frame of Reference UID may not be sufficient. The Referenced Image Sequence (0008,1140) provides an unambiguous method for relating localizer images.

###### C.7.4.1.1.2 Position Reference Indicator

The Position Reference Indicator (0020,1040) specifies the part of the imaging target that was used as a reference point associated with a specific Frame of Reference UID. The Position Reference Indicator may or may not coincide with the origin of the fixed frame of reference related to the Frame of Reference UID.

For a Patient-related Frame of Reference, this is an anatomical reference point such as the iliac crest, orbital-medial, sternal notch, symphysis pubis, xiphoid, lower coastal margin, or external auditory meatus, or a fiducial marker placed on the patient. The patient-based coordinate system is described in Section C.7.6.2.1.1.

For a slide-related Frame of Reference, this is the slide corner as specified in Section C.8.12.2.1 and shall be identified in this attribute with the value "SLIDE_CORNER". The slide-based coordinate system is described in Section C.8.12.2.1.

For a corneal vertex based Frame of Reference, this is the corneal vertex determined by the measuring instrument and shall be identified in this attribute with the value CORNEAL_VERTEX_R (for the right eye) or CORNEAL_VERTEX_L (for the left eye). The corneal vertex based coordinate system is described in Section C.8.30.3.1.4.

The Position Reference Indicator shall be used only for annotation purposes and is not intended to be used as a mathematical spatial reference.

### Note

The Position Reference Indicator may be sent zero length when it has no meaning, for example, when the Frame of Reference Module is required to relate mammographic images of the breast acquired without releasing breast compression, but where there is no meaningful anatomical reference point as such.

#### C.7.4.2 Synchronization Module

Table C.7-7 specifies the Attributes necessary to uniquely identify a frame of reference that establishes the temporal relationship of SOP Instances. A synchronized environment may be established based on a shared time of day clock, and/or on a shared trigger event or synchronization waveform channel.

### Note

Within a synchronized environment, different devices may use the shared data differently. An electrical pulse, for example, may be treated as a trigger event by one device (e.g., an x-ray imaging system), but may be recorded as a synchronization waveform by another device (e.g., a hemodynamics system).

Table C.7-7. Synchronization Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Synchronization Frame of Reference UID | (0020,0200) | 1 | UID of common synchronization environment. See Section C.7.4.2.1.1.
Synchronization Trigger | (0018,106A) | 1 | Data acquisition synchronization with external equipment Enumerated Values: SOURCE this equipment provides synchronization channel or trigger to other equipment EXTERNAL this equipment receives synchronization channel or trigger from other equipment PASSTHRU this equipment receives synchronization channel or trigger and forwards it NO TRIGGER data acquisition not synchronized by common channel or trigger
Trigger Source or Type | (0018,1061) | 3 | Specifies equipment ID of trigger source and/or type of trigger
Synchronization Channel | (0018,106C) | 1C | Identifier of waveform channel that records the synchronization channel or trigger, see Section C.7.4.2.1.3. Required if synchronization channel or trigger is encoded in a waveform in this SOP Instance
Acquisition Time Synchronized | (0018,1800) | 1 | Acquisition DateTime (0008,002A) synchronized with external time reference. Enumerated Values: Y N See Section C.7.4.2.1.4
Time Source | (0018,1801) | 3 | ID of equipment or system providing time reference
Time Distribution Protocol | (0018,1802) | 3 | Method of time distribution used to synchronize this equipment. Enumerated Values: NTP Network Time Protocol IRIG Inter Range Instrumentation Group GPS Global Positioning System SNTP Simple Network Time Protocol PTP IEEE 1588 Precision Time Protocol
NTP Source Address | (0018,1803) | 3 | IP Address of NTP, SNTP, or PTP time source. IPv4 addresses shall be in dotted decimal (e.g., 192.168.1.1). The IPv6 addresses shall be in colon separated hexadecimal (e.g., 12:34:56:78:9a:bc:de:f0). ### Note Identity of this value in two instances acquired contemporaneously implies a common time base. The NTP Source Address might not persist over time.

##### C.7.4.2.1 Synchronization Attribute Descriptions

###### C.7.4.2.1.1 Synchronization Frame of Reference UID

A set of equipment may share a common acquisition synchronization environment, which is identified by a Synchronization Frame of Reference UID. All SOP Instances that share the same Synchronization Frame of Reference UID shall be temporally related to each other. If a Synchronization Frame of Reference UID is present, all SOP Instances in the Series must share the same Frame of Reference.

The UTC Synchronization UID, 1.2.840.10008.15.1.1, may be used when the equipment is synchronized to the international standard UTC. In this case the quality of synchronization may be determined by means of the Time Distribution Protocol (0018,1802) and NTP Source Address (0018,1803).

### Note

1. The Synchronization Frame of Reference UID defines an equipment synchronization environment, and does not need to be changed for each unrelated acquisition. SOP Instances may therefore share a Synchronization Frame of Reference UID, but be clinically unrelated (e.g., apply to different patients).

2. When a synchronization environment is recalibrated, a new UID must be issued.

3. The method of distributing the Synchronization Frame of Reference UID to multiple devices is not specified.

###### C.7.4.2.1.2 Time Source and Time Distribution Protocol

Time may originate with a primary source (e.g., a national standards bureau) and be distributed through a chain of secondary distribution systems until reaching the imaging equipment. Time Distribution Protocol (0018,1802) specifies the immediate (last link) method used by the equipment to receive time from the immediately prior Time Source (0018,1801). It does not specify the ultimate time reference from which the Time Source may derive its synchronization.

### Note

The time value distributed through the specified Time Distribution Protocol may need to be corrected to align with UTC. For example, GPS does not compensate for leap seconds.

###### C.7.4.2.1.3 Synchronization Channel

Synchronization Channel (0018,106C) is specified as a pair of values (M,C), where the first value is the ordinal of the sequence item of Waveform Sequence (5400,0100) (i.e., the Multiplex Group), and the second value is the ordinal of the sequence item of the Channel Definition Sequence (003A,0200) attribute (i.e., the Waveform Channel Number) within the multiplex group.

###### C.7.4.2.1.4 Acquisition Time Synchronized

The Acquisition Time Synchronized (0018,1800) attribute specifies whether Acquisition DateTime (0008,002A) of the Waveform Identification Module or the General Image Module represents an accurate synchronized timestamp for the acquisition of the waveform and/or image data. For triggered multi-frame images, the Acquisition DateTime applies to the trigger for the first image frame (see attribute Image Trigger Delay (0018.1067) in the Cine Module).

### Note

The degree of precision of the Acquisition DateTime and its accuracy relative to the external clock are not specified, but need to be appropriate for the clinical application.

For IODs that include the SR Document Content Module, the Acquisition Time Synchronized (0018,1800) attribute specifies whether Observation DateTime (0040,A032) of Items in Content Sequence (0040,A730) of the SR Document Content Module represents an accurate synchronized timestamp for the Item.

### C.7.5 Common Equipment IE Modules

The following Equipment IE Module is common to all Composite IODs that reference the Equipment IE.

#### C.7.5.1 General Equipment Module

Table C.7-8 specifies the Attributes that identify and describe the piece of equipment that produced a Series of Composite Instances.

Table C.7-8. General Equipment Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Manufacturer | (0008,0070) | 2 | Manufacturer of the equipment that produced the composite instances.
Institution Name | (0008,0080) | 3 | Institution where the equipment that produced the composite instances is located.
Institution Address | (0008,0081) | 3 | Mailing address of the institution where the equipment that produced the composite instances is located.
Station Name | (0008,1010) | 3 | User defined name identifying the machine that produced the composite instances.
Institutional Department Name | (0008,1040) | 3 | Department in the institution where the equipment that produced the composite instances is located.
Manufacturer's Model Name | (0008,1090) | 3 | Manufacturer's model name of the equipment that produced the composite instances.
Device Serial Number | (0018,1000) | 3 | Manufacturer's serial number of the equipment that produced the composite instances. ### Note This identifier corresponds to the device that actually created the images, such as a CR plate reader or a CT console, and may not be sufficient to identify all of the equipment in the imaging chain, such as the generator or gantry or plate.
Software Versions | (0018,1020) | 3 | Manufacturer's designation of software version of the equipment that produced the composite instances. See Section C.7.5.1.1.3.
Gantry ID | (0018,1008) | 3 | Identifier of the gantry or positioner.
Spatial Resolution | (0018,1050) | 3 | The inherent limiting resolution in mm of the acquisition equipment for high contrast objects for the data gathering and reconstruction technique chosen. If variable across the images of the series, the value at the image center.
Date of Last Calibration | (0018,1200) | 3 | Date when the image acquisition device calibration was last changed in any way. Multiple entries may be used for additional calibrations at other times. See Section C.7.5.1.1.1 for further explanation.
Time of Last Calibration | (0018,1201) | 3 | Time when the image acquisition device calibration was last changed in any way. Multiple entries may be used. See Section C.7.5.1.1.1 for further explanation.
Pixel Padding Value | (0028,0120) | 1C | Single pixel value or one limit (inclusive) of a range of pixel values used in an image to pad to rectangular format or to signal background that may be suppressed. See Section C.7.5.1.1.2 for further explanation. Required if Pixel Padding Range Limit (0028,0121) is present and either Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present. May be present otherwise only if Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present. ### Note The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). This Attribute is not used in Presentation State Instances; there is no means in a Presentation State to "override" any Pixel Padding Value specified in the referenced images. This Attribute does apply to RT Dose and Segmentation instances, since they include Pixel Data.

##### C.7.5.1.1 General Equipment Attribute Descriptions

### Note

The attributes Manufacturer (0008,0070), Manufacturer's Model Name (0008,1090) and Device Serial Number (0018,1000) are intended to be a primary identification of the system that produces the data (e.g., modality or workstation application providing the content of the SOP Instance) and not the identification of the component that encodes the SOP Instance (e.g., a commonly used DICOM encoding toolkit).

###### C.7.5.1.1.1 Date of Last Calibration, Time of Last Calibration

Date of Last Calibration (0018,1200) and Time of Last Calibration (0018,1201) are used to convey the date and time of calibration. The Attribute Date of Last Calibration (0018,1200) may be supported alone, however, Time of Last Calibration (0018,1201) Attribute has no meaning unless Attribute Date of Last Calibration (0018,1200) is also supported. The order for each Attribute shall be from the oldest date/time to the most recent date/time. When the Attributes are both supported they shall be provided as pairs.

###### C.7.5.1.1.2 Pixel Padding Value and Pixel Padding Range Limit

Pixel Padding Value (0028,0120) is used to pad grayscale images (those with a Photometric Interpretation of MONOCHROME1 or MONOCHROME2) to rectangular format. The native format of some images is not rectangular. It is common for devices with this format to pad the images to the rectangular format required by the DICOM Standard with a specific pixel value that is not contained in the native image. Further, when resampling, such as after spatial registration, padding may need to be used to fill previously non-existent pixels.

Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) are also used to identify pixels to be excluded from the normal grayscale rendering pipeline for other reasons, such as suppression of background air. Pixel Padding Range Limit (0028,0121) is defined in the Image Pixel Module.

### Note

1. The "native image" is that which is being padded to the required rectangular format, e.g., the area within the circular reconstruction perimeter of a CT image, or the subset of the rectangular area that contains useful image information.

2. The pixel padding value is explicitly described in order to prevent display applications from taking it into account when determining the dynamic range of an image, since the Pixel Padding Value will be outside the range between the minimum and maximum values of the pixels in the native image

3. No pixels in the native image will have a value equal to Pixel Padding Value.

Pixel Padding Value (0028,0120) specifies either a single value of this padding value, or when combined with Pixel Padding Range Limit (0028,0121), a range of values (inclusive) that are padding.

The values of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall be valid values within the constraints defined by Bits Allocated (0028,0100), Bits Stored (0028,0101), and High Bit (0028,0102).

Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall not be present when padding is performed but the pixel value used for padding does occur in the native image.

If Photometric Interpretation (0028,0004) is MONOCHROME2, Pixel Padding Value (0028,0120) shall be less than (closer to or equal to the minimum possible pixel value) or equal to Pixel Padding Range Limit (0028,0121). If Photometric Interpretation (0028,0004) is MONOCHROME1, Pixel Padding Value (0028,0120) shall be greater than (closer to or equal to the maximum possible pixel value) or equal to Pixel Padding Range Limit (0028,0121).

### Note

1. When the relationship between pixel value and X-Ray Intensity is unknown, it is recommended that the following values be used to pad with black when the image is unsigned:

   - 0 if Photometric Interpretation (0028,0004) is MONOCHROME2.

   - 2Bits Stored - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.

   and when the image is signed:

   - -2Bits Stored-1 if Photometric Interpretation (0028,0004) is MONOCHROME2.

   - 2Bits Stored-1 - 1 if Photometric Interpretation (0028,0004) is MONOCHROME1.

2. For projection radiography, when the relationship between pixel value and X-Ray Intensity is known (for example as defined by Pixel Intensity Relationship (0028,1040) and Pixel Intensity relationship Sign (0028,1041)), it is recommended that a pixel value equivalent to, or rendered similarly to, air (least X-Ray absorbance) be used for padding. However, if such a value may occur in the native image, the Pixel Padding Value (0028,0120) Attribute itself should not be sent.

   E.g., for an XRF image obtained with an image intensifier, if air is black then a padded perimeter, if any, should also appear black. Typically though, if unpadded, this area would be collimated with a circular collimator, in which case the pixels would appear natively as white (greatest X-Ray absorbance) and a circular shutter would be necessary to neutralize them as black. Whether collimated areas are detected and treated as padded, or neutralized with shutters is at the discretion of the application. See also the Display Shutter Module Section C.7.6.11.

3. The conditional requirement for the Pixel Padding Value Range Limit (0028,0121) in the Image Pixel Module means that it shall not be present unless Pixel Padding Value (0028,0120) is also present.

4. The range of values to be suppressed between Pixel Padding Value (0028,0120) and Pixel Padding Value Range Limit (0028,0121) is specified as being inclusive, that is the values themselves as well as all values between are suppressed.

5. When Pixel Padding Value Range Limit (0028,0121) is present, but not supported by a rendering application, the constraint that Pixel Padding Value (0028,0120) is closest to the "blackest" value, which is typically the most frequently occurring background pixel, will most often result in an acceptable display, permitting "backward compatibility" in the majority of cases.

When modifying equipment changes the pixel padding value in the image, it shall change the values of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121), if present. If modifying equipment changes the pixel padding values in the image to values present in the native image, the attribute Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) shall be removed.

### Note

1. For example, if a CT image containing signed values from -1024 to 3191 and a Pixel Padding Value of -2000 and a Rescale Intercept of 0 is converted to an unsigned image with a Rescale Intercept of -1024 by adding 1024 to all pixels and clipping all more negative pixels to 0, then the padding pixels will be indistinguishable from some of the modified native image pixels, and hence Pixel Padding Value (0028,0120) needs to be removed.

2. If the modification involves lossy compression, which may result in changes to the pixel values, then the application of Pixel Padding Value and Pixel Padding Range Limit may result in a different appearance, and hence these attributes may need different values also.

###### C.7.5.1.1.3 Software Versions

Software Versions (0018,1020) is a multi-valued attribute. For equipment that is composed of several components, it may be used to identify the name and version for each of those components. This may also include the identifier and version of libraries or configuration files that significantly affect the production of the SOP Instance.

#### C.7.5.2 Enhanced General Equipment Module

Table C.7-8b specifies the Attributes that identify and describe the piece of equipment that produced a Series of Composite Instances.

### Note

1. This table contains a subset of the attributes of General Equipment Module (Table C.7-8) but the Type Designation is changed into Type 1. Including this module in an IOD overwrites the Type Designation of the General Equipment Module.

2. The attributes are intended to be a primary identification of the system that produces the data (e.g., modality or workstation application providing the content of the SOP Instance) and not the identification of the component that encodes the SOP Instance (e.g., a commonly used DICOM encoding toolkit).

Table C.7-8b. Enhanced General Equipment Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Manufacturer | (0008,0070) | 1 | Manufacturer of the equipment that produced the composite instances.
Manufacturer's Model Name | (0008,1090) | 1 | Manufacturer's model name of the equipment that produced the composite instances.
Device Serial Number | (0018,1000) | 1 | Manufacturer's serial number of the equipment that produced the composite instances.
Software Versions | (0018,1020) | 1 | Manufacturer's designation of software version of the equipment that produced the composite instances. See Section C.7.5.1.1.3.

### C.7.6 Common Image IE Modules

The following Image IE Modules are common to all Composite Image IODs that reference the Image IE.

#### C.7.6.1 General Image Module

Table C.7-9 specifies the Attributes that identify and describe an image within a particular series.

Table C.7-9. General Image Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Instance Number | (0020,0013) | 2 | A number that identifies this image. ### Note This Attribute was named Image Number in earlier versions of this Standard.
Patient Orientation | (0020,0020) | 2C | Patient direction of the rows and columns of the image. Required if image does not require Image Orientation (Patient) (0020,0037) and Image Position (Patient) (0020,0032). May be present otherwise. See Section C.7.6.1.1.1 for further explanation. ### Note IODs may have attributes other than Patient Orientation, Image Orientation, or Image Position (Patient) to describe orientation in which case this attribute will be zero length.
Content Date | (0008,0023) | 2C | The date the image pixel data creation started. Required if image is part of a series in which the images are temporally related. May be present otherwise. ### Note This Attribute was formerly known as Image Date.
Content Time | (0008,0033) | 2C | The time the image pixel data creation started. Required if image is part of a series in which the images are temporally related. May be present otherwise.
Image Type | (0008,0008) | 3 | Image identification characteristics. See Section C.7.6.1.1.2 for Defined Terms and further explanation.
Acquisition Number | (0020,0012) | 3 | A number identifying the single continuous gathering of data over a period of time that resulted in this image.
Acquisition Date | (0008,0022) | 3 | The date the acquisition of data that resulted in this image started
Acquisition Time | (0008,0032) | 3 | The time the acquisition of data that resulted in this image started
Acquisition DateTime | (0008,002A) | 3 | The date and time that the acquisition of data that resulted in this image started. ### Note The synchronization of this time with an external clock is specified in the Synchronization Module in Acquisition Time Synchronized (0018,1800).
Referenced Image Sequence | (0008,1140) | 3 | Other images significantly related to this image (e.g., post-localizer CT image or Mammographic biopsy or partial view images). One or more Items are permitted in this sequence.
>Include Table 10-3 “Image SOP Instance Reference Macro Attributes” |
>Purpose of Reference Code Sequence | (0040,A170) | 3 | Describes the purpose for which the reference is made. Only a single Item is permitted in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7201 “Referenced Image Purposes of Reference”.
Derivation Description | (0008,2111) | 3 | A text description of how this image was derived. See Section C.7.6.1.1.3 for further explanation.
Derivation Code Sequence | (0008,9215) | 3 | A coded description of how this image was derived. See Section C.7.6.1.1.3 for further explanation. One or more Items are permitted in this Sequence. More than one Item indicates that successive derivation steps have been applied.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7203 “Image Derivation”.
Source Image Sequence | (0008,2112) | 3 | The set of Image SOP Class/Instance pairs of the Images that were used to derive this Image. One or more Items are permitted in this Sequence. See Section C.7.6.1.1.4 for further explanation.
>Include Table 10-3 “Image SOP Instance Reference Macro Attributes” |
>Purpose of Reference Code Sequence | (0040,A170) | 3 | Describes the purpose for which the reference is made, that is what role the source image or frame(s) played in the derivation of this image. Only a single Item is permitted in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7202 “Source Image Purposes of Reference”.
>Spatial Locations Preserved | (0028,135A) | 3 | The extent to which the spatial locations of all pixels are preserved during the processing of the source image that resulted in the current image Enumerated Values: YES NO REORIENTED_ONLY A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees ### Note This applies not only to images with a known relationship to a 3D space, but also to projection images. For example, a projection radiograph such as a mammogram that is processed by a point image processing operation such as contrast enhancement, or a smoothing or edge enhancing convolution, would have a value of YES for this attribute. A projection radiograph that had been magnified or warped geometrically would have a value of NO for this attribute. A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees, such that transformation of pixel locations is possible by comparison of the values of Patient Orientation (0020,0020) would have a value of REORIENTED_ONLY. This attribute is typically of importance in relating images with Presentation Intent Type (0008,0068) values of FOR PROCESSING and FOR PRESENTATION. When the value of this attribute is NO, it is not possible to locate on the current image any pixel coordinates that are referenced relative to the source image, such as for example, might be required for rendering CAD findings derived from a referenced FOR PROCESSING image on the current FOR PRESENTATION image.
>Patient Orientation | (0020,0020) | 1C | The Patient Orientation values of the source image. Required if the value of Spatial Locations Preserved (0028,135A) is REORIENTED_ONLY.
Referenced Instance Sequence | (0008,114A) | 3 | Non-image composite SOP Instances that are significantly related to this Image, including waveforms that may or may not be temporally synchronized with this image. One or more Items are permitted in this sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
>Purpose of Reference Code Sequence | (0040,A170) | 1 | Code describing the purpose of the reference to the Instance(s). Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7004 “Waveform Purposes of Reference” for referenced waveforms.
Images in Acquisition | (0020,1002) | 3 | Number of images that resulted from this acquisition of data
Image Comments | (0020,4000) | 3 | User-defined comments about the image
Quality Control Image | (0028,0300) | 3 | Indicates whether or not this image is a quality control or phantom image. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not be a quality control or phantom image. The phantom device in the image can be described using the Device Module. See Section C.7.6.12
Burned In Annotation | (0028,0301) | 3 | Indicates whether or not image contains sufficient burned in annotation to identify the patient and date the image was acquired. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not contain burned in annotation.
Recognizable Visual Features | (0028,0302) | 3 | Indicates whether or not the image contains sufficiently recognizable visual features to allow the image or a reconstruction from a set of images to identify the patient. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not contain recognizable visual features.
Lossy Image Compression | (0028,2110) | 3 | Specifies whether an Image has undergone lossy compression (at a point in its lifetime). Enumerated Values: 00 Image has NOT been subjected to lossy compression. 01 Image has been subjected to lossy compression. Once this value has been set to 01 it shall not be reset. See Section C.7.6.1.1.5.
Lossy Image Compression Ratio | (0028,2112) | 3 | Describes the approximate lossy compression ratio(s) that have been applied to this image. See Section C.7.6.1.1.5 for further explanation. May be multi-valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Method (0028,2114). ### Note For example, a compression ratio of 30:1 would be described in this Attribute with a single value of 30. For historical reasons, the lossy compression ratio may also be described in Derivation Description (0008,2111).
Lossy Image Compression Method | (0028,2114) | 3 | A label for the lossy compression method(s) that have been applied to this image. See Section C.7.6.1.1.5 for further explanation. May be multi-valued if successive lossy compression steps have been applied; the value order shall correspond to the values of Lossy Image Compression Ratio (0028,2112). ### Note For historical reasons, the lossy compression method may also be described in Derivation Description (0008,2111).
Icon Image Sequence | (0088,0200) | 3 | This icon image is representative of the Image. Only a single Item is permitted in this Sequence.
>Include Table C.7-11b “Image Pixel Macro Attributes” | See Section C.7.6.1.1.6 for further explanation.
Presentation LUT Shape | (2050,0020) | 3 | When present, specifies an identity transformation for the Presentation LUT such that the output of all grayscale transformations, if any, are defined to be in P-Values. Enumerated Values: IDENTITY output is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME2 or any color photometric interpretation. INVERSE output after inversion is in P-Values - shall be used if Photometric Interpretation (0028,0004) is MONOCHROME1. When this attribute is used with a color photometric interpretation then the luminance component is in P-Values.
Irradiation Event UID | (0008,3010) | 3 | Unique identification of the irradiation event(s) associated with the acquisition of this image. See Section C.7.6.1.1.7.
Real World Value Mapping Sequence | (0040,9096) | 3 | The mapping of stored values to associated Real World values. One or more Items are permitted in this sequence.
>Include Table C.7.6.16-12b “Real World Value Mapping Item Macro Attributes” |

### Note

Previous editions of this Standard specified use of the Referenced Waveform Sequence (0008,113A), but that use has been superseded by Referenced Instance Sequence (0008,114A). See PS3.3-2004.

##### C.7.6.1.1 General Image Attribute Descriptions

###### C.7.6.1.1.1 Patient Orientation

Patient Orientation (0020,0020) relative to the image plane shall be specified by two values that designate the anatomical direction of the positive row axis (left to right) and the positive column axis (top to bottom). The first entry is the direction of the rows, given by the direction of the last pixel in the first row from the first pixel in that row. The second entry is the direction of the columns, given by the direction of the last pixel in the first column from the first pixel in that column. Shall be consistent with Image Orientation (Patient) (0020,0037), if both Attributes are present and Patient Orientation (0020,0020) is not zero length.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, anatomical direction shall be designated by abbreviations using the capital letters:

- A (anterior)

- P (posterior)

- R (right)

- L (left)

- H (head)

- F (foot)

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, anatomical direction shall be designated by the abbreviations using capital letters:

- LE (Le or Left)

- RT (Rt or Right)

- D (Dorsal)

- V (Ventral)

- CR (Cr or Cranial)

- CD (Cd or Caudal)

- R (Rostral)

- M (Medial)

- L (Lateral)

- PR (Pr or Proximal)

- DI (Di or Distal)

- PA (Pa or Palmar)

- PL (Pl or Plantar)

### Note

1. These abbreviations are capitalized versions of those defined in Smallwood et al for describing radiographic projections. Because of the Code String (CS) Value Representation of Patient Orientation (0020,0020), lowercase letters cannot be used.

2. It is unfortunate that the conventional veterinary abbreviations (e.g., R for rostral and Rt for right) differ from those chosen for humans for DICOM usage (e.g., R for right), but confusion with in the respective human and animal domains will be reduced. Hanging protocols may need to account for the difference by checking for the correct species.

3. Smallwood et al define an O (Oblique) abbreviation, which is useful for describing radiographic projections, but do not specify its use for directional terms, and hence it is not included here for describing the row and column directions.

4. The terms "anterior" and "posterior" are commonly used in vertebrate zoology to describe the cranial and caudal directions respectively, the veterinary terms are used in preference here, also in order to avoid confusion with the contradictory human use of anterior and posterior to mean ventral and dorsal.

5. For animals other than quadrupeds, for example, birds and fish, it is anticipated that the same nomenclature can be logically extended to describe, for example, wings and fins.

Each value of the orientation attribute shall contain at least one of these abbreviations. If refinements in the orientation descriptions are to be specified, then they shall be designated by one or two additional abbreviations in each value. Within each value, the abbreviations shall be ordered with the principal orientation designated in the first abbreviations.

### Note

1. For bipeds, since each abbreviation is a single character, no delimiter is required within a single value and none is used. For quadrupeds, though lowercase letters cannot be used, delimiters are not necessary within a single value to eliminate ambiguity, since the abbreviations used are sufficiently distinct, and can be parsed from left to right with a single character of lookahead.

2. E.g., a medio-lateral oblique projection of the left breast of a human might be encoded with Patient Orientation values of "A\FR" rather than "A\F", since the plane is obliquely inclined such that the columns are directed both downwards and medially, which for a left breast is towards the right, though the downwards direction is the principal column orientation.

3. E.g., a right dorsal-left ventral oblique view of a quadruped's abdomen might be encoded with Patient Orientation values of "LEV\CD", rather than "LE\CD", since the plane is obliquely inclined such that the rows are directed both to the left and ventrally, though the left direction is the principal row orientation. The abbreviations "LEV", "LE" and "CD", correspond to the designations in Smallwood et al of "LeV", "Le" and "Cd", respectively

###### C.7.6.1.1.2 Image Type

Image Type (0008,0008) identifies important image identification characteristics. These characteristics are:

1. Pixel Data Characteristics

   1. is the image an ORIGINAL Image; an image whose pixel values are based on original or source data

   2. is the image a DERIVED Image; an image whose pixel values have been derived in some manner from the pixel value of one or more other images

2. Patient Examination Characteristics

   1. is the image a PRIMARY Image; an image created as a direct result of the Patient examination

   2. is the image a SECONDARY Image; an image created after the initial Patient examination

3. Modality Specific Characteristics

4. Implementation specific identifiers; other implementation specific identifiers shall be documented in an implementation's conformance statement.

The Image Type attribute is multi-valued and shall be provided in the following manner:

1. Value 1 shall identify the Pixel Data Characteristics

   Enumerated Values:

   ORIGINAL

     identifies an Original Image

   DERIVED

     identifies a Derived Image

2. Value 2 shall identify the Patient Examination Characteristics

   Enumerated Values:

   PRIMARY

     identifies a Primary Image

   SECONDARY

     identifies a Secondary Image

3. Value 3 shall identify any Image IOD specific specialization (optional)

4. Other Values that are implementation specific (optional)

Any of the optional values (value 3 and beyond) may be sent either with a value or zero-length, independent of other optional values, unless otherwise specified by a specialization of this attribute in an IOD.

If the pixel data of the derived Image is different from the pixel data of the source images and this difference is expected to affect professional interpretation of the image, the Derived Image shall have a UID different than all the source images.

###### C.7.6.1.1.3 Derivation Description

If an Image is identified to be a derived image (see Section C.7.6.1.1.2 Image Type), Derivation Description (0008,2111) and Derivation Code Sequence (0008,9215) describe the way in which the image was derived. They may be used whether or not the Source Image Sequence (0008,2112) is provided. They may also be used in cases when the Derived Image pixel data is not significantly changed from one of the source images and the SOP Instance UID of the Derived Image is the same as the one used for the source image.

### Note

1. Examples of Derived Images that would normally be expected to affect professional interpretation and would thus have a new UID include:

   1. images resulting from image processing of another image (e.g., unsharp masking),

   2. a multiplanar reformatted CT image,

   3. a DSA image derived by subtracting pixel values of one image from another.

   4. an image that has been decompressed after having been compressed with a lossy compression algorithm. To ensure that the user has the necessary information about the lossy compression, the approximate compression ratio may be included in Derivation Description (0008,2111).

   An example of a Derived Image that would normally not be expected to affect professional interpretation and thus would not require a new UID is an image that has been padded with additional rows and columns for more display purposes.

2. An image may be lossy compressed, e.g., for long term archive purposes, and its SOP Instance UID changed. PS3.4 provides a mechanism by which a query for the original image Instance may return a reference to the UID of the lossy compressed version of the image using the Alternate Representation Sequence (0008,3001). This allows an application processing a SOP Instance that references the original image UID, e.g., a Structured Report, to obtain a reference to an accessible version of the image even if the original SOP Instance is no longer available.

###### C.7.6.1.1.4 Source Image Sequence

If an Image is identified to be a Derived image (see Section C.7.6.1.1.2), Source Image Sequence (0008,2112) is an optional list of Referenced SOP Class UID (0008,1150) / Referenced SOP Instance UID (0008,1155) pairs that identify the source images used to create the Derived image. It may be used whether or not there is a description of the way the image was derived in Derivation Description (0008,2111) or Derivation Code Sequence (0008,9215).

### Note

Multiple Items may be present within Source Image Sequence (0008,2112), in which case either:

1. those images were combined to make the derived image (e.g., multiple source images to make an MPR or MIP), or

2. each of the items represents a step in the successive derivation of an image (e.g., when an image has had successive lossy compression steps applied to it),

3. some combination of the above.

The Purpose of Reference Code Sequence (0040,A170) and the Attributes within the referenced images themselves may be used to determine the history of the derivation, which is not otherwise explicitly specified.

###### C.7.6.1.1.5 Lossy Image Compression

The Attribute Lossy Image Compression (0028,2110) conveys that the Image has undergone lossy compression. It provides a means to record that the Image has been compressed (at a point in its lifetime) with a lossy algorithm and changes have been introduced into the pixel data. Once the value has been set to "01", it shall not be reset.

### Note

If an image is compressed with a lossy algorithm, the attribute Lossy Image Compression (0028,2110) is set to "01". Subsequently, if the image is decompressed and transferred in uncompressed format, this attribute value remains "01".

The value of Lossy Image Compression (0028,2110) in SOP Instances containing multiple frames in which one or more of the frames have undergone lossy compression shall be "01".

### Note

It is recommended that the applicable frames be noted in the Attribute Derivation Description (0008,2111).

If an image is originally obtained as a lossy compressed image from the sensor, then Lossy Image Compression (0028,2110) is set to "01" and Value 1 of the Attribute Image Type (0008,0008) shall be set to ORIGINAL.

If an image is a compressed version of another image, Lossy Image Compression (0028,2110) is set to "01", Value 1 of the Attribute Image Type (0008,0008) shall be set to DERIVED, and if the predecessor was a DICOM image, then the Image shall receive a new SOP Instance UID.

### Note

1. It is recommended that the approximate compression ratio be provided in the Attribute Derivation Description (0008,2111). Furthermore, it is recommended that Derivation Description (0008,2111) be used to indicate when pixel data changes might affect professional interpretation. (see Section C.7.6.1.1.3).

2. The attribute Lossy Image Compression (0028,2110) is defined as Type 3 for backward compatibility with existing IODs. It is expected to be required (i.e., defined as Type 1C) for new Image IODs and for existing IODs that undergo a major revision (e.g., a new IOD is specified).

Defined Terms for Lossy Image Compression Method (0028,2114):

ISO_10918_1

  JPEG Lossy Compression

ISO_14495_1

  JPEG-LS Near-lossless Compression

ISO_15444_1

  JPEG 2000 Irreversible Compression

ISO_13818_2

  MPEG2 Compression

ISO_14496_10

  MPEG-4 AVC/H.264 Compression

###### C.7.6.1.1.6 Icon Image Sequence

An Icon Image may be used as a key representative of an Image. It is defined as a Sequence that contains a single Item encapsulating the Data Set made of the Data Elements of the Icon Image. The Data Elements are defined by the Image Pixel Macro (see Section C.7.6.3). Unless otherwise specified in the Module or Macro table where the Icon Image Sequence (0088,0200) is used, the following restrictions shall apply on the Image Pixel Macro usage:

1. Only monochrome and palette color images shall be used. Samples per Pixel (0028,0002) shall have a Value of 1, Photometric Interpretation (0028,0004) shall have a Value of either MONOCHROME 1, MONOCHROME 2 or PALETTE COLOR, Planar Configuration (0028,0006) shall not be present.

   ### Note

   True color icon images are not supported. This is due to the fact that the reduced size of the Icon Image makes the quality of a palette color image (with 256 colors) sufficient in most cases.

2. There is no explicite limitation on the size of an Icon Image specified by Rows (0028,0010) and Columns (0028,0011).

3. Pixel samples shall have a Value of either 1 or 8 for Bits Allocated (0028,0100) and Bits Stored (0028,0101). High Bit (0028,0102) shall have a Value of one less than the Value used in Bit Stored.

4. Pixel Representation (0028,0103) shall specify an unsigned integer representation (Value 0000H).

5. Pixel Aspect Ratio (0028,0034) shall have a Value of 1:1.

6. If a Palette Color lookup Table is used, Bits Allocated (0028,0100) shall have a Value of 8.

###### C.7.6.1.1.7 Irradiation Event UID

An irradiation event is the loading of X-Ray equipment caused by a single continuous actuation of the equipment's irradiation switch, from the start of the loading time of the first pulse until the loading time trailing edge of the final pulse. Any on-off switching of the irradiation source during the event shall not be treated as separate events, rather the event includes the time between start and stop of irradiation as triggered by the user. E.g., a pulsed fluoro X-Ray acquisition shall be treated as a single irradiation event.

#### C.7.6.2 Image Plane Module

Table C.7-10 specifies the Attributes that define the transmitted pixel array of a two dimensional image plane.

### Note

In previous versions of this Standard, image position and image orientation were specified relative to a specific equipment coordinate system. This equipment coordinate system was not fully defined and a number of ambiguities existed. The equipment based coordinate system has been retired and replaced by the patient based coordinate system defined in this Module.

Table C.7-10. Image Plane Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Pixel Spacing | (0028,0030) | 1 | Physical distance in the patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See Section 10.7.1.3 for further explanation.
Image Orientation (Patient) | (0020,0037) | 1 | The direction cosines of the first row and the first column with respect to the patient. See Section C.7.6.2.1.1 for further explanation.
Image Position (Patient) | (0020,0032) | 1 | The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the image, in mm. See Section C.7.6.2.1.1 for further explanation.
Slice Thickness | (0018,0050) | 2 | Nominal slice thickness, in mm.
Slice Location | (0020,1041) | 3 | Relative position of the image plane expressed in mm. See Section C.7.6.2.1.2 for further explanation.

##### C.7.6.2.1 Image Plane Attribute Descriptions

###### C.7.6.2.1.1 Image Position and Image Orientation

Image Position (0020,0032) specifies the x, y, and z coordinates of the upper left hand corner of the image; it is the center of the first voxel transmitted. Image Orientation (0020,0037) specifies the direction cosines of the first row and the first column with respect to the patient. These Attributes shall be provide as a pair. Row value for the x, y, and z axes respectively followed by the Column value for the x, y, and z axes respectively.

The direction of the axes is defined fully by the patient's orientation.

If Anatomical Orientation Type (0010,2210) is absent or has a value of BIPED, the x-axis is increasing to the left hand side of the patient. The y-axis is increasing to the posterior side of the patient. The z-axis is increasing toward the head of the patient.

If Anatomical Orientation Type (0010,2210) has a value of QUADRUPED, the

- x-axis is increasing to the left (as opposed to right) side of the patient

- the y-axis is increasing towards

  - the dorsal (as opposed to ventral) side of the patient for the neck, trunk and tail,

  - the dorsal (as opposed to ventral) side of the patient for the head,

  - the dorsal (as opposed to plantar or palmar) side of the distal limbs,

  - the cranial (as opposed caudal) side of the proximal limbs, and

- the z-axis is increasing towards

  - the cranial (as opposed to caudal) end of the patient for the neck, trunk and tail,

  - the rostral (as opposed to caudal) end of the patient for the head, and

  - the proximal (as opposed to distal) end of the limbs

### Note

1. The axes for quadrupeds are those defined and illustrated in Smallwood et al for proper anatomic directional terms as they apply to various parts of the body.

2. It should be anticipated that when quadrupeds are imaged on human equipment, and particularly when they are position in a manner different from the traditional human prone and supine head or feet first longitudinal position, then the equipment may well not indicate the correct orientation, though it will remain an orthogonal Cartesian right-handed system that could be corrected subsequently.

The patient based coordinate system is a right handed system, i.e., the vector cross product of a unit vector along the positive x-axis and a unit vector along the positive y-axis is equal to a unit vector along the positive z-axis.

### Note

If a patient is positioned parallel to the ground, in dorsal recumbency (i.e., for humans, face-up on the table), with the caudo-cranial (i.e., for humans, feet-to-head) direction the same as the front-to-back direction of the imaging equipment, the direction of the axes of this patient based coordinate system and the equipment based coordinate system in previous versions of this Standard will coincide.

The Image Plane Attributes, in conjunction with the Pixel Spacing Attribute, describe the position and orientation of the image slices relative to the patient-based coordinate system. In each image frame Image Position (Patient) (0020,0032) specifies the origin of the image with respect to the patient-based coordinate system. RCS and Image Orientation (Patient) (0020,0037) values specify the orientation of the image frame rows and columns. The mapping of pixel location (i,j) to the RCS is calculated as follows:

Equation C.7.6.2.1-1.

Where:

- Pxyz The coordinates of the voxel (i,j) in the frame's image plane in units of mm.

- Sxyz The three values of Image Position (Patient) (0020,0032). It is the location in mm from the origin of the RCS.

- Xxyz The values from the row (X) direction cosine of Image Orientation (Patient) (0020,0037).

- Yxyz The values from the column (Y) direction cosine of Image Orientation (Patient) (0020,0037).

- i Column index to the image plane. The first column is index zero.

- Δi Column pixel resolution of Pixel Spacing (0028,0030) in units of mm.

- j Row index to the image plane. The first row index is zero.

- Δj Row pixel resolution of Pixel Spacing (0028,0030) in units of mm.

Additional constraints apply:

1. The row and column direction cosine vectors shall be orthogonal, i.e., their dot product shall be zero.

2. The row and column direction cosine vectors shall be normal, i.e., the dot product of each direction cosine vector with itself shall be unity.

###### C.7.6.2.1.2 Slice Location

Slice Location (0020,1041) is defined as the relative position of the image plane expressed in mm. This information is relative to an unspecified implementation specific reference point.

#### C.7.6.3 Image Pixel Module

Table C.7-11a describes the Image Pixel Module.

Table C.7-11a. Image Pixel Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Include Table C.7-11b “Image Pixel Macro Attributes” |
Pixel Data Provider URL | (0028,7FE0) | 1C | A URL of a provider service that supplies the pixel data of the Image. Required if the image is to be transferred in one of the following presentation contexts identified by Transfer Syntax UID: 1.2.840.10008.1.2.4.94 (DICOM JPIP Referenced Transfer Syntax) 1.2.840.10008.1.2.4.95 (DICOM JPIP Referenced Deflate Transfer Syntax) ### Note The VR of this attribute has changed from UT to UR.
Pixel Padding Range Limit | (0028,0121) | 1C | Pixel value that represents one limit (inclusive) of a range of padding values used together with Pixel Padding Value (0028,0120) as defined in the General Equipment Module. See Section C.7.5.1.1.2 for further explanation. Required if pixel padding is to be defined as a range rather than a single value. ### Note The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103). Pixel Padding Value (0028,0120) is also required when this Attribute is present.

Table C.7-11b specifies the common attributes that describe the pixel data of the image.

Table C.7-11b. Image Pixel Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Samples per Pixel | (0028,0002) | 1 | Number of samples (planes) in this image. See Section C.7.6.3.1.1 for further explanation.
Photometric Interpretation | (0028,0004) | 1 | Specifies the intended interpretation of the pixel data. See Section C.7.6.3.1.2 for further explanation.
Rows | (0028,0010) | 1 | Number of rows in the image.
Columns | (0028,0011) | 1 | Number of columns in the image
Bits Allocated | (0028,0100) | 1 | Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated. See PS3.5 for further explanation.
Bits Stored | (0028,0101) | 1 | Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored. See PS3.5 for further explanation.
High Bit | (0028,0102) | 1 | Most significant bit for pixel sample data. Each sample shall have the same high bit. See PS3.5 for further explanation.
Pixel Representation | (0028,0103) | 1 | Data representation of the pixel samples. Each sample shall have the same pixel representation. Enumerated Values: 0000H unsigned integer. 0001H 2's complement
Pixel Data | (7FE0,0010) | 1C | A data stream of the pixel samples that comprise the Image. See Section C.7.6.3.1.4 for further explanation. Required if Pixel Data Provider URL (0028,7FE0) is not present.
Planar Configuration | (0028,0006) | 1C | Indicates whether the pixel data are sent color-by-plane or color-by-pixel. Required if Samples per Pixel (0028,0002) has a value greater than 1. See Section C.7.6.3.1.3 for further explanation.
Pixel Aspect Ratio | (0028,0034) | 1C | Ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. Required if the aspect ratio values do not have a ratio of 1:1 and the physical pixel spacing is not specified by Pixel Spacing (0028,0030), or Imager Pixel Spacing (0018,1164) or Nominal Scanned Pixel Spacing (0018,2010), either for the entire Image or per-frame in a Functional Group Macro. See Section C.7.6.3.1.7.
Smallest Image Pixel Value | (0028,0106) | 3 | The minimum actual pixel value encountered in this image.
Largest Image Pixel Value | (0028,0107) | 3 | The maximum actual pixel value encountered in this image.
Red Palette Color Lookup Table Descriptor | (0028,1101) | 1C | Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor | (0028,1102) | 1C | Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor | (0028,1103) | 1C | Specifies the format of the Blue Palette Color Lookup Table Data (0028,1203). Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.5 for further explanation.
Red Palette Color Lookup Table Data | (0028,1201) | 1C | Red Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data | (0028,1202) | 1C | Green Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data | (0028,1203) | 1C | Blue Palette Color Lookup Table Data. Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR or Pixel Presentation (0008,9205) at the image level equals COLOR or MIXED. See Section C.7.6.3.1.6 for further explanation.
ICC Profile | (0028,2000) | 3 | An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. See Section C.11.15.1.1. When present, defines the color space of color Pixel Data (7FE0,0010) values, and the output of Palette Color Lookup Table Data (0028,1201-1203). ### Note The profile applies only to Pixel Data (7FE0,0010) at the same level of the Data Set and not to any icons nested within sequences, which may or may not have their own ICC profile specified.

##### C.7.6.3.1 Image Pixel Attribute Descriptions

###### C.7.6.3.1.1 Samples Per Pixel

Samples per Pixel (0028,0002) is the number of separate planes in this image. One and three image planes are defined. Other numbers of image planes are allowed, but their meaning is not defined by this Standard.

For monochrome (gray scale) and palette color images, the number of planes is 1. For RGB and other three vector color models, the value of this attribute is 3.

### Note

The use of a value of 4 was previously described, but the Photometric Interpretations that used it have been retired.

All image planes shall have the same number of Rows (0028,0010), Columns (0028,0011), Bits Allocated (0028,0100), Bits Stored (0028,0101), High Bit (0028,0102), Pixel Representation (0028,0103), and Pixel Aspect Ratio (0028,0034).

The data in each pixel may be represented as a "Composite Pixel Code". If Samples Per Pixel is one, the Composite Pixel Code is just the "n" bit pixel sample, where "n" = Bits Allocated. If Samples Per Pixel is greater than one, Composite Pixel Code is a "k" bit concatenation of samples, where "k" = Bits Allocated multiplied by Samples Per Pixel, and with the sample representing the vector color designated first in the Photometric Interpretation name comprising the most significant bits of the Composite Pixel Code, followed in order by the samples representing the next vector colors, with the sample representing the vector color designated last in the Photometric Interpretation name comprising the least significant bits of the Composite Pixel Code. For example, for Photometric Interpretation = "RGB", the most significant "Bits Allocated" bits contain the Red sample, the next "Bits Allocated" bits contain the Green sample, and the least significant "Bits Allocated" bits contain the Blue sample.

###### C.7.6.3.1.2 Photometric Interpretation

The value of Photometric Interpretation (0028,0004) specifies the intended interpretation of the image pixel data.

See PS3.5 for restrictions imposed by compressed Transfer Syntaxes.

The following values are defined. Other values are permitted but the meaning is not defined by this Standard.

Defined Terms:

MONOCHROME1

  Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as white after any VOI gray scale transformations have been performed. See PS3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1.

MONOCHROME2

  Pixel data represent a single monochrome image plane. The minimum sample value is intended to be displayed as black after any VOI gray scale transformations have been performed. See PS3.4. This value may be used only when Samples per Pixel (0028,0002) has a value of 1.

PALETTE COLOR

  Pixel data describe a color image with a single sample per pixel (single image plane). The pixel value is used as an index into each of the Red, Blue, and Green Palette Color Lookup Tables (0028,1101-1103&1201-1203). This value may be used only when Samples per Pixel (0028,0002) has a value of 1. When the Photometric Interpretation is Palette Color; Red, Blue, and Green Palette Color Lookup Tables shall be present.

RGB

  Pixel data represent a color image described by red, green, and blue image planes. The minimum sample value for each color plane represents minimum intensity of the color. This value may be used only when Samples per Pixel (0028,0002) has a value of 3.

HSV

  Retired.

ARGB

  Retired.

CMYK

  Retired.

YBR_FULL

  Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to half full scale.

  ### Note

  In the case where Bits Allocated (0028,0100) has value of 8 half full scale is 128.

  In the case where Bits Allocated (0028,0100) has a value of 8 then the following equations convert between RGB and YCBCR Photometric Interpretation.

  Y = + .2990R + .5870G + .1140B

  CB= - .1687R - .3313G + .5000B + 128

  CR= + .5000R - .4187G - .0813B + 128

  ### Note

  The above is based on CCIR Recommendation 601-2 dated 1990.

YBR_FULL_422

  The same as YBR_FULL except that the CB and CR values are sampled horizontally at half the Y rate and as a result there are half as many CB and CR values as Y values.

  This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. Two Y values shall be stored followed by one CB and one CR value. The CB and CR values shall be sampled at the location of the first of the two Y values. For each Row of Pixels, the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc.

  ### Note

  This subsampling is often referred to as cosited sampling.

YBR_PARTIAL_422

  The same as YBR_FULL_422 except that:

  1. black corresponds to Y = 16;

  2. Y is restricted to 220 levels (i.e., the maximum value is 235);

  3. CB and CR each has a minimum value of 16;

  4. CB and CR are restricted to 225 levels (i.e., the maximum value is 240);

  5. lack of color is represented by CB and CR equal to 128.

  In the case where Bits Allocated (0028,0100) has value of 8 then the following equations convert between RGB and YBR_PARTIAL_422 Photometric Interpretation

  Y = + .2568R + .5041G + .0979B + 16

  CB= - .1482R - .2910G + .4392B + 128

  CR= + .4392R - .3678G - .0714B + 128

  ### Note

  The above is based on CCIR Recommendation 601-2 dated 1990.

YBR_PARTIAL_420

  The same as YBR_PARTIAL_422 except that the CB and CR values are sampled horizontally and vertically at half the Y rate and as a result there are four times less CB and CR values than Y values, versus twice less for YBR_PARTIAL_422.

  This Photometric Interpretation is only allowed with Planar Configuration (0028,0006) equal to 0. The CB and CR values shall be sampled at the location of the first of the two Y values. For the first Row of Pixels (etc.), the first CB and CR samples shall be at the location of the first Y sample. The next CB and CR samples shall be at the location of the third Y sample etc. The next Rows of Pixels containing CB and CR samples (at the same locations than for the first Row) will be the third etc.

YBR_ICT

  Irreversible Color Transformation:

  Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero.

  Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YCBCR Photometric Interpretation.

  Y = + .29900R + .58700G + .11400B

  CB= - .16875R - .33126G + .50000B

  CR= + .50000R - .41869G - .08131B

  ### Note

  1. The above is based on ISO/IEC 15444-1 (JPEG 2000).

  2. In a JPEG 2000 bit stream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1).

  3. In JPEG 2000, spatial down-sampling of the chrominance components, if performed, is signaled in the JPEG 2000 bit stream.

YBR_RCT

  Reversible Color Transformation:

  Pixel data represent a color image described by one luminance (Y) and two chrominance planes (CB and CR). This photometric interpretation may be used only when Samples per Pixel (0028,0002) has a value of 3. Black is represented by Y equal to zero. The absence of color is represented by both CB and CR values equal to zero.

  Regardless of the value of Bits Allocated (0028,0100), the following equations convert between RGB and YBR_RCT Photometric Interpretation.

  Y = ⌊(R + 2G +B) / 4⌋ (Note: ⌊…⌋ mean floor)

  CB= B - G

  CR= R - G

  The following equations convert between YBR_RCT and RGB Photometric Interpretation.

  G = Y - ⌊ (CR+ CB) / 4⌋

  R = CR+ G

  B = CB+ G

  ### Note

  1. The above is based on ISO/IEC 15444-1 (JPEG 2000).

  2. In a JPEG 2000 bit stream, DC level shifting (used if the untransformed components are unsigned) is applied before forward color transformation, and the transformed components may be signed (unlike in JPEG ISO/IEC 10918-1).

  3. This photometric interpretation is a reversible approximation to the YUV transformation used in PAL and SECAM.

###### C.7.6.3.1.3 Planar Configuration

Planar Configuration (0028,0006) indicates whether the color pixel data are sent color-by-plane or color-by-pixel. This Attribute shall be present if Samples per Pixel (0028,0002) has a value greater than 1. It shall not be present otherwise.

Enumerated Values:

0

  The sample values for the first pixel are followed by the sample values for the second pixel, etc. For RGB images, this means the order of the pixel values sent shall be R1, G1, B1, R2, G2, B2, …, etc.

1

  Each color plane shall be sent contiguously. For RGB images, this means the order of the pixel values sent is R1, R2, R3, …, G1, G2, G3, …, B1, B2, B3, etc.

### Note

Planar Configuration (0028,0006) is not meaningful when a compression transfer syntax is used that involves reorganization of sample components in the compressed bit stream. In such cases, since the Attribute is required to be sent, then an appropriate value to use may be specified in the description of the Transfer Syntax in PS3.5, though in all likelihood the value of the Attribute will be ignored by the receiving implementation.

###### C.7.6.3.1.4 Pixel Data

Pixel Data (7FE0,0010) for this image. The order of pixels sent for each image plane is left to right, top to bottom, i.e., the upper left pixel (labeled 1,1) is sent first followed by the remainder of row 1, followed by the first pixel of row 2 (labeled 2,1) then the remainder of row 2 and so on.

For multi-plane images see Planar Configuration (0028,0006) in this Section.

###### C.7.6.3.1.5 Palette Color Lookup Table Descriptor

The three values of Palette Color Lookup Table Descriptor (0028,1101-1104) describe the format of the Lookup Table Data in the corresponding Data Element (0028,1201-1204) or (0028,1221-1223). In this section, the term "input value" is either the Palette Color Lookup Table input value described in the Enhanced Palette Color Lookup Table Sequence (0028,140B) or if that attribute is absent, the stored pixel value.

The first Palette Color Lookup Table Descriptor value is the number of entries in the lookup table. When the number of table entries is equal to 216 then this value shall be 0. The first value shall be identical for each of the Red, Green, Blue and Alpha Palette Color Lookup Table Descriptors.

The second Palette Color Lookup Table Descriptor value is the first input value mapped. This input value is mapped to the first entry in the Lookup Table Data. All input values less than the first value mapped are also mapped to the first entry in the Lookup Table Data if the Photometric Interpretation is PALETTE COLOR.

### Note

In the case of the Supplemental Palette Color LUT, the stored pixel values less than the second descriptor value are grayscale values.

An input value one greater than the first value mapped is mapped to the second entry in the Lookup Table Data. Subsequent input values are mapped to the subsequent entries in the Lookup Table Data up to an input value equal to number of entries + first value mapped - 1, which is mapped to the last entry in the Lookup Table Data. Input values greater than or equal to number of entries + first value mapped are also mapped to the last entry in the Lookup Table Data. The second value shall be identical for each of the Red, Green, Blue and Alpha Palette Color Lookup Table Descriptors.

The third Palette Color Lookup Table Descriptor value specifies the number of bits for each entry in the Lookup Table Data. It shall take the value of 8 or 16. The LUT Data shall be stored in a format equivalent to 8 bits allocated when the number of bits for each entry is 8, and 16 bits allocated when the number of bits for each entry is 16, where in both cases the high bit is equal to bits allocated-1. The third value shall be identical for each of the Red, Green and Blue Palette Color Lookup Table Descriptors.

### Note

Some implementations have encoded 8 bit entries with 16 bits allocated, padding the high bits; this can be detected by comparing the number of entries specified in the LUT Descriptor with the actual value length of the LUT Data entry. The value length in bytes should equal the number of entries if bits allocated is 8, and be twice as long if bits allocated is 16.

When the Red, Green, or Blue Palette Color Lookup Table Descriptor (0028,1101-1103) are used as part of the Palette Color Lookup Table Module or the Supplemental Palette Color Lookup Table Module in an Image or Presentation State IOD, the third value shall be equal to 16. When the Alpha Palette Color Lookup Table Descriptor (0028,1104) is used, the third value shall be equal to 8.

When the Red, Green, or Blue Palette Color Lookup Table Descriptor (0028,1101-1103) are used as part of the Palette Color Lookup Table Module in a Color Palette IOD, the 3rd value of Palette Color Lookup Table Descriptor (0028,1101-1103) (i.e, the number of bits for each entry in the Lookup Table Data) shall be 8.

### Note

1. A value of 16 indicates the Lookup Table Data will range from (0,0,0) minimum intensity to (65535,65535,65535) maximum intensity.

2. Since the Palette Color Lookup Table Descriptor (0028,1101-1104) Attributes are multi-valued, in an Explicit VR Transfer Syntax, only one value representation (US or SS) may be specified, even though the first and third values are always by definition interpreted as unsigned. The explicit VR actually used is dictated by the VR needed to represent the second value, which will be consistent with Pixel Representation (0028,0103).

###### C.7.6.3.1.6 Palette Color Lookup Table Data

Palette Color Lookup Table Data (0028,1201-1204) contain the lookup table data corresponding to the Lookup Table Descriptor (0028,1101-1104).

Palette color values must always be scaled across the full range of available intensities. This is indicated by the fact that there are no bits stored and high bit values for palette color data.

### Note

For example, if there are 16 bits per entry specified and only 8 bits of value are truly used then the 8 bit intensities from 0 to 255 must be scaled to the corresponding 16 bit intensities from 0 to 65535. To do this for 8 bit values, simply replicate the value in both the most and least significant bytes.

These lookup tables shall be used only when there is a single sample per pixel (single image plane) in the image.

###### C.7.6.3.1.7 Pixel Aspect Ratio

The pixel aspect ratio is the ratio of the vertical size and horizontal size of the pixels in the image specified by a pair of integer values where the first value is the vertical pixel size, and the second value is the horizontal pixel size. To illustrate, consider the example pixel size shown in Figure C.7.6.3.1.7-1

Figure C.7.6.3.1.7-1. Example of Pixel Size and Aspect Ratio

Pixel Aspect Ratio = Vertical Size \ Horizontal Size = 0.30 mm \0.25 mm. Thus the Pixel Aspect Ratio could be represented as the multi-valued integer string "6\5", "60\50", or any equivalent integer ratio.

#### C.7.6.4 Contrast/Bolus Module

Table C.7-12 specifies the Attributes that describe the contrast /bolus used in the acquisition of the Image.

Table C.7-12. Contrast/Bolus Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Contrast/Bolus Agent | (0018,0010) | 2 | Contrast or bolus agent
Contrast/Bolus Agent Sequence | (0018,0012) | 3 | Sequence that identifies the contrast agent. One or more Items are permitted in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 12 “Radiographic Contrast Agent”.
Contrast/Bolus Route | (0018,1040) | 3 | Administration route of contrast agent
Contrast/Bolus Administration Route Sequence | (0018,0014) | 3 | Sequence that identifies the route of administration of contrast agent. Only a single Item is permitted in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 11 “Route of Administration”.
>Additional Drug Sequence | (0018,002A) | 3 | Sequence that identifies any additional drug that is administered with the contrast agent bolus. One or more Items are permitted in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Contrast/Bolus Volume | (0018,1041) | 3 | Volume injected in milliliters of diluted contrast agent
Contrast/Bolus Start Time | (0018,1042) | 3 | Time of start of injection
Contrast/Bolus Stop Time | (0018,1043) | 3 | Time of end of contrast injection
Contrast/Bolus Total Dose | (0018,1044) | 3 | Total amount in milliliters of the undiluted contrast agent
Contrast Flow Rate | (0018,1046) | 3 | Rate(s) of injection(s) in milliliters/sec
Contrast Flow Duration | (0018,1047) | 3 | Duration(s) of injection(s) in seconds. Each Contrast Flow Duration value shall correspond to a value of Contrast Flow Rate (0018,1046).
Contrast/Bolus Ingredient | (0018,1048) | 3 | Active ingredient of agent. Defined Terms: IODINE GADOLINIUM CARBON DIOXIDE BARIUM
Contrast/Bolus Ingredient Concentration | (0018,1049) | 3 | Milligrams of active ingredient per milliliter of (diluted) agent

### Note

1. Flow duration is an alternate method of specifying stop time

2. Flow rate allows for stepped injections by being capable of multiple values (1,N) instances.

3. For a 100 ml injection of 76% Diatrizoate and meglumine/sodium, diluted 1:1,

   - the Contrast/Bolus Agent would be "76% Diatrizoate" as text

   - the Contrast/Bolus Volume would be 100 ml,

   - the Contrast/Bolus Total Dose would be 50 ml,

   - the Contrast/Bolus Ingredient would be "IODINE",

   - the Contrast/Bolus Ingredient Concentration would be 370mg/ml.

#### C.7.6.4b Enhanced Contrast/Bolus Module

Table C.7-12b specifies the Attributes that describe the contrast/bolus used in the acquisition of the Image.

Table C.7-12b. Enhanced Contrast/Bolus Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Contrast/Bolus Agent Sequence | (0018,0012) | 1 | Sequence that identifies one or more contrast agents administered prior to or during the acquisition. One or more Items shall be included in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 12 “Radiographic Contrast Agent”.
>Contrast/Bolus Agent Number | (0018,9337) | 1 | Identifying number, unique within this SOP Instance, of the agent administered. Used to reference this particular agent from the Contrast/Bolus Functional Group Macro. The number shall be 1 for the first Item and increase by 1 for each subsequent Item.
>Contrast/Bolus Administration Route Sequence | (0018,0014) | 1 | Sequence that identifies the route of administration of contrast agent. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 11 “Route of Administration”.
>Contrast/Bolus Ingredient Code Sequence | (0018,9338) | 2 | Active ingredient of agent. Zero or more Items shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 13 “Radiographic Contrast Agent Ingredient”.
>Contrast/Bolus Volume | (0018,1041) | 2 | Total volume administered in milliliters of diluted contrast agent.
>Contrast/Bolus Ingredient Concentration | (0018,1049) | 2 | Milligrams of active ingredient per milliliter of agent.
>Contrast/Bolus Ingredient Percent by Volume | (0052,0001) | 3 | Percentage by volume of active ingredient in the total volume.
>Contrast/Bolus Ingredient Opaque | (0018,9425) | 3 | Absorption of the ingredient greater than the absorption of water (tissue). Enumerated Values: YES NO See Section C.7.6.4b.1.
>Contrast/Bolus T1 Relaxivity | (0018,0013) | 3 | T1 Relaxivity of the MR Contrast/Bolus used specified in s-1*mmol-1 specified at body temperature in human blood plasma.
>Contrast Administration Profile Sequence | (0018,9340) | 3 | Sequence that describes one or more phases of contrast administered. One or more Items are permitted in this sequence.
>>Contrast/Bolus Volume | (0018,1041) | 2 | Volume administered during this phase in milliliters of diluted contrast agent.
>>Contrast/Bolus Start Time | (0018,1042) | 3 | Time of start of administration.
>>Contrast/Bolus Stop Time | (0018,1043) | 3 | Time of end of administration.
>>Contrast Flow Rate | (0018,1046) | 3 | Rate of administration in milliliters/sec. Only a single value shall be present.
>>Contrast Flow Duration | (0018,1047) | 3 | Duration of injection in seconds. Only a single value shall be present.

##### C.7.6.4b.1 Enhanced Contrast/Bolus Module Attributes

###### C.7.6.4b.1.1 Contrast/Bolus Ingredient Opaque for X-Ray Equipment

Contrast/Bolus Ingredient Opaque (0018,9425) attribute specifies the type of relative X-Ray absorption of the contrast/bolus ingredient, compared to the X-Ray absorption of water.

Enumerated Values:

YES

  The contrast/bolus ingredient absorbs more X-Ray photons than water

NO

  The contrast/bolus ingredient absorbs less X-Ray photons than water

### Note

The Contrast/Bolus Ingredient Opaque (0018,9425) attribute determines the sign of the gradient of X-Ray beam intensity from inside to outside the injected vessel, thus allowing optimal settings of the image processing applications (e.g., vessel edge detection, etc.), see Figure C.7.6.4b-1.

The relative gray level of the injected vessel with respect to the gray level of the water of Pixel Data (7FE0,0010) is determined by the Contrast/Bolus Ingredient Opaque (0018,9425) and by the Pixel Intensity Relationship Sign (0028,1041). For example, if the contrast/bolus ingredient is more radio graphically dense than water (i.e., YES), and the Pixel Intensity Relationship Sign (0028,1041) is -1, then the contrast/bolus ingredient is represented by higher values of Pixel Data than water.

Figure C.7.6.4b-1. X-Ray beam intensity vs. Contrast/Bolus Ingredient Opaque

#### C.7.6.5 Cine Module

Table C.7-13 specifies the Attributes of a Multi-frame Cine Image.

Table C.7-13. Cine Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Preferred Playback Sequencing | (0018,1244) | 3 | Describes the preferred playback sequencing for a multi-frame image. Enumerated Values: 0 Looping (1,2…n,1,2,…n,1,2,….n,…) 1 Sweeping (1,2,…n,n-1,…2,1,2,…n,…)
Frame Time | (0018,1063) | 1C | Nominal time (in msec) per individual frame. See Section C.7.6.5.1.1 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Frame Time.
Frame Time Vector | (0018,1065) | 1C | An array that contains the real time increments (in msec) between frames for a Multi-frame image. See Section C.7.6.5.1.2 for further explanation. Required if Frame Increment Pointer (0028,0009) points to Frame Time Vector. ### Note Frame Time Vector arrays may not be properly encoded if Explicit VR transfer syntax is used and the VL of this attribute exceeds 65534 bytes.
Start Trim | (0008,2142) | 3 | The frame number of the first frame of the Multi-frame image to be displayed.
Stop Trim | (0008,2143) | 3 | The Frame Number of the last frame of a Multi-frame image to be displayed.
Recommended Display Frame Rate | (0008,2144) | 3 | Recommended rate at which the frames of a Multi-frame image should be displayed in frames/second.
Cine Rate | (0018,0040) | 3 | Number of frames per second.
Frame Delay | (0018,1066) | 3 | Time (in msec) from Content Time (0008,0033) to the start of the first frame in a Multi-frame image.
Image Trigger Delay | (0018,1067) | 3 | Delay time in milliseconds from trigger (e.g., X-Ray on pulse) to the first frame of a Multi-frame image.
Effective Duration | (0018,0072) | 3 | Total time in seconds that data was actually taken for the entire Multi-frame image.
Actual Frame Duration | (0018,1242) | 3 | Elapsed time of data acquisition in msec per each frame.
Multiplexed Audio Channels Description Code Sequence | (003A,0300) | 2C | Description of any multiplexed audio channels. See Section C.7.6.5.1.3. Zero or more items may be included in this sequence. Required if the Transfer Syntax used to encode the multi-frame image contains multiplexed (interleaved) audio channels, such as is possible with MPEG2 Systems (see [ISO/IEC 13818-1]).
>Channel Identification Code | (003A,0301) | 1 | A reference to the audio channel as identified within Transfer Syntax encoded bit stream (1 for the main channel, 2 for the second channel and 3 to 9 to the complementary channels).
>Channel Mode | (003A,0302) | 1 | A coded descriptor qualifying the mode of the channel: Enumerated Values: MONO 1 signal STEREO 2 simultaneously acquired (left and right) signals
>Channel Source Sequence | (003A,0208) | 1 | A coded descriptor of the audio channel source. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID Audio Channel Source 3000.

##### C.7.6.5.1 Cine Attribute Descriptions

###### C.7.6.5.1.1 Frame Time

Frame Time (0018,1063) is the nominal time (in milliseconds) between individual frames of a Multi-frame image. If the Frame Increment Pointer points to this Attribute, Frame Time shall be used in the following manner to calculate 'the relative time' for each frame:

Frame 'Relative Time' (n) = Frame Delay + Frame Time * (n-1)

where: n = number of frame within the Multi-frame image and the first frame number is one

### Note

When there is only one frame present, Frame Time (0018,1063) may have either a value of 0, or a nominal value that would apply if there were multiple frames.

###### C.7.6.5.1.2 Frame Time Vector

Frame Time Vector (0018,1065) is an array that contains the time increments (in milliseconds) between the nth frame and the previous frame for a Multi-frame image. The first frame always has a time increment of 0. If the Frame Increment Pointer points to this Attribute, the Frame Time Vector shall be used in the following manner to calculate 'relative time' T(n) for frame n:

where Δti is the ith Frame Time Vector component.

###### C.7.6.5.1.3 Multiplexed Audio

During a video acquisition, audio may be used for voice commentary of what is being observed, as well as to record sound-based physiological information such as Doppler audio.

Some Transfer Syntaxes allow for the multiplexing of interleaved audio with video data, and the Attributes of the Cine Module support this encoding paradigm. They are not intended to describe audio acquired simultaneously when it is encoded in other SOP Instances or within Attributes other than Pixel Data (7FE0,0010) of the same SOP Instance.

Synchronization between audio and video is assumed to be encoded at the Transfer Syntax level (i.e., within the encoded bit stream).

### Note

If no audio was recorded, the Multiplexed Audio Channels Description Code Sequence (003A,0300) will be present and contain no sequence items.

#### C.7.6.6 Multi-frame Module

Table C.7-14 specifies the Attributes of a Multi-frame pixel data Image.

Table C.7-14. Multi-frame Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Number of Frames | (0028,0008) | 1 | Number of frames in a Multi-frame Image. See Section C.7.6.6.1.1 for further explanation.
Frame Increment Pointer | (0028,0009) | 1 | Contains the Data Element Tag of the attribute that is used as the frame increment in Multi-frame pixel data. See Section C.7.6.6.1.2 for further explanation.

##### C.7.6.6.1 Multi-frame Attribute Descriptions

###### C.7.6.6.1.1 Number of Frames and Frame Increment Pointer

A Multi-frame Image is defined as a Image whose pixel data consists of a sequential set of individual Image Pixel frames. A Multi-frame Image is transmitted as a single contiguous stream of pixels. Frame headers do not exist within the data stream.

Each individual frame shall be defined (and thus can be identified) by the Attributes in the Image Pixel Module (see Section C.7.6.3). All Image IE Attributes shall be related to the first frame in the Multi-frame image.

The total number of frames contained within a Multi-frame Image is conveyed in the Number of Frames (0028,0008).

###### C.7.6.6.1.2 Frame Increment Pointer

The frames within a Multi-frame Image shall be conveyed as a logical sequence. The information that determines the sequential order of the frames shall be identified by the Data Element Tag or tags conveyed by the Frame Increment Pointer (0028,0009). Each specific Image IOD that supports the Multi-frame Module specializes the Frame Increment Pointer (0028,0009) to identify the Attributes that may be used as sequences.

Even if only a single frame is present, Frame Increment Pointer (0028,0009) is still required to be present and have at least one value, each of which shall point to an attribute that is also present in the Data Set and has a value.

### Note

For example, in single-frame instance of an IOD that is required to or may contain the Cine Module, it may be appropriate for Frame Time (0018,1063) to be present with a value of 0, and be the only target of Frame Increment Pointer (0028,0009).

When the IOD Permits the use of Multi-frame Functional Groups as a Standard or Standard Extended SOP Class, Frame Increment Pointer may contain the single value of Per-frame Functional Groups Sequence (5200,9230) to indicate that the Functional Groups contain the descriptors of the frames.

### Note

For example, the Multi-frame Grayscale Word SC Image IOD requires the Multi-frame Module but also permits the Multi-frame Functional Groups, for example, to describe the plane position of each frame.

#### C.7.6.7 Bi-plane Sequence Module (Retired)

#### C.7.6.8 Bi-plane Image Module (Retired)

#### C.7.6.9 Frame Pointers Module

Table C.7-15 specifies the attributes of a Frame Pointer Module.

Table C.7-15. Frame Pointers Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Representative Frame Number | (0028,6010) | 3 | The frame number selected for use as a pictorial representation (e.g., icon) of the Multi-frame Image
Frame Numbers Of Interest (FOI) | (0028,6020) | 3 | Frame number(s) selected as frames of interest. A frame number may appear more than once.
Frame Of Interest Description | (0028,6022) | 3 | Description of each one of the Frame(s) of Interest selected in (0028,6020). If multiple Frames of Interest are selected and this Attribute is used, it shall contain the same number of values as are in Frame Numbers of Interest (0028,6020).
Frame of Interest Type | (0028,6023) | 3 | A Defined Term for each one of the Frame(s) of Interest (0028,6020) that identifies the significance of the frame. If multiple Frames of Interest are selected and this Attribute is used, it shall contain the same number of values as are in Frame Numbers of Interest (0028,6020). Defined Terms: HIGHMI a frame acquired at the time of the high power pulse that destroys acoustic contrast RWAVE the frame closest to the R-Wave TRIGGER a trigger frame, for example a set delay from the R Wave ENDSYSTOLE the frame closest to end of systole, at the end of the T-wave

### Note

1. Frame numbers begin at 1.

2. Frame of Interest Description is intended to indicate such frames as Systolic, Diastolic, Stenotic Artery, or trigger label.

#### C.7.6.10 Mask Module

Table C.7-16 specifies the Attributes that describe mask operations for a Multi-frame image.

Table C.7-16. Mask Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Mask Subtraction Sequence | (0028,6100) | 1 | Defines a sequence that describes mask subtraction operations for a Multi-frame Image. One or more items shall be included in this sequence.
>Mask Operation | (0028,6101) | 1 | Defined Term identifying the type of mask operation to be performed. See Section C.7.6.10.1 for further explanation.
>Subtraction Item ID | (0028,9416) | 1C | Identification of the Subtraction Item used to associate a certain Mask Sub-Pixel Shift (0028,6114) in the Frame Pixel Shift Functional Group. See Section C.7.6.16.2.14.1. Required if SOP Class UID (0008,0016) equals "1.2.840.10008.5.1.4.1.1.12.1.1" or "1.2.840.10008.5.1.4.1.1.12.2.1". May be present otherwise.
>Applicable Frame Range | (0028,6102) | 1C | Each pair of numbers in this multi-valued attribute specify a beginning and ending frame number inclusive of a range where this particular mask operation is valid. Discontinuous ranges are represented by multiple pairs of numbers. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. If this Attribute is missing in this particular sequence item, then the mask operation is applicable throughout the entire Multi-frame Image, subject to certain limits as described in Section C.7.6.10.1.1. Required if Mask Operation (0028,6101) equals REV_TID. May be present otherwise.
>Mask Frame Numbers | (0028,6110) | 1C | Specifies the frame numbers of the pixel data used to generate this mask. Frames in a Multi-frame Image are specified by sequentially increasing number values beginning with 1. Required if Mask Operation (0028,6101) is AVG_SUB.
>Contrast Frame Averaging | (0028,6112) | 3 | Specifies the number of contrast frames to average together before performing the mask operation. If the Attribute is missing, no averaging is performed.
>Mask Sub-pixel Shift | (0028,6114) | 3 | A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. See Section C.7.6.10.1.2. ### Note When the Frame Pixel Shift Functional Group is present the values of the Mask Pixel Shift attribute of that Functional Group prevails over the values specified in this module.
>TID Offset | (0028,6120) | 2C | If Mask Operation is TID, specifies the offset to be subtracted from the current frame number in order to locate the mask frame in TID mode. If Mask Operation is REV_TID, specifies the initial offset to be subtracted from the first contrast frame number. See Section C.7.6.10.1.1. If zero length, TID Offset defaults to 1. Required if Mask Operation (0028,6101) is TID or REV_TID.
>Mask Operation Explanation | (0028,6190) | 3 | Free form explanation of this particular mask operation.
>Mask Selection Mode | (0028,9454) | 3 | Specifies the method of selection of the mask operations of this item. Enumerated Values: SYSTEM USER
Recommended Viewing Mode | (0028,1090) | 2 | Specifies the recommended viewing protocol(s). Defined Terms: SUB For subtraction with mask images. NAT Native viewing of image as sent. ### Note If an implementation does not recognize the Defined Term for Recommended Viewing Mode (0028,1090), reverting to native display mode is recommended.

### Note

Frame numbers begin at 1.

##### C.7.6.10.1 Mask Subtraction Attribute Descriptions

###### C.7.6.10.1.1 Mask Operation

Mask Operation (0028,6101) specifies a type of mask operation to be performed.

Defined Terms:

NONE

  (No Subtraction) No mask subtraction operation is specified;

AVG_SUB

  (Average Subtraction) The frames specified by the Mask Frame Numbers (0028,6110) are averaged together, shifted by the amount specified in the Mask Sub-pixel Shift (0028,6114), then subtracted from the contrast frames in the range specified in the Applicable Frame Range (0028,6102). Contrast Frame Averaging (0028,6112) number of frames starting with the current frame are averaged together before the subtraction. If the Applicable Frame Range is not present in this sequence item, the Applicable Frame Range is assumed to end at the last frame number of the image minus Contrast Frame Averaging (0028,6112) plus one;

TID

  (Time Interval Differencing) The mask for each frame within the Applicable Frame Range (0028,6102) is selected by subtracting TID Offset (0028,6120) from the respective frame number. If the Applicable Frame Range is not present in this sequence item, the Applicable Frame Range is assumed to be a range where TID offset subtracted from any frame number with the range results in a valid frame number within the Multi-frame image.

  ### Note

  A positive value for TID Offset (0028,6120) means that the mask frame numbers are lower than the subtracted frame numbers. A negative TID Offset means that the mask frame numbers are higher than the subtracted frame numbers.

REV_TID

  (Reversed Time Interval Differencing) The number of the mask frame for each contrast frame within the Applicable Frame Range (0028,6102) is calculated by subtracting TID Offset (0028,6120) from the first frame within the Applicable Frame Range, TID Offset (0028,6120) +2 from the second frame within the Applicable Frame Range, TID Offset (0028,6120) +4 from the third frame and so on. The Applicable Frame Range (0028,6102) shall be present.

  When multiple pairs of frame numbers are specified in the Applicable Frame Range attribute, the beginning frame numbers (i.e., the first frame number in each pair) shall be in increasing order.

  Algorithm to calculate the Mask Frame Number:

  MFN = (FCFN - TID Offset) - (CFN - FCFN)

  Where:

  MFN = Mask Frame Number

  CFN = Contrast Frame Number

  FCFN = First Contrast Frame Number, the first frame number of the first pair in the Applicable Frame Range

  ### Note

  A positive value for TID Offset (0028,6120) means that the mask frame numbers are lower than the subtracted frame numbers. A negative TID Offset means that the mask frame numbers are higher than the subtracted frame numbers.

### Note

Example of TID Offset, see Figure C.7.6.10-1:

Figure C.7.6.10-1. Example of TID Offset

Number of Frames: 32

Applicable Frame Range: 20 to 30

TID Offset: 5

For Calculating the TID Offset for Mask Operation REV_TID see Table C.7.6.10-1.

Table C.7.6.10-1. Example Mask Frame Numbers for Mask Operation REV_TID

Contrast Frame Number (CFN) (Absolute value) | Mask Frame Number (MFN) (Absolute value)
--- | ---
20 | 15
21 | 14
22 | 13
… | …
28 | 7
29 | 6
30 | 5

In this example the acquisition of the mask frames starts with frame 5 and ends with frame 15. The acquisition of the contrast frames starts with frame 20 and ends with frame 30 (Applicable Frame Range). The number 5 for TID Offset indicates a gap between "end of mask frames" and "begin of contrast frames" of 4 frames, e.g., injection phase and/or time needed to drive C-arm in reverse. Additionally, in this example, the first 4 frames and the last two frames are not used for this Reversed Time Interval Differencing loop.

###### C.7.6.10.1.2 Mask Sub-pixel Shift

A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from the contrast frame. The row offset results in a shift of the pixels along the column axis. The column offset results in a shift of the pixels along the row axis. A positive row offset is a shift toward the pixels of the lower row of the pixel plane. A positive column offset is a shift toward the pixels of the left hand side column of the pixel plane.

#### C.7.6.11 Display Shutter Module

The Display shutter is a geometric mask consisting of one or more combined shapes that may be applied on the image for presentation purposes in order to neutralize the display of any of the pixels located outside of the shutter shape. Geometry of the shutter is specified with respect to a row and column coordinate system where the origin is the upper left hand pixel. This origin is specified by the values 1,1 for row/column. A row coordinate represents a row spacing (vertical) and a column coordinate represents a column spacing (horizontal). Up to three different shutter shapes may be used and superimposed.

The manner in which the display area is neutralized (black-out, gray, or other means) is defined by the Attribute Shutter Presentation Value (0018,1622), or undefined if this Attribute is absent or empty.

Table C.7-17. Display Shutter Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Include Table C.7-17a “Display Shutter Macro Attributes” |

Table C.7-17a. Display Shutter Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Shutter Shape | (0018,1600) | 1 | Shape(s) of the shutter defined for display. Enumerated Values: RECTANGULAR CIRCULAR POLYGONAL This multi-valued Attribute shall contain at most one of each Enumerated Value. When multiple values are present, and the shutter is applied to a displayed image, then all of the shapes shall be combined and applied simultaneously, that is, the least amount of image remaining shall be visible (unoccluded). See Figure C.7-4b.
Shutter Left Vertical Edge | (0018,1602) | 1C | Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the left edge of the rectangular shutter with respect to pixels in the image given as column.
Shutter Right Vertical Edge | (0018,1604) | 1C | Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the right edge of the rectangular shutter with respect to pixels in the image given as column.
Shutter Upper Horizontal Edge | (0018,1606) | 1C | Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the upper edge of the rectangular shutter with respect to pixels in the image given as row.
Shutter Lower Horizontal Edge | (0018,1608) | 1C | Required if Shutter Shape (0018,1600) is RECTANGULAR. Location of the lower edge of the rectangular shutter with respect to pixels in the image given as row.
Center of Circular Shutter | (0018,1610) | 1C | Required if Shutter Shape (0018,1600) is CIRCULAR. Location of the center of the circular shutter with respect to pixels in the image given as row and column.
Radius of Circular Shutter | (0018,1612) | 1C | Required if Shutter Shape (0018,1600) is CIRCULAR. Radius of the circular shutter with respect to pixels in the image given as a number of pixels along the row direction.
Vertices of the Polygonal Shutter | (0018,1620) | 1C | Required if Shutter Shape (0018,1600) is POLYGONAL. Multiple Values where the first set of two values are: row of the origin vertexcolumn of the origin vertex Two or more pairs of values follow and are the row and column coordinates of the other vertices of the polygon shutter. Polygon shutters are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices.
Shutter Presentation Value | (0018,1622) | 3 | A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). ### Note The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth.
Shutter Presentation Color CIELab Value | (0018,1624) | 3 | A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See Section C.10.7.1.1.

Figure C.7-1, Figure C.7-2, Figure C.7-3, Figure C.7-4 and Figure C.7-4b illustrate the values of coordinate attributes for 1:1 aspect and 2:1 aspect ratio images with rectangular and circular display shutters applied.

Figure C.7-1. Rectangular Display Shutter (1:1 aspect ratio image)

Figure C.7-2. Rectangular Display Shutter (2:1 aspect ratio images as they would appear before interpolation for display)

Figure C.7-3. Circular Display Shutter (1:1 aspect ratio image)

Figure C.7-4. Circular Display Shutter (2:1 aspect ratio images as they would appear before interpolation for display)

Figure C.7-4b illustrates the combined application of rectangular and circular display shutters to show the least amount of visible image.

Figure C.7-4b. Combined Rectangular and Circular Display Shutter

#### C.7.6.12 Device Module

Table C.7-18 describes the Attributes of devices or calibration objects (e.g., catheters, markers, baskets) that are associated with a study and/or image.

Table C.7-18. Device Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Device Sequence | (0050,0010) | 1 | A sequence of items describing devices used that may be visible in the image. One or more Items shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 4051 “General Devices”.
>Manufacturer | (0008,0070) | 3 | Manufacturer of the device
>Manufacturer's Model Name | (0008,1090) | 3 | Manufacturer's model name of the device
>Device Serial Number | (0018,1000) | 3 | Manufacturer's serial number of the device
>Device ID | (0018,1003) | 3 | User-supplied identifier for the device
>Device Length | (0050,0014) | 3 | Length in mm of device. See Section C.7.6.12.1.1.
>Device Diameter | (0050,0016) | 3 | Unit diameter of device. See Section C.7.6.12.1.1.
>Device Diameter Units | (0050,0017) | 2C | Required if Device Diameter (0050,0016) is present. Defined Terms: FR French GA Gauge IN Inch MM Millimeter
>Device Volume | (0050,0018) | 3 | Volume of device in ml. See Section C.7.6.12.1.1.
>Inter-Marker Distance | (0050,0019) | 3 | Distance in mm between markers on calibrated device. See Section C.7.6.12.1.1.
>Device Description | (0050,0020) | 3 | Further description in free form text describing the device.

##### C.7.6.12.1 Device Attribute Descriptions

###### C.7.6.12.1.1 Device Type and Size

Depending on the type of device specified by Code Value (0008,0100) in an item of Device Sequence (0050,0010), various device size attributes (e.g., Device Length (0050,0014), Device Diameter (0050,0016), Device Volume (0050,0018), Inter Marker Distance (0050,0019)) may be required to fully characterize the device.

#### C.7.6.13 Intervention Module

Table C.7-19 describes the Attributes of therapies (e.g., interventions during an angiographic procedure) that are associated with a study and/or image.

Table C.7-19. Intervention Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Intervention Sequence | (0018,0036) | 3 | Sequence describing interventional therapies or procedures. One or more Items are permitted in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 9 “Image Guided Therapeutic Procedures”.
>Intervention Status | (0018,0038) | 2 | Temporal relation of SOP Instance to intervention Enumerated Values: PRE INTERMEDIATE POST NONE
>Intervention Drug Code Sequence | (0018,0029) | 3 | Sequence that identifies the interventional drug. Only a single item is permitted in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 10 “Interventional Drug”.
>Intervention Drug Start Time | (0018,0035) | 3 | Time of administration of the interventional drug.
>Intervention Drug Stop Time | (0018,0027) | 3 | Time of completion of administration of the intervention drug.
>Administration Route Code Sequence | (0054,0302) | 3 | Sequence that identifies the Administration Route. Only a single Item is permitted in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 11 “Route of Administration”.
>Intervention Description | (0018,003A) | 3 | Further description in free form text describing the therapy or other intervention.

### Note

Therapy Description (0018,0039) was included in this Module in earlier editions, but its use has been retired. See PS3.3-2003.

#### C.7.6.14 Acquisition Context Module

Table C.7.6.14-1 specifies Attributes for description of the conditions present during data acquisition.

This Module shall not contain descriptions of conditions that replace those that are already described in specific Modules or Attributes that are also contained within the IOD that contains this Module.

### Note

1. Each item of the Acquisition Context Sequence (0040,0555) contains one item of the Concept Name Code Sequence (0040,A043) and one of the mutually-exclusive Observation-value Attributes: Concept Code Sequence (0040,A168), the pair of Numeric Value (0040,A30A) and Measurement Units Code Sequence (0040,08EA), Date (0040,A121), Time (0040,A122), Person Name (0040,A123) or Text Value (0040,A160).

2. If this SOP Instance is a Multi-frame SOP Instance, each item of the Acquisition Context Sequence (0040,0555) may be configured to describe one frame, all frames, or any specifically enumerated subset set of frames of the Multi-frame SOP Instance.

Table C.7.6.14-1. Acquisition Context Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Acquisition Context Sequence | (0040,0555) | 2 | A sequence of Items that describes the conditions present during the acquisition of the data of the SOP Instance. Zero or more items shall be included in this sequence.
>Value Type | (0040,A040) | 3 | The type of the value encoded in this Item. Defined Terms: TEXT NUMERIC CODE DATE TIME PNAME See Section 10.2.
>Concept Name Code Sequence | (0040,A043) | 1 | A concept that constrains the meaning of (i.e., defines the role of) the Observation Value. The "Name" component of a Name/Value pair. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline Context is defined.
>Referenced Frame Numbers | (0040,A136) | 1C | References one or more frames in a Multi-frame SOP Instance. The first frame shall be denoted as frame number one. Required if this SOP Instance is a Multi-frame SOP Instance and the values in this sequence item do not apply to all frames.
>Numeric Value | (0040,A30A) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a set of one or more numeric values. Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a set of one or more integers or real numbers. Shall not be present otherwise.
>Floating Point Value | (0040,A161) | 1C | The floating point representation of Numeric Value (0040,A30A). The same number of values as Numeric Value (0040,A30A) shall be present. Required if Numeric Value (0040,A30A) has insufficient precision to represent the value as a string. May be present otherwise.
>Rational Numerator Value | (0040,A162) | 1C | The integer numerator of a rational representation of Numeric Value (0040,A30A). Encoded as a signed integer value. The same number of values as Numeric Value (0040,A30A) shall be present. Required if Numeric Value (0040,A30A) has insufficient precision to represent a rational value as a string. May be present otherwise.
>Rational Denominator Value | (0040,A163) | 1C | The integer denominator of a rational representation of Numeric Value (0040,A30A). Encoded as a non-zero unsigned integer value. The same number of values as Numeric Value (0040,A30A) shall be present. Required if Rational Numerator Value (0040,A162) is present.
>Measurement Units Code Sequence | (0040,08EA) | 1C | Units of measurement. Only a single Item shall be included in this Sequence. Required if Numeric Value (0040,A30A) is sent. Shall not be present otherwise.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 82 “Units of Measurement”.
>Date | (0040,A121) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a date. ### Note The purpose or role of the date value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a date. Shall not be present otherwise.
>Time | (0040,A122) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a time. ### Note The purpose or role of the time value could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a time. Shall not be present otherwise.
>Person Name | (0040,A123) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Person Name. ### Note The role of the person could be specified in Concept Name Code Sequence (0040,A043). Required if the value that Concept Name Code Sequence (0040,A043) requires (implies) is a person name. Shall not be present otherwise.
>Text Value | (0040,A160) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Text Observation Value. Required if Date (0040,A121), Time (0040,A122), and Person Name (0040,A123) do not fully describe the concept specified by Concept Name Code Sequence (0040,A043). Shall not be present otherwise.
>Concept Code Sequence | (0040,A168) | 1C | This is the Value component of a Name/Value pair when the Concept implied by Concept Name Code Sequence (0040,A043) is a Coded Value. Only a single Item shall be included in this sequence. Required if Date (0040,A121), Time (0040,A122), Person Name (0040,A123), Text Value (0040,A160), and the pair of Numeric Value (0040,A30A) and Measurement Units Code Sequence (0040,08EA) are not present.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline Context is defined.
Acquisition Context Description | (0040,0556) | 3 | Free-text description of the image-acquisition context.

#### C.7.6.15 Bitmap Display Shutter Module

The Bitmap Display Shutter is a bitmap that defines an arbitrary shape that may be applied on the image for presentation purposes in order to neutralize the display of any of the pixels defined in the bitmap.

The manner in which the display area is neutralized (black-out, gray, or other means) is defined by the Attribute Shutter Presentation Value (0018,1622).

The bitmap is specified as a reference to an instance of the Overlay Plane Module Section C.9.2. The referenced Overlay is specialized such that:

- Overlay Type (60xx,0040) shall be "G",

- Overlay Bits Allocated (60xx,0100) shall be 1,

- Overlay Bit Position (60xx,0102) shall be 0 and

- Overlay Origin (60xx,0050) shall be 1\1.

Overlay Rows (60xx,0010) and Overlay Columns (60xx,0011) shall be the same as Rows (0028,0010) and Columns (0028,0011) in the image respectively.

A value of 1 in Overlay Data (60xx,3000) shall indicate a pixel to which the shutter is applied, i.e., replaced with Shutter Presentation Value (0018,1622).

The Overlay specified in this Attribute shall not be activated (used as a conventional overlay) by the Overlay Activation Module Section C.11.7.

Table C.7.6.15-1. Bitmap Display Shutter Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Shutter Shape | (0018,1600) | 1 | Shape of the shutter defined for display. Enumerated Values: BITMAP This Attribute shall contain one Value.
Shutter Overlay Group | (0018,1623) | 1 | Specifies the Group (60xx) of an Overlay stored within the Presentation State IOD that contains the bitmap data, as defined in the Overlay Plane Module Section C.9.2.
Shutter Presentation Value | (0018,1622) | 1 | A single gray unsigned value used to replace those parts of the image occluded by the shutter, when rendered on a monochrome display. The units are specified in P-Values, from a minimum of 0000H (black) up to a maximum of FFFFH (white). ### Note The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth.
Shutter Presentation Color CIELab Value | (0018,1624) | 3 | A color triplet value used to replace those parts of the image occluded by the shutter, when rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab. See Section C.10.7.1.1.

#### C.7.6.16 Multi-frame Functional Groups Module

Table C.7.6.16-1 specifies the attributes of the Multi-frame Functional Groups Module. This module is included in SOP instances even if there is only one frame in the instance.

Table C.7.6.16-1. Multi-frame Functional Groups Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Shared Functional Groups Sequence | (5200,9229) | 1 | Sequence that contains the Functional Group Macros that are shared for all frames in this SOP Instance and Concatenation. ### Note The contents of this sequence are the same in all SOP Instances that comprise a Concatenation. Only a single Item shall be included in this sequence. See Section C.7.6.16.1.1 for further explanation.
>Include one or more Functional Group Macros that are shared by all frames. The selected Functional Group Macros shall not be present in the Per-frame Functional Groups Sequence (5200,9230). | For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified. The Item may be empty if the requirements for inclusion of the Functional Groups are not satisfied.
Per-frame Functional Groups Sequence | (5200,9230) | 1 | Sequence that contains the Functional Group Sequence Attributes corresponding to each frame of the Multi-frame Image. The first Item corresponds with the first frame, and so on. One or more Items shall be included in this sequence. The number of Items shall be the same as the number of frames in the Multi-frame image. See Section C.7.6.16.1.2 for further explanation.
>Include one or more Functional Group Macros. | For each IOD that includes this module, a table is defined in which the permitted Functional Group Macros and their usage is specified. An Item may be empty if the requirements for inclusion of the Functional Groups for the corresponding frame are not satisfied.
Instance Number | (0020,0013) | 1 | A number that identifies this instance. The value shall be the same for all SOP Instances of a Concatenation, and different for each separate Concatenation and for each SOP Instance not within a Concatenation in a series.
Content Date | (0008,0023) | 1 | The date the data creation was started. ### Note For instance, this is the date the pixel data is created, not the date the data is acquired.
Content Time | (0008,0033) | 1 | The time the data creation was started. ### Note For instance, this is the time the pixel data is created, not the time the data is acquired.
Number of Frames | (0028,0008) | 1 | Number of frames in a multi-frame image. See Section C.7.6.6.1.1 for further explanation.
Concatenation Frame Offset Number | (0020,9228) | 1C | Offset of the first frame in a multi-frame image of a concatenation. Logical frame numbers in a concatenation can be used across all its SOP instances. This offset can be applied to the implicit frame number to find the logical frame number in a concatenation. The offset is numbered from zero; i.e., the instance of a concatenation that begins with the first frame of the concatenation has a Concatenation Frame Offset Number (0020,9228) of zero. Required if Concatenation UID (0020,9161) is present.
Representative Frame Number | (0028,6010) | 3 | The frame number selected for use as a pictorial representation (e.g., icon) of the multi-frame Image.
Concatenation UID | (0020,9161) | 1C | Identifier of all SOP Instances that belong to the same concatenation. Required if a group of multi-frame image SOP Instances within a Series are part of a Concatenation.
SOP Instance UID of Concatenation Source | (0020,0242) | 1C | The SOP Instance UID of the single composite SOP Instance of which the Concatenation is a part. All SOP Instances of a concatenation shall use the same value for this attribute, see Section C.7.6.16.1.3. ### Note May be used to reference the entire instance rather than individual instances of the concatenation, which may be transient (e.g., from a presentation state). Required if Concatenation UID (0020,9161) is present.
In-concatenation Number | (0020,9162) | 1C | Identifier for one SOP Instance belonging to a concatenation. See Section C.7.6.16.2.2.4 for further specification. The first instance in a concatenation (that with the lowest Concatenation Frame Offset Number (0020,9228) value) shall have an In-concatenation Number (0020,9162) value of 1, and subsequent instances shall have values monotonically increasing by 1. Required if Concatenation UID (0020,9161) is present.
In-concatenation Total Number | (0020,9163) | 3 | The number of SOP Instances sharing the same Concatenation UID.

##### C.7.6.16.1 Multi-frame Functional Groups Module Attribute Description

###### C.7.6.16.1.1 Functional Group

A Functional Group is a set of Attributes that are logically related and may vary together. Functional Groups are defined by editorial convention in Macros. Those Functional Groups that apply to all frames are included in the Shared Functional Groups Sequence (5200,9229). Functional Groups whose attribute values may vary from frame to frame are included in the Per-frame Functional Groups Sequence (5200,9230).

A single Functional Group shall not be included in both the Shared Functional Groups Sequence (5200,9229) and the Per-frame Functional Groups Sequence (5200,9230).

### Note

1. In the case of a SOP Instance containing a single frame, some Functional Groups may be contained in the Shared Functional Groups Sequence (5200,9229) and others in the one Item of the Per-frame Functional Groups Sequence (5200,9230).

2. Even if there are no Functional Groups in the Per-frame Functional Groups Sequence 5200,9230) an empty Item is encoded for every frame, which an IOD is permitted to specify for a Type 1 Sequence, as described in PS3.5.

It may happen that the Data Set for the Item of a Functional Group Sequence Attribute does not contain any Attributes (e.g., a condition for a single Type 1C attribute in the sequence is not met). In this case, the Item is included but is empty.

### Note

PS3.5 describes that an empty Item is permitted for a Type 1 or Type 2 Sequence depending on what the IOD in PS3.3 defines for the Data Set that is defined for that Sequence Item.

It may happen that a Functional Group Sequence Attribute is not required for a particular frame (e.g., an optional Functional Group). In this case the Functional Group Sequence Attribute is not included in the Per-frame Functional Groups Sequence (5200,9230) Item for that frame.

### Note

The absence of the sequence attribute corresponding to a particular functional group indicates that the functional group is not used for a particular frame.

Private Functional Groups may be defined. The attributes of such a group may be standard or private attributes. A Private Functional Group may not replicate the attributes of a standard Functional Group.

A Private Functional Group can be added to either the Shared Functional Groups Sequence (5200,9229) or the Per-frame Functional Groups Sequence (5200,9230).

###### C.7.6.16.1.2 Per-frame Functional Groups Sequence

The Per-frame Functional Groups Sequence Attribute (5200,9230) consists of a Sequence of Items. Each Item describes the frame of the same rank in the multi-frame pixel data. The first Item describes frame 1, the second Item describes frame 2, etc. Frames are implicitly numbered starting from 1. See Figure C.7.6.16-1.

Figure C.7.6.16-1. A Graphical Presentation of the Multi-frame Functional Groups Structure

###### C.7.6.16.1.3 SOP Instance UID of Concatenation Source

The SOP Instance UID of Concatenation Source (0020,0242) attribute contains the SOP Instance UID of the original, not concatenated, SOP Instance and does not change when a concatenation is created. It is independent of Concatenation UID (0020,9161) because a SOP Instance can be divided into concatenations only during exchange and there can be more than one concatenation with different Concatenation UIDs of an original SOP Instance; See Figure C.7.6.16-1a.

Figure C.7.6.16-1a. SOP Instance UID of Concatenation Source

##### C.7.6.16.2 Common Functional Group Macros

The following sections contain Functional Group Macros common to more than one IOD specification.

### Note

The attribute descriptions in the Functional Group Macros are written as if they were applicable to a single frame (i.e., the macro is part of the Per-frame Functional Groups Sequence). If an attribute is applicable to all frames (i.e., the macro is part of the Shared Functional Groups Sequence) the phrase "this frame" in the attribute description shall be interpreted to mean "for all frames".

###### C.7.6.16.2.1 Pixel Measures Macro

Table C.7.6.16-2 specifies the attributes of the Pixel Measures Functional Group Macro.

Table C.7.6.16-2. Pixel Measures Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Pixel Measures Sequence | (0028,9110) | 1 | Identifies the physical characteristics of the pixels of this frame. Only a single Item shall be included in this sequence.
>Pixel Spacing | (0028,0030) | 1C | Physical distance in the imaging target (patient, specimen, or phantom) between the centers of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See Section 10.7.1.3 for further explanation of the value order. ### Note In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE, the pixel spacing is that in a plane normal to the central ray of the diverging X-Ray beam as it passes through the data collection center. Required if Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED. May be present otherwise.
>Slice Thickness | (0018,0050) | 1C | Nominal reconstructed slice thickness (for tomographic imaging) or depth of field (for optical non-tomographic imaging), in mm. See Section C.7.6.16.2.3.1 for further explanation. ### Note Depth of field may be an extended depth of field created by focus stacking (see Section C.8.12.4). Required if Volumetric Properties (0008,9206) is VOLUME or SAMPLED. May be present otherwise.

###### C.7.6.16.2.2 Frame Content Macro

Table C.7.6.16-3 specifies the attributes of the Frame Content Functional Group Macro.

This Functional Group Macro may only be part of the Per-frame Functional Groups Sequence (5200,9230) attribute.

Table C.7.6.16-3. Frame Content Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame Content Sequence | (0020,9111) | 1 | Identifies general characteristics of this frame. Only a single Item shall be included in this sequence.
>Frame Acquisition Number | (0020,9156) | 3 | A number identifying the single continuous gathering of data over a period of time that resulted in this frame.
>Frame Reference DateTime | (0018,9151) | 1C | The point in time that is most representative of when data was acquired for this frame. See Section C.7.6.16.2.2.1 and Section C.7.6.16.2.2.2 for further explanation. ### Note The synchronization of this time with an external clock is specified in the synchronization Module in Acquisition Time synchronized (0018,1800). Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and the SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" or "1.2.840.10008.5.1.4.1.1.4.4" or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted). May be present otherwise.
>Frame Acquisition DateTime | (0018,9074) | 1C | The date and time that the acquisition of data that resulted in this frame started. See Section C.7.6.16.2.2.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and the SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" or "1.2.840.10008.5.1.4.1.1.4.4" or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted). May be present otherwise.
>Frame Acquisition Duration | (0018,9220) | 1C | The actual amount of time [in milliseconds] that was used to acquire data for this frame. See Section C.7.6.16.2.2.1 and Section C.7.6.16.2.2.3 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and the SOP Class UID is not "1.2.840.10008.5.1.4.1.1.2.2" or "1.2.840.10008.5.1.4.1.1.4.4" or "1.2.840.10008.5.1.4.1.1.128.1" (Legacy Converted). May be present otherwise.
>Cardiac Cycle Position | (0018,9236) | 3 | Description of the position in the cardiac cycle that is most representative of this frame. Defined Terms: END_SYSTOLE END_DIASTOLE UNDETERMINED
>Respiratory Cycle Position | (0018,9214) | 3 | Description of the position in the respiratory cycle that is most representative of this frame. Defined Terms: START _RESPIR END_RESPIR UNDETERMINED
>Dimension Index Values | (0020,9157) | 1C | Contains the values of the indices defined in the Dimension Index Sequence (0020,9222) for this multi-frame header frame. The number of values is equal to the number of Items of the Dimension Index Sequence and shall be applied in the same order. See Section C.7.6.17.1 for a description. ### Note In Section C.7.6.17.1, the index values are defined to start from 1 and monotonically increase by 1, within the scope of the Dimension Organization UID (0020,9164). Required if the value of Dimension Index Sequence (0020,9222) exists.
>Temporal Position Index | (0020,9128) | 1C | Ordinal number (starting from 1) of the frame in the set of frames with different temporal positions. Required if the value of SOP Class UID (0008,0016) equals "1.2.840.10008.5.1.4.1.1.130". May be present otherwise. See Section C.7.6.16.2.2.6.
>Stack ID | (0020,9056) | 1C | Identification of a group of frames, with different positions and/or orientations that belong together, within a dimension organization. See Section C.7.6.16.2.2.4 for further explanation. Required if the value of SOP Class UID (0008,0016) equals "1.2.840.10008.5.1.4.1.1.130". May be present otherwise. See Section C.7.6.16.2.2.7.
>In-Stack Position Number | (0020,9057) | 1C | The ordinal number of a frame in a group of frames, with the same Stack ID Required if Stack ID (0020,9056) is present. See Section C.7.6.16.2.2.4 for further explanation.
>Frame Comments | (0020,9158) | 3 | User-defined comments about the frame.
>Frame Label | (0020,9453) | 3 | Label corresponding to a specific dimension index value. Selected from a set of dimension values defined by the application. This attribute may be referenced by the Dimension Index Pointer (0020,9165) attribute in the Multi-frame Dimension Module. See Section C.7.6.16.2.2.5 for further explanation.

###### C.7.6.16.2.2.1 Timing Parameter Relationships

Figure C.7.6.16-2 shows the relationships among the various timing parameters used.

Figure C.7.6.16-2. Relationship of Timing Related Attributes

###### C.7.6.16.2.2.2 Frame Reference DateTime

The Frame Reference DateTime (0018,9151) is used to indicate the point in time that is most representative for that specific frame.

### Note

1. For example, in the case of MR it might be the time of acquisition of the data for the ky = 0 line in k-space (the central Fourier segment).

2. For cardiac gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Cardiac Trigger Delay Time (0020,9153). For respiratory gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Respiratory Trigger Delay Time (0020,9255).

###### C.7.6.16.2.2.3 Frame Acquisition Duration

The Frame Acquisition Duration (0018,9220) is used to indicate the duration of the acquisition related to this frame.

For SOP Instances or Concatenations of the Enhanced PET Image Storage SOP Class (1.2.840.10008.5.1.4.1.1.130) the Frame Acquisition Duration (0018,9220) is the sum of the portion of each cycle during which data contributing to this frame has actually been acquired for all of the cardiac or respiratory cycles of a gated acquisition (i.e., if Cardiac Synchronization Technique (0018,9037) equals other than NONE, and/or if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE).

###### C.7.6.16.2.2.4 Concatenations and Stacks

Due to implementation specific reasons (such as maximum object size) the information of a multi-frame image may be split into more than one SOP Instance. These SOP Instances form together a Concatenation. This is a group of SOP Instances within a Series that is uniquely identified by Concatenation UID (0020,9161).

The Dimension Index Sequence (0020,9222) for each SOP Instance with the same Concatenation UID (0020,9161) shall contain exactly the same tags and values.

In a Concatenation the Dimension Index Sequence (0020,9222) items of the Shared Functional Groups (5200,9229) shall be identical and have the same values for all individual SOP Instances. The items of the Per-frame Functional Groups (5200,9230) shall be identical for all individual SOP Instances but the values may change per frame. For all other Attributes of all the Modules of the IOD, the same Attributes shall be present and the values shall be identical, with the exception of the following Attributes:

- Number of Frames (0028,0008)

- Concatenation Frame Offset Number (0020,9228)

- In-concatenation Number (0020,9162)

- SOP Instance UID (0008,0018)

- Instance Creation Time (0008,0013)

### Note

The intent of Concatenations is to split what might have been encoded in a single SOP Instance into smaller fragments for more convenient storage or transmission. All the multiple SOP Instances of a Concatenation should be able to be assembled into a valid single SOP Instance. Hence it is not permitted to change such Attributes as Photometric Interpretation (0028,0004), Rows (0028,0010), Columns (0028,0011), etc.

Stacks describe application-specific groups of frames that have a geometric relationship. Stacks have a Stack ID (0020,9056) that contains a descriptive name that identifies the stack. A Stack ID (0020,9056) may be re-used in another SOP Instance even outside a concatenation. The value of Stack ID (0020,9056) is unique within the scope of a particular Dimension Organization UID (0020,9164) if present, otherwise it is unique within the scope of a particular Concatenation UID (0020,9161). See Figure C.7.6.16-3 for an example.

Figure C.7.6.16-3. Identifying Attributes for Concatenation, SOP Instances, Frames and Stacks

Each frame in a stack has an In-Stack Position Number (0020,9057) that is the ordinal number (starting from 1) of the frame within the set of frames with the same Stack ID (0020,9056), see Figure C.7.6.16-4 for an example.

Figure C.7.6.16-4. Example of multiple stacks

In order to allow interoperable operations on stacks, 2 different frames with the same Stack ID (0020,9056) can only have the same In-Stack Position Number (0020,9057) if they have the same values for the following attributes:

1. Dimension Organization UID (0020,9164) to qualify the Stack ID

2. Image Position (Patient) (0020,0032)

3. Image Orientation (Patient) (0020,0037)

4. Rows (0028,0010) * first value of Pixel Spacing (0028,0030) (= field of view in the row direction)

5. Columns (0028,0011) * second value of Pixel Spacing (0028,0030) (= field of view in the column direction)

6. Slice Thickness (0018,0050)

###### C.7.6.16.2.2.5 Frame Label

The Frame Label attribute (0020,9453) can be used to label frames that need to be handled as a group in application. The Dimension Index Pointer (0020,9165) from the Dimension Module may point to this attribute if it is the base of a dimension.

###### C.7.6.16.2.2.6 Temporal Position Index and Stack ID in PET images

For PET Dynamic images, i.e., images in which Image Type (0008,0008) Value 3 is DYNAMIC, Temporal Position Index is used to distinguish between the multiple acquisitions of the same anatomical area. Similarly, the frames that result from one acquisition over the anatomic area shall be contained in one stack. Thus, for Dynamic images, Temporal Position Index (0020,9128), Stack ID (0020,9056), and In-Stack Position Number (0020,9057) shall be used as three of the dimensions of the image, in that order.

Figure C.7.6.16-4b describes the usage for a PET dynamic image.

Figure C.7.6.16-4b. PET dynamic frame organization

###### C.7.6.16.2.2.7 Stack ID usage in PET static, whole body and gated images

For static and whole body PET images, a single Stack ID (0020,9056) is used to group all of the transverse slices over the entire imaged volume together. That is, a single Stack ID (0020,9056) is used no matter how many acquisition bed positions are involved. In-Stack Position Number (0020,9057) is then used as the spatial dimension index. When rectangular sagittal, coronal or oblique images are created from these, a single Stack ID (0020,9056) is again used.

Similarly, in cardiac or respiratory gated images, the entire volume is again identified by a single Stack ID (0020,9056), and In-Stack Position Number (0020,9057) is the spatial dimension index. The time dimension is indicated by one of the timing attributes, such as trigger delay time or respiratory phase.

###### C.7.6.16.2.3 Plane Position (Patient) Macro

Table C.7.6.16-4 specifies the attributes of the Plane Position (Patient) Functional Group Macro.

Table C.7.6.16-4. Plane Position (Patient) Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Plane Position Sequence | (0020,9113) | 1 | Identifies the position of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Position (Patient) | (0020,0032) | 1C | The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the frame, in mm. See Section C.7.6.2.1.1 and Section C.7.6.16.2.3.1 for further explanation. ### Note In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE the image plane is defined to pass through the data collection center and be normal to the central ray of the diverging X-Ray beam. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED, may be present otherwise.

###### C.7.6.16.2.3.1 Position and Orientation for SAMPLED Frames

In the case of Volumetric Properties (0008,9206) having a value of SAMPLED, Image Position (0020,0032), Image Orientation (0020,0037) and Slice Thickness (0018,0050) shall represent the volume from which the frame was derived based on the orientation of the sampling performed.

### Note

For example in the case of MAX_IP:

The Image Orientation shall be the direction of the ray used for projection of the center of the plane.

The image position shall contain the x, y, and z coordinates of the intersection of the mid-plane of the sampled volume with the ray used to project the upper left hand corner of the frame.

The Slice Thickness shall contain the distance that the ray used for projection of the center of the plane traveled through the volume.

###### C.7.6.16.2.4 Plane Orientation (Patient) Macro

Table C.7.6.16-5 specifies the attributes of the Plane Orientation (Patient) Functional Group Macro.

Table C.7.6.16-5. Plane Orientation (Patient) Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Plane Orientation Sequence | (0020,9116) | 1 | Identifies orientation of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Orientation (Patient) | (0020,0037) | 1C | The direction cosines of the first row and the first column with respect to the patient. See Section C.7.6.2.1.1 and Section C.7.6.16.2.3.1 for further explanation. Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED. May be present otherwise.

###### C.7.6.16.2.5 Referenced Image Macro

Table C.7.6.16-6 specifies the attributes of the Referenced Image Functional Group Macro.

Table C.7.6.16-6. Referenced Image Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Referenced Image Sequence | (0008,1140) | 2 | The set of images or other composite SOP Instances used to plan the acquisition, if any, and other significant related images. See Section C.7.6.16.2.5.1 for further explanation. Zero or more Items shall be included in this Sequence.
>Include Table 10-3 “Image SOP Instance Reference Macro Attributes” |
>Purpose of Reference Code Sequence | (0040,A170) | 1 | Describes the purpose for which the reference is made. Only a single Item shall be included in this sequence. See Section C.7.6.16.2.5.1 for further explanation.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7201 “Referenced Image Purposes of Reference”, or as specified in the IOD invocation of this Functional Group.

###### C.7.6.16.2.5.1 Use of Referenced Image Macro

Referenced Image Sequence (0008,1140) shall be used to identify other data objects used to plan the acquisition of this image. Instances referenced for this purpose shall have the same Frame of Reference UID (0020,0052) as this image. For each Item that contains such a reference, the value of Purpose of Reference Code Sequence (0040,A170) shall be ("121311", DCM, "Localizer"). Applications can use the Referenced Image Sequence (0008,1140) in combination with data in Plane Position (Patient) and Plane Orientation (Patient) Macros to provide projections of the position of an image with respect to the referenced image.

The Referenced Image Sequence (0008,1140) may also be present when references to other images (or frames within other images) are required for other reasons, as specified by Purpose of Reference Code Sequence (0040,A170).

### Note

An Image may contain references to itself (e.g., to other frames within itself).

###### C.7.6.16.2.6 Derivation Image Macro

Table C.7.6.16-7 specifies the attributes of the Derivation Image Functional Group Macro.

Table C.7.6.16-7. Derivation Image Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Derivation Image Sequence | (0008,9124) | 2 | The set of Images or other composite SOP Instances that were used to derive this frame. Zero or more Items shall be included in this Sequence.
>Derivation Description | (0008,2111) | 3 | A text description of how this frame data was derived. See Section C.7.6.1.1.3 for further explanation.
>Derivation Code Sequence | (0008,9215) | 1 | A coded description of how this frame was derived. See Section C.7.6.1.1.3 for further explanation. One or more Items shall be included in this Sequence. More than one Item indicates that successive derivation steps have been applied.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7203 “Image Derivation”.
>Source Image Sequence | (0008,2112) | 2 | The set of Images or other Composite SOP Instances that were used to derive this frame. Zero or more Items shall be included in this Sequence. See Section C.7.6.1.1.4 for further explanation.
>>Include Table 10-3 “Image SOP Instance Reference Macro Attributes” |
>>Purpose of Reference Code Sequence | (0040,A170) | 1 | Describes the purpose for which the reference is made, that is what role the source image or frame played in the derivation of this image or frame. Only a single Item shall be included in this Sequence.
>>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7202 “Source Image Purposes of Reference”.
>>Spatial Locations Preserved | (0028,135A) | 3 | The extent to which the spatial locations of all pixels are preserved during the processing of the source image that resulted in the current image or frame. Enumerated Values: YES NO REORIENTED_ONLY A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees ### Note This applies not only to images with a known relationship to a 3D space, but also to projection images. For example, a projection radiograph such as a mammogram that is processed by a point image processing operation such as contrast enhancement, or a smoothing or edge enhancing convolution, would have a value of YES for this attribute. A projection radiograph that had been magnified or warped geometrically would have a value of NO for this attribute. A projection radiograph that has been flipped, and/or rotated by a multiple of 90 degrees, such that transformation of pixel locations is possible by comparison of the values of Patient Orientation (0020,0020) would have a value of REORIENTED_ONLY. This attribute is typically of importance in relating images with Presentation Intent Type (0008,0068) values of FOR PROCESSING and FOR PRESENTATION. When the value of this attribute is NO, it is not possible to locate on the current image any pixel coordinates that are referenced relative to the source image, such as for example, might be required for rendering CAD findings derived from a referenced FOR PROCESSING image on the current FOR PRESENTATION image.
>>Patient Orientation | (0020,0020) | 1C | The Patient Orientation values of the source image. Required if the value of Spatial Locations Preserved (0028,135A) is REORIENTED_ONLY.

###### C.7.6.16.2.7 Cardiac Synchronization Macro

Table C.7.6.16-8 specifies the attributes of the Cardiac Synchronization Functional Group Macro.

Table C.7.6.16-8. Cardiac Synchronization Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Cardiac Synchronization Sequence | (0018,9118) | 1 | Sequence that describes the frame specific cardiac synchronization parameters. Only a single Item shall be included in this sequence.
>Nominal Percentage of Cardiac Phase | (0020,9241) | 1C | The nominal time relative to the preceding R peak divided by the nominal R-R interval multiplied by 100. Required if used as a dimension index, may be present otherwise.
>Nominal Cardiac Trigger Delay Time | (0020,9153) | 1 | The nominal time in ms from the time of the previous R-peak to the value of Frame Reference DateTime (0018,9151) expressed as a positive value. See Section C.7.6.16.2.7.1 for further explanation.
>Actual Cardiac Trigger Delay Time | (0020,9252) | 1C | The actual time in ms from the time of the previous R-peak to the value of Frame Reference DateTime (0018,9151) expressed as a positive value. See Section C.7.6.16.2.7.1 for further explanation. Required if Intervals Acquired (0018,1083) is present and has a value of 1. May be present otherwise.
>Nominal Cardiac Trigger Time Prior to R-peak | (0020,9154) | 3 | The nominal time in ms from the time of the next R-peak to the value of Frame Reference DateTime (0018,9151) expressed as a negative value. See Section C.7.6.16.2.7.1 for further explanation.
>Actual Cardiac Trigger Time Prior to R-peak | (0020,9155) | 3 | The actual time in ms from the time of the next R-peak to the value of Frame Reference DateTime (0018,9151) expressed as a negative value. See Section C.7.6.16.2.7.1 for further explanation.
>Intervals Acquired | (0018,1083) | 3 | Number of R-R intervals acquired.
>Intervals Rejected | (0018,1084) | 3 | Number of R-R intervals rejected.
>Heart Rate | (0018,1088) | 3 | Average number of heart beats per minute for the collection period for this frame. This shall include all accepted beats as well as rejected beats. ### Note During prolonged acquisitions the average heart rate may differ from the reciprocal of the nominal R-R interval.
>R-R Interval Time Nominal | (0020,9251) | 1C | Nominal R-peak - R-peak interval time in ms for the cardiac cycle used for the acquisition of this frame. See Section C.7.6.16.2.7.1 for further explanation. Required if Cardiac Synchronization Technique (0018,9037) equals other than NONE or REALTIME. May be present otherwise.
>Low R-R Value | (0018,1081) | 3 | R-R interval low limit for beat rejection, in ms.
>High R-R Value | (0018,1082) | 3 | R-R interval high limit for beat rejection, in ms.

###### C.7.6.16.2.7.1 Relationship of Cardiac Timing Attributes

The Nominal Cardiac Trigger Delay Time (0020,9153) is the nominal trigger delay time in ms from the previous R-peak to the value of Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the R-peak, it may be that Actual Cardiac Trigger Delay Time (0020,9252) and the Nominal Cardiac Trigger Delay Time (0020,9153) have the same value.

However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired ECG waveform and fitted into time slots corresponding to nominal phases of the cardiac cycle, then Nominal Cardiac Trigger Delay Time (0020,9153) and the Actual Cardiac Trigger Delay Time (0020,9252) may have different values. When applicable the same is valid for the Nominal Cardiac Trigger Time Prior to R-peak (0020,9154) and the Actual Cardiac Trigger Time Prior to R-peak (0020,9155) attributes.

When multiple cardiac cycles are averaged together, then the Low R-R Value (0018,1081), and High R-R Value (0018,1082) are an average of the cardiac cycles that were accepted in the frame.

### Note

For cardiac gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Cardiac Trigger Delay Time (0020,9153). For respiratory gated acquisitions the choice of the Frame Reference DateTime (0018,9151) is influenced by the Nominal Respiratory Trigger Delay Time (0020,9255).

Figure C.7.6.16-5a depicts the usage.

Figure C.7.6.16-5a. Cardiac Timing Tags

Nominal Cardiac Trigger Time Prior to R-peak (0020,9154) and the Actual Cardiac Trigger Time Prior to R-peak (0020,9155) attributes can be used to store a time of the next R-peak to the value of Frame Reference DateTime (0018,9151) expressed as a negative value. In this case the Actual Cardiac Trigger Delay Time (0020,9252), when present, and the Nominal Cardiac Trigger Delay Time (0020,9153) shall contain a value calculated based on the R-R interval applicable for this frame. See Figure C.7.6.16-5b.

Figure C.7.6.16-5b. Cardiac Timing Relationships

### Note

Specifying the time interval prior to the R-peak is relevant for applications such as capturing P- and Q-wave related morphology.

###### C.7.6.16.2.8 Frame Anatomy Macro

Table C.7.6.16-9 specifies the attributes of the Frame Anatomy Functional Group Macro.

Table C.7.6.16-9. Frame Anatomy Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame Anatomy Sequence | (0020,9071) | 1 | Identifies anatomic characteristics of this frame. Only a single Item shall be included in this sequence.
>Frame Laterality | (0020,9072) | 1 | Laterality of (possibly paired) body parts (as described in Anatomic Region Sequence (0008,2218)) examined. Enumerated Values: R right L left U unpaired B both left and right ### Note This Attribute is mandatory, in order to ensure that frames maybe positioned correctly relative to one another for display. Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230), if present.
>Include Table 10-5 “General Anatomy Mandatory Macro Attributes” | Defined CID for the Anatomic Region Sequence (0008,2218) is 4030. Defined CID for Anatomic Region Modifier Sequence (0008,2220) and Primary Anatomic Structure Modifier Sequence (0008,2230) is 2.

###### C.7.6.16.2.9 Pixel Value Transformation Macro

Table C.7.6.16-10 specifies the attributes of the Pixel Value Transformation Functional Group Macro.

### Note

This Macro is equivalent with the Modality LUT transformation in non Multi-frame IODs.

Table C.7.6.16-10. Pixel Value Transformation Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Pixel Value Transformation Sequence | (0028,9145) | 1 | Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be included in this sequence.
>Rescale Intercept | (0028,1052) | 1 | The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b.
>Rescale Slope | (0028,1053) | 1 | m in the equation specified by Rescale Intercept (0028,1052).
>Rescale Type | (0028,1054) | 1 | Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See Section C.11.1.1.2 for further explanation. Enumerated Values: US Unspecified if Modality (0008,0060) equals MR or PT.

### Note

Window Center (0028,1050) and Window Width (0028,1051) are applied after Rescale Slope (0028,1053) and Rescale Intercept (0028,1054) have been applied to Stored Pixel Values, see Section C.11.2.1.2.

###### C.7.6.16.2.9b Identity Pixel Value Transformation Macro

Table C.7.6.16-10b specifies the attributes of the Identity Pixel Value Transformation Functional Group Macro.

### Note

This Macro constrains the Modality LUT Transformation step in the grayscale rendering pipeline to be an identity transformation.

Table C.7.6.16-10b. Identity Pixel Value Transformation Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Pixel Value Transformation Sequence | (0028,9145) | 1 | Contains the attributes involved in the transformation of stored pixel values. Only a single Item shall be included in this sequence.
>Rescale Intercept | (0028,1052) | 1 | The value b in relationship between stored values (SV) and the output units. Output units = m*SV + b. Enumerated Values: 0
>Rescale Slope | (0028,1053) | 1 | m in the equation specified by Rescale Intercept (0028,1052). Enumerated Values: 1
>Rescale Type | (0028,1054) | 1 | Specifies the output units of Rescale Slope (0028,1053) and Rescale Intercept (0028,1052). See Section C.11.1.1.2 for further explanation. Enumerated Values: US Unspecified

###### C.7.6.16.2.10 Frame VOI LUT Macro

Table C.7.6.16-11 specifies the attributes of the Frame VOI LUT Functional Group Macro.

Table C.7.6.16-11. Frame VOI LUT Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame VOI LUT Sequence | (0028,9132) | 1 | Window Center and Width values applied to the frame. Only a single item is permitted in this sequence.
>Window Center | (0028,1050) | 1 | Window Center for display. See Section C.11.2.1.2 for further explanation.
>Window Width | (0028,1051) | 1 | Window Width for display. See Section C.11.2.1.2 for further explanation.
>Window Center & Width Explanation | (0028,1055) | 3 | Explanation of the Window Center and Width. Defined Terms for CT: BRAIN SOFT_TISSUE LUNG BONE
>VOI LUT Function | (0028,1056) | 3 | Describes a VOI LUT function to apply to the values of Window Center (0028,1050) and Window Width (0028,1051). See Section C.11.2.1.3 for further explanation. Defined Terms: LINEAR SIGMOID LINEAR_EXACT When this attribute is not present, the interpretation of the values of Window Center (0028,1050) and Window Width (0028,1051) is linear as in Section C.11.2.1.2.

###### C.7.6.16.2.10b Frame VOI LUT With LUT Macro

Table C.7.6.16-11b specifies the attributes of the Frame VOI LUT With LUT Functional Group Macro. This macro contains one or more sets of linear or sigmoid window values and/or one or more sets of lookup tables.

Table C.7.6.16-11b. Frame VOI LUT with LUT Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame VOI LUT Sequence | (0028,9132) | 1 | The VOI LUT transformations applied to this frame. Only a single item is permitted in this sequence.
>Include Table C.11-2b “VOI LUT Macro Attributes” |

###### C.7.6.16.2.11 Real World Value Mapping Macro

Table C.7.6.16-12 specifies the attributes of the Real World Value Mapping Functional Group Macro.

Table C.7.6.16-12. Real World Value Mapping Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Real World Value Mapping Sequence | (0040,9096) | 1 | The mapping of stored values to associated Real World values. One or more Items shall be included in this sequence.
>Include Table C.7.6.16-12b “Real World Value Mapping Item Macro Attributes” | Defined CID for Measurement Units Code Sequence is 82, or as specified in the macro invocation.

Table C.7.6.16-12b. Real World Value Mapping Item Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Real World Value First Value Mapped | (0040,9216) | 1 | Specifies the first stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See Section C.7.6.16.2.11.1 for further explanation.
Real World Value Last Value Mapped | (0040,9211) | 1 | Specifies the last stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) or Real World Value LUT (0040,9212) of this Item. See Section C.7.6.16.2.11.1 for further explanation.
Real World Value Intercept | (0040,9224) | 1C | The Intercept value in relationship between stored values (SV) and the Real World values. See Section C.7.6.16.2.11.1.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present.
Real World Value Slope | (0040,9225) | 1C | The Slope value in relationship between stored values (SV) and the real world values. See Section C.7.6.16.2.11.1.2 for further explanation. Required if Real World Value LUT Data (0040,9212) is not present.
Real World Value LUT Data | (0040,9212) | 1C | LUT Data in this Sequence. Required if Real World Value Intercept (0040,9224) is not present.
LUT Explanation | (0028,3003) | 1 | Free form text explanation of the meaning of the transformation in this Item.
LUT Label | (0040,9210) | 1 | Label that is used to identify the transformation of this Item.
Measurement Units Code Sequence | (0040,08EA) | 1 | Units of measurement. Only a single Item shall be included in this sequence. See Section C.7.6.16.2.11.1 for further explanation.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 82 “Units of Measurement”, or as specified in the macro invocation.

###### C.7.6.16.2.11.1 Real World Value Representation

###### C.7.6.16.2.11.1.1 Real World Value Mapping Sequence

The items in the Real World Value Mapping Sequence (0040,9096) may be used to translate stored values into real world values when there is such a relationship. The Real World Value Mapping Sequence (0040,9096) is independent of the Modality LUT (or Pixel Value Transformation Macro), as illustrated in Figure C.7.6.16-6.

Each item specifies the range of stored values as well as the associated mapping function. Each item can specify either a linear mapping, using Real World Value Slope (0040,9225) and Real World Value Intercept (0040,9224), or a non-linear mapping using Real World Value LUT Data (0040,9212). More than one Real World Value Mapping Item is allowed.

The range of stored pixel values specified by different Real Value World Mapping Sequence (0040,9096) Items can overlap (as illustrated in the example in Figure C.7.6.16-7).

Figure C.7.6.16-6. The Real World Value LUT and the Image Viewing Pipeline

### Note

For example, MR images may contain data that is not only the result of the physical/chemical properties of the scanned anatomy, but may also contain information that is representing real world values, such as, temperature [in degrees C], flow [in l/min], speed [in m/sec], relative activity [in %], relative contrast enhancement [in %], diffusion [in sec/mm2], etc.

In some cases the conversion from Stored Values to Real World Values can be linear (through "slope" and "intercept") or non-linear (through look-up tables).

Both transformation methods can be applied to one range of stored values. Overlapped ranges might be used for different representations such as log versus linear scales or for different representations in units such as cm/sec versus mm/sec. Alternative methods can be identified by the labels assigned to the transformations.

###### C.7.6.16.2.11.1.2 Real World Values Mapping Sequence Attributes

The Real World Value First Value Mapped (0040,9216) and Real World Value Last Value Mapped (0040,9211) Attributes describe the range of stored pixel values that are mapped by the Sequence Item. Stored pixel values less than the first value mapped, or greater than the last value mapped have no real value attached.

When the Real World Value Intercept (0040,9224) and Real World Value Slope (0040,9225) attributes are supplied, the stored value (SV) is converted to a real world value (RV) using the equation:

RV = (Real World Value Slope) * SV + Real World Value Intercept

When the Real World Value LUT Data (0040,9212) attribute is supplied, Real World Values are obtained via a lookup operation. The stored pixel value of the first value mapped is mapped to the first entry in the LUT Data. Subsequent stored pixel values are mapped to the subsequent entries in the LUT Data up to a stored pixel value equal to the last value mapped.

The number of entries in the LUT data is given by:

Number of entries = Real World Value Last Value Mapped- Real World Value First Value Mapped + 1

The physical units for the real world values obtained from the sequence item are given by the Measurement Units Code Sequence (0040,08EA).

Figure C.7.6.16-7. Example of mapping stored values to real world values

###### C.7.6.16.2.12 Contrast/Bolus Usage Macro

Table C.7.16-13 specifies the attributes of the Contrast/Bolus Usage macro.

Table C.7.16-13. Contrast/Bolus Usage Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Contrast/Bolus Usage Sequence | (0018,9341) | 1 | Contains the attributes describing the use of contrast for this frame. One or more Items shall be included in this sequence.
>Contrast/Bolus Agent Number | (0018,9337) | 1 | Identifying number corresponding to the agent described in the Enhanced Contrast/Bolus Module.
>Contrast/Bolus Agent Administered | (0018,9342) | 1 | The administration of the selected agent had begun by the time this frame was acquired. Enumerated Values: YES NO
>Contrast/Bolus Agent Detected | (0018,9343) | 2 | The selected agent was detected in the frame. Enumerated Values: YES NO May only be zero length if the acquisition device is not capable of detecting the presence of this contrast agent in the frame.
>Contrast/Bolus Agent Phase | (0018,9344) | 2C | Nominal phase of intravenous contrast administration. Defined Terms: PRE_CONTRAST POST_CONTRAST IMMEDIATE DYNAMIC STEADY_STATE DELAYED ARTERIAL CAPILLARY VENOUS PORTAL_VENOUS Required if Contrast/Bolus Administration Route Sequence (0018,0014) for the Contrast/Bolus Agent Number (0018,9337) defined in the Contrast/Bolus Agent Sequence (0018,0012) is (G-D101, SRT, "Intravenous route") or (G-D101, SNM3, "Intravenous route"); may be present otherwise. ### Note SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16.

###### C.7.6.16.2.13 Pixel Intensity Relationship LUT Macro

Table C.7.6.16-14 specifies the attributes of the Pixel Intensity Relationship LUT Functional Group Macro.

Table C.7.6.16-14. Pixel Intensity Relationship LUT Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Pixel Intensity Relationship LUT Sequence | (0028,9422) | 1 | Defines a sequence of Pixel Intensity Relationship LUTs. One or more items shall be included in this sequence. If Pixel Intensity Relationship (0028,1040) value equals LOG, exactly one item with LUT Function (0028,9474) value TO_LINEAR LUT shall be present; other Items with other values of LUT Function (0028,9474) may be present.
>LUT Descriptor | (0028,3002) | 1 | Specifies the format of the LUT Data in this Sequence. See Section C.11.1.1 and Section C.7.6.16.2.13.1 for further explanation.
>LUT Data | (0028,3006) | 1 | LUT Data in this Sequence.
>LUT Function | (0028,9474) | 1 | The transformation function this LUT applies to the stored pixel values. Defined Terms: TO_LOG TO_LINEAR

###### C.7.6.16.2.13.1 Pixel Intensity Relationship LUT

The purpose of this Pixel Intensity Relationship LUT Sequence is to provide information to recalculate the pixel values proportional to the X-Ray beam intensity from the stored pixel values. It is intended to be used by any application that needs transformed pixel values (e.g., scaled back to acquired pixel values) pixel values for further processing and not as replacement of the Modality LUT in the display pipeline, see Figure C.7.6.16-7a.

Figure C.7.6.16-7a. Purpose of Pixel Intensity Relationship LUT

###### C.7.6.16.2.13.2 Pixel Intensity Relationship LUT Data Attribute

The number of bits in LUT Data (0028,3006) may be different from the value of Bit Stored attribute (0028,0101).

###### C.7.6.16.2.14 Frame Pixel Shift Macro

Table C.7.6.16-15 specifies the attributes of the Frame Pixel Shift Functional Group Macro.

Table C.7.6.16-15. Frame Pixel Shift Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame Pixel Shift Sequence | (0028,9415) | 1 | Sequence containing the pixel shift for a number of masks for this frame. One or more items shall be included in this sequence.
>Subtraction Item ID | (0028,9416) | 1 | Identifier of the Subtraction Item in the Mask Subtraction Sequence (0028,6100) to which this pixel shift is associated. See Section C.7.6.16.2.14.1.
>Mask Sub-pixel Shift | (0028,6114) | 1 | A pair of floating point numbers specifying the fractional vertical [adjacent row spacing] and horizontal [adjacent column spacing] pixel shift applied to the mask before subtracting it from this contrast frame. ### Note If no pixel shift has to be applied a pair of zero values should be specified. See Section C.7.6.10.1.2.

###### C.7.6.16.2.14.1 Subtraction Item ID Description

Subtraction Item ID (0028,9416) specifies the ID of a subtraction operation to which the Mask Sub-pixel Shift (0028,6114) is associated. The Subtraction Item ID is also present in the Mask Subtraction Sequence (0028,6100) to allow this association.

When used as per-frame macro, the Subtraction Item ID (0028,9416) allows to specify different values of Mask Sub-pixel Shift (0028,6114) individually frame by frame, and relate them to a single item of the Mask Subtraction Sequence (0028,6100).

### Note

There is no restriction in the number of Subtraction Item ID's associated to each contrast frame. The same contrast frame may be present in several items of the Mask Subtraction Sequence, each item having a different value of Subtraction Item ID.

When used as shared macro, the Subtraction Item ID (0028,9416) allows to specify one or more values of Mask Sub-pixel Shift that will be applied to all the frames of the Multi-frame image.

### Note

Example of usage of Subtraction Item ID in a per-frame macro, see Figure C.7.6.16-8:

In this example of Multi-frame Image with 3 frames, one Mask Frame (i.e., Frame 1) is applied to the next two frames of the Multi-frame image (i.e., Frames 2 and 3). Therefore, there is only one item in the Mask Subtraction Sequence, containing its own Subtraction Item ID value (i.e., 100). The Frame Pixel Shift Macro allows to define a Mask Sub-Pixel Shift different for each contrast frame.

First Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 2, with Sub-Pixel Shift 1.3\2.4

Second Frame Subtracted: Subtraction of Frame 1 (Mask) to Frame 3, with Sub-Pixel Shift 1.9\3.0

Figure C.7.6.16-8. Example of usage of Subtraction Item ID in a per-frame Macro

###### C.7.6.16.2.15 Patient Orientation in Frame Macro

Table C.7.6.16-16 specifies the attributes of the Patient Orientation in Frame Functional Group Macro.

Table C.7.6.16-16. Patient Orientation in Frame Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Patient Orientation in Frame Sequence | (0020,9450) | 1 | Sequence containing the row and column directions for this frame in the patient. Only a single Item shall be included in this sequence.
>Patient Orientation | (0020,0020) | 1 | Patient direction of the rows and columns of this frame. See Section C.7.6.1.1.1 for further explanation.

###### C.7.6.16.2.16 Frame Display Shutter

Table C.7.6.16-17 specifies the attributes of the Frame Display Shutter Functional Group Macro.

Table C.7.6.16-17. Frame Display Shutter Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Frame Display Shutter Sequence | (0018,9472) | 1 | Sequence containing the display shutter parameters for this frame. Only a single Item shall be included in this sequence.
>Include Table C.7-17a “Display Shutter Macro Attributes” |

###### C.7.6.16.2.17 Respiratory Synchronization Macro

Table C.7.6.16-18 specifies the attributes of the Respiratory Synchronization Functional Group Macro.

Table C.7.6.16-18. Respiratory Synchronization Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Respiratory Synchronization Sequence | (0020,9253) | 1 | Sequence that describes the frame specific respiratory synchronization parameters. Only a single Item shall be included in this sequence.
>Respiratory Interval Time | (0020,9254) | 1C | Measured interval time in ms from maximum respiration peak to the next peak for the respiratory cycle in which this frame occurs. See Section C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE or REALTIME and Respiratory Trigger Type (0020,9250) is absent or has a value of TIME or BOTH.
>Nominal Percentage of Respiratory Phase | (0020,9245) | 1C | The nominal time relative to the preceding respiratory inspiration maximum divided by the nominal respiratory interval multiplied by 100. Required if used as a dimension index, may be present otherwise.
>Nominal Respiratory Trigger Delay Time | (0020,9255) | 1 | The nominal time in ms from the beginning of the respiratory interval to the value of Frame Reference DateTime (0018,9151). See Section C.7.6.16.2.17.1 for further explanation.
>Actual Respiratory Trigger Delay Time | (0020,9257) | 1C | The actual time in ms from the beginning of the respiratory interval to the value of Frame Reference DateTime (0018,9151). See Section C.7.6.16.2.17.1 for further explanation. Required if Respiratory Trigger Type (0020,9250) is TIME or BOTH.
>Starting Respiratory Amplitude | (0020,9246) | 1C | Nominal amplitude of the respiratory signal at which the acquisition of data for this frame begins, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH.
>Starting Respiratory Phase | (0020,9247) | 1C | The phase of respiration at which the Starting Respiratory Amplitude (0020,9246) was measured. Enumerated Values: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Starting Respiratory Amplitude (0020,9246) is present.
>Ending Respiratory Amplitude | (0020,9248) | 1C | Nominal amplitude of the respiratory signal at which the acquisition of data for this frame ends, in percent of the nominal maximum value (which represents maximum inspiration). Required if Respiratory Trigger Type (0020,9250) is AMPLITUDE or BOTH.
>Ending Respiratory Phase | (0020,9249) | 1C | The phase of respiration at which the Ending Respiratory Amplitude (0020,9248) was measured. Enumerated Values: INSPIRATION MAXIMUM EXPIRATION MINIMUM Required if Ending Respiratory Amplitude (0020,9248) is present.

###### C.7.6.16.2.17.1 Relationship of Respiratory Timing Attributes

For time based respiratory gating, the Nominal Respiratory Trigger Delay Time (0020,9255) is the prescribed trigger delay time in ms from the previous Respiratory-peak to the value of Frame Reference DateTime (0018,9151). When frames are acquired with prospective gating, that is, the data acquisition actually begins in response to a timed delay from the Respiratory trigger, it may be that Actual Respiratory Trigger Delay Time (0020,9257) and the Nominal Respiratory Trigger Delay Time (0020,9255) have the same value.

However, when frames are the result of retrospective gating, that is, the data is continuously acquired and then later compared with a simultaneously acquired respiratory waveform and fitted into bins corresponding to nominal phases of the respiratory cycle, then Nominal Respiratory Trigger Delay Time (0020,9255) and the Actual Respiratory Trigger Delay Time (0020,9257) may have different values.

Figure C.7.6.16-9a and Figure C.7.6.16-9b depict the usage.

Figure C.7.6.16-9a. Respiratory Timing Tags

Figure C.7.6.16-9b. Relationship of Respiratory Amplitude Attributes

###### C.7.6.16.2.18 Irradiation Event Identification Macro

Table C.7.6.16-19 specifies the attributes containing the Irradiation Event Identification Functional Group Macro.

Table C.7.6.16-19. Irradiation Event Identification Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Irradiation Event Identification Sequence | (0018,9477) | 1 | Sequence containing the Irradiation Event Identification for this frame. Only a single Item shall be included in this sequence.
>Irradiation Event UID | (0008,3010) | 1 | Unique identification of the irradiation event(s) associated with the acquisition of this image.

###### C.7.6.16.2.19 Radiopharmaceutical Usage Macro

Table C.7.6.16.2-20 specifies the attributes of the Radiopharmaceutical Usage Functional Group Macro.

Table C.7.6.16.2-20. Radiopharmaceutical Usage Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Radiopharmaceutical Usage Sequence | (0018,9737) | 1 | One or more Items shall be included in this sequence.
>Radiopharmaceutical Agent Number | (0018,9729) | 1 | Identifying number corresponding to the radiopharmaceutical described in the Enhanced PET Isotope Module.

###### C.7.6.16.2.20 Patient Physiological State Macro

Table C.7.6.16.2-21 specifies the attributes of the Patient Physiological State Functional Group Macro, which describes the physiological state of the patient.

Table C.7.6.16.2-21. Patient Physiological State Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Patient Physiological State Sequence | (0018,9771) | 1 | Contains the attributes describing the physiological sate of the patient for this frame. Only a single Item shall be included in this sequence.
>Patient Physiological State Code Sequence | (0018,9772) | 1 | The physiological state of the patient. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 3101 “Cardiac Procedural State Values”.

###### C.7.6.16.2.21 Plane Position (Volume) Macro

Table C.7.6.16.2.21-1 specifies the attributes of the Plane Position (Volume) Functional Group Macro.

Table C.7.6.16.2.21-1. Plane Position (Volume) Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Plane Position (Volume) Sequence | (0020,930E) | 1 | Identifies the position of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Position (Volume) | (0020,9301) | 1 | The x, y, and z coordinates, in mm, of the upper left hand corner (center of the first voxel transmitted) of the plane in the Volume Frame of Reference.

###### C.7.6.16.2.22 Plane Orientation (Volume) Macro

Table C.7.6.16.2.22-1 specifies the attributes of the Plane Orientation (Volume) Functional Group Macro.

Table C.7.6.16.2.22-1. Plane Orientation (Volume) Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Plane Orientation (Volume) Sequence | (0020,930F) | 1 | Identifies orientation of the plane of this frame. Only a single Item shall be included in this sequence.
>Image Orientation (Volume) | (0020,9302) | 1 | The direction cosines of the first row and the first column of the frame with respect to the Volume Frame of Reference.

###### C.7.6.16.2.23 Temporal Position Macro

Table C.7.6.16.2.23-1 specifies the attributes of the Temporal Position Functional Group Macro.

Table C.7.6.16.2.23-1. Temporal Position Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Temporal Position Sequence | (0020,9310) | 1 | Identifies the temporal position of the plane of this frame. Only a single Item shall be included in this sequence.
>Temporal Position Time Offset | (0020,930D) | 1 | Time offset of the frame in the set of frames with different temporal positions, in seconds.

###### C.7.6.16.2.24 Image Data Type Macro

Table C.7.6.16.2.24-1 specifies the attributes of the Image Data Type Functional Group Macro.

Table C.7.6.16.2.24-1. Image Data Type Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Image Data Type Sequence | (0018,9807) | 1 | Identifies the data type characteristics of this frame. Only a single Item shall be included in this sequence.
>Data Type | (0018,9808) | 1 | Identification of the data type of a frame. See Section C.7.6.16.2.24.1 for Defined Terms and further explanation.
>Aliased Data Type | (0018,980B) | 1 | Indicates whether this data type is "aliased". Enumerated Values: YES data are aliased values NO data are not aliased values See Section C.7.6.16.2.24.2 for further explanation.
>Zero Velocity Pixel Value | (0018,9810) | 1C | Data value at which velocity is zero. See Section C.7.6.16.2.24.3 for further information. Required if Data Type (0018,9808) is TISSUE_VELOCITY, FLOW_VELOCITY or DIRECTION_POWER. May be present otherwise.

###### C.7.6.16.2.24.1 Data Type

Data Type (0018,9808) indicates the data type of an image frame. Table C.7.6.16.2.24.1-1 lists Defined Terms for this value.

Table C.7.6.16.2.24.1-1. Data Type Defined Terms

Defined Term Name | Defined Term Description
--- | ---
TISSUE_INTENSITY | Tissue intensity typically displayed as grayscale (e.g., B-mode)
TISSUE_VELOCITY | Velocity (Doppler shifts) of tissue
FLOW_VELOCITY | Velocity (Doppler shifts) of blood flow
FLOW_POWER | Power contained in the Doppler signal
DIRECTION_POWER | Directional power contained in the Doppler signal
FLOW_VARIANCE | Statistical variance of blood velocity relative to mean
ELASTICITY | Scalar value related to the elastic properties of the tissue
PERFUSION | Scalar value related to the volume of blood perfusing into tissue
SOUND_SPEED | Speed of sound in tissue
ATTENUATION | Reduction in strength of ultrasound signal as the wave traverses through the medium

###### C.7.6.16.2.24.2 Aliased Data Type

Some data types require special treatment when interpolating data values whose type is "aliased", such as FLOW_VELOCITY when derived from discrete data samples as is done for PW Doppler or sampled CW Doppler. Values of these types are "cyclical" in that the maximum value should be considered adjacent to the minimum value in any interpolation algorithm. Aliased Data Type (0018,980B) indicates whether modular arithmetic is necessary for the associated data type.

### Note

For example, when Data Type (0018,9808) is FLOW_VELOCITY, Aliased Data Type (0018,980B) should be set to YES indicating that an interpolation algorithm should support aliased data. When several FLOW_VELOCITY values near the maximum or minimum are interpolated, this algorithm should produce a value near the maximum or minimum. It would be incorrect to use an interpolation algorithm such as the arithmetic mean, which would erroneously produce a result near the mid-point of the range.

###### C.7.6.16.2.24.3 Zero Velocity Pixel Value

Certain data types represent velocity that is directional by nature. For these data types, there shall be one particular pixel data value that corresponds to zero velocity. Zero Velocity Pixel Value (0018,9810) indicates the pixel data value corresponding to zero velocity.

The VR of Zero Velocity Pixel Value (0018,9810) corresponds to the value of Pixel Representation (0028,0103): If Pixel Representation (0028,0103) is 0000H (unsigned integer), the VR of Zero Velocity Pixel Value (0018,9810) shall be US; otherwise the VR of Zero Velocity Pixel Value (0018,9810) shall be SS.

###### C.7.6.16.2.25 Unassigned Shared and Per-frame Converted Attributes Macros

Attributes that are present in the Classic images to be converted but that are not defined in specific Modules or specific Functional Groups required or supported by the IOD, or have their values changed during conversion, either may:

- be identical in all images, in which case they shall be included in the top level Data Set or in the Unassigned Shared Converted Attributes Sequence, or

- only be present in some images, or have a different number of values, or different values, in which case they shall be included in the Unassigned Per-Frame Converted Attributes Sequence.

### Note

1. An example of an Attribute that might be included in the Unassigned Shared Converted Attributes Macro is Filter Type (0018,1160), which typically would be the same for all Classic CT images in a set, and is not included in any modality-specific Module or Functional Group Macro.

2. An example of an Attribute that might be included in the Unassigned Per-Frame Converted Attributes Macro is Slice Location (0020,1041), which typically would be different for each Classic CT image in a set, and is not included in any modality-specific Module or Functional Group Macro.

3. An example of an Attribute that might be included in the Unassigned Shared Converted Attributes Macro is Series Number (0020,0011), which typically would be the same for all Classic CT images in a set (but is not required to be), and will be replaced with a different value in the top-level Data Set, and hence if the original is to be preserved, needs to be recorded.

4. An example of an Attribute that might be included in the Unassigned Per-Frame Converted Attributes Macro is Instance Number (0020,0013), which typically would be different for each Classic CT image in a set, and will be replaced with a different value in the top-level Data Set, and hence if the original is to be preserved, needs to be recorded.

5. The UIDs of the converted instances are recorded in the Conversion Source Attributes Sequence, and are not included in the Unassigned Shared and Per-Frame Converted Attributes Macros.

For the purpose of comparing values, an Attribute that is not present in a Classic image to be converted is considered the same as an Attribute that is present but has no value. Sequence Attributes match when they have the same number of Items and Item contents in the same order (irrespective of whether the Sequences or Items are encoded with fixed or variable length).

The Unassigned Shared Converted Attributes Sequence, and the Unassigned Per-Frame Converted Attributes Sequence may be absent, if there are no such Attributes available to be included. E.g., there may be no shared Attributes with the same values, all the shared Attributes may be included in the top-level Data Set, there may be no Attributes that vary per-frame or an individual frame may have no such Attribute.

The necessary Private Creator Data Element within each Sequence Item accompanies Private Data Elements. There is no requirement to preserve the private block of Data Elements used in the Classic images to be converted. Nor is there a requirement that a Private Data Element use the same private block in all of the Classic images.

Matching of Private Attribute Values for the purpose of determining whether they are shared or per-frame may be performed using the equivalent meaning if the Value Representation is Explicit and not UN, or known through other means, otherwise, byte matching of the UN VR shall be performed.

###### C.7.6.16.2.25.1 Unassigned Shared Converted Attributes Macro

Table C.7.6.16.2.25.1-1 specifies the attributes of the Unassigned Shared Converted Attributes Functional Group Macro.

Table C.7.6.16.2.25.1-1. Unassigned Shared Converted Attributes Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Unassigned Shared Converted Attributes Sequence | (0020,9170) | 1C | Contains all of the Standard and Private Attributes that are present in all of the converted Classic images, that have the same number of values, that have the same values, and that are not in the top-level Data Set. Only a single Item shall be included in this sequence. Required if any unassigned shared attributes are present.

###### C.7.6.16.2.25.2 Unassigned Per-Frame Converted Attributes Macro

Table C.7.6.16.2.25.2-1 specifies the attributes of the Unassigned Per-Frame Converted Attributes Functional Group Macro.

Table C.7.6.16.2.25.2-1. Unassigned Per-Frame Converted Attributes Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Unassigned Per-Frame Converted Attributes Sequence | (0020,9171) | 1C | Contains all of the Standard and Private Attributes that are present in only some of the converted Classic images, or that have a different number of values, or that have different values. Only a single Item shall be included in this sequence. Required if any unassigned per-frame attributes are present for this frame.

###### C.7.6.16.2.25.3 Image Frame Conversion Source Macro

Table C.7.6.16.2.25.2-1 specifies the attributes of the Image Frame Conversion Source Functional Group Macro.

Table C.7.6.16.2.25.3-1. Image Frame Conversion Source Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Conversion Source Attributes Sequence | (0020,9172) | 1 | The image or other composite SOP Instance that was converted to this frame. Only a single Item shall be included in this sequence.
>Include Table 10-3 “Image SOP Instance Reference Macro Attributes” |

#### C.7.6.17 Multi-frame Dimension Module

The Multi-frame Dimension Module contains a sequence with items pointing to attributes defining a set of dimensions that are usually known prior to the acquisition commencing. It is up to the generating applications to decide what attributes are important to describe the multi-frame dimensions.

The application that generates the Concatenation or SOP Instances may use the order of Dimension Index Pointers (0020,9165) in the Dimension Index Sequence (0020,9222) to guide the receiving application in determining the order of the presentation of image frames. The first index has the highest ranking, the next index has a lower ranking, etc. Frames with higher values for the dimension with the highest ranking would only be presented after all frames that have values for Dimension Index Pointers (0020,9165) of the lower rankings have been presented.

If the set of Dimension Index Pointers does not provide an attribute set whose values are unique for each frame then the order for the frames with the same value set will be incompletely specified. The receiving application could use the logical frame number to resolve this ambiguity. If the attribute set contains more dimensions than are needed to specify a unique ordering, the lower order ranking attribute(s) will have no effect on the ordering.

### Note

For example if there were the following indices in the following order:

- Stack ID (1-3)

- In-stack Position Number (1-2 for Stack ID 1, 1-4 for Stack ID 2, 1-3 for Stack ID 3)

- Effective Echo Time (1-2), i.e., every slice has been scanned with 2 different effective echo's

Then the frames could be presented in the following order:

(Stack ID, In-stack Position, Effective Echo Time)

(1,1,1), (1,1,2), (1,2,1), (1,2,2),

(2,1,1), (2,1,2), (2,2,1), (2,2,2), (2,3,1), (2,3,2), (2,4,1), (2,4,2)

(3,1,1), (3,1,2), (3,2,1), (3,2,2), (3,3,1), (3,3,2)

The actual order of the frames in the object is up to the generating application.

If the effective echo time was not included in the Dimension Index Pointers in the above example then the order of sorting for the frames with the same indices will be undefined - in this case there would be 2 frames with the index set (Stack ID, In-stack Position) = (1,1) and the order of these frames is not specified.

If there were another attribute appended to the Dimension Index Pointers, for example TR, then the TR index would not be used in determining the order of the frames. So the Index Frame Pointers would contain (Stack ID, In-stack Position, Effective Echo Time, TR) but the TR index would be irrelevant for frame ordering purposes.

Table C.7.6.17-1 specifies the attributes of the Multi-frame Dimension Module.

Table C.7.6.17-1. Multi-frame Dimension Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Dimension Organization Sequence | (0020,9221) | 1 | Sequence that lists the Dimension Organization UIDs referenced by the containing SOP Instance. See Section C.7.6.17.2 for further explanation. One or more Items shall be included in this Sequence.
>Dimension Organization UID | (0020,9164) | 1 | Uniquely identifies a set of dimensions referenced within the containing SOP Instance. See Section C.7.6.17.2 for further explanation.
Dimension Organization Type | (0020,9311) | 3 | Dimension organization of the instance. Defined Terms: 3D Spatial Multi-frame image of parallel planes (3D volume set) 3D_TEMPORAL Temporal loop of parallel-plane 3D volume sets.
Dimension Index Sequence | (0020,9222) | 1 | Identifies the sequence containing the indices used to specify the dimension of the multi-frame object. One or more Items shall be included in this sequence.
>Dimension Index Pointer | (0020,9165) | 1 | Contains the Data Element Tag that is used to identify the Attribute connected with the index. See Section C.7.6.17.1 for further explanation.
>Dimension Index Private Creator | (0020,9213) | 1C | Identification of the creator of a group of private data elements. Required if the Dimension Index Pointer (0020,9165) value is the Data Element Tag of a Private Attribute.
>Functional Group Pointer | (0020,9167) | 1C | Contains the Data Element Tag of the Functional Group Sequence that contains the Attribute that is referenced by the Dimension Index Pointer (0020,9165). See Section C.7.6.17.1 for further explanation. Required if the value of Dimension Index Pointer (0020,9165) is the Data Element Tag of an Attribute that is contained within a Functional Group Sequence.
>Functional Group Private Creator | (0020,9238) | 1C | Identification of the creator of a group of private data elements. Required if the Functional Group Pointer 0020,9167) value is the Data Element Tag of a Private Attribute.
>Dimension Organization UID | (0020,9164) | 1C | Uniquely identifies a set of dimensions referenced within the containing SOP Instance. In particular the dimension described by this sequence item is associated with this Dimension Organization UID. See Section C.7.6.17.2 for further explanation. Required if the value of Dimension Organization Sequence (0020,9221) contains Items
>Dimension Description Label | (0020,9421) | 3 | Free text description that explains the meaning of the dimension.

##### C.7.6.17.1 Dimension Indices

With the Dimension Index Sequence (0020,9222), Data Element Tags are specified that identify the indices used for a particular SOP Instance.

The actual index values for each frame in a multi-frame header are stored in a single Dimension Index Values Attribute (0020,9157) defined in the Frame Content Functional Group. For each SOP Instance this Attribute has a Value Multiplicity equal to the number of Items in the Sequence. The ordering of the Items in the Sequence defines the ordering in the Dimension Index Values Attribute: Item 1 of the Sequence relates to Value 1, Item 2 to Value 2, etc.

The Dimension Index Pointer (0020,9165) references a single Attribute that describes the actual values that define the dimension. Each Attribute referenced in the Dimension Index Sequence (0020,9222) will have an index stored in the Dimension Index Values (0020,9157) for each frame. Each index value is an ordinal number starting from 1 and monotonically increasing by 1 within the scope of a Dimension Organization UID (0020,9164). These values are independent of the actual values of the attribute referenced by the Dimension Index Pointer (0020,9165), i.e., the index values are logical indices, rather than actual indices. Frames assigned the same index shall contain nominally the same value for the referenced Attribute. If the referenced Attribute is not present for some frames, or is present but has no value, then a single index shall be assigned to indicate the lack of the value (i.e., all such frames shall have the same index value, which is different from other index values). It is at the discretion of the SOP Instance creator whether the Attribute values are equivalent, and therefore appropriate for assignment to the same index value.

The Dimension Index Pointer (0020,9165) shall contain the Data Element Tag (gggg,eeee) of the Attribute being indexed.

### Note

1. Dimension Index Pointer (0020,9165) may point to a Sequence containing a Functional Group. In that case all the Attributes of the Sequence are associated with the index value.

2. The Dimension Index Pointer (0020,9165) may point to a Data Element Tag (gggg,eeee) that is not present for all frames of an object, or does not have a value for all frames of an object. For such frames, index values are still assigned, as described above.

3. The indices used in the Dimension Index Values (0020,9157) may or may not be identical to the value of indexed attribute referenced by Dimension Index Pointer (0020,9165). For example, if the referenced Attribute is itself encoded in an index-like fashion (being an ordinal number starting from 1), such as In-Stack Position Number (0020,9057), then index value 1 would typically correspond to In-Stack Position Number (0020,9057) value 1. On the other hand, if the referenced attribute encodes some physical measure, such as a time or distance, or a categorical value, such as a string describing the phase of contrast, or a more complex description such as an entire functional group, then the index value is independent of the encoded value.

4. The scope of the values of Dimension Index Pointer (0020,9165) is defined to be within a single Dimension Organization UID (0020,9164). If the same Dimension Organization UID (0020,9164) is present in multiple Instances (whether part of a Concatenation or not), at least one of those Instances (though not necessarily every Instance) will contain a value of 1 for the Dimension Index Values (0020,9157).

The Functional Group Pointer (0020,9167) value is the Data Element Tag (gggg,eeee) of the Functional Group Sequence that contains the Attribute being indexed. If the Dimension Index Pointer 0020,9165) contains a Data Element Tag that identifies a Functional Group Sequence then the Functional Group Pointer (0020,9167) shall not be present.

If the Dimension Index Pointer (0020,9165) attribute contains a Private Data Element, then the Dimension Index Private Creator (0020,9213) shall contain the Private Creator of the block of Private Data Elements.

If the Functional Group Pointer (0020,9167) attribute contains a Private Data Element, then the Functional Group Private Creator (0020,9238) shall contain the Private Creator of the block of Private Data Elements.

### Note

An example of the usage of the Dimension Index Sequence (0020,9222) and Dimension Index Values (0020,9157) attributes:

Dimension Index Sequence (0020,9222) specifies two indices:

- Cardiac Trigger Delay Time (0020,9153)

- Image Position (Patient) (0020,0032)

The Dimension Index Sequence (0020,9222) is filled with the following contents:

Item | Attribute | Value
--- | --- | ---
1 | Dimension Index Pointer | (0020,9153)
Functional Group Pointer | (0018,9118)
… |
2 | Dimension Index Pointer | (0020,0032)
Functional Group Pointer | (0020,9113)
… |

The Dimension Index Values (0020,9157) (in the Frame Content Functional Group) for each frame consists of two values:

Index of Cardiac Trigger Delay Time \ Index of Image Position

The SOP Instance creator is responsible for maintaining consistency between the actual value of the attribute listed as the Dimension Index Pointer (0020,9165) and the corresponding value in the Dimension Index Values (0020,9157) attribute.

See Figure C.7.6.17-1 for an illustration of this example.

Figure C.7.6.17-1. Example of Dimension Index Sequence and Dimension Index Values Attributes

##### C.7.6.17.2 Dimension Organization UID

The Dimension Organization UID (0020,9164) value identifies a set of dimensions to which an Item of the Dimension Index Sequence (0020,9222) belongs.

When different SOP Instances share the same Dimension Organization UID (0020,9164) for a particular Item of the Dimension Index Sequence (0020,9222), equivalent indices from the corresponding Dimension Index Values (0020,9157) shall have the same meaning across the SOP Instances.

This mechanism allows an image creator to explicitly specify that indices are intended to convey identical information across SOP Instances.

The Dimension Organization Sequence attribute (0020,9221) contains a summary of all the Dimension Organization UID (0020,9164) values used in a SOP Instance.

### Note

Figure C.7.6.17-2 illustrates how this is used for a SOP Instance created by a multi-planar reformat application from a SOP Instance containing three Items in the Dimension Index Sequence. The meaning of the indices for Temporal Position Index (0020,9128), and MR Echo Sequence (0018,9114) were preserved in the derived SOP Instance, so it shares the Dimension Organization UID for these attributes with the original. Since the reformat was performed with a different orientation, the meaning of the In-Stack Position Number (0020,9057) was not preserved. Therefore a new Dimension Organization UID (0020,9164) was created.

Figure C.7.6.17-2. Example of Use of Dimension Organization Module

#### C.7.6.18 Physiological Synchronization

##### C.7.6.18.1 Cardiac Synchronization Module

Table C.7.6.18-1 specifies the attributes of the Cardiac Synchronization Module.

Table C.7.6.18-1. Cardiac Synchronization Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Cardiac Synchronization Technique | (0018,9037) | 1C | Defines if a cardiac synchronization technique was applied during or after the acquisition. Enumerated Values: NONE REALTIME total time for the acquisition is shorter than cardiac cycle, no gating is applied PROSPECTIVE certain thresholds have been set for a gating window that defines the acceptance of measurement data during the acquisition RETROSPECTIVE certain thresholds have been set for a gating window that defines the acceptance of measurement data after the acquisition PACED there is a constant RR interval (e.g., Pacemaker), which makes thresholding not required Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Cardiac Signal Source | (0018,9085) | 1C | Cardiac Signal Source. Defined Terms: ECG electrocardiogram VCG vector cardiogram PP peripheral pulse MR magnetic resonance, i.e., M-mode or cardiac navigator Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Cardiac RR Interval Specified | (0018,9070) | 1C | R-R interval in ms measured prior to or during the scan. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. ### Note Heart Rate (0018,1088) is not used in this Module, since its value can be derived as 1/ Cardiac RR Interval Specified (0018,9070).
Cardiac Beat Rejection Technique | (0018,9169) | 1C | Cardiac arrhythmia rejection technique. Defined Terms: NONE RR_INTERVAL rejection based on deviation from average RR interval QRS_LOOP rejection based on deviation from regular QRS loop PVC rejection based on PVC criteria Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
Low R-R Value | (0018,1081) | 2C | R-R interval low limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
High R-R Value | (0018,1082) | 2C | R-R interval high limit for beat rejection, in ms. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals PROSPECTIVE or RETROSPECTIVE.
Intervals Acquired | (0018,1083) | 2C | Number of R-R intervals acquired and used to create the image (not including the intervals rejected). Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Intervals Rejected | (0018,1084) | 2C | Number of R-R intervals rejected. Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Cardiac Synchronization Technique (0018,9037) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Cardiac Synchronization Technique (0018,9037) equals other than NONE.
Skip Beats | (0018,1086) | 3 | Number of beats prescribed to be skipped after each detected arrhythmia.
Cardiac Framing Type | (0018,1064) | 1C | Description of type of framing performed. See Section C.7.6.18.1.1.1 for description and Defined Terms. Required if type of framing is not time forward from trigger, may be present otherwise.

### Note

Low R-R Value (0018,1081), High R-R Value (0018,1082), Intervals Acquired (0018,1083) and Intervals Rejected (0018,1084) in this Module apply to the entire Image. The Cardiac Gating Sequence (0018,9118) in the Cardiac Gating Functional Group uses the same attributes and specifies the values for a single frame.

###### C.7.6.18.1.1 Attribute Descriptions

###### C.7.6.18.1.1.1 Cardiac Framing Type

Cardiac Framing Type (0018,1064) is the mechanism used to select the data acquired to construct the frames within a specified cardiac timing interval.

Defined Terms:

FORW

  time forward from trigger

BACK

  time back before trigger

PCNT

  percentage of R-R forward from trigger

##### C.7.6.18.2 Respiratory Synchronization Module

Table C.7.6.18-2 specifies the attributes of the Respiratory Synchronization Module.

Table C.7.6.18-2. Respiratory Synchronization Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Respiratory Motion Compensation Technique | (0018,9170) | 1C | Applied technique to reduce respiratory motion artifacts. Defined Terms: NONE BREATH_HOLD REALTIME Image acquisition shorter than respiratory cycle GATING Prospective gating TRACKING Prospective through-plane or in-plane motion tracking PHASE_ORDERING Prospective phase ordering PHASE_RESCANNING Prospective techniques, such as real-time averaging, diminishing variance and motion adaptive gating RETROSPECTIVE Retrospective gating CORRECTION Retrospective image correction Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Respiratory Signal Source | (0018,9171) | 1C | Signal source from which respiratory motion is derived. Defined Terms: NONE BELT includes various devices that detect or track expansion of the chest NASAL_PROBE CO2_SENSOR NAVIGATOR MR navigator and organ edge detection MR_PHASE phase (of center k-space line) ECG baseline demodulation of the ECG Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Respiratory Motion Compensation Technique (0018,9170) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Respiratory Motion Compensation Technique (0018,9170equals other than NONE.
Respiratory Trigger Delay Threshold | (0020,9256) | 1C | Respiratory trigger threshold in percent of the chest expansion for the frame relative to the last Respiratory-Peak. See Section C.7.6.16.2.17.1 for further explanation. Required if Respiratory Motion Compensation Technique (0018,9170) equals other than NONE, REALTIME or BREATH_HOLD and if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Respiratory Trigger Type | (0020,9250) | 1C | Characteristic of the respiratory signal used to the define the respiratory triggering. Defined Terms: TIME AMPLITUDE BOTH Required if the value is not TIME, may be present otherwise.

##### C.7.6.18.3 Bulk Motion Synchronization Module

Table C.7.6.18-3 specifies the attributes of the Bulk Motion Synchronization Module.

Table C.7.6.18-3. Bulk Motion Synchronization Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Bulk Motion Compensation Technique | (0018,9172) | 1C | Applied technique to reduce bulk or other physiology motion artifacts. Defined Terms: NONE REALTIME image acquisition shorter than motion cycle GATING prospective gating TRACKING prospective through and/or in-plane motion tracking RETROSPECTIVE retrospective gating CORRECTION retrospective image correction Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED. May be present otherwise.
Bulk Motion Signal Source | (0018,9173) | 1C | Signal source to measure motion. Defined Terms: JOINT joint motion detection NAVIGATOR MR navigator and organ edge detection MR_PHASE phase (of center k-space line) Required if Image Type (0008,0008) Value 1 is ORIGINAL or MIXED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE. Otherwise may be present if Image Type (0008,0008) Value 1 is DERIVED and Bulk Motion Compensation Technique (0018,9172) equals other than NONE.

#### C.7.6.19 Supplemental Palette Color Lookup Table Module

This module is used in conjunction with Multi-frame IODs that use RGB color in a number of frames. The value of Pixel Presentation (0008,9205) for such frames equals COLOR.

Table C.7.6.19-1 specifies the Attributes that describe the Lookup table data.

Table C.7.6.19-1. Supplemental Palette Color Table Lookup Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Red Palette Color Lookup Table Descriptor | (0028,1101) | 1 | Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See Section C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor | (0028,1102) | 1 | Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See Section C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor | (0028,1103) | 1 | Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See Section C.7.6.3.1.5 for further explanation.
Red Palette Color Lookup Table Data | (0028,1201) | 1 | Red Palette Color Lookup Table Data. See Section C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data | (0028,1202) | 1 | Green Palette Color Lookup Table Data. See Section C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data | (0028,1203) | 1 | Blue Palette Color Lookup Table Data. See Section C.7.6.3.1.6 for further explanation.

#### C.7.6.20 Patient Orientation Module

This section describes attributes of the Patient Orientation Module by describing the patient orientation related to gravity and equipment. Table C.7.6.20-1 contains IOD Attributes that describe the Patient Orientation.

Table C.7.6.20-1. Patient Orientation Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Include Table 10-15 “Patient Orientation Macro Attributes” |

#### C.7.6.21 Image - Equipment Coordinate Relationship Module

This section describes the Image - Equipment Coordinate Relationship module. Table C.7.6.21-1 contains the attributes that specify how the equipment (e.g., gantry) and patient oriented coordinate system (in conjunction with Image Position (Patient) (0020,0032) and Image Orientation (Patient) (0020,0037) attributes) are related.

Table C.7.6.21-1. Image - Equipment Coordinate Relationship Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Image to Equipment Mapping Matrix | (0028,9520) | 1 | A 4x4 rigid transformation matrix that maps patient coordinate space of the reconstructed image to the equipment defined original coordinate space. Matrix elements shall be listed in row-major order. See Section C.7.6.21.1.
Equipment Coordinate System Identification | (0028,9537) | 1 | Identification of the type of equipment coordinate system in which the projection images were acquired. See Section C.7.6.21.2. Defined Terms: ISOCENTER

##### C.7.6.21.1 Image to Equipment Mapping Matrix

The Image to Equipment Mapping Matrix (0028,9520) is used to describe the relationship between the Patient oriented coordinate system and a modality specific equipment coordinate system. This mapping can only be used with systems that have a well-defined equipment coordinate system (such as XA, etc.).

The Image to Equipment Mapping Matrix AMB describes how to transform a point (Bx,By,Bz) with respect to the Patient coordinate system into (Ax,Ay,Az) with respect to the equipment coordinate system according to the equation below.

Equation C.7.6.21.1-1.

The Image to Equipment Mapping Matrix is a rigid transformation that involves only translations and rotations. Mathematically, the matrix shall be orthonormal and can describe six degrees of freedom: three translations, and three rotations.

### Note

Both the Patient Coordinate System and the Equipment Coordinate System are expressed in millimeters.

##### C.7.6.21.2 Equipment Coordinate System Identification

The Equipment Coordinate System Identification (0028,9537) identifies the Reference Coordinate System to which the Image to Equipment Mapping Matrix (0028,9520) is related.

The Defined Term ISOCENTER refers to a coordinate reference system where the origin corresponds with the center of rotation of the projections.

#### C.7.6.22 Specimen Module

Table C.7.6.22-1 specifies the Attributes that identify one or more Specimens being imaged.

Table C.7.6.22-1. Specimen Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Include Table C.7.6.22-2 “Specimen Macro Attributes” |

Table C.7.6.22-2. Specimen Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Container Identifier | (0040,0512) | 1 | The identifier for the container that contains the specimen(s) being imaged. See Section C.7.6.22.1.1.
Issuer of the Container Identifier Sequence | (0040,0513) | 2 | Organization that assigned the Container Identifier. Zero or one Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Alternate Container Identifier Sequence | (0040,0515) | 3 | Sequence of alternate identifiers for the container that contains the specimen(s) being imaged. These may have been assigned, e.g., by the manufacturer, or by another institution that collected the specimen. One or more Items are permitted in this sequence.
>Container Identifier | (0040,0512) | 1 | The identifier for the container that contains the specimen(s) being imaged.
>Issuer of the Container Identifier Sequence | (0040,0513) | 2 | Organization that assigned the Container Identifier. Zero or one Item shall be included in this sequence.
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Container Type Code Sequence | (0040,0518) | 2 | Type of container that contains the specimen(s) being imaged. Zero or one Item shall be included in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 8101 “Container Types”.
Container Description | (0040,051A) | 3 | Description of the container.
Container Component Sequence | (0040,0520) | 3 | Description of one or more components of the container (e.g., description of the slide and of the coverslip). One or more Items are permitted in this sequence.
>Container Component Type Code Sequence | (0050,0012) | 1 | Type of container component. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 8102 “Container Component Types”.
>Manufacturer | (0008,0070) | 3 | Manufacturer of the container component.
>Manufacturer's Model Name | (0008,1090) | 3 | Manufacturer's model name of the container component.
>Container Component ID | (0050,001B) | 3 | Manufacturer's identifier of the container component, e.g., Lot Number and/or Version.
>Container Component Length | (0050,001C) | 3 | Length in mm of container component.
>Container Component Width | (0050,0015) | 3 | Width in mm of container component.
>Container Component Diameter | (0050,001D) | 3 | Diameter in mm of container component for cylindrical or circular components.
>Container Component Thickness | (0050,0013) | 3 | Thickness in mm of container component
>Container Component Material | (0050,001A) | 3 | Material of container component. Defined Terms: GLASS PLASTIC METAL
>Container Component Description | (0050,001E) | 3 | Container component text description.
Specimen Description Sequence | (0040,0560) | 1 | Sequence of identifiers and detailed description of the specimen(s) being imaged. One or more Items shall be included in this sequence. Each specimen imaged in the Pixel Data shall be identified by an Item in this Sequence. Other specimens in/on the container, but not imaged in the Pixel Data, may also be identified by Items in this Sequence.
>Specimen Identifier | (0040,0551) | 1 | A departmental information system identifier for the Specimen. See Section C.7.6.22.1.1 and Section C.7.6.22.1.2. If a single specimen is present in a container, the value of the Specimen Identifier and the value of the Container Identifier are typically the same.
>Issuer of the Specimen Identifier Sequence | (0040,0562) | 2 | The name or code for the institution that has assigned the Specimen Identifier. Zero or one Item shall be included in this sequence.
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
>Specimen UID | (0040,0554) | 1 | Unique Identifier for Specimen. See Section C.7.6.22.1.2.
>Specimen Type Code Sequence | (0040,059A) | 3 | Specimen Type. Only a single Item is permitted in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 8103 “Anatomic Pathology Specimen Types”.
>Specimen Short Description | (0040,0600) | 3 | Short textual specimen description (may include ancestor specimen descriptions).
>Specimen Detailed Description | (0040,0602) | 3 | Detailed textual specimen description (may include ancestor specimen descriptions).
>Specimen Preparation Sequence | (0040,0610) | 2 | Sequence of Items identifying the process steps used to prepare the specimen for image acquisition. This includes description of all processing necessary to interpret the image. Zero or more Items shall be included in this sequence. This Sequence includes description of the specimen sampling step from an ancestor specimen, potentially back to the original part collection. See Section C.7.6.22.1.3.
>>Specimen Preparation Step Content Item Sequence | (0040,0612) | 1 | Sequence of Content Items identifying the processes used in one preparation step to prepare the specimen for image acquisition. One or more Items shall be included in this sequence.
>>>Include Table 10-2 “Content Item Macro Attributes Description” | Baseline TID 8001 “Specimen Preparation”
>Include Table 10-8 “Primary Anatomic Structure Macro Attributes” | Original anatomic location in patient of specimen. This location may be identical to that of the parent specimen, may be further refined by modifiers depending on the sampling procedure for this specimen, or may be a distinct concept.
>Specimen Localization Content Item Sequence | (0040,0620) | 1C | Sequence of Content Items identifying the location of the specimen in the container and/or in the image. See Section C.7.6.22.1.4. One or more Items shall be included in this sequence. Required if multiple specimens present in the image. May be present otherwise.
>>Include Table 10-2 “Content Item Macro Attributes Description” | Defined TID is TID 8004 “Specimen Localization”.

##### C.7.6.22.1 Specimen Module Attributes

###### C.7.6.22.1.1 Container Identifier and Specimen Identifier

"Specimen" is the role played by a discrete physical object (or a collection of objects that are considered as a unit) that is the subject of pathology examination.

A specimen is a physical object (or a collection of objects) when the laboratory considers it a single discrete, uniquely identified unit that is the subject of one or more steps in the laboratory (diagnostic) workflow. This includes objects at all levels of processing, including fresh tissue, dissected organs, tissue embedded in paraffin, sections made from embedded tissue, and liquid preparations.

Specimens are physically managed by being placed in or on a container. The concept of container includes buckets, cassettes, vials, and slides. While there is usually one specimen per container, it is possible, in some laboratory workflows, for multiple specimens to be in/on a container.

Both specimens and specimen containers have logical identifiers for workflow management. The logical identifier of a container is usually conveyed on a label on the container. The specimen itself will typically not be physically labeled with its identifier. For the usual case of a single specimen in/on a container, the logical identifiers may be identical. However, when there are multiple specimens in/on a container, each specimen receives a distinct logical identifier. These identifiers are encoded in the SOP Instance using attributes Container Identifier (0040,0512) and Specimen Identifier (0040,0551).

### Note

1. This definition of "specimen" extends the common definition beyond the part or parts that were submitted for examination (e.g., from surgery) to include any derivative piece that may be separately analyzed or examined, such as a block or slide preparation.

2. Although many Pathology Information Systems use a hierarchical system for identifying parts, blocks and slides, there should be no assumption made that this will be the case and in particular, there should be no attempt to parse a given Specimen Identifier to retrieve an accession number or other higher level identifier.

###### C.7.6.22.1.2 Specimen Identifier and Specimen UID

Specimen Identifier (0040,0551) must be unique at least within the Study; the actual scope of uniqueness is determined by the departmental information system that assigns the IDs. Each specimen shall also be assigned a globally unique Specimen UID (0040,0554) that allows referencing beyond the scope of a Study. This UID may be used, for instance, if a specimen is sent to another institution for further analysis.

###### C.7.6.22.1.3 Specimen Preparation Sequence and Specimen Preparation Step Content Item Sequence

Interpretation of specimen images requires information about the source of the specimen and its preparation (e.g., sampling, fixation, staining). The processing steps used to prepare a specimen are recorded in the Specimen Preparation Sequence (0040,0610). This sequence may include one Item for each processing step (as defined in the laboratory workflow) in the history of the specimen, and those Items are composed of a set of Content Items in the Specimen Preparation Step Content Item Sequence (0040,0612).

The Specimen Preparation Sequence may include description of the original part collected from the patient, the processing of that part, the sampling of tissue from the part and the preparation of that sample, and the further sub-sampling and processing of the tissue. In other words, the description of a specific specimen may include descriptions of the specimen's ancestors.

The Specimen Preparation Sequence Items shall be in ascending chronological order.

###### C.7.6.22.1.4 Specimen Localization Content Item Sequence

When there are multiple specimens in/on a container, the Specimen Localization Content Item Sequence (0040,0620) is used to identify the location of the specimen in the container, as there is no physical label with the Specimen Identifier. This Content Item Sequence, in accordance with TID 8004 “Specimen Localization”, allows the specimen to be localized by a distance in one to three dimensions from a reference point on the container, by an identified physical description such as a colored ink, or by its location as shown in a referenced image of the container. The referenced image may use an overlay, burned-in annotation, or an associated Presentation State SOP Instance to specify the location of the specimen.

#### C.7.6.23 Enhanced Palette Color Lookup Table Module

Table C.7.6.23-1 specifies the attributes that define data flow through the Enhanced Blending and Display Pipeline. See Section C.7.6.23.1 for an overview of the Enhanced Blending and Display Pipeline.

Table C.7.6.23-1. Enhanced Palette Color Lookup Table Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Data Frame Assignment Sequence | (0028,1401) | 1 | Sequence of items each assigning frames of one particular value of Data Type (0018,9808) to a data path in the Enhanced Blending and Display Pipeline. One, two, or three items shall be included in this sequence.
>Data Type | (0018,9808) | 1 | Identification of the data type of frames using this data path assignment.
>Data Path Assignment | (0028,1402) | 1 | The data path to use for this data type in the Enhanced Blending and Display Pipeline. Enumerated Values: PRIMARY_PVALUES PRIMARY_SINGLE SECONDARY_SINGLE SECONDARY_HIGH SECONDARY_LOW See Section C.7.6.23.2 for usage.
>Bits Mapped to Color Lookup Table | (0028,1403) | 3 | The number of most significant bits of each value of Pixel Data (7FE0,0010) from this frame contributing to the Palette Color Lookup Table input. If absent, Bits Stored (0028,0101) bits of each value of Pixel Data (7FE0,0010) from this frame contributes to the Palette Color Lookup Table input. See Section C.7.6.23.3 for usage.
>Include Table C.11-2b “VOI LUT Macro Attributes” |
Blending LUT 1 Sequence | (0028,1404) | 1C | Specification of the weight of the primary path input to the Blending Operation, i.e., the value that is referred to as "Weight 1" in the Enhanced Blending and Display Pipeline. Only a single item shall be included in this sequence. Required if there are one or more items of the Data Path Assignment Sequence (0028,1402) other than PRIMARY_PVALUES.
>Blending LUT 1 Transfer Function | (0028,1405) | 1 | Specifies the algorithm used to determine the output value of Blending LUT 1. Enumerated Values: CONSTANT ALPHA_1 ALPHA_2 TABLE See Section C.7.6.23.4 for details.
>Blending Weight Constant | (0028,1406) | 1C | Constant value of the Weight input to blending operation. Shall be from 0.0 to 1.0, inclusive. Required if Blending LUT 1 Transfer Function (0028,1405) is CONSTANT.
>Blending Lookup Table Descriptor | (0028,1407) | 1C | Specifies the format of Blending Lookup Table Data (0028,1408) in this sequence item. The second value (first stored pixel value mapped) shall be zero. See Section C.7.6.23.5 for further explanation. Required if Blending LUT 1 Transfer Function (0028,1405) is TABLE.
>Blending Lookup Table Data | (0028,1408) | 1C | Contains the Blending Lookup Table values for this Weight input to the Blending Operation. Required if Blending LUT 1 Transfer Function (0028,1405) is TABLE.
Blending LUT 2 Sequence | (0028,140C) | 1C | Specification of the weight of the secondary path input to the Blending Operation, i.e., the value that is referred to as "Weight 2" in the Enhanced Blending and Display Pipeline. Only a single item shall be included in this sequence. Required if there are one or more items of the Data Path Assignment Sequence (0028,1402) other than PRIMARY_PVALUES.
>Blending LUT 2 Transfer Function | (0028,140D) | 1 | Specifies the algorithm used to determine the output value of Blending LUT 2. Enumerated Values: CONSTANT ONE_MINUS ALPHA_1 ALPHA_2 TABLE See Section C.7.6.23.4 for details.
>Blending Weight Constant | (0028,1406) | 1C | Constant value of the Weight input to blending operation. Shall be from 0.0 to 1.0, inclusive. Required if Blending LUT 2 Transfer Function (0028,140D) is CONSTANT.
>Blending Lookup Table Descriptor | (0028,1407) | 1C | Specifies the format of Blending Lookup Table Data (0028,1408) in this sequence item. The second value (first stored pixel value mapped) shall be zero. See Section C.7.6.23.5 for further explanation. Required if Blending LUT 2 Transfer Function (0028,140D) is TABLE.
>Blending Lookup Table Data | (0028,1408) | 1C | Contains the Blending Lookup Table values for this Weight input to the Blending operation. Required if Blending LUT 2 Transfer Function (0028,140D) is TABLE.
Enhanced Palette Color Lookup Table Sequence | (0028,140B) | 1C | This sequence contains the Palette Color Lookup Table. One or two items shall be included in this sequence. Required if Data Path Assignment (0028,1402) is present with a value other than PRIMARY_PVALUES.
>Data Path ID | (0028,140E) | 1 | Identifier of the data path in which this Palette Color Lookup Table is used. Enumerated Values: PRIMARY SECONDARY Each item shall have a distinct value of Data Path ID.
>RGB LUT Transfer Function | (0028,140F) | 1 | Specifies the mapping that takes place between the input value and RGB input to the Blending Operation. Enumerated Values: EQUAL_RGB Output is R=G=B=input value TABLE Output is RGB LUT values
>Alpha LUT Transfer Function | (0028,1410) | 1 | Specifies the transformation that is used to create the Alpha input to the Blending LUTs. ### Note Depending on the values of Blending LUT 1 Transfer Function (0028,1405) and Blending LUT 2 Transfer Function (0028,140D) the Alpha LUT value may be ignored. It is recommended that IDENTITY be used if this is the case. Enumerated Values: NONE IDENTITY TABLE
>Red Palette Color Lookup Table Descriptor | (0028,1101) | 1C | Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Green Palette Color Lookup Table Descriptor | (0028,1102) | 1C | Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Blue Palette Color Lookup Table Descriptor | (0028,1103) | 1C | Specifies the format of the Blue Palette Color Lookup Table Data (0028,1203). The second value (first stored pixel value mapped) shall be zero. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Alpha Palette Color Lookup Table Descriptor | (0028,1104) | 1C | Specifies the format of the Alpha Palette Color Lookup Table Data. The second value (first stored pixel value mapped) shall be zero. Required if Alpha LUT Transfer Function (0028,1410) is TABLE.
>Red Palette Color Lookup Table Data | (0028,1201) | 1C | Red Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Green Palette Color Lookup Table Data | (0028,1202) | 1C | Green Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Blue Palette Color Lookup Table Data | (0028,1203) | 1C | Blue Palette Color Lookup Table Data. Required if RGB LUT Transfer Function (0028,140F) is TABLE.
>Alpha Palette Color Lookup Table Data | (0028,1204) | 1C | Alpha LUT contains the blending values for the data frames. Required if Alpha LUT Transfer Function (0028,1410) is TABLE.
ICC Profile | (0028,2000) | 1C | An ICC Profile encoding the transformation of device-dependent color stored pixel values into PCS-Values. See Section C.11.15.1.1 When present, defines the color space of the output of the Enhanced Blending and Display Pipeline. Required if Data Path Assignment (0028,1402) is present and there exists any value other than PRIMARY_PVALUES.

##### C.7.6.23.1 Description of the Enhanced Blending and Display Pipeline

The Enhanced Blending and Display Pipeline describes a scheme for blending of data frames of different Data Types and a color/grayscale mapping for display recommended by the provider of this information. There are no requirements upon an receiving application to utilize this recommendation in the processing and display of the referenced image.

The blending transformation model in Figure C.7.6.23-1 applies for mapping images derived from one, two, or three data frames with the same image position and orientation but of different values of Data Type (0018,9808) to grayscale P-Values or color PCS-values for presentation. These inputs to the pipeline are frames of pixel values obtained from Pixel Data (7FE0,0010) and structured as described by attributes of the Image Pixel Module. Co-located pixels from each data frame are processed through the Pipeline, resulting in one output sample at that location.

The model utilizes up to two data paths called the Primary and the Secondary data paths. Each input data frame may be initially processed by a Modality LUT and a VOI LUT. If not explicitly specified, the Modality LUT and VOI LUT are assumed to be identity transformations. The Primary path may be used alone to obtain only grayscale transformation without blending. In this case, the Primary data path input after going through the Modality LUT and VOI LUT is mapped through a Presentation LUT to obtain device independent grayscale values (P-Values) for presentation.

Either Primary or Secondary paths alone or both paths together may be used to obtain color transformation with blending. Up to one data frame input in the Primary data path and up to two data frames input in the Secondary data path are allowed for this blending transformation. These frames may be mapped to color using one-input or two-input palette color lookup tables depending on the number of data frames input to the data path. Alternatively if a path has one data frame, values may be converted to RGB (where R=G=B) before blending, if pseudo-color presentation of this data path is not desired. RGB values from Primary and Secondary data paths are combined via a "Blending Operation" in which the RGB color components are multiplied by a corresponding blending weight function (Weight 1 and Weight 2, respectively), and for each color component the two products are added together to produce the blended output value of that component. All inputs to the Blending Operation are normalized to the range 0.0 to 1.0, inclusive, even if they are fixed integer values that had been the entries in a lookup table.

Each of the Weight inputs to the blending operation is the output of a corresponding Blending LUT Transfer Function, which is selectable as either a constant or a derivation of the data frame values as described in Section C.7.6.23.4.

The RGB output from the Blending Operation is clamped to limit each color component (R, G, and B) to fall within the range 0.0 to 1.0, inclusive. The clamping function simply sets the value of any color component to 1.0 if the output from the Blending operation for that component exceeds 1.0. The RGB output of the clamping function is made available for use in rendering and slicing algorithms. Further, the output of the clamping function is transformed by the Profile Connection Space Transformation to device independent color values (PCS-values) for presentation.

If the input data frame values are representative of real world data, then they can be mapped to the real world values and units using the Real World Value Mapping Macro.

### Note

Annex QQ “Enhanced US Data Type Blending Examples (Informative)” in PS3.17 describes a number of examples of the Enhanced Blending and Display Pipeline with specific attribute values for each example that invoke particular data flows through the pipeline.

Figure C.7.6.23-1. Enhanced Blending and Display Pipeline

##### C.7.6.23.2 Data Path Assignment

Data Path Assignment (0028,1402) specifies the data path to use in the Enhanced Blending and Display Pipeline for each data frames of a particular data type.

Enumerated Values:

PRIMARY_PVALUES

  Data Frame values are passed through the Presentation LUT to produce grayscale P-Values; no blending is performed

PRIMARY_SINGLE

  Data Frame values are inputs to the Primary Palette Color Lookup Table

SECONDARY_SINGLE

  Data Frame values are inputs to the Secondary Palette Color Lookup Table

SECONDARY_HIGH

  Data Frame values having Data Path Assignment (0028,1402) of SECONDARY_HIGH are concatenated as the most significant bits with Data Frame values having Data Path Assignment of SECONDARY_LOW to form inputs to the Secondary Palette Color Lookup Table

SECONDARY_LOW

  Data Frame values having Data Path Assignment (0028,1402) of SECONDARY_LOW are concatenated as the least significant bits with Data Frame values having Data Path Assignment of SECONDARY_HIGH to form inputs to the Secondary Palette Color Lookup Table

##### C.7.6.23.3 Bits Mapped to Color Lookup Table

The number of entries of each Palette Color Lookup Table is specified in the Palette Color Lookup Table Descriptors of the lookup table components. As described in Section C.7.6.3.1.5, a maximum of 65,536 (216) data entries is permitted, which would require input values of 16 bits to access all Palette Color Lookup Table entries. For tables with less than the maximum number of Palette Color Lookup Table entries, correspondingly smaller input values are required.

In the Enhanced Blending and Display Pipeline, the Palette Color Lookup Table input values are obtained from one or two data frames, depending on the values of the Data Path Assignment (0028,1402) attributes; for Data Path Assignment (0028,1402) = PRIMARY_SINGLE or SECONDARY_SINGLE, the input values are obtained from stored pixel values of a single data frame (after processing through the Modality LUT and/or VOI LUT), while for Data Path Assignment (0028,1402)= SECONDARY_HIGH and SECONDARY_LOW, the input values are constructed from stored pixel values of two data frames (after processing through Modality LUTs and/or VOI LUTs) as described below.

The number of bits in each data frame stored pixel value is specified by the value of Bits Stored (0028,0101). It is possible that the number of bits in the PRIMARY_SINGLE or SECONDARY_SINGLE data frame or the sum of the numbers of bits in the SECONDARY_HIGH and SECONDARY_LOW data frames is greater than the number of bits needed to address all Palette Color Lookup Table entries. The values of Bits Mapped to Color Lookup Table (0028,1403) specify the number of bits from the corresponding data frame stored pixel values that contribute to the Palette Color Lookup Table input values, as follows:

If Data Path Assignment is PRIMARY_SINGLE or SECONDARY_SINGLE, the input to the Palette Color Lookup Table is the number of most significant bits specified by Bits Mapped to Color Lookup Table (0028,1403) from the data frame stored pixel values. For Data Path Assignment SECONDARY_HIGH or SECONDARY_LOW, the number of most significant bits specified by Bits Mapped to Color Lookup Table (0028,1403) from each data frame's stored pixel values are concatenated to create the Palette Color Lookup Table input values, with the SECONDARY_HIGH frame's bits comprising the most significant part of the input value and the SECONDARY_LOW frame's bits comprising the least significant part of the input value.

If the resulting Palette Color Lookup Table input value is greater than the number of Palette Color Lookup Table entries as specified by the Palette Color Lookup Table Descriptor first value, then the output from the Palette Color Lookup Table shall be the last value in the Palette Color Lookup Table. However, it is recommended that the values of Bits Mapped To Color Lookup Table (0028,1403) and number of Palette Color Lookup Table entries be selected such that all input values are mapped to distinct entries in the Palette Color Lookup Table.

##### C.7.6.23.4 Blending LUT Transfer Function

The value of Blending LUT 1 Transfer Function (0028,1405) and Blending LUT 2 Transfer Function (0028,140D) specify the algorithm used to determine the output values of the Blending LUT 1 and Blending LUT 2, respectively.

Enumerated Values:

CONSTANT

  A constant floating point value from 0.0 to 1.0, inclusive

ALPHA_1

  Pass-through the Alpha 1 input value from the Alpha Palette Color Lookup Table of the Primary data path

ALPHA_2

  Pass-through the Alpha 2 input value from the Alpha Palette Color Lookup Table of the Secondary data path

TABLE

  The output of a Table defining a function of the Alphas from both data paths

ONE_MINUS

  The Blending LUT 2 value is (1 - Blending LUT 1 output); used for Blending LUT 2 Transfer Function (0028,140D) only

If the value is TABLE:

- The Alpha 1 input value from the Alpha Palette Color Lookup Table of the Primary data path and the Alpha 2 input value from the Alpha Palette Color Lookup Table of the Secondary data are concatenated to form an index into a Lookup Table, with the Alpha 1 value providing the most significant bits of the index and the Alpha 2 value providing the least significant bits of the index.

- If the index is too large for the number of entries in the Lookup Table, the last value of the Lookup Table is used for any index value greater than the number of Lookup Table entries. If the index is too small for the number of entries in the Lookup Table, than not all entries in the Lookup Table are accessed. The total number of bits in the index value shall be equal to or less than 16.

##### C.7.6.23.5 Blending LUT Descriptor

The three values of the Blending Lookup Table Descriptor (0028,1407) describe the format of the data in Blending Lookup Table Data (0028,1408).

The first value is the number of entries in the lookup table. When the number of table entries is equal to 65,536 (216), then this value shall be 0. The number of entries shall be equal to the number of possible values in the input.

### Note

For example, for 8 bit input to the Blending LUT the tables must have 256 entries, while for 16 bit input to the Blending LUT the tables must have 65,536 entries.

The second value is the first input value mapped, and shall always be 0 for an Blending LUT. This input value is mapped to the first entry in the LUT. Subsequent input values are mapped to the subsequent entries in the LUT Data up to an input value equal to number of entries + first value mapped - 1 that is mapped to the last entry in the LUT Data. There are no input values greater than number of entries - 1.

The third value specifies the number of bits for each entry in the LUT Data. This value shall be between 8 and 16, inclusive. The LUT Data shall be stored in a format equivalent to 16 bits allocated where the high bit is equal to bits stored - 1, where bits stored is the third value.

##### C.7.6.23.6 Lossy Compression and Palette Color Lookup Tables (Informative)

Image objects containing non-monotonic Palette Color LUTs that are lossy compressed may potentially experience a change in the index values that results in the displayed image having a significantly different appearance than the original image.

### C.7.7 Patient Summary Module

Retired. See PS3.3-2004.

### C.7.8 Study Content Module

Retired. See PS3.3-2004.

### C.7.9 Palette Color Lookup Table Module

Table C.7-22 specifies the Attributes that describe the Lookup table data for images with Palette Color photometric interpretation.

When the Palette Color Lookup Table Module is present in an Image IOD, the conditional requirements for the use of Palette Color Lookup Table Data (0028,1201-1203) and Segmented Palette Color Lookup Table Data (0028,1221-1223), described in Table C.7-22, shall take precedence over the conditional requirements described in the Image Pixel Module (see Section C.7.6.3). When the Palette Color Lookup Table Module is present in a Presentation State IOD or Color Palette IOD, the Palette Color Lookup Table Data (0028,1201-1203) attributes are mandatory and the Segmented Palette Color Lookup Table Data (0028,1221-1223) shall not be present.

When the Palette Color Lookup Table Module is present in a Color Palette IOD, the 3rd value of Palette Color Lookup Table Descriptor (0028,1101-1103) (i.e, the number of bits for each entry in the Lookup Table Data) shall be 8.

Table C.7-22. Palette Color Lookup Table Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Include Table C.7-22a “Palette Color Lookup Table Macro Attributes” |

Table C.7-22a. Palette Color Lookup Table Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Red Palette Color Lookup Table Descriptor | (0028,1101) | 1 | Specifies the format of the Red Palette Color Lookup Table Data (0028,1201). See Section C.7.6.3.1.5 for further explanation.
Green Palette Color Lookup Table Descriptor | (0028,1102) | 1 | Specifies the format of the Green Palette Color Lookup Table Data (0028,1202). See Section C.7.6.3.1.5 for further explanation.
Blue Palette Color Lookup Table Descriptor | (0028,1103) | 1 | Specifies the format of the Blue Palette Color Lookup table Data (0028,1203). See Section C.7.6.3.1.5 for further explanation.
Palette Color Lookup Table UID | (0028,1199) | 3 | Palette Color Lookup Table UID. See Section C.7.9.1 for further explanation.
Red Palette Color Lookup Table Data | (0028,1201) | 1C | Red Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See Section C.7.6.3.1.6 for further explanation.
Green Palette Color Lookup Table Data | (0028,1202) | 1C | Green Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See Section C.7.6.3.1.6 for further explanation.
Blue Palette Color Lookup Table Data | (0028,1203) | 1C | Blue Palette Color Lookup Table Data. Required if segmented data is NOT used in an Image IOD, or if the IOD is a Presentation State IOD or Color Palette IOD. See Section C.7.6.3.1.6 for further explanation.
Segmented Red Palette Color Lookup Table Data | (0028,1221) | 1C | Segmented Red Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD or Color Palette IOD. See Section C.7.9.2 for further explanation.
Segmented Green Palette Color Lookup Table Data | (0028,1222) | 1C | Segmented Green Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD. or Color Palette IOD See Section C.7.9.2 for further explanation.
Segmented Blue Palette Color Lookup Table Data | (0028,1223) | 1C | Segmented Blue Palette Color Lookup Table Data. Required if segmented data is used in an Image IOD; shall not be present in a Presentation State IOD or Color Palette IOD. See Section C.7.9.2 for further explanation.

#### C.7.9.1 Palette Color Lookup Table UID

This data element uniquely identifies a palette color lookup table set (red, green, blue).

### Note

This can be used to avoid reloading a palette if a system already has that palette loaded without examining all the data entries in the palette.

If this Attribute is present in a Color Palette IOD, it shall have the same value as the SOP Instance UID.

#### C.7.9.2 Segmented Palette Color Lookup Table Data

The Segmented Palette Color Lookup Table Data (0028,1221-1223) is stored as a series of segments, see Table C.7-23. When the segments are expanded into the actual lookup table data, it shall have the number of table entries specified by the first value of the Palette Color Lookup Table Descriptors (0028,1101-1103), Number of Table Entries.

These lookup tables shall be used only when segmented lookup table data use is desirable and there is a single sample per pixel (single image plane) in the image.

Table C.7-23. Compressed Palette Color Lookup Table Data

Segment 0
Segment 1
…
Segment n

There are currently three types of segments: discrete, linear, and indirect. The segments type is identified by the opcodes in Table C.7-24.

Table C.7-24. Segment Types

Opcode | Segment type
--- | ---
0 | Discrete
1 | Linear
2 | Indirect
3 & above | reserved

##### C.7.9.2.1 Discrete Segment Type

The discrete segment is used to represent a series of palette components that are not monotonic with respect to their predecessors or successors. The Segment Length indicates the number of lookup table entries.

The format of the Discrete Segment Type shall be as in Table C.7-25.

Table C.7-25. Discrete Segment Type

Segment Opcode = 0
Segment Length
Segment Length number of lookup table entries

##### C.7.9.2.2 Linear Segment Type

The linear segment represents a series of palette components whose values may be represented by a straight line.

X = palette address, Y = Value contained in the palette.

(Xo, Yo) = end of the previous segment

(Xo+ Segment Length, Y1) = end of this linear segment

Where: Y1 is contained in the data portion of this segment.

During expansion, the application should "connect" the previous segment's endpoint, (Xo, Yo), with this segment's endpoint, (Xo+ Segment Length, Y1) using a straight line, by computing the values for each point between the endpoints.

### Note

Because the linear segment uses the end point from the previous segment, a linear segment can not be the first segment.

The linear segment's format shall be as in Table C.7-26.

Table C.7-26. Linear Segment Type

Segment Opcode = 1
Segment Length
Y1

##### C.7.9.2.3 Indirect Segment Type

The indirect segment allows the re-use of repetitive regions within lookup table without respecifying the segment. The opcode is followed by the number of segments to copy and one offset pointer to the first segment to copy. The byte offset is relative to the beginning of the lookup table. For example, if an indirect segment wants to point to the first segment, then the offset will be zero. The offset is a 32 bit value but is stored in the segment as a least significant 16 bit value followed by a most significant 16 bit value. An indirect segment shall not point to or copy another indirect segment. This avoids the need for recursion and also avoids the possibility of infinite loops.

The indirect segment's format shall be as follows:

Table C.7-27. Indirect Segment Type

Segment Opcode = 2
Number of segments to copy
Least significant 16 bits of byte offset to first segment to copy
Most significant 16 bits of byte offset to first segment to copy

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