A.47 Enhanced X-Ray Angiographic Image IOD
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## A.47 Enhanced X-Ray Angiographic Image IOD

### A.47.1 Enhanced XA Image IOD Description

This Section defines the enhanced Information Object for single plane X-Ray Angiographic Imaging that includes those data elements and information objects necessary for the interchange of digital X-Ray Angiographic data. This includes images of the heart and all blood vessels.

The enhanced XA IOD is also applicable to clinical areas other than angiography (e.g., Interventional Procedures, Myelography, Biopsy/Localization, and Neurology).

### Note

1. For the purpose of X-Ray Angiography (XA), this enhanced IOD can be used to encode a single frame image, or a Cine Run, or a single multi-frame image with non-time related dimensions.

2. A typical study might include all the images generated between the time a patient gets on and gets off the procedure table. As several separable diagnostic or therapeutic processes may occur during a single study (e.g., pre-intervention CA, left ventriculography, and post-intervention CA), a series may be defined as comprising a set of images (single or multi-frame) associated with one such process within a study.

3. This enhanced IOD can be used to encode a single plane acquisition, or one plane of a biplane acquisition.

### A.47.2 Enhanced XA Image IOD Entity-Relationship Model

The E-R Model in Section A.1.2 depicts those components of the DICOM Application Information Model that directly reference the enhanced X-Ray Angiographic Image IOD. Additionally, "Image" in Figure A.1-1 may represent a single frame or a multi-frame image. A frame denotes a two-dimensional organization of pixels recorded as a single exposure.

### A.47.3 Enhanced XA Image IOD Module Table

Table A.47-1. Enhanced X-Ray Angiographic Image IOD Modules

IE | Module | Reference | Usage
--- | --- | --- | ---
Patient | Patient | C.7.1.1 | M
Clinical Trial Subject | C.7.1.3 | U
Study | General Study | C.7.2.1 | M
Patient Study | C.7.2.2 | U
Clinical Trial Study | C.7.2.3 | U
Series | General Series | C.7.3.1 | M
XA/XRF Series | C.8.19.1 | M
Clinical Trial Series | C.7.3.2 | U
Frame of Reference | Frame of Reference | C.7.4.1 | C - Required if C-arm Positioner Tabletop Relationship (0018,9474) equals YES. May be present otherwise.
Synchronization | C.7.4.2 | C - Required if C-arm Positioner Tabletop Relationship (0018,9474) equals YES. May be present otherwise.
Equipment | General Equipment | C.7.5.1 | M
Enhanced General Equipment | C.7.5.2 | M
Image | Image Pixel | C.7.6.3 | M
Enhanced Contrast/Bolus | C.7.6.4b | C - Required if contrast media was applied and the system is able to register contrast usage.
Mask | C.7.6.10 | U
Device | C.7.6.12 | U
Intervention | C.7.6.13 | U
Acquisition Context | C.7.6.14 | M
Multi-frame Functional Groups | C.7.6.16 | M
Multi-frame Dimension Module | C.7.6.17 | U
Cardiac Synchronization | C.7.6.18.1 | C - Required if cardiac synchronization was applied.
Respiratory Synchronization | C.7.6.18.2 | C - Required if respiratory synchronization was applied.
Specimen | C.7.6.22 | U
X-Ray Filtration | C.8.7.10 | U
X-Ray Grid | C.8.7.11 | U
Enhanced XA/XRF Image | C.8.19.2 | M
XA/XRF Acquisition | C.8.19.3 | C - Required if Image Type (0008,0008) Value 1 equals ORIGINAL. May be present otherwise.
X-Ray Image Intensifier | C.8.19.4 | C - Required if X-Ray Receptor Type (0018,9420) is present and equals IMG_INTENSIFIER.
X-Ray Detector | C.8.19.5 | C - Required if X-Ray Receptor Type (0018,9420) is present and equals DIGITAL_DETECTOR.
XA/XRF Multi-frame Presentation | C.8.19.7 | U
SOP Common | C.12.1 | M
Common Instance Reference | C.12.2 | U
Frame Extraction | C.12.3 | C - Required if the SOP Instance was created in response to a Frame-Level retrieve request

#### A.47.3.1 Enhanced XA Image IOD Content Constraints

##### A.47.3.1.1 Modality Type Attribute

The Modality Type attribute (0008,0060) shall have the value XA.

##### A.47.3.1.2 Overlay Plane, Curve, VOI LUT and Specimen Identification Modules

The Overlay Plane Module, VOI LUT Module and Softcopy Presentation LUT Module shall not be used in a Standard Extended SOP Class of the Enhanced XA Image.

### Note

1. The VOI LUT function is provided by a Frame VOI LUT Functional Group.

2. The Curve Module was previously include in the list of Modules that shall not be present, but has been retired from DICOM. It is still not permitted to be present. See PS3.3-2004.

3. The Specimen Identification Module was previously included in this IOD but has been retired, and its functionality replaced by the Specimen Module. See PS3.3-2008.

##### A.47.3.1.3 Positioner Type

Positioner Type (0018,1508) shall have the value CARM if the XA/XRF Acquisition Module is present.

### A.47.4 Enhanced XA Image Functional Group Macros

Table A.47-2 specifies the use of the Functional Group Macros used in the Multi-frame Functional Groups Module for the Enhanced XA Image IOD.

Table A.47-2. Enhanced XA Image Functional Group Macros

Functional Group Macro | Section | Usage
--- | --- | ---
Frame Content | C.7.6.16.2.2 | M - May not be used as a Shared Functional Group.
Referenced Image | C.7.6.16.2.5 | U
Derivation Image | C.7.6.16.2.6 | C - Required if the image or frame has been derived from another SOP Instance.
Cardiac Synchronization | C.7.6.16.2.7 | U
Frame Anatomy | C.7.6.16.2.8 | M
Frame VOI LUT | C.7.6.16.2.10 | M
Contrast/Bolus Usage | C.7.6.16.2.12 | C - Required if the Enhanced Contrast/Bolus Module is present
Pixel Intensity Relationship LUT | C.7.6.16.2.13 | C - Required if Pixel Intensity Relationship (0028,1040) equals LOG. May be present otherwise.
Frame Pixel Shift | C.7.6.16.2.14 | U
Patient Orientation in Frame | C.7.6.16.2.15 | C - Required if C-arm Positioner Tabletop Relationship (0018,9474) is present and equals YES. May be present otherwise.
Frame Display Shutter | C.7.6.16.2.16 | U
Respiratory Synchronization | C.7.6.16.2.17 | U
Irradiation Event Identification | C.7.6.16.2.18 | M
X-Ray Frame Characteristics | C.8.19.6.1 | U
X-Ray Field of View | C.8.19.6.2 | C - Required if Isocenter Reference System Sequence (0018,9462) is present. May be present otherwise.
X-Ray Exposure Control Sensing Regions | C.8.19.6.3 | U
X-Ray Frame Pixel Data Properties | C.8.19.6.4 | M
X-Ray Frame Detector Parameters | C.8.19.6.5 | C - Required if X-Ray Receptor Type (0018,9420) is present and equals DIGITAL_DETECTOR.
X-Ray Calibration Device Usage | C.8.19.6.6 | U
X-Ray Object Thickness | C.8.19.6.7 | U
X-Ray Frame Acquisition | C.8.19.6.8 | U
X-Ray Projection Pixel Calibration | C.8.19.6.9 | C - Required if C-arm Positioner Tabletop Relationship (0018,9474) is present and equals YES.
X-Ray Positioner | C.8.19.6.10 | C - Required if Image Type (0008,0008) Value 1 equals ORIGINAL and C-arm Positioner Tabletop Relationship (0018,9474) is present and equals YES. May be present otherwise.
X-Ray Table Position | C.8.19.6.11 | C - Required if Image Type (0008,0008) Value 1 equals ORIGINAL and C-arm Positioner Tabletop Relationship (0018,9474) is present and equals YES. May be present otherwise.
X-Ray Collimator | C.8.19.6.12 | C - Required if Image Type (0008,0008) Value 1 equals ORIGINAL. May be present otherwise.
X-Ray Isocenter Reference System | C.8.19.6.13 | U - May not be used if C-arm Positioner Tabletop Relationship (0018,9474) is not present or equals NO.
X-Ray Geometry | C.8.19.6.14 | C - Required if Projection Pixel Calibration Sequence (0018,9401) is present. May be present otherwise.

#### A.47.4.1 Enhanced XA Image Functional Group Macros Content Constraints

##### A.47.4.1.1 Frame Anatomy Functional Group Macro

The Defined CID for the Anatomic Region Sequence (0008,2218) shall be CID 4042 “XA/XRF Anatomy Imaged”.

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