C.4 Study Modules
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## C.4 Study Modules

The following Sections specify Modules relevant to a Real World diagnostic imaging study performed on a patient.

### C.4.1 Study Relationship Module

Retired. See PS3.3-2004.

### C.4.2 Study Identification Module

Retired. See PS3.3-2004.

### C.4.3 Study Classification Module

Retired. See PS3.3-2004.

### C.4.4 Study Scheduling Module

Retired. See PS3.3-2004.

### C.4.5 Study Acquisition Module

Retired. See PS3.3-2004.

### C.4.6 Study Read Module

Retired. See PS3.3-2004.

### C.4.7 Study Component Module

Retired. See PS3.3-2004.

### C.4.8 Study Component Relationship Module

Retired. See PS3.3-2004.

### C.4.9 Study Component Acquisition Module

Retired. See PS3.3-2004.

### C.4.10 Scheduled Procedure Step Module

Table C.4-10. Scheduled Procedure Step Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Scheduled Procedure Step Sequence | (0040,0100) | One or more Scheduled Procedure Steps for one Requested Procedure.
>Scheduled Station AE Title | (0040,0001) | The AE title of the modality on which the Scheduled Procedure Step is scheduled to be performed.
>Scheduled Station Name | (0040,0010) | An institution defined name for the modality on which the Scheduled Procedure Step is scheduled to be performed.
>Scheduled Procedure Step Location | (0040,0011) | The location at which the Procedure Step is scheduled to be performed.
>Scheduled Procedure Step Start Date | (0040,0002) | Date on which the Scheduled Procedure Step is scheduled to start.
>Scheduled Procedure Step Start Time | (0040,0003) | Time at which the Scheduled Procedure Step is scheduled to start.
>Scheduled Procedure Step End Date | (0040,0004) | Date on which the Scheduled Procedure Step is scheduled to end.
>Scheduled Procedure Step End Time | (0040,0005) | Time at which the Scheduled Procedure Step is scheduled to end.
>Scheduled Performing Physician's Name | (0040,0006) | Name of the physician scheduled to administer the Scheduled Procedure Step.
>Scheduled Performing Physician Identification Sequence | (0040,000B) | Identification of the physician scheduled to administer the Scheduled Procedure Step. Only a single item shall be included in this sequence.
>>Include Table 10-1 “Person Identification Macro Attributes Description” |
>Scheduled Procedure Step Description | (0040,0007) | Institution-generated description or classification of the Scheduled Procedure Step to be performed. ### Note The purpose of this attribute is to store a description or classification that is used at a local level (e.g., a hospital or a managed care network), and this description need not comply to an accepted standard.
>Scheduled Protocol Code Sequence | (0040,0008) | Sequence describing the Scheduled Protocol following a specified coding scheme. One or more Items shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>>Protocol Context Sequence | (0040,0440) | Sequence that specifies the context for the Scheduled Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.
>>>Content Item Modifier Sequence | (0040,0441) | Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.
>Scheduled Procedure Step ID | (0040,0009) | Identifier that identifies the Scheduled Procedure Step.
>Scheduled Procedure Step Status | (0040,0020) | A Real World condition that may affect the selection of of the Scheduled Procedure Step. Defined Terms: SCHEDULED Procedure Step scheduled ARRIVED patient is available for the Scheduled Procedure Step READY all patient and other necessary preparation for this step has been completed STARTED at least one Performed Procedure Step has been created that references this Scheduled Procedure Step DEPARTED patient is no longer available for the Scheduled Procedure Step
>Comments on the Scheduled Procedure Step | (0040,0400) | User-defined comments on the Scheduled Procedure Step. ### Note The Comments attribute is intended to transmit non-structured information, which can be displayed to the operator of the Modality.
>Modality | (0008,0060) | Source equipment for the image. See Section C.7.3.1.1.1 for Defined Terms.
>Requested Contrast Agent | (0032,1070) | Contrast agent requested for use in the Scheduled Procedure Step.
>Pre-Medication | (0040,0012) | Medication to be administered at the beginning of the Scheduled Procedure Step, e.g., Nuclear Medicine radiopharmaceutical.
>Anatomical Orientation Type | (0010,2210) | The anatomical orientation type appropriate for this patient. Enumerated Values: BIPED QUADRUPED
Scheduled Specimen Sequence | (0040,0500) | Sequence of Items identifying specimens to be imaged in the identified Scheduled Procedure Step(s), with their characteristics.
>Include Table C.7.6.22-2 “Specimen Macro Attributes” |

#### C.4.10.1 Protocol Context Sequence

The Protocol Context Sequence (0040,0440) allows the specification of parameters that further qualify the scheduled protocol, provided through a set of generic name/value pairs of context Content Items.

### Note

This allows the specification of clinical, acquisition, or procedural qualifiers for the scheduled protocol, such as a specific body part, imaging technique, or parameters of a preparatory event (e.g., radionuclide injection). Specific uses of this Sequence may be documented in a Template defined in accordance with PS3.16.

### C.4.11 Requested Procedure Module

Table C.4-11. Requested Procedure Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Requested Procedure ID | (0040,1001) | Identifier that identifies the Requested Procedure in the Imaging Service Request.
Reason for the Requested Procedure | (0040,1002) | Reason for requesting this imaging procedure.
Requested Procedure Comments | (0040,1400) | User-defined comments on the Requested Procedure.
Reason for Requested Procedure Code Sequence | (0040,100A) | Coded Reason for requesting this procedure. One or more Items shall be included in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Requested Procedure Code Sequence | (0032,1064) | A sequence that conveys the Requested Procedure of one Procedure Type.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Study Instance UID | (0020,000D) | Unique identifier to be used to identify the Study
Study Date | (0008,0020) | Date the Study started, if any previous procedure steps within the same study have already been performed.
Study Time | (0008,0030) | Time the Study started, if any previous procedure steps within the same study have already been performed.
Referenced Study Sequence | (0008,1110) | Uniquely identifies the Study SOP Instances associated with this SOP Instance. One or more Items shall be included in this sequence. See Section 10.6.1.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
Requested Procedure Description | (0032,1060) | Institution-generated administrative description or classification of Requested Procedure
Requested Procedure Priority | (0040,1003) | Requested Procedure Type Urgency. Defined Terms: STAT HIGH ROUTINE MEDIUM LOW
Patient Transport Arrangements | (0040,1004) | Mode of transportation of the patient to the location of examination.
Requested Procedure Location | (0040,1005) | Physical location at which the Requested Procedure is to be performed.
Confidentiality Code | (0040,1008) | Confidentiality Constraints on the Requested Procedure by the party filling the order.
Reporting Priority | (0040,1009) | Requested Reporting Priority. Defined Terms: HIGH ROUTINE MEDIUM LOW
Names of Intended Recipients of Results | (0040,1010) | Names of the physicians, who are intended recipients of results.
Intended Recipients of Results Identification Sequence | (0040,1011) | Identification of the physicians who are intended recipients of results. One or more items shall be included in this sequence. If more than one Item, the number and order shall correspond to the value of Names of Intended Recipients of Results (0040,1010), if present.
>>Include Table 10-1 “Person Identification Macro Attributes Description” |

### Note

Attributes (0040,1006) Placer Order Number/Procedure and (0040,1007) Filler Order Number/Procedure were previously defined in DICOM. They are now retired (see PS3.3-1998).

### C.4.12 Imaging Service Request Module

Table C.4-12. Imaging Service Request Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Imaging Service Request Comments | (0040,2400) | User-defined comments on the Imaging Service Request. ### Note The Comments attribute is intended to transmit non-structured information, which can be displayed to the operator of the equipment (e.g., Modality).
Requesting Physician | (0032,1032) | Name of the physician who requested the Imaging Service Request.
Requesting Physician Identification Sequence | (0032,1031) | Identification of the physician who requested the Imaging Service Request. Only a single item shall be included in this sequence.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Referring Physician's Name | (0008,0090) | Name of the patient's referring physician for this Imaging Service Request.
Referring Physician Identification Sequence | (0008,0096) | Identification of the patient's referring physician. Only a single item shall be included in this sequence.
>Include Table 10-1 “Person Identification Macro Attributes Description” |
Requesting Service | (0032,1033) | Institutional department where the request initiated.
Requesting Service Code Sequence | (0032,1034) | Institutional department where the request initiated. Equivalent to HL7 v2.x ORC-17. Only a single item shall be included in this sequence. See Note 3.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 7030 “Institutional Departments, Units and Services”.
Accession Number | (0008,0050) | A departmental IS generated number that identifies the order for the Imaging Service Request.
Issuer of Accession Number Sequence | (0008,0051) | Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Issue Date of Imaging Service Request | (0040,2004) | Date on which the Imaging Service Request was issued by the requester.
Issue Time of Imaging Service Request | (0040,2005) | Time at which the Imaging Service Request was issued by the requester.
Placer Order Number / Imaging Service Request | (0040,2016) | The order number assigned to the Imaging Service Request by the party placing the order.
Order Placer Identifier Sequence | (0040,0026) | Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Filler Order Number / Imaging Service Request | (0040,2017) | The order number assigned to the Imaging Service Request by the party filling the order.
Order Filler Identifier Sequence | (0040,0027) | Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Order entered by … | (0040,2008) | The person who entered the Imaging Service Request into an Information System.
Order Enterer's Location | (0040,2009) | The location at which the Imaging Service Request was entered.
Order Callback Phone Number | (0040,2010) | Telephone Number at which additional information can be retrieved.
Admission ID | (0038,0010) | Identification number of the visit as assigned by the healthcare provider
Issuer of Admission ID Sequence | (0038,0014) | Identifier of the Assigning Authority that issued the Admission ID. Only a single Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |

### Note

1. Attributes (0040,2016) and (0040,2017) Placer Order Number and Filler Order Number/Imaging Service Request are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.

2. Attributes (0040,2001), (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (see PS3.3-1998).

3. Both the attribute Requesting Service (0032,1033) and Requesting Service Code Sequence (0032,1034) are defined in this table; the latter has been added and is preferred, but the former is not retired since in some uses it may be copied from an HL7 message without the ability to map it to a coded form (e.g., with only ORC-17 component 1 valued).

### C.4.13 Performed Procedure Step Relationship

Table C.4-13 specifies the Attributes used to reference other SOP Classes and other Information Entities of the DICOM real-world model as defined in Section 7.3.1.6.

Table C.4-13. Performed Procedure Step Relationship Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Patient's Name | (0010,0010) | Patient's full legal name.
Patient ID | (0010,0020) | 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) | Date of birth of the named patient
Patient's Sex | (0010,0040) | Sex of the named Patient Enumerated Values: M male F female O other
Referenced Patient Sequence | (0008,1120) | Uniquely identifies the Patient SOP Instance. Only a single Item shall be included in this sequence.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
Service Episode ID | (0038,0060) | Identifier of the Service Episode as assigned by the healthcare provider
Issuer of Service Episode ID Sequence | (0038,0064) | Identifier of the Assigning Authority that issued the Service Episode ID. Only a single Item shall be included in this sequence.
>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
Service Episode Description | (0038,0062) | Description of the type of service episode.
Scheduled Step Attributes Sequence | (0040,0270) | Sequence containing attributes that are related to the scheduling of the Procedure Step. One or more Items shall be included in this sequence.
>Study Instance UID | (0020,000D) | Unique identifier for the Study.
>Referenced Study Sequence | (0008,1110) | Uniquely identifies the Study SOP Instance associated with this Scheduled Procedure Step. Only a single Item shall be included in this sequence. See Section 10.6.1.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
>Accession Number | (0008,0050) | A departmental IS generated number that identifies the order for the Study.
>Issuer of Accession Number Sequence | (0008,0051) | Identifier of the Assigning Authority that issued the Accession Number. Only a single Item shall be included in this sequence.
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
>Placer Order Number/Imaging Service Request | (0040,2016) | The order number assigned to the Imaging Service Request by the party placing the order.
>Order Placer Identifier Sequence | (0040,0026) | Identifier of the Assigning Authority that issued the Placer Order Number. Only a single Item shall be included in this sequence.
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
>Filler Order Number/Imaging Service Request | (0040,2017) | The order number assigned to the Imaging Service Request by the party filling the order.
>Order Filler Identifier Sequence | (0040,0027) | Identifier of the Assigning Authority that issued the Filler Order Number. Only a single Item shall be included in this sequence.
>>Include Table 10-17 “HL7v2 Hierarchic Designator Macro Attributes” |
>Requested Procedure ID | (0040,1001) | Identifier of the related Requested Procedure.
>Requested Procedure Description | (0032,1060) | Institution-generated administrative description or classification of Requested Procedure.
>Requested Procedure Code Sequence | (0032,1064) | A sequence that conveys the Procedure Type of the requested procedure. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>Scheduled Procedure Step ID | (0040,0009) | Identifier of the related Scheduled Procedure Step.
>Scheduled Procedure Step Description | (0040,0007) | Institution-generated description or classification of the Scheduled Procedure Step to be performed.
>Scheduled Protocol Code Sequence | (0040,0008) | Sequence describing the Scheduled Protocol following a specific coding scheme. One or more Items shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>>Protocol Context Sequence | (0040,0440) | Sequence that specifies the context for the Scheduled Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.
>>>Content Item Modifier Sequence | (0040,0441) | Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.

### Note

1. The patient information is included in order to relate the Modality Performed Procedure Step SOP Instance to the Study Management SOP Instance and other associated IODs in case the SCU (the modality) is unable to obtain or use the Study Instance UID created by the Information System.2. Attributes (0040,2016) and (0040,2017) Placer Order Number and Filler Order Number/Imaging Service Request are intended to convey the corresponding order numbers as defined in HL7, in the case where interoperability with an HL7 environment is the objective.

2. Attributes (0040,2006) and (0040,2007) were previously defined in DICOM. They are now retired (see PS3.3-1998).

3. Attributes (0040,1006) Placer Order Number/Procedure and (0040,1007) Filler Order Number/Procedure were previously defined in DICOM. They are now retired (see PS3.3-1998).

### C.4.14 Performed Procedure Step Information

Table C.4-14 defines the general attributes that may be used by all specific Procedure Steps.

Table C.4-14. Performed Procedure Step Information Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Performed Station AE Title | (0040,0241) | AE title of the modality on which the Performed Procedure Step was performed.
Performed Station Name | (0040,0242) | An institution defined name for the modality on which the Performed Procedure Step was performed.
Performed Location | (0040,0243) | Description of the location at which the Performed Procedure Step was performed.
Performed Procedure Step Start Date | (0040,0244) | Date on which the Performed Procedure Step started. ### Note This value may be used to determine the earliest date to use as Study Date (0008,0020) in composite instances and in updated Modality Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step Start Time | (0040,0245) | Time at which the Performed Procedure Step started. ### Note This value may be used to determine the earliest time to use as Study Time (0008,0030) in composite instances and in updated Modality Scheduled Procedure Steps in order to allow Study level attributes to have consistent values if additional Procedure Steps are performed.
Performed Procedure Step ID | (0040,0253) | User or equipment generated identifier of that part of a Procedure that has been carried out within this step.
Performed Procedure Step End Date | (0040,0250) | Date on which the Performed Procedure Step ended.
Performed Procedure Step End Time | (0040,0251) | Time at which the Performed Procedure Step ended.
Performed Procedure Step Status | (0040,0252) | Contains the state of the Performed Procedure Step. Enumerated Values: IN PROGRESS Started but not complete DISCONTINUED Canceled or unsuccessfully terminated COMPLETED Successfully completed
Performed Procedure Step Description | (0040,0254) | Institution-generated description or classification of the Procedure Step that was performed.
Comments on the Performed Procedure Step | (0040,0280) | User-defined comments on the Performed Procedure Step.
Performed Procedure Type Description | (0040,0255) | A description of the type of procedure performed.
Procedure Code Sequence | (0008,1032) | A sequence that conveys the (single) type of procedure performed. Only a single Item shall be included 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) | 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 shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Performed Procedure Step Discontinuation Reason Code Sequence | (0040,0281) | The reason the Performed Procedure Step Status (0040,0252) was set to DISCONTINUED.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 9300 “Procedure Discontinuation Reasons”.

### C.4.15 Image Acquisition Results Module

Table C.4-15 specifies attributes that describe the acquisition of images during the performance of the Procedure Step and that provide references to the Series, Images and other Composite SOP Instances associated with this Modality Performed Procedure Step.

Table C.4-15. Image Acquisition Results Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Modality | (0008,0060) | Type of equipment that originally acquired the data used to create the images associated with this Modality Performed Procedure Step. See Section C.7.3.1.1.1 for Defined Terms. ### Note A Modality value in the created SOP Instances may be different from the MPPS Modality value. For example, multiple series may have been created during the MPPS (images, waveforms, softcopy presentation states and/or structured reports) with SOP Instances in different series having different modality values.
Study ID | (0020,0010) | User or equipment generated Study Identifier.
Performed Protocol Code Sequence | (0040,0260) | Sequence describing the Protocol performed for this Procedure Step. Zero or more Items shall be included in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>Protocol Context Sequence | (0040,0440) | Sequence that specifies the context for the Performed Protocol Code Sequence Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.
>>Content Item Modifier Sequence | (0040,0441) | Sequence that specifies modifiers for a Protocol Context Content Item. One or more items shall be included in this sequence. See Section C.4.10.1.
>>>Include Table 10-2 “Content Item Macro Attributes Description” | No Baseline TID is defined.
Performed Series Sequence | (0040,0340) | Attributes of the Series that comprise this Modality Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Performing Physician's Name | (0008,1050) | Name of the physician(s) administering this Series.
>Performing Physician Identification Sequence | (0008,1052) | Identification of the physician(s) administering the Series. One or more items shall be included 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” |
>Operators' Name | (0008,1070) | Name(s) of the operator(s) who supporting this Series.
>Operator Identification Sequence | (0008,1072) | Identification of the operator(s) supporting the Series. One or more items shall be included 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” |
>Protocol Name | (0018,1030) | 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 Instance UID | (0020,000E) | Unique Identifier of the Series.
>Series Description | (0008,103E) | Description of the Series
>Series Description Code Sequence | (0008,103F) | A coded description of the Series. Only a single Item shall beincludedin this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>Retrieve AE Title | (0008,0054) | Title of the DICOM Application Entity where the Images and other Composite SOP Instances in this Series may be retrieved on the network. ### Note The duration for which this location remains valid is unspecified.
>Archive Requested | (0040,A494) | The instances in this series are expected to be archived in the long term archive. Enumerated Values: NO YES
>Referenced Image Sequence | (0008,1140) | A Sequence that provides reference to Composite SOP Instances created during the acquisition of the procedure step. Zero or more Items shall be included in this sequence. ### Note The use of Referenced Image Sequence is historical, and in this context it allows the reference of any Composite SOP Instance.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
>>Container Identifier | (0040,0512) | The identifier for the container that contains the specimen(s) imaged.
>>Specimen Description Sequence | (0040,0560) | Sequence of identifiers and detailed description of the specimen(s) imaged. One or more Items shall be included in this Sequence.
>>>Specimen Identifier | (0040,0551) | A departmental information system identifier for the Specimen.
>>>Specimen UID | (0040,0554) | Unique identifier for the Specimen.
>Referenced Non-Image Composite SOP Instance Sequence | (0040,0220) | Uniquely identifies instances, other than images, of any SOP Class that conforms to the DICOM Composite IOD Information Model, such as Waveforms, Presentation States or Structured Reports, created during the acquisition of the procedure step, and that are not referenced in Referenced Image Sequence (0008,1140). Zero or more Items shall be included in this sequence.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes” |

### C.4.16 Radiation Dose Module

Table C.4-16 defines the Attributes that may be used to communicate information related to radiation dose values. The attributes are intended to enable the Information System to store Patient exposure to ionizing radiation for legal purposes. Though these attributes are not intended to be used to accurately calculate volume dose distribution, they may serve for some quality control purposes.

This module provides a means to communicate radiation dose values but DICOM does not define any requirements for the accuracy of these values, which may be defined in other professional, national or international standards.

The scope of the attributes contained in this module covers the entire acquisition that comprises the Modality Performed Procedure Step. Attributes that relate to single images, such as mAs or kVp, may be included in the Image IODs. It is beyond the scope of DICOM to define what attributes may be required to calculate or estimate area dose product values.

### Note

The X-Ray Radiation Dose SR SOP Class provides a more comprehensive means of reporting radiation dose. Such a dose report may be referenced in the Image Acquisition Results Module.

Table C.4-16. Radiation Dose Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Anatomic Structure, Space or Region Sequence | (0008,2229) | Anatomic structure, space or region that has been exposed to ionizing radiation. Zero or one Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Total Time of Fluoroscopy | (0040,0300) | Total duration of X-Ray exposure during fluoroscopy in seconds (pedal time) during this Performed Procedure Step.
Total Number of Exposures | (0040,0301) | Total number of exposures made during this Performed Procedure Step. The number includes non-digital and digital exposures.
Distance Source to Detector | (0018,1110) | Distance in mm from the source to detector center. ### Note This value is traditionally referred to as Source Image Receptor Distance (SID).
Distance Source to Entrance | (0040,0306) | Distance in mm from the source to the surface of the patient closest to the source during this Performed Procedure Step. ### Note This may be an estimated value based on assumptions about the patient's body size and habitus.
Entrance Dose | (0040,0302) | Average entrance dose value measured in dGy at the surface of the patient during this Performed Procedure Step. ### Note This may be an estimated value based on assumptions about the patient's body size and habitus.
Entrance Dose in mGy | (0040,8302) | Average entrance dose value measured in mGy at the surface of the patient during this Performed Procedure Step. ### Note This may be an estimated value based on assumptions about the patient's body size and habitus.
Exposed Area | (0040,0303) | Typical dimension of the exposed area at the detector plane. If Rectangular: row dimension followed by column; if Round: diameter. Measured in mm. ### Note This may be an estimated value based on assumptions about the patient's body size and habitus. This attribute is used in the X-Ray Acquisition Dose Module with units in cm (see Section C.8.7.8, Table C.8-33 “X-Ray Acquisition Dose Module Attributes”).
Image and Fluoroscopy Area Dose Product | (0018,115E) | Total area-dose-product to which the patient was exposed, accumulated over the complete Performed Procedure Step and measured in dGy*cm*cm, including fluoroscopy. ### Note The sum of the area dose product of all images of a Series or a Study may not result in the total area dose product to which the patient was exposed. This may be an estimated value based on assumptions about the patient's body size and habitus.
Comments on Radiation Dose | (0040,0310) | User-defined comments on any special conditions related to radiation dose encountered during this Performed Procedure Step.
Exposure Dose Sequence | (0040,030E) | Exposure Dose Sequence will contain Total Number of Exposures (0040,0301) items plus an item for each fluoroscopy episode not already counted as an exposure. Zero or more Items shall be included in this sequence.
>Radiation Mode | (0018,115A) | Specifies X-Ray radiation mode. Enumerated Values: CONTINUOUS PULSED
>KVP | (0018,0060) | Peak kilo voltage output of the x-ray generator used. An average in the case of fluoroscopy (continuous radiation mode).
>X-Ray Tube Current in µA | (0018,8151) | X-Ray Tube Current in µA. An average in the case of fluoroscopy (continuous radiation mode).
>Exposure Time | (0018,1150) | Time of x-ray exposure or fluoroscopy in msec.
>Filter Type | (0018,1160) | Type of filter(s) inserted into the X-Ray beam (e.g., wedges). See Section C.8.7.10 and Section C.8.15.3.9 (for enhanced CT) for Defined Terms.
>Filter Material | (0018,7050) | The X-Ray absorbing material used in the filter. May be multi-valued. See Section C.8.7.10 and Section C.8.15.3.9 (for enhanced CT) for Defined Terms.
>Comments on Radiation Dose | (0040,0310) | User-defined comments on any special conditions related to radiation dose encountered during during the episode described by this Exposure Dose Sequence Item.

### Note

1. The Anatomic Region may be deduced from attribute values available within the Modality Worklist Management SOP Class, such as Reason for Service Request, Reasons for Requested Procedure, Scheduled Procedure Step Description and Scheduled Protocol Code Sequence.

2. The Image Area Dose Product should take into account collimator position and filters, and the value for the Exposed Area should also take into account collimator position. If the equipment does not provide the Entrance Dose, it may be calculated using Area Dose Product, Exposed Area, SID and an assumed body thickness.

3. The Distance Source to Detector (0018,1110) and Exposed Area (0040,0303) are only meaningful if they remain constant for all acquisitions during this Performed Procedure Step.

### C.4.17 Billing and Material Management Codes

The Attributes defined in Table C.4-17 provide a means to transmit billing and material management codes from a modality to an Information System. It is beyond the scope of this Standard to define all the required coding schemes and the relevant codes.

Table C.4-17. Billing and Material Management Code Module Attributes

Attribute name | Tag | Attribute Description
--- | --- | ---
Billing Procedure Step Sequence | (0040,0320) | Contains billing codes for the Procedure Type performed within the Procedure Step. Zero or more Items shall be included in this sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
Film Consumption Sequence | (0040,0321) | Information about the film consumption for this Performed Procedure Step. Zero or more Items shall be included in this sequence.
>Number of Films | (2100,0170) | Number of films actually printed.
>Medium Type | (2000,0030) | Type(s) of medium on which images were printed. For Defined Terms see Table C.13-1.
>Film Size ID | (2010,0050) | Size(s) of film on which images were printed. For Defined Terms see Table C.13-3.
Billing Supplies and Devices Sequence | (0040,0324) | Chemicals, supplies and devices for billing used in the Performed Procedure Step.One or more Items shall be included in this sequence.
>Billing Item Sequence | (0040,0296) | Code values of chemicals, supplies or devices required for billing. Zero or one Item shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | No Baseline CID is defined.
>Quantity Sequence | (0040,0293) | Sequence containing the quantity of used chemicals or devices. Zero or one Item shall be included in this Sequence.
>>Quantity | (0040,0294) | Numerical quantity value.
>>Measuring Units Sequence | (0040,0295) | Unit of measurement. Zero or one Item shall be included in this Sequence.
>>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 82 “Units of Measurement”.

### C.4.18 General Purpose Scheduled Procedure Step Relationship Module (Retired)

Retired. See PS3.3-2011.

### C.4.19 General Purpose Scheduled Procedure Step Information Module (Retired)

Retired. See PS3.3-2011.

### C.4.20 General Purpose Performed Procedure Step Relationship Module (Retired)

Retired. See PS3.3-2011.

### C.4.21 General Purpose Performed Procedure Step Information Module (Retired)

Retired. See PS3.3-2011.

### C.4.22 General Purpose Results (Retired)

Retired. See PS3.3-2011.

### C.4.23 Instance Availability Notification Module

Table C.4.23-1 specifies the Attributes used to describe which Instances are available and their relationships.

Table C.4.23-1. Instance Availability Notification Module Attributes

Attribute Name | Tag | Attribute Description
--- | --- | ---
Referenced Performed Procedure Step Sequence | (0008,1111) | Uniquely identifies the Performed Procedure Step SOP Instance to which this availability notification instance is related, if any. Zero or one Item shall be included in this sequence. ### Note This may refer to a different PPS than that encoded in the composite instances themselves. It is typically used for notification about instances created as a consequence of some scheduled activity.
>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
>Performed Workitem Code Sequence | (0040,4019) | A sequence that conveys the (single) type of procedure performed. Only a single Item shall be included in this sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Baseline CID 9231 “Workitem Definition”.
Study Instance UID | (0020,000D) | Unique identifier for the Study of which all the Instances referenced in this notification are part.
Referenced Series Sequence | (0008,1115) | Sequence of Items where each Item includes references to Instances within the same Series. One or more Items shall be included in this Sequence.
>Series Instance UID | (0020,000E) | Unique identifier of the Series of which all the Instances referenced in this Item are part.
>Referenced SOP Sequence | (0008,1199) | Sequence of Items where each Item includes a reference to a single Instance within this Series. One or more Items shall be included in this Sequence.
>>Include Table 10-11 “SOP Instance Reference Macro Attributes” |
>>Instance Availability | (0008,0056) | The availability of the referenced Instance. See Section C.4.23.1.1
>>Retrieve AE Title | (0008,0054) | Title of the DICOM Application Entity from which the referenced Instance may or may not be retrievable, i.e., the scope for which Instance Availability (0008,0056) applies. See Section C.4.23.1.1.
>>Retrieve Location UID | (0040,E011) | Unique identifier of the system where the Composite Object(s) may be retrieved on the network.
>>Retrieve URI | (0040,E010) | Retrieval access path to the referenced SOP instance(s). Includes fully specified scheme, authority, path, and query in accordance with [RFC 3986]. ### Note The VR of this attribute has changed from UT to UR.
>>Storage Media File-Set ID | (0088,0130) | The user or implementation specific human readable identifier that identifies the offline storage media on which the instance resides.
>>Storage Media File-Set UID | (0088,0140) | Uniquely identifies the offline storage media on which the instance resides.

#### C.4.23.1 Instance Availability Notification Module Attribute Definitions

##### C.4.23.1.1 Instance Availability

Enumerated Values:

ONLINE

  The instances are immediately available from the Retrieve AE Title (0008,0054), and if a C-MOVE were to be requested, it would succeed in a reasonably short time.

NEARLINE

  The instances need to be retrieved from relatively slow media such as optical disk or tape, and if a C-MOVE were to be requested from the Retrieve AE Title (0008,0054), it would succeed, but may take a considerable time.

OFFLINE

  A manual intervention is needed before the instances may be retrieved, and if a C-MOVE were to be requested from the Retrieve AE Title (0008,0054), it would fail (e.g., by timeout) without such manual intervention.

UNAVAILABLE

  The instances cannot be retrieved from the Retrieve AE Title (0008,0054), and if a C-MOVE were to be requested, it would fail.

  ### Note

  SOP Instances that are unavailable from this AE may be available from other AEs, or may have an alternate representation that is available from this AE.

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