C.8.11.7 Mammography Image Module
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#### C.8.11.7 Mammography Image Module

Table C.8-74 contains IOD Attributes that describe a Digital Mammography X-Ray Image including its acquisition and positioning.

Table C.8-74. Mammography Image Module Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
Image Type | (0008,0008) | 1 | Image identification characteristics. See Section C.8.11.7.1.4 for specialization.
Positioner Type | (0018,1508) | 1 | Enumerated Values: MAMMOGRAPHIC NONE
Distance Source to Detector | (0018,1110) | 3 | Distance in mm from source to detector center on the chest wall line ### Note This value is traditionally referred to as Source Image Distance (SID). See Section C.8.11.7.1.1.
Distance Source to Patient | (0018,1111) | 3 | Distance in mm from source to the breast support side that is closest to the Imaging Subject, as measured along the X-Ray beam vector. ### Note This value is traditionally referred to as Source Object Distance (SOD). See notes for this attribute in Section C.8.11.5 DX Positioning Module. See Section C.8.11.7.1.1 for description of X-Ray beam vector.
Positioner Primary Angle | (0018,1510) | 3 | Signed position in degrees of the X-Ray beam vector in the coronal anatomical plane as if the patient were standing facing the equipment where vertical is zero.
Positioner Primary Angle Direction | (0018,9559) | 3 | The interpretation of the sign of the Positioner Primary Angle (0018,1510). Enumerated Values: CW Clockwise. Positioner Primary Angle movement is positive when movement is from vertical to the patient's right (with patient standing, facing equipment). CC Counter clockwise. Positioner Primary Angle is positive when movement is from vertical to the patient's left (with patient standing, facing the equipment). See Section C.8.31.2.1.
Positioner Secondary Angle | (0018,1511) | 3 | Position in degrees of the X-Ray beam vector in the sagittal anatomical plane as if the patient were standing where movement of the X-Ray source from anterior to posterior is positive, and vertical is zero.
Image Laterality | (0020,0062) | 1 | Laterality of the region examined. Enumerated Values: R right L left B both (e.g., cleavage)
Organ Exposed | (0040,0318) | 1 | Organ to which Organ Dose (0040,0316) applies. Enumerated Values: BREAST ### Note In the Mammography IOD, Organ Dose (0040,0316) refers to the mean glandular dose.
Breast Implant Present | (0028,1300) | 3 | Whether or not the imaged breast contains a breast implant regardless of the visibility of a breast implant in the Pixel Data. Enumerated Values: YES NO ### Note The value is expected to be YES for all images acquired on a breast that contains a breast implant, even when a breast implant is displaced during image acquisition.
Partial View | (0028,1350) | 3 | Indicates whether this image is a partial view, that is a subset of a single view of the breast. Enumerated Values: YES NO If this Attribute is absent, then the image may or may not be a partial view. ### Note This may occur when a breast is larger than the active area of the detector. If this Attribute is present, its value shall be NO if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, "Magnification") or (R-102D7, SRT, "Spot Compression"). ### Note SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16.
Partial View Description | (0028,1351) | 3 | Free text description of the portion of the breast captured in a partial view image. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, "Magnification") or (R-102D7, SRT, "Spot Compression"). ### Note SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16.
Partial View Code Sequence | (0028,1352) | 3 | Sequence that describes the portion or section of the breast captured in a partial view image. Only one or two Items are permitted in this sequence. See Section C.8.11.7.1.3. If this Attribute is absent, then the image may or may not be a partial view. This Attribute shall not be present if there is a View Modifier Code Sequence (0054,0222) Item of value (R-102D6, SRT, "Magnification") or (R-102D7, SRT, "Spot Compression"). ### Note SRT is the preferred designator for SNOMED, but SNM3 is allowed for backward compatibility. See PS3.16.
>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 4005 “Partial View Section for Mammography”.
Include Table 10-5 “General Anatomy Mandatory Macro Attributes” | Defined CID for the Anatomic Region Sequence is CID 4013 “Anatomic Region for Mammography”.
View Code Sequence | (0054,0220) | 1 | Sequence that describes the projection of the anatomic region of interest on the image receptor. Only a single Item shall be included in this Sequence.
>Include Table 8.8-1 “Code Sequence Macro Attributes” . | Defined CID 4014 “View for Mammography”.
>View Modifier Code Sequence | (0054,0222) | 2 | View modifier. Zero or more Items shall be included in this Sequence.
>>Include Table 8.8-1 “Code Sequence Macro Attributes” | Defined CID 4015 “View Modifier for Mammography”.
Biopsy Target Sequence | (0018,2041) | 3 | Sequence that identifies the targets of a biopsy procedure. One or more Items are permitted in this sequence, where the coordinate system is the same for all Items within a pair of stereo images.
>Target UID | (0018,2042) | 1 | Unique identifier for the target. ### Note To identify the same target in corresponding minus and plus stereo images.
>Localizing Cursor Position | (0018,2043) | 1 | Coordinates of localizing cursor position with respect to pixels in the image specified by a column (delimiter) row pair. The values shall be in the range 0\0 (TLHC) to Columns\Rows (BRHC).
>Calculated Target Position | (0018,2044) | 1 | The calculated target position (x, y, z) in mm in an equipment relative right-handed coordinate system where the origin is under the central X-Ray beam at the chest wall, and a z value of zero is located at the surface that the breast is in contact with that is closest to the detector. X is parallel to the chest wall, y is positive toward the patient's nipple, and z is positive toward the X-Ray source.
>Displayed Z Value | (0018,2046) | 1 | The z value in mm displayed to the user at the time of biopsy. ### Note This may be the same as the z value of Calculated Target Position or different in direction or reference point, such as relative to the compression paddle. This is not the distance that the needle was inserted, particularly for a lateral (parallel) approach.
>Target Label | (0018,2045) | 3 | Target description.

##### C.8.11.7.1 Mammography Image Attribute Descriptions

###### C.8.11.7.1.1 Mammography X-Ray Beam and X-Ray Beam Vector Definition

Figure C.8.11.7-1 shows the X-Ray beam for a digital mammography system. The X-Ray beam vector is defined from the Focal Spot to the center of the chest wall line of the Image Detection device.

Figure C.8.11.7-1. X-Ray Beam for a Digital Mammography System

###### C.8.11.7.1.2 Detector Primary and Secondary Angles

Detector Angles are defined in a fashion similar to the positioner angles, except that the angle of the x-ray beam vector is relative to the detector plane rather than the patient plane. Zero degrees is referenced to the normal of the detector plane pointing toward the x-ray source. The valid range of the Detector Angles is -90 to + 90 degrees.

The Primary Axis of rotation is defined along the line in the column direction of the detector plane that intersects the x-ray beam vector. The Detector Primary Angle is defined in the plane perpendicular to the Primary Axis of rotation at the point where the x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane and +90 in the direction of the higher numbered columns of the detector in that plane. The valid range of Detector Primary Angle is -90 to +90 degrees.

The Secondary Axis is in the detector plane and is perpendicular to the Primary Axis at the intersection of the beam vector with the detector plane (i.e., it is along the row direction). The Detector Secondary Angle is defined in the plane perpendicular to the Secondary Axis at the point where the x-ray beam vector intersects the detector plane, with zero degrees in the direction normal to the detector plane. +90 degrees corresponds to the direction of the lower numbered rows of the detector in that plane. The Detector Secondary Angle range is -90 to + 90 degrees.

###### C.8.11.7.1.3 Partial View Code Sequence

Combinations of coded terms may be used in the Partial View Code Sequence (0028,1352) to express the breast section imaged. Figure C.8.11.7-2 shows examples for the right and left FB, XCC, XCCL and XCCM views, and Figure C.8.11.7-3 shows examples for the right and left ML, MLO, LM, LMO, SIO and ISO views.

Partial View Code Sequence Items (Code Meaning) | Partial View Images (A, B, C, D, E)
--- | ---
A) item 1 = Lateral B) item 1 = Medial |
A) item 1 = Posterior B) item 1 = Anterior |
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Medial, item 2 = Posterior C) item1 = Anterior |
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Medial, item 2 = Posterior C) item 1 = Lateral, item 2 = Anterior D) item 1 = Medial, item 2 = Anterior |
A) item 1 = Lateral, item 2 = Posterior B) item 1 = Central, item 2 = Posterior C) item 1 = Medial, item 2 = Posterior D) item 1 = Lateral, item 2 = Anterior E) item 1 = Medial, item 2 = Anterior |

Figure C.8.11.7-2. CC, FB, XCCL and XCCM partial views

### Note

If six images are required, then the "Central, Anterior" combination would be added.

Partial View Code Sequence Items (Code Meaning) | Partial View Images (A, B, C, D, E)
--- | ---
A) item 1 = Superior B) item 1 = Inferior |
A) item 1 = Posterior B) item 1 = Anterior |
A) item 1 = Superior, item 2 = Posterior B) item1 = Inferior, item 2 = Posterior C) item 1 = Anterior |
A) item 1 = Superior, item 2 = Posterior B) item 1 = Inferior, item 2 = Posterior C) item 1 = Superior, item 2 = Anterior D) item 1 = Inferior, item 2 = Anterior |
A) item 1 = Superior, item 2 = Posterior B) item 1 = Central, item 2 = Posterior C) item 1 = Inferior, item 2 = Posterior D) item 1 = Superior, item 2 = Anterior E) item 1 = Inferior, item 2 = Anterior |

Figure C.8.11.7-3. ML, MLO, LM, LMO, SIO and ISO partial views

### Note

If six images are required, then the "Central, Anterior" combination would be added.

###### C.8.11.7.1.4 Image Type

Image Type (0008,0008) Value 1 and Value 2 shall identify the Pixel Data Characteristics in accordance with Section C.8.11.3.1.1.

Value 3 shall be present and have zero length (null value), except when used to identify a stereotactic mammography image, digital breast tomosynthesis projection or generated 2D image, or contrast enhanced image.

### Note

In a previous version of PS3.3, Value 3 was required to be zero length (null value). If Value 3 is zero length, the image may or may not be a stereotactic mammography image, digital breast tomosynthesis projection or generated 2D image, or contrast enhanced image, if the Instance was created before these terms were defined.

The Enumerated Values for Value 3 of stereotactic mammography images are listed in Table C.8-74a.

Table C.8-74a. Enumerated Values of Image Type (0008,0008) Value 3 for Stereotactic Mammography

Enumerated Value | Definition | ACR MQCM Equivalent
--- | --- | ---
STEREO_SCOUT | A localizer image for a stereotactic acquisition. | …SC
STEREO_MINUS | The paired image obtained with the X-Ray source angle decreased from the scout position, to determine positioning coordinates prior to needle positioning. | …ST-
STEREO_PLUS | The paired image obtained with the X-Ray source angle increased from the scout position, to determine positioning coordinates prior to needle positioning. | …ST+
PREFIRE_MINUS | The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position prior to needle deployment. | …PRF-
PREFIRE_PLUS | The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position prior to needle deployment. | …PRF+
POSTFIRE_MINUS | The paired image obtained with the X-Ray source angle decreased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion. | …POF-
POSTFIRE_PLUS | The paired image obtained with the X-Ray source angle increased from the scout position, with the biopsy needle in position following needle deployment through the targeted lesion. | …POF+
POSTBIOPSY_MINUS | The image obtained following tissue acquisition with the X-Ray source angle decreased from the scout position. | …POB-
POSTBIOPSY_PLUS | The image obtained following tissue acquisition with the X-Ray source angle increased from the scout position. | …POB+
POSTBIOPSY | The image obtained following tissue acquisition with the X-Ray source in the scout position. | …POB
POSTMARKER_MINUS | The image obtained following micromarker placement with the X-Ray source angle decreased from the scout position. | …POM-
POSTMARKER_PLUS | The image obtained following micromarker placement with the X-Ray source angle increased from the scout position. | …POM+
POSTMARKER | The image obtained following micromarker placement with the X-Ray source in the scout position. | …POM

The Enumerated Values for Value 3 of digital breast tomosynthesis projection images and mathematically generated 2D images are:

Table C.8-74b. Enumerated Values of Image Type (0008,0008) Value 3 for Digital Breast Tomosynthesis Projection and Generated 2D Images

Enumerated Value | Definition | ACR MQCM Equivalent
--- | --- | ---
TOMO_PROJ | Identifies the image as a digital breast tomosynthesis projection image. | n/a
TOMOSYNTHESIS | Identifies the image as digital breast tomosynthesis; shall be used only for generated 2D images when no other Value 3 takes precedence. | n/a
TOMO_SCOUT | A localizer image that may be used to determine positioning coordinates prior to needle positioning. | …SC
PREFIRE | The image obtained with the biopsy needle in position prior to needle deployment. | …PRF
POSTFIRE | The image obtained with the biopsy needle in position following needle deployment through the targeted lesion. | …POF
POSTBIOPSY | The image obtained following tissue acquisition with the X-Ray source in the scout position. | …POB
POSTMARKER | The image obtained following micromarker placement with the X-Ray source in the scout position. | …POM

### Note

Digital breast tomosynthesis projection images acquired as part of a biopsy procedure (and resulting derived images such as mathematically generated 2D) omit the _MINUS and _PLUS endings because a single digital breast tomosynthesis acquisition produces a set of projection images that replaces the _MINUS and _PLUS image pair used in conventional 2D breast biopsy imaging.

The Enumerated Values for Value 3 of contrast enhanced images are:

Table C.8-74c. Enumerated Values of Image Type (0008,0008) Value 3 for Contrast Enhanced Images

Enumerated Value | Definition
--- | ---
PRE_CONTRAST | Collected before contrast was administered.
POST_CONTRAST | Collected during or after contrast was administered.

If more than one characteristic (biopsy, tomosynthesis, contrast enhanced) applies to an image, Value 3 shall contain the biopsy image type. If biopsy is not involved, Value 3 shall contain the tomosynthesis image type.

### Note

For example, attributes of the Contrast/Bolus module may be used to identify contrast enhanced characteristics of a biopsy and/or tomosynthesis projection or generated 2D image that is also contrast enhanced.

Value 4 shall be present for images acquired using contrast enhanced digital x-ray imaging of the breast (but may be empty if none of the Defined Terms applies), and for mathematically generated 2D images. For other images Value 4 remains optional and implementation specific.

Table C.8-74d. Defined Terms of Image Type (0008,0008) Value 4 for Contrast Enhanced and Generated 2D Images

Enumerated Value | Definition
--- | ---
GENERATED_2D | Mathematically generated 2D view.
ADDITION | Created through Pixel by pixel addition operation.
SUBTRACTION | Created through Pixel by pixel subtraction operation.

If more than one characteristic (contrast enhanced, tomosynthesis) applies to an image, Value 4 shall contain the contrast enhanced image type. If contrast enhanced is not involved, Value 4 shall contain the generated 2D image type.

Value 5 shall be present for images acquired using contrast enhanced digital x-ray imaging of the breast, but may be empty if none of the Defined Terms applies. For non-contrast images Value 5 remains optional and implementation specific.

Table C.8-74e. Defined Terms of Image Type (0008,0008) Value 5 for Contrast Enhanced 2D Images

Enumerated Value | Definition
--- | ---
LOW_ENERGY | Low energy image.
HIGH_ENERGY | High energy image.

### Note

A recipient may use the different values for biopsy, tomosynthesis and contrast views to determine how to display them, for example in hanging protocols:

| Image Type Value 3 | Image Type Value 4 | Image Type Value 5
--- | --- | --- | ---
Conventional 2D mammography | empty | - | -
Stereotactic post-biopsy | POSTBIOPSY | - | -
Pre-contrast 2D | PRE_CONTRAST | empty | empty
Post-contrast 2D low energy | POST_CONTRAST | - | LOW_ENERGY
Post-contrast 2D addition | POST_CONTRAST | ADDITION | empty
Stereotactic scout pre-contrast | STEREO_SCOUT | empty | empty
Stereotactic stereo post-contrast high energy | STEREO_PLUS | empty | HIGH_ENERGY
Stereotactic post-fire post-contrast subtraction | POSTFIRE_MINUS | SUBTRACTION | empty
Tomosynthesis generated 2D | TOMOSYNTHESIS | GENERATED_2D | -
Tomosynthesis biopsy scout generated 2D | TOMO_SCOUT | GENERATED_2D | -
Tomosynthesis generated 2D post-contrast low energy | TOMOSYNTHESIS | GENERATED_2D | LOW_ENERGY
Tomosynthesis generated 2D post-contrast subtraction | TOMOSYNTHESIS | SUBTRACTION | empty
Tomosynthesis projection | TOMO_PROJ | - | -
Tomosynthesis projection post-biopsy | POSTBIOPSY | - | -
Tomosynthesis projection post-biopsy post-contrast subtraction | POSTBIOPSY | SUBTRACTION | empty

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