C.7.6 Common Image IE Modules
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### 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.7.6.1.1.5.2.
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.7.6.1.1.5.1.
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).

###### C.7.6.1.1.5.1 Lossy Image Compression Method

Lossy Image Compression Method (0028,2114) 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), if present.

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.7.6.1.1.5.2 Lossy Image Compression Ratio

The value of the "compression ratio" is encoded as a numeric value that represents the numerator of an implicit ratio in which the denominator is always one, consistent with the traditional representation in the literature.

### Note

For example, a compression ratio of 30:1 would be described with a value of 30.

The value may be an estimate (e.g., the nominal value that is supplied to the compressor), or it may be a measured value (e.g., computed by dividing the uncompressed pixel data size by the size of the compressed bit stream).

Lossy Image Compression Ratio (0028,2112) may be multivalued if successive lossy compression steps have been applied; if so, the value order shall correspond to the multiple values of Lossy Image Compression Method (0028,2114), if present.

### Note

For historical reasons, the lossy compression ratio should also be described in Derivation Description (0008,2111).

###### 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.

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