DICOM PS3.3 2016c - Information Object Definitions

C.7.6.16.2 Common Functional Group Macros
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##### 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 either: Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present 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 either: Volumetric Properties (0008,9206) is VOLUME or SAMPLED SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present May be present otherwise.
>Spacing Between Slices | (0018,0088) | 3 | Spacing between adjacent slices, in mm. The spacing is measured from the center-to-center of each slice, and if present shall not be negative.

###### 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" or Functional MR Sequence (0018,9621) is present. May be present otherwise. See Section C.7.6.16.2.2.6 and Section C.7.6.16.2.2.8.
>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" or Functional MR Sequence (0018,9621) is present. May be present otherwise. See Section C.7.6.16.2.2.7 and Section C.7.6.16.2.2.8.
>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) or Functional MR Sequence (0018,9621) is present. See Section C.7.6.16.2.2.4 and Section C.7.6.16.2.2.8 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 Multi-frame 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.7.6.16.2.2.8 Usage of Temporal Position Index, Stack ID and In-Stack Position Number in fMRI Volumes

For fMRI volumes the Temporal Position Index is used to distinguish between the multiple volumes acquired in time (phases of a volume) for the same Stack ID. Each frame in the volume has an In-Stack Position Number that is the ordinal number in space of each volume. See Figure C.7.6.16-4c for an example.

Figure C.7.6.16-4c. Example of Functional MRI volumes

###### 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 either: Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present 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 either: Frame Type (0008,9007) Value 1 of this frame is ORIGINAL and Volumetric Properties (0008,9206) of this frame is other than DISTORTED SOP Class UID is Segmentation Storage ("1.2.840.10008.5.1.4.1.1.66.4") and Frame of Reference UID (0020,0052) is present 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) | 1C | 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. Required if Pixel Data (7FE0,0010) or Real World Value LUT Data (0040,9212) is present or Double Float Real World Value First Value Mapped (0040,9214) is absent. ### Note This Attribute may be used even when Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are used instead of Pixel Data (7FE0,0010) if an integer of the size of this Attribute is sufficient to define the range. See Section C.7.6.16.2.11.1 for further explanation.
Real World Value Last Value Mapped | (0040,9211) | 1C | 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. Required if Pixel Data (7FE0,0010) or Real World Value LUT Data (0040,9212) is present or Double Float Real World Value Last Value Mapped (0040,9213) is absent. ### Note This Attribute may be used even when Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are used instead of Pixel Data (7FE0,0010) if an integer of the size of this Attribute is sufficient to define the range. See Section C.7.6.16.2.11.1 for further explanation.
Double Float Real World Value First Value Mapped | (0040,9214) | 1C | Specifies the first stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) of this Item. Required if Real World Value First Value Mapped (0040,9216) is absent. ### Note The same Attribute with a double float precision value is used whether or not Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present, an integer value is not sufficient.
Double Float Real World Value Last Value Mapped | (0040,9213) | 1C | Specifies the last stored value mapped for the Real Word Value Intercept (0040,9224) and Real World Value Slope (0040,9225) of this Item. Required if Real World Value Last Value Mapped (0040,9211) is absent. ### Note The same Attribute with a double float precision value is used whether or not Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present, an integer value is not sufficient.
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 Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present or 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 Float Pixel Data (7FE0,0008) or Double Float Pixel Data (7FE0,0009) are present or 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 7181 “Abstract Multi-dimensional Image Model Component Units”, or as specified in the macro invocation.
Quantity Definition Sequence | (0040,9220) | 3 | A list of name-value pairs that describe the characteristics of the quantity represented by the Real World Value. One or more Items are permitted in this Sequence. One of the items shall have a concept name that specifies the quantified characteristic, though it is not required that (G-C1C6, SRT, "Quantity") be used if there is a reason to use a similar concept from a different coding scheme. Other items may be concept modifiers, such as (G-C036, SRT, "Measurement Method"). The order of the items is not significant.
>Include Table 10-2 “Content Item Macro Attributes Description” | Baseline CID for Concept Name Code Sequence is CID 9000 “Physical Quantity Descriptors”. Baseline CID for Concept Code Sequence for Concept Name of (G-C1C6, SRT, "Quantity") is CID 7180 “Abstract Multi-dimensional Image Model Component Semantics”.

###### 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

### Note

If the stored pixel values that are encoded as floating point rather than integer values, only the equation and not the lookup operation is defined.

The Value Representation of Real World Value First Value Mapped (0040,9216) and Real World Value Last Value Mapped (0040,9211) (US or SS) is determined by the value of Pixel Representation (0028,0103) in the case of integer pixel data, or is SS in the case of floating point pixel data if these Attributes are present.

### Note

In practice, integer values may well be sufficient to define an input range that exceeds the actual stored floating point pixel value range. The reason to permit floating point alternatives to an integer range is that sometimnes the stored floating point values may be very large and exceed what can be specified as an integer value.

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

The quantity that the real world values represent may be described by the Quantity Definition Sequence (0040,9220), which consists of a list of name-value pairs, in which the coded concept name specifies what aspect of the physical quantity is being described.

### Note

For example, Cerebral Blood Flow (CBF) may be described by units and quantity as follows:

- Measurement Units Code Sequence (0040,08EA) = (ml/[100]g/min, UCUM, "milliliter per 100 gram per minute")

- Quantity Definition Sequence (0040,9220):

  - (G-C1C6, SRT, "Quantity") = (113055, DCM, "Regional Cerebral Blood Flow")

The Quantity Definition Sequence (0040,9220) describes only the stored pixel values that are mapped using the Real World Values Mapping, and does not describe derived values from multiple pixels to which the Real World Values Mapping applies.

### Note

I.e., the mapping is a "point" operation, and as a consequence various modifiers that might be applied to a group of pixels, such as in an ROI, should not be used. E.g., an ROI encoded in a Structured Report using TID 1419 "ROI Measurements" might be the mean or maximum value (e.g., SUVbw mean or SUVbw max), and be encoded with (121401, DCM, "Derivation") = (R-00317, SRT, "Mean") or (G-A437, SRT, "Maximum"), respectively. These would not be appropriate to use within Quantity Definition Sequence (0040,9220), unless the individual pixel values were themselves derived in such a manner, e.g., when multiple images are averaged together. Thus the content items used in an SR to describe an ROI might be a superset of the name-value pairs used in Quantity Definition Sequence (0040,9220).

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” |

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