<?xml version="1.0" encoding="utf-8" standalone="no"?>
<book xmlns="http://docbook.org/ns/docbook" xmlns:xhtml="http://www.w3.org/1999/xhtml" xmlns:xl="http://www.w3.org/1999/xlink" label="PS3.1" version="5.0" xml:id="PS3.1">
  <title>PS3.1</title>
  <subtitle>DICOM PS3.1 2017b - Introduction and Overview</subtitle>
  <info>
    <author>
      <orgname>DICOM Standards Committee</orgname>
    </author>
    <copyright>
      <year>2017</year>
      <holder>NEMA</holder>
    </copyright>
  </info>
  <chapter label="" status="1" xml:id="chapter_Notice">
    <title>Notice and Disclaimer</title>
    <para xml:id="para_4bd261d3-b1d8-4e07-bc19-025147cdf31e">The information in this publication was considered technically sound by the consensus of
      persons engaged in the development and approval of the document at the time it was developed.
      Consensus does not necessarily mean that there is unanimous agreement among every person
      participating in the development of this document.</para>
    <para xml:id="para_77b285e6-9884-456a-a8fe-fcb3ad5626f5">NEMA standards and guideline publications, of which the document contained herein is one,
      are developed through a voluntary consensus standards development process. This process brings
      together volunteers and/or seeks out the views of persons who have an interest in the topic
      covered by this publication. While NEMA administers the process and establishes rules to
      promote fairness in the development of consensus, it does not write the document and it does
      not independently test, evaluate, or verify the accuracy or completeness of any information or
      the soundness of any judgments contained in its standards and guideline publications.</para>
    <para xml:id="para_e483c01f-c2ff-459b-a444-20d802b817a2">NEMA disclaims liability for any personal injury, property, or other damages of any nature
      whatsoever, whether special, indirect, consequential, or compensatory, directly or indirectly
      resulting from the publication, use of, application, or reliance on this document. NEMA
      disclaims and makes no guaranty or warranty, expressed or implied, as to the accuracy or
      completeness of any information published herein, and disclaims and makes no warranty that the
      information in this document will fulfill any of your particular purposes or needs. NEMA does
      not undertake to guarantee the performance of any individual manufacturer or seller's products
      or services by virtue of this standard or guide.</para>
    <para xml:id="para_a70658ab-726d-41a7-be6c-e10f1d9cca4a">In publishing and making this document available, NEMA is not undertaking to render
      professional or other services for or on behalf of any person or entity, nor is NEMA
      undertaking to perform any duty owed by any person or entity to someone else. Anyone using
      this document should rely on his or her own independent judgment or, as appropriate, seek the
      advice of a competent professional in determining the exercise of reasonable care in any given
      circumstances. Information and other standards on the topic covered by this publication may be
      available from other sources, which the user may wish to consult for additional views or
      information not covered by this publication.</para>
    <para xml:id="para_ae4d3d9d-7556-4876-a4cc-de365dc0a6c6">NEMA has no power, nor does it undertake to police or enforce compliance with the contents
      of this document. NEMA does not certify, test, or inspect products, designs, or installations
      for safety or health purposes. Any certification or other statement of compliance with any
      health or safety-related information in this document shall not be attributable to NEMA and is
      solely the responsibility of the certifier or maker of the statement.</para>
  </chapter>
  <chapter label="" status="1" xml:id="chapter_Foreword">
    <title>Foreword</title>
    <para xml:id="para_b5f10157-a778-4ad5-b339-2233ce0b3e60">The DICOM Standards Committee is an independent, international standards development organization comprising biomedical
      professional societies whose specialties include the use of medical imaging, manufacturers of medical imaging equipment and
      related information systems, and  government agencies, trade associations, and other standards development organizations with
      an interest in standardization of medical imaging information and related data. Membership is open to all organizations with
      a material interest in the work of the Committee.  The Committee collaborates closely with other standards development
      organizations in the fields of Healthcare Informatics and Electrical Equipment in Medical Practice. The Secretariat of the
      Committee is the National Electrical Manufacturers Association and its Medical Imaging and Technology Alliance division.</para>
    <para xml:id="para_78a26edd-d78a-413f-aaed-8d10f5b1e376">The principal product of the Committee is this Standard, Digital Imaging and Communications in Medicine (DICOM).</para>
    <para xml:id="para_d38dcd6e-56f5-4548-b1d6-3118ac63fa9b">This DICOM Standard was developed according to the procedures of the DICOM Standards Committee.</para>
    <para xml:id="para_882e39f2-e05f-4512-9679-77d6a2fa6cd2">The DICOM Standard is structured as a multi-part document using the guidelines established in <xref linkend="biblio_ISODirectives2"/>.</para>
    <para xml:id="para_8f7819be-9d91-42c9-a24f-bd2c2f9d058b">The Standard is published as NEMA Standard PS3, and its Parts are identified by the numbering of the NEMA publication (PS3.1, PS3.2, etc.).</para>
    <para xml:id="para_5e7cf400-834e-4621-95a9-9a8d003b44e0">DICOM® is the registered trademark of the National Electrical Manufacturers Association for its standards publications relating to digital communications of medical information, all rights reserved.</para>
    <para xml:id="para_f3031d7d-3e6e-47f0-9cb5-d70056284b2b">HL7® and CDA® are the registered trademarks of Health Level Seven International, all rights reserved.</para>
    <para xml:id="para_a9231a05-4bc8-4615-827c-8829b34ed019">SNOMED®, SNOMED Clinical Terms®, SNOMED CT® are the registered trademarks of the International Health Terminology Standards Development <foreignphrase xml:lang="en-GB">Organisation</foreignphrase> (IHTSDO), all rights reserved.</para>
    <para xml:id="para_2ea4fb45-5b3b-491c-a032-4b464156d42a">LOINC® is the registered trademark of Regenstrief Institute, Inc, all rights reserved.</para>
  </chapter>
  
  <chapter label="1" status="1" xml:id="chapter_1">
    <title>Scope and Field of Application</title>
    <para xml:id="para_2017ee20-1d0a-4e65-ad76-eb8b297cda3a">PS3.1 provides an overview of the entire Digital Imaging and Communications in Medicine
      (DICOM) Standard. It describes the history, scope, goals, and structure of the Standard. In
      particular, it contains a brief description of the contents of each part of the
      Standard.</para>
    <section label="1.1" status="2" xml:id="sect_1.1">
      <title>Scope of DICOM</title>
      <para xml:id="para_7a47dcbe-eab3-4dd2-9275-31c38c13b90b">Digital Imaging and Communications in Medicine (DICOM) is the standard for the communication and management of medical imaging information and related data.</para>
      <para xml:id="para_d255c7c7-c0dc-46ff-8c21-43e1546688de">The DICOM Standard facilitates interoperability of medical imaging equipment by
        specifying:</para>
      <para xml:id="para_c4aee28b-f6c1-49a7-a2b8-585665d3ccfc">
        <itemizedlist>
          <listitem>
            <para xml:id="para_3e2dd910-26a3-40b6-9be8-34339e7e458e">For network communications, a set of protocols to be followed by devices claiming
              conformance to the Standard.</para>
          </listitem>
          <listitem>
            <para xml:id="para_2d012715-a95a-4b23-94cf-2fc870c25884">The syntax and semantics of Commands and associated information that can be
              exchanged using these protocols.</para>
          </listitem>
          <listitem>
            <para xml:id="para_de5b591c-3858-47d4-af37-0da3de7ce937">For media communication, a set of media storage services to be followed by devices
              claiming conformance to the Standard, as well as a File Format and a medical directory
              structure to facilitate access to the images and related information stored on
              interchange media.</para>
          </listitem>
          <listitem>
            <para xml:id="para_16e42287-7940-4186-8381-1bc32f4d1ef9">Information that must be supplied with an implementation for which conformance to
              the Standard is claimed.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_82b08f72-8223-4fff-b824-7e26b3f4429f">The DICOM Standard does not specify:</para>
      <para xml:id="para_b02ecb93-bede-426f-a448-eb62c5375019">
        <itemizedlist>
          <listitem>
            <para xml:id="para_e25fbe43-5c0b-4db3-ae07-6256f0e18ae4">The implementation details of any features of the Standard on a device claiming
              conformance.
            </para>
          </listitem>
          <listitem>
            <para xml:id="para_bbd0115f-12ab-4665-870d-43420ba9bf3e">The overall set of features and functions to be expected from a system implemented
              by integrating a group of devices each claiming DICOM conformance.</para>
          </listitem>
          <listitem>
            <para xml:id="para_6605eae4-88a5-4ab1-af9e-955832deeaa8">A testing/validation procedure to assess an implementation's conformance to the
              Standard.</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="1.2" status="2" xml:id="sect_1.2">
      <title>Field of Application</title>
    <para xml:id="para_34ba4ab2-828c-4305-a704-930c077376ee">The DICOM Standard pertains to the field of Medical Informatics. Within that field, it
      addresses the exchange of digital information between medical imaging equipment and other
      systems. Because such equipment may interoperate with other medical devices and information systems, the scope of this
      Standard needs to overlap with other areas of medical informatics. However, the DICOM Standard
      does not address the breadth of this field.</para>
      <para xml:id="para_c95bc0bb-d13a-4770-a96e-23a8faf6159b">This Standard has been developed with an emphasis on diagnostic medical imaging as practiced in radiology, cardiology, pathology, dentistry,
        ophthalmology and related disciplines, and image-based therapies such as interventional radiology, radiotherapy and surgery.
        However, it is also applicable to a wide range of image and non-image related information exchanged in clinical, research,
        veterinary, and other medical environments.</para>
      <para xml:id="para_082e8a0c-4ec0-4a75-b70f-e6c7c11368c6">This Standard facilitates interoperability of systems claiming conformance in a multi-vendor environment, but does not, by itself,
        guarantee interoperability.</para>
    </section>
    <section label="1.3" status="2" xml:id="sect_1.3">
      <title>History</title>
      <para xml:id="para_0f07e136-3ada-463c-8073-19dae3b76a69">With the introduction of computed tomography (CT) followed by other digital diagnostic
        imaging modalities in the 1970's, and the increasing use of computers in clinical
        applications, the American College of Radiology (ACR) and the National Electrical
        Manufacturers Association (NEMA) recognized the emerging need for a standard method for
        transferring images and associated information between devices manufactured by various
        vendors. These devices produce a variety of digital image formats.</para>
      <para xml:id="para_b3b697a6-f1cc-4145-8b63-71ee23f3084e">The American College of Radiology (ACR) and the National Electrical Manufacturers
        Association (NEMA) formed a joint committee in 1983 to develop a standard to:</para>
      <para xml:id="para_be25197e-2e12-4a83-908c-3ee729088495">
        <itemizedlist>
          <listitem>
            <para xml:id="para_d29090b2-888d-4947-b102-d50b660d285d">Promote communication of digital image information, regardless of device
              manufacturer</para>
          </listitem>
          <listitem>
            <para xml:id="para_66b53335-cd6e-467e-9245-b9634cf11a78">Facilitate the development and expansion of picture archiving and communication
              systems (PACS) that can also interface with other systems of hospital
              information</para>
          </listitem>
          <listitem>
            <para xml:id="para_c947e565-ab1c-4cd5-97ba-a2b85ddbeeb8">Allow the creation of diagnostic information data bases that can be interrogated
              by a wide variety of devices distributed geographically.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_ff76949a-0981-40dd-a0a8-826f7cc55188">ACR-NEMA Standards Publication No. 300-1985, published in 1985 was designated version
        1.0. The Standard was followed by two revisions: No. 1, dated October 1986 and No. 2, dated
        January 1988. These Standards Publications specified a hardware interface, a minimum set of software commands, and a consistent set of data formats.</para>
      <para xml:id="para_ab30fa0a-8642-4195-a5ba-c0701fc684c5">ACR-NEMA Standards Publication No. 300-1988, published in 1988 was designated version
        2.0. It included version 1.0, the published revisions, and additional revisions. It also
        included new material to provide command support for display devices, to introduce a new
        hierarchy scheme to identify an image, and to add data elements for increased specificity
        when describing an image.</para>
      <para xml:id="para_f31f883a-165b-4fdd-b57f-0d5253aa4ac2">In 1993, ACR-NEMA Standard 300 was substantially revised and replaced by this Standard, designated Digital Imaging and Communications in
        Medicine (DICOM). It embodies a number of major enhancements to previous versions of the
        ACR-NEMA Standard:</para>
      <para xml:id="para_f251abd6-c0ba-4337-8044-e35386baa3a7">
        <itemizedlist>
          <listitem>
            <para xml:id="para_8dc4f1ea-d6c9-479c-9d06-6aa317e18cb4">It is applicable to a networked environment. The ACR-NEMA Standard was applicable
              in a point-to-point environment only; for operation in a networked environment a
              Network Interface Unit (NIU) was required. DICOM supports operation in a networked
              environment using the industry standard networking protocol TCP/IP.</para>
          </listitem>
          <listitem>
            <para xml:id="para_cd7615a9-a1ce-48e5-8794-c54d9650a966">It is applicable to off-line media exchange. The ACR-NEMA Standard did not
              specify a file format or choice of physical media or logical filesystem. DICOM
              supports operation in an off-line media environment using industry standard media such
              as CD-R, DVD-R and USB and common file systems.</para>
          </listitem>
          <listitem>
            <para xml:id="para_daa65848-d128-471d-aaeb-c20161536e9f">It is a service oriented protocol, specifying the semantics of commands and associated data, and how devices claiming conformance to the Standard react to commands
              and data being exchanged. Specified services include support for management of the workflow of an imaging department. The ACR-NEMA Standard was confined to the transfer of data
              with only implicit service requirements.</para>
          </listitem>
          <listitem>
            <para xml:id="para_d2a0ba35-3fc1-4b61-a779-05311005737a">It specifies levels of conformance. The ACR-NEMA Standard specified a minimum
              level of conformance. DICOM explicitly describes how an implementor must structure a
              Conformance Statement to select specific options.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_7a4232f0-c4e5-4ead-86f6-531096bedc80">In 1995, with the addition of DICOM capabilities for cardiology imaging supported by the American College of Cardiology, the ACR-NEMA Joint Committee
        was reorganized as the DICOM Standards Committee, a broad collaboration of stakeholders across all medical imaging specialties.</para>
    </section>
    <section label="1.4" status="2" xml:id="sect_1.4">
      <title>Principles</title>
      <section label="1.4.1" status="3" xml:id="sect_1.4.1">
        <title>Global Applicability and Localization</title>
        <para xml:id="para_04123766-a3d6-498d-8ab8-2477d98f19cb">DICOM is a world-wide standard that can be used in every locale. It provides mechanisms to handle data  that support cultural requirements,
          such as different writing systems, character sets, languages, and structures for addresses and person names. It supports the variety of workflows,
          processes and policies used for biomedical imaging in different geographic regions, medical specialties and local practices.</para>
        <para xml:id="para_b30e2faf-eb75-4d6e-a913-8b15187823fe">Localization to meet the requirements of national or local health and workflow policies can be done without deviating from the Standard.
          Such localization may include specifying code sets (e.g., procedure codes), or profiling data element usage (both specifying locally allowed
          values, and making elements that are optional in the Standard mandatory for local use).</para>
        <para xml:id="para_f0f399c4-33b7-43ca-813b-06182686d3b9">Localization and profiling can be specified in a number of mechanisms outside the purview of the DICOM Standard.
          One such mechanism is Integration Profiles from the Integrating the Healthcare Enterprise (IHE) organization.
          It is important that Profiling adhere to the concept of non-contradiction.
          A Profile can add requirements but should not contradict DICOM requirements, as that would make it
          impossible to comply with both DICOM and the Profile.</para>
      </section>
      <section label="1.4.2" status="3" xml:id="sect_1.4.2">
        <title>Continuous Maintenance</title>
        <para xml:id="para_92d8fc17-e16c-4f3f-aa59-4a363e85e5ea">The DICOM Standard is an evolving standard and it is maintained in accordance with
          the Procedures of the DICOM Standards Committee.
          Proposals for enhancements are welcome from all users of the Standard, and may be submitted to the Secretariat.
          Supplements and corrections to the Standard are balloted and approved several times a year.
          When approved as Final Text, each change becomes official, is published separately, and goes into effect immediately.
          At intervals, all of the approved Final Text changes are consolidated and published in an updated edition of the Standard.
          Once changes are consolidated into an updated edition of the Standard, the individual change documents are not maintained;
          readers are directed to use the consolidated edition of the Standard.</para>
        <para xml:id="para_f90e202d-d0df-4f16-a448-249415749e26">A requirement in updating the Standard is to maintain effective compatibility with previous editions.</para>
        <para xml:id="para_38486599-c754-4f17-87ad-987c1542a50f">The maintenance process may involve retirement of sections of the Standard.</para>
        <para xml:id="para_0eae6a18-2317-4baf-8bc9-c7d9db9f8eb1">Retirement does not imply that these features cannot be used. However, the DICOM
          Standards Committee will not maintain the documentation of retired features. The reader is
          referred to earlier editions of the Standard.</para>
        <para xml:id="para_d3113d8d-92c2-466a-9caa-fdeb11436b1f">The use of the retired features is discouraged for new implementations, in favor of those
          alternatives remaining in the standard.</para>
      </section>
      <section label="1.4.3" status="3" xml:id="sect_1.4.3">
        <title>Information Objects and Unique Object Identification</title>
        <para xml:id="para_cceb855c-648d-45b2-bcd3-0c20c258a0b9">Many DICOM services involve the exchange of persistent information objects, such as images.
          An instance of such an information object may be exchanged across many systems and many organizational contexts, and over time.
          While minor changes may be made to the attributes of an instance to facilitate its handling within a particular organization
          (e.g., by coercing a Patient ID to the value used in a local context), the semantic content of an instance does not change.</para>
        <para xml:id="para_ed5b9ea4-0f90-4a87-af56-3ada86b43246">Each instance is identified by a globally unique object identifier, which
          persists with the instance across all exchanges. Changes to the semantic content of an instance are defined to create a new instance,
          which is assigned a new globally unique object identifier.</para>
      </section>
      <section label="1.4.4" status="3" xml:id="sect_1.4.4">
        <title>Conformance</title>
        <para xml:id="para_1d8943a1-ead9-44e8-b712-33000a2475c8">Conformance to the DICOM Standard is stated in terms of Service-Object Pair (SOP) Classes, which represent Services
          (such as Storage using network, media, or web) operating on types of Information Objects  (such as CT or MR images).</para>
        <para xml:id="para_13265bb8-dae6-459d-8e3f-d343efee9e86">SOP Class specifications in the DICOM Standard are only changed in a manner that is intended to be forward and backward
          compatible for all editions of the Standard. Conformance requirements and conformance claims are therefore referenced to the
          identifier of the SOP Class, and never referenced to an edition of the Standard.</para>
        <para xml:id="para_33420af3-935a-46e5-bdbd-3fc4b4eac001">Each implementation is required to provide a Conformance Statement, in accordance with a consistent <foreignphrase xml:lang="la">pro forma</foreignphrase> structure,
          facilitating comparison of products for interoperability.</para>
      </section>
      <section label="1.4.5" status="3" xml:id="sect_1.4.5">
        <title>Consistency of Information Model</title>
        <para xml:id="para_c953a659-68b4-49b2-b0b1-1e74b09218f4">A large number of information objects defined in the DICOM Standard follow a common composite information model with
          information entities representing Patient, Study, Series, Equipment, Frame of Reference, and the specific instance data type.
          This information model is a simplification of the real world concepts and activities of medical imaging;
          for acquisition modalities, a Study is approximately equivalent to an ordered procedure, and a Series is approximately
          equivalent to a performed data acquisition protocol element. In other domains, such as Radiotherapy, the Study and Series are
          less clearly related to real world entities or activities, but are still required for consistency.
          This simplified model is sufficient for the pragmatic needs of managing imaging and related data collected in routine practice.</para>
        <para xml:id="para_4a62af23-9477-4017-bbb4-2349cbaad4d0">New information objects defined in DICOM will typically conform to this existing common information model,
          allowing reuse of implementations with minimal changes to support the new objects.</para>
      </section>
    </section>
  </chapter>
  <chapter label="2" status="1" xml:id="chapter_2">
    <title>Normative References</title>
    <para xml:id="para_d480ea5b-96f8-4a78-a381-909c8600ec4b"/>
    <bibliography>
      <title/>
      <biblioentry xml:id="biblio_ISODirectives2">
        <abbrev>ISO/IEC Directives, Part 2</abbrev>
        <author>
          <orgname>ISO/IEC</orgname>
        </author>
        <date>2016/05</date>
        <edition>7.0</edition>
        <title>Rules for the structure and drafting of International Standards</title>
        <bibliosource>
          <link xl:href="http://www.iec.ch/members_experts/refdocs/iec/isoiecdir-2%7Bed7.0%7Den.pdf"/>
        </bibliosource>
      </biblioentry>
      <biblioentry xml:id="biblio_ACRNEMA300_1988">
        <abbrev>ACR/NEMA 300</abbrev>
        <author>
          <orgname>ACR/NEMA</orgname>
        </author>
        <date>1988</date>
        <title>Digital Imaging and Communications</title>
      </biblioentry>
      <biblioentry xml:id="biblio_ISO8822_1994">
        <abbrev>ISO/IEC 8822</abbrev>
        <author>
          <orgname>ISO/IEC</orgname>
        </author>
        <date>1994</date>
        <title>Information Processing Systems - Open Systems Interconnection - Connection Oriented Presentation Service Definition</title>
      </biblioentry>
      <biblioentry xml:id="biblio_ISO8649_1996">
        <abbrev>ISO/IEC 8649</abbrev>
        <author>
          <orgname>ISO/IEC</orgname>
        </author>
        <date>1996</date>
        <title>Information Processing Systems - Open Systems Interconnection - Service Definition for the Association Control Service Element</title>
        <releaseinfo>
          <remark>Withdrawn 2012.</remark>
        </releaseinfo>
      </biblioentry>
    </bibliography>
  </chapter>
  <chapter label="3" status="1" xml:id="chapter_3">
    <title>Definitions</title>
    <para xml:id="para_892f86ea-a08b-43d4-92b2-fb556ab0774d"/>
    <glossary>
      <title/>
      <glossentry>
        <glossterm>Attribute</glossterm>
        <glossdef>
          <para xml:id="para_6918bd83-fed4-4a97-882a-3e200b3c2878">A property of an Information Object. An Attribute
        has a name and a value that are independent of any encoding scheme.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Command</glossterm>
        <glossdef>
          <para xml:id="para_19044bbb-225f-450f-bfc7-bb06da9c810a">A request to operate on information across a network.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Command Element</glossterm>
        <glossdef>
          <para xml:id="para_006b42b8-8b45-4b5f-9871-cab6b7163466">An encoding of a parameter of a command that conveys this parameter's value.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Command Stream</glossterm>
        <glossdef>
          <para xml:id="para_6acc4490-c493-4b9c-bc27-a359b4453727">The result of encoding a set of DICOM Command Elements using the DICOM encoding scheme.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Conformance Statement</glossterm>
        <glossdef>
          <para xml:id="para_c43f5184-0342-4a51-9b07-7b5fd5545993">A formal statement that describes a
      specific product implementation that uses the DICOM Standard. It specifies the Service
      Classes, Information Objects, and Communication Protocols supported by the implementation.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Data Dictionary</glossterm>
        <glossdef>
          <para xml:id="para_f0a61682-18f1-4d68-a613-9361e05b0d17">A registry of DICOM Data Elements that assigns a unique tag, a name,
        value characteristics, and semantics to each Data
      Element.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Data Element</glossterm>
        <glossdef>
          <para xml:id="para_fb6c4bfb-93ea-4500-8c94-2ea10f3a26a6">A unit of information as defined by a single entry in the data dictionary.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Data Set</glossterm>
        <glossdef>
          <para xml:id="para_ad8cecfa-d44a-49b4-ae75-801f0cf960ef">Exchanged information consisting of a structured
      set of Attributes. The value of each Attribute in a Data Set is expressed as a Data
      Element.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Data Stream</glossterm>
        <glossdef>
          <para xml:id="para_5e3c3316-1066-4125-9cc0-e5869ac21f0f">The result of encoding a Data Set using the
      DICOM encoding scheme (Data Element Numbers and representations as specified by the Data
      Dictionary).</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Information Object</glossterm>
        <glossdef>
          <para xml:id="para_34d8edce-dea8-4043-9d4a-653d4f228634">An abstraction of a real information
      entity (e.g., CT Image, Structured Report, etc.) that is acted upon by one or more DICOM
      Commands.</para>
          <note>
            <para xml:id="para_8de67f41-9f1d-48bb-afd0-238392f3b865">This term is primarily used in PS3.1, with a few references in <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/>. It is an
            informal term corresponding to a formal term that is introduced in <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/>. In all other
            parts of the DICOM Standard this formal term is known as an Information Object
            Definition.</para>
          </note>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Information Object Class</glossterm>
        <glossdef>
          <para xml:id="para_0612db04-d94d-4220-bb9f-20c044587a15">A formal description of an Information Object, which includes a description of its purpose and
          the Attributes it possesses. It does not include values for these attributes.</para>
          <note>
            <para xml:id="para_544fcd11-963a-484e-bb96-8e4a4409235d">This term is only used in PS3.1. It is an informal term corresponding to a formal
            term that is introduced in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>. This formal term is known as a Service-Object Pair Class
            or more commonly as a SOP Class.</para>
          </note>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Information Object Instance</glossterm>
        <glossdef>
          <para xml:id="para_5018512a-d7e7-4d1e-85bb-d5a2d598c6be">A representation of an occurrence of an real-world entity, which includes values for the
          Attributes of the Information Object Class to which the entity belongs.</para>
          <note>
            <para xml:id="para_f46795a4-3588-4be5-8d4a-1e2e9bbed96e">This term is only used in PS3.1. It is an informal term corresponding to a formal
            term that is introduced in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>. This formal term is known as a Service-Object Pair
            Instance or more commonly as a SOP Instance.</para>
          </note>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Message</glossterm>
        <glossdef>
          <para xml:id="para_bda3f417-dad1-4296-abed-8288c235ccfd">A data unit of the Message Exchange Protocol
      exchanged between two cooperating DICOM Applications. A Message is composed of a Command
      Stream followed by an optional Data Stream.</para>
        </glossdef>
      </glossentry>
      <glossentry>
        <glossterm>Service Class</glossterm>
        <glossdef>
          <para xml:id="para_e938b4ab-8346-47e4-90f7-0116eaad38c2">A structured description of a service that is
      supported by cooperating DICOM Applications using specific DICOM Commands acting on a specific
      class of Information Object.</para>
        </glossdef>
      </glossentry>
    </glossary>
  </chapter>
  <chapter label="4" status="1" xml:id="chapter_4">
    <title>Symbols and Abbreviations</title>
    <variablelist>
      <varlistentry>
        <term>ACSE</term>
        <listitem>
          <para xml:id="para_2ff05edb-de2d-43f1-bf22-6d495ca774b6">Association Control Service Element</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>CT</term>
        <listitem>
          <para xml:id="para_57c9b597-effe-4b96-a052-f0dd3d804821">Computed Tomography</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>DICOM</term>
        <listitem>
          <para xml:id="para_27c4717c-7201-4038-a14a-61876e7b84d0">Digital Imaging and Communications in Medicine</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>HIS</term>
        <listitem>
          <para xml:id="para_ad7613ba-5318-47a2-965e-dfd59408ec7d">Hospital Information System</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>JIRA</term>
        <listitem>
          <para xml:id="para_462513c9-1938-41f7-b776-241aa1cf4180">Japan Medical Imaging and Radiological Systems Industries Association</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>OSI</term>
        <listitem>
          <para xml:id="para_a612b68e-7b33-4cce-b4a4-602fca9c1549">Open Systems Interconnection</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>PACS</term>
        <listitem>
          <para xml:id="para_e61ca775-dc6e-4acb-b816-3d6f3c4079b2">Picture Archiving and Communication Systems</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>REST</term>
        <listitem>
          <para xml:id="para_c60e17b8-4a34-4258-a37f-594861a74336">Representational State Transfer</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>RESTful</term>
        <listitem>
          <para xml:id="para_3ddd07b0-6bfb-4865-98ab-e3781dbb1db3">A RESTful Web service is a Web service implemented using REST architecture and HTTP (see
        <link xl:href="http://www.ics.uci.edu/~fielding/pubs/dissertation/fielding_dissertation.pdf"/>)</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>RIS</term>
        <listitem>
          <para xml:id="para_012920c3-044d-4405-b48a-cbab3d18a8b9">Radiology Information System</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>STOW-RS</term>
        <listitem>
          <para xml:id="para_15a0a882-025a-4d4d-84e7-f161bd4cda7b">STore Over the Web by RESTful Services</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>TCP/IP</term>
        <listitem>
          <para xml:id="para_bbb5cf73-2e31-46d1-8836-568754128804">Transmission Control Protocol/Internet Protocol</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>WADO-RS</term>
        <listitem>
          <para xml:id="para_04685d69-3464-4e35-ae01-a4c6c0a4775a">Web Access to DICOM Objects by RESTful Services</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>WADO-URI</term>
        <listitem>
          <para xml:id="para_065d1572-aceb-41c8-b52c-72bce2a4850f">Web Access to DICOM Objects by URI</para>
        </listitem>
      </varlistentry>
      <varlistentry>
        <term>WADO-WS</term>
        <listitem>
          <para xml:id="para_14cc1188-89d9-4e20-a03f-98d0b117d043">Web Access to DICOM Objects by Web Services (WS*)</para>
        </listitem>
      </varlistentry>
    </variablelist>
  </chapter>
  <chapter label="5" status="1" xml:id="chapter_5">
    <title>The DICOM Communication Model</title>
    <para xml:id="para_41d06a43-df74-4eb7-92d5-a88a6bafc255">The DICOM Standard facilitates interoperability of devices claiming conformance. In
      particular, it:</para>
    <para xml:id="para_076a5f1e-abc7-44fa-b811-746b1ce9ca9c">
      <itemizedlist>
        <listitem>
          <para xml:id="para_940bb802-a2d9-4fae-aa1d-e66583762ef7">Addresses the semantics of Commands and associated data. For devices to interact,
            there must be standards on how devices are expected to react to Commands and associated
            data, not just the information that is to be moved between devices.</para>
        </listitem>
        <listitem>
          <para xml:id="para_fda94652-6cd0-4eb5-9fc4-cda920b0bcc3">Addresses the semantics of file services, file formats and information directories
            necessary for off-line communication.</para>
        </listitem>
        <listitem>
          <para xml:id="para_f50732ca-fb95-4139-9118-24ab620709f3">Is explicit in defining the conformance requirements of implementations of the
            Standard. In particular, a conformance statement must specify enough information to
            determine the functions for which interoperability can be expected with another device
            claiming conformance.</para>
        </listitem>
        <listitem>
          <para xml:id="para_4cf7aeab-2161-465c-8306-4d2cddcac199">Facilitates operation in a networked environment.</para>
        </listitem>
        <listitem>
          <para xml:id="para_a74745a5-2250-484c-9dee-9be441736bd6">Is structured to accommodate the introduction of new services, thus facilitating
            support for future medical imaging applications.</para>
        </listitem>
        <listitem>
          <para xml:id="para_91d71d4c-082a-412a-b8a3-b73d57f6d290">Makes use of existing international standards wherever applicable, and itself
            conforms to established documentation guidelines for international standards.</para>
        </listitem>
      </itemizedlist>
    </para>
    <para xml:id="para_7514f59e-066a-4fc9-8297-695395626c95">
<xref linkend="figure_5-1" xrefstyle="select: label"/> presents the general communication model of the Standard, which spans both
      network (on-line) and media storage interchange (off-line) communication. Applications may
      utilize any of the following transport mechanisms:</para>
    <para xml:id="para_3adcc852-71e5-4e56-b59e-4c46e4133c04">
      <itemizedlist>
        <listitem>
          <para xml:id="para_eb67ee46-3400-44ec-ae0c-d5af8e2011ea">the DICOM Message Service and Upper Layer Service, which provides independence from specific physical
            networking communication support and protocols such as TCP/IP. </para>
        </listitem>
        <listitem>
          <para xml:id="para_bc812d57-953f-4c9e-8864-e275dea08784">the DICOM Web Service API and HTTP Service, which allows use of common hypertext and associated protocols for transport of DICOM services</para>
        </listitem>
        <listitem>
          <para xml:id="para_f1368667-cbeb-4f40-a789-33a02cc2bd60">The Basic DICOM File Service, which provides access to Storage Media independently
            from specific media storage formats and file structures.</para>
        </listitem>
      </itemizedlist>
    </para>
    <para xml:id="para_ea38162d-7112-496c-b343-ee5e48f366d4">
      <figure label="5-1" pgwide="1" xml:id="figure_5-1">
        <title>General Communication Model</title>
        <mediaobject>
          <imageobject>
            <imagedata fileref="figures/PS3.1_5-1.svg"/>
          </imageobject>
        </mediaobject>
      </figure>
    </para>
  </chapter>
  <chapter label="6" status="1" xml:id="chapter_6">
    <title>Overview of The Content of The DICOM Standard</title>
    <section label="6.1" status="2" xml:id="sect_6.1">
      <title>Document Structure</title>
      <para xml:id="para_97e20a36-ae4e-4c38-8257-72a58ab88c9d">DICOM consists of the following parts:</para>
      <itemizedlist>
        <listitem>
          <para xml:id="para_e199e49c-e2f1-413e-9e58-65ad92df4ede">PS3.1: Introduction and Overview (this document)</para>
        </listitem>
        <listitem>
          <para xml:id="para_b6e49d56-c4d5-4986-bf41-cb9bd0a3dd80">
<olink targetdoc="PS3.2" targetptr="PS3.2">PS3.2: Conformance</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_c441bb8b-d6fb-4752-b1ef-aeb3306c6f29">
<olink targetdoc="PS3.3" targetptr="PS3.3">PS3.3: Information Object Definitions</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_c0f85f60-6899-4a5b-9724-ab2804d62e05">
<olink targetdoc="PS3.4" targetptr="PS3.4">PS3.4: Service Class Specifications</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_e55c4ca7-c163-4a70-a12a-4823913b561f">
<olink targetdoc="PS3.5" targetptr="PS3.5">PS3.5: Data Structures and Encoding</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_f63cb4a4-af61-4294-b1ea-4e555c2108d8">
<olink targetdoc="PS3.6" targetptr="PS3.6">PS3.6: Data Dictionary</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_326cf503-6f35-4e7f-a690-f2c0d02ad7e6">
<olink targetdoc="PS3.7" targetptr="PS3.7">PS3.7: Message Exchange</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_cdca89c7-fed6-4cc8-a4e6-b14f3b6cd9a3">
<olink targetdoc="PS3.8" targetptr="PS3.8">PS3.8: Network Communication Support for Message Exchange</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_faf7f297-d093-4cc3-9065-5277160c315b">PS3.9: Retired</para>
        </listitem>
        <listitem>
          <para xml:id="para_d5e4e97f-6eed-4470-9f04-32fb1f9d4fda">
<olink targetdoc="PS3.10" targetptr="PS3.10">PS3.10: Media Storage and File Format for Media Interchange</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_2dc49567-84f4-461e-aff8-e4ae9a456137">
<olink targetdoc="PS3.11" targetptr="PS3.11">PS3.11: Media Storage Application Profiles</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_520a7854-3e35-4146-8d2a-1b5b64efd0dc">
<olink targetdoc="PS3.12" targetptr="PS3.12">PS3.12: Formats and Physical Media</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_e3dc69bc-48a1-4d04-85a0-47c144ef750a">PS3.13: Retired</para>
        </listitem>
        <listitem>
          <para xml:id="para_4df1cddf-2ff2-41d4-bb30-86dbbd8875d9">
<olink targetdoc="PS3.14" targetptr="PS3.14">PS3.14: Grayscale Standard Display Function</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_10c2f72c-9d8f-4dfe-a22f-7aba2418a22b">
<olink targetdoc="PS3.15" targetptr="PS3.15">PS3.15: Security and System Management Profiles</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_9fb4a8ca-5f8f-4dbb-bde8-e63bd32bd333">
<olink targetdoc="PS3.16" targetptr="PS3.16">PS3.16: Content Mapping Resource</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_eb960f58-1a05-4bc1-9757-2f2ec361007e">
<olink targetdoc="PS3.17" targetptr="PS3.17">PS3.17: Explanatory Information</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_cb5b5ebc-7272-479b-ae25-d1a05e2665e5">
<olink targetdoc="PS3.18" targetptr="PS3.18">PS3.18: Web Services</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_c87daed3-6a01-4975-b2a2-965295526782">
<olink targetdoc="PS3.19" targetptr="PS3.19">PS3.19: Application Hosting</olink>
</para>
        </listitem>
        <listitem>
          <para xml:id="para_cc76adf4-9f76-463e-bd77-d82bffe77394">
<olink targetdoc="PS3.20" targetptr="PS3.20">PS3.20: Imaging Reports using HL7 Clinical Document Architecture</olink>
</para>
        </listitem>
      </itemizedlist>
      <para xml:id="para_559273ae-baec-40c4-9f4d-b5182bb599db">These parts of the Standard are related but independent documents. A brief description
        of each Part is provided in this section.</para>
    </section>
    <section label="6.2" status="2" xml:id="sect_6.2">
      <title>PS3.2: Conformance</title>
      <para xml:id="para_bd45173f-bbab-4aed-94ae-b5d8f4dacd5a">
<olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/> of the DICOM Standard defines principles that implementations claiming
        conformance to the Standard shall follow:</para>
      <para xml:id="para_85f43bc4-16be-492e-a8e3-4b9252161180">
        <itemizedlist>
          <listitem>
            <para xml:id="para_26d27b1d-ad3d-405e-8703-90fb681ddefb">Conformance requirements. <olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/> specifies the general requirements that must be
              met by any implementation claiming conformance. It references the conformance sections
              of other parts of the Standard.</para>
          </listitem>
          <listitem>
            <para xml:id="para_a58ee982-9bc5-4719-bd8a-2063225d3812">Conformance Statement. <olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/> defines the structure of a Conformance Statement. It
              specifies the information that must be present in a Conformance Statement. It
              references the Conformance Statement sections of other parts of the Standard.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_8971f950-0d5c-47f3-9e80-05515bdfca6c">
<olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/> does not specify a testing/validation procedure to assess an implementation's
        conformance to the Standard.</para>
      <para xml:id="para_74f8cb8b-024d-4740-b122-66a91a059437">
<xref linkend="figure_6.2-1" xrefstyle="select: label"/> and <xref linkend="figure_6.2-2" xrefstyle="select: label"/> depict the construction process for a Conformance Statement for
        both network communication and media exchange. A Conformance Statement consists of the
        following parts:</para>
      <para xml:id="para_4165e61d-2015-4fa8-b11f-cf4373de0f86">
        <itemizedlist>
          <listitem>
            <para xml:id="para_62593999-27cf-445b-aef8-5cfe8e1286e9">Set of Information Objects that is recognized by this implementation</para>
          </listitem>
          <listitem>
            <para xml:id="para_e702c702-30fb-4c86-98aa-7371909b6b6d">Set of Service Classes that this implementation supports</para>
          </listitem>
          <listitem>
            <para xml:id="para_3b632bdc-7851-40c0-9f3a-f4b69dae0b3f">Set of communications protocols or physical media that this implementation
              supports</para>
          </listitem>
          <listitem>
            <para xml:id="para_5ce334c8-0a7b-4b71-8d97-bc782e6a30e4">Set of security measures that this implementation supports.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_f45708d6-0234-4517-87ab-6160fc2f7ccb">
        <figure label="6.2-1" pgwide="1" xml:id="figure_6.2-1">
          <title>Construction Process for a Network Conformance Claim</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.2-1.svg"/>
            </imageobject>
          </mediaobject>
        </figure>
      </para>
      <para xml:id="para_0113578c-2ed3-4952-812a-a66cee891759">
        <figure label="6.2-2" pgwide="1" xml:id="figure_6.2-2">
          <title>Construction Process for a Media Conformance Claim</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.2-2.svg"/>
            </imageobject>
          </mediaobject>
        </figure>
      </para>
    </section>
    <section label="6.3" status="2" xml:id="sect_6.3">
      <title>PS3.3: Information Object Definitions</title>
      <para xml:id="para_aba0d24b-4d90-4f20-860b-592fe71e6d9d">
<olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies a number of Information Object Classes that
        provide an abstract definition of real-world entities applicable to communication of digital
        medical images and related information (e.g., waveforms, structured reports, radiation
        therapy dose, etc.). Each Information Object Class definition consists of a description of
        its purpose and the Attributes that define it. An Information Object Class does not include
        the values for the Attributes that comprise its definition.</para>
      <para xml:id="para_3b8c193d-2046-4259-b756-4145f0e7a11b">Two types of Information Object Classes are defined: normalized and composite.</para>
      <para xml:id="para_c4dbba5f-1bea-48b5-85fe-8df5ac34b0fb">Normalized Information Object Classes include only those Attributes inherent in the
        real-world entity represented. For example the study Information Object Class, which is
        defined as normalized, contains study date and study time Attributes because they are
        inherent in an actual study. Patient name, however, is not an Attribute of the study
        Information Object Class because it is inherent in the patient on which the study was
        performed and not the study itself.</para>
      <para xml:id="para_d488d879-a222-4058-91ed-507c0471cab6">Composite Information Object Classes may additionally include Attributes that are
        related to but not inherent in the real-world entity. For example, the Computed Tomography
        Image Information Object Class, which is defined as composite, contains both Attributes that are inherent in the image (e.g., image date) and Attributes that are related to but
        not inherent in the image (e.g., patient name). Composite Information Object Classes provide
        a structured framework for expressing the communication requirements of images where image
        data and related data needs to be closely associated.</para>
      <para xml:id="para_251d843c-5f76-4eaa-9375-16ed4bdbe249">To simplify the Information Object Class definitions, the Attributes of each Information
        Object Class are partitioned with similar Attributes being grouped together. These groupings
        of Attributes are specified as independent modules and may be reused by other Composite
        Information Object Classes.</para>
      <para xml:id="para_6a598c99-6715-48f8-bf2d-d140796b59a5">
<olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/> defines a model of the Real World along with the corresponding Information Model
        that is reflected in the Information Object Definitions. Future editions of this Standard
        may extend this set of Information Objects to support new functionality.</para>
      <para xml:id="para_375ff34b-067b-4c72-b35c-537dc146100d">To represent an occurrence of a real-world entity, an Information Object Instance is
        created, which includes values for the Attributes of the Information Object Class. The
        Attribute values of this Information Object Instance may change over time to accurately
        reflect the changing state of the entity that it represents. This is accomplished by
        performing different basic operations upon the Information Object Instance to render a
        specific set of services defined as a Service Class. These Service Classes are defined in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> of the Standard.</para>
    </section>
    <section label="6.4" status="2" xml:id="sect_6.4">
      <title>PS3.4: Service Class Specifications</title>
      <para xml:id="para_dd16f025-0039-4d38-bd01-ec611d2d4d63">
<olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> of the DICOM Standard defines a number of Service Classes. A Service Class
        associates one or more Information Objects with one or more Commands to be performed upon
        these objects. Service Class Specifications state requirements for Command Elements and how
        resulting Commands are applied to Information Objects. Service Class Specifications state
        requirements for both providers and users of communications services.</para>
      <para xml:id="para_b497c5c3-c439-4e6d-8f27-8c424326d331">
<olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> of the DICOM Standard defines the characteristics shared by all Service Classes,
        and how a Conformance Statement to an individual Service Class is structured. It contains a
        number of normative annexes that describe individual Service Classes in detail.</para>
      <para xml:id="para_2d372b66-d4d2-4408-973f-43642eee4ad9">Examples of Service Classes include the following:</para>
      <para xml:id="para_74745882-eb53-4b2d-b1d3-bf60b3d169fe">
        <itemizedlist>
          <listitem>
            <para xml:id="para_82b75555-dafe-47b5-a659-3e93562b01cc">Storage Service Class</para>
          </listitem>
          <listitem>
            <para xml:id="para_d80ba4d7-e030-4d2e-8d32-ad875590347c">Query/Retrieve Service Class</para>
          </listitem>
          <listitem>
            <para xml:id="para_06085b4d-578f-4cae-87dc-b38228873518">Basic Worklist Management Service Class</para>
          </listitem>
          <listitem>
            <para xml:id="para_2a885f6a-92d2-492b-8ed3-f760d41f6980">Print Management Service Class.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_9c8c9db8-d849-4be7-945b-eafa58fcea42">
<olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> defines the operations performed upon the Information Objects defined in <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/>.
        <olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/> defines the Commands and protocols for using the Commands to accomplish the
        operations and notifications described in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>.</para>
    </section>
    <section label="6.5" status="2" xml:id="sect_6.5">
      <title>PS3.5: Data Structure and Semantics</title>
      <para xml:id="para_cb506be7-ebeb-4d38-b84e-7cc334623813">
<olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies how DICOM applications construct and encode the
        Data Set information resulting from the use of the Information Objects and Services Classes
        defined in <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/> and <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> of the DICOM Standard. The support of a number of standard
        image compression techniques (e.g., JPEG lossless and lossy) is specified.</para>
      <para xml:id="para_67a9844a-0dc6-4ada-93e9-42338a3d3d0d">
<olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/> addresses the encoding rules necessary to construct a Data Stream to be conveyed
        in a Message as specified in <olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/> of the DICOM Standard. This Data Stream is produced from
        the collection of Data Elements making up the Data Set.</para>
      <para xml:id="para_9dc1f3d0-4a2c-49c2-9039-d2301bfd3632">
<olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/> also defines the semantics of a number of generic functions that are common to
        many Information Objects. <olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/> defines the encoding rules for international character sets
        used within DICOM.</para>
    </section>
    <section label="6.6" status="2" xml:id="sect_6.6">
      <title>PS3.6: Data Dictionary</title>
      <para xml:id="para_988fef22-c88d-473c-a339-a5e5f782ec7a">
<olink targetdoc="PS3.6" targetptr="PS3.6" xrefstyle="select: labelnumber"/> of the DICOM Standard is the centralized registry that defines the collection of
        all DICOM Data Elements available to represent information, along with elements utilized for
        interchangeable media encoding and a list of uniquely identified items that are assigned by
        DICOM.</para>
      <para xml:id="para_0dde5b6f-37f4-43a1-8c8a-1afc74d7e4f9">For each element, <olink targetdoc="PS3.6" targetptr="PS3.6" xrefstyle="select: labelnumber"/> specifies:</para>
      <para xml:id="para_4b99e13f-f095-4f34-84d6-4ba05d5fcc3e">
        <itemizedlist>
          <listitem>
            <para xml:id="para_a3fbcde3-9eff-4c4c-adc3-e3fbdb71ddd1">its unique tag, which consists of a group and element number,</para>
          </listitem>
          <listitem>
            <para xml:id="para_b9725eaf-e3ee-4cd7-a96d-aed15e4714c4">its name,</para>
          </listitem>
          <listitem>
            <para xml:id="para_fa843b1f-b5e8-4a0d-a234-a0cb5773defb">its value representation (character string, integer, etc),</para>
          </listitem>
          <listitem>
            <para xml:id="para_dd9c9d81-d6ef-41a4-ae93-bd11139e8a86">its value multiplicity (how many values per attribute),</para>
          </listitem>
          <listitem>
            <para xml:id="para_dcd587ef-d93c-4f21-82ce-eb3364f8e0ad">whether it is retired.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_4d9666e1-ea20-4da7-9b0d-6f8c7ebd85c8">For each uniquely identified item, <olink targetdoc="PS3.6" targetptr="PS3.6" xrefstyle="select: labelnumber"/> specifies:</para>
      <para xml:id="para_27583f25-acf1-4e8a-8dd7-f83bc7085b44">
        <itemizedlist>
          <listitem>
            <para xml:id="para_f9213c23-7500-4dff-9e68-40742f50f32d">its unique value, which is numeric with multiple components separated by decimal
              points and limited to 64 characters,</para>
          </listitem>
          <listitem>
            <para xml:id="para_f080c9df-7e6a-4362-9886-a773f01e1053">its name,</para>
          </listitem>
          <listitem>
            <para xml:id="para_0656f3c9-0289-4348-b78a-8fec556ae542">its type, either Information Object Class, definition of encoding for data
              transfer, or certain well known Information Object Instances,</para>
          </listitem>
          <listitem>
            <para xml:id="para_87f4cf8c-5f81-47cd-8bd8-2a530364fcee">in which part of the DICOM Standard it is defined.</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="6.7" status="2" xml:id="sect_6.7">
      <title>PS3.7: Message Exchange</title>
      <para xml:id="para_929ca60e-13b9-4406-9118-095527359720">
<olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies both the service and protocol used by an
        application in a medical imaging environment to exchange Messages over the communications
        support services defined in <olink targetdoc="PS3.8" targetptr="PS3.8" xrefstyle="select: labelnumber"/>. A Message is composed of a Command Stream defined in <olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/> followed by an optional Data Stream as defined in <olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/>.</para>
      <para xml:id="para_a763806a-d766-4099-b6cd-86bd7df67fd1">
<olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/> specifies:</para>
      <para xml:id="para_c62c98f8-1461-4746-818b-08af9e1e87ae">
        <itemizedlist>
          <listitem>
            <para xml:id="para_d8b6d4a1-b4ca-452d-a80a-c5e212fb27ac">the operations and notifications (DIMSE Services) made available to Service
              Classes defined in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>,</para>
          </listitem>
          <listitem>
            <para xml:id="para_7b4613a1-66d1-439f-9ee1-e321067f8f93">rules to establish and terminate associations provided by the communications
              support specified in <olink targetdoc="PS3.8" targetptr="PS3.8" xrefstyle="select: labelnumber"/>, and the impact on outstanding transactions,</para>
          </listitem>
          <listitem>
            <para xml:id="para_091fbd17-7076-408c-ac9d-76924a3337d5">rules that govern the exchange of Command requests and responses,</para>
          </listitem>
          <listitem>
            <para xml:id="para_176b0403-53d5-4a29-ba89-e0cdf6116925">encoding rules necessary to construct Command Streams and Messages.</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="6.8" status="2" xml:id="sect_6.8">
      <title>PS3.8: Network Communication Support For Message Exchange</title>
      <para xml:id="para_4309f366-c769-4cb9-9e76-22a9f411edd5">
<olink targetdoc="PS3.8" targetptr="PS3.8" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies the communication services and the upper layer
        protocols necessary to support, in a networked environment, communication between DICOM
        applications as specified in <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/>, <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>, <olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/>, <olink targetdoc="PS3.6" targetptr="PS3.6" xrefstyle="select: labelnumber"/>, and <olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/>. These communication
        services and protocols ensure that communication between DICOM applications is performed in
        an efficient and coordinated manner across the network.</para>
      <para xml:id="para_6b56fe55-502d-417d-9c24-ce083b2872fe">The communication services specified in <olink targetdoc="PS3.8" targetptr="PS3.8" xrefstyle="select: labelnumber"/> are a proper subset of the services
        offered by the OSI Presentation Service (ISO 8822) and of the OSI Association Control
        Service Element (ACSE) (ISO 8649). They are referred to as the Upper Layer Service, which
        allows peer applications to establish associations, transfer messages and terminate
        associations.</para>
      <para xml:id="para_88e5fb7a-5f03-4faf-ac2e-f4fbf5129d3f">This definition of the Upper Layer Service specifies the use of the DICOM Upper Layer
        Protocol in conjunction with TCP/IP transport protocols.</para>
      <para xml:id="para_ce41ff30-24ca-4c12-ab97-957fb5797f3a">The TCP/IP communication protocol specified by <olink targetdoc="PS3.8" targetptr="PS3.8" xrefstyle="select: labelnumber"/> is a general purpose communication
        protocol not specific to the DICOM Standard. <xref linkend="figure_5-1" xrefstyle="select: label"/> shows this protocol stack.</para>
    </section>
    <section label="6.9" status="2" xml:id="sect_6.9">
      <title>PS3.9: Retired (formerly Point-to-point Communication Support For Message
        Exchange)</title>
      <para xml:id="para_f7d10194-0bbc-45e2-84db-d64cf1e0eb93">PS3.9 of the DICOM Standard previously specified the services and protocols used for
        point-to-point communications in a manner compatible with ACR-NEMA 2.0. It has been
        retired.</para>
    </section>
    <section label="6.10" status="2" xml:id="sect_6.10">
      <title>PS3.10 Media Storage and File Format</title>
      <para xml:id="para_32d11e4e-6d3f-4b68-a7f0-fb466b3314bd">
<olink targetdoc="PS3.10" targetptr="PS3.10" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies a general model for the storage of medical
        imaging information on removable media (see <xref linkend="figure_6.10-1" xrefstyle="select: label"/>). The purpose of this Part is to
        provide a framework allowing the interchange of various types of medical images and related
        information on a broad range of physical storage media.</para>
      <note>
        <para xml:id="para_8e0c48db-da50-49e1-b13a-a6cac22cd9a9">See <xref linkend="figure_5-1" xrefstyle="select: label"/> for understanding how the media interchange model compares to the
          network model.</para>
      </note>
      <para xml:id="para_2f9d8305-4758-4efb-aba7-d23368de9543">
<olink targetdoc="PS3.10" targetptr="PS3.10" xrefstyle="select: labelnumber"/> Specifies:</para>
      <para xml:id="para_1d0a0a1c-48b2-4899-ac2c-b0a9572c4fda">
        <itemizedlist>
          <listitem>
            <para xml:id="para_566ce5a4-469c-4a58-bd7e-702d7c4775f4">a layered model for the storage of medical images and related information on
              storage media. This model introduces the concept of media storage application
              profiles, which specify application specific subsets of the DICOM Standard to which a
              media storage implementation may claim conformance. Such a conformance applies only to
              the writing, reading and updating of the content of storage media.</para>
          </listitem>
          <listitem>
            <para xml:id="para_436bde1b-7b6a-4e43-8003-9c86d64731bc">a DICOM file format supporting the encapsulation of any Information Object;</para>
          </listitem>
          <listitem>
            <para xml:id="para_7cabdd29-c973-426a-8d11-d86125cfc556">a secure DICOM file format supporting the encapsulation of a DICOM file format in
              a cryptographic envelope;</para>
          </listitem>
          <listitem>
            <para xml:id="para_bdf5f8d1-e71c-4e1d-83b9-9456c05b887e">a DICOM file service providing independence from the underlying media format and
              physical media.</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_a1601c9a-cb33-47e3-b14a-7cf21f9f18c9">
<olink targetdoc="PS3.10" targetptr="PS3.10" xrefstyle="select: labelnumber"/> defines various media storage concepts:</para>
      <para xml:id="para_abc792a9-3bfb-42c4-a9c1-bbfaaf5616fc">
        <itemizedlist>
          <listitem>
            <para xml:id="para_1eb4109f-4fa8-4d46-acfe-5bb012214621">the method to identify a set of files on a single medium</para>
          </listitem>
          <listitem>
            <para xml:id="para_7507dfdf-2352-4307-a121-392871095d83">the method for naming a DICOM file within a specific file system</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_e81ea5d2-4863-42be-8734-20570f7095f0">
        <figure label="6.10-1" pgwide="1" xml:id="figure_6.10-1">
          <title>DICOM Media Communication Model</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.10-1.svg"/>
            </imageobject>
          </mediaobject>
        </figure>
      </para>
    </section>
    <section label="6.11" status="2" xml:id="sect_6.11">
      <title>PS3.11: Media Storage Application Profiles</title>
      <para xml:id="para_a62432f7-30dd-4cd5-a79a-dbc2473dea91">
<olink targetdoc="PS3.11" targetptr="PS3.11" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies application specific subsets of the DICOM
        Standard to which an implementation may claim conformance. These application specific
        subsets will be referred to as Application Profiles in this section. Such a conformance
        statement applies to the interoperable interchange of medical images and related information
        on storage media for specific clinical uses. It follows the framework, defined in <olink targetdoc="PS3.10" targetptr="PS3.10" xrefstyle="select: labelnumber"/>,
        for the interchange of various types of information on storage media.</para>
      <para xml:id="para_78b512e3-0119-4a43-a4aa-926f96090ac0">An Application Profile annex is organized into the following major parts:</para>
      <para xml:id="para_166da13d-8ed3-447d-87a6-24dd9be5a685">
        <itemizedlist>
          <listitem>
            <para xml:id="para_4b3ddf9c-73bd-425b-b2b4-fd0985f89130">The name of the Application Profile, or the list of Application Profiles grouped
              in a related class</para>
          </listitem>
          <listitem>
            <para xml:id="para_899f02dc-86f4-457e-b334-2c4a25ad0f3a">A description of the clinical context of the Application Profile</para>
          </listitem>
          <listitem>
            <para xml:id="para_afdcf75f-19f0-43ad-90d2-a027b3b995d3">The definition of the media storage Service Class with the device roles for the
              Application Profile and associated options</para>
          </listitem>
          <listitem>
            <para xml:id="para_c25ae8a8-e0f5-43e0-966b-43904768341d">Informative section describing the operational requirements of the Application
              Profile</para>
          </listitem>
          <listitem>
            <para xml:id="para_caccab6f-655d-4a2f-aa59-3b584a7b305e">Specification of the Information Object Classes and associated Information Objects
              supported and the encoding to be used for the data transfer</para>
          </listitem>
          <listitem>
            <para xml:id="para_81652156-d1ed-40ba-b064-0b2034d26116">The selection of media formats and physical media to be used</para>
          </listitem>
          <listitem>
            <para xml:id="para_46399d8f-120b-4d84-b334-0b19e2f863d3">Other parameters that need to be specified to ensure interoperable media
              interchange</para>
          </listitem>
          <listitem>
            <para xml:id="para_5745eccf-a2a4-4412-84e0-2d936abaa76b">Security parameters that select the cryptographic techniques to be used with
              secure media storage Application Profiles</para>
          </listitem>
        </itemizedlist>
      </para>
      <para xml:id="para_98c0fc1b-48b8-489e-9296-5958a2336909">The structure of DICOM and the design of the Application Profile mechanism is such that
        extension to additional Information Object Classes and the new exchange media is
        straightforward.</para>
      <note>
        <para xml:id="para_8a5f467e-6821-4eb1-9c02-2280c19605d0">
<xref linkend="figure_6.11-1" xrefstyle="select: label"/> shows how individual aspects of an Application profile map to the
          various parts of the DICOM Standard.</para>
      </note>
      <para xml:id="para_b5618d9a-e12f-4b59-8b9a-7df08c02512e">
        <figure label="6.11-1" pgwide="1" xml:id="figure_6.11-1">
          <title>Relationship Between an Application Profile and Parts of DICOM</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.11-1.svg"/>
            </imageobject>
          </mediaobject>
        </figure>
      </para>
    </section>
    <section label="6.12" status="2" xml:id="sect_6.12">
      <title>PS3.12: Storage Functions and Media Formats For Data Interchange</title>
      <para xml:id="para_af72fe20-124f-485b-b042-5260c4f34f0a">
<olink targetdoc="PS3.12" targetptr="PS3.12" xrefstyle="select: labelnumber"/> of the DICOM Standard facilitates the interchange of information between
        applications in medical environments by specifying:</para>
      <para xml:id="para_b1b30cdc-f3e4-4ed3-a562-2729bf831d22">
        <itemizedlist>
          <listitem>
            <para xml:id="para_31c3837c-b48e-45f7-885f-28a3e72e6c23">A structure for describing the relationship between the media storage model and a
              specific physical media and media format.</para>
          </listitem>
          <listitem>
            <para xml:id="para_73bb8a05-ba8c-46d9-bad3-74a58ddc4d26">Specific physical media characteristics and associated media formats.</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="6.13" status="2" xml:id="sect_6.13">
      <title>PS3.13: Retired (formerly Print Management Point-to-point Communication
        Support)</title>
      <para xml:id="para_45a56daf-6deb-461b-a172-efeeefb207a4">PS3.13 previously specified the services and protocols used for point-to-point
        communication of print management services. It has been retired.</para>
    </section>
    <section label="6.14" status="2" xml:id="sect_6.14">
      <title>PS3.14: Grayscale Standard Display Function</title>
      <para xml:id="para_3a21ac02-2d73-4d25-9535-05ea129120a1">
<olink targetdoc="PS3.14" targetptr="PS3.14" xrefstyle="select: labelnumber"/> specifies a standardized display function for consistent display of grayscale
        images. This function provides methods for calibrating a particular display system for the
        purpose of presenting images consistently on different display media (e.g., monitors and
        printers).</para>
      <para xml:id="para_0bbae57d-d76c-4147-9346-5812f86c72dc">The chosen display function is based on human visual perception. Human eye contrast
        sensitivity is distinctly non-linear within the luminance range of display devices. This
        standard uses Barten's model of the human visual system.</para>
    </section>
    <section label="6.15" status="2" xml:id="sect_6.15">
      <title>PS3.15: Security and System Management Profiles</title>
      <para xml:id="para_429a2f8d-ccae-47fb-8cc6-17d821b25037">
<olink targetdoc="PS3.15" targetptr="PS3.15" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies security and system management profiles to which
        implementations may claim conformance. Security and system management profiles are defined
        by referencing externally developed standard protocols, such as DHCP, LDAP, TLS and ISCL.
        Security protocols may use security techniques like public keys and "smart cards". Data
        encryption can use various standardized data encryption schemes.</para>
      <para xml:id="para_6fd02b6d-c186-480a-9989-3abc33488a8c">This part does not address issues of security policies. The standard only provides
        mechanisms that can be used to implement security policies with regard to the interchange of
        DICOM objects. It is the local administrator's responsibility to establish appropriate
        security policies.</para>
    </section>
    <section label="6.16" status="2" xml:id="sect_6.16">
      <title>PS3.16: Content Mapping Resource</title>
      <para xml:id="para_615ffc16-e560-4246-8d19-bfc59ef047cc">
<olink targetdoc="PS3.16" targetptr="PS3.16" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies:</para>
      <para xml:id="para_87e7d86c-f1dd-42bd-8bbe-cddece4ecf51">
        <itemizedlist>
          <listitem>
            <para xml:id="para_74b14a70-9d77-41cc-92af-58bab13be4bd">templates for structuring documents as DICOM Information Objects</para>
          </listitem>
          <listitem>
            <para xml:id="para_406a8a15-d6e7-40bb-8d07-07c63d5e18be">sets of coded terms for use in Information Objects</para>
          </listitem>
          <listitem>
            <para xml:id="para_b7bee21b-203d-4c1e-aa1e-1375c493f6c5">a lexicon of terms defined and maintained by DICOM</para>
          </listitem>
          <listitem>
            <para xml:id="para_f4d6ed16-490c-4436-884e-e3103c55e7ca">country specific translations of coded terms</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="6.17" status="2" xml:id="sect_6.17">
      <title>PS3.17: Explanatory Information</title>
      <para xml:id="para_7c092949-e655-425f-b758-77667295d255">
<olink targetdoc="PS3.17" targetptr="PS3.17">PS3.17</olink> of the DICOM Standard specifies:</para>
      <para xml:id="para_9aed0d4d-6ed0-4153-b21b-7a5e9b0c135a">
        <itemizedlist>
          <listitem>
            <para xml:id="para_22758d51-f886-48a2-a71a-51dc506ddff9">informative and normative annexes containing explanatory information</para>
          </listitem>
        </itemizedlist>
      </para>
    </section>
    <section label="6.18" status="2" xml:id="sect_6.18">
      <title>PS3.18: Web Services</title>
      <para xml:id="para_4a2bda40-4c5d-480f-ab83-c3a4b7185ea5">
<olink targetdoc="PS3.18" targetptr="PS3.18" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies the means whereby Web Services can be used for
        retrieving or storing a DICOM object.</para>
      <para xml:id="para_d04c0a56-b7d8-442f-9e8f-68d769ba7283">Requests that retrieve data specify the media type (format) of the response body.
        Requests that store data specify the media type of the request body.</para>
      <para xml:id="para_a9148c09-134b-4974-90fc-bd6ca55e6fcb">The HTTP requests as defined within this standard are sufficient for the HTTP server to
        act as a DICOM SCU (Service Class User) to retrieve or store the requested objects from an
        appropriate DICOM SCP (Service Class Provider) using baseline DICOM functionality as defined
        in <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/> and <olink targetdoc="PS3.7" targetptr="PS3.7" xrefstyle="select: labelnumber"/>, which is to say that the HTTP server can act as a proxy for the DICOM
        SCP.</para>
    </section>
    <section label="6.19" status="2" xml:id="sect_6.19">
      <title>PS3.19: Application Hosting</title>
      <para xml:id="para_e583b063-0635-434a-adaf-2f94304038ea">
<olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies an Application Programming Interface (API) to a
        DICOM based medical computing system into which programs written to that standardized
        interface can "plug-in" (see <xref linkend="figure_6.19-1" xrefstyle="select: label"/>). A Hosting System implementer only needs to create the standardized API once to support
        a wide variety of add-on Hosted Applications.</para>
      <para xml:id="para_ff88e04c-9747-4f6c-aa9b-70920e3eec27">
        <figure label="6.19-1" pgwide="1" xml:id="figure_6.19-1">
          <title>Interface Between a Hosted Application and a Hosting System</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.19-1.svg"/>
              <!--<imagedata fileref="part01_fromword_files/image011.png"/>-->
            </imageobject>
          </mediaobject>
        </figure>
      </para>
      <para xml:id="para_e271987e-22d0-48f6-bba8-79342087b685">In the traditional "plug-in" model, the "plug-in" is dedicated to a particular host
        system (e.g., a web browsing program), and might not run under other host systems (e.g.,
        other web browsing programs). <olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/> defines an API that may be implemented by any Hosting
        System. A "plug-in" Hosted Application written to the API would be able run in any
        environment provided by a Hosting System that implements that API (see <xref linkend="figure_6.19-2" xrefstyle="select: label"/>).</para>
      <para xml:id="para_0b44cd72-f5aa-46c9-af83-f6cb159b8fd3">
        <figure label="6.19-2" pgwide="1" xml:id="figure_6.19-2">
          <title>Illustration of Platform Independence via the Hosted Application</title>
          <mediaobject>
            <imageobject>
              <imagedata fileref="figures/PS3.1_6.19-2.svg"/>
              <!--<imagedata fileref="part01_fromword_files/image012.png"/>-->
            </imageobject>
          </mediaobject>
        </figure>
      </para>
      <para xml:id="para_d544f8fd-c62d-4a4c-a383-39bc8fc05a18">
<olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/> specifies both the interactions and the Application Programming Interfaces (API)
        between Hosting Systems and Hosted Applications. <olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/> also defines the data models that
        are used by the API.</para>
    </section>
    <section label="6.20" status="2" xml:id="sect_6.20">
      <title>PS3.20: Imaging Reports using HL7 Clinical Document Architecture</title>
      <para xml:id="para_ec628c68-d210-4339-a802-52ac4b4be8ac">
<olink targetdoc="PS3.20" targetptr="PS3.20" xrefstyle="select: labelnumber"/> of the DICOM Standard specifies templates for the encoding of imaging reports using the HL7 Clinical Document Architecture Release 2 (CDA R2, or simply CDA) Standard. Within this scope are clinical procedure reports for specialties that use imaging for screening, diagnostic, or therapeutic purposes.</para>
      <para xml:id="para_90f8ff36-6cea-439e-a990-f0162666407c">
<olink targetdoc="PS3.20" targetptr="PS3.20" xrefstyle="select: labelnumber"/> constitutes an implementation guide for CDA, and is harmonized with the approach to standardized templates for CDA implementation guides developed by HL7. It also provides Business Names for data elements that link data in user terminology, e.g., collected by a report authoring application, to specific CDA encoded elements.</para>
      <para xml:id="para_ca4c111a-bd4e-4649-9f2c-08d64075e8af">As an implementation guide for imaging reports, particular attention is given to the use and reference of data collected in imaging procedures as explicit evidence within reports. This data includes images, waveforms, measurements, annotations, and other analytic results managed as DICOM SOP Instances. Specifically, this Part includes a specification for transformation into CDA documents of DICOM Structured Report instances that represent imaging reports.</para>
    </section>
  </chapter>
  <chapter label="7" status="1" xml:id="chapter_7">
    <title>Referencing The DICOM Standard</title>
    <para xml:id="para_0a7c601c-1749-44bd-b8e5-516a60750a02">Under the procedures of the DICOM Standards Committee, the Standard is in constant
      revision. Supplements and corrections to the Standard are balloted and approved several times
      a year. Each change when approved as Final Text immediately goes into effect. At intervals,
      all of the approved Final Text changes are consolidated into a published edition of the
      Standard, identified by year of publication, but such publication is only a convenience to the
      user; the Standard is officially changed when each change is approved.</para>
    <para xml:id="para_dfc3171c-6c12-4b9f-afdd-cb3ec45e94d1">Conformance to the DICOM Standard is through specified SOP Classes using DIMSE messages (see <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>), Web Services (see <olink targetdoc="PS3.18" targetptr="PS3.18" xrefstyle="select: labelnumber"/>), media interchange (see <olink targetdoc="PS3.4" targetptr="chapter_I" xrefstyle="template:Annex %n “%t” in PS3.4"/> and <olink targetdoc="PS3.10" targetptr="PS3.10" xrefstyle="select: labelnumber"/>), or the hosted application API (see <olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/>). Additional conformance claims may be made to Profiles
      (see <olink targetdoc="PS3.11" targetptr="PS3.11" xrefstyle="select: labelnumber"/> and <olink targetdoc="PS3.15" targetptr="PS3.15" xrefstyle="select: labelnumber"/>). Once such a unit of conformance is
      specified in the Standard, all changes thereto are forward and backward compatible (except in
      rare cases where the original specification was non-interoperable, or conflicted with another
      standard). Conformance requirements and conformance claims are therefore referenced to the
      name and/or identifier of the feature, and never referenced to an edition of the Standard.
      Generally, the only appropriate reference to a particular edition of the Standard is to
      identify a retired feature (see <xref linkend="sect_1.4.2" xrefstyle="select: label title"/>).</para>
    <para xml:id="para_9b0cee4f-2d62-41a2-9cb1-f6f7fe9a40cd">The following citation form is preferred for general references to the Standard, without
      specification of date of edition, when specific conformance requirements are not
      invoked:</para>
    <para xml:id="para_803149b0-2dba-41e7-a472-4a25b1c89d71">NEMA PS3 / ISO 12052, Digital Imaging and Communications in Medicine (DICOM) Standard,
      National Electrical Manufacturers Association, Rosslyn, VA, USA (available free at <link xl:href="http://medical.nema.org/"/>)</para>
    <para xml:id="para_7a2a65fd-ab52-4916-a401-f4ac4a314556">The requirements of this section do not override the requirement to provide a DICOM Conformance Statement as described in <olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/>.</para>
    <para xml:id="para_ac213f23-6621-4a16-b519-c5846ef26809">The following forms are preferred for references to units of conformance to the
      Standard when they are made outside the context of a DICOM Conformance Statement (e.g., in customer requirements):</para>
    <para xml:id="para_75989daf-c499-4f83-bf67-5ef4e16f85ed">
      <itemizedlist>
        <listitem>
          <para xml:id="para_523cf9cf-8e9f-4abb-a2e1-8eccb00854cc">
            <quote>… conformant to the DICOM &lt;name&gt; SOP Class for network exchange [as a Service Class &lt;User | Provider&gt;], as specified in DICOM <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>: Service Class Specifications.</quote>
          </para>
        </listitem>
        <listitem>
          <para xml:id="para_a1d3cc62-aef4-454c-9bb8-bb76b98016a2">
            <quote>… conformant to the DICOM &lt;name&gt; SOP Class for media exchange [as a File Set &lt;Creator | Updater | Reader&gt;], as specified in DICOM <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>: Service Class Specifications.</quote>
          </para>
        </listitem>
        <listitem>
          <para xml:id="para_0da85449-f995-46bf-8f21-05e694a2fce2">
            <quote>… conformant to the DICOM &lt;name&gt; Web Service [as &lt;an Origin-server | a User-agent&gt;] [for the &lt;name&gt; SOP Class], as specified in DICOM <olink targetdoc="PS3.18" targetptr="PS3.18" xrefstyle="select: labelnumber"/>: Web Services.</quote>
          </para>
        </listitem>
        <listitem>
          <para xml:id="para_4eba59c8-396b-4d33-ac89-e1b0e07543eb">
            <quote>… conformant to DICOM Application Hosting [as a &lt;Hosting System | Hosted Application&gt;] for the &lt;name&gt; SOP Class, as specified in DICOM <olink targetdoc="PS3.19" targetptr="PS3.19" xrefstyle="select: labelnumber"/>: Application Hosting.</quote>
          </para>
        </listitem>
        <listitem>
          <para xml:id="para_5ed5702a-47bb-4ed7-a952-85d0a757bef1">
            <quote>… conformant to the DICOM &lt;identifier&gt; Application Profile [as a File Set &lt;Creator | Updater | Reader&gt;] [for the &lt;name&gt; SOP Class], as specified in DICOM <olink targetdoc="PS3.11" targetptr="PS3.11" xrefstyle="select: labelnumber"/>: Media Storage Application Profiles.</quote>
          </para>
        </listitem>
        <listitem>
          <para xml:id="para_f6633f45-7c5f-4ee0-974a-17ef5d94ace8">
            <quote>… conformant to the DICOM &lt;name&gt; Profile, as specified in DICOM <olink targetdoc="PS3.15" targetptr="PS3.15" xrefstyle="select: labelnumber"/>: Security and System Management Profiles.</quote>
          </para>
        </listitem>
      </itemizedlist>
    </para>
    <note>
      <orderedlist>
        <listitem>
          <para xml:id="para_691c7e82-9f3d-4e01-9849-3cb80a7ab3b1">Some Application Profiles and Web Services may fully specify the information objects exchanged,
            while others may require explicit specification of SOP Classes in the references.</para>
        </listitem>
        <listitem>
          <para xml:id="para_f73fd703-de73-428f-ab0f-a66e1624a132">Examples:</para>
          <itemizedlist>
            <listitem>
              <para xml:id="para_60d781e7-4e16-4994-97c9-c3510467f774">
                <quote>The modality shall be conformant to the DICOM CT Image Storage and MR Image Storage SOP Classes
                  for network exchange as a Service Class User, as specified in DICOM <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>: Service Class Specifications.</quote>
              </para>
            </listitem>
            <listitem>
              <para xml:id="para_e9b00ecc-a3ce-47a7-a199-814746e81ed5">
                <quote>The workstation shall be conformant to the DICOM STD-XA1K-DVD Application Profile as a File Set Reader,
                  as specified in DICOM <olink targetdoc="PS3.11" targetptr="PS3.11" xrefstyle="select: labelnumber"/>: Media Storage Application Profiles.</quote>
              </para>
            </listitem>
            <listitem>
              <para xml:id="para_a0cd731c-83ff-4d52-9e20-0c765d9ce117">
                <quote>The PACS shall be conformant to the DICOM WADO-RS and STOW-RS Web Services as an Origin-server for the SOP Classes listed in Table X,
                  as specified in DICOM <olink targetdoc="PS3.18" targetptr="PS3.18" xrefstyle="select: labelnumber"/>: Web Services.</quote>
              </para>
            </listitem>
          </itemizedlist>
        </listitem>
        <listitem>
          <para xml:id="para_635b6cb1-9ebe-42b2-a3f3-5230adb7b6c5">Such references are not permitted in lieu of a Conformance Statement for a product.
            For example, a product that reads or creates DICOM interchange media is required to have a Conformance Statement
            (as described in <olink targetdoc="PS3.2" targetptr="PS3.2" xrefstyle="select: labelnumber"/>)
            that enumerates the Media Application Profiles it implements.
            A statement in some other format, or a document that describes that a product supports recording of files of a particular SOP Class defined in
            <olink targetdoc="PS3.4" targetptr="PS3.4" xrefstyle="select: labelnumber"/>,
            is not sufficient as an alternative to a Conformance Statement. </para>
        </listitem>
      </orderedlist>
    </note>
    <para xml:id="para_c9e802a6-27c9-4dea-9de0-1bcdda57a7ef">Reference may be made to other features of the Standard, but these shall not be construed
      as DICOM conformance requirements (although they may be conformance requirements for non-DICOM
      implementation guides or regulations). Following are some examples:</para>
    <itemizedlist>
      <listitem>
        <para xml:id="para_48fabc2e-e5c0-4777-9155-27f1b401f294">
          <quote>… SOP Instances in accordance with the &lt;name&gt; Information Object Definition, as
            specified in DICOM <olink targetdoc="PS3.3" targetptr="PS3.3" xrefstyle="select: labelnumber"/>: Information Object Definitions.</quote>
        </para>
      </listitem>
      <listitem>
        <para xml:id="para_d76ee814-eae9-4cba-90d0-27ee15dfd64a">
          <quote>… Structured Reporting SOP Instances using DICOM Template ID &lt;number and name&gt;, as
            specified in DICOM <olink targetdoc="PS3.16" targetptr="PS3.16" xrefstyle="select: labelnumber"/>: Content Mapping Resource.</quote>
        </para>
      </listitem>
      <listitem>
        <para xml:id="para_a09e2de4-357d-46ea-ab42-88f75f344caf">
          <quote>… HL7 CDA instances using Template ID &lt;identifier and name&gt;, as specified in DICOM <olink targetdoc="PS3.20" targetptr="PS3.20" xrefstyle="select: labelnumber"/>: Imaging Reports using HL7 Clinical Document Architecture.</quote>
        </para>
      </listitem>
      <listitem>
        <para xml:id="para_69afa62e-a8cc-433f-a899-16e9fcf16d7b">
          <quote>… using the &lt;name&gt; Transfer Syntax, as specified in DICOM <olink targetdoc="PS3.5" targetptr="PS3.5" xrefstyle="select: labelnumber"/>: Data Structure and
        Semantics.</quote>
        </para>
      </listitem>
    </itemizedlist>
    <note>
      <para xml:id="para_25c6f4e1-31bb-4f80-84b6-6f0be028e58a">For example, products producing or receiving SR documents must conform to a SOP Class, such as Enhanced SR;
        such products may also cite use of Template ID 5200 Echocardiography Procedure Report, but that is not a formal DICOM Conformance assertion.
        However, a non-DICOM implementation guide, such as the IHE Echocardiography Workflow Profile, may require use of that Template,
        and an implementation may describe its use of specific Templates in its Conformance Statement.</para>
    </note>
    <para xml:id="para_c8fca69e-e2f5-4ebe-8acb-3eb5d88ac3cd">Since changes to the Standard shall not be cited prior to adoption as Final Text, and
      since after adoption they are formally part of the Standard, there should be no citations to
      supplements or correction items for the purpose of describing conformance. Reference to such
      change documents may be made for describing the historical development of the DICOM
      Standard.</para>
  </chapter>
</book>
