A.86 RT Second Generation

A.86 RT Second Generation (Current)
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A.86.1.1 RT Second Generation Common Information

This section provides a description of the Module structure which is shared by the RT Second Generation IODs.

A.86.1.1.1 RT Second Generation Entity-Relationship Model

The E-R Model in Figure A.86.1.1.1-1 depicts those components of the DICOM Information Model that are relevant to RT Second Generation IODs.

Figure A.86.1.1.1-1. RT Second Generation IOD Information Model

A.86.1.1.1.1 Use of Study and Series in RT Second Generation Radiotherapy

For first generation IODs, no specific semantics are attached to a Study or a Series in RT. Similarly, for RT Second Generation IODs, internal references shall be used to relate and locate SOP Instances rather than making assumptions about how related SOP Instances are grouped into Studies or Series. For practical reasons it may be indicated to create a new Study separate from imaging Studies that are used for radiotherapeutic planning because of billing or reimbursement for Series that contain RT instances.

Implementers should also note that the DICOM Standard, in general, does place some restrictions on how such SOP Instances should be grouped, as defined in Section A.1.2.3.

For non-image modalities like radiotherapy, the Series may not be the most efficient way to search for objects. Instead, an application might find it easier to use references in the RT Course object, Key Object Selection objects or Unified Worklist Procedure Steps to directly retrieve required instances rather than search for them.

A.86.1.2 RT Physician Intent IOD

A.86.1.2.1 RT Physician Intent IOD Description

The RT Physician Intent IOD carries the prescriptions by which the physician describes the therapeutic goal and strategy for the radiotherapeutic treatment.

A.86.1.2.2 RT Physician Intent IOD Entity-Relationship Model

See Figure A.86.1.1.1-1.

A.86.1.2.3 RT Physician Intent IOD Module Table

Table A.86.1.2-1. RT Physician Intent IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Physician Intent	General Reference	C.12.4	M
	RT Physician Intent	C.36.5	M
	RT Enhanced Prescription	C.36.6	U
	RT Treatment Phase Intent	C.36.7	C - Required if RT Treatment Phase Intent Presence Flag (3010,0045) equals YES.
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.2.4 RT Physician Intent IOD Constraints

A.86.1.2.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTINTENT.

A.86.1.2.4.2 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9536 “Radiotherapy Prescribing and Segmenting Person Roles”.

A.86.1.3 RT Segment Annotation IOD

A.86.1.3.1 RT Segment Annotation IOD Description

The RT Segment Annotation IOD annotates any general-purpose entity that represents geometric information such as Segmentation IOD, Surface Segmentation IOD, and RT Structure Set IOD with radiotherapy-specific information that cannot be encoded in the content of the annotated SOP Instance, or overrides that content with new or additional interpretation.

A.86.1.3.2 RT Segment Annotation IOD Entity-Relationship Model

See Figure A.86.1.1.1-1.

A.86.1.3.3 RT Segment Annotation IOD Module Table

Table A.86.1.3-1. RT Segment Annotation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
RT Segment Annotation	RT Segment Annotation	C.36.8	M
	Segment Reference	C.36.9	M
	General Reference	C.12.4	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.3.4 RT Segment Annotation IOD Constraints

A.86.1.3.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTSEGANN.

A.86.1.3.4.2 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9536 “Radiotherapy Prescribing and Segmenting Person Roles”.

A.86.1.4 RT Radiation Set IOD

A.86.1.4.1 RT Radiation Set IOD Description

The RT Radiation Set IOD represents an RT Radiation Set, which is a set of radiation deliveries that are intended to be delivered together in a single fraction (see Section 7.14.5). The RT Radiation Set also contains a description of the fractionation pattern, the intended number of fractions and the associated dose contributions.

A.86.1.4.2 RT Radiation Set IOD Entity-Relationship Model

See Figure A.86.1.1.1-1.

A.86.1.4.3 RT Radiation Set IOD Module Table

Table A.86.1.4-1. RT Radiation Set IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation Set	General Reference	C.12.4	M
	RT Radiation Set	C.36.10	M
	RT Dose Contribution	C.36.11	C - Required if the dose delivered is tracked.
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.4.4 RT Radiation Set IOD Constraints

A.86.1.4.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.4.4.2 RT Radiation Set and Referenced RT Radiation Instances

The User Content Label (3010,0033) in each RT Radiation Instance shall be unique across all SOP Instances referenced by an Instance of the RT Radiation Set.

A.86.1.4.4.3 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9555 “Radiotherapy Treatment Planning Person Roles”.

A.86.1.5 C-Arm Photon-Electron Radiation IOD

A.86.1.5.1 C-Arm Photon-Electron Radiation IOD Description

The C-Arm Photon-Electron Radiation IOD describes a radiotherapy treatment to be performed on a C-Arm delivery device using photon or electron radiation.

A.86.1.5.2 C-Arm Photon-Electron Radiation IOD Entity-Relationship Model

See Figure A.86.1.1.1-1.

A.86.1.5.3 C-Arm Photon-Electron Radiation IOD Module Table

Table A.86.1.5-1. C-Arm Photon-Electron Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	C-Arm Photon-Electron Delivery Device	C.36.14	M
	C-Arm Photon-Electron Beam	C.36.15	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.5.4 C-Arm Photon-Electron Radiation IOD Constraints

A.86.1.5.4.1 Modality Attribute

The Value of Modality (0008,0060) shall be RTRAD.

A.86.1.5.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the IEC 61217 Fixed Coordinate System Frame of Reference; see Section C.36.12.2.1.

The Frame of Reference identifies the Patient Coordinate System used to define the geometric setup of the radiation beam with respect to the patient. The relationship of the patient-based coordinates to the Equipment Frame of Reference is specified by a transformation (see Section 10.39).

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9552 “C-Arm Photon-Electron Dosimeter Units”.

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, “Nominal Radiation Source Location”).

A.86.1.5.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9511 “General External Radiotherapy Procedure Techniques”.
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Modes”.

A.86.1.5.4.4 Radiotherapy Common Instance Module

The following Code Sequences shall have a value from the specified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9555 “Radiotherapy Treatment Planning Person Roles”

A.86.1.6 Tomotherapeutic Radiation IOD

A.86.1.6.1 Tomotherapeutic Radiation IOD Description

The Tomotherapeutic Radiation IOD represents the information required to describe a radiotherapy treatment on a serial or helical tomotherapeutic delivery device.

A.86.1.6.2 Tomotherapeutic Radiation IOD Entity-relationship Model

See Figure A.86.1.1.1-1.

A.86.1.6.3 Tomotherapeutic Radiation IOD Module Table

Table A.86.1.6-1. Tomotherapeutic Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	Tomotherapeutic Delivery Device	C.36.16	M
	Tomotherapeutic Beam	C.36.17	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.6.4 Tomotherapeutic Radiation IOD Constraints

A.86.1.6.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.6.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.1, which identifies the IEC 61217 Fixed Coordinate System Frame of Reference; see Section C.36.12.2.1.

The Frame of Reference identifies the Patient Coordinate System used to define the geometric setup of the radiation beam with respect to the patient. The relationship of the patient-based coordinates to the Equipment Frame of Reference is specified by a transformation (see Section 10.39).

The following Code Sequence shall have a value from the identified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9557 “Tomotherapeutic Dosimeter Units”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, “Nominal Radiation Source Location”).

A.86.1.6.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following Code Sequences shall have a value from the identified CIDs:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9512 “Tomotherapeutic Radiotherapy Procedure Techniques”
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Modes”

A.86.1.6.4.4 Radiotherapy Common Instance Module

The following code sequence shall have a value from the identified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9555 “Radiotherapy Treatment Planning Person Roles”

A.86.1.7 Robotic-Arm Radiation IOD

A.86.1.7.1 Robotic-Arm Radiation IOD Description

The Robotic-Arm Radiation IOD specifies the Robotic Path and collimation parameters required to describe a radiotherapy treatment on a robotic-arm delivery device. A Robotic Path is a sequence of Robotic Nodes. A Robotic Node specifies a Radiation Source location for a Robotic-Arm delivery device.

A.86.1.7.2 Robotic-Arm Radiation IOD Entity-relationship Model

See Figure A.86.1.1.1-1.

A.86.1.7.3 Robotic-Arm Radiation IOD Module Table

Table A.86.1.7-1. Robotic-Arm Radiation IOD Modules

IE	Module	Reference	Usage
Patient	Patient	C.7.1.1	M
Patient	Clinical Trial Subject	C.7.1.3	U
Study	General Study	C.7.2.1	M
	Patient Study	C.7.2.2	U
	Clinical Trial Study	C.7.2.3	U
Series	General Series	C.7.3.1	M
	Clinical Trial Series	C.7.3.2	U
	Enhanced RT Series	C.36.3	M
Equipment	General Equipment	C.7.5.1	M
Equipment	Enhanced General Equipment	C.7.5.2	M
Frame of Reference	Frame of Reference	C.7.4.1	M
RT Radiation	General Reference	C.12.4	M
	RT Delivery Device Common	C.36.12	M
	RT Radiation Common	C.36.13	M
	Robotic-Arm Delivery Device	C.36.18	M
	Robotic-Arm Path	C.36.19	M
	SOP Common	C.12.1	M
	Common Instance Reference	C.12.2	M
	Radiotherapy Common Instance	C.36.4	M

A.86.1.7.4 Robotic-Arm Radiation IOD Module Constraints

A.86.1.7.4.1 Modality Attribute

The value of Modality (0008,0060) shall be RTRAD.

A.86.1.7.4.2 RT Delivery Device Common Module

The Equipment Frame of Reference UID (300A,0675) shall be 1.2.840.10008.1.4.3.2, which identifies the Standard Robotic-Arm Coordinate System Frame of Reference; see Section C.36.12.2.2.

The Frame of Reference identifies the Patient Coordinate System used to define the geometric setup of the radiation beam with respect to the patient. The relationship of the patient-based coordinates to the Equipment Frame of Reference is specified by a transformation (see Section 10.39).

The following code sequences shall have a value from the identified CID:

Code Sequence	CID
Radiation Dosimeter Unit Sequence (300A,0658)	DCID 9559 “Robotic Delivery Device Dosimeter Units”

The RT Device Distance Reference Location Code Sequence (300A,0659) shall contain the value (130358, DCM, “Nominal Radiation Source Location”).

A.86.1.7.4.3 RT Radiation Common Module

The value of RT Record Flag (300A,0639) shall be NO.

The following code sequences shall have a value from the identified CID:

Code Sequence	CID
RT Treatment Technique Code Sequence (3010,0080)	DCID 9523 “Robotic Radiotherapy Procedure Techniques”
Treatment Machine Special Mode Code Sequence (300A,0635)	DCID 9543 “Radiotherapy Treatment Machine Modes”

A.86.1.7.4.4 Radiotherapy Common Instance Module

The following code sequence shall have a value from the identified CID:

Code Sequence	CID
Author Identification Sequence (3010,0019)	Defined CID for Organizational Role Code Sequence (0044,010A) is CID 9555 “Radiotherapy Treatment Planning Person Roles”

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