DICOM PS3.3 2020c - Information Object Definitions

C.36.2.2.5 RT Control Point General Macro (Current)
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##### C.36.2.2.5 RT Control Point General Macro

This Macro specifies the base Attributes for the definition of an RT Radiation Control Point.

Table C.36.2.2.5-1. RT Control Point General Macro Attributes

Attribute Name | Tag | Type | Attribute Description
--- | --- | --- | ---
RT Control Point Index | (300A,0600) | 1 | The index of the RT Control Point within the Sequence where this Macro is included. RT Control Points shall be executed in the order of the RT Control Point Index. The value shall start at 1 and increase monotonically by 1 within the Sequence where this Macro is included.
Cumulative Meterset | (300A,063C) | 1C | Meterset at the RT Control Point. The units are specified by Radiation Dosimeter Unit Sequence (300A,0658). For the Item with RT Control Point Index equal 1, the Cumulative Meterset shall be equal to 0.0. Required if RT Radiation Physical and Geometric Content Detail Flag (300A,0638) equals FULL or IDENT_ONLY or RT Record Flag (300A,0639) equals YES and if the conditions in Section C.36.2.2.5.1.1 are satisfied. May be present otherwise only if the conditions in Section C.36.2.2.5.1.1 are satisfied. See Section C.36.2.2.5.1.3.
Referenced Treatment Position Index | (300A,060B) | 1C | The value of Treatment Position Index (300A,0606) from the Treatment Position Sequence (300A,063F) within this IOD that this RT Control Point refers to. Required if Treatment Position Sequence (300A,063F) is present and the conditions in Section C.36.2.2.5.1.1 are satisfied.
Recorded RT Control Point DateTime | (300A,073A) | 1C | Date and time of the Recorded RT Control Point. For all but the final Control Point this shall be the date and time when the delivery of radiation at this Control Point began. For the final Control Point this shall be the date and time when the previous control point ended. Required if RT Record Flag (300A,0639) equals YES and if the SOP Class of the SOP Instance including this Module is not RT Radiation Salvage Record Storage ("1.2.840.10008.5.1.4.1.1.481.17"). May be present otherwise only if RT Record Flag (300A,0639) equals YES.
Referenced Radiation RT Control Point Index | (300A,073B) | 2C | The value of RT Control Point Index (300A,0600) of the RT Control Point in the RT Radiation SOP Instance referenced by Referenced RT Instance Sequence (300A,0631) in this Instance. Required if RT Record Flag (300A,0639) equals YES and if the recorded RT Control Point Index corresponds to a planned RT Radiation Control Point Index.

###### C.36.2.2.5.1 RT Control Point Attribute Concept

The treatment-modality Modules use a common formalism to represent parameters that define the behaviour of a delivery device during delivery of radiation. These parameters are communicated as a sequence of values, organized as Control Points (see Section C.36.1.1.1) and represented as RT Control Points. The resolution of RT Control Points depends on the level of detail required to define the behaviour of the delivery device.

A Control Point is a point on a timeline of a delivery process. RT Control Points are sequenced using an index number starting with 1, e.g., 1, 2, 3, 4. The RT Control Point parameters reflect the state of the delivery device at that point in time. The Control Point Cumulative Meterset reflects the dose that has been delivered from the beginning of the delivery process up to that point in time.

For all beam deliveries there are at least two RT Control Points, corresponding to the start and end of delivery. E.g., for a simple Static Beam delivery with a constant field aperture, only two RT Control Points are needed to define the start and end, as there are no changes in-between. For a dynamic delivery, in which the MLC leaves are changing while radiation is delivered, the number of Control Points will be higher to provide enough detail to define the leaf movement with sufficient resolution to achieve the radiation fluence distribution expected for the prescribed dose.

DICOM does not specify the behavior of the machine parameters between Control Points. The planning system needs to know the hardware-specific characteristics of the delivery system for which the plan is being created.

###### C.36.2.2.5.1.1 Requirements for Changing Values within RT Control Point Sequence Attributes

This Section specifies when individual attributes shall be present in a Sequence.

The RT Control Point Sequence specifies a certain order of execution.

At each RT Control Point the value of various Attributes may be specified as an explicit value (which in the case of a type 2C attribute may be a null value) and if absent remain at the same value as specified previously. There are physical and mechanical implications of specifying a new value as opposed to staying at the same value, for example gear lash, floating point jitter, etc.

At the first Sequence Item in RT Control Point Sequences (i.e., with an RT Control Point Index (300A,0600) equal to 1) all Attributes affected by this Section shall be present if applicable conditions are met.

For Sequence Items other than the first Sequence Item, Attributes shall be present if applicable conditions are met and the value is different from the previously populated value for the same Attribute (in the case of a type 2C attribute, a null value is considered as a value). The previously populated value is the value from the Item where the Attribute was present with the greatest value of RT Control Point Index (300A,0600) less than the value of the RT Control Point Index (300A,0600) in the current Item.

This means that for an Item in which an Attribute is absent, the application stays at the value of the previously populated Item.

For Sequences inside a RT Control Point Sequence Item, the Sequence shall be present if any of the nested Attributes affected by this Section differ from the corresponding previously populated Item.

For multi-valued Attributes, such as Parallel RT Beam Delimiter Positions (300A,064A), all values shall be present if any value changes.

###### C.36.2.2.5.1.2 Control Point Attribute Example

The following examples illustrate RT Control Points:

1. Static Beam delivery:

   RT Control Point Index (300A,0600) | Cumulative Meterset (300A,063C) | All other parameters
   --- | --- | ---
   1 | 0 | <defined>
   2 | 76 | <not present>

   At completion this beam delivers 76 Monitor Units using a fixed static set of treatment parameters defined in RT Control Point 1.

2. Arc delivery:

   RT Control Point Index (300A,0600) | Cumulative Meterset (300A,063C) | Source Roll Angle (300A,067A) | All other parameters
   --- | --- | --- | ---
   1 | 0 | <initial angle> | <defined>
   2 | 56 | <final angle> | <not present>

   At completion this delivers 56 Monitor Units while rotating the gantry from initial angle to final angle.

3. Dynamic delivery of two equally weighted segments:

   RT Control Point Index (300A,0600) | Cumulative Meterset (300A,063C) | Parallel RT Beam Delimiter Positions (300A,064A) X Referenced Device Index 1 | Parallel RT Beam Delimiter Positions(300A,064A) Y Referenced Device Index 2 | RT Beam Limiting Device Angle (300A,0679) | All other parameters
   --- | --- | --- | --- | --- | ---
   1 | 0 | 2\2 | 2\2 | 30 | <defined>
   2 | 40 | <not present> | 4\4 | <not present> | <not present>
   3 | 80 | 4\4 | <not present> | <not present> | <not present>

   At completion this delivers 80 Monitor Units while first increasing the Y opening and then increasing the X opening, while the beam limiting device angle stays fixed. For the RT Beam Limiting Device Opening Sequence (300A,0656) this results in having three Items for the first Control Point and only one for Control Points 2 (Referenced Device Index 2 only) and 3 (Referenced Device Index 1 only). See also Figure C.36.2.2.5.1-1.

   Figure C.36.2.2.5.1-1. Control Points Sub-Sequence Attribute Presence

4. Dynamic Delivery of two unequally weighted segments with a step change of 5 degrees in the positive direction of the Patient Support Angle:

   ### Note

   Patient Support Angle is represented by the Image to Equipment Mapping Matrix (0028,9520). The table contains the effective angle and not the complete matrix.

   RT Control Point Index (300A,0600) | Cumulative Meterset (300A,063C) | Image to Equipment Mapping Matrix (0028,9520) | Source Roll Angle (300A,067A) | All other parameters
   --- | --- | --- | --- | ---
   1 | 0 | 0 | -90 | <defined>
   2 | 30 | <not present> | <not present> | <not present>
   3 | <not present> | 5 | 0 | <not present>
   4 | 90 | <not present> | <not present> | <not present>

   At completion this delivers 90 Monitor Units. Between RT Control Point 2 and 3 the Patient Support Angle and Source Roll Continuous Angle are changed and no radiation is delivered.

###### C.36.2.2.5.1.3 Cumulative Meterset

The Meterset at a given Control Point is specified by Cumulative Meterset (300A,063C). This value is specified in units defined by Radiation Dosimeter Unit Sequence (300A,0658) in the RT Delivery Device Common Module in Section C.36.12. The Meterset values are intended to correspond to the values produced by the primary or the single Meterset-measuring device of a RT Radiation Delivery Device.

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DICOM PS3.3 2020c - Information Object Definitions