MRIdian® Linac System Version 5 - ViewRay...ViewRay Incorporated MRIdian® Linac System ii This...

ViewRay Incorporated MRIdian® Linac System i

MRIdian® Linac System

Version 5.2

DICOM Conformance Statement 11/13/17

Document No. L-0094 Rev. A Nov 13, 2017

ViewRay Incorporated MRIdian® Linac System ii

This document contains the confidential and proprietary information of ViewRay, Inc. Neither this document nor any of the information contained is to be reproduced, distributed, used or disclosed, either in whole or in part, except as specifically authorized by ViewRay, Inc.

Copyright Statement Copyright © 2017 ViewRay, Inc. All rights reserved. No part of this Statement may be photocopied, reproduced or translated into another language without written permission from ViewRay, Inc.

ViewRay, Inc. has taken care to ensure the accuracy of this Conformance Statement; however, ViewRay Inc. assumes no liability for errors or omissions and reserves the right to make changes without further notice to this Conformance Statement and any products herein to improve reliability, function or design.

ViewRay provides this Conformance Statement without warranty of any kind, either implied or expressed, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose.

This document contains proprietary information that is protected by copyright. ViewRay Inc. reserves the right to revise this publication and to make changes in content from time to time

Scope

The scope of this Conformance Statement is to facilitate communication between the MRIdian Linac system and other vendor’s medical equipment. The Conformance Statement should be read and understood in conjunction with the DICOM standard. DICOM is the usual choice for exchanging data with an open standard protocol for most vendors and institutions. ViewRay is committed to standard-based cross-vendor interoperability as well as making use of the DICOM protocol among its own products.

Conformance with DICOM, by itself, does not guarantee interoperability. However, the Conformance Statement guides validation for interoperability between different applications supporting the same DICOM functionality.

This Conformance Statement is not intended to replace physical validation with other DICOM equipment to ensure proper exchange of information.

Because the DICOM standard is subject to ongoing changes, enhancements and improvements, ViewRay reserves the right to change their products by making use of upcoming DICOM features without prior announcement.

ViewRay Incorporated MRIdian® Linac System iii

1. CONFORMANCE STATEMENT OVERVIEW

The MRIdian® Linac system contains two applications that utilize DICOM. The Remote Import Service provides an endpoint for DICOM network communications. It queries external systems to fulfill requests made by the user on one of many planning or delivery consoles, and receives or transfer image, and dose data from and to external systems. The MRIdian Linac Console Software provides the user with options to import, export and create DICOM data files including image data, and RT dose, structure and point data and RT plan.

Table 1-1: Network Services

SOP Classes User of Service (SCU) Provider of Service (SCP)

Transfer

CT Image Storage Yes Yes

MR Image Storage Yes Yes

PET Image Storage Yes Yes

RT Dose Storage Yes Yes

RT Struct Storage Yes Yes

RT Plan Storage Yes Yes

Storage Commit Push Model Yes No

Query/Retrieve Study Root Query/Retrieve Information Model – FIND

Yes No

Study Root Query/Retrieve Information Model – MOVE

Yes No

Verification

Verification (Echo) Yes Yes

Table 1-2: Media Services

Media Storage Application Profile Write Files (FSC or FSU) Read Files (FSR)

Compact Disk – Recordable

General Purpose CD-R No Yes

CT/MR CD-R No Yes

DVD

General Purpose DVD No Yes

CT/MR DVD No Yes

The MRIdian Linac Console software provides the user with the ability to create DICOM files compliant with part PS 3.10 of the DICOM standard to any user-specified directory. However, it does not meet the definition of a File Set Creator or File Set Updater defined for any of the application profiles in part PS 3.11.

ViewRay Incorporated MRIdian® Linac System iv

2. TABLE OF CONTENTS

1. CONFORMANCE STATEMENT OVERVIEW .................................................................................... iii

2. TABLE OF CONTENTS .................................................................................................................. iv

3. INTRODUCTION ..........................................................................................................................1

3.1 Revision History ......................................................................................................................... 1 3.2 Audience .................................................................................................................................... 1 3.3 Remarks ..................................................................................................................................... 1 3.4 Terms and Definitions ............................................................................................................... 1 3.5 Basics of DICOM Communication .............................................................................................. 3 3.6 Abbreviations ............................................................................................................................ 4 3.7 References ................................................................................................................................. 4

4. NETWORKING .............................................................................................................................5

4.1 Implementation Model ............................................................................................................. 5 4.2 Functional Definition of AEs ...................................................................................................... 6 4.3 AE Specifications ....................................................................................................................... 7 4.4 Network Interfaces .................................................................................................................. 16 4.5 Configuration ........................................................................................................................... 16

5. MEDIA INTERCHANGE ............................................................................................................... 18

5.1 Implementation Model ........................................................................................................... 18 5.2 AE Specifications ..................................................................................................................... 19 5.3 Augmented and Private Application Profiles .......................................................................... 19 5.4 Media Configuration ............................................................................................................... 19

6. SUPPORT OF CHARACTER SETS .................................................................................................. 20

7. SECURITY .................................................................................................................................. 21

Appendix A speciAlization ............................................................................................................ 22

A.1 IOD Contents ........................................................................................................................... 22 A.2 Data Dictionary of Private Attributes ...................................................................................... 22 A.3 Coded Terminology and Templates ........................................................................................ 22 A.4 Grayscale Image Consistency .................................................................................................. 22 A.5 Standard Extended/Specialized/Private Sop Classes .............................................................. 22 A.6 Private Transfer Syntaxes ........................................................................................................ 23

Appendix B Created SOP Instances ............................................................................................... 24

B.1 IOD Definitions ........................................................................................................................ 24 B.2 Module Definitions .................................................................................................................. 28

ViewRay Incorporated MRIdian® Linac System 1

3. INTRODUCTION

3.1 Revision History

Rev. Rev. Date Submitted by Description of Changes Reason for changes A 13-Nov-2017 S. Wang Initial Release CN-02389

3.2 Audience

This document is intended for those that need to understand how the MRIdian Linac system will integrate into their healthcare facility. This includes both anyone responsible for overall network policy and architecture, as well as integrators who need to have a detailed understanding of the DICOM features of the product. This document contains some basic DICOM definitions so that any reader may understand how this product implements DICOM features. However, integrators are expected to fully understand all the DICOM terminology, how the tables in this document relate to the product’s functionality, and how that functionality integrates with other devices that support compatible DICOM features.

3.3 Remarks

The scope of this DICOM Conformance Statement is to facilitate integration between the MRIdian Linac system and other DICOM compliant systems. The Conformance Statement should be read and understood in conjunction with the DICOM Standard. DICOM by itself does not guarantee interoperability. The Conformance Statement does, however, facilitate a first-level comparison for interoperability between different applications supporting compatible DICOM functionality. This Conformance Statement is not supposed to replace validation with other DICOM equipment to ensure proper exchange of intended information. In fact, the user should be aware of the following important issues:

The comparison of different Conformance Statements is just the first step towards assessing interconnectivity and interoperability between the MRIdian Linac system and other DICOM conformant equipment.

Test procedures should be defined and executed to validate the required level of interoperability with specific compatible DICOM equipment, as established by the healthcare facility.

3.4 Terms and Definitions

Informal definitions are provided for the following terms used in this Conformance Statement. The DICOM Standard is the authoritative source for formal definitions of these terms.

Abstract Syntax – the information agreed to be exchanged between applications, generally equivalent to a Service/Object Pair (SOP) Class. Examples: Verification SOP Class, Modality Worklist Information Model Find SOP Class, Computed Radiography Image Storage SOP Class.

Application Entity (AE) – an end point of a DICOM information exchange, including the DICOM network or media interface software; i.e., the software that sends or receives DICOM information objects or messages. A single device may have multiple Application Entities.

Application Entity Title – the externally known name of an Application Entity, used to identify a DICOM application to other DICOM applications on the network.

Application Context – the specification of the type of communication used between Application Entities. Example: DICOM network protocol.

Association – a network communication channel set up between Application Entities.


Attribute – a unit of information in an object definition; a data element identified by a tag. The information may be a complex data structure (Sequence), itself composed of lower level data elements. Examples: Patient ID (0010,0020), Accession Number (0008,0050), Photometric Interpretation (0028,0004), Procedure Code Sequence (0008,1032).

Information Object Definition (IOD) – the specified set of Attributes that comprise a type of data object; does not represent a specific instance of the data object, but rather a class of similar data objects that have the same properties. The Attributes may be specified as Mandatory (Type 1), Required but possibly unknown (Type 2), or Optional (Type 3), and there may be conditions associated with the use of an Attribute (Types 1C and 2C). Examples: MR Image IOD, CT Image IOD, Print Job IOD.

Joint Photographic Experts Group (JPEG) – a set of standardized image compression techniques, available for use by DICOM applications.

Media Application Profile – the specification of DICOM information objects and encoding exchanged on removable media (e.g., CDs)

Module – a set of Attributes within an Information Object Definition that are logically related to each other. Example: Patient Module includes Patient Name, Patient ID, Patient Birth Date, and Patient Sex.

Negotiation – first phase of Association establishment that allows Application Entities to agree on the types of data to be exchanged and how that data will be encoded.

Presentation Context – the set of DICOM network services used over an Association, as negotiated between Application Entities; includes Abstract Syntaxes and Transfer Syntaxes.

Protocol Data Unit (PDU) – a packet (piece) of a DICOM message sent across the network. Devices must specify the maximum size packet they can receive for DICOM messages.

Security Profile – a set of mechanisms, such as encryption, user authentication, or digital signatures, used by an Application Entity to ensure confidentiality, integrity, and/or availability of exchanged DICOM data

Service Class Provider (SCP) – role of an Application Entity that provides a DICOM network service; typically, a server that performs operations requested by another Application Entity (Service Class User). Examples: Picture Archiving and Communication System (image storage SCP, and image query/retrieve SCP), Radiology Information System (modality worklist SCP).

Service Class User (SCU) – role of an Application Entity that uses a DICOM network service; typically, a client. Examples: imaging modality (image storage SCU, and modality worklist SCU), imaging workstation (image query/retrieve SCU)

Service/Object Pair (SOP) Class – the specification of the network or media transfer (service) of a particular type of data (object); the fundamental unit of DICOM interoperability specification. Examples: Ultrasound Image Storage Service, Basic Grayscale Print Management.

Service/Object Pair (SOP) Instance – an information object; a specific occurrence of information exchanged in a SOP Class. Examples: a specific x-ray image.

Tag – a 32-bit identifier for a data element, represented as a pair of four digit hexadecimal numbers, the “group” and the “element”. If the “group” number is odd, the tag is for a private (manufacturer-specific) data element. Examples: (0010,0020) [Patient ID], (07FE,0010) [Pixel Data], (0019,0210) [private data element]

Transfer Syntax – the encoding used for exchange of DICOM information objects and messages. Examples: JPEG compressed (images), little endian explicit value representation.


Unique Identifier (UID) – a globally unique “dotted decimal” string that identifies a specific object or a class of objects; an ISO-8824 Object Identifier. Examples: Study Instance UID, SOP Class UID, SOP Instance UID.

Value Representation (VR) – the format type of an individual DICOM data element, such as text, an integer, a person’s name, or a code. DICOM information objects can be transmitted with either explicit identification of the type of each data element (Explicit VR), or without explicit identification (Implicit VR); with Implicit VR, the receiving application must use a DICOM data dictionary to look up the format of each data element.

3.5 Basics of DICOM Communication

This section describes terminology used in this Conformance Statement for the non-specialist. The key terms used in the Conformance Statement are highlighted in italics below. This section is not a substitute for training about DICOM, and it makes many simplifications about the meanings of DICOM terms.

Two Application Entities (devices) that want to communicate with each other over a network using DICOM protocol must first agree on several things during an initial network “handshake”. One of the two devices must initiate an Association (a connection to the other device), and ask if specific services, information, and encoding can be supported by the other device (Negotiation).

DICOM specifies a number of network services and types of information objects, each of which is called an Abstract Syntax for the Negotiation. DICOM also specifies a variety of methods for encoding data, denoted Transfer Syntaxes. The Negotiation allows the initiating Application Entity to propose combinations of Abstract Syntax and Transfer Syntax to be used on the Association; these combinations are called Presentation Contexts. The receiving Application Entity accepts the Presentation Contexts it supports.

For each Presentation Context, the Association Negotiation also allows the devices to agree on Roles – which one is the Service Class User (SCU - client) and which is the Service Class Provider (SCP - server). Normally the device initiating the connection is the SCU, i.e., the client system calls the server, but not always.

The Association Negotiation finally enables exchange of maximum network packet (PDU) size, security information, and network service options (called Extended Negotiation information). This limitation can be optional.

The Application Entities, having negotiated the Association parameters, may now commence exchanging data. Common data exchanges include queries for worklists and lists of stored images, transfer of image objects and analyses (structured reports), and sending images to film printers. Each exchangeable unit of data is formatted by the sender in accordance with the appropriate Information Object Definition, and sent using the negotiated Transfer Syntax. There is a Default Transfer Syntax that all systems must accept, but it may not be the most efficient for some use cases. Each transfer is explicitly acknowledged by the receiver with a Response Status indicating success, failure, or that query or retrieve operations are still in process.

Two Application Entities may also communicate with each other by exchanging media (such as a CD-R). Since there is no Association Negotiation possible, they both use a Media Application Profile that specifies “pre-negotiated” exchange media format, Abstract Syntax, and Transfer Syntax.


3.6 Abbreviations

Acronym / Term Definition

AE Application Entity

AET Application Entity Title

CD-R Compact Disk Recordable

CT Computed Tomography

DHCP Dynamic Host Configuration Protocol

DICOM Digital Imaging and Communications in Medicine

FSC File-Set Creator

FSU File-Set Updater

FSR File-Set Reader

IOD Information Object Definition

IPv4 Internet Protocol version 4

MR Magnetic Resonance Imaging

MTU Maximum Transmission Unit (IP)

O Optional (Key Attribute)

OSI Open Systems Interconnection

PACS Picture Archiving and Communication System

PET Positron Emission Tomography

R Required (Key Attribute)

RT Radiotherapy

SCP Service Class Provider

SCU Service Class User

SOP Service-Object Pair

TCP/IP Transmission Control Protocol/Internet Protocol

U Unique (Key Attribute)

VR Value Representation 3.7 References

• NEMA PS3 Digital Imaging and Communications in Medicine (DICOM) Standard, available free at http://medical.nema.org/

http://medical.nema.org/


4. NETWORKING

4.1 Implementation Model

4.1.1 Application Data Flow

Figure 4.1-1: Functional Overview

The query/retrieve, storage and verification endpoints shown here reside within the Remote Import Service. This is a single application that runs as a component of the overall MRIdian Linac system. Store SCU initiated from the application does not support batch upload functionality to remote server in this release and user may only export from image or plan level with separate operations, no simultaneous export operations allowed.

• The Q/R SCU is responsible for performing queries and initiating inbound data transfer requested by the user application.

• The Storage SCU is responsible for performing outbound data storage to remote server requested by the user application.

• The Storage Commit SCU is responsible for initiating a request to retrieve storage status report. The report shall advise whether a file of interest exists on remote server or not.


• The Storage SCP is responsible for receiving DICOM objects from remote server either through unsolicited push from the server or through the sub-operation following the Q/R operation.

• Verification SCU is responsible for initiating echo request to remote server.

• Verification SCP is responsible for responding to the echo request initiated from remote server.

All of these application entities share a single (configurable) AE Title.

4.2 Functional Definition of AEs

4.2.1.1 Functional Definition of Q/R SCU AE

Whenever the Remote Import Service receives a request to perform a Q/R operation on remote server, the Q/R SCU AE:

- Create an association with SCP AE and perform query using C_FIND SOP. If error occurs, association will be aborted. Query can be performed without subsequent retrieve operation.

- Create an association with SCP AE after the query and submit data retrieval request to SCP AE using C_MOVE SOP. If error occurs, association will be aborted.

- Receive and analyze appropriate response from the SCP AE.

The Q/R SCU AE acts solely as an SCU, and cannot receive an association request.

4.2.1.2 Functional Definition of Storage and Storage Commit SCU AE

Whenever the Remote Import Service receives a request to export data to remote server, the Storage and Storage Commit SCU AE:

- Create an association with SCP AE and transmit DICOM messages, aka DICOM objects using C_STORE SOP. If error occurs, association will be aborted.

- Receive and analyze appropriate response from the SCP AE.

- Create an association with SCP AE after the export and perform Storage Commit request. If error occurs, the association will be aborted.

The Storage and Storage Commit SCU AE acts solely as an SCU, and cannot receive an association request.

4.2.1.3 Functional Definition of Storage SCP AE

The Storage SCP AE:

- Wait for an association request from an SCU AE.

- Accept the association for supported SOP classes and receive DICOM messages sent from the SCU AE.

- Process the messages and store them to database or disks. If error occurs, association will be aborted.

- Send response messages to SCU AE indicating the healthiness of the connection and data.

The Storage SCP AE acts solely as an SCP and cannot initiate an association request.


4.2.1.4 Functional Definition of Verification SCU AE

Whenever the Remote Import Service receives a request to echo a remote server, the Verification SCU AE:

- Create an association with SCP AE and perform echo using C_ECHO SOP. If error occurs, association will be aborted.

Verification SCU AE acts solely as an SCU and cannot receive an association request. 4.2.1.5 Functional Definition of Verification SCP AE

The Verification SCP AE:

- Wait for an association request from an SCU AE.

- Accept the association for supported SOP class and send response message to SCU AE.

Verification SCP AE solely as an SCP and cannot initiate an association request.

4.2.2 Sequencing of Real World Activities

The Remote Import Service does not enforce any sequence between activities.

As a matter of workflow, query operations are always performed before transfer requests, which is part of the prerequisite in Q/R operation.

Data may be received at any time. Data is received and stored through association initiated from either Remote Import Service Q/R SCU or another remote server, e.g. PACS station.

After Storage SCU AE has completed the export operation, a Store Commit SCU AE follows to request a status report indicating whether SOPs of interest, aka the SOPs sent through Storage SCU AE in previous operation, are securely captured and stored on the remote server. However, user can configure and turn the storage commit operation off.

4.3 AE Specifications

4.3.1 Q/R SCU AE

4.3.1.1 SOP Classes

Q/R SCU AE provides Standard Conformance to the following SOP Classes:

Table 4.2-8: SOP Classes Supported by Q/R SCU AE

SOP Class Name SOP Class UID SCU SCP Study Root Query/Retrieve Information Model – FIND

1.2.840.10008.5.1.4.1.2.2.1 Yes No

Study Root Query/Retrieve Information Model – MOVE

1.2.840.10008.5.1.4.1.2.2.2 Yes No

4.3.1.2 Association Policies

4.3.1.2.1 General

The DICOM standard application context name for DICOM 3.0 is always proposed:

Table 4.2-9: DICOM Application Context for Q/R SCU AE

Application Context Name 1.2.840.10008.3.1.1.1


4.3.1.2.2 Number of Associations

Each Q/R request will result in two associations. The first association is closed before the second is established. In the event of a system failure, the Q/R SCU AE will retry the import operation, resulting in two additional associations. The number of requests is not limited by Remote Import Service.

Table 4.2-10: Number of Associations as an Association Initiator for Q/R SCU AE

Maximum number of simultaneous associations One 4.3.1.2.3 Asynchronous Nature

Only one transaction is permitted per association.

4.3.1.2.4 Implementation Identifying Information

Table 4.2-11: DICOM Implementation Class and Version for Q/R SCU AE

Implementation Class UID 2.16.840.1.114493.1.2.1.4

Implementation Version Name ViewRay TPDS v5.2 4.3.1.3 Association Initiation Policy

4.3.1.3.1 User Requests a Transfer

The user selects one or more search results to be transferred, and submits a transfer request.

4.3.1.3.1.1 Description and Sequencing of Activities

After performing a search using the Query AE, the user is presented with a list of search results. The user may then select one or more of these results to be imported, and submits the transfer job/request to the Q/R SCU AE.

The Q/R SCU AE establishes an association and performs a query to retrieve all of the SOP Instance UIDs of the instances to be transferred which is used to monitor the transfer of data. This association is closed, and another is established to perform a C_MOVE request on the data specified in the transfer job. Q/R requests are made at a series level.

The Storage SCP AE coordinates with the Q/R SCU AE to provide feedback and actual data transfer operation to the user.

4.3.1.3.1.2 Proposed Presentation Contexts

Table 4.2-12: Proposed Presentation Context for Q/R SCU AE

Presentation Context Table

Abstract Syntax Transfer Syntax Role Extended

Negotiation Name UID Name List UID List Patient Root Query/Retrieve Information Model - FIND1

1.2.840.10008.5.1.4.1.2.1.1

Implicit VR Little Endian

1.2.840.10008.1.2

SCU None




Negotiation Name UID Name List UID List Study Root Query/Retrieve Information Model – FIND2

1.2.840.10008.5.1.4.1.2.2.1


1.2.840.10008.1.2

SCU None

Patient Root Query/Retrieve Information Model - MOVE1

1.2.840.10008.5.1.4.1.2.1.2


1.2.840.10008.1.2

SCU None

Study Root Query/Retrieve Information Model - MOVE2

1.2.840.10008.5.1.4.1.2.2.2


1.2.840.10008.1.2

SCU None

Note 1 – This presentation context is proposed, but not used.

Note 2 – If this presentation context is not accepted, the AE will not continue.

4.3.1.3.1.3 SOP Specific Conformance for SOP Class

The table below describes the behavior of the software in response to the status codes received in response to a request.

Table 4.2-13: Query Response Status Handling Behavior

Service Status Further Meaning Error Code Behavior Failure Cancel

* A700 A900 Cxxx FE00

The association is closed and a message is displayed to the user describing the error. The transfer is canceled.

Success Matching is complete – No final identifier is supplied

0000 The association is closed. The Transfer AE opens another connection and performs a MOVE operation.

Pending Matches are continuing – Current Match is supplied and any Optional Keys were supported in the same manner as Required Keys.

FF00 The result is added to the list of expected SOP Instance UIDs.

Matches are continuing – Warning that one or more Optional Keys were not supported for existence and/or matching for this Identifier.

FF01


Table 4.2-14: MOVE Response Status Handling Behavior


* A701 A702 A801 A900 Cxxx FE00

The association is closed and a message is displayed to the user describing the error. The transfer is canceled.

Warning Sub-operations Complete – One or more Failures

B000 Operation is canceled and warning is logged.

Success Sub-operations Complete – No Failures

0000 The association is closed. Once all instances are received, the user is notified that the job is complete (if listening).

Pending Sub-operations are continuing FF00 No response required.

Table 4.2-15: Communication Failure Behavior

Exception Behavior Association Aborted A message is displayed to the user indicating that communication has failed,

and providing a reason when possible. Timeout Receiving Instances After Move Operation Responds Completed.

If the move operation reports Success, the system waits for all expected instances to be received. If there are instances expected by the Transfer AE that have not received, and no instance is received for 2 minutes, the system reports an error the user.

4.3.1.4 Association Acceptance Policy

The Q/R SCU AE does not accept associations.

4.3.2 Storage and Storage Commit SCU AE

Storage and Storage Commit SCU AE provides Standard Conformance to the following SOP Classes:

Table 4.2-8: SOP Classes Supported by Storage and Storage Commit SCU AE

SOP Class Name SOP Class UID SCU SCP

CT Image Storage 1.2.840.10008.5.1.4.1.1.2 Yes No

MR Image Storage 1.2.840.10008.5.1.4.1.1.4 Yes No

PET Image Storage 1.2.840.10008.5.1.4.1.1.128 Yes No

RT Dose Storage 1.2.840.10008.5.1.4.1.1.481.2 Yes No

RT Structure Storage 1.2.840.10008.5.1.4.1.1.481.3 Yes No

RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5 Yes No

Storage Commit Push Model 1.2.840.10008.1.20.1 Yes No



4.3.2.1.1 General


Table 4.2-9: DICOM Application Context for Storage SCU AE

Application Context Name 1.2.840.10008.3.1.1.1 4.3.2.1.2 Number of Associations

Each store request will result in at most two associations.

NOTE: Storage Commit AE may be initiated after a successful store operation to check the existences of SOPs corresponding to each DICOM file. However, Storage Commit AE is optional with no impact on application functionality. Hence, it won’t be elaborated in this document.

Table 4.2-10: Number of Associations as an Association Initiator for Storage SCU AE

Maximum number of simultaneous associations One 4.3.2.1.3 Asynchronous Nature



Table 4.2-11: DICOM Implementation Class and Version for Storage SCU AE



4.3.2.2.1 User Requests a Store

The user selects one or more options from image list or plan data export window to be stored, and submits a store request.


The Storage SCU AE establishes an association and performs an operation to send list of instances to remote server for storage purpose.


Table 4.2-12: Proposed Presentation Context for Storage SCU AE



Negotiation Name UID Name List UID List

CT Image Storage 1.2.840.10008.5.1.4.1.1.2


1.2.840.10008.1.2

SCU None

MR Image Storage 1.2.840.10008.5.1.4.1.1.4


1.2.840.10008.1.2

SCU None




Negotiation Name UID Name List UID List Positron Emission Tomography Image Storage

1.2.840.10008.5.1.4.1.1.128


1.2.840.10008.1.2

SCU None

RT Dose Storage 1.2.840.10008.5.1.4.1.1.481.2


1.2.840.10008.1.2

SCU None

RT Structure Storage 1.2.840.10008.5.1.4.1.1.481.3


1.2.840.10008.1.2

SCU None

RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5


1.2.840.10008.1.2

SCU None

RT Image Storage 1.2.840.10008.5.1.4.1.1.481.1


1.2.840.10008.1.2

SCU None

Storage Commit Push Model

1.2.840.10008.1.20.1


1.2.840.10008.1.2

SCU None




The table below describes the behavior of the software in response to the status codes received in response to a request.

Table 4.2-14: STORE Response Status Handling Behavior


* A700 A900 C000 110

The association is closed and a message is displayed to the user describing the error.

Warning B000 B006 B007

Operation is canceled and warning is logged.

Success Store operation completes with no failure.

0000 The association is closed. Once all instances are stored, the user is notified that the job is complete.

Table 4.2-15: Communication Failure Behavior

Exception Behavior Association Aborted A message is displayed to the user indicating that communication has failed,

and providing a reason when possible.



The Storage SCU AE does not accept associations.

4.3.3 Storage SCP AE

4.3.3.1 SOP Classes

Storage SCP AE provides Standard Conformance to the following SOP Class(es):

Table 4.2-16: SOP Classes Supported by Storage SCP AE


CT Image Storage 1.2.840.10008.5.1.4.1.1.2 No Yes

MR Image Storage 1.2.840.10008.5.1.4.1.1.4 No Yes

Positron Emission Tomography Image Storage 1.2.840.10008.5.1.4.1.1.128 No Yes

RT Dose Storage 1.2.840.10008.5.1.4.1.1.481.2 No Yes

RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.3 No Yes

RT Structure Storage 1.2.840.10008.5.1.4.1.1.481.5 No Yes

Note 1: Only grid-based doses are supported.

Note 2: RT Plan and RT Structure can only be saved to local or network disks. Storing these two objects to the database is not supported.


4.3.3.2.1 General


Table 4.2-17: DICOM Application Context for Storage SCP AE


Table 4.2-18: Number of Associations as an Association Acceptor for Storage SCP AE

Maximum number of simultaneous associations Unlimited

4.3.3.2.3 Asynchronous Nature



Table 4.2-19: DICOM Implementation Class and Version for Storage SCP AE



The Storage SCP AE does not initiate associations.



The Storage SCP AE handles all storage association requests to the Remote Import Service.

4.3.3.4.1 Storage Requested

An external system requests to store an instance in the MRIdian Linac system. This request may be the result of a transfer job controlled by the Q/R SCU AE, or it may be unsolicited.


The Q/R SCU AE performs a C_MOVE request on a DICOM system, which then initiates a C_STORE operation on the Remote Import Service AE Title. This C_STORE request will be received and handled by the Storage SCP AE.

OR

A user of another DICOM-compliant system initiates a C_STORE operation on the Remote Import Service AE Title directly.

4.3.3.4.1.2 Accepted Presentation Contexts

Table 4.2-20: Acceptable Presentation Context for receiver AE



Negotiation Name UID Name List UID List

See Table 4.2-16 Implicit VR Little Endian

1.2.840.10008.1.2 SCP None


The table below describes the behavior of the software in indicated by each error code that the Storage SCP AE may produce.

Table 4.2-21: Storage C-STORE Response Status

Service Status Further Meaning Error Code Reason Success Success 0000 The data was stored.

Error There was an error interpreting the data.

A700 A900 C000

The data was either not supported, or invalid. The data was not stored.

4.3.4 Verification AE

4.3.4.1 SOP Classes

Verification AE provides Standard Conformance to the following SOP Classes:

Table 4.2-8: SOP Classes Supported by Verification AE


Verification Service Class 1.2.840.10008.1.1 Yes Yes



4.3.4.2.1 General


Table 4.2-9: DICOM Application Context for Verification AE


Table 4.2-10: Number of Associations as an Association Initiator for Verification AE

Maximum number of simultaneous associations One as SCU, Unlimited as SCP 4.3.4.2.3 Asynchronous Nature



Table 4.2-11: DICOM Implementation Class and Version for Verification AE



4.3.4.3.1 Echo request

Verification AE acts as SCU when user request echo to SCP AE.


When user initiates an echo request, the Verification AE will send request to SCP AE.


Table 4.2-12: Proposed Presentation Context for Verification AE



Negotiation Name UID Name List UID List Verification Service Class

1.2.840.10008.1.1


1.2.840.10008.1.2

SCU None




4.3.4.4.1 Echo request

Verification AE acts as SCP when waiting for association request from SCU AE.



When verification AE receives association from SCU AE, it sends response and performs echo operation.


Table 4.2-12: Proposed Presentation Context for Verification AE



Negotiation Name UID Name List UID List Verification Service Class

1.2.840.10008.1.1


1.2.840.10008.1.2

SCP None



4.4 Network Interfaces

4.4.1 Physical Network Interface

The MRIdian Linac Database Server system has an Ethernet connector reserved for hospital communication. All DICOM communication is done through this connection using TCP/IP.

4.4.2 Additional Protocols

Table 4.3-1:System Management Profiles Table

Profile Name Actor Protocols Used Optional Transactions Security Support

Network Address Management

DHCP Client DHCP N/A

DNS Client DNS N/A

The Remote Import Service uses the facilities of the underlying operating system to configure IP address by DHCP, and provide name resolution by DNS.

4.4.3 IPv4 and Ipv6 Support

This product supports only Ipv4.

4.5 Configuration

4.5.1 AE Title/Presentation Address Mapping

4.5.1.1 Local AE Titles

All AEs share the one AE Title which is configurable by a service engineer. This AE Title functions as both the calling AE Title for the Sender, aka Query, Transfer, Store and Echo SCU, AEs, and the destination AE Title for the Receiver, aka, Store and Echo SCP, AEs. All association requests received by the Remote Import Service for this AE title are handled by the Receiver AE and distribute to the corresponding association handler. The listening TCP/IP port is also configurable.


Table 4.4-1: AE Title Configuration Table

Application Entity Default AE Title Default TCP/IP Port

Q/R SCU AE No Default Not Applicable Storage and Storage Commit SCU

AE No Default Not Applicable

Storage SCP AE No Default 104

Verification SCU AE No Default Not Applicable

Verification SCP AE No Default 104

4.5.1.2 Remote AE Title/Presentation Address Mapping

Remote host names, TCP/IP ports, and AE Titles can be modified by the user whenever they initiate a search. These settings may also be stored for easy retrieval in the future. In this case, the entries are referenced by AE Title which must be unique.

4.5.1.2.1 Receiver

The Receiver SCP accepts associations form any known host/AE Titles. Known host/AE titles refer to either DICOM bridge server or remote AEs stored in database.

4.5.2 Parameters

Table 4.4-2: Configuration Parameters Table

Parameter Configurable (Yes/No) Default Value

General Parameters Time-out waiting for acceptance or rejection response to an Association Open Request. (Application Level timeout)

No None

Time-out waiting for a response to TCP/IP connect request (Low-level timeout)

No 9 s

Time-out for waiting for data between TCP/IP packets (Low-level timeout)

No Dynamically adjusted per connection.

Maximum PDU size the AE can receive No 64 KB

Maximum PDU size the AE can send No 64 KB


5. MEDIA INTERCHANGE

5.1 Implementation Model

5.1.1 Application Data Flow Diagram

Figure 5.1-1: Application Data Flow Diagram

The MRIdian Linac system treatment planning and treatment delivery consoles provide the user with the capability of importing and exporting data using files compliant with part PS 3.10 of the DICOM standard.

5.1.2 Functional definitions of the MRIdian Linac Console Software

The user has the option to import data into the MRIdian Linac database. The user is prompted to select the files to import from the file system. All selected instances are checked for compatibility, and imported into the MRIdian Linac database for future use.

When exporting, the user selects the data to be exported, and specifies a directory to output the data to. All selected data are written to the specified location.

5.1.3 Sequencing of Real World Activities

No sequencing of real world activities is defined.

5.1.4 File Meta Information for Implementation Class and Version


Implementation Version Name ViewRay TPDS v5.2


5.2 AE Specifications

5.2.1 MRIdian Linac Console Software – Specification

Table 5.2-1: AE RELATED APPLICATION PROFILES, REAL-WORLD ACTIVITIES, AND ROLES

Supported Application Profile Real-World Activity Roles

STD-CTMR Import Data FSR

STD-GEN Export Data See Note 1

Note 1: The MRIdian Linac Console software provides the user with the ability to create DICOM files compliant with part PS 3.10 of the DICOM standard to any user-specified directory. However, it does not meet the definition of a File Set Creator or File Set Updater for any of the application profiles defined in part PS 3.11.

5.2.1.1 File Meta Information for the MRIdian Linac Console Software

The MRIdian Linac Console software uses the configurable AE Title as the Source Application Entity Title. No private data is written to the File Meta Information.

5.2.1.2 Real-World Activities

5.2.1.2.1 Import Data

The system acts as a FSR when importing data. The user is prompted for the location of the data to be imported. These data are then loaded into the MRIdian Linac database for later use.

5.2.1.2.1.1 Media Storage Application Profiles

The STD-CTMR and STD-GEN profiles

5.2.1.2.2 Export Data

The system writes files compliant with part PS 3.10 of the DICOM standard when exporting data from the database. These data may have originated on the system, or they may be data that has been previously imported into the MRIdian Linac database. The user selects what data are to be exported, and the output location to write the files.

5.2.1.2.2.1 Media Storage Application Profiles

The MRIdian Linac Console software does not fully meet the definition of any FSC as defined in part PS 3.11.

5.3 Augmented and Private Application Profiles

5.3.1 Augmented Application Profiles

There are no augmented Application Profiles defined.

5.3.2 Private Application Profiles

There are no private Application Profiles defined.

5.4 Media Configuration

A service user may configure the AE Title used by the MRIdian Linac Console Software as the Source AE Title. This shall be configured to match the AE Title used by the Remote Import Service.


6. SUPPORT OF CHARACTER SETS

The MRIdian Linac system uses only the default character repertoire (ISO 646).

• All instances will be created with this character set.

• Any instance received or imported into the MRIdian Linac system that does not use this character set will be rejected.


7. SECURITY

The MRIdian Linac system does not support any specific Security Profiles. It is assumed that the system operates in a secured environment. Specifically it is assumed that:

a. There is a firewall or router that prevents unauthorized network access to the MRIdian Linac system. b. There is a firewall or router that prevents the MRIdian Linac system from accessing unauthorized

systems via the network. c. Any access made by a system outside of this secured network is made via an appropriate security

mechanism such as VPN. More generally, it is assumed that any access to or from the MRIdian Linac system is authorized by virtue of the fact that the network is configured to permit this access.


APPENDIX A SPECIALIZATION

A.1 IOD Contents

A.1.1 Created SOP Instance(s)

Any instance imported into the MRIdian Linac system is written without modification when exported. The instance is written into a file with a ViewRay-created File Meta Information.

See Appendix B for information on instances created by the MRIdian Linac system.

A.1.2 Usage of Attributes from received IOD’s

The MRIdian Linac system requires all type 1 fields to be present and have a value.

For 4-D image data (volumetric data in time) where all of the data is contained in one series, the MRIdian Linac system uses the value of the Instance Number (0020,0013) field to order the image data. If this field is not present on such a series, the system will not be able to divide the image data into volumes.

A.1.3 Attribute Mapping

See Appendix B for attribute mapping information.

A.1.4 Coerced/Modified fields

All imported instances are written unmodified when exporting data. This section describes the coercion of data within the MRIdian Linac system.

When the system imports a new instance, if the database already contains data for a patient with matching patient id, the system verifies that the patient’s sex and birth date are also a match. If they do, all other fields in the Patient Identification Module are coerced to the values already in the database. If they do not match, the instance is rejected.

When the system imports a new instance, if the database already contains data with the same Study Instance UID, the instance is checked to ensure that it has the same Patient ID as the existing study. If so, all fields in the Patient Identification Module and the General Study module are coerced to the existing values. If they do not match, the instance is rejected.

When the system imports a new instance, if the database already contains data with the same Series Instance UID, the instance is checked to ensure that it has the same Study Instance UID as the existing series. If it does, all fields in the Patient Identification Module, the General Study Module, and the General Series Module are coerced to the existing values. If they do not match, the instance is rejected.

A.2 Data Dictionary of Private Attributes

The MRIdian Linac system does not use any private attributes.

A.3 Coded Terminology and Templates

The MRIdian Linac system does not use coded terminology.

A.4 Grayscale Image Consistency

The MRIdian Linac system does not provide support for the DICOM Grayscale Standard Display Function.

A.5 Standard Extended/Specialized/Private Sop Classes

No extended, specialized or private SOP classes are used by the MRIdian Linac system.


A.6 Private Transfer Syntaxes

The MRIdian Linac system does not use private transfer syntaxes.


APPENDIX B CREATED SOP INSTANCES

This appendix is intended to provide information about what data will be present when exporting data that originates from the MRIdian Linac system. The first section of this appendix lists all of the IODs created by the system, and an indication of which modules will be present when exporting instances of that type. The second section lists all of the modules used by the system, and identifies the source of the data for each field.

Throughout this appendix, we reference part PS 3.3 of the DICOM standard. Such references are made in square brackets. As an example, [A.3] refers to the section of the standard identifying the CT Image IOD. The section numbers referenced are taken from the 2008 standard.

B.1 IOD Definitions

This section identifies each IOD exported by the system, the conditions under which an instance of the IOD would be created, and which modules are populated at export.

The following definitions are used in this section

INCLUDED The module is included in the instance

NOT SUPPORTED The module is not included in the instance

B.1.1 CT Image IOD [A.3]

CT Images may be created as a result of image registration or interpolation.

IE Module Reference Support

Patient Patient [C.7.1.1] INCLUDED

Clinical Trial Subject [C.7.1.3] NOT SUPPORTED

Study General Study [C.7.2.1] INCLUDED

Patient Study [C.7.2.2] NOT SUPPORTED

Clinical Trial Study [C.7.2.3] NOT SUPPORTED

Series General Series [C.7.3.1] INCLUDED

Clinical Trial Series [C.7.3.2] NOT SUPPORTED

Frame of Reference Frame of Reference [C.7.4.1] INCLUDED

Equipment General Equipment [C.7.5.1] INCLUDED

Image General Image [C.7.6.1] INCLUDED

Image Plane [C.7.6.2] INCLUDED

Image Pixel [C.7.6.3] INCLUDED

Contrast/bolus [C.7.6.4] NOT SUPPORTED

Device [C.7.6.12] NOT SUPPORTED

CT Image [C.8.2.1] INCLUDED

Overlay Plane [C.9.2] NOT SUPPORTED

VOI LUT [C.11.2] NOT SUPPORTED

SOP Common [C.12.1] INCLUDED


B.1.2 MR Image IOD [A.4]

MR Images may be created as a result of image registration or interpolation, or may be created as a result of a scan run on the system including standard imaging, and patient setup scans.














Contrast/bolus [C.7.6.4] NOT SUPPORTED


MR Image [C.8.3.1] INCLUDED



SOP Common [C.12.1] INCLUDED B.1.3 RT Dose IOD [A.18]

RT Dose data may be created as the result of image registration (dose registration) or interpolation, or may be created as a result of dose calculations made within the MRIdian Linac system.







Series RT Series [C.8.8.1] INCLUDED


Frame of Reference Frame of Reference [C.7.4.1] INCLUDED Equipment General Equipment [C.7.5.1] INCLUDED for grid-based dose

data.


IE Module Reference Support Dose General Image [C.7.6.1] INCLUDED for grid-based dose

data. Image Plane [C.7.6.2] INCLUDED for grid-based dose

data. Image Pixel [C.7.6.3] INCLUDED for grid-based dose

data. Multi-Frame [C.7.6.6] INCLUDED for grid-based dose

data. Overlay Plane [C.9.2] NOT SUPPORTED

Multi-Frame Overlay [C.9.3] NOT SUPPORTED

Modality LUT [C.11.1] NOT SUPPORTED

RT Dose [C.8.8.3] INCLUDED

RT DVH [C.8.8.4] NOT SUPPORTED

Structure Set [C.8.8.5] INCLUDED for point-based dose data.

ROI Contour [C.8.8.6] INCLUDED for point-based dose data.

RT Dose ROI [C.8.8.7] INCLUDED for point-based dose data.


B.1.4 RT Structure Set IOD [A.19]

RT Structure sets are created as a result of contouring operations on a plan.










Structure Set Structure Set [C.8.8.5] INCLUDED

ROI Contour [C.8.8.6] INCLUDED

RT ROI Observations [C.8.8.8] INCLUDED

Approval [C.8.8.16] NOT SUPPORTED



B.1.5 RT Plan IOD [A.20]

RT Plans are created containing fundamental information of a plan and reference to RT Structure Set IOD and RT Dose IOD, if applicable.











Plan RT General Plan [C.8.8.9] INCLUDED

RT Prescription [C.8.8.10] INCLUDED

RT Tolerance Tables [C.8.8.11] NOT SUPPORTED

RT Patient Setup [C.8.8.12] INCLUDED

RT Fraction Scheme [C.8.8.13] INCLUDED

RT Beams [C.8.8.14] INCLUDED

RT Brachy Application Setups

[C.8.8.15] NOT SUPPORTED

Approval [C.8.8.16] INCLUDED

SOP Common [C.12.1] INCLUDED B.1.6 PET Image IOD [A.21]

PET Images may be created as a result of image registration or interpolation.

IE Module Reference Support Patient Patient [C.7.1.1] INCLUDED







PET Series [C.8.9.1] INCLUDED

PET Isotope [C.8.9.2] INCLUDED


IE Module Reference Support PET Multi-gated

Acquisition [C.8.9.3] NOT SUPPORTED

NM/PET Patient Orientation

[C.8.4.6] INCLUDED







PET Image [C.8.9.4] INCLUDED



Acquisition Context [C.7.6.14] NOT SUPPORTED


B.2 Module Definitions

This section lists all of the modules indicated as INCLUDED in the previous section, and provides information about the source of each field.

This section uses the following definitions

ANAP Attribute Not Always Present.

AUTO The attribute value is generated automatically.

CONFIG The attribute value is taken from a configuration parameter.

COPY The attribute value is taken from the original source of the data. For example, many attributes are taken from an original image set when registration is performed.

DB The Attribute value is taken from the database and originated from user input.

EMPTY Attribute is sent without a value.

USER The attribute value is from user input at the time of export.

B.2.1 Patient Module [C.7.1.1]

Attribute Name Tag Type Value Handling Patient's Name (0010,0010) 2 COPY for interpolation

DB otherwise Patient ID (0010,0020) 2 COPY for interpolation

DB otherwise Issuer of Patient ID (0010,0021) 3 ANAP

Patient's Birth Date (0010,0030) 2 COPY for interpolation DB otherwise


Attribute Name Tag Type Value Handling Patient's Sex (0010,0040) 2 COPY for interpolation

DB otherwise Referenced Patient Sequence (0008,1120) 3 COPY for interpolation

ANAP otherwise >Include SOP Instance Reference Macro [Table 10-11] Patient's Birth Time (0010,0032) 3 COPY for interpolation

ANAP otherwise Other Patient IDs (0010,1000) 3 COPY for interpolation

ANAP otherwise Other Patient IDs Sequence (0010,1002) 3 ANAP

>Patient ID (0010,0020) 1

>Issuer of Patient ID (0010,0021) 1

>Type of Patient ID (0010,0022) 1

Other Patient Names (0010,1001) 3 COPY for interpolation EMPTY otherwise

Ethnic Group (0010,2160) 3 COPY for interpolation ANAP otherwise

Patient Comments (0010,4000) 3 COPY for interpolation ANAP otherwise

Patient Species Description (0010,2201) 1C ANAP

Patient Species Code Sequence (0010,2202) 1C ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] Patient Breed Description (0010,2292) 2C ANAP

Patient Breed Code Sequence (0010,2293) 2C ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] Breed Registration Sequence (0010,2294) 2C ANAP

>Breed Registration Number (0010,2295) 1

>Breed Registry Code Sequence (0010,2296) 1

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Responsible Person (0010,2297) 2C ANAP

Responsible Person Role (0010,2298) 1C ANAP

Responsible Organization (0010,2299) 2C ANAP

Patient Identity Removed (0012,0062) 3 ANAP

De-identification Method (0012,0063) 1C ANAP

De-identification Method Code Sequence

(0012,0064) 1C ANAP

>Include Code Sequence Macro [Table 8.8-1]


B.2.2 General Study Module [C.7.2.1]

Attribute Name Tag Type Value Handling Study Instance UID (0020,000D) 1 AUTO

Study Date (0008,0020) 2 AUTO

Study Time (0008,0030) 2 AUTO

Referring Physician's Name (0008,0090) 2 EMPTY

Referring Physician Identification Sequence

(0008,0096) 3 ANAP

>Include ‘Person Identification Macro’ [Table 10-1] Study ID (0020,0010) 2 EMPTY

Accession Number (0008,0050) 2 EMPTY

Study Description (0008,1030) 3 ANAP

Physician(s) of Record (0008,1048) 3 ANAP

Physician(s) of Record Identification Sequence

(0008,1049) 3 ANAP

>Include ‘Person Identification Macro’ [Table 10-1] Name of Physician(s) Reading Study (0008,1060) 3 ANAP

Physician(s) Reading Study Identification Sequence

(0008,1062) 3 ANAP

>Include ‘Person Identification Macro’ [Table 10-1] Referenced Study Sequence (0008,1110) 3 ANAP

>Include SOP Instance Reference Macro [Table 10-11] Procedure Code Sequence (0008,1032) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1]

B.2.3 General Series Module [C.7.3.1]

Attribute Name Tag Type Value Handling Modality (0008,0060) 1 The appropriate value for the given

modality is written. Series Instance UID (0020,000E) 1 AUTO

Series Number (0020,0011) 2 EMPTY

Laterality (0020,0060) 2C COPY for interpolation EMPTY otherwise

Series Date (0008,0021) 3 AUTO for interpolation ANAP otherwise

Series Time (0008,0031) 3 AUTO for interpolation ANAP otherwise

Performing Physicians’ Name (0008,1050) 3 ANAP

Performing Physician Identification Sequence

(0008,1052) 3 ANAP

>Include ‘Person Identification Macro’ [Table 10-1]


Attribute Name Tag Type Value Handling Protocol Name (0018,1030) 3 COPY for interpolation

ANAP otherwise Series Description (0008,103E) 3 DB

Operators' Name (0008,1070) 3 ANAP

Operator Identification Sequence (0008,1072) 3 ANAP

>Include ‘Person Identification Macro’ [Table 10-1] Referenced Performed Procedure Step Sequence

(0008,1111) 3 ANAP

>Include SOP Instance Reference Macro [Table 10-11] Related Series Sequence (0008,1250) 3 ANAP

>Study Instance UID (0020,000D) 1

>Series Instance UID (0020,000E) 1

>Purpose of Reference Code Sequence (0040,A170) 2

>>Include Code Sequence Macro [Table 8.8-1] Body Part Examined (0018,0015) 3 COPY for interpolation

ANAP otherwise Patient Position (0018,5100) 2C COPY for interpolation

DB otherwise. Smallest Pixel Value in Series (0028,0108) 3 COPY for interpolation

ANAP otherwise Largest Pixel Value in Series (0028,0109) 3 COPY for interpolation

ANAP otherwise Request Attributes Sequence (0040,0275) 3 ANAP

>Include Request Attributes Macro [Table 10-9] Performed Procedure Step ID (0040,0253) 3 ANAP

Performed Procedure Step Start Date (0040,0244) 3 ANAP

Performed Procedure Step Start Time (0040,0245) 3 ANAP

Performed Procedure Step Description (0040,0254) 3 ANAP

Performed Protocol Code Sequence (0040,0260) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] >Protocol Context Sequence (0040,0440) 3 ANAP

>>Include ‘Content Item Macro’ [Table 10-2] >> Content Item Modifier Sequence (0040,0441) 3 ANAP

>>>Include ‘Content Item Macro’ [Table 10-2] Comments on the Performed Procedure Step

(0040,0280) 3 ANAP


B.2.4 Frame Of Reference Module [C.7.4.1]

Attribute Name Tag Type Value Handling

Frame of Reference UID (0020,0052) 1 AUTO

Position Reference Indicator (0020,1040) 2 EMPTY B.2.5 General Equipment Module [C.5.5.1]


Manufacturer (0008,0070) 2 CONFIG

Institution Name (0008,0080) 3 CONFIG ANAP otherwise

Institution Address (0008,0081) 3 CONFIG ANAP otherwise

Station Name (0008,1010) 3 CONFIG ANAP otherwise

Institutional Department Name (0008,1040) 3 CONFIG ANAP otherwise

Manufacturer's Model Name (0008,1090) 3 CONFIG ANAP otherwise

Device Serial Number (0018,1000) 3 CONFIG ANAP otherwise

Software Versions (0018,1020) 3 CONFIG ANAP otherwise

Gantry ID (0018,1008) 3 ANAP

Spatial Resolution (0018,1050) 3 ANAP

Date of Last Calibration (0018,1200) 3 ANAP

Time of Last Calibration (0018,1201) 3 ANAP

Pixel Padding Value (0028,0120) 1C ANAP B.2.6 General Image Module [C.7.6.1]

Attribute Name Tag Type Value Handling Instance Number (0020,0013) 2 COPY for interpolation

AUTO otherwise Patient Orientation (0020,0020) 2C COPY for interpolation

EMPTY otherwise Content Date (0008,0023) 2C AUTO for interpolation

EMPTY otherwise Content Time (0008,0033) 2C AUTO for interpolation

EMPTY otherwise Image Type (0008,0008) 3 Value 1 is always set to “DERIVED”.

Value 2 is copied for interpolation, and set to “SECONDARY” otherwise. See other modules for specialization of values 3 and 4.


Attribute Name Tag Type Value Handling Acquisition Number (0020,0012) 3 ANAP

Acquisition Date (0008,0022) 3 ANAP

Acquisition Time (0008,0032) 3 ANAP

Acquisition DateTime (0008,002A) 3 COPY for interpolation ANAP otherwise

Referenced Image Sequence (0008,1140) 3 ANAP

>Include ‘Image SOP Instance Reference Macro’ [Table 10-3] >Purpose of Reference Code Sequence (0040,A170) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Derivation Description (0008,2111) 3 ANAP

Derivation Code Sequence (0008,9215) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] Source Image Sequence (0008,2112) 3

>Include ‘Image SOP Instance Reference Macro’ [Table 10-3] >Purpose of Reference Code Sequence (0040,A170) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] >Spatial Locations Preserved (0028,135A) 3

>Patient Orientation (0020,0020) 1C

Referenced Instance Sequence (0008,114A) 3 ANAP

>Include SOP Instance Reference Macro [Table 10-11] >Purpose of Reference Code Sequence (0040,A170) 1

>>Include 'Code Sequence Macro' [Table 8.8-1] Images in Acquisition (0020,1002) 3 ANAP

Image Comments (0020,4000) 3 ANAP

Quality Control Image (0028,0300) 3 ANAP

Burned In Annotation (0028,0301) 3 COPY for interpolation ANAP otherwise

Lossy Image Compression (0028,2110) 3 ‘N’ for interpolation ANAP otherwise

Lossy Image Compression Ratio (0028,2112) 3 ANAP

Lossy Image Compression Method (0028,2114) 3 ANAP

Icon Image Sequence (0088,0200) 3 ANAP

> Include ‘Image Pixel Macro’ [Table C.7-11b] Presentation LUT Shape (2050,0020) 3 ANAP

Irradiation Event UID (0008,3010) 3 ANAP


B.2.7 Image Plane Module [C.7.6.2]

Attribute Name Tag Type Value Handling Pixel Spacing (0028,0030) 1 Set to the pixel spacing of the

resulting volume Image Orientation (Patient) (0020,0037) 1 Set according to the orientation of

the pixel data relative to the patient Image Position (Patient) (0020,0032) 1 Set to the location of the first pixel

in the image Slice Thickness (0018,0050) 2 COPY for interpolation

Set to the distance between slices otherwise

Slice Location (0020,1041) 3 ANAP

B.2.8 Image Pixel Module [C.7.6.3]

Attribute Name Tag Type Value Handling Samples per Pixel (0028,0002) 1 AUTO

Photometric Interpretation (0028,0004) 1 AUTO

Rows (0028,0010) 1 Number of rows in the image.

Columns (0028,0011) 1 Number of columns in the image

Bits Allocated (0028,0100) 1 All instances generated by the MRIdian Linac system are 16-bit.

Bits Stored (0028,0101) 1 COPY for interpolation AUTO otherwise

High Bit (0028,0102) 1 COPY for interpolation AUTO otherwise

Pixel Representation (0028,0103) 1 COPY for interpolation AUTO otherwise

Pixel Data (7FE0,0010) 1C AUTO

Planar Configuration (0028,0006) 1C ANAP – Only data with 1 sample per pixel are supported.

Pixel Aspect Ratio (0028,0034) 1C ANAP – Pixel Spacing is used to determine pixel aspect ratio

Smallest Image Pixel Value (0028,0106) 3 ANAP

Largest Image Pixel Value (0028,0107) 3 ANAP

Red Palette Color Lookup Table Descriptor

(0028,1101) 1C ANAP – LUT not supported

Green Palette Color Lookup Table Descriptor


Blue Palette Color Lookup Table Descriptor


Red Palette Color Lookup Table Data (0028,1201) 1C ANAP – LUT not supported

Green Palette Color Lookup Table Data



Attribute Name Tag Type Value Handling Blue Palette Color Lookup Table Data (0028,1203) 1C ANAP – LUT not supported

ICC Profile (0028,2000) 3 ANAP

Pixel Data Provider URL (0028,7FE0) 1C ANAP – DICOM JPNP not supported

Pixel Padding Range Limit (0028,0121) 1C ANAP – Padding range not supported

B.2.9 Multi-Frame Module [C.7.6.6]

Attribute Name Tag Type Value Handling Number of Frames (0028,0008) 1 Number of frames in a Multi-frame

Image. Frame Increment Pointer (0028,0009) 1 AUTO

B.2.10 CT Image [C.8.2.1]

Attribute Name Tag Type Value Handling Image Type (0008,0008) 1 Values 3 and 4 are copied for

interpolated volumes. Value 3 is set to “AXIAL” and value 4 is note sent otherwise.

Samples per Pixel (0028,0002) 1 These values are defined as stated in section B.2.6. The values are compliant with the definitions in [C.8.2.1.1].

Photometric Interpretation (0028,0004) 1

Bits Allocated (0028,0100) 1

Bits Stored (0028,0101) 1

High Bit (0028,0102) 1

Rescale Intercept (0028,1052) 1 AUTO

Rescale Slope (0028,1053) 1 AUTO

KVP (0018,0060) 2 COPY for interpolation EMPTY otherwise

Acquisition Number (0020,0012) 2 EMPTY

Scan Options (0018,0022) 3 COPY for interpolation ANAP otherwise

Data Collection Diameter (0018,0090) 3 COPY for interpolation ANAP otherwise

Data Collection Center (Patient) (0018,9313) 3 COPY for interpolation ANAP otherwise

Reconstruction Diameter (0018,1100) 3 COPY for interpolation ANAP otherwise

Reconstruction Target Center (Patient) (0018,9318) 3 COPY for interpolation ANAP otherwise

Distance Source to Detector (0018,1110) 3 COPY for interpolation ANAP otherwise


Attribute Name Tag Type Value Handling Distance Source to Patient (0018,1111) 3 COPY for interpolation

ANAP otherwise Gantry/Detector Tilt (0018,1120) 3 COPY for interpolation

ANAP otherwise Table Height (0018,1130) 3 COPY for interpolation

ANAP otherwise Rotation Direction (0018,1140) 3 COPY for interpolation

ANAP otherwise Exposure Time (0018,1150) 3 COPY for interpolation

ANAP otherwise X-Ray Tube Current (0018,1151) 3 COPY for interpolation

ANAP otherwise Exposure (0018,1152) 3 COPY for interpolation

ANAP otherwise Exposure in µAs (0018,1153) 3 COPY for interpolation

ANAP otherwise Filter Type (0018,1160) 3 COPY for interpolation

ANAP otherwise Generator Power (0018,1170) 3 COPY for interpolation

ANAP otherwise Focal Spot (0018,1190) 3 COPY for interpolation

ANAP otherwise Convolution Kernel (0018,1210) 3 COPY for interpolation

ANAP otherwise Revolution Time (0018,9305) 3 COPY for interpolation

ANAP otherwise Single Collimation Width (0018,9306) 3 COPY for interpolation

ANAP otherwise Total Collimation Width (0018,9307) 3 COPY for interpolation

ANAP otherwise Table Speed (0018,9309) 3 COPY for interpolation

ANAP otherwise Table Feed per Rotation (0018,9310) 3 COPY for interpolation

ANAP otherwise Spiral Pitch Factor (0018,9311) 3 COPY for interpolation

ANAP otherwise Exposure Modulation Type (0018,9323) 3 COPY for interpolation

ANAP otherwise Estimated Dose Saving (0018,9324) 3 COPY for interpolation

ANAP otherwise CTDIvol (0018,9345) 3 COPY for interpolation

ANAP otherwise CTDI Phantom Type Code Sequence (0018,9346) 3 COPY for interpolation

ANAP otherwise >Include Code Sequence Macro [Table 8.8-1] Anatomic Region Sequence (0008,2218) 3 ANAP



>Include ‘Code Sequence Macro’ Table [8.8-1] >Anatomic Region Modifier Sequence (0008,2220) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Primary Anatomic Structure Sequence (0008,2228) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] >Primary Anatomic Structure Modifier Sequence

(0008,2230) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Calcium Scoring Mass Factor Patient (0018,9351) 3 COPY for interpolation

ANAP otherwise Calcium Scoring Mass Factor Device (0018,9352) 3 COPY for interpolation

ANAP otherwise CT Additional X-Ray Source Sequence (0018,9360) 3 COPY for interpolation

ANAP otherwise >kVP (0018,0060) 1

>X-Ray Tube Current in mA (0018,9330) 1

>Data Collection Diameter (0018,0090) 1

>Focal Spot(s) (0018,1190) 1

>Filter Type(s) (0018,1160) 1

>Filter Material (0018,7050) 1

B.2.11 MR Image Module [C.8.3.1]

Attribute Name Tag Type Value Handling Image Type (0008,0008) 1 Values 3 and 4 are copied for

interpolation. Value 3 is “OTHER” and value 4 is not sent otherwise.

Samples per Pixel (0028,0002) 1 Send as described in section B.2.6

Photometric Interpretation (0028,0004) 1


Scanning Sequence (0018,0020) 1 COPY for interpolation and registration AUTO for new images

Sequence Variant (0018,0021) 1 COPY for interpolation and registration AUTO for new images

Scan Options (0018,0022) 2 COPY for interpolation EMPTY otherwise

MR Acquisition Type (0018,0023) 2 COPY for interpolation EMPTY otherwise

Repetition Time (0018,0080) 2C COPY for interpolation EMPTY otherwise


Attribute Name Tag Type Value Handling Echo Time (0018,0081) 2 COPY for interpolation

EMPTY otherwise Echo Train Length (0018,0091) 2 COPY for interpolation

EMPTY otherwise Inversion Time (0018,0082) 2C COPY for interpolation

EMPTY otherwise Trigger Time (0018,1060) 2C COPY for interpolation

EMPTY otherwise Sequence Name (0018,0024) 3 COPY for interpolation

ANAP otherwise Angio Flag (0018,0025) 3 COPY for interpolation

ANAP otherwise Number of Averages (0018,0083) 3 COPY for interpolation

ANAP otherwise Imaging Frequency (0018,0084) 3 COPY for interpolation

ANAP otherwise Imaged Nucleus (0018,0085) 3 COPY for interpolation

ANAP otherwise Echo Number (0018,0086) 3 COPY for interpolation

ANAP otherwise Magnetic Field Strength (0018,0087) 3 COPY for interpolation

ANAP otherwise Spacing Between Slices (0018,0088) 3 COPY for interpolation

ANAP otherwise Number of Phase Encoding Steps (0018,0089) 3 COPY for interpolation

ANAP otherwise Percent Sampling (0018,0093) 3 COPY for interpolation

ANAP otherwise Percent Phase Field of View (0018,0094) 3 COPY for interpolation

ANAP otherwise Pixel Bandwidth (0018,0095) 3 COPY for interpolation

ANAP otherwise Nominal Interval (0018,1062) 3 COPY for interpolation

ANAP otherwise Beat Rejection Flag (0018,1080) 3 COPY for interpolation

ANAP otherwise Low R-R Value (0018,1081) 3 COPY for interpolation

ANAP otherwise High R-R Value (0018,1082) 3 COPY for interpolation

ANAP otherwise Intervals Acquired (0018,1083) 3 COPY for interpolation

ANAP otherwise Intervals Rejected (0018,1084) 3 COPY for interpolation

ANAP otherwise PVC Rejection (0018,1085) 3 COPY for interpolation

ANAP otherwise


Attribute Name Tag Type Value Handling Skip Beats (0018,1086) 3 COPY for interpolation

ANAP otherwise Heart Rate (0018,1088) 3 COPY for interpolation

ANAP otherwise Cardiac Number of Images (0018,1090) 3 COPY for interpolation

ANAP otherwise Trigger Window (0018,1094) 3 COPY for interpolation

ANAP otherwise Reconstruction Diameter (0018,1100) 3 COPY for interpolation

ANAP otherwise Receive Coil Name (0018,1250) 3 COPY for interpolation

ANAP otherwise Transmit Coil Name (0018,1251) 3 COPY for interpolation

ANAP otherwise Acquisition Matrix (0018,1310) 3 COPY for interpolation

ANAP otherwise In-plane Phase Encoding Direction (0018,1312) 3 COPY for interpolation

ANAP otherwise Flip Angle (0018,1314) 3 COPY for interpolation

ANAP otherwise SAR (0018,1316) 3 COPY for interpolation

ANAP otherwise Variable Flip Angle Flag (0018,1315) 3 COPY for interpolation

ANAP otherwise dB/dt (0018,1318) 3 COPY for interpolation

ANAP otherwise Temporal Position Identifier (0020,0100) 3 COPY for interpolation

ANAP otherwise Number of Temporal Positions (0020,0105) 3 COPY for interpolation

ANAP otherwise Temporal Resolution (0020,0110) 3 COPY for interpolation

ANAP otherwise Anatomic Region Sequence (0008,2218) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] >Anatomic Region Modifier Sequence (0008,2220) 3



(0008,2230) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1]


B.2.12 NM/PET Patient Orientation Module [C.8.4.6]

Attribute Name Tag Type Value Handling Patient Orientation Code Sequence (0054,0410) 2 COPY

>Include ‘Code Sequence Macro’ [Table 8.8-1] > Patient Orientation Modifier Code Sequence

(0054,0412) 2C

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Patient Gantry Relationship Code Sequence

(0054,0414) 2 COPY

>Include ‘Code Sequence Macro’ [Table 8.8-1] B.2.13 RT Series Module [C.8.8.1]

Attribute Name Tag Type Value Handling Modality (0008,0060) 1 AUTO

Series Instance UID (0020,000E) 1 AUTO

Series Number (0020,0011) 2 EMPTY

Series Description (0008,103E) 3 COPY for interpolation ANAP AUTO otherwise

Operators’ Name (0008, 1070) 2 EMPTY

Referenced Performed Procedure Step Sequence

(0008,1111) 3 ANAP

>Include ‘SOP Instance Reference Macro' [Table 10-11] Request Attributes Sequence (0040,0275) 3 ANAP

>Include Request Attributes Macro [Table 10-9] Performed Procedure Step ID (0040,0253) 3 ANAP

Performed Procedure Step Start Date (0040,0244) 3 ANAP

Performed Procedure Step Start Time (0040,0245) 3 ANAP

Performed Procedure Step Description (0040,0254) 3 ANAP

Performed Protocol Code Sequence (0040,0260) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] >Protocol Context Sequence (0040,0440) 3 ANAP

>>Include ‘Content Item Macro’ [Table 10-2] >> Content Item Modifier Sequence (0040,0441) 3 ANAP

>>>Include ‘Content Item Macro’ [Table 10-2] Comments on the Performed Procedure Step

(0040,0280) 3 ANAP


B.2.14 RT Dose Module [C.8.8.3]

Attribute Name Tag Type Value Handling Samples per Pixel (0028,0002) 1C The value 1 is always given

Photometric Interpretation (0028,0004) 1C The value MONOCHROME2 is always given

Bits Allocated (0028,0100) 1C The value 16 is always given

Bits Stored (0028,0101) 1C The value 16 is always given

High Bit (0028,0102) 1C The value 15 is always given

Pixel Representation (0028,0103) 1C COPY for interpolation The value 0 (Unsigned) is always given otherwise

Dose Units (3004,0002) 1 COPY for interpolation The value GY is always given otherwise

Dose Type (3004,0004) 1 COPY for interpolation The value PHYSICAL is always given otherwise

Instance Number (0020,0013) 3 COPY for interpolation ANAP otherwise

Dose Comment (3004,0006) 3 COPY for interpolation ANAP otherwise

Normalization Point (3004,0008) 3 COPY for interpolation ANAP otherwise

Dose Summation Type (3004,000A) 1 COPY for interpolation PLAN of FRACTION otherwise depending on the source of the data

Referenced RT Plan Sequence (300C,0002) 1C COPY for interpolation AUTO otherwise

>Include ‘SOP Instance Reference Macro' [Table 10-11] >Referenced Fraction Group Sequence (300C,0020) 1C

>>Referenced Fraction Group Number (300C,0022) 1

>>Referenced Beam Sequence (300C,0004) 1C

>>>Referenced Beam Number (300C,0006) 1

>>>Referenced Control Point Sequence

(300C,00F2) 1C

>>>>Referenced Start Control Point Index

(300C,00F4) 1

>>>>Referenced Stop Control Point Index

(300C,00F6) 1

>>Referenced Brachy Application Setup Sequence

(300C,000A) 1C

>>>Referenced Brachy Application Setup Number

(300C,000C) 1


Attribute Name Tag Type Value Handling Grid Frame Offset Vector (3004,000C) 1C COPY for interpolation

The plane location of each frame relative to the first frame (option a in [C.8.8.3.2]) otherwise.

Dose Grid Scaling (3004,000E) 1 AUTO

Tissue Heterogeneity Correction (3004,0014) 3 COPY for interpolation ANAP otherwise.

B.2.15 Structure Set Module [C.8.8.5]

Attribute Name Tag Type Value Handling Structure Set Label (3006,0002) 1 DB – Matches the plan label

Structure Set Name (3006,0004) 3 ANAP

Structure Set Description (3006,0006) 3 ANAP

Instance Number (0020,0013) 3 ANAP

Structure Set Date (3006,0008) 2 AUTO

Structure Set Time (3006,0009) 2 AUTO

Referenced Frame of Reference Sequence

(3006,0010) 3

>Frame of Reference UID (0020,0052) 1 AUTO - Matches the frame of reference UID of the primary image set

>Frame of Reference Relationship Sequence

(3006,00C0) 3 ANAP

>>Related Frame of Reference UID (3006,00C2) 1

>>Frame of Reference Transformation Type

(3006,00C4) 1C

>>Frame of Reference Transformation Matrix

(3006,00C6) 1

>>Frame of Reference Transformation Comment

(3006,00C8) 3

>RT Referenced Study Sequence (3006,0012) 3 ANAP

>>Include ‘SOP Instance Reference Macro' [Table 10-11] >>RT Referenced Series Sequence (3006,0014) 1

>>>Series Instance UID (0020,000E) 1

>>>Contour Image Sequence (3006,0016) 1

>>>>Include ‘Image SOP Instance Reference Macro’ [Table 10-3] Structure Set ROI Sequence (3006,0020) 3

>ROI Number (3006,0022) 1 AUTO

>Referenced Frame of Reference UID (3006,0024) 1 AUTO

>ROI Name (3006,0026) 2 DB


Attribute Name Tag Type Value Handling >ROI Description (3006,0028) 3 DB

>ROI Volume (3006,002C) 3 ANAP

>ROI Generation Algorithm (3006,0036) 2 EMPTY

>ROI Generation Description (3006,0038) 3 ANAP

B.2.16 ROI Contour Module [C.8.8.5]

Attribute Name Tag Type Value Handling ROI Contour Sequence (3006,0039) 1 Introduces sequence of Contour

Sequences defining ROIs. One or more items may be included in this sequence.

>Referenced ROI Number (3006,0084) 1 AUTO

>ROI Display Color (3006,002A) 3 DB

>Contour Sequence (3006,0040) 3

>>Contour Number (3006,0048) 3 ANAP

>>Attached Contours (3006,0049) 3 ANAP

>>Contour Image Sequence (3006,0016) 3 ANAP

>>>Include ‘Image SOP Instance Reference Macro’ [Table 10-3] >>Contour Geometric Type (3006,0042) 1 CLOSED_PLANAR or POINT

depending on data >>Contour Slab Thickness (3006,0044) 3 ANAP

>>Contour Offset Vector (3006,0045) 3 ANAP

>>Number of Contour Points (3006,0046) 1 AUTO

>>Contour Data (3006,0050) 1 DB

B.2.17 RT Dose ROI [C.8.8.7]

Attribute Name Tag Type Value Handling RT Dose ROI Sequence (3004,0010) 1

>Referenced ROI Number (3006,0084) 1 AUTO

>Dose Units (3004,0002) 1 The value GY is always given

>Dose Value (3004,0012) 1 The dose at the user-selected point

B.2.18 RT ROI Observations [C.8.8.8]

Attribute Name Tag Type Value Handling RT ROI Observations Sequence (3006,0080) 1

>Observation Number (3006,0082) 1 AUTO


Attribute Name Tag Type Value Handling >Referenced ROI Number (3006,0084) 1 AUTO

>ROI Observation Label (3006,0085) 3 ANAP

>ROI Observation Description (3006,0088) 3 ANAP

>RT Related ROI Sequence (3006,0030) 3 ANAP

>>Referenced ROI Number (3006,0084) 1 ANAP

>>RT ROI Relationship (3006,0033) 3

>RT ROI Identification Code Sequence (3006,0086) 3 ANAP

>>Include ‘Code Sequence Macro’ [Table 8.8-1] >Related RT ROI Observations Sequence

(3006,00A0) 3 ANAP

>>Observation Number (3006,0082) 1

>RT ROI Interpreted Type (3006,00A4) 2 EMPTY

>ROI Interpreter (3006,00A6) 2 EMPTY

>Material ID (300A,00E1) 3 ANAP

>ROI Physical Properties Sequence (3006,00B0) 3 ANAP

>>ROI Physical Property (3006,00B2) 1

>>ROI Elemental Composition Sequence

(3006,00B6) 1C

>>>ROI Elemental Composition Atomic Number

(3006,00B7) 1

>>>ROI Elemental Composition Atomic Mass Fraction

(3006,00B8) 1

>>ROI Physical Property Value (3006,00B4) 1

B.2.19 RT General Plan [C.8.8.9]

Attribute Name Tag Type Value Handling RT Plan Label (300A, 0002) 1 DB

RT Plan Name (300A, 0003) 3 ANAP

RT Plan Description (300A, 0004) 3 ANAP

Instance Number (0020, 0013) 3 ANAP

RT Plan Date (300A, 0006) 2 DB

RT Plan Time (300A, 0007) 2 DB

Treatment Protocols (300A, 0009) 3 ANAP

Plan Intent (300A, 000A) 3 DB “VERIFICATION” if QA plan

Treatment Sites (300A, 000B) 3 DB

RT Plan Geometry (300A, 000C) 1 Always “PATIENT”


Attribute Name Tag Type Value Handling Referenced Structure Set Sequence (300C, 0060) 1C AUTO

> Include ‘SOP Instance Reference Macro' [Table 10-11] Referenced Dose Sequence (300C,0080) 3 AUTO

> Include ‘SOP Instance Reference Macro' [Table 10-11] Referenced RT Plan Sequence (300C,0002) 3 ANAP

> Include ‘SOP Instance Reference Macro' [Table 10-11] >RT Plan Relationship (300A,0055) 1

B.2.20 RT Prescription [C.8.8.10]

Attribute Name Tag Type Value Handling Prescription Description (300A, 000E) 3 AUTO

Dose Reference Sequence (300A, 0010) 3

>Dose Reference Number (300A, 0012) 1 AUTO

>Dose Reference UID (300A, 0013) 3 ANAP

>Dose Reference Structure Type (300A, 0014) 1 Always “POINT” or “VOLUME”

>Dose Reference Description (300A, 0016) 3 ANAP

>Referenced ROI Number (3006, 0084) 1C AUTO

>Dose Reference Point Coordinates (300A, 0018) 1C ANAP

>Nominal Prior Dose (300A, 001A) 3 ANAP

>Dose Reference Type (300A, 0020) 1 “Target” or “ORGAN_AT_RISK”

>Constraint Weight (300A, 0021) 3 ANAP

>Delivery Warning Dose (300A, 0022) 3 ANAP

>Delivery Maximum Dose (300A, 0023) 3 ANAP

>Target Minimum Dose (300A, 0025) 3 ANAP

>Target Prescription Dose (300A, 0026) 3 DB ANAP otherwise

>Target Maximum Dose (300A, 0027) 3 ANAP

>Target Underdose Volume Fraction (300A, 0028) 3 DB ANAP otherwise

>Organ at Risk Full-volume Dose (300A, 002A) 3 ANAP

>Organ at Risk Limit Dose (300A, 002B) 3 ANAP

>Organ at Risk Maximum Dose (300A, 002C) 3 ANAP

>Organ at Risk Overdose Volume Fraction

(300A, 002D) 3 ANAP


B.2.21 RT Patient Setup [C.8.8.12]

Attribute Name Tag Type Value Handling Patient Setup Sequence (300A, 0180) 1

>Patient Setup Number (300A, 0182) 1 AUTO

>Patient Setup Label (300A, 0183) 3 ANAP

>Patient Position (0018, 5100) 1C DB

>Patient Additional Position (300A, 0184) 1C ANAP

>Referenced Setup Image Sequence (300A, 0401) 3 ANAP

>> Include ‘Image SOP Instance Reference Macro’ [Table 10-3] >Fixation Device Sequence (300A, 0190) 3 ANAP

>>Fixation Device Type (300A,0192) 1

>>Fixation Device Label (300A,0194) 2

>>Fixation Device Description (300A,0196) 3

>>Fixation Device Position (300A,0198) 3

>>Fixation Device Pitch Angle (300A,0199) 3

>>Fixation Device Roll Angle (300A,019A) 3

>>Accessory Code (300A, 00F9) 3

>Shielding Device Sequence (300A,01A0) 3 ANAP

>>Shielding Device Type (300A,01A2) 1

>>Shielding Device Label (300A,01A4) 2

>>Shielding Device Description (300A,01A6) 3

>>Shielding Device Position (300A,01A8) 3

>>Accessory Code (300A,00F9) 3

>Setup Technique (300A,01B0) 3 Always “ISOCENTRIC”

>Setup Technique Description (300A,01B2) 3 ANAP

>Setup Device Sequence (300A,01B4) 3 ANAP

>>Setup Device Type (300A,01B6) 1

>>Setup Device Label (300A,01B8) 2

>>Setup Device Description (300A,01BA) 3

>>Setup Device Parameter (300A,01BC) 2

>>Setup Reference Description (300A,01D0) 3


>Table Top Vertical Setup Displacement

(300A,01D2) 3 ANAP

>Table Top Longitudinal Setup Displacement

(300A,01D4) 3 ANAP


Attribute Name Tag Type Value Handling >Table Top Lateral Setup Displacement

(300A,01D6) 3 ANAP

>Motion Synchronization Sequence (300A,0410) 3 ANAP

>>Respiratory Motion Compensation Technique

(0018,9170) 1

>>Respiratory Signal Source (0018,9171) 1

>>Respiratory Motion Compensation Technique Description

(0018,9185) 3

>>Respiratory Signal Source ID (0018,9186) 3

B.2.22 RT Fraction Scheme [C.8.8.13]

Attribute Name Tag Type Value Handling Fraction Group Sequence (300A,0070) 1

>Fraction Group Number (300A,0071) 1 AUTO

>Fraction Group Description (300A,0072) 3 ANAP

>Referenced Dose Sequence (300C,0080) 3 ANAP

>> Include ‘SOP Instance Reference Macro' [Table 10-11] >Referenced Dose Reference Sequence

(300C,0050) 3 ANAP

>>Referenced Dose Reference Number

(300C,0051) 1

>>Constraint Weight (300A,0021) 3

>>Delivery Warning Dose (300A,0022) 3

>>Delivery Maximum Dose (300A,0023) 3

>>Target Minimum Dose (300A,0025) 3

>>Target Prescription Dose (300A,0026) 3

>>Target Maximum Dose (300A,0027) 3

>>Target Underdose Volume Fraction (300A,0028) 3

>>Organ at Risk Full-volume Dose (300A,002A) 3

>>Organ at Risk Limit Dose (300A,002B) 3

>>Organ at Risk Maximum Dose (300A,002C) 3

>>Organ at Risk Overdose Volume Fraction

(300A,002D) 3

>Number of Fractions Planned (300A,0078) 2 DB

>Number of Fraction Pattern Digits Per Day

(300A,0079) 3 ANAP

>Repeat Fraction Cycle Length (300A,007A) 3 ANAP

>Fraction Pattern (300A,007B) 3 ANAP


Attribute Name Tag Type Value Handling >Beam Dose Meaning (300A,008B) 3 ANAP

>Number of Beams (300A,0080) 1 DB

>Referenced Beam Sequence (300C,0004) 1C

>>Referenced Beam Number (300C,0006) 1 AUTO

>>Beam Dose Specification Point (300A,0082) 3 DB if fixed conformal ANAP otherwise

>>Beam Dose (300A,0084) 3 DB if fixed conformal ANAP otherwise

>>Beam Dose Verification Control Point Sequence

(300A,008C) 3 ANAP

>>>Cumulative Meterset Weight (300A,0134) 1

>>>Referenced Control Point Index (300C,00F0) 1C

>>>Average Beam Dose Point Depth (300A,008D) 2C

>>>Average Beam Dose Point Equivalent Depth

(300A,008E) 2C

>>>Average Beam Dose Point SSD (300A,008F) 2C

>>Beam Meterset (300A,0086) 3 DB

>Number of Brachy Application Setups (300A,00A0) 1 AUTO

>Referenced Brachy Application Setup Sequence

(300C,000A) 1C ANAP

>>Referenced Brachy Application Setup Number

(300C,000C) 1

>>Brachy Application Setup Dose Specification Point

(300A,00A2) 3

B.2.23 RT Beams [C.8.8.14]

Attribute Name Tag Type Value Handling Beam Sequence (300A,00B0) 1

>Beam Number (300A,00C0) 1 AUTO

>Beam Name (300A,00C2) 3 DB ANAP otherwise

>Beam Description (300A,00C3) 3 ANAP

>Beam Type (300A,00C4) 1 Always “DYNAMIC”

>Radiation Type (300A,00C6) 2 Always “PHOTON”

>Primary Fluence Mode Sequence (3002,0050) 3 ANAP

>>Fluence Mode (3002,0051) 1

>>Fluence Mode ID (3002,0052) 1C

>High-Dose Technique Type (300A,00C7) 1C ANAP

>Treatment Machine Name (300A,00B2) 2 CONFIG


Attribute Name Tag Type Value Handling >Manufacturer (0008,0070) 3 CONFIG

ANAP otherwise >Institution Name (0008,0080) 3 CONFIG

ANAP otherwise >Institution Address (0008,0081) 3 CONFIG

ANAP otherwise >Institutional Department Name (0008,1040) 3 CONFIG

ANAP otherwise >Manufacturer's Model Name (0008,1090) 3 CONFIG

ANAP otherwise >Device Serial Number (0018,1000) 3 CONFIG

ANAP otherwise >Primary Dosimeter Unit (300A,00B3) 3 “MINUTE” for plan from MRIdian

system and “MU” for plan from MRIdian Linac system

>Referenced Tolerance Table Number (300C,00A0) 3 ANAP

>Source-Axis Distance (300A,00B4) 3 ANAP

>Beam Limiting Device Sequence (300A,00B6) 1

>>RT Beam Limiting Device Type (300A,00B8) 1 Always “MLCX”

>>Source to Beam Limiting Device Distance

(300A,00BA) 3 ANAP

>>Number of Leaf/Jaw Pairs (300A,00BC) 1 DB

>>Leaf Position Boundaries (300A,00BE) 2C AUTO

>Referenced Patient Setup Number (300C,006A) 3 AUTO

>Referenced Reference Image Sequence

(300C,0042) 3 ANAP

>> Include ‘SOP Instance Reference Macro' [Table 10-11] >>Reference Image Number (300A,00C8) 1

>>Start Cumulative Meterset Weight (300C,0008) 3

>>End Cumulative Meterset Weight (300C,0009) 3

>Planned Verification Image Sequence (300A,00CA) 3 ANAP

>>Start Cumulative Meterset Weight (300C,0008) 3

>>Meterset Exposure (3002,0032) 3

>>End Cumulative Meterset Weight (300C,0009) 3

>>RT Image Plane (3002,000C) 3

>>X-Ray Image Receptor Angle (3002,000E) 3

>>RT Image Orientation (3002,0010) 3

>>RT Image Position (3002,0012) 3

>>RT Image SID (3002,0026) 3


Attribute Name Tag Type Value Handling >>Imaging Device-Specific Acquisition Parameters

(300A,00CC) 3

>>Referenced Reference Image Number

(300C,0007) 3

>Treatment Delivery Type (300A,00CE) 3 ANAP

>Referenced Dose Sequence (300C,0080) 3 ANAP

>> Include ‘SOP Instance Reference Macro' [Table 10-11] >Number of Wedges (300A,00D0) 1 Always 0

>Wedge Sequence (300A,00D1) 1C ANAP

>>Wedge Number (300A,00D2) 1

>>Wedge Type (300A,00D3) 2

>>Wedge ID (300A,00D4) 3


>>Wedge Angle (300A,00D5) 2

>>Wedge Factor (300A,00D6) 2

>>Wedge Orientation (300A,00D8) 2

>>Source to Wedge Tray Distance (300A,00DA) 3

>Number of Compensators (300A,00E0) 1 Always 0

>Total Compensator Tray Factor (300A,00E2) 3 ANAP

>Compensator Sequence (300A,00E3) 1C ANAP

>>Compensator Description (300A,02EB) 3

>>Compensator Number (300A,00E4) 1C

>>Compensator Type (300A,00EE) 3

>>Material ID (300A,00E1) 2C

>>Compensator ID (300A,00E5) 3


>>Compensator Tray ID (300A,00EF) 3

>>Source to Compensator Tray Distance

(300A,00E6) 2

>>Compensator Divergence (300A,02E0) 3

>>Compensator Mounting Position (300A,02E1) 3

>>Compensator Rows (300A,00E7) 1

>>Compensator Columns (300A,00E8) 1

>>Compensator Pixel Spacing (300A,00E9) 1

>>Compensator Position (300A,00EA) 1

>>Compensator Transmission Data (300A,00EB) 1C


Attribute Name Tag Type Value Handling >>Compensator Thickness Data (300A,00EC) 1C

>>Source to Compensator Distance (300A,02E2) 1C

>Number of Boli (300A,00ED) 1 Always 0

>Referenced Bolus Sequence (300C,00B0) 1C ANAP

>>Referenced ROI Number (3006,0084) 1

>>Bolus ID (300A,00DC) 3

>>Bolus Description (300A,00DD) 3


>Number of Blocks (300A,00F0) 1 Always 0

>Total Block Tray Factor (300A,00F2) 3 ANAP

>Block Sequence (300A,00F4) 1C ANAP

>>Block Tray ID (300A,00F5) 3


>>Source to Block Tray Distance (300A,00F6) 2

>>Block Type (300A,00F8) 1

>>Block Divergence (300A,00FA) 2

>>Block Mounting Position (300A,00FB) 3

>>Block Number (300A,00FC) 1

>>Block Name (300A,00FE) 3

>>Material ID (300A,00E1) 2

>>Block Thickness (300A,0100) 2C

>>Block Transmission (300A,0102) 2C

>>Block Number of Points (300A,0104) 2

>>Block Data (300A,0106) 2

>Applicator Sequence (300A,0107) 3 ANAP

>>Applicator ID (300A,0108) 1


>>Applicator Type (300A,0109) 1

>>Applicator Geometry Sequence (300A,0431) 3

>>>Applicator Aperture Shape (300A,0432) 1

>>>Applicator Opening (300A,0433) 1C

>>>Applicator Opening X (300A,0434) 1C

>>>Applicator Opening Y (300A,0435) 1C

>> Source to Applicator Mounting Position Distance

(300A,0436) 3


Attribute Name Tag Type Value Handling >>Applicator Description (300A,010A) 3

>General Accessory Sequence (300A,0420) 3 ANAP

>>General Accessory Number (300A,0424) 1

>>General Accessory ID (300A,0421) 1

>>General Accessory Description (300A,0422) 3

>>General Accessory Type (300A,0423) 3


>>Source to General Accessory Distance

(300A,0425) 3

>Final Cumulative Meterset Weight (300A,010E) 1C Always 1

>Number of Control Points (300A,0110) 1 DB

>Control Point Sequence (300A,0111) 1

>>Control Point Index (300A,0112) 1 AUTO

>>Cumulative Meterset Weight (300A,0134) 2 DB

>>Referenced Dose Reference Sequence

(300C,0050) 3 ANAP

>>>Referenced Dose Reference Number

(300C,0051) 1

>>>Cumulative Dose Reference Coefficient

(300A,010C) 2

>>Referenced Dose Sequence (300C,0080) 1C ANAP

>>> Include ‘SOP Instance Reference Macro' [Table 10-11] >>Nominal Beam Energy (300A,0114) 3 ANAP

>>Dose Rate Set (300A,0115) 3 ANAP

>>Wedge Position Sequence (300A,0116) 3 ANAP

>>>Referenced Wedge Number (300C,00C0) 1

>>>Wedge Position (300A,0118) 1

>>Beam Limiting Device Position Sequence

(300A,011A) 1C

>>>RT Beam Limiting Device Type (300A,00B8) 1 Always “MLCX”

>>>Leaf/Jaw Positions (300A,011C) 1 DB

>>Gantry Angle (300A,011E) 1C DB

>>Gantry Rotation Direction (300A,011F) 1C Always “NONE”

>>Gantry Pitch Angle (300A,014A) 3 ANAP

>>Gantry Pitch Rotation Direction (300A,014C) 3 ANAP

>>Beam Limiting Device Angle (300A,0120) 1C DB

>>Beam Limiting Device Rotation Direction

(300A,0121) 1C Always “NONE”


Attribute Name Tag Type Value Handling >>Patient Support Angle (300A,0122) 1C DB

>>Patient Support Rotation Direction (300A,0123) 1C Always “NONE”

>>Table Top Eccentric Axis Distance (300A,0124) 3 ANAP

>>Table Top Eccentric Angle (300A,0125) 1C DB

>>Table Top Eccentric Rotation Direction

(300A,0126) 1C Always “NONE”

>>Table Top Pitch Angle (300A,0140) 1C DB

>>Table Top Pitch Rotation Direction (300A,0142) 1C Always “NONE”

>>Table Top Roll Angle (300A,0144) 1C DB

>>Table Top Roll Rotation Direction (300A,0146) 1C Always “NONE”

>>Table Top Vertical Position (300A,0128) 2C DB

>>Table Top Longitudinal Position (300A,0129) 2C DB

>>Table Top Lateral Position (300A,012A) 2C DB

>>Isocenter Position (300A,012C) 2C DB

>>Surface Entry Point (300A,012E) 3 ANAP

>>Source to Surface Distance (300A,0130) 3 ANAP

B.2.24 Approval [C.8.8.16]

Attribute Name Tag Type Value Handling Approval Status (300E,0002) 1 DB

Review Date (300E,0004) 2C DB

Review Time (300E,0005) 2C DB

Reviewer Name (300E,0008) 2C DB

B.2.25 PET Series [C.8.9.1]

Attribute Name Tag Type Value Handling Series Date (0008,0021) 1 COPY

Series Time (0008,0031) 1 COPY

Units (0054,1001) 1 COPY

Counts Source (0054,1002) 1 COPY

Series Type (0054,1000) 1 COPY for interpolation The value STATIC is always given for registration.

Reprojection Method (0054,1004) 2C COPY

Number of R-R Intervals (0054,0061) 1C COPY

Number of Time Slots (0054,0071) 1C COPY


Attribute Name Tag Type Value Handling Number of Time Slices (0054,0101) 1C COPY

Number of Slices (0054,0081) 1 COPY

Corrected Image (0028,0051) 2 COPY

Randoms Correction Method (0054,1100) 3 COPY

Attenuation Correction Method (0054,1101) 3 COPY

Scatter Correction Method (0054,1105) 3 COPY

Decay Correction (0054,1102) 1 COPY

Reconstruction Diameter (0018,1100) 3 COPY

Convolution Kernel (0018,1210) 3 COPY

Reconstruction Method (0054,1103) 3 COPY

Detector Lines of Response Used (0054,1104) 3 COPY

Acquisition Start Condition (0018,0073) 3 COPY

Acquisition Start Condition Data (0018,0074) 3 COPY

Acquisition Termination Condition (0018,0071) 3 COPY

Acquisition Termination Condition Data

(0018,0075) 3 COPY

Field of View Shape (0018,1147) 3 COPY

Field of View Dimensions (0018,1149) 3 COPY

Gantry/Detector Tilt (0018,1120) 3 COPY

Gantry/Detector Slew (0018,1121) 3 COPY

Type of Detector Motion (0054,0202) 3 COPY

Collimator Type (0018,1181) 2 COPY

Collimator/Grid Name (0018,1180) 3 COPY

Axial Acceptance (0054,1200) 3 COPY

Axial Mash (0054,1201) 3 COPY

Transverse Mash (0054,1202) 3 COPY

Detector Element Size (0054,1203) 3 COPY

Coincidence Window Width (0054,1210) 3 COPY

Energy Window Range Sequence (0054,0013) 3

>Energy Window Lower Limit (0054,0014) 3 COPY

>Energy Window Upper Limit (0054,0015) 3 COPY

Secondary Counts Type (0054,1220) 3 COPY


B.2.26 PET Isotope Module [C.8.9.2]

Attribute Name Tag Type Value Handling Radiopharmaceutical Information Sequence

(0054,0016) 2 COPY

>Radionuclide Code Sequence (0054,0300) 2

>>Include ‘Code Sequence Macro’ [Table 8.8-1] >Radiopharmaceutical Route (0018,1070) 3

>Administration Route Code Sequence (0054,0302) 3

>>Include ‘Code Sequence Macro’[ Table 8.8-1] >Radiopharmaceutical Volume (0018,1071) 3

>Radiopharmaceutical Start Time (0018,1072) 3

>Radiopharmaceutical Start DateTime (0018,1078) 3

>Radiopharmaceutical Stop Time (0018,1073) 3

>Radiopharmaceutical Stop DateTime (0018,1079) 3

>Radionuclide Total Dose (0018,1074) 3

>Radionuclide Half Life (0018,1075) 3

>Radionuclide Positron Fraction (0018,1076) 3

>Radiopharmaceutical Specific Activity (0018,1077) 3

>Radiopharmaceutical (0018,0031) 3

>Radiopharmaceutical Code Sequence (0054,0304) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] Intervention Drug Information Sequence

(0018,0026) 3

>Intervention Drug Name (0018,0034) 3

>Intervention Drug Code Sequence (0018,0029) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1] >Intervention Drug Start Time (0018,0035) 3

>Intervention Drug Stop Time (0018,0027) 3

>Intervention Drug Dose (0018,0028) 3

B.2.27 PET Image Module [C.8.9.4]

Attribute Name Tag Type Value Handling Image Type (0008,0008) 1 Assigned as described in section

B.2.6 Samples per Pixel (0028,0002) 1 Assigned as described in section

B.2.8 Photometric Interpretation (0028,0004) 1



Attribute Name Tag Type Value Handling Bits Stored (0028,0101) 1

High Bit (0028,0102) 1

Rescale Intercept (0028,1052) 1 AUTO

Rescale Slope (0028,1053) 1 AUTO

Frame Reference Time (0054,1300) 1 EMPTY – This data is not available after interpolation or registration

Trigger Time (0018,1060) 1C ANAP

Frame Time (0018,1063) 1C ANAP

Low R-R Value (0018,1081) 1C COPY for interpolation ANAP otherwise

High R-R Value (0018,1082) 1C COPY for interpolation ANAP otherwise

Lossy Image Compression (0028,2110) 1C ANAP

Image Index (0054,1330) 1 AUTO

Acquisition Date (0008,0022) 2 EMPTY

Acquisition Time (0008,0032) 2 EMPTY

Actual Frame Duration (0018,1242) 2 EMPTY

Nominal Interval (0018,1062) 3 ANAP

Intervals Acquired (0018,1083) 3 ANAP

Intervals Rejected (0018,1084) 3 ANAP

Primary (Prompts) Counts Accumulated

(0054,1310) 3 ANAP

Secondary Counts Accumulated (0054,1311) 3 ANAP

Slice Sensitivity Factor (0054,1320) 3 ANAP

Decay Factor (0054,1321) 1C ANAP

Dose Calibration Factor (0054,1322) 3 ANAP

Scatter Fraction Factor (0054,1323) 3 ANAP

Dead Time Factor (0054,1324) 3 ANAP

Anatomic Region Sequence (0008,2218) 3 ANAP

>Include ‘Code Sequence Macro’ [Table 8.8-1] >Anatomic Region Modifier Sequence (0008,2220) 3



(0008,2230) 3

>>Include ‘Code Sequence Macro’ [Table 8.8-1]


Attribute Name Tag Type Value Handling Slice Progression Direction (0054,0500) 3 ANAP

View Code Sequence (0054,0220) 3 ANAP

> Include ‘Code Sequence Macro’ [Table 8.8-1] > View Modifier Code Sequence (0054,0222) 2C

>> Include ‘Code Sequence Macro’ [Table 8.8-1] B.2.28 SOP Common Module [C.12.1]

Attribute Name Tag Type Value Handling SOP Class UID (0008,0016) 1 AUTO

SOP Instance UID (0008,0018) 1 AUTO

Specific Character Set (0008,0005) 1C ANAP – Only the default character repertoire is supported

Instance Creation Date (0008,0012) 3 ANAP

Instance Creation Time (0008,0013) 3 ANAP

Instance Creator UID (0008,0014) 3 ANAP

Related General SOP Class UID (0008,001A) 3 ANAP

Original Specialized SOP Class UID (0008,001B) 3 ANAP

Coding Scheme Identification Sequence

(0008,0110) 3 ANAP

>Coding Scheme Designator (0008,0102) 1

>Coding Scheme Registry (0008,0112) 1C

>Coding Scheme UID (0008,010C) 1C

>Coding Scheme External ID (0008,0114) 2C

>Coding Scheme Name (0008,0115) 3

>Coding Scheme Version (0008,0103) 3

>Coding Scheme Responsible Organization

(0008,0116) 3

Timezone Offset From UTC (0008,0201) 3 ANAP

Contributing Equipment Sequence (0018,A001) 3 ANAP

>Purpose of Reference Code Sequence (0040,A170) 1

>>Include ‘Code Sequence Macro’ [Table 8.8-1] >Manufacturer (0008,0070) 1

>Institution Name (0008,0080) 3

>Institution Address (0008,0081) 3

>Station Name (0008,1010) 3

>Institutional Department Name (0008,1040) 3


Attribute Name Tag Type Value Handling >Manufacturer’s Model Name (0008,1090) 3

>Device Serial Number (0018,1000) 3

>Software Versions (0018,1020) 3

>Spatial Resolution (0018,1050) 3

>Date of Last Calibration (0018,1200) 3

>Time of Last Calibration (0018,1201) 3

>Contribution DateTime (0018,A002) 3

>Contribution Description (0018,A003) 3

Instance Number (0020,0013) 3 ANAP

SOP Instance Status (0100,0410) 3 ANAP

SOP Authorization Date and Time (0100,0420) 3 ANAP

SOP Authorization Comment (0100,0424) 3 ANAP

Authorization Equipment Certification Number

(0100,0426) 3 ANAP

Include ‘Digital Signatures Macro’ [Table C.12-6]

Encrypted Attributes Sequence (0400,0500) 1C ANAP >Encrypted Content Transfer Syntax UID

(0400,0510) 1

>Encrypted Content (0400,0520) 1 Original Attributes Sequence (0400,0561) 3 ANAP >Source of Previous Values (0400,0564) 2 >Attribute Modification DateTime (0400,0562) 1 >Modifying System (0400,0563) 1 >Reason for the Attribute Modification

(0400,0565) 1

>Modified Attributes Sequence (0400,0550) 1 HL7 Structured Document Reference Sequence

(0040,A390) 1C ANAP

>Referenced SOP Class UID (0008,1150) 1 >Referenced SOP Instance UID (0008,1155) 1 >HL7 Instance Identifier (0040,E001) 1 >Retrieve URI (0040,E010) 3

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