DICOM Supplement 147dicom.nema.org/Dicom/News/june2014/docs/sup147.doc · Web viewDigital Imaging...

document.doc: Supplement 147: Second Generation Radiotherapy

Digital Imaging and Communications in Medicine (DICOM)

Supplement 147: Second Generation Radiotherapy

DICOM Standards Committee, Working Group 7, Radiation Therapy

1300 N. 17th Street, Suite 1752

Rosslyn, Virginia 22209 USA

VERSION: Sup 147 - Revision 42March 28, 2014

Developed pursuant to DICOM Work Item 2007-06-B

This is a draft document. Do not circulate, quote, or reproduce it except with the approval of NEMA.

Table of Contents

Table of Contents................................................................................................................1Foreword........................................................................................................................... 11Scope and Field of Application...........................................................................................11

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Part 2 Addendum...............................................................................................................12Part 3 Addendum...............................................................................................................13

7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND GENERATION RADIOTHERAPY INFORMATION OBJECTS.....................................13

7.12.1.......RT Course...........................................................................................147.12.2.......RT Physician Intent..............................................................................157.12.3.......Conceptual Volume..............................................................................157.12.4.......RT Segment Annotation.......................................................................157.12.5.......RT Radiation Set..................................................................................157.12.6.......RT Radiation........................................................................................157.12.7.......RT Radiation Record............................................................................157.12.8.......RT Dose Image....................................................................................167.12.9.......RT Dose Histogram..............................................................................167.12.10.....RT Dose Samples................................................................................167.12.11.....RT Treatment Phase............................................................................16

A.VV......SECOND GENERATION RADIATION THERAPY.........................................20A.VV.1......Second Generation Radiation Therapy Objects.....................................20

A.VV.1.1......Second Generation Radiation Therapy Common Information......20A.VV.1.1.1..........Second Generation Radiation Therapy Entity-Relationship Model........................................................................20

A.VV.1.2......RT Course Information Object Definition.....................................24A.VV.1.2.1..........RT Course IOD Description................................24A.VV.1.2.2..........RT Course IOD Entity-Relationship Model..........24A.VV.1.2.3..........RT Course IOD Module Table............................24

A.VV.1.3......RT Physician Intent Information Object Definition........................25A.VV.1.3.1..........RT Physician Intent IOD Description..................25A.VV.1.3.2..........RT Physician Intent IOD Entity-Relationship Model25A.VV.1.3.3..........RT Physician Intent IOD Module Table...............25

A.VV.1.4......RT Radiation Set Information Object Definition...........................25A.VV.1.4.1..........RT Radiation Set IOD Description......................25A.VV.1.4.2..........RT Radiation Set IOD Entity-Relationship Model 25A.VV.1.4.3..........RT Radiation Set IOD Module Table...................25

A.VV.1.5......RT Segment Annotation Information Object Definition.................26A.VV.1.5.1..........RT Segment Annotation IOD Description............26A.VV.1.5.2..........RT Segment Annotation IOD Entity-Relationship Model..................26A.VV.1.5.3..........RT Segment Annotation IOD Module Table........26

A.VV.1.6......Tomotherapeutic Radiation Information Object Definition............26A.VV.1.6.1..........Tomotherapeutic Radiation IOD Description.......26A.VV.1.6.2..........Tomotherapeutic Radiation IOD Entity-Relationship Model........................................................................26A.VV.1.6.3..........Tomotherapeutic Radiation IOD Module Table. . .26

A.VV.1.7......C-Arm Photon Radiation Information Object Definition................26A.VV.1.7.1..........C-Arm Photon Radiation IOD Description...........26A.VV.1.7.2..........C-Arm Photon Radiation IOD Entity-Relationship Model..................26A.VV.1.7.3..........C-Arm Photon Radiation IOD Module Table.......27

A.VV.1.8......C-Arm Electron Radiation Information Object Definition...............27A.VV.1.8.1..........C-Arm Electron Radiation IOD Description.........27A.VV.1.8.2..........C-Arm Electron Radiation IOD Entity-Relationship Model..................27A.VV.1.8.3..........C-Arm Electron Radiation IOD Module Table......27

A.VV.1.9......Multiple Fixed Source Radiation Information Object Definition.....27A.VV.1.9.1..........Multiple Fixed Source Radiation IOD Description27

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A.VV.1.9.2..........Multiple Fixed Source Radiation IOD Entity-Relationship Model........................................................................27A.VV.1.9.3..........Multiple Fixed Source Radiation IOD Module Table28

A.VV.1.10. . . .Robotic Radiation Information Object Definition...........................28A.VV.1.10.1.........Robotic Radiation IOD Description.....................28A.VV.1.10.2.........Robotic Radiation IOD Entity-Relationship Model28A.VV.1.10.3.........Robotic Radiation IOD Module Table..................28

A.VV.1.11. . . .Multi-Axial Radiation Information Object Definition......................28A.VV.1.11.1.........Multi-Axial Radiation IOD Description.................28A.VV.1.11.2.........Multi-Axial Radiation IOD Entity-Relationship Model..................28A.VV.1.11.3.........Multi-Axial Radiation IOD Module Table.............28

A.VV.1.12. . . .RT Dose Image Information Object Definition.............................29A.VV.1.12.1.........RT Dose Image IOD Description........................29A.VV.1.12.2.........RT Dose Image IOD Entity-Relationship Model. .29A.VV.1.12.3.........RT Dose Image IOD Module Table.....................29A.VV.1.12.4.........RT Dose Image IOD Content Constraints...........29A.VV.1.12.5.........RT Dose Image Functional Group Macros..........29

A.VV.1.13. . . .RT Dose Histogram Information Object Definition.......................30A.VV.1.13.1.........RT Dose Histogram IOD Description..................30A.VV.1.13.2.........RT Dose Histogram IOD Entity-Relationship Model30A.VV.1.13.3.........RT Dose Histogram IOD Module Table..............30

A.VV.1.14. . . .RT Dose Samples Information Object Definition..........................30A.VV.1.14.1.........RT Dose Samples IOD Description....................30A.VV.1.14.2.........RT Dose Samples IOD Entity-Relationship Model30A.VV.1.14.3.........RT Dose Samples IOD Module Table.................30

A.VV.1.15. . . .Tomotherapeutic Radiation Record Information Object Definition 31A.VV.1.15.1.........Tomotherapeutic Radiation Record IOD Description..........31A.VV.1.15.2.........Tomotherapeutic Radiation Record IOD Entity-Relationship Model........................................................................31A.VV.1.15.3.........Tomotherapeutic Radiation Record IOD Module Table...................31

A.VV.1.16. . . .C-Arm Photon Radiation Record Information Object Definition.. . .31A.VV.1.16.1.........C-Arm Photon Radiation Record IOD Description31A.VV.1.16.2.........C-Arm Photon Radiation Record IOD Entity-Relationship Model........................................................................31A.VV.1.16.3.........C-Arm Photon Radiation Record IOD Module Table...................31

A.VV.1.17. . . .C-Arm Electron Radiation Record Information Object Definition...32A.VV.1.17.1.........C-Arm Electron Radiation Record IOD Description32A.VV.1.17.2.........C-Arm Electron Radiation Record IOD Entity-Relationship Model........................................................................32A.VV.1.17.3.........C-Arm Electron Radiation Record IOD Module Table...................32

A.VV.1.18. . . .Multiple Fixed Source Radiation Record Information Object Definition......32

A.VV.1.18.1.........Multiple Fixed Source Record Radiation IOD Description..........32A.VV.1.18.2.........Multiple Fixed Source Radiation Record IOD E-R Model..................32A.VV.1.18.3.........Multiple Fixed Source Radiation Record IOD Module Table......32

A.VV.1.19. . . .Robotic Radiation Record Information Object Definition...............32A.VV.1.19.1.........Robotic Radiation Record IOD Description.........32

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A.VV.1.19.2.........Robotic Radiation Record IOD Entity-Relationship Model..................32A.VV.1.19.3.........Robotic Radiation Record IOD Module Table......32

A.VV.1.20. . . .Multi-Axial Radiation Record Information Object Definition..........33A.VV.1.20.1.........Multi-Axial Radiation Record IOD Description.....33A.VV.1.20.2.........Multi-Axial Radiation Record IOD Entity-Relationship Model........................................................................33A.VV.1.20.3.........Multi-Axial Radiation Record IOD Module Table. 33

C.AA.....SECOND GENERATION RADIOTHERAPY MODULES................................34C.AA.1.....Second Generation Radiotherapy Definitions........................................34

C.AA.1.1......Control Points.............................................................................34C.AA.1.1.1..........Verification Control Points..................................34

C.AA.1.2......Nominal Energy..........................................................................34C.AA.1.3......Fractionation, Fractionation Scheme...........................................34C.AA.1.4......Treatment RT Radiation Set.......................................................34C.AA.1.5......Meterset.....................................................................................35C.AA.1.6......Radiation Dose Point..................................................................35C.AA.1.7......Treatment Phase........................................................................35

C.AA.2.....Second Generation Radiotherapy General-Purpose Macros.................36C.AA.2.1......RT Entity Labeling Macro............................................................36

C.AA.2.1.1..........RT Entity Labeling Macro Attribute Description.. .36C.AA.2.2......RT Entity Long Labeling Macro...................................................36C.AA.2.3......RT Item State Macro..................................................................37

C.AA.2.3.1..........RT Item State Macro Attribute Description..........37C.AA.2.4......RT Operation State Macro..........................................................38C.AA.2.5......Conceptual Volume Macro..........................................................40

C.AA.2.5.1..........Conceptual Volume Macro Attribute Description. 41C.AA.2.6......Conceptual Volume Segmentation Reference and Combination Macro..........41

C.AA.2.6.1..........Conceptual Volume Combination and Segmentation Macro Attribute Description......................................46

C.AA.2.9......Radiation Fraction Pattern Macro................................................52C.AA.2.9.1..........Radiation Fraction Pattern Macro Attribute Description..........52

C.AA.2.10....Treatment Device Identification Macro........................................54C.AA.2.11....Device Model Macro...................................................................54C.AA.2.12....RT Patient Support Devices Macro.............................................54C.AA.2.13....Patient Support Position Macro...................................................55C.AA.2.14....Device Identification Macro.........................................................56C.AA.2.15....RT Accessory Device Identification Macro..................................57C.AA.2.16....Control Point General Attributes Macro.......................................58

C.AA.2.16.1........Control Point Attribute Concept..........................59C.AA.2.17....External Beam Control Point General Attributes Macro...............61

C.AA.2.17.1........External Beam Control Point General Attributes Macro Attribute Description............................................................62

C.AA.2.18....External Beam Sub-Control Point General Attributes Macro........62C.AA.2.18.1........RT Beam Limiting Device Definition Macro Attribute Description......................................................................62C.AA.2.18.1.1......Sub-Control Point Attribute Requirements..........62C.AA.2.18.1.2......Cumulative Meterset..........................................63

C.AA.2.19....Beam Mode Macro.....................................................................63C.AA.2.19.1........Beam Mode.......................................................65

C.AA.2.20....RT Beam Limiting Device Definition Macro.................................65C.AA.2.20.1........RT Beam Limiting Device Definition Macro Attribute Description......................................................................67

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C.AA.2.21....RT Beam Limiting Device Positions Macro..................................67C.AA.2.22....Wedges Definition Macro............................................................68C.AA.2.23....Wedge Positions Macro..............................................................69C.AA.2.24....Compensators Definition Macro..................................................69

C.AA.2.24.1........Compensators Definition Macro Attributes Description..........72

C.AA.2.25....Blocks Definition Macro..............................................................73C.AA.2.25.1........Blocks Definition Macro Attribute Description......74

C.AA.2.26....Accessory Holder Definition Macro.............................................75C.AA.2.26.1........Accessory Holder Description.............................75

C.AA.2.27....General Accessories Definition Macro.........................................77C.AA.2.28....Boluses Definition Macro............................................................78

C.AA.2.28.1 .......Bolus Definition Macro Attribute Description.......78C.AA.2.29....Outline Definition Macro..............................................................79C.AA.2.30....RT Tolerance Set Macro.............................................................80

C.AA.2.30.1........RT Tolerance Set Attribute Description...............81C.AA.2.30.1.2......Patient Support Position Tolerance Sequence....81

C.AA.2.31....Patient to Equipment Relationship Macro....................................81C.AA.2.31.1........Patient to Equipment Relationship Macro Attributes Description..........82

C.AA.2.32....RT Treatment Position Macro.....................................................83C.AA.2.33....User Content Identification Macro...............................................84

C.AA.2.33.1........User Content Identification Macro Attribute Description..........85

C.AA.2.34....RT Treatment Phase Macro........................................................85C.AA.2.34.1........RT Treatment Phase Macro Attribute Description85

C.AA.2.35....RT Treatment Phase Interval Macro...........................................86C.AA.2.35.1........Referenced Treatment Phases...........................87

C.AA.A1. . .Enhanced RT Series Module................................................................88C.AA.A1.1....Enhanced RT Series Attribute Description..................................88

C.AA.A1.1.1........Modality.............................................................88C.AA.A2. . .Radiotherapy Common Instance Module..............................................89C.AA.A3. . .RT Course Module...............................................................................89

C.AA.A3.1....RT Course Attribute Description..................................................91C.AA.A3.1.1........RT Course Scope Indicator................................91C.AA.A3.1.2........Delivered Radiation Dose Sequence..................92C.AA.A3.1.3........RT Course State Sequence................................92

C.AA.A4. . .RT Prescription Reference Module.......................................................92C.AA.A4.1....RT Prescription Reference Attribute Description..........................93

C.AA.A4.1.1........RT Item State Macro Meanings..........................93C.AA.A5. . .RT Treatment Phase Module................................................................93

C.AA.A5.1.... RT Treatment Phase Attribute Description.................................94C.AA.A5.1.1........RT Item State Macro Meanings..........................94

C.AA.A6. . .RT Radiation Set Reference Module.....................................................94C.AA.A6.1....RT Radiation Set Reference Attribute Description.......................99

C.AA.A6.1.1........RT Item State Macro Meanings..........................99C.AA.A6.1.2........Radiation Set Start Delay...................................99

C.AA.A7. . .RT Course Associated Instance Reference Module............................102C.AA.B1. . .RT Physician Intent Module................................................................102

C.AA.B1.1....RT Physician Intent Attribute Description..................................104C.AA.B1.1.1........RT Physician Intent Sequence.........................104C.AA.B1.1.2........RT Protocol Code Sequence............................104C.AA.B1.1.3........RT Diagnostic Image Set Sequence.................104

C.AA.B2. . .RT Prescription Module......................................................................104C.AA.B2.1....RT Prescription Attribute Description.........................................112

C.AA.B2.1.1........Anatomy Property Type Code Sequence..........112

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C.AA.B2.1.2........Dosimetric Objective Parameter Sequence.......112C.AA.B2.1.3........Dosimetric Objective Parameter Sequence Examples............114C.AA.B2.1.4........Conceptual Volume Sequence.........................114C.AA.B2.1.5........Prescription Anatomy Type..............................114C.AA.B2.1.6........Radiobiological Structural Type........................115C.AA.B2.1.7........Dosimetric Objective Priority.............................115C.AA.B2.1.8........Fraction-Based Relationship Sequence............115

C.AA.B2.2....Dosimetric Objective Scope......................................................116C.AA.B3. . .RT Treatment Phase Intent Module....................................................117C.AA.C1...RT Radiation Set Module....................................................................117

C.AA.C1.1....RT Radiation Set Attribute Description......................................118C.AA.C1.1.1........Radiation Set Type...........................................118C.AA.C1.1.2........Radiation Sequence.........................................118

C.AA.C2...RT Dose Contribution Module.............................................................119C.AA.C2.1....RT Dose Contribution Attribute Description...............................123

C.AA.C2.1.1........Meterset to Dose Mapping Sequence...............123C.AA.C2.1.2........Conceptual Volume Sequence.........................123C.AA.C2.1.3........Primary Dose Value Indicator...........................124

C.AA.C2.2....Radiation Verification Control Point Description.........................124C.AA.C2.2.1........Referenced Control Point.................................124C.AA.C2.2.2........Distance Parameters........................................124C.AA.C2.2.3........Radiation Dose Value.......................................124

C.AA.D1...RT Segment Annotation Module.........................................................124C.AA.D1.1....RT Segment Annotation Description.........................................128

C.AA.D1.1.1........Segmentation SOP Instance Reference Sequence128C.AA.D1.1.2........Alternate Segmented Property Type Code Sequence............129C.AA.D1.1.3........Segmented Property Type Code Sequence......130C.AA.D1.1.4........Segmented RT Accessory Device Sequence....130C.AA.D1.1.5........Direct Segment Reference Sequence...............130C.AA.D1.1.6........Combination Segment Reference Sequence.....131C.AA.D1.1.7........Segment Properties Sequence.........................131

C.AA.E1. . .RT Delivery Device Common Module.................................................131C.AA.E1.1...........RT Delivery Device Common Module Attribute Description..........132C.AA.E1.1.3........Equipment Frame of Reference UID.................133

C.AA.E2. . .RT Radiation Common Module...........................................................134C8.A.E2.1....RT Radiation Common Attribute Description.............................134

C.AA.E2.1.1........Radiotherapy Procedure Technique Sequence. 134C.AA.E2.1.2........RT Treatment Position Macro...........................135C.AA.E2.1.3........RT Radiation Data Scope.................................135C.AA.E2.1.4........Treatment Times..............................................135C.AA.E2.1.5........Treatment Machine Mode Sequence................135

C.AA.F1. . .Tomotherapeutic Delivery Device Module...........................................135C.AA.F1.1....Tomotherapeutic Delivery Device Attribute Description..............136

C.AA.F1.1.1........Leaf Slot Definition...........................................136C.AA.F2. . .Tomotherapeutic Beam Module..........................................................136C.AA.G1...C-Arm Photon-Electron Delivery Device Module.................................138C.AA.G2...C-Arm Photon-Electron Beam Module................................................139

C.AA.G2.1. . .C-Arm Photon-Electron Beam Attribute Description...................140C.AA.G2.1.1........Radiation Particle.............................................140

C.AA.H1...Multiple Fixed Source Delivery Device Module....................................140C.AA.H1.1....Multiple Fixed Source Delivery Device Attribute Description......141

C.AA.H1.1.1........Radiation Source Angles..................................141C.AA.H2...Multiple Fixed Source Beam Set Module.............................................141

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C.AA.J1....Robotic Delivery Device Module.........................................................142C.AA.J2....Robotic Path Module..........................................................................143C.AA.L1....Multi-Axial Delivery Device Module.....................................................144

C.AA.L2.1....Multi Axial Delivery Device Attribute Description........................145C.AA.L1.1...........Source-Axis Distance.......................................145

C.AA.L2....Multi-Axial Beam Module....................................................................145C.AA.L2.1....Multi Axial Beam Attribute Description.......................................149

C.AA.L2.1.1........Multi-Axial Gantry Angles.................................149C.AA.L2.1.2........Gantry Head Angles.........................................149C.AA.L2.1.3........Multi Axial Beam Delimiter Positions.................149

C.AA.M1...Enhanced RT Dose Module................................................................151C.AA.M1.1. . .Enhanced RT Dose Attribute Description..................................157

C.AA.M1.1.1.......Dose Scope.....................................................157C.AA.M1.1.2.......Radiation Absorption Model..............................157

C.AA.M2...RT Dose Image Module......................................................................158C.AA.M2.1. . .RT Dose Image Attribute Description........................................159

C.AA.M2.1.1.......Image Type and Frame Type...........................159C.AA.M2.1.2.......Dose Grid Geometry........................................159C.AA.M2.1.3.......Dose Grid Real World Values...........................159

C.AA.M3...RT Dose Image Functional Group Macros..........................................160C.AA.M3.1. . .RT Dose Image Frame Type Macro..........................................160

C.AA.M4...RT Dose Histogram Module................................................................160C.AA.M4.1. . .RT Dose Histogram Attribute Description..................................162

C.AA.M4.1.1.......Referenced Segmentation Properties Sequence162C.AA.M4.1.2.......Dose Histogram Data.......................................162C.AA.M4.1.3.......Dose Histogram Referenced Segment Sequence162

C.AA.M5...Dose Samples Module........................................................................163C.AA.M5.1. . .RT Dose Samples Attribute Description....................................163

C.AA.M5.1.1.......Dose Samples Data.........................................163C.AA.P1. . .RT Radiation Record Common Module...............................................163

C.AA.P1.1....RT Radiation Record Common Attribute Description.................167C.AA.P1.1.1........Control Point References.................................167C.AA.P1.1.2........Referenced RT Patient Setup Sequence..........167

C.AA.P2. . .RT Dose Record Common Module.....................................................167C.AA.P2.1....RT Dose Record Common Module Attribute Description...........169

C.AA.P2.1.1........Conceptual Volume Sequence.........................169F.5.X........Radiotherapy Directory Record Definition............................................173

C.7.5.1.........General Equipment Module......................................................174C.7.6.3.........Image Pixel Module..................................................................175

Part 4 Addendum.............................................................................................................176Part 6 Addendum.............................................................................................................179

6............REGISTRY OF DICOM DATA ELEMENTS.................................................179ANNEX A REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)195

Part 16 Addendum...........................................................................................................198CID 9231 GENERAL PURPOSE WORKITEM DEFINITION.............................198CID SUP147001 DOSIMETRIC OBJECTIVE VALUE TYPES...............................199CID SUP147002 PRESCRIPTION ANATOMY CATEGORIES..............................199CID SUP147003 RADIOTHERAPY SEGMENT CATEGORIES.............................199CID SUP147004 RADIOTHERAPY TARGETS.....................................................200CID SUP147005 RT GEOMETRIC INFORMATION..............................................200CID SUP147006 FIXATION OR POSITIONING DEVICES....................................201

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CID SUP147007 BRACHYTHERAPY DEVICES...................................................201CID SUP147009 SEGMENTATION COMBINATION.............................................202CID SUP147010 BEAM LIMITING DEVICE TYPES..............................................202CID SUP147011 RADIOTHERAPY ROBOTIC PATHS.........................................202CID SUP147012 GENERAL EXTERNAL RADIOTHERAPY PROCEDURE TECHNIQUES.............203CID SUP147013 TOMOTHERAPEUTIC RADIOTHERAPY PROCEDURE TECHNIQUES.............203CID SUP147014 TREATMENT RT RADIATION SET ALTERATION TYPES........203CID SUP147015 TREATMENT TERMINATION REASONS..................................204CID SUP147016 COMPENSATOR DEVICE TYPES.............................................204CID SUP147017 RADIOTHERAPY TREATMENT MACHINE MODES..................205CID SUP147018 PRE-TREATMENT RT RADIATION SET PURPOSE.................205CID SUP147020 INSTANCE REFERENCE PURPOSES......................................205CID SUP147021 PATIENT SETUP TECHNIQUES...............................................206CID SUP147022 FIXATION DEVICE TYPES........................................................206CID SUP147023 SHIELDING DEVICE TYPES.....................................................207CID SUP147024 SETUP DEVICES.......................................................................207CID SUP147025 RT PATIENT SUPPORT DEVICES............................................207CID SUP147026 DOSE STATISTICS...................................................................208CID SUP147027 FIXED BEAM LIMITING DEVICE TYPES...................................208CID SUP147028 RADIOTHERAPY WEDGE TYPES............................................208CID SUP147030 GENERAL ACCESSORY DEVICE TYPES.................................209CID SUP147031 RADIOTHERAPY BOLUS DEVICE TYPES................................209CID SUP147032 RADIOTHERAPY BLOCK DEVICE TYPES................................209CID SUP147033 RADIOTHERAPY ACCESSORY NO-SLOT HOLDER DEVICE TYPES.............210CID SUP147034 RADIOTHERAPY ACCESSORY SLOT HOLDER DEVICE TYPES210CID SUP147035 EFFECTIVE DOSE METHOD CODE DEFINITION....................210CID SUP147036 PURPOSE OF REFERENCED DOSE CALCULATION ANNOTATION OBJECT211CID SUP147037 DOSE DATA SOURCE MEASUREMENT DEFINITION..............211CID SUP147039 DOSE HISTOGRAM SPATIAL UNIT DEFINITION.....................211CID SUP147040 SEGMENTED RT ACCESSORY DEVICES................................212CID SUP147041 DOSE ALGORITHM CLASS......................................................212CID SUP147042 ENERGY UNIT...........................................................................213CID SUP147043 RT ITEM STATES......................................................................213CID SUP147044 RT OPERATION STATES..........................................................213CID SUP147045 MULTI-SOURCE RADIATION TECHNIQUE...............................214CID SUP147046 ROBOTIC RADIATION TECHNIQUE.........................................214CID SUP147047 RADIOTHERAPY PROCEDURE TECHNIQUES........................214CID SUP147048 REVISED VALUE.......................................................................215

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CID SUP147049 RADIOTHERAPY GENERAL WORKITEM DEFINITION............215CID SUP147050 BEAM MODE TYPE DEFINITION.............................................215CID SUP147051 DELIVERY RATE UNIT DEFINITION........................................216CID SUP147052 RADIATION PARTICLE............................................................216CID SUP147053 REGULATORY DEVICE IDENTIFIER TYPE.............................216CID SUP147054 TREATMENT DELIVERY DEVICE TYPE..................................217CID SUP147055 DOSIMETER UNIT DEFINITION...............................................217CID SUP147056 TREATMENT SESSION SIGN-OFF..........................................217CID SUP147060 SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES...........217CID SUP147061 PERCENTAGE AND DOSE-RELATED DOSIMETRIC OBJECTIVES.............218CID SUP147062 VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES. 218CID SUP147063 DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES.............218CID SUP147064 CODED DOSIMETRIC OBJECTIVES.......................................219CID SUP147065 RADIOTHERAPY DOSE REAL WORLD UNITS.........................219CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition220CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition.............220CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition.............220ANNEX C ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE).............221TID SUP147001 RT PRESCRIPTION ANNOTATION...........................................221TID SUP147003 RT SEGMENT ANNOTATION PROPERTIES............................223TID SUP147004 PATIENT SUPPORT POSITION PARAMETERS.......................223ANNEX D DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE)225

Part 17 Addendum...........................................................................................................242Annex Z.Second Generation RT (Informative)............................................................242ZZ.1......INTRODUCTION.........................................................................................242ZZ.2......ENTITY DESCRIPTIONS............................................................................246

ZZ.2.1......RT Course..........................................................................................246ZZ.2.2......RT Physician Intent............................................................................248ZZ.2.3......RT Segment Annotation.....................................................................251ZZ.2.4......RT Radiation Set................................................................................251ZZ.2.5......RT Radiation......................................................................................252ZZ.2.6......RT Dose Image..................................................................................253ZZ.2.7......RT Dose Histogram............................................................................254ZZ.2.8......RT Dose Samples..............................................................................255ZZ.2.9......RT Radiation Record..........................................................................256

ZZ.3......NOTES ON RT COURSE............................................................................257ZZ.3.1......Introduction........................................................................................257ZZ.3.2......Evolution of an RT Course SOP Instance...........................................257ZZ.3.3......Elements of the RT Course................................................................258

ZZ.3.3.1.......Physician Intent........................................................................258ZZ.3.3.2.......Treatment Phase......................................................................258

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ZZ.3.3.3.......Radiation Sets..........................................................................258ZZ.3.3.4.......Clinical State Information..........................................................259

ZZ.4......NOTES ON SECOND-GENERATION IODS................................................260ZZ.4.1......RT Radiation Set IOD.........................................................................260

ZZ.4.1.1.......General Notes..........................................................................260ZZ.4.1.2.......Fractionation.............................................................................260ZZ.4.1.2.......Meterset and other parameters resolution.................................260

ZZ.4.2......RT Radiation IODs.............................................................................260ZZ.4.2.1.......Control Points...........................................................................260ZZ.4.2.2.......Sub-Control Points...................................................................260

ZZ.4.3......RT Segment Annotation IOD..............................................................260ZZ.4.3.1.......Conceptual Volume..................................................................260ZZ.4.3.2.......Segment...................................................................................261

ZZ.5......EXAMPLE USE CASES..............................................................................261ZZ.5.1......Use Case Actors................................................................................261ZZ.5.2......Treatment Planning Using Managed Workflow....................................262

ZZ.5.2.1.......Message Sequencing...............................................................262ZZ.5.2.2.......Transactions and Message Flow...............................................262

ZZ.5.3......Treatment Planning Using Received RT Course.................................265ZZ.5.3.1.......Message Sequencing...............................................................265ZZ.5.3.2.......Transactions and Message Flow...............................................265

ZZ.5.4......Treatment Planning Using DICOM Media...........................................267ZZ.5.4.1.......Message Sequencing...............................................................267ZZ.5.4.2.......Transactions and Message Flow...............................................267

ZZ.5.5......Treatment Planning Using Archive Query of RT Course......................269ZZ.5.5.1.......Message Sequencing...............................................................269ZZ.5.5.2.......Transactions and Message Flow...............................................269

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Foreword

This Supplement specifies the additional IODs necessary to support the new Second Generation Radiotherapy IODs and operations.

This document is an extension to the following parts of the published DICOM Standard:

PS 3.2 Conformance

PS 3.3 Information Object Definitions

PS 3.4 Service Class Specifications

PS 3.6 Data Dictionary

PS 3.16 Content Mapping Resource

PS 3.17 Explanatory Information

Scope and Field of Application

Introduction

Existing radiotherapy IODs were designed to provide a set of containers for use in communicating radiation therapy data of all types, in a generic and flexible way.

Since the development of those the initial IODs, both radiation therapy practice and the DICOM Standard itself have evolved considerably. In particular, workflow management is now a key aspect of DICOM’s domain of application, and the introduction of Unified Worklist and Procedure Step (by Supplement 74 in conjunction with Supplement 96) have begun the growth of radiation therapy into workflow management.

This supplement addresses the need for a new generation of IODs and processes required for use in radiation therapy. The general principles under which these IODs and processes have been developed are documented below.

General Architectural Principles

The DICOM “STRATEGIC DOCUMENT Version 10.4, October 25, 2010” outlines a number of principles applicable across the entire DICOM standard. The key relevant points, and how this supplement addresses those concerns, are as follows:

Image IOD development follows the “enhanced multi-frame” paradigm, rather than stacks of 2D SOP Instances. The new RT Dose Image follows this paradigm.

Different representations of data are encoded in different IODs. This is in contrast to first-generation objects, where multiple different types of data are encoded in a single IOD, such as RT Structure Set.

These new IODs do not define an architecture for the entire system, or functional requirements beyond behavior required for specific services. This is because the mode of manual exchange of objects (see PS3.17) supports an arbitrary system architecture. The worklist mode of

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operation does place some constraints on the architecture – for example, it implies the existence of one or more workflow servers that have knowledge of department-wide scheduling. The Radiation Oncology domain of the IHE initiative may adapt workflows that will utilize 2nd Generation Radiotherapy objects and define their usage in a clinical workflow, as it was done with Supplement 74 and the IHE-RO Technical Profile "Treatment and Delivery Workflow".

RT Architectural Principles

In addition to the general principles outlined above, additional principles specific to radiation therapy have been used in the development of this supplement:

Support for available technologies: The new IODs are designed to support legacy and full-featured, modern equipment.

Compatibility with First-Generation IODs: In general, where the technologies continue to be supported, it will be possible for the content of first-generation IODs to be re-encoded into the second generation IODs described in the supplement. However, such a translation will not be a basic re-encoding and will require additional information supplied by the translating device.

New data representation approaches in DICOM: Where possible, use has been made of new and powerful approaches, such as 3D segmentation, mesh representation, rigid and deformable registrations.

IODs specific to use cases: Explicit separate IODs have been developed for specific treatment modalities with the concept of RT Radiation IOD – for example, Tomotherapeutic, C-Arm, and Robotic beams are modeled separately. This allows more stringent conditions to be applied to the presence or absence of attributes within those IODs, and thereby increases the potential for interoperability.

Expandability of concept: New treatment modalities currently not considered by this standard can be modeled along the existing RT Radiation IODs and be introduced later on, fitting into the existing concept.

Workflow Management: The concept of workflow management using Unified Procedure Step has been fully integrated into the new IODs. However, specific instruction and result IODs needed for some of these workflows will be standardized in a subsequent supplement.

New techniques in oncology: The existence of new treatment techniques (such as robotic therapy and tomotherapy) have been taken into account, along with new treatment strategies (such as image-guided therapy and adaptive therapy).

See Part 17 for descriptions of new radiotherapy entities and sample use cases.

Part 2 Addendum

Add new SOP Classes to PS3.2 Table A.1-2 UID Values:

UID Value UID Name Category1.2.840.10008.5.1.4.1.1.481.XN.1 RT Course Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.2 RT Physician Intent Storage Transfer

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1.2.840.10008.5.1.4.1.1.481.XN.3 RT Radiation Set Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.4 RT Segment Annotation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.5.1 Tomotherapeutic Radiation Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.5.2 C-Arm Photon Radiation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.5.3 C-Arm Electron Radiation Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.5.4 Multiple Fixed Source Radiation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.5.5 Robotic Radiation Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.5.7 Multi-Axial Radiation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.6.1 Tomotherapeutic Radiation Record Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.6.2 C-Arm Photon Radiation Record Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.6.3 C-Arm Electron Radiation Record Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.6.4 Multiple Fixed Source Radiation Record

StorageTransfer

1.2.840.10008.5.1.4.1.1.481.XN.6.5 Robotic Radiation Record Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.6.7 Multi-Axial Radiation Record Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.7.1 RT Dose Image Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.7.2 RT Dose Histogram Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.7.3 RT Dose Samples Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.8 RT Patient Setup Storage Transfer1.2.840.10008.5.1.4.1.1.481.XN.20 Radiation Set Delivery Instruction Storage Workflow

Management

Part 3 Addendum

Add the following in PS3.3 Chapter 7 DICOM model of the real-world

7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND GENERATION OF RADIOTHERAPY INFORMATION OBJECTS

For the purpose of Radiotherapy Second Generation SOP Classes the DICOM Model of the Real-World is described in this section. This subset of the real-world model covers the requirements for transferring information about planned and performed radiotherapeutic treatments and associated data.

Figure 7.12-1 describes the most important elements involved in radiotherapy domain in DICOM.

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Figure 7.12-1 — DICOM MODEL OF THE REAL WORLD – RADIOTHERAPY

7.12.1 RT CourseThe RT Course is a top-level entity that represents a radiotherapy treatment course, specified in one or more RT Pprescriptions, generally for a defined tumor or group of tumors. A patient undergoing treatments of radiotherapy has one treatment course at a time. The RT Course may consist of several Treatment Phases (possibly with breaks of treatment in between them); each Phase may consist of one or more Treatment Sessions. A Treatment Session is delivered in one patient visit to a venue with a treatment machine and will typically deliver a fraction of one or more Radiation Sets. A new RT Course is administered, when the patient is treated for a re-occurrence or

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a new tumor site – typically after a period of a year or more after the previous RT Course has been finished.

The RT Course is to be seencan be thought of as a container as a binder collecting all major objects which are relevant to this course. The most important objects are the Physician Intent and RT Radiation Sets; they in turn reference other companion objects necessary to prepare, conduct and review the treatment. Timing information (start dates and phasing of treatment, breaks etc.) are also part of the RT Course entity information. Additionally it contains information of the ongoing status in treatment planning and delivery. The RT Course is a dynamic object thattherefore represents the current status of the patient’s treatment.

The RT Course may also include information about previously conducted treatments bye referencing previous RT Course objectss or by directly recording the information in attributes to record information about previous treatment having been available in any other form.

7.12.2 RT Physician Intent and PrescriptionThe RT Physician Intent represents the prescription content: it describes how the physician wishes to achieve curative or palliative therapy. This information includes, but is not limited to the use of external radiation therapy or brachytherapy, total and fractional doses and fractionation schemes, treatment sites, dosimetric objectives, envisioned treatment technique and beam energy, and patient setup notes.

7.12.3 Conceptual VolumeThe Conceptual Volume serves asis a reference to a certain anatomical region or point where therapeutic doses or dosimetric constraints are specified, calculated and tracked during the course of treatment. For exaaxmple at the time of prescription, physicians specify regions to which dose is prescribed to. Subsequently those regions are referenced in other objects in order to track calculated and delivered dose in the course of treatment. This referencing capability is provided by the Conceptual Volume facility. Conceptual Volumes may or may not have a representation in segmented images, e.g. in case of ‘emergency’ treatments, sites may be treated which are not volumetrically segmented, but still are to be identified by labeling and textual annotations to be able to track doses. In most cases though, they will be related to one or more volumetric representations in various image sets taken at different times during the course of treatment.

7.12.4 RT Segment AnnotationThe RT Segment Annotation annotates segmented regions defined in other SOP Instances with radiotherapy-specific information about the role and RT-specific types of the regions (e.g. clinical target volume, organ at risk, bolus), and other information such as density definitions. An RT Segment Annotation SOP instance always references one of these three general-purpose representation entities: Segmentation, Surface Segmentation or RT Structure Set.

7.12.5 RT Radiation SetAn RT Radiation Set is a collection of RT Radiations. An RT Radiation Set which constitute defines a fraction of a radiation therapy treatment fraction, which will be applied one or more times. The RT Radiation Set is treated delivered by delivering the radiation of all referenced RT Radiations which are included in this set.

Parallel and intermittent fractionation schemes, e.g. treatment ofto several target sites within different timing schemes, are represented by different multiple RT Radiation Sets, where each set consists of the group of beams.

7.12.6 RT RadiationAn RT Radiation is a contiguous set of control points, describing machine and positioning parameters to be applied during treatment delivery. An RT Radiation describes one portion of an RT Radiation Set; this is perceived as and represents an uninterrupted delivery of therapeutic radiation

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and intended to be delivered in an contiguous and indivisible manner. An RT Radiation is typically referred to in end-user terminology used as a in external beam treatment to annotate an RT Radiation entity is beam (in external beam treatment) or a catheter (or in Bbrachytherapy) a catheter. An RT Radiation is a contiguous set of control points, describing machine and positioning parameters to be applied during treatment delivery.

7.12.7 RT Radiation RecordThe RT Radiation Record represents a records of actual treatment parameters which have been applied during thea delivery of a fractionof an RT Radiation in the context of a specific fraction. Typically, those parameters are the same as those described within an RT Radiation, but may differ due to therapist decisions and/or circumstances of the delivery technology and/or for various other reasons.

7.12.8 RT Dose ImageThe RT Dose Image contains the representation of a 3-dimensional dose distribution using the multi-frame and functional group paradigms. This dose distribution may represent entity has references to treatment parameter scope definitions (likethe planned or delivered dose corresponding to an RT Radiation Set orf an individual RT Radiation) which have been utilized to calculate the dose.

7.12.9 RT Dose HistogramThe RT Dose Histogram describes dose-volume histogram data, based on a volumetric dose calculation and references a segmented Conceptual Volume and an RT Segment Annotation object that annotates the anatomical region where the histogram applies.

7.12.10 RT Dose SamplesThe RT Dose Samples allows represents a representation of dose point data, which are calculated or measured.

7.12.11 RT Treatment PhaseAn RT Course may be divided into multiple RT Treatment Phases. The Each RT Treatment Phase represents a period of time during which a defined number of treatment fractionss are delivered by RT Radiation Sets is delivered to the patient in order to reach a specific treatment goal. In some cases a different treatment phase may follow one already delivered with a defined break in-between.

A treatment phase also defines the chronological relationship between radiation sets which are concurrently and/or subsequently treated.

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Add the following columns in PS3.3 Section A.1.4, Table A.1-13 COMPOSITE INFORMATION OBJECT MODULES OVERVIEW – RADIOTHERAPY

IODsModules

RT Cours

e

RT Phys Intent

RT Rad Set

Seg RT

Ann

Tomo Rad

C-Arm Ph

Rad

C-Arm El Rad

Multi-Fixed Rad

Rob Rad

Multi-Axial Rad

Tomo Rec

C-Arm Ph Rec

C-Arm El Rec

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

DelivPatient M M M M M M M M M M M M M M M M M M M M M

Clinical Trial Subject

U U U U U U U U U U U U U U U U U U U U U

General Study M M M M M M M M M M M M M M M M M M M M M

Patient Study U U U U U U U U U U U U U U U U U U U U U

Clinical Trial Study U U U U U U U U U U U U U U U U U U U U U

General Series M M M M M M M M M M M M M M M M M M M M M

Clinical Trial Series U U U U U U U U U U U U U U U U U U U U U

Enhanced RT Series

M M M M M M M M M M M M M M M M M M M M M

General Equipment M M M M M M M M M M M M M M M M M M M M M

Enhanced General Equipment


Frame Of Reference

M M M M M M M M M M M M M M M

Synchronization C

Radiotherapy Common Instance


RT Course M

RT Prescription Reference

C

RT Treatment Phase

C

RT Radiation Set Reference

C

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650


IODsModules

RT Cours

e

RT Phys Intent

RT Rad Set

Seg RT

Ann

Tomo Rad

C-Arm Ph

Rad

C-Arm El Rad

Multi-Fixed Rad

Rob Rad

Multi-Axial Rad

Tomo Rec

C-Arm Ph Rec

C-Arm El Rec

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

DelivRT Course Associated

Instance Reference

U

RT Physician Intent M

RT Prescription C

RT Radiation Set M

RT Dose Contribution

C

RT Segment Annotation

M

RT Delivery Device Common

M M M M M M M M M M M M

RT Radiation Common

M M M M M M M M M M M M

Tomotherapeutic Delivery Device

M M

Tomotherapeutic Beam

M M

C-Arm Photon-Electron Delivery

Device

M M M M

C-Arm Photon-Electron Beam

M M M M

Multiple Fixed Source Delivery

Device

M M

Multiple Fixed Source Beam Set

M M

Robotic Delivery Device

M M

Robotic Path M M

Multi-Axial Delivery Device

M M

Multi-Axial Beam M M

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IODsModules

RT Cours

e

RT Phys Intent

RT Rad Set

Seg RT

Ann

Tomo Rad

C-Arm Ph

Rad

C-Arm El Rad

Multi-Fixed Rad

Rob Rad

Multi-Axial Rad

Tomo Rec

C-Arm Ph Rec

C-Arm El Rec

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

DelivImage Pixel M

Acquisition Context

M M M

Enhanced RT Dose M M M

RT Dose Image M

RT Dose Histogram M

RT Dose Samples M

RT Patient Setup M

Multi-frame Functional Groups

M

Multi-frame Dimension

M

Respiratory Synchronization

C

RT Radiation Set Delivery Instruction

M

Common Instance Reference Module


SOP Common M M M M M M M M M M M M M M M M M M M M M


Add the following to PS3.3 Annex A:

A.VV SECOND GENERATION RADIATION THERAPY

A.VV.1 Second Generation Radiation Therapy ObjectsThis Section provides a brief description of the IODs of Second Generation Radiation Therapy. Specifically, this description includes:

The Real-World Object which is represented by the IOD

Information as to the scope of the represented object if appropriate

A.VV.1.1 Second Generation Radiation Therapy Common InformationThis section provides a description of the module structure which is shared by the Second Generation Radiation Therapy IODs.

A.VV.1.1.1 Second Generation Radiation Therapy Entity-Relationship ModelThe E-R Model in Figure A.VV.1.1.1-1 depicts those components of the DICOM Information Model that are relevant to second-generation RT IODs.

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Figure A.VV.1.1.1-1 — RT Second Generation IOD information model

Patient

is thesubject of

Study

contains

Series

1

1,n

1

1,n

contains

creates

1,n

Equipment

1 1

spatially or temporally

defines

Frame of Reference


RT RadiationRT Dose Image

RT PhysicianIntent

RT Dose Samples

RT Course

RT DoseHistogram

0,n

0,n

0,n0,n

0,n0,n

0,n

0,n

0-1

1,n

RT RadiationSet

RT Radiation Record

0,n0,n


A.VV.1.1.1.2 Use of Series in Second Generation Radiation TherapyFor first generation IODs, no specific semantics are attached to a series in RT. Similarly, for second generation IODs, internal references shall be used to relate and locate SOP Instances rather than making assumptions about how related SOP Instances are grouped into series. Implementers should note however, that the DICOM standard, in general, does place some restrictions on how such SOP Instances should be grouped, such as:

SOP Instances within a single series shall share the same value for the “Modality” attribute (which is equal to “RT” for all second generation composite IODs defined in this document, but differs for first-generation IODs).

As soon as attributes present in the Series IE change, a new series should be created. Examples of this include when a different operator creates the IOD, or if it is created at a significantly different time (such as in a different planning session).

IOD instances within a single series shall be created on the same equipment.

IOD instances within a single series shall be created by the same Procedure Step, where applicable. If not performed as part of a Procedure Step, the same SOP Instance UID shall be created in the Referenced Performed Procedure Step Sequence for each instance.

IOD instances within a single series need shallto share a common frame of reference (where such a frame of reference is present).

As soon as attributes present in the Series IE change, a new series should be created. All composite instances within a series shall have the same series information. Examples of this include when a different operator creates the IOD, or if it is created at a significantly different time (such as in a different planning session).

In general, application of tThhe above rules could result in a study containing a diagnostic CT series, another containing a diagnostic MR series, and and an another containing RT-specific information series for a given course in a proliferation of series. An application might find it easier to Uuse references in theof RT Course object to directly retrieve required instances would generallyrather than search for thembe required to sort and access this information in a convenient way.

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A.VV.1.1.1.3 Second Generation Radiation Therapy IOD Modules MacroRT Second Generation IODs use a shared common module structure in most IODs. Where this structure is applied, IODs reference this structure as defined in the following Table A.VV.1.1.1-1.

Table A.VV.1.1.1-1RT SECOND GENERATION IOD MODULES MACRO

IE Module Reference UsagePatient Patient C.7.1.1 M

Clinical Trial Subject C.7.1.3 U

Study General Study C.7.2.1 MPatient Study C.7.2.2 U

Clinical Trial Study C.7.2.3 USeries General Series C.7.3.1 M

Clinical Trial Series C.7.3.2 UEnhanced RT Series C.AA.A0 M

Equipment General Equipment C.7.5.1 MEnhanced General Equipment

C.7.5.2 M

Common Instance-level IEs

Radiotherapy Common Instance Module

C.AA.A2 M

Common Instance Reference Module

C.12.2 M

SOP Common C.12.1 M

A.VV.1.1.1.4 RT Radiation IOD Modules Macro Specific RT Radiation IODs (Tomotherapeutic Radiation IOD, C-Arm Photon Radiation IOD, etc.) share common modules as defined in the following Table A.VV.1.1.1-2. This macro is always used in conjunction with the specific RT Radiation IODs.

Table A.VV.1.1.1-2RT RADIATION IOD MODULES MACRO

IE Module Reference UsageInclude 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1Frame of Reference

Frame of Reference C.7.4.1 M

RT Radiation RT Delivery Device Common

C.AA.E1 M

RT Radiation Common C.AA.E2 M

A.VV.1.1.1.5 RT Radiation Record IOD Modules MacroSpecific RT Radiation Record IODs (Tomotherapeutic Radiation Record IOD, C-Arm Photon Radiation Record IOD, etc.) share common modules as defined in the following Table A.VV.1.1.1-3. This macro is always used in conjunction with the specific RT Radiation Record IODs.

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Table A.VV.1.1.1-3RT RADIATION RECORD IOD MODULES MACRO

IE Module Reference UsageRT Treated Radiation

RT Radiation Record Common

C.AA.P1 M

RT Dose Record Common C.AA.P2 M

A.VV.1.2 RT Course Information Object DefinitionA.VV.1.2.1 RT Course IOD DescriptionThe RT Course IOD binds together various entities needed in radiotherapy for preparation, execution and review of radiotherapeutic treatment of a patient. It facilitates complete archiving of a patient RT treatment delivery and communication of data needed for planning or treatment steps not managed by DICOM workflow.

The content of an RT Course may undergo frequent updates resulting in a new SOP Instance UID following each update. As a result, querying for the current Each query on an RT Course object may create return a new SOP Instance UID different than previously used to access the object because content details change often.

It is not necessary to keep track of all versions triggered by such queries. A system keeping the RT Course could store some historical versions at some point in time when clinically of interest (e.g. in between two series of radiation). Those persistent versions are tracked in this sequence for later retrieval. Note however, that for essential information about the whole treatment course, the latest SOP Instance is always sufficient.

See PS 3.17Part 17 for further explanation.

A.VV.1.2.2 RT Course IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.2.3 RT Course IOD Module TableTable A.VV.1.2-4

RT COURSE IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1RT Course RT Course C.AA.A3 M

RT Prescription Reference

C.AA.A4 CRequired if RT Prescription Reference Presence Flag (30xx,0805) equals YES.

RT Treatment Phase C.AA.A5 CRequired if RT Treatment Phase

Presence Flag (30xx,0806) equals YES.


C.AA.A6 CRequired if RT Radiation Set

Reference Presence Flag (30xx,0807) equals YES.

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RT Course Associated Instance Reference

C.AA.A7 U


A.VV.1.3 RT Physician Intent Information Object DefinitionA.VV.1.3.1 RT Physician Intent IOD DescriptionThe RT Physician Intent carries the prescriptions by which the physician describes the therapeutic goal and strategy for the radiotherapeutic treatment.

A.VV.1.3.2 RT Physician Intent IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.3.3 RT Physician Intent IOD Module TableTable A.VV.1.3-1

RT PHYSICIAN INTENT IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1RT Physician Intent

RT Physician Intent C.AA.B1 M

RT Prescription C.AA.B2 URT Treatment Phase Intent

C.AA.B3 CRequired if RT Treatment Phase


A.VV.1.4 RT Radiation Set Information Object DefinitionA.VV.1.4.1 RT Radiation Set IOD DescriptionThe RT Radiation Set represents a set of radiation deliveries which are intended to be delivered together in a single fraction. The RT Radiation Set also contains a description of the fractionation pattern and the Number of Fractions and the associated dose contributions. See Part 17 for further explanation.

A.VV.1.4.2 RT Radiation Set IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.4.3 RT Radiation Set IOD Module TableTable A.VV.1.4-1

RT RADIATION SET IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1RT Radiation Set

RT Radiation Set C.AA.C1 M

RT Dose Contribution C.AA.C2 CRequired if RT Dose Contribution


A.VV.1.5 RT Segment Annotation Information Object DefinitionA.VV.1.5.1 RT Segment Annotation IOD DescriptionThe RT Segment Annotation IOD annotates a Segmentation IOD, Surface Segmentation IOD, or RT Structure Set IOD with radiotherapy-specific information that cannot be encoded in the content of the annotated SOP Instance, or overrides that content with new or additional interpretation.

26

736

738

740

742

744

746

748

750

752

754

756

758

760

762


A.VV.1.5.2 RT Segment Annotation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.5.3 RT Segment Annotation IOD Module TableTable A.VV.1.5-1

RT SEGMENT ANNOTATION IOD MODULES

IE Module Reference UsageInclude 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1RT Segment Annotation

RT Segment Annotation C.AA.D1 M

A.VV.1.6 Tomotherapeutic Radiation Information Object DefinitionA.VV.1.6.1 Tomotherapeutic Radiation IOD DescriptionThe Tomotherapeutic Radiation IOD represents the information required to describe a radiotherapy treatment on a serial or helical tomotherapeutic delivery device.

A.VV.1.6.2 Tomotherapeutic Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.6.3 Tomotherapeutic Radiation IOD Module TableTable A.VV.1.6-1

TOMOTHERAPEUTIC RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2RT Radiation Tomotherapeutic Delivery Device C.AA.F1 M

Tomotherapeutic Beam C.AA.F2 M

A.VV.1.6.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the Tomotherapeutic Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147013.

A.VV.1.7 C-Arm Photon Radiation Information Object DefinitionA.VV.1.7.1 C-Arm Photon Radiation IOD DescriptionThe C-Arm Photon Radiation IOD represents the information required to describe a radiotherapy treatment on a C-Arm photon delivery device.

A.VV.1.7.2 C-Arm Photon Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.7.3 C-Arm Photon Radiation IOD Module TableTable A.VV.1.7-1

C-ARM PHOTON RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2

764

766

768

770

772

774

776

778

780

782

784

786

788

790


RT Radiation C-Arm Photon-Electron Delivery Device

C.AA.G1 M

C-Arm Photon-Electron Beam C.AA.G2 M

A.VV.1.7.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the C-Arm Photon Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147012.

A.VV.1.8 C-Arm Electron Radiation Information Object DefinitionA.VV.1.8.1 C-Arm Electron Radiation IOD DescriptionThe C-Arm Electron Radiation IOD represents the information required to describe a radiotherapy treatment on a C-Arm electron delivery device.

A.VV.1.8.2 C-Arm Electron Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.8.3 C-Arm Electron Radiation IOD Module TableTable A.VV.1.8-1

C-ARM ELECTRON RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2RT Radiation C-Arm Photon-Electron Delivery

DeviceC.AA.G1 M

C-Arm Photon-Electron Beam C.AA.G2 M

A.VV.1.8.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the C-Arm Electron Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147012.

A.VV.1.9 Multiple Fixed Source Radiation Information Object DefinitionA.VV.1.9.1 Multiple Fixed Source Radiation IOD DescriptionThe Multiple Fixed Source Radiation IOD represents the information required to describe a radiotherapy treatment on a multiple fixed source photon delivery device.

A.VV.1.9.2 Multiple Fixed Source Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.9.3 Multiple Fixed Source Radiation IOD Module TableTable A.VV.1.9-1

MULTIPLE FIXED SOURCE RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2RT Radiation Multiple Fixed Source Delivery

DeviceC.AA.H1 M

28

792

794

796

798

800

802

804

806

808

810

812

814

816

818


Multiple Fixed Source Beam Set C.AA.H2 M

A.VV.1.9.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the Multiple Fixed Source Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147045.

A.VV.1.10 Robotic Radiation Information Object DefinitionA.VV.1.10.1 Robotic Radiation IOD DescriptionThe Robotic Radiation IOD represents the information required to describe a radiotherapy treatment on a robotic delivery device, such as paths, nodes, and collimation type.

A.VV.1.10.2 Robotic Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.10.3 Robotic Radiation IOD Module TableTable A.VV.1.10-1

ROBOTIC RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2RT Radiation Robotic Delivery Device C.AA.J1 M

Robotic Path C.AA.J2 M

A.VV.1.10.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the Robotic Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147046.

A.VV.1.11 Multi-Axial Radiation Information Object DefinitionA.VV.1.11.1 Multi-Axial Radiation IOD DescriptionThe Multi-Axial Radiation IOD represents the information required to describe a radiotherapy treatment on a C-arm device having additional degrees of freedom in source positioning.

A.VV.1.11.2 Multi-Axial Radiation IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.11.3 Multi-Axial Radiation IOD Module TableTable A.VV.1.11-1

MULTI-AXIAL RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2RT Radiation Multi-Axial Delivery Device C.AA.L1 M

Multi-Axial Beam C.AA.L2 M

820

822

824

826

828

830

832

834

836

838

840

842

844

846


A.VV.1.11.3.1 RT Radiation Common Module in RT Radiation IOD Modules MacroFor the Multi-Axial Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147012.

A.VV.1.12 RT Dose Image Information Object DefinitionA.VV.1.12.1 RT Dose Image IOD DescriptionThe RT Dose Image IOD represents 2D or 3D calculated or measured dose distributions in the DICOM Patient Coordinate System. This IOD does not provide for definition of doses in beam or other coordinate systems. The application is responsible for transforming data in other, non-patient based coordinate systems to the patient based coordinate system described in C.7.6.2.1.1.

A.VV.1.12.2 RT Dose Image IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.12.3 RT Dose Image IOD Module TableTable A.VV.1.12-1

RT DOSE IMAGE IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1Frame of Reference

Frame of Reference C.7.4.1 M

Synchronization C.7.4.2 C – Required if time synchronization was applied.

RT Dose Image

Image Pixel C.7.6.3 MMulti-frame Functional Groups

C.7.6.16 M

Multi-frame Dimension C.7.6.17 M

Respiratory Synchronization C.7.6.18.2 C – Required if respiratory synchronization was applied.

Acquisition Context C.7.6.14 MEnhanced RT Dose C.AA.M1 M

RT Dose Image C.AA.M2 M

A.VV.1.12.4 RT Dose Image IOD Content ConstraintsThe General Image Module, Overlay Plane Module, Curve Module and VOI LUT Module shall not be used in a Standard Extended SOP Class of the RT Dose Image IOD.

A.VV.1.12.5 RT Dose Image Functional Group MacrosTable A.VV.1.12-2

RT DOSE IMAGE FUNCTIONAL GROUP MACROSFunction Group

MacroSection Usage

Pixel Measures C.7.6.16.2.1 M – Shall be used as a Shared Functional Group

Plane Position (Patient) C.7.6.16.2.3 M – Shall be used as a Per-Frame Functional Group

30

848

850

852

854

856

858

860

862

864

866

868


Plane Orientation (Patient)

C.7.6.16.2.4 M – Shall be used as a Shared Functional Group

Respiratory Trigger C.7.6.16.2.17 C – Required if Respiratory Synchronization Technique is used. May be present otherwise.

RT Dose Image Frame Type

C.AA.M3.1 M

Real World Value Mapping

C.7.6.16.2.11 M – Shall be used as a Shared Functional Group

Defined CID for Measurement Units Code Sequence (0040,08EA) shall be SUP147065.

A.VV.1.13 RT Dose Histogram Information Object DefinitionA.VV.1.13.1 RT Dose Histogram IOD DescriptionThe RT Dose Histogram IOD specifies dose-volume histogram (DVH) and dose-area histogram data and statistics, calculated by radiotherapy treatment planning systems.

A.VV.1.13.2 RT Dose Histogram IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.13.3 RT Dose Histogram IOD Module TableTable A.VV.1.13-1

RT DOSE HISTOGRAM RADIATION IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1RT Dose Histogram


RT Dose Histogram C.AA.M4 M

A.VV.1.14 RT Dose Samples Information Object DefinitionA.VV.1.14.1 RT Dose Samples IOD DescriptionThe RT Dose Samples IOD specifies a list of spatial locations and associated dose values created by a treatment planning system or dose measurement device. Spatial locations are specified in the patient based coordinate system described in C.7.6.2.1.1.

A.VV.1.14.2 RT Dose Samples IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.14.3 RT Dose Samples IOD Module TableTable A.VV.1.14-1

RT DOSE SAMPLES IOD MODULESIE Module Reference Usage

Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1Frame of Reference C.7.4.1 M

870

872

874

876

878

880

882

884

886

888

890


Frame of Reference

Synchronization C.7.4.2 C – Required if time

synchronization was applied.

RT Dose Samples


Dose Samples C.AA.M5 M

A.VV.1.15 Tomotherapeutic Radiation Record Information Object DefinitionA.VV.1.15.1 Tomotherapeutic Radiation Record IOD DescriptionThe Tomotherapeutic Radiation Record IOD records the radiation delivered using the Tomotherapeutic Radiation IOD.

A.VV.1.15.2 Tomotherapeutic Radiation Record IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.15.3 Tomotherapeutic Radiation Record IOD Module TableTable A.VV.1.15-1

TOMOTHERAPEUTIC RADIATION RECORD IOD MODULESIE Module Reference Usage

Include 'Tomotherapeutic Radiation IOD Modules' Table A.VV.1.6-1Include 'RT Radiation Record IOD Modules Macro' Table A.VV.1.1.1-3

A.VV.1.16 C-Arm Photon Radiation Record Information Object DefinitionA.VV.1.16.1 C-Arm Photon Radiation Record IOD DescriptionThe C-Arm Photon Radiation Record IOD records the radiation delivered using the C-Arm Photon Radiation IOD.

A.VV.1.16.2 C-Arm Photon Radiation Record IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.16.3 C-Arm Photon Radiation Record IOD Module TableTable A.VV.1.16-1

C-ARM PHOTON RADIATION RECORD IOD MODULESIE Module Reference Usage

Include ‘C-Arm Photon Radiation IOD Modules’ Table A.VV.1.7-1Include ’RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3

A.VV.1.17 C-Arm Electron Radiation Record Information Object DefinitionA.VV.1.17.1 C-Arm Electron Radiation Record IOD DescriptionThe C-Arm Electron Radiation Record IOD records the radiation delivered using the C-Arm Electron Radiation IOD.

A.VV.1.17.2 C-Arm Electron Radiation Record IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

32

892

894

896

898

900

902

904

906

908

910

912

914

916


A.VV.1.17.3 C-Arm Electron Radiation Record IOD Module TableTable A.VV.1.17-1

C-ARM ELECTRON RADIATION RECORD IOD MODULESIE Module Reference Usage

Include ‘C-Arm Electron Radiation IOD Modules’ Table A.VV.1.8-1Include ‘RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3

A.VV.1.18 Multiple Fixed Source Radiation Record Information Object DefinitionA.VV.1.18.1 Multiple Fixed Source Record Radiation IOD DescriptionThe Multiple Fixed Source Radiation Record IOD records the radiation delivered using the Multiple Fixed Source Radiation IOD.

A.VV.1.18.2 Multiple Fixed Source Radiation Record IOD E-R ModelSee Figure A.VV.1.1.1-1.

A.VV.1.18.3 Multiple Fixed Source Radiation Record IOD Module TableTable A.VV.1.18-1

MULTIPLE FIXED SOURCE RADIATION RECORD IOD MODULESIE Module Reference Usage

Include ‘Multiple Fixed Source Radiation IOD Modules’ Table A.VV.1.9-1Include ‘RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3

A.VV.1.19 Robotic Radiation Record Information Object DefinitionA.VV.1.19.1 Robotic Radiation Record IOD DescriptionThe Robotic Radiation Record IOD records the radiation delivered using the Robotic Radiation IOD.

A.VV.1.19.2 Robotic Radiation Record IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

A.VV.1.19.3 Robotic Radiation Record IOD Module TableTable A.VV.1.19-1

ROBOTIC RADIATION RECORD IOD MODULESIE Module Reference Usage

Include ‘Robotic Radiation IOD Modules’ Table A.VV.1.10-1Include ‘RT Radiation Record IOD Modules Table A.VV.1.1.1-3

A.VV.1.20 Multi-Axial Radiation Record Information Object DefinitionA.VV.1.20.1 Multi-Axial Radiation Record IOD DescriptionThe Multi-Axial Radiation Record IOD records the radiation delivered using the Multi-Axial Radiation IOD.

A.VV.1.20.2 Multi-Axial Radiation Record IOD Entity-Relationship ModelSee Figure A.VV.1.1.1-1.

918

920

922

924

926

928

930

932

934

936

938

940

942

944

946


A.VV.1.20.3 Multi-Axial Radiation Record IOD Module TableTable A.VV.1.20-1

MULTI-AXIAL RADIATION RECORD IOD MODULESIE Module Reference Usage

Include ‘Multi-Axial Radiation IOD Modules’ Table A.VV.1.11-1Include ‘RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3

34

948

950


Add the following to PS3.3 Annex C:

C.AA SECOND GENERATION RADIOTHERAPY MODULES

The following macros and modules are used by the second generation radiotherapy IODs.

C.AA.1 Second Generation Radiotherapy DefinitionsThis chapter section lists some of the most-often used terms in the scope of Second Generation Radiotherapy Modules and provides definitions for a better understanding.

NeverthelessNotes:, 1. Tthis ssection does not replace a profound understanding of clinical knowledge related to radiotherapy treatments.

2. Please also refer to See the explanations to in Sectionchapter 7.12 “Extension of the DICOM model of the real-world for Second Generation of Radiotherapy Information Objects”, to the in IOD definitions in Sectionchapter A.VV.1 and to in Part PS 3.17 Addendum Annex ZZ.

C.AA.1.1 Control PointsA Control Point represents the planned state of a (delivery) device at one of a series sequence of instances states defined by a progress variable. For radiation delivery the Cumulative Radiation Meterset (30xx,5021) is the progress variable is the Cumulative Radiation Meterset (30xx,5021).

The Control Point Sequence represents the geometric and radiological parameters as a sequence of states at specified values of the Cumulative Radiation Meterset. The sequence is used by the delivery device to implement a planned delivery and to record the actual delivery.

Some treatment modalities may use sub-control points to specify changes of a subset of parameters within a control point.

C.AA.1.1.1 Verification Control PointsVerification Control Points represent the expected expected cumulative dose for a set of geometric parameters. Verification is performed by comparing the expected dose at a Verification Control Point to a corresponding dose. The corresponding dose may be directly measured or recalculated.

The purpose of Verification Control Points is to verify the dose (e.g. by measuring or calculating) by comparing it to planned dose.

C.AA.1.2 Nominal Energy

A nominal energy is an equipment setting used by the manufacturer to characterize the penetration of the beam into a material. For photon beam delivery, the maximum energy of the delivered photon spectrum is typically specified. For electron beam delivery, the most probable energy of the spectrum is typically specified.

C.AA.1.3 Fractionation, Fractionation SchemeFractionation describes the splitting of a course of radiation into multiple sessions. Each session may consist of the delivery of one or more RT Radiation Sets. Traditionally, in ionizing radiation treatments, fractionation allows healthy tissue to recover from radiation effects over the course of treatment. The temporal pattern of deliveries is termed called a fractionation scheme.

C.AA.1.4 Treatment RT Radiation SetA The term Treatment RT Radiation Set is used to indicate an RT Radiation Set that has been selected for treatment, is being treated, or has been treated. RT Radiation Sets which are not called Treatment RT Radiation Set include alternatives or rejected proposals for treatment.

952

954

956

958

960

962

964

966

968

970

972

974

976

978

980

982

984

986

988

990


C.AA.1.5 MetersetA parameter from which, through a calibration procedure with additional information, the absorbed dose delivered can be calculated. (fFor meterset representing monitor units, the definition is based on IEC 60601-2-64).,

The meterset can be is used to measure the progress of radiation delivery during treatment, or report on progress after treatment.

C.AA.1.6 Radiation Dose PointA point chosen in space, or in the patient treatment volume, to measure or plan for a specific amount of radiation. The point usually is placed at a significant location, such as within a tumor, or within healthy tissue to be spared or where a measurement device can be positioned.

C.AA.1.7 Treatment PhaseA specific period within a treatment course when the prescribed medical treatment is applied to the patient. Typically, if more than one RT Radiation Set is delivered, they are in overlapping or sequential phases.

36

992

994

996

998

1000

1002

1004


C.AA.2 Second Generation Radiotherapy General-Purpose MacrosC.AA.2.1 RT Entity Labeling MacroThe RT Entity Labeling Macro contains the attributes needed to identifiesy a radiotherapy concept using a 16-character label, a name, and a description.

This information is intended only for display to human readers. For display purposes only, shall not be used for other purposes. and shall not be used programmatically.

Table C.AA.2.1-1RT ENTITY LABELING MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionRT Entity Label (30xx,51E2) 1 User defined label for this entity.

See C.AA.2.1.1.1.

RT Entity Name (30xx,51E3) 3 User defined name for this entity.See C.AA.2.1.1.2.

RT Entity Description (30xx,51E4) 3 User defined description for this entity.See C.AA.2.1.1.2.

C.AA.2.1.1 RT Entity Labeling Macro Attribute DescriptionC.AA.2.1.1.1 RT Entity LabelThe RT Entity Label (30xx,51E2) attribute represents a user-definable short free text providing the primary identification of this entity to other users. The label may be used to provide unique identification to the user.

C.AA.2.1.1.2 RT Entity Name and RT Entity DescriptionThe optional attribute RT Entity Name (30xx,51E3) allows a longer string containing additional descriptive identifying text for one-line headings etc. The optional attribute RT Entity Description (30xx,51E4) allows adding additional information when needed.

C.AA.2.2 RT Entity Long Labeling MacroThe RT Entity Long Labeling Macro contains the attributes needed to identifiesy a radiotherapy concept using a 64-character label and a description.

This information is intended only for display to human readers. For display purposes only, shall not be used for other purposes. and shall not be used programmatically.

Table C.AA.2.2-1RT ENTITY LONG LABELING MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionRT Entity Long Label (30xx,51E5) 1 User defined label for this entity.

See C.AA.2.1.2.1

RT Entity Description (30xx,51E4) 3 User defined description for this entity.See C.AA.2.1.1.2.

1006

1008

1010

1012

1014

1016

1018

1020

1022

1024

1026

1028

1030


C.AA.2.1.2.1 RT Entity Long LabelThe RT Entity Long Label (30xx,51E5) attribute represents a user-definable free text providing the primary identification of this entity to other users. The label may be used to provide unique identification to the user.

C.AA.2.3 RT Item State MacroThis macro may beis invoked to record the clinical state, such as approval or review,ed of either an entire SOP Instance or for a specific part of the information content of a SOP Instance.

Table C.AA.2.3-1RT ITEM STATE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionRT Item State Sequence (30xx,5080) 1 States that have been set on the

item that the RT Item State belongs to.One or more Items shall be included in this sequence.

>Include 'Assertion Macro' Table 10-XW1-1(Editor’s Note: That Macro is defined in Sup 121. The version referenced in here is Sup 121_pc,October 2013)

No Baseline CID defined.See C.AA.2.3.1.1.

>Active Item Indicator (30xx,5082) 1 Indicator of the active versus historic status of this item.Enumerated Values:

ACTIVEHISTORIC

See C.AA.2.3.1.2.

> RT Item State Creation Authority Description Sequence

(30xx,5084) 3 User defined description of authority used to create this Item State entry.

>>Include 'HL7v2 Hierarchic Designator' Macro Table 10-17

C.AA.2.3.1 RT Item State Macro Attribute DescriptionC.AA.2.3.1.1 RT Item State SequenceThe RT Item State Sequence (30xx,5080) contains a sequence of Items which define the state. The CIDs which define the codes to be used in Assertion Code Sequence (30xx,50A0) attribute of the Assertion Macro are defined at the invocation of the macro.

C.AA.2.3.1.2 Active Item IndicatorThe Active Item Indicator (30xx,5082) attribute is used to specify which state definiton items in the RT Item State Sequence (30xx,5080) are active and which items do only convey an audit trail of states having been in place in the past at the time the SOP instance was created.

This indication additionally allows conveying more than one state entry of different persons as being active. E.g. if the department requires approvals by more than one person, several items having an approved state can be marked as active, indicating the list of persons having provided approval.

38

1032

1034

1036

1038

1040

1042

1044

1046

1048

1050

1052


The semantics of the states are defined in the code definition and may be further specialized at invocation of that macro. Which state transitions are allowed and which are the pre-conditions to perform a state transition if outside of the scope of the standard.

C.AA.2.4 RT Operation State MacroThis macro describes the attributes that record the operation state of referenced SOP Instances. The RT Operation State encodes the progress of the entity through the delivery process, rather than the approval stateus as encoded in RT Item State (see Section C.AA.2.3).

The initial state of a SOP Instance, to which the sequence applies, is undefined and specified by an empty sequence.

Table C.AA.2.4-1RT OPERATION STATE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionRT Operation State Sequence (30xx,5086) 2 Operation state of the item the state

belongs to. The current state is the one with the latest Date/Time as denoted in Assertion Macro in Assertion DateTime (30xx,50A4).Zero or more Items shall be included in this sequence.

>Include ‘Assertion Macro’ Table 10-XW1 Defined CID shall be SUP147044.RT Operation State Code Sequence

(30xx,508A) 1 The code representing the operation state.Only a single Item shall be included in this sequence.

>Include ‘Code Sequence Macro’ Table 8.8-1 Defined CID shall be SUP147044.Author Observer Sequence (0040,A078) 1C The person or device updating the

operation state.Only a single Item shall be included in this sequence.See below)

>Include ‘Identified Person or Device Macro’ Table C.17-3b(Editor’s Note: That Macro used here is one defined in PS3.3 with the extensions of Sup 121. The supplement version referenced in here is Sup 121_pc, 2013-04-11)

No Baseline CIDs defined

RT Operation State DateTime (30xx,508C) 1 Date and time at which the operation state did change.

RT Operation State Change Reason Description

(30xx,508E) 3 Description of the reason for moving to this state, especially in the case of early completion

>RT Operation State Change Reason Code Sequence

(30xx,5088) 3 Code describing the reason for moving to this state, especially in the case of early completion. Only a single Item shall be included in this sequence.

1054

1056

1058

1060

1062

1064


>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline CID is specified.>Include 'Digital Signatures Macro' Table C.12-6

40

1066


C.AA.2.5 Conceptual Volume Reference MacroA Conceptual Volume is an abstract spatial entity . It can be used to identify an anatomic region (such as a planning target volume or a combination of multiple anatomic segments) or non-anatomic volumes such as a bolus or a marker. A Conceptual Volume can be established without necessarily defining its spatial extent (for example a Conceptual Volume for a tumor can be established prior to segmenting it). The spatial extent of a Conceptual Volume may change over time (for example as treatment proceeds the tumor volume corresponding to the Conceptual Volume will change).

The spatial extent of Conceptual Volumes may also be defined as a combination of other Conceptual Volumes.

The Conceptual Volume can be referenced by SOP Instances without necessarily defining its spatial or temporal extent. aA Conceptual Volume exists may be defined independently of by any Segmentation, Surface Segmentation or RT Structure Set SOP Instance that may be associated with itor a combination thereof, although the Conceptual Volume does exist independently of a specific definition of its spatial extent. (i.e. the segmentations may not be definitive representations of the Conceptual Volume).

A Conceptual Volume may also be defined as a combination of other Conceptual Volumes.

Examples for Conceptual Volumes:

1. A Conceptual Volume (with a Conceptual Volume UID) can be used to represent the treatment target in an RT Physician Intent SOP Instance based upon a diagnostic image set, although the actual delineation of a specific target volume has not yet taken place. Later, the target volume is contoured. The RT Segment Annotation SOP Instance references the volume contours and associates it with the Conceptual Volume via the Conceptual Volume UID.

2. In an adaptive workflow, the anatomic volume may change over time. The Conceptual Volume on the other hand does not change. Multiple RT Segment Annotation SOP Instances, each referencing different Segmentation instances, can be associated with the same Conceptual Volume via the Conceptual Volume UID, making it possible to track the volume over time.

3. A Conceptual Volume may be used to define fraction doses, for example in emergency treatments in RT Physician Intent SOP instances and subsequently defined RT Radiation SOP instances where the beam dose is manually calculated. After treatment, these Conceptual Volumes are used in Radiation Records to track the delivered dose. Such Conceptual Volumes may never reference a segmentation, but serve as a key for referencing the Conceptual Volume across different SOP instances.

The Conceptual Volume Macro contains the attributes needed to reference a conceptual volume from other SOP instances by using the same Conceptual Volume UID.

Table C.AA.2.5-1CONCEPTUAL VOLUME REFERENCE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionConceptual Volume UID (30xx,1301) 1 A UID identifying the Conceptual

Volume.

1068

1070

1072

1074

1076

1078

1080

1082

1084

1086

1088

1090

1092

1094

1096

1098

1100

1102

1104


Originating SOP Instance Reference Sequence

(30xx,1302) 1C Reference to the SOP Instance that contains the original definition of this Conceptual Volume identified by Conceptual Volume UID (30xx,1301).Required when the Conceptual Volume UID (30xx,1301) was not issued in the current SOP Instance, but read from another SOP instance.Only a single Item shall be included in this sequence.Note: The SOP Instance should be taken from the Originating SOP Instance Reference Sequence of the Instance from which the Conceptual Volume UID was read unless that Instance was the originating SOP Instance in which case the Originating SOP Instance Reference Sequence will be absent.

>Include 'SOP Instance Reference Macro' Table 10-11Equivalent Conceptual Volumes Sequence

(30xx,1305) 3 References one or more existing Conceptual Volumes that represent the same concept as the current Conceptual Volume. This sequence might be used when Conceptual Volume references of existing SOP instances are retrospectively identified as representing the same entity. One or more Items are permitted in this sequence.See C.AA.2.5.1.1.

>Conceptual Volume UID (30xx,1301) 1 A UID identifying the Conceptual Volume.

>Equivalent Conceptual Volume Instance Reference Sequence

(30xx,1304) 1 Reference to the SOP Instance that contains the referenced Conceptual Volume UID (30xx,1301) of the Equivalent Conceptual Volume.Only a single Item shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11

C.AA.2.5.1 Conceptual Volume Macro Attribute DescriptionC.AA.2.5.1.1 Equivalent Conceptual VolumesConceptual Volumes can also be relatedbe declared to be equivalent to other Conceptual Volumes. In such cases, the Equivalent Conceptual Volumes Sequence (30xx,1305) is used in derived SOP instances which are aware of other SOP instances defining a semantically equivalent volume, but

42

1106

1108

1110


using different Conceptual Volume UIDs. A reason for this might be that these Conceptual Volume UIDs have been defined independently from each other.

C.AA.2.6 Extended Conceptual Volume Segmentation Reference and Combination MacroThe Extended Conceptual Volume Reference Base MacroThis macro allows the combination of conceptual Volumes as constituents of a combined volume. A representative example is to have the Left Lung and the Right Lung segmented, and then to declare the LungLungs as a combined Conceptual Volume, where, for example,which prescription constraints can be defined for.

The Extended Conceptual Volume Reference Base adds the facility tomacro also allows reference to RT Segment Annotation SOP instances, which contain a segmented representation of the conceptual volumeConceptual Volume. At the invocation of this macro it is declared, whether this segmented representation is required or not.

SOP Instance 1

Conceptual Volume A

Conceptual Volume B

Segmentation SOP Instance 1

SOP Instance 2

Conceptual Volume B

Conceptual Volume C

Segmentation SOP Instance 2

1112

1114

1116

1118

1120

1122

1124


Figure C.AA.2.6-1Conceptual Volume References

Figure C.AA.2.6-1 describes an RT Physician Intent instance where Conceptual Volumes “Lung, left” and “Lung, right” are referenced, but not defined. In this example, the RT Segmentation Annotation Instances then define the volumetric information of the Conceptual Volumes by referencing a specific segment of a Segmentation Instance and a specific ROI in an RT Structure Set Instance.a SOP Instance 1 where a Conceptual Volume A is fully defined, but Conceptual Volume B does not yet have a reference to an actual instance. SOP Instance 2 then defines the volumetric information of Conceptual Volume B by referencing a different Segmentation SOP Instance 2.

RT Structure Set

RT Physician Intent

Conceptual Volume

“Lung, left”

Conceptual Volume

“Lung, right”

RT Segmentation Annotation (I)

Conceptual Volume

“Lung, left”

Conceptual Volume

“Lung, right”

SegmentationSegment

3ROI 5

RT Segmentation Annotation (II)

SOP Instance

Conceptual Volume A

Conceptual Volume B

Conceptual Volume C

44

1126

1128

1130

1132

1134

1136


Figure C.AA.2.6-2Conceptual Volume Combination References

Figure C.AA.2.6-2 describes an RT Physician Intent Instance defining Conceptual Volumes “Lung, left” and “Lung, right” and Conceptual Volume “Lung” as a combination of the first two without a direct reference to a volume definitiona SOP Instance 1 defining Conceptual Volumes A and B and Conceptual Volume C as a combination of A and B without a direct reference to a volume definition.

Table C.AA.2.6-1EXTENDED CONCEPTUAL VOLUME REFERENCESEGMENTATION REFERENCE AND

COMBINATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInclude 'Conceptual Volume Reference Macro' Table C.AA.2.5-1Conceptual Volume Combination IndicatorFlag

(30xx,1309) 1 Indication that this Conceptual Volume reference is a combination of other Conceptual Volumes.Enumerated Values:

YESNO

Conceptual Volume Combination Expression

(30xx,1307) 1C Symbolic expression specifying the combination of Conceptual Volumes as a text string consisting of Conceptual Volume Constituent Index (30xx,1308) values, combination operators and parentheses.Required if Conceptual Volume Combination Indicator (30xx,1309) equals YES.See C.AA.2.6.1.2.

RT Physician Intent

Conceptual Volume

“Lung, left”

Conceptual Volume

“Lung, right”

Conceptual Volume

“Lung”

1138

1140

1142

1144

1146

1148


Conceptual Volume Combination Description

(30xx,1310) 2C Human readable annotation describing the combination of Conceptual Volumes. This description is for display only and shall not be used programmatically.Required if Conceptual Volume Combination Indicator (30xx,1309) equals YES.

Conceptual Volume Constituent Sequence

(30xx,1303) 1C References to other Conceptual Volumes which are constituents of this Conceptual Volume. See C.AA.2.6.1.12.Required if Conceptual Volume Combination Indicator Flag (30xx,1309) equals YES.One or more Items shall be included in this sequence.The combined Conceptual Volume UID shall not be included in the sequence.

>Conceptual Volume Constituent Index

(30xx,1308) 1 An index referened in the Conceptual Volume Combination Expression (30xx,1307) identifying the Conceptual Volume Constituent Item index. The value shall start at 1, and increase monotonically by 1.

>Conceptual Volume UID (30xx,1301) 1 UID identifying the Conceptual Volume that is a constituent of thisthe combined Conceptual Volume.

>Originating SOP Instance Reference Sequence

(30xx,1302) 1C Reference to the SOP Instance that contains the original definition of the Conceptual Volume constituent identified by Conceptual Volume UID (30xx,1301) in this sequence.Required if this UID was not issued within the current SOP Instance containing this macro, but read from another SOP Instance for reference.Only a single Item shall be included in this sequence.


46


Conceptual Volume Combination Expression

(30xx,1307) 1C Symbolic expression specifying the combination of Conceptual Volumes as a text string consisting of Conceptual Volume Constituent Index (30xx,1308) values, combination operators and parentheses.Required if Conceptual Volume Combination Flag (30xx,1309) equals YES.See C.AA.2.6.1.1.

Conceptual Volume Combination Description

(30xx,1310) 2C Human readable description of the combination of Conceptual Volumes. For display purposes only, shall not be used for other purposes.Required if Conceptual Volume Combination Flag (30xx,1309) equals YES.

Conceptual Volume Segmentation Defined Flag

(30xx,1311) 1 States whether the Conceptual Volumes present in this Item have segmentations referenced.Enumerated Values YES NO

Conceptual Volume Segmentation Reference Sequence

(30xx,1312) 1C Contains the reference to the RT Segment Annotation instance defining this Conceptual Volume.Required when Conceptual Volume Segmentation Defined Flag (30xx,1311) Flag equals YES and Conceptual Volume Combination Flag Indicator (30xx,1309) equals NO.If Conceptual Volume Combination Indicator (30xx,1309) equals YES, the number of Items included in this sequence shall equal the number of Items in the Conceptual Volume Constituent Sequence (30xx,1303). If Conceptual Volume Combination Indicator (30xx,1309) equals NO, only a single Item shall be included in this sequence.Only a single Item shall be included in this sequence.See C.AA.2.6.1.23.


>Referenced Conceptual Volume Constituent Index

(30xx,1313) 1C A reference to a Conceptual Volume Constituent Index (30xx,1308) within the Conceptual Volume Constituent Sequence (30xx,1303) for which the reference to the segmentation is provided.Required if Conceptual Volume Combination Indicator (30xx,1309) equals YES.

>Referenced RT Segment Annotations Sequence

(30xx,0874) 1 Reference to the RT Segment Annotations SOP instance that contains the segmentation.Only a single Item shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>Referenced Segment Annotation Index

(30xx,0151) 1 The value of Reference to theReference to the Segment Index (30xx,0121) in the Segment Sequence (0062,0002) of corresponding to the referenced RT Segment Annotation instance.

Conceptual Volume Constituent Segmentation Reference Sequence

(30xx,1314) 1C Contains the reference to the constituents of the RT Segment Annotation instance defining this Conceptual Volume.Required when Conceptual Volume Segmentation Defined Flag (30xx,1311) equals YES and Conceptual Volume Combination Flag Indicator (30xx,1309) equals YES.The number of Items included in this sequence shall equal the number of Items in the Conceptual Volume Constituent Sequence (30xx,1303).See C.AA.2.6.1.23.

>Referenced Conceptual Volume Constituent Index

(30xx,1313) 1 The value of Reference to the Conceptual Volume Constituent Index (30xx,1308) within the Conceptual Volume Constituent Sequence (30xx,1303) for which the reference to the segmentation is provided.

>Referenced RT Segment Annotations Sequence

(30xx,0874) 1 Reference to the RT Segment Annotations SOP instance that contains the segmentation.Only a single Item shall be included in this sequence.


48


>Referenced Segment Annotation Index

(30xx,0151) 1 The value of Reference to the Segment Index (30xx,0121) in the Segment Sequence (0062,0002) corresponding to the referenced RT Segment Annotation instance.

Referenced Spatial Registration Sequence

(0070,0404) 1C Registrations between referenced segmentations, of which the relation is not the unity transformation and which are present in Conceptual Volume Segmentation Reference Sequence (30xx,1312). May only be present, if Conceptual Volume Combination Flag Indicator (30xx,1309) equals YES,One or more Items shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11

C.AA.2.6.1 Conceptual Volume Combination and Segmentation Base Macro Attribute DescriptionC.AA.2.6.1.1 Conceptual Volume Combination ExpressionFor Conceptual Volume referencesVolumes specified as a combination of other referenced Conceptual Volumes, the effective volumecombination logic is specified asby the text string value of the Conceptual Volume Combination Expression (30xx,1307). The combination syntax uses a symbolic expression notation similar to that used in the Lisp programming language.

A nested list notation is used to apply geometric operators to a set of Conceptual Volumes.

A list isshall be delimited by parentheses and consists of two or more elements.

The first element of the list is a geometric operator.

c. Subsequent elements specify arguments of the geometric operator and are either Conceptual Volume Constituent Index (positive integer) values or parenthesized lists.

2. The shall be one of the following geometric operators are defined:

UNION – geometric union of 2 or more arguments INTERSECTION – geometric intersection of 2 or more arguments NEGATION – geometric inverse of (a single) argument EXCLUSION – geometric difference of second argument from the first

Subsequent elements shall specify arguments of the geometric operator. An argument is either a Conceptual Volume Combination Expression (30xx,1307) shall only ocntain characters of the default Character Repertoire Constituent Index value, i.e. positive integer, or a parenthesized list.

1150

1152

1154

1156

1158

1160

1162

1164

1166

1168

1170


Examples:

1. Union of paired organs 1X and 2Y (disjoint).

Conceptual Volume Combination Expression (30xx,1307):

(UNION 1 2)

Items in Conceptual Volume Constituent Sequence (30xx,1303):

Conceptual Volume Constituent Index

(30xx,1308)

Conceptual Volume

1 Right LungX

2 Left LungY

2. Union of paired organs 1 and 2 (non-disjoint)


(UNION 1 2)

Right

Lung

Left

Lung

Input Result

Spinal Cord PRV

Left

Lung

Input Result

50

1172

1174

1176

1178

1180

1182

1184




(30xx,1308)

Conceptual Volume

1 Spinal Cord PRV2 Left Lung

3: Union of paired organs (e.g., lungs) X and Y, with excluded volume W (e.g., PTV).


(EXCLUSION (UNION 1 2) 3)



(30xx,1308)

Conceptual Volume

1 X2 Y

3 W

3. Union of two organs 1 and 2 with excluded volume 3 using NEGATION.

Heart

Left

Lung

CTV

Input Result

1186

1188

1190

1192

1194



(INTERSECTION (UNION 1 2) (NEGATION 3))



(30xx,1308)

Conceptual Volume

1 Heart2 Left Lung

3 CTV

43. Union of paired organs (e.g., lungs) X and Y1 and 2, with exclusion of multiple volumes 3, 4 and 5organs U, V, and W (e.g. target volumes and organs at risk).


(INTERSECTION (UNION 1 2) (NEGATION (UNION 3 4 5)))(EXCLUSION (UNION 1 2) (UNION 3 4 5))


Heart

Left

Lung

CTV

Input Result

R Lung L Lung

CTV

Node 1

Node 2

Input Result

52

1196

1198

1200

1202

1204

1206

1208



(30xx,1308)

Conceptual Volume

1 R LungX2 L LeftY

3 Node 1U4 Node 2V

5 CTVW

54. Intersection of overlapping volumes 1X (e.g., PTV) and volume 2Y (e.g. Rectum).


(INTERSECTION 1 2)



(30xx,1308)

Conceptual Volume

1 RectumX

2 Prostate PTVY

6. Intersection of disjoint volumes 1 and 2.

Prostate

PTV

Rectum

Input Result

1210

1212

1214

1216

1218

1220



(INTERSECTION 1 2)



(30xx,1308)

Conceptual Volume

1 Bladder2 Prostate

Bladder

Prostate

ResultInput

54

1222

1224

1226


C.AA.2.6.1.2 Conceptual Volume Segmentation ReferencesThe Conceptual Volume Segmentation Reference Sequence (30xx,1312) is used to refer to the segmentation(s) representing this Conceptual Volume respectively the constituent parts of the Combination of Conceptual Volumes in the context, in which this macro is invoked.

C.AA.2.6.1.23 Conceptual Volume Segmentation Reference SequenceThe Conceptual Volume Segmentation Reference Sequence (30xx,1312) contains a reference to a Segmentation, which represnetrepresent that volumvolume geometically.

In case of combination, the Conceptual Volume Segmentation Reference Sequence (30xx,1312) lists the segmentations used for definition of a combined Conceptual Volume. The segmentations referenced may be in one or more Frames of Reference. The constituent Conceptual Volumes in this sequence must shall not include the combined Conceptual Volume being defined. Applications that wish to combine existing segmentations within the same Conceptual Volume must create a new Segmentation Instance.

C.AA.2.7 Conceptual Volume Combination and Segmentation MacroThe Conceptual Volume Combination and Segmentation Macro uses all capabilities of the Conceptual Volume Combination and Segmentation Base Macro. It does not require the presence of the segmented volume representation.

Table C.AA.2.7-1EXTENDED CONCEPTUAL VOLUME REFERENCE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInclude Conceptual Volume Reference Base Macro' Table C.AA.2.6-1

Conceptual Volume Segmentation Defined

(30xx,1311) 1 States whether the Conceptual Volumes present in this Item have segmentations referenced in the following.Enumerated Values YES NO

C.AA.2.8 Segmented Conceptual Volume MacroThe Segmented Conceptual Volume Macro uses all capabilities of the Extended Conceptual Volume Reference Base Macro, but requires the presence of the segmented volume representation.

Table C.AA.2.8-1SEGMENTED CONCEPTUAL VOLUME REFERENCE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInclude 'Extended Conceptual Volume Reference Base Macro' Table C.AA.2.6-1Conceptual Volume Segmentation Defined

(30xx,1311) 1 States whether the Conceptual Volumes present in this Item have segmentations referenced in the following.Enumerated Values YES

1228

1230

1232

1234

1236

1238

1240

1242

1244

1246

1248

1250

1252


C.AA.2.9 Radiation Fractionation Pattern MacroThe Radiation Fractionation PatternRadiation Fraction Pattern Macro contains the attributes needed to specifiesy the intended fractionation pattern to be used to deliver the radiation treatment.

Table C.AA.2.9-1RADIATION FRACTIONATION PATTERNRADIATION FRACTION PATTERN MACRO

ATTRIBUTES

Attribute Name Tag Type DescriptionFraction Pattern Sequence (30xx,0965) 1C A description of tThe fractionation

pattern in a machine-readable form.Required if a fraction pattern has been defined.Only a single Item shall be included in this sequence.

>Number of Fraction Pattern Digits Per Day

(300A,0079) 1 Number of digits in a Fraction Pattern (300A,007B) used to represent one day. See C.AA.2.9.1.1.

>Repeat Fraction Cycle Length (300A,007A) 1 Number of weeks needed to describe treatment fraction pattern. See C.AA.2.9.1.1.

>Fraction Pattern (300A,007B) 1 String of 0's (no treatment) and 1's (treatment) describing the treatment fraction pattern for the fractions defined by this set. Length of string is 7 x Number of Fraction Pattern Digits Per Day x Repeat Fraction Cycle Length. Pattern shall start on a Monday. See C.AA.2.9.1.1.

C.AA.2.9.1 Radiation Fractionation PatternRadiation Fraction Pattern Macro Attribute DescriptionC.AA.2.9.1.1 FractionationThe Radiation Fractionation PatternRadiation Fraction Pattern describes the intended scheme, i.e. how fractions are to be distributed along calendar days for the actual radiation set.

Examples of Fractionation Patterns:

a) 1 fraction per day (Monday to Fridayy), no fractions on Saturday and Sunday:

Number of Fraction Pattern Digits per Day = 1Repeat Fraction Cycle Length = 1Fraction Pattern = 1111100

b) 2 fractions per day (Monday to Friday), no fractions on Saturday and Sunday:

Number of Fraction Pattern Digits Per Day = 2Repeat Fraction Cycle Length = 1Fraction Pattern = 1111111111000000

56

1254

1256

1258

1260

1262

1264

1266

1268

1270

1272


c) 1 fraction per day (Monday, Wednesday, to Friday), no fractions on Saturday and Sundayfractions every second day:


d) 2 fraction per day (Monday, Wednesday, Friday), one fraction on Saturday and Sunday:


e) 1 fraction per day every other day:


1274

1276

1278

1280

1282

1284

1286


C.AA.2.10 Treatment Device Identification MacroThe Treatment Device Identification Macro iis invoked to identifiesy a device used to deliver radiation to the patient during a radiotherapy treatment session.

Table C.AA.2.10-1Treatment Device Identification Macro Attributes

Attribute Name Tag Type Attribute DescriptionTreatment Device Identification Sequence

(30xx,5015) 1 Identifies treatment device to be used.Only a single Item shall be included in this sequence.

>Treatment Machine Name

(300A,00B2) 1 User-defined name identifying treatment device to be used for radiation delivery.

>Treatment Machine Delivery Subsystem ID

(30xx,0BB2) 1C User-supplied identifier for the device, when this device is a sub-device of a treatment device, e.g. the gantry.Required, if the treatment machine consists of several sub-devices for delivery.

>Include 'RT Device Model Macro' Table C.AA.2.11-1>Include 'Device Model Macro' Table C.AA.2.11-1

Identifies the device model for the Treatment Device.If Treatment Machine Delivery Subsystem ID (30xx,0BB2) is present, these attributes identify that subsystem.

>Include 'Device Identification Macro' Table C.AA.2.14-1.

Defined CID SUP147054.

>Institution Name (0008,0080) 3 Institution where the equipment is located.

>Institution Address (0008,0081) 3 Mailing address of the institution where the equipment is located.

>Institutional Department Name

(0008,1040) 3 Department in the institution where the equipment is located.

C.AA.2.11 RT Device Model MacroThe RT Device Model Macro contains general attributes needed to specify a radiotherapy device.

Table C.AA.2.11-1RT DEVICE MODEL MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionManufacturer (0008,0070) 2 Manufacturer of the device.

Manufacturer's Model Name (0008,1090) 2 Manufacturer’s model name of the device.

Manufacturer's Model Version (30xx,1324) 2 A more detailed definition of the Manufacturer’s model of the device.

Device Manufacturer's Model Class UID

(30xx,0BB0) 2 Manufacturer’s Unique identifier (UID) for the specific model class of of the device.

Device Serial Number (0018,1000) 2 Manufacturer’s serial number of the

58

1288

1290

1292

1294

1296


Attribute Name Tag Type Descriptiondevice.

Software Versions (0018,1020) 2 Manufacturer’s designation of software version of the equipment.

C.AA.2.12 RT Patient Support Devices MacroThe RT Patient Support Devices Macro identifies a patient support device (table, table top, chair or similar) which shall be used for treatment.

Table C.AA.2.12-1RT PATIENT SUPPORT DEVICES IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Description

Number of Patient Support Devices

(30xx,51F1) 1 Number of Patient Support Devices Sequence defined in the Patient Support Devices Sequence (30xx,51F0).

Patient Support Devices Sequence

(30xx,51F0) 1C Patient support device definitions. Required if the Number of Patient Support Devices (30xx,51F1) is not-zero.one or more patient support devices are presentThe number of Items included in this sequence shall equal the value of Number of Patient Support Devices (30xx,51F1).One or more Items shall be included in this sequence

>Device Index (30xx,0112) 1 Index of the Device.The value shall start at 1, and increase monotonically by 1.

>>Include 'RT Device Model Macro' Table C.AA.2.11-1>Include 'Device Identification Macro' Table C.AA.2.14-1.


>Conceptual Volume Sequence (30xx,1346) 2 References a conceptual volume that describes the geometry and properties of the patient support device.Zero or one a single Item is permitted in this sequence.

>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1

1298

1300

1302

1304


C.AA.2.13 Patient Support Position MacroThis macro may be invoked to define those attributes describingprovides the device-specific geometric settings for the settings of the various attributes related to a Patient Support devicedevice.

The information is intended only for display to human readers, while the authoritative definition of the patient position with respect to the treatment device is contained in the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040).

The items in this macro shall only serve the purpose of annotating geometric information with numerical values using vendor-specific definitions of device axes.

The authoritative definition of the patient position with respect to the device system is contained in the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040).

Table C.AA.2.13-1PATIENT SUPPORT POSITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionPatient Support Position Parameter Sequence

(30xx,5142) 2 Patient Support tTranslational and rotational parameters supported forby a particular Patient Support systemdevice.Zero or more Items shall be included in this sequence.

>Referenced Device Index

(30xx,0142) 1 The value of Reference to the Device Index (30xx,0112) in Patient Support Devices Sequence (30xx,51F0) corresponding to the Patient Support Device in use.

>Include Content Item Macro Table 10-2 Baseline TID of Concept Name Code Sequence is TID SUP147004.See C.AA.G2.1.4 for description of Continuous Rotation Angle usage.

C.AA.2.14 Device Component Identification MacroThe Device Identification Component Identification Macro contains the attributes needed to identifyidentifies (physical or virtual) which is used by a certaindevice in using or creating the SOP instance where the macro is included.

Table C.AA.2.14-1DEVICE IDENTIFICATION COMPONENT IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionDevice Type Code Sequence (30xx,5026) 1 The type of the device.

Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1.

Device Index (30xx,0112) 1 Index of the Device in the sequence, where the macro is invoked, used for internal or external references.The value shall start at 1, and increase monotonically by 1.

60

1306

1308

1310

1312

1314

1316

1318

1320

1322

1324


Device Label (30xx,5025) 1 A user-readable label identifying the device.

Device Component Subtype Code Sequence

(30xx,5026) 1 A fine-granular specification of the component.Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1. Context ID defined at the location of macro usage.

Device Description (30xx,5027) 3 User defined description for the device.

Device Serial Number (0018,1000) 2 Manufacturer’s serial number of the device.

Software Versions (0018,1020) 2 Manufacturer’s designation of software version of the equipment.

Regulatory Device Identifier Sequence

(30xx,5031) 2 Regulatory Identifiers for this device.Zero or more Items shall be included in this sequence.

>Regulatory Device Identifier (30xx,5033) 1 The Regulatory Device Identifier

>Regulatory Device Identifier Type Code Sequence

(30xx,5035) 1 The type of the regulatory device identifier.Only a single Item shall be included in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1. Defined CID SUP147053Manufacturer's Device CodeIdentifier

(30xx,054D) 2 An identifier issued by the manufacturer.

Note. Typically, the Device Identifier is a code which can be electronically read by the machine utilizing that device, e.g. to verifiy the presence of that device. for the component intended as a machine-readable code of the device.

Device Alternate Identifier (30xx,1326) 1C An identifier intended to be read by a device such as a bar code reader.Required, if a hospital-issued identifier is used, e.g. attached as a bar code.

Device Alternate Identifier Type (30xx,1327) 1C Defines the type of Device Alternate Identifier.Required if Device Alternate Identifier (30xx,1326) is present.Defined Terms: BARCODE RFID


Device Alternate Identifier Format (30xx,1328) 1C Description of the format in which the Device Alternate Identifier (30xx,1326) is issued.Required if Device Alternate Identifier (30xx,1326) is present.For Barcodes, see C.22.1.1.

C.AA.2.14.1 Device Component Identification Macro AttributesC.AA.2.14.1.1 Device Alternate Identifier FormatThe Device Alternate Identifier Format (30xx,1328) specifies the format of the value of the Device Alternate Identifier (30xx,1326).

For Device Alternate Identifiers of Device Alternate Identifier Type (30xx,1327) = RFID, a big variety of RFID formats exists (some examples are DOD-96, DOD-64 UID, GID-96, sgtin-96). Supported format values shall be defined in the Conformance Statement.

For Device Alternate Identifiers of Device Alternate Identifier Type (30xx,1327) = BARCODE see C.22.1.1.

C.AA.2.15 RT Accessory Device Identification MacroThe RT Accessory Device Identification Macro contains the attributes needed to identify identifies an RT accessory device and it’s location, along with the device type and (if known) concrete SOP Instance details. The macro is intended to support a consistent header tag block across all IODs and RT devices.

Certain RT devices may define a specific macro, which includes this macro and additional type-specific tags.

Table C.AA.2.15-1RT ACCESSORY DEVICE IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInclude 'Device Model Macro' Table C.AA.2.11-1Include 'Device Component Identification Macro' Table C.AA.2.14-1.Context ID defined at the location of macro usage.Include 'RT Device Model Macro' Table C.AA.2.11-1Hospital Specific Accessory Code (30xx,1326) 2C A hospital-specific code used instead

of the Device Component Code (30xx,054D) intended to be read by a device such as a bar-code reader.Required if the device has an Accessory Code defined, but the hospital uses a different code for verification, e.g. attached as a bar code.

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Hospital Specific Accessory Code Type

(30xx,1327) 2C Defines the type of Hospital Specific Accessory Code.Required if Hospital Specific Accessory Code (30xx,1326) is present.Defined Terms: BARCODE

RT Accessory Device Slot ID (30xx,054B) 1C Identifier for location (slot) of RT Radiation Modifier accessory where the current accessory inserted.Required if accessory is located in a slot and Shall not be present if Referenced RT Accessory Holder Device Index (30xx,0540B) is not present.

RT Accessory Slot Distance (30xx,0548) 2C Distance (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the Accessory Slot.Required if RT Accessory Device Slot ID (30xx,054B) is present.

RT Accessory Holder Device Sequence

(30xx,054B) 2C Identifier of the holder which this accessory.Required if accessory is mounted on a holder device. Shall not be present if Device Component Subtype Code Sequence (30xx,5026) contains (S147481, 99SUP147, “Applicator”).

>Referenced RT Accessory Holder Device Index

(30xx,05400112)

1C The value of Reference to theReference to the Device Index (30xx,0112) index of the Accessory Holder device in the RT Accessory Holder Definition Sequence (30xx,054A5170).Required if accessory is mounted on a holder device and RT Accessory Slot ID (30xx,054B) is not present.

>RT Accessory Device Slot ID (30xx,054B) 2C Identifier for location (slot) of Radiation Modifier in the Accessory Holding device.Required if Device Component Subtype Code Sequence (30xx,5026) contains (S147481, 99SUP147, “Applicator”).


RT Accessory Holder Slot ID (30xx,0544) 1C Identifier for location (slot) of Radiation Modifier in the Accessory Holding device where the current accessory is inserted.Required if Referenced RT Accessory Holder Device Index (30xx,0540) is present andthe referenced Accessory Holder Device contains an RT Accessory Holder Slot Sequence (30xx,0542).

C.AA.2.16 Control Point General Attributes MacroThis macro specifies the base attributes for the definition of a Radiation Control Point.

Table C.AA.2.16-1CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionControl Point Item Index

(30xx,0111) 1 The order the control points are executed.Index used to reference items corresponding to a control point in a sequence.o.f the Control Point Item in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

Cumulative Radiation Meterset

(30xx,5021) 1C Meterset at the Control Point expressed in the units of the reported by Primary Radiation Dosimeter Unit (30xx,5113). The Meterset of the first Control Point shall be equal to 0.0.Required at all Control Points if RT Radiation Data Scope (30xx,5013) is not GEOMETRIC. See C.AA.2.16.1.12.

C.AA.2.16.1 Control Point Attribute RequirementsConceptThe treatment-modality modules use a common formalism to represent parameters that define the behaviour of a delivery device during delivery of radiation. along with certain meterset values. These parameters are communicated as a sequence of values, organized as ‘Control Points’, see C.AA.1.1. The resolution of Control Points depends on the level of detail required to define the behaviour of the delivery device.

For any given treatment technique, some parameters may be constant for all Control Points. Such static parameters shall only be present at the first Control Point and shall be absent in all other Control Points. All other parameters that are changing at any of the Control Points shall be present in each single Control Point.

For all beam deliveries there are at least two control points, corresponding to the start and end of delivery. E.g. Ffor a simple Static Beam delivery with a constant field aperture, only two Control

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Points are needed to define the start and the end, as there are no changes in between. For a dDynamic delivery, where in which the MLC leavefs are changingmoving while radiation is delivered, the number of Control Points will be higher to provide enough detail to define the leaf movement with a sufficient resolution to achieve the radiation fluence distribution expected for the prescribed dose.

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

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

C.AA.2.16.1.1 Control Point Attribute RequirementsAttributes that are constant for all Control Points shall only be specified at the first Control Point with Control Point Item Index (30xx,0111) equal to 1. Attributes that change at any Control Point shall be specified explicitly at all Control Points.

C.AA.2.16.1.2 Control Point Sequence Attribute RequirementsSequences with constant attribute values for all Items at all Control Points shall only be present at the first Control Point with Control Point Item Index (30xx,0111) equal to 1. Sequences with attribute values changing at any Item at any Control Point shall be present at all Control Points.

C.AA.2.16.1.3 Control Point Attribute Examples

The following examples illustrate the specification of parameters using Control Points:

1. Static Beam delivery example:

Control Point 1: Cumulative Meterset = 0All applicable treatment parameters defined

Control Point 2: Cumulative Meterset = 76No other parameters defined

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

2. Arc delivery example:

Control Point 1: Cumulative Meterset = 0Gantry Rotation Direction = CW, Gantry Angle = initial angleAll other applicable treatment parameters definedGantry Rotation Direction = CW, Gantry Angle = initial angle

Control Point 2: Cumulative Meterset = 56the following parameters are defined onlyGantry Rotation Direction = NONE, Gantry Angle = final angleNo other parameters defined

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

3. Dynamic delivery of two equally weighted segments example:

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Control Point 1: Cumulative Meterset = 0All applicable treatment parameters definedCollmator Opening X: 2x2Collmator Opening Y: 2x2All other applicable treatment parameters defined

Control Point 2: Cumulative Meterset = 40All treatment parameters defined which change at any control point (including those which do not change at this specific Control Point)Collmator Opening X: 2x2Collmator Opening Y: 4x4All other treatment parameters which change at any control point (including those which do not change at this specific Control Point)

Control Point 3: Cumulative Meterset Weight = 80All treatment parameters defined which change at any control point (including those which do not change at this specific Control Point)Collmator Opening X: 4x4Collmator Opening Y: 4x4All other treatment parameters which change at any control point (including those which do not change at this specific Control Point)

At completion this delivers 80 Monitor Units while first increasing the Y opening and then increasing the X opening.

4. Dynamic Delivery of two unequally weighted segments with a step change of 5 degrees in the clock-wise direction of the table angle example:

Control Point 1: Cumulative Meterset Weight = 0All applicable treatment parameters defined Patient Support Angle = initial angle0Patient Support Rotation Direction = rotation directionNONE, All other applicable treatment parameters defined

Control Point 2: Cumulative Meterset = 30All treatment parameters defined which change at any control point (including those which do not change at this specific control point)Patient Support Angle = initial angle0Patient Support Rotation Direction = NONECWAll other treatment parameters defined which change at any control point (including those which do not change at this specific control point)

Control Point 3: Cumulative Meterset = 30All treatment parameters defined which change at any control point (including those which do not change at this specific control point)Patient Support Angle = new angle5Patient Support Rotation Direction = rotation directionNONEAll other treatment parameters defined which change at any control point (including those which do not change at this specific control point)

Control Point 4: Cumulative Meterset = 90All treatment parameters defined which change at any control point (including those which do not change at this specific control point)Patient Support Angle = new angle5Patient Support Rotation Direction = NONEAll other treatment parameters defined which change at any control point (including those

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which do not change at this specific control point)

At completion this delivers 90 Monitor Units, while between Control Point 2 and 3 the patient support angle is changed and no radiation is delivered.

No assumptions are made about the behavior of machine parameters between specified Control Points and communicating devices shall agree on this behavior outside the current standard.

C.AA.2.16.1.1 Meterset CalculationsThe Meterset at a given Control Point is specified in the Cumulative Meterset (30xx,5021). That value is specified in units defined by Radiation Dosimeter Unit (30xx,5113) in the RT Delivery Device Common Module in section C.AA.E1.

The meterset values correspond to the meterset readout of a RT Radiation Delivery Device. In case that device has multiple meterset readouts, the values correspond to the primary meterset readout.

C.AA.2.17 External Beam Control Point General Attributes MacroThis macro may be invoked to specify the generic Control Point attributes used to model external beam radiation.

Table C.AA.2.17-1EXTERNAL BEAM CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInclude ‘Control Point General Attributes Macro’ Table C.AA.1.16-1Primary Meterset Delivery Rate

(30xx,5023) 12C Specifies tThe intended nominal rate of delivery of the specified Cumulative Primary Meterset (30xx,5021TBD). See C.AA.2.17.1.2 for units.Required ifthe Control Point Index (30xx,0111) equals 1 or this attribute value attribute value changes at any Control Point,.andthe specification of the Delivery Rate is required by the Delivery Device for RT treatment deliveryandRT Radiation Data Scope (30xx,5013) is not GEOMETRIC.Maybe present otherwise.and all of the following are true all of the following are true:a) Primary Radiation Dosimeter Unit (30xx,5113) is not RELATIVE and not BQ_SECOND,andb) RT Radiation Data Scope (30xx,5013) is not GEOMETRIC and See C.AA.2.16.1 and C.AA.2.17.1.1.

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Primary MetersetDelivery Rate Unit Sequence

(30xx,5024) 1C The unit of the Primary MMetersetDelivery Rate (30xx,5023).Required if the Primary DeliveryMeterset Rate (30xx,5023) is present with a valueand Primary Radiation Dosimeter Unit (30xx,5113) is SECOND and if the Control Point Item Index (30xx,0111) equals 1 or attribute value changes at any Control Point. See C.AA.2.16.1 and C.AA.2.17.1.121.Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1

Defined CID SUP147051

Beam-On Area Sequence

(30xx,6050) 1C Sequence defining an aArea in which the treatment beam is enabled. Required if patient geometry requires limitation of the beam delineation.Only a single Item shall be included in this sequence.Required if patient geometry requires limitation of the beam delineation and if the Control Point Index (30xx,0111) equals 1 or this attribute value changes at any Control Point.See C.AA.2.16.1.

>Include 'Outline Definition Macro' Table C.AA.2.29-1

C.AA.2.17.1 External Beam Control Point General Attributes Macro Attribute DescriptionC.AA.2.17.1.1 Meterset CalculationsThe Meterset at a given Control Point for RT Radiation objects working with a Radiation Device as described in the module RT Delivery Device Common Module in section C.AA.E1 is specified in the Cumulative Radiation Meterset (30xx,5021). The Meterset is specified in units defined by Primary Radiation Dosimeter Unit (30xx,5113) in the RT Delivery Device Common Module in section C.AA.E1.

C.AA.2.17.1.12 Primary MetersetDelivery RateWhen the delivery device requires the Delivery Rate (30xx,5023) to be specified, the application specifying that attribute shall ensure that the code in the Delivery Rate Unit Sequence (30xx,5024) is the code expected by the delivery device.

Units used for Primary Meterset Rate (30xx,5023) shall be determined by the value of Primary Radiation Dosimeter Unit (30xx,5113) as follows:

MU: Units shall be MU/sec

NP: Units shall be particles/sec

RELATIVE Attribute not present

Machines working with a Primary Radiation Dosimeter Unit (30xx,5113) having the value SECOND use different units for the Primary Meterset Rate (30xx,5023). This unit shall be encoded in Primary Meterset Rate Unit Sequence (30xx,5024).

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C.AA.2.18 External Beam Sub-Control Point General Attributes Macro

This macro may be invoked to specify the generic Control Point attributes used to model external beam radiation on Sub-Control Point level. Sub-Control Points may be necessary to define more detailed information between Control Points or to encode some information with a finer granularity.

Table C.AA.2.18-1EXTERNAL BEAM SUB-CONTROL POINT GENERAL ATTRIBUTES MACROAttribute Name Tag Type Attribute Description

Sub-Control Point Index (30xx,0115) 1 Index of the items in the sequence. Used for internal or external references. The value shall start at 1, and increase monotonically by 1.

Cumulative Meterset (30xx,5021) 1C Meterset at the Sub-Control Point at sequence level expressed in units ofreported by the Radiation Dosimeter Unit (30xx,5113).The Meterset is on the same absolute scale as the Meterset on control point level.Required, if RT Radiation Data Scope (30xx,5013) is not GEOMETRIC, and Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See Section C.8.1.18.1.2.

Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1

C.AA.2.18.1 RT Beam Limiting Device Definition Macro Attribute DescriptionC.AA.2.18.1.1 Sub-Control Point Attribute RequirementsNo assumptions are made about the behavior of machine parameters between specified items in the sequence. , and Ccommunicating devices shall agree on this behavior outside the current standard.

The representation of parameters in sub-control points follows the formalism as descibed in C.AA.2.16.1.

C.AA.2.18.1.2 Cumulative MetersetThe values of the Cumulative Meterset (30xx,5021) are defined on the same absolute scale as the Cumulative Meterset (30xx,5021) in the Control Point Sequence.

The Sub-Control Point Cumulative Meterset must span the interval from the Control Point containing the Sub-Control Point Sequence to the subsequent Control Point.

The value of the Cumulative Meterset (30xx,5021) of the first item of this sequence (having a value of 1 in the Sub-Control Point Index (30xx,0115)) shall have exactly the same value as the Cumulative Meterset (30xx,5021) of the Control Point which containings this Sub-Control Point sequence.

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The value of the Cumulative Meterset (30xx,5021) of the last item of this sequence (having the highest value in the Sub-Control Point Index (30xx,0115)) shall have exactly the same value as the Cumulative Meterset (30xx,5021) of the Control Point which follows the Control Point, which containings this Sub-Control Point sequence.

C.AA.2.19 Beam Mode MacroThe Beam Mode Macro contains attributes to identify the beam mode of a delivery device use the in current Radiation.

Table C.AA.2.19-1BEAM MODE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Beam Modes (30xx,51CB) 1 Number of Beam Modes defined in the

Beam Mode Sequence (30xx,51C0). The Number shall be greater than zero.

Beam Mode Sequence (30xx,51C0) 1 Sequence defining the Beam Mode.The number of Items included in this sequence shall equal the value of Number of Beam Modes (300A,00D0).One or more Items shall be included in this sequence.

>Beam Mode Index (30xx,0113) 1 Index of thise Beam Mode Item in the Beam Mode Ssequence. used for internal or external references.The value shall start at 1, and increase monotonically by 1.

>Beam Mode Label (30xx,51C1) 1 User readable label that identifies this beam mode.e primary beam configuration used by the deviceIt is expected that each distinct combination of beam parameters which produces a distinct beam profile uses a unique identifier.See Note 1.See C.AA.2.19.1.3.

>Beam Mode Description (30xx,51C2) 2 User-defined description of the beam mode.

>Beam Mode Machine Code

(30xx,51C3) 1 A internal vendor-specified machine-readable code thato uniquely identifiesy thise beam mode with a code as specified by the treatment device vendor.See C.AA.2.19.1.2.

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>Radiation Type (300A,00C6) 1 Type of Radiation for thisat Beam Mode.Defined Terms:

PHOTONELECTRONNEUTRONPROTONION

Within the context of specific IODs in which this macro occurs, only a subset of these terms may be valid as defined by the IOD.

>Nominal Energy (30xx,51C5) 1C The Nominal Energy in units as defined in the Energy Unit Code Sequence (30xx,51C9).Required if Minimum Nominal Energy (30xx,51C6) and Maximum Nominal Energy (30xx,51C7) are not present, i.e. if the beam energy is fixed within the scope of a Control Point.See C.AA.2.19.1.1.

>Minimum Nominal Energy (30xx,51C6) 1C The minimum nominal beam energy in units as defined in the Energy Unit Code Sequence (30xx,51C9).Required if Nominal Energy (30xx,51C5) is not present, i.e. if the beam energy is modulated (e.g. via energy map) over a range within the scope of a Control Point.See C.AA.2.19.1.1.

>Maximum Nominal Energy (30xx,51C7) 1C The maximum nominal beam energy in units as defined in the Energy Unit Code Sequence (30xx,51C9).Required if Nominal Energy (30xx,51C5) is not present, i.e.if the beam energy is modulated (e.g. via energy map) over a range within the scope of a Control Point.See C.AA.2.19.1.1.

>Energy Unit Code Sequence

(30xx,51C9) 1 The unit of energy values specified used in Nominal Energy (30xx,51C5), Minimum Nominal Energy (30xx,51C6), Maximum Nominal Energy (30xx,51C7).

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147042


>Beam Mode Type Code Sequence

(30xx,51C8) 1 Identifies the general category of this beam.One or more Items shall be included in this sequence.


Notes: 1. In particular, each unique combination of energy, radiation type and beam filter requires a distinct identifier.

C.AA.2.19.1 Beam ModeTreatment devices can produce a multitude of different beams with unique properties such as energy spectrum, depth dose, surface dose and beam profile. A particular combination of such properties is referred to as a Beam Mode. These Such Bbeam Modes modes are created byin the machine by using different primary electron / particle beams, flattening and scattering filters, etc., creating a specific physical and geometric distribution of radiation. In many cases, the Bbeam Mmode identifies characterizes the fluence just below the Monitor Chamber. Subsequently these primary beams may be modulated by beam modifiers such as Beam Limiting Devices, Wedges, Spreaders etc. While these beam modifiers are described in the Control Point Sequence, the primary beam is assumed to have fixed characteristics within the range as specified by the control point index using Control Point Index (30xx,0111). In many cases, the bBeam mMode will be constant throughout the Radiation, therefore the Beam Mode Macro will only contain one item with the Control Point Index (30xx,0111) equal to 1.

Different BBeam Modes Labels (30xx,51C1) shall are intended only be used to identify characterize different primary beams. It shall not be used to , but shall not be used to convey any other meaning by using different beam modes having the same fluence, e.g. , like annotation offor annotating the role of the beam in the clinical process or the usage of that beam duringat a treatment session. For other definitions, e.g. to annotate constraints, other attributes are available like RT Radiation Set Intent (30xx,5011) in the Radiation Set Module and information provided by the workflow protocols.

C.AA.2.19.1.1 Energy AttributesIn many cases, Tthe Bbeam Mmode will usually correspond to a specific combination of nominal energy and radiation typewhich remains fixed. The Nominal Energy (30xx,51C5) parameter is provided for beams, where a single discrete energy is annotated by that value. Energy modulation can be used at the control point level (both discrete and continguous), in which case the Minimal Nominal Energy (30xx,51C6) and Maximal Nominal Energy (30xx,51C7) is used.

Other than uniquely identifying a specific mode within a machine, no assumptions shall be made about the structure, encoding or syntax of the Beam Mode Label (30xx,51C1).

C.AA.2.19.1.2 Beam Mode Machine CodeThe Beam Mode Machine Code (30xx,51C3) is a manufacturer-provided code that allows unambigious identification of a Beam Mode. For each unique combination of machine parameters that produces a distinct beam profile and for a distinsct set of values of the attributes contained in that macroan Item in the Sequence, a device- specific unique identifer is to be provided. Beam Mode Machine Code (30xx,51C3) is assigned a vendor provided code that permits lookup by the machine of the corresponding machine configuration matching that mode. In particular, each unique combination of energy, radiation type and beam filter requires a distinct identifier.

C.AA.2.19.1.3 Beam Mode LabelBeam Mode Label (30xx,51C1) should uniquely identify a specific mode within a machine. No assumptions shall be made about the structure, encoding or syntax of the Beam Mode Label (30xx,51C1).

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C.AA.2.20 RT Beam Limiting Device Definition MacroThis Mmacro may be invoked to define those attributes describing the configuration of the Beam Limiting Device which cannot vary during delivery.

Table C.AA.2.20-1RT BEAM LIMITING DEVICE DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of RT Beam Limiting Devices

(30xx,5041) 1 Number of RT Beam Limiting Devices in the RT Beam Limiting Device Definition Sequence (30xx,504D). The number shall be greater than zero.

RT Beam Limiting Device Definition Sequence

(30xx,504D) 1 Beam limiting device (collimator) jaw or leaf (element) sets. The number of Items included in this sequence shall equal the value of Number of RT Beam Limiting Devices (30xx,5041).One or more Items shall be included in this sequence.

>Include 'RT Accessory Device Identification Macro' Table C.AA.2.15-1



>RT Beam Limiting Device Proximal Distance

(30xx,5042F) 2 Distances (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the proximal end of beam limiting device (collimator) along the beam axis.Two values shall be provided.The first value shall be the distance from the Reference Location (30xx,5114) to the proximal end of the device.The second value shall be the distance from the Reference Location (30xx,5114) to the distal end of the device.

>RT Beam Limiting Device Distal Distance

(30xx,5043) 2 Distance (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the distal end of beam limiting device (collimator) along the beam axis.

>Number of RT Beam Delimiter Pairs

(30xx,5048) 1C Number of beam delimiter pairs. E.g. standard beam limiting device jaws have one delimiter pair.Required if Device Type Code Sequence (30xx,5026) contains either (S147172, 99SUP147, “X Leaves”) or (S147173, 99SUP147, “Y Leaves”). May be present otherwise.

>RT Beam Delimiter Element Position

(30xx,5049) 1C Boundaries of beam delimiter elements (in mm) with respect to the Coordinate System

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Attribute Name Tag Type Attribute DescriptionBoundaries Declaration (30xx,5208) axis appropriate to RT

Beam Limiting Device Type (300A,00B8) i.e. X-axis for Y, Y-axis for X. See C.AA.2.20.1.1.N+1 values shall be provided, where N is the Number of RT Beam Delimiter Pairs (30xx,5048) starting from pPair 1. Required if Device Type Code Sequence (30xx,5026) contains either (S147172, 99SUP147, “X Leaves”) or (S147173, 99SUP147, “Y Leaves”). May be present otherwise.

>RT Beam Delimiter Geometry Sequence

(30xx,504C) 1C The outline of the Beam Limiting Device position.Required if Device Type Code Sequence (30xx,5026) is part of CID SUP147027.Only a single Item shall be included in this sequence.

>>Include ‘Outline Definition Macro’ Table C.AA.2.29-1

C.AA.2.20.1 RT Beam Limiting Device Definition Macro Attribute DescriptionC.AA.2.20.1.1 RT Beam Delimiter Element Position BoundariesThe RT Beam Delimiter Element Position Boundaries (30xx,5049) shall be the positions of the mechanical boundaries (projected on the plane defined by the Beam Limiting Device Definition Distance (30xx,5210) ) between beam delimiter elements, fixed for a given beam limiting device (collimator). RT Beam Delimiter Element Positions (30xx,504A) are values specific to a given control point, specifying the beam limiting device (collimator) leaf (element) openings.

C.AA.2.21 RT Beam Limiting Device Positions MacroThis macro may be invoked to define the positions of RT Beam Limiting Devices used in a specific Control Point or set of Control Points.

Table C.AA.2.21-1RT BEAM LIMITING DEVICE POSITIONS MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionRT Beam Limiting Device Settings Sequence

(30xx,5070) 1C Beam limiting device (collimator) jaw or leaf (element) positions for the current Control Point.Required if the Control Point Index (30xx,0111) equals 1 or attribute values change at any Control Point. See C.AA.2.16.1.If Control Point Index (30xx,0111) equals 1, the number of Items included in this sequence shall equal the value of Number of RT Beam Limiting

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Attribute Name Tag Type Attribute DescriptionDevices (30xx,5041).If Control Point Index (30xx,0111) is greater than 1, the Items present shall be those whose values change at any control point.One or more Items shall be included in this sequence.


(30xx,0142) 1 The value of Reference to theValue of Device Index (30xx,0112) from the RT Beam Limiting Device Definition Sequence (30xx,504D) for corresponding to the Beam Limiting Device used in this Iitem.

>RT Beam Limiting Device Continuous Angle

(30xx,51B4) 1C RT Beam Limiting Device angle, i.e. orientation of the coordinate system referenced in Coordinate System Declaration (30xx,5208) with respect to the beam line axis. See C.AA.G2.1.4.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.Required if Device Type Code Sequence (30xx,5026) contains (S147170, 99SUP147, “X Jaw”), (S147171, 99SUP147, “Y Jaw”), (S147172, 99SUP147, “X Leaves”) or (S147173, 99SUP147, “Y Leaves”).

>RT Beam Delimiter Element Positions

(30xx,504A) 1C Positions (in mm) of beam delimiter elements projected as defined in C.AA.20.1.1. . Contains 2N values, where N is the Number of RT Beam Delimiter Pairs (30xx,5048) in RT Beam Limiting Device Sequence (30xx,504D). Values shall be listed in the Coordinate System Declaration (30xx,5208) leaf (element) subscript order.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control PointandRequired if Device Type Code Sequence (30xx,5026) contains (S147170, 99SUP147, “X Jaw”), (S147171, 99SUP147, “Y Jaw”), (S147172, 99SUP147, “X Leaves”) or (S147173, 99SUP147, “Y Leaves”).

>RT Beam Delimiter Geometry Sequence

(30xx,504C) 1C The outline of the Beam Limiting Device position.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control PointandRequired if Device Type Code Sequence (30xx,5026) contains (S147174, 99SUP147, “Variable Circular Collimator”).


Attribute Name Tag Type Attribute DescriptionOnly a single Item shall be included in this sequence.

>>Include ‘Outline Definition Macro’ Table C.AA.2.29-1

C.AA.2.22 Wedges Definition MacroThis macro may be invoked to define those attributes describing the geometric configuration of Wedges which cannot vary during delivery.

Table C.AA.2.22-1WEDGES DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Wedges (300A,00D0) 1 Number of Wedges defined in the Wedge

Definition Sequence (30xx,5062).

Wedge Definition Sequence

(30xx,5062) 1C Treatment wedge definitions. Required if Number of Wedges (300A,00D0) is non-zero. one or more wedges are present.One or more Items shall be included in this sequence.The number of Items included in this sequence shall equal the value of Number of Wedges (300A,00D0).




>Wedge Angle (300A,00D5) 1 Nominal wedge angle (degrees).

>Wedge Orientation (300A,00D8) 1 Orientation of wedge, with respect to the Coordinate System Declaration (30xx,5208) (degrees). When the wedge orientation has the values of 0, the thin edge of the wedge is directed towards the positive direction of the y-axis of the declared coordinate system. The rotation is defined as a positive rotation around the z-axis.

>Wedge Factor (300A,00D6) 2 Nominal wedge factor under machine calibration conditions at the beam energy as specified by Nominal Reference Energy (30xx,51CA). The wedge factor is the field dose with the wedge divided by the field does with open field.

>Nominal Reference Energy

(30xx,51CA) 1C The beam energy at which the Wedge Factor (300A,00D6) is specified, expressed in units as specified in Unit Energy Unit Code Sequence (30xx,51C9).Required, if Wedge Factor (300A,00D6) is present and not empty.

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C.AA.2.23 Wedge Positions MacroThis macro may be invoked to define the positions of Wedges used in a specific Control Point or set of Control Points.

Table C.AA.2.23-1WEDGE POSITIONS MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionWedge Position Sequence

(300A,0116) 1C A Sequence of Items describing Wedge Positions for thise current Control Point.Required if Number of Wedges (300A,00D0) is non-zeroWedge Definition Sequence (30xx,5062) is present and as specified in C.AA.16.2.1.2.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.If Control Point Index (30xx,0111) equals 1, the number of Items included in this sequence shall equal the value of Number of Wedges (300A,00D0).If Control Point Index (30xx,0111) is greater than 1, the Items present shall be those whose values change at any control pointThe number of items in this sequence shall equal the number of items in Wedge Definition Sequence (30xx,5062).See C.AA.2.16.1.


(30xx,0142) 1 The value of Reference to theUniquely references Wedge described by Device Index (30xx,0112) in Wedge Definition Sequence (30xx,5062) for the Wedge being used.

>Wedge Position (300A,0118) 1 Position of Wedge at current Control Point. Enumerated Values:

IN = Wedge is in fully inserted positionOUT = Wedge is in fully retracted

positionPARTIAL = wedge is inserted only part

the way to the fully inserted position

>Wedge Thin Edge Position

(300A,00DB) 1C Closest distance (in mm) from the central axis of the beam along the wedge angle directiona wedge axis to the thin edge as projected on the plane defined by the Beam Limiting Device Definition Distance (30xx,5210) (mm). Value is positive if the wedge does not cover the central axis, negative if it does.Required if Wedge Position (300A,0118) is PARTIAL.

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Attribute Name Tag Type Attribute DescriptionSee section C.8.8.25.6.4.

C.AA.2.24 Compensators Definition MacroThis macro may be invoked to define those attributes describing the geometric configuration of Compensators which cannot vary during delivery.

Table C.AA.2.24-1COMPENSATORS DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Compensators

(300A,00E0) 1 Number of compensators associated with current Beam.

Total Compensator Tray Factor

(300A,00E2) 2C Compensator Tray transmission factor (between 0 and 1), at the beam energy specified as specified by Nominal Reference Energy (30xx,51CA).Required if Compensator Definition Sequence (30xx,5150) is present.

Nominal Reference Energy

(30xx,51CA) 1C The beam energy at which the Total Compensator Tray Factor (300A,00E2) is specified, expressed in units as specified in Unit Energy Unit Code Sequence (30xx,51C9).Required, if Total Compensator Tray Factor (300A,00E2) is present and not empty.

Compensator Definition Sequence

(30xx,5150) 1C Treatment compensator definitions. Required if the Number of Compensators (300A,00E0) is non-zeroif one or more compensators are present. The number of Items included in this sequence shall equal the value of Number of Compensators (300A,00E0).One or more Items shall be included in this sequence.




>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture Compensator.

>Compensator Divergence

(300A,02E0) 1 Specifies Whether or not the compensator is shaped according to the beam geometrical divergencepresence or absence of geometrical divergence of the compensator.Enumerated Values:

PRESENT = the compensator is shaped according to the beam geometrical divergence.

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Attribute Name Tag Type Attribute DescriptionABSENT = the compensator is not

shaped according to the beam geometrical divergence.

>Compensator Mounting Map OrientationPosition

(300A,02E1)(30xx,5151)

1 Specifies on which side of the Compensator Tray the compensator base the contoured surface faces. is mounted.Enumerated Values:

PATIENT_SIDE = the compensator surface shape is mounted on the side of the Compensator Tray which isdirected towards the patient.

SOURCE_SIDE = the compensator surface shape is directedis mounted on the side of the Compensator Tray which is towards the radiation source.

DOUBLE_SIDED = the compensator has two compensator surface shapes which are directed towards the patient and source respectivelyhas a shaped (i.e. non-flat) surface on both sides of the Compensator Tray.

>Compensator Base Plane Offset

(30xx,5154) 1 The distance (in mm) between the mounting position and the base plane of the compensator.The value shall be positive when the base plane is further away from the RT Beam Distance Reference Location (30xx,5114) than the mounting position.See C.AA.2.24.1.2

>Compensator Rows (300A,00E7) 1 Number of rows in the compensator. A row is defined to be in the X direction with respect to the Coordinate System Declaration (30xx,5208).

>Compensator Columns

(300A,00E8) 1 Number of columns in the compensator. A column is defined to be in the Y direction with respect to the Coordinate System Declaration (30xx,5208).

>Compensator Pixel Spacing

(300A,00E9) 1 Physical distance (in mm) between the center of each adjacent pixels projected on the plane defined by the Beam Limiting Device Definition Distance (30xx,5210). Specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See 10.7.1.3 for further explanation of the value order.

>Compensator Position

(300A,00EA) 1 The x and y coordinates (in mm) with respect to the Coordinate System Declaration (30xx,5208) of the upper left hand corner (first pixel transmitted) of the compensator, projected on the plane defined by the Beam Limiting Device


Attribute Name Tag Type Attribute DescriptionDefinition Distance (30xx,5210).

>Compensator Column Offset

(300A,02E5) 1C The offset distance (in mm) applied to the x coordinate of the Compensator Position (300A,00EA) for even numbered rows. Required if the compensator pattern is

hexagonal.

>Compensator Transmission Map

(30xx,5151) 1C A data stream of the pixel samples which comprise the compensator, expressed as broad-beam transmission values (between 0 and 1) along a ray line passing through the pixel, at the beam energy as specified by Nominal Reference Energy (30xx,51CA). The order of pixels sent is left to right, top to bottom (i.e., the upper left pixel is sent first followed by the remainder of the first row, followed by the first pixel of the 2nd row, then the remainder of the 2nd row and so on) when viewed from the radiation source.Required if Material ID (300A,00E1) is zero-length, May be present otherwise.See C.AA.2.23.1.1.

>Compensator Proximal Thickness Map

(30xx,5152) 1C A map of the distances (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the compensator surface closest to the radiation source. The order of samples sent is left to right, top to bottom (upper left-sample, followed by the remainder of row 1, followed by the remainder of the rows).Required if Compensator Mounting Position (300A,02E1) is SOURCE_SIDE or DOUBLE_SIDED.For the geometric definition, section C.8.8.14.10 applies.See C.AA.2.23.1.1.

>Compensator Distal Thickness Map

(30xx,5153) 1C A map of the distances (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the compensator surface closest to the patient. The order of samples sent is left to right, top to bottom (upper left sample, followed by the remainder of row 1, followed by the remainder of the rows).Required if Compensator Mounting Position (300A,02E1) is PATIENT_SIDE or DOUBLE_SIDED.For the geometric definition, section C.8.8.14.10 applies.

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Attribute Name Tag Type Attribute DescriptionSee C.AA.2.23.1.1.

>Compensator Thickness Map

(30xx,5152) 1C A data stream of the pixel samples that comprise the compensator, expressed as physical thickness (in mm), either parallel to radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT. The order of pixels sent is left to right, top to bottom (upper left-pixel, followed by the remainder of row 1, followed by the remainder of the rows).Required if Material ID (300A,00E1) is non-zero length, may be present otherwise.See C.AA.2.23.1.1 and C.AA.2.23.1.2.

>Compensator Distance Map

(30xx,5153) 1C A data stream of the pixel samples which comprise the distance from the RT Beam Distance Reference Location (30xx,5114) to the compensator surface closest to the radiation source (in mm). The order of pixels sent is left to right, top to bottom (upper left pixel, followed by the remainder of row 1, followed by the remainder of the rows).Required if Material ID (300A,00E1) is non-zero length, and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED. May be present if Material ID (300A,00E1) is zero length and Compensator Mounting Position (300A,02E1) is DOUBLE_SIDED.For the geometric definition, section C.8.8.14.10 applies.See C.AA.2.23.1.1 and C.AA.2.23.1.2.

>Compensator Pixel Shape

1 The shape of a pixel.Defined Terms:CONTINUOUSSQUARECIRCULARHEXAGONAL

>Compensator Column Offset

(300A,02E5) 1C The offset distance (in mm) applied to the x coordinate of the Compensator Position (300A,00EA) for even numbered rows. Required if not CONTINUOUS or SQUARE.

>Compensator Milling Tool Diameter

(300A,02E8) 23 The diameter (in mm) of the milling tool to be used to create the compensator. The diameter is expressed as the actual physical size and not a size projected on the plane defined by the Beam Limiting Device Definition Distance (30xx,5210).


C.AA.2.24.1 Compensators Definition Macro Attributes DescriptionC.AA.2.24.1.1 Compensator Thickness and Transmission Map PrecedenceIf Compensator Thickness Map (30xx,5152) and Compensator Transmission Map (30xx,5151) are present, Compensator Transmission Map (30xx,5151) shall have precedence for dosimetric calculations.

C.AA.2.24.1.12 Compensator Thickness Map and Tray DistanceThe values stored in Compensator Proximal Thickness Map (30xx,5152) and Compensator Distal Thickness Map (30xx,5153) and Tray Distance (30xx,5148) shall be parallel to the radiation beam axis if Compensator Divergence (300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if Compensator Divergence (300A,02E0) equals PRESENT.

C.AA.2.24.1.22 Compensator Base PlaneThe compensator base plane is the side of the compensator which is flat. In case of a double –sided compensator, the base plan is the plane from which the compensator thickness is specified.

CompensatorBase Plane

Block and Compensator Tray in Accessory Slot Isocenter

RT Accessory Slot Distance(30xx,0548)

Compensator Base Plane Offset (30xx,5154)

( Attribute Value is negative )

Block Thickness(300A,0100)

Compensator Distal Thickness Map(30xx,5153)

Block Orientation (30xx,5162)

= SOURCE_SIDE

Compensator Map Orientation (30xx,5151)

= PATIENT_SIDE

RT Beam Distance Reference Location(30xx,5114)

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CompensatorBase Plane

Block and Compensator Tray in Accessory Slot

Isocenter

Block Orientation (30xx,5162)

= SOURCE_SIDE

Compensator Map Orientation (30xx,5151)

= PATIENT_SIDE

RT Beam Distance Reference Location(30xx,5114) = ISOCENTER

RT Accessory Slot Distance(30xx,0548)

Compensator Base Plane Offset (30xx,5154)

( Attribute Value is negative )

Block Thickness(300A,0100)

Compensator Distal Thickness Map(30xx,5153)

Figure C.AA.2.24.1-1Compensator Geometry

C.AA.2.25 Blocks Definition MacroThis macro may be invoked to define those attributes describing the geometric configuration of Blocks or Apertures which cannot vary during delivery.

Table C.AA.2.25-1BLOCKS DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Blocks (300A,00F0) 1 Number of Blocks defined in the Block


Total Block Tray Factor

(300A,00F2) 2C Total block tray transmission for all block trays (between 0 and 1) at the beam energy as specified by Nominal Reference Energy (30xx,51CA). Required when Radiation Particle (30xx,5110) is PHOTON or ELECTRON.

Nominal Reference Energy

(30xx,51CA) 1C The beam energy at which the Total Compensator Tray Factor (300A,00E2) is

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Attribute Name Tag Type Attribute Descriptionspecified, expressed in units as specified in Unit Energy Unit Code Sequence (30xx,51C9).Required, if Total Compensator Tray Factor (300A,00E2) is present and not empty.

Block Definition Sequence

(30xx,5160) 1C Block definitions.Required if Number of Blocks (300A,00F0) is non-zero.one or more blocks are present.The number of Items included in this sequence shall equal the value of Number of Blocks (300A,00F0).One or more Items shall be included in this sequence.




>Material ID (300A,00E1) 2 User-supplied identifier for material used to manufacture the Block.

>Block Divergence (300A,00FA) 1 Whether or not the block is shaped according to the beam geometrical divergenceSpecifies presence or otherwise of geometrical divergence..Enumerated Values:

PRESENT = block edges are shaped for beam divergence

ABSENT = block edges are not shaped for beam divergence

>Block Mounting PositiOrientation

(300A,00FB)(30xx,5162)

1 Specifies on which side of the Compensator Tray the block base the block extends. Enumerated Values:

PATIENT_SIDE = the block extends from its base towards the patient.

SOURCE_SIDE = the block extends from its base towards the radiation source.

>Block Base Offset (30xx,5163) 1 The distance (in mm) between the mounting position and the base plane of the block.The value shall be positive when the base plane is further away from the RT Beam Distance Reference Location (30xx,5114) than the mounting position.

>Block Thickness (300A,0100) 2C Physical thickness of block (in mm) parallel to radiation beam axis. Required if Material ID (300A,00E1) is non-zero lengthhas a value. May be present if Material ID (300A,00E1) is zero lengthhas no value.See C.AA.2.25.1.1 and C.AA.2.25.1.2.

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Attribute Name Tag Type Attribute Description>Block Transmission (300A,0102) 2C Transmission through the block (between 0 and

1) at the beam energy as specified by Nominal Reference Energy (30xx,51CA). Required if the SOP Class UID of the instance using this attribute is either 1.2.840.10008.5.1.4.1.1.481.XN.5.2 (C-Arm Photon Radiation Storage) or 1.2.840.10008.5.1.4.1.1.481.XN.5.3 (C-Arm Electron Radiation Storage), and Material ID (300A,00E1) is zero length. May be present if Material ID (300A,00E1) is non-zero length.See C.AA.2.25.1.1 and C.AA.2.25.1.2.

>Block Edge Data (30xx,5161) 2 A data stream of (x,y) pairs (in mm) with respect to the Coordinate System Declaration (30xx,5208) which comprise the block edge. The pairs shall be interpreted as a closed polygon. Coordinates are projected on the plane defined by the Beam Limiting Device Definition Distance (30xx,5210).

C.AA.2.25.1 Blocks Definition Macro Attribute DescriptionC.AA.2.25.1.1 Multiple aperture blocksAll blocks with Device Type Code Sequence (30xx,5026) with a value of (S147471, 99SUP147, “Aperture Block”) for a given beam shall have equal values of Block Transmission (300A,0102) and/or Block Thickness (300A,0100) if they are specified. The composite aperture shall be evaluated as the union of the individual apertures within a single Block. Shielding block transmission(s) shall be applied multiplicatively after the (composite) aperture has been evaluated.

C.AA.2.25.1.2 Block Thickness and Transmission PrecedenceIf Block Thickness (300A,0100) and Block Transmission (300A,0102) are both present, Block Transmission (300A,0102) shall have precedence for dosimetric calculations.

C.AA.2.26 Accessory Holder Definition MacroThis macro may be invoked to define those attributes describing the Accessory Holders which are used to hold accessories.

Table C.AA.2.26-1ACCESSORY HOLDER DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of RT Accessory Holders

(30xx,5171) 1 Number of RT Accessory Holders defined in the RT Accessory Holder Definition Sequence (30xx,054A).

RT Accessory Holder Definition Sequence

(30xx,054A5170)

1C Accessory Holder definitions. Required if the Number of RT Accessory Holders (30xx,5171) is non-zeroone or more Accessory Holders are present.The number of Items included in this sequence shall equal the value of Number of RT Accessory

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Attribute Name Tag Type Attribute DescriptionHolders (30xx,5171).One or more Items shall be included in this sequence.


Defined CID SUP147033 and SUP147034.


>Tray Distance (30xx,5148) 2C Distance (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the tray edge

to which the mounted item is attached.Required if Device Type Code Sequence

(30xx,5026) contains (S147480, 99SUP147, “Tray””).

>Tray RT Accessory Holder Water-

Equivalent Thickness

(30xx,02E3) 2C Water-Equivalent thickness of the tray Accessory Holder (in mm) parallel to radiation beam axis.Required if Device Type Code Sequence (30xx,5026) contains (S147480, 99SUP147, “Tray””).

>RT Accessory Holder Slot Sequence

(30xx,0542) 1C Slots being available in this Accessory Holder.Required if Device Type Code Sequence (30xx,5026) is part of CID SUP147034 contains (S147481, 99SUP147, “Applicator”).One or more Items shall be included in this sequence.

>>RT Accessory Holder Slot ID

(30xx,0544) 1 The ID of the slot where the accessoriesy isare inserted.

>> RT Accessory Holder Slot Distance

(30xx,0546) 2 Distance (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the slot along the radiation beam axis.

C.AA.2.26.1 Accessory Holder DescriptionA treatment delivery unit may allow the attachment of one or more aAccessory hHolders within which the user may install various devices for applying the beam to the patient. These installed devices may include, but not be limited to, one or more of the following items:

custom blocks for patient specific lateral collimation (beam limiting),

pre-collimators for general lateral collimation (beam limiting),

uniform thickness range shifter for modifying the range uniformly across the beam,

two-dimensional range shifters (custom boluses) for modifying the range differentially across the defined field,

ridge filters for creating multiple ranges within the beam,

cross-wires for aligning the patient with the beam,

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a mirror or camera for aligning or viewing the irradiated area,

beam monitoring detectors, and a

applicator sealer for preventing fluids from entering the applicator.

Several beam applicators may be available with a single radiation head to reduce the weight of components lifted by therapists, decrease the block and/or bolus to skin distance, and reduce leakage of radiation.

The following example illustrates the use of the Accessory Holder Macro and the RT Accessory Device Identification Macro:

The Gantry Head has a slot called 'Acc Mount'.

In this example, an electron applicator is mounted in that slot. The electron applicator itself has a slot called 'E Aperture', where other accessories can be mounted. Therefore the electron applicator is an Accessory Holder, which includes a slot sequence to model that slot.

In this example, a block tray is mounted in the 'E Aperture' slot. The block tray can support blocks, therefore it is an Accessory Holder, but the slot sequence is absent in the block tray definition, since the tray has not slots.

The block is an RT Accessory, which is mounted in the block tray.

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Accessory Slot‘Acc Mount’

Isocenter

Gantry Head

Applicator

Block

Block Tray

RT Beam Distance Reference Location(30xx,5114)

First item ofRT Accessory Holder Definition Sequence (30xx,054A):

Accessory Holder: Electron Applicator 10 x 10

Device Index (30xx,0112) = 1

mounted on:RT Accessory Slot ID (30xx,054B) = ‘Acc Mount’RT Accessory Slot Distance (30xx,0548) = 30 cm

includes: RT Accessory Holder Slot Sequence (30xx,0542)> RT Accessory Slot ID (30xx,054B) = ‘E Aperture’> RT Accessory Slot Distance (30xx,5148) = 50 cm

Second item ofRT Accessory Holder Definition Sequence (30xx,054A):

Accessory Holder: Block Tray

Device Index (30xx,0112) = 2

mounted on:Referenced RT Accessory Holder Device Index (30xx,0540) = 1RT Accessory Slot ID (30xx,054B) = ‘E Aperture’

Accessory: Block

mounted on:Referenced RT Accessory Holder Device Index (30xx,0540) = 2

Accessory Slot‘E Aperture’

Figure C.AA.2.26.1-1Accessory Holders

C.AA.2.27 General Accessories Definition MacroThis macro may be invoked to define those attributes describing the geometric configuration of General Accessories which cannot vary during delivery.

Table C.AA.2.27-1GENERAL ACCESSORIES DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of General Accessories

(30xx,5181) 1 Number of General Accessories defined in the General Accessory Definition Sequence (30xx,5180).

General Accessory Definition Sequence

(30xx,5180) 1C General accessories.

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Attribute Name Tag Type Attribute DescriptionRequired if the Number of General Accessories (30xx,5181) is non-zero.one or more general accessories are present.The number of Items included in this sequence shall equal the value of Number of General Accessories (30xx,5181)One or more Items shall be included in this sequence..


Baseline CID SUP147030.


C.AA.2.28 Boluses Definition MacroThis macro may be invoked to define those attributes describing the geometric configuration of Boluses which cannot vary during delivery.

Table C.AA.2.28-1BOLUSES DEFINITION MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Boli (300A,00ED) 1 Number of boli defined in the Boluses


Boluses Definition Sequence

(30xx,5190) 1C Bolus definitions.Required if the Number of Boli (300A,00ED) is non-zreo.one or more boluses are present.The number of Items included in this sequence shall equal the value of Number of Boli (300A,00ED)One or more Items shall be included in this sequence..




>Conceptual Volume Sequence

(30xx,1346) 23 References a conceptual volume that describes the geometry and properties of the bolus.See Section C.AA.2.28.1.1.Only Zero or one a single Item is permitted in this sequence.


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C.AA.2.28.1 Bolus Definition Macro Attribute DescriptionC.AA.2.28.1.1 Conceptual Volume SequenceThe Conceptual Volume Sequence (30xx,1346), if present, identifies the segmented Conceptual Volume used to define the bolus. The segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6). Alternatively, the bolus may not be associated with a segment. For example, a bolus may cover the entire area of radiation and not require a specific segmentation for definition.

C.AA.2.29 Outline Definition MacroThe Outline Definition Macro contains attributes to describes a geometric 2D geometric outline in a given coordinate system.

Table C.AA.2.29-1OUTLINE DEFINITON MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionOutline Shape Type (30xx,5200) 1 Shape of the outline.

Enumerated values:SQUARERECTANGULARCIRCULARPOLYGONAL

Outline Symmetry (30xx,5201) 1 Defines the sSymmetry of the Outline Shape with respect to the z- axis of the central axis of the beam.Enumerated Values: SYMMETRIC ASYMMETRICSee section C.AA.2.29.1.1.

Outline Definition Plane Distance

(30xx,5209) 1 Distance along the beam line from the RT Beam Distance Reference Location (30xx,5114) to the plane in which the outline is outline definedition plane. The outline definition plane shall be normal to the beam line.

Outline Edges X (30xx,5202) 1C Position of the X1 and X2 edges of a rectangular outline with respect to the Coordinate System Declaration (30xx,5208). Required if Outline Shape Type (30xx,5200) is SQUARE or RECTANGULAR.Only a single value shall be present Item shall be included in this sequence if Outline Shape Type is

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(30xx,5200) is SQUARE and Outline Symmetry (30xx,5201) is SYMMETRIC which describes the X edges symmetrical to the y-axis with respect to the Coordinate System Declaration (30xx,5208).The absolute values of X1 and X2 shall be equal in case Outline Shape Type (30xx,5200) is RECTANGULAR and Outline Symmetry (30xx,5201) is SYMMETRIC.

Outline Edges Y (30xx,5203) 1C Position of the Y1 and Y2 edges of rectangular outline with respect to the Coordinate System Declaration (30xx,5208). Required if Outline Shape Type (30xx,5200) is RECTANGULAR.Required if Outline Shape Type (30xx,5200) is SQUARE or RECTANGULAR.Only a single Item shall be included in this sequence if Outline Shape Type is (30xx,5200) is SQUARE and Outline Symmetry (30xx,5201) is SYMMETRIC which describes the Y edges symmetrical to the x-axis with respect to the Coordinate System Declaration (30xx,5208).The absolute values of Y1 and Y2 shall be equal in case Outline Shape Type (30xx,5200) is RECTANGULAR and Outline Symmetry (30xx,5201) is SYMMETRIC.

Center of Circular Outline (30xx,5204) 2C Location (x,y) of the center of the circular outline in with respect to the Coordinate System Declaration (30xx,5208). Required if Outline Shape Type (30xx,5200) is CIRCULAR. and Outline Symmetry (30xx,5201) is ASYMMETRIC.

Diameter of Circular Outline (30xx,5205) 1C Diameter of circular outline in with respect to the Coordinate System Declaration (30xx,5208). If Outline Symmetry (30xx,5201) is SYMMETRIC the center location is defined as the center of the beam.Required if Outline Shape Type (30xx,5200) is CIRCULAR.

Number of Polygonal Vertices (30xx,5206) 1C Number of Vertices in Vertices of the


Polygonal Outline (30xx,5207). Required if Outline Shape Type (30xx,5200) is POLYGONAL.

Vertices of the Polygonal Outline

(30xx,5207) 1C List of (x,y) pairs with respect to the Coordinate System Declaration (30xx,5208). Polygonal outlines are implicitly closed from the last vertex to the origin vertex and all edges shall be non-intersecting except at the vertices. Required if Outline Shape Type (30xx,5200) is POLYGONAL.If Outline Symmetry (30xx,5201) is SYMMETRIC the polygonal shall be symmetric to the origin with respect to the Coordinate System Declaration (30xx,5208).

C.AA.2.29.1 Outline Definition Macro Attribute DescriptionC.AA.2.29.1.1 Outline SymmetryThe term SYMMETRIC applies when the outline is mirror symmetric in respect to both the x-axis and the y-axis of the coordinate system referenced in Coordinate System Declaration (30xx,5208). This terminology also applies to outlines having the Outline Shape Type (30xx,5200) POLYGONAL, if those conditions are fulfilled.

C.AA.2.30 RT Tolerance Set MacroThe RT Tolerance Set Macro contains information describing the maximum permitted differences between planned and delivered values. This information is used in the context of delivery of the RT Radiation Set. If the absolute difference between a planned and delivered value exceeds the tolerance value, then delivery of the RT Radiation Set shall be inhibited unless an authorized operator confirms that the tolerance may be exceeded.

Table C.AA.2.30-1RT TOLERANCE SET MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionRT Tolerance Set Label

(30xx,0BA2) 1 User defined label for the Tolerance Set.

RT Tolerance Set Index

(30xx,0114) 1 Index of the item Tolerance Set in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

Attribute Tolerance Values Sequence

(30xx,0BA6) 21C Tolerance values representing the allowed difference between the planned and actual values.for the attributes specified by tThe Selector Attribute Macro identifies the attributes for which the tolerances are specified. Zero or more Items shall be included in this sequence.

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Required, if a tolerance value is specified for at least one attribute which can be referenced by the Selector Attribute Macro. For further information sSee section C.AA.2.30.1.Zero or more Items shall be included in this sequence.

>Include 'Selector Attribute Macro' Table 10-20>Tolerance Value (30xx,0BA8) 1 Maximum permitted difference between the

planned and the delivered value. Units are those specified for the corresponding attribute referenced by the Selector Attribute Macro.

Patient Support Position Tolerance Sequence

(30xx,0BAA) 21C Tolerance values for a patient support position as supported by a delivery device.Required if a tolerance value is specified for at least one patient support position parameter.For further information sSee section C.AA.2.30.1.2.Zero Zero or more Items shall be included in this sequence.

>Include 'Content Item Macro' Table 10-2 Baseline TID of Concept Name Code Sequence is TID SUP147004.Content items shall use UCUM units of mm and degrees where applicable.

C.AA.2.30.1 RT Tolerance Set Attribute DescriptionC.AA.2.30.1.1 Attribute Tolerance Values SequenceThe Attribute Tolerance Values Sequence (30xx,0BA6) allows for the reference to any numerical parameter in a Radiation IOD. The RT Tolerance Set Macro is invoked to specify a tolerance value for this parameter. The reference specification is conveyed by the Selector Attribute Macro, which allows reference to a tag on any level of nested sequences, and to refer to specific items in the sequence.

If the specified tolerance applies to the values of the specified tag in all items of a sequence, the identification of the Selector Sequence Pointer Items (0074,1057) on the level in question shall have the value 0.

The unit of the tolerance value is the unit as specified by the data element tag referenced in the Selector Attribute (0072,0026).

C.AA.2.30.1.2 Patient Support Position Tolerance SequenceWhen describing a tolerance for a specific patient support position value, the patient support device parameter is defined using the same code otherwise used in the Patient Support Position Macro in section C.AA.2.13.

C.AA.2.31 Patient to Equipment Relationship MacroThe Patient to Equipment Relationship Macro describes a position of the patient in respect to an RT device. That position could be a Treatment Position, an Imaging Position, a Setup Position or

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anything else. The purpose of the patient position in the equipment system is defined at the invocation of the macro. The position is defined by either the means of a transformation matrix between a patient frame of reference and a equipment system, or by a set of device-specific parameters, or both.

Table C.AA.2.31-1PATIENT TO EQUIPMENT RELATIONSHIP MACRO ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionFrame of Reference Transformation Comment

(3006,00C8) 3 Comments about the relationship between the patient frame of reference and the equipment. Shall be free text entered by a human operator, shall not be used programmatically.

Patient Frame of Reference to Equipment Mapping Matrix

(30xx,6040) 1C A rigid, homogeneous 4x4 transformation matrix that maps the patient coordinate space in the Frame of Reference used for the patient model to the equipment-defined Equipment Frame of Reference. Matrix elements shall be listed in row-major order. See C.AA.2.31.1.Required if the relation of the patient coordinate system to the treatment equipment coordinate system can be described by such a transformation between these systems.

Frame of Reference Transformation Comment

(3006,00C8) 3 Comments entered by a human operator about the relationship between the patient frame of reference and the equipment. For display purposes only, shall not be used for other purposes.

Patient Location Coordinates Sequence

(30xx,6042) 12C Sequence of pPatient coordinates for transformation to the equipment coordinate system.Required, if the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040) is present and if any specific points should be annotated, which are useful at the position where the patient located in respect to the equipment.Zero One or more Items shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1>3D Point Coordinate (0068,6590) 1C Coordinate describing a location in the patient

Frame of Reference that will be transformed to the Equipment Frame of Reference by using the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040).Required if Fiducial UID (0070,031A) is not present.

>Fiducial UID (0070,031A) 1C The UID that identifies the fiducial describing a location in the patient Frame of Reference that will be transformed to the Equipment Frame of Reference by using the Patient Frame of

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Reference to Equipment Matrix (30xx,6040).Required if 3D Point Coordinate (0068,6590) is not present.

>Patient Location Coordinates Code Sequence

(30xx,0644) 1 Identifies the type of Patient Location Coordinate.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 147005Patient Support Position Sequence

(30xx,6046) 1C Sequence of Items describing the aActual Patient Support Position Parameters. Required if the patient position is only available by machine-parameters of the patient support system. May be present otherwise. See C.AA.2.31.1.Only a single Item shall be included in this sequence.

>Include 'Patient Support Position Macro' Table C.AA.2.13-1.

C.AA.2.31.1 Patient to Equipment Relationship Macro Attributes DescriptionC.AA.2.31.1.1 Patient Frame of Reference to Equipment Mapping Matrix and Patient Support Position MacroThe Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040) describes the relationship between the Patient-oriented coordinate system and an RT Device-Specific coordinate system. This matrix AMB describes a rigid transformation of how to transform a point (Bx,By,Bz) with respect to the Patient coordinate system into (Ax,Ay,Az) with respect to the equipment coordinate system as defined in chapter section C.7.6.21.1. It shall be a rigid transformation that only includes rotations and translations.

The RT Device-specific coordinate system is identified by the Equipment Frame of Reference UID (30xx,51A0). For further information on the definition of the Equipment Frame of Reference, see Section C.AA.E1.1.3. The patient-oriented coordinate system is identified by the Frame Of Reference UID (0020,0052) in the Frame of Reference Module of the SOP instance it is used within. Both coordinate systems are expressed in millimeters.

The Patient Support Position Macro allows the specification definition of device-specific parameters for the patient support device, and thereby provides the relationship between a Patient Support System and the RT Device-Specific coordinate Ssystem. This relationship is known to all applications which know the geometric interpretation of those parameters. Applications that are unable to decompose the transformation between these two coordinate systems which do not know that cannot construct this geometric relationship, but will be able to display the labels and numerical values of those parameters.

In standard planning cases where the relation between the patient system and the equipment system is known, the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040) shall be used over the Patient Support Position Sequence (30xx,6046). The Patient Support Position Sequence (30xx,6046) may be present in this case to annotate the matrix and visualize the decomposed matrix contents. The content of the Patient Support Position Macro shall be used for display purposes only. It shall not be used for other purposes. The content of this macro shall not be used as a substitute for the Equipment Mapping Matrix (30xx,6040)No programmatic information shall then be derived from the Patient Support Position Macro in this case. In general, there is more than one way to reach the point in space that is described by the Patient Frame of Reference to Equipment Mapping Matrix. Hence it is explicitly not implied how this position is reached.

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In some cases (e.g. emergency treatments), the relationship between the DICOM Patient Coordinate System and the Equipment Frame of Reference may not be known or a Patient Coordinate System may not be administered at all. In this case an arbitrary Frame of Reference is used for the patient coordinate system in the Frame of Reference Module of the SOP instance, but the Patient Frame of Reference to Equipment Mapping Matrix may not be used. In this case, the patient support parameters shall be supplied by the Patient Support Position Sequence (30xx,6046).

If the Patient Frame of Reference to Equipment Mapping Matrix and the Patient Support Position Sequence (30xx,6046) are both present, the information in both locations shall be consistent.

C.AA.2.32 RT Treatment Position MacroThe RT Treatment Position Macro establishes a connection between the patient’s geometry and the treatment delivery equipment to define the treatment position. This treatment position is the one as prescribed, when used in a RT Radiation object, and one as recorded in the RT Radiation Record object.

Table C.AA.2.32-1RT TREATMENT POSITION MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionPatient Orientation Code Sequence

(0054,0410) 1 Sequence that describes the orientation of the patient with respect to gravity. See C.8.4.6.1.1 for further explanation.Only one item shall be present.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 19Patient Orientation Modifier Code Sequence

(0054,0412) 1 Sequence describing the orientation of the patient with respect to gravity. Only one item shall be present.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 20Patient Gantry Equipment Relationship Code Sequence

(30xx,50300054,0414)

1 Sequence describing the orientation of the patient with respect to gantryequipment.Only one item shall be present.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 21Patient Setup UID (30xx,5060) 1 Identifies a conceptual patient setup,

realized by one or more RT Patient Setup instances.

Treatment Position Sequence (30xx,5028) 1 Sequence of Items describing the tTreatment positions.There shall be no more items present than number of Items in the enclosing Control Point Sequence.One or more Items shall be included in this sequence.

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Ulrich Busch, 03/28/14,

Question to WG-06: Is this code needed, since the modifier provides everything as well (e.g. sitting, standing)


Attribute Name Tag Type Description>Referenced Control Point Index (30xx,0141) 1 The value of Reference to the

References the Control Point Index (30xx,0111) identifying the control point, starting from which that treatment position is applied.Only control points at which changes occur shall be referenced. No control point shall be referenced more than once. The Referenced Item Number shall be monotonically increasing.The first item in the Treatment Position Sequence (30xx,5028) shall have the value 1.

>Include 'Patient to Equipment Relationship Macro' Table C.AA.2.31-1


C.AA.2.33 User Content Identification MacroThe User Content Identification Macro identifies content using a label supporting lower case characters and differing character sets. If a Code String is required, see Content Identification Macro (Section 10.9).

Table C.AA.2.33-1USER CONTENT IDENTIFICATION MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionUser Content Label (30xx,51E0) 1 A short, free text label that is used to

identify this SOP Instance.See C.AA.2.33.1.1.

Content Description (0070,0081) 2 A description of the content of the SOP Instance.See C.AA.2.33.1.1.

Content Creator’s Name (0070,0084) 2 Name of operator (such as a technologist or physician) creating the content of the SOP Instance.

Content Creator’s Identification Code Sequence

(0070,0086) 3 Identification of the person who created the real world value mapping. Only a single Item is permitted in this sequence.

> Include 'Person Identification Macro' Table 10-1

C.AA.2.33.1 User Content Identification Macro Attribute DescriptionC.AA.2.33.1.1 User Content Label and Content DescriptionUser Content Label (30xx,51E0) shall represent a user-definable short free text providing the primary identification of this entity to other users. Note that the Content Label (0070,0080) attribute used in the widely-used Content Identification Macro is a Code String, not free text. Content Description (0070,0081) allows a longer string containing additional descriptive identifying text for one-line headings etc.

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This information is intended only for display to human readers and shall not be used programmatically.. For display purposes only, shall not be used for other purposes.

For RT Radiation IODs (those including the RT Radiation Common Module), User Content Label (30xx,51E0) is intended to be unique across a particular radiation set. Content Description (0070,0081) contains additional information intended for detailed display, such as in a tool tip.

C.AA.2.34 RT Treatment Phase MacroThe treatment phase macro contains the information about a RT Treatment Phase

Table C.AA.2.34-1RT TREATMENT PHASE MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionTreatment Phase Index (30xx,0116) 1 Index of the Treatment Phase in the

sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

Include 'RT Entity Labeling Macro' Table C.AA.2.1-1Intended Phase Start Date (30xx,088C) 2 The date, when this treatment phase

is suggested to start.See section C.AA.2.34.1

Intended Phase End Date (30xx,088E) 2 The date, when this treatment phase is suggested to be completed.See section C.AA.2.34.1

C.AA.2.34.1 RT Treatment Phase Macro Attribute DescriptionC.AA.2.34.1.1 Intended Phase Start Date, Intended Phase end DateThe Intended Phase Start Date (30xx,088C) and Intended Phase End Date (30xx,088E) contains the definition of the date, when this treatment phase is intended to be started respectively to be completed. It is important not to confuse the content of that attribute with date when the treatment delivery actual starts respectively ends. That effective date is managed by workflow systems, where definitive treatment session scheduling is maintained. Actual dates of performed delivery will then be available by RT Radiation Record IODs. Those actual dates may differ from the Intended Phase Start Date (30xx,088C) and/or Intended Phase End Date (30xx,088E).

C.AA.2.35 RT Treatment Phase Interval MacroThe Treatment Phase Interval Macro contains the information about time-relationship between RT Treatment Phases.

Table C.AA.2.35-1RT TREATMENT PHASE INTERVAL MACRO ATTRIBUTES

Attribute Name Tag Type DescriptionTreatment Phase Interval Sequence

(30xx,0890) 2 Sequence of iIntervals between treatment phases.Zero or more items shall be included in that sequence.See C.AA.2.35.1.

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Attribute Name Tag Type Description>Previous Treatment Phase Index

(30xx,0116) 1 The Treatment Phase for which a Treatment Phase Interval is defined.This index corresponds to an item in the Treatment Phase Sequence (30xx,0880). Each Treatment Phase Index value shall appear only once in this sequence.See C.AA.2.35.1.

>Consecutive Treatment Phase Index

(30xx,01446)

1 The Treatment Phase to which the phase identified by Treatment Phase Index (30xx,0116) is related.See C.AA.2.35.1.

>Temporal Relationship Interval Anchor

(30xx,0892) 1C The anchor point of the Interval specified in that item in respect to the phase referenced by the Consecutive Treatment Phase Index (30xx,01464).Enumerated Values:

START: The interval is specified with respect to the start of the reference phase.

END: The interval is specified with respect to the end of the reference phase.Required if Minimum Number of Interval Days (30xx,0894) or Maximum Number of Interval Days (30xx,0896) is present and not empty.

>Minimum Number of Interval Days

(30xx,0894) 2C The minimum number of days when the actual phase should follow the treatment phase referenced in Referenced Treatment Phase Index (30xx,0146). Fractional days and negative values are allowed.

>Maximum Number of Interval Days

(30xx,0896) 2C The maximum number of days when the actual phase should follow the treatment phase referenced in Referenced Treatment Phase Index (30xx,0146). Fractional days and negative values are allowed.

C.AA.2.35.1 Referenced Treatment PhasesThe Treatment Phase Interval Sequence (30xx,0890) allows to define an interval between two treatment phases. Treatment Phases referenced by Previous Treatment Phase Index (30xx,0116) and Consecutive Treatment Phase Index (30xx,01446) are linked together along with the definition of the number of days in-between them. Note that the number of days can also be negative and therefore the consecutive treatment phase will start before the prior treatment phase.

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See also section C.AA.B2.1.8.

As a result of the combinations possible, tThe maximum number of Items in the Treatment Phase Interval Sequence (30xx,0890) shall be one less than the number of treatment phases present.

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C.AA.A1 Enhanced RT Series ModuleThe Second Generation Radiotherapy IODs use the General Series module described in section C.7.3.1, specialized by the Enhanced RT Series Module.

Table C.AA.A0-1 specifies the attributes that identify and describe general information about the Enhanced RT Series.

Table C.AA.A1-1ENHANCED RT SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionModality (0008,0060) 1 Type of equipment that originally

acquired the data used to create the images instances in this Series. See C.AA.A1.1.1.Enumerated Values:

RT

Referenced Performed Procedure Step Sequence

(0008,1111) 1C Uniquely identifies the Performed Procedure Step SOP Instance that resulted in creation of the Series (e.g. a Modality or Unified Procedure Step SOP Instance). Only a single Item shall be included in this sequence. Required if theis instance series has been created as a result of a single procedure step request and the Instance-Level Referenced Performed Procedure Step Sequence (30xx,0802) is not present.See Note 1:


Note 1: If different instances in the series are created as a result of a procedures step, the Instance-Level Referenced Performed Procedure Step Sequence (30xx,0802) in the Radiotherapy Common Instance Module shall be used.

C.AA.A1.1 Enhanced RT Series Attribute DescriptionC.AA.A1.1.1 ModalityThe Modality (0008,0060) of ‘RT’ allows a single device to include SOP instances of different SOP Classes created in the same session of activity to be stored in the same series. A treatment planning system creating a segmentation properties object, plan, and dose as output of a planning process is one such example. See Section A.VV.1.1.1.2 for further explanation on use of Modality in radiotherapy.

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C.AA.A2 Radiotherapy Common Instance ModuleTable C.AA.A2-1 specifies the attributes that identify and describe general information about any and all Second Generation Radiotherapy IODs.

Table C.AA.A2-1RADIOTHERAPY COMMON INSTANCE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionInstance Number (0020,0013) 1 A number that identifies this SOP

Instance. The value shall be unique within a Series.

Include 'RT Entity Labeling Macro' Table C.AA.2.1-1Include 'User Content Identification Macro' Table C.AA.2.33-1Instance Creation Date (0008,0012) 1 Date the SOP Instance was created.

Instance Creation Time (0008,0013) 1 Time the SOP Instance was created.

Instance-Level Referenced Performed Procedure Step Sequence

(30xx,0802) 1C Uniquely identifies the Performed Procedure Step SOP Instance that resulted in creation of this instance (e.g. a Modality or Unified Procedure Step SOP Instance). Required if this instance has been created as a result of a procedure step request and the Referenced Performed Procedure Step Sequence (0008,1111) is not present.One or more Items shall be included in this sequence.

Include 'User Content Identification Macro' Table C.AA.2.33-1Include 'RT Entity Labeling Macro' Table C.AA.2.1-1

C.AA.A3 RT Course ModuleThe RT Course module contains general information for the RT Course IOD.

Table C.AA.A3-1RT COURSE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRT Course Scope Indicator (30xx,0804) 2 Definition of the scope of this RT

Course.Defined Terms:

PARTIAL = RT Course SOP Instance contains a subset of all data related to the treatment course at the time it was created.

COMPLETE = The RT Course originated from an application with an authoritative role in managing the RT Course in a department.See C.AA.A3.1.1.

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Attribute Name Tag Type DescriptionRT Prescription Reference Presence Flag

(30xx,0805) 1 Defines whether an RT Prescription Reference is present.Enumerated Values:

YESNO

RT Treatment Phase Presence Flag

(30xx,0806) 1 Defines whether an RT Treatment Phase definition is present.Enumerated Values:

YESNO

RT Radiation Set Reference Presence Flag

(30xx,0807) 1 Defines whether a RT Radiation Set Reference is present.Enumerated Values:

YESNO

Current Course Predecessor Sequence

(30xx,080A) 2 Reference to historical versions of the RT Course. Zero or more Items shall be included in this sequence.See Note 1.

>Include 'SOP Instance Reference Macro' Table 10-11Prior Treatment Sequence (30xx,0822) 2C Former treatments that have been

delivered to this patient.Required if a previous radiation therapy treatment of the patient occurred and is known.Zero or more Items shall be included in this sequence.

>Prior RT Course Sequence (30xx,0824) 1C Reference to an RT Course previously established and terminated.Required if Delivered Radiation Dose Sequence (30xx,0826) is not present.Only a single Item shall be included in this sequence.See Note 1.



Attribute Name Tag Type Description>Delivered Radiation Dose Sequence

(30xx,0826) 1C Delivered doses from former treatments before the current RT Course.Required if Prior RT Course Sequence (30xx,0824) is not present. May be present otherwise.One or more Items shall be included in this sequence.See C.AA.A3.1.2Note 2.

>>Delivered Radiation Dose (30xx,0828) 1 The Dose (in Gray) that was delivered.

>>Conceptual Volume Sequence

(30xx,1346) 1C References to conceptual volumes which received dose in former treatments. Required if the former dose can be traced back to a conceptual volume. One or more Items shall be included in this sequence.

>>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1>>Delivered Irradiated Volume Description

(30xx,082C) 1C A textual description of the volume that received dose in former treatments.Required if Conceptual Volume Sequence (30xx,1346) is not present. May be present otherwise.

RT Course State Sequence (30xx,0830) 1 Defines the state of this RT Course. Only a single Item shall be included in this sequence.See C.AA.A3.1.3Note 3.

>Include 'RT Item State Macro’ Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.See C.AA.A3.1.3.

C.AA.A3.1 RT Course Attribute DescriptionC.AA.A3.1.1 RT Course Scope IndicatorIt is generally assumed that there is only one ‘active’ RT Course SOP Instance at a given time, for a given ‘course’ of treatment. However, this is not guaranteed by technical means, and therefore it is the specific configuration of devices and the workflow definition within a department that defines the roles with respect to the RT Course (for further information see DICOM Part 17, Section ZZ.2). Within this paradigm, a device may know that it has only a partial knowledge of all involved SOP Instances (e.g. only that knowledge needed to perform a specific activity), and therefore deliberately annotate an RT Course with a RT Course Scope Indicator (30xx,0804) of PARTIAL.

In absence of a value no statement can be made about the scope of the current RT Course SOP instance.

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C.AA.A3.1.2 Delivered Radiation Dose SequenceThe Delivered Radiation Dose Sequence (30xx,0826) in the Prior Treatment Sequence is intended to contain information about treatments that have not been under the regime of a former RT Course, and therefore have to be recorded explicitly. This shall address especially the situation of denoting former treatments handled by an application which does not support the 2nd generation RT IODs.

C.AA.A3.1.3 RT Course State SequenceThe value of this attribute identifies the state of the RT Course itself. implies nothing about the state of the SOP instances referenced in this RT Course SOP instance.The state of referenced SOP instances is part of the Associated Instance State Sequence (30xx,0903).

Figure C.AA.A3-1State of RT Course and Associated Instances

The transitions between states are not defined in DICOM.

The meaning of the following codes is specialized in the RT Course State Sequence.

A value of (S147652, 99SUP147, “Approved”) means, that all of the information in this instance of the RT Course SOP instance is approved, but not the information in objects referenced by the RT Course.

. Those referenced object have their own states at the place, where they are referenced.

(TBD Figures – Issue R94)

C.AA.A4 RT Prescription Reference ModuleThe RT Prescription Reference Module contains information about the state of physician’s prescriptions and the intended time structure phase relationship of treatment delivery.

Table C.AA.A4-1RT PRESCRIPTION REFERENCE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionPhysician Intent RT Prescription Reference Sequence

(30xx,0860) 1 Referenced physician intentsList of referenced Prescriptions for the RT Course.One or more Items shall be included in this sequence.

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Attribute Name Tag Type Description>RT Prescription Reference Index

(30xx,01180861)

1 Index of the Iitem in the sequence. used for internal or external references.The value shall start at 1, and increase monotonically by 1.

>Referenced Physician IntentRT Prescription Sequence

(30xx,0864) 1 Reference to a prescription within an RT Physician Intent SOP Instance that contains the prescription referenced in this sequence.Only a single Item shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>>Referenced RT Prescription Index

(30xx,0148) 1 The value of Reference to the RT Prescription Index (30xx,0118) corresponding to the prescription in the referenced SOP Instance encoded in the Referenced Physician Intent Sequence (30xx,0864), identifying the prescription for this sequence.

>Physician Intent Prescription Stateus Sequence

(30xx,0866) 1 Defines Sthe stateus of the prescription in the physician intent. Only a single Item shall be included in this sequence.

>>Include 'RT Item State Macro’ Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.See C.AA.A4.1.1.

>Referenced Treatment Phase Reference Sequence

(30xx,0870) 1C Referenced Reference to Ttreatment Pphase(s ) to which prescribed by this prescription applies, and which will contain the radiation sets for the treatments administered by this prescription.Required if Treatment Phase Sequence (30xx,0880) is present in the RT Treatment Phase module of this RT Course SOP instance.One or more Items shall be included in this sequence.

>>Referenced Treatment Phase Index

(30xx,0146) 1 The value of Treatment Phase Index (30xx,0116) corresponding to the referenced treatment phase.Reference to the Treatment Phase Index (30xx,0116) where this prescription does apply to.

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Attribute Name Tag Type Description>Referenced RT Segment Annotation Sequence

(30xx,0874) 2 Reference to d RT Segment Annotation SOP Instances on for which this prescription is appliesbased.Zero or more Items shall be included in this sequence.


C.AA.A4.1 RT Prescription Reference Attribute DescriptionC.AA.A4.1.1 RT Item State Macro MeaningsThe meaning of the following codes is specialized in the Prescription State Sequence.

For the states listed in the following, further annotations are provided, how the definitions in ANNEX D, DICOM CONTROLLED TERMINOLOGY DEFINITIONS shall be applied in this context:

A value of (S147651, 99SUP147, “Reviewed”) means, that the Intent has been reviewed.

A value of (S147652, 99SUP147, “Approved”) means, that the Intent prescription has been approved. It is ready to be used for treatment planning.

A value of (S147653, 99SUP147, “Rejected”) means, that the Intent prescription has been rejected and shall not be used for treatment planning.

C.AA.A5 RT Treatment Phase ModuleThe treatment phases defined for this RT Course. This module defines RT Treatment Pphases define the time structure of the RT Course, by defining phases for treatment and the time order in which RT rRadiation sSets are treated in relation to each other.

Table C.AA.A5-1RT TREATMENT PHASE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionTreatment Phase Sequence (30xx,0880) 1 Treatment Phases for the this SOP

current RT Course.instance. The treatment phases serve as the basis to define the chronological relationship between radiation sets, which are concurrently and/or subsequently treated in a defined relationship to each other. The order of the Treatment Phase Index (30xx,0116) defines the date sequencing of the phases.One or more Items shall be included in this sequence.

>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1>RT Treatment Phase State Sequence

(30xx,088A) 1 Defines the sState of this phase. Only a single Item shall be included in this sequence.

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Attribute Name Tag Type Description>>Include 'RT Item State Macro' Table C.AA.2.3-1 Defined CID for the Assertion Code

Sequence (30xx,50A0) shall be SUP147043.See C.AA.A5.1.1

Include 'RT Treatment Phase Interval Macro' Table C.AA.2.35-1

C.AA.A5.1 RT Treatment Phase Attribute Description C.AA.A5.1.1 RT Item State Macro MeaningsThe meaning of the following codes is specialized in the RT Treatment Phase State Sequence.

A value of (S147651, 99SUP147, “Reviewed”) means, that the treatment phase has been reviewed.

A value of (S147652, 99SUP147, “Approved”) means, that the treatment phase has been approved. The intended timing is ready to be used for fractionation.

A value of (S147653, 99SUP147, “Rejected”) means, that the current treatment phase has been rejected and shall not be used.

C.AA.A6 RT Radiation Set Reference ModuleThe RT Radiation Set Reference Module contains information about multiple radiation sets being prepared, in treatment and finished (discontinued or retired). These radiation sets will typically refer to prescriptions contained in the RT Prescription Reference Module, as being part of the realization of a certain prescription. The module also contains information about the chronological relation of the radiation sets to each other (subsequent, in parallel, etc.).

The top-level sequence is called the ‘Meta RT Radiation Set Sequence’ because it may include several radiation sets for several purposes. Those may be a set to perform and record a virtual or real simulation, a set to calculate dose, and typically the actual radiation set(s) to be treated.

Table C.AA.A6-1RT RADIATION SET REFERENCE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionMeta RT Radiation Set Sequence

(30xx,08B0) 1 List of Meta RT Radiation Sets within this phase.One or more Items shall be included in this sequence.

>Include 'RT Entity Labeling Macro' Table C.AA.2.1-1>Meta RT Radiation Set Index (30xx,0117) 1 Index of the Meta RT Radiation Set in

the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

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1950

1952

1954


Attribute Name Tag Type Description>Referenced RT Prescription Index

(30xx,08C2) 1C The value of Reference to the References the Prescription Index (30xx,0118) in the RT Prescription Reference Module forcorresponding to prescription for which this RT Radiation Set is defined.Required if the referenced RT Radiation Set is based on a Physician Intent.

>Referenced Treatment Phase Index

(30xx,08C3) 1C The value of Treatment Phase Index (30xx,0116) corresponding to the phase to which this Radiation Set belongs.References the Treatment Phase Index (30xx,0116) in the Treatment Phase Sequence (30xx,0880) in the RT Treatment Phase module of this SOP instance.Required if the Treatment Phase Sequence (30xx,0880) is present.

>Radiation Set Start Delay (30xx,08C6) 1C Defines tThe minimum delay innumber of days for the first day of treatment with respect tofrom the beginning of the treatment phase to first day of treatment. See C.AA.A6.1.2The treatment phase is identified containing the referenced RT Radiation Set, as referenced by Referenced Treatment Phase IndexTreatment Phase Referenced Item Number (30xx,08C3).

If a Fractionation Pattern (300A,007B) contains one or more zeros starting on the week day of the first day following the Radiation Set Start Delay (30xx,08C6), then treatment starts at the first occurrence of 1 in the pattern.Required if Referenced Treatment Phase IndexTreatment Phase Referenced Item Number (30xx,08C3) is present.See C.AA.A6.1.2

>Meta RT Radiation Set Relationship Sequence

(30xx,0123) 2 Fraction-based relationship to another Meta RT Radiation Set.Zero or one Item shall be included in this sequence.


Attribute Name Tag Type Description>>Referenced Meta RT Radiation Set Index

(30xx,0122) 1 The value of Reference to the The referenced RT Meta Radiation Set Index (30xx,0117) corresponding to the Meta Radiation Set to which the current RT Meta Radiation Set is related.

>> Fraction-Based Relationship Interval AnchorTemporal Relationship Interval Anchor

(30xx,09840892)

1 The anchor point of the Interval specified in this the current Meta RT Radiation Set Sequence Item with respect to the related Meta RT Radiation Set referenced by the Referenced Meta RT Radiation Set Index (30xx,0122).Enumerated Values:START: The interval is specified with respect to the start of the reference related prescriptionMeta RT Radiation Set.END: The interval is specified with respect to the end of the related Meta RT Radiation Setreference prescription.

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Attribute Name Tag Type Description>>Number of Fractions (30xx,0972) 1 The interval expressed in number of

fractions. in The respect to Temporal Relationship Interval Anchor (30xx,0892) Fraction-Based Relationship Interval Anchor (30xx,0984) establishes the anchor point where the interval is tied towhen the delivery of current RT Meta Radiation Set should be started.A value of 0 means, that the current Meta RT Radiation Set starts simultaneously with the anchor of the related Meta RT Radiation Set.If Fraction-Based Relationship Interval Anchor (30xx,0984)Temporal Relationship Interval Anchor (30xx,0892) equals START, this is the number of fractions after the first fraction of the delivery of the referenced RT Meta Radiation Set , when the delivery of the current RT Meta Radiation Set should start.If Fraction-Based Relationship Interval Anchor (30xx,0984)Temporal Relationship Interval Anchor (30xx,0892) equals END, this is the number of fractions prior to the last fraction of the delivery of the referenced RT Meta Radiation Set, when the delivery of the current RT Meta Radiation Set should start.See TBD (diagrams)

>Pre-treatment RT Radiation Set Reference Sequence

(30xx,08CA) 1C Referenced Pre-treatment RT Radiation Sets that have been used in developing the final Treatment RT Radiation sets.Required if the specified Rradiation sSets have been used to preparein the final Treatment RT Radiation sets.One or more Items shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>>Pre-treatment RT Radiation Set Role Purpose Code Sequence

(30xx,08CB) 1 Defines the role purpose of the referenced RT Pre-treatment RT Radiation Set, in preparation of the current treatment.Only a single Item shall be included in this sequence.

>>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147018.


Attribute Name Tag Type Description>>Referenced RT Segment Annotation Sequence

(30xx,0874) 1 Referenced RT Segment Annotation SOP Instances which have been used during definition of the RT Radiation Set.One or more Items shall be included in this sequence.

>>>Include 'SOP Instance Reference Macro' Table 10-11>>>Conceptual Volume State Sequence

(30xx,08CC) 21C A sequence of sStates associated with the Conceptual Volumes defined in the RT Segment Annotation SOP instance referenced in this Referenced RT Segment Annotation Sequence (30xx,0874) Item.sequence.Required if status information is available for Conceptual Volumes in this scope.An Item shall be present for each.Conceptual Volume for which a state is defined by a clinician.One Zero or more Items shall be included in this sequence.

>>>>Conceptual Volume UID (30xx,1301) 1 The unique identifier of the Conceptual Volume UID of a Conceptual Volume defined in the Segment RT Annotations SOP instance referenced in this sequence.

>>>>Include 'RT Item State Macro' Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.See C.AA.A6.1.1

>>RT Radiation Set State Sequence

(30xx,08C8) 1 Defines the state of this Pre-Treatment RT Radiation Set.Only a single Item shall be included in this sequence.

>>>Include 'RT Item State Macro' Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.See C.AA.A6.1.1

>Treatment RT Radiation Set Reference Sequence

(30xx,08F2) 1C2 Referenced RT Radiation Sets to be used in this RT Course Meta RT Radiation Set.Required if Treatment RT Radiation Sets are defined.OneZero or more Items shall be included in this sequence.See Note 1.


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Attribute Name Tag Type Description>>Treatment RT Radiation Set Sequence Number

(30xx,08F4) 1 A number oThe ordering thise radiation set was added s as their reference has been added to this sequence. See Note 1.

>>Treatment RT Radiation Set State Sequence

(30xx,08F6) 1 Defines tThe state of this Radiation Set..Only a single Item shall be included in this sequence.

>>>Include 'RT Item State Macro' Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.See C.AA.A6.1.1

>>Treatment RT Radiation Set Operation State Sequence

(30xx,08F8) 1 Defines tThe operation state of this Radiation Set. Only a single Item shall be included in this sequence.Zero orOnly one item in the enclosing Treatment RT Radiation Set Reference Sequence (30xx,08F2) shall have a value of IN PROGRESS for RT Operation State (30xx,5051) at a time.Only a single Item shall be included in this sequence.

>>>Include 'RT Operation State Macro' Table C.AA.2.4-1>>Referenced RT Radiation Record Sequence

(30xx,08FF) 2C The RT Radiation Records, which have been created in the course of delivery.Zero or more Items shall be included in this sequence.

>>>Include 'SOP Instance Reference Macro' Table 10-11>>Treatment RT Radiation Set Relation Sequence

(30xx,08FA) 1C Defines tThe relation to another Treatment RT Radiation Sset within this Treatment RT Radiation Set Reference Sequence (30xx,08F2) of this Meta Radiation Set to denote the reason for retiring the referenced Treatment RT Radiation Set item.Required if the Treatment RT Radiation Set Reference Sequence (30xx,08F2) has more than one item and this item in the RT Treatment RT Radiation Set Reference Sequence (30xx,08F2) is not the first item in the sequence.Only a single Item shall be included in this sequence.


Attribute Name Tag Type Description>>>Treatment RT Radiation Set Sequence Number

(30xx,08F4) 1 References the previous Treatment RT Radiation Set identified by the RT Treatment RT Radiation Set Sequence Number (30xx,08F4) within theis actual RT Treatment RT Radiation Set Reference Sequence (30xx,08F2). References to other Meta RT Radiation Sets are not permitted.Defines the previous Treatment RT Radiation sSet that was altered to form this radiation set.

>>>Treatment RT Radiation Set Alteration Type Sequence

(30xx,08FC) 1C2 Defines the nature type of the changes when this radiation set was altered.Required if Treatment Radiation Set referenced by Treatment RT Radiation Set Sequence Number (30xx,08F4) was altered.Zero or more Items shall be included in this sequence.

>>>>Include 'Code Sequence Macro Table 8.8-1 Defined CID SUP147014.>>>Treatment RT Radiation Set Change Description

(30xx,08FE) 2 User- defined description of the change to the RT Radiation Set.

Notes: 1. The Treatment RT Radiation Set Reference Sequence (30xx,08F2) sequence of radiation sets supports versioning of radiation sets. The typical situations to cover are small adaptations (perhaps after a few days, or daily) of a radiation set without changing the beam layout, treatment technique etc. Typically, the hHigher numbers in the Treatment RT Radiation Set Sequence Number (30xx,08F4) denote RT rRadiation sSet references that have been added later, and . See Treatment RT Radiation Set State Sequence (30xx,08F6) tnormally the latest one is in treatment. However, those numbers only serve as a first-level ordering scheme. o determine the state information of the Treatment Radiation Set. See Treatment Phases (blablabla) for The binding state information of the Treatment RT Radiation Sets contained in this sequence is handled by the state macros of this sequence. Note that different treatment phases, different treatment targets, fractionation patterns, etc are covered by treatment phases and not covered within this sequence but by Treatment Phases.

C.AA.A6.1 RT Radiation Set Reference Attribute Description C.AA.A6.1.1 RT Item State Macro MeaningsThe meaning of the following codes is specialized in the RT Radiation Set State Sequence of the Pre-Treatment RT Radiation Set Sequence.

For the states listed in the following, further annotations are provided, how the definitions in ANNEX D, DICOM CONTROLLED TERMINOLOGY DEFINITIONS shall be applied in this context:

Usage for Pre-Treatment RT Radiation Set:

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed for use to define initial geometric setup for the planning step.

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A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is approved to be used to define initial geometric setup for the planning step.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set has been rejected and shall not be used as planning input.

The meaning of the following codes is specialized in the Treatment RT Radiation Set Sequence.

Usage for Treatment RT Radiation Set:

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed for use for treatment.

A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is ready for treatment.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set shall not be used for treatment.

C.AA.A6.1.2 Radiation Set Start DelayC.AA.A6.1.2.1 Radiation Set Start Delay OverviewThe Radiation Set Start Delay (30xx,08C6) describes the minimum delay in days after the beginning of the treatment phase. Treatment will be on next available non-zero day of the fractionation pattern.

The Radiation Set Start Delay (30xx,08C6) belongs to the Radiation Set Reference module, while the Fraction Pattern is defined at the Radiation Set level. The Radiation Set Start Delay (30xx,08C6) is counted from the Treatment Phase start. The Treatment Phase groups one or more Radiation Sets. Hence, Radiation Set Start Delay (30xx,08C6) can be used to individually shift Radiation Sets within their Treatment Phase.

RT Course IOD RT Radiation IOD

RT Treatment Phase Module


Module

+ Radiation Set Start Delay

RT Radiation Set IOD

+ Fraction Pattern+ Number of Fraction Pattern Digits Per Day+Repeat Fraction Cycle Length

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If a Fractionation Pattern (300A,007B) contains one or more zeros starting on the week day of the first day following the Radiation Set Start Delay (30xx,08C6), then treatment starts at the first occurrence of 1 in the pattern.

C.AA.A6.1.2.2 Examples of Radiation Set Start Delaya) Scenario 1: Single Fraction Each Day

Description: First Calender Day of Phase Start is Wednesday. The Delay for Start of Treatment is defined as 1 day.

Attributes:

Number of Fraction Pattern Digits per Day = 1

Repeat Fraction Cycle Length = 1

Fraction Pattern = 1111100

Radiation Set Start Delay = 1

Result: Radiation Set treatment begins Thursday.

Day of the week

Mo Tu We Th Fr Sa Su Mo Tu We

Th Fr Sa Su Mo

Pattern 1 1 1 1 1 0 0 1 1 1 1 1 0 0 1

Phase start: Wednesday

Delay 1 day

Actual Treatmen

t

1 1 0 0 1 1 1 1 1 0 0 …

Result: Radiation Set treatment begins the next treatment day as defined by the pattern which is Thursday.

b) Scenario 2: Single Fraction Every Other Day

Description: First Calendar Day of Phase Start is Wednesday. The Delay for Start of Treatment is defined as 3 days. 0 or 1 fractions are scheduled per day, along the pattern 1 fraction on Monday, Wednesday, Friday:

Attributes:

Number of Fraction Pattern Digits Per Day = 1




Day of the week


Th Fr Sa Su M

Pattern 1 0 1 0 1 0 0 1 0 1 0 1 0 0 1

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2010

2012

2014

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2018

2020

2022

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2026



Delay 3 days


Actual Treatmen

t

0 0 1 0 1 0 1 0 0 …

Result: Radiation Set treatment begins the next treatment day as defined by the pattern after Saturday which is Monday of the following week.

c) Scenario 3: Varying Fractions Every Other Day

Description: Same as Scenario 2, but with varying fractions per day

Note: Readers should not focus on the clinical relevance of the pattern in this scenario. The scenario is provided as follows to illustrate the role purpose of the attributes.

Attributes:

Number of Fraction Pattern Digits Per Day = 2




Day of the week


Th Fr Sa Su M

Pattern 01 00 11 00 10 00 00 01 00 11 00 10 00 00 01


Delay 3 days

Actual Treatmen

t

00 00 01 00 11 00 10 00 00 …

Result: Radiation Set treatment begins the next treatment day as defined by the pattern after Saturday which is Monday afternoon of the following week.

C.AA.A7 RT Course Associated Instance Reference ModuleThe RT Course Associated Instance Reference Module contains information about other instances relevant to this course. This list of references provides the facility to reference SOP instances, which are not referenced directly in the RT Course IOD. The Instance Reference Purpose Code Sequence (30xx,0901) annotates the role purpose the references play in the scope of that an RT Course.

Table C.AA.A7-1 RT COURSE ASSOCIATED INSTANCE REFERENCE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRT Course Associated Instance Reference Sequence

(30xx,0900) 1 References to other SOP instances of any SOP class supporting specific use cases, with the role or purpose of those instances.One or more Items shall be included in this sequence.

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Attribute Name Tag Type Description>Associated Instance State Sequence

(30xx,0903) 1C Defines tThe state of this associated instance.Required if this instance has a state has been defined in the context of the current is RT Course.Only a single Item shall be included in this sequence.

>>Include 'RT Item State Macro’ Table C.AA.2.3-1 Defined CID for the Assertion Code Sequence (30xx,50A0) shall be SUP147043.

>Instance Reference Purpose Code Sequence

(30xx,0901) 1 The purpose or role of the RT Course Associated Instance Reference Sequence item.Only a single Item shall be included in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147020.>Include 'SOP Instance Reference Macro' Table 10-11

C.AA.B1 RT Physician Intent ModuleThe RT Physician Intent Module contains information about the overall intent of the treatment. The data are mostly descriptive text and allow freely formulated advice by the physician along the established nomenclature of the actual institution.

Table C.AA.B1-1 RT PHYSICIAN INTENT MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRT Treatment Phase Presence Flag

(30xx,0806) 1 Defines wWhether an RT Treatment Phase Intent definition is present.Enumerated Values:

YESNO

RT Physician Intent Sequence (30xx,0912) 1 Sequence of Items representing Physician Intents.One or more Items shall be included in this sequence.See C.AA.B1.1.1

>RT Physician Intent Index (30xx,0913) 1 Index of the RT Physician Intent in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

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Attribute Name Tag Type Description>RT Treatment Intent Type (30xx,0914) 2 Type of treatment intent.

Defined Terms:CURATIVEPALLIATIVEPROPHYLACTIC

>RT Physician Intent Narrative (30xx,0915) 2 Narrative of RT Physician Intent.

>RT Physician Intent Predecessor Sequence

(30xx,0910) 1C Reference to the RT Physician Intent SOP Instance which was replaced by current Physician Intent.Required if this RT Physician iIntent replaces a previous version.Only a single Item shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>>Supersession Reason (30xx,0917) 2 Reason that the previous RT

Physician Intent was superseded by the current SOP Instance.

>RT Protocol Code Sequence (30xx,0916) 12C The protocol(s) to be used. Required if this RT Physician iIntent is based on a known protocol. Zero One or more Items shall be included in this sequence.See C.AA.B1.1.2.

>>Include 'Code Sequence Macro’ Table 8.8-1 No Baseline Context Group ID defined>RT Diagnosis Code Sequence (30xx,0918) 2C Diagnostic codes to describe the

disease condition handled by this RT Physician iIntent. Required if a diagnosis code is known. Zero or more Items shall be included in this sequence.See Note 1.

>>Include 'Code Sequence Macro’ Table 8.8-1 No Baseline CID is defined>RT Diagnostic Image Set Sequence

(30xx,091A) 2 References to the Iimages SOP Instances or reference to frames from multi-frame Image SOP Instances used in the definition of the initial to make the diagnosis.Zero or more Items shall be included in this sequence.Only a single Item shall be included in this sequence.See C.AA.B1.1.3.

>>Include 'Image SOP Instance Reference Macro' Table 10-3

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Notes 1. The RT Diagnosis Code Sequence (30xx,0918) may contain clinical codes, which are used at the prescription state and for other categorization purposes of the diagnosis covered by that Intent like charging. There is no specific baseline CID recommended. Possible coding schemes that could be used include ICD-10 (i10) or SNOMED (SRT). ICD-10 is widely used in the USA, while SNOMED is the preferred DICOM classification. However, any other coding schemes are applicable as well if preferred by the user.

C.AA.B1.1 RT Physician Intent Attribute DescriptionC.AA.B1.1.1 RT Physician Intent SequenceThe RT Physician Intent Sequence allows one or more clinical intents to be identified for treatment in a single temporal period (e.g. a treatment course). For example, the simultaneous treatment of multiple primary targetsies would may usually require separate intents to be defined, each with its own prescription(s) and having different sets of reference imaging studies.

C.AA.B1.1.2 RT Protocol Code SequenceRT Protocol Code Sequence (30xx,0916) contains a coded description of the radiotherapy clinical protocol the patient is being followed for the patienting. This is not necessarily the same as the Procedure Step protocol.

C.AA.B1.1.3 RT Diagnostic Image Set SequenceDiagnostic image references contained in the RT Diagnostic Image Set Sequence (30xx,091A) shall reference images which were present when the initial diagnosis was established. Images used in treatment planning for radiotherapy treatments are referenced in the RT Prescription Module. If those are the same images, they shall be referenced at both places.

C.AA.B2 RT Prescription ModuleThe RT Prescription Module contains the prescription(s) by the physician to define the intended treatment for a specific target. The content of this module consists mainly of descriptive text and allows to freely formulating advice by the physician along the established nomenclature of the institution.

Table C.AA.B2-1 RT PRESCRIPTION MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRT Prescription Sequence (30xx,0940) 1 Prescriptions to deliver therapeutic

radiation.One or more Items shall be included in this sequence.

>RT Prescription Label (30xx,0902) 1 User defined label for this prescription.See C.AA.2.1.1.1.

>Prescription Index (30xx,0118) 1 Index of the Prescription in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

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2076

2078

2080

2082

2084

2086


Attribute Name Tag Type Description>Referenced RT Physician Intent Index

(30xx,0919) 1C The value of Reference Reference to the RT Physician Intent Index (30xx,0913) in the RT Physician Intent Sequence (30xx,0912) corresponding to the intent for which this prescription is created.Shall not be present if a Parent RT Prescription Index (30xx,0149) is present.See C.AA.B2.1.9.

>Parent RT Prescription Index (30xx,0149) 2C The value of Reference to the Prescription Index (30xx,0118) corresponding to a Reference to a prescription that represents a is the parent prescription to this one.Shall not be present if the Referenced RT Physician Intent Index (30xx,0919) is present or if the referenced prescription contains a Parent RT Prescription Index (30xx,0149).See C.AA.B2.1.9.

>Referenced Dosimetric Objectives Sequence

(30xx,0951) 1C Sequence of Items referencing References to Dosimetric Objectives that are dosimetrically relevant to this prescription.Required if Dosimetric Objectives are defined for this prescription.One or more Items shall be included in this sequence.

>>Referenced Dosimetric Objective UID

(30xx,0949) 1 Reference to a Dosimetric Objective UID (30xx,0948) in the RT Anatomic Prescription Sequence (30xx,0920), identifying the anatomic prescription for this sequence.

>Referenced Treatment Phase SequenceTreatment Phase Reference Sequence

(30xx,0870) 1C Referenced treatment phase(s) to which this prescription applies., and which The referenced treatment phases will contain the radiation sets for the treatments administered by this prescription.Required if RT Treatment Phase Presence Flag (30xx,0806) of this RT Physician Intent SOP instance equals YES.One or more Items shall be included in this sequence.

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Attribute Name Tag Type Description>>Referenced Treatment Phase Index

(30xx,0146) 1 The value of Reference Reference to the Treatment Phase Index (30xx,0116) corresponding to a treatment phase where to which this prescription does appliesy to.

>Fraction-Basedation Relationship Sequence

(30xx,0982) 2 Fraction-based relationship to another prescription.Zero or one Item shall be included in this sequence.See C.AA.B2.1.8.

>>Referenced RT Prescription Index

(30xx,0148) 1 The value of Reference to the Prescription Index (30xx,0118) corresponding to a prescription The referenced prescription to which the current prescription is related.

>>Temporal Fraction-Based Relationship Interval Anchor

(30xx,0984892)

1 The anchor point of this RT Prescription Sequence Item with respect to the prescription referenced by Referenced RT Prescription Index (30xx,0148).Enumerated Values:

START: The interval is specified with respect to the start of the reference prescription.

END: The interval is specified with respect to the end of the reference prescription.

>>Number of Fractions (30xx,0972) 1 The number of fractions with respect to Fraction-BasedTemporal Relationship Interval Anchor (30xx,09840892) when the delivery of current prescription should be started.If Fraction-BasedTemporal Relationship Interval Anchor (30xx,09840892) equals START, this is the number of fractions after the first fraction of the delivery of the referenced prescription, when the delivery of the current prescription should start.If Fraction-BasedTemporal Relationship Interval Anchor (30xx,09840892) equals END, this is the number of fractions prior to the last fraction of the delivery of the referenced prescription, when the delivery of the current prescription should start.


Attribute Name Tag Type Description>Prior Dose Description (30xx,0924) 3 Description of dose previously

delivered to the patient.

>Prior Dose Reference Sequence

(30xx,0925) 2 Reference to RT Dose Image or RT Dose SOP Instance representing dose previously delivered to the patient, that may be used to evaluate dosimetric objectives for this prescription.Zero or more Items shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11’>>Prior Dose Description (30xx,0924) 3 Description of dose previously

delivered to the patient.

>Planning Input Information Sequence

(30xx,0960) 12C Instances which are intended to be used for the planning process. Required if planning process shall should be advised to use based on input information from certain objects like images and Segment RT Annotations for the planning process. Zero One or more Items shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>General Prescription Notes (30xx,0970) 2 Notes on this prescription in general.

>Number of Fractions (30xx,0972) 2 Number of Fractions in this prescription.

>Intended Delivery Duration (30xx,0973) 2 Number of days across which the fractions in this prescription bed here shall will be delivered.

>Fractionation Description (30xx,0974) 2 Description of the fractionation approach (Bi-fractionation, Breaks, Hyper-fractionation, etc.) to be used.

>Include 'Radiation Fraction Pattern Macro' Table C.AA.2.9-1>Treatment Technique Description

(30xx,0966) 2 Description of the treatment technique to be used.In case Radiotherapy Procedure Technique Code Sequence is present this description shall be consistent with the technique code.

>Radiotherapy Procedure Technique Code Sequence

(30xx,0C99) 2 The Coded treatment technique that should to be used for treatment.Zero or one Item shall be included in this sequence.


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Attribute Name Tag Type Description>Prescription Annotation Sequence

(30xx,0978) 1C3 Further Additional aAnnotations to the about preparation and execution of the treatment covered by this prescription.Required if there are annotations for the prescription.One or more Items shall are permittedbe included in this sequence.

>>Include 'Content Item Macro' Table 10-2 Defined TID is SUP147001 RT Prescription Annotation

>>Prescription Annotation DateTime

(30xx,0979) 12 Date and time on which the annotation was made.

RT Anatomic Prescription Sequence

(30xx,0920) 1 Prescriptions for Conceptual Volumes defining an anatomic regiony.One or more Items shall be included in this sequence.

>Anatomy Label (30xx,0922) 1 Descriptive definition on of the anatomic regiony.

>Conceptual Volume Sequence (30xx,1346) 1 Reference to a cConceptual vVolume which identify defines the anatomic regions etc. for which where therapeutic goals are prescribed against. See C.AA.B2.1.4.Only a single Item shall be included in this sequence. Each Conceptual Volume UID (30xx,1301) shall appear only appear once in the RT Anatomic Prescription Sequence (30xx,0920) that sequence.

>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1>Prescription Anatomy Notes (30xx,0928) 2C Additional notes on what to pay

attention to in with respect to the definition of dosimetric objectives for this anatomy.Required if the Dosimetric Objective Sequence (30xx,0942) is empty. May be present otherwise.


Attribute Name Tag Type Description>Prescription Anatomy Role Type

(30xx,0930) 1 The radiotherapeutic designation of the anatomic regiony. See C.AA.B2.1.5.Defined Terms:

TARGETOARAVOIDANCEDOSE_SHAPINGCONFORMALITY_SHELLOTHER

See C.AA.B2.1.5.

>Radiobiological Structural Type (30xx,0932) 2 The radiobiological structural type of the anatomic regiony.See C.AA.B2.1.6.Enumerated Values:

SERIALPARALLELOTHER

See C.AA.B2.1.6.

>Conceptual Volume Optimization Precedence

(30xx,0933) 2 Integer (1-n) used in dose optimization to resolve ownership of regions from two Conceptual Volumes that overlap. Regions shall belong to the Conceptual Volume with the lowest value of this attribute.

>Conceptual Volume Optimization Blocking

(30xx,0935) 1 Specifies wWhether or not primary radiation shall is not be allowed to pass through the cConceptual vVolume when performing a dose optimization.Enumerated Values:

NONE = No restrictionsUPSTREAM = Primary

radiation not permitted prior to reaching target

DOWNSTREAM = Primary radiation not permitted after passing through target

TOTAL = No primary radiation permitted

>Anatomy Category Code Sequence

(30xx,0934) 2 Sequence defining tThe general category of this anatomy for radiotherapy purposes.Zero or one Item shall be included in this sequence.

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Attribute Name Tag Type Description>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147002.

>Anatomy Property Type Code Sequence

(30xx,0936) 2 Sequence defining tThe specific property type of this anatomy for radiotherapy purposes.Zero or one Item shall be included in this sequence.See C.AA.B2.1.1.

>>Include 'Code Sequence Macro' Table 8.8-1 See C.AA.B2.1.1.>Alternate Segmented Property Type Code Sequence

(30xx,134E) 3 Sequence defining aAlternate specific property types of this segment for radiotherapy purposes.One or more Items are permitted in this sequence.See C.AA.D1.1.2.

>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.>>Purpose of Alternate Segmented Property Type Code Sequence

(30xx,134F) 3 Identifies tThe purpose for which the identification code is assigned.Only a single Item is permitted in this sequence.See C.AA.D1.1.2.

>>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.>Dosimetric Objective Sequence

(30xx,0942) 12C Objectives applicable for this anatomy.Required if objectives are known for this anatomy.Zero One or more Items shall be included in this sequence.

>>Dosimetric Objective UID (30xx,0948) 1 A UID by which a Dosimetric Objective can be cross-referenced between prescriptions.Required, if Type of Prescription (30xx,0944) is CONSTRAINTS.See C.AA.B2.2.

>>Originating SOP Instance Reference Sequence

(30xx,1302) 1C Reference to the SOP Instance that contains the original definition of this Dosimetric Objective identified by Dosimetric Objective UID (30xx,0948).Required when the Dosimetric Objective UID (30xx,0948) was not issued in the current SOP Instance, but read from another SOP instance.Only a single Item shall be included in this sequence.

>>>Include 'SOP Instance Reference Macro' Table 10-11


Attribute Name Tag Type Description>>Dosimetric Objective Value Type Code Sequence

(30xx,0943) 1 The type of dose objective which this item represents.Only a single Item shall be included in this sequence.

>>>Include ‘Code Sequence Macro' Table 8.8-1 Defined CID SUP147001.>>Dosimetric Objective Parameter Sequence

(30xx,0950) 2 Parameters of the objective. Zero or more Items shall be included in this sequence.See C.AA.B2.1.2

>>>Dosimetric Objective Parameter Index

(30xx,0119) 1 Index of the Dosimetric Objective Parameter in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

>>>Include 'Content Item Macro' Table 10-2 See C.AA.B2.1.2>>Dosimetric Objective Preservation

(30xx,0954) 1 Defines, whether the objective has to be preserved under all conditions or not.Enumerated Values:

ABSOLUTE = Objective shall be attained under all conditions

NOT_ABSOLUTE = Objective is desired, but may be not be met under all conditions.

>>Dosimetric Objective Priority (30xx,0956) 1C Objective Penalty Weight (Importance). A higher value means that this objective is more important. Values are not scaled in absolute terms, but are scaled across the items in this sequence.Required if Dosimetric Objective Preservation (30xx,0954) is NOT_ABSOLUTE.See C.AA.B2.1.7.

128


Attribute Name Tag Type Description>>Dosimetric Objective Priority Type

(30xx,0958) 2C The type of priority, which defines how the priority shall be used.Shall be present, when Dosimetric Objective Priority (30xx,0956) is present.Enumerated Values:

OPTIMIZATION = used as an input to the optimization process

EVALUATION = used as a tool for evaluation

BOTH = used as both OPTIMIZATION and EVALUATIONSee C.AA.B2.1.7.

>>Dosimetric Objective Evaluation Including Prior Dose

(30xx,0926) 1 Dosimetric objective is to be evaluated including prior dose delivered to the patient. Enumerated Values:

YESNO

See C.AA.B2.2.

C.AA.B2.1 RT Prescription Attribute DescriptionC.AA.B2.1.1 Anatomy Property Type Code SequenceThe Anatomy Property Type Code Sequence (30xx,0936) further specifies the anatomy along the Anatomy Category. The following conditions apply to the codes permitted in the Anatomy Property Type Code Sequence (30xx,0936), when the code used in the Anatomy Category Code Sequence (30xx,0934) is as follows:

Value of Conceptual Volume Category Code Sequence (S147050, 99SUP147, “Target”): Defined CID for Property Type shall be SUP147004.

C.AA.B2.1.2 Dosimetric Objective Parameter SequenceA dosimetric objective for optimization is described by specifying a functional identity (defined by the Dosimetric Objective Value Type Code Sequence (30xx,0943) using CID SUP147001) for the objective and a sequence of zero or more parameters necessary to quantify the objective (Dosimetric Objective Parameter Sequence (30xx,0950)) as defined in the following.

C.AA.B2.1.2.1 Single Dose ParameterIf the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147060 Single Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameter.

Dosimetric Objective Parameter

Index (30xx,0119)

Concept Name Code Value Type Measurement Units Code

1 EV (S147025, NUMERIC Units = EV

2088

2090

2092

2094

2096

2098

2100

2102

2104


99SUP147, “Dose Parameter”)

(Gy,UCUM,”Gray”)

C.AA.B2.1.2.2 Percentage and Dose ParameterIf the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147061 Percentage and Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameters.


Index (30xx,0119)


1 EV (S147027, 99SUP147, “Percent Parameter”)

NUMERIC Units = EV (%,UCUM,”Percent”)

2 EV (S147025, 99SUP147, “Dose Parameter”)

NUMERIC Units = EV (Gy,UCUM,”Gray”)

C.AA.B2.1.2.3 Volume and Dose ParameterIf the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147062 Volume and Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameters.


Index (30xx,0119)


1 EV (S147026, 99SUP147, “Volume Parameter”)

NUMERIC Units = EV (cm3,UCUM,”Cubic Centimeter”)

2 EV (S147025, 99SUP147, “Dose Parameter”)


C.AA.B2.1.2.4 Unitless and Dose ParameterIf the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147063 Dimensionless and Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameters.


Index (30xx,0119)


1 EV (S147028, 99SUP147, “Numeric

NUMERIC Units = EV (1,UCUM,”no units”)

130

2106

2108

2110

2112

2114

2116

2118


Parameter”)2 EV (S147025,

99SUP147, “Dose Parameter”)


C.AA.B2.1.2.5 Coded ParameterIf the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147064 Coded Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following coded parameter.

Coding Scheme Designator(0008,0102)

Code Value(0008,0100)

Code Meaning(0008,0104)

CID used inDosimetric Objective Parameter Sequence

(30xx,0950)99SUP147 S147018 Minimize MeterSet Defined CID is

DCID (230) Yes-No

C.AA.B2.1.3 Dosimetric Objective Parameter Sequence ExamplesFor example, to describe the objective of specifying the maximum volume that can receive 50 Gy or more (V50 <= 30%), one would use the Dosimetric Objective Value Type Code Sequence (30xx,0943) with code value Maximum Percent Volume at Dose (S147013) with the parameters specified in the Dosimetric Objective Parameter Sequence (30xx,0950) as follows:

Dosimetric Objective Sequence (30xx,0942): Item 1: Dosimetric Objective Value Type Code Sequence (30xx,0943):

o Item 1: (S147015, 99SUP147, “Maximum Percent Volume at Dose”)o Dosimetric Objective Parameter Sequence (30xx,0950)

o Item 1:o Item Referencing Index (30xx,51E1) = 1o Value Type (0040,A040) = NUMERICo Concept Name Code Sequence (0040,A043)

o Item 1: (S147027, 99SUP147; “Percent Parameter”) o Numeric Value (0040,A30A) = 30o Measurement Units Code Sequence (0040, 08EA)

o Item 1: (%, UCUM, “Percent”)o Item 2:o Item Referencing Index (30xx,51E1) = 2o Value Type (0040,A040) = NUMERICo Concept Name Code Sequence (0040,A043)

o Item 1: (S147025, 99SUP147, “Dose Parameter”)o Numeric Value (0040,A30A) = 50o Measurement Units Code Sequence (0040,08EA)

o Item 1: (Gy, UCUM, “Gray”)

C.AA.B2.1.4 Conceptual Volume SequenceThe Conceptual Volume Sequence (30xx,1346) identifies the Conceptual Volume associated with an RT Anatomy Prescription item. If the Conceptual Volume is associated with a segment, the segment

2120

2122

2124

2126

2128

2130

2132

2134

2136

2138

2140

2142

2144

2146

2148

2150

2152

2154


is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume ReferenceCombination and Segmentation Macro (see section C.AA.2.6). Alternatively, the anatomy volume may not (yet) be associated with a segment. For example, an initial prescription may be entered prior to the definition of an OAR.

C.AA.B2.1.5 Prescription Anatomy RoleTypeThe following table contains the meanings of the Defined Terms for Prescription Anatomy Role Type (30xx,0930):

Defined Term MeaningTARGET Volume containing tissue to intentionally received doseOAR Organ-at-Risk as defined by ICRU 62

AVOIDANCE Volume through which a radiation’s fluence should not passDOSE_SHAPING Volume used to specify a dose constraint

CONFORMALITY_SHELL Surface used to specify a dose constraintOTHER Other volume

C.AA.B2.1.6 Radiobiological Structural TypeThe following table contains the meanings of the Defined Terms for Radiobiological Structural Type (30xx,0932):

Defined Term Meaning

SERIAL Organ structure for which damage to any segment of the organ damages the entire organ

PARALLEL Organ structure for which damage to any segment of the organm damages only that segment

OTHER Other organ structure

C.AA.B2.1.7 Dosimetric Objective Priority Dosimetric objective weights may be used for differing purposes in the treatment planning process. Certain objectives are used to guide the optimization of dosimetric plans by some automatic or semi-automatic process. These objectives may, for example, involve “avoidance” anatomies that influence the optimized dose distributions, but may not have biological significance in themselves.

C.AA.B2.1.8 Fraction-Based Relationship SequenceThe Fraction-Based Relationship Sequence (30xx,0982) allows to specify the relationship of prescriptions to each other.

Additionally the C.AA.B3 RT Treatment Phase Intent Module allows to specify the relationship of treatment phases to each other.

The following example shows a treatment performed in 2 phases, with a break of 7 days between phases.

In Treatment Phase 1, the treatment of Prescription B should start 10 fraction prior to the end of Prescription A.

132

2156

2158

2160

2162

2164

2166

2168

2170

2172

2174

2176

2178

2180


RT Treatment Phase 1: Normal RT Treatment Phase 2: Boost

RT Course

Prescription A (Index 1): PTV-A

Timeline

RT Prescription Sequence (30xx,0940)>Prescription Index (30xx,0118) = 2...>Fraction-Based Relationship Sequence (30xx,0982)>>Referenced RT Prescription Index (30xx,0148) = 1>>Fraction-Based Relationship Interval Anchor (30xx,0984) = END>>Number of Fractions (30xx,0972) = -10

Treatment Phase Interval Sequence (30xx,0890)>Previous Treatment Phase Index (30xx,0116) = 1>Temporal Relationship Interval Anchor (30xx,0892) = END>Minimum Number of Interval Days (30xx,0894) = 7>Maximum Number of Interval Days (30xx,0896) = 7

Prescription C (Index 3): PTV-C

Prescription B (Index 2): PTV-B

Figure C.AA.B2.1-1Relationship of Prescriptions

C.AA.B2.1.9 Parent RT PrescriptionThe RT Prescription Module supports a two level prescription model in order to support an approach where initially a high-level prescription is created and later on in the process more detailed will be added. The first level would typically be created during the time of prescription definition with only high-level prescription information based on the RT Physician Intent. The second level would represent a derived prescription containing more detailed information, such as constraints and objectives.

2182

2184

2186

2188

2190


Figure C.AA.B2.1-2Prescription-Physician Intent Relationship

C.AA.B2.2 Dosimetric Objective ScopeThe scope of a dosimetric objective comprises all objects, where the same Dosimetric Objective UID (30xx,0948) is used. E.g. if 2 prescriptions share the same Dosimetric Objective UID (30xx,0948) for a maximum dose, the value of that objective is applicable across both prescriptions. If 2 prescriptions reference an objective for maximum dose, but each with a different UID, the value applies to the prescriptions separately.

The attribute Dosimetric Objective Evaluation Including Prior Dose (30xx,0926) is only used in situations, where not all patient prescriptions of the past have been covered by Dosimetric Objective sequence items. Otherwise it is sufficient to reference a Dosimetric Objective using the same Dosimetric Objective UID (30xx,0948) as it has been used in prior treatments. This implies, that the scope of that objective includes all prior and the current treatments covered by the prescriptions referencing this UID.

When the Dosimetric Objective Evaluation Including Prior Dose (30xx,0926) has value YES, all prior treatments shall be included in the dosimetric objective. This may also include information not represented by Dosimetric Objective sequence items, such as RT Dose objects, unformatted electronic reports, paper records etc. .

When the attribute has value NO, the scope of the objective does comprise only those prescriptions as defined in the beginning of this section, even if information of prior treatment is available otherwise.

C.AA.B3 RT Treatment Phase Intent ModuleThe treatment phases defined in the actual RT Physician Intent SOP. RT Treatment pPhases define phases of treatment and their temporal relationship.the intended phase time structurerelationship of the prescribed treatment, by defining phases for treatment and the time order of them.

Table C.AA.B3-1RT TREATMENT PHASE INTENT MODULE ATTRIBUTES

134

2192

2194

2196

2198

2200

2202

2204

2206

2208

2210

2212

2214

2216

2218

2220


Attribute Name Tag Type DescriptionTreatment Phase Sequence (30xx,0880) 1 Treatment Phases definitions. for the

current RT Course. The tTreatment pPhases serve as the basis to define the chronological relationship between Rradiation sSets, which are concurrently and/or subsequently treated in a defined relationship to each other.The order of the Treatment Phase Index (30xx,0116) defines the date sequencing of the phases.One or more Items shall be included in this sequence.

>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1Include 'RT Treatment Phase Interval Macro' Table C.AA.2.35-1

C.AA.C1 RT Radiation Set ModuleThe RT Radiation Set Module contains information describing describes treatment fractions, containing a set of beams and/or brachytherapy setups being used within a treatment session to help achieve the dosimetric requirements of a given Treatment pPhase.

It references a set of RT Radiation instances describing the geometrical and physical parameters defining the delivery of dose within a for a single fraction. The whole set defines a fraction of treatment. For those fractions, In addition the overall number of treatments is defined, as well as possibly the interval schema along which those the fractions shall be treated. It also specifies weighting of the beams and brachytherapy setups contained for those fractions.

An RT Radiation Set can be referenced externally for dosimetric purposes. A tTreatment pPhase is achieved by delivering one or more RT Radiation Sets. One or more new RT Radiation Sets may be required each time adaptive therapy is used to attempt to maintain maintaing a phase prescription.

The chronological relationships between RT Radiation Sets (the actual start of each set, the order or timing among sets etc.) are handled outside the RT Radiation Set.

Table C.AA.C1-1 RT RADIATION SET MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionNumber of Fractions (30xx,0972) 1 Number of Fractions.

Include 'Radiation Fraction Pattern Macro' Table C.AA.2.9-1

2222

2224

2226

2228

2230

2232

2234

2236


Attribute Name Tag Type DescriptionRT Radiation Set Intent (30xx,5011) 1 A general indication of the type of

information contained within this RT Radiation Set. This annotation does not specify whether or not the Radiation Set has been approved for that type of use. Defined Terms:

PATIENT_TREATMENTPLAN_QAMACHINE_QARESEARCHSERVICE

See C.AA.C1.1.1.

RT Dose Contribution Presence Flag

(30xx,5012) 1 Indicates whether this object contains an RT Dose Contribution.Enumerated Values

YESNO

Radiation Sequence (30xx,0B26) 1C RT Radiation instances which are referenced by this RT Radiation Set. Required once RT Radiations have been added to this RT Radiation Set. One or more Items shall be included in this sequence.See C.AA.C1.1.2.


C.AA.C1.1 RT Radiation Set Attribute DescriptionC.AA.C1.1.1 Radiation Set TypePATIENT_TREATMENT = The RT Radiation Set has been prepared to be ready for treatment delivery. All parameters necessary to guide the delivery of rRadiations beams are included.

PLAN_QA = The RT Radiation Set has been created for the purpose of validating the dose to be deposited in a patient by delivering the identical beams Radiations to a phantom and comparing the calculated dose to the phantom with actual measurements made in the phantom.

MACHINE_QA= The RT Radiation Set is used for quality assurance procedures of the delivery machine and is not patient specific. It has been created for the purpose of performing system quality assurance and calibration (geometric, dosimetric or both).

RESEARCH = The RT Radiation Set is used in a Rresearch project. It has been created for the purpose of performing independent research on the treatment planning system and/or the delivery system.

SERVICE = The Radiation Set is created by a service technician for machine repair or to perform a maintenance operation.

136

2238

2240

2242

2244

2246

2248

2250

2252


The value of RT Radiation Set Intent does not implicitly specify whether RT Radiation Set has been approved for that type of use.

C.AA.C1.1.2 Radiation SequenceAll SOP Instances referenced in that sequence shall have the same SOP Class.

The SOP Classes permitted to be referenced in this sequence are SOP Classes representing Radiation IODs describing a radiotherapy delivery. The pre-requisite to belong to this type of SOP Class is the presence of the following modules:

The modules specified in Table A.VV.1.1.1-2 RT RADIATION IOD MODULES MACRO.

The RT Delivery Device Common Module specified in section C.AA.E1.

The RT Radiation Common Module specified in section C.AA.E2.

C.AA.C2 RT Dose Contribution ModuleThe RT Dose Contribution module contains information about the contribution of dose of the radiations referenced in by this RT Radiation Set to the patient. Dose contributions refer to the radiations delivering the dose and to anatomies receiving the dose.

Note that an anatomical structure (as defined by the Conceptual Volume Macro) can be a textually tagged definition only, or a reference to a Conceptual Volume defined in the Segment RT Annotation IOD. In any case, Conceptual Volumes are at minimum identified by a UID, which allows accumulation of dose across RT Radiation Sets and comparison with originally prescribed dose objectives.

Dose contributions are defined along the meterset value. The definition points in the lookup table may, but do not need to, align with the meterset valuess at the control points of the RT Radiation SOP Instance. For example, where a dose deposition between control points cannot be determined individually per segment, or where this definition is not useful, the lookup table may just contain the meterset of first and last control points. The meterset and dose contribution of the first control point are always zero.

Where dose contributions are not available at the time ofr rRT Radiation sSet definition and application (e.g. for emergency treatments), thise mModule may be absent. This does not exclude retrospective dose calculation and creation of associated RT Dose Image objects.

Table C.AA.C2-1RT DOSE CONTRIBUTION MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRadiation Dose Identification Sequence

(30xx,0B42) 1 Radiation Dose parameters to identify and scope the dose values that are delivered by this radiation.One or more Items shall be included in this sequence.

>Radiation Dose Identification Index

(30xx,0120) 1 Index of the Radiation Dose Identification in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

2254

2256

2258

2260

2262

2264

2266

2268

2270

2272

2274

2276

2278

2280

2282

2284


Attribute Name Tag Type Description>Radiation Dose Identification Label

(30xx,0B46) 1 User defined label for the radiation dose definition.See C.AA.2.1.1.1.

>Reference Dose Type (30xx,0B48) 1 Defines type of reference dose for the radiation.Defined terms:

NOMINAL: Nominal radiation dose. Dose values are nominally assigned to the individual RT Radiation SOP instances only. Dose may be calculated on the Fraction level only, or otherwise be assigned to individual RT Radiation instance without instance-specific calculations. RADIATION: Dose values carry a representative dose specifically calculated for each referenced RT Radiation SOP instance.

>Reference Dose Point Coordinates

(30xx,0B62) 1C Coordinates of the reference dose in DICOM Patient Coordinate System. If present, the dose values are calculated to the specified point.Required, if dose is calculated at a point.

>Conceptual Volume Sequence

(30xx,1346) 1 Reference to a conceptual volume which receive dose. See C.AA.C2.1.2.Only a single Item shall be included in this sequence. Each Conceptual Volume UID (30xx,1301) shall only appear once in that sequence.

>>Include 'Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1Radiation Dose Sequence (30xx,0B40) 1C SOP instances by which dose is

delivered. Required if Radiation Sequence (30xx,0B26) in the Radiation Set module is present. Exactly the same SOP instance references as present in Radiation Sequence (30xx,0B26) shall be present in this sequence.


138


Attribute Name Tag Type Description>Radiation Dose Values Sequence

(30xx,0B64) 1 Dose values of this actual radiation in respect to the dose identification items defined in the Radiation Dose Identification Sequence (30xx,0B42). The number of Items included in this sequence shall be exactly the number of Items in the Radiation Dose Identification Sequence (30xx,0B42).

>>Referenced Radiation Dose Identification Index

(30xx,0150) 1 The value of Reference to theReference to the Radiation Dose Identification Index (30xx,0120) in the Radiation Dose Identification Sequence (30xx,0B42) within this SOP Instance identifying the dose contribution.

>>Primary Dose Value Indicator

(30xx,0B49) 1 Defines, if the dose value serves as the primary dose indicator for this Radiation Set.Enumerated Values:

YESNO

Exactly one item in the Radiation Dose Values Sequence (30xx,0B64) shall have the value YES.See C.AA.C2.1.3.

>>Dose Type (3004,0004) 1 Type of Dose of the Radiation Dose Values (30xx,0B6C).Defined Terms:

PHYSICALEFFECTIVE

>> Meterset to Dose Mapping Sequence

(30xx,0B68) 1C Sequence of Items containing the Mmapping of Meterset Value (30xx,0B6A) to Radiation Dose Value (30xx,0B6C). Required, if the meterset to dose mapping is known.See C.AA.C2.1.Two or more Items shall be included in this sequence.

>>>Cumulative Meterset (30xx,5021) 1 The meterset value, where the corresponding dose value is delivered as specified in Radiation Dose Values (30xx,0B6C). See C.AA.C2.1.

>>>Radiation Dose Value (30xx,0B7B) 1 The dose value (in Gy) delivered at the corresponding meterset value. See C.AA.C2.1.


Attribute Name Tag Type Description>>Radiation Verification Control Point Sequence

(30xx,0B6D) 2 Sequence of Items containing Radiation Verification Control Points.Zero or more Items shall be included in this sequence.

>>>Cumulative Meterset (30xx,5021) 1 The Cumulative Meterset value, at which the Radiation Verification Control Point Parameters in that sequence item apply, are expressed in units of the Radiation Dosimeter Unit (30xx,5113).

>>>Radiation Dose Value (30xx,0B7B) 1 Cumulative dose value (in Gy) for the Cumulative Meterset (30xx,5021) and the geometric parameters provided in this sequence Item.See C.AA.C2.2.3

>>>Referenced Control Point Index

(30xx,0141) 1C The value of Reference to Value ofthe Control Point Index (30xx,0111) from the Control Point Sequence of the Radiation SOP Instance referenced within this Radiation Dose Sequence Item (30xx,0B40).See C.AA.C2.2.1.Required if the Cumulative Meterset (30xx,5021) corresponds to a Control Point in the Control Point Sequence of the Radiation SOP instance referenced within this Radiation Dose Sequence Item (30xx,0B40)

>>>Reference Dose Point Coordinates

(30xx,0B62) 2 Coordinates (x,y,z) of the reference dose point in DICOM Patient Coordinate System.

>>>Radiation Dose Point Depth

(30xx,0B70) 2C The depth (in mm) in the patient along a ray from the source to the dose point specified by the Reference Dose Point Coordinates (30xx,0B62) from the current Radiation Verification Control Point to the next one.See C.AA.C2.2.2.Required for all items in this sequence but the last one.

140


Attribute Name Tag Type Description>>>Radiation Dose Point Equivalent Depth

(30xx,0B72) 2C The radiological depth (in mm) - water-equivalent depth, taking tissue heterogeneity into account - in the patient along a ray from the source to the dose point specified by the Reference Dose Point Coordinates (30xx,0B62) from the current Radiation Verification Control Point to the next one.See C.AA.C2.2.2.Required for all items in this sequence but the last one.

>>>Radiation Dose Point SSD

(30xx,0B74) 2C Source to patient surface distance (in mm) along a ray from the source to the dose point specified by the Reference Dose Point Coordinates (30xx,0B62) from the current Radiation Verification Control Point to the next one.See C.AA.C2.2.2.Required for all items in this sequence but the last one.

>Radiation Dose In Vivo Measurement Sequence

(30xx,0B76) 1C In vivo measurement reference doses.Required if in vivo measurement doses are calculated for this Radiation SOP Instance.One or more Items shall be included in this sequence.

>>Radiation Dose In Vivo Measurement Label

(30xx,0B78) 1 Label to identify the in vivo measurement point.See C.AA.2.1.1.1.

>>Radiation Dose Central Axis Displacement

(30xx,0B7A) 1C Displacement vector of the point from the central axis (in mm).Required if radiation technique uses a central beam axis.

>>Radiation Dose Value (30xx,0B7B) 1 Dose Value (in Gy) for comparison to the measured dose.

>>Radiation Dose Source-Skin Distance

(30xx,0B7C) 2 Source to patient surface distance along the ray from the source to the in vivo measurement point (in mm).

>>Radiation Dose Measurement Point Coordinates

(30xx,0B7D) 2 Coordinates of the point in the frame of reference as referred to by this Radiation Set SOP Instance.


C.AA.C2.1 RT Dose Contribution Attribute DescriptionC.AA.C2.1.1 Meterset to Dose Mapping SequenceThe Meterset to Dose Mapping Sequence (30xx,0B68) establishes a lookup table of dose values delivered at certain metersets. The first value of Cumulative Meterset (30xx,5021) and of Radiation Dose Value (30xx,0B7B) shall always be zero. The value of Meterset Value in the last item shall be the meterset of the final control point of the referenced RT Radiation. The value of Radiation Dose Value in the last item therefore represents the dose delivered to the referenced anatomy when one fraction is completely delivered. Meterset Values shall be strictly monotonically increasing. Radiation Dose Values shall be monotonically non-decreasing. The actual clinical behavior of the increase of dose between 2two points of the lookup table is in a strict sense unknown, but shall be interpreted as linear, where fractional doses in between 2 points are exposed to the user.

C.AA.C2.1.2 Conceptual Volume SequenceThe Conceptual Volume Sequence (30xx,1346) identifies a Conceptual Volume defining a volume for which dose is tracked during treatments. If the Conceptual Volume is associated with a segment, the segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume ReferenceCombination and Segmentation Macro (see section C.AA.2.6). Alternatively, the dosimetric volume may not be associated with a segment. For example, dose tracking may be specified using a nominal dose to a anatomical region of interest and the tracking coefficients approximated by meterset values.

C.AA.C2.1.3 Primary Dose Value IndicatorThe Primary Dose Value Indicator (30xx,0B49) is intended to be used to indicate the one representative dose value out of the list of doses which is used for display purposes. Typically, this value refers to the primary target, while the other non-primary values may refer to e.g. organs at risk.

C.AA.C2.2 Radiation Verification Control Point DescriptionC.AA.C2.2.1 Referenced Control PointThe number of Items in the Radiation Verification Control Point Sequence is not required to be the same as in the Control Point sequence of the Radiation. A different sampling can be chosen for the Radiation Verification Control Point Sequence, but where the Cumulative Meterset (30xx,5021) of a Control Point of the Radiation is the same it shall be referenced by the Referenced Control Point Index (30xx,0141).

C.AA.C2.2.2 Distance ParametersThe values given in Radiation Dose Point Depth (30xx,0B70), Radiation Dose Point Equivalent Depth (30xx,0B72) and Radiation Dose Point SSD (30xx,0B74) shall always contain average values from the current Radiation Verification Control Point to the next. In case of e.g. an arc therapy, these values reflect the changing depth parameters. In case these distances do not change, e.g. for a static beam treatment, the average value equals the static value under the given geometric conditions.

C.AA.C2.2.3 Radiation Dose ValueThe Radiation Dose Value (30xx,0B7B) represents the cumulative dose delivered from the beginning of radiation delivery to the Cumulative Meterset (30xx,5021).

C.AA.D1 RT Segment Annotation ModuleThe RT Segment Annotation Module references segments and provides radiotherapy-specific annotations for them. The geometry of each segment is defined by a referenced Segmentation, Surface Segmentation, or RT Structure Set instance. Any segment-related information used in radiotherapy shall only be derived from a RT Segment Annotation object. The referenced instances

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shall not be used to supply any information that is unspecified in the RT Segment Annotation. Only the geometric definition of the segments shall be extracted from the referenced instances.

Table C.AA.D1-1RT SEGMENT ANNOTATION MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionSegment Sequence (0062,0002) 1 Segments described in this module.

One or more Items shall be included in this sequence.

>Segment Index (30xx,0121) 1 Index of the Segment used for internal or external references.The value shall start at 1, and increase monotonically by 1.

>Include ‘RT Entity Long Labeling Macro’ Table C.AA.2.2-1>Segmented Property Category Code Sequence

(0062,0003) 1 Sequence defining the general category of this segment for radiotherapy purposes.Only a single Item shall be included in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147003.>Segmented Property Type Code Sequence

(0062,000F) 1 Sequence defining the specific property type of this segment for radiotherapy purposes.Only a single Item shall be included in this sequence.See C.AA.D1.1.3.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID is defined in C.AA.D1.1.3.

>Alternate Segmented Property Type Code Sequence

(30xx,134E) 3 Sequence defining alternate specific property types of this segment for radiotherapy purposes.One or more Items are permitted in this sequence.See C.AA.D1.1.2.

>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.>>Purpose of Alternate Segmented Property Type Code Sequence

(30xx,134F) 3 Identifies the purpose for which the identification code is assigned.Only a single Item is permitted in this sequence.See C.AA.D1.1.2.

>>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.>Segmentation Template Label

(30xx,1332) 3 Label for the template that was used when defining the segmentation.

>Segmentation Template UID (30xx,1334) 3 Unique identifier of the template that was used when defining the segmentation.

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Attribute Name Tag Type Description>Segmented RT Accessory Device Sequence

(30xx,1349) 2 Describes an RT accessory device, if the segment represents such a device.See section C.AA.D1.1.4.Zero or more shall be included in this sequence.

>>Include 'RT Accessory Device Identification Macro' Table C.AA.2.15-1


>>Device Index (30xx,0112) 1 Index of the Device.The value shall start at 1, and increase monotonically by 1.

>Segment Properties Sequence

(30xx,134B) 3 Segment properties associated with the current segment’s interpretation.One or more Items are permitted in this sequence.See C.AA.D1.1.7.

>>Include 'Content Item Macro' Table 10-2’ Defined TID of Concept Name Code Sequence is TID SUP147003.

>>Segment Properties Modifier Sequence

(30xx,134B) 3 Physical properties modifier for the property.One or more Items are permitted in this sequence.See C.AA.D1.1.7.

>>>Include 'Content Item Macro' Table 10-2 No Baseline defined.>Recommended Display Grayscale Value

(0062,000C) 3 A default single gray unsigned value in which it is recommended that the maximum pixel value in this surface be rendered on a monochrome display. The units are specified in P-Values from a minimum of 0000H (black) up to a maximum of FFFFH (white).Note: The maximum P-Value for this Attribute may be different from the maximum P-Value from the output of the Presentation LUT, which may be less than 16 bits in depth.

>Recommended Display CIELab Value

(0062,000D) 3 A default triplet value in which it is recommended that the surface be rendered on a color display. The units are specified in PCS-Values, and the value is encoded as CIELab.

>Recommended Presentation Opacity

(0066,000C) 3 Specifies the opacity in which it is recommended that the surface be rendered.See C.27.1.1.3.

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Attribute Name Tag Type Description>Recommended Presentation Type

(0066,000D) 3 Specifies the representation type in which it is recommended that the surface be rendered.See C.27.1.1.3.

>Direct Segment Reference Sequence

(30xx,1343) 1C Identifies the segment geometric definition in the SOP instance referenced in the Segmentation SOP Instance Reference Sequence (30xx,1331).Shall not be present, if Combination Segment Reference Sequence (30xx,1344) is present.Only a single Item shall be included in this sequence. Each Conceptual Volume UID (30xx,1301) shall only appear once in that sequence.See C.AA.D1.1.5.

>>Include 'Conceptual Volume Macro' Table C.AA.2.5-1>>Referenced ROI Number (3006,0084) 1C The value of Reference to the ROI

Number (3006,0022) Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020) corresponding to the ROI annotated by this item.Required if Referenced SOP Class UID (0008,1150) in Segmentation SOP Instance Reference Sequence (30xx,1331) has the value of “1.2.840.10008.5.1.4.1.1.481.3” (RT Structure Set).

>>Referenced Segment Number

(0062,000B) 1C The value of Reference to the Segment Number (0062,0004)Uniquely identifies the segment described in the Segment Sequence (0062,0002) by reference to the Segment Number (0062,0004) corresponding to the segment annotated by this item. Referenced Segment Number (0062,000B) shall not be multi-valued.Required if Referenced SOP Class UID in Segmentation SOP Instance Reference Sequence (30xx,1331) has the value of either “1.2.840.10008.5.1.4.1.1.66.4” (Segmentation IOD) or “1.2.840.10008.5.1.4.1.1.66.5” (Surface Segmentation IOD).


Attribute Name Tag Type Description>>Referenced Segmentation Instance Index

(30xx,1351) 1 The value of Reference to theReferences the Segmentation Instance Index (30xx,1350) in Segmentation SOP Instance Reference Sequence (30xx,1331) corresponding to defining the SOP instance this Direct Segment Reference refers to.

>Combination Segment Reference Sequence

(30xx,1344) 1C Identifies the segment geometric definition in the SOP instance referenced in the Segmentation SOP Instance Reference Sequence (30xx,1331), when this segment is a combination of other segments present in the Segment Sequence (0062,0002).Shall not be present, if Direct Segment Reference Sequence (30xx,1343) is present.Only a single Item shall be included in this sequence. Each Conceptual Volume UID (30xx,1301) shall only appear once in the Segment Sequence (0062,0002).See C.AA.D1.1.6.


The value of Conceptual Volume Combination Flag (30xx,1309) shall be YES,The value of Conceptual Volume Segmentation Defined Flag (30xx,1311) shall be YES.

Segmentation SOP Instance Reference Sequence

(30xx,1331) 1 Identifies the SOP Instance, which is augmented by the content of the SOP Instance including this module.One or more Items shall be included in this sequence. For further information, see section C.AA.D1.1.1.

>Segmentation Instance Index (30xx,1350) 1 Index of the Instance items in the sequence.The value shall start at 1, and increase monotonically by 1.


C.AA.D1.1 RT Segment Annotation DescriptionC.AA.D1.1.1 Segmentation SOP Instance Reference SequenceOnly the following SOP Classes are permitted to be referenced in this sequence:

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Table C.AA.D1.1-1 PERMITTED SOP CLASSES

SOP Class Name SOP Class UIDSegmentation Storage 1.2.840.10008.5.1.4.1.1.66.4

Surface Segmentation Storage 1.2.840.10008.5.1.4.1.1.66.5RT Structure Set 1.2.840.10008.5.1.4.1.1.481.3

In case more than one Item is included in this sequence, all referenced objects shall use the same Frame of Reference UID.

C.AA.D1.1.2 Alternate Segmented Property Type Code SequenceThe Alternate Segmented Property Type Code Sequence (30xx,134E) associates one or more additional identifiers with a segment to support uniform naming of anatomic structures and target volumes for data registries and clinical trials, cross-institutional, cross-application classification for clinical workflow, automated treatment planning, DVH analysis etc. Any relevant Context IDs defined by clinical trial or other organizations may be used in this code.

Examples of the use of the Alternate Segmented Property Type Code Sequence are shown below. In the first example, an anatomic structure representing the right lung of a patient with a right-lung lesion (Segmented Property Type Code of “Lung_R”) is further identified as the ipsi-lateral lung using Alternate Property Type Code of “Lung_Ipsi” as required by Clinical Trial Protocol 1234.

>Segmented Property Category Code Sequence

(0062,0003) (SRT, T-D000A, Anatomical Structure)

>Segmented Property Type Code Sequence

(0062,000F) (CODESCHEME1, Lung_R, Right Lung)


(30xx,134E) (CODESCHEME2, Lung_Ipsi, Ipsi-lateral Lung)

>>Purpose of Alternate Segmented Property Type Code Sequence

(30xx,134F) (CODESCHEME3,CT1234, Clinical Trial Protocol 1234)

In the second example, a Clinical Target Volume (CTV) is further identified as the volume whose prescription dose is 5400 cGy as required by Clinical Trial Protocol 1234.


(0062,0003) (99SUP147, S147050, Target)


(0062,000F) (CODESCHEME1, CTV, Clinical Target Volume)


(30xx,134E) (CODESCHEME2, CTV_5400, CTV 5400 cGy)

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(30xx,134F) (CODESCHEME3, ,CT1234, Clinical Trial Protocol 1234)

In the third example, a Gross Tumor Volume (GTV) is further identified as the Gross Tumor Volume delineated on the Cone-Beam CT image acquired in fraction 3 to support processing of IGRT data in clinical workflow.


(0062,0003) (99SUP147, S147050, Target)


(0062,000F) (CODESCHEME1, GTV, Gross Tumor Volume)


(30xx,134E) (CODESCHEME2, GTV_CBCT3, GTV delineated on fraction 3 CBCT)


(30xx,134F) (CODESCHEME3, IGRT Target, Target Segmented on IGRT)

C.AA.D1.1.3 Segmented Property Type Code SequenceIf the Segmented Property Category Code Sequence (0062,0003) has the code value specified in the left column below, the CID for Segmented Property Type Code Sequence (0062,000F) shall be the one specified in the right column below.

Code Value of Category CID for Property Type(S147050, 99SUP147, “Target”) DCID SUP147004 Radiotherapy Targets(S147053, 99SUP147, “Geometrical Information”)

DCID SUP147005 RT Geometric Information

(S147054, 99SUP147, “Fixation or Positioning Device”)

DCID SUP147006 Fixation or Positioning Devices

(S147055, 99SUP147, “Internal Brachytherapy Device”)

DCID SUP147007 Brachytherapy Devices

(S147056, 99SUP147, “Artifical Structure”) BCID 7157 Device Segmentation Types

(S147057, 99SUP147, “Geometric Combination”)

DCID SUP147009 Combination

C.AA.D1.1.4 Segmented RT Accessory Device SequenceA segment represents an RT accessory, when the Segmented Property Category Code Sequence (0062,0003) contains one of the following values:

Value of (S147054, 99SUP147, “Fixation or Positioning Device”)

Value of (S147055, 99SUP147, “Internal Brachytherapy Device”)

Value of (S147056, 99SUP147, “Artificial Structure”)

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C.AA.D1.1.5 Direct Segment Reference SequenceThis sequence defines the reference to the geometric representation of the segment annotated in the actual item of Segment Sequence (0062,0002).

The Conceptual Volume Macro in the Direct Segment Reference Sequence (30xx,1343) establishes the identification of the conceptual volume associated with the segment as referenced in that sequence. Where combination of segments is defined, the Combination Segment Reference Sequence (30xx,1344) shall be used instead.

C.AA.D1.1.6 Combination Segment Reference SequenceThis sequence allows establishing new segments as combinations of other segments. Those other segments are referenced in the Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6).

All Conceptual Volume References in that Macro may reference only segments that are defined in the Direct Segment Reference Sequence (30xx,1343) in the Segment Sequence (0062,0002).

These segments are identified by referencing their corresponding Conceptual Volume UID (30xx,1301) within the Direct Segment Reference Sequence.

At least two sequence Items in the Segment Sequence including a Direct Segment Reference Sequence are required to be present in the Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6).

C.AA.D1.1.7 Segment Properties SequenceIf a property of a segment requires only a single parameter, the parameter is specified by the Content Item in the Segment Properties Sequence (30xx,134B).

If a property of a segment requires more than one parameter, the first parameter is specified by the Content Item in the Segment Properties Sequence (30xx,134B). Subsequent parameters are specified in the Segment Properties Modifier Sequence (30xx,134B). The following table defines the additional parameters for properties having more then one parameter.

Concept in Segment Properties Sequence

Sequence (30xx,134B)

Concept in Segment Properties Modifier

Sequence (30xx,134B)

Unit of Content Item in Segment Properties Modifier Sequence

(30xx,134B)S147161, 99SUP147, "Elemental Composition Atomic Number"

S147163, 99SUP147, “Elemental Composition Atomic Mass Fraction”

Units = EV (ratio, UCUM, "ratio")

C.AA.E1 RT Delivery Device Common ModuleThe RT Delivery Device Common Module contains general information pertaining to the physical device used to deliver the treatment.

Table C.AA.E1-1RT DELIVERY DEVICE COMMON MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionInclude 'Treatment Device Identification Macro' Table C.AA.2.10-1

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Attribute Name Tag Type DescriptionAlternate Treatment Device Sequence

(30xx,5016) 2 Alternate Treatment Devices that are declared as equivalent for delivery purposes.See section C.AA.E1.1.1.Zero or more Items shall be included in this sequence.

>Include 'Treatment Device Identification Macro' Table C.AA.2.10-1Radiation Dosimeter Unit Sequence

(30xx,5113) 1 Measurement unit of machine dosimeter.See section C.AA.E1.1.2.Only a single item shall be present in the sequence.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147055Coordinate System Declaration (30xx,5208) 1 Defines the coordinate system for use

by beam limiting device measurements.Defined Terms:

IEC_BM_LIMIT_DEVSee section C.AA.E1.8.2.1

RT Beam Distance Reference Location

(30xx,5114) 1 Describes the point of reference for the distances measured to various devices within the beam line.Enumerated values:

SOURCE = Distances measured from the source of radiation

ISOCENTER = Distances measured from the isocenter

Beam Limiting Device Definition Distance

(30xx,5210) 1 Distance along the beam line from the RT Beam Distance Reference Location (30xx,5114) to the beam limiting device definition plane. The beam limiting device definition plane shall be normal to the beam line.

Equipment Frame of Reference UID

(30xx,51A0) 1 Frame of Reference identifier for the Treatment Delivery Device. See C.AA.E1.1.3.

Equipment Frame of Reference Description

(30xx,51A1) 3 Informal description of device coordinate system identified by the Equipment Frame of Reference UID (30xx,51A0) used for the Treatment Delivery Device. See C.AA.E1.1.4.

Synchronization Frame of Reference UID

(0020,0200) 3 UID of common synchronization environment. See C.7.4.2.1.1.

Include 'RT Patient Device Support Identification Macro' Table C.AA.2.12-1

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C.AA.E1.1 RT Delivery Device Common Module Attribute DescriptionC.AA.E1.1.1 Alternate Treatment Device SequenceThe Alternate Treatment Device Sequence identifies treatment devices, which may be suited to deliver this radiation in lieu of the primary target machine defined by the top-level invocation of the ‘Treatment Device Identification Macro’. The scope of dosimetry equivalence of treatment delivered by an alternate device is not defined by the standard.

C.AA.E1.1.2 Radiation Dosimeter UnitA Radiation Dosimeter Unit (30xx,5113) of RELATIVE is commonly used for delivery devices where calculation of MU is not possible at the planning stage, but where the radiation is calibrated prior to treatment, using some independent calibration step.

C.AA.E1.1.3 Equipment Frame of Reference UIDThe Equipment Frame of Reference UID (30xx,51A0) uniquely identifies the coordinate system of the Treatment Device.

The Equipment Frame of Reference is always defined for any class of devices that share a common definition. The UID uniquely identifies this coordinate system. The coordinate system is described by a definition of where the origin is located in respect to this class of devices, and how the axes are oriented with respect to those devices. Each RT Delivery Device being called out in one of the IODs using this tag has to specify to which class of Equipment Frame of Reference it belongs, by specifying the Equipment Frame of Reference UID (30xx,51A0) in its Conformance Statement.

The choice of origin for the RT Delivery Device is device-specific. It could be a significant location on the machine such as a machine isocenter. The Equipment Frame of Reference is a right handed system, i.e. the vector cross product of a unit vector along the positive x-axis and a unit vector along the positive y-axis is equal to a unit vector along the positive z-axis. No recommendation is made concerning the orientation of the axes.

Instances of the C-Arm Photon Radiation Storage SOP Class and C-Arm Electron Radiation Storage SOP Class shall use the well-known UID for the IEC FIXED Reference System Frame of Reference.

It is the responsibility of any vendor or organization to provide a precise definition of location and orientation of this coordinate system for a class of devices covered when issuing a new Equipment Frame of Reference UID. Note that the Equipment Frame of Reference Description (30xx,51A1) is an informal annotation only and shall not be used for any normative description of the device coordinate system.

Note also that the use of the Equipment Frame of Reference UID is restricted to the classification of the device coordinate system and shall not be used for any patient-based Frame of Reference UID definition.

C.AA.E1.2 ConformanceC.AA.E1.2.1 Coordinate System DeclarationIf IEC 61217 'Radiotherapy equipment – Coordinates, movements and scales' applies to the delivery device in question (this is true for most C-Arm type devices), this attribute shall equal IEC_BM_LIMIT_DEV.

If this attribute value is not IEC_BM_LIMIT_DEV, the DICOM Conformance Statement of the device shall specify the value of the Defined Term in this attribute. It shall also specify a right-handed coordinate system (RCS). The z-axis shall coincide with the beam axis. If needed, the Conformance Statement shall also specify a leaf entry order for this coordinate system e.g. for IEC: 101, 102, ... 1N, 201, 202, ... 2N.

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C.AA.E2 RT Radiation Common ModuleThe RT Radiation Common Module contains a specification of attributes required by all Radiation IODs that are to be used in an external beam treatment delivery.

Table C.AA.E2-1RT RADIATION COMMON MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRT Radiation Data Scope (30xx,5013) 1 Intended use of this radiation.

Defined Terms:GEOMETRIC = Treatment

simulationDOSIMETRIC = Dosimetric

verificationSee C.AA.E2.1.3.

Radiotherapy Procedure Technique Sequence

(30xx,0C99) 1 Type of treatment technique. Only a single Item shall be included in this sequence.See C.AA.E2.1.1.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID is defined in the IOD including this module

Include 'RT Treatment Position Macro' Table C.AA.2.32-1

See C.AA.E2.1.2

RT Tolerance Set Sequence (30xx,0BA0) 3 A set of tolerance values to be applied to delivery of the Radiation.Only a single Item shall be included in this sequence.

>Include 'RT Tolerance Set Macro' Table C.8.A1.27-1Treatment Time Limit (30xx,0BAD) 2 The expected maximum delivery time

in [sec].See C.AA.E2.1.4.

Treatment Machine Special Mode Sequence

(30xx,0C97) 1C Annotates the mode of operation for treatment machine. Required if a special delivery mode is necessary for treatment.Only one Item shall be included in this sequence.See C.AA.E2.1.5.

>Include 'Code Sequence Macro' Table 8.8-1. Defined CID SUP147017.

C8.A.E2.1 RT Radiation Common Attribute DescriptionC.AA.E2.1.1 Radiotherapy Procedure Technique SequenceThe Radiotherapy Procedure Technique Sequence (30xx,0C99) describes the treatment technique, i.e. how the radiation beam is shaped and targeted. This information is generated from the content of the Radiation SOP instance (especially from the Control Point parameters), and shall be consistent

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with that content. Its primary purpose is to summarize the radiation technique for the end user by means of an established term.

C.AA.E2.1.2 RT Treatment Position MacroThe RT Treatment Position Macro describes how the patient has to be positioned with respect to the delivery device for treatment (Treatment Position).

Item Numbers in the Referenced Control Point Index (30xx,0141) identify the Control Point, at which the treatment position is first applied. In many cases, the treatment position will remain constant throughout the Radiation, therefore the RT Treatment Position Macro will only contain one item with the Referenced Control Point Index (30xx,0141) equal to 1. Otherwise, it will have one item in the Treatment Position Sequence (30xx,5028) for each control point, where the position has changed compared with the previous control point.

No assumptions are made about the behavior of machine parameters regarding the patient position between specified Control Points, and communicating devices shall agree on this behavior outside the current standard.

C.AA.E2.1.3 RT Radiation Data ScopeThe value GEOMETRIC indicates, that the content of the SOP instance has the scope which allows to define geometric definitions, where any dosimetric information is not necessary. This scope is useful when such an object is instantiated in a context, where only geometric treatment parameters are being considered. A typical example is the virtual simulation use case.

C.AA.E2.1.4 Treatment TimesThe Treatment Time Limit (30xx,0BAD) is the maximum time allowed for the accumulated time of radiation delivery to prevent significant overtreatments. Treatment is expected to be terminated upon reaching the Treatment Time Limit as a safety limit independent of the meterset. During actual delivery, fluences or dose rates may vary from nominal settings due to technical reasons. Therefore this limit is expected to include a factor greater than 1 to accommodate variations. The Treatment Time Limit will be greater than the Calculated Treatment Time.

C.AA.E2.1.5 Treatment Machine Mode SequenceThe Treatment Machine Mode Sequence contains a code, which conveys a set of vendor- and machine-specific modes (for example total body irradiation, total skin electron), which alter the allowed range of treatment parameters, set specific safety constraints for machine operations during treatment or similar function.

C.AA.F1 Tomotherapeutic Delivery Device ModuleThe Tomotherapeutic Delivery Device Module contains tomotherapy-specific information pertaining to the physical device used to deliver the treatment, including geometrical parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment.

Table C.AA.F1-1TOMOTHERAPEUTIC DELIVERY DEVICE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionSource-Axis Distance (300A,00B4) 1 Radiation source to Gantry rotation

axis distance of the equipment that is to be used for beam delivery (mm).

Include 'Beam Mode Macro' Table C.AA.2.19-1Include ‘Accessory Holder Definition Macro' Table C.AA.2.26-1

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Attribute Name Tag Type DescriptionTomotherapeutic Leaf Bank Definition Sequence

(30xx,1000) 1 Describes the leaf slot positions for Leaf Banks.One or more Items shall be included in this sequence.

>Leaf Bank Offset (30xx,1001) 1 Offset (in mm) of central axis of Leaf Bank in X-axis of IEC BEAM LIMITING DEVICE coordinate system, relative to the nominal central axis of the delivery machine.

>Number of Leaf Slots (30xx,1002) 1 Number of leaf slots in the current Leaf Bank.See C.AA.F1.1.1.

>Binary MLC Leaf Slot Boundaries

(30xx,1003) 1 Boundaries of beam limiting device (collimator) leaves (in mm) in Y-axis of IEC BEAM LIMITING DEVICE coordinate system. Contains N+1 values, where N is the Number of Binary MLC Leaf Slots.

C.AA.F1.1 Tomotherapeutic Delivery Device Attribute DescriptionC.AA.F1.1.1 Leaf Slot DefinitionA ‘Leaf Slot’ is a channel perpendicular to the binary collimator long axis that can be occluded by a leaf or leaves during treatment. A Leaf Slot could be occluded by a single leaf (for example, in the case of opposing banks of interleaved leaves), or by two leaves (in the case of opposed leaf pairs). The exact nature of these leaves is not described in this module: for beam characterization purposes it is sufficient to model the Leaf Slot dimensions only.

C.AA.F2 Tomotherapeutic Beam ModuleThe Tomotherapeutic Beam Module contains a specification of how a specific tomotherapeutic treatment beam is to be delivered.

Table C.8A.F2-1TOMOTHERAPEUTIC BEAM MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRadiation Particle (30xx,5110) 1 Particle Type of Radiation.

Defined Terms:PHOTONELECTRONPROTON

Maximum Binary MLC Jaw 1 Opening

(30xx,1005) 1 Position (in mm) of Jaw 1 (IEC Y1) edge defining the maximum extent of the opening for the current Beam, as defined by IEC BEAM LIMITING DEVICE coordinate system.

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2514


Attribute Name Tag Type DescriptionMaximum Binary MLC Jaw 2 Opening

(30xx,1006) 1 Position (in mm) of Jaw 2 (IEC Y2) edge defining the maximum extent of the opening at the current Beam, as defined by IEC BEAM LIMITING DEVICE coordinate system.

Tomotherapeutic Nominal Couch Speed

(30xx,1007) 1 Nominal Couch Speed for beam (mm/sec).

Tomotherapeutic Nominal Gantry Period

(30xx,1008) 1C Nominal Gantry Period for beam (seconds).Required if Code Value in Radiotherapy Procedure Technique Sequence (30xx,0C99) is (S147240, 99SUP147, “Helical Beam”). May be present otherwise.

Tomotherapeutic Nominal Delivery Pitch

(30xx,1009) 1C Nominal Delivery Pitch for beam.Required if Code Value in Radiotherapy Procedure Technique Sequence (30xx,0C99) is (S147240, 99SUP147, “Helical Beam”). May be present otherwise.

Tomotherapeutic Control Point Sequence

(30xx,1010) 1 Control points used to model the beam delivery.Two or more Items shall be included in this sequence.

>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1>Beam Mode Index (30xx,0113) 1 Uniquely references the Beam Mode

identified by Beam Mode Index (30xx,0113) in Beam Mode Sequence (30xx,51C0).

>Gantry Roll Continuous Angle (30xx,51B5) 1C Continuous gantry angle of radiation source at the Control Point in IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees).Required as specified in C.AA.16.2.1.1.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.G2.1.4.

>Binary MLC Jaw 1 Opening (30xx,1024) 1C Position (in mm) of Jaw 1 (IEC Y1) edge defining the extent of the opening at the current Control Point, as defined by IEC Beam Limiting Device coordinate system.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.


Attribute Name Tag Type Description>Binary MLC Jaw 2 Opening (30xx,1025) 1C Position (in mm) of Jaw 2 (IEC Y2)

edge defining the extent of the opening at the current Control Point, as defined by IEC Beam Limiting Device coordinate system.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.

>Tomotherapeutic Leaf Open Percentages

(30xx,1030) 1C Percentage of projection time jaw leaves are open during the projection following the Control Point for the current leaf bank. Value multiplicity is equal to Number of Leaf Slots.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.

>Tomotherapeutic Leaf Open Start Percentages

(30xx,1031) 1C Percentage of projection time at which jaw leaves open during the projection following the Control Point for the current leaf bank. Value multiplicity is equal to Number of Leaf Slots.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.andif one or more leaf open times are not symmetrical about the projection center. May be present otherwise.

C.AA.G1 C-Arm Photon-Electron Delivery Device ModuleThe C-Arm Photon-Electron Delivery Device Module contains C-Arm-specific information pertaining to the physical device used to deliver photon and electron treatments, including geometrical parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment.

Table C.AA.G1-1C-ARM PHOTON-ELECTRON DELIVERY DEVICE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionSource-Axis Distance (300A,00B4) 1 Distance (in mm) from the Radiation

source perpendicular to Gantry Roll rotation axis of the equipment that is to be used for beam delivery.

Include 'Beam Mode Macro' Table' C.AA.2.19-1Include 'Beam Limiting Device Definition Macro' Table C.AA.2.20-1Include 'Wedges Definition Macro' Table C.AA.2.22-1Include 'Compensators Definition Macro' Table C.AA.2.24-1

156

2516

2518

2520

2522


Attribute Name Tag Type DescriptionInclude 'Blocks Definition Macro' Table C.AA.2.25-1Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1Include 'General Accessories Definition Macro' Table C.AA.2.27-1Include 'Boluses Definition Macro' Table C.AA.2.28-1

C.AA.G2 C-Arm Photon-Electron Beam ModuleThe C-Arm Photon-Electron Beam Module contains a specification of how a specific C-Arm photon or electron treatment beam is to be delivered.

Table C.AA.G2-1C-ARM PHOTON-ELECTRON BEAM MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRadiation Particle (30xx,5110) 1 Particle Type of Radiation. See

C.AA.G2.1.1.Enumerated Values:

PHOTONELECTRON

C-Arm Photon-Electron Control Point Sequence

(30xx,0C00) 1 Control points used to model the beam delivery. Two or more Items shall be included in this sequence.



>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1>Include 'Wedge Positions Macro' Table C.AA.2.23-1>Gantry Roll Continuous Angle (30xx,51B5) 1C Treatment machine gantry angle, i.e.

orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.G2.1.2.

2524

2526

2528


Attribute Name Tag Type Description>Surface Entry Point (300A,012E) 2C Patient surface entry point coordinates

(x,y,z), along the central axis of the beam, in the patient based coordinate system described in C.7.6.2.1.1 (mm).Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

>Source to Surface Distance (300A,0130) 2C Source to Patient Surface distance (mm).Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

C.AA.G2.1 C-Arm Photon-Electron Beam Attribute DescriptionC.AA.G2.1.1 Radiation ParticleIf the C-Arm Photon-Electron Beam Module is contained within a C-Arm Photon Radiation IOD, the value of Radiation Particle (30xx,5110) shall be PHOTON.

If the C-Arm Photon-Electron Beam Module is contained within a C-Arm Electron Radiation IOD, the value of Radiation Particle (30xx,5110) shall be ELECTRON.

C.AA.G2.1.2 Continuous Rotation AnglesA continuous rotation angle is an angle in the range (-∞,+∞), such that:

The continuous rotation angle modulo 360 yields the angle in the coordinate system as specified IEC 61217 'Radiotherapy equipment – Coordinates, movements and scales', where applicable.

Relative to a previous continuous rotation angle, an increase in continuous rotation angle shall specifiy a clockwise (CW) rotation, where a difference of more than 360 between the two values specifies more than one CW rotation.

Relative to a previous continuous rotation angle, a decrease in continuous rotation angle shall specify a counter-clockwise (CC) rotation, where a difference of less than -360 between the two values specifies more than one CC rotation.

The angles are called continuous to express the capability to run continuously beyond a full circle. This is especially important for rotational movement going beyond 360 degrees. This notion provides the ability to unambiguously specify the direction of rotation (CW or CC), when specifying a rotation from a start angle to a stop angle. For gantries which cannot rotate continuously but have over-travel capabilities beyond their nominal rotational limit, continuous rotation angle removes the need to flag the rotational position in the over-travel state.

C.AA.H1 Multiple Fixed Source Delivery Device ModuleThe Multiple Fixed Source Delivery Device Module contains multiple fixed source device-specific information pertaining to the physical device used to deliver the treatment, including geometrical parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment.

158

2530

2532

2534

2536

2538

2540

2542

2544

2546

2548

2550

2552

2554

2556


Table C.AA.H1-1MULTIPLE FIXED SOURCE DELIVERY DEVICE MODULE

Attribute Name Tag Type DescriptionRadiation Source Sequence (30xx,5130) 1 The radiation sources of the device.

One or more Items shall be included in this sequence.

>Radiation Source Label (30xx,5131) 1 Identification label for the Radiation Source. The label shall be unique within the sequence.

>Radiation Source Collimator Size

(30xx,513B) 1 Diameter (full width at half maximum) in the machine isocenter of the beam originating from the radiation source through the collimator (mm).

>Radiation Source Distance (30xx,5132) 2 Source to isocenter distance (mm).

>Radiation Source Theta (30xx,5133) 1 The theta angle from the isocenter to the radiation source (degrees).See C.AA.H1.1.1.

>Radiation Source Phi (30xx,5134) 1 The phi angle from the isocenter to the radiation source (degrees).See C.AA.H1.1.1.

C.AA.H1.1 Multiple Fixed Source Delivery Device Attribute DescriptionC.AA.H1.1.1 Radiation Source AnglesRadiation Source Theta (30xx,5133) is the angle from the Z axis of the equipment coordinate system to the vector from the isocenter to the source. Radiation Source Phi (30xx,5134) is the angle from the X axis of the device coordinate system to the projection of the vector from the isocenter to the source on the XY plane of the device coordinate system.

C.AA.H2 Multiple Fixed Source Beam Set ModuleThe Multiple Fixed Source Beam Set Module contains a specification of how a specific multiple fixed source treatment beam is to be delivered. In this context “beam” refers to a radiation for a period of time from multiple radiation sources.

Table C.8A.H2-1MULTIPLE FIXED SOURCE BEAM SET MODULE ATTRIBUTES

Attribute Name Tag Type

Description

Radiation Particle (30xx,5110) 1 Particle Type of Radiation.Defined Terms:

PHOTON

Radiation Source Pattern Sequence

(30xx,513C) 1 Radiation source patterns.One or more Items shall be included in this sequence.

2558

2560

2562

2564

2566

2568

2570

2572



Description

>Radiation Source Pattern Label

(30xx,513D) 1 Identification label for the Radiation Source Pattern. The label shall be unique within this sequence.

>Radiation Source Pattern Source Sequence

(30xx,513F) 1 Radiation sources used for the enclosing pattern.One or more Items shall be included in this sequence.

>>Referenced Radiation Source Label

(30xx,513A) 1 Uniquely identifies the Radiation Source described in the Radiation Source Sequence (30xx,5130) by a reference to the Radiation Source Label (30xx,5131).

Radiation Source Control Point Sequence

(30xx,5137) 1 Control points used to model the radiation delivery.The sequence shall contain an even number of Items, where each pair marks the start and end of a radiation.Two or more Items shall be included in this sequence.

>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1>Referenced Radiation Source Pattern

(30xx,513E) 1C Uniquely identifies the Radiation Source Pattern described in the Radiation Source Pattern Sequence (30xx,513C) by a reference to the Radiation Source Pattern Label (30xx,513D).Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

C.AA.J1 Robotic Delivery Device ModuleThe Robotic Delivery Device Module contains robot-specific information pertaining to the physical device used to deliver the treatment, including geometrical parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment.

Table C.AA.J1-1ROBOTIC DELIVERY DEVICE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionRobotic Device Geometry (30xx,0F03) 1 Imaging geometry with which this path

is associated.Defined Terms:

NORMALMIRROR

Include 'Beam Mode Macro' Table C.AA.2.19-1Include 'RT Beam Limiting Device Definition Macro' Table C.AA.2.20-1

160

2574

2576

2578

2580


Attribute Name Tag Type DescriptionInclude ‘Accessory Holder Definition Macro' Table C.AA.2.26-1

C.AA.J2 Robotic Path ModuleThe Robotic Path Module contains a specification of how a specific robotic path is to be delivered. Each SOP Instance corresponds to a single robotic “path”. Multiple paths are encoded as separate Radiation instances defined by reference in the Radiation Set IOD.

Table C.AA.J2-1ROBOTIC PATH MODULE ATTRIBUTES


Defined Terms:PHOTONELECTRON PROTON

Robotic Path Identifier Sequence

(30xx,0F15) 1 Path Set identifier.Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1. Defined CID SUP147011.Robotic Control Point Sequence

(30xx,0F50) 1 Control points used to model the beam delivery. Two or more Items shall be included in this sequence.



>Robotic Path Node Number (30xx,0F33) 1 A unique number that determines the sequence of delivery of individual nodes within the path. The value monotonically increases but may be non-contiguous.See Note 1.

>RT Treatment Source Coordinate

(30xx,0F40) 1 Coordinates (x,y,z) of the source of the beam in the equipment defined original (device) coordinate system.

2582

2584

2586


Attribute Name Tag Type Description>RT Treatment Target Coordinate

(30xx,0F44) 1C Cartesian values (x,y,z) of the target of the beam in the equipment defined original (device) coordinate system.Required if Robotic Beam Sub-Control Point Sequence (30xx,0F42) is not present and the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.1.

>Robot Head Yaw Angle (30xx,0F46) 1C Robot Head Yaw Angle, i.e. the rotation of ROBOTIC COLLIMATOR coordinate system about the Z-axis of the ROBOTIC HEAD coordinate system (degrees).Required if Robotic Beam Sub-Control Point Sequence (30xx,0F42) is not present and if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.1.

>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1>Robotic Beam Sub-Control Point Sequence

(30xx,0F42) 1C Sequence of Items describing Beam parameters changes within a Control Point.Required at all Control Points but the last. C.AA.Two or more Items shall be included in this sequence.

>>Include 'External Beam Sub-Control Point General Attributes Macro’ Table C.AA.2.18-1>>RT Treatment Target Coordinate

(30xx,0F44) 1C Cartesian values (x,y,z) of the target of the beam in the equipment defined original (device) coordinate system.Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See C.AA.2.18.1.1.

>>Robot Head Yaw Angle (30xx,0F46) 1C Robot Head Yaw Angle, i.e. the rotation of ROBOTIC COLLIMATOR coordinate system about the Z-axis of the ROBOTIC HEAD coordinate system (degrees).Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See C.AA.2.18.1.1.

162

2588


Note 1: The value may reference node positions being pre-defined in the device configuration. Therefore it is not the same as the Control Point Index (30xx,0111), but has another purpose then just indexing the items within the Robotic Control Point Sequence (30xx,0F50).

C.AA.L1 Multi-Axial Delivery Device ModuleThe Multi-Axial Delivery Device Module contains specific information pertaining to the physical device used to deliver photon and electron treatments, including geometrical parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment.

Table C.AA.L1-1MULTI-AXIAL DELIVERY DEVICE MODULE ATTRIBUTES

Attribute Name Tag Type DescriptionSource-Axis Distance (300A,00B4) 1 Distance in (mm) from the Radiation

source perpendicular to Gantry Roll rotation axis of the equipment that is to be used for beam delivery.See C.AA.L1.1.

Center of Rotation-Axis Distance

(30xx,1501) 1 Distance in (mm) from the Center of Rotation of the Multi-Axial Gantry Head perpendicular to Gantry Roll rotation axis of the equipment that is to be used for beam delivery (mm). See C.AA.L2.1.3.

Include 'Beam Mode Macro' Table C.AA.2.19-1Include 'Beam Limiting Device Definition Macro' Table C.AA.2.20-1Include 'Wedges Definition Macro' Table C.AA.2.22-1Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1Include 'Boluses Definition Macro' Table C.AA.2.28-1

C.AA.L2.1 Multi Axial Delivery Device Attribute DescriptionC.AA.L1.1 Source-Axis DistanceThe Source Axis Distance (300A,00B4) for a Multi-Axial Delivery Device is defined with Gantry Head pitch and roll rotation angles at zero degree position (see figure C.AA.L2.1.3-1).

C.AA.L2 Multi-Axial Beam ModuleThe Multi-Axial Beam Module contains a specification of how a specific Multi-Axial treatment beam is to be delivered.

Table C.AA.L2-1MULTI-AXIAL BEAM MODULE ATTRIBUTES


Enumerated Values:PHOTONELECTRON

2590

2592

2594

2596

2598

2600

2602

2604

2606

2608


Attribute Name Tag Type DescriptionGantry Head Mode (30xx,1546) 1 The Gantry Head Mode.

Defined Terms:STATIC = no Gantry Head

movement is allowedDYNAMIC_TRACKING =

Gantry Head movement is allowed, but no detailed information is provided

DYNAMIC = detailed Gantry Head movement information is provided

Multi-Axial Control Point Sequence

(30xx,1500) 1 Control points used to model the beam delivery.Two or more Items shall be included in this sequence.



>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1. See C.AA.L2.1.1.>Include 'Wedge Positions Macro' Table C.AA.2.23-1>Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1>Gantry Pitch Continuous Angle

(30xx,51B7) 1C Continuous gantry pitch angle at the Control Point, i.e. the rotation of the IEC GANTRY coordinate system about the x-axis of the system rotated by the Gantry Yaw Continuous Angle (30xx,51B3) in (degrees). See C.AA.G2.1.4 and C.AA.L2.1.3.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

>Gantry Roll Continuous Angle

(30xx,51B5) 1C Continuous gantry angle of radiation source at the Control Point, i.e. the rotation of the IEC GANTRY coordinate system about the y-axis of the system rotated by the Gantry Yaw Continuous Angle (30xx,51B3) and rotated by the Gantry Pitch Continuous Angle (30xx,51B7) in (degrees). See C.AA.G2.1.4 and C.AA.L2.1.3.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

164


Attribute Name Tag Type Description>Gantry Yaw Continuous Angle

(30xx,51B3) 1C Continuous gantry yaw angle at the Control Point, i.e. the rotation of the IEC GANTRY coordinate system about the z-axis of the IEC FIXED SYSTEM in (degrees). See C.AA.G2.1.4 and C.AA.L2.1.3.Required if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1.

>Gantry Head Pitch Angle (30xx,1520) 1C Gantry Head Pitch Angle, i.e. the rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the X-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if Multi-Axial Sub-Control Point Sequence (30xx,1540) is not present and if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.L2.1.2.

>Gantry Head Roll Angle (30xx,1521) 1C Gantry Head Roll Angle, i.e. the rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the Y-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if Multi-Axial Sub-Control Point Sequence (30xx,1540) is not present and if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.L2.1.2.

>Gantry Head Yaw Angle (30xx,1522) 1C Gantry Head Yaw Angle, i.e. the rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the Z-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if Multi-Axial Sub-Control Point Sequence (30xx,1540) is not present and if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.L2.1.2.


Attribute Name Tag Type Description>Multi-Axial Target Coordinate (30xx,1525) 2C Target coordinates (x,y,z) in the patient

based coordinate system described in C.7.6.2.1.1 (mm) at Source-Axis Distance.Required if Multi-Axial Sub-Control Point Sequence (30xx,1540) is not present and if the Control Point Index (30xx,0111) equals 1 or attribute value changes at any Control Point.See C.AA.2.16.1 and C.AA.L2.1.2.

>Surface Entry Point (300A,012E) 2 Patient surface entry point coordinates (x,y,z), along the central axis of the beam, in the patient based coordinate system described in C.7.6.2.1.1 (mm).

>Source to Surface Distance (300A,0130) 2 Source to Patient Surface distance (mm).

>Multi-Axial Sub-Control Point Sequence

(30xx,1540) 1C Sequence of Items describing Sub-Control Points.Required at every Control Point but the last if Gantry Head Mode (30xx,1546) is DYNAMIC. May be present at every Control Point but the last if Gantry Head Mode is DYNAMIC_TRACKING.Two or more Items shall be included in this sequence.

>>Include 'External Beam Sub-Control Point General Attributes Macro’ Table C.AA.2.18-1>>Gantry Head Pitch Angle (30xx,1520) 1C Gantry Head Pitch Angle, i.e. the

rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the X-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point. See C.AA.2.18.1.1.and C.AA.L2.1.2.

>>Gantry Head Roll Angle (30xx,1521) 1C Gantry Head Roll Angle, i.e. the rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the Y-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See C.AA.2.18.1.1.and C.AA.L2.1.2.

166


Attribute Name Tag Type Description>>Gantry Head Yaw Angle (30xx,1522) 1C Gantry Head Yaw Angle, i.e. the

rotation of the MULTI-AXIAL GANTRY HEAD coordinate system about the Z-axis of the MULTI-AXIAL GANTRY HEAD coordinate system (degrees).Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See C.AA.2.18.1.1. and C.AA.L2.1.2.

>>Multi-Axial Target Coordinate

(30xx,1525) 2C Target coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm) at Source-Axis Distance.Required if the Sub-Control Point Index (30xx,0115) equals 1 or attribute value changes at any Sub-Control Point.See C.AA.2.18.1.1.

C.AA.L2.1 Multi Axial Beam Attribute DescriptionC.AA.L2.1.1 Multi-Axial Gantry AnglesFor a Multi-Axial treatment machine the Gantry Pitch Continuous Angle (30xx,51B7), Gantry Roll Continuous Angle (30xx,51B5) and Gantry Yaw Continuous Angle (30xx,51B3) shall be applied in the order z, x, y: first the yaw angle about the z-axis, then the pitch angle about the x-axis and then the roll angle about the y-axis.

C.AA.L2.1.2 Gantry Head AnglesGantry Head Pitch Angle (30xx,1520), Gantry Head Roll Angle (30xx,1521) and Gantry Head Yaw Angle (30xx,1522) shall be applied in the order z, x, y: first the angle about the Zh-axis, then the angle about the Xh-axis and then the angle about the Yh-axis. These angles are the authoritative definition of the Gantry Head. The coordinate defined in Multi-Axial Target Coordinate (30xx,1525) shall only serve the purpose of annotation.

C.AA.L2.1.3 Multi Axial Beam Delimiter PositionsFor the Multi-Axial Delivery Device, there is an "h" coordinate system which is fixed with respect to the MULTI-AXIAL GANTRY HEAD and its mother system is the IEC GANTRY coordinate system. Its origin Ih is the MULTI-AXIAL GANTRY HEAD center of rotation.

Its daughter system is the IEC BEAM LIMITING DEVICE or DELINEATOR coordinate system ("b").

2610

2612

2614

2616

2618

2620

2622

2624

2626


Figure C.AA.L2.1.3-1Multi-Axial treatment machine GANTRY HEAD system

Thus, the RT Beam Delimiter Element Positions (30xx,504A) within RT Beam Limiting Device Positions Macro are always defined at Source-Axis Distance (300A,00B4) as defined in the Multi-Axial Delivery Device Module even if the Gantry Head Pitch Angle (30xx,1520) or the Gantry Head Roll Angle (30xx,1521) are not at a zero degree position. The distance from the Center of Rotation of the Gantry Head to the Axis, is called the Center of Rotation-Axis Distance (CoRAD).

The RADIATION FIELD or DELINEATED RADIATION FIELD (R/D F) is always normal to the beam axis. Therefore, if the Gantry Head Pitch Angle and/or Gantry Head Roll Angle are not at a zero

168

2628

2630

2632

2634

2636


degree position, the R/D F is not within the Treatment Position x-y-plane (respectively the X/Y plane of the IEC Gantry System at the isocenter).

C.AA.M1 Enhanced RT Dose ModuleThe Enhanced RT Dose module is used to convey non-image aspects of 2D or 3D radiation dose data generated from treatment planning systems or similar devices. The attributes defined within the module support dose for a single radiation instance (e.g. an external beam), one or more fractions of the planned dose of an RT Radiation Set, or composite dose derived from multiple RT Dose Image instances.

Table C.AA.M1-1ENHANCED RT DOSE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionDose Type (3004,0004) 1 Type of dose.

Defined Terms:PHYSICAL = physical doseEFFECTIVE = dose after

correction for biological effect using user-defined modeling technique

Effective Dose Method Code Sequence

(30xx,1132) 2C The method used to calculate the effective dose.Required, if Dose Type (3004,0004) is EFFECTIVE.Zero or more Items shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147035.>Effective Dose Method Modifier Code Sequence

(30xx,1137) 3 Modifier Code further defining the effective dose method.One or more Items are permitted in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.Referenced Dose Calculation Annotation Object Sequence

(30xx,1135) 3 Reference to SOP instances describing dose calculation methods, parameters and / or other information used in calculation and / or modification of the dose.One or more Items are permitted in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11>Purpose of Reference Code Sequence

(0040,A170) 1 Code describing the purpose of the reference to the Instance(s).Only a single Item shall be included in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147036.Effective Dose Method Description

(30xx,1134) 2C The description of the method used to calculate the effective dose.

2638

2640

2642

2644

2646

2648


Required, if Dose Type (3004,0004) is EFFECTIVE.

Dose Purpose (30xx,1136) 3 The intended use of the dose.Defined Terms: PLAN_QA = for Dose QA TREATMENT = for treatment of a patient IMAGING = representing dose contributed by imaging procedures

Dose Data Source (30xx,1138) 1 The source of the dose data.Defined Terms:

PLANNED = Dose calculated from Radiation(s) or Radiation Set(s).

MEASUREMENT = Measured dose

RECONSTRUCTED = Dose reconstructed from measured exit dose

RECORD = Dose calculated using delivered dose values from radiation record

IMAGE_ACQ = Dose record calculated for performed image acquisition

Dose Data Source Measurement Code Sequence

(30xx,113C) 1C A detailed specification of the data source.Required, if Dose Data Source (30xx,1138) is MEASUREMENT.Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147037.Radiation Absorption Model (30xx,1130) 1C Specifies a list of patient

heterogeneity characteristics used for calculating dose. This attribute shall be multi-valued if the computed dose has multiple differing correction techniques.Defined Terms:

IMAGE = image dataROI_OVERRIDE = one or

more ROI (segment) densities override image or water values where they exist

WATER = entire volume treated as water equivalent

170


OTHER = mixed model usage (when not specified by multiple values), other or unspecifiedShall be present if Dose Data Source (30xx,1138) is PLANNED. May be present otherwise.See section C.AA.M1.1.2.

Effective Tissue Composition (30xx,113E) 1 Tissue composition used for dose reporting.Defined Terms:

WATER = dose calculated assuming tissue has atomic characteristics similar to water

MUSCLE = dose calculated assuming that tissue has atomic characteristics similar to muscle.

MEDIUM = dose calculated using known characteristics of the material

OTHER = methodology used for the dose calculation is not defined or unknown

Algorithm Type Code Sequence (30xx,1144) 1C The dose algorithm class.Shall be present if Dose Data Source (30xx,1138) is PLANNED. May be present otherwise.One or more items shall be present in this sequence.

>Include ‘Algorithm Identification Macro’ Table 10-19 Defined CID for Algorithm Family Code shall be SUP147041.

Dose Scope (30xx,113A) 1 The Scope of the entities represented by that dose.Defined Terms:

PARTIAL = dose for zero or more complete fractions and for partial delivery of one or more partial fractions of a single radiation instance.

RADIATION = dose for one or more complete fractions of a single radiation instance.

RADIATION_SET = dose for one or more complete fractions of a single RT Radiation Set.

ACCUMULATED = dose for zero or more complete fractions and for partial delivery of one or more partial fractions of one or more RT Radiation Sets.


COMPOSITE = composition of separate doses for one or more courses.

Dose Contribution Accumulation Type

(30xx,1124) 1C The operator used to accumulate the dose from the referenced Instance(s).Required, if Contributing Radiation Sequence (30xx,1118), Contributing Radiation Set Sequence (30xx,1102), Composite Dose Sequence (30xx,1100) or Contributing RT Radiation Record Sequence (30xx,1128) includes more than one item.Defined terms:

LINEAR = contributions are summed linearly.

OTHER = Unspecified/non-linear contribution to the dose.

Contributing Radiation Sequence (30xx,1118) 1C Reference to the SOP Instance of Radiation that contributes to the dose.Required if the Dose Scope is RADIATION or PARTIAL.Only a single Item shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11>Number of Complete Fractions Contributing

(30xx,1120) 1 The number of complete fractions of the RT Radiation contributing to the dose. May be 0 if only a partial delivery is represented.

>Partial Delivery Limits Sequence

(30xx,1122) 1C Reference to the cumulative meterset value(s) to which the dose is calculated for the partial fractions included. If several partial fractions are included in that dose, the segments defined by Start Meterset (30xx,1140) and Stop Meterset (30xx,1141) within that sequence may overlap.Required if Dose Scope (30xx,113A) is PARTIAL.One or more Items shall be included in this sequence.

>>Start Meterset (30xx,1140) 1 The value of Cumulative Meterset at which partial delivery of the referenced Radiation SOP Instance starts.

>>Stop Meterset (30xx,1141) 1 The value of Cumulative Meterset at which partial delivery of the

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referenced Radiation SOP Instance stops.

Contributing Radiation Set Sequence

(30xx,1102) 1C Reference to one or more RT Radiation Sets instances that contribute to the dose.Required if Dose Scope is RADIATION_SET or ACCUMULATED.If Dose Scope is RADIATION_SET, only a single Item shall be included in this sequence. Otherwise, one or more Items shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11>Number of Complete Fractions Contributing

(30xx,1120) 1 The number of complete fractions of the RT Radiation Set contributing to the dose. May be 0 if only a partial delivery is represented.

> Fraction Completion Status (30xx,1123) 1C Indication of whether the dose contribution from the current RT Radiation Set includes an incomplete fraction.Defined terms:COMPLETE = Dose represents contribution of an integral number of complete fractions INCOMPLETE = Dose represents contribution of one or more incomplete fractionsRequired, if Dose Scope (30xx,113A) is ACCUMULATED.

>Contributing Radiation Sequence

(30xx,1118) 1C Reference to the SOP Instances of RT Radiation that contributes to the dose.Required if the Fraction Completion Status (30xx,1123) is INCOMPLETE.One or more Items shall be included in this sequence.

>>Include 'SOP Instance Reference Macro' Table 10-11>>Radiation Completion Status (30xx,1125) 1 Indication of whether the dose

contribution from the current RT Radiation is complete.Defined terms:

COMPLETE = Dose represents contribution of the complete radiation.

INCOMPLETE = Dose represents contribution of one or


more meterset intervals of a single incomplete fraction

>>Partial Delivery Limits Sequence

(30xx,1122) 1C Reference to the cumulative meterset value(s) to which the dose is calculated. If several partial fractions are included in that dose, the segments defined by Start Meterset (30xx,1140) and Stop Meterset (30xx,1141) within that sequence may overlap.Required if the Radiation Completion Status (30xx,1125) is INCOMPLETE.One or more Items shall be included in this sequence.

>>>Start Meterset (30xx,1140) 1 The value of Cumulative Meterset at which partial delivery of the referenced Radiation SOP Instance starts.

>>>Stop Meterset (30xx,1141) 1 The value of Cumulative Meterset at which partial delivery of the referenced Radiation SOP Instance stops.

Composite Dose Sequence (30xx,1100) 1C RT Dose Image or RT Dose SOP instances that contribute to the dose.Required if the Dose Scope (30xx,113A) is COMPOSITE. One or more Items shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11>Dose Contribution Weight (30xx,1110) 1C A numeric value representing the

scale factor used in compositing the referenced dose Instance. Negative values maybe used for dose differences.Required if the Dose Contribution Accumulation Operator Type (30xx,1124) is LINEAR.

Contributing RT Radiation Record Sequence

(30xx,1128) 1C RT Radiation Record SOP instances used to calculate the dose. Required if Dose Data Source (30xx,1138) is RECORD. One or more Items shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11>Treatment Session UID (30xx,6000) 1 The UID identifying a treatment

session. This UID serves as a key to collect all Radiation Record instances, which have been

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delivered within the same treatment session.

Spatial Transform of Dose (3004,0005) 3 The use of transformation in the calculation of the combined dose.Defined Terms:

NONE: No transformation. Calculated on the original image set

RIGID: Only Rigid transform used (see definition in C.20.2.1.2)

NON_RIGID: Any other transform used


(0070,0404) 2C A reference to a Spatial Registration SOP Instance or a Deformable Spatial Registration SOP Instance, which defines the transformation used to transform the dose.Required, if Spatial Transform of Dose (3004,0005) is provided and has a value of RIGID or NON_RIGID.Zero or one Item shall be included in this sequence.See Section C.8.8.3.5

>Include 'SOP Instance Reference Macro' Table 10-11Referenced RT Segment Annotation Sequence

(30xx,0874) 2C Reference to a RT Segment Annotation SOP Instance containing structures which were used to calculate the content of the current IOD.Required if Radiation Absorption Model(30xx,1130) contains ROI_OVERRIDE or if the module is used in the RT Dose Histogram IOD. May be present otherwise.Only a single Item shall be included in this sequence.


C.AA.M1.1 Enhanced RT Dose Attribute DescriptionC.AA.M1.1.1 Dose ScopeThe scope of the dose described in that module is given by the referenced SOP instances, which are included in the actual reference sequences as required by the Dose Scope (30xx,113A).

It is important, that a dose provided in absolute values (i.e the Real World Value Mapping C.7.6.16.2.11 macro contain the code (Gy, UCUM, “Gray”) for the unit) is consistent with the absolute planned or delivered Meterset values as specified by Cumulative Meterset (30xx,5021) in those referenced SOP instances.

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C.AA.M1.1.2 Radiation Absorption ModelThe multipicity of the value shall be 1 for dose objects which represent a dose having been directly calculated based on image data. For doses which have been calculated by compositing several other doses, the attribute shall contain each value found in the the composited doses once and only once.

C.AA.M2 RT Dose Image ModuleThe RT Dose Image module describes specializations for attributes in the General Image Module and provides information to position the image planes in the axial dimension and to scale the pixel data values to real-world dose values. It provides the mechanism to transmit a 3D array of dose data as a multi-frame image whose frames represent 2D dose image planes that may or may not be related to CT or MR image planes.

Table C.AA.M2-1RT DOSE IMAGE MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionImage Type (0008,0008) 1 Image identification characteristics.

See C.AA.M2.1.1.

Samples per Pixel (0028,0002) 1 Number of samples (planes) in this image. This value shall be 1.

Photometric Interpretation (0028,0004) 1 Specifies the intended interpretation of the pixel data. Shall have the enumerated value MONOCHROME2.

Bits Allocated (0028,0100) 1 Number of bits allocated for each pixel sample. Each sample shall have the same number of bits allocated which shall be the Enumerated Value of 32.

Bits Stored (0028,0101) 1 Number of bits stored for each pixel sample. Each sample shall have the same number of bits stored which shall be Enumerated Value of 32.

High Bit (0028,0102) 1 Most significant bit for each pixel sample. Each sample shall have the same high bit which shall be Enumerated Value of 31.

Pixel Representation (0028,0103) 1 Data representation of the pixel samples. Each sample shall have the same pixel representation. Shall use the following enumerated value:0000H = unsigned integer

Dose Grid Geometry (30xx,1150) 1 Geometry of the Dose Grid array. Specifies whether dose grid planes form a cuboid or a sheared parallelepiped. Enumerated values:

NON_SHEARED = planes of dose grid form a cuboid, i.e. a

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rectangular parallelepiped. SHEARED= successive

planes of dose grid form a sheared parallelepiped.See C.AA.M2.1.2.

Source Image Sequence (0008,2112) 1C Reference to images from which the dose has been calculated.Required if Dose Data Source (30xx,1138) in the Enhanced RT Dose Module is PLANNED or RECORD. May be present otherwise.One or more Items shall be included in this sequence.

>Include 'Image SOP Instance Reference Macro' Table 10-3

C.AA.M2.1 RT Dose Image Attribute DescriptionC.AA.M2.1.1 Image Type and Frame TypeValue 1 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 1 shall be DERIVED.

C.AA.M2.1.1.1 Patient Examination CharacteristicsValue 2 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 2 shall be SECONDARY.

C.AA.M2.1.1.2 Image FlavorValue 3 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.3. No additional requirements. The value shall be VOLUME.

C.AA.M2.1.1.3 Derived Pixel ContrastValue 4 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.4. The value shall be NONE.

C.AA.M2.1.2 Dose Grid GeometryIf Dose Grid Geometry (30xx,1150) is NON_SHEARED, the Image Position (Patient) values of all frames are co-linear and lie along a vector normal to each of the planes. Mathematically, all dose grid frames shall be aligned such that the vector difference (Xm-Xn, Ym-Yn, Zm-Zn) of Image Position (Patient) vectors (Xm, Ym, Zm) and (Xn, Yn, Zn) in the Plane Position Functional Group of any pair of frames is proportional to the cross product of row and column direction cosine vectors specified by Image Orientation (Patient) in the Shared Plane Orientation Functional Group.

C.AA.M2.1.3 Dose Grid Real World ValuesC.AA.M2.1.3.1 Dose Grid ScalingThe real world values of the dose grid shall be derived from the stored pixel values by scaling according to the Real World Intercept (0040,9224) and Real World Value Slope (0040,9225). See C.7.6.16.2.11.1.2.

C.AA.M2.1.3.2 Dose Grid Pixel PaddingLong Dose Grid Padding Value (0028,xxxx) is used to identify pixels for which dose grid values are not specified (see C.7.5.1.1.2). Applications consuming RT Dose Image instances shall handle pixel padding correctly to avoid misinterpreting pixel padding as dose. In particular:

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1. Long Dose Grid Padding Value (0028,xxxx) specifies a single value of this padding value.

2. The value of Long Pixel Padding Value (0028,xxxx) shall be valid values within the objectives defined by Bits Allocated (0028,0100) Bits Stored (0028,0101) and High Bit (0028,0102).

3. No points within the native dose grid shall have a value equal to pixel padding value. Values within the pixel padding range shall lie outside the range between the minimum and maximum values of valid dose values in the dose grid.

The applicable parts of section C.7.6.16.2.11.2 apply correspondingly.

The tag Pixel Padding Value (0028,0120) shall not be used.

C.AA.M3 RT Dose Image Functional Group MacrosThe following sections contain Functional Group macros specific to the RT Dose Image IOD.

Note: The attribute descriptions in the Functional Group Macros are written as if they were applicable to a single frame (i.e., the macro is part of the Per-frame Functional Groups Sequence). If an attribute is applicable to all frames (i.e. the macro is part of the Shared Functional Groups Sequence) the phrase "this frame" in the attribute description shall be interpreted to mean "for all frames".

C.AA.M3.1 RT Dose Image Frame Type MacroTable C.AA.M3.1-1 specifies the attributes of the RT Dose Image Frame Type Functional Group macro.

Table C.AA.M3.1-1RT DOSE IMAGE FRAME TYPE MACRO ATTRIBUTES


Attribute Description

RT Dose Image Frame Type Sequence

(30xx,1116) 1 Identifies the characteristics of this frame.Only a single Item shall be included in this sequence.

>Frame Type (0008,9007) 1 Type of Frame. A multi-valued attribute analogous to the Image Type (0008,0008).Enumerated Values and Defined Terms are the same as those for the four values of the Image Type (0008,0008) attribute. See C.8.16.1 and C.AA.M2.1.

C.AA.M4 RT Dose Histogram ModuleThe RT Dose Histogram module provides for the inclusion of dose volume histogram (DVH) and dose area histogram (DAH), and natural dose volume histogram (NDVH) data. Any combination of these dose histogram types may be contained within this module.

Table C.AA.M4-1RT DOSE HISTOGRAM MODULE ATTRIBUTES

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Attribute Name Tag Type Attribute DescriptionDose Histogram Normalization Dose Value

(30xx,1201) 3 Nominal Dose Reference Value indicating prescribed dose.

Dose Histogram Sequence (30xx,1202) 1 Sequence of Items describing Dose Histograms.One or more Items shall be included in this sequence.

>Dose Histogram Referenced Segment Sequence

(30xx,1203) 1 Referenced anatomies used to calculate the Dose Histogram.See C.AA.M4.1.3.One or more Items shall be included in this sequence.

>>Include ' Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1

The value of Conceptual Volume Segmentation Defined Flag (30xx,1311) shall be YES.

>Dose Histogram Type (30xx,1210) 1 Type of Dose Histogram:Defined Terms:

VOLUME = dose-volume histogram

AREA = dose-area histogram

>Histogram Tally Type (30xx,1205) 1 Method of tallying spatial quantity in constructing dose histogramDefined Terms:

DIFFERENTIAL = differential dose histogram

NATURAL = natural dose (volume) histogram

>Dose Histogram Dose Unit Code Sequence

(30xx,1207) 1 Units of measurement for the dose dimension of the histogram.Only a single Item shall be included in this sequence.See C.7.6.16.2.11.1 for further explanation.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147065>Dose Histogram Spatial Unit Code Sequence

(30xx,1206) 1 Units of measurement for the spatial dimension of the histogram.Only a single Item shall be included in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147039>Segment Total Size (30xx,1209) 1 Total size of all segments referenced in

Dose Histogram Referenced Segment Sequence (30xx,1203), in units of Dose Histogram Spatial Units (30xx,1206)


Attribute Name Tag Type Attribute Description>Dose Histogram Data (30xx,1204) 1 A data stream describing the dose bin

widths Dn and associated volumes (or areas) Vn in Dose Histogram Spatial Units (3004,0054) in the order D1V1, D2V2, ... DnVn.

>Dose Statistics Sequence (30xx,1211) 3 Dose statistic information.One or more Items are permitted in this sequence.

>>Include 'Content Item Macro' Table 10-2 Defined CID of Concept Name Code Sequence is CID SUP147026.The Content Item shall have a Value Type (0040,A040) of NUMERIC.Content items shall use UCUM units of Gy where applicable.

Source Image Sequence (0008,2112) 2 Reference to RT Dose Image SOP instances from which the dose histogram has been calculated.Zero or more Items shall be included in this sequence.


C.AA.M4.1 RT Dose Histogram Attribute DescriptionC.AA.M4.1.1 Referenced Segmentation Properties SequenceThe Conceptual Volume Macro in the Dose Histogram Referenced Segment Sequence (30xx,1203) is used to specify the segments or combinations of segments used to compute Dose Histograms. Segments are defined in the Segmentation Properties SOP Instance referenced by the Referenced RT Segment Annotation Sequence (30xx,0874) and are identified using their Conceptual Volume UIDs.

The geometry of segments represented in the referenced Segmentation Properties SOP Instance may be defined in an RT Structure Set, Segmentation, or Surface Segmentation SOP Instance. Segments defined by an RT Structure Set SOP Instance shall contain only contours with a Contour Geometric Type (3006,0042) of CLOSED_PLANAR.

C.AA.M4.1.2 Dose Histogram DataThe RT Dose Histogram Module differs from the earlier RT DVH module in that the attribute Dose Histogram Data (30xx,1204) is encoded with VR of OF. In the earlier DVH Module, the corresponding DVH Data (3004,0058) was encoded with VR of DS, leading to attribute value length limitations when the dataset was encoded with ELE transfer syntax and there were many histogram bins.

The RT Dose Histogram Module differs from the earlier RT DVH module in that Dose Histogram Data (30xx,1204) attribute represents DIFFERENTIAL dose-volume or dose-area histograms, i.e., in the sequence of pairs, D1V1, D2V2, ... DnVn the Values Vi represent the volume (or area) of the referenced segment(s) receiving dose < Di and > Di-1 for i>1 and dose > 0 for i=1.

C.AA.M4.1.3 Dose Histogram Referenced Segment SequenceThe Dose Histogram Referenced Segment Sequence (30xx,1203) identifies Conceptual Volumes used to define the volume for calculation of the dose histograms. In this context, the Conceptual

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Volume shall be well-defined and point to the appropriate segment as identified by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6).

C.AA.M5 Dose Samples ModuleThe Dose Samples module provides for the inclusion of a list of spatial dose sample data.

Table C.AA.M5-1DOSE SAMPLES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionNumber of Dose Samples (30xx,1250) 1 Number of sample values n used to

store Dose Samples Data (3004,1251).

Dose Samples Data (30xx,1251) 1 A data stream describing locations of the dose samples X, Y, Z and associated dose values in the order X1Y1Z1D1, X2Y2Z2D2,, ... XnYnZnDn.

Dose Samples Dose Unit Code Sequence

(30xx,1253) 1 Units of measurement for the dose dimension of the dose samples. Only a single Item shall be included in this sequence.See C.7.6.16.2.11.1 for further explanation.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147065.Source Image Sequence (0008,2112) 1C Reference to images from which the

dose has been calculated. Required if Dose Data Source (30xx,1138) in the Enhanced RT Dose Module is PLANNED or RECORD. May be present otherwise.One or more Items shall be included in this sequence.

>Include 'Image SOP Instance Reference Macro' Table 10-3

C.AA.M5.1 RT Dose Samples Attribute DescriptionC.AA.M5.1.1 Dose Samples DataDose Samples Module encodes a list of (x, y, z, dose) values with VR of OF. This VR avoids limitations in the VL specified using Explicit-VR transfer syntax.

The Dose Samples Module represents N dose samples as a sequence of 4-tuples: X1Y1Z1D1, X2Y2Z2D2,, ... XNYNZNDN, the Values Xi, Yi, Zi represent the location in patient coordinates of dose sample Di , expressed in units specified by Dose Samples Dose Unit Code Sequence(30xx,1253).

C.AA.P1 RT Radiation Record Common ModuleThe RT Radiation Record Common Module contains treatment-modality independent information about a delivered radiation. A delivered radiation may be a radiation to a patient or a radiation without a patient being present (e.g. for QA purposes).

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The radiation record may refer to a Radiation SOP instance or Radiation Set SOP instance, which has been used to define delivery. It may however also record an unsolicited delivery.

Table C.AA.P1-1RT RADIATION RECORD COMMON MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionTreatment Session UID (30xx,6000) 1 UID identifying a treatment session.

This UID serves as a key to collect all Radiation Record instances, which have been delivered within the same treatment session.

Referenced RT Patient Setup Sequence

(30xx,0C20) 1C References the RT Patient Setup SOP Instance that was used as the setup instruction to setup the patient prior to delivery of the radiation.Required if there was a Patient Setup SOP Instance defined providing the instructions to the delivery system.Only a single Item shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11Referenced Radiation Set Sequence

(30xx,0C02) 1C References the Radiation Set SOP Instance that was the instruction to deliver the radiation.Required if there was a Radiation Set SOP Instance defined providing the instructions to the delivery system.Only a single Item shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11Referenced Radiation Sequence (30xx,0C04) 1C References the Radiation SOP

Instance that was the instruction to deliver the radiation.Required if there was a Radiation SOP Instance defined providing the instructions to the delivery system.Only a single Item shall be included in this sequence.

>Include 'SOP Instance Reference Macro' Table 10-11Current Fraction Number (3008,0022) 1C Fraction number for this radiation.

Required if Referenced Radiation Sequence (30xx,0C04) is present and Treatment Delivery Type (300A,00CE) is TREATMENT or CONTINUATION. May be present otherwise.

Treatment Delivery Type (300A,00CE) 1 Delivery Type of treatment.Defined Terms:

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TREATMENT = normal patient treatment

CONTINUATION = continuation of interrupted treatment

PLAN_QA = Treatment used for Quality Assurance rather than patient treatment

Treatment Termination Status (3008,002A) 1 Conditions under which treatment was terminated.Enumerated Values:

NORMAL = treatment terminated normally

OPERATOR = operator terminated treatment

MACHINE = machine terminated treatment

UNKNOWN = status at termination unknown

Treatment Termination Reason Code Sequence

(30xx,6015) 1C Treatment machine termination code. This code is dependent upon the particular application and equipment.Required if Treatment Termination Status (3008,002A) is MACHINE or OPERATOR.Only a single Item shall be included in this sequence.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147015>Machine-Specific Treatment Termination Code Sequence

(30xx,6016) 3 Machine-specific termination codes.One or more Items are permitted in this sequence.

>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline CID is specified.Treatment Termination Description

(30xx,6030) 2C A user defined description for an abnormal termination. Required if Treatment Termination Status (3008,002A) is not NORMAL.

Treatment Recording Method (30xx,6035) 1 Method with which treatment was recorded.Enumerated Values:

ELECTRONICMANUAL

Treatment Tolerance Status (30xx,6036) 1 Tolerance status of delivery.Enumerated Values:

IN_TOLERANCE = Delivery remained within tolerance

MACH_TOL = Out of machine tolerance


CLINICAL_TOL = Out of clinical tolerance, not overridden by operator.

CLINICAL_TOL_OVR = Out of clinical tolerance, overridden by operator

Referenced Control Point Sequence

(300C,00F2) 1 References the control point that is declared in the module containing the Control Points.This sequence shall contain the same number of Items as the referenced Control Point Sequence.See C.AA.P1.1.1.

>Referenced Control Point Index (30xx,0141) 1 The value of Reference to the Control Point Index (30xx,0111)Index of the Control Point referenced by that item

>Treatment Control Point Start DateTime

(30xx,603A) 1 Date and time when the delivery of radiation at this control point began. For the final control point this shall be the Date when the previous control point ended.

>Treatment Control Point End DateTime

(30xx,603BC) 1C Date and time when the delivery of radiation, which started at this control point, was ended. Required for all but the last control point.

Override Sequence (3008,0060) 2 Introduces sequence of pParameters that were re-specified or overridden during the administration of the Radiation immediately prior to delivery.Zero or more Items shall be included in this sequence.

>Include 'Selector Attribute Macro' Table 10-20 Point to attribute in current Record IOD

>Operators’ Name (0008,1070) 1 Name of operator who authorized override.

>Override Reason (3008,0066) 2 User-defined description of reason for override of parameter specified by Override Parameter Pointer (3008,0062).

Alternate Specified Value Sequence

(30xx,603E) 2 Defines new specified value for the referenced Attribute.Only a single Item shall be included in this sequence.

>Include 'Selector Attribute Macro' Table 10-20 Point to attribute in current Record IOD

>Include 'Content Item Macro' Table 10-2 Defined CID SUP147048Sign-Off Sequence (30xx,603F) 2 Records sign-offs by treatment

session operators, containing

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confirmation of the use of resources, the execution of activities etc. which are required to perform the treatment, but are not verified electronically.Zero or more Items shall be included in this sequence.

>Operators’ Name (0008,1070) 1 Name of operator who authorized override.

>Sign-Off UID (30xx,6037) 2 UID to identify the sign-off item. This UID alows to uniquely identify an distinct sign-off item issued in a system other than the treatment delivery system.

>Sign-Off DateTime (30xx,603D) 2 Date and Time when the item has been signed-off.

>Sign-Off Item Description (30xx,603C) 2 Description of the item having been signed-off.

>Include 'Code Sequence Macro' Table 8.8-1 Baseline CID SUP147056

C.AA.P1.1 RT Radiation Record Common Attribute DescriptionC.AA.P1.1.1 Control Point ReferencesThe control point references in the Referenced Control Point Sequence (300C,00F2) refer to the control points defined in the specific radiation modules within this IOD. The reference is conveyed by the Referenced Control Point Index (30xx,0141), which refers to the corresponding Control Point Index (30xx,0111) present in the referenced RT Radiation IOD.

C.AA.P1.1.2 Referenced RT Patient Setup SequenceThe Referenced RT Patient Setup Sequence (30xx,0C20) references the specific RT Patient Setup instance used to position the patient. This is not to be confused with the Patient Setup UID (30xx,5060) which identifies a conceptual patient setup that can be realized by one or more RT Patient Setup SOP instances.

C.AA.P2 RT Dose Record Common ModuleThe RT Dose Record Common module contains information about the delivered and measured dose.

Table C.AA.P2-1RT DOSE RECORD COMMON MODULE ATTRIBUTES

Attribute Name Tag Type Attribute DescriptionRadiation Dose Identification Sequence

(30xx,0B42) 1 Dose values that are delivered by this radiation.One or more Items shall be included in this sequence.

>Radiation Dose Identification Index

(30xx,0120) 1 Index of the Radiation Dose Identification in the sequence used for internal or external references.The value shall start at 1, and increase monotonically by 1.

>Radiation Dose Identification (30xx,0B46) 1 User defined label for the radiation

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Label dose definition.See C.AA.2.1.1.1.

>Conceptual Volume Sequence (30xx,1346) 1 Reference to a conceptual volume which received dose during treatment delivery..See C.AA.P2.1.1.Only a single Item shall be included in this sequence.

>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table C.AA.2.6-1>Calculated Radiation Dose Values Sequence

(30xx,6110) 1C Calculated dose values of this treated radiation. Required if Measured Radiation Dose Values Sequence (30xx,6114) is not present, may be present otherwise. One or more Items shall be included in this sequence.

>>Number of Dose Meterset Points

(30xx,0B68) 1 The number of dose value points represented by the list of values in Meterset Values (30xx,0B6A) and Radiation Dose Values (30xx,0B6C). The number shall be greater than 1. See C.AA.C2.1.

>>Meterset Values (30xx,0B6A) 1 The list of meterset values, where the corresponding dose values are delivered as specified in Radiation Dose Values (30xx,0B6C). See C.AA.C2.1.

>>Radiation Dose Values (30xx,0B6C) 1 The dose values (in Gy) delivered at the corresponding meterset value. See C.AA.C2.1.

>Measured Radiation Dose Values Sequence

(30xx,6114) 1C Measured dose values of this treated radiation. Required if Calculated Radiation Dose Values Sequence (30xx,6110) is not present, may be present otherwise.One or more Items shall be included in this sequence.

>>Number of Dose Meterset Points

(30xx,0B68) 1 The number of dose value points represented by the list of values in Meterset Values (30xx,0B6A) and Radiation Dose Values (30xx,0B6C). The number shall be greater than 1. See C.AA.C2.1.

>>Meterset Values (30xx,0B6A) 1 The list of meterset values, where the corresponding dose values are delivered as specified in Radiation Dose Values (30xx,0B6C). See

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C.AA.C2.1.

>>Radiation Dose Values (30xx,0B6C) 1 The dose values (in Gy) delivered at the corresponding meterset value. See C.AA.C2.1.

>Measured Dose Type (3008,0014) 2 Type of dose measurement. Defined Terms:

DIODE = semiconductor diode

TLD = thermo-luminescent dosimeter

ION_CHAMBER = ion chamber

GEL = dose sensitive gelEPID = electronic portal

imaging deviceFILM = dose sensitive film

>Measured Dose Description (3008,0012) 3 User-defined description of Dose Reference (e.g. “Exit dose”, “Point A”).

C.AA.P2.1 RT Dose Record Common Module Attribute DescriptionC.AA.P2.1.1 Conceptual Volume SequenceThe Conceptual Volume Sequence (30xx,1346) identifies a Conceptual Volume defining a volume for which dose has been recorded during treatments. If the Conceptual Volume is associated with a segment, the segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6). Alternatively, the dosimetric volume may not be associated with a segment. For example, dose recording may be specified using a nominal dose to a volume and the tracking coefficients approximated by meterset values.

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Make the following additions to PS3.3, Annex F, Table F.4-1:

Table F.4-1RELATIONSHIP BETWEEN DIRECTORY RECORDS

Directory Record Type Section Directory Record Types which may be included in the next lower-level directory Entity

(Root Directory Entity) PATIENT, HANGING PROTOCOL, PALETTE, PRIVATE

PATIENT F.5.1 STUDY, HL7 STRUC DOC, PRIVATE

STUDY F.5.2 SERIES, PRIVATE

SERIES F.5.3 IMAGE, RT DOSE, RT STRUCTURE SET, RT PLAN, RT TREAT RECORD, PRESENTATION, WAVEFORM, SR DOCUMENT, KEY OBJECT DOC, SPECTROSCOPY, RAW DATA, REGISTRATION, FIDUCIAL, ENCAP DOC, VALUE MAP, STEREOMETRIC, RADIOTHERAPY, PRIVATE

IMAGE F.5.4 PRIVATE

RT DOSE F.5.19 PRIVATE

RT STRUCTURE SET F.5.20 PRIVATE

RT PLAN F.5.21 PRIVATE

RT TREAT RECORD F.5.22 PRIVATE

PRESENTATION F.5.23 PRIVATE

WAVEFORM F.5.24 PRIVATE

SR DOCUMENT F.5.25 PRIVATE

KEY OBJECT DOC F.5.26 PRIVATE

SPECTROSCOPY F.5.27 PRIVATE

RAW DATA F.5.28 PRIVATE

REGISTRATION F.5.29 PRIVATE

FIDUCIAL F.5.30 PRIVATE

HANGING PROTOCOL F.5.31 PRIVATE

ENCAP DOC F.5.32 PRIVATE

HL7 STRUC DOC F.5.33 PRIVATE

VALUE MAP F.5.34 PRIVATE

STEREOMETRIC F.5.35 PRIVATE

PALETTE F.5.36 PRIVATE

RADIOTHERAPY F.5.X PRIVATEPRIVATE F.6.1 PRIVATE, (any of the above as privately defined)

188

2804

2806


Add the “RADIOTHERAPY DR” box at the bottom of PS3.3, Annex F, Figure F.4-1:2808

2810


Add the following to PS3.3, Annex F, Section F.5.X:

F.5.X Radiotherapy Directory Record DefinitionThe Directory Record is based on the specification of Section F.3. It is identified by a Directory Record Type of Value "RADIOTHERAPY". Table F.5-X lists the set of keys with their associated Types for such a Directory Record Type. The description of these keys may be found in the Modules related to the Instance-level IEs of Second-generation Radiotherapy IODs. This Directory Record shall be used to reference one of the class of Second-generation Radiotherapy SOP Instances having a Modality (0008,0060) of “RT”. This type of Directory Record may reference a Lower-Level Directory Entity that includes one or more Directory Records as defined in Table F.4-1.

Table F.5-XRADIOTHERAPY KEYS

Key Tag Type Attribute DescriptionSpecific Character Set (0008,0005) 1C Required if an extended or replacement

character set is used in one of the keys.

Instance Number (0020,0013) 1

User Content Label (30xx,51E0) 1

Content Description (0070,0081) 2

Content Creator’s Name

(0070,0084) 2

Any other Attribute of the Instance-level IE Modules

3

Note: Because Referenced SOP Instance UID in File (0004,1511) may be used as a "pseudo" Directory Record Key (See Table F.3-3), it is not duplicated in this list of keys.

190

2812

2814

2816

2818

2820

2822

2824

2826


Change the following in PS3.3, section C.7.5.1 General Equipment Module

C.7.5.1 General Equipment Module…

Attribute Name Tag Type Attribute Description

Pixel Padding Value (0028,0120) 1C Single pixel value or one limit (inclusive) of a range of pixel values used in an image to pad to rectangular format or to signal background that may be suppressed. See C.7.5.1.1.2 for further explanation.Required if Pixel Padding Range Limit (0028,0121) is present and either Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present and Bits Stored (0028,0101) is less or equal 16. May be present otherwise only if Pixel Data (7FE0,0010) or Pixel Data Provider URL (0028,7FE0) is present.

Notes: 1. The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103).2. This Attribute is not used in Presentation State Instances; there is no means in a Presentation State to “override” any Pixel Padding Value specified in the referenced images.3. This Attribute does apply to RT Dose and Segmentation instances, since they include Pixel Data.

2828

2830



Long Pixel Padding Value (0028,xxxx) 1C Pixel Padding Value, which shall be used instead of Pixel Padding Value (0028,0120), when this attribute ir present.Required, when the rules of Pixel Padding Value (0028,0120) apply and Bits Stored (0028,0101) is greater than 16.Otherwise, all specifications of Pixel Padding Value (0028,0120) apply.

Change the following in PS3.3, section C.7.6.3 Image Pixel Module

C.7.6.3 Image Pixel Module


Pixel Padding Range Limit (0028,0121) 1C Pixel value that represents one limit (inclusive) of a range of padding values used together with Pixel Padding Value (0028,0120) as defined in the General Equipment Module. See C.7.5.1.1.2 for further explanation.Required if pixel padding is to be defined as a range rather than a single value and Bits Stored (0028,0101) is less or equal 16.

Notes: 1. The Value Representation of this Attribute is determined by the value of Pixel Representation (0028,0103).2. Pixel Padding Value (0028,0120) is also required when this Attribute is present.

192

2832

2834



Long Pixel Padding Range Limit

(0028,yyyy) 1C Pixel Padding Value, which shall be used instead of Pixel Padding Value Range Limit (0028,0121), when this attribute ir present.Required, when the rules of Pixel Padding Value Range Limit (0028,0121) apply and Bits Stored (0028,0101) is greater than 16.Otherwise, all specifications of Pixel Padding Range Limit (0028,0121) apply.


Part 4 Addendum

Add the following to PS3.4, Appendix B.5, Table B.5-1

SOP Class Name SOP Class UID IOD Spec

(defined in PS 3.3)

RT Course Storage 1.2.840.10008.5.1.4.1.1.481.XN.1RT Physician Intent Storage 1.2.840.10008.5.1.4.1.1.481.XN.2

RT Radiation Set Storage 1.2.840.10008.5.1.4.1.1.481.XN.3RT Segment Annotation Storage 1.2.840.10008.5.1.4.1.1.481.XN.4

Tomotherapeutic Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.1C-Arm Photon Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.2

C-Arm Electron Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.3Multiple Fixed Source Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.4

Robotic Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.5Multi-Axial Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.7

Tomotherapeutic Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.1

C-Arm Photon Radiation Record Storage 1.2.840.10008.5.1.4.1.1.481.XN.6.2C-Arm Electron Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.3

Multiple Fixed Source Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.4

Robotic Radiation Record Storage 1.2.840.10008.5.1.4.1.1.481.XN.6.5

Multi-Axial Radiation Record Storage 1.2.840.10008.5.1.4.1.1.481.XN.6.7RT Dose Image Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.1

RT Dose Histogram Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.2RT Dose Samples Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.3

194

2836

2838


Add the following to PS3.4, Table I.4-1

Table I.4-1 Media Storage Standard SOP Classes

SOP Class Name SOP Class UID IOD SpecificationRT Course Storage 1.2.840.10008.5.1.4.1.1.481.XN.1 RT Course

RT Physician Intent Storage

1.2.840.10008.5.1.4.1.1.481.XN.2 RT Physician Intent

RT Radiation Set Storage 1.2.840.10008.5.1.4.1.1.481.XN.3 RT Radiation Set

RT Segment Annotation Storage

1.2.840.10008.5.1.4.1.1.481.XN.4 RT Segment Annotation

Tomotherapeutic Radiation Storage

1.2.840.10008.5.1.4.1.1.481.XN.5.1 Tomotherapeutic Radiation

C-Arm Photon Radiation Storage

1.2.840.10008.5.1.4.1.1.481.XN.5.2 C-Arm Photon Radiation

C-Arm Electron Radiation Storage

1.2.840.10008.5.1.4.1.1.481.XN.5.3 C-Arm Electron Radiation

Multiple Fixed Source Radiation Storage

1.2.840.10008.5.1.4.1.1.481.XN.5.4 Multiple Fixed Source Radiation

Robotic Radiation Storage 1.2.840.10008.5.1.4.1.1.481.XN.5.5 Robotic Radiation

Multi-Axial Radiation Storage

1.2.840.10008.5.1.4.1.1.481.XN.5.7 Multi-Axial Radiation


1.2.840.10008.5.1.4.1.1.481.XN.6.1 Tomotherapeutic Radiation Record

C-Arm Photon Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.2 C-Arm Photon Radiation Record

C-Arm Electron Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.3 C-Arm Electron Radiation Record


1.2.840.10008.5.1.4.1.1.481.XN.6.4 Multiple Fixed Source Radiation Record

Robotic Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.5 Robotic Radiation Record

Multi-Axial Radiation Record Storage

1.2.840.10008.5.1.4.1.1.481.XN.6.7 Multi-Axial Radiation Record

RT Dose Image Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.1 RT Dose Image

RT Dose Histogram Storage

1.2.840.10008.5.1.4.1.1.481.XN.7.2 RT Dose Histogram

RT Dose Samples Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.3 RT Dose Samples

2840

2842


Add the following to PS3.4, Appendix Z.1.3, Table Z.1-1

Table Z.1-1Attributes not to be Included in Instances Sent

Attribute TagDose Samples Data (30xx,1251)

Dose Histogram Data (30xx,1204)

196

2844

2846


Part 6 Addendum

Add the following data elements to PS3.6:

6 REGISTRY OF DICOM DATA ELEMENTS

(30xx,0111) Control Point Index ControlPointIndex US 1

(30xx,0112) Device Index DeviceIndex US 1

(30xx,0113) Beam Mode Index BeamModeIndex US 1

(30xx,0114) RT Tolerance Set Index RTToleranceSetIndex US 1

(30xx,0115) Sub-Control Point Index SubControlPointIndex US 1

(30xx,0116) Treatment Phase Index TreatmentPhaseIndex US 1

(30xx,0117) Meta RT Radiation Set Index

MetaRTRadiationSetIndex US 1

(30xx,0118) RT Prescription Index RTPrescriptionIndex US 1

(30xx,0119) Dosimetric Objective Parameter Index

DosimetricObjectiveParameterIndex US 1

(30xx,0120) Radiation Dose Identification Index

RadiationDoseIdentificationIndex US 1

(30xx,0121) Segment Index SegmentIndex US 1

(30xx,0122) Referenced Meta RT Radiation Set Index

ReferencedMetaRTRadiationSetIndex US 1

(30xx,0123) Meta RT Radiation Set Relationship Sequence

Meta RT Radiation Set Relationship Sequence

SQ 1

(30xx,0141) Referenced Control Point Index

ReferencedControlPointIndex US 1

(30xx,0142) Referenced Device Index ReferencedDeviceIndex US 1

(30xx,0144) Consecutive Treatment Phase Index

ConsecutiveTreatmentPhaseIndex US 1

(30xx,0146) Referenced Treatment Phase Index

ReferencedTreatmentPhaseIndex US 1

(30xx,0148) Referenced RT Prescription Index

ReferencedRTPrescriptionIndex US 1

(30xx,0149) Parent RT Prescription Index

ParentRTPrescriptionIndex US 1

(30xx,0150) Referenced Radiation Dose Identification Index

ReferencedRadiationDoseIdentificationIndex

US 1

(30xx,0151) Referenced Segment Annotation Index

ReferencedSegmentAnnotationIndex US 1

2848

2850

2852


(30xx,02E3) RT Accessory Holder Water-Equivalent Thickness

RTAccessoryHolderWaterEquivalentThickness

FD 1

(30xx,0540) Referenced RT Accessory Holder Device Index

ReferencedRTAccessoryHolderDeviceIndex

US 1

(30xx,0542) RT Accessory Holder Slot Sequence

RTAccessoryHolderSlotSequence SQ 1

(30xx,0544) RT Accessory Holder Slot ID

RTAccessoryHolderSlotID LO 1

(30xx,0546) RT Accessory Holder Slot Distance

RTAccessoryHolderSlotDistance FD 1

(30xx,0548) RT Accessory Slot Distance

RTAccessorySlotDistance FD 1

(30xx,054A) RT Accessory Holder Definition Sequence

RTAccessoryHolderDefinitionSequence SQ 1

(30xx,054B) RT Accessory Device Slot ID

RTAccessoryDeviceSlotID LO 1

(30xx,054D) Manufacturer's Device Identifier

ManufacturerDeviceIdentifier LO 1

(30xx,0800) RT Course Creation DateTime

RTCourseCreationDateTime DT 1

(30xx,0802) Instance-Level Referenced Performed Procedure Step Sequence

InstanceLevelReferencedPerformedProcedureStepSequence

SQ 1

(30xx,0804) RT Course Scope Indicator

RTCourseScopeIndicator CS 1

(30xx,0805) RT Prescription Reference Presence Flag

RTPrescriptionReferencePresenceFlag CS 1

(30xx,0806) RT Treatment Phase Presence Flag

RTTreatmentPhasePresenceFlag CS 1

(30xx,0807) RT Radiation Set Reference Presence Flag

RTRadiationSetReferencePresenceFlag CS 1

(30xx,080A) RT Course Predecessor Sequence

RTCoursePredecessorSequence SQ 1

(30xx,0822) Prior Treatment Sequence PriorTreatmentSequence SQ 1

(30xx,0824) Prior RT Course Sequence

PriorRTCourseSequence SQ 1

(30xx,0826) Delivered Radiation Dose Sequence

DeliveredRadiationDoseSequence SQ 1

(30xx,0828) Delivered Radiation Dose DeliveredRadiationDose FD 1

(30xx,082C) Delivered Irradiated Volume Description

DeliveredIrradiatedVolumeDescription ST 1

(30xx,0830) RT Course State Sequence

RTCourseStateSequence SQ 1

(30xx,0832) Person Role Code Sequence

PersonRoleCodeSequence SQ 1

198


(30xx,0860) Physician IntentRT Prescription Reference Sequence

PhysicianIntentPrescriptionSequenceRTPrescriptionReferenceSequence

SQ 1

(30xx,0861) RT Prescription Reference Index

RTPrescriptionReferenceIndex US 1

(30xx,0864) Referenced RT PrescriptionPhysician Intent Sequence

ReferencedPhysicianIntentRTPrescriptionSequence

SQ 1

(30xx,0866) Prescription State SequenceReferenced Intent Prescription Status Sequence

PrescriptionStateSequenceReferencedIntentPrescriptionStatusSequence

SQ 1

(30xx,0870) Referenced Treatment Phase SequenceTreatment Phase Reference Sequence

ReferencedTreatmentPhaseSequenceTreatmentPhaseReferenceSequence

SQ 1

(30xx,0874) Referenced RT Segment Annotation Sequence

ReferencedRTSegmentAnnotationSequence

SQ 1

(30xx,0880) Treatment Phase Sequence

TreatmentPhaseSequence SQ 1

(30xx,088A) RT Treatment Phase State Sequence

RTTreatmentPhaseStateSequence SQ 1

(30xx,088C) Intended Phase Start Date

IntendedPhaseStartDate DA 1

(30xx,088E) Intended Phase End Date IntendedPhaseEndDate DA 1

(30xx,0890) Treatment Phase Relationship Sequence

TreatmentPhaseRelationshipSequence SQ 1

(30xx,0892) Temporal Relationship Interval Anchor

TemporalRelationshipIntervalAnchor CS 1

(30xx,0894) Minimum Number of Interval Days

MinimumNumberOfIntervalDays DS 1

(30xx,0896) Maximum Number of Interval Days

MaximumNumberOfIntervalDays DS 1

(30xx,08B0) Meta RT Radiation Set Sequence

MetaRTRadiationSetSequence SQ 1

(30xx,08C3) Referenced Treatment Phase Index

ReferencedTreatmentPhaseIndex US 1

(30xx,08C6) Radiation Set Start Delay RadiationSetStartDelay US 1

(30xx,08C8) RT Radiation Set State Sequence

RTRadiationSetStateSequence SQ 1

(30xx,08CA) Pre-treatment RT Radiation Set Reference Sequence

PretreatmentRTRadiationSetReferenceSequence

SQ 1

(30xx,08CB) Pre-treatment RT Radiation Set Role Purpose Code Sequence

PretreatmentRTRadiationSetPurposeRoleCodeSequence

SQ 1


(30xx,08CC) Conceptual Volume State Sequence

ConceptualVolumeStateSequence SQ 1

(30xx,08F2) Treatment RT Radiation Set Reference Sequence

TreatmentRTRadiationSetReferenceSequence

SQ 1

(30xx,08F4) Treatment RT Radiation Set Sequence Number

TreatmentRTRadiationSetSequenceNumber

US 1

(30xx,08F6) Treatment RT Radiation Set State Sequence

TreatmentRTRadiationSetStateSequence

SQ 1

(30xx,08F8) Treatment RT Radiation Set Operation State Sequence

TreatmentRTRadiationSetOperationStateSequence

SQ 1

(30xx,08FA) Treatment RT Radiation Set Relation Sequence

TreatmentRTRadiationSetRelationSequence

SQ 1

(30xx,08FC) Treatment RT Radiation Set Alteration Type Sequence

TreatmentRTRadiationSetAlterationTypeSequence

SQ 1

(30xx,08FD) Treatment RT Radiation Set Alteration Type Code Sequence

TreatmentRTRadiationSetAlterationTypeCodeSequence

SQ 1

(30xx,08FE) Treatment RT Radiation Set Change Description

TreatmentRTRadiationSetChangeDescription

ST 1

(30xx,08FF) Referenced RT Radiation Record Sequence

ReferencedRTRadiationRecordSequence

SQ 1

(30xx,0900) RT Course Associated Instance Reference Sequence

RTCourseAssociatedInstanceReferenceSequence

SQ 1

(30xx,0901) Instance Reference Purpose Code Sequence

InstanceReferencePurposeCodeSequence

SQ 1

(30xx,0902) RT Prescription Label RTPrescriptionLabel LO 1

(30xx,0903) Associated Instance State Sequence

AssociatedInstanceStateSequence SQ 1

(30xx,0910) Physician Intent Predecessor Sequence

PhysicianIntentPredecessorSequence SQ 1

(30xx,0912) RT Physician Intent Nominal Sequence

RTPhysicianIntentNominalSequence FD 1

(30xx,0913) RT Physician Intent Index RTPhysicianIntentIndex US 1

(30xx,0914) RT Treatment Intent Type RTTreatmentIntentType CS 1

(30xx,0915) RT Physician Intent Narrative

RTPhysicianIntentNarrative ST 1

(30xx,0916) RT Protocol Code Sequence

RTProtocolCodeSequence SQ 1

(30xx,0917) Supersession Reason SupersessionReason ST 1

(30xx,0918) RT Diagnostic Code Sequence

RTDiagnosticCodeSequence SQ 1

(30xx,0919) Referenced RT Physician Intent Index

ReferencedRTPhysicianIntentIndex US 1

200


(30xx,091A) RT Diagnostic Image Set Sequence

RTDiagnosticImageSetSequence SQ 1

(30xx,0920) RT Anatomic Prescription Sequence

RTAnatomicPrescriptionSequence SQ 1

(30xx,0922) Anatomy Label AnatomyLabel LO 1

(30xx,0924) Prior Dose Description PriorDoseDescription ST 1

(30xx,0925) Prior Dose Reference Sequence

PriorDoseReferenceSequence SQ 1

(30xx,0926) Dosimetric Objective Evaluation Including Prior Dose

DosimetricObjectiveEvaluationIncludingPriorDose

CS 1

(30xx,0928) Prescription Anatomy Notes

PrescriptionAnatomyNotes ST 1

(30xx,0930) Prescription Anatomy TypeRole

PrescriptionAnatomyTypeRole CS 1

(30xx,0932) Radiobiological Structural Type

RadiobiologicalStructuralType CS 1

(30xx,0933) Conceptual Volume Optimization Precedence

ConceptualVolumeOptimizationPrecedence

US 1

(30xx,0934) Anatomy Category Code Sequence

AnatomyCategoryCodeSequence SQ 1

(30xx,0935) Conceptual Volume Optimization Blocking

ConceptualVolumeOptimizationBlocking CS 1

(30xx,0936) Anatomy Property Type Code Sequence

AnatomyPropertyTypeCodeSequence SQ 1

(30xx,0940) RT Prescription Sequence RTPrescriptionSequence SQ 1

(30xx,0942) Dosimetric Objective Sequence

DoseObjectiveSequence SQ 1

(30xx,0943) Dosimetric Objective Value Type Code Sequence

DoseObjectiveValueTypeCodeSequence

SQ 1

(30xx,0944) Type of Prescription TypeofPrescription CS 1

(30xx,0946) Dosimetric Objective Value Unit Code Sequence

DoseObjectiveValueUnitCodeSequence SQ 1

(30xx,0948) Dosimetric Objective UID DosimetricObjectiveUID UI 1

(30xx,0949) Referenced Dosimetric Objective UID

ReferencedDosimetricObjectiveUID UI 1

(30xx,0950) Dosimetric Objective Parameter Sequence

DoseObjectiveParameterSequence SQ 1

(30xx,0951) Referenced Dosimetric Objectives Sequence

ReferencedDosimetricObjectivesSequence

SQ 1

(30xx,0954) Dosimetric Objective Preservation

DoseObjectivePreservation CS 1

(30xx,0956) Dosimetric Objective Priority

DoseObjectivePriority FD 1


(30xx,0958) Dosimetric Objective Priority Type

DoseObjectivePriorityType CS 1

(30xx,0960) Planning Input Information Sequence

PlanningInputInformationSequence SQ 1

(30xx,0965) Fraction Pattern Sequence

FractionPatternSequence SQ 1

(30xx,0966) Treatment Technique Description

TreatmentTechniqueDescription ST 1

(30xx,0970) General Prescription Notes

GeneralPrescriptionNotes ST 1

(30xx,0972) Number of Fractions NumberOfFractions US 1

(30xx,0973) Intended Delivery Duration

IntendedDeliveryDuration US 1

(30xx,0974) Fractionation Description FractionationDescription ST 1

(30xx,0976) Treatment Technique Code Sequence

TreatmentTechniqueCodeSequence SQ 1

(30xx,0978) Prescription Annotation Sequence

PrescriptionAnnotationSequence SQ 1

(30xx,0979) Prescription Annotation DateTime

PrescriptionAnnotationDateTime DT 1

(30xx,0982) Fraction-Basedation Relationship Sequence

FractionBasedationRelationshipSequence

SQ 1

(30xx,0984) Fraction-Based Relationship Interval Anchor

FractionBasedRelationshipIntervalAnchor

CS 1

(30xx,0B26) Radiation Sequence RadiationSequence SQ 1

(30xx,0B40) Radiation Dose Sequence RadiationDoseSequence SQ 1

(30xx,0B42) Radiation Dose Identification Sequence

RadiationDoseIdentificationSequence SQ 1

(30xx,0B46) Radiation Dose Identification Label

RadiationDoseIdentificationLabel LO 1

(30xx,0B48) Reference Dose Type ReferenceDoseType CS 1

(30xx,0B49) Primary Dose Value Indicator

PrimaryDoseValueIndicator CS 1

(30xx,0B62) Reference Dose Point Coordinates

ReferenceDosePointCoordinates FD 3

(30xx,0B64) Radiation Dose Values Sequence

RadiationDoseValuesSequence SQ 1

(30xx,0B68) Dose Meterset to Dose Mapping SequencePo

DoseMetersetToDoseMappingSequencePo

SQ 1

(30xx,0B6D) Radiation Verification Control Point Sequence

RadiationVerificationControlPointSequence

SQ 1

(30xx,0B70) Radiation Dose Point Depth

RadiationDosePointDepth FD 1

202


(30xx,0B72) Radiation Dose Point Equivalent Depth

RadiationDosePointEquivalentDepth FD 1

(30xx,0B74) Radiation Dose Point SSD RadiationDosePointSSD FD 1

(30xx,0B76) Radiation Dose In Vivo Measurement Sequence

RadiationDoseInVivoMeasurementSequence

SQ 1

(30xx,0B78) Radiation Dose In Vivo Measurement Label

RadiationDoseInVivoMeasurementLabel LO 1

(30xx,0B7A) Radiation Dose Central Axis Displacement

RadiationDoseCentralAxisDisplacement FD 1

(30xx,0B7B) Radiation Dose Value RadiationDoseValue FD 1

(30xx,0B7C) Radiation Dose Source-Skin Distance

RadiationDoseSourceSkinDistance FD 1

(30xx,0B7D) Radiation Dose Measurement Point Coordinates

RadiationDoseMeasurementPointCoordinates

FD 3

(30xx,0BA0) RT Tolerance Set Sequence

RTToleranceSetSequence SQ 1

(30xx,0BA2) RT Tolerance Set Label RTToleranceSetLabel SH 1

(30xx,0BA6) Attribute Tolerance Values Sequence

AttributeToleranceValuesSequence SQ 1

(30xx,0BA8) Tolerance Value ToleranceValue FD 1

(30xx,0BAA) Patient Support Position Tolerance Sequence

PatientSupportPositionToleranceSequence

SQ 1

(30xx,0BAC) Calculated Treatment Time

CalculatedTreatmentTime FD 1

(30xx,0BAD) Treatment Time Limit TreatmentTimeLimit FD 1

(30xx,0BB0) Manufacturer's Model Class UID

ManufacturersModelClassUID UI 1

(30xx,0BB2) Treatment Machine Delivery Subsystem ID

TreatmentMachineDeliverySubsystemID SH 1

(30xx,0C00) C-Arm Photon-Electron Control Point Sequence

CArmPhotonElectronControlPointSequence

SQ 1

(30xx,0C02) Referenced Radiation Set Sequence

ReferencedRadiationSetSequence SQ 1

(30xx,0C04) Referenced Radiation Sequence

ReferencedRadiationSequence SQ 1

(30xx,0C97) Treatment Machine Special Mode Sequence

TreatmentMachineSpecialModeSequence

SQ 1

(30xx,0C99) Radiotherapy Procedure Technique Sequence

RadiotherapyProcedureTechniqueSequence

SQ 1

(30xx,0F00) Robotic Beam Limiting Device Supported Type

RoboticBeamLimitingDeviceSupportedType

CS 1

(30xx,0F03) Robotic Device Geometry RoboticDeviceGeometry CS 1

(30xx,0F10) Robotic Collimation Type RoboticCollimationType CS 1


(30xx,0F15) Robotic Path Identifier Sequence

RoboticPathIdentifierSequence SQ 1

(30xx,0F33) Robotic Path Node Number

RoboticPathNodeSequenceNumber UL 1

(30xx,0F40) RT Treatment Source Coordinates

RTTreatmentSourceCoordinates FL 3

(30xx,0F42) Robotic Beam Sub-Control Point Sequence

RoboticBeamSubControlPointSequence SQ 1

(30xx,0F44) RT Treatment Target Coordinates

RTTreatmentTargetCoordinates FL 3

(30xx,0F46) Robot Head Yaw Angle RobotHeadYawAngle FL 1

(30xx,0F50) Robotic Control Point Sequence

RoboticControlPointSequence SQ 1

(30xx,1000) Tomotherapeutic Leaf Bank Definition Sequence

TomotherapeuticLeafBankDefinitionSequence

SQ 1

(30xx,1001) Leaf Bank Offset LeafBankOffset FD 1

(30xx,1002) Number of Leaf Slots NumberOfLeafSlots US 1

(30xx,1003) Binary MLC Leaf Slot Boundaries

BinaryMLCLeafSlotBoundaries FD 2-n

(30xx,1005) Maximum Binary MLC Jaw 1 Opening

MaximumBinaryMLCJaw1Opening FD 1

(30xx,1006) Maximum Binary MLC Jaw 2 Opening

MaximumBinaryMLCJaw2Opening FD 1

(30xx,1007) Tomotherapeutic Nominal Couch Speed

TomotherapeuticNominalCouchSpeed FD 1

(30xx,1008) Tomotherapeutic Nominal Gantry Period

TomotherapeuticNominalGantryPeriod FD 1

(30xx,1009) Tomotherapeutic Nominal Delivery Pitch

TomotherapeuticNominalDeliveryPitch FD 1

(30xx,1010) Tomotherapeutic Control Point Sequence

TomotherapeuticControlPointSequence SQ 1

(30xx,1024) Binary MLC Jaw 1 Opening

BinaryMLCJaw1Opening FL 1

(30xx,1025) Binary MLC Jaw 2 Opening

BinaryMLCJaw2Opening FL 1

(30xx,1030) Tomotherapeutic Leaf Open Percentages

TomotherapeuticLeafOpenPercentages FL 1-n

(30xx,1031) Tomotherapeutic Leaf Open Start Percentages

TomotherapeuticLeafOpenStartPercentages

FL 1-n

(30xx,1100) Composite Dose Sequence

CompositeDoseSequence SQ 1

(30xx,1102) Contributing Radiation Set Sequence

ContributingRadiationSetSequence SQ 1

(30xx,1110) Dose Contribution Weight DoseContributionWeight FD 1

204


(30xx,1116) RT Dose Image Frame Type Sequence

RTDoseImageFrameTypeSequence SQ 1

(30xx,1118) Contributing Radiation Sequence

ContributingRadiationSequence SQ 1

(30xx,1120) Number of Complete Fractions Contributing

NumberOfCompleteFractionsContributing

US 1

(30xx,1122) Partial Delivery Limits Sequence

PartialDeliveryLimitsSequence SQ 1

(30xx,1123) Fraction Completion Status

FractionCompletionStatus CS 1

(30xx,1124) Dose Contribution Accumulation Type

DoseContributionAccumulationType CS 1

(30xx,1125) Radiation Completion Status

RadiationCompletionStatus CS 1

(30xx,1128) Contributing RT RadiationRecord Sequence

ContributingRTRadiationRecordSequence

SQ 1

(30xx,1130) Radiation Absorption Model

RadiationAbsorptionModel CS 1-n

(30xx,1132) Effective Dose Method Code Sequence

EffectiveDoseMethodCodeSequence SQ 1

(30xx,1134) Effective Dose Method Description

EffectiveDoseMethodDescription LO 1

(30xx,1135) Referenced Dose Calculation Annotation Object Sequence

ReferencedDoseCalculationAnnotationObjectSequence

SQ 1

(30xx,1136) Dose Purpose DosePurpose CS 1(30xx,1137) Effective Dose Method

Modifier Code SequenceEffectiveDoseMethodModifierCodeSequence

SQ 1

(30xx,1138) Dose Data Source DoseDataSource CS 1

(30xx,113A) Dose Scope DoseScope CS 1(30xx,113C) Dose Data Source

Measurement Code Sequence

DoseDataSourceMeasurementCodeSequence

SQ 1

(30xx,113E) Effective Tissue Composition

EffectiveTissueComposition CS 1

(30xx,1140) Start Meterset StartMeterset FD 1

(30xx,1141) Stop Meterset StopMeterset FD 1

(30xx,1144) Algorithm Type Code Sequence

AlgorithmTypeCodeSequence SQ 1

(30xx,1146) Referenced Annotating Object Sequence

ReferencedAnnotatingObjectSequence SQ 1

(30xx,1150) Dose Grid Geometry DoseGridGeometry CS 1

(30xx,1201) Dose Histogram Normalization Dose Value

DoseHistogramNormalizationDoseValue FD 1


(30xx,1202) Dose Histogram Sequence

DoseHistogramSequence SQ 1

(30xx,1203) Dose Histogram Referenced Segment Sequence

DoseHistogramReferencedSegmentSequence

SQ 1

(30xx,1204) Dose Histogram Data DoseHistogramData OF 1

(30xx,1205) Histogram Tally Type HistogramTallyType CS 1

(30xx,1206) Dose Histogram Spatial Units

DoseHistogramSpatialUnits CS 1

(30xx,1207) Dose Histogram Dose Unit Code Sequence

DoseHistogramDoseUnitCodeSequence SQ 1

(30xx,1209) Segment Total Size SegmentTotalSize FD 1

(30xx,1210) Dose Histogram Type DoseHistogramType CS 1

(30xx,1211) Dose Statistics Sequence DoseStatisticsSequence SQ 1

(30xx,1250) Number of Dose Samples NumberOfDoseSamples UL 1

(30xx,1251) Dose Samples Data DoseSamplesData OF 1

(30xx,1253) Dose Samples Dose Unit Code Sequence

DoseDoseSamplesUnitCodeSequence SQ 1

(30xx,1301) Conceptual Volume UID ConceptualVolumeUID UI 1

(30xx,1302) Originating SOP Instance Reference Sequence

OriginatingSOPInstanceReferenceSequence

SQ 1

(30xx,1303) Conceptual Volume Constituent Sequence

ConceptualVolumeConstituentSequence

SQ 1

(30xx,1304) Equivalent Conceptual Volume Instance Reference Sequence

EquivalentConceptualVolumeInstanceReferenceSequence

SQ 1

(30xx,1305) Equivalent Conceptual Volumes Sequence

EquivalentConceptualVolumesSequence

SQ 1

(30xx,1306) Conceptual Volume Set Sequence

ConceptualVolumeSetSequence SQ 1

(30xx,1307) Conceptual Volume Combination Expression

ConceptualVolumeCombinationExpression

ST 1

(30xx,1308) Conceptual Volume Constituent Index

ConceptualVolumeConstituentIndex US 1

(30xx,1309) Conceptual Volume Combination Flag

ConceptualVolumeCombinationFlag CS 1

(30xx,1310) Conceptual Volume Combination Description

ConceptualVolumeCombinationDescription

ST 1

(30xx,1311) Conceptual Volume Segmentation Defined Flag

ConceptualVolumeSegmentationDefinedFlag

CS 1

(30xx,1312) Conceptual Volume Segmentation Reference Sequence

ConceptualVolumeSegmentationReferenceSequence

SQ 1

206


(30xx,1313) Referenced Conceptual Volume Constituent Index

ReferencedConceptualVolumeConstituentIndex

US 1

(30xx,1314) Conceptual Volume Constituent Segmentation Reference Sequence

ConceptualVolumeConstituentSegmentationReferenceSequence

SQ 1

(30xx,1324) Manufacturer's Model Version

ManufacturersModelVersion LO 1

(30xx,1326) Device Alternate Identifier DeviceAlternateIdentifier ST 1

(30xx,1327) Device Alternate Identifier Type

DeviceAlternateIdentifierType CS 1

(30xx,1328) Device Alternate Identifier Format

DeviceAlternateIdentifierFormat LO 1

(30xx,1331) Segmentation SOP Instance Reference Sequence

SegmentationSOPInstanceReferenceSequence

SQ 1

(30xx,1332) Segmentation Template Label

SegmentationTemplateLabel SH 1

(30xx,1334) Segmentation Template UID

SegmentationTemplateUID UI 1

(30xx,1343) Direct Segment Reference Sequence

DirectROIReferenceSequence SQ 1

(30xx,1344) Combination Segment Reference Sequence

CombinationSegmentReferenceSequence

SQ 1

(30xx,1346) Conceptual Volume Sequence

ConceptualVolumeSequence SQ 1

(30xx,1349) Segment RT Accessory Device Sequence

SegmentRTAccessoryDeviceSequence SQ 1

(30xx,134B) Segment Properties Sequence

SegmentPropertiesSequence SQ 1

(30xx,134C) Segment Properties Modifier Sequence

SegmentPropertiesModifierSequence SQ 1

(30xx,134E) Alternate Segmented Property Type Code Sequence

AlternateSegmentedPropertyTypeCodeSequence

SQ 1

(30xx,134F) Purpose of Alternate Segmented Property Type Code Sequence

PurposeOfAlternateSegmentedPropertyTypeCodeSequence

SQ 1

(30xx,1350) Segmentation Instance Index

SegmentationInstanceIndex US 1

(30xx,1351) Referenced Segmentation Instance Index

ReferencedSegmentationInstanceIndex US 1

(30xx,1500) Multi-Axial Control Point Sequence

MultiAxialControlPointSequence SQ 1

(30xx,1501) Center of Rotation Axis Distance

CenterOfRotationAxisDistance FD 1

(30xx,1520) Gantry Head Pitch Angle GantryHeadPitchAngle FD 1


(30xx,1521) Gantry Head Roll Angle GantryHeadRollAngle FD 1

(30xx,1522) Gantry Head Yaw Angle GantryHeadYawAngle FD 1

(30xx,1525) Multi-Axial Target Coordinate

MultiAxialTargetCoordinate FD 3

(30xx,1540) Multi-Axial Sub-Control Point Sequence

Multi-AxialSubControlPointSequence SQ 1

(30xx,1542) Target Position Meterset Weight

TargetPositionMetersetWeight FL 1

(30xx,1544) Dynamic Beam Limiting Device Positions Sequence

DynamicBeamLimitingDevicePositionsSequence

SQ 1

(30xx,5011) RT Radiation Set Intent RTRadiationSetIntent CS 1

(30xx,5012) RT Dose Contribution Presence Flag

RTDoseContributionPresenceFlag CS 1

(30xx,5013) RT Radiation Data Scope RTRadiationDataScope CS 1

(30xx,5014) Alternate Patient Position Code Sequence

AlternatePatientPositionCodeSequence SQ 1

(30xx,5015) Treatment Device Identification Sequence

TreatmentDeviceIdentificationSequence SQ 1

(30xx,5016) Alternate Treatment Device Sequence

AlternateTreatmentDeviceSequence SQ 1

(30xx,5017) Treatment Device Equivalence UID

MachineEquivalenceUID UI 1

(30xx,5019) Treatment Device Identifier

TreatmentDeviceIdentifier SH 1

(30xx,5021) Cumulative Meterset CumulativeMeterset FD 1

(30xx,5023) Delivery Rate DeliveryRate FD 1

(30xx,5024) Delivery Rate Unit Sequence

DeliveryRateUnitSequence SQ 1

(30xx,5025) Device Label DeviceLabel LO 1

(30xx,5026) Device Type Code Sequence

DeviceTypeCodeSequence SQ 1

(30xx,5027) Device Description DeviceDescription ST 1

(30xx,5028) Treatment Position Sequence

TreatmentPositionSequence SQ 1

(30xx,5030) Patient Equipment Relationship Code Sequence

PatientEquipmentRelationshipCodeSequence

SQ 1

(30xx,5031) Regulatory Device Identifier Sequence

RegulatoryDeviceIdentifierSequence SQ 1

(30xx,5033) Regulatory Device Identifier

RegulatoryDeviceIdentifier ST 1

(30xx,5035) Regulatory Device Identifier Type Code Sequence

RegulatoryDeviceIdentifierTypeCodeSequence

SQ 1

208


(30xx,5041) Number of RT Beam Limiting Devices

NumberOfRTBeamLimitingDevices SQ 1

(30xx,5042) RT Beam Limiting Device Proximal Distance

RTBeamLimitingDeviceProximalDistance

FD 1

(30xx,5043) RT Beam Limiting Device Distal Distance

RTBeamLimitingDeviceDistalDistance FD 1

(30xx,5048) Number of RT Beam Delimiter Pairs

NumberOfRTBeamDelimiterPairs US 1

(30xx,5049) RT Beam Delimiter Element Position Boundaries

RTBeamDelimiterPositionElementBoundaries

FD 2-n

(30xx,504A) RT Beam Delimiter Element Positions

RTBeamDelimiterElementPositions FD 2-n

(30xx,504B) RT Beam Delimiter Diameter

RTBeamDelimiterDiameter FD 1

(30xx,504C) RT Beam Delimiter Geometry Sequence

RTBeamDelimiterGeometrySequence SQ 1

(30xx,504D) RT Beam Limiting Device Definition Sequence

RTBeamLimitingDeviceDefinitionSequence

SQ 1

(30xx,504E) RT Rectangular Beam Limiting Device Definition Sequence

RTRectangularBeamLimitingDeviceDefinitionSequence

SQ 1

(30xx,5051) RT Operation State RTOperationState CS 1

(30xx,5060) Patient Setup UID PatientSetupUID UI 1

(30xx,5062) Wedge Definition Sequence

WedgeDefinitionSequence SQ 1

(30xx,5070) RT Beam Limiting Device Settings Sequence

BeamLimitingDeviceSettingsSequence SQ 1

(30xx,5080) RT Item State Sequence RTItemStateSequence SQ 1

(30xx,5082) Active Item Indicator ActiveItemIndicator CS 1

(30xx,5084) RT Item State Creation Authority Description Sequence

RTItemStateCreationAuthorityDescriptionSequence

SQ 1

(30xx,5086) RT Operation State Sequence

RTOperationStateSequence SQ 1

(30xx,5088) RT Operation State Change Reason Code Sequence

RTOperationStateChangeReasonCodeSequence

SQ 1

(30xx,508A) RT Operation State Code Sequence

RTOperationStateCodeSequence SQ 1

(30xx,508C) RT Operation State DateTime

RTOperationStateDateTime DT 1

(30xx,508E) RT Operation State Change Reason Description

RTOperationStateChangeReasonDescription

ST 1

(30xx,5110) Radiation Particle RadiationParticle CS 1


(30xx,5113) Radiation Dosimeter Unit RadiationDosimeterUnit CS 1

(30xx,5114) RT Beam Distance Reference Location

RTBeamDistanceReferenceLocation CS 1

(30xx,5130) Radiation Source Sequence

RadiationSourceSequence SQ 1

(30xx,5131) Radiation Source Label RadiationSourceLabel LO 1

(30xx,5132) Radiation Source Distance

RadiationSourceDistance FD 1

(30xx,5133) Radiation Source Theta RadiationSourceTheta FD 1

(30xx,5134) Radiation Source Phi RadiationSourcePhi FD 1

(30xx,5137) Radiation Source Control Point Sequence

RadiationSourceControlPointSequence SQ 1

(30xx,513A) Referenced Radiation Source Label

ReferencedRadiationSourceLabel LO 1

(30xx,513B) Radiation Source Collimator Size

RadiationSourceCollimatorSize FD 1

(30xx,513C) Radiation Source Pattern Sequence

RadiationSourcePatternSequence SQ 1

(30xx,513D) Radiation Source Pattern Label

RadiationSourcePatternLabel LO 1

(30xx,513E) Referenced Radiation Source Pattern

ReferencedRadiationSourcePattern SH 1

(30xx,513F) Radiation Source Pattern Source Sequence

RadiationSourcePatternSourceSequence

SQ 1

(30xx,5142) Patient Support Position Parameter Sequence

PatientSupportPositionParameterSequence

SQ 1

(30xx,5150) Compensator Definition Sequence

CompensatorDefinitionSequence SQ 1

(30xx,5151) Compensator Map Orientation

CompensatorMapOrientation CS 1

(30xx,5152) Compensator Proximal Thickness Map

CompensatorProximalThicknessMap OF 1-n

(30xx,5153) Compensator Distal Thickness Map

CompensatorDistalThicknessMap OF 1-n

(30xx,5154) Compensator Base Plane Offset

CompensatorBasePlaneOffset FD 1

(30xx,5160) Block Definition Sequence BlockDefinitionSequence SQ 1

(30xx,5161) Block Edge Data BlockEdgeData OF 1-n

(30xx,5162) Block Orientation BlockOrientation CS 1

(30xx,5163) Block Base Offset BlockBaseOffset FD 1

(30xx,5171) Number of RT Accessory Holders

NumberOfRTAccessoryHolders IS 1

(30xx,5180) General Accessory Definition Sequence

GeneralAccessoryDefinitionSequence SQ 1

210


(30xx,5181) Number of General Accessories

NumberOfGeneralAccessories IS 1

(30xx,5185) Tray Definition Sequence TrayDefinitionSequence SQ 1

(30xx,5190) Boluses Definition Sequence

BolusesDefinitionSequence SQ 1

(30xx,51A0) Equipment Frame of Reference UID

EquipmentFrameOfReferenceUID UI 1

(30xx,51A1) Equipment Frame of Reference Description

EquipmentFrameOfReferenceDescription

ST 1

(30xx,51B3) Gantry Yaw Continuous Angle

GantryYawContinuousAngle FD 1

(30xx,51B4) RT Beam Limiting Device Continuous Angle

RTBeamLimitingDeviceContinuousAngle

FD 1

(30xx,51B5) Gantry Roll Continuous Angle

GantryRollContinuousAngle FD 1

(30xx,51B7) Gantry Pitch Continuous Angle

GantryPitchContinuousAngle FD 1

(30xx,51C0) Beam Mode Sequence BeamModeSequence SQ 1

(30xx,51C1) Beam Mode Label BeamModeLabel SH 1

(30xx,51C2) Beam Mode Description BeamModeDescription ST 1

(30xx,51C3) Beam Mode Machine Code

BeamModeMachineCode LO 1

(30xx,51C5) Nominal Energy NominalEnergy IS 1

(30xx,51C6) Minimum Nominal Energy MinimumNominalEnergy IS 1

(30xx,51C7) Maximum Nominal Energy MaximumNominalEnergy IS 1

(30xx,51C8) Beam Mode Type Code Sequence

BeamModeTypeCodeSequence SQ 1

(30xx,51C9) Energy Unit Code Sequence

EnergyUnitCodeSequence SQ 1

(30xx,51CB) Number of Beam Modes NumberOfBeamModes IS 1

(30xx,51E0) User Content Label UserContentLabel SH 1

(30xx,51E2) RT Entity Label RTEntityLabel SH 1

(30xx,51E3) RT Entity Name RTEntityName LO 1

(30xx,51E4) RT Entity Description RTEntityDescription ST 1

(30xx,51E5) RT Entity Long Label RTEntityLongLabel LO 1

(30xx,51F0) Patient Support Devices Sequence

PatientSupportDevicesSequence SQ 1

(30xx,51F1) Number of Patient Support Devices Sequence

Number of Patient Support Devices Sequence

IS 1

(30xx,5200) Outline Shape Type OutlineShapeType CS 1

(30xx,5202) Outline Edges X OutlineEdgesX FL 1-2

(30xx,5203) Outline Edges Y OutlineEdgesY FL 1-2


(30xx,5204) Center of Circular Outline CenterOfCircularOutline FL 2

(30xx,5205) Diameter of Circular Outline

DiameterOfCircularOutline FL 1

(30xx,5206) Number of Polygonal Vertices

NumberOfPolygonalVertices UL 1

(30xx,5207) Vertices of the Polygonal Outline

VerticesOfThePolygonalOutline FL 2-2n

(30xx,5208) Coordinate System Declaration

CoordinateSystemDeclaration CS 1

(30xx,5209) Outline Definition Plane Distance

OutlineDefinitionPlaneDistance FL 1

(30xx,5210) Beam Limiting Device Definition Distance

BeamLimitingDeviceDefinitionDistance FL 1

(30xx,6000) Treatment Session UID TreatmentSessionUID UI 1

(30xx,6015) Treatment Termination Reason Code Sequence

TreatmentTerminationReasonCodeSequence

SQ 1

(30xx,6016) Machine-Specific Treatment Termination Code Sequence

MachineSpecificTreatmentTerminationCodeSequence

SQ 1

(30xx,6030) Treatment Termination Description

TreatmentTerminationDescription ST 1

(30xx,6035) Treatment Recording Method

TreatmentRecordingMethod CS 1

(30xx,6036) Treatment Tolerance Status

TreatmentToleranceStatus CS 1

(30xx,6037) Sign-Off UID SignOffUID UI 1

(30xx,603A) Treatment Control Point Start DateTime

TreatmentControlPointStartDateTime DT 1

(30xx,603BC)

Treatment Control Point End DateTime

TreatmentControlPointEndDateTime DT 1

(30xx,603C) Sign-Off Item Description SignOffItemDescription ST 1

(30xx,603D) Sign-Off Item DateTime SignOffItemDateTime DT 1

(30xx,603E) Alternate Specified Value Sequence

AlternateSpecifiedValueSequence SQ 1

(30xx,603F) Sign-Off Sequence SignOffSequence SQ 1

(30xx,6040) Patient Frame of Reference to Equipment Mapping Matrix

PatientFrameOfReferenceToEquipmentMappingMatrix

FD 16

(30xx,6042) Patient Location Coordinates Sequence

PatientLocationCoordinatesSequence SQ 1

(30xx,6044) Patient Location Coordinates Code Sequence

PatientLocationCoordinatesCodeSequence

SQ 1

(30xx,6046) Patient Support Position Sequence

PatientSupportPositionSequence SQ 1

212


(30xx,6050) Beam-On Area Sequence BeamOnAreaSequence SQ 1

(30xx,6110) Calculated Radiation Dose Values Sequence

CalculatedRadiationDoseValuesSequence

SQ 1

(30xx,6114) Measured Radiation Dose Values Sequence

MeasuredRadiationDoseValuesSequence

SQ 1

(0028,xxxx) Long Pixel Padding Value LongPixelPaddingValue UL or SL

1

(0028,yyyy) Long Pixel Padding Range Limit

LongPixelPaddingRangeLimit UL or SL

1


Add the following to PS3.6 Annex A:

ANNEX A REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)

Table A-1UID VALUES

UID Value UID NAME UID TYPE Part1.2.840.10008.5.1.4.1.1.481.XN.1 RT Course Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.2 RT Physician Intent Storage SOP Class PS 3.41.2.840.10008.5.1.4.1.1.481.XN.3 RT Radiation Set Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.4 RT Segment Annotation Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.1

Tomotherapeutic Radiation Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.2

C-Arm Photon Radiation Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.3

C-Arm Electron Radiation Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.4

Multiple Fixed Source Radiation Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.5

Robotic Radiation Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.5.7

Multi-Axial Radiation Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.1


SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.2

C-Arm Photon Radiation Record Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.3

C-Arm Electron Radiation Record Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.4


SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.5

Robotic Radiation Record Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.6.7

Multi-Axial Radiation Record Storage

SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.7.1

RT Dose Image Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.7.2

RT Dose Histogram Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.7.3

RT Dose Samples Storage SOP Class PS 3.4

1.2.840.10008.5.1.4.1.1.481.XN.8 RT Patient Storage SOP Class PS 3.4

214

2854

2856

2858


1.2.840.10008.1.XN.1 IEC FIXED Reference System Frame of Reference

Well-known frame of reference

PS 3.3

2860


Add the following data elements to PS3.6, Annex A:

Table A-3CONTEXT GROUP UID VALUES

Context UID Context Identifier

Context Group Name

1.2.840.10008.6.1.FFF.1 SUP147001 Dosimetric Objective Value Types

1.2.840.10008.6.1.FFF.2 SUP147002 Prescription Anatomy Categories

1.2.840.10008.6.1.FFF.3 SUP147003 Radiotherapy Segment Categories

1.2.840.10008.6.1.FFF.4 SUP147004 Radiotherapy Targets

1.2.840.10008.6.1.FFF.5 SUP147005 RT Geometric Information

1.2.840.10008.6.1.FFF.6 SUP147006 Fixation or Positioning Devices

1.2.840.10008.6.1.FFF.7 SUP147007 Brachytherapy Devices

1.2.840.10008.6.1.FFF.09

SUP147009 Segmentation Combination

1.2.840.10008.6.1.FFF.10

SUP147010 Beam Limiting Device Types

1.2.840.10008.6.1.FFF.11

SUP147011 Radiotherapy Robotic Paths

1.2.840.10008.6.1.FFF.12

SUP147012 General External Radiotherapy Procedure Techniques

1.2.840.10008.6.1.FFF.13

SUP147013 Tomotherapeutic Radiotherapy Procedure Techniques

1.2.840.10008.6.1.FFF.14

SUP147014 Treatment RT Radiation Set Alteration Types

1.2.840.10008.6.1.FFF.15

SUP147015 Treatment Termination Reasons

1.2.840.10008.6.1.FFF.16

SUP147016 Compensator Device Types

1.2.840.10008.6.1.FFF.17

SUP147017 Radiotherapy Treatment Machine Modes

1.2.840.10008.6.1.FFF.18

SUP147018 Pre-Treatment RT Radiation Set Purpose

1.2.840.10008.6.1.FFF.20

SUP147020 Instance Reference Purposes

1.2.840.10008.6.1.FFF.21

SUP147021 Patient Setup Techniques

1.2.840.10008.6.1.FFF.22

SUP147022 Fixation Device Types

1.2.840.10008.6.1.FFF.23

SUP147023 Shielding Device Types

1.2.840.10008.6.1.FFF.24

SUP147024 Setup Devices

1.2.840.10008.6.1.FFF.2 SUP147025 RT Patient Support Devices

216

2862


5

1.2.840.10008.6.1.FFF.26

SUP147026 Dose Statistics

1.2.840.10008.6.1.FFF.27

SUP147027 Fixed Beam Limiting Device Types

1.2.840.10008.6.1.FFF.28

SUP147028 Radiotherapy Wedge Types

1.2.840.10008.6.1.FFF.30

SUP147030 General Accessory Device Types

1.2.840.10008.6.1.FFF.31

SUP147031 Radiotherapy Bolus Device Types

1.2.840.10008.6.1.FFF.32

SUP147032 Radiotherapy Block Device Types

1.2.840.10008.6.1.FFF.33

SUP147033 Radiotherapy Accessory No-Slot Holder Device Types

1.2.840.10008.6.1.FFF.34

SUP147034 Radiotherapy Accessory Slot Holder Device Types

1.2.840.10008.6.1.FFF.35

SUP147035 Effective Dose Method Code Definition

1.2.840.10008.6.1.FFF.36

SUP147036 Purpose of Referenced Dose Calculation Annotation Object

1.2.840.10008.6.1.FFF.37

SUP147037 Dose Data Source Measurement Definition

1.2.840.10008.6.1.FFF.39

SUP147039 Dose Histogram Spatial Unit Definition

1.2.840.10008.6.1.FFF.40

SUP147040 Segmented Rt Accessory Devices

1.2.840.10008.6.1.FFF.41

SUP147041 Dose Algorithm Class

1.2.840.10008.6.1.FFF.42

SUP147042 Energy Unit

1.2.840.10008.6.1.FFF.43

SUP147043 RT Item States

1.2.840.10008.6.1.FFF.44

SUP147044 RT Operation States

1.2.840.10008.6.1.FFF.45

SUP147045 Multi-Source Radiation Technique

1.2.840.10008.6.1.FFF.46

SUP147046 Robotic Radiation Technique

1.2.840.10008.6.1.FFF.47

SUP147047 Radiotherapy Procedure Techniques

1.2.840.10008.6.1.FFF.48

SUP147048 Revised value

1.2.840.10008.6.1.FFF.49

SUP147049 Radiotherapy General Workitem Definition

1.2.840.10008.6.1.FFF.5 SUP147050 Beam Mode Type Definition


0

1.2.840.10008.6.1.FFF.51

SUP147051 Delivery Rate Unit Definition

1.2.840.10008.6.1.FFF.52

SUP147052 Radiation Particle

1.2.840.10008.6.1.FFF.53

SUP147053 Regulatory Device Identifier Type

1.2.840.10008.6.1.FFF.54

SUP147054 Treatment Delivery Device Type

1.2.840.10008.6.1.FFF.55

SUP147055 Dosimeter Unit Definition

1.2.840.10008.6.1.FFF.56

SUP147056 Treatment Session Sign-Off

1.2.840.10008.6.1.FFF.60

SUP147060 Single Dose-related Dosimetric Objectives

1.2.840.10008.6.1.FFF.61

SUP147061 Percentage and Dose-related Dosimetric Objectives

1.2.840.10008.6.1.FFF.62

SUP147062 Volume and Dose-related Dosimetric Objectives

1.2.840.10008.6.1.FFF.63

SUP147063 Dimensionless and Dose-related Dosimetric Objectives

1.2.840.10008.6.1.FFF.64

SUP147064 Coded Dosimetric Objectives

1.2.840.10008.6.1.FFF.65

SUP147065 Radiotherapy Dose Real World Units

218

2864


Part 16 Addendum

Add the following workitem codes to CID 9231 of PS3.16, Annex B:

CID 9231 GENERAL PURPOSE WORKITEM DEFINITION

Context ID 9231General Purpose Workitem Definition

Type: Extensible Version: yyyymmddCoding Scheme

Designator(0008,0102)



99SUP147 110014 Registration99SUP147 110015 Segmentation

2866

2868

2870

2872

2874


Add the following new CIDs to PS3.16, Annex B:

CID SUP147001 DOSIMETRIC OBJECTIVE VALUE TYPES

Context ID SUP147001Dose Objective Value Types

Type: Extensible Version: yyyymmdd

Coding SchemeDesignator(0008,0102)



Include CID SUP147060 Single Dose-related Dosimetric ObjectivesInclude CID SUP147061 Percentage and Dose-related Dosimetric ObjectivesInclude CID SUP147062 Volume and Dose-related Dosimetric ObjectivesInclude CID SUP147063 Dimensionless and Dose-related Dosimetric ObjectivesInclude CID SUP147064 Coded Dosimetric Objectives

CID SUP147002 PRESCRIPTION ANATOMY CATEGORIES

Context ID SUP147002Prescription Anatomy Categories





99SUP147 S147050 Target

SRT T-D000A Anatomical Structure

99SUP147 S147052 Extended Anatomical Structure

99SUP147 S147056 Artificial Structure

99SUP147 S147057 Geometrical Combination

99SUP147 S147058 Dosimetric Optimization Structure

CID SUP147003 RADIOTHERAPY SEGMENT CATEGORIES

Context ID SUP147003Radiotherapy Segment Categories





INCLUDE CID SUP147002 Prescription Anatomy Categories

220

2876

2878

2880

2882

2884

2886

2888

2890





99SUP147 S147053 RT Geometrical Information

99SUP147 S147054 Fixation or Positioning Device

99SUP147 S147055 Internal Brachytherapy Device

CID SUP147004 RADIOTHERAPY TARGETS

Context ID SUP147004Radiotherapy Targets





99SUP147 S147070 CTV Nodal

99SUP147 S147071 CTV Primary

99SUP147 S147072 CTV

99SUP147 S147073 GTV Nodal

99SUP147 S147074 GTV Primary

99SUP147 S147075 GTV

99SUP147 S147076 PTV Nodal

99SUP147 S147077 PTV Primary

99SUP147 S147078 PTV

99SUP147 S147079 ITV

99SUP147 S147080 PRV

99SUP147 S147081 Avoidance

99SUP147 S147082 Treated Volume

99SUP147 S147083 Irradiated Volume

99SUP147 S147084 Body

CID SUP147005 RT GEOMETRIC INFORMATION

Context ID SUP147005RT Geometric Information





99SUP147 S147100 Patient Setup Point

2892

2894

2896

2898

2900





99SUP147 S147101 Patient Laser Setup Point

99SUP147 S147102 Moveable Laser Setup Point

99SUP147 S147103 Patient Position Verification Point

99SUP147 S147104 Reference Acquisition Point

99SUP147 S147105 Virtual Simulation Isocenter

99SUP147 S1471056 Planning Treatment Point

99SUP147 S1471067 Treatment Point

99SUP147 S1471078 Planning Target Point

99SUP147 S1471089 Target Point

99SUP147 S1471109 External Marker

99SUP147 S1471101 Internal Marker

CID SUP147006 FIXATION OR POSITIONING DEVICES

Context ID SUP147006Fixation or Positioning Devices





Include CID SUP147022 Fixation Device Type IdentifiersInclude CID SUP147025 RT Patient Support Devices

CID SUP147007 BRACHYTHERAPY DEVICES

Context ID SUP147007Brachytherapy Devices





99SUP147 S147130 Brachytherapy accessory device

99SUP147 S147131 Brachytherapy source applicator

99SUP147 S147132 Brachytherapy channel shield

99SUP147 S147133 Brachytherapy channel

222

2902

2904

2906

2908

2910


CID SUP147009 SEGMENTATION COMBINATION

Context ID SUP147009Segmentation Combination





99SUP147 S147145 Combination

CID SUP147010 BEAM LIMITING DEVICE TYPES

Context ID SUP147010Beam Limiting Device Types

Type: Non-Extensible Version: yyyymmdd




99SUP147 S147170 X Jaw

99SUP147 S147171 Y Jaw

99SUP147 S147172 X Leaves

99SUP147 S147173 Y Leaves

99SUP147 S147174 Variable Circular Collimator

INCLUDE CID SUP147027 FIXED BEAM LIMITING DEVICE TYPES

CID SUP147011 RADIOTHERAPY ROBOTIC PATHS

Context ID SUP147011Radiotherapy Robotic Paths





99SUP147 S147200 One Path Head

99SUP147 S147201 One Path Body

99SUP147 S147202 Even Paths Head

99SUP147 S147203 Even Paths Body

99SUP147 S147204 Short Paths Head

99SUP147 S147205 Short Path Body

99SUP147 S147206 Prostate

99SUP147 S147207 Prostate Short

2912

2914

2916

2918

2920

2922

2924





99SUP147 S147208 Trigeminal

CID SUP147012 GENERAL EXTERNAL RADIOTHERAPY PROCEDURE TECHNIQUES

Context ID SUP147012General External Radiotherapy Procedure Techniques





99SUP147 S147221 Static Beam

99SUP147 S147225 Arc Beam

99SUP147 S147226 Conformal Arc Beam

99SUP147 S147227 Step and Shoot Beam

99SUP147 S147228 Sliding Window Beam

99SUP147 S147229 VMAT

99SUP147 S147230 Arc and Static Hybrid

CID SUP147013 TOMOTHERAPEUTIC RADIOTHERAPY PROCEDURE TECHNIQUES

Context ID SUP147013Tomotherapeutic Radiotherapy Procedure Techniques





99SUP147 S147240 Helical Beam

99SUP147 S147241 Topographic Beam

CID SUP147014 TREATMENT RT RADIATION SET ALTERATION TYPES

Context ID SUP147014Treatment RT Radiation Set Alteration Types





99SUP147 S147250 Collimator Change

224

2926

2928

2930

2932

2934

2936

2938

2940





99SUP147 S147251 Gantry Change

99SUP147 S147252 Gantry Pitch Change

99SUP147 S147253 MLC Change

99SUP147 S147254 Wedge Change

99SUP147 S147255 Accessory Holder Change

99SUP147 S147256 Block Change

99SUP147 S147257 Compensator Change

99SUP147 S147258 Other Beam Modifier Change

99SUP147 S147259 Meterset Change

CID SUP147015 TREATMENT TERMINATION REASONS

Context ID SUP147015Treatment Termination Reasons





99SUP147 S147260 Patient Morbidity

99SUP147 S147261 Patient Mortality

99SUP147 S147262 General Machine Interlock

99SUP147 S147263 Patient Support Interlock

99SUP147 S147264 Patient Choice

CID SUP147016 COMPENSATOR DEVICE TYPES

Context ID SUP147016Compensator Device Types





99SUP147 S147270 Standard Compensator

CID SUP147017 RADIOTHERAPY TREATMENT MACHINE MODES

Context ID SUP147017Radiotherapy Treatment Machine Modes

2942

2944

2946

2948

2950

2952

2954






99SUP147 S147281 Total Body Irradiation

99SUP147 S147282 Total Skin Electron

CID SUP147018 PRE-TREATMENT RT RADIATION SET ROLESPURPOSE

Context ID SUP147018Pre-Treatment RT Radiation Set RolesPurpose





99SUP147 S147290 Dosimetric

99SUP147 S147291 Simulation on a Simulator Device

99SUP147 S147292 Virtual Simulation

99SUP147 S147293 Rejected Alternates

99SUP147 S147294 Plan QA

99SUP147 S147295 Simulation on a Treatment Device

CID SUP147020 INSTANCE REFERENCE PURPOSES

Context ID SUP147020Instance Reference Purposes





99SUP147 S147820 Treatment Session Record of Delivered Radiation

99SUP147 S147821 Historical Prescription

99SUP147 S147822 Current Prescription

99SUP147 S147823 Volumetric Dose for Radiation Set

99SUP147 S147824 Volumetric Dose for Radiation

99SUP147 S147825 Volumetric Dose for Radiation Record

99SUP147 S147826 Dose Volume Histogram

99SUP147 S147827 Dose Sample

99SUP147 S147828 Segmentation Properties used in Planning

99SUP147 S147829 Segmentation Properties created during Treatment

226

2956

2958

2960

2962

2964





99SUP147 S147830 Image used for Treatment Planning

99SUP147 S147831 Image Acquired during Treatment

99SUP147 S147832 Image used as Reference Image for Treatment

99SUP147 S147833 Registration used in Planning

99SUP147 S147834 Registration created during Treatment

99SUP147 S147835 Presentation during Planning

99SUP147 S147836 Presentation during Treatment

99SUP147 S147837 Key Object Selection during Planning

99SUP147 S147838 Images created during Planning

CID SUP147021 PATIENT SETUP TECHNIQUES

Context ID SUP147021Patient Setup Techniques




Code Meaning (0008,0104)

99SUP147 S147330 Isocentric99SUP147 S147331 Fixed SSD99SUP147 S147332 Fixed Midline Distance

CID SUP147022 FIXATION DEVICE TYPES

Context ID SUP147022Fixation Device Types





99SUP147 S147340 Biteblock99SUP147 S147341 Headframe99SUP147 S147342 Head Mask99SUP147 S147343 Head and Neck Mask99SUP147 S147344 Mold99SUP147 S147345 Cast99SUP147 S147346 Headrest99SUP147 S147347 Breast Board99SUP147 S147348 Body Frame

2966

2968

2970

2972

2974


99SUP147 S147349 Vacuum Mold99SUP147 S147350 Whole Body Pod99SUP147 S147351 Rectal Balloon99SUP147 S147352 Head Ring

CID SUP147023 SHIELDING DEVICE TYPES

Context ID SUP147023Shielding Device Types





99SUP147 S147380 Gum Shielding99SUP147 S147381 Eye Shielding99SUP147 S147382 Gonad Shielding

CID SUP147024 SETUP DEVICES

Context ID SUP147024Setup Devices





99SUP147 S147400 Laser Pointer99SUP147 S147401 Distance Meter99SUP147 S147402 Table Height99SUP147 S147403 Mechanical Pointer99SUP147 S147404 Arc

CID SUP147025 RT PATIENT SUPPORT DEVICES

Context ID SUP147025RT Patient Support Devices





SRT A-17350 Table99SUP147 S147411 Chair

228

2976

2978

2980

2982

2984

2986

2988

2990


CID SUP147026 DOSE STATISTICS

Context ID SUP147026Dose Statistics





99SUP147 S147420 Maximum Dose99SUP147 S147421 Minimum Dose99SUP147 S147422 Median Dose99SUP147 S147423 Mean Dose99SUP147 S147424 Dose Standard Deviation

CID SUP147027 FIXED BEAM LIMITING DEVICE TYPES

Context ID SUP147027Fixed Beam Limiting Device Types





99SUP147 S147431 Electron Fixed Aperture

99SUP147 S147432 Photon Fixed Aperture

99SUP147 S147433 Intraoperative Aperture

99SUP147 S147470 Shielding Block

99SUP147 S147471 Aperture Block

CID SUP147028 RADIOTHERAPY WEDGE TYPES

Context ID SUP147028Radiotherapy Wedge Types





99SUP147 S147440 Hard Wedge

99SUP147 S147441 Motorized Wedge

99SUP147 S147442 Dynamic Wedge

2992

2994

2996

2998

3000

3002

3004

3006


CID SUP147030 GENERAL ACCESSORY DEVICE TYPES

Context ID SUP147030General Accessory Device Types





99SUP147 S147451 Graticule

99SUP147 S147452 Reticle

99SUP147 S147453 Image Detector

99SUP147 S147454 Film Holder

99SUP147 S147455 Winston-Lutz Pointer

99SUP147 S147456 Bowtie Filter

CID SUP147031 RADIOTHERAPY BOLUS DEVICE TYPES

Context ID SUP147031Radiotherapy Bolus Device Types





99SUP147 S147460 Bolus

CID SUP147032 RADIOTHERAPY BLOCK DEVICE TYPES

Context ID SUP147032Radiotherapy Block Device Types





99SUP147 S147470 Shielding Block

99SUP147 S147471 Aperture Block

CID SUP147033 RADIOTHERAPY ACCESSORY NO-SLOT HOLDER DEVICE TYPES

Context ID SUP147033Radiotherapy Accessory No-Slot Holder Device Types


230

3008

3010

3012

3014

3016

3018

3020

3022

3024





99SUP147 S147480 Tray

CID SUP147034 RADIOTHERAPY ACCESSORY SLOT HOLDER DEVICE TYPES

Context ID SUP147034Radiotherapy Accessory Slot Holder Device TypesType: Extensible Version: yyyymmdd




99SUP147 S147481 Applicator

CID SUP147035 EFFECTIVE DOSE METHOD CODE DEFINITION

Context ID SUP147035Effective Dose Method Definition





99SUP147 S147580 LET-based method.

99SUP147 S147581 Fractionation-based or temporally-based method

CID SUP147036 PURPOSE OF REFERENCED DOSE CALCULATION ANNOTATION OBJECT

Context ID SUP147036Purpose of Referenced Dose Calculation Annotation Object





99SUP147 S147750 Annotating Documents for the Calculated Dose

CID SUP147037 DOSE DATA SOURCE MEASUREMENT DEFINITION

Context ID SUP147037

3026

3028

3030

3032

3034

3036

3038

3040

3042

3044


Dose Data Source Measurement DefinitionType: Extensible Version: yyyymmdd




99SUP147 S147530 Film99SUP147 S147531 3D Gel99SUP147 S147532 Diode Array99SUP147 S147533 Ion Chamber Array 99SUP147 S147534 TLD99SUP147 S147535 Diode99SUP147 S147536 Liquid Ion Chamber99SUP147 S147537 MOSFET99SUP147 S147538 OSLD99SUP147 S147539 Ion Chamber99SUP147 S147540 EPID99SUP147 S147541 Diamond Detector

CID SUP147039 DOSE HISTOGRAM SPATIAL UNIT DEFINITION

Context ID SUP147039Dose Histogram Spatial Unit Definition





UCUM cm2 Square centimeterUCUM cm3 Cubic centimeter

99SUP147 S147600 Cubic centimeter PER_U {cm3_PER_U}UCUM % Percent

Note: The unit PER_U is defined in: Anderson, LL: “A “natural” volume-dose histogram for brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.

CID SUP147040 SEGMENTED RT ACCESSORY DEVICES

Context ID SUP147040Segmented RT Accessory Devices


232

3046

3048

3050

3052

3054

3056

3058





Include CID SUP147022 Fixation Device TypesInclude CID SUP147007 Brachytherapy DevicesInclude CID SUP147025 RT Patient Support DevicesInclude CID SUP147031 Radiotherapy Bolus Device TypesInclude CID SUP147032 Radiotherapy Block Device TypesInclude CID SUP147033 Radiotherapy Accessory No-Slot Holder Device TypesInclude CID SUP147034 Radiotherapy Accessory Slot Holder Device Types

CID SUP147041 DOSE ALGORITHM CLASS

Context ID SUP147041Dose algorithm class





99SUP147 S147700 Mixed

99SUP147 S147701 Other

99SUP147 S147702 Monte Carlo

99SUP147 S147703 Convolution

99SUP147 S147704 Superposition

99SUP147 S147705 Pencil Beam

99SUP147 S147706 Transport Equation

99SUP147 S147707 Measurement-based

99SUP147 S147708 Clarkson

CID SUP147042 ENERGY UNIT

Context ID SUP147042Energy Unit





UCUM MV Mega-volt

UCUM MeV Mega-electronvolt

UCUM kV Kilo-volt

3060

3062

3064

3066

3068


CID SUP147043 RT ITEM STATES

Context ID SUP147043RT Item States





99SUP147 S147650 Created

99SUP147 S147651 Reviewed

99SUP147 S147652 Approved

99SUP147 S147653 Rejected

99SUP147 S147654 Demoted

CID SUP147044 RT OPERATION STATES

Context ID SUP147044RT Operation States





99SUP147 S147680 New

99SUP147 S147681 In Preparation

99SUP147 S147682 Ready

99SUP147 S147683 In Progress

99SUP147 S147685 Suspended

99SUP147 S147686 Discontinued

99SUP147 S147687 Completed

CID SUP147045 MULTI-SOURCE RADIATION TECHNIQUE

Context ID SUP147045Multi-Source Radiation Technique


234

3070

3072

3074

3076

3078

3080

3082

3084





99SUP147 S147900 Multiple Fixed Sources

CID SUP147046 ROBOTIC RADIATION TECHNIQUE

Context ID SUP147046Robotic Radiation Technique





99SUP147 S147910 Synchrony

99SUP147 S147911 Non-Synchrony

CID SUP147047 RADIOTHERAPY PROCEDURE TECHNIQUES

Context ID SUP147047Radiotherapy Procedure Techniques





Include CID SUP147012 General External Radiotherapy Procedure TechniquesInclude CID SUP147013 Tomotherapeutic Radiotherapy Procedure TechniquesInclude CID SUP147045 Multiple Fixed Sources Procedure TechniquesInclude CID SUP147046 Robotic Procedure Techniques

CID SUP147048 REVISED VALUE

Context ID SUP147048Revised value

Type: Non-Extensible Version: yyyymmddCoding Scheme




99SUP147 S147710 Revised Value

3086

3088

3090

3092

3094

3096

3098

3100


CID SUP147049 RADIOTHERAPY GENERAL WORKITEM DEFINITION

Context ID SUP147049Radiotherapy General Workitem Definition





99SUP147 121731 RT Prescription99SUP147 121732 RT Simulation99SUP147 121733 RT Forward Planning99SUP147 121734 RT Inverse Planning99SUP147 121735 RT Dose Computation99SUP147 121736 RT Plan Review99SUP147 121737 RT Delivery Review

CID SUP147050 BEAM MODE TYPE DEFINITION

Context ID SUP147050Beam Mode Type Definition





99SUP147 S147560 Flattening Filter Beam99SUP147 S147561 No Flattening Filter Beam99SUP147 S147562 Partial Flattening Filter Beam

CID SUP147051 DELIVERY RATE UNIT DEFINITION

Context ID SUP147051Delivery Rate Unit Definition





UCUM Gy/s Gray / Second99SUP147 S147571 MU / Second99SUP147 S147572 Particles / Second

UCUM [arb'U] arbitrary unit

CID SUP147052 RADIATION PARTICLE

Context ID SUP147052

236

3102

3104

3106

3108

3110

3112

3114

3116


Radiation ParticleType: Non-Extensible Version: yyyymmdd




99SUP147 S147950 Photon99SUP147 S147951 Electron99SUP147 S147952 Proton99SUP147 S147953 Carbon nucleus99SUP147 S147954 Neutron

CID SUP147053 REGULATORY DEVICE IDENTIFIER TYPE

Context ID SUP147053Regulatory Device Identifier Type





99SUP147 S147590 FDA Unique Device Identifier (UDI)

CID SUP147054 TREATMENT DELIVERY DEVICE TYPE

Context ID SUP147054Treatment Delivery Device Type





99SUP147 S147890 Radiotherapy Treatment Device

CID SUP147055 DOSIMETER UNIT DEFINITION

Context ID SUP147055Dosimeter Unit Definition





99SUP147 MU Monitor Units99SUP147 NP Number of Particles

UCUM s SecondUCUM Bq.s Bequerel Second

3118

3120

3122

3124

3126

3128

3130

3132

3134


UCUM [arb'U] arbitrary unit

CID SUP147056 TREATMENT SESSION SIGN-OFF

Context ID SUP147056Treatment Session Sign-Off





99SUP147 S147770 Presence of Bolus99SUP147 S147771 Presence of Cones

CID SUP147060 SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES

Context ID SUP147060Single Dose-related Dosimetric Objectives





99SUP147 S147001 Minimum Surface Dose99SUP147 S147002 Maximum Surface Dose99SUP147 S147003 Minimum Dose99SUP147 S147004 Maximum Dose99SUP147 S147005 Minimum Mean Dose99SUP147 S147006 Maximum Mean Dose99SUP147 S147007 Minimum Equivalent Uniform Dose99SUP147 S147008 Maximum Equivalent Uniform Dose99SUP147 S147009 Prescription Dose

CID SUP147061 PERCENTAGE AND DOSE-RELATED DOSIMETRIC OBJECTIVES

Context ID SUP147061Percentage and Dose-related Dosimetric ObjectivesType: Extensible Version: yyyymmdd




99SUP147 S147014 Minimum Percent Volume at Dose99SUP147 S147015 Maximum Percent Volume at Dose

238

3136

3138

3140

3142

3144

3146

3148

3150


CID SUP147062 VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES

Context ID SUP147062Volume and Dose-related Dosimetric Objectives





99SUP147 S147016 Minimum Absolute Volume at Dose99SUP147 S147017 Maximum Absolute Volume at Dose

CID SUP147063 DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES

Context ID SUP147063Dimensionless and Dose-related Dosimetric Objectives





99SUP147 S147010 Minimum Conformity Index (see Note 1)99SUP147 S147011 Minimum Healthy Tissue Conformity Index (see Note

1)99SUP147 S147012 Minimum Conformation Number (see Note 1)99SUP147 S147013 Maximum Homogeneity Index (see Note 1)

Note 1: These following dosimetric indices are defined by reference to Feuvret et al, (IJROBP 64(2):333-342, 2006):

Dosimeter Index Description in Feuvret et al, page 335Minimum Conformity Index Conformity IndexRTOG

Minimum Healthy Tissue Conformity Index Healthy Tissue Conformity IndexMinimum Conformation Number Conformation Number (CN)Maximum Homogeneity Index Homogeneity Index

CID SUP147064 CODED DOSIMETRIC OBJECTIVES

Context ID SUP147064Coded Dosimetric Objectives





99SUP147 S147018 Minimize MeterSet

3152

3154

3156

3158

3160

3162

3164

3166

3168


CID SUP147065 RADIOTHERAPY DOSE REAL WORLD UNITS

Context ID SUP147065Radiotherapy Dose Real World Units





UCUM Gy Gray

240

3170

3172


Rename the following definitions of existing CIDs of PS3.16, Annex B:

CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition

Context ID 9241

Radiotherapy General Treatment Workitem Definition

Correct cases of the following definitions of existing CIDs of PS3.16, Annex B:

CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition

CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition

3174

3176

3178

3180


Add the following workitem codes to CID 9231 of PS3.16, Annex C:

ANNEX C ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE)

TID SUP147001 RT PRESCRIPTION ANNOTATION

TID SUP147001RT Prescription Annotation

Type: Extensible Order: Non-Significant

Value Type Concept Name VM Req Type

Condition Value Set Constraint

1 TEXT EV (S147030, 99SUP147, “Radiation Description”)

1 U

2 TEXT EV (S147031, 99SUP147, “Beam Shaping Means”)

1 U

3 TEXT EV (S147032, 99SUP147, “Planning Advice Note”)

1 U

4 TEXT EV (S147033, 99SUP147, “Special Procedure Note”)

1 U

5 TEXT EV (S147034, 99SUP147, “Patient Positioning Note”)

1 U

6 TEXT EV (S147035, 99SUP147, “Motion Compensation Note”)

1 U

7 TEXT EV (S147036, 99SUP147, “Patient Setup Note”)

1 U

8 TEXT EV (S147037, 99SUP147, “Previous Radiation Note”)

1 U

9 TEXT EV (S147038, 99SUP147, “Planning Imaging Note”)

1 U

10 TEXT EV (S147039, 99SUP147, “Delivery Verification Note”)

1 U

11 TEXT EV (S147040, 99SUP147, “Simulation Notes”)

1 U

12 CODE DT (S147041, 99SUP147, “Radiation Type”)

1-n U BCID (SUP147052) Radiation Particle

13 NUMERIC DT (S147042, 99SUP147, “Radiation Energy”)

1-n U UNITS=DCID (SUP147042) Energy Unit

14 CODE DT (S147034, 99SUP147, “Positioning Procedures”)

1-n U BCID (9242) Radiotherapy Acquisition Workitem Definition

242

3182

3184

3186

3188


3190


Add the following templates to PS3.16, Annex A:

TID SUP147003 RT SEGMENT ANNOTATION PROPERTIES

TID SUP147003RT Segment Annotation Properties


NL Value Type Concept Name VM Req Typ

e


1 NUMERIC EV (S147150, 99SUP147, “Relative Mass Density”)

1 U Units = EV (%, UCUM, "Percent")

2 NUMERIC EV (S147151, 99SUP147, "Relative Electron Density")

1 U Units = EV (ratio, UCUM, "ratio")

3 NUMERIC EV (S147152, 99SUP147, "Effective Z")

1 U Units = EV (1, UCUM, "no units")

4 NUMERIC EV (S147153, 99SUP147, "Effective Z per A")


5 NUMERIC EV (S147154, 99SUP147, "Relative Stop Ratio")


6 NUMERIC EV (S147156, 99SUP147, "Linear Cell Kill Factor")


7 NUMERIC EV (S147157, 99SUP147, "Quadratic Cell Kill Factor")


8 NUMERIC EV (S147158, 99SUP147, "High Dose Fraction Linear Cell Kill Factor")


9 NUMERIC EV (S147159, 99SUP147, "Half-time for Tissue Repair ")

1 U Units = EV (s, UCUM, "second")

10 NUMERIC EV (S147160, 99SUP147, "High Dose Fraction Transition Dose")

1 U Units = EV (Gy, UCUM, "Gray")

11 NUMERIC EV (S147161, 99SUP147, * Elemental Composition Atomic Number ”)

1-n U Units = EV (1, UCUM, "no units")

TID SUP147004 PATIENT SUPPORT POSITION PARAMETERS

TID SUP147004Patient Support Position Parameters


244

3192

3194

3196

3198

3200

3202


Value Type Concept Name VM Req Typ

e


1 NUMERIC EV (S147300, 99SUP147, "IEC Table Top Continuous Pitch Angle ")

1 U Units = EV (deg, UCUM, "º")

2 NUMERIC EV (S147301, 99SUP147, "IEC Table Top Continuous Roll Angle ")


3 NUMERIC EV (S147302, 99SUP147, "IEC Patient Support Continuous Angle ")


4 NUMERIC EV (S147303, 99SUP147, "IEC Table Top Eccentric Axis Distance")

1 U Units = EV (mm, UCUM, "mm")

5 NUMERIC EV (S147304, 99SUP147, "IEC Table Top Continuous Eccentric Angle ")


6 NUMERIC EV (S147305, 99SUP147, "IEC Table Top Lateral Position ")


7 NUMERIC EV (S147306, 99SUP147, "IEC Table Top Longitudinal Position ")


8 NUMERIC EV (S147307, 99SUP147, "IEC Table Top Vertical Position ")


3204


Add the following to the table in PS3.16, Annex D:

ANNEX D DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE)

Code Value Code Meaning Definition Notes121731 Prescription Determination of the patient prescription

for a course of treatment.121732 RT Simulation Patient localization and (virtual) placement

of external beam radiation therapy beams or brachytherapy sources.

121733 RT Forward Planning The process of optimizing the dose distribution by manually varying beam angles, intensities and other properties.

121734 RT Inverse Planning The process of optimizing the dose distribution by automatically varying beam angles, intensities and other properties, such that the resulting dose distribution approaches or exceeds the requirements of a specified set of dose constraints.

121735 RT Dose Computation Calculation of the dose distribution based on a specified anatomy, beam geometry and beam or source fluence distribution.

121736 RT Plan Review Human review of a treatment plan prior to plan approval for treatment.

121737 RT Delivery Review Human review of one or more treatment deliveries in conjunction with the treatment plan.

110014 Registration General Image registration work item, used to request an image registration through Unified Worklist and Procedure Step Protocol

110015 Segmentation General Image segmentation work item, used to request an segmentation through Unified Worklist and Procedure Step Protocol

S147001 Minimum Surface Dose The objective is a desired or constrained minimum dose (parameter 1) to the surface of the volume

S147002 Maximum Surface Dose The objective is a desired or constrained maximum dose (parameter 1) to the surface of the volume

S147003 Minimum Dose The objective is a desired or constrained minimum dose (parameter 1) to the volume

246

3206

3208


Code Value Code Meaning Definition NotesS147004 Maximum Dose The objective is a desired or constrained

maximum dose (parameter 1) to the volume

S147005 Minimum Mean Dose The objective is a desired or constrained minimum mean dose (parameter 1) to the volume

S147006 Maximum Mean Dose The objective is a desired or constrained maximum mean dose (parameter 1) to the volume

S147007 Minimum Equivalent Uniform Dose

The objective is a desired or constrained minimum EUD (parameter 1) to the volume

S147008 Maximum Equivalent Uniform Dose

The objective is a desired or constrained maximum EUD (parameter 1) to the volume

S147009 Prescription Dose The objective is a desired or constrained nominal prescription dose (parameter 1)

S147010 Minimum Conformity Index

The objective is a minimum Conformity Index (parameter 1) for a reference dose (parameter 2)

S147011 Minimum Healthy Tissue Conformity Index

The objective is a minimum Healthy Tissue Conformity Index (parameter 1) for a reference dose (parameter 2)

S147012 Minimum Conformation Number

The objective is a minimum Conformation Number (parameter 1) for a reference dose (parameter 2)

S147013 Maximum Homogeneity Index

The objective is a maximum Homogeneity Index (parameter 1) for a reference dose (parameter 2)

S147014 Minimum Percent Volume at Dose

The objective is a desired or constrained minimum percent (parameter 1) of a volume with dose greater than or equal to a specified value (parameter 2)

S147015 Maximum Percent Volume at Dose

The objective is a desired or constrained maximum percent (parameter 1) of a volume with dose greater than or equal to a specified value (parameter 2)

S147016 Minimum Absolute Volume at Dose

The objective is a desired or constrained minimum absolute measure (parameter 1) of a volume with dose greater than or equal to a specified value (parameter 2)

S147017 Maximum Absolute Volume at Dose

The objective is a desired or constrained maximum absolute measure (parameter 1) of a volume with dose greater than or equal to a specified value (parameter 2)

S147018 Minimize MeterSet The objective is to minimize the total meterset required to deliver the radiation set


Code Value Code Meaning Definition Notes

S147025 Dose Parameter A value (in Gy) used as a Dosimetric Objective

S147026 Volume Parameter A value (in cm3) used as a Dosimetric Objective

S147027 Percent Parameter A value (in %) used as a Dosimetric Objective

S147028 Numeric Parameter A value (dimensionless) used as a Dosimetric Objective

S147030 Radiation Description General description of radiationS147031 Beam Shaping Means Description of the devices and techniques

used to shape the radiation beamS147032 Planning Advice Note Advice for the planning processS147033 Special Procedure Note Notes on special proceduresS147034 Patient Positioning Note Notes on patient positioningS147035 Motion Compensation

NoteNotes on motion compensation

S147036 Patient Setup Note Notes on patient setupS147037 Previous Radiation Note Notes on any previous radiationS147038 Planning Imaging Note Notes on imaging obtained or required for

planningS147039 Delivery Verification Note Notes on how delivery is to be verifiedS147040 Simulation Notes Notes on simluation proceduresS147041 Radiation Type The type of Radiation intended to be used

for the Radiotherapy TreatmentS147042 Radiation Energy The Energy of Radiation intended to be

used for the Radiotherapy TreatmentS147043 Positioning Procedures The intended Positioning Procedures to be

used at the time of Treatment Position Verification.

S147050 Target Volume containing tissues to be irradiated to a specified dose, typically encompassing a tumor, and possibly including surrounding subclinical disease, and margin(s) to account for uncertainties in patient positioning, organ motion, and dose delivery.

S147052 Extended Anatomical Structure

Extension of an anatomical structure to include a surrounding margin, used in radiotherapy treatment planning to specify limits on doses to sensitive tissues, i.e planning risk volume.

S147053 Geometrical Information Points or volumes used to locate spatial references, e.g., treatment or imaging device isocenter or fiducial markers.

248


Code Value Code Meaning Definition NotesS147054 Fixation or Positioning

DeviceDevice used to reproducibly position or limit the motion of a patient or portion of a patient during treatment

S147055 Internal Brachytherapy Device

Device used to position radioactive sources to deliver radiation treatment interstitially or within a body cavity.

S147056 Artificial Structure Artificial element inside the body, such as pace maker, prosthesis …

S147057 Geometrical Combination A geometric combination of segments with heterogeneous properties.

S147070 CTV Nodal Clinical Target Volume encompassing involved lymph node(s), with margin to include surrounding sub-clinical disease

S147071 CTV Primary Clinical Target Volume encompassing (primary) tumor(s), with margin to include surrounding sub-clinical disease

S147072 CTV Clinical Target Volume with margin to include surrounding sub-clinical disease

S147073 GTV Nodal Gross Tumor Volume encompassing diseased lymph nodes

S147074 GTV Primary Gross Tumor Volume encompassing (primary) tumor(s)

S147075 GTV Gross Tumor VolumeS147076 PTV Nodal Planning Target Volume encompassing a

Nodal CTV, with margin to include surrounding sub-clinical disease and to account for uncertainty in patient positioning and organ motion

S147077 PTV Primary Planning Target Volume encompassing a Primary CTV with margin to include surrounding sub-clinical disease and to account for uncertainty in patient positioning and organ motion

S147078 PTV Planning Target Volume with margin to include surrounding sub-clinical disease and to account for uncertainty in patient positioning and organ motion

S147079 ITV Internal Target Volume, used to account for internal motion of a Clinical Target Volume, often delineated using a composite of multiple images, e.g., acquired over a breathing cycle, cardiac cycle, etc.

S147080 PRV Volume used in treatment planning for specifying limits on dose to be delivered.


Code Value Code Meaning Definition NotesS147081 Avoidance Volume enclosed by an isodose surface

appropriate to achieve the purpose of treatment (e.g., tumor eradication or palliation)

S147082 Treated Volume Volume receiving radiation dose that is considered significant in relation to normal tissue tolerance

S147083 Irradiated Volume Volume encompassing the patient’s external body surface

S147084 Body Clinical Target Volume encompassing involved lymph node(s), with margin to include surrounding sub-clinical disease

S147100 Patient Setup Point Point at which initial manual patient setup is performed.

S147101 Patient Laser Setup Point A fixed point at which initial patient setup is performed based on room lasers.

S147102 Moveable Laser Setup Point

A movable point at which initial patient setup is performed based on room lasers.

S147103 Patient Position Verification Point

Point at which verification of patient position is performed

S147104 Reference Acquisition Point

Point at which patient position verification references are acquired.

S147105 Virtual Simulation Isocenter

Isocenter point defined by a virtual simulator.

S1471056 Planning Treatment Point Point at which the patient is planned to be positioned for treatment.

S1471067 Treatment Point Point at which the patient is positioned during treatment.

S1471078 Planning Target Point Point at which the center of the beam-line is planned to target.

S1471089 Target Point Point at which the center of the beam-line targets during treatment.

S1471109 External Marker External markers such as tattoos or adhesive metal spheres (‘BB’s)

S1471101 Internal Marker Internal markers such as fiducials or anatomical structures.

S147130 Brachytherapy accessory device

Accessory device used in brachytherapy treatment delivery

S147131 Brachytherapy source applicator

Source applicator used in brachytherapy treatment delivery

S147132 Brachytherapy channel shield

Channel shield used in brachytherapy treatment delivery

S147133 Brachytherapy channel Accessory device used in brachytherapy treatment delivery

S147150 Relative Mass Density Ratio of the mass density of a material relative to the mass density of water.

250


Code Value Code Meaning Definition NotesS147151 Relative Electron Density Ratio of the electron density of a material

relative to the electron density of water.S147152 Effective Z The average atomic number of a material.S147153 Effective Z per A Ratio of effective atomic number to mass

(AMU-1) for a material.S147154 Relative Linear Stopping

PowerRatio of the linear stopping power of a material to the linear stopping power of water.

S147155 Elemental Fraction The fraction of the mass of one element to the total mass of the compound.

S147156 Linear Cell Kill Factor Linear Cell Kill Factor (α) (Gy-1)S147157 Quadratic Cell Kill Factor Quadratic Cell Kill Factor (β) (Gy-1)S147158 High Dose Fraction

Linear Cell Kill FactorHigh Dose Fraction Linear Cell Kill Factor (γ) (Gy-1)

S147159 Half-time for Tissue Repair

Half-time for Tissue Repair (Tr) (Hrs)

S147160 High Dose Fraction Transition Dose

High Dose Fraction Transition Dose (DT) (Gy)

S147161 Elemental Composition Atomic Number

The atomic number of the element.Any value of the atomic number shall only appear once in the sequence.

S147162 Elemental Composition Atomic Mass Fraction

The fractional weight of the element.

S147170 X Jaw An adjustable jaw pair in the X directionS147171 Y Jaw An adjustable jaw pair in the Y directionS147172 X Leaves An adjustable multi-element jaw pair in X

directionS147173 Y Leaves An adjustable multi-element jaw pair in Y

directionS147174 Variable Circular

CollimatorA circular, aperture size adjustable beam limiting device.

S147200 One Path Head The robotic path one path head S147201 One Path Body The robotic path one path bodyS147202 Even Paths Head The robotic path even paths headS147203 Even Paths Body The robotic path one path bodyS147204 Short Paths Head The robotic path short paths headS147205 Short Path Body The robotic path short path bodyS147206 Prostate The robotic path prostateS147207 Prostate Short The robotic path prostate shortS147208 Trigeminal The robotic path trigeminalS147221 Static Beam Annotates a beam in which the beam field

shape or position does not change during delivery.


Code Value Code Meaning Definition NotesS147225 Arc Beam Annotates a beam that maintains a

constant field shape while moving through a gantry arc.

S147226 Conformal Arc Beam Annotates a beam that has a varying field shape as it moves through a gantry arc.

S147227 Step and Shoot Beam Annotates a beam which does not change in field shape during delivery at each gantry position. The beam is turned off as the gantry is moved to its next position.

S147228 Sliding Window Beam Annotates a beam which changes in field shape via a series of control points at each gantry position. The beam is turned off as the gantry is moved to its next position.

S147229 VMAT Annotates a Volumetric intensity Modulated Arc Therapy beam, in which the MLC moves during delivery while the gantry speed and dose rate are also varied.

S147230 Arc and Static Hybrid Annotates an intensity-modulated arc therapy beam in which one or more segments are delivered having a static gantry angle.

S147240 Helical Beam Helical (spiral beam delivery), with continuous gantry rotation and simultaneous couch movement

S147241 Topographic Beam Topographic (fixed angle) beam delivery, with fixed gantry angle during couch movement

S147250 Collimator Change The plan has been modified by changes to the collimator angles for one or more of the beams

S147251 Gantry Change The plan has been modified by changes to the collimator angles for one or more of the beams

S147252 Gantry Pitch Change The plan has been modified by changes to the gantry pitch angles for one or more of the beams

S147253 MLC Change The plan has been modified by changes to one or more of the MLC leaves for one or more of the beams

S147254 Wedge Change The plan has been modified by using a different wedge

S147255 Applicator Change The plan has been modified by using a different applicator

S147256 Block Change The plan has been modified by using a different block

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Code Value Code Meaning Definition NotesS147257 Compensator Change The plan has been modified by using a

different compensatorS147258 Other Beam Modifier

ChangeThe plan has been modified by using a different beam modifier of any kind

S147259 Meterset Change The plan has been modified setting a different meterset value of the specified unit.

S147260 Patient Morbidity Patient unable to continueS147261 Patient Mortality Patient deceasedS147262 General Machine

InterlockMachine exception condition detected, stopping delivery

S147263 Patient Support Interlock Patient support exception condition detected, stopping delivery

S147264 Patient Choice Patient chose to discontinue treatmentS147270 Compensator External beam compensatorS147281 Total Body Irradiation Total-body irradiation treatment modeS147282 Total Skin Electron Total Skin Electron treatment modeS147290 Dosimetric Annotates that a referenced RT Radiation

Set included in a Meta Radiation Set was created to serve the The RT purpose Radiation Set is used to calculate the dose delivered to the patient. This concept is especially useful when the final Treatment RT Radiation set has to be further altered to allow treatment. In this case, the treatment plan will not be associated with a 3.dimensional dose (although it may still contain single-valued dose information)

S147291 Simulation Annotates that a referencedThe RT Radiation Set included in a Meta Radiation Set was is used in simulate the patient treatment at a convention simulator device.

S147292 Virtual Simulation Annotates that a referencedThe RT Radiation Set included in a Meta Radiation Set wasis used in determine information for the patient treatment during virtual simulation session at a CT scanner or similar (e.g. to determine the patient to treatment device transformation matrix or establish patient to device registration by external markers).

S147293 Rejected Alternates Annotates that a referenced The RT Radiation Set included in a Meta Radiation Set represents one of several alternatives for patient treatment, but was rejected in the course of clinical review.


Code Value Code Meaning Definition NotesS147294 Plan QA Annotates that a referencedThe RT

Radiation Set included in a Meta Radiation Set wasis used for any QA procedures, which have been performed on a different Radiation Set then the finally used one out of any reasons.

S147300 IEC Patient Support Continuous Angle

Patient Support Continuous Angle in IEC PATIENT SUPPORT Coordinate System

S147301 IEC Table Top Continuous Pitch Angle

Table Top Continuous Pitch Angle in the direction of the IEC TABLE TOP Coordinate System

S147302 IEC Table Top Continuous Roll Angle

Table Top Continuous Roll Angle in the direction of the IEC TABLE TOP Coordinate System

S147303 IEC Table Top Eccentric Axis Distance

Table Top Eccentric Axis Distance

S147304 IEC Table Top Continuous Eccentric Angle

Table Top Continuous Eccentric Angle in the direction of the IEC TABLE TOP ECCENTRIC Coordinate System

S147305 IEC Table Top Vertical Position

Table Top Vertical Position in IEC TABLE TOP Coordinate System

S147306 IEC Table Top Lateral Position

Table Top Lateral Position

S147307 IEC Table Top Longitudinal Position

Table Top Longitudinal Position

S147330 Isocentric Delivery device isocenter remains at a fixed point in the patient for the all radiations using this patient setup.

S147331 Fixed SSD Delivery device isocenter moves if necessary to maintain a constant distance between the virtual radiation source and the location of the beam’s first intersection with the patient for the all radiations using this patient setup.

S147332 Fixed Midline Distance Delivery device isocenter moves if necessary to maintain a constant distance between the virtual radiation source and the location of the central axis of the beam’s first intersection with the patient for the all radiations using this patient setup.

S147340 Biteblock A device attached to the table top that is also placed in the patient's mouth to position and orient the head in a prescribed geometry.

254


Code Value Code Meaning Definition NotesS147341 Headframe A device attached to the tabletop that is

also screwed into the skull of the patient's head to position and orient the head in a prescribed geometry relative to the tabletop. The device is commonly known as a "halo".

S147342 Head Mask A device that is placed over the patient's face and attached to the tabletop to prevent the patient from moving relative to the tabletop.

S147343 Head and Neck Mask A device that is placed over the patient's face and neck and attached to the tabletop to prevent the patient from moving relative to the tabletop.

S147344 Mold MoldS147345 Cast CastS147346 Headrest A device placed beneath a patient to

support the head in a prescribed position and orientation relative to the table top.

S147347 Breast Board A device placed on the tabletop to support the chest and arms of a patient in a prescribed position and orientation.

S147348 Body Frame A device placed beneath a patient to support the whole body in a prescribed position and orientation relative to the table top.

S147349 Vacuum Mold A device placed beneath a patient to support a body part in a prescribed position and orientation relative to the table top. It is commonly a bag containing low density polystyrene spheres that becomes semi-hard when vacuum is applied conforming to the bottom surface of the patient.

S147350 Whole Body Pod A device placed beneath a patient to support the whole body in a prescribed position and orientation relative to the table top. It is commonly shaped like a hollow half cylinder. The space between the patient and the wall is commonly filled with a dual component foam that hardens conforming to the bottom surface of the patient.

S147351 Rectal Balloon A flexible fluid container inserted into the rectum to maintain an immovable geometry during treatment.

S147352 Head Ring ’Head ring’ device fixed to patient headS147380 Gum Shielding Type of device shielding the gum S147381 Eye Shielding Type of device shielding the eye


Code Value Code Meaning Definition NotesS147382 Gonad Shielding Type of device shielding the gonadS147400 Laser Pointer Laser position indicatorS147401 Distance Meter Optical (visual) distance indicatorS147402 Table Height Recorded table heightS147403 Mechanical Pointer Mechanical front pointerS147404 Arc Arc shaped device for mechanical position

indicationS147405 Film A Port Film taken using a film cassette

(rather than an EPID device)S147410 Table ‘Table-like’ support deviceS147411 Chair ‘Chair-like’ support deviceS147420 Maximum Dose Maximum dose to any point in the

anatomical referenceS147421 Minimum Dose Maximum dose to any point in the

anatomical referenceS147422 Median Dose Median of dose to the anatomical

referenceS147423 Mean Dose Mean of dose to the anatomical referenceS147424 Dose Standard Deviation Standard deviation of dose to the

anatomical referenceS147431 Electron Fixed Aperture A device that is attached to the radiation

head into which beam modifiers are installed. This device is also commonly known as a "cone".(TBD)

S147432 Photon Fixed Aperture A device that attaches to the applicator carriage for the purpose of holding an aperture and a bolus close to the patient's skin. Several beam applicators may be available to reduce the weight of apertures lifted by therapists, decrease the aperture/bolus-to-skin distance, and reduce leakage radiation. This device is also commonly known as a "cone".(TBD)

S147433 Intraoperative Fixed Aperture

A device which is used to delimit the radiation in case of an intraoperative radiotherapeutic treatment.(TBD)

S147440 Hard Wedge A physical device manually placed between the radiation head and the patient used to modify the fluence distribution across the field. It is motorized and can be inserting/extracted from the beam path without user action.

256


Code Value Code Meaning Definition NotesS147441 Motorized Wedge A physical device placed inside the

radiation head used to modify the fluence distribution across the field.

S147442 Dynamic Wedge An effective wedge generated by the movement of jaw across the treatment field while delivering radiation.

S147451 Graticule Mechanical gridS147452 Reticle Mechanical crosshairS147453 Image Detector A electronic imaging deviceS147454 Film Holder Mechanical device to hold imaging filmS147455 Winston-Lutz Pointer A spherical mechanical indicator used for

alignmentS147456 Bowtie Filter A bowtie filter used in kV imaging to

account for patient shapeS147460 Bolus A device, typically placed on the patient,

that provides differential penetration laterally across a beam generally to increase the dose delivered to shallow depths. Typically the bolus is made of a material with scatter and penetration characteristics similar to tissue.

S147470 Shielding Block A device, typically made of a low temperature alloy such as Lipowitz’s metal, that provides constant attenuation across an area of the beam to prevent or reduce dose delivery to normal tissues.For shielding blocks, blocking material is inside the shape defined by the Outline Macro.

S147471 Aperture Block A device, typically made of a low temperature alloy such as Lipowitz’s metal, that provides an opening in a whole beam block with constant attenuation across an area of the beam to prevent or reduce dose delivery to normal tissues.For aperture blocks, blocking material is outside the shape defined by the Outline Macro.

S147480 Tray A device placed into a machine slot or an applicator or similar, to which accessories are attached. For ion beams, the tray is usually a virtual device used for determining the distance to the accessory.

S147481 Applicator A device placed into a machine slot with one or more slots, to which accessories are attached.

S147490 Standard Flattening Filter Standard Flattening Filter


Code Value Code Meaning Definition NotesS147491 Flattening Filter Free

ModeFlattening Filter Free Mode

S147500 Relative Biological Effectiveness

A number that expresses the amount of damage from an amount of ionizing radiation relative to the damage from a reference amount of a specific ionizing radiation.

S147501 Scale Factor A number which multiplies a quantity. The result can be larger or smaller in magnitude than the original quantity.

S147530 Film A sheet of plastic coated with light sensitive material which is chemically changed by the exposure to ionizing radiation or light.

S147531 3D Gel A volume of gel that changes physical characteristics when exposed to ionizing radiation.

S147532 Diode Array A number of semiconductor devices that generates current when exposed to ionizing radiation. The devices are arranged systematically in a regular pattern.

S147533 Ion Chamber Array A number of devices that measures charge from the ions produced in a medium when exposed to ionizing radiation. The devices are arranged systematically in a regular pattern.

S147534 TLD Thermoluminescent dosimeter. It is a crystal that when heated, emits visible light in proportion to the amount of ionizing radiation it has been exposed to.

S147535 Diode A semiconductor device that generates current when exposed to ionizing radiation.

S147536 Liquid Ion Chamber An ion chamber that uses a liquid as the medium.

S147537 MOSFET Metal Oxide Semiconductor Field Effect Transistor. The transistor experiences a change in voltage upon irradiation with ionizing radiation.

S147538 OSLD Optically Stimulated Luminescent Dosimeter. It is a crystal that when exposed to green light, emits blue light in proportion to the amount of ionizing radiation it has been exposed to.

S147539 Ion Chamber A device that measures charge from the ions produced in a medium when exposed to ionizing radiation.

258


Code Value Code Meaning Definition NotesS147540 EPID Electronic Portal Imaging Device. This

device is able to record a digital image during treatment delivery on a teletherapy machine. It may consist of the image of an array of ion chambers, a CCD video camera or flat panel detectors.

S147541 Diamond Detector A semiconductor detector that uses diamond as the medium.

S147560 Flattening Filter Beam Beam that uses a filter to produce a nearly uniform intensity profile.

S147561 No Flattening Filter Beam Beam that does not use a filter to produce a nearly uniform intensity profile.

S147562 Partial Flattening Filter Beam

Beam that uses a filter to produce a nearly uniform region across part of the intensity profile.

S147571 MU / Seconds Unit for a dose rate, measured as the number of Monitor Units per second

S147572 Particles / Seconds Unit for a dose rate, measured as the number of particles per second.

S147580 LET-based An Linear Energy-Transfer (LET) -based method has been used to incorporate the Relative Biological Effectiveness based on the quality of the radiation used[Wambersie A, RBE, reference RBE and clinical RBE: Applications of these concepts in hadron therapy, Strahlentherapie und Onkologie 1999 June, 175(2): 39-43][Paganetti H, et al., Relative biological effectiveness (RBE) values for proton beam therapy, Int J Rad. Onc Biol Phys, 2002 June; 53(2): 407-421]

S147581 Fractionation-based A Fractionation-based or temporally-based method has been used to assess the Biologically Effective Dose.[Fowler JF, Br J Radiol. 2010 July; 83(991): 554–568]

S147590 FDA unique device identifier (UDI)

The unique device identifier(UDI) is created and maintained by device labelers based on global device identification standards managed by FDA-accredited Issuing Agencies.

S147600 Cubic centimeter PER_U {cm3_PER_U}

Cubic centimeter PER_U {cm3_PER_U}The unit PER_U is defined in: Anderson, LL: “A “natural” volume-dose histogram for brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.

http://link.springer.com/journal/66


Code Value Code Meaning Definition NotesS147650 Created No review or approval has been

performedThe item has been created.S147651 Reviewed Reviewer recorded that he has reviewed

tThe item has been reviewed, but not yet finally approved it. No conclusion has been reached.

S147652 Approved Reviewer recorded that tThe item has been concluded to meet an implied criterion.

S147653 Rejected Reviewer recorded that iThe item failed has been concluded to fail to meet an implied criterion.

S147654 Demoted An review or approval state The item has been demoted to a non-qualified statehad a previous conclusion retracted.

S147680 New Preparation of this SOP Instance has not yet started.

S147681 In Preparation SOP Instance is in preparation.S147682 Ready SOP Instance has been prepared, but not

yet used for treatment.S147683 In Progress SOP Instance is currently being used in

the treatment process.S147685 Suspended SOP Instance has been used in the

treatment process, but is not currently in use.

S147686 Discontinued The treatment based on this SOP Instance has been discontinued before it has been completely applied as originally planned.

S147687 Completed The treatment based on this SOP Instance has been completed as originally planned.

S147700 Mixed Contributing doses use different dose algorithm types

S147701 Other Other unspecified algorithmS147702 Monte Carlo A Monte Carlo based algorithmS147703 Convolution A convolution based algorithmS147704 Superposition A superposition based algorithmS147705 Pencil Beam A pencil-beam based algorithmS147706 Transport Equation An algorithm based on diffusion or other

transport mechanismS147707 Measurement-based An empirical algorithm based on physical

measurementsS147708 Clarkson A scatter-summation method using

Clarkson integration

260


Code Value Code Meaning Definition NotesS147710 Revised Value Identifies a value for a setting that is

different from the one specified in the Radiation Set.E.g.: a change on the specified meterset or a specified gantry angle.

S147720 Multiple Fixed Sources Multiple Fixed Sources S147730 Synchrony Synchronized with breathingS147731 Non-Synchrony Non synchronizedS147750 Annotating Documents

for the Calculated DoseDocuments, which annotate clinical and physics rationale of the approach chosen to calculate the dose (e.g. choice of algorithms, dose composition approaches etc.).

S147770 Presence of Bolus The operator performing a radiotherapy treatment session confirmed that the boluses required have present during treatment.

S147771 Presence of Cone The operator performing a radiotherapy treatment session confirmed that a cone was present during treatment.

S147820 Treatment Session Record of Delivered Radiation

A record of a treatment session previously delivered

S147821 Historical Prescription A prescription given prior to the application of the current prescription

S147822 Current Prescription The prescription currently in useS147823 Volumetric Dose for

Radiation SetA Volumetric dose calculated for a Radiation Set

S147824 Volumetric Dose for Radiation

A Volumetric dose calculated for a Radiation

S147825 Volumetric Dose for Radiation Record

A Volumetric dose calculated for a Radiation Record

S147826 Dose Volume Histogram A Dose Volume HistogramS147827 Dose Sample A collection of calculated Dose Sample

PointsS147828 Segmentation Properties

used in PlanningSegmentation Properties on segmented SOP instances, which have been used in the treatment planning process

S147829 Segmentation Properties created during Treatment Session

Segmentation Properties on segmented SOP instances, which have been created in the execution of a treatment session.

S147830 Image used for Treatment Planning

Images, which have been used in the treatment planning process.

S147832 Image Acquired during Treatment

Images, which have been acquired during a treatment session.


Code Value Code Meaning Definition NotesS147833 Image used as Reference

Image for TreatmentImages, which are used in a treatment session as reference images to position the patient.

S147834 Registration used in Planning

Registrations, which have been used in the treatment planning process

S147835 Registration created during Treatment Session

Registrations, which have been created in the execution of a treatment session

S147890 Radiotherapy Treatment Device

A device delivering radiotherapy treatments.

S147900 Multiple Fixed Sources Multiple Fixed SourcesS147910 Synchrony Synchrony Treatment Technique on a

Robotic Treatment DeviceS147911 Non-Synchrony Non-Synchrony Treatment Technique on a

Robotic Treatment DeviceS147950 Photon PhotonS147951 Electron ElectronS147952 Proton ProtonS147953 Carbon Carbon nucleusS147954 Neutron NeutronMU Monitor Units A measure of machine output of a

radiotherapy treatment devices. The devices are calibrated to give a particular absorbed dose under particular conditions, although the definition and measurement configuration will vary between centres.

NP Number of Particles A measure of machine output of a radiotherapy treatment devices along the number of particles, used by some Ion Therapy devices.

262

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Part 17 Addendum

Add the following to PS3.17:

Annex Z Second Generation RT (Informative)

ZZ.1 INTRODUCTION

This annex provides additional explanations and sample use cases for the 2nd Generation RT IODs. It is not intended as an exhaustive list of procedure step types that could be undertaken with these objects.

The main clinical purposes of the relationships amongst the important IODs are show in the following diagram:

3212

3214

3216

3218

3220


Therapeutic Dose Delivery Definition

Radiotherapeutic Treatment Course

Oncologist Prescription for Radiotherapy Treatment

Patient Diagnosis and Volumetric Model

Therapeutic Fraction Delivered

Therapeutic Dose Delivery Definition

… others modalities

… other modalities

3D Objects

Dose Objects

RT Course IOD

RT Physician Intent IOD

C-Arm Photon Radiation IOD

RT Dose Image IOD

RT Dose Samples IOD

RT Patient Setup IOD

RT Dose Histogram IOD

RT Segmentation Properties IOD


Defines Tx Fraction by

Is calculatedDose of

C-Arm Photon Radiation Record IOD

Records treatment of

Realizes

Annotates

or

or

uses

Is calculated Dose for

Shows DVH for

Surface IOD

Segmentation IOD

Structure Set IOD

Treats Target and Spares Healthy Tissue

Sets Constraints for

264

3222


Figure ZZ.1-1Relationship between important IODs

The fundamental relationships between the entities are shown in the following diagram:

RT PrescriptionReference

RT TreatmentPhase

RT Radiation SetReferences

Conceptual Volume

FormerTreatments

RT Course IOD

RT PhysicianIntent

RT Prescription

Conceptual Volume

<RT Radiation> IOD

Radiation ReferencesRT Dose Contribution

Conceptual Volume



Control Points

Segment References

RT SegmentationProperties

Conceptual VolumeSource IOD Reference

VolumeSegment

SurfaceSegment

VolumeSegment

RT Segmentation Properties IOD

Segmentation IOD Surface Segmentation IOD RT Structure Set IOD

RT Dose Histogram IODRT Dose Image IOD &RT Dose Samples IOD

Radiation SetReferences

Radiation References

Reference by RT Course

Key Direct Reference

UID Reference

Other Direct Reference

3224

3226

3228


Figure ZZ.1-2Fundamental Entity Relationships

Note 1: Former Treatments refers to the sequence in the RT Course IOD that documents any rediologically significant delivery to this patient that is not captured in a previous RT Course instance.

266

3230

3232


ZZ.2 ENTITY DESCRIPTIONS

The following entities are modeled:

ZZ.2.1 RT CourseA top-level entity that describes a given treatment course. All relevant objects are referenced, including acquisition images, registrations, segmentations, physician intent, beam sets, reference and verification imaging, and output records. In particular, all information relating to the current approval state of treatment, treatment phases, and changes due to adaptation of the therapy are described in this IOD. It describes the overall intended delivery scheme, including fractionation. This consists of one or more phases of treatment (e.g. ‘normal’ and ‘boost’). Each phase is achieved by referencing one or more RT Radiation Set instances (multiple sets are required if adaptive therapy is used to achieve the dosimetric objectives of the phase).

RT Course also contains phase-specific fractionation schemes that describe how the beams/catheters are combined to achieve the phase prescription. Note that multiple independent treatment sites will generally be represented by the same conceptual ‘course’ (i.e. chain of RT Course instances) when treated within the same treatment time frame, otherwise they should be represented by different courses. Phases are also modeled within the RT Course. The treatment session summary IODs in the first generation of RT IODs are also effectively replaced by RT Course.

The DICOM Standard does not specify how a given radiotherapy course is mapped onto the DICOM IE level hierarchy.To avoid a proliferation of series within a Study, one reasonable approach is to map a course of treatment to a DICOM Study, such that a Study contains all data created by radiotherapy systems for the purpose of addressing a particular course of treatment, however such a mapping is not mandated.

3234

3236

3238

3240

3242

3244

3246

3248

3250

3252

3254

3256

3258


RT Radiation Set Reference Module (See also Figure ZZ.2.1-2)

RT Course IOD

Previous radiation delivered to this patient

Current Course

Predecessor Sequence

RT Course SOP Instance

Predecessors (Former Versions of this RT

Course)

RT Course Module

Delivered Radiation

Dose Seq

RT Prescription Reference Module

RT Course Associated Instance Reference Module

(Contains: References to other

relevant IOD instances)

Conceptual Volume Seq

Prior Treatment Sequence


Referenced Physician Intent Seq

RT Physician Intent SOP Instance

Reference to Prescription

Index(es) Inside Physicain Intent

Prescription Instance

Treatment Phase Reference Seq

(Matches prescription to

Treatment Phase)

RT Segmentation Properties SOP

Instance

Referenced RT Segment Annotations

Seq

RT Radiation Set SOP Instance

RT Course SOP

Instance

Pre-Treatment RT

Rad. Set Reference

Seq

Referenced RT Segment Anno Seq.

Treatment RT Rad Set Reference Seq

RT Segmentation Properties SOP

InstanceNote: Common Modules found in RT Second Generation

IOD Modules Macro are not shown here.


Treatment Phase Index

Prior RT Course Seq

RT Course State

Sequence

See Diagram B in Phys. Intent IOD

Physician Intent Prescription Seq.

Phys. Intent Presc. Status Seq.

Treatment Phase Sequence

RT Treatment Phase State Sequence

Treatment Phase Interval Sequence

Meta RT Radiation Set SequenceMeta RT Radiation Set Relationship

Sequence

Pre-Treat. RT Radiation Set

Role Code Seq.

Conceptual Volume State

SequenceReferenced RT Radiation

Record Sequence

RT Radiation Record SOP

Instance

Trtmnt RT Rad. Set Rel. Seq.Treatment RT Rad. Set

Alteration Type Seq.

Figure ZZ.2.1-1RT Course IOD

The following diagram shows the referencing indeces used within the RT Course referenceing RT Prescriptions, RT Treatment Phases and RT Radiation Sets.

RT Radiation Set Reference Module

Referenced Prescription Index

Referenced Treatment Phase Index

RT Prescription Reference Module

Referenced Physician Intent Sequence Entry



Referenced Treatment Phase Index

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Figure ZZ.2.1-2Relationships in RT Course IOD using Indexes

ZZ.2.2 RT Physician IntentDescribes how the physician wishes to achieve curative or palliative therapy, as inputs to the planning process. The actual planned parameters may differ from the intended parameters described here. Items in the RT Physician Intent can include

use of external therapy or brachytherapy,

total and fractional dose,

fractionation scheme,

treatment sites,

treatment target volume names,

constructive solid geometry of targets and critical structures,

field/MLC margins to be used (in case of 3D Conformal RT),

dosimetric objectives (dose constraints for targets, organs at risk and normal tissue),

beam energy,

use of dose optimization and IMRT,

use of motion management (e.g. gated treatment, tracking etc.),

patient setup to be used including immobilization,

image set(s) used for treatment planning,

type of image-guided patient setup/treatment delivery (e.g. daily 3D CT, radiographic, fluoroscopic, ultrasound, etc.).

There is also a location where the physician can enter details of dose from previous treatments.

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Physician Intent Predecessor Sequence


Predecessor (RT Physician Intent that

was replaced by current version)

RT Physician Intent Module

(Contains: Nominal Dose, Intent Type, Narrative)

RT Prescription Module (Contains: Rx Info, Delivery Info)

RT Protocol Code

Sequence

RT Treatment Phase Intent Module

Image SOP Instance

RT Dose Image SOP Instance

Note: Common Modules found in RT Second Generation IOD Modules Macro are not shown

here.

RT Diagnosis Code

Sequence

RT Diagnostic Image Set Sequence

RT Prescription Sequence

Treatment Phase Sequence

Treatment Phase Reference Sequence

Prior Dose Reference Sequence

RT Anatomic Prescription Sequence

Planning Input Information Sequence

Radiotherapy Procedure Technique

Sequence

Prescription Annotation Sequence

Referenced Treatment Phase

Index


RT Dose SOP InstanceOR

Conceptual Volume Sequence

Anatomy Category Code

Sequence

Anatomy Property Type

Code Sequence

Alternate Segmented

Property Type Code Sequence

Dosimetric ObjectiveSequence

Dosimetric Objective Value Type Code

Sequence

Dosimetric Objective Parameter Sequence

Various SOP

Instances

Instances which are intended to be used for the planning process

See Figure ZZ.2.2-2

Purpose of Alt. Segmented Prop. Type Code Seq.

Referenced Dosimetric Objectives

Sequence

Fraction Pattern Sequence

Originating SOP Instance Reference

Seq.

Reference to the RT Physician Intent SOP

instance

Treatment Phase Interval Sequence

RT Physician Intent SOP

Instance

Fractionation Relationship Sequence

RT Physician Intent Sequence

Referenced RT Physician Intent Index

Parent RT Prescription Index

Figure ZZ.2.2-1Physician Intent IOD

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Originating SOP Instance Reference Sequence

Conceptual Volumes UID

Equivalent Conceptual Volume Instance

Reference Sequence

Conceptual Volume Constituent Sequence

Originating SOP Instance Reference

Sequence

Conceptual Volume Constituent Segmentation Reference

Sequence

Referenced RT Segment

Annotations Sequence

Conceptual Volume

Reference to the SOP Instance that contains the original definition of each Conceptual Volume

RT SOP Instance


IOD

RT SOP Instance

Reference to the SOP Instance that contains the original definition of each Conceptual Volume

RT SOP Instance

Reference to the SOP Instance that contains A segmentation for the consituentReferences the index of the

originating SOP Instance Reference Sequence

Conceptual Volume Segmentation Reference

Sequence

Referenced RT Segment

Annotations Sequence


IOD

Reference to the SOP Instance that contains a segmentation for the conceptual volume

Reference to the SOP Instance that contains An equivalent Conceptual Volume

Figure ZZ.2.2-2Conceptual Volumes

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ZZ.2.3 RT Segment AnnotationDescribes the clinical segmentation types (e.g. clinical target volume, organ at risk, bolus), density overrides, and other RT-specific ROI properties.

Figure ZZ.2.3-1RT Segment annotation IOD

ZZ.2.4 RT Radiation SetDescribes a set of beams and/or catheters being used within a treatment session to help achieve the dosimetric requirements of a given phase. References a set of <RT Radiation> SOP Instances. A treatment phase is achieved by delivering one or more RT Radiation Sets. One or more new RT Radiation Sets may be required each time adaptive therapy is used to attempt to maintain a phase prescription.

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Figure ZZ.2.4-1RT Radiation Set IOD

A new concept of meta-classes is modeled. Their content is inherent to all members of a such a meta-class and are to be considered as of one type. An example for this is the <RT Radiation> with its multiple concrete definitions. The notation such a meta-class is always within <> brackets.

ZZ.2.5 RT Radiation A conceptual metaclass representing a means of administering a quantity of radiation generated by a radiation source and intended to be delivered in a contiguous and indivisible manner (such as a static beam, dynamic arc, helical delivery, step-and-shoot IMRT sequence or catheter). An <RT Radiation> description includes a contiguous set of control points. An <RT Radiation> cannot be further subdivided in the DICOM model and is the delivery unit for which dose is reported. If the delivery of an <RT Radiation> is interrupted, this is considered to be an error condition and the remaining radiation required to complete the beam will usually need to be computed based upon the planned treatment versus delivered treatment. An <RT Radiation> may be used for the purposes dosimetric verification or therapeutic treatment. Specific IODs that are members of this Meta-SOP Class include C-Arm Photon Radiation, Tomotherapeutic Radiation, etc.

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ZZ.2.6 RT Dose ImageDescribes a representation of 3D dose distributions using the multi-frame and functional group paradigms.

RT Dose Image IOD

Frame of ReferenceMulti-frame Functional Groups

Synchronization

Multi-frame Dimension

Image Pixel

Note: Common Modules found in RT Second Generation IOD Modules Macro are not shown here.

Respiratory Synchronization

Acquisition Context

Enhanced RT Dose

RT Dose Image

Includes sequences for Functional Group Macros. See table A.VV.1.12-2 for allowed RT Dose Image Functional Group Macros

Dimension Organization Sequence

Dimension Index Sequence

Acquisition Context Sequence

Source Image Sequence

Image SOP Instance

See Figure ZZ.2.6-2 for details on the Enhanced RT Dose Module

Figure ZZ.2.6-1RT Dose Image IOD

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Enhanced RT Dose Module

RT Object SOP Instance


Enhanced RT Dose

Effective Dose Method Code Sequence

Effective Dose Method Modifier Code Sequence

Referenced Dose Calculation Description

Sequence

Dose Data Source Measurement Code

Sequence

Algorithm Type Code Sequence

Composite Dose Sequence

Contributing Radiation Set Sequence

Partial Delivery Limits Sequence


Referenced RT

Segment Annotation Sequence

Referenced Annotating Object Sequence

RT Radiation SOP Instance

SOP Instances that describe the

calculation of the dose

Radiations that contribute to the dose

Contributing Radiation Sequence

RT Radiation Set SOP Instance

Radiation Sets that contribute to the dose

Partial Delivery Limits Sequence

Contributing Radiation Sequence

RT Dose Image SOP Instance

RT Dose SOP Instance

OR

Contributing RT Radiation Record

Sequence

Spatial Registration SOP

Instance

Deformable Spatial Registration SOP

InstanceOR

RT Radiation Record SOP

Instance


RT SOP Instance

Any Instance that provides additional annotation to this dose object

RT Segment Annotation SOP

Instance

Contains structures used to calculate the current IOD

Figure ZZ.2.6-2Enhanced RT Dose IOD

ZZ.2.7 RT Dose HistogramDescribes a representation for dose-volume histogram data.

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RT Dose Histogram IOD


Acquisition Context


Enhanced RT Dose

See Figure ZZ.2.6-2 for details on the Enhanced

RT Dose Module

Dose Histogram Sequence

RT Dose HistogramDose Histogram Dose Unit Code Sequence

Dose Histogram Referenced Segment

SequenceDose Histogram Spatial

Unit Code Sequence

Dose Statistics Sequence


RT Dose Image SOP

Instance

See Diagram B for details on the Conceptual Volume

Reference Macro

Figure ZZ.2.7-1RT Dose Histogram IOD

ZZ.2.8 RT Dose SamplesDescribes a representation for dose point data.

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RT Dose Samples IOD

Frame of Reference

Synchronization


Acquisition Context

Enhanced RT Dose


See Figure ZZ.2.6-2 for details on the

Enhanced RT Dose Module

Dose Samples

Dose Samples Dose Unit Code Sequence


RT Image SOP Instance

Figure ZZ.2.8-1RT Dose Samples IOD

ZZ.2.9 RT Radiation RecordA conceptual metaclass representing the parameters of an actual delivery of an <RT Radiation>. Specific IODs that are members of this Meta-SOP Class include C-Arm Photon Radiation, Multi-Axial Radiation, etc.

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ZZ.3 NOTES ON RT COURSE

ZZ.3.1 IntroductionThe RT Course IOD is a composite representation of a course of radiation therapy, treating one or more anatomical sites in a coordinated sequence of events over time. It represents the state and history of a single coordinated process at a particular point in time.

The main elements of a treatment course are the specification of the physician’s desired treatment approach represented by physician intents, and the realization of this approach through radiation sets organized along the phases of treatments. The RT Course IOD provides a structure to represent the elements of a treatment course, but makes no assumption how the Physician Intents and Treatment Phases are interpreted or implemented. This is usually very specific to a department and case-dependent. While the RT Course IOD supports quite complex treatment strategies, it can also serve as the container for a simple Physician Intent with one Radiation Set as well, as it does not suggest any specific approaches.

The RT Course IOD represents the actual state of a treatment and links together the different RT IODs, maintaining their relation and status. It binds together various entities needed in radiotherapy for preparation, execution and review of a radiotherapeutic treatment of a patient. This is accomplished by providing data structures to reference the relevant SOP Instances and indicate their status and their progress in the treatment process.

These component IODs have been designed to represent smaller units of information as compared with the first-generation DICOM.

With the definition of RT Course, it is possible to render the second-generation RT SOP Instances (representing those entities) stateless. This allows them be stable data containers by isolating the changes in status or relationship with other data, thereby reducing the need to create new instances. In second-generation RT, RT Course factors out the process-related information and separate that from the content-related information in the referenced SOP Instances.

The RT Course can be used both in a worklist-driven managed environment as well as in an unmanaged Media-file driven environment. It is generally assumed that there is only one RT Course SOP Instance active at a time that serves as the reference for the current treatment definition for a patient. Since this cannot be guaranteed technically, it is the responsibility of the departmental workflow and/or policies and procedures to ensure that there is only one RT Course SOP Instance active at a time. This also applies to other objects in the radiotherapy context such as physician intents, radiation sets etc. See the example use cases below for further explanation.

It is not necessary to keep track of all versions triggered by queries for RT Course objects. A system keeping the RT Course could store some historical versions at some point in time when clinically of interest (e.g. in between two series of radiation). Those persistent versions are tracked in this sequence for later retrieval. Note however, that for essential information about the whole treatment course, the latest SOP Instance is always sufficient.

ZZ.3.2 Evolution of an RT Course SOP InstanceIn a typical case, the RT Course SOP Instance initially contains references to the physician intent(s) for a specific case, references image sets, and segmentation objects used in setting up the physician intent.

Further on an RT Course SOP Instance has the capability to describe the treatment phases throughout the course of treatment. Phases represent the grouped fractions of certain treatment techniques/modalities, such as a photon treatment with a normal radiation phase and a boost phase, or a photon treatment phase followed by a ion treatment phases. A treatment course can have only one phase in the course, multiple phases build a sequence of consecutive periods of treatment within the course.

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The RT Course IOD does not place any constraints on how a department or physician partitions the treatment of a patient into physician intents and treatment phases.

When treatment planning starts, an RT Course SOP Instance references RT Radiation Set SOP Instances in different states. It also carries the relations between RT Radiation Set SOP Instances, i.e. whether radiation sets have been derived from other radiation sets, which collections of radiation sets are grouped for dose summation, etc.

There will be a sequence of RT Course SOP Instances over the time of treatment. A change of the content of the treatment course (e.g. changing physician intents, new treatment phases, new radiation sets, changed radiation set status etc.) will be presented in a new RT Course SOP Instance. The most recent RT Course SOP Instance is always complete, i.e. it contains all physician intents, phases, and previous radiation sets of the course, whether they are already treated, in treatment, or foreseen. Therefore no cumulative logic across historic RT Course SOP Instances is needed. Previous versions referenced in an RT Course SOP Instance do however allow tracing of the evolution of the current course definition.

ZZ.3.3 Elements of the RT CourseZZ.3.3.1. Physician IntentA Physician Intent is the clinical roadmap of a physician to define the therapeutic goals and strategy to treat the disease. It is a high-level description in accordance with the nomenclatures and policies of a certain oncology department. The manner in which physician intents are structured and formulated is often very specifically defined in a given department. Therefore the physician intent provides flexibility for department-specific representation. In general, it allows the physician to describe the intended treatment mainly in free text as strategy to following process points like planning and simulation with the nomenclature and detail level as prescribed by the operating procedures in the department.

ZZ.3.3.2. Treatment PhaseToday’s radiotherapy treatments are increasingly complex. To support sequences of various treatments throughout the treatment course the treatment phases support explicit definitions to structure the course into segments. The Treatment Phase provides a means to represent changes in the patient’s radiation sets, by organizing the sequence of sets under treatment.

A radiation set which is currently in treatment will be frozen, while other sets might be in preparation and still undergo various changes until approved for treatment. The granularity of radiation sets supports the atomic units of treatment. The RT Course with its phases organizes those units into a structured time-related sequence of intended dose delivery. The arrangement of those radiation sets across time, and their grouping as treatment phases (e.g. a normal treatment and a boost treatment) are supported by the treatment phase sequence.

ZZ.3.3.3. Radiation SetsThe radiation set defines a set of beams which are treated together for one or multiple fractions. The radiation set therefore defines the physical and geometrical parameters of the treatment and indirectly the dose delivered. It is the smallest unit of delivery at one time.

A radiation set therefore describes a series of identical beam collections usually being applied repeatedly. A new treatment series (or another treatment phase, like a boost treatment etc.) is represented by one or more new radiation sets.

Relations between radiation sets are not handled within the radiation set IODs itself, but in the RT Course IOD as follows:

The relation in respect to time, i.e. how those radiation sets should be treated in series or parallel, is described in the RT Treatment Phase module (describing the treatment phases in

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relation to each other) and the RT Radiation Set Reference module (describing the radiation sets of a treatment phase in relation to each other) of the RT Course IOD.

The relation in respect to changes of a radiation set in the course of treatment are described in a specific sequence of the RT Radiation Set Reference module of the RT Course IOD. The use of those relations is restricted to small adaptations of the actual radiation set within the intended series of fractions, keeping the intended treatment technique, beam layout and planned dose distribution. Any change which lies beyond this scope, for example re-planning, is typically handled on a treatment phase level.

Radiation sets may be defined to a greater or lesser extent, depending on the progress of the treatment definition. For the typical stages (Simulation, Planning, Treatment), different radiation sets can be referenced. The final one, the Treatment RT Radiation Set, is intended to be a complete definition, deliverable by a TDS without further changes once approved.

ZZ.3.3.4 Clinical State InformationThe RT SOP Classes handled in the RT Course exist in various states during the clinical process. Instances may have been just created, may have been reviewed by physicians but not yet approved, or may be finally approved to be ready to use. Those states are not part of the data IOD itself, because their transitions should not necessarily trigger a change of the SOP Instance. States are often set without further changes to the SOP Instance, for example final approval.

The RT Course SOP Class maintains information about the states for most of the SOP Instances it references. It does so by having 2 types of states:

Clinical states are used to denote the clinical state in the decision process about the maturity and applicability of a SOP Instance.

RT Operation State is applicable for objects used to effectively perform the treatment (most prominently the radiation sets) and denotes the current state of the execution.

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ZZ.4 NOTES ON SECOND-GENERATION IODS

ZZ.4.1 RT Radiation Set IODZZ.4.1.1 General NotesThe RT Radiation Set represents a fractionation and a set of external beams or brachytherapy radiation configurations which are treated as a collection and always grouped together. Radiation sets are delivered in fractions. Therefore a RT Radiation Set is a collection of <RT Radiation> SOP Instances which define treatments for the same modality. In some cases it is possible for multiple radiations sets to contain the same <RT Radiation> SOP Instance.

By referencing other <RT Radiation> SOP Instances, an RT Radiation Set SOP Instance specifies all physical and geometric information that is needed to define the delivery of the therapeutic dose to the patient.

The methods of defining, verifying and correcting the position of the patient as well as attributes varying within the treatment cycle of a specific radiation set are out of scope for this IOD. An instance of a radiation set remains unchanged across all fractions. A change in the desired treatment normally requires a new radiation set to be created.

ZZ.4.1.2. FractionationFractionation defines the timing of treatments for a radiation set. It defines the number of fractions and the dose for each fraction. It also defines the Radiation Fraction Pattern to be delivered, i.e. daily and/or weekly patterns. Note that the actual schedule of treatments may not completely match the intended scheme (because of holidays, no-shows etc.), but the fractionation provides guidance for the scheduler.

ZZ.4.1.2. Meterset and other parameters resolutionIt is strongly recommended that the specified Cumulative Meterset and other machine parameters match the resolution as expected by the Radiation Device to deliver the radiation. If the calculation for Meterset results in a meterset value which is not an exact multiple of the meterset resolution, the result should be rounded to the nearest allowed meterset value.

ZZ.4.2 RT Radiation IODsZZ.4.2.1 Control PointsThe RT Radiation IODs make use of the Control Point concept as it was introduced within the Beam Sequence (300A,00B0) of the RT Beams Module in first generation RT objects. But due to the different characteristics of Control Points in different treatment devices, concrete definitions of Control Points will be device-specific. Examples are the Tomotherapeutic Control Point Sequence (30xx,1010) or the Multi-Axial Control Point Sequence (30xx,1500). Despite from that fact, the base concept is the same for all device-specific Control Points.

For the easy of reading, whenever the Control Point concept is referenced within this standard, it is only referenced as "Control Points" without relation to a specific device-related definition.

ZZ.4.2.2 Sub-Control PointsDue to additional requirements of some treatment techniques a new level below the Control Points is introduced, called Sub-Control Point. The base concept is the same for the Control Point level.

ZZ.4.3 RT Segment Annotation IODZZ.4.3.1 Conceptual VolumeThe term Conceptual Volume refers to an abstract spatial entity used in radiation therapy (or elsewhere) to identify the region of a patient that is relevant to treatment prescription, treatment planning, plan evaluation, and/or treatment verification.

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Generally, a Conceptual Volume is a volume that has a diagnostic or therapeutic purpose. The Conceptual Volume may or may not be specified by a specific segmentation, as defined in a Segmentation, Surface Segmentation, or RT Structure Set SOP Instance. The Conceptual Volume UID ties together instances created at different times and from different imaging modalities. A Conceptual Volume can also be used to reference abstract spatial entities (prior to delineation) for the purpose of prescribing dosimetry constraints for therapy.

ZZ.4.3.2 SegmentThe term Segment refers to a delineation of a spatial entity in a Segmentation, Surface Segmentation, or RT Structure Set SOP Instance. A Segment is a realization of a Conceptual Volume and is identified by its Conceptual Volume UID.

ZZ.5 EXAMPLE USE CASES

Four different use cases are illustrated in this section:

Using Managed Workflow: A treatment planning example where workflow is fully managed using a Workflow Manager (TMS) and the Unified Procedure Step – Pull (UPS-Pull) service class.

Using Received RT Course: A treatment planning example where workflow is managed externally to DICOM and the work item is initiated as a result of a transfer from an actor that has performed a previous work item. This corresponds to the case where the RT Course SOP Instance corresponds to an “electronic chart” that is passed from actor to actor, by DICOM Network Storage (“push”) from the previous Performing Device.

Using DICOM Media File Set: A treatment planning example where workflow is managed externally, but transfer occurs using DICOM storage media.

Using Archive Query of RT Course: A treatment planning example where workflow is managed externally to DICOM and the work item is retrieved from a central location (the archive). This corresponds to the case where the RT Course SOP Instance corresponds to an “electronic chart”, and where the location of the “chart” is constant but its validity must be managed externally.

ZZ.5.1 Use Case ActorsThe following actors are used in the example use cases:

User: A person controlling the performing of the procedure step.

Archive: A database storing SOP Instances (images, plans, structures, dose distributions, etc).

Treatment Management System (TMS): A suite of applications managing worklists and tracks performance of procedures. This role is commonly fullfilled by an Oncology Information System in the Oncology Department.

Virtual Simulation System (VSS): A workstation performing virtual simulation (localization, segmentation, and beam placement), often as part of a CT Simulation System.

Treatment Planning System (TPS): A workstation performing radiotherapy treatment planning. This includes localization, segmentation, beam placement or optimization, dose calculation, and dose review.

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Treatment Delivery System (TDS): An application performing the treatment delivery specified by the worklist, updating a UPS, and storing treatment records and related SOP instances (such as verification images). Acts as a Performing SCU.

Plan Review Station (PRS): A workstation performing radiotherapy treatment planning review, displaying and reviewing patient anatomy, beam geometry, and dose distributions.

Delivery Review Station (DRS): A workstation performing radiotherapy treatment delivery review, displaying and reviewing for patient anatomy, beam geometry, and planned and delivered dose distributions.

ZZ.5.2 Treatment Planning Using Managed WorkflowZZ.5.2.1 Message SequencingFigure ZZ.5.2.2-1 illustrates a message sequence example in the case where a Treatment Planning System (TPS) retrieves a UPS worklist and selects an inverse planning worklist item from a Treatment Management System (TMS). It then retrieves all necessary input objects such as instruction SOP Instances, image sets, Registration SOP Instances, Segmentation SOP Instances, a simulation RT Radiation Set and related <RT Radiation> SOP Instances, and an RT Prescription. The TPS then generates and stores SOP Instances such as a dosimetric RT Radiation Set, RT Dose Image and reference images or image sets to be used for delivery verification. Finally, it updates the procedure step.

ZZ.5.2.2 Transactions and Message Flow

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Figure ZZ.5.2.2-1Treatment Planning Normal Flow - Message Sequence

1. ‘List Procedures for Planning’ on TPS

The User requests a of patients requiring treatment planning.

2. Query UPS

The TPS queries the TMS for Unified Procedure Steps (UPSs) that match its search criteria. For example, all worklist items with a Procedure Step State of ’SCHEDULED’ and Workitem Code Sequence containing an item corresponding to ‘RT Inverse Planning’. This message is conveyed using the C-FIND request primitive of the Unified Procedure Step - Pull SOP Class.

3. Receive 0-n UPS

The TPS receives the set of Unified Procedure Steps (UPSs) resulting from the Query UPS message. The Receive UPS message is conveyed via one or more C-FIND response primitives of the UPS - Pull SOP Class. Each response with status ‘Pending’ contains the

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requested attributes of a single UPS. The TMS returns a list of zero or more UPSs containing the planned tasks for the querying device.

4. ‘Select Procedure’ on TPS

The User selects one of the scheduled procedures specified on the TPS. If exactly one UPS was returned from the UPS query described above, then the returned UPS is selected by default.

5. Retrieve Archive Objects

Archive Objects are retrieved by a C-MOVE Request, transmitting the SOP Instances to the TPS. SOP instances locations are fully specified in the Input Information Sequence of the Worklist response.

6. Start ‘Planning Session’ on TPS

The User begins the planning process on the TPS.

7. Set UPS (IN PROGRESS)

As the User begins the planning process, the TPS sets a UPS to have the Procedure Step State of ‘IN PROGRESS’. The SOP Instance UID of the UPS will have been obtained via the returned worklist query response. This message is conveyed using the N-ACTION primitive of the Unified Procedure Step – Pull SOP Class with an action type “UPS Status Change”. This message allows the TMS to update its worklist and permits other Performing Devices to detect that the UPS is being worked on.

8. Complete ‘Planning Session’ on TPS

The User completes the planning process on the TPS.

9. Store Results

When the planning process is complete, the TPS stores the results to the Archive. This would typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP instances are detailed in Section ZZ.6.

10. Set UPS Progress to Final State

Upon completion of the final beam (although this is not required) the TPS may then update the UPS Progress Information Sequence. The TPS must include references to any results in the Output Information Sequence (results are themselves conveyed by the Store Results step). Any attributes still required for UPS completion must be assigned in this step. This message is conveyed using the N-SET primitive of the Unified Procedure Step - Pull SOP Class.

11. Set UPS (COMPLETED)

The TPS sets the Procedure Step State of the UPS to ‘COMPLETED’ upon completion of the scheduled step and storage of results. This message is conveyed using the N-ACTION primitive of the UPS SOP Class with an action type “Request UPS State Modification”. This message informs the TMS that the UPS is now complete.

12. Indicate ‘Planning Session Completed Successfully’ on TPS

Finally the TPS notifies the User that the requested procedure has completed successfully, and all generated SOP Instances have been stored.

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ZZ.5.3 Treatment Planning Using Received RT CourseZZ.5.3.1 Message SequencingFigure ZZ.5.3.2-1 illustrates a message sequence example in the case where a TPS performs a treatment planning operation. The operation is based on an RT Course SOP Instance received from another performing device. In this example the TPS needs to be a RT Course Storage SCP.

This use case supports a special case of the “electronic chart” scenario where an independent system (e.g. a physical patient chart) has been used to determine that the next task is a planning procedure, and the User has identified a suitable workstation for the planning procedure.

ZZ.5.3.2 Transactions and Message FlowThis section describes in detail the interactions illustrated in Figure ZZ.5.3.2-1.

Archive

User

Treatment Planning System (TPS)

1. Store RT Course (C-STORE)

3. ‘Select ‘Active’ RT Course on TPS

Planning images, Segmentation IOD, Prescription IOD, etc

7. Store Results to Archive (C-STORE)

4. Retrieve Archive objects (C-MOVE)

Extract UIDs from selected RT Course

Display list of RT Courses to user

PLAN TREATMENT

PLAN TREATMENT

8. Store RT Course on Next Performing Device (C-STORE)

Virtual Simulation System (VSS)

Treatment Delivery System

(TDS)




Figure ZZ.5.3.2-1Treatment Planning Using Received RT Course - Message Sequence

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1. Store RT Course to TPS

The User of another performing device (such as a Virtual Simulation System) initiates a transfer of an RT Course SOP Instance to the TPS. The TPS receives this instance (acting as an RT Course Storage SCP) and stores it locally. Other instances - originating from other devices, or sent at other times - may also have previously been stored.


The User indicates on the TPS that they want the list of patients requiring treatment planning. The TPS then displays all relevant RT Course SOP Instances that have been stored locally.

3. Select ‘Active’ RT Course on TPS

The User selects one of the displayed RT Course objects as the active one. The TPS then extracts the required input SOP Instance UIDs from the selected RT Course.


The SOP Instances to be used as input information are transmittedby the Archive to the TPS in response to C-MOVE requests. Typical SOP Instances retrieved are detailed in Section ZZ.4. The TPS knows the location of these SOP instances by virtue of the fully-specified RT Course SOP Instance returned in the previous step.





7. Store Results to Archive

When the planning process is complete, the TPS stores the results to the Archive. This would typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP Instances are detailed in Section ZZ.6.

8. Store RT Course on Next Performing Device

The TPS stores a new RT Course SOP Instance on the next performing device, such as a Treatment Delivery System (TDS). It contains the complete history of the treatment course, including the planning step just performed.

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ZZ.5.4 Treatment Planning Using DICOM MediaZZ.5.4.1 Message SequencingFigure ZZ.5.4.2-1 illustrates a message sequence example in the case where a TPS performs a treatment planning operation based upon an RT Course SOP Instance that it has received by reading DICOM Media. In this example the TPS needs to be DICOM Media File Set Reader (FSR) for this to occur.

This use case supports a special case of the “electronic chart” scenario where an independent system (e.g. a physical patient chart) is used to track and indicate the procedures to be performed.User has been able to obtain a DICOM Storage Media File Set containing the latest information regarding the treatment course.

As before, the SOP Instances that may be consumed and produced by this procedure are shown in Section ZZ.6.


User

Treatment PlanningSystem (TPS)


2. ‘Select ‘Active’ RT Course on TPS

Extract UIDs fromselected RT Course

Display list of RT Coursesto user

PLANTREATMENT

PLANTREATMENT

6. Store RT Course and resultObjects to media (File SetUpdate)

DICOM StorageMedium (e.g.DVD or BD)

Read input RT Course(s) frommedia (File Set Reader)

3. Read input SOP Instances frommedia (File Set Reader)



Figure ZZ.5.4.2-1Treatment Planning Using DICOM Media - Message Sequence


The User indicates on the TPS that they want a the list of patients requiring treatment planning. The TPS initiates a retrieval of one or more RT Course SOP Instances from a

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DICOM Medium such as CD-R, DVD or BD. It does this by acting in the role of a DICOM File Set Reader (FSR). It then displays the list to the user.

2. Select ‘Active’ RT Course on TPS

The User confirms one of the displayed RT Course SOP Instances as the active one. The TPS then extracts the required input SOP Instance UIDs from the selected RT Course.

3. Read Input SOP Instances from Media

The TPS initiates a retrieval of required input SOP Instances from the DICOM Medium. It does this by acting in the role of a DICOM File Set Reader (FSR). Typical SOP Instances retrieved are detailed in Section ZZ.4. The TPS knows the location of these SOP instances by virtue of the fully-specified RT Course SOP Instance returned in the previous step.





6. Store Results to Media

When the planning process is complete, the TPS stores the results to a DICOM Media File Set.The stored objects include a new RT Course SOP Instance referencing the planning procedure step and any generated SOP Instances. These SOP Instances are detailed in Section ZZ.6.

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ZZ.5.5 Treatment Planning Using Archive Query of RT CourseZZ.5.5.1 Message SequencingFigure ZZ.5.5.2-1 illustrates a message sequence example in the case where a TPS performs a treatment planning operation based upon the contents of an RT Course SOP Instance selected from the Archive.

The use case supports a special case of the “electronic chart” scenario where an independent system (e.g. a physical patient chart) is used to track and indicate the procedures to be performed, including the current RT Course SOP Instances retrieved from the Archive.

As before, the SOP Instances that may be consumed and produced by this procedure are shown in Section ZZ.6.


Archive

User

Treatment Planning System (TPS)


2. Query RT Course (C-FIND)

3. Retrieve 0-n C-FIND responses

4. ‘Select RT Course on TPS

Planning images, Segmentation IOD, Prescription IOD, etc

9. Store Results

6. Retrieve Archive objects (C-MOVE)

Extract UIDs from selected RT Course

Display list of RT Courses to user

PLAN TREATMENT

PLAN TREATMENT

10. Store RT Course (new instance)

Selected RT Course IOD

5. Retrieve selected RT Course (C-MOVE)



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Figure ZZ.5.5.2-1Treatment Planning Using Archive Query of RT Course - Message Sequence


The User indicates on the TPS that they want a the list of patients requiring treatment planning.

2. Query RT Course

The TPS queries the Archive for RT Course SOP Instances that match its search criteria. For example, all RT Courses for a specific patient where the contents of the RT Course indicate that a simulation has already been performed. This message is conveyed using the C-FIND request primitive of the DICOM Query/Retrieve service class.

3. Receive 0-n C-FIND Responses

The TPS receives the set of results from the Query/Retrieve operation. The result set is conveyed via one or more C-FIND response primitives of the Query/Retrieve SOP Class. The Archive returns a list of zero or more items matching the specified search criteria.

4. ‘Select RT Course’ on TPS

The User selects one of the returned RT Course SOP Instances on the TPS.

5. Retrieve Selected RT Course

In response to a C-MOVE Request, the Archive transmits to the TPS the selected RT Course SOP Instance.


Archive Objects are retrieved by a C-MOVE Request, transmitting the SOP Instances to the TPS. SOP Instance locations are fully-specified in the RT Course SOP Instance returned in the previous step.





9. Store Results

When the planning process is complete, the TPS stores the results to the Archive. This would typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP Instances are detailed in Section ZZ.6.

10. Store RT Course

The TPS stores a new RT Course SOP Instance on the Archive. It contains the complete history of the treatment course, including the planning step just performed and the locations of any objects generated.

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document.doc: Supplement 147: Second Generation Radiotherapy 292

DICOM Supplement 147dicom.nema.org/Dicom/News/june2014/docs/sup147.doc · Web viewDigital Imaging...

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