Digital Imaging and Communications in Medicine (DICOM ...dicom.nema.org/Dicom/supps/sup45_08.pdf ·...

ASE • ACR • NEMA

Digital Imaging and Communications in Medicine (DICOM)

Supplement 45: Ultrasound Protocol Supplement

Prepared by:

DICOM Standards Committee, Working Group 12 Ultrasound

1300 N. 17th Street

Rosslyn, Virginia 22209 USA

Version: 0.7

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8 June, 1999

Supplement 45: Ultrasound ProtocolPage i

Foreword..........................................................................................................................................................iii

Scope and Field of Application....................................................................................................................... ivA.1.4 Overview of the Composite IOD Module Content.....................................................................2A.6.4 US Image IOD Module Table ...................................................................................................4A.7.4 US Multi-Frame Image IOD Module Table...............................................................................6

C.8.5.x US Series Module ........................................................................................................7C.8.5.y US Protocol Module .....................................................................................................9

6. REGISTRY OF DICOM DATA ELEMENTS .......................................................................................15

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DOCUMENT HISTORY

DocumentVersion

Date Content

0.1 3 June, 1998 New draft based on 26-27 February meeting output

0.2 4 June, 1998 Added data elements to Part 6. Added note in C.8.5.y USProtocol Module

0.3 8 June, 1998 Synchronized with Supplement 36. Added tables withpreliminary picklists for microglossary inclusion.

0.4 30 November, 1998 Added supplement number (45). Added DICOMDIRsupport for Part 11. Made new modules optional. Definedrelationship of ultrasound protocols to DICOM Real-WorldModel.

0.5 1 December, 1998 Clean up of Forward, Scope and Field of Application andpage numbering.

0.6 3 December, 1998 Clarify relationship of ultrasound protocols to DICOMReal-World Model.

0.7 8 June, 1999 Updated with changes from 3/29/99 teleconference.Added informative SDM codes from ASE.

OPEN ISSUES

Finish defining picklists and context ID’s.

Get element numbers for new attributes.

Supplement 45: Ultrasound ProtocolPage iii

Foreword

This draft Supplement to the DICOM Standard was developed according to NEMA Procedures. ThisSupplement to the Standard is developed in liaison with other standardization organizations including CENTC251 in Europe, MEDIS-DC and JIRA in Japan, with review also by other organizations including IEEE,HL7 and ANSI in the USA.

The DICOM Standard is structured as a multi-part document using the guidelines established in thefollowing document:

- ISO/IEC Directives, 1989 Part 3 : Drafting and Presentation of International Standards.

This document is a Supplement to the DICOM Standard. It is an extension to PS 3.3, 3.6 and 3.11 of thepublished DICOM Standard which consists of the following parts:

PS 3.1 - Introduction and Overview

PS 3.2 - Conformance

PS 3.3 - Information Object Definitions

PS 3.4 - Service Class Specifications

PS 3.5 - Data Structures and Encoding

PS 3.6 - Data Dictionary

PS 3.7 - Message Exchange

PS 3.8 - Network Communication Support for Message Exchange

PS 3.9 - Point-to-Point Communication Support for Message Exchange

PS 3.10 Media Storage and File Format for Data Interchange

PS 3.11 Media Storage Application Profiles

PS 3.12 Media Formats and Physical Media for Data Interchange

PS 3.13 Print Management Point-to-Point Communication Support

PS 3.14 Gray-scale Display Function Standard

These parts are related but independent documents.

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Scope and Field of Application

This Supplement to the DICOM Standard specifies changes to the DICOM Image Information ObjectDefinition (IOD) for Ultrasound (US) and Ultrasound Multi-frame (USMF) Images. It specifies the newmodules necessary to identify images acquired as part of an ultrasound acquisition protocol.

Since this document proposes changes to existing Parts of DICOM the reader should have a workingunderstanding of the Standard.

This proposed Supplement includes a number of Addenda to existing Parts of DICOM:

1. PS 3.3 Addenda (Extension to Annex A and Annex C)

2. PS 3.6 Addenda (Extension to Section 6)

3. PS 3.11 Addenda (Extension to Annex C)

Supplement 45: Ultrasound ProtocolPage 1

Changes to:

NEMA Standards Publication PS 3.3-1998


Part 3: Information Object Definitions

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3.X Ultrasound

The following definitions are commonly used in the specification of the Ultrasound IOD’s.

3.X.1 Acquisition Protocol

An Acquisition Protocol is a Procedure Type that defines the particular ultrasound images that will beacquired.

Note: These can be well known or locale specific.

3.X.2 Staged Protocol

A Staged Protocol is an Acquisition Protocol that is repeated at more than one specific instance of time.

Note: These instances commonly occur due to simple events. The introduction of contrast media, drugs or stressto the patient are typical events.

Item: Add to PS 3.3 Table A.1-1

A.1.4 Overview of the Composite IOD Module Content

Table A.1-1 provides an overview of the Modules used throughout the Composite IODs. This table is forinformative purposes only. It is based on the IOD definitions found in the remaining sections of Annex Awhich are normative.

Table A.1-1COMPOSITE INFORMATION OBJECT MODULES OVERVIEW

IODs

ModulesUS US-

mf

Patient M M

PatientSummary

GeneralStudy

M M

Patient study U U

Study Content

GeneralSeries

M M

CR Series

NM Series

US Series U U

Frame OfReference

U U

U S Frame ofRef.

C C

GeneralEquipment

M M

SC Equipment


GeneralImage

M* M

Image Plane

Image Pixel M* M

NM ImagePixel

Pallet ColorL o oku p Ta b le

C C

Contrast/Bolus

C* C

Cine M

Multi-frame M

NM Multi-frame

FramePointers

Mask

DisplayShutter

Device

Therapy

CR Image

CT Image

MR Image

NM Image

NM Isotope

NM Detector

NM TOMOAcquisition

NM Multi-GatedAcquisition

NM Phase

NMRe co n str u ct io n

US RegionCalibration

U* U

US Image M* M

US Protocol U U

SC Image

X-Ray Image

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X-RayAcquisition

X-RayCollimator

X-Ray Table

XRFPositioner

XRF TomoAcquisition

XA Positioner

Bi-PlaneSequence

Bi-PlaneImage

OverlayIdentification

Overlay Plane U*

Multi-frameOverlay

Bi-PlaneOverlay

CurveIdentification

M* M*

Curve M* M*

Audio U U

Modality LUT

VOI LUT U* U

LUTIdentification

SOPCommon

M* M*

Item: Add to PS 3.3 Table A.6.4-1 - for clarity, those modules that are changed from the existing standardor new are shown in Bold and Underlined

A.6.4 US Image IOD Module Table

Table A.6.4-1US IMAGE IOD MODULES

IE Module Reference Usage


Patient Patient C.7.1.1 M

Study General Study C.7.2.1 M

Patient Study C.7.2.2 U

Series General Series C.7.3.1 M

US Series C.8.5.x U – Suggested if image ispart of an acquisition

protocol

Frame ofReference

Frame of Reference C.7.4.1 U

US Frame of Reference C.8.5.4 C - Required if images arespatially related

Equipment General Equipment C.7.5.1 M

Image General Image C.7.6.1 M

(See A.6.4.1) Image Pixel C.7.6.3 M

Contrast/bolus C.7.6.4 C - Required if contrastmedia was used in this

image

Palette Color Lookup table C.7.9 C - Required if PhotometicInterpretation (0028,0004)has a value of PALETTE

COLOR

US Region Calibration C.8.5.5 U

US Image C.8.5.6 M

US Staged Protocol C.8.5.y U – Suggested if image ispart of a staged protocol

Overplay Plane C.9.2 U

VOI LUT C.11.2 U

SOP Common C.12.1 M

Curve Curve Identification C.10.1 M

(See A.6.4.1) Curve C.10.2 M

Audio C.10.3 U

SOP Common C.12.1 M

A.6.4.1 Mutually Exclusive IEs

The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactlyone of these IEs.

A.6.5 US Image IOD Relationship to the DICOM Real-World Model

Ultrasound images that make use of the US Series & Protocol Modules have a more specificrelationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisitionprotocol is considered one Requested Procedure and has one Procedure Plan. The ProcedurePlan will have one or more Action Items. An ultrasound acquisition protocol will typically consist

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of one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisitionprotocol was successfully completed, this will result in one Modality Performed Procedure Step.Therefore, all images that are part of this particular instance of an ultrasound acquisition protocolwill have the same Procedure Code Sequence (0032,1064). It is recommended that all the imagesthat are part of this particular instance of an ultrasound acquisition protocol have the samePerformed Procedure Step ID. In an environment with information system connectivity, theProcedure Code Sequence can be used to identify all the images that were acquired as part of thatprotocol. If no information system connectivity is available, then Performed Procedure Step IDmay be used to identify all the images that were acquired as part of that protocol.

It is recommended that each stage should map to a separate series.

Item: Add to PS 3.3 Table A.7.4-1 - for clarity, those modules that are changed from the existing standardor new are shown in Bold and Underlined

A.7.4 US Multi-Frame Image IOD Module Table

Table A.7.4-1US MULTI-FRAME IMAGE IOD MODULES

IE Module Reference Usage

Patient Patient C.7.1.1 M

Study General Study C.7.2.1 M

Patient Study C.7.2.2 U

Series General Series C.7.3.1 M

US Series C.8.5.x U – Suggested if image ispart of an acquisition

protocol

Frame ofReference

Frame of Reference C.7.4.1 U

US Frame of Reference C.8.5.4 C - Required if images arespatially related

Equipment General Equipment C.7.5.1 M

Image General Image C.7.6.1 M

(See A.7.4.1) Image Pixel C.7.6.3 M

Contrast/bolus C.7.6.4 C - Required if contrastmedia was used in this

image.

Cine C.7.6.5 M

Multi-frame C.7.6.6 M

Palette Color Lookup Table C.7.9 C - Required if PhotometricInterpretation (0028,0004)has a value of PALETTE

COLOR


US Region Calibration C.8.5.5 U

US Image C.8.5.6 M

US Staged Protocol C.8.5.y U – Suggested if image ispart of a staged protocol

VOI LUT C.11.2 U

SOP Common C.12.1 M

Curve Curve Identification C.10.1 M

(see A.7.4.1) Curve C.10.2 M

Audio C.10.3 U

SOP Common C.12.1 M

A.7.4.1 Mutually Exclusive IEs

The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactlyone of these IEs.

A.7.5 US Multi-Frame Image IOD Relationship to the DICOM Real-World Model

Ultrasound images that make use of the US Series & Protocol Modules have a more specificrelationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisitionprotocol is considered one Requested Procedure and has one Procedure Plan. The ProcedurePlan will have one or more Action Items. An ultrasound acquisition protocol will typically consistof one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisitionprotocol was successfully completed, this will result in one Modality Performed Procedure Step.Therefore, all images that are part of this particular instance of an ultrasound acquisition protocolwill have the same Procedure Code Sequence (0032,1064). It is recommended that all the imagesthat are part of this particular instance of an ultrasound acquisition protocol have the samePerformed Procedure Step ID. In an environment with information system connectivity, theProcedure Code Sequence can be used to identify all the images that were acquired as part of thatprotocol. If no information system connectivity is available, then Performed Procedure Step IDmay be used to identify all the images that were acquired as part of that protocol.

It is recommended that each stage should map to a separate series.

Item: Add to PS 3.3 New Sections C.8.5.x and C.8.5.y

C.8.5.x US Series Module

Table C.8-x contains IOD attributes that describe an ultrasound series.

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Table C.8-xUS SERIES MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description

Protocol Name (0018,1030) 1C User-defined description of the conditionsunder which the Series was performed.Required if Protocol Type Sequence(0018,xxxx) has no value.

Protocol Type Sequence (0018,xxxx) 2 Sequence of one or more Items thatidentifies the protocol used to acquire thisimage.

See section C.8.5.x.1.y

>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???.

>Protocol Type Modifier Sequence (0018,xxxx) 3 Sequence of one or more Items thatmodifies the primary protocol type used toacquire this image.

See section C.8.5.x.1.y

>>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???.

Performed Procedure Step ID (0040,0253) 1C Identification of that Procedure that hasbeen carried out within this step. Required ifimage was acquired in an acquisitionprotocol.

C.8.5.x.1 US Series Attributes Descriptions

C.8.5.x.1.y Protocol Type Sequence

These Data Elements are intended to replace Protocol Name (0018,1030) Data Element.

Protocol Type Sequence (0018,xxxx) describes the acquisition protocol used to acquire this image.

The Coding Scheme Designator (0008,0102) shall be SNM3.

The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX.

Note: The existence of this attribute means that this image is part of an acquisition protocol.

Note: The following will not be included in the standard.

Code Meaning(0008,0104)

Code Value(0008,0100)

Transesophageal echocardiography P5-B3002

Transthoracic echocardiography P5-B3003

Epicardial echocardiography P5-B3004

Intravascular echocardiography P5-B3005

Intracardiac echocardiography P5-B3006

Limited M-mode only echocardiography P5-B301F

Limited Doppler only echocardiography P5-B303F

Exercise stress echocardiography P5-B3050

Maximal stress echocardiography P5-B3051


Submaximal stress echocardiography P5-B3052

Treadmill exercise stress echocardiography P5-B3053

Bruce treadmill stress echocardiography P5-B3054

Modified Bruce treadmill stress echocardiography P5-B3055

Naughton treadmill stress echocardiography P5-B3056

Bicycle exercise stress echocardiography P5-B3058

Echocardiography with administered drug stress P5-B3060

Dobutamine stress echocardiography P5-B3061

High dose dobutamine stress echocardiography P5-B3062

Low dose dobutamine stress echocardiography P5-B3063

Arbutamine stress echocardiography P5-B3065

Dipyridamole stress echocardiography P5-B3066

Cardiac pacing echocardiography P5-B3070

Adult echocardiography P5-B3081

Pediatric echocardiography P5-B3082

Intraoperative echocardiography P5-B3083

Upright echocardiography P5-B3084

Supine echocardiography P5-B3085

Contrast echocardiography P5-B3090

Contrast left ventricular opacification echocardiography P5-B3091

Contrast perfusion echocardiography P5-B3092

Contrast Doppler enhancement echocardiography P5-B3093

2D complete echocardiography P5-B3191

Limited 2D only echocardiography P5-B3192

Fetal echocardiography P5-B8215

Protocol Type Modifier Sequence (0018,xxxx) modifies the primary acquisition protocol stage when theimage was acquired.



C.8.5.y US Staged Protocol Module

Table C.8-y contains IOD attributes that describe an ultrasound staged protocol.

Table C.8-yUS STAGED PROTOCOL MODULE ATTRIBUTES

Attribute Name Tag Type Attribute Description

Number of Stages (0008,2124) 2 Number of Stages in this protocol.

Number of Views in Stage (0008,212A) 2 Number of views in this Stage.

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Stage Name (0008,2120) 1C A Stage is a particular time slice of aprotocol in which a set of images arecollected. The names can be free form text.Recommended text for Stress Echo stagenames are:

PRE-EXERCISE, POST-EXERCISE, PEAK-EXERCISE, RECOVERY, BASELINE, LOW DOSE, PEAK DOSE

Required if Stage Type Sequence(0008,xxxx) has no value.

Stage Type Sequence (0008,xxxx) 2 Sequence of one or more items thatidentifies the acquisition protocol stagewhen the image was acquired.

See Section 8.5.y.1.1


>Stage Type Modifier Sequence (0008,xxxx) 3 Sequence of one or more Items thatmodifies the primary stage type in thisimage.

See Section 8.5.y.1.1


Stage Number (0008,2122) 1 A number that identifies the Stage. StageNumber starts at one.

See Section C.8.5.y.1.4

View Number (0008,2128) 2 A number that identifies the View. Can beempty if View Number is unknown or ifknown, View Number starts at one.


Transducer Position Sequence (0008,2240) 2 Sequence of one or more Items thatidentifies the transducer position used in thisimage.

See section C.8.5.y.1.2.

>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 4.

> Transducer Position ModifierSequence

(0008,2242) 3 Sequence of one or more Items thatmodifies the primary transducer position ofinterest in this image.

See Section C.8.5.y.1.2.

>>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 5.

Transducer Orientation Sequence (0008,2244) 2 Sequence of one or more Items thatidentifies the Transducer Orientation used inthis image.

See section C.8.5.y.1.3.



> Transducer Orientation ModifierSequence

(0008,2246) 3 Sequence of one or more Items thatmodifies the primary Transducer Orientationof interest in this image.



Note: Images that are part of a staged acquisition protocol should be identified by using Stage Type Sequence(0008,xxxx), Transducer Position Sequence (0008, 2240) and Transducer Orientation Sequence(0008,2244).

Stage Number (0008,2122), View Number (0008,2128), Number of Stages (0008,2124), Number of Views inStage (0008,212A) and Stage Name (0008, 2120) are maintained for backwards compatibility but mayproduce ambiguous results when used to identify a staged acquisition protocol.

C.8.5.y.1 US Staged Protocol Attribute Descriptions

C.8.5.y.1.1 Stage Type Sequence

These Data Elements are intended to replace Stage Name (0008,2120) Data Element.

Stage Type Sequence (0008,xxxx) describes the acquisition protocol stage when the image wasacquired.


The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX

Note: The existence of this attribute means that this image is part of an staged protocol.

Note: The following will not be included in the standard.

The following terms must be defined and a new Context ID created for them:

These codes have been defined by SNOMED and are available. There is some debate that SNOMEDrequires a licensing fee, so these terms need to be defined in such a way that is agreeable to WorkingGroup 6.

Code Meaning(0008,0104)

Code Value(0008,0100)

Image acquisition procedure P5-01000

Image acquisition after administration of contrast agent P5-01101

Image acquisition during cardiac pacing P5-01103

Image acquisition at user-defined cardiac pacing rate P5-01104

Image acquisition during hand grip maneuver P5-01111

Image acquisition during Valsalva P5-01112

Image acquisition during postural maneuver P5-01113

Pre-procedure image acquisition P5-01120

Preoperative image acquisition P5-01121

Intra-procedure image acquisition P5-01130

Intra-operative image acquisition P5-01131

Post-procedure image acquisition P5-01140

Post-operative image acquisition P5-01141

Image acquisition following first cardiopulmonary bypass P5-01142

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Image acquisition following second cardiopulmonarybypass

P5-01143

Image acquisition following third cardiopulmonary bypass P5-01144

Image acquisition during stress procedure P5-01200

Image acquisition at baseline P5-01201

Pre-stress image acquisition P5-01202

Mid-stress image acquisition P5-01203

Peak-stress image acquisition P5-01204

Image acquisition during recovery P5-01205

Image acquisition after drug administration P5-01300

Image acquisition at user-defined dobutamine dose P5-01310

Image acquisition at low-dose dobutamine P5-01311

Image acquisition at mid-dose dobutamine P5-01312

Image acquisition at peak dose dobutamine P5-01313

Image acquisition at dobutamine 5 mcg/kg/min P5-01314






Image at dobutamine 40 mcg/kg/min plus atropine P5-0131A

Image acquisition at dobutamine 50 mcg/kg/min plusatropine

P5-0131B

Image acquisition at peak Arbutamine dose P5-01323

Image acquisition at peak dipyridamole P5-01333

Image acquisition after nitroglycerin P5-01341

Image acquisition after amyl nitrite P5-01342

Image acquisition after adenosine P5-01343

Stage Type Modifier Sequence (0008,xxxx) modifies the primary acquisition protocol stage when theimage was acquired.



C.8.5.y.1.2 Transducer Position Sequence

Transducer Position Sequence (0008,2240) identifies the transducer position used in this image.


The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 4.

Transducer Position Modifier Sequence (0008,2242) modifies the transducer position used in this image.




C.8.5.y.1.3 Transducer Orientation Sequence

Transducer Orientation Sequence (0008,2244) identifies the transducer orientation used in this image.



Transducer Orientation Modifier Sequence (0008,2246) modifies the transducer orientation used in thisimage.



C.8.5.y.1.4 Stages

The Number of Stages (0008,2124) shall be the total number of stages performed in this instance of theprotocol. Stage Number (0008,2122) shall be the number that indicates the default order in which thestages are to be presented. Stage Number shall start from 1.

C.8.5.y.1.5 Views

The View Number (0008,2128) shall be used identify the same view across stages and defines a defaultorder for presentation within and across stages. If a particular view appears in one stage but not in asubsequent stage, then that View Number will not be used during that subsequent stage. View Numbershall start from 1. The Number of Views in Stage (0008,212A) shall be used to indicate how many uniqueView Numbers exist for this stage.

The addition of modification of the value for this attribute shall not by itself force a SOP Instance UIDchange.

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Changes to:



Part 6: Data Dictionary


6. REGISTRY OF DICOM DATA ELEMENTS

Add the following Data Elements to PS 3.6, Section 6.

Tag Name VR VM(0008,xxxx) Stage Type Sequence SQ 1(0008,xxxx) Stage Type Modifier Sequence SQ 1(0018,xxxx) Protocol Type Sequence SQ 1(0018,xxxx) Protocol Type Modifier Sequence SQ 1

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Changes to:



Part 11: Media Storage Application Profiles


Item: Add to PS 3.11 Section C.3.3.1 - for clarity, that text which is removed from the existing standard is2

shown as Strikethrough and that text which is changed or new is shown in Underlined

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C.3.3.1 Additional Keys6

File Set Creators and Updaters are only required to generate mandatory elements specified in PS 3.10.Table C.3-4 specifies the additional associated keys that shall be supported. Refer to the Basic Directory8

IOD in PS 3.3. At each directory record level any additional data elements can be added as keys, but isnot required by File Set Readers to be able to use them as keys.10

Table C.3-4STD-US-XX-XX-XXXX ADDITIONAL DICOMDIR KEYS12

Key Attribute Tag DirectoryRecord Type

Type Notes

Protocol TypeSequence

(0018,xxxx) SERIES 2C Sequence of one or more Itemsthat identifies the protocol used toacquire this image. Required if USSeries module is included.

See Part 3.3 Section C.8.5.x.1.y


>Protocol TypeModifier Sequence

(0018,xxxx) SERIES 3 Sequence of one or more Itemsthat modifies the primary protocoltype used to acquire this image.

See Part 3.3 Section C.8.5.x.1.y


PerformedProcedure Step ID

(0040,0253) SERIES 1C Identification of that Procedure thathas been carried out within thisstep. Required if series was part ofa performed procedure step.

Number of Stages (0008,2124) IMAGE 2C Number of Stages in this protocol.Required if Stage Type Sequence(0008,xxxx) is present.

See Part 3.3 Section C.8.5.y.1.4

Number of Views inStage

(0008,212A) IMAGE 2C Number of unique views in thisStage. Required if Stage TypeSequence (0008,xxxx) is present.


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Stage TypeSequence

(0008,xxxx) IMAGE 2C Sequence of one or more items thatidentifies the acquisition protocolstage when the image wasacquired. Required US Protocolmodule is present.

See Part 3.3 Section 8.5.y.1.1


>Stage TypeModifier Sequence

(0008,xxxx) IMAGE 3 Sequence of one or more Itemsthat modifies the primary stage typein this image.

See Part 3.3 Section 8.5.y.1.1


Stage Number (0008,2122) IMAGE 1C A number that identifies the Stage.Stage Number starts at one.Required if Stage Type Sequence(0008,xxxx) is present.


View Number (0008,2128) IMAGE 1C A number that identifies the View.View Number starts at one.Required if Stage Type Sequence(0008,xxxx) is present.


TransducerPosition Sequence

(0008,2240) IMAGE 2C Sequence of one or more Itemsthat identifies the transducerposition used in this image.Required if Stage Type Sequence(0008,xxxx) is present.

See Part 3.3 Section C.8.5.y.1.2.


> TransducerPosition ModifierSequence

(0008,2242) IMAGE 3 Sequence of one or more Itemsthat modifies the primarytransducer position of interest inthis image.



TransducerOrientationSequence

(0008,2244) IMAGE 2C Sequence of one or more Itemsthat identifies the TransducerOrientation used in this image.Required if Stage Type Sequence(0008,xxxx) is present.




> TransducerOrientation ModifierSequence

(0008,2246) IMAGE 3 Sequence of one or more Itemsthat modifies the primaryTransducer Orientation of interestin this image.



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