supplement 147: second generation...

sup147_42sup147_42.doc: Supplement 147: Second Generation Radiotherapy

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Digital Imaging and Communications in Medicine (DICOM) 4

Supplement 147: Second Generation Radiotherapy 6

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DICOM Standards Committee, Working Group 7, Radiation Therapy 16

1300 N. 17th Street, Suite 1752

Rosslyn, Virginia 22209 USA 18

VERSION: Sup 147 - Revision 42 20 September 20, 2013

Developed pursuant to DICOM Work Item 2007-06-B 22

This is a draft document. Do not circulate, quote, or reproduce it except with the approval of NEMA. 24


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Table of Contents

Table of Contents ...................................................................................................................... 2 28

Foreword ................................................................................................................................. 11 Scope and Field of Application ............................................................................................... 11 30

Part 2 Addendum .................................................................................................................... 12 Part 3 Addendum .................................................................................................................... 13 32

7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND GENERATION RADIOTHERAPY INFORMATION OBJECTS ........................................ 13 34

7.12.1 ....... RT Course ................................................................................................ 14 7.12.2 ....... RT Physician Intent .................................................................................. 15 36 7.12.3 ....... Conceptual Volume .................................................................................. 15 7.12.4 ....... RT Segment Annotation ........................................................................... 15 38 7.12.5 ....... RT Radiation Set ...................................................................................... 15 7.12.6 ....... RT Radiation ............................................................................................ 15 40 7.12.7 ....... RT Radiation Record ........................................................................... 1615 7.12.8 ....... RT Dose Image ........................................................................................ 16 42 7.12.9 ....... RT Dose Histogram.................................................................................. 16 7.12.10 ..... RT Dose Samples .................................................................................... 16 44 7.12.11 ..... RT Treatment Phase ................................................................................ 16

A.VV ..... SECOND GENERATION RADIATION THERAPY ............................................ 20 46 A.VV.1 ...... Second Generation Radiation Therapy Objects ...................................... 20

A.VV.1.1 ...... Second Generation Radiation Therapy Common Information ...... 20 48 A.VV.1.1.1 .......... Second Generation Radiation Therapy Entity-Relationship Model ................................................................................. 20 50

A.VV.1.2 ...... RT Course Information Object Definition ....................................... 24 A.VV.1.2.1 .......... RT Course IOD Description ...................................... 24 52 A.VV.1.2.2 .......... RT Course IOD Entity-Relationship Model ............... 24 A.VV.1.2.3 .......... RT Course IOD Module Table ................................... 24 54

A.VV.1.3 ...... RT Physician Intent Information Object Definition ..................... 2625 A.VV.1.3.1 .......... RT Physician Intent IOD Description..................... 2625 56 A.VV.1.3.2 .......... RT Physician Intent IOD Entity-Relationship Model2625 A.VV.1.3.3 .......... RT Physician Intent IOD Module Table ................. 2625 58

A.VV.1.4 ...... RT Radiation Set Information Object Definition ......................... 2625 A.VV.1.4.1 .......... RT Radiation Set IOD Description ........................ 2625 60 A.VV.1.4.2 .......... RT Radiation Set IOD Entity-Relationship Model . 2625 A.VV.1.4.3 .......... RT Radiation Set IOD Module Table ..................... 2625 62

A.VV.1.5 ...... RT Segment Annotation Information Object Definition .............. 2726 A.VV.1.5.1 .......... RT Segment Annotation IOD Description ............. 2726 64 A.VV.1.5.2 .......... RT Segment Annotation IOD Entity-Relationship Model .................. 2726 66 A.VV.1.5.3 .......... RT Segment Annotation IOD Module Table ......... 2726

A.VV.1.6 ...... Tomotherapeutic Radiation Information Object Definition ......... 2726 68 A.VV.1.6.1 .......... Tomotherapeutic Radiation IOD Description ........ 2726 A.VV.1.6.2 .......... Tomotherapeutic Radiation IOD Entity-70 Relationship Model ............................................................................. 2726 A.VV.1.6.3 .......... Tomotherapeutic Radiation IOD Module Table ..... 2726 72

A.VV.1.7 ...... C-Arm Photon Radiation Information Object Definition ............. 2726


A.VV.1.7.1 .......... C-Arm Photon Radiation IOD Description ............. 2726 74 A.VV.1.7.2 .......... C-Arm Photon Radiation IOD Entity-Relationship Model .................. 2726 76 A.VV.1.7.3 .......... C-Arm Photon Radiation IOD Module Table ......... 2827

A.VV.1.8 ...... C-Arm Electron Radiation Information Object Definition ........... 2827 78 A.VV.1.8.1 .......... C-Arm Electron Radiation IOD Description ........... 2827 A.VV.1.8.2 .......... C-Arm Electron Radiation IOD Entity-Relationship 80 Model .................. 2827 A.VV.1.8.3 .......... C-Arm Electron Radiation IOD Module Table ....... 2827 82

A.VV.1.9 ...... Multiple Fixed Source Radiation Information Object Definition . 2827 A.VV.1.9.1 .......... Multiple Fixed Source Radiation IOD Description . 2827 84 A.VV.1.9.2 .......... Multiple Fixed Source Radiation IOD Entity-Relationship Model ............................................................................. 2827 86 A.VV.1.9.3 .......... Multiple Fixed Source Radiation IOD Module Table2928

A.VV.1.10 .... Robotic Radiation Information Object Definition ........................ 2928 88 A.VV.1.10.1 ........ Robotic Radiation IOD Description ....................... 2928 A.VV.1.10.2 ........ Robotic Radiation IOD Entity-Relationship Model 2928 90 A.VV.1.10.3 ........ Robotic Radiation IOD Module Table ................... 2928

A.VV.1.11 .... Multi-Axial Radiation Information Object Definition ................... 2928 92 A.VV.1.11.1 ........ Multi-Axial Radiation IOD Description ................... 2928 A.VV.1.11.2 ........ Multi-Axial Radiation IOD Entity-Relationship 94 Model .................. 2928 A.VV.1.11.3 ........ Multi-Axial Radiation IOD Module Table ............... 2928 96

A.VV.1.12 .... RT Dose Image Information Object Definition ........................... 3029 A.VV.1.12.1 ........ RT Dose Image IOD Description ........................... 3029 98 A.VV.1.12.2 ........ RT Dose Image IOD Entity-Relationship Model .... 3029 A.VV.1.12.3 ........ RT Dose Image IOD Module Table ....................... 3029 100 A.VV.1.12.4 ........ RT Dose Image IOD Content Constraints ............. 3029 A.VV.1.12.5 ........ RT Dose Image Functional Group Macros ........... 3029 102

A.VV.1.13 .... RT Dose Histogram Information Object Definition .................... 3130 A.VV.1.13.1 ........ RT Dose Histogram IOD Description .................... 3130 104 A.VV.1.13.2 ........ RT Dose Histogram IOD Entity-Relationship Model3130 A.VV.1.13.3 ........ RT Dose Histogram IOD Module Table ................ 3130 106

A.VV.1.14 .... RT Dose Samples Information Object Definition ....................... 3130 A.VV.1.14.1 ........ RT Dose Samples IOD Description ...................... 3130 108 A.VV.1.14.2 ........ RT Dose Samples IOD Entity-Relationship Model 3130 A.VV.1.14.3 ........ RT Dose Samples IOD Module Table ................... 3130 110

A.VV.1.15 .... Tomotherapeutic Radiation Record Information Object Definition3231 A.VV.1.15.1 ........ Tomotherapeutic Radiation Record IOD 112 Description ......... 3231 A.VV.1.15.2 ........ Tomotherapeutic Radiation Record IOD Entity-114 Relationship Model ............................................................................. 3231 A.VV.1.15.3 ........ Tomotherapeutic Radiation Record IOD Module 116 Table ................... 3231

A.VV.1.16 .... C-Arm Photon Radiation Record Information Object Definition 3231 118 A.VV.1.16.1 ........ C-Arm Photon Radiation Record IOD Description 3231 A.VV.1.16.2 ........ C-Arm Photon Radiation Record IOD Entity-120 Relationship Model ............................................................................. 3231 A.VV.1.16.3 ........ C-Arm Photon Radiation Record IOD Module 122 Table ................... 3231

A.VV.1.17 .... C-Arm Electron Radiation Record Information Object Definition3332 124 A.VV.1.17.1 ........ C-Arm Electron Radiation Record IOD Description3332 A.VV.1.17.2 ........ C-Arm Electron Radiation Record IOD Entity-126 Relationship Model ............................................................................. 3332 A.VV.1.17.3 ........ C-Arm Electron Radiation Record IOD Module 128 Table ................... 3332


A.VV.1.18 .... Multiple Fixed Source Radiation Record Information Object 130 Definition ...... 3332

A.VV.1.18.1 ........ Multiple Fixed Source Record Radiation IOD 132 Description ......... 3332 A.VV.1.18.2 ........ Multiple Fixed Source Radiation Record IOD E-R 134 Model .................. 3332 A.VV.1.18.3 ........ Multiple Fixed Source Radiation Record IOD 136 Module Table ...... 3332

A.VV.1.19 .... Robotic Radiation Record Information Object Definition ........... 3332 138 A.VV.1.19.1 ........ Robotic Radiation Record IOD Description ........... 3332 A.VV.1.19.2 ........ Robotic Radiation Record IOD Entity-Relationship 140 Model .................. 3332 A.VV.1.19.3 ........ Robotic Radiation Record IOD Module Table ....... 3332 142

A.VV.1.20 .... Multi-Axial Radiation Record Information Object Definition ....... 3433 A.VV.1.20.1 ........ Multi-Axial Radiation Record IOD Description ...... 3433 144 A.VV.1.20.2 ........ Multi-Axial Radiation Record IOD Entity-Relationship Model ............................................................................. 3433 146 A.VV.1.20.3 ........ Multi-Axial Radiation Record IOD Module Table .. 3433

C.AA ..... SECOND GENERATION RADIOTHERAPY MODULES .............................. 3534 148 C.AA.1 ...... Second Generation Radiotherapy Definitions ...................................... 3534

C.AA.1.1 ...... Control Points ............................................................................ 3534 150 C.AA.1.1.1 .......... Control Points of Radiations .................................. 3534 C.AA.1.1.2 .......... Verification Control Points ..................................... 3534 152

C.AA.1.2 ...... Nominal Energy ......................................................................... 3534 C.AA.1.3 ...... Fractionation, Fractionation Scheme ......................................... 3534 154 C.AA.1.4 ...... Treatment RT Radiation Set ...................................................... 3534 C.AA.1.5 ...... Meterset ..................................................................................... 3635 156 C.AA.1.6 ...... Radiation Dose Point ................................................................. 3635 C.AA.1.7 ...... Treatment Phase ....................................................................... 3635 158

C.AA.2 ...... Second Generation Radiotherapy General-Purpose Macros .............. 3736 C.AA.2.1 ...... RT Entity Labeling Macro .......................................................... 3736 160

C.AA.2.1.1 .......... RT Entity Labeling Macro Attribute Description .... 3736 C.AA.2.2 ...... RT Entity Long Labeling Macro ................................................. 3736 162 C.AA.2.3 ...... RT Item State Macro .................................................................. 3837

C.AA.2.3.1 .......... RT Item State Macro Attribute Description ........... 3837 164 C.AA.2.4 ...... RT Operation State Macro ......................................................... 3938 C.AA.2.5 ...... Conceptual Volume Macro ........................................................ 4140 166

C.AA.2.5.1 .......... Conceptual Volume Macro Attribute Description .. 4241 C.AA.2.6 ...... Conceptual Volume Combination and Segmentation Base Macro4341 168

C.AA.2.6.1 .......... Conceptual Volume Combination and Segmentation Base Macro Attribute Description ............................... 4946 170

C.AA.2.7 ...... Conceptual Volume Combination and Segmentation Macro..... 5552 C.AA.2.8 ...... Segmented Conceptual Volume Macro ..................................... 5552 172 C.AA.2.9 ...... Radiation Fraction Pattern Macro .............................................. 5753

C.AA.2.9.1 .......... Radiation Fractionation Pattern Macro Attribute 174 Description ......... 5753

C.AA.2.10 .... Treatment Device Identification Macro ...................................... 5955 176 C.AA.2.11 .... Device Model Macro .................................................................. 5955 C.AA.2.12 .... RT Patient Support Device Identification Macro ........................ 6056 178 C.AA.2.13 .... Patient Support Position Macro ................................................. 6056 C.AA.2.14 .... Device Identification Macro ........................................................ 6156 180 C.AA.2.15 .... RT Accessory Device Identification Macro ................................ 6257 C.AA.2.16 .... Control Point General Attributes Macro ..................................... 6358 182

C.AA.2.16.1 ........ Control Point Attribute Requirements.................... 6358 C.AA.2.17 .... External Beam Control Point General Attributes Macro ............ 6660 184


C.AA.2.16.1 ........ External Beam Control Point General Attributes Macro Attribute Description ................................................................ 6761 186

C.AA.2.18 .... External Beam Sub-Control Point General Attributes Macro .... 6761 C.AA.2.18.1 ........ RT Beam Limiting Device Definition Macro 188 Attribute Description ........................................................................... 6862 C.AA.2.18.1.1 ..... Sub-Control Point Attribute Requirements ............ 6862 190 C.AA.2.18.1.2 ..... Cumulative Radiation Meterset ............................. 6862

C.AA.2.19 .... Beam Mode Macro .................................................................... 6862 192 C.AA.2.19.1 ........ Beam Mode ........................................................... 7064

C.AA.2.20 .... RT Beam Limiting Device Definition Macro ............................... 7165 194 C.AA.2.20.1 ........ RT Beam Limiting Device Definition Macro Attribute Description ........................................................................... 7266 196

C.AA.2.21 .... RT Beam Limiting Device Positions Macro ............................... 7266 C.AA.2.22 .... Wedges Definition Macro ........................................................... 7367 198 C.AA.2.23 .... Wedge Positions Macro ............................................................. 7468 C.AA.2.24 .... Compensators Definition Macro ................................................ 7569 200

C.AA.2.24.1 ........ Compensators Definition Macro Attributes Description ......... 7871 202

C.AA.2.25 .... Blocks Definition Macro ............................................................. 7872 C.AA.2.25.1 ........ Blocks Definition Macro Attribute Description ....... 7973 204

C.AA.2.26 .... Accessory Holder Definition Macro ........................................... 8073 C.AA.2.26.1 ........ Accessory Holder Description ............................... 8174 206

C.AA.2.27 .... General Accessories Definition Macro ...................................... 8174 C.AA.2.28 .... Boluses Definition Macro ........................................................... 8175 208

C.AA.2.28.1 ....... Bolus Definition Macro Attribute Description ......... 8275 C.AA.2.29 .... Outline Definition Macro ............................................................ 8275 210 C.AA.2.30 .... RT Tolerance Set Macro ............................................................ 8477

C.AA.2.30.1 ........ RT Tolerance Set Attribute Description ................ 8578 212 C.AA.2.30.1.2 ..... Patient Support Position Tolerance Sequence ..... 8579

C.AA.2.31 .... Patient to Equipment Relationship Macro ................................. 8579 214 C.AA.2.31.1 ........ Patient to Equipment Relationship Macro Attributes Description ......... 8780 216

C.AA.2.32 .... RT Treatment Position Macro .................................................... 8781 C.AA.2.33 .... User Content Identification Macro ............................................. 8881 218

C.AA.2.33.1 ........ User Content Identification Macro Attribute Description ......... 8982 220

C.AA.2.34 .... RT Treatment Phase Macro ...................................................... 8982 C.AA.2.34.1 ........ RT Treatment Phase Macro Attribute Description 9083 222

C.AA.2.35 .... RT Treatment Phase Interval Macro ......................................... 9083 C.AA.2.35.1 ........ Referenced Treatment Phases ............................. 9184 224 C.AA.2.29.1 ........ Outline Definition Macro Attribute Description ...... 9184

C.AA.A1 ... Enhanced RT Series Module ............................................................... 9285 226 C.AA.A1.1 .... Enhanced RT Series Attribute Description ................................ 9285

C.AA.A1.1.1 ........ Modality ................................................................. 9285 228 C.AA.A2 ... Radiotherapy Common Instance Module ............................................ 9285 C.AA.A3 ... RT Course Module ............................................................................... 9386 230

C.AA.A3.1 .... RT Course Attribute Description ................................................ 9588 C.AA.A3.1.1 ........ RT Course Scope Indicator ................................... 9588 232 C.AA.A3.1.2 ........ Delivered Radiation Dose Sequence .................... 9588 C.AA.A3.1.3 ........ RT Course State Sequence .................................. 9588 234

C.AA.A4 ... RT Prescription Reference Module ...................................................... 9588 C.AA.A4.1 .... RT Prescription Reference Attribute Description ....................... 9689 236

C.AA.A4.1.1 ........ RT Item State Macro Meanings ............................ 9689 C.AA.A5 ... RT Treatment Phase Module ............................................................... 9790 238

C.AA.A5.1 .... RT Treatment Phase Attribute Description ............................... 9790 C.AA.A5.1.1 ........ RT Item State Macro Meanings ............................ 9790 240


C.AA.A6 ... RT Radiation Set Reference Module ................................................... 9891 C.AA.A6.1 .... RT Radiation Set Reference Attribute Description .................. 10396 242

C.AA.A6.1.1 ........ RT Item State Macro Meanings .......................... 10396 C.AA.A6.1.2 ........ Radiation Set Start Delay .................................... 10396 244

C.AA.A7 ... RT Course Associated Instance Reference Module .......................... 10699 C.AA.B1 ... RT Physician Intent Module ............................................................... 10699 246

C.AA.B1.1 .... RT Physician Intent Attribute Description .............................. 108101 C.AA.B1.1.1 ........ RT Physician Intent Sequence .......................... 108101 248 C.AA.B1.1.2 ........ RT Protocol Code Sequence ............................ 108101 C.AA.B1.1.3 ........ RT Diagnostic Image Set Sequence ................. 108101 250

C.AA.B2 ... RT Prescription Module ................................................................... 108101 C.AA.B2.1 .... RT Prescription Attribute Description .................................... 116108 252

C.AA.B2.1.1 ........ Anatomy Property Type Code Sequence ......... 116108 C.AA.B2.1.2 ........ Dosimetric Objective Parameter Sequence ...... 116109 254 C.AA.B2.1.3 ........ Dosimetric Objective Parameter Sequence Examples ............ 118110 256 C.AA.B2.1.4 ........ Conceptual Volume Sequence .......................... 118111 C.AA.B2.1.5 ........ Prescription Anatomy Role ................................ 118111 258 C.AA.B2.1.6 ........ Radiobiological Structural Type ........................ 119111 C.AA.B2.1.7 ........ Dosimetric Objective Priority ............................. 119111 260

C.AA.B2.2 .... Dosimetric Objective Scope ................................................... 119112 C.AA.B3 ... RT Treatment Phase Intent Module ................................................. 119112 262 C.AA.C1 ... RT Radiation Set Module ................................................................. 120112

C.AA.C1.1 .... RT Radiation Set Attribute Description .................................. 121114 264 C.AA.C1.1.1 ....... Radiation Set Type ............................................ 121114 C.AA.C1.1.2 ....... Radiation Sequence .......................................... 121114 266

C.AA.C2 ... RT Dose Contribution Module .......................................................... 122114 C.AA.C2.1 .... RT Dose Contribution Attribute Description ........................... 126118 268

C.AA.C2.1.1 ....... Meterset to Dose Mapping Sequence ............... 126118 C.AA.C2.1.2 ....... Conceptual Volume Sequence .......................... 126119 270 C.AA.C2.1.3 ....... Primary Dose Value Indicator ........................... 127119

C.AA.C2.2 .... Radiation Verification Control Point Description .................... 127119 272 C.AA.C2.2.1 ....... Referenced Control Point .................................. 127119 C.AA.C2.2.2 ....... Distance Parameters ......................................... 127119 274 C.AA.C2.2.3 ....... Radiation Dose Value ....................................... 127119

C.AA.D1 ... RT Segment Annotation Module ...................................................... 127119 276 C.AA.D1.1 .... RT Segment Annotation Description ..................................... 131123

C.AA.D1.1.1 ....... Segmentation SOP Instance Reference Sequence131123 278 C.AA.D1.1.2 ....... Alternate Segmented Property Type Code Sequence ........... 131123 280 C.AA.D1.1.3 ....... Segmented Property Type Code Sequence ..... 133125 C.AA.D1.1.4 ....... Segmented RT Accessory Device Sequence ... 133125 282 C.AA.D1.1.5 ....... Direct Segment Reference Sequence .............. 133125 C.AA.D1.1.6 ....... Combination Segment Reference Sequence .... 133125 284 C.AA.D1.1.7 ....... Segment Properties Sequence ......................... 134126

C.AA.E1 ... RT Delivery Device Common Module .............................................. 134126 286 C.AA.E1.1 ........... RT Delivery Device Common Module Attribute Description ......... 135127 288 C.AA.E1.1.3 ........ Equipment Frame of Reference UID ................. 135127

C.AA.E2 ... RT Radiation Common Module ........................................................ 137129 290 C8.A.E2.1 .... RT Radiation Common Attribute Description ......................... 137129

C.AA.E2.1.1 ........ Radiotherapy Procedure Technique Sequence 137129 292 C.AA.E2.1.2 ........ RT Treatment Position Macro ........................... 137129 C.AA.E2.1.3 ........ RT Radiation Data Scope ................................. 138130 294 C.AA.E2.1.4 ........ Treatment Times ............................................... 138130

C.AA.F1.... Tomotherapeutic Delivery Device Module ....................................... 138130 296


C.AA.F1.1 .... Tomotherapeutic Delivery Device Attribute Description ........ 139131 C.AA.F1.1.1 ........ Leaf Slot Definition ............................................ 139131 298

C.AA.F2.... Tomotherapeutic Beam Module ....................................................... 139131 C.AA.G1 ... C-Arm Photon-Electron Delivery Device Module ............................. 141133 300 C.AA.G2 ... C-Arm Photon-Electron Beam Module ............................................ 141133

C.AA.G2.1 ... C-Arm Photon-Electron Beam Attribute Description ............. 143135 302 C.AA.G2.1.1 ....... Radiation Particle .............................................. 143135

C.AA.H1 ... Multiple Fixed Source Delivery Device Module ............................... 143135 304 C.AA.H1.1 .... Multiple Fixed Source Delivery Device Attribute Description 144136

C.AA.H1.1.1 ....... Radiation Source Angles ................................... 144136 306 C.AA.H2 ... Multiple Fixed Source Beam Set Module ......................................... 144136 C.AA.J1 .... Robotic Delivery Device Module ...................................................... 145137 308 C.AA.J2 .... Robotic Path Module ........................................................................ 145137 C.AA.L1 .... Multi-Axial Delivery Device Module .................................................. 147139 310

C.AA.L2.1 .... Multi Axial Delivery Device Attribute Description ................... 148140 C.AA.L1.1 ........... Source-Axis Distance ........................................ 148140 312

C.AA.L2 .... Multi-Axial Beam Module ................................................................. 148140 C.AA.L2.1 .... Multi Axial Beam Attribute Description .................................. 152144 314

C.AA.L2.1.1 ........ Multi-Axial Gantry Angles .................................. 152144 C.AA.L2.1.2 ........ Gantry Head Angles .......................................... 152144 316 C.AA.L2.1.3 ........ Multi Axial Beam Delimiter Positions ................. 152144

C.AA.M1 ... Enhanced RT Dose Module ............................................................. 154146 318 C.AA.M1.1 ... Enhanced RT Dose Attribute Description .............................. 160152

C.AA.M1.1.1 ....... Dose Scope ....................................................... 160152 320 C.AA.M1.1.2 ....... Radiation Absorption Model .............................. 161152

C.AA.M2 ... RT Dose Image Module ................................................................... 161153 322 C.AA.M2.1 ... RT Dose Image Attribute Description .................................... 162154

C.AA.M2.1.1 ....... Image Type and Frame Type ............................ 162154 324 C.AA.M2.1.2 ....... Dose Grid Geometry ......................................... 162154 C.AA.M2.1.3 ....... Dose Grid Real World Values ........................... 162154 326

C.AA.M3 ... RT Dose Image Functional Group Macros ...................................... 163155 C.AA.M3.1 ... RT Dose Image Frame Type Macro ...................................... 163155 328

C.AA.M4 ... RT Dose Histogram Module ............................................................. 163155 C.AA.M4.1 ... RT Dose Histogram Attribute Description .............................. 165157 330

C.AA.M4.1.1 ....... Referenced Segmentation Properties Sequence165157 C.AA.M4.1.2 ....... Dose Histogram Data ........................................ 165157 332 C.AA.M4.1.3 ....... Dose Histogram Referenced Segment Sequence165157

C.AA.M5 ... Dose Samples Module ..................................................................... 166158 334 C.AA.M5.1 ... RT Dose Samples Attribute Description ................................ 166158

C.AA.M5.1.1 ....... Dose Samples Data .......................................... 166158 336 C.AA.P1 ... RT Radiation Record Common Module ........................................... 166158

C.AA.P1.1 .... RT Radiation Record Common Attribute Description ............ 170161 338 C.AA.P1.1.1 ........ Control Point References .................................. 170161 C.AA.P1.1.2 ........ Referenced RT Patient Setup Sequence .......... 170162 340

C.AA.P2 ... RT Dose Record Common Module .................................................. 170162 C.AA.P2.1 .... RT Dose Record Common Module Attribute Description ...... 172163 342

C.AA.P2.1.1 ........ Conceptual Volume Sequence .......................... 172163 F.5.X ......... Radiotherapy Directory Record Definition ....................................... 176168 344

C.7.5.1 ......... General Equipment Module ................................................... 177169 C.7.6.3 ......... Image Pixel Module ............................................................... 178170 346

Part 4 Addendum ............................................................................................................ 179171 Part 6 Addendum ............................................................................................................ 182174 348

6 ............ REGISTRY OF DICOM DATA ELEMENTS .............................................. 182174 ANNEX A REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)198190 350


Part 16 Addendum .......................................................................................................... 203193 CID 9231 GENERAL PURPOSE WORKITEM DEFINITION ......................... 203193 352

CID SUP147001 DOSIMETRIC OBJECTIVE VALUE TYPES ........................... 204194 CID SUP147002 PRESCRIPTION ANATOMY CATEGORIES .......................... 204194 354

CID SUP147003 RADIOTHERAPY SEGMENT CATEGORIES ......................... 204194 CID SUP147004 RADIOTHERAPY TARGETS .................................................. 205195 356

CID SUP147005 RT GEOMETRIC INFORMATION ........................................... 205195 CID SUP147006 FIXATION OR POSITIONING DEVICES ................................ 206196 358

CID SUP147007 BRACHYTHERAPY DEVICES ................................................ 206196 CID SUP147009 SEGMENTATION COMBINATION ......................................... 207197 360

CID SUP147010 BEAM LIMITING DEVICE TYPES ........................................... 207197 CID SUP147011 RADIOTHERAPY ROBOTIC PATHS ...................................... 207197 362

CID SUP147012 GENERAL EXTERNAL RADIOTHERAPY PROCEDURE TECHNIQUES .............. 208198 364

CID SUP147013 TOMOTHERAPEUTIC RADIOTHERAPY PROCEDURE TECHNIQUES .............. 208198 366

CID SUP147014 TREATMENT RT RADIATION SET ALTERATION TYPES .... 209199 CID SUP147015 TREATMENT TERMINATION REASONS .............................. 209199 368

CID SUP147016 COMPENSATOR DEVICE TYPES ......................................... 210200 CID SUP147017 RADIOTHERAPY TREATMENT MACHINE MODES ............. 210200 370

CID SUP147018 PRE-TREATMENT RT RADIATION SET ROLES .................. 210200 CID SUP147020 INSTANCE REFERENCE PURPOSES .................................. 211201 372

CID SUP147021 PATIENT SETUP TECHNIQUES ............................................ 211201 CID SUP147022 FIXATION DEVICE TYPES ..................................................... 212202 374

CID SUP147023 SHIELDING DEVICE TYPES .................................................. 212202 CID SUP147024 SETUP DEVICES .................................................................... 212202 376

CID SUP147025 RT PATIENT SUPPORT DEVICES......................................... 213203 CID SUP147026 DOSE STATISTICS ................................................................. 213203 378

CID SUP147027 FIXED BEAM LIMITING DEVICE TYPES ............................... 213203 CID SUP147028 RADIOTHERAPY WEDGE TYPES ......................................... 214204 380

CID SUP147030 GENERAL ACCESSORY DEVICE TYPES ............................. 214204 CID SUP147031 RADIOTHERAPY BOLUS DEVICE TYPES ............................ 215205 382

CID SUP147032 RADIOTHERAPY BLOCK DEVICE TYPES ............................ 215205 CID SUP147033 RADIOTHERAPY ACCESSORY HOLDER DEVICE TYPES . 215205 384

CID SUP147034 RADIOTHERAPY DOSE REAL WORLD UNITS .................... 215205 CID SUP147035 EFFECTIVE DOSE METHOD CODE DEFINITION ................ 216206 386

CID SUP147037 DOSE DATA SOURCE MEASUREMENT DEFINITION ......... 216206 CID SUP147039 DOSE HISTOGRAM SPATIAL UNIT DEFINITION ................. 217207 388

CID SUP147040 SEGMENTED RT ACCESSORY DEVICES ............................ 217207 CID SUP147041 DOSE ALGORITHM CLASS ................................................... 217207 390

CID SUP147042 ENERGY UNIT ........................................................................ 218208 CID SUP147043 RT ITEM STATES .................................................................... 218208 392


CID SUP147044 RT OPERATION STATES ....................................................... 219209 CID SUP147045 MULTI-SOURCE RADIATION TECHNIQUE .......................... 219209 394

CID SUP147046 ROBOTIC RADIATION TECHNIQUE ..................................... 220209 CID SUP147047 RADIOTHERAPY PROCEDURE TECHNIQUES ................... 220210 396

CID SUP147048 REVISED VALUE .................................................................... 220210 CID SUP147049 RADIOTHERAPY GENERAL WORKITEM DEFINITION ........ 220210 398

CID SUP147050 BEAM MODE TYPE DEFINITION .......................................... 221211 CID SUP147051 PRIMARY METERSET RATE UNIT DEFINITION ................. 221211 400

CID SUP147052 RADIATION PARTICLE .......................................................... 221211 CID SUP147060 SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES ...... 222212 402

CID SUP147061 PERCENTAGE AND DOSE-RELATED DOSIMETRIC OBJECTIVES .............. 222212 404

CID SUP147062 VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES223212 CID SUP147063 DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES406 .............. 223213 CID SUP147064 CODED DOSIMETRIC OBJECTIVES .................................... 223213 408

CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition225214 CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition410 .............. 225214 CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition412 .............. 225214 ANNEX C ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE)414 .............. 226215 TID SUP147001 RT PRESCRIPTION ANNOTATION ....................................... 226215 416

TID SUP147003 RT SEGMENT ANNOTATION PROPERTIES ........................ 227217 TID SUP147004 PATIENT SUPPORT POSITION PARAMETERS ................... 227217 418

ANNEX D DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE)229219 Part 17 Addendum .......................................................................................................... 245235 420

Annex Z Second Generation RT (Informative) ......................................................... 245235 ZZ.1 ...... INTRODUCTION ....................................................................................... 245235 422

ZZ.2 ...... ENTITY DESCRIPTIONS .......................................................................... 249239 ZZ.2.1 ....... RT Course ........................................................................................ 249239 424 ZZ.2.2 ....... RT Physician Intent .......................................................................... 251241 ZZ.2.3 ....... RT Segment Annotation ................................................................... 254244 426 ZZ.2.4 ....... RT Radiation Set .............................................................................. 254244 ZZ.2.5 ....... RT Radiation .................................................................................... 255245 428 ZZ.2.6 ....... RT Dose Image ................................................................................ 256246 ZZ.2.7 ....... RT Dose Histogram.......................................................................... 257247 430 ZZ.2.8 ....... RT Dose Samples ............................................................................ 258248 ZZ.2.9 ....... RT Radiation Record ....................................................................... 259249 432

ZZ.3 ...... NOTES ON RT COURSE .......................................................................... 260250 ZZ.3.1 ....... Introduction ...................................................................................... 260250 434 ZZ.3.2 ....... Evolution of an RT Course SOP Instance ....................................... 260250 ZZ.3.3 ....... Elements of the RT Course .............................................................. 261251 436

ZZ.3.3.1. ...... Physician Intent ...................................................................... 261251 ZZ.3.3.2. ...... Treatment Phase ................................................................... 261251 438 ZZ.3.3.3. ...... Radiation Sets ........................................................................ 261251


ZZ.3.3.4 ....... Clinical State Information ....................................................... 262252 440 ZZ.4 ...... NOTES ON SECOND-GENERATION IODS ............................................ 263253

ZZ.4.1 ....... RT Radiation Set IOD ...................................................................... 263253 442 ZZ.4.1.1 ....... General Notes ........................................................................ 263253 ZZ.4.1.2. ...... Fractionation .......................................................................... 263253 444 ZZ.4.1.2. ...... Meterset and other parameters resolution ............................. 263253

ZZ.4.2 ....... RT Radiation IODs ........................................................................... 263253 446 ZZ.4.2.1 ....... Control Points ........................................................................ 263253 ZZ.4.2.2 ....... Sub-Control Points ................................................................. 263253 448

ZZ.4.3 ....... RT Segment Annotation IOD ........................................................... 263253 ZZ.4.3.1 ....... Conceptual Volume ............................................................... 263253 450 ZZ.4.3.2 ....... Segment ................................................................................. 264254

ZZ.5 ...... EXAMPLE USE CASES ............................................................................ 264254 452 ZZ.5.1 ....... Use Case Actors .............................................................................. 264254 ZZ.5.2 ....... Treatment Planning Using Managed Workflow ............................... 265255 454

ZZ.5.2.1 ....... Message Sequencing ............................................................ 265255 ZZ.5.2.2 ....... Transactions and Message Flow ........................................... 265255 456

ZZ.5.3 ....... Treatment Planning Using Received RT Course ............................. 268258 ZZ.5.3.1 ....... Message Sequencing ............................................................ 268258 458 ZZ.5.3.2 ....... Transactions and Message Flow ........................................... 268258

ZZ.5.4 ....... Treatment Planning Using DICOM Media ....................................... 270260 460 ZZ.5.4.1 ....... Message Sequencing ............................................................ 270260 ZZ.5.4.2 ....... Transactions and Message Flow ........................................... 270260 462

ZZ.5.5 ....... Treatment Planning Using Archive Query of RT Course ................. 272262 ZZ.5.5.1 ....... Message Sequencing ............................................................ 272262 464 ZZ.5.5.2 ....... Transactions and Message Flow ........................................... 272262

466


468

Foreword

This Supplement specifies the additional IODs necessary to support the new Second Generation 470 Radiotherapy IODs and operations.

This document is an extension to the following parts of the published DICOM Standard: 472

PS 3.2 Conformance

PS 3.3 Information Object Definitions 474

PS 3.4 Service Class Specifications

PS 3.6 Data Dictionary 476

PS 3.16 Content Mapping Resource

PS 3.17 Explanatory Information 478

Scope and Field of Application

Introduction 480

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. 482

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 484 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 486 workflow management.

This supplement addresses the need for a new generation of IODs and processes required for use 488 in radiation therapy. The general principles under which these IODs and processes have been developed are documented below. 490

General Architectural Principles

The DICOM “STRATEGIC DOCUMENT Version 10.4, October 25, 2010” outlines a number of 492 principles applicable across the entire DICOM standard. The key relevant points, and how this supplement addresses those concerns, are as follows: 494

Image IOD development follows the “enhanced multi-frame” paradigm, rather than stacks of 2D SOP Instances. The new RT Dose Image follows this paradigm. 496

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 498 RT Structure Set.

These new IODs do not define an architecture for the entire system, or functional requirements 500 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 502 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. 504 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 506 with Supplement 74 and the IHE-RO Technical Profile "Treatment and Delivery Workflow".

RT Architectural Principles 508

In addition to the general principles outlined above, additional principles specific to radiation therapy have been used in the development of this supplement: 510

Support for available technologies: The new IODs are designed to support legacy and full-featured, modern equipment. 512

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 514 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. 516

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 518 deformable registrations.

IODs specific to use cases: Explicit separate IODs have been developed for specific treatment 520 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 522 the presence or absence of attributes within those IODs, and thereby increases the potential for interoperability. 524

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 526 existing concept.

Workflow Management: The concept of workflow management using Unified Procedure Step 528 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. 530

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 532 (such as image-guided therapy and adaptive therapy).

See Part 17 for descriptions of new radiotherapy entities and sample use cases. 534

Part 2 Addendum

Add new SOP Classes to PS3.2 Table A.1-2 UID Values: 536

UID Value UID Name Category

1.2.840.10008.5.1.4.1.1.481.XN.1 RT Course Storage Transfer


1.2.840.10008.5.1.4.1.1.481.XN.2 RT Physician Intent Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.3 RT Radiation Set Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.4 RT Segment Annotation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.5.1 Tomotherapeutic Radiation Storage Transfer

1.2.840.10008.5.1.4.1.1.481.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 Transfer

1.2.840.10008.5.1.4.1.1.481.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 Transfer

1.2.840.10008.5.1.4.1.1.481.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 Transfer

1.2.840.10008.5.1.4.1.1.481.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 Transfer

1.2.840.10008.5.1.4.1.1.481.XN.6.4 Multiple Fixed Source Radiation Record Storage

Transfer

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 Transfer

1.2.840.10008.5.1.4.1.1.481.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 Transfer

1.2.840.10008.5.1.4.1.1.481.XN.7.3 RT Dose Samples Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.8 RT Patient Setup Storage Transfer

1.2.840.10008.5.1.4.1.1.481.XN.20 Radiation Set Delivery Instruction Storage Workflow Management

538

Part 3 Addendum 540

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

542

7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND GENERATION OF RADIOTHERAPY INFORMATION OBJECTS 544

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 546 transferring information about planned and performed radiotherapeutic treatments and associated data. 548

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

550


Patient

Treatment Phase

1

0-n

1

0-1

0-n

0-1

0-n

has

0-n

RT Radiation Set

0-1

1-n

0-n

0-n

RT Segment Annotation

1

RT Radiation

0-n

0-n

0-1

0-n

0-n

RT DoseImage

1

results in

0-n

0-n

0-n

0-n

0-n

1

0-n

is subject of

RT Physician Intent

RT Course

Is based on

RT Radiation Record

subdivided by

prescribes

0-10-1 0-n

0-n

contains

0-1

prescribes to

1

Conceptual Volume

0-1

0-1

RT Dose Histogram

RT Dose Samples

calculated for

constitutes fraction composed of

has

0-n

1

1

0.nannotates

defines

applies to

volumetrically represented

by

references references

Segmentation

Surface Segmentation

RT Structure Set

OR

OR

Prescription

contains

1

-n

1-n

552

Figure 7.12-1 — DICOM MODEL OF THE REAL WORLD – RADIOTHERAPY 554

7.12.1 RT Course

The RT Course is a top-level entity that represents a radiotherapy treatment course, specified in one 556 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 558 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 560 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 a new tumor 562 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 564 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 566 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 568 status in treatment planning and delivery. The RT Course is a dynamic object thattherefore represents the current status of the patient’s treatment. 570

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 572 record information about previous treatment having been available in any other form.

7.12.2 RT Physician Intent and Prescription 574

The 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 576 external radiation therapy or brachytherapy, total and fractional doses and fractionation schemes, treatment sites, dosimetric objectives, envisioned treatment technique and beam energy, and 578 patient setup notes.

7.12.3 Conceptual Volume 580

The 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 582 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 584 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 586 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 588 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. 590

7.12.4 RT Segment Annotation

The RT Segment Annotation annotates segmented regions defined in other SOP Instances with 592 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 594 Segment Annotation SOP instance always references one of these three general-purpose representation entities: Segmentation, Surface Segmentation or RT Structure Set. 596

7.12.5 RT Radiation Set

An RT Radiation Set is a collection of RT Radiations. An RT Radiation Set which constitute defines 598 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 600 are included in this set.

Parallel and intermittent fractionation schemes, e.g. treatment ofto several target sites within 602 different timing schemes, are represented by different multiple RT Radiation Sets, where each set consists of the group of beams. 604

7.12.6 RT Radiation

An RT Radiation is a contiguous set of control points, describing machine and positioning 606 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 608 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 610 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 612 parameters to be applied during treatment delivery.

7.12.7 RT Radiation Record 614

The 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. 616 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 618 reasons.

7.12.8 RT Dose Image 620

The 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 622 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 624 calculate the dose.

7.12.9 RT Dose Histogram 626

The 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 628 that annotates the anatomical region where the histogram applies.

7.12.10 RT Dose Samples 630

The RT Dose Samples allows represents a representation of dose point data, which are calculated or measured. 632

7.12.11 RT Treatment Phase

An RT Course may be divided into multiple RT Treatment Phases. The Each RT Treatment Phase 634 represents a period of time during which a defined number of treatment fractionss are delieverd by RT Radiation Sets is delivered to the patient in order to reach a specific treatment goal. In some 636 cases a different treatment phase may follow one already delivered with a defined break in-between. 638


Add the following columns in PS3.3 Section A.1.4, Table A.1-3 COMPOSITE INFORMATION OBJECT MODULES OVERVIEW – 2 RADIOTHERAPY

4

IODs

Modules

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

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

Deliv

Patient 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

General Study 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

Clinical Trial Study 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

Clinical Trial Series

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

General Equipment 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

Synchronization C

Radiotherapy Common Instance


RT Course M

RT Prescription Reference

C

RT Treatment Phase

C


IODs

Modules

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

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

Deliv

RT Radiation Set Reference

C

RT Course Associated

Instance Reference

U

RT Physician Intent

M

RT Prescription C

RT Radiation Set M

RT Dose Contribution

C


M

RT Delivery Device Common

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

Tomotherapeutic Delivery Device

M M

Tomotherapeutic Beam

M M

C-Arm Photon-Electron Delivery

Device

M M M

C-Arm Photon-Electron Beam

M M M

Multiple Fixed Source Delivery

Device

M M

Multiple Fixed Source Beam Set

M M

Robotic Delivery Device

M M


IODs

Modules

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

Multi Fixed Rec

Rob Rec

Multi Axial Rec

RT Dose Img

RT Dose Hist

RT Dose Samp

RT Pat

Setup

RT Rad Set

Deliv

Robotic Path M M

Multi-Axial Delivery Device

M M

Multi-Axial Beam M M

Image 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


Add the following to PS3.3 Annex A:

A.VV SECOND GENERATION RADIATION THERAPY 2

A.VV.1 Second Generation Radiation Therapy Objects

This Section provides a brief description of the IODs of Second Generation Radiation Therapy. 4 Specifically, this description includes:

The Real-World Object which is represented by the IOD 6

Information as to the scope of the represented object if appropriate

A.VV.1.1 Second Generation Radiation Therapy Common Information 8

This section provides a description of the module structure which is shared by the Second Generation Radiation Therapy IODs. 10

A.VV.1.1.1 Second Generation Radiation Therapy Entity-Relationship Model

The E-R Model in Figure A.VV.1.1.1-1 depicts those components of the DICOM Information Model 12 that are relevant to second-generation RT IODs.

14


Figure A.VV.1.1.1-1 — RT Second Generation IOD information model 2

Patient

is the subject of

Study

contains

Series

1

1,n

1

1,n

contains

create

1,n

Equipment

1 1

spatially or temporally

defines

Frame of

RT SegmentAnnotation

RT RadiationRT Dose Image

RT PhysicianIntent

RT Dose Samples

RT Course

RT Dose Histogram

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 Therapy

For first generation IODs, no specific semantics are attached to a series in RT. Similarly, for second 2 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 4 note however, that the DICOM standard, in general, does place some restrictions on how such SOP Instances should be grouped, such as: 6

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 8 differs for first-generation IODs).

As soon as attributes present in the Series IE change, a new series should be created. 10 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). 12

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 14 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. 16

IOD instances within a single series need shallto share a common frame of reference (where such a frame of reference is present). 18

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 20 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). 22

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 24 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 26 than search for thembe required to sort and access this information in a convenient way.

28


A.VV.1.1.1.3 Second Generation Radiation Therapy IOD Modules Macro

RT Second Generation IODs use a shared common module structure in most IODs. Where this 2 structure is applied, IODs reference this structure as defined in the following Table A.VV.1.1.1-1.

Table A.VV.1.1.1-1 4 RT SECOND GENERATION IOD MODULES MACRO

IE Module Reference Usage

Patient Patient C.7.1.1 M

Clinical Trial Subject C.7.1.3 U

Study General Study C.7.2.1 M

Patient Study C.7.2.2 U

Clinical Trial Study C.7.2.3 U

Series General Series C.7.3.1 M

Clinical Trial Series C.7.3.2 U

Enhanced RT Series C.AA.A0 M

Equipment General Equipment C.7.5.1 M

Enhanced 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

6

A.VV.1.1.1.4 RT Radiation IOD Modules Macro

Specific RT Radiation IODs (Tomotherapeutic Radiation IOD, C-Arm Photon Radiation IOD, etc.) 8 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. 10

Table A.VV.1.1.1-2 RT RADIATION IOD MODULES MACRO 12


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

Frame 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 Macro 14

Specific 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. 16 This macro is always used in conjunction with the specific RT Radiation Record IODs.


Table A.VV.1.1.1-3 RT RADIATION RECORD IOD MODULES MACRO 2


RT 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 Definition 4

A.VV.1.2.1 RT Course IOD Description

The RT Course IOD binds together various entities needed in radiotherapy for preparation, execution 6 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 8 by DICOM workflow.

The content of an RT Course may undergo frequent updates resulting in a new SOP Instance UID 10 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 12 content details change often.

It is not necessary to keep track of all versions triggered by such queries. A system keeping the RT 14 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 16 retrieval. Note however, that for essential information about the whole treatment course, the latest SOP Instance is always sufficient. 18

See PS 3.17Part 17 for further explanation.

A.VV.1.2.2 RT Course IOD Entity-Relationship Model 20

See Figure A.VV.1.1.1-1.

A.VV.1.2.3 RT Course IOD Module Table 22

Table A.VV.1.2-4 RT COURSE IOD MODULES 24



RT Course RT Course C.AA.A3 M

RT Prescription Reference

C.AA.A4 C

Required if RT Prescription Reference Presence Flag (30xx,0805) equals YES.

RT Treatment Phase C.AA.A5 C

Required if RT Treatment Phase Presence Flag (30xx,0806)

equals YES.


C.AA.A6 C

Required if RT Radiation Set Reference Presence Flag (30xx,0807) equals YES.


RT Course Associated Instance Reference

C.AA.A7 U


A.VV.1.3 RT Physician Intent Information Object Definition

A.VV.1.3.1 RT Physician Intent IOD Description 2

The RT Physician Intent carries the prescriptions by which the physician describes the therapeutic goal and strategy for the radiotherapeutic treatment. 4

A.VV.1.3.2 RT Physician Intent IOD Entity-Relationship Model

See Figure A.VV.1.1.1-1. 6

A.VV.1.3.3 RT Physician Intent IOD Module Table

Table A.VV.1.3-1 8 RT PHYSICIAN INTENT IOD MODULES



RT Physician Intent

RT Physician Intent C.AA.B1 M

RT Prescription C.AA.B2 U

RT Treatment Phase Intent

C.AA.B3 C

Required if RT Treatment Phase Presence Flag (30xx,0806)

equals YES.

10

A.VV.1.4 RT Radiation Set Information Object Definition

A.VV.1.4.1 RT Radiation Set IOD Description 12

The 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 14 pattern and the Number of Fractions and the associated dose contributions. See Part 17 for further explanation. 16

A.VV.1.4.2 RT Radiation Set IOD Entity-Relationship Model


A.VV.1.4.3 RT Radiation Set IOD Module Table

Table A.VV.1.4-1 20 RT RADIATION SET IOD MODULES



RT Radiation Set

RT Radiation Set C.AA.C1 M

RT Dose Contribution C.AA.C2 C

Required if RT Dose Contribution Presence Flag (30xx,5012) equals YES.

22


A.VV.1.5 RT Segment Annotation Information Object Definition

A.VV.1.5.1 RT Segment Annotation IOD Description 2

The 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 4 annotated SOP Instance, or overrides that content with new or additional interpretation.

A.VV.1.5.2 RT Segment Annotation IOD Entity-Relationship Model 6


A.VV.1.5.3 RT Segment Annotation IOD Module Table 8

Table A.VV.1.5-1 RT SEGMENT ANNOTATION IOD MODULES 10




RT Segment Annotation C.AA.D1 M

A.VV.1.6 Tomotherapeutic Radiation Information Object Definition 12

A.VV.1.6.1 Tomotherapeutic Radiation IOD Description

The Tomotherapeutic Radiation IOD represents the information required to describe a radiotherapy 14 treatment on a serial or helical tomotherapeutic delivery device.

A.VV.1.6.2 Tomotherapeutic Radiation IOD Entity-Relationship Model 16


A.VV.1.6.3 Tomotherapeutic Radiation IOD Module Table 18

Table A.VV.1.6-1 TOMOTHERAPEUTIC RADIATION IOD MODULES 20


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

RT 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 Macro 22

For 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 24 SUP147013.

A.VV.1.7 C-Arm Photon Radiation Information Object Definition 26

A.VV.1.7.1 C-Arm Photon Radiation IOD Description

The C-Arm Photon Radiation IOD represents the information required to describe a radiotherapy 28 treatment on a C-Arm photon delivery device.

A.VV.1.7.2 C-Arm Photon Radiation IOD Entity-Relationship Model 30


Formatted: Centered


A.VV.1.7.3 C-Arm Photon Radiation IOD Module Table

Table A.VV.1.7-1 2 C-ARM PHOTON RADIATION IOD MODULES



RT Radiation C-Arm Photon-Electron Delivery Device

C.AA.G1 M

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

4

A.VV.1.7.3.1 RT Radiation Common Module in RT Radiation IOD Modules Macro

For the C-Arm Photon Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure 6 Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147012. 8

A.VV.1.8 C-Arm Electron Radiation Information Object Definition

A.VV.1.8.1 C-Arm Electron Radiation IOD Description 10

The C-Arm Electron Radiation IOD represents the information required to describe a radiotherapy treatment on a C-Arm electron delivery device. 12

A.VV.1.8.2 C-Arm Electron Radiation IOD Entity-Relationship Model


A.VV.1.8.3 C-Arm Electron Radiation IOD Module Table

Table A.VV.1.8-1 16 C-ARM ELECTRON RADIATION IOD MODULES



RT Radiation C-Arm Photon-Electron Delivery Device

C.AA.G1 M

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

18


For the C-Arm Electron Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure 20 Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147012. 22

A.VV.1.9 Multiple Fixed Source Radiation Information Object Definition

A.VV.1.9.1 Multiple Fixed Source Radiation IOD Description 24

The Multiple Fixed Source Radiation IOD represents the information required to describe a radiotherapy treatment on a multiple fixed source photon delivery device. 26

A.VV.1.9.2 Multiple Fixed Source Radiation IOD Entity-Relationship Model



A.VV.1.9.3 Multiple Fixed Source Radiation IOD Module Table

Table A.VV.1.9-1 2 MULTIPLE FIXED SOURCE RADIATION IOD MODULES



RT Radiation Multiple Fixed Source Delivery Device

C.AA.H1 M

Multiple Fixed Source Beam Set C.AA.H2 M

4


For the Multiple Fixed Source Radiation IOD, the Code Sequence Macro in the Radiotherapy 6 Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147045. 8

A.VV.1.10 Robotic Radiation Information Object Definition

A.VV.1.10.1 Robotic Radiation IOD Description 10

The Robotic Radiation IOD represents the information required to describe a radiotherapy treatment on a robotic delivery device, such as paths, nodes, and collimation type. 12

A.VV.1.10.2 Robotic Radiation IOD Entity-Relationship Model


A.VV.1.10.3 Robotic Radiation IOD Module Table

Table A.VV.1.10-1 16 ROBOTIC RADIATION IOD MODULES



RT Radiation Robotic Delivery Device C.AA.J1 M

Robotic Path C.AA.J2 M

18


For the Robotic Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique 20 Sequence (30xx,0C99) in the RT Radiation Common Module will shall use Defined CID SUP147046.

A.VV.1.11 Multi-Axial Radiation Information Object Definition 22

A.VV.1.11.1 Multi-Axial Radiation IOD Description

The Multi-Axial Radiation IOD represents the information required to describe a radiotherapy 24 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 Model 26


A.VV.1.11.3 Multi-Axial Radiation IOD Module Table 28

Table A.VV.1.11-1 MULTI-AXIAL RADIATION IOD MODULES 30




RT Radiation Multi-Axial Delivery Device C.AA.L1 M

Multi-Axial Beam C.AA.L2 M

A.VV.1.11.3.1 RT Radiation Common Module in RT Radiation IOD Modules Macro 2

For 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 4 SUP147012.

A.VV.1.12 RT Dose Image Information Object Definition 6

A.VV.1.12.1 RT Dose Image IOD Description

The RT Dose Image IOD represents 2D or 3D calculated or measured dose distributions in the 8 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 10 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 Model 12


A.VV.1.12.3 RT Dose Image IOD Module Table 14

Table A.VV.1.12-1 RT DOSE IMAGE IOD MODULES 16



Frame of Reference


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

RT Dose Image

Image Pixel C.7.6.3 M

Multi-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 M

Enhanced RT Dose C.AA.M1 M

RT Dose Image C.AA.M2 M

A.VV.1.12.4 RT Dose Image IOD Content Constraints 18

The 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. 20

A.VV.1.12.5 RT Dose Image Functional Group Macros

Table A.VV.1.12-2 22 RT DOSE IMAGE FUNCTIONAL GROUP MACROS


Function Group Macro Section 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

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 SUP147034.

A.VV.1.13 RT Dose Histogram Information Object Definition 2

A.VV.1.13.1 RT Dose Histogram IOD Description

The RT Dose Histogram IOD specifies dose-volume histogram (DVH) and dose-area histogram data 4 and statistics, calculated by radiotherapy treatment planning systems.

A.VV.1.13.2 RT Dose Histogram IOD Entity-Relationship Model 6


A.VV.1.13.3 RT Dose Histogram IOD Module Table 8

Table A.VV.1.13-1 RT DOSE HISTOGRAM RADIATION IOD MODULES 10



RT Dose Histogram



RT Dose Histogram C.AA.M4 M

A.VV.1.14 RT Dose Samples Information Object Definition 12

A.VV.1.14.1 RT Dose Samples IOD Description

The RT Dose Samples IOD specifies a list of spatial locations and associated dose values created by 14 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. 16

A.VV.1.14.2 RT Dose Samples IOD Entity-Relationship Model


A.VV.1.14.3 RT Dose Samples IOD Module Table

Table A.VV.1.14-1 20 RT DOSE SAMPLES IOD MODULES




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 Definition 2

A.VV.1.15.1 Tomotherapeutic Radiation Record IOD Description

The Tomotherapeutic Radiation Record IOD records the radiation delivered using the 4 Tomotherapeutic Radiation IOD.

A.VV.1.15.2 Tomotherapeutic Radiation Record IOD Entity-Relationship Model 6


A.VV.1.15.3 Tomotherapeutic Radiation Record IOD Module Table 8

Table A.VV.1.15-1 TOMOTHERAPEUTIC RADIATION RECORD IOD MODULES 10


Include 'Tomotherapeutic Radiation IOD Modules' Table A.VV.1.6-1

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

A.VV.1.16 C-Arm Photon Radiation Record Information Object Definition 12

A.VV.1.16.1 C-Arm Photon Radiation Record IOD Description

The C-Arm Photon Radiation Record IOD records the radiation delivered using the C-Arm Photon 14 Radiation IOD.

A.VV.1.16.2 C-Arm Photon Radiation Record IOD Entity-Relationship Model 16


A.VV.1.16.3 C-Arm Photon Radiation Record IOD Module Table 18

Table A.VV.1.16-1 C-ARM PHOTON RADIATION RECORD IOD MODULES 20


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

Include ’RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3


A.VV.1.17 C-Arm Electron Radiation Record Information Object Definition

A.VV.1.17.1 C-Arm Electron Radiation Record IOD Description 2

The C-Arm Electron Radiation Record IOD records the radiation delivered using the C-Arm Electron Radiation IOD. 4

A.VV.1.17.2 C-Arm Electron Radiation Record IOD Entity-Relationship Model


A.VV.1.17.3 C-Arm Electron Radiation Record IOD Module Table

Table A.VV.1.17-1 8 C-ARM ELECTRON RADIATION RECORD IOD MODULES


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

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

10

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

A.VV.1.18.1 Multiple Fixed Source Record Radiation IOD Description 12

The Multiple Fixed Source Radiation Record IOD records the radiation delivered using the Multiple Fixed Source Radiation IOD. 14

A.VV.1.18.2 Multiple Fixed Source Radiation Record IOD E-R Model


A.VV.1.18.3 Multiple Fixed Source Radiation Record IOD Module Table

Table A.VV.1.18-1 18 MULTIPLE FIXED SOURCE RADIATION RECORD IOD MODULES


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


20

A.VV.1.19 Robotic Radiation Record Information Object Definition

A.VV.1.19.1 Robotic Radiation Record IOD Description 22

The Robotic Radiation Record IOD records the radiation delivered using the Robotic Radiation IOD.

A.VV.1.19.2 Robotic Radiation Record IOD Entity-Relationship Model 24


A.VV.1.19.3 Robotic Radiation Record IOD Module Table 26

Table A.VV.1.19-1 ROBOTIC RADIATION RECORD IOD MODULES 28


Include ‘Robotic Radiation IOD Modules’ Table A.VV.1.10-1

Include ‘RT Radiation Record IOD Modules Table A.VV.1.1.1-3


A.VV.1.20 Multi-Axial Radiation Record Information Object Definition

A.VV.1.20.1 Multi-Axial Radiation Record IOD Description 2

The Multi-Axial Radiation Record IOD records the radiation delivered using the Multi-Axial Radiation IOD. 4

A.VV.1.20.2 Multi-Axial Radiation Record IOD Entity-Relationship Model


A.VV.1.20.3 Multi-Axial Radiation Record IOD Module Table

Table A.VV.1.20-1 8 MULTI-AXIAL RADIATION RECORD IOD MODULES


Include ‘Multi-Axial Radiation IOD Modules’ Table A.VV.1.11-1


10


Add the following to PS3.3 Annex C: 2

C.AA SECOND GENERATION RADIOTHERAPY MODULES

The following macros and modules are used by the second generation radiotherapy IODs. 4

C.AA.1 Second Generation Radiotherapy Definitions

This chapter section lists some of the most-often used terms in the scope of Second Generation 6 Radiotherapy Modules and provides definitions for a better understanding.

NeverthelessNotes:, 1. Tthis ssection does not replace a profound understanding of clinical knowledge 8 related to radiotherapy treatments.

2. Please also refer to See the explanations to in Sectionchapter 7.12 “Extension of the DICOM 10 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. 12

C.AA.1.1 Control Points

C.AA.1.1.1 Control Points of Radiations 14

A 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 16 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 18 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. 20

Some treatment modalities may use sub-control points to specify changes of a subset of parameters within a control point. 22

C.AA.1.1.2 Verification Control Points

Verification Control Points represent the expected expected cumulative dose for a set of geometric 24 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. 26

The purpose of Verification Control Points is to verify the dose (e.g. by measuring or calculating) by comparing it to planned dose. 28

C.AA.1.2 Nominal Energy

A nominal energy is an equipment setting used by the manufacturer to characterize the penetration 30 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 32 is typically specified.

C.AA.1.3 Fractionation, Fractionation Scheme 34

Fractionation 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 36 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. 38

C.AA.1.4 Treatment RT Radiation Set

A The term Treatment RT Radiation Set is used to indicate an RT Radiation Set that has been 40 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. 42


C.AA.1.5 Meterset

A parameter from which, through a calibration procedure with additional information, the absorbed 2 dose delivered can be calculated. (fFor meterset representing monitor units, the definition is based on IEC 60601-2-64)., 4

The meterset can be is used to measure the progress of radiation delivery during treatment, or report on progress after treatment. 6

C.AA.1.6 Radiation Dose Point

A point chosen in space, or in the patient treatment volume, to measure or plan for a specific amount 8 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. 10

C.AA.1.7 Treatment Phase

A specific period within a treatment course when the prescribed medical treatment is applied to the 12 patient. Typically, if more than one RT Radiation Set is delivered, they are in overlapping or sequential phases. 14


C.AA.2 Second Generation Radiotherapy General-Purpose Macros

C.AA.2.1 RT Entity Labeling Macro 2

The RT Entity Labeling Macro contains the attributes needed to identify a radiotherapy concept using a 16-character label, a name, and a description. 4

This information is intended only for display to human readers and shall not be used programmatically. 6

Table C.AA.2.1-1 RT ENTITY LABELING MACRO ATTRIBUTES 8

Attribute Name Tag Type Description

RT 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 Description 10

C.AA.2.1.1.1 RT Entity Label

The RT Entity Label (30xx,51E2) attribute represents a user-definable short free text providing the 12 primary identification of this entity to other users. The label may be used to provide unique identification to the user. 14

C.AA.2.1.1.2 RT Entity Name and RT Entity Description

The optional attribute RT Entity Name (30xx,51E3) allows a longer string containing additional 16 descriptive identifying text for one-line headings etc. The optional attribute RT Entity Description (30xx,51E4) allows adding additional information when needed. 18

C.AA.2.2 RT Entity Long Labeling Macro

The RT Entity Long Labeling Macro contains the attributes needed to identify a radiotherapy concept 20 using a 64-character label and a description.

This information is intended only for display to human readers and shall not be used 22 programmatically.

Table C.AA.2.2-1 24 RT ENTITY LONG LABELING MACRO ATTRIBUTES


RT 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.

26


C.AA.2.1.2.1 RT Entity Long Label

The RT Entity Long Label (30xx,51E5) attribute represents a user-definable free text providing the 2 primary identification of this entity to other users. The label may be used to provide unique identification to the user. 4

C.AA.2.3 RT Item State Macro

This macro may beis invoked to record the clinical state, such as approval or review,ed of either an 6 entire SOP Instance or for a specific part of the information content of a SOP Instance.

Table C.AA.2.3-1 8 RT ITEM STATE MACRO ATTRIBUTES

Attribute Name Tag Type Attribute Description

RT 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 – Revision 14c, 2013-04-11)

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:

ACTIVE

HISTORIC

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

10

C.AA.2.3.1 RT Item State Macro Attribute Description

C.AA.2.3.1.1 RT Item State Sequence 12

The 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 14 Assertion Macro are defined at the invocation of the macro.

C.AA.2.3.1.2 Active Item Indicator 16

The 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 18 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 20 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. 22


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 2 perform a state transition if outside of the scope of the standard.

C.AA.2.4 RT Operation State Macro 4

This 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 6 approval status 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 8 empty sequence.

Table C.AA.2.4-1 10 RT OPERATION STATE MACRO ATTRIBUTES


RT 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.

Content Creator’s Identification Code Sequence

(0070,0086) 1C The person updating the operation state.

Required if Creating Device’s Identification Code Sequence (0070,00QQ) is not present.


See 10.XW1.1. (See Editor’s Note below)

>Include ‘Person Identification Macro’ Table 10-1 No Baseline CID defined

Creating Device’s Identification Code Sequence

(See Editor’s Note below)

(0070,00QQ) 1C The device making the assertion.

Required if Content Creator’s Identification Code Sequence (0070,0086) is not present.


>Include ‘Device Identification Macro’ Table 10-XW3

(See Editor’s Note below)

No Baseline CID 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.


>>Include 'Code Sequence Macro' Table 8.8-1 No Baseline CID is specified.

>Include 'Digital Signatures Macro' Table C.12-6

(Editor’s Note: The ‘Device Identification Macro’ and the attribute ‘Creating Device’s Identification 2 Code Sequence’ is defined in Sup 121. The version referenced in here is Sup 121 – Revision 14c, 2013-04-11) 4


C.AA.2.5 Conceptual Volume Reference Macro 2

A 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 4 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 6 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). 8

The spatial extent of Conceptual Volumes may also be defined as a combination of other Conceptual Volumes. 10

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 12 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 14 definition of its spatial extent. (i.e. the segmentations may not be definitive representations of the Conceptual Volume). 16

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

Examples for Conceptual Volumes: 18

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, 20 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 22 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 24 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 26 same Conceptual Volume via the Conceptual Volume UID, making it possible to track the volume over time. 28

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 30 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 32 conceptual volumes may never reference a segmentation, but serve as a key for referencing the conceptual volume across different SOP instances. 34

The Conceptual Volume Macro contains the attributes needed to reference a conceptual volume from other SOP instances by using the same Conceptual Volume UID. 36

Table C.AA.2.5-1 CONCEPTUAL VOLUME REFERENCE MACRO ATTRIBUTES 38


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


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.


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 10-11

Equivalent 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.


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

C.AA.2.5.1 Conceptual Volume Macro Attribute Description 2

C.AA.2.5.1.1 Equivalent Conceptual Volumes

Conceptual Volumes can also be relatedbe declared to be equivalent to other Conceptual Volumes. 4 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 6


using different Conceptual Volume UIDs. A reason for this might be that these Conceptual Volume UIDs have been defined independently from each other. 2

C.AA.2.6 Extended Conceptual Volume ReferenceCombination and Segmentation Base Macro 4

The 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 6 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. 8

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 10 conceptual volumeConceptual Volume. At the invocation of this macro it is declared, whether this segmented representation is required or not. 12

14

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


Figure C.AA.2.6-1 2 Conceptual Volume References

Figure C.AA.2.6-1 describes an RT Physician Intent instance where Conceptual Volumes “Lung, left” 4 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 6 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 8 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. 10

12

14

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”

Segmentation

Segment 3 ROI 5

RT Segmentation Annotation (II)

SOP Instance

Conceptual Volume A

Conceptual Volume B

Conceptual Volume C


2

Figure C.AA.2.6-2 Conceptual Volume Combination References 4

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 6 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. 8

Table C.AA.2.6-1 EXTENDED CONCEPTUAL VOLUME REFERENCECOMBINATION AND SEGMENTATION BASE 10

MACRO ATTRIBUTES


Include 'Conceptual Volume Reference Macro' Table C.AA.2.5-1

Conceptual Volume Combination IndicatorFlag

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

Enumerated Values:

YES

NO

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”


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.


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.


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.




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. This description is for display only and shall not be used programmatically.

Required if Conceptual Volume Combination Flag (30xx,1309) equals YES.

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 (30xx,1311) 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.


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.



>Referenced RT Segment Annotations Sequence

(30xx,0874) 1 Reference to the RT Segment Annotations SOP instance that contains the segmentation.



>Referenced Segment Annotation Index

(30xx,0151) 1 Reference to the Segment Index (30xx,0121) in the Segment Sequence (0062,0002) of 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 (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 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.

>Referenced RT Segment Annotations Sequence

(30xx,0874) 1 Reference to the RT Segment Annotations SOP instance that contains the segmentation.



>Referenced Segment Annotation Index

(30xx,0151) 1 Reference to the Segment Index (30xx,0121) in the Segment Sequence (0062,0002) of 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,



C.AA.2.6.1 Conceptual Volume Combination and Segmentation Base Macro Attribute 2 Description

C.AA.2.6.1.1 Conceptual Volume Combination Expression 4

For Conceptual Volume referencesVolumes specified as a combination of other referenced Conceptual Volumes, the effective volumecombination logic is specified asby the text string value of 6 the Conceptual Volume Combination Expression (30xx,1307). The combination syntax uses a symbolic expression notation similar to that used in the Lisp programming language. 8

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. 10

The first element of the list is a geometric operator.

c. Subsequent elements specify arguments of the geometric operator and are either 12 Conceptual Volume Constituent Index (positive integer) values or parenthesized lists.

2. The shall be one of the following geometric operators are defined: 14

UNION – geometric union of 2 or more arguments

INTERSECTION – geometric intersection of 2 or more arguments 16

NEGATION – geometric inverse of (a single) argument

EXCLUSION – geometric difference of second argument from the first (intersection of the 18 first argument with the negation of the second argument).

20

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 22 Character Repertoire Constituent Index value, i.e. positive integer, or a parenthesized list.


Examples:

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

4

Conceptual Volume Combination Expression (30xx,1307): 6

(UNION 1 2)

Items in Conceptual Volume Constituent Sequence (30xx,1303): 8

Conceptual Volume Constituent Index

(30xx,1308)

Conceptual Volume

1 X

2 Y

2. Union of paired organs X and Y (non-disjoint) 10


(UNION 1 2)


Result

X Y

Input



(30xx,1308)

Conceptual Volume

1 X

2 Y

3: Union of paired organs (e.g., lungs) X and Y, with excluded volume W (e.g., PTV). 2


(EXCLUSION (UNION 1 2) 3)



(30xx,1308)

Conceptual Volume

1 X

2 Y

3 W

4. Union of paired organs (e.g., lungs) X and Y, with excluded volume W (e.g., PTV) using 8 NEGATION. (Note that this expression is equivalent to the one in example #3.)

10


Conceptual Volume Combination Expression (30xx,1307):

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

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


(30xx,1308)

Conceptual Volume

1 X

2 Y

3 W

4

6

53. Union of paired organs (e.g., lungs) X and Y, with exclusion of multiple organs U, V, and W (e.g. target volumes and organs at risk). 8


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



(30xx,1308)

Conceptual Volume

1 X

2 Y

3 U

4 V

5 W

14

64. Intersection of volume X (e.g., PTV) and volume Y (e.g. rectum).


2

Conceptual Volume Combination Expression (30xx,1307):

(INTERSECTION 1 2) 4

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


(30xx,1308)

Conceptual Volume

1 X

2 Y

6

7. Intersection of disjoint volumes X (e.g., Prostate) and Y (e.g. rectum).

8


(INTERSECTION 1 2)



(30xx,1308)

Conceptual Volume

X

Y

Input Result


1 X

2 Y

2


C.AA.2.6.1.2 Conceptual Volume Segmentation References 2

The 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 4 Combination of Conceptual Volumes in the context, in which this macro is invoked.

C.AA.2.6.1.23 Conceptual Volume Segmentation Reference Sequence 6

The Conceptual Volume Segmentation Reference Sequence (30xx,1312) contains a reference to a Segmentation, which represnetrepresent that volumvolume geometically. 8

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 10 referenced may be in one or more Frames of Reference. The constituent Conceptual Volumes in this sequence must not include the combined Conceptual Volume being defined. Applications that wish to 12 combine existing segmentations within the same Conceptual Volume must create a new Segmentation Instance. 14

C.AA.2.7 Conceptual Volume Combination and Segmentation Macro

The Conceptual Volume Combination and Segmentation Macro uses all capabilities of the 16 Conceptual Volume Combination and Segmentation Base Macro. It does not require the presence of the segmented volume representation. 18

Table C.AA.2.7-1 EXTENDED CONCEPTUAL VOLUME COMBINATION AND SEGMENTATION REFERENCE 20

MACRO ATTRIBUTES


Include ‘Conceptual Volume Combination and SegmentationReference 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

22

C.AA.2.8 Segmented Conceptual Volume Macro

The Segmented Conceptual Volume Macro uses all capabilities of the Extended Conceptual Volume 24 Reference Base Macro, but requires the presence of the segmented volume representation.

Table C.AA.2.8-1 26 SEGMENTED CONCEPTUAL VOLUME REFERENCE MACRO ATTRIBUTES


Include 'Extended Conceptual Volume Combination and Segmentation 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

2


C.AA.2.9 Radiation Fractionation Pattern Macro

The Radiation Fractionation Pattern Macro contains the attributes needed to specifiesy the intended 2 fractionation pattern to be used to deliver the radiation treatment.

Table C.AA.2.9-1 4 RADIATION FRACTIONATION PATTERN MACRO ATTRIBUTES


Fraction Pattern Sequence (30xx,0965) 1C A description of tThe fractionation pattern in a machine-readable form.

Required if a fraction pattern has been defined.


>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.

6

C.AA.2.9.1 Radiation Fractionation Pattern Macro Attribute Description

C.AA.2.9.1.1 Fractionation 8

The Radiation Fractionation Pattern describes the intended scheme, i.e. how fractions are to be distributed along calendar days for the actual radiation set. 10

Examples of Fractionation Patterns:

a) 1 fraction per day (Monday to Fridayy), no fractions on Saturday and Sunday: 12

Number of Fraction Pattern Digits per Day = 1 Repeat Fraction Cycle Length = 1 14 Fraction Pattern = 1111100

b) 2 fractions per day (Monday to Friday), no fractions on Saturday and Sunday: 16

Number of Fraction Pattern Digits Per Day = 2 Repeat Fraction Cycle Length = 1 18 Fraction Pattern = 1111111111000000

c) 1 fraction per day (Monday, Wednesday, to Friday), no fractions on Saturday and Sundayfractions 20 every second day:



d) 2 fraction per day (Monday, Wednesday, Friday), one fraction on Saturday and Sunday: 4


e) 1 fraction per day every other day: 8


12


C.AA.2.10 Treatment Device Identification Macro

The Treatment Device Identification Macro iis invoked to identifiesy a device used to deliver radiation 2 to the patient during a radiotherapy treatment session.

Table C.AA.2.10-1 4 Treatment Device Identification Macro Attributes


Treatment Device Identification Sequence

(30xx,5015) 1 Identifies treatment device to be used.


>Treatment Device IdentifierMachine Name

(300A,00B230xx,5019)

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.

>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.

6

C.AA.2.11 RT Device Model Macro

The RT Device Model Macro contains general attributes needed to specify a radiotherapy device. 8

Table C.AA.2.11-1 RT DEVICE MODEL MACRO ATTRIBUTES 10


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

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



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

C.AA.2.12 RT Patient Support Device Identification Macro 2

The RT Patient Device Support Identification Macro identifies a patient support device (table, chair or similar) which shall be used for treatment. 4

Table C.AA.2.12-1 RT PATIENT SUPPORT DEVICE IDENTIFICATION MACRO ATTRIBUTES 6


Device Component Subtype Type Code Sequence

(30xx,5026) 1 The type of patient support device.


>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147025

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

C.AA.2.13 Patient Support Position Macro 8

This 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. 10

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 12 Equipment Mapping Matrix (30xx,6040).

The items in this macro shall only serve the purpose of annotating geometric information with 14 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 16 the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040).

Table C.AA.2.13-1 18 PATIENT SUPPORT POSITION MACRO ATTRIBUTES


Patient Support Position Parameter Sequence

(30xx,5142) 2 Patient Support tTranslational and rotational parameters supported forby a particular Patient Support systemdevice.


>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.

20


C.AA.2.14 Device Component Identification Macro

The Device Identification Component Identification Macro contains the attributes needed to 2 identifyidentifies (physical or virtual) which is used by a certaindevice in using or creating the SOP instance where the macro is included. 4

Table C.AA.2.14-1 DEVICE IDENTIFICATION COMPONENT IDENTIFICATION MACRO ATTRIBUTES 6


Device Type Code Sequence (30xx,5026) 1 The type of the device.


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

Device Index (30xx,0112) 1 Index of the Device in the sequence, where the macro is invoked, used for internal or external references.


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.


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

Device Description (30xx,054C) 3 User defined description for the device.

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


C.AA.2.15 RT Accessory Device Identification Macro

The RT Accessory Device Identification Macro contains the attributes needed to identify identifies an 2 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 4 RT devices.

Certain RT devices may define a specific macro, which includes this macro and additional type-6 specific tags.

Table C.AA.2.15-1 8 RT ACCESSORY DEVICE IDENTIFICATION MACRO ATTRIBUTES


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

Include '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.2.11-1

Hospital 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.

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 RTadiation Modifier accessory.

Required if accessory is located in a slot and .

Shall not be present if RT Accessory Holder Device SequenceDevice Index (30xx,054AB) is not 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”).


>RT Accessory Holder Device Index

(30xx,05400112)

1C Reference to the Device Index (30xx,0112) index of the Accessory Holder device in the Accessory Holder Definition Sequence (30xx,5170).

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,054A) 1C Identifier for location (slot) of Radiation Modifier in the Accessory Holding device.

Required if RT Accessory Holder Device Index (30xx,0540) is present.

C.AA.2.16 Control Point General Attributes Macro 2

This macro specifies the base attributes for the definition of a Radiation Control Point.

Table C.AA.2.16-1 4 CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES


Control 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 sequenceo.f the Control Point Item in the sequence used for internal or external references.


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.2.16.1.2.

6

C.AA.2.16.1 Control Point Attribute Requirements

The treatment-modality modules use a common formalism to represent parameters that define the 8 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. 10


The resolution of Control Points depends on the level of details required to define the behaviour of the delivery device. 2

For any given treatment technique, some parameters may be constant for all Control Points. Such static parameters shall are only be present at the first Control Point and shall be are absent in all 4 other Control Points. All other parameters that are changing at any of the Control Points shall arebe present in each single Control Point. 6

For a Static Beam delivery with a constant field aperture, 2 Control Points are needed to define the start and the end. For a Dynamic delivery, where MLC leavefs are moving while radiation is 8 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 10 prescribed dose.

A Control Point is a point on a timeline of a delivery process. Control Points are sequenced using an 12 index number, e.g. 1, 2, 3. 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 14 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 16 planning system needs to know the hardware-specific characteristics of the delivery system for which the plan is being created. 18

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

Static Beam delivery example: 20 Control Point 1: Cumulative Meterset = 0 22 All applicable treatment parameters defined 24 Control Point 2: Cumulative Meterset = 76 No other parameters defined 26 At completion this beam delivers 76 Monitor Units using a fixed static set of treatment 28 parameters defined in Control Point 1.

Arc delivery example: 30 Control Point 1: Cumulative Meterset = 0 32 Gantry Rotation Direction = CW, Gantry Angle = initial angle All other applicable treatment parameters defined 34 Gantry Rotation Direction = CW, Gantry Angle = initial angle 36 Control Point 2: Cumulative Meterset = 56 the following parameters are defined onlyGantry Rotation Direction = NONE, Gantry Angle = final 38 angle No other parameters defined 40 At completion this delivers 56 Monitor Units while rotating the gantry from initial angle to final 42 angle.

Dynamic delivery of two equally weighted segments example: 44 Control Point 1: Cumulative Meterset = 0 46 All applicable treatment parameters defined Collmator Opening X: 2x2 48 Collmator Opening Y: 2x2

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All other applicable treatment parameters defined 2 Control Point 2: Cumulative Meterset = 40 All treatment parameters defined which change at any control point (including those which do not 4 change at this specific Control Point) Collmator Opening X: 2x2 6 Collmator Opening Y: 4x4 All other treatment parameters which change at any control point (including those which do not 8 change at this specific Control Point) 10 Control Point 3: Cumulative Meterset Weight = 80 All treatment parameters defined which change at any control point (including those which do not 12 change at this specific Control Point) Collmator Opening X: 4x4 14 Collmator Opening Y: 4x4 All other treatment parameters which change at any control point (including those which do not 16 change at this specific Control Point) 18 At completion this delivers 80 Monitor Units while first increasing the Y opening and then increasing the X opening. 20

Dynamic Delivery of two unequally weighted segments with a step change in table angle: 22 Control Point 1: Cumulative Meterset Weight = 0 All applicable treatment parameters defined 24 Patient Support Angle = initial angle, Patient Support Rotation Direction = rotation direction, All other applicable treatment parameters defined 26 Control Point 2: Cumulative Meterset = 30 28 All treatment parameters defined which change at any control point (including those which do not change at this specific control point) 30 Patient Support Angle = initial angle, Patient Support Rotation Direction = NONE All other treatment parameters defined which change at any control point (including those which 32 do not change at this specific control point) 34 Control Point 3: Cumulative Meterset = 30 All treatment parameters defined which change at any control point (including those which do not 36 change at this specific control point) Patient Support Angle = new angle, Patient Support Rotation Direction = rotation direction 38 All other treatment parameters defined which change at any control point (including those which do not change at this specific control point) 40 Control Point 4: Cumulative Meterset = 90 42 All treatment parameters defined which change at any control point (including those which do not change at this specific control point) 44 Patient Support Angle = new angle, Patient Support Rotation Direction = NONE All other treatment parameters defined which change at any control point (including those which 46 do not change at this specific control point) 48 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. 50

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. 52


C.AA.2.17 External Beam Control Point General Attributes Macro

This macro may be invoked to specify the generic Control Point attributes used to model external 2 beam radiation.

Table C.AA.2.17-1 4 EXTERNAL BEAM CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES


Include ‘Control Point General Attributes Macro’ Table C.AA.1.16-1

Primary Meterset Rate

(30xx,5023) 2C Specifies tThe intended nominal rate of delivery of the specified Primary Meterset (TBD). See C.AA.2.17.1.2 for units.

Required if all of the following are true:

a) Primary Radiation Dosimeter Unit (30xx,5113) is not RELATIVE and not BQ_SECOND,

and

b) RT Radiation Data Scope (30xx,5013) is not GEOMETRIC, and

c) and

the Control Point Item Index (30xx,0111) equals 1

or

this attribute value attribute value changes at any Control Point.

See C.AA.2.1.1 and C.AA.2.17.1.

Primary Meterset Rate Unit Sequence

(30xx,5024) 1C The unit of the Primary MMeterset Rate (30xx,5023).

Required if the Primary Meterset 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.2.1.1 and C.AA.2.17.21.


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


Required if patient geometry requires limitation of the beam delineation and if the Control Point Item Index (30xx,0111) equals 1 or this attribute


value changes at any Control Point.

See C.AA.2.1.1.

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

C.AA.2.16.1 External Beam Control Point General Attributes Macro Attribute Description 2

C.AA.2.17.1.1 Meterset Calculations

The Meterset at a given Control Point for RT Radiation objects working with a Radiation Device as 4 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 6 Radiation Dosimeter Unit (30xx,5113) in the RT Delivery Device Common Module in section C.AA.E1. 8

C.AA.2.17.1.2 Primary Meterset Rate

Units used for Primary Meterset Rate (30xx,5023) shall be determined by the value of Primary 10 Radiation Dosimeter Unit (30xx,5113) as follows:

MU: Units shall be MU/sec 12

NP: Units shall be particles/sec

RELATIVE: Attribute not present 14

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 16 Meterset Rate Unit Sequence (30xx,5024).

18

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 20 beam radiation on Sub-Control Point level.

Table C.AA.2.18-1 22 EXTERNAL BEAM SUB-CONTROL POINT GENERAL ATTRIBUTES MACRO


Sub-Control Point Item Index (30xx,0115) 1 Index of the items in the sequence. Used for internal or external references.


Cumulative Radiation Meterset (30xx,5021) 1C Meterset at sequence level expressed in units of the Primary 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 Item 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 Description 2

C.AA.2.18.1.1 Sub-Control Point Attribute Requirements

No assumptions are made about the behavior of machine parameters between specified items, and 4 communicating devices shall agree on this behavior outside the current standard.

The representation of parameters in sub-control points follows the formalism as descibed in 6 C.AA.2.16.1.

C.AA.2.18.1.2 Cumulative Radiation Meterset 8

The values of the Cumulative Radiation Meterset (30xx,5021) are defined on the same absolute scale as the Cumulative Radiation Meterset (30xx,5021) in the Control Point Sequence. 10

The value of the Cumulative Radiation Meterset (30xx,5021) of the first item of this sequence (having a value of 1 in the Sub-Control Point Item Index (30xx,0115)) shall have exactly the same value as 12 the Cumulative Radiation Meterset (30xx,5021) of the Control Point which contains this Sub-Control Point sequence. 14

The value of the Cumulative Radiation Meterset (30xx,5021) of the last item of this sequence (having the highest value in the Sub-Control Point Item Index (30xx,0115)) sall have exactly the same value 16 as the Cumulative Radiation Meterset (30xx,5021) of the Control Point which follows the Control Point, which contains this Sub-Control Point sequence. 18

C.AA.2.19 Beam Mode Macro

The Beam Mode Macro contains attributes to identify the beam mode of a delivery device. 20

Table C.AA.2.19-1 BEAM MODE MACRO ATTRIBUTES 22


Beam Mode Sequence (30xx,51C0) 1 Sequence defining the Beam Mode.


>Beam Mode Index (30xx,0113) 1 Index of the Beam Mode Item in the sequence used for internal or external references.



>Referenced Control Point Item Index

(30xx,0141) 1 References the Control Point Item Index (30xx,0111) identifying the first Control Point, at which that Beam Mode is first applied.

Only Control Points at which changes occur shall be referenced. No Control Point shall be referenced more the once. The referenced Control Point Item Index (30xx,0111) shall be monotonically increasing.

The first item in the Beam Mode Sequence (30xx,51C0) shall have the value 1.

>Beam Mode Label (30xx,51C1) 1 User readable label that identifies the primary beam configuration used by the device. It is expected that each distinct combination of beam parameters which produces a distinct beam profile uses a unique identifier.

See Note 1.

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

>Beam Mode Machine Code

(30xx,51C3) 1 An internal machine-readable code to uniquely identify the beam mode with a code as specified by the treatment device vendor.

>Radiation Type (300A,00C6) 1 Type of Radiation for that Beam.

Defined Terms:

PHOTON

ELECTRON

NEUTRON

PROTON

ION

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.


>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.

>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.

>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 Context ID shall be SUP147042

>Beam Mode Type Code Sequence

(30xx,51C8) 1 Identifies the general category of this beam.


>>Include 'Code Sequence Macro' Table 8.8-1 Context ID shall be SUP147050

Notes: 1. In particular, each unique combination of energy, radiation type and beam filter requires a distinct 2 identifier.

C.AA.2.19.1 Beam Mode 4

Treatment devices can produce a multitude of different beams with unique properties such as energy spectrum, depth dose, surface dose and beam profile. These beam modes are created in the 6 machine by using different primary electron beams, flattening and scattering filters, etc. In many cases, the beam mode identifies the fluence just below the Monitor Chamber. Subsequently these 8 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 10 beam is assumed to have fixed characteristics within the range as specified by the control point index using Control Point Item Index (30xx,0111). In many cases, the beam mode will be constant 12 throughout the Radiation, therefore the Beam Mode Macro will only contain one item with the Control Point Item Index (30xx,0111) equal to 1. 14

For each unique combination of machine parameters that produces a distinct beam profile and distinst set of values of the attributes contained in that macro, a device specific unique identifer is to 16 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 18 particular, each unique combination of energy, radiation type and beam filter requires a distinct identifier. 20

In many cases, the beam mode will correspond to a specific nominal energy which remains fixed. The Nominal Energy (30xx,51C5) parameter is provided for beams, where a single discrete energy is 22


annotated by that value. Energy modulation can be used at the control point level (both discrete and contiguous), in which case the Minimal Nominal Energy (30xx,51C6) and Maximal Nominal Energy 2 (30xx,51C7) is used.

Other than uniquely identifying a specific mode within a machine, no assumptions shall be made 4 about the structure, encoding or syntax of the Beam Mode Label (30xx,51C1).

Different Beam Mode Labels (30xx,51C1) shall only be used to identify different primary beams, but 6 shall not be used to convey any other meaning, like annotation of the role of the beam in the clinical process or the usage of that beam at a treatment session. 8

C.AA.2.20 RT Beam Limiting Device Definition Macro 10

This macro may be invoked to define those attributes describing the configuration of the Beam Limiting Device which cannot vary during delivery. 12

Table C.AA.2.20-1 RT BEAM LIMITING DEVICE DEFINITION MACRO ATTRIBUTES 14


RT Beam Limiting Device Definition Sequence

(30xx,504D) 1 Beam limiting device (collimator) jaw or leaf (element) sets.


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

Defined CID SUP147010

>Device Index (30xx,0112) 1 Index of the Device.


>RT Beam Limiting Device Distance

(30xx,504F) 2 Distances (in mm) from the RT Beam Distance Reference Location (30xx,5114) to the 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.

>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 Component SubtypeType 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



Boundaries 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 Pair 1.

Required if Device Component Type Subtype 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 Component Type Subtype Code Sequence (30xx,5026) is part of CID SUP147027.


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

C.AA.2.20.1 RT Beam Limiting Device Definition Macro Attribute Description 2

C.AA.2.20.1.1 RT Beam Delimiter Element Position Boundaries

The RT Beam Delimiter Element Position Boundaries (30xx,5049) shall be the positions of the 4 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 6 (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. 8

C.AA.2.21 RT Beam Limiting Device Positions Macro 10

This macro may be invoked to define the positions of RT Beam Limiting Devices used in a specific Control Point or set of Control Points. 12

Table C.AA.2.21-1 RT BEAM LIMITING DEVICE POSITIONS MACRO ATTRIBUTES 14


RT 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 Item Index (30xx,0111) equals 1 or attribute values change at any Control Point.

See C.AA.2.16.1.




>Referenced Device Index

(30xx,0142) 1 Value of Device Index (30xx,0112) from the RT Beam Limiting Device Definition Sequence (30xx,504D) for Beam Limiting Device used in this item.

>RT Beam Limiting Device Continuous Angle

(30xx,51B4) 1C RT Beam Limiting Device angle, i.e. orientation 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 Device Component Type Subtype 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 Device Component Type Subtype 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 Device Component Type Subtype Code Sequence (30xx,5026) contains (S147174, 99SUP147, “Variable Circular Collimator”).


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

C.AA.2.22 Wedges Definition Macro 2

This macro may be invoked to define those attributes describing the geometric configuration of Wedges which cannot vary during delivery. 4

Table C.AA.2.22-1 WEDGES DEFINITION MACRO ATTRIBUTES 6


Wedge Definition Sequence

(30xx,5062) 1C Treatment wedge definitions.

Required if one or more wedges are present.





Defined CID SUP147028.



>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 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.

C.AA.2.23 Wedge Positions Macro 2

This macro may be invoked to define the positions of Wedges used in a specific Control Point or set of Control Points. 4

Table C.AA.2.23-1 WEDGE POSITIONS MACRO ATTRIBUTES 6


Wedge Position Sequence

(300A,0116) 1C A Sequence of Items describing Wedge Positions for the current Control Point.

Required is Wedge Definition Sequence (30xx,5062) is present.

Required if the Control Point Item Index (30xx,0111) equals 1 or attribute value changes at any Control Point.

The number of items in this sequence shall equal the number of items in Wedge Definition Sequence (30xx,5062).

See C.AA.2.16.1.

>Referenced Device (30xx,0142) 1 Uniquely references Wedge described by Device Index (30xx,0112) in Wedge Definition



Index Sequence (30xx,5062)

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

IN = Wedge is in fully inserted position

OUT = Wedge is in fully retracted position

PARTIAL = 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 a 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. See section C.8.8.25.6.4.

C.AA.2.24 Compensators Definition Macro 2

This macro may be invoked to define those attributes describing the geometric configuration of Compensators which cannot vary during delivery. 4

Table C.AA.2.24-1 COMPENSATORS DEFINITION MACRO ATTRIBUTES 6


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



Compensator Definition Sequence

(30xx,5150) 1C Treatment compensator definitions.

Required if one or more compensators are present.





The value shall start at 1, and increase



monotonically by 1.

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

>Compensator Divergence

(300A,02E0) 1 Specifies presence or absence of geometrical divergence of the compensator.

Enumerated Values:

PRESENT = the compensator is shaped according to the beam geometrical divergence. ABSENT = the compensator is not shaped according to the beam geometrical divergence.

>Compensator Mounting Position

(300A,02E1) 1 Specifies on which side of the Compensator Tray the compensator is mounted.

Enumerated Values:

PATIENT_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the patient. SOURCE_SIDE = the compensator is mounted on the side of the Compensator Tray which is towards the radiation source. DOUBLE_SIDED = the compensator has a shaped (i.e. non-flat) surface on both sides of the Compensator Tray.

>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 pixel 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 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 Definition Distance (30xx,5210) (mm).

>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 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 Milling Tool Diameter

(300A,02E8) 3 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 Description 2

C.AA.2.24.1.1 Compensator Thickness and Transmission Map Precedence

If Compensator Thickness Map (30xx,5152) and Compensator Transmission Map (30xx,5151) are 4 present, Compensator Transmission Map (30xx,5151) shall have precedence for dosimetric calculations. 6

C.AA.2.24.1.2 Compensator Thickness Map and Tray Distance

The values stored in Compensator Thickness Map (30xx,5152) and Tray Distance (30xx,5148) shall 8 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) 10 equals PRESENT.

12

C.AA.2.25 Blocks Definition Macro

This macro may be invoked to define those attributes describing the geometric configuration of 14 Blocks or Apertures which cannot vary during delivery.

Table C.AA.2.25-1 16 BLOCKS DEFINITION MACRO ATTRIBUTES


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



Block Definition Sequence

(30xx,5160) 1C Block definitions.

Required if one or more blocks are present.






>Block Divergence (300A,00FA) 1 Specifies 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 Position

(300A,00FB) 1 Specifies on which side of the Block Tray the block is mounted.

Enumerated Values:

PATIENT_SIDE = the block is mounted on the side of the Block Tray which is towards the patient. SOURCE_SIDE = the block is mounted on the side of the Block Tray which is towards the radiation source.

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

>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 length. May be present if Material ID (300A,00E1) is zero length.

See C.AA.2.25.1.1 and C.AA.2.25.1.2.

>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 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) (mm).

C.AA.2.25.1 Blocks Definition Macro Attribute Description 2

C.AA.2.25.1.1 Multiple aperture blocks

All blocks with Device Component Type Subtype Code Sequence (30xx,5026) with a value of 4 (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 6


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 2 evaluated.

C.AA.2.25.1.2 Block Thickness and Transmission Precedence 4

If Block Thickness (300A,0100) and Block Transmission (300A,0102) are both present, Block Transmission (300A,0102) shall have precedence for dosimetric calculations. 6

C.AA.2.26 Accessory Holder Definition Macro 8

This macro may be invoked to define those attributes describing the Accessory Holders which are used to hold accessories.. 10

Table C.AA.2.26-1 ACCESORY HOLDER DEFINITION MACRO ATTRIBUTES 12


Accessory Holder Definition Sequence

(30xx,5170) 1C Accessory Holder definitions.

Required if one or more Accessory Holders are present.






>Tray Water-Equivalent Thickness

(30xx,02E3) 2C Water-Equivalent thickness of the tray (in mm) parallel to radiation beam axis.

Required if Device Component Type Subtype Code Sequence (30xx,5026) contains (S147480, 99SUP147, “Tray””).

>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 Component Type Subtype Code Sequence (30xx,5026) contains (S147480, 99SUP147, “Tray””).

>Slot Sequence (30xx,) 1C Slots being available in this Accessory Holder.

Required if Device Component Type Subtype Code Sequence (30xx,5026) contains (S147481, 99SUP147, “Applicator”).


>>RT Accessory Device Holder Slot ID

(30xx,054AB)

1 The slot where the accessory is inserted

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


C.AA.2.26.1 Accessory Holder Description 2

A treatment delivery unit may allow the attachment of one or more Accessory Holders within which the user may install various devices for applying the beam to the patient. These installed devices 4 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 6 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 8 field, ridge filters for creating multiple ranges within the beam, cross-wires for aligning the patient with the beam, a mirror or camera for aligning or viewing the irradiated area, beam monitoring detectors, 10 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, 12 decrease the block and/or bolus to skin distance, and reduce leakage radiation.

14

C.AA.2.27 General Accessories Definition Macro

This macro may be invoked to define those attributes describing the geometric configuration of 16 General Accessories which cannot vary during delivery.

Table C.AA.2.27-1 18 GENERAL ACCESSORIES DEFINITION MACRO ATTRIBUTES


General Accessory Definition Sequence

(30xx,5180) 1C General accessories.

Required if one or more general accessories are present.



Baseline CID SUP147030.



20

C.AA.2.28 Boluses Definition Macro

This macro may be invoked to define those attributes describing the geometric configuration of 22 Boluses which cannot vary during delivery.

Table C.AA.2.28-1 24 BOLUSES DEFINITION MACRO ATTRIBUTES


Boluses Definition Sequence

(30xx,5190) 1C Bolus definitions.

Required if one or more boluses are present.








>Conceptual Volume Sequence

(30xx,1346) 3 References a conceptual volume that describes the geometry and properties of the bolus.

See Section C.AA.2.28.1.1.

Only a single Item is permitted in this sequence.

>>Include ‘Conceptual Volume Combination and Segmentation Macro' Table C.AA.2.7-1

C.AA.2.28.1 Bolus Definition Macro Attribute Description 2

C.AA.2.28.1.1 Conceptual Volume Sequence

The Conceptual Volume Sequence (30xx,1346), if present, identifies the segmented Conceptual 4 Volume used to define the bolus. The segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume Combination and Segmentation Macro (see section 6 C.AA.2.8). 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. 8

C.AA.2.29 Outline Definition Macro 10

The Outline Definition Macro contains attributes to describes a geometric 2D geometric outline in a given coordinate system. 12

Table C.AA.2.29-1 OUTLINE DEFINITON MACRO ATTRIBUTES 14


Outline Shape Type (30xx,5200) 1 Shape of the outline.

Enumerated values:

SQUARE

RECTANGULAR

CIRCULAR

POLYGONAL

Outline Symmetry (30xx,5201) 1 Defines the s

Symmetry of the Outline Shape with respect to the z- axis of the central axis of the beam.

Enumerated Values:

SYMMETRIC

ASYMMETRIC

See 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 (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 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.2.30 RT Tolerance Set Macro 2

The 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 4 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 6 operator confirms that the tolerance may be exceeded.

Table C.AA.2.30-1 8 RT TOLERANCE SET MACRO ATTRIBUTES


RT Tolerance Set Label

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

RT Tolerance Set Index

(30xx,0114) 1 Index of the item in the sequence used for internal or external references


Attribute Tolerance Values Sequence

(30xx,0BA6) 1C Tolerance values for the attributes specified by the Selector Attribute Macro.



Required, if a tolerance value is specified for at least one attribute which can be referenced by the Selector Attribute Macro.

For further information see section C.AA.2.30.1.

>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) 1C 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 see section C.AA.2.30.1.2.

>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 Description 2

C.AA.2.30.1.1 Attribute Tolerance Values Sequence

The Attribute Tolerance Values Sequence (30xx,0BA6) allows for the reference to any numerical 4 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 6 allows reference to a tag on any level of nested sequences, and to refer to specific items in the sequence. 8

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 10 the value 0.

The unit of the tolerance value is the unit as specified by the data element tag referenced in the 12 Selector Attribute (0072,0026).

C.AA.2.30.1.2 Patient Support Position Tolerance Sequence 14

When 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 16 section C.AA.2.13.

18

C.AA.2.31 Patient to Equipment Relationship Macro

The Patient to Equipment Relationship Macro describes a position of the patient in respect to an RT 20 device. That position could be a Treatment Position, an Imaging Position, a Setup Position or anything else. The purpose of the patient position in the equipment system is defined at the 22 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 24 parameters, or both.


Table C.AA.2.31-1 PATIENT TO EQUIPMENT RELATIONSHIP MACRO ATTRIBUTES 2


Frame 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 a transformation between these systems.

Patient Location Coordinates Sequence

(30xx,6042) 2C Sequence of patient 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.


>Include 'Code Sequence Macro' Table 8.8-1 Context ID is defined at invocation of that macro.

>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 Reference to Equipment Matrix (30xx,6040).

Required if 3D Point Coordinate (0068,6590) is not present.

Patient Support Position Sequence

(30xx,6046) 1C Sequence of items describing the actual 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.



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

C.AA.2.31.1 Patient to Equipment Relationship Macro Attributes Description 2

C.AA.2.31.1.1 Patient Frame of Reference to Equipment Mapping Matrix and Patient Support Position Macro 4

The 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 6 matrix AMB describes 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 C.7.6.21.1. It 8 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 10 (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 12 UID (0020,0052) in the Frame of Reference Module of the SOP instance it is used within. Both coordinate systems are expressed in millimeters. 14

The Patient Support Position Macro allows the specification of device-specific parameters for the patient support device, and thereby provides the relationship between a Patient Support System and 16 the RT Device-Specific coordinate System. This relationship is known to all applications which know the geometric interpretation of those parameters. Applications which do not know that cannot 18 construct this geometric relationship, but will be able to display the labels and numerical values of those parameters. 20

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 22 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 24 contents. No programmatic information shall then be derived from the Patient Support Position Macro in this case. 26

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 28 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 30 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). 32

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. 34

C.AA.2.32 RT Treatment Position Macro

The RT Treatment Position Macro establishes a connection between the patient’s geometry and the 36 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 38 object.

Table C.AA.2.32-1 40 RT TREATMENT POSITION MACRO ATTRIBUTES




Patient 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 20

Patient Gantry Relationship Code Sequence

(0054,0414) 1 Sequence describing the orientation of the patient with respect to gantry. Only one item shall be present.

>Include 'Code Sequence Macro' Table 8.8-1 Defined CID 21

Patient 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 treatment position.

There shall be no more items present than number of items in the enclosing Control Point Sequence.



(30xx,0141) 1 References the Control Point Item 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

Defined CID SUP147005

C.AA.2.33 User Content Identification Macro 2

The User Content Identification Macro contains the attributes needed to identify content using a label supporting lower case characters and differing character sets. If a Code String is required, see 4 Content Identification Macro (Section 10.9).

Table C.AA.2.33-1 6 USER CONTENT IDENTIFICATION MACRO ATTRIBUTES


User 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.


> Include 'Person Identification Macro' Table 10-1

C.AA.2.33.1 User Content Identification Macro Attribute Description 2

C.AA.2.33.1.1 User Content Label and Content Description

User Content Label (30xx,51E0) shall represent a user-definable short free text providing the primary 4 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 6 (0070,0081) allows a longer string containing additional descriptive identifying text for one-line headings etc. 8

This information is intended only for display to human readers.

For RT Radiation IODs (those including the RT Radiation Common Module), User Content Label 10 (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. 12

C.AA.2.34 RT Treatment Phase Macro

The treatment phase macro contains the information about a RT Treatment Phase 14

Table C.AA.2.34-1 RT TREATMENT PHASE MACRO ATTRIBUTES 16


Treatment Phase Index (30xx,0116) 1 Index of the Treatment Phase in the sequence used for internal or external references.


Include 'RT Entity Labeling Macro' Table C.AA.2.1-1

Intended 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 Description

C.AA.2.34.1.1 Intended Phase Start Date, Intended Phase end Date 2

The 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 4 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 6 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 8 Date (30xx,088C) and/or Intended Phase End Date (30xx,088E).

C.AA.2.35 RT Treatment Phase Interval Macro 10

The Treatment Phase Interval Macro contains the information about time-relationship between RT Treatment Phases. 12

Table C.AA.2.35-1 RT TREATMENT PHASE INTERVAL MACRO ATTRIBUTES 14


Treatment Phase Interval Sequence

(30xx,0890) 2 Sequence of intervals between treatment phases.

Zero or more items shall be included in that sequence.

See C.AA.2.35.1.

>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,0146) 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,0146).

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 Phases 2

The 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) 4 and Consecutive Treatment Phase Index (30xx,0146) 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 6 therefore the consecutive treatment phase will start before the prior treatment phase.

As a result of the combinations possible, The maximum number of Items in the Treatment Phase 8 Interval Sequence (30xx,0890) shall be one less than the number of treatment phases present.

10

C.AA.2.29.1 Outline Definition Macro Attribute Description

C.AA.2.29.1.1 Outline Symmetry 12

The 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 14 terminology also applies to outlines having the Outline Shape Type (30xx,5200) POLYGONAL, if those conditions are fulfilled. 16


C.AA.A1 Enhanced RT Series Module 2

The Second Generation Radiotherapy IODs use the General Series module described in section C.7.3.1, specialized by the Enhanced RT Series Module. 4

Table C.AA.A0-1 specifies the attributes that identify and describe general information about the Enhanced RT Series. 6

Table C.AA.A1-1 ENHANCED RT SERIES MODULE ATTRIBUTES 8


Modality (0008,0060) 1 Type of equipment that originally acquired the data used to create the images 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).


Required if this instance has been created as a result of a procedure step request.


C.AA.A1.1 Enhanced RT Series Attribute Description 10

C.AA.A1.1.1 Modality

The Modality (0008,0060) of ‘RT’ allows a single device to include SOP instances of different SOP 12 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 14 one such example. See Section A.VV.1.1.1.2 for further explanation on use of Modality in radiotherapy. 16

C.AA.A2 Radiotherapy Common Instance Module 18

Table C.AA.A2-1 specifies the attributes that identify and describe general information about any and all Second Generation Radiotherapy IODs. 20

Table C.AA.A2-1 RADIOTHERAPY COMMON INSTANCE MODULE ATTRIBUTES 22


Instance Number (0020,0013) 1 A number that identifies this SOP Instance.


Include 'User Content Identification Macro' Table C.AA.2.33-1

Include 'RT Entity Labeling Macro' Table C.AA.2.1-1

C.AA.A3 RT Course Module 2

The RT Course module contains general information for the RT Course IOD.

Table C.AA.A3-1 4 RT COURSE MODULE ATTRIBUTES


RT Course Creation DateTime (30xx,0800) 1 The date and time when this RT Course definition was created.

RT 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.

RT Prescription Reference Presence Flag

(30xx,0805) 1 Defines whether an RT Prescription Reference is present.

Enumerated Values:

YES

NO

RT Treatment Phase Presence Flag

(30xx,0806) 1 Defines whether an RT Treatment Phase definition is present.

Enumerated Values:

YES

NO

RT Radiation Set Reference Presence Flag

(30xx,0807) 1 Defines whether a RT Radiation Set Reference is present.

Enumerated Values:

YES

NO

Current Course Predecessor Sequence

(30xx,080A) 2 Reference to historical versions of the RT Course.


See Note 1.




Prior 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.


>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.


See Note 1.


>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.


See Note 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.


>>>Include ‘Conceptual Volume Combination and Segmentation Macro' Table C.AA.2.7-1

>>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.


See Note 3.



>Include 'RT Item State Macro’ Table C.AA.2.3-1 Defined CIDfor the Assertion Code Sequence (30xx,50A0) shall be SUP147043.

See C.AA.A3.1.3.

C.AA.A3.1 RT Course Attribute Description 2

C.AA.A3.1.1 RT Course Scope Indicator

It is generally assumed that there is only one ‘active’ RT Course SOP Instance at a given time, for a 4 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 6 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 8 (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. 10

In absence of a value no statement can be made about the scope of the current RT Course SOP instance. 12

C.AA.A3.1.2 Delivered Radiation Dose Sequence

The Delivered Radiation Dose Sequence (30xx,0826) in the Prior Treatment Sequence is intended to 14 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 16 former treatments handled by an application which does not support the 2nd generation RT IODs.

C.AA.A3.1.3 RT Course State Sequence 18

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 20 Course . Those referenced object have their own states at the place, where they are referenced.

The transitions between states are not defined in DICOM. 22

C.AA.A4 RT Prescription Reference Module 24

The RT Prescription Reference Module contains information about the physician’s prescriptions and the intended time structure of treatment delivery. 26

Table C.AA.A4-1 RT PRESCRIPTION REFERENCE MODULE ATTRIBUTES 28


Physician Intent Prescription Sequence

(30xx,0860) 1 Referenced physician intents for the RT Course.


>RT Prescription Index (30xx,0118) 1 Index of the item in the sequence used for internal or external references.




>Referenced Physician Intent Sequence

(30xx,0864) 1 Reference to RT Physician Intent SOP Instance that contains the prescription referenced in this sequence.



>>Referenced RT Prescription Index

(30xx,0148) 1 Reference to the RT Prescription Index (30xx,0118) in the SOP Instance encoded in the Referenced Physician Intent Sequence (30xx,0864), identifying the prescription for this sequence.

>Physician Intent Prescription Status Sequence

(30xx,0866) 1 Defines the status of the prescription in the physician intent.


>>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

>Treatment Phase Reference Sequence

(30xx,0870) 1C Referenced treatment phase(s) to which 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.


>>Referenced Treatment Phase Index

(30xx,0146) 1 Reference to the Treatment Phase Index (30xx,0116) where this prescription does apply to.

>Referenced RT Segment Annotation Sequence

(30xx,0874) 2 Referenced RT Segment Annotation SOP Instances for which this prescription applies.



C.AA.A4.1 RT Prescription Reference Attribute Description 2

C.AA.A4.1.1 RT Item State Macro Meanings

For the states listed in the following, further annotations are provided, how the definitions in ANNEX 4 D, DICOM CONTROLLED TERMINOLOGY DEFINITIONS shall be applied in this context:

A value of (S147651, 99SUP147, “Reviewed”) means, that the Intent has been reviewed. 6


A value of (S147652, 99SUP147, “Approved”) means, that the Intent has been approved. It is ready to be used for treatment planning. 2

A value of (S147653, 99SUP147, “Rejected”) means, that the Intent has been rejected shall not be used for treatment planning. 4

C.AA.A5 RT Treatment Phase Module 6

The treatment phases defined for this RT Course. Treatment phases define the time structure of the RT Course, by defining phases for treatment and the time order in which radiation sets are treated in 8 relation to each other.

Table C.AA.A5-1 10 RT TREATMENT PHASE MODULE ATTRIBUTES


Treatment Phase Sequence (30xx,0880) 1 Phases for the current RT Course. 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.


>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1

>RT Treatment Phase State Sequence

(30xx,088A) 1 Defines the state of this phase.


>>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

12

C.AA.A5.1 RT Treatment Phase Attribute Description

C.AA.A5.1.1 RT Item State Macro Meanings 14

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: 16

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. 18 The intended timing is ready to be used for fractionation.

A value of (S147653, 99SUP147, “Rejected”) means, that the current treatment phase has been 20 rejected and shall not be used.


C.AA.A6 RT Radiation Set Reference Module 2

The RT Radiation Set Reference Module contains information about radiation sets being prepared, in treatment and finished (discontinued or retired). These radiation sets will typically refer to 4 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 6 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 8 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. 10

Table C.AA.A6-1 RT RADIATION SET REFERENCE MODULE ATTRIBUTES 12


Meta RT Radiation Set Sequence

(30xx,08B0) 1 Meta RT Radiation Sets within this phase.


>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.


>Referenced RT Prescription Index

(30xx,08C2) 1C References the Prescription Index (30xx,0118) in the RT Prescription Reference Module 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 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 the minimum delay in days for the first day of treatment with respect to the beginning of the treatment phase containing the referenced RT Radiation Set, as referenced by Treatment 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 Treatment 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.

>>Referenced Meta RT Radiation Set Index

(30xx,0122) 1 The referenced RT Meta Radiation Set to which the current RT Meta Radiation Set is related.

>>Temporal Relationship Interval Anchor

(30xx,0892) 1 The anchor point of the Interval specified in this Meta RT Radiation Set Sequence Item with respect to the 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 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 in respect to Temporal Relationship Interval Anchor (30xx,0892) when the delivery of current RT Meta Radiation Set should be started.

If 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 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.

>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 radiation sets have been used in the final Treatment RT Radiation sets.



>>Pre-treatment RT Radiation Set Role Code Sequence

(30xx,08CB) 1 Defines the role of the referenced RT Pre-treatment RT Radiation Set, in preparation of the current treatment.


>>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147018.

>>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.


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



>>>Conceptual Volume State Sequence

(30xx,08CC) 1C A sequence of states associated with the Conceptual Volumes defined in the RT Segment Annotation SOP instance referenced in this sequence.

Required if status information is available for Conceptual Volumes in this scope.


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


>>>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) 1C Referenced RT Radiation Sets to be used in this RT Course.

Required if Treatment RT Radiation Sets are defined.


See Note 1.


>>Treatment RT Radiation Set Sequence Number

(30xx,08F4) 1 A number ordering the radiation sets as their reference has been added to this sequence.

See Note 1.

>>Treatment RT Radiation Set State Sequence

(30xx,08F6) 1 Defines the state of this Radiation Set.


>>>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 the operation state of this Radiation Set.

Only 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.


>>>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.



>>Treatment RT Radiation Set Relation Sequence

(30xx,08FA) 1C Defines the relation to another Treatment RT Radiation set 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.


>>>Treatment RT Radiation Set Sequence Number

(30xx,08F4) 1 References the previous Treatment T Radiation Set identified by the RT Treatment RT Radiation Set Sequence Number (30xx,08F4) within this 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 set that was altered to form this radiation set.

>>>Treatment RT Radiation Set Alteration Type Sequence

(30xx,08FC) 2 Defines the nature of the changes when this radiation set was altered.


>>>>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 sequence of radiation sets supports versioning of radiation sets. The typical situations to 2 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 higher numbers in the Treatment RT 4 Radiation Set Sequence Number (30xx,08F4) denote radiation set references that have been added later, and normally the latest one is in treatment. However, those numbers only serve as a 6 first-level ordering scheme. 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 8 treatment phases, different treatment targets, fractionation pattern etc are covered by treatment phases and not within this sequence. 10

C.AA.A6.1 RT Radiation Set Reference Attribute Description 12

C.AA.A6.1.1 RT Item State Macro Meanings

For the states listed in the following, further annotations are provided, how the definitions in ANNEX 14 D, DICOM CONTROLLED TERMINOLOGY DEFINITIONS shall be applied in this context:

Usage for Pre-Treatment RT Radiation Set: 16

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed.

A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is approved to be 18 used to define initial geometric setup for the planning step.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set has been rejected 20 and shall not be used as planning input.

Usage for Treatment RT Radiation Set: 22

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed.

A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is ready for 24 treatment.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set shall not be used for 26 treatment.

C.AA.A6.1.2 Radiation Set Start Delay 28

C.AA.A6.1.2.1 Radiation Set Start Delay Overview

The Radiation Set Start Delay (30xx,08C6) describes the minimum delay in days after the beginning 30 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 32 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. 34 Hence, Radiation Set Start Delay (30xx,08C6) can be used to individually shift Radiation Sets within their Treatment Phase. 36


C.AA.A6.1.2.2 Examples of Radiation Set Start Delay 2

a) Scenario 1: Single Fraction Each Day

Description: First Calender Day of Phase Start is Wednesday. The Delay for Start of Treatment is 4 defined as 1 day.

Attributes: 6

Number of Fraction Pattern Digits per Day = 1

Repeat Fraction Cycle Length = 1 8

Fraction Pattern = 1111100

Radiation Set Start Delay = 1 10

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 …

12

Result: Radiation Set treatment begins the next treatment day as defined by the pattern which is Thursday. 14

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


b) Scenario 2: Single Fraction Every Other Day 2

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, 4 Wednesday, Friday:

Attributes: 6

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


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 12 Saturday which is Monday of the following week.

c) Scenario 3: Varying Fractions Every Other Day 14

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 16 provided as follows to illustrate the role of the attributes.

Attributes: 18

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 2 Saturday which is Monday of the following week.

4

C.AA.A7 RT Course Associated Instance Reference Module

The RT Course Associated Instance Reference Module contains information about other instances 6 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 8 (30xx,0901) annotates the role the references play in the scope of that RT Course.

Table C.AA.A7-1 10 RT COURSE ASSOCIATED INSTANCE REFERENCE MODULE ATTRIBUTES


RT 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.


>Associated Instance State Sequence

(30xx,0903) 1C Defines the state of this associated instance.

Required if a state has been defined in the context of the RT Course.


>>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.


>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147020.


12

C.AA.B1 RT Physician Intent Module

The RT Physician Intent Module contains information about the overall intent of the treatment. The 14 data are mostly descriptive text and allow freely formulated advice by the physician along the established nomenclature of the actual institution. 16

Table C.AA.B1-1 RT PHYSICIAN INTENT MODULE ATTRIBUTES 18




RT Treatment Phase Presence Flag

(30xx,0806) 1 Defines whether an RT Treatment Phase definition is present.

Enumerated Values:

YES

NO

RT Physician Intent Sequence (30xx,0912) 1 Sequence of Items representing physician intents.


See C.AA.B1.1.1

>RT Physician Intent Index (30xx,0913) 1 Index of the Physician Intent in the sequence used for internal or external references.


>RT Treatment Intent Type (30xx,0914) 2 Type of treatment intent.

Defined Terms:

CURATIVE

PALLIATIVE

PROPHYLACTIC

>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 intent replaces a previous version.



>>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) 2C The protocol(s) to be used.

Required if this intent is based on a known protocol.


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 handled by this intent.

Required if a diagnosis code is known.


See Note 1.

>>Include 'Code Sequence Macro’ Table 8.8-1 No Baseline CID is defined

>RT Diagnostic Image Set Sequence

(30xx,091A) 2 Reference to the Image SOP Instances or reference to frames from multi-frame Image SOP Instances used in the definition of the initial diagnosis.



See C.AA.B1.1.3.

>>Include 'Image SOP Instance Reference Macro' Table 10-3

Notes 1. The RT Diagnosis Code Sequence (30xx,0918) may contain clinical codes, which are used at the 2 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 4 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 6 preferred by the user.

8

C.AA.B1.1 RT Physician Intent Attribute Description

C.AA.B1.1.1 RT Physician Intent Sequence 10

The 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 12 multiple primaries would usually require separate intents to be defined, each with its own prescription(s) and having different sets of reference imaging studies. 14

C.AA.B1.1.2 RT Protocol Code Sequence

RT Protocol Code Sequence (30xx,0916) contains a coded description of the radiotherapy clinical 16 protocol the patient is following. This is not necessarily the same as the Procedure Step protocol.

C.AA.B1.1.3 RT Diagnostic Image Set Sequence 18

Diagnostic 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 20 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. 22

C.AA.B2 RT Prescription Module

The RT Prescription Module contains the prescription(s) by the physician to define the intended 24 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 26 institution.


Table C.AA.B2-1 RT PRESCRIPTION MODULE ATTRIBUTES 2


RT Prescription Sequence (30xx,0940) 1 Prescriptions to deliver therapeutic radiation.


>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.


>Referenced RT Physician Intent Index

(30xx,0919) 1C Reference to the RT Physician Intent Index (30xx,0913) in the RT Physician Intent Sequence (30xx,0912).

Shall not be present if a Parent RT Prescription Index (30xx,0149) is present.

>Parent RT Prescription Index (30xx,0149) 2C Reference to a prescription that represents a 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).

>Referenced Dosimetric Objectives Sequence

(30xx,0951) 1C Sequence of Items referencing Dosimetric Objectives that are dosimetrically relevant to this prescription.

Required if Dosimetric Objectives are defined for this prescription.


>>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.



>Treatment Phase Reference Sequence

(30xx,0870) 1C Referenced treatment phase(s) to which this prescription applies, and which 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.


>>Referenced Treatment Phase Index

(30xx,0146) 1 Reference to the Treatment Phase Index (30xx,0116) where this prescription does apply to.

>Fractionation Relationship Sequence

(30xx,0982) 2 Fraction-based relationship to another prescription.


>>Referenced RT Prescription Index

(30xx,0148) 1 The referenced prescription to which the current prescription is related.

>>Temporal Relationship Interval Anchor

(30xx,0892) 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 Temporal Relationship Interval Anchor (30xx,0892) when the delivery of current prescription should be started.

If Temporal Relationship Interval Anchor (30xx,0892) 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 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 prescription, when the delivery of the current prescription should start.

>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.

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

>Planning Input Information Sequence

(30xx,0960) 2C Instances which are intended to be used for the planning process.

Required if planning shall be advised to use certain objects like images and Segment RT Annotations for the planning process.



>General Prescription Notes (30xx,0970) 2 Notes on this prescription in general.

>Number of Fractions (30xx,0972) 2 Number of Fractions.

>Intended Delivery Duration (30xx,0973) 2 Number of days across which the fractions prescribed here shall be delivered.

>Fractionation Description (30xx,0974) 2 Description of the fractionation approach (Bi-fractionation, Breaks, Hyper-fractionation, etc.) to be used.

>Include 'Radiation Fractionation Pattern Macro' Table C.AA.2.9-1

>Treatment Technique Description

(30xx,0966) 2 Description of the treatment technique to be used.



>Radiotherapy Procedure Technique Sequence

(30xx,0C99) 2 The treatment technique that should be used for treatment.


>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147047

>Prescription Annotation Sequence

(30xx,0978) 1C Further Annotations to the preparation and execution of the treatment covered by this prescription.

Required if there are annotations for the prescription.


>>Include 'Content Item Macro' Table 10-2 Defined TID is SUP147001 RT Prescription Annotation

>>Prescription Annotation DateTime

(30xx,0979) 2 Date and time on which the annotation was made.

RT Anatomic Prescription Sequence

(30xx,0920) 1 Prescriptions for Conceptual Volumes defining anatomy.


>Anatomy Label (30xx,0922) 1 Descriptive definition of the anatomy.

>Conceptual Volume Sequence (30xx,1346) 1 Reference to a conceptual volume which identify anatomic regions etc. 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 only appear once in that sequence.


>Prescription Anatomy Notes (30xx,0928) 2C Additional notes on what to pay attention to in respect to this anatomy.

Required if the Dosimetric Objective Sequence (30xx,0942) is empty. May be present otherwise.



>Prescription Anatomy Role (30xx,0930) 1 The radiotherapeutic designation of the anatomy.

See C.AA.B2.1.5.

Defined Terms:

TARGET

OAR

AVOIDANCE

DOSE_SHAPING

CONFORMALITY_SHELL

OTHER

>Radiobiological Structural Type (30xx,0932) 2 The radiobiological type of the anatomy.

See C.AA.B2.1.6.

Enumerated Values:

SERIAL

PARALLEL

OTHER

>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 whether or not primary radiation shall be allowed to pass through the conceptual volume when performing a dose optimization.

Enumerated Values:

NONE = No restrictions

UPSTREAM = 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 the general category of this anatomy for radiotherapy purposes.





>Anatomy Property Type Code Sequence

(30xx,0936) 2 Sequence defining the specific property type of this anatomy for radiotherapy purposes.


>>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 alternate specific property types of this segment for radiotherapy purposes.


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.


See C.AA.D1.1.2.

>>>Include 'Code Sequence Macro' Table 8.8-1 No baseline CID defined.

>Dosimetric Objective Sequence

(30xx,0942) 2C Objectives applicable for this anatomy.

Required if objectives are known for this anatomy.


>>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.



>>Dosimetric Objective Value Type Code Sequence

(30xx,0943) 1 The type of dose objective which this item represents.




>>>Include ‘Code Sequence Macro' Table 8.8-1 Defined CID SUP147001.

>>Dosimetric Objective Parameter Sequence

(30xx,0950) 2 Parameters of the objective.


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.


>>>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.

>>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 EVALUATION

See 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:

YES

NO

See C.AA.B2.2.

C.AA.B2.1 RT Prescription Attribute Description 2

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

The Anatomy Property Type Code Sequence (30xx,0936) further specifies the anatomy along the 4 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 6 (30xx,0934) is as follows:

Value of Conceptual Volume Category Code Sequence (S147050, 99SUP147, “Target”): 8 Defined CID for Property Type shall be SUP147004.

C.AA.B2.1.2 Dosimetric Objective Parameter Sequence 10

A 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 12 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. 14

C.AA.B2.1.2.1 Single Dose Parameter

If the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID 16 SUP147060 Single Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameter. 18

Dosimetric Objective Parameter

Index (30xx,0119)

Concept Name Code Value Type Measurement Units Code

1 EV (S147025, 99SUP147, “Dose Parameter”)

NUMERIC Units = EV (Gy,UCUM,”Gray”)

C.AA.B2.1.2.2 Percentage and Dose Parameter 20

If 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 22 Parameter Sequence (30xx,0950) shall include the following parameters.


Index (30xx,0119)



1 EV (S147027, 99SUP147, “Percent Parameter”)

NUMERIC Units = EV (%,UCUM,”Percent”)



C.AA.B2.1.2.3 Volume and Dose Parameter 2

If 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 4 Sequence (30xx,0950) shall include the following parameters.


Index (30xx,0119)


1 EV (S147026, 99SUP147, “Volume Parameter”)

NUMERIC Units = EV (cm3,UCUM,”Cubic Centimeter”)



6

C.AA.B2.1.2.4 Unitless and Dose Parameter

If the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID 8 SUP147063 Dimensionless and Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter Sequence (30xx,0950) shall include the following parameters. 10


Index (30xx,0119)


1 EV (S147028, 99SUP147, “Numeric Parameter”)

NUMERIC Units = EV (1,UCUM,”no units”)



C.AA.B2.1.2.5 Coded Parameter 12

If the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID SUP147064 Coded Dosimetric Objectives, the Dosimetric Objective Parameter Sequence 14 (30xx,0950) shall include the following coded parameter.

Coding Scheme Designator (0008,0102)

Code Value (0008,0100)

Code Meaning (0008,0104)

CID used in

Dosimetric 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 Examples 2

For 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 4 (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: 6

Dosimetric Objective Sequence (30xx,0942): Item 1: 8 Dosimetric Objective Value Type Code Sequence (30xx,0943):

o Item 1: (S147015, 99SUP147, “Maximum Percent Volume at Dose”) 10 o Dosimetric Objective Parameter Sequence (30xx,0950)

o Item 1: 12 o Item Referencing Index (30xx,51E1) = 1 o Value Type (0040,A040) = NUMERIC 14 o Concept Name Code Sequence (0040,A043)

o Item 1: (S147027, 99SUP147; “Percent Parameter”) 16 o Numeric Value (0040,A30A) = 30 o Measurement Units Code Sequence (0040, 08EA) 18

o Item 1: (%, UCUM, “ Percent”) o Item 2: 20 o Item Referencing Index (30xx,51E1) = 2 o Value Type (0040,A040) = NUMERIC 22 o Concept Name Code Sequence (0040,A043)

o Item 1: (S147025, 99SUP147, “Dose Parameter”) 24 o Numeric Value (0040,A30A) = 50 o Measurement Units Code Sequence (0040,08EA) 26

o Item 1: (Gy, UCUM, “ Gray”) 28

C.AA.B2.1.4 Conceptual Volume Sequence

The Conceptual Volume Sequence (30xx,1346) identifies the Conceptual Volume associated with an 30 RT Anatomy Prescription item. If the Conceptual Volume is associated with a segment, the segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Segmented Conceptual 32 Volume Macro (see section C.AA.2.8). Alternatively, the anatomy volume may not (yet) be associated with a segment. For example, an initial prescription may be entered prior to the definition 34 of an OAR.

C.AA.B2.1.5 Prescription Anatomy Role 36

The following table contains the meanings of the Defined Terms for Prescription Anatomy Role (30xx,0930): 38

Defined Term Meaning

TARGET Volume containing tissue to intentionally received dose

OAR Organ-at-Risk as defined by ICRU 62

AVOIDANCE Volume through which a radiation’s fluence should not pass

DOSE_SHAPING Volume used to specify a dose constraint


CONFORMALITY_SHELL Surface used to specify a dose constraint

OTHER Other volume

C.AA.B2.1.6 Radiobiological Structural Type 2

The following table contains the meanings of the Defined Terms for Radiobiological Structural Type (30xx,0932): 4

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 orgam damages only that segment

OTHER Other organ structure

C.AA.B2.1.7 Dosimetric Objective Priority 6

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-8 automatic process. These objectives may, for example, involve “avoidance” anatomies that influence the optimized dose distributions, but may not have biological significance in themselves. 10

C.AA.B2.2 Dosimetric Objective Scope

The scope of a dosimetric objective comprises all objects, where the same Dosimetric Objective UID 12 (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 14 reference an objective for maximum dose, but each with a different UID, the value applies to the prescriptions separately. 16

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 18 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 20 scope of that objective includes all prior and the current treatments covered by the prescriptions referencing this UID. 22

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 24 represented by Dosimetric Objective sequence items, such as RT Dose objects, unformatted electronic reports, paper records etc. . 26

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 28 otherwise.

C.AA.B3 RT Treatment Phase Intent Module 30

The treatment phases defined in the actual RT Physician Intent SOP. Treatment phases define the intended time structure of the prescribed treatment, by defining phases for treatment and the time 32 order of them.

Table C.AA.B3-1 34 RT TREATMENT PHASE INTENT MODULE ATTRIBUTES




Treatment Phase Sequence (30xx,0880) 1 Phases for the current RT Course. 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.


>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1

Include 'RT Treatment Phase Interval Macro' Table C.AA.2.35-1

C.AA.C1 RT Radiation Set Module 2

The RT Radiation Set Module contains information describing treatment fractions, containing a set of beams and/or brachytherapy setups being used within a treatment session to help achieve the 4 dosimetric requirements of a given phase.

It references a set of RT Radiation instances describing the geometrical and physical parameters 6 defining the delivery of dose within a fraction. The whole set defines a fraction of treatment. For those fractions, the number of treatments is defined, as well as possibly the interval schema along which 8 those fractions shall be treated. It also specifies weighting of the beams and brachytherapy setups contained for those fractions. 10

An RT Radiation Set can be referenced externally for dosimetric purposes. A treatment phase is achieved by delivering one or more RT Radiation Sets. One or more new RT Radiation Sets may be 12 required each time adaptive therapy is used to attempt to maintain a phase prescription.

The chronological relationships between Radiation Sets (the actual start of each set, the order or 14 timing among sets etc.) are handled outside the Radiation Set.

Table C.AA.C1-1 16 RT RADIATION SET MODULE ATTRIBUTES


Number of Fractions (30xx,0972) 1 Number of Fractions.

Include 'Radiation Fractionation Pattern Macro' Table C.AA.2.9-1



RT 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_TREATMENT

PLAN_QA

MACHINE_QA

RESEARCH

SERVICE

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

YES

NO

Radiation Sequence (30xx,0B26) 1C Radiation instances which are referenced by this RT Radiation Set.

Required once Radiations have been added to this RT Radiation Set.


See C.AA.C1.1.2.


C.AA.C1.1 RT Radiation Set Attribute Description 2

C.AA.C1.1.1 Radiation Set Type

PATIENT_TREATMENT = The Radiation Set has been prepared to be ready for treatment delivery. 4 All parameters necessary to guide the delivery of radiation beams are included.

PLAN_QA = The Radiation Set has been created for the purpose of validating the dose to be 6 deposited in a patient by delivering the identical beams to a phantom and comparing the calculated dose to the phantom with actual measurements made in the phantom. 8

MACHINE_QA= The 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 10 assurance and calibration (geometric, dosimetric or both).

RESEARCH = The Radiation Set is used in a Research project. It has been created for the purpose 12 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 14 maintenance operation.

C.AA.C1.1.2 Radiation Sequence 16

All 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 2 Class is the presence of the following modules:

The modules specified in Table A.VV.1.1.1-2 RT RADIATION IOD MODULES MACRO. 4

The RT Delivery Device Common Module specified in section C.AA.E1.

The RT Radiation Common Module specified in section C.AA.E2. 6

C.AA.C2 RT Dose Contribution Module 8

The RT Dose Contribution module contains information about the contribution of dose of the radiations in this Radiation Set to the patient. Dose contributions refer to the radiations delivering the 10 dose and to anatomies receiving the dose.

Note that an anatomical structure (as defined by the Conceptual Volume Macro) can be a textually 12 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 14 accumulation of dose across RT Radiation Sets and comparison with originally prescribed dose objectives. 16

Dose contributions are defined along the meterset value. The definition points in the lookup table may, but do not need to, align with the metersets at the control points of the Radiation SOP Instance. 18 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 20 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 or radiation set definition and application (e.g. 22 for emergency treatments), the module may be absent. This does not exclude retrospective dose calculation and creation of associated RT Dose Image objects. 24

Table C.AA.C2-1 RT DOSE CONTRIBUTION MODULE ATTRIBUTES 26


Radiation Dose Identification Sequence

(30xx,0B42) 1 Radiation Dose parameters to identify and scope the dose values that are delivered by this radiation.


>Radiation Dose Identification Index

(30xx,0120) 1 Index of the Radiation Dose Identification in the sequence used for internal or external references.


>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.


>>Include 'Extended Conceptual Volume Reference Macro' Table C.AA.2.7-1

Radiation 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.


>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 shall be exactly the number of items in the Radiation Dose Identification Sequence (30xx,0B42).



>>Referenced Radiation Dose Identification Index

(30xx,0150) 1 Reference to the Radiation Dose Identification Index (30xx,0120) in the Radiation Dose Identification Sequence 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:

YES

NO

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:

PHYSICAL

EFFECTIVE

>> Meterset to Dose Mapping Sequence

(30xx,0B68) 1C Sequence of Items containing the mapping 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 Radiation 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.

>>Radiation Verification Control Point Sequence

(30xx,0B6D) 2 Sequence of Items containing Radiation Verification Control Points.


>>>Cumulative Radiation Meterset

(30xx,5021) 1 The Cumulative Radiation Meterset value at which the Radiation Meterset Check Parameters apply are expressed in units of the Primary Radiation Dosimeter Unit (30xx,5113).



>>>Radiation Dose Value (30xx,0B7B) 1 Cumulative dose value (in Gy) for the Cumulative Radiation Meterset and the geometric parameters provided in this sequence Item.

See C.AA.C2.2.3

>>>Referenced Control Point Item Index

(30xx,0141) 1C Value of Control Point Item 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 Radiation Meterset 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.

>>>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.




>>>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.


>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.


>>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 Description 2

C.AA.C2.1.1 Meterset to Dose Mapping Sequence

The Meterset to Dose Mapping Sequence (30xx,0B68) establishes a lookup table of dose values 4 delivered at certain metersets. The first value of Cumulative Radiation Meterset (30xx,5021) and of Radiation Dose Value (30xx,0B7B) shall always be zero. The value of Meterset Value in the last item 6 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 8 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 10 increase of dose between 2 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. 12

C.AA.C2.1.2 Conceptual Volume Sequence

The Conceptual Volume Sequence (30xx,1346) identifies a Conceptual Volume defining a volume for 14 which dose is tracked during treatments. If the Conceptual Volume is associated with a segment, the segment is defined by the Segment Index (30xx,0121) in the Segmented Conceptual Volume Macro 16


(see section C.AA.2.8). 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 2 and the tracking coefficients approximated by meterset values.

C.AA.C2.1.3 Primary Dose Value Indicator 4

The 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 6 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 Description 8

C.AA.C2.2.1 Referenced Control Point

The number of items in the Radiation Verification Control Point Sequence is not required to be the 10 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 Radiation Meterset of a 12 Control Point of the Radiation is the same it shall be referenced by the Referenced Control Point Item Index (30xx,0141). 14

C.AA.C2.2.2 Distance Parameters

The values given in Radiation Dose Point Depth (30xx,0B70), Radiation Dose Point Equivalent Depth 16 (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 18 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. 20

C.AA.C2.2.3 Radiation Dose Value

The Radiation Dose Value (30xx,0B7B) represents the cumulative dose delivered from the beginning 22 of radiation delivery to the Cumulative Radiation Meterset (30xx,5021).

24

C.AA.D1 RT Segment Annotation Module

The RT Segment Annotation Module references segments and provides radiotherapy-specific 26 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 28 radiotherapy shall only be derived from a RT Segment Annotation object. The referenced instances shall not be used to supply any information that is unspecified in the RT Segment Annotation. Only 30 the geometric definition of the segments shall be extracted from the referenced instances.

Table C.AA.D1-1 32 RT SEGMENT ANNOTATION MODULE ATTRIBUTES


Segment Sequence (0062,0002) 1 Segments described in this module.


>Segment Index (30xx,0121) 1 Index of the Segment used for internal or external references.


>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.



>Segmented Property Type Code Sequence

(0062,000F) 1 Sequence defining the specific property type of this segment for radiotherapy purposes.


See C.AA.D1.1.3.

>>Include 'Code Sequence Macro' Table 8.8-1 Defined CID is defined in C.AA.D1.1.3.


(30xx,134E) 3 Sequence defining alternate specific property types of this segment for radiotherapy purposes.


See C.AA.D1.1.2.



(30xx,134F) 3 Identifies the purpose for which the identification code is assigned.


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.

>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.




>Segment Properties Sequence

(30xx,134B) 3 Segment properties associated with the current segment’s interpretation.


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.


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.

>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.


See C.AA.D1.1.5.

>>Include 'Conceptual Volume Macro' Table C.AA.2.5-1

>>Referenced ROI Number (3006,0084) 1C Uniquely identifies the referenced ROI described in the Structure Set ROI Sequence (3006,0020).

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 Uniquely identifies the segment described in the Segment Sequence (0062,0002) by reference to the Segment Number (0062,0004). 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).

>>Referenced Segmentation Instance Index

(30xx,1351) 1 References the Segmentation Index in Segmentation SOP Instance Reference Sequence (30xx,1331) defining the SOP instance this Direct Segment Reference refers to.



>Combination Segment Reference Sequence

(30xx,1344) 1C Identifies the segment geometric definition in a SOP Class as defined by Table C.AA.D1.1-1.

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.


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.



C.AA.D1.1 RT Segment Annotation Description 2

C.AA.D1.1.1 Segmentation SOP Instance Reference Sequence

Only the following SOP Classes are permitted to be referenced in this sequence: 4

Table C.AA.D1.1-1

PERMITTED SOP CLASSES 6

SOP Class Name SOP Class UID

Segmentation Storage 1.2.840.10008.5.1.4.1.1.66.4

Surface Segmentation Storage 1.2.840.10008.5.1.4.1.1.66.5

RT 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 8 Frame of Reference UID.

C.AA.D1.1.2 Alternate Segmented Property Type Code Sequence 10

The 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 12 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 14 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 2 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. 4


(0062,0003) (SRT, T-D000A, Anatomical Structure)


(0062,000F) (CODESCHEME1, Lung_R, Right Lung)


(30xx,134E) (CODESCHEME2, Lung_Ipsi, Ipsi-lateral Lung)


(30xx,134F) (CODESCHEME3,CT1234, Clinical Trial Protocol 1234)

6

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. 8


(0062,0003) (99SUP147, S147050, Target)


(0062,000F) (CODESCHEME1, CTV, Clinical Target Volume)


(30xx,134E) (CODESCHEME2, CTV_5400, CTV 5400 cGy)


(30xx,134F) (CODESCHEME3, ,CT1234, Clinical Trial Protocol 1234)

10

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 12 clinical workflow.

14


(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 Sequence 2

If 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 4 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

6

C.AA.D1.1.4 Segmented RT Accessory Device Sequence

A segment represents an RT accessory, when the Segmented Property Category Code Sequence 8 (0062,0003) contains one of the following values:

Value of (S147054, 99SUP147, “Fixation or Positioning Device”) 10

Value of (S147055, 99SUP147, “Internal Brachytherapy Device”)

Value of (S147056, 99SUP147, “Artificial Structure”) 12

C.AA.D1.1.5 Direct Segment Reference Sequence

This sequence defines the reference to the geometric representation of the segment annotated in the 14 actual item of Segment Sequence (0062,0002).

The Conceptual Volume Macro in the Direct Segment Reference Sequence (30xx,1343) establishes 16 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 18 Sequence (30xx,1344) shall be used instead.

C.AA.D1.1.6 Combination Segment Reference Sequence 20

This sequence allows establishing new segments as combinations of other segments. Those other segments are referenced in the Conceptual Volume Combination and Segmentation Macro. 22

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). 24

These segments are identified by referencing their corresponding Conceptual Volume UID (30xx,1301) within the Direct Segment Reference Sequence. 26


At least two sequence Items in the Segment Sequence including a Direct Segment Reference Sequence are required to be present in the Conceptual Volume Combination and Segmentation 2 Macro.

C.AA.D1.1.7 Segment Properties Sequence 4

If 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). 6

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 8 specified in the Segment Properties Modifier Sequence (30xx,134B). The following table defines the additional parameters for properties having more then one parameter. 10

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 Module 12

The RT Delivery Device Common Module contains general information pertaining to the physical device used to deliver the treatment. 14

Table C.AA.E1-1 RT DELIVERY DEVICE COMMON MODULE ATTRIBUTES 16


Include 'Treatment Device Identification Macro' Table C.AA.2.10-1

Alternate Treatment Device Sequence

(30xx,5016) 2 Alternate Treatment Devices that are declared as equivalent for delivery purposes.

See section C.AA.E1.1.1.


>Include 'Treatment Device Identification Macro' Table C.AA.2.10-1

Primary Radiation Dosimeter Unit

(30xx,5113) 1 Measurement unit of machine dosimeter.

See C.AA.E1.1.1.

Enumerated Values:

MU = Monitor Unit

SECOND = Second

BQ_SECOND = Becquerel Seconds

NP = Number of Particles

RELATIVE = Relative values

See section C.AA.E1.1.2.



Coordinate System Declaration (30xx,5208) 1 Defines the coordinate system for use by beam limiting device measurements.

Defined Terms:

IEC_BM_LIMIT_DEV

See 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

C.AA.E1.1 RT Delivery Device Common Module Attribute Description 2

C.AA.E1.1.1 Alternate Treatment Device Sequence

The Alternate Treatment Device Sequence identifies treatment devices, which may be suited to 4 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 6 by an alternate device is not defined by the standard.

C.AA.E1.1.2 Primary Radiation Dosimeter Unit 8

A Primary 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 10 prior to treatment, using some independent calibration step.

C.AA.E1.1.3 Equipment Frame of Reference UID 12

The Equipment Frame of Reference UID (30xx,51A0) uniquely identifies the coordinate system of the Treatment Device. 14


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 2 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 4 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. 6

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 8 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 10 concerning the orientation of the axes.

Instances of the C-Arm Photon Radiation Storage SOP Class and C-Arm Electron Radiation Storage 12 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 14 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 16 informal annotation only and shall not be used for any normative description of the device coordinate system. 18

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 20 definition.

C.AA.E1.2 Conformance 22

C.AA.E1.2.1 Coordinate System Declaration

If IEC 61217 'Radiotherapy equipment – Coordinates, movements and scales' applies to the delivery 24 device in question (this is true for most C-Arm type devices), this attribute shall equal IEC_BM_LIMIT_DEV. 26

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 28 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, ... 30 1N, 201, 202, ... 2N.

32


C.AA.E2 RT Radiation Common Module

The RT Radiation Common Module contains a specification of attributes required by all Radiation 2 IODs that are to be used in an external beam treatment delivery.

Table C.AA.E2-1 4 RT RADIATION COMMON MODULE ATTRIBUTES


RT Radiation Data Scope (30xx,5013) 1 Intended use of this radiation.

Defined Terms:

GEOMETRIC = Treatment simulation

DOSIMETRIC = Dosimetric verification

See C.AA.E2.1.3.

Radiotherapy Procedure Technique Sequence

(30xx,0C99) 1 Type of treatment technique.


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.


>Include 'RT Tolerance Set Macro' Table C.8.A1.27-1

Calculated Treatment Time (30xx,0BAC) 2 The expected treatment time to deliver that Radiation in [sec].

See C.AA.E2.1.4.

Treatment Time Limit (30xx,0BAD) 2 The expected maximum delivery time in [sec].

See C.AA.E2.1.4.

6

C8.A.E2.1 RT Radiation Common Attribute Description

C.AA.E2.1.1 Radiotherapy Procedure Technique Sequence 8

The 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 10 the Radiation SOP instance (especially from the Control Point parameters), and shall be consistent with that content. Its primary purpose is to summarize the radiation technique for the end user by 12 means of an established term.

C.AA.E2.1.2 RT Treatment Position Macro 14

The RT Treatment Position Macro describes how the patient has to be positioned with respect to the delivery device for treatment (Treatment Position). 16


Item Numbers in the Referenced Control Point Item Index (30xx,0141) identify the Control Point, at which the treatment position is first applied. In many cases, the treatment position will remain 2 constant throughout the Radiation, therefore the RT Treatment Position Macro will only contain one item with the Referenced Control Point Item Index (30xx,0141) equal to 1. Otherwise, it will have one 4 item in the Treatment Position Sequence (30xx,5028) for each control point, where the position has changed compared with the previous control point. 6

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 8 the current standard.

C.AA.E2.1.3 RT Radiation Data Scope 10

The 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 12 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. 14

C.AA.E2.1.4 Treatment Times

The Calculated Treatment Time (30xx,0BAC) is the estimated time needed for the delivery of that 16 Radiation. The Calculated Treatment Time is computed from the meterset and the meterset rate and is related to the beam-on time respectively source exposure time. 18

The 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 20 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 22 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. 24

C.AA.F1 Tomotherapeutic Delivery Device Module

The Tomotherapeutic Delivery Device Module contains tomotherapy-specific information pertaining 26 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. 28

Table C.AA.F1-1 TOMOTHERAPEUTIC DELIVERY DEVICE MODULE ATTRIBUTES 30


Source-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 ‘Accessory Holder Definition Macro' Table C.AA.2.26-1

Tomotherapeutic Leaf Bank Definition Sequence

(30xx,1000) 1 Describes the leaf slot positions for Leaf Banks.


>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 Description 2

C.AA.F1.1.1 Leaf Slot Definition

A ‘Leaf Slot’ is a channel perpendicular to the binary collimator long axis that can be occluded by a 4 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). 6 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. 8

C.AA.F2 Tomotherapeutic Beam Module 10

The Tomotherapeutic Beam Module contains a specification of how a specific tomotherapeutic treatment beam is to be delivered. 12

Table C.8A.F2-1 TOMOTHERAPEUTIC BEAM MODULE ATTRIBUTES 14


Radiation Particle (30xx,5110) 1 Particle Type of Radiation.

Defined Terms:

PHOTON

ELECTRON

PROTON

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.

Maximum 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.

Include 'Beam Mode Macro' Table C.AA.2.19-1

Tomotherapeutic Control Point Sequence

(30xx,1010) 1 Control points used to model the beam delivery.


>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1

>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).


See C.AA.2.16.1 and C.AA.G2.1.4.

>Tomotherapeutic Leaf Bank Position Sequence

(30xx,1020) 1 Set of collimator bank settings for the projection following the current Control Point. Banks are encoded in spatial order, with the bank nearest the front of the machine first.


>>Binary MLC Jaw 1 Opening (30xx,1024) 1 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.

>>Binary MLC Jaw 2 Opening (30xx,1025) 1 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.



>>Tomotherapeutic Leaf Open Percentages

(30xx,1030) 1 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.

>>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 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 Module 2

The 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 4 parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment. 6

Table C.AA.G1-1 C-ARM PHOTON-ELECTRON DELIVERY DEVICE MODULE ATTRIBUTES 8


Source-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 Limiting Device Definition Macro' Table C.AA.2.20-1

Include 'Wedges Definition Macro' Table C.AA.2.22-1

Include 'Compensators Definition Macro' Table C.AA.2.24-1

Include 'Blocks Definition Macro' Table C.AA.2.25-1

Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1

Include 'General Accessories Definition Macro' Table C.AA.2.27-1

Include 'Boluses Definition Macro' Table C.AA.2.28-1

C.AA.G2 C-Arm Photon-Electron Beam Module 10

The C-Arm Photon-Electron Beam Module contains a specification of how a specific C-Arm photon or electron treatment beam is to be delivered. 12

Table C.AA.G2-1 C-ARM PHOTON-ELECTRON BEAM MODULE ATTRIBUTES 14




Radiation Particle (30xx,5110) 1 Particle Type of Radiation. See C.AA.G2.1.1.

Enumerated Values:

PHOTON

ELECTRON

Treatment Machine Mode Sequence

(30xx,0C97) 1 Annotates the mode of operation for treatment machine.


See C.AA.G2.1.3.

>Include 'Code Sequence Macro' Table 8.8-1. Defined CID SUP147017.

Include 'Beam Mode Macro' Table' C.AA.2.19-1

C-Arm Photon-Electron Control Point Sequence

(30xx,0C00) 1 Control points used to model the beam delivery.



>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).


See C.AA.2.16.1 and C.AA.G2.1.2.

>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).


See C.AA.2.16.1.

>Source to Surface Distance (300A,0130) 2C Source to Patient Surface distance (mm).


See C.AA.2.16.1.


C.AA.G2.1 C-Arm Photon-Electron Beam Attribute Description

C.AA.G2.1.1 Radiation Particle 2

If 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. 4

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. 6

C.AA.G2.1.2 Continuous Rotation Angles

A continuous rotation angle is an angle in the range (-∞,+∞), such that: 8

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. 10

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 12 specifies more than one CW rotation.

Relative to a previous continuous rotation angle, a decrease in continuous rotation angle shall 14 specify a counter-clockwise (CC) rotation, where a difference of less than -360 between the two values specifies more than one CC rotation. 16

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 18 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 20 capabilities beyond their nominal rotational limit, continuous rotation angle removes the need to flag the rotational position in the over-travel state. 22

C.AA.H1 Multiple Fixed Source Delivery Device Module 24

The 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 26 parameters of the collimation system. This information is constant for all possible beam deliveries with this equipment. 28

Table C.AA.H1-1 MULTIPLE FIXED SOURCE DELIVERY DEVICE MODULE 30


Radiation Source Sequence (30xx,5130) 1 The radiation sources of the device.


>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 Description 2

C.AA.H1.1.1 Radiation Source Angles

Radiation Source Theta (30xx,5133) is the angle from the Z axis of the equipment coordinate system 4 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 6 on the XY plane of the device coordinate system.

8

C.AA.H2 Multiple Fixed Source Beam Set Module

The Multiple Fixed Source Beam Set Module contains a specification of how a specific multiple fixed 10 source treatment beam is to be delivered. In this context “beam” refers to a radiation for a period of time from multiple radiation sources. 12

Table C.8A.H2-1 MULTIPLE FIXED SOURCE BEAM SET MODULE ATTRIBUTES 14

Attribute Name Tag Type

Description


Defined Terms:

PHOTON

Radiation Source Pattern Sequence

(30xx,513C) 1 Radiation source patterns.


>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.


>>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).



Description

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.



>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).


See C.AA.2.16.1.

C.AA.J1 Robotic Delivery Device Module 2

The 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. 4 This information is constant for all possible beam deliveries with this equipment.

Table C.AA.J1-1 6 ROBOTIC DELIVERY DEVICE MODULE ATTRIBUTES


Robotic Device Geometry (30xx,0F03) 1 Imaging geometry with which this path is associated.

Defined Terms:

NORMAL

MIRROR

Include 'RT Beam Limiting Device Definition Macro' Table C.AA.2.20-1

Include ‘Accessory Holder Definition Macro' Table C.AA.2.26-1

8

C.AA.J2 Robotic Path Module

The Robotic Path Module contains a specification of how a specific robotic path is to be delivered. 10 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. 12

Table C.AA.J2-1 ROBOTIC PATH MODULE ATTRIBUTES 14





Defined Terms:

PHOTON

ELECTRON PROTON

Robotic Path Identifier Sequence

(30xx,0F15) 1 Path Set identifier.


>Include 'Code Sequence Macro' Table 8.8-1. Defined CID SUP147011.

Include 'Beam Mode Macro Table' C.AA.2.19-1

Robotic Control Point Sequence

(30xx,0F50) 1 Control points used to model the beam delivery.



>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.

>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 Item 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 Item 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.


>>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 Item 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).


See C.AA.2.18.1.1.

Note 1: The value may reference node positions being pre-defined in the device configuration. Therefore it 2 is not the same as the Control Point Item Index (30xx,0111), but has another purpose then just indexing the items within the Robotic Control Point Sequence (30xx,0F50). 4

C.AA.L1 Multi-Axial Delivery Device Module 6

The 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 8 system. This information is constant for all possible beam deliveries with this equipment.

Table C.AA.L1-1 10 MULTI-AXIAL DELIVERY DEVICE MODULE ATTRIBUTES


Source-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 Limiting Device Definition Macro' Table C.AA.2.20-1

Include 'Wedges Definition Macro' Table C.AA.2.22-1

Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1

Include 'Boluses Definition Macro' Table C.AA.2.28-1

C.AA.L2.1 Multi Axial Delivery Device Attribute Description 2

C.AA.L1.1 Source-Axis Distance

The Source Axis Distance (300A,00B4) for a Multi-Axial Delivery Device is defined with Gantry Head 4 pitch and roll rotation angles at zero degree position (see figure C.AA.L2.1.3-1).

6

C.AA.L2 Multi-Axial Beam Module

The Multi-Axial Beam Module contains a specification of how a specific Multi-Axial treatment beam is 8 to be delivered.

Table C.AA.L2-1 10 MULTI-AXIAL BEAM MODULE ATTRIBUTES



Enumerated Values:

PHOTON

ELECTRON

Gantry Head Mode (30xx,1546) 1 The Gantry Head Mode.

Defined Terms:

STATIC = no Gantry Head movement is allowed

DYNAMIC_TRACKING = Gantry Head movement is allowed, but no detailed information is provided

DYNAMIC = detailed Gantry Head movement information is provided

Include 'Beam Mode Macro' Table C.AA.2.19-1

Multi-Axial Control Point Sequence

(30xx,1500) 1 Control points used to model the beam delivery.





>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.


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.


See C.AA.2.16.1.

>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.


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 Item 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).



>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).



>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.



>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.


>>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).


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).


See C.AA.2.18.1.1.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).


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.


See C.AA.2.18.1.1.

C.AA.L2.1 Multi Axial Beam Attribute Description 2

C.AA.L2.1.1 Multi-Axial Gantry Angles

For a Multi-Axial treatment machine the Gantry Pitch Continuous Angle (30xx,51B7), Gantry Roll 4 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 6 the roll angle about the y-axis.

C.AA.L2.1.2 Gantry Head Angles 8

Gantry 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 10 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) 12 shall only serve the purpose of annotation.

C.AA.L2.1.3 Multi Axial Beam Delimiter Positions 14

For 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 16 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"). 18


Figure C.AA.L2.1.3-1 2 Multi-Axial treatment machine GANTRY HEAD system

Thus, the RT Beam Delimiter Element Positions (30xx,504A) within RT Beam Limiting Device 4 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 6 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). 8

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 10


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). 2

C.AA.M1 Enhanced RT Dose Module 4

The 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 6 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 8 instances.

Table C.AA.M1-1 10 ENHANCED RT DOSE MODULE ATTRIBUTES


Dose Type (3004,0004) 1 Type of dose.

Defined Terms:

PHYSICAL = physical dose

EFFECTIVE = 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.


>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.



Referenced Dose Calculation Description Sequence

(30xx,1135) 3 Reference to a SOP instance describing the dose calculation methods, parameters and other information used in calculation and / or modification of the dose.



Effective Dose Method Description

(30xx,1134) 2C The description of the method used to calculate the effective dose.

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.



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 data

ROI_OVERRIDE = one or more ROI (segment) densities override image or water values where they exist

WATER = entire volume treated as water equivalent

OTHER = mixed model usage (when not specified by multiple values), other or unspecified

Shall 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.



>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 Radiation Meterset (30xx,1140) and Stop Radiation Meterset (30xx,1141) within that sequence may overlap.

Required if Dose Scope (30xx,113A) is PARTIAL.


>>Start Radiation Meterset (30xx,1140) 1 The value of Cumulative Meterset at which partial delivery of the referenced Radiation SOP Instance starts.

>>Stop Radiation Meterset (30xx,1141) 1 The value of Cumulative Meterset at which partial delivery of the 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.


>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 fractions

Required, 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.



>>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


Radiation Meterset (30xx,1140) and Stop Radiation Meterset (30xx,1141) within that sequence may overlap.

Required if the Radiation Completion Status (30xx,1125) is INCOMPLETE.


>>>Start Radiation Meterset (30xx,1140) 1 The value of Cumulative Meterset at which partial delivery of the referenced Radiation SOP Instance starts.

>>>Stop Radiation 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.



>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.



>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 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.


See Section C.8.8.3.5


Referenced 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.



Referenced Annotating Object Sequence

(30xx,1146) 3 Reference to other SOP Instances that provide additional annotation to this dose object.


>Include 'Referenced Instances and Access Macro' Table 10-3b

C.AA.M1.1 Enhanced RT Dose Attribute Description 2

C.AA.M1.1.1 Dose Scope

The scope of the dose described in that module is given by the referenced SOP instances, which are 4 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 6 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 Radiation Meterset (30xx,5021) in 8 those referenced SOP instances.


C.AA.M1.1.2 Radiation Absorption Model

The multipicity of the value shall be 1 for dose objects which represent a dose having been directly 2 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. 4

C.AA.M2 RT Dose Image Module 6

The 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 8 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 10 related to CT or MR image planes.

Table C.AA.M2-1 12 RT DOSE IMAGE MODULE ATTRIBUTES


Image 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


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.


>Include 'Image SOP Instance Reference Macro' Table 10-3

C.AA.M2.1 RT Dose Image Attribute Description 2

C.AA.M2.1.1 Image Type and Frame Type

Value 1 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 1 4 shall be DERIVED.

C.AA.M2.1.1.1 Patient Examination Characteristics 6

Value 2 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 2 shall be SECONDARY. 8

C.AA.M2.1.1.2 Image Flavor

Value 3 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.3. No 10 additional requirements. The value shall be VOLUME.

C.AA.M2.1.1.3 Derived Pixel Contrast 12

Value 4 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.4. The value shall be NONE. 14

C.AA.M2.1.2 Dose Grid Geometry

If Dose Grid Geometry (30xx,1150) is NON_SHEARED, the Image Position (Patient) values of all 16 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 18 (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 20 Image Orientation (Patient) in the Shared Plane Orientation Functional Group.

C.AA.M2.1.3 Dose Grid Real World Values 22

C.AA.M2.1.3.1 Dose Grid Scaling

The real world values of the dose grid shall be derived from the stored pixel values by scaling 24 according to the Real World Intercept (0040,9224) and Real World Value Slope (0040,9225). See C.7.6.16.2.11.1.2. 26

C.AA.M2.1.3.2 Dose Grid Pixel Padding

Long Dose Grid Padding Value (0028,xxxx) is used to identify pixels for which dose grid values are 28 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: 30


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 2 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 4 within the pixel padding range shall lie outside the range between the minimum and maximum values of valid dose values in the dose grid. 6

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. 8

C.AA.M3 RT Dose Image Functional Group Macros 10

The 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 12 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 14 phrase "this frame" in the attribute description shall be interpreted to mean "for all frames".

C.AA.M3.1 RT Dose Image Frame Type Macro 16

Table C.AA.M3.1-1 specifies the attributes of the RT Dose Image Frame Type Functional Group macro. 18

Table C.AA.M3.1-1 RT DOSE IMAGE FRAME TYPE MACRO ATTRIBUTES 20


Attribute Description

RT Dose Image Frame Type Sequence

(30xx,1116) 1 Identifies the characteristics of this frame.


>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 Module 22

The 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 24 these dose histogram types may be contained within this module.

Table C.AA.M4-1 26 RT DOSE HISTOGRAM MODULE ATTRIBUTES



Dose 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.


>Dose Histogram Referenced Segment Sequence

(30xx,1203) 1 Referenced anatomies used to calculate the Dose Histogram.

See C.AA.M4.1.3.


>>Include 'Segmented Conceptual Volume Macro' Table C.AA.2.8-1

>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 histogram

Defined 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.


See C.7.6.16.2.11.1 for further explanation.


>Dose Histogram Spatial Unit Code Sequence

(30xx,1206) 1 Units of measurement for the spatial dimension of the histogram.



>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)



>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.


>>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.



C.AA.M4.1 RT Dose Histogram Attribute Description 2

C.AA.M4.1.1 Referenced Segmentation Properties Sequence

The Conceptual Volume Macro in the Dose Histogram Referenced Segment Sequence (30xx,1203) 4 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 6 RT Segment Annotation Sequence (30xx,0874) and are identified using their Conceptual Volume UIDs. 8

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. 10 Segments defined by an RT Structure Set SOP Instance shall contain only contours with a Contour Geometric Type (3006,0042) of CLOSED_PLANAR. 12

C.AA.M4.1.2 Dose Histogram Data

The RT Dose Histogram Module differs from the earlier RT DVH module in that the attribute Dose 14 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 16 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 18 (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 20 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 Sequence 22

The 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 24 Volume shall be well-defined and point to the appropriate segment as identified by the Referenced


Segment Annotation Index (30xx,0151) in the Segmented Conceptual Volume Macro (see section C.AA.2.8). 2

C.AA.M5 Dose Samples Module 4

The Dose Samples module provides for the inclusion of a list of spatial dose sample data.

Table C.AA.M5-1 6 DOSE SAMPLES MODULE ATTRIBUTES


Number 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.


See C.7.6.16.2.11.1 for further explanation.


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.


>Include 'Image SOP Instance Reference Macro' Table 10-3

8

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

C.AA.M5.1.1 Dose Samples Data 10

Dose 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. 12

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 14 sample Di , expressed in units specified by Dose Samples Dose Unit Code Sequence(30xx,1253).

16

C.AA.P1 RT Radiation Record Common Module

The RT Radiation Record Common Module contains treatment-modality independent information 18 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). 20


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. 2

Table C.AA.P1-1 RT RADIATION RECORD COMMON MODULE ATTRIBUTES 4


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 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.



Referenced 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.



Referenced 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.



Current 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:


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.


>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147015

>Machine-Specific Treatment Termination Code Sequence

(30xx,6016) 3 Machine-specific termination codes.


>>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:

ELECTRONIC

MANUAL

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.


(30xx,0141) 1 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,603C) 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 parameters that were re-specified or overridden during the administration of the Radiation immediately prior to delivery.


>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 Define new specified value for the referenced Attribute.


>Include 'Selector Attribute Macro' Table 10-20 Point to attribute in current Record IOD

>Include 'Content Item Macro' Table 10-2 Defined CID SUP147048


C.AA.P1.1 RT Radiation Record Common Attribute Description

C.AA.P1.1.1 Control Point References 2

The 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 4 the Referenced Control Point Item Index (30xx,0141), which refers to the corresponding Control Point Item Index (30xx,0111) present in the referenced RT Radiation IOD. 6

C.AA.P1.1.2 Referenced RT Patient Setup Sequence

The Referenced RT Patient Setup Sequence (30xx,0C20) references the specific RT Patient Setup 8 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 10 Patient Setup SOP instances.

C.AA.P2 RT Dose Record Common Module 12

The RT Dose Record Common module contains information about the delivered and measured dose.

Table C.AA.P2-1 14 RT DOSE RECORD COMMON MODULE ATTRIBUTES



(30xx,0B42) 1 Dose values that are delivered by this radiation.


>Radiation Dose Identification Index

(30xx,0120) 1 Index of the Radiation Dose Identification in the sequence used for internal or external references


>Radiation Dose Identification Label

(30xx,0B46) 1 User defined label for the radiation 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.



>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.


>>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.


>>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 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 gel

EPID = electronic portal imaging device

FILM = 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 Description

C.AA.P2.1.1 Conceptual Volume Sequence 2

The 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 4 segment, the segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume Combination and Segmentation Macro (see section C.AA.2.8). Alternatively, the 6 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 8 values.

10


Make the following additions to PS3.3, Annex F, Table F.4-1:

Table F.4-1 2 RELATIONSHIP 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 PRIVATE

PRIVATE F.6.1 PRIVATE, (any of the above as privately defined)

4


Add the “RADIOTHERAPY DR” box at the bottom of PS3.3, Annex F, Figure F.4-1:

2


Patient DR

Study DR

references

Image DR

RT Dose DR

0-n

1

1

1-n

Root Directory Entity

includes 1

0-n

RT Structure SetDR

RT Plan DR

RT TreatmentRecord DR

Series DR

references

1

0-n

0-n

0-n

0-n

0-n

references

Higher Level DR

Lower Level DR

references

The Higher-Level Directory Record references a Lower- Level Directory Entity that includes the Lower-Level Directory Record

Presentation DR0-nWaveform DR 0-n

SR Document DR0-n

0-n

Fiducials DR 0-n

Spectroscopy DR

Registrat ion DR0-n

0-nRaw Data DR

Hanging Protocol DR

0-n

0-n

HL7 Struc Doc DR

0-nEncapsulated

Document DR

0-nReal World

Value DR

0-n

Stereometric DR

Color PaletteDR

0-n

Radiotherapy DR 0-n

2


Add the following to PS3.3, Annex F, Section F.5.X:

2

F.5.X Radiotherapy Directory Record Definition

The Directory Record is based on the specification of Section F.3. It is identified by a Directory 4 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 6 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 8 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. 10

Table F.5-X RADIOTHERAPY KEYS 12

Key Tag Type Attribute Description

Specific 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 14 Record Key (See Table F.3-3), it is not duplicated in this list of keys.

16


Change the following in PS3.3, section C.7.5.1 General Equipment Module

2

C.7.5.1 General Equipment Module

… 4


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.

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 2

C.7.6.3 Image Pixel Module

4


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.

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.

6


Part 4 Addendum

Add the following to PS3.4, Appendix B.5, Table B.5-1 2

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.1

RT 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.3

RT 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.5.1

C-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.5.3

Multiple 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.5.5

Multi-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.6.2

C-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.6.7

RT 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.7.2

RT Dose Samples Storage 1.2.840.10008.5.1.4.1.1.481.XN.7.3

4


Add the following to PS3.4, Table I.4-1

2

Table I.4-1 Media Storage Standard SOP Classes

SOP Class Name SOP Class UID IOD Specification

RT 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


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

4


Add the following to PS3.4, Appendix Z.1.3, Table Z.1-1 2

Table Z.1-1 4

Attributes not to be Included in Instances Sent

Attribute Tag

Dose Samples Data (30xx,1251)

Dose Histogram Data (30xx,1204)

6


Part 6 Addendum

Add the following data elements to PS3.6: 2

6 REGISTRY OF DICOM DATA ELEMENTS 4

(30xx,0111) Control Point Item Index ControlPointItemIndex 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 Item Index

SubControlPointItemIndex 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 Item Index

ReferencedControlPointItemIndex US 1

(30xx,0142) Referenced Device Index ReferencedDeviceIndex 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


(30xx,02E3) Tray Water-Equivalent Thickness

TrayWaterEquivalentThickness FD 1

(30xx,0540) RT Accessory Holder Device Index

RTAccessoryHolderDeviceIndex US 1

(30xx,054A) RT Accessory Holder Device SequenceSlot ID

RTAccessoryHolderDeviceSequenceRTAccessoryHolderSlotID

STQ

1

(30xx,054B) RT Accessory Device Slot ID

RTAccessoryDeviceSlotID ST 1

(30xx,054C) Device Description DeviceDescription ST 1

(30xx,054D) Device Identifier DeviceIdentifier LO 1

(30xx,0800) RT Course Creation DateTime

RTCourseCreationDateTime DT 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

(30xx,0860) Physician Intent Prescription Sequence

PhysicianIntentPrescriptionSequence SQ 1

(30xx,0864) Referenced Physician Intent Sequence

ReferencedPhysicianIntentSequence SQ 1

(30xx,0866) Referenced Intent Prescription Status Sequence

ReferencedIntentPrescriptionStatusSequence

SQ 1

(30xx,0870) Treatment Phase Reference Sequence

TreatmentPhaseReferenceSequence 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

TemporalRelationship IntervalAnchor 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 Code Sequence

PretreatmentRTRadiationSetRoleCodeSequence

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 Status Sequence

TreatmentRTRadiationSetStatusSequence

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

(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 Role

PrescriptionAnatomyRole 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) Fractionation Relationship Sequence

FractionationRelationshipSequence SQ 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

(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) Device Model UID DeviceModelUID 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 Mode Sequence

TreatmentMachineModeSequence 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,1020) Tomotherapeutic Leaf Bank Position Sequence

TomotherapeuticLeafBankPositionSequence

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

(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 Description Sequence

ReferencedDoseCalculationDescriptionSequence

SQ 1

(30xx,1136) Dose Purpose DosePurpose CS 1

(30xx,1137) Effective Dose Method Modifier Code Sequence

EffectiveDoseMethodModifierCodeSequence

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 Radiation Meterset StartRadiationMeterset FD 1

(30xx,1141) Stop Radiation Meterset StopRadiationMeterset 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 FlagIndicator

ConceptualVolumeCombinationFlagIndicator

CS 1

(30xx,1310) Conceptual Volume Combination Description

ConceptualVolumeCombinationDescription

ST 1

(30xx,1311) Conceptual Volume Segmentation Defined

ConceptualVolumeSegmentationDefined

CS 1

(30xx,1312) Conceptual Volume Segmentation Reference Sequence

ConceptualVolumeSegmentationReferenceSequence

SQ 1

(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 IdentifierHospital Specific Accessory Code

DeviceAlternateIdentifierHospitalSpecificAccessoryCode

LO 1

(30xx,1327) Device Alternate Identifier Type

DeviceAlternateIdentifierType CS 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 Radiation Meterset

CumulativeRadiationMeterset FD 1

(30xx,5023) Primary Meterset Rate PrimaryMetersetRate FD 1

(30xx,5024) Primary Meterset Rate Unit Sequence

PrimaryMetersetRateUnitSequence SQ 1

(30xx,5025) Device Label DeviceLabel LO 1

(30xx,5026) Device Component Type Subtype Code Sequence

DeviceComponentSubtTypeCodeSequence

SQ 1

(30xx,5028) Treatment Position Sequence

TreatmentPositionSequence SQ 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,504F) RT Beam Limiting Device Distance

RTBeamLimitingDeviceDistance FD 2

(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) Primary Radiation Dosimeter Unit

PrimaryRadiationDosimeterUnit 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,5148) Tray Distance TrayDistance FD 1

(30xx,5150) Compensator Definition Sequence

CompensatorDefinitionSequence SQ 1

(30xx,5151) Compensator Transmission Map

CompensatorTransmissionMap OF 1-n

(30xx,5152) Compensator Thickness Map

CompensatorThicknessMap OF 1-n

(30xx,5153) Compensator Distance Map

CompensatorDistanceMap OF 1-n

(30xx,5160) Block Definition Sequence BlockDefinitionSequence SQ 1


(30xx,5161) Block Edge Data BlockEdgeData OF 1-n

(30xx,5170) Accessory Holder Definition Sequence

AccessoryHolderDefinitionSequence SQ 1

(30xx,5180) General Accessory Definition Sequence

GeneralAccessoryDefinitionSequence SQ 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,51CA) Nominal Reference Energy

NominalReferenceEnergy 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,51F2) Patient Setup Technique Sequence

PatientSetupTechniqueSequence SQ 1

(30xx,51F3) Patient Setup Fixation Device Sequence

PatientSetupFixationDeviceSequence SQ 1


(30xx,51F4) Patient Setup Fixation Parameter Sequence

PatientSetupFixationParameterSequence

SQ 1

(30xx,51F5) Patient Setup Shielding Device Sequence

PatientSetupShieldingDeviceSequence SQ 1

(30xx,51F6) Additional Patient Setup Procedure Sequence

AdditionalPatientSetupProcedureSequence

SQ 1

(30xx,51F8) Additional Setup Device Sequence

AdditionalSetupDeviceSequence SQ 1

(30xx,51F9) Additional Patient Setup Parameter Sequence

AdditionalPatientSetupParameterSequence

SQ 1

(30xx,5200) Outline Shape Type OutlineShapeType CS 1

(30xx,5201) Outline Symmetry OutlineSymmetry 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 Distance OutlineDefinitionDistance 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,603A) Treatment Control Point Start DateTime

TreatmentControlPointStartDateTime DT 1

(30xx,603C) Treatment Control Point End DateTime

TreatmentControlPointEndDateTime DT 1

(30xx,603E) Alternate Specified Value Sequence

AlternateSpecifiedValueSequence 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,6046) Patient Support Position Sequence

PatientSupportPositionSequence SQ 1

(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

2


Add the following to PS3.6 Annex A:

2

ANNEX A REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)

Table A-1 4 UID VALUES

6

UID Value UID NAME UID TYPE Part

1.2.840.10008.5.1.4.1.1.481.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 3.4

1.2.840.10008.5.1.4.1.1.481.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


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


1.2.840.10008.1.XN.1 IEC FIXED Reference System Frame of Reference

Well-known frame of reference

PS 3.3

2


Add the following data elements to PS3.6, Annex A:

Table A-3 2 CONTEXT 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.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 Roles

1.2.840.10008.6.1.FFF.19

SUP147019 RT Segment Annotation

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


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 Holder Device Types

1.2.840.10008.6.1.FFF.34

SUP147034 Radiotherapy Dose Real World Units

1.2.840.10008.6.1.FFF.35

SUP147035 Effective Dose Method Code Definition

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.41

SUP147040 Segemented Rt Accessory Devices

1.2.840.10008.6.1.FFF.42

SUP147041 Dose Algorithm Class

1.2.840.10008.6.1.FFF.43

SUP147042 Energy Unit

1.2.840.10008.6.1.FFF.44

SUP147043 RT Item States

1.2.840.10008.6.1.FFF.45

SUP147044 RT Operation States

1.2.840.10008.6.1.FFF.46

SUP147045 Multiple Fixed Sources Procedure Techniques

1.2.840.10008.6.1.FFF.47

SUP147046 Robotic Procedure Techniques

1.2.840.10008.6.1.FFF.48

SUP147047 Radiotherapy Procedure Techniques

1.2.840.10008.6.1.FFF.49

SUP147048 Revised value

1.2.840.10008.6.1.FFF.50

SUP147049 Radiotherapy General Workitem Definition

1.2.840.10008.6.1.FFF.51

SUP147050 Beam Mode Type Definition

1.2.840.10008.6.1.FFF.5 SUP147051 Primary Meterset Rate Unit Definition


2

1.2.840.10008.6.1.FFF.53

SUP147052 Radiation Particle

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

2


Part 16 Addendum 2

Add the following workitem codes to CID 9231 of PS3.16, Annex B:

4

CID 9231 GENERAL PURPOSE WORKITEM DEFINITION

Context ID 9231 6

General Purpose Workitem Definition

Type: Extensible Version: yyyymmdd 8




99SUP147 110014 Registration

99SUP147 110015 Segmentation

10


Add the following new CIDs to PS3.16, Annex B:

2

CID SUP147001 DOSIMETRIC OBJECTIVE VALUE TYPES

Context ID SUP147001 4

Dose Objective Value Types


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

Include CID SUP147060 Single Dose-related Dosimetric Objectives

Include CID SUP147061 Percentage and Dose-related Dosimetric Objectives

Include CID SUP147062 Volume and Dose-related Dosimetric Objectives

Include CID SUP147063 Dimensionless and Dose-related Dosimetric Objectives

Include CID SUP147064 Coded Dosimetric Objectives

CID SUP147002 PRESCRIPTION ANATOMY CATEGORIES 8

Context ID SUP147002

Prescription Anatomy Categories 10

Type: Extensible Version: yyyymmdd

Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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

12

CID SUP147003 RADIOTHERAPY SEGMENT CATEGORIES


Radiotherapy Segment Categories



Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

INCLUDE CID SUP147002 Prescription Anatomy Categories

99SUP147 S147053 RT Geometrical Information

99SUP147 S147054 Fixation or Positioning Device

99SUP147 S147055 Internal Brachytherapy Device

CID SUP147004 RADIOTHERAPY TARGETS 2


Radiotherapy Targets 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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

6

CID SUP147005 RT GEOMETRIC INFORMATION


RT Geometric Information



Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147100 Patient Setup Point

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 S147106 Planning Treatment Point

99SUP147 S147107 Treatment Point

99SUP147 S147108 Planning Target Point

99SUP147 S147109 Target Point

99SUP147 S147110 External Marker

99SUP147 S147111 Internal Marker

CID SUP147006 FIXATION OR POSITIONING DEVICES 2


Fixation or Positioning Devices 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

Include CID SUP147022 Fixation Device Type Identifiers

Include CID SUP147025 RT Patient Support Devices

6

CID SUP147007 BRACHYTHERAPY DEVICES


Brachytherapy Devices


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147130 Brachytherapy accessory device

99SUP147 S147131 Brachytherapy source applicator

99SUP147 S147132 Brachytherapy channel shield


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147133 Brachytherapy channel

CID SUP147009 SEGMENTATION COMBINATION 2


Segmentation Combination 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147145 Combination

6

CID SUP147010 BEAM LIMITING DEVICE TYPES


Beam Limiting Device Types

Type: Non-Extensible Version: yyyymmdd 10

Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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 12


Radiotherapy Robotic Paths 14



Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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

99SUP147 S147208 Trigeminal

CID SUP147012 GENERAL EXTERNAL RADIOTHERAPY PROCEDURE TECHNIQUES 2


General External Radiotherapy Procedure Techniques 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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

6

CID SUP147013 TOMOTHERAPEUTIC RADIOTHERAPY PROCEDURE TECHNIQUES


Tomotherapeutic Radiotherapy Procedure Techniques


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147240 Helical Beam


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147241 Topographic Beam

CID SUP147014 TREATMENT RT RADIATION SET ALTERATION TYPES 2


Treatment RT Radiation Set Alteration Types 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147250 Collimator Change

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

6

CID SUP147015 TREATMENT TERMINATION REASONS


Treatment Termination Reasons


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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


Compensator Device Types


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147270 Standard Compensator

CID SUP147017 RADIOTHERAPY TREATMENT MACHINE MODES 6


Radiotherapy Treatment Machine Modes 8


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147280 Normal

99SUP147 S147281 Total Body Irradiation

99SUP147 S147282 High Dose Rate

10

CID SUP147018 PRE-TREATMENT RT RADIATION SET ROLES


Pre-Treatment RT Radiation Set Roles


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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


Instance Reference Purposes


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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

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 6


Patient Setup Techniques 8





99SUP147 S147330 Isocentric

99SUP147 S147331 Fixed SSD


99SUP147 S147332 Fixed Midline Distance

CID SUP147022 FIXATION DEVICE TYPES 2


Fixation Device Types 4





99SUP147 S147340 Biteblock

99SUP147 S147341 Headframe

99SUP147 S147342 Head Mask

99SUP147 S147343 Head and Neck Mask

99SUP147 S147344 Mold

99SUP147 S147345 Cast

99SUP147 S147346 Headrest

99SUP147 S147347 Breast Board

99SUP147 S147348 Body Frame

99SUP147 S147349 Vacuum Mold

99SUP147 S147350 Whole Body Pod

99SUP147 S147351 Rectal Balloon

99SUP147 S147352 Head Ring

6

CID SUP147023 SHIELDING DEVICE TYPES


Shielding Device Types





99SUP147 S147380 Gum Shielding

99SUP147 S147381 Eye Shielding

99SUP147 S147382 Gonad Shielding

CID SUP147024 SETUP DEVICES 12


Setup Devices 14






99SUP147 S147400 Laser Pointer

99SUP147 S147401 Distance Meter

99SUP147 S147402 Table Height

99SUP147 S147403 Mechanical Pointer

99SUP147 S147404 Arc

2

CID SUP147025 RT PATIENT SUPPORT DEVICES

Context ID SUP 147025 4

RT Patient Support Devices





SRT A-17350 Table

99SUP147 S147411 Chair

CID SUP147026 DOSE STATISTICS 8

Context ID SUP 147026

Dose Statistics 10





99SUP147 S147420 Maximum Dose

99SUP147 S147421 Minimum Dose

99SUP147 S147422 Median Dose

99SUP147 S147423 Mean Dose

99SUP147 S147424 Dose Standard Deviation

12

CID SUP147027 FIXED BEAM LIMITING DEVICE TYPES


Fixed Beam Limiting Device Types



Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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 2


Radiotherapy Wedge Types 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147440 Hard Wedge

99SUP147 S147441 Motorized Wedge

99SUP147 S147442 Dynamic Wedge

6

CID SUP147030 GENERAL ACCESSORY DEVICE TYPES


General Accessory Device Types


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147451 Graticule

99SUP147 S147452 Reticule

99SUP147 S147453 Image Detector

99SUP147 S147454 Film Holder

99SUP147 S147455 Winston-Lutz Pointer

99SUP147 S147456 Bowtie Filter


CID SUP147031 RADIOTHERAPY BOLUS DEVICE TYPES


Radiotherapy Bolus Device Types


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147460 Bolus

CID SUP147032 RADIOTHERAPY BLOCK DEVICE TYPES 6


Radiotherapy Block Device Types 8


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147470 Shielding Block

99SUP147 S147471 Aperture Block

10

CID SUP147033 RADIOTHERAPY ACCESSORY HOLDER DEVICE TYPES


Radiotherapy Accessory Holder Device Types


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147480 Tray

99SUP147 S147481 Applicator

CID SUP147034 RADIOTHERAPY DOSE REAL WORLD UNITS 16


Radiotherapy Dose Real World Units 18

Type: Non-Extensible Version: yyyymmdd


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

UCUM Gy Gray

CID SUP147035 EFFECTIVE DOSE METHOD CODE DEFINITION 2


Effective Dose Method Definition 4





99SUP147 S147580 LET-based method.

99SUP147 S147581 Fractionation-based or temporally-based method

6

CID SUP147037 DOSE DATA SOURCE MEASUREMENT DEFINITION


Dose Data Source Measurement Definition





99SUP147 S147530 Film

99SUP147 S147531 3D Gel

99SUP147 S147532 Diode Array

99SUP147 S147533 Ion Chamber Array

99SUP147 S147534 TLD

99SUP147 S147535 Diode

99SUP147 S147536 Liquid Ion Chamber

99SUP147 S147537 MOSFET

99SUP147 S147538 OSLD

99SUP147 S147539 Ion Chamber

99SUP147 S147540 EPID

99SUP147 S147541 Diamond Detector


CID SUP147039 DOSE HISTOGRAM SPATIAL UNIT DEFINITION


Dose Histogram Spatial Unit Definition





UCUM cm2 Square centimeter

UCUM 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 6 brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.

8

CID SUP147040 SEGMENTED RT ACCESSORY DEVICES


Segmented RT Accessory Devices


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

Include CID SUP147022 Fixation Device Types

Include CID SUP147007 Brachytherapy Devices

Include CID SUP147025 RT Patient Support Devices

Include CID SUP147031 Radiotherapy Bolus Device Types

Include CID SUP147032 Radiotherapy Block Device Types

CID SUP147041 DOSE ALGORITHM CLASS 14


Dose algorithm class 16


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

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 2


Energy Unit 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

UCUM MV Mega-volt

UCUM MeV Mega-electronvolt

UCUM kV Kilo-volt

6

CID SUP147043 RT ITEM STATES


RT Item States


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147650 Created

99SUP147 S147651 Reviewed

99SUP147 S147652 Approved


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147653 Rejected

99SUP147 S147654 Demoted

CID SUP147044 RT OPERATION STATES 2


RT Operation States 4


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147680 New

99SUP147 S147681 In Preparation

99SUP147 S147682 Ready

99SUP147 S147683 In Progress

99SUP147 S147685 Suspended

99SUP147 S147686 Discontinued

99SUP147 S147687 Completed

6

CID SUP147045 MULTI-SOURCE RADIATION TECHNIQUE


Multi-Source Radiation Technique


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147900 Multiple Fixed Sources


CID SUP147046 ROBOTIC RADIATION TECHNIQUE


Robotic Radiation Technique


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

99SUP147 S147910 Synchrony

99SUP147 S147911 Non-Synchrony

CID SUP147047 RADIOTHERAPY PROCEDURE TECHNIQUES 6


Radiotherapy Procedure Techniques 8


Coding Scheme

Designator

(0008,0102)

Code Value

(0008,0100)

Code Meaning

(0008,0104)

Include CID SUP147012 General External Radiotherapy Procedure Techniques

Include CID SUP147013 Tomotherapeutic Radiotherapy Procedure Techniques

Include CID SUP147045 Multiple Fixed Sources Procedure Techniques

Include CID SUP147046 Robotic Procedure Techniques

10

CID SUP147048 REVISED VALUE


Revised value





99SUP147 S147710 Revised Value

CID SUP147049 RADIOTHERAPY GENERAL WORKITEM DEFINITION 16



Radiotherapy General Workitem Definition





99SUP147 121731 RT Prescription

99SUP147 121732 RT Simulation

99SUP147 121733 RT Forward Planning

99SUP147 121734 RT Inverse Planning

99SUP147 121735 RT Dose Computation

99SUP147 121736 RT Plan Review

99SUP147 121737 RT Delivery Review

CID SUP147050 BEAM MODE TYPE DEFINITION 4


Beam Mode Type Definition 6





99SUP147 S147560 Flattening Filter Beam

99SUP147 S147561 No Flattening Filter Beam

99SUP147 S147562 Partial Flattening Filter Beam

8

CID SUP147051 PRIMARY METERSET RATE UNIT DEFINITION


Primary Meterset Rate Unit Definition





99SUP147 S147570 Gy / Seconds

CID SUP147052 RADIATION PARTICLE 14


Radiation Particle 16






99SUP147 S147950 Photon

99SUP147 S147951 Electron

99SUP147 S147952 Proton

99SUP147 S147953 Carbon nucleus

99SUP147 S147954 Neutron

2

CID SUP147060 SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES


Single Dose-related Dosimetric Objectives





99SUP147 S147001 Minimum Surface Dose

99SUP147 S147002 Maximum Surface Dose

99SUP147 S147003 Minimum Dose

99SUP147 S147004 Maximum Dose

99SUP147 S147005 Minimum Mean Dose

99SUP147 S147006 Maximum Mean Dose

99SUP147 S147007 Minimum Equivalent Uniform Dose

99SUP147 S147008 Maximum Equivalent Uniform Dose

99SUP147 S147009 Prescription Dose

CID SUP147061 PERCENTAGE AND DOSE-RELATED DOSIMETRIC OBJECTIVES 8


Percentage and Dose-related Dosimetric Objectives 10





99SUP147 S147014 Minimum Percent Volume at Dose

99SUP147 S147015 Maximum Percent Volume at Dose

12


CID SUP147062 VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES


Volume and Dose-related Dosimetric Objectives





99SUP147 S147016 Minimum Absolute Volume at Dose

99SUP147 S147017 Maximum Absolute Volume at Dose

CID SUP147063 DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES 6


Dimensionless and Dose-related Dosimetric Objectives 8





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)

10

Note 1: These following dosimetric indices are defined by reference to Feuvret et al, (IJROBP 64(2):333-342, 2006): 12

Dosimeter Index Description in Feuvret et al, page 335

Minimum Conformity Index Conformity IndexRTOG

Minimum Healthy Tissue Conformity Index Healthy Tissue Conformity Index

Minimum Conformation Number Conformation Number (CN)

Maximum Homogeneity Index Homogeneity Index

CID SUP147064 CODED DOSIMETRIC OBJECTIVES 14


Coded Dosimetric Objectives 16






99SUP147 S147018 Minimize MeterSet


Rename the following definitions of existing CIDs of PS3.16, Annex B: 2

CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition

Context ID 9241 4

Radiotherapy General Treatment Workitem Definition

Correct cases of the following definitions of existing CIDs of PS3.16, Annex B: 6

CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition 8

CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition

10


Add the following workitem codes to CID 9231 of PS3.16, Annex C: 2

ANNEX C ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE)

TID SUP147001 RT PRESCRIPTION ANNOTATION 4

TID SUP147001 RT Prescription Annotation 6

Type: Extensible Order: Non-Significant

8

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

10


Add the following templates to PS3.16, Annex A:

2

TID SUP147003 RT SEGMENT ANNOTATION PROPERTIES

TID SUP147003 4 RT Segment Annotation Properties

Type: Extensible Order: Non-Significant 6

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")

8

TID SUP147004 PATIENT SUPPORT POSITION PARAMETERS

TID SUP147004 10 Patient Support Position Parameters

Type: Extensible Order: Non-Significant 12


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 ")


2


Add the following to the table in PS3.16, Annex D: 2

ANNEX D DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE) 4

Code Value Code Meaning Definition Notes

121731 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



S147004 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



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 radiation

S147031 Beam Shaping Means Description of the devices and techniques used to shape the radiation beam

S147032 Planning Advice Note Advice for the planning process

S147033 Special Procedure Note Notes on special procedures

S147034 Patient Positioning Note Notes on patient positioning

S147035 Motion Compensation Note

Notes on motion compensation

S147036 Patient Setup Note Notes on patient setup

S147037 Previous Radiation Note Notes on any previous radiation

S147038 Planning Imaging Note Notes on imaging obtained or required for planning

S147039 Delivery Verification Note Notes on how delivery is to be verified

S147040 Simulation Notes Notes on simluation procedures

S147041 Radiation Type The type of Radiation intended to be used for the Radiotherapy Treatment

S147042 Radiation Energy The Energy of Radiation intended to be used for the Radiotherapy Treatment

S147043 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.



S147054 Fixation or Positioning Device

Device 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 Volume

S147076 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.



S147081 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.

S147106 Planning Treatment Point Point at which the patient is planned to be positioned for treatment.

S147107 Treatment Point Point at which the patient is positioned during treatment.

S147108 Planning Target Point Point at which the center of the beam-line is planned to target.

S147109 Target Point Point at which the center of the beam-line targets during treatment.

S147110 External Marker External markers such as tattoos or adhesive metal spheres (‘BB’s)

S147111 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.



S147151 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 Power

Ratio 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 Factor

High 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 direction

S147171 Y Jaw An adjustable jaw pair in the Y direction

S147172 X Leaves An adjustable multi-element jaw pair in X direction

S147173 Y Leaves An adjustable multi-element jaw pair in Y direction

S147174 Variable Circular Collimator

A 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 body

S147202 Even Paths Head The robotic path even paths head

S147203 Even Paths Body The robotic path one path body

S147204 Short Paths Head The robotic path short paths head

S147205 Short Path Body The robotic path short path body

S147206 Prostate The robotic path prostate

S147207 Prostate Short The robotic path prostate short

S147208 Trigeminal The robotic path trigeminal

S147221 Static Beam Annotates a beam in which the beam field shape or position does not change during delivery.



S147225 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



S147257 Compensator Change The plan has been modified by using a different compensator

S147258 Other Beam Modifier Change

The 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 continue

S147261 Patient Mortality Patient deceased

S147262 General Machine Interlock

Machine exception condition detected, stopping delivery

S147263 Patient Support Interlock Patient support exception condition detected, stopping delivery

S147264 Patient Choice Patient chose to discontinue treatment

S147270 Compensator External beam compensator

S147280 Normal ’Normal’ radiation delivery (‘normal’ mode)

S147281 Total Body Irradiation Total-body irradiation treatment mode

S147282 High Dose Rate High dose rate treatment mode

S147290 Dosimetric Annotates that a referenced RT Radiation Set included in a Meta Radiation Set was created to serve the purpose 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 referenced RT Radiation Set included in a Meta Radiation Set was used in simulate the patient treatment at a convention simulator device.

S147292 Virtual Simulation Annotates that a referenced RT Radiation Set included in a Meta Radiation Set was 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 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.



S147294 Plan QA Annotates that a referenced RT Radiation Set included in a Meta Radiation Set was 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 forthe 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.



S147341 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 Mold

S147345 Cast Cast

S147346 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 head

S147380 Gum Shielding Type of device shielding the gum

S147381 Eye Shielding Type of device shielding the eye



S147382 Gonad Shielding Type of device shielding the gonad

S147400 Laser Pointer Laser position indicator

S147401 Distance Meter Optical (visual) distance indicator

S147402 Table Height Recorded table height

S147403 Mechanical Pointer Mechanical front pointer

S147404 Arc Arc shaped device for mechanical position indication

S147405 Film A Port Film taken using a film cassette (rather than an EPID device)

S147410 Table ‘Table-like’ support device

S147411 Chair ‘Chair-like’ support device

S147420 Maximum Dose Maximum dose to any point in the anatomical reference

S147421 Minimum Dose Maximum dose to any point in the anatomical reference

S147422 Median Dose Median of dose to the anatomical reference

S147423 Mean Dose Mean of dose to the anatomical reference

S147424 Dose Standard Deviation Standard deviation of dose to the anatomical reference

S147431 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.



S147441 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 grid

S147452 Reticule Mechanical crosshair

S147453 Image Detector A electronic imaging device

S147454 Film Holder Mechanical device to hold imaging film

S147455 Winston-Lutz Pointer A spherical mechanical indicator used for alignment

S147456 Bowtie Filter A bowtie filter used in kV imaging to account for patient shape

S147460 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



S147491 Flattening Filter Free Mode

Flattening 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.



S147540 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 flattening filter to produce a nearly uniform intensity profile.

S147561 No Flattening Filter Beam Beam that does not use a flattening filter.

S147562 Partial Flattening Filter Beam

Beam that uses a filter to produce a nearly uniform region across part of the intensity profile.

S147570 Seconds / Gy Time in seconds needed to apply a reference dose of 1 Gy,

S147580 LET-based An 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]

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.

S147650 Created No review or approval has been performed.

S147651 Reviewed Reviewer recorded that he has reviewed the item, but not yet finally approved it.

S147652 Approved Reviewer recorded that the item met an implied criterion.

S147653 Rejected Reviewer recorded that item failed to meet an implied criterion.



S147654 Demoted An review or approval state has been demoted to a non-qualified state.

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 algorithm

S147702 Monte Carlo A Monte Carlo based algorithm

S147703 Convolution A convolution based algorithm

S147704 Superposition A superposition based algorithm

S147705 Pencil Beam A pencil-beam based algorithm

S147706 Transport Equation An algorithm based on diffusion or other transport mechanism

S147707 Measurement-based An empirical algorithm based on physical measurements

S147708 Clarkson A scatter-summation method using Clarkson integration

S147710 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 breathing

S147731 Non-Synchrony Non synchronized

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 use



S147823 Volumetric Dose for Radiation Set

A 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 Histogram

S147827 Dose Sample A collection of calculated Dose Sample Points

S147828 Segmentation Properties used in Planning

Segmentation 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.

S147833 Image used as Reference Image for Treatment

Images, 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

S147900 Multiple Fixed Sources Multiple Fixed Sources

S147910 Synchrony Synchrony Treatment Technique on a Robotic Treatment Device

S147911 Non-Synchrony Non-Synchrony Treatment Technique on a Robotic Treatment Device

S147950 Photon Photon

S147951 Electron Electron

S147952 Proton Proton

S147953 Carbon Carbon nucleus

S147954 Neutron Neutron

2


Part 17 Addendum 2

Add the following to PS3.17:

4

Annex Z Second Generation RT (Informative)

ZZ.1 INTRODUCTION 6

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 8 objects.

The main clinical purposes of the relationships amongst the important IODs are show in the following 10 diagram:


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

2


Figure ZZ.1-1 Relationship between important IODs 2

The fundamental relationships between the entities are shown in the following diagram: 4

6

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


Figure ZZ.1-2 Fundamental Entity Relationships 2

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. 4


ZZ.2 ENTITY DESCRIPTIONS

The following entities are modeled: 2

ZZ.2.1 RT Course

A top-level entity that describes a given treatment course. All relevant objects are referenced, 4 including acquisition images, registrations, segmentations, physician intent, beam sets, reference and verification imaging, and output records. In particular, all information relating to the current 6 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 8 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 10 used to achieve the dosimetric objectives of the phase). 12 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 14 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 16 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. 18 The DICOM Standard does not specify how a given radiotherapy course is mapped onto the DICOM 20 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 22 radiotherapy systems for the purpose of addressing a particular course of treatment, however such a mapping is not mandated. 24


Figure ZZ.2.1-1 2 RT Course IOD

The following diagram shows the referencing indeces used within the RT Course referenceing RT 4 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

RT Treatment Phase Module

Treatment Phase Index

Referenced Treatment Phase Index

6


Figure ZZ.2.1-2 Relationships in RT Course IOD using Indexes 2

ZZ.2.2 RT Physician Intent 4

Describes 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 6 here. Items in the RT Physician Intent can include

use of external therapy or brachytherapy, 8

total and fractional dose,

fractionation scheme, 10

treatment sites,

treatment target volume names, 12

constructive solid geometry of targets and critical structures,

field/MLC margins to be used (in case of 3D Conformal RT), 14

dosimetric objectives (dose constraints for targets, organs at risk and normal tissue),

beam energy, 16

use of dose optimization and IMRT,

use of motion management (e.g. gated treatment, tracking etc.), 18

patient setup to be used including immobilization,

image set(s) used for treatment planning, 20

type of image-guided patient setup/treatment delivery (e.g. daily 3D CT, radiographic, fluoroscopic, ultrasound, etc.). 22

There is also a location where the physician can enter details of dose from previous treatments.

24



Physician Intent Predecessor Sequence

RT Physician Intent SOP Instance

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

Treatment Phase Index

RT Dose SOP Instance

OR

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

2

Figure ZZ.2.2-1 Physician Intent IOD 4


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

2

Figure ZZ.2.2-2 Concepatual Volumes 4


ZZ.2.3 RT Segment Annotation

Describes the clinical segmentation types (e.g. clinical target volume, organ at risk, bolus), density 2 overrides, and other RT-specific ROI properties.

RT Segment Annotation IOD

Purpose of Alternate

Segmented Property Type

Code Seq.

RT Segment Annotation Module

Segment Sequence


here.

Segmented Property

Type Code Sequence

Alternate Segmented

Property Type Code Seq.

Segmented Property

Category Code Sequence

Segmented RT Accessory

Device Sequence

Segment Properties Sequence

Segment Properties Modifier

Sequence

Combination Segment Reference Sequence

Direct Segment Reference Sequence

Segmentation SOP Instance Reference Sequence

See Diagram B of RT Physician’s Intent

See Diagram B of RT Physician’s Intent

– Specifically the Originating SOP

Instance Sequence and the Equivalent

Conceptual Volumes Sequence

RT SOP Instance

Reference to the SOP Instance that is augmented by this RT Segment Annotation instance

4

Figure ZZ.2.3-1 6 RT Segment annotation IOD

8

ZZ.2.4 RT Radiation Set

Describes a set of beams and/or catheters being used within a treatment session to help achieve the 10 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 12 Radiation Sets may be required each time adaptive therapy is used to attempt to maintain a phase prescription. 14



RT Radiation Set Module

(Includes Intent, Number of Fractions)

RT Dose Contribution Module


here.


Radiation Dose Sequence

Radiation Dose Values Sequence

Radiation Verification Control Point

Sequence

Conceptual Volume Sequence

See Diagram B in RT Physician’s Intent

Radiation Sequence

Radiation Dose In Vivo Measurement

Sequence

RT Radiation SOP Instance(can be one of…)

Tomotherapeutic Radiation SOP Instance

C-Arm Photon Radiation SOP Instance

C-Arm Electron Radiation SOP Instance

Multiple Fixed Source Radiation SOP Instance

Robotic Radiation SOP Instance

Multi-Axial Radiation SOP Instance

Meterset to Dose Mapping Sequence

Fraction Pattern Sequence

2

Figure ZZ.2.4-1 RT Radiation Set IOD 4

A new concept of meta-classes is modeled. Their content is inherent to all members of a such a 6 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. 8

ZZ.2.5 RT Radiation

A conceptual metaclass representing a means of administering a quantity of radiation generated by a 10 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> 12 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 14 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 16 computed based upon the planned treatment versus delivered treatment. An <RT Radiation> may be used for the purposes dosimetric verification or therapeutic treatment. 18 Specific IODs that are members of this Meta-SOP Class include C-Arm Photon Radiation, Tomotherapeutic Radiation, etc. 20


ZZ.2.6 RT Dose Image

Describes a representation of 3D dose distributions using the multi-frame and functional group 2 paradigms.

4

RT Dose Image IOD

Frame of ReferenceMulti-frame Functional Groups

Synchronization

Multi-frame DimensionImage 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

6

Figure ZZ.2.6-1 RT Dose Image IOD 8


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

2

Figure ZZ.2.6-2 Enhanced RT Dose IOD 4

ZZ.2.7 RT Dose Histogram 6

Describes a representation for dose-volume histogram data.


2

Figure ZZ.2.7-1 RT Dose Histogram IOD 4

ZZ.2.8 RT Dose Samples 6

Describes a representation for dose point data.


RT Dose Samples IOD

Frame of Reference

Synchronization


Acquisition Context

Enhanced RT Dose

Acquisition Context Sequence

See Figure ZZ.2.6-2 for details on the Enhanced RT Dose Module

Dose Samples

Dose Samples Dose Unit Code Sequence

Source Image Sequence

RT Image SOP Instance

2

Figure ZZ.2.8-1 RT Dose Samples IOD 4

ZZ.2.9 RT Radiation Record 6

A 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 8 Radiation, etc.

10

12


ZZ.3 NOTES ON RT COURSE

ZZ.3.1 Introduction 2

The 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 4 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 6 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 8 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 10 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 12 suggest any specific approaches.

The RT Course IOD represents the actual state of a treatment and links together the different RT 14 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 16 accomplished by providing data structures to reference the relevant SOP Instances and indicate their status and their progress in the treatment process. 18

These component IODs have been designed to represent smaller units of information as compared with the first-generation DICOM. 20

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 22 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 24 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 26 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 28 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 30 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. 32

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 34 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 36 course, the latest SOP Instance is always sufficient.

ZZ.3.2 Evolution of an RT Course SOP Instance 38

In 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 40 intent.

Further on an RT Course SOP Instance has the capability to describe the treatment phases 42 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, 44 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 46 the course.


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. 2

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, 4 i.e. whether radiation sets have been derived from other radiation sets, which collections of radiation sets are grouped for dose summation, etc. 6

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 8 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 10 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 12 needed. Previous versions referenced in an RT Course SOP Instance do however allow tracing of the evolution of the current course definition. 14

ZZ.3.3 Elements of the RT Course

ZZ.3.3.1. Physician Intent 16

A 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 18 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 20 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 22 planning and simulation with the nomenclature and detail level as prescribed by the operating procedures in the department. 24

ZZ.3.3.2. Treatment Phase

Today’s radiotherapy treatments are increasingly complex. To support sequences of various 26 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 28 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 30 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 32 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) 34 are supported by the treatment phase sequence.

ZZ.3.3.3. Radiation Sets 36

The 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 38 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 40 repeatedly. A new treatment series (or another treatment phase, like a boost treatment etc.) is represented by one or more new radiation sets. 42

Relations between radiation sets are not handled within the radiation set IODs itself, but in the RT Course IOD as follows: 44

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 46


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. 2

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 4 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 6 distribution. Any change which lies beyond this scope, for example re-planning, is typically handled on a treatment phase level. 8

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 10 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. 12

ZZ.3.3.4 Clinical State Information

The RT SOP Classes handled in the RT Course exist in various states during the clinical process. 14 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, 16 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. 18

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: 20

Clinical states are used to denote the clinical state in the decision process about the maturity and applicability of a SOP Instance. 22

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. 24


ZZ.4 NOTES ON SECOND-GENERATION IODS

ZZ.4.1 RT Radiation Set IOD 2

ZZ.4.1.1 General Notes

The RT Radiation Set represents a fractionation and a set of external beams or brachytherapy 4 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 6 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. 8

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 10 patient.

The methods of defining, verifying and correcting the position of the patient as well as attributes 12 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 14 requires a new radiation set to be created.

ZZ.4.1.2. Fractionation 16

Fractionation 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 fractionation pattern to be delivered, i.e. 18 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 20 for the scheduler.

ZZ.4.1.2. Meterset and other parameters resolution 22

It is strongly recommended that the specified Cumulative Radiation Meterset and other machine parameters match the resolution as expected by the Radiation Device to deliver the radiation. If the 24 calculation for Meterset results in a meterset value which is not an exact multiple of the primary meterset resolution, the result should be rounded to the nearest allowed meterset value. 26

ZZ.4.2 RT Radiation IODs

ZZ.4.2.1 Control Points 28

The 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 30 differenct characteristics of Control Points in different treatment devices, concrete definitions of Control Points will be device-specific. Examples are the Tomotherapeutic Control Point Sequence 32 (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. 34

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. 36

ZZ.4.2.2 Sub-Control Points

Due to additional requirements of some treatment techniques a new level below the Control Points is 38 introduced, called Sub-Control Point. The base concept is the same for the Control Point level.

ZZ.4.3 RT Segment Annotation IOD 40

ZZ.4.3.1 Conceptual Volume

The term Conceptual Volume refers to an abstract spatial entity used in radiation therapy (or 42 elsewhere) to identify the region of a patient that is relevant to treatment prescription, treatment planning, plan evaluation, and/or treatment verification. 44


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 2 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 4 Conceptual Volume can also be used to reference abstract spatial entities (prior to delineation) for the purpose of prescribing dosimetry constraints for therapy. 6

ZZ.4.3.2 Segment

The term Segment refers to a delineation of a spatial entity in a Segmentation, Surface 8 Segmentation, or RT Structure Set SOP Instance. A Segment is a realization of a Conceptual Volume and is identified by its Conceptual Volume UID. 10

ZZ.5 EXAMPLE USE CASES

Four different use cases are illustrated in this section: 12

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 14 class.

Using Received RT Course: A treatment planning example where workflow is managed 16 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 18 Instance corresponds to an “electronic chart” that is passed from actor to actor, by DICOM Network Storage (“push”) from the previous Performing Device. 20

Using DICOM Media File Set: A treatment planning example where workflow is managed externally, but transfer occurs using DICOM storage media. 22

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 24 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 26 externally.

28

ZZ.5.1 Use Case Actors

The following actors are used in the example use cases: 30

User: A person controlling the performing of the procedure step.

Archive: A database storing SOP Instances (images, plans, structures, dose distributions, etc). 32

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 34 in the Oncology Department.

Virtual Simulation System (VSS): A workstation performing virtual simulation (localization, 36 segmentation, and beam placement), often as part of a CT Simulation System.

Treatment Planning System (TPS): A workstation performing radiotherapy treatment planning. 38 This includes localization, segmentation, beam placement or optimization, dose calculation, and dose review. 40


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 2 as verification images). Acts as a Performing SCU.

Plan Review Station (PRS): A workstation performing radiotherapy treatment planning review, 4 displaying and reviewing patient anatomy, beam geometry, and dose distributions.

Delivery Review Station (DRS): A workstation performing radiotherapy treatment delivery 6 review, displaying and reviewing for patient anatomy, beam geometry, and planned and delivered dose distributions. 8

ZZ.5.2 Treatment Planning Using Managed Workflow

ZZ.5.2.1 Message Sequencing 10

Figure 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 12 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 14 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 16 Image and reference images or image sets to be used for delivery verification. Finally, it updates the procedure step. 18

ZZ.5.2.2 Transactions and Message Flow

20


Archive

User

Treatment Management

System (TMS)

Treatment Planning System (TPS)

1. ‘List Procedures for Planning’ on TPS

2. Query UPS

3. Receive 0-n UPS

4. ‘Select Procedure’ on TPS (optional if only one procedure in list)

7. N-ACTION UPS ‘IN PROGRESS’

Planning images, Segmentation IOD, Prescription IOD, RT Inverse Planning Instruction IOD, etc

6. Start ‘Planning Session’ on TPS

11. N-ACTION UPS ‘COMPLETED’

9. Store Results

12. Indicate ‘Planning Session Completed Successfully’ on TPS console

5. Retrieve Archive objects (C-MOVE)

Extract UIDs from selected UPS

Display list to user

10. N-SET UPS to Final State

8. Complete ‘Planning Session’ on TPS

PLAN TREATMENT

PLAN TREATMENT

2

Figure ZZ.5.2.2-1 Treatment Planning Normal Flow - Message Sequence 4

1. ‘List Procedures for Planning’ on TPS 6

The User requests a of patients requiring treatment planning.

2. Query UPS 8

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 10 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. 12

3. Receive 0-n UPS

The TPS receives the set of Unified Procedure Steps (UPSs) resulting from the Query UPS 14 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 requested attributes of a single UPS. The TMS returns a list of zero or more UPSs containing 2 the planned tasks for the querying device.

4. ‘Select Procedure’ on TPS 4

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 6 default.

5. Retrieve Archive Objects 8

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 10 Worklist response.

6. Start ‘Planning Session’ on TPS 12

The User begins the planning process on the TPS.

7. Set UPS (IN PROGRESS) 14

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 16 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 18 message allows the TMS to update its worklist and permits other Performing Devices to detect that the UPS is being worked on. 20


The User completes the planning process on the TPS. 22

9. Store Results

When the planning process is complete, the TPS stores the results to the Archive. This would 24 typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP instances are detailed in Section ZZ.6. 26

10. Set UPS Progress to Final State

Upon completion of the final beam (although this is not required) the TPS may then update the 28 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). 30 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. 32

11. Set UPS (COMPLETED)

The TPS sets the Procedure Step State of the UPS to ‘COMPLETED’ upon completion of the 34 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 36 message informs the TMS that the UPS is now complete.

12. Indicate ‘Planning Session Completed Successfully’ on TPS 38

Finally the TPS notifies the User that the requested procedure has completed successfully, and all generated SOP Instances have been stored. 40


ZZ.5.3 Treatment Planning Using Received RT Course


Figure 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 4 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 6 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. 8


This section describes in detail the interactions illustrated in Figure ZZ.5.3.2-1. 10

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)

2. ‘List Procedures for Planning’ on TPS



12

Figure ZZ.5.3.2-1 14 Treatment Planning Using Received RT Course - Message Sequence

16


1. Store RT Course to TPS

The User of another performing device (such as a Virtual Simulation System) initiates a 2 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 4 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. 8

3. Select ‘Active’ RT Course on TPS

The User selects one of the displayed RT Course objects as the active one. The TPS then 10 extracts the required input SOP Instance UIDs from the selected RT Course.

4. Retrieve Archive Objects 12

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. 14 The TPS knows the location of these SOP instances by virtue of the fully-specified RT Course SOP Instance returned in the previous step. 16


The User begins the planning process on the TPS. 18



7. Store Results to Archive

When the planning process is complete, the TPS stores the results to the Archive. This would 22 typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP Instances are detailed in Section ZZ.6. 24

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 26 Treatment Delivery System (TDS). It contains the complete history of the treatment course, including the planning step just performed. 28


ZZ.5.4 Treatment Planning Using DICOM Media


Figure 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 4 reading DICOM Media. In this example the TPS needs to be DICOM Media File Set Reader (FSR) for this to occur. 6

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 8 performed.User has been able to obtain a DICOM Storage Media File Set containing the latest information regarding the treatment course. 10

As before, the SOP Instances that may be consumed and produced by this procedure are shown in Section ZZ.6. 12



16

Figure ZZ.5.4.2-1 Treatment Planning Using DICOM Media - Message Sequence 18


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 22


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

2. Select ‘Active’ RT Course on TPS

The User confirms one of the displayed RT Course SOP Instances as the active one. The TPS 4 then extracts the required input SOP Instance UIDs from the selected RT Course.

3. Read Input SOP Instances from Media 6

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 8 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. 10





6. Store Results to Media

When the planning process is complete, the TPS stores the results to a DICOM Media File 16 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 18 Section ZZ.6.

20


ZZ.5.5 Treatment Planning Using Archive Query of RT Course


Figure 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 4 the Archive.

The use case supports a special case of the “electronic chart” scenario where an independent 6 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. 8

As before, the SOP Instances that may be consumed and produced by this procedure are shown in Section ZZ.6. 10



14


Figure ZZ.5.5.2-1 Treatment Planning Using Archive Query of RT Course - Message Sequence 2


The User indicates on the TPS that they want a the list of patients requiring treatment planning. 6

2. Query RT Course

The TPS queries the Archive for RT Course SOP Instances that match its search criteria. For 8 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 10 request primitive of the DICOM Query/Retrieve service class.

3. Receive 0-n C-FIND Responses 12

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 14 Archive returns a list of zero or more items matching the specified search criteria.

4. ‘Select RT Course’ on TPS 16

The User selects one of the returned RT Course SOP Instances on the TPS.

5. Retrieve Selected RT Course 18

In response to a C-MOVE Request, the Archive transmits to the TPS the selected RT Course SOP Instance. 20

6. Retrieve Archive Objects

Archive Objects are retrieved by a C-MOVE Request, transmitting the SOP Instances to the 22 TPS. SOP Instance locations are fully-specified in the RT Course SOP Instance returned in the previous step. 24





9. Store Results

When the planning process is complete, the TPS stores the results to the Archive. This would 30 typically be achieved using the Storage and/or Storage Commitment Service Classes. These SOP Instances are detailed in Section ZZ.6. 32

10. Store RT Course

The TPS stores a new RT Course SOP Instance on the Archive. It contains the complete 34 history of the treatment course, including the planning step just performed and the locations of any objects generated. 36

supplement 147: second generation...

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