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Digital Imaging and Communications in Medicine (DICOM)
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Supplement 147: Second Generation Radiotherapy
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DICOM Standards Committee, Working Group 7, Radiation Therapy
1300 N. 17th Street, Suite 1752
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Rosslyn, Virginia 22209 USA
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VERSION:
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Developed pursuant to DICOM Work Item 2007-06-B
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This is a draft document. Do not circulate, quote, or reproduce it except with the approval of NEMA.
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Sup 147 - Revision 42
March 28, 2014
Table of Contents
Table of Contents ...................................................................................................................... 1
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Foreword ................................................................................................................................. 11
Scope and Field of Application ................................................................................................ 11
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Part 2 Addendum .................................................................................................................... 12
Part 3 Addendum .................................................................................................................... 13
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7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND
GENERATION RADIOTHERAPY INFORMATION OBJECTS ........................................ 13
7.12.1 .......RT Course ................................................................................................ 14
7.12.2 .......RT Physician Intent .................................................................................. 15
7.12.3 .......Conceptual Volume .................................................................................. 15
7.12.4 .......RT Segment Annotation ........................................................................... 15
7.12.5 .......RT Radiation Set ...................................................................................... 15
7.12.6 .......RT Radiation ............................................................................................ 15
7.12.7 .......RT Radiation Record ................................................................................ 15
7.12.8 .......RT Dose Image ........................................................................................ 16
7.12.9 .......RT Dose Histogram .................................................................................. 16
7.12.10 .....RT Dose Samples .................................................................................... 16
7.12.11 .....RT Treatment Phase ................................................................................ 16
A.VV...... SECOND GENERATION RADIATION THERAPY ............................................ 20
A.VV.1 ......Second Generation Radiation Therapy Objects ....................................... 20
A.VV.1.1....... Second Generation Radiation Therapy Common Information ....... 20
A.VV.1.1.1 .......... Second Generation Radiation Therapy EntityRelationship Model ................................................................................. 20
A.VV.1.2....... RT Course Information Object Definition ....................................... 24
A.VV.1.2.1 .......... RT Course IOD Description ....................................... 24
A.VV.1.2.2 .......... RT Course IOD Entity-Relationship Model ................ 24
A.VV.1.2.3 .......... RT Course IOD Module Table ................................... 24
A.VV.1.3....... RT Physician Intent Information Object Definition ......................... 25
A.VV.1.3.1 .......... RT Physician Intent IOD Description ......................... 25
A.VV.1.3.2 .......... RT Physician Intent IOD Entity-Relationship Model .. 25
A.VV.1.3.3 .......... RT Physician Intent IOD Module Table ..................... 25
A.VV.1.4....... RT Radiation Set Information Object Definition ............................. 25
A.VV.1.4.1 .......... RT Radiation Set IOD Description ............................. 25
A.VV.1.4.2 .......... RT Radiation Set IOD Entity-Relationship Model ...... 25
A.VV.1.4.3 .......... RT Radiation Set IOD Module Table ......................... 25
A.VV.1.5....... RT Segment Annotation Information Object Definition .................. 26
A.VV.1.5.1 .......... RT Segment Annotation IOD Description .................. 26
A.VV.1.5.2 .......... RT Segment Annotation IOD Entity-Relationship
Model .................. 26
A.VV.1.5.3 .......... RT Segment Annotation IOD Module Table .............. 26
A.VV.1.6....... Tomotherapeutic Radiation Information Object Definition ............. 26
A.VV.1.6.1 .......... Tomotherapeutic Radiation IOD Description ............. 26
A.VV.1.6.2 .......... Tomotherapeutic Radiation IOD Entity-Relationship
Model .................. 26
A.VV.1.6.3 .......... Tomotherapeutic Radiation IOD Module Table ......... 26
A.VV.1.7....... C-Arm Photon Radiation Information Object Definition ................. 26
A.VV.1.7.1 .......... C-Arm Photon Radiation IOD Description ................. 26
A.VV.1.7.2 .......... C-Arm Photon Radiation IOD Entity-Relationship
Model .................. 26
A.VV.1.7.3 .......... C-Arm Photon Radiation IOD Module Table ............. 27
A.VV.1.8....... C-Arm Electron Radiation Information Object Definition ................ 27
A.VV.1.8.1 .......... C-Arm Electron Radiation IOD Description ............... 27
A.VV.1.8.2 .......... C-Arm Electron Radiation IOD Entity-Relationship
Model .................. 27
A.VV.1.8.3 .......... C-Arm Electron Radiation IOD Module Table ........... 27
A.VV.1.9....... Multiple Fixed Source Radiation Information Object Definition ...... 27
A.VV.1.9.1 .......... Multiple Fixed Source Radiation IOD Description ..... 27
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A.VV.1.9.2 .......... Multiple Fixed Source Radiation IOD EntityRelationship Model ................................................................................. 27
A.VV.1.9.3 .......... Multiple Fixed Source Radiation IOD Module Table.. 28
A.VV.1.10..... Robotic Radiation Information Object Definition ............................ 28
A.VV.1.10.1 ........ Robotic Radiation IOD Description ............................ 28
A.VV.1.10.2 ........ Robotic Radiation IOD Entity-Relationship Model ..... 28
A.VV.1.10.3 ........ Robotic Radiation IOD Module Table ........................ 28
A.VV.1.11..... Multi-Axial Radiation Information Object Definition ........................ 28
A.VV.1.11.1 ........ Multi-Axial Radiation IOD Description ....................... 28
A.VV.1.11.2 ........ Multi-Axial Radiation IOD Entity-Relationship Model . 28
A.VV.1.11.3 ........ Multi-Axial Radiation IOD Module Table.................... 28
A.VV.1.12..... RT Dose Image Information Object Definition ............................... 29
A.VV.1.12.1 ........ RT Dose Image IOD Description ............................... 29
A.VV.1.12.2 ........ RT Dose Image IOD Entity-Relationship Model ........ 29
A.VV.1.12.3 ........ RT Dose Image IOD Module Table ........................... 29
A.VV.1.12.4 ........ RT Dose Image IOD Content Constraints ................. 29
A.VV.1.12.5 ........ RT Dose Image Functional Group Macros ................ 29
A.VV.1.13..... RT Dose Histogram Information Object Definition ......................... 30
A.VV.1.13.1 ........ RT Dose Histogram IOD Description ........................ 30
A.VV.1.13.2 ........ RT Dose Histogram IOD Entity-Relationship Model .. 30
A.VV.1.13.3 ........ RT Dose Histogram IOD Module Table..................... 30
A.VV.1.14..... RT Dose Samples Information Object Definition ........................... 30
A.VV.1.14.1 ........ RT Dose Samples IOD Description ........................... 30
A.VV.1.14.2 ........ RT Dose Samples IOD Entity-Relationship Model .... 30
A.VV.1.14.3 ........ RT Dose Samples IOD Module Table ....................... 30
A.VV.1.15..... Tomotherapeutic Radiation Record Information Object Definition. 31
A.VV.1.15.1 ........ Tomotherapeutic Radiation Record IOD
Description.......... 31
A.VV.1.15.2 ........ Tomotherapeutic Radiation Record IOD EntityRelationship Model ................................................................................. 31
A.VV.1.15.3 ........ Tomotherapeutic Radiation Record IOD Module
Table................... 31
A.VV.1.16..... C-Arm Photon Radiation Record Information Object Definition ..... 31
A.VV.1.16.1 ........ C-Arm Photon Radiation Record IOD Description .... 31
A.VV.1.16.2 ........ C-Arm Photon Radiation Record IOD EntityRelationship Model ................................................................................. 31
A.VV.1.16.3 ........ C-Arm Photon Radiation Record IOD Module Table . 31
A.VV.1.17..... C-Arm Electron Radiation Record Information Object Definition ... 32
A.VV.1.17.1 ........ C-Arm Electron Radiation Record IOD Description... 32
A.VV.1.17.2 ........ C-Arm Electron Radiation Record IOD EntityRelationship Model ................................................................................. 32
A.VV.1.17.3 ........ C-Arm Electron Radiation Record IOD Module
Table................... 32
A.VV.1.18..... Multiple Fixed Source Radiation Record Information Object
Definition ...... 32
A.VV.1.18.1 ........ Multiple Fixed Source Record Radiation IOD
Description.......... 32
A.VV.1.18.2 ........ Multiple Fixed Source Radiation Record IOD E-R
Model .................. 32
A.VV.1.18.3 ........ Multiple Fixed Source Radiation Record IOD
Module Table ...... 32
A.VV.1.19..... Robotic Radiation Record Information Object Definition................ 32
A.VV.1.19.1 ........ Robotic Radiation Record IOD Description ............... 32
A.VV.1.19.2 ........ Robotic Radiation Record IOD Entity-Relationship
Model .................. 32
A.VV.1.19.3 ........ Robotic Radiation Record IOD Module Table ........... 32
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A.VV.1.20..... Multi-Axial Radiation Record Information Object Definition ........... 33
A.VV.1.20.1 ........ Multi-Axial Radiation Record IOD Description ........... 33
A.VV.1.20.2 ........ Multi-Axial Radiation Record IOD EntityRelationship Model ................................................................................. 33
A.VV.1.20.3 ........ Multi-Axial Radiation Record IOD Module Table ....... 33
C.AA ..... SECOND GENERATION RADIOTHERAPY MODULES .................................. 34
C.AA.1 ......Second Generation Radiotherapy Definitions .......................................... 34
C.AA.1.1 ...... Control Points................................................................................. 34
C.AA.1.1.1 .......... Verification Control Points ......................................... 34
C.AA.1.2 ...... Nominal Energy.............................................................................. 34
C.AA.1.3 ...... Fractionation, Fractionation Scheme ............................................. 34
C.AA.1.4 ...... Treatment RT Radiation Set .......................................................... 34
C.AA.1.5 ...... Meterset ......................................................................................... 35
C.AA.1.6 ...... Radiation Dose Point ..................................................................... 35
C.AA.1.7 ...... Treatment Phase ........................................................................... 35
C.AA.2 ......Second Generation Radiotherapy General-Purpose Macros ................... 36
C.AA.2.1 ...... RT Entity Labeling Macro ............................................................... 36
C.AA.2.1.1 .......... RT Entity Labeling Macro Attribute Description ......... 36
C.AA.2.2 ...... RT Entity Long Labeling Macro ...................................................... 36
C.AA.2.3 ...... RT Item State Macro ...................................................................... 37
C.AA.2.3.1 .......... RT Item State Macro Attribute Description ................ 37
C.AA.2.4 ...... RT Operation State Macro ............................................................. 38
C.AA.2.5 ...... Conceptual Volume Macro ............................................................. 40
C.AA.2.5.1 .......... Conceptual Volume Macro Attribute Description ....... 41
C.AA.2.6 ...... Conceptual Volume Segmentation Reference and Combination
Macro ........... 41
C.AA.2.6.1 .......... Conceptual Volume Combination and
Segmentation Macro Attribute Description ............................................. 46
C.AA.2.9 ...... Radiation Fraction Pattern Macro .................................................. 52
C.AA.2.9.1 .......... Radiation Fraction Pattern Macro Attribute
Description.......... 52
C.AA.2.10 .... Treatment Device Identification Macro .......................................... 54
C.AA.2.11 .... Device Model Macro ...................................................................... 54
C.AA.2.12 .... RT Patient Support Devices Macro ................................................ 54
C.AA.2.13 .... Patient Support Position Macro...................................................... 55
C.AA.2.14 .... Device Identification Macro ............................................................ 56
C.AA.2.15 .... RT Accessory Device Identification Macro .................................... 57
C.AA.2.16 .... Control Point General Attributes Macro ......................................... 58
C.AA.2.16.1 ........ Control Point Attribute Concept ................................. 59
C.AA.2.17 .... External Beam Control Point General Attributes Macro ................. 61
C.AA.2.17.1 ........ External Beam Control Point General Attributes
Macro Attribute Description .................................................................... 62
C.AA.2.18 .... External Beam Sub-Control Point General Attributes Macro ......... 62
C.AA.2.18.1 ........ RT Beam Limiting Device Definition Macro
Attribute Description ............................................................................... 62
C.AA.2.18.1.1 ..... Sub-Control Point Attribute Requirements ................ 62
C.AA.2.18.1.2 ..... Cumulative Meterset.................................................. 63
C.AA.2.19 .... Beam Mode Macro ......................................................................... 63
C.AA.2.19.1 ........ Beam Mode ............................................................... 65
C.AA.2.20 .... RT Beam Limiting Device Definition Macro ................................... 65
C.AA.2.20.1 ........ RT Beam Limiting Device Definition Macro
Attribute Description ............................................................................... 67
C.AA.2.21 .... RT Beam Limiting Device Positions Macro .................................... 67
C.AA.2.22 .... Wedges Definition Macro ............................................................... 68
C.AA.2.23 .... Wedge Positions Macro ................................................................. 69
C.AA.2.24 .... Compensators Definition Macro..................................................... 69
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C.AA.2.24.1 ........ Compensators Definition Macro Attributes
Description.......... 72
C.AA.2.25 .... Blocks Definition Macro ................................................................. 73
C.AA.2.25.1 ........ Blocks Definition Macro Attribute Description ........... 74
C.AA.2.26 .... Accessory Holder Definition Macro ................................................ 75
C.AA.2.26.1 ........ Accessory Holder Description ................................... 75
C.AA.2.27 .... General Accessories Definition Macro ........................................... 76
C.AA.2.28 .... Boluses Definition Macro ............................................................... 76
C.AA.2.28.1 ....... Bolus Definition Macro Attribute Description ............. 77
C.AA.2.29 .... Outline Definition Macro ................................................................. 77
C.AA.2.30 .... RT Tolerance Set Macro ................................................................ 78
C.AA.2.30.1 ........ RT Tolerance Set Attribute Description ..................... 79
C.AA.2.30.1.2 ..... Patient Support Position Tolerance Sequence .......... 80
C.AA.2.31 .... Patient to Equipment Relationship Macro ...................................... 80
C.AA.2.31.1 ........ Patient to Equipment Relationship Macro Attributes
Description.......... 81
C.AA.2.32 .... RT Treatment Position Macro ........................................................ 82
C.AA.2.33 .... User Content Identification Macro .................................................. 83
C.AA.2.33.1 ........ User Content Identification Macro Attribute
Description.......... 83
C.AA.2.34 .... RT Treatment Phase Macro .......................................................... 83
C.AA.2.34.1 ........ RT Treatment Phase Macro Attribute Description .... 84
C.AA.2.35 .... RT Treatment Phase Interval Macro .............................................. 84
C.AA.2.35.1 ........ Referenced Treatment Phases ................................. 85
C.AA.A1 ...Enhanced RT Series Module ................................................................... 86
C.AA.A1.1 .... Enhanced RT Series Attribute Description .................................... 86
C.AA.A1.1.1 ........ Modality ..................................................................... 86
C.AA.A2 ...Radiotherapy Common Instance Module ................................................. 86
C.AA.A3 ...RT Course Module ................................................................................... 87
C.AA.A3.1 .... RT Course Attribute Description .................................................... 89
C.AA.A3.1.1 ........ RT Course Scope Indicator ....................................... 89
C.AA.A3.1.2 ........ Delivered Radiation Dose Sequence......................... 89
C.AA.A3.1.3 ........ RT Course State Sequence ...................................... 89
C.AA.A4 ...RT Prescription Reference Module .......................................................... 89
C.AA.A4.1 .... RT Prescription Reference Attribute Description ........................... 90
C.AA.A4.1.1 ........ RT Item State Macro Meanings ................................. 90
C.AA.A5 ...RT Treatment Phase Module ................................................................... 91
C.AA.A5.1 .... RT Treatment Phase Attribute Description ................................... 91
C.AA.A5.1.1 ........ RT Item State Macro Meanings ................................. 91
C.AA.A6 ...RT Radiation Set Reference Module........................................................ 91
C.AA.A6.1 .... RT Radiation Set Reference Attribute Description......................... 96
C.AA.A6.1.1 ........ RT Item State Macro Meanings ................................. 96
C.AA.A6.1.2 ........ Radiation Set Start Delay .......................................... 97
C.AA.A7 ...RT Course Associated Instance Reference Module ................................ 99
C.AA.B1 ...RT Physician Intent Module ................................................................... 100
C.AA.B1.1 .... RT Physician Intent Attribute Description..................................... 101
C.AA.B1.1.1 ........ RT Physician Intent Sequence ................................ 101
C.AA.B1.1.2 ........ RT Protocol Code Sequence ................................... 102
C.AA.B1.1.3 ........ RT Diagnostic Image Set Sequence ....................... 102
C.AA.B2 ...RT Prescription Module .......................................................................... 102
C.AA.B2.1 .... RT Prescription Attribute Description ........................................... 109
C.AA.B2.1.1 ........ Anatomy Property Type Code Sequence ................ 109
C.AA.B2.1.2 ........ Dosimetric Objective Parameter Sequence ............ 109
C.AA.B2.1.3 ........ Dosimetric Objective Parameter Sequence
Examples ............ 111
C.AA.B2.1.4 ........ Conceptual Volume Sequence ................................ 111
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C.AA.B2.1.5 ........ Prescription Anatomy Role ...................................... 111
C.AA.B2.1.6 ........ Radiobiological Structural Type ............................... 112
C.AA.B2.1.7 ........ Dosimetric Objective Priority ................................... 112
C.AA.B2.2 .... Dosimetric Objective Scope ......................................................... 112
C.AA.B3 ...RT Treatment Phase Intent Module ....................................................... 112
C.AA.C1 ...RT Radiation Set Module ....................................................................... 113
C.AA.C1.1 .... RT Radiation Set Attribute Description ........................................ 114
C.AA.C1.1.1 ........ Radiation Set Type .................................................. 114
C.AA.C1.1.2 ........ Radiation Sequence ................................................ 114
C.AA.C2 ...RT Dose Contribution Module ................................................................ 115
C.AA.C2.1 .... RT Dose Contribution Attribute Description ................................. 119
C.AA.C2.1.1 ........ Meterset to Dose Mapping Sequence ..................... 119
C.AA.C2.1.2 ........ Conceptual Volume Sequence ................................ 119
C.AA.C2.1.3 ........ Primary Dose Value Indicator .................................. 120
C.AA.C2.2 .... Radiation Verification Control Point Description .......................... 120
C.AA.C2.2.1 ........ Referenced Control Point ........................................ 120
C.AA.C2.2.2 ........ Distance Parameters ............................................... 120
C.AA.C2.2.3 ........ Radiation Dose Value .............................................. 120
C.AA.D1 ...RT Segment Annotation Module ............................................................ 120
C.AA.D1.1 .... RT Segment Annotation Description ............................................ 124
C.AA.D1.1.1 ........ Segmentation SOP Instance Reference Sequence 124
C.AA.D1.1.2 ........ Alternate Segmented Property Type Code
Sequence ........... 125
C.AA.D1.1.3 ........ Segmented Property Type Code Sequence ............ 126
C.AA.D1.1.4 ........ Segmented RT Accessory Device Sequence ......... 126
C.AA.D1.1.5 ........ Direct Segment Reference Sequence ..................... 126
C.AA.D1.1.6 ........ Combination Segment Reference Sequence .......... 127
C.AA.D1.1.7 ........ Segment Properties Sequence ............................... 127
C.AA.E1 ...RT Delivery Device Common Module .................................................... 127
C.AA.E1.1 ........... RT Delivery Device Common Module Attribute
Description.......... 128
C.AA.E1.1.3 ........ Equipment Frame of Reference UID ....................... 129
C.AA.E2 ...RT Radiation Common Module .............................................................. 130
C8.A.E2.1 .... RT Radiation Common Attribute Description ............................... 130
C.AA.E2.1.1 ........ Radiotherapy Procedure Technique Sequence....... 130
C.AA.E2.1.2 ........ RT Treatment Position Macro ................................. 131
C.AA.E2.1.3 ........ RT Radiation Data Scope ........................................ 131
C.AA.E2.1.4 ........ Treatment Times ..................................................... 131
C.AA.E2.1.5 ........ Treatment Machine Mode Sequence ...................... 131
C.AA.F1....Tomotherapeutic Delivery Device Module .............................................. 131
C.AA.F1.1 .... Tomotherapeutic Delivery Device Attribute Description ............... 132
C.AA.F1.1.1 ........ Leaf Slot Definition .................................................. 132
C.AA.F2....Tomotherapeutic Beam Module ............................................................. 132
C.AA.G1 ...C-Arm Photon-Electron Delivery Device Module ................................... 134
C.AA.G2 ...C-Arm Photon-Electron Beam Module ................................................... 135
C.AA.G2.1 ... C-Arm Photon-Electron Beam Attribute Description .................... 136
C.AA.G2.1.1 ....... Radiation Particle .................................................... 136
C.AA.H1 ...Multiple Fixed Source Delivery Device Module ...................................... 136
C.AA.H1.1 .... Multiple Fixed Source Delivery Device Attribute Description ....... 137
C.AA.H1.1.1 ........ Radiation Source Angles ......................................... 137
C.AA.H2 ...Multiple Fixed Source Beam Set Module ............................................... 137
C.AA.J1 ....Robotic Delivery Device Module............................................................. 138
C.AA.J2 ....Robotic Path Module .............................................................................. 139
C.AA.L1 ....Multi-Axial Delivery Device Module ........................................................ 140
C.AA.L2.1 .... Multi Axial Delivery Device Attribute Description.......................... 141
C.AA.L1.1 ........... Source-Axis Distance .............................................. 141
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C.AA.L2 ....Multi-Axial Beam Module........................................................................ 141
C.AA.L2.1 .... Multi Axial Beam Attribute Description ......................................... 145
C.AA.L2.1.1 ........ Multi-Axial Gantry Angles ........................................ 145
C.AA.L2.1.2 ........ Gantry Head Angles ................................................ 145
C.AA.L2.1.3 ........ Multi Axial Beam Delimiter Positions ....................... 145
C.AA.M1 ...Enhanced RT Dose Module ................................................................... 147
C.AA.M1.1 ... Enhanced RT Dose Attribute Description .................................... 153
C.AA.M1.1.1 ....... Dose Scope ............................................................. 153
C.AA.M1.1.2 ....... Radiation Absorption Model .................................... 153
C.AA.M2 ...RT Dose Image Module ......................................................................... 154
C.AA.M2.1 ... RT Dose Image Attribute Description .......................................... 155
C.AA.M2.1.1 ....... Image Type and Frame Type .................................. 155
C.AA.M2.1.2 ....... Dose Grid Geometry................................................ 155
C.AA.M2.1.3 ....... Dose Grid Real World Values ................................. 155
C.AA.M3 ...RT Dose Image Functional Group Macros............................................. 156
C.AA.M3.1 ... RT Dose Image Frame Type Macro ............................................ 156
C.AA.M4 ...RT Dose Histogram Module ................................................................... 156
C.AA.M4.1 ... RT Dose Histogram Attribute Description .................................... 158
C.AA.M4.1.1 ....... Referenced Segmentation Properties Sequence .... 158
C.AA.M4.1.2 ....... Dose Histogram Data .............................................. 158
C.AA.M4.1.3 ....... Dose Histogram Referenced Segment Sequence .. 158
C.AA.M5 ...Dose Samples Module ........................................................................... 159
C.AA.M5.1 ... RT Dose Samples Attribute Description ...................................... 159
C.AA.M5.1.1 ....... Dose Samples Data ................................................ 159
C.AA.P1 ...RT Radiation Record Common Module ................................................. 159
C.AA.P1.1 .... RT Radiation Record Common Attribute Description .................. 163
C.AA.P1.1.1 ........ Control Point References ........................................ 163
C.AA.P1.1.2 ........ Referenced RT Patient Setup Sequence ................ 163
C.AA.P2 ...RT Dose Record Common Module ........................................................ 163
C.AA.P2.1 .... RT Dose Record Common Module Attribute Description ............ 165
C.AA.P2.1.1 ........ Conceptual Volume Sequence ................................ 165
F.5.X.........Radiotherapy Directory Record Definition .............................................. 169
C.7.5.1 ......... General Equipment Module ......................................................... 170
C.7.6.3 ......... Image Pixel Module...................................................................... 171
Part 4 Addendum .................................................................................................................. 172
Part 6 Addendum .................................................................................................................. 175
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6 ............ REGISTRY OF DICOM DATA ELEMENTS .................................................... 175
ANNEX A
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Part 16 Addendum ................................................................................................................ 194
CID 9231
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REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)191
GENERAL PURPOSE WORKITEM DEFINITION ............................... 194
CID SUP147001
DOSIMETRIC OBJECTIVE VALUE TYPES .................................. 195
CID SUP147002
PRESCRIPTION ANATOMY CATEGORIES................................. 195
CID SUP147003
RADIOTHERAPY SEGMENT CATEGORIES ............................... 195
CID SUP147004
RADIOTHERAPY TARGETS......................................................... 196
CID SUP147005
RT GEOMETRIC INFORMATION ................................................. 196
CID SUP147006
FIXATION OR POSITIONING DEVICES ...................................... 197
CID SUP147007
BRACHYTHERAPY DEVICES ...................................................... 197
CID SUP147009
SEGMENTATION COMBINATION ................................................ 198
CID SUP147010
BEAM LIMITING DEVICE TYPES ................................................. 198
CID SUP147011
RADIOTHERAPY ROBOTIC PATHS ............................................ 198
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CID SUP147012
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GENERAL EXTERNAL RADIOTHERAPY PROCEDURE TECHNIQUES
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CID SUP147013
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TOMOTHERAPEUTIC RADIOTHERAPY PROCEDURE TECHNIQUES
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CID SUP147014
TREATMENT RT RADIATION SET ALTERATION TYPES .......... 200
CID SUP147015
TREATMENT TERMINATION REASONS .................................... 200
CID SUP147016
COMPENSATOR DEVICE TYPES ................................................ 201
CID SUP147017
RADIOTHERAPY TREATMENT MACHINE MODES .................... 201
CID SUP147018
PRE-TREATMENT RT RADIATION SET ROLES......................... 201
CID SUP147020
INSTANCE REFERENCE PURPOSES ......................................... 202
CID SUP147021
PATIENT SETUP TECHNIQUES .................................................. 202
CID SUP147022
FIXATION DEVICE TYPES ........................................................... 203
CID SUP147023
SHIELDING DEVICE TYPES......................................................... 203
CID SUP147024
SETUP DEVICES .......................................................................... 203
CID SUP147025
RT PATIENT SUPPORT DEVICES ............................................... 204
CID SUP147026
DOSE STATISTICS ....................................................................... 204
CID SUP147027
FIXED BEAM LIMITING DEVICE TYPES ..................................... 204
CID SUP147028
RADIOTHERAPY WEDGE TYPES ............................................... 205
CID SUP147030
GENERAL ACCESSORY DEVICE TYPES ................................... 205
CID SUP147031
RADIOTHERAPY BOLUS DEVICE TYPES .................................. 206
378
CID SUP147032
RADIOTHERAPY BLOCK DEVICE TYPES .................................. 206
CID SUP147033
.............. 206
RADIOTHERAPY ACCESSORY NO-SLOT HOLDER DEVICE TYPES
380
CID SUP147034
RADIOTHERAPY ACCESSORY SLOT HOLDER DEVICE TYPES206
382
CID SUP147035
EFFECTIVE DOSE METHOD CODE DEFINITION ...................... 207
CID SUP147036
OBJECT 207
PURPOSE OF REFERENCED DOSE CALCULATION ANNOTATION
384
CID SUP147037
DOSE DATA SOURCE MEASUREMENT DEFINITION ............... 207
CID SUP147039
DOSE HISTOGRAM SPATIAL UNIT DEFINITION ....................... 208
CID SUP147040
SEGMENTED RT ACCESSORY DEVICES .................................. 208
CID SUP147041
DOSE ALGORITHM CLASS.......................................................... 209
CID SUP147042
ENERGY UNIT .............................................................................. 209
CID SUP147043
RT ITEM STATES.......................................................................... 210
CID SUP147044
RT OPERATION STATES ............................................................. 210
CID SUP147045
MULTI-SOURCE RADIATION TECHNIQUE................................. 210
CID SUP147046
ROBOTIC RADIATION TECHNIQUE............................................ 211
CID SUP147047
RADIOTHERAPY PROCEDURE TECHNIQUES .......................... 211
CID SUP147048
REVISED VALUE........................................................................... 211
CID SUP147049
RADIOTHERAPY GENERAL WORKITEM DEFINITION .............. 212
CID SUP147050
BEAM MODE TYPE DEFINITION ................................................ 212
CID SUP147051
DELIVERY RATE UNIT DEFINITION ........................................... 212
CID SUP147052
RADIATION PARTICLE ................................................................ 213
CID SUP147053
REGULATORY DEVICE IDENTIFIER TYPE ............................... 213
364
366
368
370
372
374
376
386
388
390
392
394
396
398
400
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CID SUP147054
TREATMENT DELIVERY DEVICE TYPE .................................... 213
CID SUP147055
DOSIMETER UNIT DEFINITION .................................................. 214
CID SUP147056
TREATMENT SESSION SIGN-OFF ............................................. 214
404
CID SUP147060
SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES ............. 214
CID SUP147061
.............. 215
PERCENTAGE AND DOSE-RELATED DOSIMETRIC OBJECTIVES
406
CID SUP147062
VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES .. 215
408
CID SUP147063
.............. 215
DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES
410
CID SUP147064
CODED DOSIMETRIC OBJECTIVES .......................................... 216
CID SUP147065
RADIOTHERAPY DOSE REAL WORLD UNITS........................... 216
412
CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition 217
414
CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition
.............. 217
416
CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition
.............. 217
418
ANNEX C
.............. 218
420
422
ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE)
TID SUP147001
RT PRESCRIPTION ANNOTATION ............................................. 218
TID SUP147003
RT SEGMENT ANNOTATION PROPERTIES .............................. 220
TID SUP147004
PATIENT SUPPORT POSITION PARAMETERS ......................... 220
ANNEX D
DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE)222
Part 17 Addendum ................................................................................................................ 239
424
Annex Z Second Generation RT (Informative) ............................................................... 239
ZZ.1 ...... INTRODUCTION ............................................................................................. 239
426
428
430
432
434
436
438
440
442
444
446
448
ZZ.2 ...... ENTITY DESCRIPTIONS ................................................................................ 243
ZZ.2.1 .......RT Course .............................................................................................. 243
ZZ.2.2 .......RT Physician Intent ................................................................................ 245
ZZ.2.3 .......RT Segment Annotation ......................................................................... 248
ZZ.2.4 .......RT Radiation Set .................................................................................... 248
ZZ.2.5 .......RT Radiation .......................................................................................... 249
ZZ.2.6 .......RT Dose Image ...................................................................................... 250
ZZ.2.7 .......RT Dose Histogram ................................................................................ 251
ZZ.2.8 .......RT Dose Samples .................................................................................. 252
ZZ.2.9 .......RT Radiation Record .............................................................................. 253
ZZ.3 ...... NOTES ON RT COURSE ................................................................................ 254
ZZ.3.1 .......Introduction............................................................................................. 254
ZZ.3.2 .......Evolution of an RT Course SOP Instance .............................................. 254
ZZ.3.3 .......Elements of the RT Course .................................................................... 255
ZZ.3.3.1. ...... Physician Intent ............................................................................ 255
ZZ.3.3.2. ...... Treatment Phase ......................................................................... 255
ZZ.3.3.3. ...... Radiation Sets .............................................................................. 255
ZZ.3.3.4 ....... Clinical State Information ............................................................. 256
ZZ.4 ...... NOTES ON SECOND-GENERATION IODS ................................................... 257
ZZ.4.1 .......RT Radiation Set IOD............................................................................. 257
ZZ.4.1.1 ....... General Notes .............................................................................. 257
ZZ.4.1.2. ...... Fractionation ................................................................................ 257
ZZ.4.1.2. ...... Meterset and other parameters resolution ................................... 257
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452
454
456
458
460
462
464
466
468
470
Page 10
ZZ.4.2 .......RT Radiation IODs ................................................................................. 257
ZZ.4.2.1 ....... Control Points............................................................................... 257
ZZ.4.2.2 ....... Sub-Control Points ....................................................................... 257
ZZ.4.3 .......RT Segment Annotation IOD ................................................................. 257
ZZ.4.3.1 ....... Conceptual Volume ...................................................................... 257
ZZ.4.3.2 ....... Segment ....................................................................................... 258
ZZ.5 ...... EXAMPLE USE CASES .................................................................................. 258
ZZ.5.1 .......Use Case Actors .................................................................................... 258
ZZ.5.2 .......Treatment Planning Using Managed Workflow...................................... 259
ZZ.5.2.1 ....... Message Sequencing................................................................... 259
ZZ.5.2.2 ....... Transactions and Message Flow ................................................. 259
ZZ.5.3 .......Treatment Planning Using Received RT Course ................................... 262
ZZ.5.3.1 ....... Message Sequencing................................................................... 262
ZZ.5.3.2 ....... Transactions and Message Flow ................................................. 262
ZZ.5.4 .......Treatment Planning Using DICOM Media .............................................. 264
ZZ.5.4.1 ....... Message Sequencing................................................................... 264
ZZ.5.4.2 ....... Transactions and Message Flow ................................................. 264
ZZ.5.5 .......Treatment Planning Using Archive Query of RT Course ....................... 266
ZZ.5.5.1 ....... Message Sequencing................................................................... 266
ZZ.5.5.2 ....... Transactions and Message Flow ................................................. 266
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Foreword
This Supplement specifies the additional IODs necessary to support the new Second Generation
Radiotherapy IODs and operations.
This document is an extension to the following parts of the published DICOM Standard:
476
478
480
PS 3.2
Conformance
PS 3.3
Information Object Definitions
PS 3.4
Service Class Specifications
PS 3.6
Data Dictionary
PS 3.16
Content Mapping Resource
PS 3.17
Explanatory Information
482
Scope and Field of Application
Introduction
484
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.
486
Since the development of the initial IODs, both radiation therapy practice and the DICOM Standard
itself have evolved considerably. In particular, workflow management is now a key aspect of
DICOM’s domain of application, and the introduction of Unified Worklist and Procedure Step (by
Supplement 74 in conjunction with Supplement 96) have begun the growth of radiation therapy into
workflow management.
488
490
492
This supplement addresses the need for a new generation of IODs and processes required for use
in radiation therapy. The general principles under which these IODs and processes have been
developed are documented below.
494
General Architectural Principles
496
The DICOM “STRATEGIC DOCUMENT Version 10.4, October 25, 2010” outlines a number of
principles applicable across the entire DICOM standard. The key relevant points, and how this
supplement addresses those concerns, are as follows:
498

Image IOD development follows the “enhanced multi-frame” paradigm, rather than stacks of 2D
SOP Instances. The new RT Dose Image follows this paradigm.
500

Different representations of data are encoded in different IODs. This is in contrast to firstgeneration objects, where multiple different types of data are encoded in a single IOD, such as
RT Structure Set.

These new IODs do not define an architecture for the entire system, or functional requirements
beyond behavior required for specific services. This is because the mode of manual exchange of
objects (see PS3.17) supports an arbitrary system architecture. The worklist mode of operation
502
504
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Page 12
does place some constraints on the architecture – for example, it implies the existence of one or
more workflow servers that have knowledge of department-wide scheduling. The Radiation
Oncology domain of the IHE initiative may adapt workflows that will utilize 2nd Generation
Radiotherapy objects and define their usage in a clinical workflow, as it was done with
Supplement 74 and the IHE-RO Technical Profile "Treatment and Delivery Workflow".
506
508
510
RT Architectural Principles
512
In addition to the general principles outlined above, additional principles specific to radiation therapy
have been used in the development of this supplement:
514

Support for available technologies: The new IODs are designed to support legacy and fullfeatured, modern equipment.
516

Compatibility with First-Generation IODs: In general, where the technologies continue to be
supported, it will be possible for the content of first-generation IODs to be re-encoded into the
second generation IODs described in the supplement. However, such a translation will not be a
basic re-encoding and will require additional information supplied by the translating device.

New data representation approaches in DICOM: Where possible, use has been made of new
and powerful approaches, such as 3D segmentation, mesh representation, rigid and deformable
registrations.

IODs specific to use cases: Explicit separate IODs have been developed for specific treatment
modalities with the concept of RT Radiation IOD – for example, Tomotherapeutic, C-Arm, and
Robotic beams are modeled separately. This allows more stringent conditions to be applied to
the presence or absence of attributes within those IODs, and thereby increases the potential for
interoperability.

Expandability of concept: New treatment modalities currently not considered by this standard can
be modeled along the existing RT Radiation IODs and be introduced later on, fitting into the
existing concept.

Workflow Management: The concept of workflow management using Unified Procedure Step
has been fully integrated into the new IODs. However, specific instruction and result IODs
needed for some of these workflows will be standardized in a subsequent supplement.

New techniques in oncology: The existence of new treatment techniques (such as robotic
therapy and tomotherapy) have been taken into account, along with new treatment strategies
(such as image-guided therapy and adaptive therapy).
518
520
522
524
526
528
530
532
534
536
See Part 17 for descriptions of new radiotherapy entities and sample use cases.
538
Part 2 Addendum
Add new SOP Classes to PS3.2 Table A.1-2 UID Values:
540
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
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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
542
Part 3 Addendum
544
Add the following in PS3.3 Chapter 7 DICOM model of the real-world
546
7.12 EXTENSION OF THE DICOM MODEL OF THE REAL-WORLD FOR SECOND GENERATION
RADIOTHERAPY INFORMATION OBJECTS
548
For the purpose of Radiotherapy Second Generation SOP Classes the DICOM Model of the RealWorld is described in this section. This subset of the real-world model covers the requirements for
transferring information about planned and performed radiotherapeutic treatments and associated
data.
550
552
Figure 7.12-1 describes the most important elements involved in radiotherapy domain in DICOM.
106737321: Supplement 147: Second Generation Radiotherapy
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1
1
Patient
1
has
is subject
of
has
0-n
0-n
references
0-1
0-1
RT Course
0-n
references
1
0-n
subdivided
by
0-n
RT Physician Intent
1
0-n
1-n
prescribes
0-n
Treatment Phase
0-1
contains
contains
0-n
0-1
1-n
0-1
Prescription
0-n
Is based on
0-n
0-n
prescribes
to
to
RT Segment
Annotation
0-1
annotates
0-1
0-n
volumetrically
1
represented
by
Conceptual
Volume
0-1
Segmentation
OR
Surface
Segmentation
OR
0-1
constitutes fraction
composed of
applies
to
1-n
1
0-n
RT Radiation
1
calculated
for
results
in
0-n
0.n
RT Dose
Histogram
1
0-n
0-n
RT Radiation Set
0-n
RT Dose
Samples
0-n
RT Dose
Image
0-n
0-n
RT Radiation
Record
defines
RT Structure Set
554
556
Figure 7.12-1 — DICOM MODEL OF THE REAL WORLD – RADIOTHERAPY
558
560
562
564
566
7.12.1
RT Course
The RT Course is a top-level entity that represents a radiotherapy treatment course, specified in one
or more RT Prescriptions, generally for a defined tumor or group of tumors. A patient undergoing
treatments of radiotherapy has one treatment course at a time. The RT Course may consist of
several Treatment Phases (possibly with breaks of treatment in between them); each Phase may
consist of one or more Treatment Sessions. A Treatment Session is delivered in one patient visit to a
venue with a treatment machine and will typically deliver a fraction of one or more Radiation Sets. A
new RT Course is administered, when the patient is treated for a re-occurrence or a new tumor site –
typically after a period of a year or more after the previous RT Course has been finished.
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572
The RT Course can be thought of as a container collecting all major objects which are relevant to
this course. The Physician Intent and RT Radiation Sets reference other companion objects
necessary to prepare, conduct and review the treatment. Timing information (start dates and phasing
of treatment, breaks etc.) are also part of the RT Course information. Additionally it contains
information of the ongoing status in treatment planning and delivery. The RT Course is a dynamic
object that represents the current status of the patient’s treatment.
574
The RT Course may also include information about previously conducted treatments by referencing
previous RT Course objects or by directly recording the information in attributes.
568
570
7.12.2
576
578
580
582
584
586
588
590
The RT Physician Intent describes how the physician wishes to achieve curative or palliative therapy.
This information includes, but is not limited to the use of external radiation therapy or brachytherapy,
total and fractional doses and fractionation schemes, treatment sites, dosimetric objectives,
envisioned treatment technique and beam energy, and patient setup notes.
7.12.3
594
596
RT Segment Annotation
The RT Segment Annotation annotates segmented regions defined in other SOP Instances with
radiotherapy-specific information about the role and RT-specific types of the regions (e.g. clinical
target volume, organ at risk, bolus), and other information such as density definitions. An RT
Segment Annotation SOP instance always references one of these three general-purpose
representation entities: Segmentation, Surface Segmentation or RT Structure Set.
7.12.5
598
Conceptual Volume
The Conceptual Volume is a reference to a certain anatomical region or point where therapeutic
doses or dosimetric constraints are specified, calculated and tracked during the course of treatment.
For example at the time of prescription, physicians specify regions to which dose is prescribed.
Subsequently those regions are referenced in other objects in order to track calculated and delivered
dose in the course of treatment. This referencing capability is provided by the Conceptual Volume.
Conceptual Volumes may or may not have a representation in segmented images, e.g. in case of
‘emergency’ treatments, sites may be treated which are not volumetrically segmented, but still are to
be identified by labeling and textual annotations to be able to track doses. In most cases though,
they will be related to one or more volumetric representations in various image sets taken at different
times during the course of treatment.
7.12.4
592
RT Physician Intent
RT Radiation Set
600
An RT Radiation Set is a collection of RT Radiations. An RT Radiation Set defines a radiation
therapy treatment fraction, which will be applied one or more times. The RT Radiation Set is
delivered by delivering the radiation of all referenced RT Radiations.
602
Parallel and intermittent fractionation schemes, e.g. treatment of several target sites with different
timing schemes, are represented by multiple RT Radiation Sets.
7.12.6
604
606
608
An RT Radiation is a contiguous set of control points, describing machine and positioning
parameters to be applied during treatment delivery. An RT Radiation describes one portion of an RT
Radiation Set and represents an uninterrupted delivery of therapeutic radiation intended to be
delivered in an indivisible manner. An RT Radiation is typically referred to in end-user terminology as
a beam (in external beam treatment) or a catheter (in brachytherapy).
7.12.7
610
612
RT Radiation
RT Radiation Record
The RT Radiation Record records actual treatment parameters which have been applied during the
delivery of an RT Radiation in the context of a specific fraction. Typically, those parameters are the
same as those described within an RT Radiation, but may differ due to therapist decisions and/or
circumstances of the delivery technology and/or for various other reasons.
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614
7.12.8
RT Dose Image
616
The RT Dose Image contains the representation of a 3-dimensional dose distribution using the multiframe and functional group paradigms. This dose distribution may represent the planned or delivered
dose corresponding to an RT Radiation Set or an individual RT Radiation.
618
7.12.9
620
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
that annotates the anatomical region where the histogram applies.
622
7.12.10
RT Dose Histogram
RT Dose Samples
The RT Dose Samples represents dose point data, which are calculated or measured.
624
7.12.11
RT Treatment Phase
626
An RT Course may be divided into multiple RT Treatment Phases. Each RT Treatment Phase
represents a period of time during which a defined number of treatment fractions are delivered by RT
Radiation Sets in order to reach a specific treatment goal.
628
630
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.
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Page 17
Add the following columns in PS3.3 Section A.1.4, Table A.1-3 COMPOSITE INFORMATION OBJECT MODULES OVERVIEW –
RADIOTHERAPY
4
IODs
Modules
RT
RT
RT
Cours Phys Rad
e
Intent Set
Seg Tomo C-Arm C-Arm Multi- Rob Multi- Tomo C- Multi Rob Multi RT
RT
RT
RT
RT
RT
Rad
Ph El Rad Fixed Rad Axial Rec Arm Fixed Rec Axial Dose Dose Dose Pat Rad
Ann
Rad
Rad
Rad
Ph Rec
Rec Img Hist Samp Setup Set
Rec
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
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
Frame Of
Reference
C
Synchronization
Radiotherapy
Common Instance
M
RT Course
M
RT Prescription
Reference
C
M
M
M
M
M
106737321: Supplement 147: Second Generation Radiotherapy
IODs
Modules
RT
RT
RT
Cours Phys Rad
e
Intent Set
RT Treatment
Phase
C
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
RT Segment
Annotation
Page 18
Seg Tomo C-Arm C-Arm Multi- Rob Multi- Tomo C- Multi Rob Multi RT
RT
RT
RT
RT
RT
Rad
Ph El Rad Fixed Rad Axial Rec Arm Fixed Rec Axial Dose Dose Dose Pat Rad
Ann
Rad
Rad
Rad
Ph Rec
Rec Img Hist Samp Setup Set
Rec
Deliv
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 PhotonElectron Delivery
Device
M
M
M
C-Arm PhotonElectron Beam
M
M
M
Multiple Fixed
Source Delivery
Device
M
M
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IODs
Modules
RT
RT
RT
Cours Phys Rad
e
Intent Set
Page 19
Seg Tomo C-Arm C-Arm Multi- Rob Multi- Tomo C- Multi Rob Multi RT
RT
RT
RT
RT
RT
Rad
Ph El Rad Fixed Rad Axial Rec Arm Fixed Rec Axial Dose Dose Dose Pat Rad
Ann
Rad
Rad
Rad
Ph Rec
Rec Img Hist Samp Setup Set
Rec
Deliv
M
Multiple Fixed
Source Beam Set
M
Robotic Delivery
Device
M
M
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
M
RT Dose
Histogram
M
RT Dose Samples
M
RT Patient Setup
Multi-frame
Functional Groups
M
Multi-frame
Dimension
M
Respiratory
Synchronization
C
M
RT Radiation Set
Delivery
Instruction
Common Instance
Reference Module
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
SOP Common
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
106737321: Supplement 147: Second Generation Radiotherapy
Page 20
Add the following to PS3.3 Annex A:
2
A.VV
SECOND GENERATION RADIATION THERAPY
A.VV.1
Second Generation Radiation Therapy Objects
4
This Section provides a brief description of the IODs of Second Generation Radiation Therapy.
Specifically, this description includes:
6

The Real-World Object which is represented by the IOD

Information as to the scope of the represented object if appropriate
8
10
A.VV.1.1
This section provides a description of the module structure which is shared by the Second Generation
Radiation Therapy IODs.
A.VV.1.1.1
12
14
Second Generation Radiation Therapy Common Information
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
that are relevant to second-generation RT IODs.
106737321: Supplement 147: Second Generation Radiotherapy
Page 21
Patient
1
is the
subject of
1,n
Study
1
contains
1,n
spatially or
temporally
defines
1,n
1,n
Series
creates
0,n
RT Dose
Histogram
2
Frame of Reference
Equipment
0,n
RT Physician
Intent
RT Segment
Annotation
0,n
RT Dose
Samples
1
0,n
0,n
RT Course
0-1
0,n
RT Dose
Image
1
contains
0,n
RT Radiation
Set
0,n
RT Radiation
0,n
RT Radiation
Record
Figure A.VV.1.1.1-1 — RT Second Generation IOD information model
0,n
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.1.1.2
2
4
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 differs for
first-generation IODs).

IOD instances within a single series shall be created on the same equipment.

IOD instances within a single series shall be created by the same Procedure Step, where
applicable.

IOD instances within a single series shall share a common frame of reference (where such a
frame of reference is present).

All composite instances within a series shall have the same series information. Examples of this
include when a different operator creates the IOD, or if it is created at a significantly different time
(such as in a different planning session).
12
14
16
18
20
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
generation IODs, internal references shall be used to relate and locate SOP Instances rather than
making assumptions about how related SOP Instances are grouped into series. Implementers should
note however, that the DICOM standard, in general, does place some restrictions on how such SOP
Instances should be grouped, such as:
8
10
Page 22
The above rules could result in a study containing a diagnostic CT series, a diagnostic MR series, and
an RT-specific series for a given course. An application might find it easier to use references in the
RT Course object to directly retrieve required instances rather than search for them.
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.1.1.3
2
Page 23
Second Generation Radiation Therapy IOD Modules Macro
RT Second Generation IODs use a shared common module structure in most IODs. Where this
structure is applied, IODs reference this structure as defined in the following Table A.VV.1.1.1-1.
4
Table A.VV.1.1.1-1
RT SECOND GENERATION IOD MODULES MACRO
IE
Module
Patient
Study
Series
Reference
Usage
Patient
C.7.1.1
M
Clinical Trial Subject
C.7.1.3
U
General Study
C.7.2.1
M
Patient Study
C.7.2.2
U
Clinical Trial Study
C.7.2.3
U
General Series
C.7.3.1
M
Clinical Trial Series
C.7.3.2
U
C.AA.A0
M
General Equipment
C.7.5.1
M
Enhanced General
Equipment
C.7.5.2
M
C.AA.A2
M
Common Instance
Reference Module
C.12.2
M
SOP Common
C.12.1
M
Enhanced RT Series
Equipment
Common
Instance-level
IEs
Radiotherapy Common
Instance Module
6
A.VV.1.1.1.4
8
RT Radiation IOD Modules Macro
10
Specific RT Radiation IODs (Tomotherapeutic Radiation IOD, C-Arm Photon Radiation IOD, etc.)
share common modules as defined in the following Table A.VV.1.1.1-2. This macro is always used in
conjunction with the specific RT Radiation IODs.
12
Table A.VV.1.1.1-2
RT RADIATION IOD MODULES MACRO
IE
Module
Reference
Usage
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
14
A.VV.1.1.1.5
RT Radiation Record IOD Modules Macro
16
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.
This macro is always used in conjunction with the specific RT Radiation Record IODs.
106737321: Supplement 147: Second Generation Radiotherapy
Table A.VV.1.1.1-3
RT RADIATION RECORD IOD MODULES MACRO
2
IE
Module
RT Treated
Radiation
4
A.VV.1.2
8
10
12
Reference
Usage
RT Radiation Record
Common
C.AA.P1
M
RT Dose Record Common
C.AA.P2
M
RT Course Information Object Definition
A.VV.1.2.1
6
Page 24
RT Course IOD Description
The RT Course IOD binds together various entities needed in radiotherapy for preparation, execution
and review of radiotherapeutic treatment of a patient. It facilitates complete archiving of a RT
treatment delivery and communication of data needed for planning or treatment steps not managed
by DICOM workflow.
The content of an RT Course may undergo frequent updates resulting in a new SOP Instance UID
following each update. As a result, querying for the current RT Course object may return a SOP
Instance UID different than previously used to access the object.
See PS 3.17 for further explanation.
14
A.VV.1.2.2
RT Course IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
16
A.VV.1.2.3
RT Course IOD Module Table
Table A.VV.1.2-4
RT COURSE IOD MODULES
18
IE
Module
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
RT Course
RT Course
C.AA.A3
M
RT Prescription
Reference
C.AA.A4
C
RT Treatment Phase
C.AA.A5
Required if RT Prescription
Reference Presence Flag
(30xx,0805) equals YES.
C
Required if RT Treatment Phase
Presence Flag (30xx,0806) equals
YES.
RT Radiation Set
Reference
C.AA.A6
RT Course Associated
Instance Reference
C.AA.A7
C
Required if RT Radiation Set
Reference Presence Flag
(30xx,0807) equals YES.
U
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.3
Page 25
RT Physician Intent Information Object Definition
2
A.VV.1.3.1
4
The RT Physician Intent carries the prescriptions by which the physician describes the therapeutic
goal and strategy for the radiotherapeutic treatment.
A.VV.1.3.2
6
RT Physician Intent IOD Description
RT Physician Intent IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.3.3
RT Physician Intent IOD Module Table
8
Table A.VV.1.3-1
RT PHYSICIAN INTENT IOD MODULES
IE
Module
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
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
12
14
16
RT Radiation Set Information Object Definition
A.VV.1.4.1
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
pattern and the Number of Fractions and the associated dose contributions. See Part 17 for further
explanation.
A.VV.1.4.2
18
RT Radiation Set IOD Description
RT Radiation Set IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.4.3
RT Radiation Set IOD Module Table
20
Table A.VV.1.4-1
RT RADIATION SET IOD MODULES
IE
Module
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
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
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.5
Page 26
RT Segment Annotation Information Object Definition
2
A.VV.1.5.1
RT Segment Annotation IOD Description
4
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
annotated SOP Instance, or overrides that content with new or additional interpretation.
6
A.VV.1.5.2
RT Segment Annotation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
8
A.VV.1.5.3
RT Segment Annotation IOD Module Table
Table A.VV.1.5-1
RT SEGMENT ANNOTATION IOD MODULES
10
IE
Module
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
RT Segment
Annotation
12
A.VV.1.6
RT Segment Annotation
C.AA.D1
M
Tomotherapeutic Radiation Information Object Definition
A.VV.1.6.1
Tomotherapeutic Radiation IOD Description
14
The Tomotherapeutic Radiation IOD represents the information required to describe a radiotherapy
treatment on a serial or helical tomotherapeutic delivery device.
16
A.VV.1.6.2
Tomotherapeutic Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
18
A.VV.1.6.3
Tomotherapeutic Radiation IOD Module Table
Table A.VV.1.6-1
TOMOTHERAPEUTIC RADIATION IOD MODULES
20
IE
Module
Reference
Usage
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
22
A.VV.1.6.3.1
24
For the Tomotherapeutic Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure
Technique Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined CID
SUP147013.
26
A.VV.1.7
A.VV.1.7.1
RT Radiation Common Module in RT Radiation IOD Modules Macro
C-Arm Photon Radiation Information Object Definition
C-Arm Photon Radiation IOD Description
28
The C-Arm Photon Radiation IOD represents the information required to describe a radiotherapy
treatment on a C-Arm photon delivery device.
30
A.VV.1.7.2
C-Arm Photon Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.7.3
Page 27
C-Arm Photon Radiation IOD Module Table
2
Table A.VV.1.7-1
C-ARM PHOTON RADIATION IOD MODULES
IE
Module
Reference
Usage
Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2
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
6
8
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
Technique Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined CID
SUP147012.
A.VV.1.8
C-Arm Electron Radiation Information Object Definition
10
A.VV.1.8.1
12
The C-Arm Electron Radiation IOD represents the information required to describe a radiotherapy
treatment on a C-Arm electron delivery device.
A.VV.1.8.2
14
C-Arm Electron Radiation IOD Description
C-Arm Electron Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.8.3
C-Arm Electron Radiation IOD Module Table
16
Table A.VV.1.8-1
C-ARM ELECTRON RADIATION IOD MODULES
IE
Module
Reference
Usage
Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2
RT Radiation
C-Arm Photon-Electron Delivery
Device
C.AA.G1
M
C-Arm Photon-Electron Beam
C.AA.G2
M
18
A.VV.1.8.3.1
20
22
RT Radiation Common Module in RT Radiation IOD Modules Macro
For the C-Arm Electron Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure
Technique Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined CID
SUP147012.
A.VV.1.9
Multiple Fixed Source Radiation Information Object Definition
24
A.VV.1.9.1
26
The Multiple Fixed Source Radiation IOD represents the information required to describe a
radiotherapy treatment on a multiple fixed source photon delivery device.
A.VV.1.9.2
28
Multiple Fixed Source Radiation IOD Description
Multiple Fixed Source Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.9.3
Page 28
Multiple Fixed Source Radiation IOD Module Table
2
Table A.VV.1.9-1
MULTIPLE FIXED SOURCE RADIATION IOD MODULES
IE
Module
Reference
Usage
Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2
RT Radiation
Multiple Fixed Source Delivery
Device
C.AA.H1
M
Multiple Fixed Source Beam Set
C.AA.H2
M
4
A.VV.1.9.3.1
6
8
RT Radiation Common Module in RT Radiation IOD Modules Macro
For the Multiple Fixed Source Radiation IOD, the Code Sequence Macro in the Radiotherapy
Procedure Technique Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined
CID SUP147045.
A.VV.1.10
Robotic Radiation Information Object Definition
10
A.VV.1.10.1
12
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.
A.VV.1.10.2
14
Robotic Radiation IOD Description
Robotic Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.10.3
Robotic Radiation IOD Module Table
16
Table A.VV.1.10-1
ROBOTIC RADIATION IOD MODULES
IE
Module
Reference
Usage
Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2
RT Radiation
Robotic Delivery Device
C.AA.J1
M
Robotic Path
C.AA.J2
M
18
A.VV.1.10.3.1 RT Radiation Common Module in RT Radiation IOD Modules Macro
20
For the Robotic Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure Technique
Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined CID SUP147046.
22
A.VV.1.11
A.VV.1.11.1
Multi-Axial Radiation Information Object Definition
Multi-Axial Radiation IOD Description
24
The Multi-Axial Radiation IOD represents the information required to describe a radiotherapy
treatment on a C-arm device having additional degrees of freedom in source positioning.
26
A.VV.1.11.2
Multi-Axial Radiation IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
28
30
A.VV.1.11.3
Multi-Axial Radiation IOD Module Table
Table A.VV.1.11-1
MULTI-AXIAL RADIATION IOD MODULES
106737321: Supplement 147: Second Generation Radiotherapy
IE
Page 29
Module
Reference
Usage
Include 'RT Radiation IOD Modules Macro' Table A.VV.1.1.1-2
RT Radiation
Multi-Axial Delivery Device
C.AA.L1
M
Multi-Axial Beam
C.AA.L2
M
2
A.VV.1.11.3.1 RT Radiation Common Module in RT Radiation IOD Modules Macro
4
For the Multi-Axial Radiation IOD, the Code Sequence Macro in the Radiotherapy Procedure
Technique Sequence (30xx,0C99) in the RT Radiation Common Module shall use Defined CID
SUP147012.
6
A.VV.1.12
RT Dose Image Information Object Definition
A.VV.1.12.1
8
10
12
RT Dose Image IOD Description
The RT Dose Image IOD represents 2D or 3D calculated or measured dose distributions in the
DICOM Patient Coordinate System. This IOD does not provide for definition of doses in beam or other
coordinate systems. The application is responsible for transforming data in other, non-patient based
coordinate systems to the patient based coordinate system described in C.7.6.2.1.1.
A.VV.1.12.2
RT Dose Image IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
14
A.VV.1.12.3
RT Dose Image IOD Module Table
Table A.VV.1.12-1
RT DOSE IMAGE IOD MODULES
16
IE
Module
Reference
Usage
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
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
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
Respiratory Synchronization
18
A.VV.1.12.4
20
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.
A.VV.1.12.5
22
RT Dose Image IOD Content Constraints
RT Dose Image Functional Group Macros
Table A.VV.1.12-2
RT DOSE IMAGE FUNCTIONAL GROUP MACROS
106737321: Supplement 147: Second Generation Radiotherapy
Function Group Macro
Page 30
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.
C.AA.M3.1
M
C.7.6.16.2.11
M – Shall be used as a Shared Functional
Group
RT Dose Image Frame
Type
Real World Value
Mapping
Defined CID for Measurement Units Code
Sequence (0040,08EA) shall be SUP147065.
2
A.VV.1.13
RT Dose Histogram Information Object Definition
A.VV.1.13.1
RT Dose Histogram IOD Description
4
The RT Dose Histogram IOD specifies dose-volume histogram (DVH) and dose-area histogram data
and statistics, calculated by radiotherapy treatment planning systems.
6
A.VV.1.13.2
RT Dose Histogram IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
8
A.VV.1.13.3
RT Dose Histogram IOD Module Table
Table A.VV.1.13-1
RT DOSE HISTOGRAM RADIATION IOD MODULES
10
IE
Module
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
RT Dose
Histogram
12
A.VV.1.14
A.VV.1.14.1
14
16
M
Enhanced RT Dose
C.AA.M1
M
RT Dose Histogram
C.AA.M4
M
RT Dose Samples Information Object Definition
RT Dose Samples IOD Description
RT Dose Samples IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.14.3
20
C.7.6.14
The RT Dose Samples IOD specifies a list of spatial locations and associated dose values created by
a treatment planning system or dose measurement device. Spatial locations are specified in the
patient based coordinate system described in C.7.6.2.1.1.
A.VV.1.14.2
18
Acquisition Context
RT Dose Samples IOD Module Table
Table A.VV.1.14-1
RT DOSE SAMPLES IOD MODULES
106737321: Supplement 147: Second Generation Radiotherapy
IE
Module
Page 31
Reference
Usage
Include 'RT Second Generation IOD Modules Macro' Table A.VV.1.1.1-1
2
Frame of
Reference
Frame of Reference
C.7.4.1
M
Synchronization
C.7.4.2
C – Required if
time
synchronization
was applied.
RT Dose
Samples
Acquisition Context
C.7.6.14
M
Enhanced RT Dose
C.AA.M1
M
Dose Samples
C.AA.M5
M
A.VV.1.15
A.VV.1.15.1
Tomotherapeutic Radiation Record Information Object Definition
Tomotherapeutic Radiation Record IOD Description
4
The Tomotherapeutic Radiation Record IOD records the radiation delivered using the
Tomotherapeutic Radiation IOD.
6
A.VV.1.15.2
Tomotherapeutic Radiation Record IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
8
A.VV.1.15.3
Tomotherapeutic Radiation Record IOD Module Table
Table A.VV.1.15-1
TOMOTHERAPEUTIC RADIATION RECORD IOD MODULES
10
IE
Module
Reference
Usage
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
12
A.VV.1.16
A.VV.1.16.1
C-Arm Photon Radiation Record Information Object Definition
C-Arm Photon Radiation Record IOD Description
14
The C-Arm Photon Radiation Record IOD records the radiation delivered using the C-Arm Photon
Radiation IOD.
16
A.VV.1.16.2
C-Arm Photon Radiation Record IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
18
A.VV.1.16.3
C-Arm Photon Radiation Record IOD Module Table
Table A.VV.1.16-1
C-ARM PHOTON RADIATION RECORD IOD MODULES
20
IE
Module
Reference
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
Usage
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.17
Page 32
C-Arm Electron Radiation Record Information Object Definition
2
A.VV.1.17.1
4
The C-Arm Electron Radiation Record IOD records the radiation delivered using the C-Arm Electron
Radiation IOD.
A.VV.1.17.2
6
C-Arm Electron Radiation Record IOD Description
C-Arm Electron Radiation Record IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.17.3
8
C-Arm Electron Radiation Record IOD Module Table
Table A.VV.1.17-1
C-ARM ELECTRON RADIATION RECORD IOD MODULES
IE
Module
Reference
Usage
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
12
A.VV.1.18.1
14
The Multiple Fixed Source Radiation Record IOD records the radiation delivered using the Multiple
Fixed Source Radiation IOD.
A.VV.1.18.2
16
Multiple Fixed Source Record Radiation IOD Description
Multiple Fixed Source Radiation Record IOD E-R Model
See Figure A.VV.1.1.1-1.
A.VV.1.18.3
18
Multiple Fixed Source Radiation Record IOD Module Table
Table A.VV.1.18-1
MULTIPLE FIXED SOURCE RADIATION RECORD IOD MODULES
IE
Module
Reference
Usage
Include ‘Multiple Fixed Source Radiation IOD Modules’ Table A.VV.1.9-1
Include ‘RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3
20
A.VV.1.19
22
A.VV.1.19.1
Robotic Radiation Record Information Object Definition
Robotic Radiation Record IOD Description
The Robotic Radiation Record IOD records the radiation delivered using the Robotic Radiation IOD.
24
A.VV.1.19.2
Robotic Radiation Record IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
26
A.VV.1.19.3
Robotic Radiation Record IOD Module Table
Table A.VV.1.19-1
ROBOTIC RADIATION RECORD IOD MODULES
28
IE
Module
Reference
Include ‘Robotic Radiation IOD Modules’ Table A.VV.1.10-1
Include ‘RT Radiation Record IOD Modules Table A.VV.1.1.1-3
Usage
106737321: Supplement 147: Second Generation Radiotherapy
A.VV.1.20
Page 33
Multi-Axial Radiation Record Information Object Definition
2
A.VV.1.20.1
4
The Multi-Axial Radiation Record IOD records the radiation delivered using the Multi-Axial Radiation
IOD.
A.VV.1.20.2
6
Multi-Axial Radiation Record IOD Description
Multi-Axial Radiation Record IOD Entity-Relationship Model
See Figure A.VV.1.1.1-1.
A.VV.1.20.3
8
Multi-Axial Radiation Record IOD Module Table
Table A.VV.1.20-1
MULTI-AXIAL RADIATION RECORD IOD MODULES
IE
Module
Reference
Include ‘Multi-Axial Radiation IOD Modules’ Table A.VV.1.11-1
Include ‘RT Radiation Record IOD Modules’ Table A.VV.1.1.1-3
10
Usage
106737321: Supplement 147: Second Generation Radiotherapy
2
Add the following to PS3.3 Annex C:
C.AA
4
SECOND GENERATION RADIOTHERAPY MODULES
The following macros and modules are used by the second generation radiotherapy IODs.
C.AA.1
6
8
Notes:
12
C.AA.1.1
16
18
Second Generation Radiotherapy Definitions
This section lists some of the most-often used terms in the scope of Second Generation Radiotherapy
Modules and provides definitions for a better understanding.
10
14
Page 34
1. This section does not replace a profound understanding of clinical knowledge related to
radiotherapy treatments.
2. See the explanations in Section 7.12 “Extension of the DICOM model of the real-world for
Second Generation of Radiotherapy Information Objects”, in IOD definitions in Section A.VV.1 and
in PS 3.17 Annex ZZ.
Control Points
A Control Point represents the planned state of a (delivery) device at one of a sequence of states
defined by a progress variable. For radiation delivery the Cumulative Meterset (30xx,5021) is the
progress variable.
The Control Point Sequence represents the geometric and radiological parameters as a sequence of
states at specified values of the Cumulative 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.1.1.1
24
Verification Control Points represent the expected cumulative dose for a set of geometric parameters.
Verification is performed by comparing the expected dose at a Verification Control Point to a
corresponding dose. The corresponding dose may be directly measured or recalculated.
26
C.AA.1.2
28
30
34
Nominal Energy
A nominal energy is an equipment setting used by the manufacturer to characterize the penetration of
the beam into a material. For photon beam delivery, the maximum energy of the delivered photon
spectrum is typically specified. For electron beam delivery, the most probable energy of the spectrum
is typically specified.
C.AA.1.3
32
Verification Control Points
Fractionation, Fractionation Scheme
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 treatments,
fractionation allows healthy tissue to recover from radiation effects over the course of treatment. The
temporal pattern of deliveries is called a fractionation scheme.
36
C.AA.1.4
Treatment RT Radiation Set
38
A Treatment RT Radiation Set is an RT Radiation Set that has been selected for treatment, is being
treated, or has been treated. RT Radiation Sets which are not called Treatment RT Radiation Set
include alternatives or rejected proposals for treatment.
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.1.5
2
Page 35
Meterset
4
A parameter from which, through a calibration procedure with additional information, the absorbed
dose delivered can be calculated. For meterset representing monitor units, the definition is based on
IEC 60601-2-64.
6
The meterset is used to measure the progress of radiation delivery during treatment, or report on
progress after treatment.
C.AA.1.6
8
10
A point chosen in space, or in the patient treatment volume, to measure or plan for a specific amount
of radiation. The point usually is placed at a significant location, such as within a tumor, or within
healthy tissue to be spared or where a measurement device can be positioned.
C.AA.1.7
12
14
Radiation Dose Point
Treatment Phase
A specific period within a treatment course when the prescribed medical treatment is applied to the
patient. Typically, if more than one RT Radiation Set is delivered, they are in overlapping or sequential
phases.
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.2
2
Page 36
Second Generation Radiotherapy General-Purpose Macros
C.AA.2.1
RT Entity Labeling Macro
The RT Entity Labeling Macro identifies a radiotherapy concept.
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
Attribute Name
RT Entity Label
Tag
Type
(30xx,51E2)
1
Description
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.
8
C.AA.2.1.1
RT Entity Labeling Macro Attribute Description
10
C.AA.2.1.1.1
RT Entity Label
12
The RT Entity Label (30xx,51E2) attribute represents a user-definable short free text providing the
primary identification of this entity to other users. The label may be used to provide unique
identification to the user.
14
C.AA.2.1.1.2
16
The optional attribute RT Entity Name (30xx,51E3) allows a longer string containing additional
descriptive identifying text for one-line headings etc. The optional attribute RT Entity Description
(30xx,51E4) allows adding additional information when needed.
18
C.AA.2.2
RT Entity Name and RT Entity Description
RT Entity Long Labeling Macro
The RT Entity Long Labeling Macro identifies a radiotherapy concept.
20
22
This information is intended only for display to human readers and shall not be used
programmatically.
Table C.AA.2.2-1
RT ENTITY LONG LABELING MACRO ATTRIBUTES
Attribute Name
RT Entity Long Label
Tag
Type
(30xx,51E5)
1
Description
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.
24
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.2.1.2.1
2
4
Page 37
RT Entity Long Label
The RT Entity Long Label (30xx,51E5) attribute represents a user-definable free text providing the
primary identification of this entity to other users. The label may be used to provide unique
identification to the user.
C.AA.2.3
RT Item State Macro
6
This macro is invoked to record the clinical state, such as approval or review, of either an entire SOP
Instance or a specific part of the information content of a SOP Instance.
8
Table C.AA.2.3-1
RT ITEM STATE MACRO ATTRIBUTES
Attribute Name
RT Item State Sequence
Tag
Type
(30xx,5080)
1
Attribute Description
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
No Baseline CID defined.
(Editor’s Note: That Macro is defined in Sup 121. The
version referenced in here is Sup 121_pc, 2013-04-11)
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
12
C.AA.2.3.1.1
RT Item State Sequence
14
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
Assertion Macro are defined at the invocation of the macro.
16
C.AA.2.3.1.2
18
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
having been in place in the past .
20
22
Active Item Indicator
This indication additionally allows conveying more than one state entry of different persons as being
active. E.g. if the department requires approvals by more than one person, several items having an
approved state can be marked as active, indicating the list of persons having provided approval.
106737321: Supplement 147: Second Generation Radiotherapy
Page 38
2
The semantics of the states are defined in the code definition and may be further specialized at
invocation of that macro. Which state transitions are allowed and which are the pre-conditions to
perform a state transition if outside of the scope of the standard.
4
C.AA.2.4
6
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
approval status as encoded in RT Item State (see Section C.AA.2.3).
8
10
RT Operation State Macro
The initial state of a SOP Instance, to which the sequence applies, is undefined and specified by an
empty sequence.
Table C.AA.2.4-1
RT OPERATION STATE MACRO ATTRIBUTES
Attribute Name
RT Operation State Sequence
Tag
Type
Attribute Description
(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.
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
Author Observer Sequence
(0040,A078)
Defined CID shall be SUP147044.
1C
The person or device updating the
operation state.
Only a single Item shall be included
in this sequence.
>Include ‘Identified Person or Device Macro’ Table
C.17-3b
No Baseline CIDs defined
(Editor’s Note: That Macro used here is one defined in
PS3.3 with the extensions of Sup 121. The supplement
version referenced in here is Sup 121_pc, 2013-04-11)
RT Operation State DateTime
(30xx,508C)
1
Date and time at which the operation
state did change.
RT Operation State Change
Reason Description
(30xx,508E)
3
Description of the reason for moving
to this state, especially in the case of
early completion
>RT Operation State Change
Reason Code Sequence
(30xx,5088)
3
Code describing the reason for
moving to this state, especially in the
case of early completion.
Only a single Item shall be included
in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
12
No Baseline CID is specified.
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 39
106737321: Supplement 147: Second Generation Radiotherapy
2
4
6
8
C.AA.2.5
Page 40
Conceptual Volume Macro
A Conceptual Volume is an abstract entity used to identify an anatomic region (such as a planning
target volume or a combination of multiple anatomic segments) or non-anatomic volumes such as a
bolus or a marker. A Conceptual Volume can be established without necessarily defining its spatial
extent (for example a Conceptual Volume for a tumor can be established prior to segmenting it). The
spatial extent of a Conceptual Volume may change over time (for example as treatment proceeds the
tumor volume corresponding to the Conceptual Volume will change).
10
The spatial extent of a Conceptual Volume may be defined by a Segmentation, Surface Segmentation
or RT Structure Set SOP Instance or a combination thereof, although the Conceptual Volume does
exist independently of a specific definition of its spatial extent.
12
A Conceptual Volume may also be defined as a combination of other Conceptual Volumes.
Examples for Conceptual Volumes:
14
16
18
20
22
24
26
28
30
1.
A Conceptual Volume (with a Conceptual Volume UID) can be used to represent the
treatment target in an RT Physician Intent SOP Instance based upon a diagnostic image set,
although the actual delineation of a specific target volume has not yet taken place. Later, the
target volume is contoured. The RT Segment Annotation SOP Instance references the volume
contours and associates it with the Conceptual Volume via the Conceptual Volume UID.
2.
In an adaptive workflow, the anatomic volume may change over time. The
Conceptual Volume on the other hand does not change. Multiple RT Segment Annotation SOP
Instances, each referencing different Segmentation instances, can be associated with the
same Conceptual Volume via the Conceptual Volume UID, making it possible to track the
volume over time.
3.
A Conceptual Volume may be used to define fraction doses, for example in
emergency treatments in RT Physician Intent SOP instances and subsequently defined RT
Radiation SOP instances where the beam dose is manually calculated. After treatment, these
Conceptual Volumes are used in Radiation Records to track the delivered dose. Such
Conceptual Volumes may never reference a segmentation, but serve as a key for referencing
the Conceptual Volume across different SOP instances.
Table C.AA.2.5-1
CONCEPTUAL VOLUME MACRO ATTRIBUTES
Attribute Name
Tag
Type
Conceptual Volume UID
(30xx,1301)
1
Originating SOP Instance
Reference Sequence
(30xx,1302)
1C
Attribute Description
A UID identifying the Conceptual
Volume.
Reference to the SOP Instance that
contains the original definition of this
Conceptual Volume identified by
Conceptual Volume UID (30xx,1301).
Required when the Conceptual
Volume UID (30xx,1301) was not
issued in the current SOP Instance,
but read from another SOP instance.
Only a single Item shall be included
in this sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Page 41
>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.
Only a single Item shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
2
4
6
8
10
12
14
16
C.AA.2.5.1
Conceptual Volume Macro Attribute Description
C.AA.2.5.1.1
Equivalent Conceptual Volumes
Conceptual Volumes can be declared to be equivalent to other Conceptual Volumes. In such cases,
the Equivalent Conceptual Volumes Sequence (30xx,1305) is used in derived SOP instances which
are aware of other SOP instances defining a semantically equivalent volume, but using different
Conceptual Volume UIDs.
C.AA.2.6
Conceptual Volume Segmentation Reference and Combination Macro
This macro allows the combination of conceptual Volumes as constituents of a combined volume. A
representative example is to have the Left Lung and the Right Lung segmented, and then to declare
the Lungs as a combined Conceptual Volume, for which prescription constraints can be defined.
The macro also allows reference to RT Segment Annotation SOP instances, which contain a
segmented representation of the Conceptual Volume. At the invocation of this macro it is declared,
whether this segmented representation is required or not.
106737321: Supplement 147: Second Generation Radiotherapy
RT Physician Intent
Conceptual
Volume
“Lung, left”
Conceptual
Volume
“Lung, right”
Page 42
RT Segmentation
Annotation (I)
RT Segmentation
Annotation (II)
Conceptual
Volume
“Lung, left”
Conceptual
Volume
“Lung, right”
Segment 3
ROI 5
Segmentation
RT Structure Set
2
Figure C.AA.2.6-1
Conceptual Volume References
4
Figure C.AA.2.6-1 describes an RT Physician Intent instance where Conceptual Volumes “Lung, left”
and “Lung, right” are referenced, but not defined. In this example, the RT Segmentation Annotation
Instances then define the volumetric information of the Conceptual Volumes by referencing a specific
segment of a Segmentation Instance and a specific ROI in an RT Structure Set Instance.
6
8
10
RT Physician Intent
Conceptual
Volume
“Lung”
Conceptual
Volume
“Lung, left”
12
Conceptual
Volume
“Lung, right”
106737321: Supplement 147: Second Generation Radiotherapy
2
4
6
8
Page 43
Figure C.AA.2.6-2
Conceptual Volume Combination References
Figure C.AA.2.6-2 describes an RT Physician Intent Instance defining Conceptual Volumes “Lung,
left” and “Lung, right” and Conceptual Volume “Lung” as a combination of the first two without a direct
reference to a volume definition
Table C.AA.2.6-1
CONCEPTUAL VOLUME SEGMENTATION REFERENCE AND COMBINATION MACRO
ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Include 'Conceptual Volume Macro' Table C.AA.2.5-1
Conceptual Volume Combination
Flag
(30xx,1309)
1
Indication that this Conceptual
Volume reference is a combination of
other Conceptual Volumes.
Enumerated Values:
YES
NO
Conceptual Volume Constituent
Sequence
(30xx,1303)
1C
References to Conceptual Volumes
which are constituents of this
Conceptual Volume.
See C.AA.2.6.1.1.
Required if Conceptual Volume
Combination Flag (30xx,1309) equals
YES.
One or more Items shall be included
in this sequence.
The combined Conceptual Volume
UID shall not be included in the
sequence.
>Conceptual Volume Constituent
Index
(30xx,1308)
1
An index referened in the Conceptual
Volume Combination Expression
(30xx,1307) identifying the
Conceptual Volume Constituent.
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 the
combined Conceptual Volume.
106737321: Supplement 147: Second Generation Radiotherapy
>Originating SOP Instance
Reference Sequence
(30xx,1302)
Page 44
1C
Reference to the SOP Instance that
contains the original definition of the
Conceptual Volume constituent
identified by Conceptual Volume UID
(30xx,1301) in this sequence.
Required if this UID was not issued
within the current SOP Instance
containing this macro, but read from
another SOP Instance for reference.
Only a single Item shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
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 (30xx,1311)
Defined Flag
1
States whether the Conceptual
Volumes present in this Item have
segmentations referenced.
Enumerated Values
YES
NO
Conceptual Volume Segmentation (30xx,1312)
Reference Sequence
1C
Contains the reference to the RT
Segment Annotation instance
defining this Conceptual Volume.
Required when Conceptual Volume
Segmentation Defined Flag
(30xx,1311) Flag equals YES and
Conceptual Volume Combination
Flag Indicator (30xx,1309) equals
NO.
Only a single Item shall be included
in this sequence.
See C.AA.2.6.1.2.
106737321: Supplement 147: Second Generation Radiotherapy
>Referenced RT Segment
Annotations Sequence
(30xx,0874)
Page 45
1
Reference to the RT Segment
Annotations SOP instance that
contains the segmentation.
Only a single Item shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
>Referenced Segment Annotation (30xx,0151)
Index
Conceptual Volume Constituent
Segmentation Reference
Sequence
(30xx,1314)
1
1C
Reference to the Segment Index
(30xx,0121) in the Segment
Sequence (0062,0002) of the
referenced RT Segment Annotation
instance.
Contains the reference to the
constituents of the RT Segment
Annotation instance defining this
Conceptual Volume.
Required when Conceptual Volume
Segmentation Defined Flag
(30xx,1311) equals YES and
Conceptual Volume Combination
Flag Indicator (30xx,1309) equals
YES.
The number of Items included in this
sequence shall equal the number of
Items in the Conceptual Volume
Constituent Sequence (30xx,1303).
See C.AA.2.6.1.2.
>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.
Only a single Item shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
>Referenced Segment Annotation (30xx,0151)
Index
1
Reference to the Segment Index
(30xx,0121) in the Segment
Sequence (0062,0002) of the
referenced RT Segment Annotation
instance.
106737321: Supplement 147: Second Generation Radiotherapy
Referenced Spatial Registration
Sequence
(0070,0404)
Page 46
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
(30xx,1309) equals YES,
One or more Items shall be included
in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.2.6.1
Description
Conceptual Volume Combination and Segmentation Macro Attribute
4
C.AA.2.6.1.1
Conceptual Volume Combination Expression
6
8
For Conceptual Volumes specified as a combination of other Conceptual Volumes, the combination
logic is specified by the text string value of the Conceptual Volume Combination Expression
(30xx,1307). The combination syntax uses a symbolic expression notation similar to that used in the
Lisp programming language.
A nested list notation is used to apply geometric operators to a set of Conceptual Volumes.
10
A list shall be delimited by parentheses and consists of two or more elements.
The first element of the list shall be one of the following geometric operators:
12
14




UNION – geometric union of 2 or more arguments
INTERSECTION – geometric intersection of 2 or more arguments
NEGATION – geometric inverse of a single argument
16
18
Subsequent elements shall specify arguments of the geometric operator. An argument is either a
Conceptual Volume Constituent Index value, i.e. positive integer, or a parenthesized list.
106737321: Supplement 147: Second Generation Radiotherapy
Page 47
Examples:
2
1. Union of paired organs 1 and 2 (disjoint).
Input
Result
Left
Lung
Right
Lung
4
6
Conceptual Volume Combination Expression (30xx,1307):
(UNION 1 2)
8
10
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
Right Lung
2
Left Lung
2. Union of paired organs 1 and 2 (non-disjoint)
Result
12
Conceptual Volume Combination Expression (30xx,1307):
14
(UNION 1 2)
106737321: Supplement 147: Second Generation Radiotherapy
Page 48
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
Spinal Cord PRV
2
Left Lung
2
4
3. Union of two organs 1 and 2 with excluded volume 3 using NEGATION.
6
Input
Result
CTV
Heart
8
Left
Lung
Conceptual Volume Combination Expression (30xx,1307):
(INTERSECTION (UNION 1 2) (NEGATION 3))
10
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
Heart
2
Left Lung
3
CTV
12
14
4. Union of paired organs 1 and 2, with exclusion of multiple volumes 3, 4 and 5.
106737321: Supplement 147: Second Generation Radiotherapy
Page 49
Result
Input
CTV
Node 2
R Lung
L Lung
Node 1
2
Conceptual Volume Combination Expression (30xx,1307):
(INTERSECTION (UNION 1 2) (NEGATION (UNION 3 4 5)))
4
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
R Lung
2
L Left
3
Node 1
4
Node 2
5
CTV
6
5. Intersection of overlapping volumes 1 and 2.
8
Input
Result
Prostate
PTV
Rectum
10
Conceptual Volume Combination Expression (30xx,1307):
(INTERSECTION 1 2)
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Page 50
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
Rectum
2
Prostate PTV
2
6. Intersection of disjoint volumes 1 and 2.
4
Input
Result
Bladder
Prostate
6
Conceptual Volume Combination Expression (30xx,1307):
(INTERSECTION 1 2)
8
10
Items in Conceptual Volume Constituent Sequence (30xx,1303):
Conceptual Volume
Constituent Index
(30xx,1308)
Conceptual Volume
1
Bladder
2
Prostate
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C.AA.2.6.1.2
Page 51
Conceptual Volume Segmentation Reference Sequence
2
The Conceptual Volume Segmentation Reference Sequence (30xx,1312) contains a reference to a
Segmentation, which represent that volume geometically.
4
In case of combination, the Conceptual Volume Segmentation Reference Sequence (30xx,1312) lists
the segmentations used for definition of a combined Conceptual Volume. The segmentations
referenced may be in one or more Frames of Reference. The constituent Conceptual Volumes in this
sequence shall not include the combined Conceptual Volume being defined. Applications that wish to
combine existing segmentations within the same Conceptual Volume must create a new
Segmentation Instance.
6
8
12
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.2.9
Page 52
Radiation Fraction Pattern Macro
2
The Radiation Fraction Pattern Macro specifies the intended fractionation pattern to be used to deliver
the radiation treatment.
4
Table C.AA.2.9-1
RADIATION FRACTION PATTERN MACRO ATTRIBUTES
Attribute Name
Fraction Pattern Sequence
Tag
Type
(30xx,0965)
1C
Description
The fraction pattern in a machinereadable form.
Required if a fraction pattern has
been defined.
Only a single Item shall be included in
this sequence.
>Number of Fraction Pattern
Digits Per Day
(300A,0079)
1
Number of digits in a Fraction Pattern
(300A,007B) used to represent one
day. See C.AA.2.9.1.1.
>Repeat Fraction Cycle Length
(300A,007A)
1
Number of weeks needed to describe
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 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
8
10
C.AA.2.9.1
Radiation Fraction Pattern Macro Attribute Description
C.AA.2.9.1.1
Fractionation
The Radiation Fraction Pattern describes the intended scheme, i.e. how fractions are to be distributed
along calendar days for the actual radiation set.
Examples of Fractionation Patterns:
12
a) 1 fraction per day (Monday to Friday), no fractions on Saturday and Sunday:
14
Number of Fraction Pattern Digits per Day = 1
Repeat Fraction Cycle Length = 1
Fraction Pattern = 1111100
16
b) 2 fractions per day (Monday to Friday), no fractions on Saturday and Sunday:
18
Number of Fraction Pattern Digits Per Day = 2
Repeat Fraction Cycle Length = 1
Fraction Pattern = 11111111110000
20
c) 1 fraction per day (Monday, Wednesday, Friday), no fractions on Saturday and Sunday:
22
Number of Fraction Pattern Digits Per Day = 1
Repeat Fraction Cycle Length = 1
Fraction Pattern = 1010100
106737321: Supplement 147: Second Generation Radiotherapy
Page 53
d) 2 fraction per day (Monday, Wednesday, Friday), one fraction on Saturday and Sunday:
2
4
Number of Fraction Pattern Digits Per Day = 2
Repeat Fraction Cycle Length = 1
Fraction Pattern = 11001100111010
e) 1 fraction per day every other day:
6
8
Number of Fraction Pattern Digits Per Day = 1
Repeat Fraction Cycle Length = 2
Fraction Pattern = 10101010101010
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.2.10
2
Page 54
Treatment Device Identification Macro
The Treatment Device Identification Macro identifies a device used to deliver radiation to the patient
during a radiotherapy treatment session.
4
Table C.AA.2.10-1
Treatment Device Identification Macro Attributes
Attribute Name
Treatment Device
Identification
Sequence
Tag
Type
(30xx,5015)
1
Attribute Description
Identifies treatment device.
Only a single Item shall be included in this
sequence.
>Include 'Device Model Macro' Table
C.AA.2.11-1
Identifies the device model for the Treatment
Device.
If Treatment Machine Delivery Subsystem ID
(30xx,0BB2) is present, these attributes identify
that subsystem.
>Include 'Device Identification Macro' Table
C.AA.2.14-1.
Defined CID SUP147054.
>Institution Name
(0008,0080)
3
Institution where the equipment is located.
>Institution Address
(0008,0081)
3
Mailing address of the institution where the
equipment is located.
>Institutional
Department Name
(0008,1040)
3
Department in the institution where the
equipment is located.
6
C.AA.2.11
8
Device Model Macro
The Device Model Macro contains general attributes needed to specify a radiotherapy device.
Table C.AA.2.11-1
DEVICE MODEL MACRO ATTRIBUTES
10
Attribute Name
Tag
Type
Description
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.
Manufacturer's Model Class UID
(30xx,0BB0)
2
Manufacturer’s Unique identifier
(UID) for the class of the device.
12
C.AA.2.12
RT Patient Support Devices Macro
14
The RT Patient Support Devices Macro identifies a patient support device (table, table top, chair or
similar) which shall be used for treatment.
106737321: Supplement 147: Second Generation Radiotherapy
Page 55
Table C.AA.2.12-1
RT PATIENT SUPPORT DEVICES IDENTIFICATION MACRO ATTRIBUTES
2
Attribute Name
Tag
Type
Description
Number of Patient Support
Devices
(30xx,51F1)
1
Number of Patient Support Devices
Sequence defined in the Patient
Support Devices Sequence
(30xx,51F0).
Patient Support Devices
Sequence
(30xx,51F0)
1C
Patient support device definitions.
Required if the Number of Patient
Support Devices (30xx,51F1) is
not-zero.
The number of Items included in
this sequence shall equal the value
of Number of Patient Support
Devices (30xx,51F1).
>Device Index
(30xx,0112)
1
Index of the Device.
The value shall start at 1, and
increase monotonically by 1.
>Include 'Device Model Macro' Table C.AA.2.11-1
>Include 'Device Identification Macro' Table
C.AA.2.14-1.
Defined CID SUP147006.
>Conceptual Volume Sequence (30xx,1346)
2
References a conceptual volume
that describes the geometry and
properties of the patient support
device.
Zero or one a single Item is
permitted in this sequence.
>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
4
6
C.AA.2.13
Patient Support Position Macro
This macro provides the device-specific geometric settings for the Patient Support device.
8
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
Equipment Mapping Matrix (30xx,6040).
12
Table C.AA.2.13-1
PATIENT SUPPORT POSITION MACRO ATTRIBUTES
Attribute Name
Patient Support
Position Parameter
Sequence
Tag
Type
(30xx,5142)
2
Attribute Description
Translational and rotational parameters for a
particular Patient Support device.
Zero or more Items shall be included in this
sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Referenced Device
Index
Tag
Type
(30xx,0142)
1
>Include Content Item Macro Table 10-2
Page 56
Attribute Description
Uniquely references Patient Support Device
described by Device Index (30xx,0112) in
Patient Support Devices Sequence
(30xx,51F0).
Baseline TID of Concept Name Code Sequence
is TID SUP147004.
See C.AA.G2.1.4 for description of Continuous
Rotation Angle usage.
2
C.AA.2.14
Device Identification Macro
The Device Identification Macro identifies (physical or virtual) device.
4
Table C.AA.2.14-1
DEVICE IDENTIFICATION MACRO ATTRIBUTES
Attribute Name
Device Type Code Sequence
Tag
Type
(30xx,5026)
1
Attribute Description
The type of the device.
Only a single Item shall be included
in this sequence.
>Include 'Code Sequence Macro' Table 8.8-1.
Device Label
(30xx,5025)
1
A user-readable label identifying the
device.
Device Description
(30xx,5027)
3
User defined description for the
device.
Device Serial Number
(0018,1000)
2
Manufacturer’s serial number of the
device.
Software Versions
(0018,1020)
2
Manufacturer’s designation of
software version of the equipment.
Regulatory Device Identifier
Sequence
(30xx,5031)
2
Regulatory Identifiers for this device.
>Regulatory Device Identifier
(30xx,5033)
1
The Regulatory Device Identifier
>Regulatory Device Identifier
Type Code Sequence
(30xx,5035)
1
The type of the regulatory device
identifier.
Zero or more Items shall be included
in this sequence.
Only a single Item shall be included
in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1.
Manufacturer's Device Identifier
(30xx,054D)
Defined CID SUP147053
2
An identifier issued by the
manufacturer.
Note.
Typically, the Device
Identifier is a code which can
be electronically read by the
machine utilizing that device,
e.g. to verifiy the presence of
that device.
106737321: Supplement 147: Second Generation Radiotherapy
Device Alternate Identifier
(30xx,1326)
Page 57
1C
An identifier intended to be read by a
device such as a bar code reader.
Required, if a hospital-issued
identifier is used, e.g. attached as a
bar code.
Device Alternate Identifier Type
(30xx,1327)
1C
Defines the type of Device Alternate
Identifier.
Required if Device Alternate Identifier
(30xx,1326) is present.
Defined Terms:
BARCODE
RFID
Device Alternate Identifier
Symbology
2
C.AA.2.15
(Maybe not – look at the history of
the barcode-related attributes – Issue
R57)
(30xx,TBD)
RT Accessory Device Identification Macro
The RT Accessory Device Identification Macro identifies an RT accessory device and it’s location.
4
Table C.AA.2.15-1
RT ACCESSORY DEVICE IDENTIFICATION MACRO ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Include 'Device Model Macro' Table C.AA.2.11-1
Include 'Device Identification Macro' Table C.AA.2.14-1.
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
106737321: Supplement 147: Second Generation Radiotherapy
RT Accessory Device Slot ID
(30xx,054B)
Page 58
1C
Identifier for location (slot) of RT
Radiation Modifier accessory where
the current accessory inserted.
Required if accessory is located in a
slot and Referenced RT Accessory
Holder Device Index (30xx,0540) is
not present.
RT Accessory Slot Distance
(30xx,0548)
2C
Distance (in mm) from the RT Beam
Distance Reference Location
(30xx,5114) to the Accessory Slot.
Required if RT Accessory Device
Slot ID (30xx,054B) is present.
Referenced RT Accessory Holder
Device Index
(30xx,0540)
1C
Reference to the Device Index
(30xx,0112) of the Accessory Holder
device in the RT Accessory Holder
Definition Sequence (30xx,054A).
Required if accessory is mounted on
a holder device and RT Accessory
Slot ID (30xx,054B) is not present.
RT Accessory Holder Slot ID
(30xx,0544)
1C
Identifier for location (slot) of
Radiation Modifier in the Accessory
Holding device where the current
accessory is inserted.
Required if Referenced RT
Accessory Holder Device Index
(30xx,0540) is present
and
the referenced Accessory Holder
Device contains an RT Accessory
Holder Slot Sequence (30xx,0542).
2
C.AA.2.16
Control Point General Attributes Macro
This macro specifies the base attributes for the definition of a Radiation Control Point.
4
Table C.AA.2.16-1
CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES
Attribute Name
Control Point Index
Tag
Type
(30xx,0111)
1
Attribute Description
The order the control points are executed.
Index used to reference items corresponding to
a control point in a sequence...
The value shall start at 1, and increase
monotonically by 1.
Cumulative Meterset
(30xx,5021)
1C
Meterset at the Control Point expressed in the
units reported by Radiation Dosimeter Unit
(30xx,5113).
The Meterset of the first Control Point shall be
equal to 0.0.
Required if RT Radiation Data Scope
106737321: Supplement 147: Second Generation Radiotherapy
Page 59
(30xx,5013) is not GEOMETRIC.
See C.AA.2.16.1.1.
2
4
6
8
10
12
14
16
18
20
C.AA.2.16.1
Control Point Attribute Concept
The treatment-modality modules use a common formalism to represent parameters that define the
behaviour of a delivery device during delivery of radiation. These parameters are communicated as a
sequence of values, organized as ‘Control Points’, see C.AA.1.1. The resolution of Control Points
depends on the level of detail required to define the behaviour of the delivery device.
For any given treatment technique, some parameters may be constant for all Control Points. Such
static parameters shall only be present at the first Control Point and shall be absent in all other
Control Points. All other parameters that are changing at any of the Control Points shall be present in
each Control Point.
For all beam deliveries there are at least two control points, corresponding to the start and end of
delivery. E.g. for a simple Static Beam delivery with a constant field aperture, only two Control Points
are needed to define start and end, as there are no changes in between. For a dynamic delivery, in
which the MLC leaves are changing while radiation is delivered, the number of Control Points will be
higher to provide enough detail to define the leaf movement with sufficient resolution to achieve the
radiation fluence distribution expected for the prescribed dose.
A Control Point is a point on a timeline of a delivery process. Control Points are sequenced using an
index number starting with 1, e.g. 1, 2, 3, 4. The Control Point parameters reflect the state of the
delivery device at that point in time. The Control Point Cumulative Meterset reflects the dose that has
been delivered from the beginning of the delivery process up to that point in time.
22
DICOM does not specify the behavior of the machine parameters between Control Points. The
planning system needs to know the hardware-specific characteristics of the delivery system for which
the plan is being created.
24
C.AA.2.16.1.1 Control Point Attribute Requirements
26
Attributes that are constant for all Control Points shall only be specified at the first Control Point with
Control Point Item Index (30xx,0111) equal to 1. Attributes that change at any Control Point shall be
specified explicitly at all Control Points.
28
C.AA.2.16.1.2 Control Point Sequence Attribute Requirements
30
Sequences with constant attribute values for all Items at all Control Points shall only be present at the
first Control Point with Control Point Item Index (30xx,0111) equal to 1. Sequences with attribute
values changing at any Item at any Control Point shall be present at all Control Points.
32
C.AA.2.16.1.3 Control Point Attribute Examples
34
The following examples illustrate Control Points:
1. Static Beam delivery example:
36
Control Point 1: Cumulative Meterset = 0
All applicable treatment parameters defined
38
40
Control Point 2: Cumulative Meterset = 76
No parameters defined
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 60
At completion this beam delivers 76 Monitor Units using a fixed static set of treatment
parameters defined in Control Point 1.
2. Arc delivery example:
4
6
8
10
12
14
16
18
20
22
24
26
28
30
32
34
36
38
Control Point 1: Cumulative Meterset = 0
Gantry Rotation Direction = CW, Gantry Angle = initial angle
All other applicable treatment parameters defined
Control Point 2: Cumulative Meterset = 56
Gantry Rotation Direction = NONE, Gantry Angle = final angle
No other parameters defined
At completion this delivers 56 Monitor Units while rotating the gantry from initial angle to final
angle.
3. Dynamic delivery of two equally weighted segments example:
Control Point 1: Cumulative Meterset = 0
Collmator Opening X: 2x2
Collmator Opening Y: 2x2
All other applicable treatment parameters defined
Control Point 2: Cumulative Meterset = 40
Collmator Opening X: 2x2
Collmator Opening Y: 4x4
All other treatment parameters which change at any control point (including those which do not
change at this specific Control Point)
Control Point 3: Cumulative Meterset Weight = 80
Collmator Opening X: 4x4
Collmator Opening Y: 4x4
All other treatment parameters which change at any control point (including those which do not
change at this specific Control Point)
At completion this delivers 80 Monitor Units while first increasing the Y opening and then
increasing the X opening.
4. Dynamic Delivery of two unequally weighted segments with a step change of 5 degrees in the
clock-wise direction of the table angle example:
Control Point 1: Cumulative Meterset Weight = 0
Patient Support Angle = 0
Patient Support Rotation Direction = NONE,
All other applicable treatment parameters defined
40
42
44
Control Point 2: Cumulative Meterset = 30
Patient Support Angle = 0
Patient Support Rotation Direction = CW
All other treatment parameters defined which change at any control point (including those
which do not change at this specific control point)
46
48
50
Control Point 3: Cumulative Meterset = 30
Patient Support Angle = 5
Patient Support Rotation Direction = NONE
All other treatment parameters defined which change at any control point (including those
which do not change at this specific control point)
106737321: Supplement 147: Second Generation Radiotherapy
2
4
6
8
Page 61
Control Point 4: Cumulative Meterset = 90
Patient Support Angle = 5
Patient Support Rotation Direction = NONE
All other treatment parameters defined which change at any control point (including those
which do not change at this specific control point)
At completion this delivers 90 Monitor Units, while between Control Point 2 and 3 the patient
support angle is changed and no radiation is delivered.
10
C.AA.2.16.1.1 Meterset Calculations
12
14
16
The Meterset at a given Control Point is specified in the Cumulative Meterset (30xx,5021). That value
is specified in units defined by Radiation Dosimeter Unit (30xx,5113) in the RT Delivery Device
Common Module in section C.AA.E1. The meterset values correspond to the meterset readout of a
RT Radiation Delivery Device. In case that device has multiple meterset readouts, the values
correspond to the primary meterset readout.
C.AA.2.17
18
20
External Beam Control Point General Attributes Macro
This macro may be invoked to specify the generic Control Point attributes used to model external
beam radiation.
Table C.AA.2.17-1
EXTERNAL BEAM CONTROL POINT GENERAL ATTRIBUTES MACRO ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Include ‘Control Point General Attributes Macro’ Table C.AA.1.16-1
Delivery Rate
(30xx,5023)
1C
The intended nominal rate of delivery of the
specified Cumulative Meterset (30xx,5021). See
C.AA.2.17.1.2 for units.
Required if
Control Point Index (30xx,0111) equals 1 or this
attribute value changes at any Control Point,
and
the specification of the Delivery Rate is required
by the Delivery Device for RT treatment delivery
and
RT Radiation Data Scope (30xx,5013) is not
GEOMETRIC.
Maybe present otherwise.
See C.AA.2.16.1 and C.AA.2.17.1.1.
Delivery Rate Unit
Sequence
(30xx,5024)
1C
The unit of the Delivery Rate (30xx,5023).
Required if the Delivery Rate (30xx,5023) is
present.
See C.AA.2.16.1 and C.AA.2.17.1.1.
Only a single Item shall be included in this
sequence.
>Include 'Code Sequence Macro' Table 8.8-1 Defined CID SUP147051
Beam-On Area
(30xx,6050)
1C
Area in which the treatment beam is enabled.
106737321: Supplement 147: Second Generation Radiotherapy
Sequence
Page 62
Only a single Item shall be included in this
sequence.
Required if patient geometry requires limitation
of the beam delineation and if the Control Point
Index (30xx,0111) equals 1 or this attribute
value changes at any Control Point.
See C.AA.2.16.1.
>Include 'Outline Definition Macro' Table C.AA.2.29-1
2
C.AA.2.17.1
External Beam Control Point General Attributes Macro Attribute Description
C.AA.2.17.1.1 Delivery Rate
4
6
When the delivery device requires the Delivery Rate (30xx,5023) to be specified, the application
specifying that attribute shall ensure that the code in the Delivery Rate Unit Sequence (30xx,5024) is
the code expected by the delivery device.
C.AA.2.18
8
10
12
External Beam Sub-Control Point General Attributes Macro
This macro may be invoked to specify the generic Control Point attributes used to model external
beam radiation on Sub-Control Point level. Sub-Control Points may be necessary to define more
detailed information between Control Points or to encode some information with a finer granularity.
Table C.AA.2.18-1
EXTERNAL BEAM SUB-CONTROL POINT GENERAL ATTRIBUTES MACRO
Attribute Name
Sub-Control Point Index
Tag
Type
(30xx,0115)
1
Attribute Description
Index of the items in the sequence.
Used for internal or external
references.
The value shall start at 1, and
increase monotonically by 1.
Cumulative Meterset
(30xx,5021)
1C
Meterset at the Sub-Control Point
expressed in units reported by the
Radiation Dosimeter Unit
(30xx,5113).
Required, if RT Radiation Data
Scope (30xx,5013) is not
GEOMETRIC, and Sub-Control Point
Index (30xx,0115) equals 1 or
attribute value changes at any SubControl Point.
See Section C.8.1.18.1.2.
Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1
14
C.AA.2.18.1
RT Beam Limiting Device Definition Macro Attribute Description
C.AA.2.18.1.1 Sub-Control Point Attribute Requirements
16
No assumptions are made about the behavior of machine parameters between specified items in the
sequence. Communicating devices shall agree on this behavior outside the standard.
18
The representation of parameters in sub-control points follows the formalism as descibed in
C.AA.2.16.1.
106737321: Supplement 147: Second Generation Radiotherapy
Page 63
C.AA.2.18.1.2 Cumulative Meterset
2
The values of the Cumulative Meterset (30xx,5021) are defined on the same absolute scale as the
Cumulative Meterset (30xx,5021) in the Control Point Sequence.
4
The Sub-Control Point Cumulative Meterset must span the interval from the Control Point containing
the Sub-Control Point Sequence to the subsequent Control Point.
6

The value of the Cumulative Meterset (30xx,5021) of the item having a value of 1 in the SubControl Point Index (30xx,0115) shall have the same value as the Cumulative Meterset
(30xx,5021) of the Control Point containing this Sub-Control Point.

The value of the Cumulative Meterset (30xx,5021) of the item having the highest value in the
Sub-Control Point Index (30xx,0115) shall have the same value as the Cumulative Meterset
(30xx,5021) of the Control Point which follows the Control Point containing this Sub-Control Point.
8
10
12
C.AA.2.19
14
Beam Mode Macro
The Beam Mode Macro contains attributes to identify the beam mode of a delivery device use the in
current Radiation.
16
Table C.AA.2.19-1
BEAM MODE MACRO ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Number of Beam Modes
(30xx,51CB)
1
Number of Beam Modes defined in the
Beam Mode Sequence (30xx,51C0).
The Number shall be greater than zero.
Beam Mode Sequence
(30xx,51C0)
1
Sequence defining the Beam Mode.
The number of Items included in this
sequence shall equal the value of
Number of Beam Modes (300A,00D0).
>Beam Mode Index
(30xx,0113)
1
Index of this Item in the Beam Mode
Sequence. Used for internal or external
references.
The value shall start at 1, and increase
monotonically by 1.
>Beam Mode Label
(30xx,51C1)
1
User readable label that identifies this
beam mode.
See C.AA.2.19.1.3.
>Beam Mode Description
(30xx,51C2)
2
User-defined description of the beam
mode.
>Beam Mode Machine
Code
(30xx,51C3)
1
A vendor-specified machine-readable
code that uniquely identifies this beam
mode.
See C.AA.2.19.1.2.
106737321: Supplement 147: Second Generation Radiotherapy
>Radiation Type
(300A,00C6)
Page 64
1
Type of Radiation for this Beam Mode.
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.
See C.AA.2.19.1.1.
>Minimum Nominal Energy
(30xx,51C6)
1C
The minimum nominal beam energy in
units as defined in the Energy Unit
Code Sequence (30xx,51C9).
Required if Nominal Energy
(30xx,51C5) is not present, i.e. if the
beam energy is modulated (e.g. via
energy map) over a range within the
scope of a Control Point.
See C.AA.2.19.1.1.
>Maximum Nominal Energy
(30xx,51C7)
1C
The maximum nominal beam energy in
units as defined in the Energy Unit
Code Sequence (30xx,51C9).
Required if Nominal Energy
(30xx,51C5) is not present, i.e.if the
beam energy is modulated (e.g. via
energy map) over a range within the
scope of a Control Point.
See C.AA.2.19.1.1.
>Energy Unit Code
Sequence
(30xx,51C9)
1
>>Include 'Code Sequence Macro' Table 8.8-1
>Beam Mode Type Code
Sequence
(30xx,51C8)
The unit of energy values specified in
Nominal Energy (30xx,51C5),
Minimum Nominal Energy (30xx,51C6),
Maximum Nominal Energy
(30xx,51C7).
Defined CID SUP147042
1
Identifies the general category of this
beam.
One or more Items shall be included in
this sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Page 65
>>Include 'Code Sequence Macro' Table 8.8-1
2
4
6
8
10
12
14
16
C.AA.2.19.1
Defined CID SUP147050
Beam Mode
Treatment devices can produce a multitude of different beams with properties such as energy
spectrum, depth dose, surface dose and beam profile. A particular combination of such properties is
referred to as a Beam Mode. Such Beam Modes are created by the machine by using different
primary electron beams, flattening and scattering filters, etc., creating a specific physical and
geometric distribution of radiation. In many cases the Beam Mode characterizes the fluence just
below the Monitor Chamber. Subsequently these primary beams may be modulated by beam
modifiers such as Beam Limiting Devices, Wedges, Spreaders etc. While these beam modifiers are
described in the Control Point Sequence, the primary beam is assumed to have fixed characteristics.
In many cases, the Beam Mode will be constant throughout the Radiation.
Beam Modes are intended only to characterize different primary beams. It shall not be used to convey
any other meaning by using different beam modes having the same fluence, e.g. for annotating the
role of the beam in the clinical process or the usage of that beam during a treatment session. For
other definitions, e.g. to annotate constraints, other attributes are available like RT Radiation Set
Intent (30xx,5011) in the Radiation Set Module and information provided by the workflow protocols.
C.AA.2.19.1.1 Energy Attributes
18
20
22
The Beam Mode will usually correspond to a specific combination of nominal energy and radiation
type. The Nominal Energy (30xx,51C5) parameter is provided for beams, where a single discrete
energy is annotated by that value. Energy modulation can be used at the control point level (both
discrete and continuous), in which case the Minimal Nominal Energy (30xx,51C6) and Maximal
Nominal Energy (30xx,51C7) is used.
C.AA.2.19.1.2 Beam Mode Machine Code
24
26
28
The Beam Mode Machine Code (30xx,51C3) is a manufacturer-provided code that allows
unambigious identification of a Beam Mode. For each unique combination of machine parameters
that produces a distinct beam profile and for a distinct set of values of the attributes contained in an
Item in the Sequence a device-specific unique identifer is to be provided. In particular, each unique
combination of energy, radiation type and beam filter requires a distinct identifier.
C.AA.2.19.1.3 Beam Mode Label
30
32
Beam Mode Label (30xx,51C1) should uniquely identify a specific mode within a machine. No
assumptions shall be made about the structure, encoding or syntax of the Beam Mode Label
(30xx,51C1).
34
C.AA.2.20
36
This Macro may be invoked to define those attributes describing the configuration of the Beam
Limiting Device.
38
RT Beam Limiting Device Definition Macro
Table C.AA.2.20-1
RT BEAM LIMITING DEVICE DEFINITION MACRO ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Number of RT Beam
Limiting Devices
(30xx,5041)
1
Number of RT Beam Limiting Devices in the
RT Beam Limiting Device Definition Sequence
(30xx,504D). The number shall be greater than
zero.
RT Beam Limiting
(30xx,504D)
1
Beam limiting device (collimator) jaw or leaf
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Device Definition
Sequence
Tag
Type
Page 66
Attribute Description
(element) sets.
The number of Items included in this sequence
shall equal the value of Number of RT Beam
Limiting Devices (30xx,5041).
>Include 'RT Accessory Device Identification
Macro' Table C.AA.2.15-1
Defined CID SUP147010
>Device Index
Index of the Device.
(30xx,0112)
1
The value shall start at 1, and increase
monotonically by 1.
>RT Beam Limiting
Device Proximal
Distance
(30xx,5042)
2
Distance (in mm) from the RT Beam Distance
Reference Location (30xx,5114) to the
proximal end of beam limiting device
(collimator) along the beam axis.
>RT Beam Limiting
Device Distal Distance
(30xx,5043)
2
Distance (in mm) from the RT Beam Distance
Reference Location (30xx,5114) to the distal
end of beam limiting device (collimator) along
the beam axis.
>Number of RT Beam
Delimiter Pairs
(30xx,5048)
1C
Number of beam delimiter pairs. E.g. standard
beam limiting device jaws have one delimiter
pair.
Required if Device Type Code Sequence
(30xx,5026) contains either (S147172,
99SUP147, “X Leaves”) or (S147173,
99SUP147, “Y Leaves”). May be present
otherwise.
>RT Beam Delimiter
Element Position
Boundaries
(30xx,5049)
1C
Boundaries of beam delimiter elements (in
mm) with respect to the Coordinate System
Declaration (30xx,5208) axis appropriate to RT
Beam Limiting Device Type (300A,00B8) i.e. Xaxis 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 Type Code Sequence
(30xx,5026) contains either (S147172,
99SUP147, “X Leaves”) or (S147173,
99SUP147, “Y Leaves”). May be present
otherwise.
>RT Beam Delimiter
Geometry Sequence
(30xx,504C)
1C
The outline of the Beam Limiting Device
position.
Required if Device Type Code Sequence
(30xx,5026) is part of CID SUP147027.
Only a single Item shall be included in this
sequence.
>>Include ‘Outline Definition Macro’ Table C.AA.2.29-1
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.2.20.1
2
4
6
Page 67
RT Beam Limiting Device Definition Macro Attribute Description
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
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. RT
Beam Delimiter Element Positions (30xx,504A) are values specific to a given control point, specifying
the beam limiting device element openings.
8
C.AA.2.21
10
12
RT Beam Limiting Device Positions Macro
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.
Table C.AA.2.21-1
RT BEAM LIMITING DEVICE POSITIONS MACRO ATTRIBUTES
Attribute Name
RT Beam Limiting
Device Settings
Sequence
Tag
Type
Attribute Description
(30xx,5070)
1C
Beam limiting device (collimator) jaw or leaf
(element) positions for the current Control Point.
Required if the Control Point Index (30xx,0111)
equals 1 or attribute values change at any
Control Point.
See C.AA.2.16.1.
If Control Point Index (30xx,0111) equals 1, the
number of Items included in this sequence shall
equal the value of Number of RT Beam Limiting
Devices (30xx,5041).
If Control Point Index (30xx,0111) is greater
than 1, the Items present shall be those whose
values change at any control point.
>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
of the coordinate system referenced in
Coordinate System Declaration (30xx,5208)
with respect to the beam line axis.
See C.AA.G2.1.4.
Required if the Control Point Index (30xx,0111)
equals 1 or attribute value changes at any
Control Point.
>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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 68
Type
Attribute Description
Required if the Control Point Index (30xx,0111)
equals 1 or attribute value changes at any
Control Point
andif Device Type Code Sequence (30xx,5026)
contains (S147170, 99SUP147, “X Jaw”),
(S147171, 99SUP147, “Y Jaw”), (S147172,
99SUP147, “X Leaves”) or (S147173,
99SUP147, “Y Leaves”).
>RT Beam Delimiter
Geometry Sequence
(30xx,504C)
1C
The outline of the Beam Limiting Device
position.
Required if the Control Point Index (30xx,0111)
equals 1 or attribute value changes at any
Control Point
and
if Device Type Code Sequence (30xx,5026)
contains (S147174, 99SUP147, “Variable
Circular Collimator”).
Only a single Item shall be included in this
sequence.
>>Include ‘Outline Definition Macro’ Table C.AA.2.29-1
2
C.AA.2.22
Wedges Definition Macro
4
This macro may be invoked to define those attributes describing the geometric configuration of
Wedges.
Table C.AA.2.22-1
WEDGES DEFINITION MACRO ATTRIBUTES
6
Attribute Name
Tag
Type
Number of Wedges
(300A,00D0)
1
Wedge Definition
Sequence
(30xx,5062)
1C
Attribute Description
Number of Wedges defined in the Wedge
Definition Sequence (30xx,5062).
Treatment wedge definitions.
Required if Number of Wedges (300A,00D0) is
non-zero. The number of Items included in this
sequence shall equal the value of Number of
Wedges (300A,00D0).
>Include 'RT Accessory Device Identification Defined CID SUP147028.
Macro' Table C.AA.2.15-1
>Device Index
(30xx,0112)
1
Index of the Device.
The value shall start at 1, and increase
monotonically by 1.
>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-
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Type
Page 69
Attribute Description
axis of the declared coordinate system.
2
C.AA.2.23
Wedge Positions Macro
4
This macro may be invoked to define the positions of Wedges used in a specific Control Point or set
of Control Points.
Table C.AA.2.23-1
WEDGE POSITIONS MACRO ATTRIBUTES
6
Attribute Name
Wedge Position
Sequence
Tag
Type
(300A,0116)
1C
Attribute Description
Wedge Positions for this Control Point.
Required if Number of Wedges (300A,00D0) is
non-zero and as specified in C.AA.16.2.1.2.
If Control Point Index (30xx,0111) equals 1, the
number of Items included in this sequence shall
equal the value of Number of Wedges
(300A,00D0).
If Control Point Index (30xx,0111) is greater
than 1, the Items present shall be those whose
values change at any control point
See C.AA.2.16.1.
>Referenced Device
Index
(30xx,0142)
1
Uniquely references Wedge described by
Device Index (30xx,0112) in Wedge Definition
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 the wedge angle direction 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.
8
10
C.AA.2.24
Compensators Definition Macro
This macro may be invoked to define those attributes describing the geometric configuration of
Compensators which cannot vary during delivery.
106737321: Supplement 147: Second Generation Radiotherapy
Page 70
Table C.AA.2.24-1
COMPENSATORS DEFINITION MACRO ATTRIBUTES
2
Attribute Name
Tag
Type
Number of
Compensators
(300A,00E0)
1
Compensator
Definition Sequence
(30xx,5150)
1C
Attribute Description
Number of compensators associated with
current Beam.
Treatment compensator definitions.
Required if the Number of Compensators
(300A,00E0) is non-zero.
The number of Items included in this sequence
shall equal the value of Number of
Compensators (300A,00E0).
>Include 'RT Accessory Device Identification Defined CID SUP147016.
Macro' Table C.AA.2.15-1
>Device Index
(30xx,0112)
1
Index of the Device.
The value shall start at 1, and increase
monotonically by 1.
>Material ID
(300A,00E1)
2
User-supplied identifier for material used to
manufacture Compensator.
>Compensator
Divergence
(300A,02E0)
1
Whether or not the compensator is shaped
according to the beam geometrical divergence.
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 Map
Orientation
(30xx,5151)
1
Specifies on which side of the compensator
base the contoured surface faces.
Enumerated Values:
PATIENT_SIDE = the compensator
surface shape is directed towards the patient.
SOURCE_SIDE = the compensator
surface shape is directed towards the radiation
source.
DOUBLE_SIDED = the compensator
has two compensator surface shapes which are
directed towards the patient and source
respectively.
>Compensator Base
Plane Offset
(30xx,5154)
1
The distance (in mm) between the mounting
position and the base plane of the compensator.
The value shall be positive when the base plane
is further away from the RT Beam Distance
Reference Location (30xx,5114) than the
mounting position.
See C.AA.2.24.1.2
>Compensator Rows
(300A,00E7)
1
Number of rows in the compensator. A row is
defined to be in the X direction with respect to
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 71
Tag
Type
Attribute Description
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
adjacent pixels projected on the plane defined
by the Beam Limiting Device Definition Distance
(30xx,5210). Specified by a numeric pair adjacent row spacing (delimiter) adjacent
column spacing. See 10.7.1.3 for further
explanation of the value order.
>Compensator
Position
(300A,00EA)
1
The x and y coordinates (in mm) with respect to
the Coordinate System Declaration (30xx,5208)
of the upper left hand corner (first pixel
transmitted) of the compensator, projected on
the plane defined by the Beam Limiting Device
Definition Distance (30xx,5210).
>Compensator
Proximal Thickness
Map
(30xx,5152)
1C
A map of the distances (in mm) from the RT
Beam Distance Reference Location (30xx,5114)
to the compensator surface closest to the
radiation source.
The order of samples sent is left to right, top to
bottom (upper left-sample, followed by the
remainder of row 1, followed by the remainder
of the rows).
Required if Compensator Mounting Position
(300A,02E1) is SOURCE_SIDE or
DOUBLE_SIDED.
For the geometric definition, section C.8.8.14.10
applies.
See C.AA.2.23.1.1.
>Compensator Distal
Thickness Map
(30xx,5153)
1C
A map of the distances (in mm) from the RT
Beam Distance Reference Location (30xx,5114)
to the compensator surface closest to the
patient.
The order of samples sent is left to right, top to
bottom (upper left sample, followed by the
remainder of row 1, followed by the remainder
of the rows).
Required if Compensator Mounting Position
(300A,02E1) is PATIENT_SIDE or
DOUBLE_SIDED.
For the geometric definition, section C.8.8.14.10
applies.
See C.AA.2.23.1.1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 72
Type
>Compensator Pixel
Shape
1
Attribute Description
The shape of a pixel.
Defined Terms:
CONTINUOUS
SQUARE
CIRCULAR
HEXAGONAL
>Compensator
Column Offset
(300A,02E5)
1C
The offset distance (in mm) applied to the x
coordinate of the Compensator Position
(300A,00EA) for even numbered rows.
Required if not CONTINUOUS or SQUARE.
>Compensator Milling
Tool Diameter
2
C.AA.2.24.1
(300A,02E8)
2
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).
Compensators Definition Macro Attributes Description
C.AA.2.24.1.1 Compensator Thickness Map and Tray Distance
4
6
8
10
The values stored in Compensator Proximal Thickness Map (30xx,5152) and Compensator Distal
Thickness Map (30xx,5153) shall be parallel to the radiation beam axis if Compensator Divergence
(300A,02E0) equals ABSENT, or divergent according to the beam geometrical divergence if
Compensator Divergence (300A,02E0) equals PRESENT.
C.AA.2.24.1.2 Compensator Base Plane
The compensator base plane is the side of the compensator which is flat. In case of a double –sided
compensator, the base plan is the plane from which the compensator thickness is specified.
106737321: Supplement 147: Second Generation Radiotherapy
Page 73
Compensator Distal Thickness Map
(30xx,5153)
Block Thickness
(300A,0100)
Compensator Map Orientation
(30xx,5151)
= PATIENT_SIDE
Block Orientation
(30xx,5162)
= SOURCE_SIDE
RT Beam Distance Reference Location
(30xx,5114)
Block and Compensator Tray
in Accessory Slot
Compensator
Base Plane
Compensator Base Plane Offset
(30xx,5154)
( Attribute Value is negative )
2
Isocenter
RT Accessory Slot Distance
(30xx,0548)
Figure C.AA.2.24.1-1
Compensator Geometry
4
C.AA.2.25
6
This macro may be invoked to define those attributes describing the geometric configuration of Blocks
or Apertures which cannot vary during delivery.
Blocks Definition Macro
8
Table C.AA.2.25-1
BLOCKS DEFINITION MACRO ATTRIBUTES
Attribute Name
Tag
Type
Number of Blocks
(300A,00F0)
1
Block Definition
Sequence
(30xx,5160)
1C
Attribute Description
Number of Blocks defined in the Block
Definition Sequence (30xx,5160).
Block definitions.
Required if Number of Blocks (300A,00F0) is
non-zero..
The number of Items included in this sequence
shall equal the value of Number of Blocks
(300A,00F0).
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Type
Page 74
Attribute Description
>Include 'RT Accessory Device Identification Defined CID SUP147032.
Macro' Table C.AA.2.15-1
>Device Index
(30xx,0112)
1
Index of the Device.
The value shall start at 1, and increase
monotonically by 1.
>Material ID
(300A,00E1)
2
User-supplied identifier for material used to
manufacture the Block.
>Block Divergence
(300A,00FA)
1
Whether or not the block is shaped according to
the beam geometrical divergence.
Enumerated Values:
PRESENT = block edges are shaped
for beam divergence
ABSENT = block edges are not shaped
for beam divergence
>Block Orientation
(30xx,5162)
1
Specifies on which side of the block base the
block extends.
Enumerated Values:
PATIENT_SIDE = the block extends
from its base towards the patient.
SOURCE_SIDE = the block extends
from its base towards the radiation source.
>Block Base Offset
(30xx,5163)
1
The distance (in mm) between the mounting
position and the base plane of the block.
The value shall be positive when the base plane
is further away from the RT Beam Distance
Reference Location (30xx,5114) than the
mounting position.
>Block Thickness
(300A,0100)
2C
Physical thickness of block (in mm) parallel to
radiation beam axis. Required if Material ID
(300A,00E1) has a value. May be present if
Material ID (300A,00E1) has no value.
See C.AA.2.25.1.1.
>Block Edge Data
2
C.AA.2.25.1
(30xx,5161)
2
A data stream of (x,y) pairs (in mm) with respect
to the Coordinate System Declaration
(30xx,5208) which comprise the block edge.
The pairs shall be interpreted as a closed
polygon. Coordinates are projected on the plane
defined by the Beam Limiting Device Definition
Distance (30xx,5210).
Blocks Definition Macro Attribute Description
C.AA.2.25.1.1 Multiple aperture blocks
4
6
All blocks with Device Type Code Sequence (30xx,5026) with a value of (S147471, 99SUP147,
“Aperture Block”) for a given beam shall have equal values of Block Thickness (300A,0100) if they are
specified. The composite aperture shall be evaluated as the union of the individual apertures within a
106737321: Supplement 147: Second Generation Radiotherapy
2
single Block. Shielding block transmission(s) shall be applied multiplicatively after the (composite)
aperture has been evaluated.
C.AA.2.26
4
Page 75
Accessory Holder Definition Macro
This macro may be invoked to define those attributes describing the Accessory Holders which are
used to hold accessories.
6
Table C.AA.2.26-1
ACCESSORY HOLDER DEFINITION MACRO ATTRIBUTES
Attribute Name
Tag
Type
Number of RT
Accessory Holders
(30xx,5171)
1
RT Accessory Holder
Definition Sequence
(30xx,054A)
1C
Attribute Description
Number of RT Accessory Holders defined in the
RT Accessory Holder Definition Sequence
(30xx,054A).
Accessory Holder definitions.
Required if the Number of RT Accessory Holders
(30xx,5171) is non-zero.
The number of Items included in this sequence
shall equal the value of Number of RT Accessory
Holders (30xx,5171).
>Include 'RT Accessory Device
Identification Macro' Table C.AA.2.15-1
>Device Index
(30xx,0112)
Defined CID SUP147033 and SUP147034.
1
Index of the Device.
The value shall start at 1, and increase
monotonically by 1.
>RT Accessory
Holder WaterEquivalent Thickness
(30xx,02E3)
>RT Accessory
(30xx,0542)
Holder Slot Sequence
2
Water-Equivalent thickness of the Accessory
Holder (in mm) parallel to radiation beam axis.
1C
Slots being available in this Accessory Holder.
Required if Device Type Code Sequence
(30xx,5026) is part of CID SUP147034.
One or more Items shall be included in this
sequence.
>>RT Accessory
Holder Slot ID
(30xx,0544)
1
The ID of the slot where accessories are
inserted.
>> RT Accessory
Holder Slot Distance
(30xx,0546)
2
Distance (in mm) from the RT Beam Distance
Reference Location (30xx,5114) to the slot along
the radiation beam axis.
8
C.AA.2.26.1
10
12
14
Accessory Holder Description
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 may
include, but not be limited to, one or more of the following items:

custom blocks for patient specific lateral collimation (beam limiting),

pre-collimators for general lateral collimation (beam limiting),

uniform thickness range shifter for modifying the range uniformly across the beam,
106737321: Supplement 147: Second Generation Radiotherapy

two-dimensional range shifters (custom boluses) for modifying the range differentially across the
defined field,

ridge filters for creating multiple ranges within the beam,

cross-wires for aligning the patient with the beam,

a mirror or camera for aligning or viewing the irradiated area,

beam monitoring detectors,

applicator sealer for preventing fluids from entering the applicator.
2
4
6
8
Page 76
10
Several beam applicators may be available with a single radiation head to reduce the weight of
components lifted by therapists, decrease the block and/or bolus to skin distance, and reduce leakage
of radiation.
12
C.AA.2.27
14
This macro may be invoked to define those attributes describing the geometric configuration of
General Accessories which cannot vary during delivery.
General Accessories Definition Macro
Table C.AA.2.27-1
GENERAL ACCESSORIES DEFINITION MACRO ATTRIBUTES
16
Attribute Name
Tag
Type
Number of General
Accessories
(30xx,5181)
1
General Accessory
Definition Sequence
(30xx,5180)
1C
Attribute Description
Number of General Accessories defined in the
General Accessory Definition Sequence
(30xx,5180).
General accessories.
Required if the Number of General Accessories
(30xx,5181) is non-zero.
The number of Items included in this sequence
shall equal the value of Number of General
Accessories (30xx,5181).
>Include 'RT Accessory Device Identification Baseline CID SUP147030.
Macro' Table C.AA.2.15-1
>Device Index
(30xx,0112)
1
Index of the Device.
The value shall start at 1, and increase
monotonically by 1.
18
C.AA.2.28
Boluses Definition Macro
20
This macro may be invoked to define those attributes describing the geometric configuration of
Boluses which cannot vary during delivery.
Table C.AA.2.28-1
BOLUSES DEFINITION MACRO ATTRIBUTES
22
Attribute Name
Number of Boli
Tag
Type
(300A,00ED)
1
Attribute Description
Number of boli defined in the Boluses
Definition Sequence (30xx,5190).
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Boluses Definition
Sequence
Tag
Type
(30xx,5190)
1C
Page 77
Attribute Description
Bolus definitions.
Required if the Number of Boli (300A,00ED) is
non-zreo.
The number of Items included in this sequence
shall equal the value of Number of Boli
(300A,00ED).
>Include 'RT Accessory Device Identification
Macro' Table C.AA.2.15-1
Defined CID SUP147031.
>Device Index
Index of the Device.
(30xx,0112)
1
The value shall start at 1, and increase
monotonically by 1.
>Conceptual Volume
Sequence
(30xx,1346)
2
References a conceptual volume that
describes the geometry and properties of the
bolus.
See Section C.AA.2.28.1.1.
Zero or one a single Item is permitted in this
sequence.
>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
2
C.AA.2.28.1
Bolus Definition Macro Attribute Description
C.AA.2.28.1.1 Conceptual Volume Sequence
4
6
8
10
The Conceptual Volume Sequence (30xx,1346), if present, identifies the segmented Conceptual
Volume used to define the bolus. The segment is defined by the Referenced Segment Annotation
Index (30xx,0151) in the Conceptual Volume Segmentation Reference and Combination Macro (see
section C.AA.2.6). Alternatively, the bolus may not be associated with a segment. For example, a
bolus may cover the entire area of radiation and not require a specific segmentation for definition.
C.AA.2.29
Outline Definition Macro
The Outline Definition Macro describes a 2D outline in a given coordinate system.
12
Table C.AA.2.29-1
OUTLINE DEFINITON MACRO ATTRIBUTES
Attribute Name
Outline Shape Type
Tag
Type
(30xx,5200)
1
Attribute Description
Shape of the outline.
Enumerated values:
RECTANGULAR
CIRCULAR
POLYGONAL
Outline Definition Plane
Distance
(30xx,5209)
1
Distance along the beam line from
the RT Beam Distance Reference
106737321: Supplement 147: Second Generation Radiotherapy
Page 78
Location (30xx,5114) to the plane in
which the outline is defined. 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 RECTANGULAR.
Outline Edges Y
(30xx,5203)
1C
Position of the Y1 and Y2 edges of
rectangular outline with respect to
the Coordinate System Declaration
(30xx,5208).
Required if Outline Shape Type
(30xx,5200) is RECTANGULAR.
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.
Diameter of Circular Outline
(30xx,5205)
1C
Diameter of circular outline in with
respect to the Coordinate System
Declaration (30xx,5208)..
Required if Outline Shape Type
(30xx,5200) is CIRCULAR.
2
4
6
8
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.
C.AA.2.30
RT Tolerance Set Macro
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
Radiation Set. If the absolute difference between a planned and delivered value exceeds the
tolerance value, then delivery of the RT Radiation Set shall be inhibited unless an authorized operator
confirms that the tolerance may be exceeded.
Table C.AA.2.30-1
RT TOLERANCE SET MACRO ATTRIBUTES
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 79
Tag
Type
Attribute Description
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
The value shall start at 1, and increase
monotonically by 1.
Attribute Tolerance
Values Sequence
(30xx,0BA6)
2
Tolerance values representing the allowed
difference between the planned and actual
values.
The Selector Attribute Macro identifies the
attributes for which the tolerances are specified.
Required if a tolerance value is specified for at
least one attribute which can be referenced by
the Selector Attribute Macro.
See C.AA.2.30.1.
Zero or more Items shall be included in this
sequence.
>Include 'Selector Attribute Macro' Table 10-20
>Tolerance Value
(30xx,0BA8)
1
Maximum permitted difference between the
planned and the delivered value. Units are
those specified for the corresponding attribute
referenced by the Selector Attribute Macro.
Patient Support
Position Tolerance
Sequence
(30xx,0BAA)
2
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.
See C.AA.2.30.1.2.
Zero or more Items shall be included in this
sequence.
>Include 'Content Item Macro' Table 10-2
Baseline TID of Concept Name Code Sequence
is TID SUP147004.
Content items shall use UCUM units of mm and
degrees where applicable.
2
C.AA.2.30.1
RT Tolerance Set Attribute Description
C.AA.2.30.1.1 Attribute Tolerance Values Sequence
4
6
8
The Attribute Tolerance Values Sequence (30xx,0BA6) allows for the reference to any numerical
parameter in a Radiation IOD. The RT Tolerance Set Macro is invoked to specify a tolerance value for
this parameter. The reference specification is conveyed by the Selector Attribute Macro, which allows
reference to a tag on any level of nested sequences, and to refer to specific items in the sequence.
10
If the specified tolerance applies to the values of the specified tag in all items of a sequence, the
identification of the Selector Sequence Pointer Items (0074,1057) on the level in question shall have
the value 0.
12
The unit of the tolerance value is the unit as specified by the data element tag referenced in the
Selector Attribute (0072,0026).
106737321: Supplement 147: Second Generation Radiotherapy
Page 80
C.AA.2.30.1.2 Patient Support Position Tolerance Sequence
2
4
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
section C.AA.2.13.
6
C.AA.2.31
8
10
12
Patient to Equipment Relationship Macro
The Patient to Equipment Relationship Macro describes a position of the patient in respect to an RT
device. That position could be a Treatment Position, an Imaging Position, a Setup Position or anything
else. The purpose of the patient position in the equipment system is defined at the invocation of the
macro. The position is defined by either the means of a transformation matrix between a patient
frame of reference and a equipment system, or by a set of device-specific parameters, or both.
Table C.AA.2.31-1
PATIENT TO EQUIPMENT RELATIONSHIP MACRO ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
Frame of Reference
Transformation Comment
(3006,00C8)
3
Comments entered by a human operator about
the relationship between the patient frame of
reference and the equipment. For display
purposes only, , shall not be used for other
purposes.
Patient Frame of
Reference to Equipment
Mapping Matrix
(30xx,6040)
1C
A rigid, homogeneous 4x4 transformation
matrix that maps the patient coordinate space
in the Frame of Reference used for the patient
model to the equipment-defined Equipment
Frame of Reference. Matrix elements shall be
listed in row-major order. See C.AA.2.31.1.
Required if the relation of the patient
coordinate system to the treatment equipment
coordinate system can be described by such a
transformation between these systems.
Patient Location
Coordinates Sequence
(30xx,6042)
1C
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.
One or more Items shall be included in this
sequence.
>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.
106737321: Supplement 147: Second Generation Radiotherapy
>Fiducial UID
(0070,031A)
1C
Page 81
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.
>blabla Code Sequence
What this is for
>>Include 'Code Sequence Macro' Table 8.8-1
CID
Patient Support Position
Sequence
Sequence of Items describing the actual
Patient Support Position Parameters.
(30xx,6046)
1C
Required if the patient position is only available
by machine-parameters of the patient support
system. May be present otherwise. See
C.AA.2.31.1.
Only a single Item shall be included in this
sequence.
>Include 'Patient Support Position Macro' Table C.AA.2.13-1.
2
C.AA.2.31.1
4
C.AA.2.31.1.1 Patient Frame of Reference to Equipment Mapping Matrix and Patient Support
Position Macro
6
8
10
12
14
16
18
20
22
24
26
28
30
Patient to Equipment Relationship Macro Attributes Description
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
matrix AMB describes a rigid transformation of 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 section
C.7.6.21.1.
The RT Device-specific coordinate system is identified by the Equipment Frame of Reference UID
(30xx,51A0). For further information on the definition of the Equipment Frame of Reference, see
Section C.AA.E1.1.3. The patient-oriented coordinate system is identified by the Frame Of Reference
UID (0020,0052) in the Frame of Reference Module of the SOP instance it is used within. Both
coordinate systems are expressed in millimeters.
(TBD) 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 the RT Device-Specific coordinate System. Applications which do not know that cannot construct
this geometric relationship, but will be able to display the labels and numerical values of those
parameters.
In standard planning cases where the relation between the patient system and the equipment system
is known, the Patient Frame of Reference to Equipment Mapping Matrix (30xx,6040) shall be used.
The Patient Support Position Sequence (30xx,6046) may be present in this case to annotate the
matrix and visualize the decomposed matrix contents. (TBD) No programmatic information shall then
be derived from the Patient Support Position Macro in this case.
In some cases (e.g. emergency treatments), the relationship between the DICOM Patient Coordinate
System and the Equipment Frame of Reference may not be known or a Patient Coordinate System
may not be administered at all. In this case an arbitrary Frame of Reference is used for the patient
coordinate system in the Frame of Reference Module of the SOP instance, but the Patient Frame of
Reference to Equipment Mapping Matrix may not be used. In this case, the patient support
parameters shall be supplied by the Patient Support Position Sequence (30xx,6046).
106737321: Supplement 147: Second Generation Radiotherapy
2
If the Patient Frame of Reference to Equipment Mapping Matrix and the Patient Support Position
Sequence (30xx,6046) are both present, the information in both locations shall be consistent.
C.AA.2.32
4
6
Page 82
RT Treatment Position Macro
The RT Treatment Position Macro establishes a connection between the patient’s geometry and the
treatment delivery equipment to define the treatment position. This treatment position is the one as
prescribed, when used in a RT Radiation object, and one as recorded in the RT Radiation Record
object.
8
Table C.AA.2.32-1
RT TREATMENT POSITION MACRO ATTRIBUTES
Attribute Name
Patient Orientation Code
Sequence
Tag
Type
Description
(0054,0410)
1
Sequence that describes the
orientation of the patient with respect
to gravity. See C.8.4.6.1.1 for further
explanation.
Only one item shall be present.
>Include 'Code Sequence Macro' Table 8.8-1
Patient Orientation Modifier
Code Sequence
(0054,0412)
Defined CID 19
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
Patient Gantry Relationship
Code Sequence
(0054,0414)
Defined CID 20
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.
One or more Items shall be included
in this sequence.
>Referenced Control Point Index
(30xx,0141)
1
References the Control Point Index
(30xx,0111) identifying the control
point, starting from which that
treatment position is applied.
Only control points at which changes
occur shall be referenced. No control
point shall be referenced more than
once. The Referenced Item Number
shall be monotonically increasing.
The first item in the Treatment
Position Sequence (30xx,5028) shall
have the value 1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 83
Type
>Include 'Patient to Equipment Relationship Macro'
Table C.AA.2.31-1
Description
Defined CID SUP147005
2
C.AA.2.33
4
The User Content Identification Macro identifies content using a label supporting lower case
characters and differing character sets. If a Code String is required, see Content Identification Macro
(Section 10.9).
6
User Content Identification Macro
Table C.AA.2.33-1
USER CONTENT IDENTIFICATION MACRO ATTRIBUTES
Attribute Name
User Content Label
Tag
Type
Description
(30xx,51E0)
1
A short, free text label that is used to
identify this SOP Instance.
See C.AA.2.33.1.1.
Content Description
(0070,0081)
2
A description of the content of the
SOP Instance.
See C.AA.2.33.1.1.
Content Creator’s Name
(0070,0084)
2
Name of operator (such as a
technologist or physician) creating the
content of the SOP Instance.
Content Creator’s Identification
Code Sequence
(0070,0086)
3
Identification of the person who
created the real world value mapping.
Only a single Item is permitted in this
sequence.
> Include 'Person Identification Macro' Table 10-1
8
C.AA.2.33.1
10
12
14
User Content Identification Macro Attribute Description
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
identification of this entity to other users. Note that the Content Label (0070,0080) attribute used in the
widely-used Content Identification Macro is a Code String, not free text. Content Description
(0070,0081) allows a longer string containing additional descriptive identifying text for one-line
headings etc.
16
(TBD) This information is intended only for display to human readers and shall not be used
programmatically.
18
For RT Radiation IODs (those including the RT Radiation Common Module), User Content Label
(30xx,51E0) is intended to be unique across a particular radiation set. Content Description
(0070,0081) contains additional information intended for detailed display, such as in a tool tip.
20
C.AA.2.34
22
24
RT Treatment Phase Macro
The treatment phase macro contains the information about a RT Treatment Phase
Table C.AA.2.34-1
RT TREATMENT PHASE MACRO ATTRIBUTES
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Treatment Phase Index
Page 84
Tag
Type
(30xx,0116)
1
Description
Index of the Treatment Phase in the
sequence used for internal or
external references.
The value shall start at 1, and
increase monotonically by 1.
Include 'RT Entity Labeling Macro' Table C.AA.2.1-1
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
2
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
4
6
8
10
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
completed. It is important not to confuse the content of that attribute with date when the treatment
delivery actual starts respectively ends. That effective date is managed by workflow systems, where
definitive treatment session scheduling is maintained. Actual dates of performed delivery will then be
available by RT Radiation Record IODs. Those actual dates may differ from the Intended Phase Start
Date (30xx,088C) and/or Intended Phase End Date (30xx,088E).
C.AA.2.35
12
14
RT Treatment Phase Interval Macro
The Treatment Phase Interval Macro contains the information about time-relationship between RT
Treatment Phases.
Table C.AA.2.35-1
RT TREATMENT PHASE INTERVAL MACRO ATTRIBUTES
Attribute Name
Treatment Phase Interval
Sequence
Tag
Type
(30xx,0890)
2
Description
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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Consecutive Treatment Phase
Index
Page 85
Tag
Type
Description
(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.
2
4
6
8
10
>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
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)
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
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
Interval Sequence (30xx,0890) shall be one less than the number of treatment phases present.
106737321: Supplement 147: Second Generation Radiotherapy
Page 86
2
C.AA.A1
Enhanced RT Series Module
4
The Second Generation Radiotherapy IODs use the General Series module described in section
C.7.3.1, specialized by the Enhanced RT Series Module.
6
Table C.AA.A0-1 specifies the attributes that identify and describe general information about the
Enhanced RT Series.
Table C.AA.A1-1
ENHANCED RT SERIES MODULE ATTRIBUTES
8
Attribute Name
Modality
Tag
Type
(0008,0060)
1
Attribute Description
Type of equipment that originally
acquired the data used to create the
instances in this Series. See
C.AA.A1.1.1.
Enumerated Values:
RT
Referenced Performed
Procedure Step Sequence
(0008,1111)
1C
Uniquely identifies the Performed
Procedure Step SOP Instance that
resulted in creation of the Series (e.g.
a Modality or Unified Procedure Step
SOP Instance).
Only a single Item shall be included in
this sequence.
Required if this instance has been
created as a result of a procedure
step request.
(TBD): if this fits, use it. Otherwise
use it on the instance level
>Include 'SOP Instance Reference Macro' Table 10-11
10
C.AA.A1.1
Enhanced RT Series Attribute Description
C.AA.A1.1.1
Modality
16
The Modality (0008,0060) of ‘RT’ allows a single device to include SOP instances of different SOP
Classes created in the same session of activity to be stored in the same series. A treatment planning
system creating a segmentation properties object, plan, and dose as output of a planning process is
one such example. See Section A.VV.1.1.1.2 for further explanation on use of Modality in
radiotherapy.
18
C.AA.A2
20
Table C.AA.A2-1 specifies the attributes that identify and describe general information about any and
all Second Generation Radiotherapy IODs.
22
Table C.AA.A2-1
RADIOTHERAPY COMMON INSTANCE MODULE ATTRIBUTES
12
14
Radiotherapy Common Instance Module
Attribute Name
Tag
Type
Attribute Description
106737321: Supplement 147: Second Generation Radiotherapy
Instance Number
Page 87
(0020,0013)
1
A number that identifies this SOP
Instance. The value shall be unique
within a Series.
(TBD) Add a UPS reference
(performed procedure step – with
a new attribute)
Include 'User Content Identification Macro' Table C.AA.2.33-1
Include 'RT Entity Labeling Macro' Table C.AA.2.1-1
2
C.AA.A3
RT Course Module
The RT Course module contains general information for the RT Course IOD.
4
Table C.AA.A3-1
RT COURSE MODULE ATTRIBUTES
Attribute Name
Tag
Type
Description
RT Course Creation DateTime
(30xx,0800)
1
The date and time when this RT
Course instance 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
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Current Course Predecessor
Sequence
Page 88
Tag
Type
(30xx,080A)
2
Description
Reference to historical versions of the
RT Course.
Zero or more Items shall be included in
this sequence.
See (TBD) Note 1.
>Include 'SOP Instance Reference Macro' Table 10-11
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.
Zero or more Items shall be included in
this sequence.
>Prior RT Course Sequence
(30xx,0824)
1C
Reference to an RT Course previously
established and terminated.
Required if Delivered Radiation Dose
Sequence (30xx,0826) is not present.
Only a single Item shall be included in
this sequence.
See (TBD) Note 1.
>>Include 'SOP Instance Reference Macro' Table 10-11
>Delivered Radiation Dose
Sequence
(30xx,0826)
1C
Delivered doses from former
treatments before the current RT
Course.
Required if Prior RT Course Sequence
(30xx,0824) is not present. May be
present otherwise.
One or more Items shall be included in
this sequence.
See (TBD) Note 2.
>>Delivered Radiation Dose
(30xx,0828)
1
>>Conceptual Volume
Sequence
(30xx,1346)
1C
The Dose (in Gray) that was delivered.
References to conceptual volumes
which received dose in former
treatments.
Required if the former dose can be
traced back to a conceptual volume.
One or more Items shall be included in
this sequence.
>>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
>>Delivered Irradiated Volume
Description
(30xx,082C)
1C
A textual description of the volume that
received dose in former treatments.
Required if Conceptual Volume
Sequence (30xx,1346) is not present.
May be present otherwise.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
RT Course State Sequence
Page 89
Tag
Type
(30xx,0830)
1
Description
Defines the state of this RT Course.
Only a single Item shall be included in
this sequence.
See (TBD) 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.
2
C.AA.A3.1
RT Course Attribute Description
C.AA.A3.1.1
RT Course Scope Indicator
10
It is generally assumed that there is only one ‘active’ RT Course SOP Instance at a given time, for a
given ‘course’ of treatment. However, this is not guaranteed by technical means, and therefore it is
the specific configuration of devices and the workflow definition within a department that defines the
roles with respect to the RT Course (for further information see DICOM Part 17, Section ZZ.2). Within
this paradigm, a device may know that it has only a partial knowledge of all involved SOP Instances
(e.g. only that knowledge needed to perform a specific activity), and therefore deliberately annotate an
RT Course with a RT Course Scope Indicator (30xx,0804) of PARTIAL.
12
In absence of a value no statement can be made about the scope of the current RT Course SOP
instance.
4
6
8
C.AA.A3.1.2
14
16
Delivered Radiation Dose Sequence
The Delivered Radiation Dose Sequence (30xx,0826) in the Prior Treatment Sequence is intended to
contain information about treatments that have not been under the regime of a former RT Course,
and therefore have to be recorded explicitly. This shall address especially the situation of denoting
former treatments handled by an application which does not support the 2nd generation RT IODs.
18
C.AA.A3.1.3
RT Course State Sequence
20
A value of (S147652, 99SUP147, “Approved”) means that the information in this instance of the RT
Course SOP instance is approved.
22
The value of this attribute implies nothing about the state of the SOP instances referenced in this RT
Course SOP instance.
The transitions between states are not defined in DICOM.
24
(TBD Figures)
26
C.AA.A4
28
The RT Prescription Reference Module contains information about the state of prescriptions and the
intended phase relationship of treatment delivery.
30
RT Prescription Reference Module
Table C.AA.A4-1
RT PRESCRIPTION REFERENCE MODULE ATTRIBUTES
Attribute Name
Tag
Type
Description
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 90
Tag
Type
Prescription Collection
Sequence
(30xx,0860)
1
>Prescription Collection Index
(30xx,0118)
Description
List of Prescriptions.
One or more Items shall be included in
this sequence.
1
Index of the Item in the sequence.
The value shall start at 1, and increase
monotonically by 1.
>Referenced Prescription
Sequence
(30xx,0864)
1
Reference to a prescription within an
RT Physician Intent SOP Instance.
Only a single Item shall be included in
this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
>>Referenced RT Prescription
Index
(30xx,0148)
1
The value of RT Prescription Index
(30xx,0118) corresponding to the
prescription in the referenced SOP
Instance.
>Prescription State Sequence
(30xx,0866)
1
State of the prescription.
Only a single Item shall be included in
this sequence.
>>Include 'RT Item State Macro’ Table C.AA.2.3-1
Defined CID for the Assertion Code
Sequence (30xx,50A0) shall be
SUP147043.
See C.AA.A4.1.1.
> Referenced Treatment Phase
Sequence
(30xx,0870)
1C
Reference to Treatment Phases
prescribed by this prescription.
Required if Treatment Phase
Sequence (30xx,0880) is present in the
RT Treatment Phase module of this
SOP instance.
One or more Items shall be included in
this sequence.
>>Referenced Treatment Phase (30xx,0146)
Index
1
The value of Treatment Phase Index
(30xx,0116) corresponding to the
referenced treatment phase.
>Referenced RT Segment
Annotation Sequence
2
Reference to RT Segment Annotation
SOP Instances on which this
prescription is based.
(30xx,0874)
Zero or more Items shall be included in
this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.A4.1
C.AA.A4.1.1
4
RT Prescription Reference Attribute Description
RT Item State Macro Meanings
The meaning of the following codes is specialized in the Prescription State Sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Page 91
2
A value of (S147652, 99SUP147, “Approved”) means that the prescription has been approved. It is
ready to be used for treatment planning.
4
A value of (S147653, 99SUP147, “Rejected”) means that the prescription has been rejected and shall
not be used for treatment planning.
6
C.AA.A5
8
This module defines Treatment Phases and the time order in which radiation sets are treated in
relation to each other.
RT Treatment Phase Module
Table C.AA.A5-1
RT TREATMENT PHASE MODULE ATTRIBUTES
10
Attribute Name
Treatment Phase Sequence
Tag
Type
(30xx,0880)
1
Description
Treatment Phases for this SOP
instance.
One or more Items shall be included in
this sequence.
>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1
>RT Treatment Phase State
Sequence
(30xx,088A)
>>Include 'RT Item State Macro' Table C.AA.2.3-1
1
State of this phase.
Only a single Item shall be included in
this sequence.
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
(TBD) 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 (S147652, 99SUP147, “Approved”) means that the treatment phase has been approved.
The intended timing is ready to be used for fractionation.
18
A value of (S147653, 99SUP147, “Rejected”) means that the current treatment phase has been
rejected and shall not be used.
20
C.AA.A6
22
24
26
RT Radiation Set Reference Module
The RT Radiation Set Reference Module contains information about multiple radiation sets being
prepared, in treatment and finished (discontinued or retired). These radiation sets will typically refer to
prescriptions contained in the RT Prescription Reference Module, as being part of the realization of a
certain prescription. The module also contains information about the chronological relation of the
radiation sets to each other (subsequent, in parallel, etc.).
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 92
Table C.AA.A6-1
RT RADIATION SET REFERENCE MODULE ATTRIBUTES
Attribute Name
Meta RT Radiation Set
Sequence
Tag
Type
(30xx,08B0)
1
Description
List of Meta RT Radiation Sets.
One or more Items shall be included in
this sequence.
>Include 'RT Entity Labeling Macro' Table C.AA.2.1-1
>Meta RT Radiation Set Index
(30xx,0117)
1
Index of the Meta RT Radiation Set in
the sequence.
The value shall start at 1, and increase
monotonically by 1.
>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
The value of Treatment Phase Index
(30xx,0116) corresponding to the
phase to which this Radiation Set
belongs.
Required if the Treatment Phase
Sequence (30xx,0880) is present.
>Radiation Set Start Delay
(30xx,08C6)
1C
The minimum number of days from the
beginning of the treatment phase to
first day of treatment. See C.AA.A6.1.2
The treatment phase is identified by
Referenced Treatment Phase Index
(30xx,08C3).
Required if Referenced Treatment
Phase Index (30xx,08C3) is present.
>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 RT Meta Radiation Set to which
the current RT Meta Radiation Set is
related.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Temporal Relationship
Interval Anchor
Page 93
Tag
Type
Description
(30xx,0892)
1
The anchor point of the Interval
specified in the current Meta RT
Radiation Set with respect to the
related Meta RT Radiation Set
referenced by the Referenced Meta RT
Radiation Set Index (30xx,0122).
Enumerated Values:
START: The interval is specified with
respect to the start of the related Meta
RT Radiation Set.
END: The interval is specified with
respect to the end of the related Meta
RT Radiation Set.
>>Number of Fractions
(30xx,0972)
1
The interval expressed in number of
fractions. The Temporal Relationship
Interval Anchor (30xx,0892) establishes
the anchor point where the interval is
tied to.
A value of 0 means, that the current
Meta RT Radiation Set starts
simultaneously with the anchor of the
related Meta RT Radiation Set.
If 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 Relationship Interval Anchor
(30xx,0892) equals END, this is the
number of fractions prior to the last
fraction of the delivery of the
referenced RT Meta Radiation Set,
when the delivery of the current RT
Meta Radiation Set should start.
See TBD (diagrams)
>Pre-treatment RT Radiation
Set Reference Sequence
(30xx,08CA)
1C
Referenced Pre-treatment RT
Radiation Sets that have been used in
developing the final Treatment RT
Radiation sets.
Required if the specified radiation sets
have been used in the final Treatment
RT Radiation sets.
One or more Items shall be included in
this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Pre-treatment RT Radiation
Set Purpose Code Sequence
Page 94
Tag
Type
(30xx,08CB)
1
Description
Defines the role of the referenced RT
Pre-treatment RT Radiation Set, in
preparation of the current treatment.
Only a single Item shall be included in
this sequence.
>>>Include 'Code Sequence Macro' Table 8.8-1
>>Referenced RT Segment
Annotation Sequence
(30xx,0874)
Defined CID SUP147018.
1
Referenced RT Segment Annotation
SOP Instances which have been used
during definition of the RT Radiation
Set.
One or more Items shall be included in
this sequence.
>>>Include 'SOP Instance Reference Macro' Table 10-11
>>>Conceptual Volume State
Sequence
(30xx,08CC)
2
States associated with the Conceptual
Volumes defined in this Referenced RT
Segment Annotation Sequence
(30xx,0874) Item..
An Item shall be present for
each.Conceptual Volume for which a
state is defined by a clinician.
Zero or more Items shall be included in
this sequence.
>>>>Conceptual Volume UID
(30xx,1301)
1
>>>>Include 'RT Item State Macro' Table C.AA.2.3-1
The unique identifier of the Conceptual
Volume.
Defined CID for the Assertion Code
Sequence (30xx,50A0) shall be
SUP147043.
See C.AA.A6.1.1
>>RT Radiation Set State
Sequence
(30xx,08C8)
1
Defines the state of this Pre-Treatment
RT Radiation Set.
Only a single Item shall be included in
this sequence.
>>>Include 'RT Item State Macro' Table C.AA.2.3-1
Defined CID for the Assertion Code
Sequence (30xx,50A0) shall be
SUP147043.
See C.AA.A6.1.1
>Treatment RT Radiation Set
Reference Sequence
(30xx,08F2)
1C
Referenced RT Radiation Sets to be
used in this RT Course.
Required if Treatment RT Radiation
Sets are defined.
One or more Items shall be included in
this sequence.
See Note 1.
>>Include 'SOP Instance Reference Macro' Table 10-11
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Treatment RT Radiation Set
Sequence Number
Page 95
Tag
Type
Description
(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.
Only a single Item shall be included in
this sequence.
>>>Include 'RT Item State Macro' Table C.AA.2.3-1
Defined CID for the Assertion Code
Sequence (30xx,50A0) shall be
SUP147043.
See C.AA.A6.1.1
>>Treatment RT Radiation Set
Operation State Sequence
(30xx,08F8)
1
The operation state of this Radiation
Set.
Zero or one item in the enclosing
Treatment RT Radiation Set Reference
Sequence (30xx,08F2) shall have a
value of IN PROGRESS for RT
Operation State (30xx,5051) at a time.
Only a single Item shall be included in
this sequence.
>>>Include 'RT Operation State Macro' Table C.AA.2.4-1
>>Referenced RT Radiation
Record Sequence
(30xx,08FF)
2C
The RT Radiation Records, which have
been created in the course of delivery.
Zero or more Items shall be included in
this sequence.
>>>Include 'SOP Instance Reference Macro' Table 10-11
>>Treatment RT Radiation Set
Sequence
(30xx,08FA)
1C
The relation to another Treatment RT
Radiation Set within this Treatment RT
Radiation Set Reference Sequence
(30xx,08F2) to denote the reason for
retiring the referenced Treatment RT
Radiation Set item.
Required if this item in the Treatment
RT Radiation Set Reference Sequence
(30xx,08F2) is not the first item in the
sequence.
Only a single Item shall be included in
this sequence.
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Attribute Name
Tag
Type
Description
>>>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.
Zero or more Items shall be included in
this sequence.
>>>>Include 'Code Sequence Macro Table 8.8-1
>>>Treatment RT Radiation Set
Change Description
2
Notes:
4
6
8
10
12
(30xx,08FE)
Defined CID SUP147014.
2
User defined description of the change
to the RT Radiation Set.
1. The sequence of radiation sets supports versioning of radiation sets. The typical situations to
cover are small adaptations (perhaps after a few days, or daily) of a radiation set without changing
the beam layout, treatment technique etc. Typically, the higher numbers in the Treatment RT
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
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
treatment phases, different treatment targets, fractionation pattern etc are covered by treatment
phases and not within this sequence.
C.AA.A6.1
C.AA.A6.1.1
RT Radiation Set Reference Attribute Description
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
Usage for Pre-Treatment RT Radiation Set:

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed
for use to define initial geometric setup for the planning step.

A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is approved to be
used to define initial geometric setup for the planning step.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set has been rejected
and shall not be used as planning input.
18
20
22
Usage for Treatment RT Radiation Set:
24

A value of (S147651, 99SUP147, “Reviewed”) means, that the Radiation Set has been reviewed
for use for treatment.
106737321: Supplement 147: Second Generation Radiotherapy

A value of (S147652, 99SUP147, “Approved”) means, that the Radiation Set is ready for
treatment.

A value of (S147653, 99SUP147, “Rejected”) means, that the Radiation Set shall not be used for
treatment.
2
4
Page 97
C.AA.A6.1.2
Radiation Set Start Delay
6
C.AA.A6.1.2.1 Radiation Set Start Delay Overview
8
The Radiation Set Start Delay (30xx,08C6) describes the minimum delay in days after the beginning
of the treatment phase. Treatment will be on next available non-zero day of the fractionation pattern.
10
12
The Radiation Set Start Delay (30xx,08C6) belongs to the Radiation Set Reference module, while the
Fraction Pattern is defined at the Radiation Set level. The Radiation Set Start Delay (30xx,08C6) is
counted from the Treatment Phase start. The Treatment Phase groups one or more Radiation Sets.
Hence, Radiation Set Start Delay (30xx,08C6) can be used to individually shift Radiation Sets within
their Treatment Phase.
RT Course IOD
RT Treatment
Phase Module
RT Radiation
Set Reference
Module
+ Radiation Set
Start Delay
RT Radiation
IOD
RT Radiation Set IOD
+ Fraction Pattern
+ Number of Fraction Pattern Digits
Per Day
+Repeat Fraction Cycle Length
14
16
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.
18
C.AA.A6.1.2.2 Examples of Radiation Set Start Delay
20
a) Scenario 1: Single Fraction Each Day
22
Description: First Calender Day of Phase Start is Wednesday. The Delay for Start of Treatment is
defined as 1 day.
Attributes:
24
Number of Fraction Pattern Digits per Day = 1
106737321: Supplement 147: Second Generation Radiotherapy
Page 98
Repeat Fraction Cycle Length = 1
2
Fraction Pattern = 1111100
Radiation Set Start Delay = 1
4
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
1
1
0
0
1
1
1
1
1
0
0
…
Phase start:
Wednesday
Delay
1 day
Actual
Treatment
6
Result: Radiation Set treatment begins the next treatment day as defined by the pattern which is
Thursday.
8
b) Scenario 2: Single Fraction Every Other Day
10
12
Description: First Calendar Day of Phase Start is Wednesday. The Delay for Start of Treatment is
defined as 3 days. 0 or 1 fractions are scheduled per day, along the pattern 1 fraction on Monday,
Wednesday, Friday:
Attributes:
14
Number of Fraction Pattern Digits Per Day = 1
Repeat Fraction Cycle Length = 1
16
Fraction Pattern = 1010100
Radiation Set Start Delay = 3
Day of the
week
Mo
Tu
We
Th
Fr
Sa
Su
Mo
Tu
We
Th
Fr
Sa
Su
M
Pattern
1
0
1
0
1
0
0
1
0
1
0
1
0
0
1
0
0
1
0
1
0
1
0
0
…
Phase start:
Wednesday
Actual
Treatment
Delay
3 days
18
20
Result: Radiation Set treatment begins the next treatment day as defined by the pattern after
Saturday which is Monday of the following week.
c) Scenario 3: Varying Fractions Every Other Day
22
Description: Same as Scenario 2, but with varying fractions per day
Note:
24
Readers should not focus on the clinical relevance of the pattern in this scenario. The scenario is
provided as follows to illustrate the role of the attributes.
106737321: Supplement 147: Second Generation Radiotherapy
Page 99
Attributes:
2
Number of Fraction Pattern Digits Per Day = 2
Repeat Fraction Cycle Length = 1
4
Fraction Pattern = 01001100100000
Radiation Set Start Delay = 3
Day of the
week
Mo
Tu
We
Th
Fr
Sa
Su
Mo
Tu
We
Th
Fr
Sa
Su
M
Pattern
01
00
11
00
10
00
00
01
00
11
00
10
00
00
01
00
00
01
00
11
00
10
00
00
…
Phase start:
Wednesday
Delay
3 days
Actual
Treatment
6
8
10
12
14
16
Result: Radiation Set treatment begins the next treatment day as defined by the pattern after
Saturday which is Monday afternoon of the following week.
C.AA.A7
RT Course Associated Instance Reference Module
The RT Course Associated Instance Reference Module contains information about other instances
relevant to this course. This list of references provides the facility to reference SOP instances, which
are not referenced directly in the RT Course IOD. The Instance Reference Purpose Code Sequence
(30xx,0901) annotates the role the references play in the scope of that RT Course.
Table C.AA.A7-1
RT COURSE ASSOCIATED INSTANCE REFERENCE MODULE ATTRIBUTES
Attribute Name
Tag
Type
Description
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.
One or more Items shall be included in
this sequence.
>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.
Only a single Item shall be included in
this sequence.
>>Include 'RT Item State Macro’ Table C.AA.2.3-1
Defined CID for the Assertion Code
Sequence (30xx,50A0) shall be
SUP147043.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Instance Reference Purpose
Code Sequence
Page 100
Tag
Type
(30xx,0901)
1
Description
The purpose or role of the RT Course
Associated Instance Reference
Sequence item.
Only a single Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
Defined CID SUP147020.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.B1
4
The RT Physician Intent Module contains information about the overall intent of the treatment. The
data are mostly descriptive text and allow freely formulated advice by the physician along the
established nomenclature of the actual institution.
6
RT Physician Intent Module
Table C.AA.B1-1
RT PHYSICIAN INTENT MODULE ATTRIBUTES
Attribute Name
RT Treatment Phase Presence
Flag
Tag
Type
(30xx,0806)
1
Description
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.
One or more Items shall be included in
this sequence.
See C.AA.B1.1.1
>RT Physician Intent Index
(30xx,0913)
1
Index of the Physician Intent in the
sequence used for internal or external
references.
The value shall start at 1, and increase
monotonically by 1.
>RT Treatment Intent Type
(30xx,0914)
2
Type of treatment intent.
Defined Terms:
CURATIVE
PALLIATIVE
PROPHYLACTIC
>RT Physician Intent Narrative
(30xx,0915)
2
>RT Physician Intent
Predecessor Sequence
(30xx,0910)
1C
Narrative of RT Physician Intent.
Reference to the RT Physician Intent
SOP Instance which was replaced by
current Physician Intent.
Required if this intent replaces a
previous version.
Only a single Item shall be included in
this sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 101
Type
Description
>>Include 'SOP Instance Reference Macro' Table 10-11
>>Supersession Reason
(30xx,0917)
2
>RT Protocol Code Sequence
(30xx,0916)
2C
Reason that the previous RT Physician
Intent was superseded by the current
SOP Instance.
The protocol(s) to be used.
Required if this intent is based on a
known protocol.
Zero or more Items shall be included
in this sequence.
See C.AA.B1.1.2.
>>Include 'Code Sequence Macro’ Table 8.8-1
>RT Diagnosis Code Sequence
(30xx,0918)
No Baseline Context Group ID defined
2C
Diagnostic codes to describe the
disease handled by this intent.
Required if a diagnosis code is known.
Zero or more Items shall be included
in this sequence.
See Note 1.
>>Include 'Code Sequence Macro’ Table 8.8-1
>RT Diagnostic Image Set
Sequence
(30xx,091A)
No Baseline CID is defined
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.
Zero or more Items shall be included
in this sequence.
Only a single Item shall be included in
this sequence.
See C.AA.B1.1.3.
>>Include 'Image SOP Instance Reference Macro' Table 10-3
2
Notes
4
6
1. The RT Diagnosis Code Sequence (30xx,0918) may contain clinical codes, which are used at the
prescription state and for other categorization purposes of the diagnosis covered by that Intent like
charging. There is no specific baseline CID recommended. Possible coding schemes that could be
used include ICD-10 (i10) or SNOMED (SRT). ICD-10 is widely used in the USA, while SNOMED is
the preferred DICOM classification. However, any other coding schemes are applicable as well if
preferred by the user.
8
C.AA.B1.1
10
12
14
C.AA.B1.1.1
RT Physician Intent Attribute Description
RT Physician Intent Sequence
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
multiple primaries would usually require separate intents to be defined, each with its own
prescription(s) and having different sets of reference imaging studies.
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.B1.1.2
Page 102
RT Protocol Code Sequence
2
RT Protocol Code Sequence (30xx,0916) contains a coded description of the radiotherapy clinical
protocol the patient is following. This is not necessarily the same as the Procedure Step protocol.
4
C.AA.B1.1.3
6
8
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
treatment planning for radiotherapy treatments are referenced in the RT Prescription Module. If those
are the same images, they shall be referenced at both places.
C.AA.B2
10
12
RT Diagnostic Image Set Sequence
RT Prescription Module
The RT Prescription Module contains the prescription(s) by the physician to define the intended
treatment for a specific target. The content of this module consists mainly of descriptive text and
allows to freely formulating advice by the physician along the established nomenclature of the
institution.
14
Table C.AA.B2-1
RT PRESCRIPTION MODULE ATTRIBUTES
Attribute Name
RT Prescription Sequence
Tag
Type
(30xx,0940)
1
Description
Prescriptions to deliver therapeutic
radiation.
One or more Items shall be included in
this sequence.
>RT Prescription Label
(30xx,0902)
1
User defined label for this prescription.
See C.AA.2.1.1.1.
>Prescription Index
(30xx,0118)
1
Index of the Prescription in the
sequence used for internal or external
references.
The value shall start at 1, and increase
monotonically by 1.
>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).
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Referenced Dosimetric
Objectives Sequence
Page 103
Tag
Type
(30xx,0951)
1C
Description
Sequence of Items referencing
Dosimetric Objectives that are
dosimetrically relevant to this
prescription.
Required if Dosimetric Objectives are
defined for this prescription.
One or more Items shall be included in
this sequence.
>>Referenced Dosimetric
Objective UID
(30xx,0949)
1
>Treatment Phase Reference
Sequence
(30xx,0870)
1C
Reference to a Dosimetric Objective
UID (30xx,0948) in the RT Anatomic
Prescription Sequence (30xx,0920),
identifying the anatomic prescription
for this sequence.
Referenced treatment phase(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.
One or more Items shall be included in
this sequence.
>>Referenced Treatment Phase (30xx,0146)
Index
1
Reference to the Treatment Phase
Index (30xx,0116) where this
prescription does apply to.
>Fractionation Relationship
Sequence
2
Fraction-based relationship to another
prescription.
(30xx,0982)
Zero or one Item shall be included in
this sequence.
>>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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Number of Fractions
Page 104
Tag
Type
Description
(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.
Zero or more Items shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
>General Prescription Notes
(30xx,0970)
2
Notes on this prescription in general.
>Number of Fractions
(30xx,0972)
2
Number of Fractions.
>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 Fraction Pattern Macro' Table C.AA.2.9-1
>Treatment Technique
Description
(30xx,0966)
2
Description of the treatment technique
to be used.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Radiotherapy Procedure
Technique Sequence
Page 105
Tag
Type
(30xx,0C99)
2
Description
The treatment technique that should
be used for treatment.
Zero or one Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
>Prescription Annotation
Sequence
(30xx,0978)
Defined CID SUP147047
1C
Further Annotations to the preparation
and execution of the treatment
covered by this prescription.
Required if there are annotations for
the prescription.
One or more Items shall be included in
this sequence.
>>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.
One or more Items shall be included in
this sequence.
>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.
>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
>Prescription Anatomy Notes
(30xx,0928)
2C
Additional notes on what to pay
attention to in respect to this anatomy.
Required if the Dosimetric Objective
Sequence (30xx,0942) is empty. May
be present otherwise.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Prescription Anatomy Role
Page 106
Tag
Type
(30xx,0930)
1
Description
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.
Zero or one Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
Defined CID SUP147002.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Anatomy Property Type Code
Sequence
Page 107
Tag
Type
(30xx,0936)
2
Description
Sequence defining the specific
property type of this anatomy for
radiotherapy purposes.
Zero or one Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
>Alternate Segmented Property
Type Code Sequence
(30xx,134E)
See C.AA.B2.1.1.
3
Sequence defining alternate specific
property types of this segment for
radiotherapy purposes.
One or more Items are permitted in
this sequence.
See C.AA.D1.1.2.
>>Include 'Code Sequence Macro' Table 8.8-1
>>Purpose of Alternate
(30xx,134F)
Segmented Property Type Code
Sequence
No baseline CID defined.
3
Identifies the purpose for which the
identification code is assigned.
Only a single Item is permitted in this
sequence.
See C.AA.D1.1.2.
>>>Include 'Code Sequence Macro' Table 8.8-1
>Dosimetric Objective
Sequence
(30xx,0942)
No baseline CID defined.
2C
Objectives applicable for this anatomy.
Required if objectives are known for
this anatomy.
Zero or more Items shall be included
in this sequence.
>>Dosimetric Objective UID
(30xx,0948)
1
A UID by which a Dosimetric Objective
can be cross-referenced between
prescriptions.
Required, if Type of Prescription
(30xx,0944) is CONSTRAINTS.
See C.AA.B2.2.
>>Originating SOP Instance
Reference Sequence
(30xx,1302)
1C
Reference to the SOP Instance that
contains the original definition of this
Dosimetric Objective identified by
Dosimetric Objective UID (30xx,0948).
Required when the Dosimetric
Objective UID (30xx,0948) was not
issued in the current SOP Instance,
but read from another SOP instance.
Only a single Item shall be included in
this sequence.
>>>Include 'SOP Instance Reference Macro' Table 10-11
>>Dosimetric Objective Value
Type Code Sequence
(30xx,0943)
1
The type of dose objective which this
item represents.
Only a single Item shall be included in
this sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 108
Type
>>>Include ‘Code Sequence Macro' Table 8.8-1
>>Dosimetric Objective
Parameter Sequence
(30xx,0950)
Description
Defined CID SUP147001.
2
Parameters of the objective.
Zero or more Items shall be included
in this sequence.
See C.AA.B2.1.2
>>>Dosimetric Objective
Parameter Index
(30xx,0119)
1
Index of the Dosimetric Objective
Parameter in the sequence used for
internal or external references.
The value shall start at 1, and increase
monotonically by 1.
>>>Include 'Content Item Macro' Table 10-2
>>Dosimetric Objective
Preservation
(30xx,0954)
See C.AA.B2.1.2
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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Dosimetric Objective
Evaluation Including Prior Dose
Page 109
Tag
Type
Description
(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.
2
C.AA.B2.1
RT Prescription Attribute Description
C.AA.B2.1.1
4
6
8
10
12
14
Anatomy Property Type Code Sequence
The Anatomy Property Type Code Sequence (30xx,0936) further specifies the anatomy along the
Anatomy Category. The following conditions apply to the codes permitted in the Anatomy Property
Type Code Sequence (30xx,0936), when the code used in the Anatomy Category Code Sequence
(30xx,0934) is as follows

Value of Conceptual Volume Category Code Sequence (S147050, 99SUP147, “Target”): Defined
CID for Property Type shall be SUP147004.
C.AA.B2.1.2
Dosimetric Objective Parameter Sequence
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
objective and a sequence of zero or more parameters necessary to quantify the objective (Dosimetric
Objective Parameter Sequence (30xx,0950)) as defined in the following.
C.AA.B2.1.2.1 Single Dose Parameter
16
18
If the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID
SUP147060 Single Dose-related Dosimetric Objectives, the Dosimetric Objective Parameter
Sequence (30xx,0950) shall include the following parameter.
Dosimetric
Objective
Parameter
Index
(30xx,0119)
1
Concept Name Code
EV (S147025,
99SUP147, “Dose
Parameter”)
Value Type
NUMERIC
Measurement Units
Code
Units = EV
(Gy,UCUM,”Gray”)
20
C.AA.B2.1.2.2 Percentage and Dose Parameter
22
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 Parameter
Sequence (30xx,0950) shall include the following parameters.
Dosimetric
Objective
Parameter
Index
(30xx,0119)
Concept Name Code
Value Type
Measurement Units
Code
106737321: Supplement 147: Second Generation Radiotherapy
Page 110
1
EV (S147027,
99SUP147, “Percent
Parameter”)
NUMERIC
Units = EV
(%,UCUM,”Percent”)
2
EV (S147025,
99SUP147, “Dose
Parameter”)
NUMERIC
Units = EV
(Gy,UCUM,”Gray”)
2
C.AA.B2.1.2.3 Volume and Dose Parameter
4
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
Sequence (30xx,0950) shall include the following parameters.
Dosimetric
Objective
Parameter
Index
(30xx,0119)
Concept Name Code
Value Type
Measurement Units
Code
1
EV (S147026,
99SUP147, “Volume
Parameter”)
NUMERIC
Units = EV
(cm3,UCUM,”Cubic
Centimeter”)
2
EV (S147025,
99SUP147, “Dose
Parameter”)
NUMERIC
Units = EV
(Gy,UCUM,”Gray”)
6
C.AA.B2.1.2.4 Unitless and Dose Parameter
8
10
If the Dosimetric Objective Value Type Code Sequence (30xx,0943) contains a code included in CID
SUP147063 Dimensionless and Dose-related Dosimetric Objectives, the Dosimetric Objective
Parameter Sequence (30xx,0950) shall include the following parameters.
Dosimetric
Objective
Parameter
Index
(30xx,0119)
Concept Name Code
Value Type
Measurement Units
Code
1
EV (S147028,
99SUP147, “Numeric
Parameter”)
NUMERIC
Units = EV
(1,UCUM,”no units”)
2
EV (S147025,
99SUP147, “Dose
Parameter”)
NUMERIC
Units = EV
(Gy,UCUM,”Gray”)
12
C.AA.B2.1.2.5 Coded Parameter
14
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
(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
106737321: Supplement 147: Second Generation Radiotherapy
Page 111
Parameter Sequence
(30xx,0950)
99SUP147
S147018
Minimize MeterSet
Defined CID is
DCID (230) Yes-No
2
4
6
8
10
12
14
16
18
20
22
24
26
C.AA.B2.1.3
Dosimetric Objective Parameter Sequence Examples
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 (30xx,0943)
with code value Maximum Percent Volume at Dose (S147013) with the parameters specified in the
Dosimetric Objective Parameter Sequence (30xx,0950) as follows:
Dosimetric Objective Sequence (30xx,0942):
 Item 1:
 Dosimetric Objective Value Type Code Sequence (30xx,0943):
o Item 1: (S147015, 99SUP147, “Maximum Percent Volume at Dose”)
o Dosimetric Objective Parameter Sequence (30xx,0950)
o Item 1:
o Item Referencing Index (30xx,51E1) = 1
o Value Type (0040,A040) = NUMERIC
o Concept Name Code Sequence (0040,A043)
o Item 1: (S147027, 99SUP147; “Percent Parameter”)
o Numeric Value (0040,A30A) = 30
o Measurement Units Code Sequence (0040, 08EA)
o Item 1: (%, UCUM, “Percent”)
o Item 2:
o Item Referencing Index (30xx,51E1) = 2
o Value Type (0040,A040) = NUMERIC
o Concept Name Code Sequence (0040,A043)
o Item 1: (S147025, 99SUP147, “Dose Parameter”)
o Numeric Value (0040,A30A) = 50
o Measurement Units Code Sequence (0040,08EA)
o Item 1: (Gy, UCUM, “Gray”)
28
C.AA.B2.1.4
30
32
34
Conceptual Volume Sequence
The Conceptual Volume Sequence (30xx,1346) identifies the Conceptual Volume associated with an
RT Anatomy Prescription item. If the Conceptual Volume is associated with a segment, the segment
is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual Volume
ReferenceCombination and Segmentation Macro (see section C.AA.2.6). Alternatively, the anatomy
volume may not (yet) be associated with a segment. For example, an initial prescription may be
entered prior to the definition of an OAR.
36
C.AA.B2.1.5
Prescription Anatomy Role
38
The following table contains the meanings of the Defined Terms for Prescription Anatomy Role
(30xx,0930):
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
106737321: Supplement 147: Second Generation Radiotherapy
Page 112
CONFORMALITY_SHELL
Surface used to specify a dose constraint
OTHER
Other volume
2
C.AA.B2.1.6
Radiobiological Structural Type
4
The following table contains the meanings of the Defined Terms for Radiobiological Structural Type
(30xx,0932):
Defined Term
6
8
10
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
14
16
18
20
22
Dosimetric Objective Priority
Dosimetric objective weights may be used for differing purposes in the treatment planning process.
Certain objectives are used to guide the optimization of dosimetric plans by some automatic or semiautomatic process. These objectives may, for example, involve “avoidance” anatomies that influence
the optimized dose distributions, but may not have biological significance in themselves.
C.AA.B2.2
12
Meaning
Dosimetric Objective Scope
The scope of a dosimetric objective comprises all objects, where the same Dosimetric Objective UID
(30xx,0948) is used. E.g. if 2 prescriptions share the same Dosimetric Objective UID (30xx,0948) for
a maximum dose, the value of that objective is applicable across both prescriptions. If 2 prescriptions
reference an objective for maximum dose, but each with a different UID, the value applies to the
prescriptions separately.
The attribute Dosimetric Objective Evaluation Including Prior Dose (30xx,0926) is only used in
situations, where not all patient prescriptions of the past have been covered by Dosimetric Objective
sequence items. Otherwise it is sufficient to reference a Dosimetric Objective using the same
Dosimetric Objective UID (30xx,0948) as it has been used in prior treatments. This implies, that the
scope of that objective includes all prior and the current treatments covered by the prescriptions
referencing this UID.
26
When the Dosimetric Objective Evaluation Including Prior Dose (30xx,0926) has value YES, all prior
treatments shall be included in the dosimetric objective. This may also include information not
represented by Dosimetric Objective sequence items, such as RT Dose objects, unformatted
electronic reports, paper records etc. .
28
When the attribute has value NO, the scope of the objective does comprise only those prescriptions
as defined in the beginning of this section, even if information of prior treatment is available otherwise.
24
C.AA.B3
30
32
34
RT Treatment Phase Intent Module
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
order of them.
Table C.AA.B3-1
RT TREATMENT PHASE INTENT MODULE ATTRIBUTES
Attribute Name
Tag
Type
Description
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Treatment Phase Sequence
Page 113
Tag
Type
Description
(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.
One or more Items shall be included in
this sequence.
>Include 'RT Treatment Phase Macro' Table C.AA.2.34-1
Include 'RT Treatment Phase Interval Macro' Table C.AA.2.35-1
2
C.AA.C1
4
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
dosimetric requirements of a given phase.
6
8
10
12
14
RT Radiation Set Module
It references a set of RT Radiation instances describing the geometrical and physical parameters
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
those fractions shall be treated. It also specifies weighting of the beams and brachytherapy setups
contained for those fractions.
An RT Radiation Set can be referenced externally for dosimetric purposes. A treatment phase is
achieved by delivering one or more RT Radiation Sets. One or more new RT Radiation Sets may be
required each time adaptive therapy is used to attempt to maintain a phase prescription.
The chronological relationships between Radiation Sets (the actual start of each set, the order or
timing among sets etc.) are handled outside the Radiation Set.
16
Table C.AA.C1-1
RT RADIATION SET MODULE ATTRIBUTES
Attribute Name
Number of Fractions
Tag
Type
(30xx,0972)
1
Description
Number of Fractions.
Include 'Radiation Fraction Pattern Macro' Table C.AA.2.9-1
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
RT Radiation Set Intent
Page 114
Tag
Type
Description
(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.
One or more Items shall be included in
this sequence.
See C.AA.C1.1.2.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.C1.1
C.AA.C1.1.1
RT Radiation Set Attribute Description
Radiation Set Type
4
PATIENT_TREATMENT = The Radiation Set has been prepared to be ready for treatment delivery.
All parameters necessary to guide the delivery of radiation beams are included.
6
PLAN_QA = The Radiation Set has been created for the purpose of validating the dose to be
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
10
12
14
16
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 assurance
and calibration (geometric, dosimetric or both).
RESEARCH = The Radiation Set is used in a Research project. It has been created for the purpose
of performing independent research on the treatment planning system and/or the delivery system
SERVICE = The Radiation Set is created by a service technician for machine repair or to perform a
maintenance operation.
C.AA.C1.1.2
Radiation Sequence
All SOP Instances referenced in that sequence shall have the same SOP Class.
106737321: Supplement 147: Second Generation Radiotherapy
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2
The SOP Classes permitted to be referenced in this sequence are SOP Classes representing
Radiation IODs describing a radiotherapy delivery. The pre-requisite to belong to this type of SOP
Class is the presence of the following modules:
4

The modules specified in Table A.VV.1.1.1-2 RT RADIATION IOD MODULES MACRO.

The RT Delivery Device Common Module specified in section C.AA.E1.
6

The RT Radiation Common Module specified in section C.AA.E2.
8
C.AA.C2
10
12
14
16
18
20
22
24
RT Dose Contribution Module
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
dose and to anatomies receiving the dose.
Note that an anatomical structure (as defined by the Conceptual Volume Macro) can be a textually
tagged definition only, or a reference to a Conceptual Volume defined in the Segment RT Annotation
IOD. In any case, Conceptual Volumes are at minimum identified by a UID, which allows
accumulation of dose across RT Radiation Sets and comparison with originally prescribed dose
objectives.
Dose contributions are defined along the meterset value. The definition points in the lookup table
may, but do not need to, align with the metersets at the control points of the Radiation SOP Instance.
For example, where a dose deposition between control points cannot be determined individually per
segment, or where this definition is not useful, the lookup table may just contain the meterset of first
and last control points. The meterset and dose contribution of the first control point are always zero.
Where dose contributions are not available at the time or radiation set definition and application (e.g.
for emergency treatments), the module may be absent. This does not exclude retrospective dose
calculation and creation of associated RT Dose Image objects.
Table C.AA.C2-1
RT DOSE CONTRIBUTION MODULE ATTRIBUTES
26
Attribute Name
Tag
Type
Radiation Dose Identification
Sequence
(30xx,0B42)
1
Description
Radiation Dose parameters to identify
and scope the dose values that are
delivered by this radiation.
One or more Items shall be included in
this sequence.
>Radiation Dose
Identification Index
(30xx,0120)
1
Index of the Radiation Dose
Identification in the sequence used for
internal or external references.
The value shall start at 1, and increase
monotonically by 1.
>Radiation Dose
Identification Label
(30xx,0B46)
1
User defined label for the radiation
dose definition.
See C.AA.2.1.1.1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Reference Dose Type
Page 116
Tag
Type
(30xx,0B48)
1
Description
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 instancespecific calculations.
RADIATION:
Dose values carry a representative
dose specifically calculated for each
referenced RT Radiation SOP instance.
>Reference Dose Point
Coordinates
(30xx,0B62)
1C
Coordinates of the reference dose in
DICOM Patient Coordinate System. If
present, the dose values are calculated
to the specified point.
Required, if dose is calculated at a
point.
>Conceptual Volume
Sequence
(30xx,1346)
1
Reference to a conceptual volume
which receive dose.
See C.AA.C2.1.2.
Only a single Item shall be included in
this sequence. Each Conceptual
Volume UID (30xx,1301) shall only
appear once in that sequence.
>>Include 'Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
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.
>Include 'SOP Instance Reference Macro' Table 10-11
>Radiation Dose Values
Sequence
(30xx,0B64)
1
Dose values of this actual radiation in
respect to the dose identification items
defined in the Radiation Dose
Identification Sequence (30xx,0B42).
The number of Items included in this
sequence shall be exactly the number
of Items in the Radiation Dose
Identification Sequence (30xx,0B42).
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 117
Tag
Type
Description
>>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 (30xx,0B68)
Sequence
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 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.
Zero or more Items shall be included in
this sequence.
>>>Cumulative Meterset
(30xx,5021)
1
The Cumulative Meterset value, at
which the Radiation Verification Control
Point Parameters in that sequence item
apply, are expressed in units of the
Radiation Dosimeter Unit (30xx,5113).
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>>Radiation Dose Value
Page 118
Tag
Type
(30xx,0B7B)
1
Description
Cumulative dose value (in Gy) for the
Cumulative Meterset (30xx,5021) and
the geometric parameters provided in
this sequence Item.
See C.AA.C2.2.3
>>>Referenced Control Point
Index
(30xx,0141)
1C
Value of Control Point Index
(30xx,0111) from the Control Point
Sequence of the Radiation SOP
Instance referenced within this
Radiation Dose Sequence Item
(30xx,0B40).
See C.AA.C2.2.1.
Required if the Cumulative Meterset
(30xx,5021) corresponds to a Control
Point in the Control Point Sequence of
the Radiation SOP instance referenced
within this Radiation Dose Sequence
Item (30xx,0B40)
>>>Reference Dose Point
Coordinates
(30xx,0B62)
2
>>>Radiation Dose Point
Depth
(30xx,0B70)
2C
Coordinates (x,y,z) of the reference
dose point in DICOM Patient
Coordinate System.
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) - waterequivalent depth, taking tissue
heterogeneity into account - in the
patient along a ray from the source to
the dose point specified by the
Reference Dose Point Coordinates
(30xx,0B62) from the current Radiation
Verification Control Point to the next
one.
See C.AA.C2.2.2.
Required for all items in this sequence
but the last one.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>>Radiation Dose Point
SSD
Page 119
Tag
Type
Description
(30xx,0B74)
2C
Source to patient surface distance (in
mm) along a ray from the source to the
dose point specified by the Reference
Dose Point Coordinates (30xx,0B62)
from the current Radiation Verification
Control Point to the next one.
See C.AA.C2.2.2.
Required for all items in this sequence
but the last one.
>Radiation Dose In Vivo
Measurement Sequence
(30xx,0B76)
1C
In vivo measurement reference doses.
Required if in vivo measurement doses
are calculated for this Radiation SOP
Instance.
One or more Items shall be included in
this sequence.
>>Radiation Dose In Vivo
Measurement Label
(30xx,0B78)
1
Label to identify the in vivo
measurement point.
See C.AA.2.1.1.1.
>>Radiation Dose Central
Axis Displacement
(30xx,0B7A)
1C
Displacement vector of the point from
the central axis (in mm).
Required if radiation technique uses a
central beam axis.
2
>>Radiation Dose Value
(30xx,0B7B)
1
Dose Value (in Gy) for comparison to
the measured dose.
>>Radiation Dose SourceSkin 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
C.AA.C2.1.1
4
6
8
10
12
16
Meterset to Dose Mapping Sequence
The Meterset to Dose Mapping Sequence (30xx,0B68) establishes a lookup table of dose values
delivered at certain metersets. The first value of Cumulative Meterset (30xx,5021) and of Radiation
Dose Value (30xx,0B7B) shall always be zero. The value of Meterset Value in the last item shall be
the meterset of the final control point of the referenced RT Radiation. The value of Radiation Dose
Value in the last item therefore represents the dose delivered to the referenced anatomy when one
fraction is completely delivered. Meterset Values shall be strictly monotonically increasing. Radiation
Dose Values shall be monotonically non-decreasing. The actual clinical behavior of the increase of
dose between 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.
C.AA.C2.1.2
14
RT Dose Contribution Attribute Description
Conceptual Volume Sequence
The Conceptual Volume Sequence (30xx,1346) identifies a Conceptual Volume defining a volume for
which dose is tracked during treatments. If the Conceptual Volume is associated with a segment, the
segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the Conceptual
106737321: Supplement 147: Second Generation Radiotherapy
2
4
Volume ReferenceCombination and Segmentation Macro (see section C.AA.2.6). Alternatively, the
dosimetric volume may not be associated with a segment. For example, dose tracking may be
specified using a nominal dose to a anatomical region of interest and the tracking coefficients
approximated by meterset values.
C.AA.C2.1.3
6
8
12
14
16
18
20
Primary Dose Value Indicator
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
value refers to the primary target, while the other non-primary values may refer to e.g. organs at risk.
C.AA.C2.2
10
Page 120
Radiation Verification Control Point Description
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
same as in the Control Point sequence of the Radiation. A different sampling can be chosen for the
Radiation Verification Control Point Sequence, but where the Cumulative Meterset (30xx,5021) of a
Control Point of the Radiation is the same it shall be referenced by the Referenced Control Point
Index (30xx,0141).
C.AA.C2.2.2
Distance Parameters
The values given in Radiation Dose Point Depth (30xx,0B70), Radiation Dose Point Equivalent Depth
(30xx,0B72) and Radiation Dose Point SSD (30xx,0B74) shall always contain average values from
the current Radiation Verification Control Point to the next. In case of e.g. an arc therapy, these
values reflect the changing depth parameters. In case these distances do not change, e.g. for a static
beam treatment, the average value equals the static value under the given geometric conditions.
22
C.AA.C2.2.3
24
The Radiation Dose Value (30xx,0B7B) represents the cumulative dose delivered from the beginning
of radiation delivery to the Cumulative Meterset (30xx,5021).
26
C.AA.D1
28
30
32
Radiation Dose Value
RT Segment Annotation Module
The RT Segment Annotation Module references segments and provides radiotherapy-specific
annotations for them. The geometry of each segment is defined by a referenced Segmentation,
Surface Segmentation, or RT Structure Set instance. Any segment-related information used in
radiotherapy shall only be derived from a RT Segment Annotation object. The referenced instances
shall not be used to supply any information that is unspecified in the RT Segment Annotation. Only
the geometric definition of the segments shall be extracted from the referenced instances.
Table C.AA.D1-1
RT SEGMENT ANNOTATION MODULE ATTRIBUTES
34
Attribute Name
Segment Sequence
Tag
Type
(0062,0002)
1
Description
Segments described in this module.
One or more Items shall be included in
this sequence.
>Segment Index
(30xx,0121)
1
Index of the Segment used for internal
or external references.
The value shall start at 1, and increase
monotonically by 1.
>Include ‘RT Entity Long Labeling Macro’ Table C.AA.2.2-1
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Segmented Property
Category Code Sequence
Page 121
Tag
Type
(0062,0003)
1
Description
Sequence defining the general
category of this segment for
radiotherapy purposes.
Only a single Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
>Segmented Property Type
Code Sequence
(0062,000F)
Defined CID SUP147003.
1
Sequence defining the specific
property type of this segment for
radiotherapy purposes.
Only a single Item shall be included in
this sequence.
See C.AA.D1.1.3.
>>Include 'Code Sequence Macro' Table 8.8-1
>Alternate Segmented
Property Type Code Sequence
(30xx,134E)
Defined CID is defined in C.AA.D1.1.3.
3
Sequence defining alternate specific
property types of this segment for
radiotherapy purposes.
One or more Items are permitted in
this sequence.
See C.AA.D1.1.2.
>>Include 'Code Sequence Macro' Table 8.8-1
>>Purpose of Alternate
Segmented Property Type
Code Sequence
(30xx,134F)
No baseline CID defined.
3
Identifies the purpose for which the
identification code is assigned.
Only a single Item is permitted in this
sequence.
See C.AA.D1.1.2.
>>>Include 'Code Sequence Macro' Table 8.8-1
No baseline CID defined.
>Segmentation Template Label
(30xx,1332)
3
Label for the template that was used
when defining the segmentation.
>Segmentation Template UID
(30xx,1334)
3
Unique identifier of the template that
was used when defining the
segmentation.
>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
Defined CID SUP147040.
>>Device Index
Index of the Device.
(30xx,0112)
1
The value shall start at 1, and increase
monotonically by 1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Segment Properties
Sequence
Page 122
Tag
Type
(30xx,134B)
3
Description
Segment properties associated with
the current segment’s interpretation.
One or more Items are permitted in
this sequence.
See C.AA.D1.1.7.
>>Include 'Content Item Macro' Table 10-2’
>>Segment Properties Modifier
Sequence
(30xx,134B)
Defined TID of Concept Name Code
Sequence is TID SUP147003.
3
Physical properties modifier for the
property.
One or more Items are permitted in
this sequence.
See C.AA.D1.1.7.
>>>Include 'Content Item Macro' Table 10-2
>Recommended Display
Grayscale Value
(0062,000C)
No Baseline defined.
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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Direct Segment Reference
Sequence
Page 123
Tag
Type
(30xx,1343)
1C
Description
Identifies the segment geometric
definition in the SOP instance
referenced in the Segmentation SOP
Instance Reference Sequence
(30xx,1331).
Shall not be present, if Combination
Segment Reference Sequence
(30xx,1344) is present.
Only a single Item shall be included in
this sequence. Each Conceptual
Volume UID (30xx,1301) shall only
appear once in that sequence.
See C.AA.D1.1.5.
>>Include 'Conceptual Volume Macro' Table C.AA.2.5-1
>>Referenced ROI Number
(3006,0084)
1C
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
Instance Index (30xx,1350) in
Segmentation SOP Instance
Reference Sequence (30xx,1331)
defining the SOP instance this Direct
Segment Reference refers to.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Combination Segment
Reference Sequence
Page 124
Tag
Type
(30xx,1344)
1C
Description
Identifies the segment geometric
definition in the SOP instance
referenced in the Segmentation SOP
Instance Reference Sequence
(30xx,1331), when this segment is a
combination of other segments
present in the Segment Sequence
(0062,0002).
Shall not be present, if Direct Segment
Reference Sequence (30xx,1343) is
present.
Only a single Item shall be included in
this sequence. Each Conceptual
Volume UID (30xx,1301) shall only
appear once in the Segment
Sequence (0062,0002).
See C.AA.D1.1.6.
>>Include ‘Conceptual Volume Segmentation
Reference and Combination Macro' Table C.AA.2.6-1
The value of Conceptual Volume
Combination Flag (30xx,1309) shall be
YES,
The value of Conceptual Volume
Segmentation Defined Flag
(30xx,1311) shall be YES.
Segmentation SOP Instance
Reference Sequence
(30xx,1331)
1
Identifies the SOP Instance, which is
augmented by the content of the SOP
Instance including this module.
One or more Items shall be included in
this sequence. For further information,
see section C.AA.D1.1.1.
>Segmentation Instance Index
(30xx,1350)
1
Index of the Instance items in the
sequence.
The value shall start at 1, and increase
monotonically by 1.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.D1.1
RT Segment Annotation Description
C.AA.D1.1.1
4
Segmentation SOP Instance Reference Sequence
Only the following SOP Classes are permitted to be referenced in this sequence:
Table C.AA.D1.1-1
6
PERMITTED SOP CLASSES
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
106737321: Supplement 147: Second Generation Radiotherapy
Page 125
2
In case more than one Item is included in this sequence, all referenced objects shall use the same
Frame of Reference UID.
4
C.AA.D1.1.2
6
8
10
12
Alternate Segmented Property Type Code Sequence
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
volumes for data registries and clinical trials, cross-institutional, cross-application classification for
clinical workflow, automated treatment planning, DVH analysis etc. Any relevant Context IDs defined
by clinical trial or other organizations may be used in this code.
Examples of the use of the Alternate Segmented Property Type Code Sequence are shown below. In
the first example, an anatomic structure representing the right lung of a patient with a right-lung lesion
(Segmented Property Type Code of “Lung_R”) is further identified as the ipsi-lateral lung using
Alternate Property Type Code of “Lung_Ipsi” as required by Clinical Trial Protocol 1234.
14
16
>Segmented Property Category
Code Sequence
(0062,0003)
(SRT, T-D000A, Anatomical Structure)
>Segmented Property Type
Code Sequence
(0062,000F)
(CODESCHEME1, Lung_R, Right Lung)
>Alternate Segmented Property
Type Code Sequence
(30xx,134E)
(CODESCHEME2, Lung_Ipsi, Ipsi-lateral
Lung)
>>Purpose of Alternate
Segmented Property Type Code
Sequence
(30xx,134F)
(CODESCHEME3,CT1234, Clinical Trial
Protocol 1234)
In the second example, a Clinical Target Volume (CTV) is further identified as the volume whose
prescription dose is 5400 cGy as required by Clinical Trial Protocol 1234.
18
20
22
>Segmented Property Category
Code Sequence
(0062,0003)
(99SUP147, S147050, Target)
>Segmented Property Type
Code Sequence
(0062,000F)
(CODESCHEME1, CTV, Clinical Target
Volume)
>Alternate Segmented Property
Type Code Sequence
(30xx,134E)
(CODESCHEME2, CTV_5400, CTV
5400 cGy)
>>Purpose of Alternate
Segmented Property Type Code
Sequence
(30xx,134F)
(CODESCHEME3, ,CT1234, Clinical
Trial Protocol 1234)
In the third example, a Gross Tumor Volume (GTV) is further identified as the Gross Tumor Volume
delineated on the Cone-Beam CT image acquired in fraction 3 to support processing of IGRT data in
clinical workflow.
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Page 126
>Segmented Property Category
Code Sequence
(0062,0003)
(99SUP147, S147050, Target)
>Segmented Property Type
Code Sequence
(0062,000F)
(CODESCHEME1, GTV, Gross Tumor
Volume)
>Alternate Segmented Property
Type Code Sequence
(30xx,134E)
(CODESCHEME2, GTV_CBCT3, GTV
delineated on fraction 3 CBCT)
>>Purpose of Alternate
Segmented Property Type Code
Sequence
(30xx,134F)
(CODESCHEME3, IGRT Target, Target
Segmented on IGRT)
2
C.AA.D1.1.3
Segmented Property Type Code Sequence
4
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
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
8
10
12
Segmented RT Accessory Device Sequence
A segment represents an RT accessory, when the Segmented Property Category Code Sequence
(0062,0003) contains one of the following values:

Value of (S147054, 99SUP147, “Fixation or Positioning Device”)

Value of (S147055, 99SUP147, “Internal Brachytherapy Device”)

Value of (S147056, 99SUP147, “Artificial Structure”)
C.AA.D1.1.5
Direct Segment Reference Sequence
14
This sequence defines the reference to the geometric representation of the segment annotated in the
actual item of Segment Sequence (0062,0002).
16
The Conceptual Volume Macro in the Direct Segment Reference Sequence (30xx,1343) establishes
the identification of the conceptual volume associated with the segment as referenced in that
sequence. Where combination of segments is defined, the Combination Segment Reference
Sequence (30xx,1344) shall be used instead.
18
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C.AA.D1.1.6
2
Page 127
Combination Segment Reference Sequence
4
This sequence allows establishing new segments as combinations of other segments. Those other
segments are referenced in the Conceptual Volume Segmentation Reference and Combination
Macro (see section C.AA.2.6).
6
All Conceptual Volume References in that Macro may reference only segments that are defined in the
Direct Segment Reference Sequence (30xx,1343) in the Segment Sequence (0062,0002).
8
These segments are identified by referencing their corresponding Conceptual Volume UID
(30xx,1301) within the Direct Segment Reference Sequence.
10
At least two sequence Items in the Segment Sequence including a Direct Segment Reference
Sequence are required to be present in the Conceptual Volume Segmentation Reference and
Combination Macro (see section C.AA.2.6).
12
C.AA.D1.1.7
14
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).
16
18
Segment Properties Sequence
If a property of a segment requires more than one parameter, the first parameter is specified by the
Content Item in the Segment Properties Sequence (30xx,134B). Subsequent parameters are
specified in the Segment Properties Modifier Sequence (30xx,134B). The following table defines the
additional parameters for properties having more then one parameter.
Concept in Segment
Properties Sequence
Sequence (30xx,134B)
S147161, 99SUP147,
"Elemental Composition
Atomic Number"
Concept in Segment
Properties Modifier
Sequence (30xx,134B)
S147163, 99SUP147,
“Elemental Composition
Atomic Mass Fraction”
Unit of Content Item in
Segment Properties
Modifier Sequence
(30xx,134B)
Units = EV (ratio, UCUM,
"ratio")
20
C.AA.E1
22
The RT Delivery Device Common Module contains general information pertaining to the physical
device used to deliver the treatment.
24
RT Delivery Device Common Module
Table C.AA.E1-1
RT DELIVERY DEVICE COMMON MODULE ATTRIBUTES
Attribute Name
Tag
Type
Description
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.
Zero or more Items shall be included in
this sequence.
>Include 'Treatment Device Identification Macro' Table C.AA.2.10-1
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Radiation Dosimeter Unit
Sequence
Page 128
Tag
Type
(30xx,5113)
1
Description
Measurement unit of machine
dosimeter.
See section C.AA.E1.1.2.
Only a single item shall be present in
the sequence.
>Include 'Code Sequence Macro' Table 8.8-1
Coordinate System Declaration
(30xx,5208)
Defined CID SUP147055
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.2.12-1
2
4
6
C.AA.E1.1
RT Delivery Device Common Module Attribute Description
C.AA.E1.1.1
Alternate Treatment Device Sequence
The Alternate Treatment Device Sequence identifies treatment devices, which may be suited to
deliver this radiation in lieu of the primary target machine defined by the top-level invocation of the
‘Treatment Device Identification Macro’. The scope of dosimetry equivalence of treatment delivered
by an alternate device is not defined by the standard.
106737321: Supplement 147: Second Generation Radiotherapy
C.AA.E1.1.2
2
4
Page 129
Radiation Dosimeter Unit
A Radiation Dosimeter Unit (30xx,5113) of RELATIVE is commonly used for delivery devices where
calculation of MU is not possible at the planning stage, but where the radiation is calibrated prior to
treatment, using some independent calibration step.
C.AA.E1.1.3
Equipment Frame of Reference UID
6
The Equipment Frame of Reference UID (30xx,51A0) uniquely identifies the coordinate system of the
Treatment Device.
8
The Equipment Frame of Reference is always defined for any class of devices that share a common
definition. The UID uniquely identifies this coordinate system. The coordinate system is described by
a definition of where the origin is located in respect to this class of devices, and how the axes are
oriented with respect to those devices. Each RT Delivery Device being called out in one of the IODs
using this tag has to specify to which class of Equipment Frame of Reference it belongs, by specifying
the Equipment Frame of Reference UID (30xx,51A0) in its Conformance Statement.
10
12
14
18
The choice of origin for the RT Delivery Device is device-specific. It could be a significant location on
the machine such as a machine isocenter. The Equipment Frame of Reference is a right handed
system, i.e. the vector cross product of a unit vector along the positive x-axis and a unit vector along
the positive y-axis is equal to a unit vector along the positive z-axis. No recommendation is made
concerning the orientation of the axes.
20
Instances of the C-Arm Photon Radiation Storage SOP Class and C-Arm Electron Radiation Storage
SOP Class shall use the well-known UID for the IEC FIXED Reference System Frame of Reference.
16
22
24
26
28
It is the responsibility of any vendor or organization to provide a precise definition of location and
orientation of this coordinate system for a class of devices covered when issuing a new Equipment
Frame of Reference UID. Note that the Equipment Frame of Reference Description (30xx,51A1) is an
informal annotation only and shall not be used for any normative description of the device coordinate
system.
Note also that the use of the Equipment Frame of Reference UID is restricted to the classification of
the device coordinate system and shall not be used for any patient-based Frame of Reference UID
definition.
C.AA.E1.2
Conformance
30
C.AA.E1.2.1
Coordinate System Declaration
32
If IEC 61217 'Radiotherapy equipment – Coordinates, movements and scales' applies to the delivery
device in question (this is true for most C-Arm type devices), this attribute shall equal
IEC_BM_LIMIT_DEV.
34
36
38
40
If this attribute value is not IEC_BM_LIMIT_DEV, the DICOM Conformance Statement of the device
shall specify the value of the Defined Term in this attribute. It shall also specify a right-handed
coordinate system (RCS). The z-axis shall coincide with the beam axis. If needed, the Conformance
Statement shall also specify a leaf entry order for this coordinate system e.g. for IEC: 101, 102, ... 1N,
201, 202, ... 2N.
106737321: Supplement 147: Second Generation Radiotherapy
Page 130
C.AA.E2 RT Radiation Common Module
2
The RT Radiation Common Module contains a specification of attributes required by all Radiation
IODs that are to be used in an external beam treatment delivery.
4
Table C.AA.E2-1
RT RADIATION COMMON MODULE ATTRIBUTES
Attribute Name
RT Radiation Data Scope
Tag
Type
(30xx,5013)
1
Description
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.
Only a single Item shall be included in
this sequence.
See C.AA.E2.1.1.
>Include 'Code Sequence Macro' Table 8.8-1
Defined CID is defined in the IOD
including this module
Include 'RT Treatment Position Macro' Table
C.AA.2.32-1
See C.AA.E2.1.2
RT Tolerance Set Sequence
(30xx,0BA0)
3
A set of tolerance values to be applied
to delivery of the Radiation.
Only a single Item shall be included in
this sequence.
>Include 'RT Tolerance Set Macro' Table C.8.A1.27-1
Treatment Time Limit
(30xx,0BAD)
2
The expected maximum delivery time
in [sec].
See C.AA.E2.1.4.
Treatment Machine Special
Mode Sequence
(30xx,0C97)
1C
Annotates the mode of operation for
treatment machine.
Required if a special delivery mode is
necessary for treatment.
Only one Item shall be included in this
sequence.
See C.AA.E2.1.5.
>Include 'Code Sequence Macro' Table 8.8-1.
Defined CID SUP147017.
6
C8.A.E2.1
8
10
C.AA.E2.1.1
RT Radiation Common Attribute Description
Radiotherapy Procedure Technique Sequence
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
the Radiation SOP instance (especially from the Control Point parameters), and shall be consistent
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 131
with that content. Its primary purpose is to summarize the radiation technique for the end user by
means of an established term.
C.AA.E2.1.2
RT Treatment Position Macro
4
The RT Treatment Position Macro describes how the patient has to be positioned with respect to the
delivery device for treatment (Treatment Position).
6
Item Numbers in the Referenced Control Point Index (30xx,0141) identify the Control Point, at which
the treatment position is first applied. In many cases, the treatment position will remain constant
throughout the Radiation, therefore the RT Treatment Position Macro will only contain one item with
the Referenced Control Point Index (30xx,0141) equal to 1. Otherwise, it will have one item in the
Treatment Position Sequence (30xx,5028) for each control point, where the position has changed
compared with the previous control point.
8
10
12
14
No assumptions are made about the behavior of machine parameters regarding the patient position
between specified Control Points, and communicating devices shall agree on this behavior outside
the current standard.
C.AA.E2.1.3
16
18
20
22
24
26
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 useful
when such an object is instantiated in a context, where only geometric treatment parameters are
being considered. A typical example is the virtual simulation use case.
C.AA.E2.1.4
30
Treatment Times
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
reaching the Treatment Time Limit as a safety limit independent of the meterset. During actual
delivery, fluences or dose rates may vary from nominal settings due to technical reasons. Therefore
this limit is expected to include a factor greater than 1 to accommodate variations. The Treatment
Time Limit will be greater than the Calculated Treatment Time.
C.AA.E2.1.5
28
RT Radiation Data Scope
Treatment Machine Mode Sequence
The Treatment Machine Mode Sequence contains a code, which conveys a set of vendor- and
machine-specific modes (for example total body irradiation, total skin electron), which alter the
allowed range of treatment parameters, set specific safety constraints for machine operations during
treatment or similar function.
32
C.AA.F1
34
The Tomotherapeutic Delivery Device Module contains tomotherapy-specific information pertaining to
the physical device used to deliver the treatment, including geometrical parameters of the collimation
system. This information is constant for all possible beam deliveries with this equipment.
36
Tomotherapeutic Delivery Device Module
Table C.AA.F1-1
TOMOTHERAPEUTIC DELIVERY DEVICE MODULE ATTRIBUTES
Attribute Name
Source-Axis Distance
Tag
Type
Description
(300A,00B4)
1
Radiation source to Gantry rotation axis
distance of the equipment that is to be
used for beam delivery (mm).
Include 'Beam Mode Macro' Table C.AA.2.19-1
Include ‘Accessory Holder Definition Macro' Table C.AA.2.26-1
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tomotherapeutic Leaf Bank
Definition Sequence
Page 132
Tag
Type
(30xx,1000)
1
Description
Describes the leaf slot positions for
Leaf Banks.
One or more Items shall be included in
this sequence.
>Leaf Bank Offset
(30xx,1001)
1
Offset (in mm) of central axis of Leaf
Bank in X-axis of IEC BEAM LIMITING
DEVICE coordinate system, relative to
the nominal central axis of the delivery
machine.
>Number of Leaf Slots
(30xx,1002)
1
Number of leaf slots in the current Leaf
Bank.
See C.AA.F1.1.1.
>Binary MLC Leaf Slot
Boundaries
2
C.AA.F1.1
6
8
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.
Tomotherapeutic Delivery Device Attribute Description
C.AA.F1.1.1
4
(30xx,1003)
Leaf Slot Definition
A ‘Leaf Slot’ is a channel perpendicular to the binary collimator long axis that can be occluded by a
leaf or leaves during treatment. A Leaf Slot could be occluded by a single leaf (for example, in the
case of opposing banks of interleaved leaves), or by two leaves (in the case of opposed leaf pairs).
The exact nature of these leaves is not described in this module: for beam characterization purposes
it is sufficient to model the Leaf Slot dimensions only.
10
C.AA.F2
Tomotherapeutic Beam Module
12
The Tomotherapeutic Beam Module contains a specification of how a specific tomotherapeutic
treatment beam is to be delivered.
Table C.8A.F2-1
TOMOTHERAPEUTIC BEAM MODULE ATTRIBUTES
14
Attribute Name
Radiation Particle
Tag
Type
(30xx,5110)
1
Description
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.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 133
Tag
Type
Description
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)
Tomotherapeutic Control Point
Sequence
(30xx,1010)
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.
1
Control points used to model the beam
delivery.
Two or more Items shall be included in
this sequence.
>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1
>Beam Mode Index
(30xx,0113)
1
>Gantry Roll Continuous Angle
(30xx,51B5)
1C
Uniquely references the Beam Mode
identified by Beam Mode Index
(30xx,0113) in Beam Mode Sequence
(30xx,51C0).
Continuous gantry angle of radiation
source at the Control Point in IEC
GANTRY coordinate system with
respect to IEC FIXED REFERENCE
coordinate system (degrees).
Required as specified in C.AA.16.2.1.1.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.G2.1.4.
>Binary MLC Jaw 1 Opening
(30xx,1024)
1C
Position (in mm) of Jaw 1 (IEC Y1)
edge defining the extent of the opening
at the current Control Point, as defined
by IEC Beam Limiting Device
coordinate system.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Binary MLC Jaw 2 Opening
Page 134
Tag
Type
Description
(30xx,1025)
1C
Position (in mm) of Jaw 2 (IEC Y2)
edge defining the extent of the opening
at the current Control Point, as defined
by IEC Beam Limiting Device
coordinate system.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
>Tomotherapeutic Leaf Open
Percentages
(30xx,1030)
1C
Percentage of projection time jaw
leaves are open during the projection
following the Control Point for the
current leaf bank. Value multiplicity is
equal to Number of Leaf Slots.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
>Tomotherapeutic Leaf Open
Start Percentages
(30xx,1031)
1C
Percentage of projection time at which
jaw leaves open during the projection
following the Control Point for the
current leaf bank. Value multiplicity is
equal to Number of Leaf Slots.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
and
if one or more leaf open times are not
symmetrical about the projection
center. May be present otherwise.
2
C.AA.G1 C-Arm Photon-Electron Delivery Device Module
6
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 parameters
of the collimation system. This information is constant for all possible beam deliveries with this
equipment.
8
Table C.AA.G1-1
C-ARM PHOTON-ELECTRON DELIVERY DEVICE MODULE ATTRIBUTES
4
Attribute Name
Source-Axis Distance
Tag
Type
Description
(300A,00B4)
1
Distance (in mm) from the Radiation
source perpendicular to Gantry Roll
rotation axis of the equipment that is to
be used for beam delivery.
Include 'Beam Mode Macro' Table' C.AA.2.19-1
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
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 135
Type
Description
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
2
C.AA.G2 C-Arm Photon-Electron Beam Module
4
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.
6
Table C.AA.G2-1
C-ARM PHOTON-ELECTRON BEAM MODULE ATTRIBUTES
Attribute Name
Radiation Particle
Tag
Type
(30xx,5110)
1
Description
Particle Type of Radiation. See
C.AA.G2.1.1.
Enumerated Values:
PHOTON
ELECTRON
C-Arm Photon-Electron Control
Point Sequence
(30xx,0C00)
1
Control points used to model the beam
delivery.
Two or more Items shall be included in
this sequence.
>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1
>Beam Mode Index
(30xx,0113)
1
Uniquely references the Beam Mode
identified by Beam Mode Index
(30xx,0113) in Beam Mode Sequence
(30xx,51C0).
>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1
>Include 'Wedge Positions Macro' Table C.AA.2.23-1
>Gantry Roll Continuous Angle
(30xx,51B5)
1C
Treatment machine gantry angle, i.e.
orientation of IEC GANTRY coordinate
system with respect to IEC FIXED
REFERENCE coordinate system
(degrees).
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.G2.1.2.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Surface Entry Point
Page 136
Tag
Type
Description
(300A,012E)
2C
Patient surface entry point coordinates
(x,y,z), along the central axis of the
beam, in the patient based coordinate
system described in C.7.6.2.1.1 (mm).
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
>Source to Surface Distance
(300A,0130)
2C
Source to Patient Surface distance
(mm).
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
2
C.AA.G2.1
C-Arm Photon-Electron Beam Attribute Description
C.AA.G2.1.1
Radiation Particle
4
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.
6
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.
8
C.AA.G2.1.2 Continuous Rotation Angles
A continuous rotation angle is an angle in the range (-∞,+∞), such that:
10

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.
12

Relative to a previous continuous rotation angle, an increase in continuous rotation angle shall
specifiy a clockwise (CW) rotation, where a difference of more than 360 between the two values
specifies more than one CW rotation.

Relative to a previous continuous rotation angle, a decrease in continuous rotation angle shall
specify a counter-clockwise (CC) rotation, where a difference of less than -360 between the two
values specifies more than one CC rotation.
14
16
18
20
22
24
26
28
The angles are called continuous to express the capability to run continuously beyond a full circle.
This is especially important for rotational movement going beyond 360 degrees. This notion provides
the ability to unambiguously specify the direction of rotation (CW or CC), when specifying a rotation
from a start angle to a stop angle. For gantries which cannot rotate continuously but have over-travel
capabilities beyond their nominal rotational limit, continuous rotation angle removes the need to flag
the rotational position in the over-travel state.
C.AA.H1
Multiple Fixed Source Delivery Device Module
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
parameters of the collimation system. This information is constant for all possible beam deliveries with
this equipment.
106737321: Supplement 147: Second Generation Radiotherapy
Page 137
Table C.AA.H1-1
MULTIPLE FIXED SOURCE DELIVERY DEVICE MODULE
2
Attribute Name
Radiation Source Sequence
Tag
Type
(30xx,5130)
1
Description
The radiation sources of the device.
One or more Items shall be included in
this sequence.
>Radiation Source Label
(30xx,5131)
1
Identification label for the Radiation
Source. The label shall be unique
within the sequence.
>Radiation Source Collimator
Size
(30xx,513B)
1
Diameter (full width at half maximum)
in the machine isocenter of the beam
originating from the radiation source
through the collimator (mm).
>Radiation Source Distance
(30xx,5132)
2
Source to isocenter distance (mm).
>Radiation Source Theta
(30xx,5133)
1
The theta angle from the isocenter to
the radiation source (degrees).
See C.AA.H1.1.1.
>Radiation Source Phi
(30xx,5134)
1
The phi angle from the isocenter to the
radiation source (degrees).
See C.AA.H1.1.1.
4
C.AA.H1.1
Multiple Fixed Source Delivery Device Attribute Description
C.AA.H1.1.1
6
8
Radiation Source Angles
Radiation Source Theta (30xx,5133) is the angle from the Z axis of the equipment coordinate system
to the vector from the isocenter to the source. Radiation Source Phi (30xx,5134) is the angle from the
X axis of the device coordinate system to the projection of the vector from the isocenter to the source
on the XY plane of the device coordinate system.
10
C.AA.H2
12
14
16
Multiple Fixed Source Beam Set Module
The Multiple Fixed Source Beam Set Module contains a specification of how a specific multiple fixed
source treatment beam is to be delivered. In this context “beam” refers to a radiation for a period of
time from multiple radiation sources.
Table C.8A.H2-1
MULTIPLE FIXED SOURCE BEAM SET MODULE ATTRIBUTES
Attribute Name
Radiation Particle
Tag
Typ
e
(30xx,5110)
1
Description
Particle Type of Radiation.
Defined Terms:
PHOTON
Radiation Source Pattern
Sequence
(30xx,513C)
1
Radiation source patterns.
One or more Items shall be included in this
sequence.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Page 138
Tag
Typ
e
Description
>Radiation Source Pattern
Label
(30xx,513D)
1
Identification label for the Radiation Source
Pattern. The label shall be unique within
this sequence.
>Radiation Source Pattern
Source Sequence
(30xx,513F)
1
Radiation sources used for the enclosing
pattern.
One or more Items shall be included in this
sequence.
>>Referenced Radiation
Source Label
(30xx,513A)
1
Uniquely identifies the Radiation Source
described in the Radiation Source
Sequence (30xx,5130) by a reference to
the Radiation Source Label (30xx,5131).
Radiation Source Control
Point Sequence
(30xx,5137)
1
Control points used to model the radiation
delivery.
The sequence shall contain an even
number of Items, where each pair marks
the start and end of a radiation.
Two or more Items shall be included in this
sequence.
>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1
>Referenced Radiation
Source Pattern
(30xx,513E)
1C
Uniquely identifies the Radiation Source
Pattern described in the Radiation Source
Pattern Sequence (30xx,513C) by a
reference to the Radiation Source Pattern
Label (30xx,513D).
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
2
C.AA.J1
4
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. This
information is constant for all possible beam deliveries with this equipment.
6
Robotic Delivery Device Module
Table C.AA.J1-1
ROBOTIC DELIVERY DEVICE MODULE ATTRIBUTES
Attribute Name
Robotic Device Geometry
Tag
Type
(30xx,0F03)
1
Description
Imaging geometry with which this path
is associated.
Defined Terms:
NORMAL
MIRROR
Include 'Beam Mode Macro' Table C.AA.2.19-1
Include 'RT Beam Limiting Device Definition Macro' Table C.AA.2.20-1
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Tag
Page 139
Type
Description
Include ‘Accessory Holder Definition Macro' Table C.AA.2.26-1
2
C.AA.J2
Robotic Path Module
4
The Robotic Path Module contains a specification of how a specific robotic path is to be delivered.
Each SOP Instance corresponds to a single robotic “path”. Multiple paths are encoded as separate
Radiation instances defined by reference in the Radiation Set IOD.
6
Table C.AA.J2-1
ROBOTIC PATH MODULE ATTRIBUTES
Attribute Name
Radiation Particle
Tag
Type
(30xx,5110)
1
Description
Particle Type of Radiation.
Defined Terms:
PHOTON
ELECTRON
Robotic Path Identifier
Sequence
(30xx,0F15)
1
Path Set identifier.
Only a single Item shall be included in
this sequence.
>Include 'Code Sequence Macro' Table 8.8-1.
Robotic Control Point
Sequence
PROTON
(30xx,0F50)
Defined CID SUP147011.
1
Control points used to model the beam
delivery.
Two or more Items shall be included in
this sequence.
>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1
>Beam Mode Index
(30xx,0113)
1
Uniquely references the Beam Mode
identified by Beam Mode Index
(30xx,0113) in Beam Mode Sequence
(30xx,51C0).
>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 Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Robot Head Yaw Angle
Page 140
Tag
Type
Description
(30xx,0F46)
1C
Robot Head Yaw Angle, i.e. the rotation
of ROBOTIC COLLIMATOR coordinate
system about the Z-axis of the
ROBOTIC HEAD coordinate system
(degrees).
Required if Robotic Beam Sub-Control
Point Sequence (30xx,0F42) is not
present and if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.1.
>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1
>Robotic Beam Sub-Control
Point Sequence
(30xx,0F42)
1C
Sequence of Items describing Beam
parameters changes within a Control
Point.
Required at all Control Points but the
last. C.AA.
Two or more Items shall be included in
this sequence.
>>Include 'External Beam Sub-Control Point General Attributes Macro’ Table C.AA.2.18-1
>>RT Treatment Target
Coordinate
(30xx,0F44)
1C
Cartesian values (x,y,z) of the target of
the beam in the equipment defined
original (device) coordinate system.
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1.
>>Robot Head Yaw Angle
(30xx,0F46)
1C
Robot Head Yaw Angle, i.e. the rotation
of ROBOTIC COLLIMATOR coordinate
system about the Z-axis of the
ROBOTIC HEAD coordinate system
(degrees).
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1.
2
Note 1:
4
The value may reference node positions being pre-defined in the device configuration. Therefore it
is not the same as the Control Point Index (30xx,0111), but has another purpose then just indexing
the items within the Robotic Control Point Sequence (30xx,0F50).
6
C.AA.L1
8
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
system. This information is constant for all possible beam deliveries with this equipment.
10
Multi-Axial Delivery Device Module
Table C.AA.L1-1
MULTI-AXIAL DELIVERY DEVICE MODULE ATTRIBUTES
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Source-Axis Distance
Page 141
Tag
Type
Description
(300A,00B4)
1
Distance in (mm) from the Radiation
source perpendicular to Gantry Roll
rotation axis of the equipment that is to
be used for beam delivery.
See C.AA.L1.1.
Center of Rotation-Axis
Distance
(30xx,1501)
1
Distance in (mm) from the Center of
Rotation of the Multi-Axial Gantry Head
perpendicular to Gantry Roll rotation
axis of the equipment that is to be used
for beam delivery (mm).
See C.AA.L2.1.3.
Include 'Beam Mode Macro' Table C.AA.2.19-1
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
2
C.AA.L2.1
C.AA.L1.1
4
Multi Axial Delivery Device Attribute Description
Source-Axis Distance
The Source Axis Distance (300A,00B4) for a Multi-Axial Delivery Device is defined with Gantry Head
pitch and roll rotation angles at zero degree position (see figure C.AA.L2.1.3-1).
6
C.AA.L2
Multi-Axial Beam Module
8
The Multi-Axial Beam Module contains a specification of how a specific Multi-Axial treatment beam is
to be delivered.
10
Table C.AA.L2-1
MULTI-AXIAL BEAM MODULE ATTRIBUTES
Attribute Name
Radiation Particle
Tag
Type
(30xx,5110)
1
Description
Particle Type of Radiation.
Enumerated Values:
PHOTON
ELECTRON
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
Gantry Head Mode
Page 142
Tag
Type
(30xx,1546)
1
Description
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
Multi-Axial Control Point
Sequence
(30xx,1500)
1
Control points used to model the beam
delivery.
Two or more Items shall be included in
this sequence.
>Include 'External Beam Control Point General Attributes Macro' Table C.AA.2.17-1
>Beam Mode Index
(30xx,0113)
1
Uniquely references the Beam Mode
identified by Beam Mode Index
(30xx,0113) in Beam Mode Sequence
(30xx,51C0).
>Include 'RT Beam Limiting Device Positions Macro' Table C.AA.2.21-1. See C.AA.L2.1.1.
>Include 'Wedge Positions Macro' Table C.AA.2.23-1
>Include 'Accessory Holder Definition Macro' Table C.AA.2.26-1
>Gantry Pitch Continuous
Angle
(30xx,51B7)
1C
Continuous gantry pitch angle at the
Control Point, i.e. the rotation of the
IEC GANTRY coordinate system about
the x-axis of the system rotated by the
Gantry Yaw Continuous Angle
(30xx,51B3) in (degrees). See
C.AA.G2.1.4 and C.AA.L2.1.3.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
>Gantry Roll Continuous Angle (30xx,51B5)
1C
Continuous gantry angle of radiation
source at the Control Point, i.e. the
rotation of the IEC GANTRY coordinate
system about the y-axis of the system
rotated by the Gantry Yaw Continuous
Angle (30xx,51B3) and rotated by the
Gantry Pitch Continuous Angle
(30xx,51B7) in (degrees). See
C.AA.G2.1.4 and C.AA.L2.1.3.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>Gantry Yaw Continuous
Angle
Page 143
Tag
Type
Description
(30xx,51B3)
1C
Continuous gantry yaw angle at the
Control Point, i.e. the rotation of the
IEC GANTRY coordinate system about
the z-axis of the IEC FIXED SYSTEM
in (degrees). See C.AA.G2.1.4 and
C.AA.L2.1.3.
Required if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1.
>Gantry Head Pitch Angle
(30xx,1520)
1C
Gantry Head Pitch Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Xaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if Multi-Axial Sub-Control
Point Sequence (30xx,1540) is not
present and if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.L2.1.2.
>Gantry Head Roll Angle
(30xx,1521)
1C
Gantry Head Roll Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Yaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if Multi-Axial Sub-Control
Point Sequence (30xx,1540) is not
present and if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.L2.1.2.
>Gantry Head Yaw Angle
(30xx,1522)
1C
Gantry Head Yaw Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Zaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if Multi-Axial Sub-Control
Point Sequence (30xx,1540) is not
present and if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.L2.1.2.
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Attribute Name
Tag
Type
Description
>Multi-Axial Target Coordinate
(30xx,1525)
2C
Target coordinates (x,y,z) in the patient
based coordinate system described in
C.7.6.2.1.1 (mm) at Source-Axis
Distance.
Required if Multi-Axial Sub-Control
Point Sequence (30xx,1540) is not
present and if the Control Point Index
(30xx,0111) equals 1 or attribute value
changes at any Control Point.
See C.AA.2.16.1 and C.AA.L2.1.2.
>Surface Entry Point
(300A,012E)
2
Patient surface entry point coordinates
(x,y,z), along the central axis of the
beam, in the patient based coordinate
system described in C.7.6.2.1.1 (mm).
>Source to Surface Distance
(300A,0130)
2
Source to Patient Surface distance
(mm).
>Multi-Axial Sub-Control Point
Sequence
(30xx,1540)
1C
Sequence of Items describing SubControl Points.
Required at every Control Point but the
last if Gantry Head Mode (30xx,1546)
is DYNAMIC.
May be present at every Control Point
but the last if Gantry Head Mode is
DYNAMIC_TRACKING.
Two or more Items shall be included in
this sequence.
>>Include 'External Beam Sub-Control Point General Attributes Macro’ Table C.AA.2.18-1
>>Gantry Head Pitch Angle
(30xx,1520)
1C
Gantry Head Pitch Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Xaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1.and C.AA.L2.1.2.
>>Gantry Head Roll Angle
(30xx,1521)
1C
Gantry Head Roll Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Yaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1.and C.AA.L2.1.2.
106737321: Supplement 147: Second Generation Radiotherapy
Attribute Name
>>Gantry Head Yaw Angle
Page 145
Tag
Type
Description
(30xx,1522)
1C
Gantry Head Yaw Angle, i.e. the
rotation of the MULTI-AXIAL GANTRY
HEAD coordinate system about the Zaxis of the MULTI-AXIAL GANTRY
HEAD coordinate system (degrees).
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1. and C.AA.L2.1.2.
>>Multi-Axial Target
Coordinate
(30xx,1525)
2C
Target coordinates (x,y,z) in the patient
based coordinate system described in
C.7.6.2.1.1 (mm) at Source-Axis
Distance.
Required if the Sub-Control Point Index
(30xx,0115) equals 1 or attribute value
changes at any Sub-Control Point.
See C.AA.2.18.1.1.
2
C.AA.L2.1
C.AA.L2.1.1
4
6
8
10
12
Multi Axial Beam Attribute Description
Multi-Axial Gantry Angles
For a Multi-Axial treatment machine the Gantry Pitch Continuous Angle (30xx,51B7), Gantry Roll
Continuous Angle (30xx,51B5) and Gantry Yaw Continuous Angle (30xx,51B3) shall be applied in the
order z, x, y: first the yaw angle about the z-axis, then the pitch angle about the x-axis and then the
roll angle about the y-axis.
C.AA.L2.1.2
Gantry Head Angles
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 angle
about the Xh-axis and then the angle about the Yh-axis. These angles are the authoritative definition of
the Gantry Head. The coordinate defined in Multi-Axial Target Coordinate (30xx,1525) shall only serve
the purpose of annotation.
14
C.AA.L2.1.3
Multi Axial Beam Delimiter Positions
16
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
origin Ih is the MULTI-AXIAL GANTRY HEAD center of rotation.
18
Its daughter system is the IEC BEAM LIMITING DEVICE or DELINEATOR coordinate system ("b").
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2
Figure C.AA.L2.1.3-1
Multi-Axial treatment machine GANTRY HEAD system
4
Thus, the RT Beam Delimiter Element Positions (30xx,504A) within RT Beam Limiting Device
Positions Macro are always defined at Source-Axis Distance (300A,00B4) as defined in the Multi-Axial
Delivery Device Module even if the Gantry Head Pitch Angle (30xx,1520) or the Gantry Head Roll
Angle (30xx,1521) are not at a zero degree position. The distance from the Center of Rotation of the
Gantry Head to the Axis, is called the Center of Rotation-Axis Distance (CoRAD).
6
8
10
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
106737321: Supplement 147: Second Generation Radiotherapy
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2
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).
4
C.AA.M1 Enhanced RT Dose Module
6
8
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
module support dose for a single radiation instance (e.g. an external beam), one or more fractions of
the planned dose of an RT Radiation Set, or composite dose derived from multiple RT Dose Image
instances.
10
Table C.AA.M1-1
ENHANCED RT DOSE MODULE ATTRIBUTES
Attribute Name
Dose Type
Tag
Type
(3004,0004)
1
Attribute Description
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.
Zero or more Items shall be included
in this sequence.
>Include 'Code Sequence Macro' Table 8.8-1
>Effective Dose Method Modifier
Code Sequence
(30xx,1137)
Defined CID SUP147035.
3
Modifier Code further defining the
effective dose method.
One or more Items are permitted in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
Referenced Dose Calculation
Annotation Object Sequence
(30xx,1135)
No baseline CID defined.
3
Reference to SOP instances
describing dose calculation methods,
parameters and / or other information
used in calculation and / or
modification of the dose.
One or more Items are permitted in
this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
>Purpose of Reference Code
Sequence
(0040,A170)
1
Code describing the purpose of the
reference to the Instance(s).
Only a single Item shall be included
in this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
Effective Dose Method
Description
(30xx,1134)
Defined CID SUP147036.
2C
The description of the method used
to calculate the effective dose.
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Page 148
Required, if Dose Type (3004,0004)
is EFFECTIVE.
Dose Purpose
(30xx,1136)
3
The intended use of the dose.
Defined Terms:
PLAN_QA = for Dose QA
TREATMENT = for
treatment of a patient
IMAGING = representing
dose contributed by imaging
procedures
Dose Data Source
(30xx,1138)
1
The source of the dose data.
Defined Terms:
PLANNED = Dose
calculated from Radiation(s) or
Radiation Set(s).
MEASUREMENT =
Measured dose
RECONSTRUCTED = Dose
reconstructed from measured exit
dose
RECORD = Dose calculated
using delivered dose values from
radiation record
IMAGE_ACQ = Dose record
calculated for performed image
acquisition
Dose Data Source Measurement
Code Sequence
(30xx,113C)
1C
A detailed specification of the data
source.
Required, if Dose Data Source
(30xx,1138) is MEASUREMENT.
Only a single Item shall be included
in this sequence.
>Include 'Code Sequence Macro' Table 8.8-1
Radiation Absorption Model
(30xx,1130)
Defined CID SUP147037.
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
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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
The Scope of the entities
represented by that dose.
(30xx,113A)
1
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
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Page 150
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/nonlinear contribution to the dose.
Contributing Radiation Sequence
(30xx,1118)
1C
Reference to the SOP Instance of
Radiation that contributes to the
dose.
Required if the Dose Scope is
RADIATION or PARTIAL.
Only a single Item shall be included
in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
>Number of Complete Fractions
Contributing
(30xx,1120)
>Partial Delivery Limits Sequence (30xx,1122)
1
The number of complete fractions of
the RT Radiation contributing to the
dose. May be 0 if only a partial
delivery is represented.
1C
Reference to the cumulative
meterset value(s) to which the dose
is calculated for the partial fractions
included. If several partial fractions
are included in that dose, the
segments defined by Start Meterset
(30xx,1140) and Stop Meterset
(30xx,1141) within that sequence
may overlap.
Required if Dose Scope (30xx,113A)
is PARTIAL.
One or more Items shall be included
in this sequence.
>>Start Meterset
(30xx,1140)
1
The value of Cumulative Meterset at
which partial delivery of the
referenced Radiation SOP Instance
starts.
>>Stop Meterset
(30xx,1141)
1
The value of Cumulative Meterset at
which partial delivery of the
referenced Radiation SOP Instance
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stops.
Contributing Radiation Set
Sequence
(30xx,1102)
1C
Reference to one or more RT
Radiation Sets instances that
contribute to the dose.
Required if Dose Scope is
RADIATION_SET or
ACCUMULATED.
If Dose Scope is RADIATION_SET,
only a single Item shall be included in
this sequence. Otherwise, one or
more Items shall be included in this
sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
>Number of Complete Fractions
Contributing
(30xx,1120)
1
The number of complete fractions of
the RT Radiation Set contributing to
the dose. May be 0 if only a partial
delivery is represented.
> Fraction Completion Status
(30xx,1123)
1C
Indication of whether the dose
contribution from the current RT
Radiation Set includes an incomplete
fraction.
Defined terms:
COMPLETE = Dose represents
contribution of an integral number of
complete fractions
INCOMPLETE = Dose represents
contribution of one or more
incomplete 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.
One or more Items shall be included
in this sequence.
>>Include 'SOP Instance Reference Macro' Table 10-11
>>Radiation Completion Status
(30xx,1125)
1
Indication of whether the dose
contribution from the current RT
Radiation is complete.
Defined terms:
COMPLETE = Dose
represents contribution of the
complete radiation.
INCOMPLETE = Dose
represents contribution of one or
more meterset intervals of a single
incomplete fraction
106737321: Supplement 147: Second Generation Radiotherapy
>>Partial Delivery Limits
Sequence
(30xx,1122)
Page 152
1C
Reference to the cumulative
meterset value(s) to which the dose
is calculated. If several partial
fractions are included in that dose,
the segments defined by Start
Meterset (30xx,1140) and Stop
Meterset (30xx,1141) within that
sequence may overlap.
Required if the Radiation Completion
Status (30xx,1125) is INCOMPLETE.
One or more Items shall be included
in this sequence.
>>>Start Meterset
(30xx,1140)
1
The value of Cumulative Meterset at
which partial delivery of the
referenced Radiation SOP Instance
starts.
>>>Stop Meterset
(30xx,1141)
1
The value of Cumulative Meterset at
which partial delivery of the
referenced Radiation SOP Instance
stops.
Composite Dose Sequence
(30xx,1100)
1C
RT Dose Image or RT Dose SOP
instances that contribute to the dose.
Required if the Dose Scope
(30xx,113A) is COMPOSITE.
One or more Items shall be included
in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
>Dose Contribution Weight
(30xx,1110)
1C
A numeric value representing the
scale factor used in compositing the
referenced dose Instance. Negative
values maybe used for dose
differences.
Required if the Dose Contribution
Accumulation Operator Type
(30xx,1124) is LINEAR.
Contributing RT Radiation
Record Sequence
(30xx,1128)
1C
RT Radiation Record SOP instances
used to calculate the dose.
Required if Dose Data Source
(30xx,1138) is RECORD.
One or more Items shall be included
in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
>Treatment Session UID
(30xx,6000)
1
The UID identifying a treatment
session. This UID serves as a key to
collect all Radiation Record
instances, which have been
delivered within the same treatment
session.
Spatial Transform of Dose
(3004,0005)
3
The use of transformation in the
calculation of the combined dose.
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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
Referenced Spatial Registration
Sequence
(0070,0404)
2C
A reference to a Spatial Registration
SOP Instance or a Deformable
Spatial Registration SOP Instance,
which defines the transformation
used to transform the dose.
Required, if Spatial Transform of
Dose (3004,0005) is provided and
has a value of RIGID or
NON_RIGID.
Zero or one Item shall be included in
this sequence.
See Section C.8.8.3.5
>Include 'SOP Instance Reference Macro' Table 10-11
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.
Only a single Item shall be included
in this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.M1.1 Enhanced RT Dose Attribute Description
C.AA.M1.1.1
Dose Scope
4
The scope of the dose described in that module is given by the referenced SOP instances, which are
included in the actual reference sequences as required by the Dose Scope (30xx,113A).
6
It is important, that a dose provided in absolute values (i.e the Real World Value Mapping
C.7.6.16.2.11 macro contain the code (Gy, UCUM, “Gray”) for the unit) is consistent with the absolute
planned or delivered Meterset values as specified by Cumulative Meterset (30xx,5021) in those
referenced SOP instances.
8
10
C.AA.M1.1.2
12
The multipicity of the value shall be 1 for dose objects which represent a dose having been directly
calculated based on image data. For doses which have been calculated by compositing several other
doses, the attribute shall contain each value found in the the composited doses once and only once.
14
Radiation Absorption Model
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C.AA.M2 RT Dose Image Module
2
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 data
values to real-world dose values. It provides the mechanism to transmit a 3D array of dose data as a
multi-frame image whose frames represent 2D dose image planes that may or may not be related to
CT or MR image planes.
8
Table C.AA.M2-1
RT DOSE IMAGE MODULE ATTRIBUTES
4
Attribute Name
Image Type
Tag
Type
(0008,0008)
1
Attribute Description
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
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dose has been calculated.
Required if Dose Data Source
(30xx,1138) in the Enhanced RT
Dose Module is PLANNED or
RECORD. May be present otherwise.
One or more Items shall be included
in this sequence.
>Include 'Image SOP Instance Reference Macro' Table 10-3
2
C.AA.M2.1 RT Dose Image Attribute Description
C.AA.M2.1.1
Image Type and Frame Type
4
Value 1 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 1
shall be DERIVED.
6
C.AA.M2.1.1.1 Patient Examination Characteristics
8
Value 2 of Image Type (0008,0008) and Frame Type (0008,9007) shall be used as follows: Value 2
shall be SECONDARY.
C.AA.M2.1.1.2 Image Flavor
10
Value 3 of Image Type (0008,0008) and Frame Type (0008,9007) is discussed in C.8.16.1.3. No
additional requirements. The value shall be VOLUME.
12
C.AA.M2.1.1.3 Derived Pixel Contrast
14
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.
C.AA.M2.1.2
16
18
20
22
Dose Grid Geometry
If Dose Grid Geometry (30xx,1150) is NON_SHEARED, the Image Position (Patient) values of all
frames are co-linear and lie along a vector normal to each of the planes. Mathematically, all dose grid
frames shall be aligned such that the vector difference (Xm-Xn, Ym-Yn, Zm-Zn) of Image Position
(Patient) vectors (Xm, Ym, Zm) and (Xn, Yn, Zn) in the Plane Position Functional Group of any pair of
frames is proportional to the cross product of row and column direction cosine vectors specified by
Image Orientation (Patient) in the Shared Plane Orientation Functional Group.
C.AA.M2.1.3
Dose Grid Real World Values
C.AA.M2.1.3.1 Dose Grid Scaling
24
26
The real world values of the dose grid shall be derived from the stored pixel values by scaling
according to the Real World Intercept (0040,9224) and Real World Value Slope (0040,9225). See
C.7.6.16.2.11.1.2.
C.AA.M2.1.3.2 Dose Grid Pixel Padding
28
30
Long Dose Grid Padding Value (0028,xxxx) is used to identify pixels for which dose grid values are
not specified (see C.7.5.1.1.2). Applications consuming RT Dose Image instances shall handle pixel
padding correctly to avoid misinterpreting pixel padding as dose. In particular:
1. Long Dose Grid Padding Value (0028,xxxx) specifies a single value of this padding value.
32
2. The value of Long Pixel Padding Value (0028,xxxx) shall be valid values within the objectives
defined by Bits Allocated (0028,0100) Bits Stored (0028,0101) and High Bit (0028,0102).
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2
3. No points within the native dose grid shall have a value equal to pixel padding value. Values
within the pixel padding range shall lie outside the range between the minimum and maximum values
of valid dose values in the dose grid.
4
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.
6
C.AA.M3 RT Dose Image Functional Group Macros
8
10
12
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
to a single frame (i.e., the macro is part of the Per-frame Functional Groups Sequence). If an attribute
is applicable to all frames (i.e. the macro is part of the Shared Functional Groups Sequence) the
phrase "this frame" in the attribute description shall be interpreted to mean "for all frames".
C.AA.M3.1 RT Dose Image Frame Type Macro
14
Table C.AA.M3.1-1 specifies the attributes of the RT Dose Image Frame Type Functional Group
macro.
16
Table C.AA.M3.1-1
RT DOSE IMAGE FRAME TYPE MACRO ATTRIBUTES
Attribute Name
RT Dose Image Frame Type
Sequence
Tag
Typ
e
(30xx,1116)
1
Attribute Description
Identifies the characteristics of this
frame.
Only a single Item shall be included
in this sequence.
>Frame Type
(0008,9007)
1
Type of Frame. A multi-valued
attribute analogous to the Image
Type (0008,0008).
Enumerated Values and Defined
Terms are the same as those for
the four values of the Image Type
(0008,0008) attribute.
See C.8.16.1 and C.AA.M2.1.
18
C.AA.M4 RT Dose Histogram Module
20
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 these
dose histogram types may be contained within this module.
24
Table C.AA.M4-1
RT DOSE HISTOGRAM MODULE ATTRIBUTES
Attribute Name
Dose Histogram Normalization
Dose Value
Tag
Type
(30xx,1201)
3
Attribute Description
Nominal Dose Reference Value
indicating prescribed dose.
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Attribute Name
Dose Histogram Sequence
Page 157
Tag
Type
(30xx,1202)
1
Attribute Description
Sequence of Items describing Dose
Histograms.
One or more Items shall be included in
this sequence.
>Dose Histogram Referenced
Segment Sequence
(30xx,1203)
1
Referenced anatomies used to
calculate the Dose Histogram.
See C.AA.M4.1.3.
One or more Items shall be included in
this sequence.
>>Include ' Conceptual Volume Segmentation
The value of Conceptual Volume
Reference and Combination Macro' Table C.AA.2.6-1 Segmentation Defined Flag
(30xx,1311) shall be YES.
>Dose Histogram Type
(30xx,1210)
1
Type of Dose Histogram:
Defined Terms:
VOLUME = dose-volume
histogram
AREA = dose-area histogram
>Histogram Tally Type
(30xx,1205)
1
Method of tallying spatial quantity in
constructing dose 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.
Only a single Item shall be included in
this sequence.
See C.7.6.16.2.11.1 for further
explanation.
>>Include 'Code Sequence Macro' Table 8.8-1
>Dose Histogram Spatial Unit
Code Sequence
(30xx,1206)
Defined CID SUP147065
1
Units of measurement for the spatial
dimension of the histogram.
Only a single Item shall be included in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
Defined CID SUP147039
>Segment Total Size
(30xx,1209)
1
Total size of all segments referenced in
Dose Histogram Referenced Segment
Sequence (30xx,1203), in units of Dose
Histogram Spatial Units (30xx,1206)
>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.
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Attribute Name
>Dose Statistics Sequence
Page 158
Tag
Type
(30xx,1211)
3
Attribute Description
Dose statistic information.
One or more Items are permitted in this
sequence.
>>Include 'Content Item Macro' Table 10-2
Defined CID of Concept Name Code
Sequence is CID SUP147026.
The Content Item shall have a Value
Type (0040,A040) of NUMERIC.
Content items shall use UCUM units of
Gy where applicable.
Source Image Sequence
(0008,2112)
2
Reference to RT Dose Image SOP
instances from which the dose
histogram has been calculated.
Zero or more Items shall be included in
this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
2
C.AA.M4.1 RT Dose Histogram Attribute Description
C.AA.M4.1.1
4
6
8
10
12
The Conceptual Volume Macro in the Dose Histogram Referenced Segment Sequence (30xx,1203)
is used to specify the segments or combinations of segments used to compute Dose Histograms.
Segments are defined in the Segmentation Properties SOP Instance referenced by the Referenced
RT Segment Annotation Sequence (30xx,0874) and are identified using their Conceptual Volume
UIDs.
The geometry of segments represented in the referenced Segmentation Properties SOP Instance
may be defined in an RT Structure Set, Segmentation, or Surface Segmentation SOP Instance.
Segments defined by an RT Structure Set SOP Instance shall contain only contours with a Contour
Geometric Type (3006,0042) of CLOSED_PLANAR.
C.AA.M4.1.2
14
16
18
20
22
24
26
28
Referenced Segmentation Properties Sequence
Dose Histogram Data
The RT Dose Histogram Module differs from the earlier RT DVH module in that the attribute Dose
Histogram Data (30xx,1204) is encoded with VR of OF. In the earlier DVH Module, the corresponding
DVH Data (3004,0058) was encoded with VR of DS, leading to attribute value length limitations when
the dataset was encoded with ELE transfer syntax and there were many histogram bins.
The RT Dose Histogram Module differs from the earlier RT DVH module in that Dose Histogram Data
(30xx,1204) attribute represents DIFFERENTIAL dose-volume or dose-area histograms, i.e., in the
sequence of pairs, D1V1, D2V2, ... DnVn the Values Vi represent the volume (or area) of the referenced
segment(s) receiving dose < Di and > Di-1 for i>1 and dose > 0 for i=1.
C.AA.M4.1.3
Dose Histogram Referenced Segment Sequence
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
Volume shall be well-defined and point to the appropriate segment as identified by the Referenced
Segment Annotation Index (30xx,0151) in the Conceptual Volume Segmentation Reference and
Combination Macro (see section C.AA.2.6).
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C.AA.M5 Dose Samples Module
2
The Dose Samples module provides for the inclusion of a list of spatial dose sample data.
Table C.AA.M5-1
DOSE SAMPLES MODULE ATTRIBUTES
4
Attribute Name
Tag
Type
Attribute Description
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.
Only a single Item shall be included in
this sequence.
See C.7.6.16.2.11.1 for further
explanation.
>Include 'Code Sequence Macro' Table 8.8-1
Source Image Sequence
(0008,2112)
Defined CID SUP147065.
1C
Reference to images from which the
dose has been calculated. Required if
Dose Data Source (30xx,1138) in the
Enhanced RT Dose Module is
PLANNED or RECORD. May be
present otherwise.
One or more Items shall be included in
this sequence.
>Include 'Image SOP Instance Reference Macro' Table 10-3
6
C.AA.M5.1 RT Dose Samples Attribute Description
C.AA.M5.1.1
8
10
Dose Samples Data
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
sample Di , expressed in units specified by Dose Samples Dose Unit Code Sequence(30xx,1253).
14
C.AA.P1
16
The RT Radiation Record Common Module contains treatment-modality independent information
about a delivered radiation. A delivered radiation may be a radiation to a patient or a radiation without
a patient being present (e.g. for QA purposes).
18
RT Radiation Record Common Module
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.
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2
Page 160
Table C.AA.P1-1
RT RADIATION RECORD COMMON MODULE ATTRIBUTES
Attribute Name
Tag
Type
Attribute Description
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.
Only a single Item shall be included in
this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
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.
Only a single Item shall be included in
this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
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.
Only a single Item shall be included in
this sequence.
>Include 'SOP Instance Reference Macro' Table 10-11
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 =
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continuation of interrupted treatment
PLAN_QA = Treatment used
for Quality Assurance rather than
patient treatment
Treatment Termination Status
(3008,002A)
1
Conditions under which treatment
was terminated.
Enumerated Values:
NORMAL = treatment
terminated normally
OPERATOR = operator
terminated treatment
MACHINE = machine
terminated treatment
UNKNOWN = status at
termination unknown
Treatment Termination Reason
Code Sequence
(30xx,6015)
1C
Treatment machine termination code.
This code is dependent upon the
particular application and equipment.
Required if Treatment Termination
Status (3008,002A) is MACHINE or
OPERATOR.
Only a single Item shall be included in
this sequence.
>Include 'Code Sequence Macro' Table 8.8-1
>Machine-Specific Treatment
Termination Code Sequence
(30xx,6016)
Defined CID SUP147015
3
Machine-specific termination codes.
One or more Items are permitted in
this sequence.
>>Include 'Code Sequence Macro' Table 8.8-1
No Baseline CID is specified.
Treatment Termination
Description
(30xx,6030)
2C
A user defined description for an
abnormal termination. Required if
Treatment Termination Status
(3008,002A) is not NORMAL.
Treatment Recording Method
(30xx,6035)
1
Method with which treatment was
recorded.
Enumerated Values:
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
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of clinical tolerance, overridden by
operator
Referenced Control Point
Sequence
(300C,00F2)
1
References the control point that is
declared in the module containing the
Control Points.
This sequence shall contain the same
number of Items as the referenced
Control Point Sequence.
See C.AA.P1.1.1.
>Referenced Control Point Index
(30xx,0141)
1
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.
Zero or more Items shall be included
in this sequence.
>Include 'Selector Attribute Macro' Table 10-20
Point to attribute in current Record
IOD
>Operators’ Name
(0008,1070)
1
Name of operator who authorized
override.
>Override Reason
(3008,0066)
2
User-defined description of reason for
override of parameter specified by
Override Parameter Pointer
(3008,0062).
Alternate Specified Value
Sequence
(30xx,603E)
2
Defines new specified value for the
referenced Attribute.
Only a single Item shall be included in
this sequence.
>Include 'Selector Attribute Macro' Table 10-20
Point to attribute in current Record
IOD
>Include 'Content Item Macro' Table 10-2
Defined CID SUP147048
Sign-Off Sequence
(30xx,603F)
2
Records sign-offs by treatment
session operators, containing
confirmation of the use of resources,
the execution of activities etc. which
are required to perform the treatment,
but are not verified electronically.
Zero or more Items shall be included
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in this sequence.
>Operators’ Name
(0008,1070)
1
Name of operator who authorized
override.
>Sign-Off Item Description
(30xx,603F)
2
Description of the item having been
signed-off.
>Include 'Code Sequence Macro' Table 8.8-1
2
C.AA.P1.1
RT Radiation Record Common Attribute Description
C.AA.P1.1.1
4
6
8
10
12
Baseline CID SUP147056
Control Point References
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
the Referenced Control Point Index (30xx,0141), which refers to the corresponding Control Point
Index (30xx,0111) present in the referenced RT Radiation IOD.
C.AA.P1.1.2
Referenced RT Patient Setup Sequence
The Referenced RT Patient Setup Sequence (30xx,0C20) references the specific RT Patient Setup
instance used to position the patient. This is not to be confused with the Patient Setup UID
(30xx,5060) which identifies a conceptual patient setup that can be realized by one or more RT
Patient Setup SOP instances.
C.AA.P2
RT Dose Record Common Module
14
The RT Dose Record Common module contains information about the delivered and measured dose.
16
Table C.AA.P2-1
RT DOSE RECORD COMMON MODULE ATTRIBUTES
Attribute Name
Radiation Dose Identification
Sequence
Tag
Type
Attribute Description
(30xx,0B42)
1
Dose values that are delivered by this
radiation.
One or more Items shall be included
in this sequence.
>Radiation Dose Identification
Index
(30xx,0120)
1
Index of the Radiation Dose
Identification in the sequence used for
internal or external references
The value shall start at 1, and
increase monotonically by 1.
>Radiation Dose Identification
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.
Only a single Item shall be included in
this sequence.
>>Include ‘Conceptual Volume Segmentation Reference and Combination Macro' Table
C.AA.2.6-1
>Calculated Radiation Dose
(30xx,6110)
1C
Calculated dose values of this treated
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Values Sequence
radiation.
Required if Measured Radiation Dose
Values Sequence (30xx,6114) is not
present, may be present otherwise.
One or more Items shall be included
in this sequence.
>>Number of Dose Meterset
Points
(30xx,0B68)
1
The number of dose value points
represented by the list of values in
Meterset Values (30xx,0B6A) and
Radiation Dose Values (30xx,0B6C).
The number shall be greater than 1.
See C.AA.C2.1.
>>Meterset Values
(30xx,0B6A)
1
The list of meterset values, where the
corresponding dose values are
delivered as specified in Radiation
Dose Values (30xx,0B6C). See
C.AA.C2.1.
>>Radiation Dose Values
(30xx,0B6C)
1
The dose values (in Gy) delivered at
the corresponding meterset value.
See C.AA.C2.1.
>Measured Radiation Dose
Values Sequence
(30xx,6114)
1C
Measured dose values of this treated
radiation.
Required if Calculated Radiation
Dose Values Sequence (30xx,6110)
is not present, may be present
otherwise.
One or more Items shall be included
in this sequence.
>>Number of Dose Meterset
Points
(30xx,0B68)
1
The number of dose value points
represented by the list of values in
Meterset Values (30xx,0B6A) and
Radiation Dose Values (30xx,0B6C).
The number shall be greater than 1.
See C.AA.C2.1.
>>Meterset Values
(30xx,0B6A)
1
The list of meterset values, where the
corresponding dose values are
delivered as specified in Radiation
Dose Values (30xx,0B6C). See
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
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GEL = dose sensitive gel
EPID = electronic portal
imaging device
FILM = dose sensitive film
>Measured Dose Description
2
C.AA.P2.1
C.AA.P2.1.1
4
6
8
10
(3008,0012)
3
User-defined description of Dose
Reference (e.g. “Exit dose”, “Point
A”).
RT Dose Record Common Module Attribute Description
Conceptual Volume Sequence
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
segment, the segment is defined by the Referenced Segment Annotation Index (30xx,0151) in the
Conceptual Volume Segmentation Reference and Combination Macro (see section C.AA.2.6).
Alternatively, the dosimetric volume may not be associated with a segment. For example, dose
recording may be specified using a nominal dose to a volume and the tracking coefficients
approximated by meterset values.
106737321: Supplement 147: Second Generation Radiotherapy
Page 166
Make the following additions to PS3.3, Annex F, Table F.4-1:
2
Table F.4-1
RELATIONSHIP BETWEEN DIRECTORY RECORDS
Directory Record Type
Section
(Root Directory Entity)
4
Directory Record Types which may be included in
the next lower-level 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)
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Add the “RADIOTHERAPY DR” box at the bottom of PS3.3, Annex F, Figure F.4-1:
2
106737321: Supplement 147: Second Generation Radiotherapy
Page 168
Root Directory
Entity
1
includes
0-n
0-n
Patient DR
0-n
Hanging Protocol DR
Color Palette
DR
1
references
1-n
0-n
Study DR
HL7 Struc Doc DR
1
references
0-n
Series DR
1
references
0-n
Image DR
RT Dose DR
Higher Level DR
The Higher-Level Directory Record
references a Lower- Level
Directory Entity that includes the
Lower-Level Directory Record
RT Structure Set
DR
RT Plan DR
0-n
0-n
0-n
0-n
Stereometric DR
references
Lower Level DR
RT Treatment
Record DR
0-n
0-n
Waveform DR
0-n
0-n
0-n
0-n
0-n
0-n
Fiducials DR
0-n
0-n
Radiotherapy DR
0-n
Spectroscopy DR
Raw Data DR
2
Real World
Value DR
Presentation DR
SR Document DR
Registration DR
Encapsulated
Document DR
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Add the following to PS3.3, Annex F, Section F.5.X:
2
F.5.X
4
Radiotherapy Directory Record Definition
10
The Directory Record is based on the specification of Section F.3. It is identified by a Directory Record
Type of Value "RADIOTHERAPY". Table F.5-X lists the set of keys with their associated Types for
such a Directory Record Type. The description of these keys may be found in the Modules related to
the Instance-level IEs of Second-generation Radiotherapy IODs. This Directory Record shall be used
to reference one of the class of Second-generation Radiotherapy SOP Instances having a Modality
(0008,0060) of “RT”. This type of Directory Record may reference a Lower-Level Directory Entity that
includes one or more Directory Records as defined in Table F.4-1.
12
Table F.5-X
RADIOTHERAPY KEYS
6
8
Key
Tag
Type
Specific Character Set
(0008,0005)
1C
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
14
16
Note:
Attribute Description
Required if an extended or replacement
character set is used in one of the keys.
3
Because Referenced SOP Instance UID in File (0004,1511) may be used as a "pseudo" Directory
Record Key (See Table F.3-3), it is not duplicated in this list of keys.
106737321: Supplement 147: Second Generation Radiotherapy
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Change the following in PS3.3, section C.7.5.1 General Equipment Module
2
C.7.5.1
4
General Equipment Module
…
Attribute Name
Pixel Padding Value
Tag
Type
Attribute Description
(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:
Long Pixel Padding Value
(0028,xxxx)
1C
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.
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.
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 171
Change the following in PS3.3, section C.7.6.3 Image Pixel Module
C.7.6.3
Image Pixel Module
4
Attribute Name
Pixel Padding Range Limit
Tag
Type
(0028,0121)
1C
Attribute Description
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:
Long Pixel Padding Range
Limit
(0028,yyyy)
1C
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.
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
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Page 172
Part 4 Addendum
2
Add the following to PS3.4, Appendix B.5, Table B.5-1
SOP Class Name
SOP Class UID
IOD
Spec
(defined
in PS
3.3)
4
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
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Add the following to PS3.4, Table I.4-1
2
Table I.4-1 Media Storage Standard SOP Classes
SOP Class Name
4
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
Tomotherapeutic Radiation
Record Storage
1.2.840.10008.5.1.4.1.1.481.XN.6.1
Tomotherapeutic
Radiation Record
C-Arm Photon Radiation
Record Storage
1.2.840.10008.5.1.4.1.1.481.XN.6.2
C-Arm Photon Radiation
Record
C-Arm Electron Radiation
Record Storage
1.2.840.10008.5.1.4.1.1.481.XN.6.3
C-Arm Electron Radiation
Record
Multiple Fixed Source
Radiation Record Storage
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
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2
Page 174
Add the following to PS3.4, Appendix Z.1.3, Table Z.1-1
4
Table Z.1-1
Attributes not to be Included in Instances Sent
6
Attribute
Tag
Dose Samples Data
(30xx,1251)
Dose Histogram Data
(30xx,1204)
106737321: Supplement 147: Second Generation Radiotherapy
Page 175
Part 6 Addendum
2
Add the following data elements to PS3.6:
4
6
REGISTRY OF DICOM DATA ELEMENTS
(30xx,0111)
Control Point Index
ControlPointIndex
US
1
(30xx,0112)
Device Index
DeviceIndex
US
1
(30xx,0113)
Beam Mode Index
BeamModeIndex
US
1
(30xx,0114)
RT Tolerance Set Index
RTToleranceSetIndex
US
1
(30xx,0115)
Sub-Control Point Index
SubControlPointIndex
US
1
(30xx,0116)
Treatment Phase Index
TreatmentPhaseIndex
US
1
(30xx,0117)
Meta RT Radiation Set
Index
MetaRTRadiationSetIndex
US
1
(30xx,0118)
RT Prescription Index
RTPrescriptionIndex
US
1
(30xx,0119)
Dosimetric Objective
Parameter Index
DosimetricObjectiveParameterIndex
US
1
(30xx,0120)
Radiation Dose
Identification Index
RadiationDoseIdentificationIndex
US
1
(30xx,0121)
Segment Index
SegmentIndex
US
1
(30xx,0122)
Referenced Meta RT
Radiation Set Index
ReferencedMetaRTRadiationSetIndex
US
1
(30xx,0123)
Meta RT Radiation Set
Relationship Sequence
Meta RT Radiation Set Relationship
Sequence
SQ
1
(30xx,0141)
Referenced Control Point
Index
ReferencedControlPointIndex
US
1
(30xx,0142)
Referenced Device Index
ReferencedDeviceIndex
US
1
(30xx,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
ReferencedRadiationDoseIdentificationI
ndex
US
1
(30xx,0151)
Referenced Segment
Annotation Index
ReferencedSegmentAnnotationIndex
US
1
(30xx,02E3)
RT Accessory Holder
Water-Equivalent
Thickness
RTAccessoryHolderWaterEquivalentThi
ckness
FD
1
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Page 176
(30xx,0540)
Referenced RT Accessory ReferencedRTAccessoryHolderDeviceIn US
Holder Device Index
dex
1
(30xx,0542)
RT Accessory Holder Slot
Sequence
RTAccessoryHolderSlotSequence
SQ
1
(30xx,0544)
RT Accessory Holder Slot
ID
RTAccessoryHolderSlotID
LO
1
(30xx,0546)
RT Accessory Holder Slot
Distance
RTAccessoryHolderSlotDistance
FD
1
(30xx,0548)
RT Accessory Slot
Distance
RTAccessorySlotDistance
FD
1
(30xx,054A)
RT Accessory Holder
Definition Sequence
RTAccessoryHolderDefinitionSequence
SQ
1
(30xx,054B)
RT Accessory Device Slot RTAccessoryDeviceSlotID
ID
LO
1
(30xx,054D)
Manufacturer's Device
Identifier
ManufacturerDeviceIdentifier
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 RTPrescriptionReferencePresenceFlag
Presence Flag
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
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Page 177
(30xx,0866)
Referenced Intent
Prescription Status
Sequence
ReferencedIntentPrescriptionStatusSeq
uence
SQ
1
(30xx,0870)
Treatment Phase
Reference Sequence
TreatmentPhaseReferenceSequence
SQ
1
(30xx,0874)
Referenced RT Segment
Annotation Sequence
ReferencedRTSegmentAnnotationSequ
ence
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
PretreatmentRTRadiationSetReference
Sequence
SQ
1
(30xx,08CB)
Pre-treatment RT
Radiation Set Role Code
Sequence
PretreatmentRTRadiationSetRoleCodeS SQ
equence
1
(30xx,08CC)
Conceptual Volume State
Sequence
ConceptualVolumeStateSequence
SQ
1
(30xx,08F2)
Treatment RT Radiation
Set Reference Sequence
TreatmentRTRadiationSetReferenceSe
quence
SQ
1
(30xx,08F4)
Treatment RT Radiation
Set Sequence Number
TreatmentRTRadiationSetSequenceNu
mber
US
1
(30xx,08F6)
Treatment RT Radiation
Set Status Sequence
TreatmentRTRadiationSetStatusSequen SQ
ce
1
(30xx,08F8)
Treatment RT Radiation
Set Operation State
Sequence
TreatmentRTRadiationSetOperationStat
eSequence
SQ
1
(30xx,08FA)
Treatment RT Radiation
Set Relation Sequence
TreatmentRTRadiationSetRelationSequ
ence
SQ
1
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Page 178
(30xx,08FC)
Treatment RT Radiation
Set Alteration Type
Sequence
TreatmentRTRadiationSetAlterationTyp
eSequence
SQ
1
(30xx,08FD)
Treatment RT Radiation
Set Alteration Type Code
Sequence
TreatmentRTRadiationSetAlterationTyp
eCodeSequence
SQ
1
(30xx,08FE)
Treatment RT Radiation
Set Change Description
TreatmentRTRadiationSetChangeDescri ST
ption
1
(30xx,08FF)
Referenced RT Radiation
Record Sequence
ReferencedRTRadiationRecordSequenc SQ
e
1
(30xx,0900)
RT Course Associated
Instance Reference
Sequence
RTCourseAssociatedInstanceReference SQ
Sequence
1
(30xx,0901)
Instance Reference
Purpose Code Sequence
InstanceReferencePurposeCodeSequen SQ
ce
1
(30xx,0902)
RT Prescription Label
RTPrescriptionLabel
LO
1
(30xx,0903)
Associated Instance State AssociatedInstanceStateSequence
Sequence
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
DosimetricObjectiveEvaluationIncluding
PriorDose
CS
1
(30xx,0928)
Prescription Anatomy
Notes
PrescriptionAnatomyNotes
ST
1
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Page 179
(30xx,0930)
Prescription Anatomy Role PrescriptionAnatomyRole
CS
1
(30xx,0932)
Radiobiological Structural
Type
RadiobiologicalStructuralType
CS
1
(30xx,0933)
Conceptual Volume
Optimization Precedence
ConceptualVolumeOptimizationPrecede
nce
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
DoseObjectiveValueTypeCodeSequenc
e
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
ReferencedDosimetricObjectivesSeque
nce
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 PlanningInputInformationSequence
Sequence
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
ST
1
FractionationDescription
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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 FractionationRelationshipSequence
Sequence
SQ
1
(30xx,0B26)
Radiation Sequence
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
DoseMetersetToDoseMappingSequenc
ePo
SQ
1
(30xx,0B6D)
Radiation Verification
Control Point Sequence
RadiationVerificationControlPointSeque
nce
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
RadiationDoseInVivoMeasurementSequ
ence
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 SourceSkin Distance
RadiationDoseSourceSkinDistance
FD
1
(30xx,0B7D)
Radiation Dose
Measurement Point
Coordinates
RadiationDoseMeasurementPointCoordi
nates
FD
3
(30xx,0BA0)
RT Tolerance Set
Sequence
RTToleranceSetSequence
SQ
1
(30xx,0BA2)
RT Tolerance Set Label
RTToleranceSetLabel
SH
1
RadiationSequence
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Attribute Tolerance Values AttributeToleranceValuesSequence
Sequence
SQ
1
(30xx,0BA8)
Tolerance Value
ToleranceValue
FD
1
(30xx,0BAA)
Patient Support Position
Tolerance Sequence
PatientSupportPositionToleranceSeque
nce
SQ
1
(30xx,0BAC)
Calculated Treatment
Time
CalculatedTreatmentTime
FD
1
(30xx,0BAD)
Treatment Time Limit
TreatmentTimeLimit
FD
1
(30xx,0BB0)
Manufacturer's Model
Class UID
ManufacturersModelClassUID
UI
1
(30xx,0BB2)
Treatment Machine
Delivery Subsystem ID
TreatmentMachineDeliverySubsystemID
SH
1
(30xx,0C00)
C-Arm Photon-Electron
Control Point Sequence
CArmPhotonElectronControlPointSeque
nce
SQ
1
(30xx,0C02)
Referenced Radiation Set
Sequence
ReferencedRadiationSetSequence
SQ
1
(30xx,0C04)
Referenced Radiation
Sequence
ReferencedRadiationSequence
SQ
1
(30xx,0C97)
Treatment Machine
Special Mode Sequence
TreatmentMachineSpecialModeSequen
ce
SQ
1
(30xx,0C99)
Radiotherapy Procedure
Technique Sequence
RadiotherapyProcedureTechniqueSequ
ence
SQ
1
(30xx,0F00)
Robotic Beam Limiting
Device Supported Type
RoboticBeamLimitingDeviceSupportedT
ype
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 SubControl 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
TomotherapeuticLeafBankDefinitionSeq
uence
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
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Maximum Binary MLC
Jaw 1 Opening
MaximumBinaryMLCJaw1Opening
FD
1
(30xx,1006)
Maximum Binary MLC
Jaw 2 Opening
MaximumBinaryMLCJaw2Opening
FD
1
(30xx,1007)
Tomotherapeutic Nominal
Couch Speed
TomotherapeuticNominalCouchSpeed
FD
1
(30xx,1008)
Tomotherapeutic Nominal
Gantry Period
TomotherapeuticNominalGantryPeriod
FD
1
(30xx,1009)
Tomotherapeutic Nominal
Delivery Pitch
TomotherapeuticNominalDeliveryPitch
FD
1
(30xx,1010)
Tomotherapeutic Control
Point Sequence
TomotherapeuticControlPointSequence
SQ
1
(30xx,1024)
Binary MLC Jaw 1
Opening
BinaryMLCJaw1Opening
FL
1
(30xx,1025)
Binary MLC Jaw 2
Opening
BinaryMLCJaw2Opening
FL
1
(30xx,1030)
Tomotherapeutic Leaf
Open Percentages
TomotherapeuticLeafOpenPercentages
FL
1-n
(30xx,1031)
Tomotherapeutic Leaf
Open Start Percentages
TomotherapeuticLeafOpenStartPercent
ages
FL
1-n
(30xx,1100)
Composite Dose
Sequence
CompositeDoseSequence
SQ
1
(30xx,1102)
Contributing Radiation Set ContributingRadiationSetSequence
Sequence
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
NumberOfCompleteFractionsContributin
g
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
ContributingRTRadiationRecordSequen
ce
SQ
1
(30xx,1130)
Radiation Absorption
Model
RadiationAbsorptionModel
CS
1-n
(30xx,1132)
Effective Dose Method
Code Sequence
EffectiveDoseMethodCodeSequence
SQ
1
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Effective Dose Method
Description
EffectiveDoseMethodDescription
LO
1
(30xx,1135)
Referenced Dose
Calculation Annotation
Object Sequence
ReferencedDoseCalculationAnnotationO SQ
bjectSequence
1
(30xx,1136)
Dose Purpose
DosePurpose
CS
1
(30xx,1137)
Effective Dose Method
Modifier Code Sequence
EffectiveDoseMethodModifierCodeSequ
ence
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
DoseDataSourceMeasurementCodeSeq SQ
uence
1
(30xx,113E)
Effective Tissue
Composition
EffectiveTissueComposition
CS
1
(30xx,1140)
Start Meterset
StartMeterset
FD
1
(30xx,1141)
Stop Meterset
StopMeterset
FD
1
(30xx,1144)
Algorithm Type Code
Sequence
AlgorithmTypeCodeSequence
SQ
1
(30xx,1146)
Referenced Annotating
Object Sequence
ReferencedAnnotatingObjectSequence
SQ
1
(30xx,1150)
Dose Grid Geometry
DoseGridGeometry
CS
1
(30xx,1201)
Dose Histogram
DoseHistogramNormalizationDoseValue
Normalization Dose Value
FD
1
(30xx,1202)
Dose Histogram
Sequence
DoseHistogramSequence
SQ
1
(30xx,1203)
Dose Histogram
Referenced Segment
Sequence
DoseHistogramReferencedSegmentSeq SQ
uence
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 DoseHistogramDoseUnitCodeSequence SQ
Code Sequence
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
OriginatingSOPInstanceReferenceSequ
ence
SQ
1
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Conceptual Volume
Constituent Sequence
ConceptualVolumeConstituentSequence SQ
1
(30xx,1304)
Equivalent Conceptual
Volume Instance
Reference Sequence
EquivalentConceptualVolumeInstanceR
eferenceSequence
SQ
1
(30xx,1305)
Equivalent Conceptual
Volumes Sequence
EquivalentConceptualVolumesSequenc
e
SQ
1
(30xx,1306)
Conceptual Volume Set
Sequence
ConceptualVolumeSetSequence
SQ
1
(30xx,1307)
Conceptual Volume
Combination Expression
ConceptualVolumeCombinationExpressi
on
ST
1
(30xx,1308)
Conceptual Volume
Constituent Index
ConceptualVolumeConstituentIndex
US
1
(30xx,1309)
Conceptual Volume
Combination Flag
ConceptualVolumeCombinationFlag
CS
1
(30xx,1310)
Conceptual Volume
Combination Description
ConceptualVolumeCombinationDescripti ST
on
1
(30xx,1311)
Conceptual Volume
Segmentation Defined
Flag
ConceptualVolumeSegmentationDefine
dFlag
CS
1
(30xx,1312)
Conceptual Volume
Segmentation Reference
Sequence
ConceptualVolumeSegmentationRefere
nceSequence
SQ
1
(30xx,1313)
Referenced Conceptual
Volume Constituent Index
ReferencedConceptualVolumeConstitue
ntIndex
US
1
(30xx,1314)
Conceptual Volume
Constituent Segmentation
Reference Sequence
ConceptualVolumeConstituentSegment
ationReferenceSequence
SQ
1
(30xx,1324)
Manufacturer's Model
Version
ManufacturersModelVersion
LO
1
(30xx,1326)
Device Alternate Identifier
DeviceAlternateIdentifier
ST
1
(30xx,1327)
Device Alternate Identifier
Type
DeviceAlternateIdentifierType
CS
1
(30xx,1328)
Device Alternate Identifier
Symbology
DeviceAlternateIdentifierSymbology
LO
1
(30xx,1331)
Segmentation SOP
Instance Reference
Sequence
SegmentationSOPInstanceReferenceSe SQ
quence
1
(30xx,1332)
Segmentation Template
Label
SegmentationTemplateLabel
SH
1
(30xx,1334)
Segmentation Template
UID
SegmentationTemplateUID
UI
1
(30xx,1343)
Direct Segment Reference DirectROIReferenceSequence
Sequence
SQ
1
(30xx,1344)
Combination Segment
Reference Sequence
SQ
1
CombinationSegmentReferenceSequen
ce
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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
AlternateSegmentedPropertyTypeCode
Sequence
SQ
1
(30xx,134F)
Purpose of Alternate
PurposeOfAlternateSegmentedProperty
Segmented Property Type TypeCodeSequence
Code Sequence
SQ
1
(30xx,1350)
Segmentation Instance
Index
US
1
(30xx,1351)
Referenced Segmentation ReferencedSegmentationInstanceIndex
Instance Index
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
DynamicBeamLimitingDevicePositionsS
equence
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
SegmentationInstanceIndex
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Treatment Device
Identifier
TreatmentDeviceIdentifier
SH
1
(30xx,5021)
Cumulative Meterset
CumulativeMeterset
FD
1
(30xx,5023)
Delivery Rate
DeliveryRate
FD
1
(30xx,5024)
Delivery Rate Unit
Sequence
DeliveryRateUnitSequence
SQ
1
(30xx,5025)
Device Label
DeviceLabel
LO
1
(30xx,5026)
Device Type Code
Sequence
DeviceTypeCodeSequence
SQ
1
(30xx,5027)
Device Description
DeviceDescription
ST
1
(30xx,5028)
Treatment Position
Sequence
TreatmentPositionSequence
SQ
1
(30xx,5031)
Regulatory Device
Identifier Sequence
RegulatoryDeviceIdentifierSequence
SQ
1
(30xx,5033)
Regulatory Device
Identifier
RegulatoryDeviceIdentifier
ST
1
(30xx,5035)
Regulatory Device
Identifier Type Code
Sequence
RegulatoryDeviceIdentifierTypeCodeSe
quence
SQ
1
(30xx,5041)
Number of RT Beam
Limiting Devices
NumberOfRTBeamLimitingDevices
SQ
1
(30xx,5042)
RT Beam Limiting Device
Proximal Distance
RTBeamLimitingDeviceProximalDistanc
e
FD
1
(30xx,5043)
RT Beam Limiting Device
Distal Distance
RTBeamLimitingDeviceDistalDistance
FD
1
(30xx,5048)
Number of RT Beam
Delimiter Pairs
NumberOfRTBeamDelimiterPairs
US
1
(30xx,5049)
RT Beam Delimiter
Element Position
Boundaries
RTBeamDelimiterPositionElementBoun
daries
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
RTBeamLimitingDeviceDefinitionSeque
nce
SQ
1
(30xx,504E)
RT Rectangular Beam
Limiting Device Definition
Sequence
RTRectangularBeamLimitingDeviceDefi
nitionSequence
SQ
1
(30xx,5051)
RT Operation State
RTOperationState
CS
1
(30xx,5060)
Patient Setup UID
PatientSetupUID
UI
1
(30xx,5062)
Wedge Definition
Sequence
WedgeDefinitionSequence
SQ
1
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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
RTItemStateCreationAuthorityDescriptio
nSequence
SQ
1
(30xx,5086)
RT Operation State
Sequence
RTOperationStateSequence
SQ
1
(30xx,5088)
RT Operation State
Change Reason Code
Sequence
RTOperationStateChangeReasonCode
Sequence
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
RTOperationStateChangeReasonDescri
ption
ST
1
(30xx,5110)
Radiation Particle
RadiationParticle
CS
1
(30xx,5113)
Radiation Dosimeter Unit
RadiationDosimeterUnit
CS
1
(30xx,5114)
RT Beam Distance
Reference Location
RTBeamDistanceReferenceLocation
CS
1
(30xx,5130)
Radiation Source
Sequence
RadiationSourceSequence
SQ
1
(30xx,5131)
Radiation Source Label
RadiationSourceLabel
LO
1
(30xx,5132)
Radiation Source Distance RadiationSourceDistance
FD
1
(30xx,5133)
Radiation Source Theta
RadiationSourceTheta
FD
1
(30xx,5134)
Radiation Source Phi
RadiationSourcePhi
FD
1
(30xx,5137)
Radiation Source Control
Point Sequence
RadiationSourceControlPointSequence
SQ
1
(30xx,513A)
Referenced Radiation
Source Label
ReferencedRadiationSourceLabel
LO
1
(30xx,513B)
Radiation Source
Collimator Size
RadiationSourceCollimatorSize
FD
1
(30xx,513C)
Radiation Source Pattern
Sequence
RadiationSourcePatternSequence
SQ
1
(30xx,513D)
Radiation Source Pattern
Label
RadiationSourcePatternLabel
LO
1
(30xx,513E)
Referenced Radiation
Source Pattern
ReferencedRadiationSourcePattern
SH
1
(30xx,513F)
Radiation Source Pattern
Source Sequence
RadiationSourcePatternSourceSequenc
e
SQ
1
(30xx,5142)
Patient Support Position
Parameter Sequence
PatientSupportPositionParameterSeque
nce
SQ
1
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Compensator Definition
Sequence
CompensatorDefinitionSequence
SQ
1
(30xx,5151)
Compensator Map
Orientation
CompensatorMapOrientation
CS
1
(30xx,5152)
Compensator Proximal
Thickness Map
CompensatorProximalThicknessMap
OF
1-n
(30xx,5153)
Compensator Distal
Thickness Map
CompensatorDistalThicknessMap
OF
1-n
(30xx,5154)
Compensator Base Plane
Offset
CompensatorBasePlaneOffset
FD
1
(30xx,5160)
Block Definition Sequence BlockDefinitionSequence
SQ
1
(30xx,5161)
Block Edge Data
BlockEdgeData
OF
1-n
(30xx,5162)
Block Orientation
BlockOrientation
CS
1
(30xx,5163)
Block Base Offset
BlockBaseOffset
FD
1
(30xx,5171)
Number of RT Accessory
Holders
NumberOfRTAccessoryHolders
IS
1
(30xx,5180)
General Accessory
Definition Sequence
GeneralAccessoryDefinitionSequence
SQ
1
(30xx,5181)
Number of General
Accessories
NumberOfGeneralAccessories
IS
1
(30xx,5185)
Tray Definition Sequence
TrayDefinitionSequence
SQ
1
(30xx,5190)
Boluses Definition
Sequence
BolusesDefinitionSequence
SQ
1
(30xx,51A0)
Equipment Frame of
Reference UID
EquipmentFrameOfReferenceUID
UI
1
(30xx,51A1)
Equipment Frame of
Reference Description
EquipmentFrameOfReferenceDescriptio
n
ST
1
(30xx,51B3)
Gantry Yaw Continuous
Angle
GantryYawContinuousAngle
FD
1
(30xx,51B4)
RT Beam Limiting Device
Continuous Angle
RTBeamLimitingDeviceContinuousAngl
e
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
106737321: Supplement 147: Second Generation Radiotherapy
Page 189
(30xx,51C8)
Beam Mode Type Code
Sequence
BeamModeTypeCodeSequence
SQ
1
(30xx,51C9)
Energy Unit Code
Sequence
EnergyUnitCodeSequence
SQ
1
(30xx,51CB)
Number of Beam Modes
NumberOfBeamModes
IS
1
(30xx,51E0)
User Content Label
UserContentLabel
SH
1
(30xx,51E2)
RT Entity Label
RTEntityLabel
SH
1
(30xx,51E3)
RT Entity Name
RTEntityName
LO
1
(30xx,51E4)
RT Entity Description
RTEntityDescription
ST
1
(30xx,51E5)
RT Entity Long Label
RTEntityLongLabel
LO
1
(30xx,51F0)
Patient Support Devices
Sequence
PatientSupportDevicesSequence
SQ
1
(30xx,51F1)
Number of Patient Support Number of Patient Support Devices
Devices Sequence
Sequence
IS
1
(30xx,5200)
Outline Shape Type
OutlineShapeType
CS
1
(30xx,5202)
Outline Edges X
OutlineEdgesX
FL
1-2
(30xx,5203)
Outline Edges Y
OutlineEdgesY
FL
1-2
(30xx,5204)
Center of Circular Outline
CenterOfCircularOutline
FL
2
(30xx,5205)
Diameter of Circular
Outline
DiameterOfCircularOutline
FL
1
(30xx,5206)
Number of Polygonal
Vertices
NumberOfPolygonalVertices
UL
1
(30xx,5207)
Vertices of the Polygonal
Outline
VerticesOfThePolygonalOutline
FL
2-2n
(30xx,5208)
Coordinate System
Declaration
CoordinateSystemDeclaration
CS
1
(30xx,5209)
Outline Definition Plane
Distance
OutlineDefinitionPlaneDistance
FL
1
(30xx,5210)
Beam Limiting Device
Definition Distance
BeamLimitingDeviceDefinitionDistance
FL
1
(30xx,6000)
Treatment Session UID
TreatmentSessionUID
UI
1
(30xx,6015)
Treatment Termination
Reason Code Sequence
TreatmentTerminationReasonCodeSeq
uence
SQ
1
(30xx,6016)
Machine-Specific
Treatment Termination
Code Sequence
MachineSpecificTreatmentTerminationC SQ
odeSequence
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
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 190
(30xx,603C)
Treatment Control Point
End DateTime
TreatmentControlPointEndDateTime
DT
1
(30xx,603E)
Alternate Specified Value
Sequence
AlternateSpecifiedValueSequence
SQ
1
(30xx,603F)
Sign-Off Sequence
SignOffSequence
SQ
1
(30xx,6040)
Patient Frame of
Reference to Equipment
Mapping Matrix
PatientFrameOfReferenceToEquipment
MappingMatrix
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 CalculatedRadiationDoseValuesSequen
Values Sequence
ce
SQ
1
(30xx,6114)
Measured Radiation Dose MeasuredRadiationDoseValuesSequenc SQ
Values Sequence
e
1
(0028,xxxx)
Long Pixel Padding Value
UL
or
SL
1
(0028,yyyy)
Long Pixel Padding Range LongPixelPaddingRangeLimit
Limit
UL
or
SL
1
LongPixelPaddingValue
106737321: Supplement 147: Second Generation Radiotherapy
Page 191
Add the following to PS3.6 Annex A:
2
ANNEX A
REGISTRY OF DICOM UNIQUE IDENTIFIERS (UID) (NORMATIVE)
4
Table A-1
UID VALUES
6
UID Value
8
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
Tomotherapeutic Radiation
Record Storage
SOP Class
PS 3.4
1.2.840.10008.5.1.4.1.1.481.XN.6.2
C-Arm Photon Radiation
Record Storage
SOP Class
PS 3.4
1.2.840.10008.5.1.4.1.1.481.XN.6.3
C-Arm Electron Radiation
Record Storage
SOP Class
PS 3.4
1.2.840.10008.5.1.4.1.1.481.XN.6.4
Multiple Fixed Source
Radiation Record Storage
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
106737321: Supplement 147: Second Generation Radiotherapy
Page 192
Add the following data elements to PS3.6, Annex A:
2
Table A-3
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.25
SUP147025
RT Patient Support Devices
1.2.840.10008.6.1.FFF.26
SUP147026
Dose Statistics
1.2.840.10008.6.1.FFF.27
SUP147027
Fixed Beam Limiting Device Types
1.2.840.10008.6.1.FFF.28
SUP147028
Radiotherapy Wedge Types
1.2.840.10008.6.1.FFF.30
SUP147030
General Accessory Device Types
1.2.840.10008.6.1.FFF.31
SUP147031
Radiotherapy Bolus Device Types
1.2.840.10008.6.1.FFF.32
SUP147032
Radiotherapy Block Device Types
1.2.840.10008.6.1.FFF.33
SUP147033
Radiotherapy Accessory No-Slot Holder Device
Types
1.2.840.10008.6.1.FFF.34
SUP147034
Radiotherapy Accessory Slot Holder Device
Types
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2
Page 193
1.2.840.10008.6.1.FFF.35
SUP147035
Effective Dose Method Code Definition
1.2.840.10008.6.1.FFF.36
SUP147036
Purpose of Referenced Dose Calculation
Annotation Object
1.2.840.10008.6.1.FFF.37
SUP147037
Dose Data Source Measurement Definition
1.2.840.10008.6.1.FFF.39
SUP147039
Dose Histogram Spatial Unit Definition
1.2.840.10008.6.1.FFF.40
SUP147040
Segemented Rt Accessory Devices
1.2.840.10008.6.1.FFF.41
SUP147041
Dose Algorithm Class
1.2.840.10008.6.1.FFF.42
SUP147042
Energy Unit
1.2.840.10008.6.1.FFF.43
SUP147043
RT Item States
1.2.840.10008.6.1.FFF.44
SUP147044
RT Operation States
1.2.840.10008.6.1.FFF.45
SUP147045
Multiple Fixed Sources Procedure Techniques
1.2.840.10008.6.1.FFF.46
SUP147046
Robotic Procedure Techniques
1.2.840.10008.6.1.FFF.47
SUP147047
Radiotherapy Procedure Techniques
1.2.840.10008.6.1.FFF.48
SUP147048
Revised value
1.2.840.10008.6.1.FFF.49
SUP147049
Radiotherapy General Workitem Definition
1.2.840.10008.6.1.FFF.50
SUP147050
Beam Mode Type Definition
1.2.840.10008.6.1.FFF.51
SUP147051
Meterset Rate Unit Definition
1.2.840.10008.6.1.FFF.52
SUP147052
Radiation Particle
1.2.840.10008.6.1.FFF.53
SUP147053
Regulatory Device Identifier Type
1.2.840.10008.6.1.FFF.54
SUP147054
Treatment Delivery Device Type
1.2.840.10008.6.1.FFF.55
SUP147055
Dosimeter Unit Definition
1.2.840.10008.6.1.FFF.56
SUP147056
Treatment Session Sign-Off
1.2.840.10008.6.1.FFF.60
SUP147060
Single Dose-related Dosimetric Objectives
1.2.840.10008.6.1.FFF.61
SUP147061
Percentage and Dose-related Dosimetric
Objectives
1.2.840.10008.6.1.FFF.62
SUP147062
Volume and Dose-related Dosimetric Objectives
1.2.840.10008.6.1.FFF.63
SUP147063
Dimensionless and Dose-related Dosimetric
Objectives
1.2.840.10008.6.1.FFF.64
SUP147064
Coded Dosimetric Objectives
1.2.840.10008.6.1.FFF.65
SUP147065
Radiotherapy Dose Real World Units
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 194
Part 16 Addendum
Add the following workitem codes to CID 9231 of PS3.16, Annex B:
4
CID 9231
GENERAL PURPOSE WORKITEM DEFINITION
6
Context ID 9231
General Purpose Workitem Definition
8
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
110014
Registration
99SUP147
110015
Segmentation
106737321: Supplement 147: Second Generation Radiotherapy
Page 195
Add the following new CIDs to PS3.16, Annex B:
2
CID SUP147001 DOSIMETRIC OBJECTIVE VALUE TYPES
4
Context ID SUP147001
Dose Objective Value Types
6
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
8
CID SUP147002 PRESCRIPTION ANATOMY CATEGORIES
Context ID SUP147002
10
Prescription Anatomy Categories
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
14
Context ID SUP147003
Radiotherapy Segment Categories
16
Type: Extensible Version: yyyymmdd
106737321: Supplement 147: Second Generation Radiotherapy
Page 196
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
INCLUDE CID SUP147002 Prescription Anatomy Categories
2
99SUP147
S147053
RT Geometrical Information
99SUP147
S147054
Fixation or Positioning Device
99SUP147
S147055
Internal Brachytherapy Device
CID SUP147004 RADIOTHERAPY TARGETS
Context ID SUP147004
4
Radiotherapy Targets
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
8
Context ID SUP147005
RT Geometric Information
10
Type: Extensible Version: yyyymmdd
106737321: Supplement 147: Second Generation Radiotherapy
Page 197
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
2
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
Context ID SUP147006
4
Fixation or Positioning Devices
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
Include CID SUP147022 Fixation Device Type Identifiers
Include CID SUP147025 RT Patient Support Devices
6
CID SUP147007 BRACHYTHERAPY DEVICES
8
Context ID SUP147007
Brachytherapy Devices
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147130
Brachytherapy accessory device
99SUP147
S147131
Brachytherapy source applicator
99SUP147
S147132
Brachytherapy channel shield
106737321: Supplement 147: Second Generation Radiotherapy
Page 198
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
2
S147133
Brachytherapy channel
CID SUP147009 SEGMENTATION COMBINATION
Context ID SUP147009
4
Segmentation Combination
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147145
Combination
6
CID SUP147010 BEAM LIMITING DEVICE TYPES
8
Context ID SUP147010
Beam Limiting Device Types
10
Type: Non-Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
12
CID SUP147011 RADIOTHERAPY ROBOTIC PATHS
Context ID SUP147011
14
Radiotherapy Robotic Paths
Type: Extensible Version: yyyymmdd
106737321: Supplement 147: Second Generation Radiotherapy
Page 199
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
2
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
Context ID SUP147012
4
General External Radiotherapy Procedure Techniques
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
8
Context ID SUP147013
Tomotherapeutic Radiotherapy Procedure Techniques
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147240
Helical Beam
106737321: Supplement 147: Second Generation Radiotherapy
Page 200
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
2
S147241
Topographic Beam
CID SUP147014 TREATMENT RT RADIATION SET ALTERATION TYPES
Context ID SUP147014
4
Treatment RT Radiation Set Alteration Types
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
8
Context ID SUP147015
Treatment Termination Reasons
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147260
Patient Morbidity
99SUP147
S147261
Patient Mortality
99SUP147
S147262
General Machine Interlock
99SUP147
S147263
Patient Support Interlock
99SUP147
S147264
Patient Choice
106737321: Supplement 147: Second Generation Radiotherapy
Page 201
CID SUP147016 COMPENSATOR DEVICE TYPES
2
Context ID SUP147016
Compensator Device Types
4
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
6
S147270
Standard Compensator
CID SUP147017 RADIOTHERAPY TREATMENT MACHINE MODES
Context ID SUP147017
8
Radiotherapy Treatment Machine Modes
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147281
Total Body Irradiation
99SUP147
S147282
Total Skin Electron
10
CID SUP147018 PRE-TREATMENT RT RADIATION SET PURPOSE
12
Context ID SUP147018
Pre-Treatment RT Radiation Set Roles
14
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
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CID SUP147020 INSTANCE REFERENCE PURPOSES
2
Context ID SUP147020
Instance Reference Purposes
4
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(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
(0008,0102)
6
CID SUP147021 PATIENT SETUP TECHNIQUES
Context ID SUP147021
8
Patient Setup Techniques
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147330
Isocentric
99SUP147
S147331
Fixed SSD
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S147332
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Fixed Midline Distance
CID SUP147022 FIXATION DEVICE TYPES
Context ID SUP147022
4
Fixation Device Types
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
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
8
Context ID SUP147023
Shielding Device Types
10
12
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147380
Gum Shielding
99SUP147
S147381
Eye Shielding
99SUP147
S147382
Gonad Shielding
CID SUP147024 SETUP DEVICES
Context ID SUP147024
14
Setup Devices
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Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
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
4
Context ID SUP 147025
RT Patient Support Devices
6
8
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
SRT
A-17350
Table
99SUP147
S147411
Chair
CID SUP147026 DOSE STATISTICS
Context ID SUP 147026
10
Dose Statistics
Type: Extensible Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
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
14
Context ID SUP147027
Fixed Beam Limiting Device Types
16
Type: Extensible Version: yyyymmdd
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Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
2
99SUP147
S147431
Electron Fixed Aperture
99SUP147
S147432
Photon Fixed Aperture
99SUP147
S147433
Intraoperative Aperture
99SUP147
S147470
Shielding Block
99SUP147
S147471
Aperture Block
CID SUP147028 RADIOTHERAPY WEDGE TYPES
Context ID SUP147028
4
Radiotherapy Wedge Types
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147440
Hard Wedge
99SUP147
S147441
Motorized Wedge
99SUP147
S147442
Dynamic Wedge
6
CID SUP147030 GENERAL ACCESSORY DEVICE TYPES
8
Context ID SUP147030
General Accessory Device Types
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147451
Graticule
99SUP147
S147452
Reticle
99SUP147
S147453
Image Detector
99SUP147
S147454
Film Holder
99SUP147
S147455
Winston-Lutz Pointer
99SUP147
S147456
Bowtie Filter
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CID SUP147031 RADIOTHERAPY BOLUS DEVICE TYPES
2
Context ID SUP147031
Radiotherapy Bolus Device Types
4
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
6
S147460
Bolus
CID SUP147032 RADIOTHERAPY BLOCK DEVICE TYPES
Context ID SUP147032
8
Radiotherapy Block Device Types
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147470
Shielding Block
99SUP147
S147471
Aperture Block
10
CID SUP147033 RADIOTHERAPY ACCESSORY NO-SLOT HOLDER DEVICE TYPES
12
Context ID SUP147033
Radiotherapy Accessory No-Slot Holder Device Types
14
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
16
S147480
Tray
CID SUP147034 RADIOTHERAPY ACCESSORY SLOT HOLDER DEVICE TYPES
Context ID SUP147034
18
Radiotherapy Accessory Slot Holder Device Types
Type: Extensible Version: yyyymmdd
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Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147481
Applicator
2
CID SUP147035 EFFECTIVE DOSE METHOD CODE DEFINITION
4
Context ID SUP147035
Effective Dose Method Definition
6
8
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147580
LET-based method.
99SUP147
S147581
Fractionation-based or temporally-based method
CID SUP147036 PURPOSE OF REFERENCED DOSE CALCULATION ANNOTATION OBJECT
Context ID SUP147036
10
Purpose of Referenced Dose Calculation Annotation Object
Type: Extensible
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147750
Version: yyyymmdd
Code Meaning
(0008,0104)
Annotating Documents for the Calculated Dose
12
CID SUP147037 DOSE DATA SOURCE MEASUREMENT DEFINITION
14
Context ID SUP147037
Dose Data Source Measurement Definition
16
Type: Extensible
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147530
Film
99SUP147
S147531
3D Gel
Version: yyyymmdd
Code Meaning
(0008,0104)
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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
Context ID SUP147039
4
Dose Histogram Spatial Unit Definition
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
UCUM
cm2
Square centimeter
UCUM
cm3
Cubic centimeter
99SUP147
S147600
UCUM
%
Cubic centimeter PER_U {cm3_PER_U}
Percent
6
8
10
Note: The unit PER_U is defined in: Anderson, LL: “A “natural” volume-dose histogram for
brachytherapy”, Medical Physics 13(6) pp 898-903, 1986.
CID SUP147040 SEGMENTED RT ACCESSORY DEVICES
Context ID SUP147040
12
Segmented RT Accessory Devices
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
Include CID SUP147022 Fixation Device Types
Include CID SUP147007 Brachytherapy Devices
Include CID SUP147025 RT Patient Support Devices
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Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
Include CID SUP147031 Radiotherapy Bolus Device Types
Include CID SUP147032 Radiotherapy Block Device Types
Include CID SUP147033 Radiotherapy Accessory No-Slot Holder Device Types
Include CID SUP147034 Radiotherapy Accessory Slot Holder Device Types
2
CID SUP147041 DOSE ALGORITHM CLASS
Context ID SUP147041
4
Dose algorithm class
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
6
CID SUP147042 ENERGY UNIT
8
Context ID SUP147042
Energy Unit
10
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
UCUM
MV
Mega-volt
UCUM
MeV
Mega-electronvolt
UCUM
kV
Kilo-volt
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CID SUP147043 RT ITEM STATES
Context ID SUP147043
4
RT Item States
Type: Non-Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147650
Created
99SUP147
S147651
Reviewed
99SUP147
S147652
Approved
99SUP147
S147653
Rejected
99SUP147
S147654
Demoted
6
CID SUP147044 RT OPERATION STATES
8
Context ID SUP147044
RT Operation States
10
Type: Non-Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
12
99SUP147
S147680
New
99SUP147
S147681
In Preparation
99SUP147
S147682
Ready
99SUP147
S147683
In Progress
99SUP147
S147685
Suspended
99SUP147
S147686
Discontinued
99SUP147
S147687
Completed
CID SUP147045 MULTI-SOURCE RADIATION TECHNIQUE
Context ID SUP147045
14
Multi-Source Radiation Technique
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Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
99SUP147
S147900
Multiple Fixed Sources
2
CID SUP147046 ROBOTIC RADIATION TECHNIQUE
4
Context ID SUP147046
Robotic Radiation Technique
6
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
8
99SUP147
S147910
Synchrony
99SUP147
S147911
Non-Synchrony
CID SUP147047 RADIOTHERAPY PROCEDURE TECHNIQUES
Context ID SUP147047
10
Radiotherapy Procedure Techniques
Type: Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
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
12
CID SUP147048 REVISED VALUE
14
Context ID SUP147048
Revised value
16
Type: Non-Extensible
Version: yyyymmdd
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Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147710
Page 212
Code Meaning
(0008,0104)
Revised Value
CID SUP147049 RADIOTHERAPY GENERAL WORKITEM DEFINITION
Context ID SUP147049
4
Radiotherapy General Workitem Definition
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
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
6
CID SUP147050
BEAM MODE TYPE DEFINITION
8
Context ID SUP147050
Beam Mode Type Definition
10
12
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147560
Flattening Filter Beam
99SUP147
S147561
No Flattening Filter Beam
99SUP147
S147562
Partial Flattening Filter Beam
CID SUP147051
Code Meaning
(0008,0104)
DELIVERY RATE UNIT DEFINITION
Context ID SUP147051
14
Delivery Rate Unit Definition
Type: Non-Extensible
Version: yyyymmdd
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Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
UCUM
Gy/s
Gray / Second
99SUP147
S147571
MU / Second
99SUP147
S147572
Particles / Second
UCUM
[arb'U]
CID SUP147052
Code Meaning
(0008,0104)
arbitrary unit
RADIATION PARTICLE
Context ID SUP147052
4
Radiation Particle
Type: Non-Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147950
Photon
99SUP147
S147951
Electron
99SUP147
S147952
Proton
99SUP147
S147953
Carbon nucleus
99SUP147
S147954
Neutron
6
CID SUP147053
REGULATORY DEVICE IDENTIFIER TYPE
8
Context ID SUP147053
Regulatory Device Identifier Type
10
12
Type: Extensible
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147590
CID SUP147054
Version: yyyymmdd
Code Meaning
(0008,0104)
FDA Unique Device Identifier (UDI)
TREATMENT DELIVERY DEVICE TYPE
Context ID SUP147054
14
Treatment Delivery Device Type
Type: Extensible
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Version: yyyymmdd
Code Meaning
(0008,0104)
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2
CID SUP147055
S147890
Page 214
Radiotherapy Treatment Device
DOSIMETER UNIT DEFINITION
Context ID SUP147055
4
Dosimeter Unit Definition
Type: Non-Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
MU
Monitor Units
99SUP147
NP
Number of Particles
UCUM
s
UCUM
Bq.s
UCUM
[arb'U]
Second
Bequerel Second
arbitrary unit
6
CID SUP147056
TREATMENT SESSION SIGN-OFF
8
Context ID SUP147056
Treatment Session Sign-Off
10
12
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147770
Presence of Bolus
99SUP147
S147771
Presence of Cones
CID SUP147060
Code Meaning
(0008,0104)
SINGLE DOSE-RELATED DOSIMETRIC OBJECTIVES
Context ID SUP147060
14
Single Dose-related Dosimetric Objectives
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147001
Minimum Surface Dose
99SUP147
S147002
Maximum Surface Dose
99SUP147
S147003
Minimum Dose
99SUP147
S147004
Maximum Dose
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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
Context ID SUP147061
4
Percentage and Dose-related Dosimetric Objectives
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147014
Minimum Percent Volume at Dose
99SUP147
S147015
Maximum Percent Volume at Dose
6
CID SUP147062
VOLUME AND DOSE-RELATED DOSIMETRIC OBJECTIVES
8
Context ID SUP147062
Volume and Dose-related Dosimetric Objectives
10
12
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147016
Minimum Absolute Volume at Dose
99SUP147
S147017
Maximum Absolute Volume at Dose
CID SUP147063
Code Meaning
(0008,0104)
DIMENSIONLESS AND DOSE-RELATED DOSIMETRIC OBJECTIVES
Context ID SUP147063
14
Dimensionless and Dose-related Dosimetric Objectives
Type: Extensible
Version: yyyymmdd
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
Code Meaning
(0008,0104)
99SUP147
S147010
Minimum Conformity Index (see Note 1)
99SUP147
S147011
Minimum Healthy Tissue Conformity Index (see Note
1)
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99SUP147
S147012
Minimum Conformation Number (see Note 1)
99SUP147
S147013
Maximum Homogeneity Index (see Note 1)
Note 1: These following dosimetric indices are defined by reference to Feuvret et al, (IJROBP
64(2):333-342, 2006):
Dosimeter Index
Description in Feuvret et al, page 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
4
CID SUP147064
CODED DOSIMETRIC OBJECTIVES
6
Context ID SUP147064
Coded Dosimetric Objectives
8
10
Type: Non-Extensible
Coding Scheme
Designator
(0008,0102)
Code Value
(0008,0100)
99SUP147
S147018
Version: yyyymmdd
Code Meaning
(0008,0104)
Minimize MeterSet
CID SUP147065 RADIOTHERAPY DOSE REAL WORLD UNITS
Context ID SUP147065
12
Radiotherapy Dose Real World Units
Type: Non-Extensible Version: yyyymmdd
Coding Scheme
Code Value
Code Meaning
Designator
(0008,0100)
(0008,0104)
(0008,0102)
UCUM
14
Gy
Gray
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Rename the following definitions of existing CIDs of PS3.16, Annex B:
CID 9241 RADIOTHERAPY GENERAL Radiotherapy Treatment Workitem Definition
4
Context ID 9241
Radiotherapy General Treatment Workitem Definition
6
Correct cases of the following definitions of existing CIDs of PS3.16, Annex B:
8
CID 9242 RADIOTHERAPY ACQUISITION Radiotherapy Acquisition Workitem Definition
CID 9243 RADIOTHERAPY REGISTRATION Radiotherapy Registration Workitem Definition
10
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Add the following workitem codes to CID 9231 of PS3.16, Annex C:
ANNEX C
4
Page 218
ACQUISITION AND PROTOCOL CONTEXT TEMPLATES (NORMATIVE)
TID SUP147001 RT PRESCRIPTION ANNOTATION
TID SUP147001
RT Prescription Annotation
Type: Extensible
Order: Non-Significant
6
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
106737321: Supplement 147: Second Generation Radiotherapy
2
Page 219
106737321: Supplement 147: Second Generation Radiotherapy
Page 220
Add the following templates to PS3.16, Annex A:
2
TID SUP147003 RT SEGMENT ANNOTATION PROPERTIES
4
TID SUP147003
RT Segment Annotation Properties
Type: Extensible
Order: Non-Significant
6
NL
Value Type
Concept Name
VM
Req
Typ
e
Condition
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")
1
U
Units = EV
(ratio, UCUM,
"ratio")
5
NUMERIC
EV (S147154,
99SUP147, "Relative
Stop Ratio")
1
U
Units = EV
(ratio, UCUM,
"ratio")
6
NUMERIC
EV (S147156,
99SUP147, "Linear
Cell Kill Factor")
1
U
Units = EV
(ratio, UCUM,
"ratio")
7
NUMERIC
EV (S147157,
99SUP147, "Quadratic
Cell Kill Factor")
1
U
Units = EV
(ratio, UCUM,
"ratio")
8
NUMERIC
EV (S147158,
99SUP147, "High
Dose Fraction Linear
Cell Kill Factor")
1
U
Units = EV
(ratio, UCUM,
"ratio")
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
10
12
Value Set
Constraint
TID SUP147004
Patient Support Position Parameters
Type: Extensible
Order: Non-Significant
106737321: Supplement 147: Second Generation Radiotherapy
Value Type
2
Concept Name
VM
Req
Typ
e
Page 221
Condition
Value Set
Constraint
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 ")
1
U
Units = EV
(deg, UCUM,
"º")
3
NUMERIC
EV (S147302,
99SUP147, "IEC
Patient Support
Continuous Angle ")
1
U
Units = EV
(deg, UCUM,
"º")
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 ")
1
U
Units = EV
(deg, UCUM,
"º")
6
NUMERIC
EV (S147305,
99SUP147, "IEC Table
Top Lateral Position ")
1
U
Units = EV
(mm, UCUM,
"mm")
7
NUMERIC
EV (S147306,
99SUP147, "IEC Table
Top Longitudinal
Position ")
1
U
Units = EV
(mm, UCUM,
"mm")
8
NUMERIC
EV (S147307,
99SUP147, "IEC Table
Top Vertical Position ")
1
U
Units = EV
(mm, UCUM,
"mm")
106737321: Supplement 147: Second Generation Radiotherapy
2
Add the following to the table in PS3.16, Annex D:
4
ANNEX D
Code Value
Page 222
DICOM CONTROLLED TERMINOLOGY DEFINITIONS (NORMATIVE)
Code Meaning
Definition
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 223
Definition
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 The objective is a minimum Healthy Tissue
Conformity Index
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 The objective is a desired or constrained
at Dose
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 224
Definition
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.
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 225
Definition
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.
Notes
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Code Value
Code Meaning
Page 226
Definition
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 Accessory device used in brachytherapy
device
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.
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 227
Definition
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 High Dose Fraction Linear Cell Kill Factor
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.
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.
Any value of the atomic number shall only
appear once in the sequence.
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 228
Definition
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 229
Definition
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
S147281
Total Body Irradiation
Total-body irradiation treatment mode
S147282
Total Skin Electron
Total Skin Electron treatment mode
S147290
Dosimetric
The radiation set is used to calculate dose
delivered to the patient.
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 230
Definition
S147303
IEC Table Top Eccentric
Axis Distance
Table Top Eccentric Axis Distance
S147304
IEC Table Top
Continuous Eccentric
Angle
Table Top Continuous Eccentric Angle in
the direction of the IEC TABLE TOP
ECCENTRIC Coordinate System
S147305
IEC Table Top Vertical
Position
Table Top Vertical Position in IEC TABLE
TOP Coordinate System
S147306
IEC Table Top Lateral
Position
Table Top Lateral Position
S147307
IEC Table Top
Longitudinal Position
Table Top Longitudinal Position
S147330
Isocentric
Delivery device isocenter remains at a
fixed point in the patient for the all
radiations using this patient setup.
S147331
Fixed SSD
Delivery device isocenter moves if
necessary to maintain a constant distance
between the virtual radiation source and
the location of the beam’s first intersection
with the patient for the all radiations using
this patient setup.
S147332
Fixed Midline Distance
Delivery device isocenter moves if
necessary to maintain a constant distance
between the virtual radiation source and
the location of the central axis of the
beam’s first intersection with the patient for
the all radiations using this patient setup.
S147340
Biteblock
A device attached to the table top that is
also placed in the patient's mouth to
position and orient the head in a
prescribed geometry.
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.
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 231
Definition
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Page 232
Code Meaning
Definition
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
Reticle
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
Notes
106737321: Supplement 147: Second Generation Radiotherapy
Code Value
Code Meaning
Page 233
Definition
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.
Notes
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Code Value
Code Meaning
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Definition
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 filter to produce a nearly
uniform intensity profile.
S147561
No Flattening Filter Beam Beam that does not use a filter to produce
a nearly uniform intensity profile.
S147562
Partial Flattening Filter
Beam
Beam that uses a filter to produce a nearly
uniform region across part of the intensity
profile.
S147571
MU / Seconds
Unit for a dose rate, measured as the
number of Monitor Units per second
S147572
Particles / Seconds
Unit for a dose rate, measured as the
number of particles per second.
Notes
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Code Value
S147580
Code Meaning
LET-based
Page 235
Definition
An Linear Energy-Transfer (LET) -based
method has been used to incorporate the
Relative Biological Effectiveness based on
the quality of the radiation used
[Wambersie A, RBE, reference RBE and
clinical RBE: Applications of these
concepts in hadron therapy,
Strahlentherapie und Onkologie 1999
June, 175(2): 39-43]
[Paganetti H, et al., Relative biological
effectiveness (RBE) values for proton
beam therapy, Int J Rad. Onc Biol Phys,
2002 June; 53(2): 407-421]
S147581
Fractionation-based
A Fractionation-based or temporally-based
method has been used to assess the
Biologically Effective Dose.
[Fowler JF, Br J Radiol. 2010 July;
83(991): 554–568]
S147590
FDA unique device
identifier (UDI)
The unique device identifier(UDI) is
created and maintained by device labelers
based on global device identification
standards managed by FDA-accredited
Issuing Agencies.
S147600
Cubic centimeter PER_U Cubic centimeter PER_U {cm3_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
The item has been created.
S147651
Reviewed
The item has been reviewed. No
conclusion has been reached.
S147652
Approved
The item has been concluded to meet an
implied criterion.
S147653
Rejected
The item has been concluded to fail an
implied criterion.
S147654
Demoted
The item has had a previous conclusion
retracted.
S147680
New
Preparation of this SOP Instance has not
yet started.
S147681
In Preparation
SOP Instance is in preparation.
S147682
Ready
SOP Instance has been prepared, but not
yet used for treatment.
S147683
In Progress
SOP Instance is currently being used in
the treatment process.
S147685
Suspended
SOP Instance has been used in the
treatment process, but is not currently in
use.
Notes
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Code Value
Code Meaning
Page 236
Definition
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
S147750
Annotating Documents for Documents, which annotate clinical and
the Calculated Dose
physics rationale of the approach chosen
to calculate the dose (e.g. choice of
algorithms, dose composition approaches
etc.).
S147770
Presence of Bolus
The operator performing a radiotherapy
treatment session confirmed that the
boluses required have present during
treatment.
S147771
Presence of Cone
The operator performing a radiotherapy
treatment session confirmed that a cone
was present during treatment.
S147820
Treatment Session
Record of Delivered
Radiation
A record of a treatment session previously
delivered
S147821
Historical Prescription
A prescription given prior to the application
of the current prescription
S147822
Current Prescription
The prescription currently in use
S147823
Volumetric Dose for
Radiation Set
A Volumetric dose calculated for a
Radiation Set
Notes
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Code Value
Page 237
Code Meaning
Definition
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 Segmentation Properties on segmented
used in Planning
SOP instances, which have been used in
the treatment planning process
S147829
Segmentation Properties Segmentation Properties on segmented
created during Treatment SOP instances, which have been created
Session
in the execution of a treatment session.
S147830
Image used for Treatment Images, which have been used in the
Planning
treatment planning process.
S147832
Image Acquired during
Treatment
S147833
Image used as Reference Images, which are used in a treatment
Image for Treatment
session as reference images to position
the patient.
S147834
Registration used in
Planning
S147835
Registration created
Registrations, which have been created in
during Treatment Session the execution of a treatment session
S147890
Radiotherapy Treatment
Device
A device delivering radiotherapy
treatments.
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
MU
Monitor Units
A measure of machine output of a
radiotherapy treatment devices. The
devices are calibrated to give a particular
absorbed dose under particular conditions,
although the definition and measurement
configuration will vary between centres.
NP
Number of Particles
A measure of machine output of a
radiotherapy treatment devices along the
number of particles, used by some Ion
Therapy devices.
Images, which have been acquired during
a treatment session.
Registrations, which have been used in the
treatment planning process
Notes
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106737321: Supplement 147: Second Generation Radiotherapy
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Page 239
Part 17 Addendum
Add the following to PS3.17:
4
Annex Z
Second Generation RT (Informative)
6
ZZ.1
8
This annex provides additional explanations and sample use cases for the 2nd Generation RT IODs. It
is not intended as an exhaustive list of procedure step types that could be undertaken with these
objects.
10
INTRODUCTION
The main clinical purposes of the relationships amongst the important IODs are show in the following
diagram:
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Page 240
Radiotherapeutic Treatment Course
RT Course IOD
Treats Target and
Spares Healthy Tissue
Patient Diagnosis and
Volumetric Model
RT Segmentation
Properties IOD
Annotates
3D Objects
Structure Set IOD
Therapeutic Dose Delivery
Definition
or
Realizes
Segmentation IOD
or
Surface IOD
RT Radiation Set
IOD
Sets Constraints for
Defines Tx Fraction by
C-Arm Photon
Radiation IOD
Oncologist Prescription for
Radiotherapy Treatment
uses
RT Physician
Intent IOD
Shows DVH for
Therapeutic Dose Delivery
Definition
… others modalities
RT Patient
Setup IOD
Records treatment of
Therapeutic Fraction
Delivered
Dose Objects
RT Dose
Histogram IOD
Is calculated
Dose for
2
RT Dose
Image IOD
RT Dose
Samples IOD
Is calculated
Dose of
C-Arm Photon
Radiation Record IOD
… other modalities
106737321: Supplement 147: Second Generation Radiotherapy
Figure ZZ.1-1
Relationship between important IODs
2
4
Page 241
The fundamental relationships between the entities are shown in the following diagram:
RT Course IOD
RT Prescription
Reference
RT Treatment
Phase
RT Radiation Set
References
Former
Treatments
Conceptual Volume
RT Physician Intent IOD
RT Radiation Set IOD
RT Physician
Intent
Radiation References
RT Dose Contribution
RT Prescription
Conceptual Volume
Conceptual Volume
<RT Radiation> IOD
Control Points
RT Segmentation Properties IOD
Source IOD Reference
Conceptual Volume
RT Dose Image IOD &
RT Dose Samples IOD
RT Dose Histogram IOD
Segment References
Radiation Set
References
RT Segmentation
Properties
Radiation References
Reference by RT Course
Volume
Segment
Surface
Segment
Volume
Segment
Key Direct Reference
Other Direct Reference
Segmentation IOD Surface Segmentation IOD RT Structure Set IOD
UID Reference
6
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2
Figure ZZ.1-2
Fundamental Entity Relationships
4
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.
106737321: Supplement 147: Second Generation Radiotherapy
ZZ.2
2
6
8
10
ENTITY DESCRIPTIONS
The following entities are modeled:
ZZ.2.1
4
Page 243
RT Course
A top-level entity that describes a given treatment course. All relevant objects are referenced,
including acquisition images, registrations, segmentations, physician intent, beam sets, reference and
verification imaging, and output records. In particular, all information relating to the current approval
state of treatment, treatment phases, and changes due to adaptation of the therapy are described in
this IOD. It describes the overall intended delivery scheme, including fractionation. This consists of
one or more phases of treatment (e.g. ‘normal’ and ‘boost’). Each phase is achieved by referencing
one or more RT Radiation Set instances (multiple sets are required if adaptive therapy is used to
achieve the dosimetric objectives of the phase).
12
14
16
18
20
22
24
RT Course also contains phase-specific fractionation schemes that describe how the
beams/catheters are combined to achieve the phase prescription. Note that multiple independent
treatment sites will generally be represented by the same conceptual ‘course’ (i.e. chain of RT Course
instances) when treated within the same treatment time frame, otherwise they should be represented
by different courses. Phases are also modeled within the RT Course. The treatment session
summary IODs in the first generation of RT IODs are also effectively replaced by RT Course.
The DICOM Standard does not specify how a given radiotherapy course is mapped onto the DICOM
IE level hierarchy.To avoid a proliferation of series within a Study, one reasonable approach is to map
a course of treatment to a DICOM Study, such that a Study contains all data created by radiotherapy
systems for the purpose of addressing a particular course of treatment, however such a mapping is
not mandated.
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RT Radiation
Record SOP
Instance
RT Radiation Set
SOP Instance
Page 244
RT Segmentation
Properties SOP
Instance
Note: Common Modules found in RT Second Generation
IOD Modules Macro are not shown here.
RT Course IOD
RT Radiation Set Reference Module (See also Figure ZZ.2.1-2)
Meta RT Radiation Set Sequence
Treatment RT Rad Set Reference
Trtmnt RT Rad. Set Rel. Seq.
Seq
Treatment RT Rad. Set
Referenced RT Radiation
Alteration Type Seq.
Record Sequence
RT Course Module
RT Course
State
Sequence
Delivered Radiation
Dose Seq
Conceptual
Volume Seq
See Diagram B in
Phys. Intent IOD
Current Course
Predecessor
Sequence
RT Treatment
Phase Module
Treatment Phase
Sequence
RT Treatment Phase
State Sequence
Prior
Treatment
Sequence
Prior RT
Course Seq
Predecessors (Former
Versions of this RT
Course)
RT Course
SOP Instance
PreTreatment RT
Rad. Set
Reference
Seq
Physician Intent Prescription Seq.
Treatment Phase
Reference Seq
(Matches
prescription to
Treatment Phase)
Referenced
Physician
Intent Seq
Treatment Phase
Interval Sequence
4
RT Course
Associated Instance
Reference Module
(Contains:
References to other
relevant IOD
instances)
Referenced
RT Segment
Annotations
Seq
RT Physician
Intent SOP
Instance
RT Physician
Intent SOP
Instance
RT Segmentation
Properties SOP
Instance
Prescription Instance
Figure ZZ.2.1-1
RT Course IOD
The following diagram shows the referencing indeces used within the RT Course referenceing RT
Prescriptions, RT Treatment Phases and RT Radiation Sets.
RT Radiation Set Reference Module
RT Prescription Reference Module
Referenced Prescription Index
Referenced Physician Intent Sequence
Entry
Referenced Treatment Phase Index
Referenced Treatment Phase Index
RT Treatment Phase Module
Treatment Phase Index
6
Phys.
Intent
Presc.
Status
Seq.
Meta RT Radiation
Set Relationship
Sequence
Reference to
Prescription
Index(es) Inside
Physicain Intent
Treatment Phase Index
2
Pre-Treat. RT
Radiation Set
Role Code
Seq.
RT Prescription
Reference Module
Previous radiation
delivered to this patient
RT Course
SOP
Instance
Conceptual
Volume
State
Sequence
Referenced
RT Segment
Anno Seq.
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Figure ZZ.2.1-2
Relationships in RT Course IOD using Indexes
2
4
ZZ.2.2
6
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 here.
Items in the RT Physician Intent can include
8

use of external therapy or brachytherapy,

total and fractional dose,

fractionation scheme,

treatment sites,

treatment target volume names,

constructive solid geometry of targets and critical structures,

field/MLC margins to be used (in case of 3D Conformal RT),

dosimetric objectives (dose constraints for targets, organs at risk and normal tissue),

beam energy,

use of dose optimization and IMRT,

use of motion management (e.g. gated treatment, tracking etc.),

patient setup to be used including immobilization,

image set(s) used for treatment planning,

type of image-guided patient setup/treatment delivery (e.g. daily 3D CT, radiographic,
fluoroscopic, ultrasound, etc.).

There is also a location where the physician can enter details of dose from previous treatments.
10
12
14
16
18
20
22
24
RT Physician Intent
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Page 246
RT Physician Intent IOD
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)
Physician Intent
Predecessor Sequence
RT Physician Intent Sequence
RT Protocol
Code
Sequence
RT Diagnosis
Code
Sequence
RT Diagnostic
Image Set
Sequence
RT Treatment Phase Intent Module
Treatment Phase Sequence
Treatment Phase Interval
Sequence
Treatment Phase
Index
RT Dose Image
SOP Instance
RT Prescription Module
OR
RT Dose SOP
Instance
(Contains: Rx Info, Delivery Info)
RT Prescription Sequence
Referenced RT
Physician Intent Index
Treatment Phase
Reference Sequence
Referenced
Treatment Phase
Index
Prior Dose Reference
Sequence
Parent RT Prescription Index
Fraction Pattern
Sequence
Referenced
Dosimetric Objectives
Sequence
Prescription
Annotation Sequence
Radiotherapy
Procedure Technique
Sequence
Planning Input
Information Sequence
Fractionation
Relationship Sequence
RT Anatomic Prescription Sequence
Anatomy
Category Code
Sequence
Anatomy
Property Type
Code Sequence
Alternate
Segmented
Property Type
Code Sequence
Purpose of Alt.
Segmented
Prop. Type
Code Seq.
See Figure ZZ.2.2-2
Conceptual Volume Sequence
Dosimetric Objective
Sequence
Dosimetric Objective
Parameter Sequence
Dosimetric Objective
Value Type Code
Sequence
Originating SOP
Instance Reference
Seq.
Reference to the RT
Physician Intent SOP
instance
RT Physician
Intent SOP
Instance
Image SOP
Instance
2
4
Note: Common Modules found
in RT Second Generation IOD
Modules Macro are not shown
here.
Figure ZZ.2.2-1
Physician Intent IOD
Instances which are
intended to be used for
the planning process
Various
SOP
Instances
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Conceptual Volume
Conceptual Volumes UID
RT SOP
Instance
Originating SOP Instance
Reference Sequence
Conceptual Volume
Segmentation Reference
Sequence
Reference to the SOP
Instance that contains
the original definition of
each Conceptual Volume
RT SOP
Instance
Referenced RT
Segment
Annotations
Sequence
Equivalent Conceptual
Volume Instance
Reference Sequence
Reference to the SOP
Instance that contains An
equivalent Conceptual
Volume
RT SOP
Instance
Conceptual Volume
Constituent Sequence
Conceptual Volume Constituent
Segmentation Reference
Sequence
Originating SOP
Instance Reference
Sequence
Referenced RT
Segment
Annotations
Sequence
Reference to the SOP
Instance that contains
the original definition of
each Conceptual Volume
References the index of the
originating SOP Instance
Reference Sequence
2
4
Figure ZZ.2.2-2
Concepatual Volumes
RT Segment
Annotation
IOD
Reference to the SOP
Instance that contains a
segmentation for the
conceptual volume
RT Segment
Annotation
IOD
Reference to the SOP
Instance that contains A
segmentation for the
consituent
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ZZ.2.3
2
Page 248
RT Segment Annotation
Describes the clinical segmentation types (e.g. clinical target volume, organ at risk, bolus), density
overrides, and other RT-specific ROI properties.
Note: Common Modules found
in RT Second Generation IOD
Modules Macro are not shown
here.
RT Segment Annotation IOD
RT Segment Annotation Module
Segment Sequence
Segmented
Property
Category Code
Sequence
Segmented RT
Accessory
Device
Sequence
Segmented
Property
Type Code
Sequence
Segment
Properties
Sequence
Alternate
Segmented
Property Type
Code Seq.
Purpose of
Alternate
Segmented
Property Type
Code Seq.
Segment
Properties
Modifier
Sequence
Direct Segment
Reference
Sequence
See Diagram B of
RT Physician’s Intent
– Specifically the
Originating SOP
Instance Sequence
and the Equivalent
Conceptual Volumes
Sequence
Combination Segment
Reference Sequence
See Diagram B of RT
Physician’s Intent
Segmentation SOP Instance Reference Sequence
RT SOP
Instance
Reference to the SOP
Instance that is
augmented by this RT
Segment Annotation
instance
4
6
Figure ZZ.2.3-1
RT Segment annotation IOD
8
ZZ.2.4
10
12
14
RT Radiation Set
Describes a set of beams and/or catheters being used within a treatment session to help achieve the
dosimetric requirements of a given phase. References a set of <RT Radiation> SOP Instances. A
treatment phase is achieved by delivering one or more RT Radiation Sets. One or more new RT
Radiation Sets may be required each time adaptive therapy is used to attempt to maintain a phase
prescription.
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Note: Common Modules found
in RT Second Generation IOD
Modules Macro are not shown
here.
RT Radiation SOP Instance
(can be one of…)
RT Radiation Set IOD
Tomotherapeutic Radiation
SOP Instance
RT Radiation Set Module
(Includes Intent, Number of
Fractions)
RT Dose Contribution Module
Radiation Dose Identification
Sequence
Conceptual Volume Sequence
C-Arm Photon Radiation
SOP Instance
Fraction Pattern Sequence
See Diagram B in RT
Physician’s Intent
Radiation Dose Sequence
C-Arm Electron Radiation
SOP Instance
Radiation Dose
Values Sequence
Radiation Sequence
Meterset to Dose
Mapping Sequence
Radiation Verification
Control Point
Sequence
Multiple Fixed Source
Radiation SOP Instance
Radiation Dose In
Vivo Measurement
Sequence
Robotic Radiation SOP
Instance
Multi-Axial Radiation SOP
Instance
2
Figure ZZ.2.4-1
RT Radiation Set IOD
4
6
8
A new concept of meta-classes is modeled. Their content is inherent to all members of a such a
meta-class and are to be considered as of one type. An example for this is the <RT Radiation> with
its multiple concrete definitions. The notation such a meta-class is always within <> brackets.
ZZ.2.5
10
12
14
16
18
20
RT Radiation
A conceptual metaclass representing a means of administering a quantity of radiation generated by a
radiation source and intended to be delivered in a contiguous and indivisible manner (such as a static
beam, dynamic arc, helical delivery, step-and-shoot IMRT sequence or catheter). An <RT Radiation>
description includes a contiguous set of control points.
An <RT Radiation> cannot be further subdivided in the DICOM model and is the delivery unit for
which dose is reported. If the delivery of an <RT Radiation> is interrupted, this is considered to be an
error condition and the remaining radiation required to complete the beam will usually need to be
computed based upon the planned treatment versus delivered treatment.
An <RT Radiation> may be used for the purposes dosimetric verification or therapeutic treatment.
Specific IODs that are members of this Meta-SOP Class include C-Arm Photon Radiation,
Tomotherapeutic Radiation, etc.
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ZZ.2.6
2
Page 250
RT Dose Image
Describes a representation of 3D dose distributions using the multi-frame and functional group
paradigms.
4
RT Dose Image IOD
Image SOP
Instance
RT Dose Image
Source Image
Sequence
Synchronization
Multi-frame Functional
Groups
Includes sequences for
Functional Group Macros.
See table A.VV.1.12-2 for
allowed RT Dose Image
Functional Group Macros
Frame of Reference
Acquisition Context
Acquisition Context
Sequence
Image Pixel
Dimension Organization
Sequence
Respiratory
Synchronization
Enhanced RT Dose
See Figure ZZ.2.6-2 for details on the
Enhanced RT Dose Module
Note: Common Modules found in RT Second Generation
IOD Modules Macro are not shown here.
6
8
Figure ZZ.2.6-1
RT Dose Image IOD
Multi-frame Dimension
Dimension Index
Sequence
106737321: Supplement 147: Second Generation Radiotherapy
Note: Common Modules found in RT Second Generation
IOD Modules Macro are not shown here.
Enhanced RT Dose
Effective Dose
Method Modifier
Code Sequence
Algorithm Type Code
Sequence
Any Instance that provides additional
annotation to this dose object
Dose Data Source
Measurement Code
Sequence
Referenced Spatial
Registration Sequence
Contributing Radiation
Sequence
Referenced Dose
Calculation Description
Sequence
RT Segment
Annotation SOP
Instance
RT SOP Instance
Enhanced RT Dose
Module
Effective Dose Method
Code Sequence
Page 251
Composite Dose
Sequence
Partial Delivery
Limits Sequence
Referenced Annotating
Object Sequence
Referenced RT
Segment Annotation
Sequence
Contributing Radiation
Set Sequence
Contributing RT
Radiation Record
Sequence
Contributing Radiation
Sequence
Referenced Spatial
Registration Sequence
Partial Delivery
Limits Sequence
Radiations that
contribute to the dose
RT Object SOP
Instance
SOP Instances that
describe the
calculation of the
dose
RT Dose Image
SOP Instance
RT Radiation
SOP Instance
Radiation Sets that
contribute to the dose
OR
Spatial
Registration SOP
Instance
RT Dose SOP
Instance
Figure ZZ.2.6-2
Enhanced RT Dose IOD
4
ZZ.2.7
RT Radiation
Record SOP
Instance
RT Radiation Set
SOP Instance
2
6
Contains structures used to calculate
the current IOD
RT Dose Histogram
Describes a representation for dose-volume histogram data.
OR
Deformable Spatial
Registration SOP
Instance
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Note: Common Modules found in RT Second Generation
IOD Modules Macro are not shown here.
RT Dose Histogram IOD
Acquisition Context
Acquisition Context
Sequence
Page 252
RT Dose Histogram
Dose Histogram
Sequence
Dose Histogram
Referenced Segment
Sequence
Enhanced RT Dose
Dose Histogram Dose
Unit Code Sequence
Dose Histogram Spatial
Unit Code Sequence
See Figure ZZ.2.6-2 for
details on the Enhanced
RT Dose Module
See Diagram B for details
on the Conceptual Volume
Reference Macro
Dose Statistics
Sequence
Source Image Sequence
RT Dose
Image SOP
Instance
2
Figure ZZ.2.7-1
RT Dose Histogram IOD
4
6
ZZ.2.8
RT Dose Samples
Describes a representation for dose point data.
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Note: Common Modules found in RT Second Generation
IOD Modules Macro are not shown here.
RT Dose Samples IOD
Frame of Reference
Synchronization
Page 253
Acquisition Context
Acquisition Context
Sequence
Dose Samples
Dose Samples Dose Unit
Code Sequence
Enhanced RT Dose
Source Image Sequence
See Figure ZZ.2.6-2 for details on the
Enhanced RT Dose Module
RT Image SOP
Instance
2
Figure ZZ.2.8-1
RT Dose Samples IOD
4
6
ZZ.2.9
8
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
Radiation, etc.
10
12
RT Radiation Record
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ZZ.3
Page 254
NOTES ON RT COURSE
2
ZZ.3.1
4
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
history of a single coordinated process at a particular point in time.
6
8
10
12
14
Introduction
The main elements of a treatment course are the specification of the physician’s desired treatment
approach represented by physician intents, and the realization of this approach through radiation sets
organized along the phases of treatments. The RT Course IOD provides a structure to represent the
elements of a treatment course, but makes no assumption how the Physician Intents and Treatment
Phases are interpreted or implemented. This is usually very specific to a department and casedependent. While the RT Course IOD supports quite complex treatment strategies, it can also serve
as the container for a simple Physician Intent with one Radiation Set as well, as it does not suggest
any specific approaches.
18
The RT Course IOD represents the actual state of a treatment and links together the different RT
IODs, maintaining their relation and status. It binds together various entities needed in radiotherapy
for preparation, execution and review of a radiotherapeutic treatment of a patient. This is
accomplished by providing data structures to reference the relevant SOP Instances and indicate their
status and their progress in the treatment process.
20
These component IODs have been designed to represent smaller units of information as compared
with the first-generation DICOM.
16
22
24
26
28
30
32
34
36
With the definition of RT Course, it is possible to render the second-generation RT SOP Instances
(representing those entities) stateless. This allows them be stable data containers by isolating the
changes in status or relationship with other data, thereby reducing the need to create new instances.
In second-generation RT, RT Course factors out the process-related information and separate that
from the content-related information in the referenced SOP Instances.
The RT Course can be used both in a worklist-driven managed environment as well as in an
unmanaged Media-file driven environment. It is generally assumed that there is only one RT Course
SOP Instance active at a time that serves as the reference for the current treatment definition for a
patient. Since this cannot be guaranteed technically, it is the responsibility of the departmental
workflow and/or policies and procedures to ensure that there is only one RT Course SOP Instance
active at a time. This also applies to other objects in the radiotherapy context such as physician
intents, radiation sets etc. See the example use cases below for further explanation.
It is not necessary to keep track of all versions triggered by queries for RT Course objects. A system
keeping the RT Course could store some historical versions at some point in time when clinically of
interest (e.g. in between two series of radiation). Those persistent versions are tracked in this
sequence for later retrieval. Note however, that for essential information about the whole treatment
course, the latest SOP Instance is always sufficient.
38
ZZ.3.2
40
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
intent.
42
44
46
Evolution of an RT Course SOP Instance
Further on an RT Course SOP Instance has the capability to describe the treatment phases
throughout the course of treatment. Phases represent the grouped fractions of certain treatment
techniques/modalities, such as a photon treatment with a normal radiation phase and a boost phase,
or a photon treatment phase followed by a ion treatment phases. A treatment course can have only
one phase in the course, multiple phases build a sequence of consecutive periods of treatment within
the course.
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2
4
6
8
10
12
14
The RT Course IOD does not place any constraints on how a department or physician partitions the
treatment of a patient into physician intents and treatment phases.
When treatment planning starts, an RT Course SOP Instance references RT Radiation Set SOP
Instances in different states. It also carries the relations between RT Radiation Set SOP Instances,
i.e. whether radiation sets have been derived from other radiation sets, which collections of radiation
sets are grouped for dose summation, etc.
There will be a sequence of RT Course SOP Instances over the time of treatment. A change of the
content of the treatment course (e.g. changing physician intents, new treatment phases, new radiation
sets, changed radiation set status etc.) will be presented in a new RT Course SOP Instance. The
most recent RT Course SOP Instance is always complete, i.e. it contains all physician intents,
phases, and previous radiation sets of the course, whether they are already treated, in treatment, or
foreseen. Therefore no cumulative logic across historic RT Course SOP Instances is needed.
Previous versions referenced in an RT Course SOP Instance do however allow tracing of the
evolution of the current course definition.
ZZ.3.3
16
18
20
22
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ZZ.3.3.1.
Elements of the RT Course
Physician Intent
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 of a
certain oncology department. The manner in which physician intents are structured and formulated is
often very specifically defined in a given department. Therefore the physician intent provides flexibility
for department-specific representation. In general, it allows the physician to describe the intended
treatment mainly in free text as strategy to following process points like planning and simulation with
the nomenclature and detail level as prescribed by the operating procedures in the department.
24
ZZ.3.3.2.
26
Today’s radiotherapy treatments are increasingly complex. To support sequences of various
treatments throughout the treatment course the treatment phases support explicit definitions to
structure the course into segments. The Treatment Phase provides a means to represent changes in
the patient’s radiation sets, by organizing the sequence of sets under treatment.
28
30
32
34
A radiation set which is currently in treatment will be frozen, while other sets might be in preparation
and still undergo various changes until approved for treatment. The granularity of radiation sets
supports the atomic units of treatment. The RT Course with its phases organizes those units into a
structured time-related sequence of intended dose delivery. The arrangement of those radiation sets
across time, and their grouping as treatment phases (e.g. a normal treatment and a boost treatment)
are supported by the treatment phase sequence.
ZZ.3.3.3.
36
38
40
Treatment Phase
Radiation Sets
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 indirectly
the dose delivered. It is the smallest unit of delivery at one time.
A radiation set therefore describes a series of identical beam collections usually being applied
repeatedly. A new treatment series (or another treatment phase, like a boost treatment etc.) is
represented by one or more new radiation sets.
42
Relations between radiation sets are not handled within the radiation set IODs itself, but in the RT
Course IOD as follows:
44

46
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 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.
106737321: Supplement 147: Second Generation Radiotherapy

2
4
6
8
10
The relation in respect to changes of a radiation set in the course of treatment are described in a
specific sequence of the RT Radiation Set Reference module of the RT Course IOD. The use of
those relations is restricted to small adaptations of the actual radiation set within the intended
series of fractions, keeping the intended treatment technique, beam layout and planned dose
distribution. Any change which lies beyond this scope, for example re-planning, is typically
handled on a treatment phase level.
Radiation sets may be defined to a greater or lesser extent, depending on the progress of the
treatment definition. For the typical stages (Simulation, Planning, Treatment), different radiation sets
can be referenced. The final one, the Treatment RT Radiation Set, is intended to be a complete
definition, deliverable by a TDS without further changes once approved.
ZZ.3.3.4
12
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Clinical State Information
16
The RT SOP Classes handled in the RT Course exist in various states during the clinical process.
Instances may have been just created, may have been reviewed by physicians but not yet approved,
or may be finally approved to be ready to use. Those states are not part of the data IOD itself,
because their transitions should not necessarily trigger a change of the SOP Instance. States are
often set without further changes to the SOP Instance, for example final approval.
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:
14

Clinical states are used to denote the clinical state in the decision process about the maturity and
applicability of a SOP Instance.

RT Operation State is applicable for objects used to effectively perform the treatment (most
prominently the radiation sets) and denotes the current state of the execution.
20
22
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ZZ.4
2
NOTES ON SECOND-GENERATION IODS
ZZ.4.1
ZZ.4.1.1
4
6
8
10
12
14
16
18
20
22
24
26
RT Radiation Set IOD
General Notes
The RT Radiation Set represents a fractionation and a set of external beams or brachytherapy
radiation configurations which are treated as a collection and always grouped together. Radiation sets
are delivered in fractions. Therefore a RT Radiation Set is a collection of <RT Radiation> SOP
Instances which define treatments for the same modality. In some cases it is possible for multiple
radiations sets to contain the same <RT Radiation> SOP Instance.
By referencing other <RT Radiation> SOP Instances, an RT Radiation Set SOP Instance specifies all
physical and geometric information that is needed to define the delivery of the therapeutic dose to the
patient.
The methods of defining, verifying and correcting the position of the patient as well as attributes
varying within the treatment cycle of a specific radiation set are out of scope for this IOD. An instance
of a radiation set remains unchanged across all fractions. A change in the desired treatment normally
requires a new radiation set to be created.
ZZ.4.1.2.
Fractionation
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 Fraction Pattern to be delivered, i.e. daily
and/or weekly patterns. Note that the actual schedule of treatments may not completely match the
intended scheme (because of holidays, no-shows etc.), but the fractionation provides guidance for the
scheduler.
ZZ.4.1.2.
Meterset and other parameters resolution
It is strongly recommended that the specified Cumulative Meterset and other machine parameters
match the resolution as expected by the Radiation Device to deliver the radiation. If the calculation for
Meterset results in a meterset value which is not an exact multiple of the meterset resolution, the
result should be rounded to the nearest allowed meterset value.
ZZ.4.2
28
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ZZ.4.2.1
RT Radiation IODs
Control Points
34
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
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
(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.
36
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.
30
32
ZZ.4.2.2
Sub-Control Points
38
Due to additional requirements of some treatment techniques a new level below the Control Points is
introduced, called Sub-Control Point. The base concept is the same for the Control Point level.
40
ZZ.4.3
ZZ.4.3.1
42
44
RT Segment Annotation IOD
Conceptual Volume
The term Conceptual Volume refers to an abstract spatial entity used in radiation therapy (or
elsewhere) to identify the region of a patient that is relevant to treatment prescription, treatment
planning, plan evaluation, and/or treatment verification.
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2
4
6
Generally, a Conceptual Volume is a volume that has a diagnostic or therapeutic purpose. The
Conceptual Volume may or may not be specified by a specific segmentation, as defined in a
Segmentation, Surface Segmentation, or RT Structure Set SOP Instance. The Conceptual Volume
UID ties together instances created at different times and from different imaging modalities. A
Conceptual Volume can also be used to reference abstract spatial entities (prior to delineation) for the
purpose of prescribing dosimetry constraints for therapy.
ZZ.4.3.2
8
10
Segment
The term Segment refers to a delineation of a spatial entity in a Segmentation, Surface Segmentation,
or RT Structure Set SOP Instance. A Segment is a realization of a Conceptual Volume and is
identified by its Conceptual Volume UID.
ZZ.5
12
Page 258
EXAMPLE USE CASES
Four different use cases are illustrated in this section:

Using Managed Workflow: A treatment planning example where workflow is fully managed
using a Workflow Manager (TMS) and the Unified Procedure Step – Pull (UPS-Pull) service class.

Using Received RT Course: A treatment planning example where workflow is managed
externally to DICOM and the work item is initiated as a result of a transfer from an actor that has
performed a previous work item. This corresponds to the case where the RT Course SOP
Instance corresponds to an “electronic chart” that is passed from actor to actor, by DICOM
Network Storage (“push”) from the previous Performing Device.
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
corresponds to the case where the RT Course SOP Instance corresponds to an “electronic chart”,
and where the location of the “chart” is constant but its validity must be managed externally.
14
16
18
24
26
ZZ.5.1
28
Use Case Actors
The following actors are used in the example use cases:

User: A person controlling the performing of the procedure step.

Archive: A database storing SOP Instances (images, plans, structures, dose distributions, etc).

Treatment Management System (TMS): A suite of applications managing worklists and tracks
performance of procedures. This role is commonly fullfilled by an Oncology Information System in
the Oncology Department.
34

Virtual Simulation System (VSS): A workstation performing virtual simulation (localization,
segmentation, and beam placement), often as part of a CT Simulation System.
36

Treatment Planning System (TPS): A workstation performing radiotherapy treatment planning.
This includes localization, segmentation, beam placement or optimization, dose calculation, and
dose review.

Treatment Delivery System (TDS): An application performing the treatment delivery specified by
the worklist, updating a UPS, and storing treatment records and related SOP instances (such as
verification images). Acts as a Performing SCU.
30
32
38
40
106737321: Supplement 147: Second Generation Radiotherapy

Plan Review Station (PRS): A workstation performing radiotherapy treatment planning review,
displaying and reviewing patient anatomy, beam geometry, and dose distributions.

Delivery Review Station (DRS): A workstation performing radiotherapy treatment delivery
review, displaying and reviewing for patient anatomy, beam geometry, and planned and delivered
dose distributions.
2
4
6
ZZ.5.2
ZZ.5.2.1
8
10
12
14
16
Page 259
Treatment Planning Using Managed Workflow
Message Sequencing
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
Treatment Management System (TMS). It then retrieves all necessary input objects such as
instruction SOP Instances, image sets, Registration SOP Instances, Segmentation SOP Instances, a
simulation RT Radiation Set and related <RT Radiation> SOP Instances, and an RT Prescription. The
TPS then generates and stores SOP Instances such as a dosimetric RT Radiation Set, RT Dose
Image and reference images or image sets to be used for delivery verification. Finally, it updates the
procedure step.
ZZ.5.2.2
Transactions and Message Flow
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Page 260
Treatment
Management
System (TMS)
Treatment Planning
System (TPS)
User
Archive
1. ‘List Procedures for Planning’ on TPS
2. Query UPS
3. Receive 0-n UPS
Display list to user
4. ‘Select Procedure’ on TPS
(optional if only one procedure in list)
Extract UIDs from selected UPS
5. Retrieve Archive objects (C-MOVE)
Planning images, Segmentation IOD, Prescription IOD,
RT Inverse Planning Instruction IOD, etc
6. Start ‘Planning Session’ on TPS
7. N-ACTION UPS ‘IN PROGRESS’
PLAN
TREATMENT
PLAN
TREATMENT
8. Complete ‘Planning Session’ on TPS
9. Store Results
10. N-SET UPS to Final State
12. Indicate ‘Planning Session Completed
Successfully’ on TPS console
11. N-ACTION UPS ‘COMPLETED’
2
Figure ZZ.5.2.2-1
Treatment Planning Normal Flow - Message Sequence
4
6
1.
‘List Procedures for Planning’ on TPS
The User requests a of patients requiring treatment planning.
8
2.
The TPS queries the TMS for Unified Procedure Steps (UPSs) that match its search criteria.
For example, all worklist items with a Procedure Step State of ’SCHEDULED’ and Workitem
Code Sequence containing an item corresponding to ‘RT Inverse Planning’. This message is
conveyed using the C-FIND request primitive of the Unified Procedure Step - Pull SOP Class.
10
12
3.
14
Query UPS
Receive 0-n UPS
The TPS receives the set of Unified Procedure Steps (UPSs) resulting from the Query UPS
message. The Receive UPS message is conveyed via one or more C-FIND response
106737321: Supplement 147: Second Generation Radiotherapy
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
the planned tasks for the querying device.
2
4
4.
5.
Retrieve Archive Objects
Archive Objects are retrieved by a C-MOVE Request, transmitting the SOP Instances to the
TPS. SOP instances locations are fully specified in the Input Information Sequence of the
Worklist response.
10
12
‘Select Procedure’ on TPS
The User selects one of the scheduled procedures specified on the TPS. If exactly one UPS
was returned from the UPS query described above, then the returned UPS is selected by
default.
6
8
Page 261
6.
Start ‘Planning Session’ on TPS
The User begins the planning process on the TPS.
14
7.
As the User begins the planning process, the TPS sets a UPS to have the Procedure Step
State of ‘IN PROGRESS’. The SOP Instance UID of the UPS will have been obtained via the
returned worklist query response. This message is conveyed using the N-ACTION primitive of
the Unified Procedure Step – Pull SOP Class with an action type “UPS Status Change”. This
message allows the TMS to update its worklist and permits other Performing Devices to detect
that the UPS is being worked on.
16
18
20
8.
22
24
Store Results
When the planning process is complete, the TPS stores the results to the Archive. This would
typically be achieved using the Storage and/or Storage Commitment Service Classes. These
SOP instances are detailed in Section ZZ.6.
26
10.
28
Set UPS Progress to Final State
Upon completion of the final beam (although this is not required) the TPS may then update the
UPS Progress Information Sequence. The TPS must include references to any results in the
Output Information Sequence (results are themselves conveyed by the Store Results step).
Any attributes still required for UPS completion must be assigned in this step. This message is
conveyed using the N-SET primitive of the Unified Procedure Step - Pull SOP Class.
30
32
11.
Set UPS (COMPLETED)
The TPS sets the Procedure Step State of the UPS to ‘COMPLETED’ upon completion of the
scheduled step and storage of results. This message is conveyed using the N-ACTION
primitive of the UPS SOP Class with an action type “Request UPS State Modification”. This
message informs the TMS that the UPS is now complete.
34
36
40
Complete ‘Planning Session’ on TPS
The User completes the planning process on the TPS.
9.
38
Set UPS (IN PROGRESS)
12.
Indicate ‘Planning Session Completed Successfully’ on TPS
Finally the TPS notifies the User that the requested procedure has completed successfully, and
all generated SOP Instances have been stored.
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ZZ.5.3
Page 262
Treatment Planning Using Received RT Course
2
ZZ.5.3.1
4
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
another performing device. In this example the TPS needs to be a RT Course Storage SCP.
6
8
This use case supports a special case of the “electronic chart” scenario where an independent
system (e.g. a physical patient chart) has been used to determine that the next task is a planning
procedure, and the User has identified a suitable workstation for the planning procedure.
ZZ.5.3.2
10
Message Sequencing
Transactions and Message Flow
This section describes in detail the interactions illustrated in Figure ZZ.5.3.2-1.
Virtual Simulation
System (VSS)
Treatment
Delivery System
(TDS)
Treatment Planning
System (TPS)
User
Archive
1. Store RT Course (C-STORE)
2. ‘List Procedures for Planning’ on TPS
Display list of RT Courses
to user
3. ‘Select ‘Active’ RT Course on TPS
Extract UIDs from
selected RT Course
4. Retrieve Archive objects (C-MOVE)
Planning images, Segmentation IOD, Prescription IOD, etc
5. Start ‘Planning Session’ on TPS
PLAN
TREATMENT
PLAN
TREATMENT
6. Complete ‘Planning Session’ on TPS
7. Store Results to Archive (C-STORE)
12
14
16
8. Store RT Course on
Next Performing Device
(C-STORE)
Figure ZZ.5.3.2-1
Treatment Planning Using Received RT Course - Message Sequence
106737321: Supplement 147: Second Generation Radiotherapy
1.
2
2.
3.
10
4.
Retrieve Archive Objects
The SOP Instances to be used as input information are transmittedby the Archive to the TPS in
response to C-MOVE requests. Typical SOP Instances retrieved are detailed in Section ZZ.4.
The TPS knows the location of these SOP instances by virtue of the fully-specified RT Course
SOP Instance returned in the previous step.
16
5.
18
Start ‘Planning Session’ on TPS
The User begins the planning process on the TPS.
6.
20
Complete ‘Planning Session’ on TPS
The User completes the planning process on the TPS.
7.
22
Store Results to Archive
When the planning process is complete, the TPS stores the results to the Archive. This would
typically be achieved using the Storage and/or Storage Commitment Service Classes. These
SOP Instances are detailed in Section ZZ.6.
24
8.
28
Select ‘Active’ RT Course on TPS
The User selects one of the displayed RT Course objects as the active one. The TPS then
extracts the required input SOP Instance UIDs from the selected RT Course.
14
26
‘List Procedures for Planning’ on TPS
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
12
Store RT Course to TPS
The User of another performing device (such as a Virtual Simulation System) initiates a transfer
of an RT Course SOP Instance to the TPS. The TPS receives this instance (acting as an RT
Course Storage SCP) and stores it locally. Other instances - originating from other devices, or
sent at other times - may also have previously been stored.
4
6
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Store RT Course on Next Performing Device
The TPS stores a new RT Course SOP Instance on the next performing device, such as a
Treatment Delivery System (TDS). It contains the complete history of the treatment course,
including the planning step just performed.
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ZZ.5.4
2
4
6
ZZ.5.4.1
Page 264
Treatment Planning Using DICOM Media
Message Sequencing
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 reading
DICOM Media. In this example the TPS needs to be DICOM Media File Set Reader (FSR) for this to
occur.
10
This use case supports a special case of the “electronic chart” scenario where an independent
system (e.g. a physical patient chart) is used to track and indicate the procedures to be
performed.User has been able to obtain a DICOM Storage Media File Set containing the latest
information regarding the treatment course.
12
As before, the SOP Instances that may be consumed and produced by this procedure are shown in
Section ZZ.6.
8
ZZ.5.4.2
14
Transactions and Message Flow
This section describes in detail the interactions illustrated in Figure ZZ.5.4.2-1.
DICOM Storage
Medium (e.g.
DVD or BD)
Treatment Planning
System (TPS)
User
1. ‘List Procedures for Planning’ on TPS
Read input RT Course(s) from
media (File Set Reader)
Display list of RT Courses
to user
2. ‘Select ‘Active’ RT Course on TPS
Extract UIDs from
selected RT Course
3. Read input SOP Instances from
media (File Set Reader)
4. Start ‘Planning Session’ on TPS
PLAN
TREATMENT
PLAN
TREATMENT
5. Complete ‘Planning Session’ on TPS
6. Store RT Course and result
Objects to media (File Set
Update)
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Figure ZZ.5.4.2-1
Treatment Planning Using DICOM Media - Message Sequence
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20
22
1.
‘List Procedures for Planning’ on TPS
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 DICOM Medium
106737321: Supplement 147: Second Generation Radiotherapy
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.
4
6
3.
4.
12
Start ‘Planning Session’ on TPS
The User begins the planning process on the TPS.
5.
14
Complete ‘Planning Session’ on TPS
The User completes the planning process on the TPS.
6.
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Read Input SOP Instances from Media
The TPS initiates a retrieval of required input SOP Instances from the DICOM Medium. It does
this by acting in the role of a DICOM File Set Reader (FSR). Typical SOP Instances retrieved
are detailed in Section ZZ.4. The TPS knows the location of these SOP instances by virtue of
the fully-specified RT Course SOP Instance returned in the previous step.
10
18
Select ‘Active’ RT Course on TPS
The User confirms one of the displayed RT Course SOP Instances as the active one. The TPS
then extracts the required input SOP Instance UIDs from the selected RT Course.
8
16
Page 265
Store Results to Media
When the planning process is complete, the TPS stores the results to a DICOM Media File
Set.The stored objects include a new RT Course SOP Instance referencing the planning
procedure step and any generated SOP Instances. These SOP Instances are detailed in
Section ZZ.6.
106737321: Supplement 147: Second Generation Radiotherapy
ZZ.5.5
Page 266
Treatment Planning Using Archive Query of RT Course
2
ZZ.5.5.1
4
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
the Archive.
6
8
10
The use case supports a special case of the “electronic chart” scenario where an independent system
(e.g. a physical patient chart) is used to track and indicate the procedures to be performed, including
the current RT Course SOP Instances retrieved from the Archive.
As before, the SOP Instances that may be consumed and produced by this procedure are shown in
Section ZZ.6.
ZZ.5.5.2
12
Message Sequencing
Transactions and Message Flow
This section describes in detail the interactions illustrated in Figure ZZ.5.5.2-1.
Treatment Planning
System (TPS)
Archive
User
1. ‘List Procedures for Planning’ on TPS
2. Query RT Course (C-FIND)
3. Retrieve 0-n C-FIND responses
4. ‘Select RT Course on TPS
Display list of RT Courses to user
5. Retrieve selected RT Course (C-MOVE)
Selected RT Course IOD
Extract UIDs from selected RT Course
6. Retrieve Archive objects (C-MOVE)
7. Start ‘Planning Session’ on TPS
PLAN
TREATMENT
Planning images, Segmentation IOD, Prescription IOD, etc
PLAN
TREATMENT
8. Complete ‘Planning Session’ on TPS
9. Store Results
14
10. Store RT Course (new instance)
106737321: Supplement 147: Second Generation Radiotherapy
Figure ZZ.5.5.2-1
Treatment Planning Using Archive Query of RT Course - Message Sequence
2
4
Page 267
1.
‘List Procedures for Planning’ on TPS
The User indicates on the TPS that they want a the list of patients requiring treatment planning.
6
2.
The TPS queries the Archive for RT Course SOP Instances that match its search criteria. For
example, all RT Courses for a specific patient where the contents of the RT Course indicate
that a simulation has already been performed. This message is conveyed using the C-FIND
request primitive of the DICOM Query/Retrieve service class.
8
10
3.
12
4.
16
‘Select RT Course’ on TPS
The User selects one of the returned RT Course SOP Instances on the TPS.
5.
18
Retrieve Selected RT Course
In response to a C-MOVE Request, the Archive transmits to the TPS the selected RT Course
SOP Instance.
6.
Retrieve Archive Objects
Archive Objects are retrieved by a C-MOVE Request, transmitting the SOP Instances to the
TPS. SOP Instance locations are fully-specified in the RT Course SOP Instance returned in the
previous step.
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24
Receive 0-n C-FIND Responses
The TPS receives the set of results from the Query/Retrieve operation. The result set is
conveyed via one or more C-FIND response primitives of the Query/Retrieve SOP Class. The
Archive returns a list of zero or more items matching the specified search criteria.
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20
Query RT Course
7.
Start ‘Planning Session’ on TPS
The User begins the planning process on the TPS.
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8.
Complete ‘Planning Session’ on TPS
The User completes the planning process on the TPS.
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9.
When the planning process is complete, the TPS stores the results to the Archive. This would
typically be achieved using the Storage and/or Storage Commitment Service Classes. These
SOP Instances are detailed in Section ZZ.6.
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32
34
36
Store Results
10.
Store RT Course
The TPS stores a new RT Course SOP Instance on the Archive. It contains the complete
history of the treatment course, including the planning step just performed and the locations of
any objects generated.