- Standard -
PS 3.17-2008
Digital Imaging and Communications in Medicine (DICOM)
Part 17: Explanatory Information
Published by
National Electrical Manufacturers Association
1300 N. 17th Street
Rosslyn, Virginia 22209 USA
© Copyright 2008 by the National Electrical Manufacturers Association. All rights including translation
into other languages, reserved under the Universal Copyright Convention, the Berne Convention for the
Protection of Literacy and Artistic Works, and the International and Pan American Copyright Conventions.
PS 3.17 - 2008
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NOTICE AND DISCLAIMER
The information in this publication was considered technically sound by the consensus of persons
engaged in the development and approval of the document at the time it was developed. Consensus
does not necessarily mean that there is unanimous agreement among every person participating in the
development of this document.
NEMA standards and guideline publications, of which the document contained herein is one, are
developed through a voluntary consensus standards development process. This process brings together
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CONTENTS
NOTICE AND DISCLAIMER .........................................................................................................................2
CONTENTS...................................................................................................................................................3
FOREWORD .................................................................................................................................................9
1 Scope and field of application ...............................................................................................................11
2 Normative references............................................................................................................................11
3 Definitions..............................................................................................................................................11
4 Symbols and abbreviations ...................................................................................................................11
5 Conventions ..........................................................................................................................................11
Annex A Explanation of patient orientation (Normative).........................................................................13
Annex B Integration of Modality Worklist and Modality Performed Procedure Step in the Original
DICOM Standard (Informative)....................................................................................................................24
Annex C Waveforms (Informative)..........................................................................................................27
C.1 DOMAIN OF APPLICATION ..........................................................................................................27
C.2 USE CASES...................................................................................................................................27
C.3 TIME SYNCHRONIZATION FRAME OF REFERENCE................................................................28
C.4 WAVEFORM ACQUISITION MODEL............................................................................................28
C.5 WAVEFORM INFORMATION MODEL ..........................................................................................29
C.6 HARMONIZATION WITH HL7 .......................................................................................................30
C.6.1 HL7 Waveform Observation .................................................................................................30
C.6.2 Channel Definition ................................................................................................................31
C.6.3 Timing ...................................................................................................................................31
C.6.4 Waveform Data .....................................................................................................................32
C.6.5 Annotation.............................................................................................................................32
C.7 HARMONIZATION WITH SCP-ECG .............................................................................................32
Annex D SR Encoding Example (Informative)........................................................................................33
Annex E Mammography CAD (Informative) ...........................................................................................41
E.1 MAMMOGRAPHY CAD SR CONTENT TREE STRUCTURE .......................................................41
E.2 MAMMOGRAPHY CAD SR OBSERVATION CONTEXT ENCODING..........................................43
E.3 MAMMOGRAPHY CAD SR EXAMPLES .......................................................................................44
E.3.1 Example 1: Calcification and Mass Detection with No Findings .......................................44
E.3.2 Example 2: Calcification and Mass Detection with Findings .............................................46
E.3.3 Example 3: Calcification and Mass Detection, Temporal Differencing with Findings .......60
E.4 CAD OPERATING POINT ..........................................................................................................72
E.5 Mammography CAD SR AND For Processing / For Presentation IMAGES...............................72
Annex F Chest CAD (Informative)..........................................................................................................74
F.1 CHEST CAD SR CONTENT TREE STRUCTURE.........................................................................74
F.2 CHEST CAD SR OBSERVATION CONTEXT ENCODING ...........................................................75
F.3 CHEST CAD SR EXAMPLES.........................................................................................................76
F.3.1 Example 1: Lung Nodule Detection with No Findings...........................................................76
F.3.2 Example 2: Lung Nodule Detection with Findings and Anatomy/Pathology Interpretation ..77
F.3.3 Example 3: Lung Nodule Detection, Temporal Differencing with Findings...........................82
F.3.4 Example 4: Lung Nodule Detection in Chest Radiograph, Spatially Correlated with CT .....85
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Annex G
Explanation of Grouping Criteria for Multi-frame Functional Group IODs (Informative) ..........90
Annex H. Clinical Trial Identification Workflow Examples (Informative)......................................................92
H.1 EXAMPLE USE-CASE ...................................................................................................................92
ANNEX I. Ultrasound Templates (Informative) ...........................................................................................93
I.1 SR CONTENT TREE STRUCTURE................................................................................................93
I.2 PROCEDURE SUMMARY...............................................................................................................93
I.3 MULTIPLE FETUSES......................................................................................................................93
I.4 EXPLICITLY SPECIFYING CALCULATION DEPENDENCIES......................................................94
I.5 LINKING MEASUREMENTS TO IMAGES, COORDINATES .........................................................94
I.6 OB PATTERNS................................................................................................................................95
I.7 SELECTED VALUE .........................................................................................................................97
I.8 OB-GYN EXAMPLES ......................................................................................................................98
Example 1: OB-GYN Root with Observation Context ....................................................................98
Example 2: OB-GYN Patient Characteristics and Procedure Summary........................................99
Example 3: OB-GYN Multiple Fetus.............................................................................................100
Example 4: Biophysical Profile .....................................................................................................101
Example 5: Biometry Ratios .........................................................................................................101
Example 6: Biometry ....................................................................................................................101
Example 7: Amniotic Sac .............................................................................................................103
Example 8: OB-GYN Ovaries.......................................................................................................103
Example 9: OB-GYN Follicles ......................................................................................................105
Example 10: Pelvis and Uterus ....................................................................................................106
ANNEX J: HANDLING OF IDENTIFYING PARAMETERS (Informative) .................................................107
J.1 PURPOSE OF THIS ANNEX.....................................................................................................107
J.2 INTEGRATED ENVIRONMENT ................................................................................................107
J.2.1 Modality Conforms to Modality Worklist and MPPS SOP Classes ..................................108
J.2.2 Modality Conforms only to the Modality Worklist SOP Class ..........................................108
J.2.3 Modality Conforms only to the MPPS SOP Class............................................................109
J.3 NON-INTEGRATED ENVIRONMENT.......................................................................................110
J.4 ONE MPPS IS CREATED IN RESPONSE TO TWO OR MORE REQUESTED PROCEDURES110
J.4.1 Choose or Create a Value for Study Instance UID and Accession Number....................111
J.4.2 Replicate the Image IOD ..................................................................................................112
J.5 MPPS SOP INSTANCE CREATED BY ANOTHER SYSTEM (NOT THE MODALITY) ...........113
J.6 MAPPING OF STUDY INSTANCE UIDS TO THE STUDY SOP INSTANCE UID.......................113
ANNEX K ULTRASOUND STAGED PROTOCOL DATA MANAGEMENT .............................................114
K.1 PURPOSE OF THIS ANNEX .......................................................................................................114
K.2 PREREQUISITES FOR SUPPORT .............................................................................................114
K.3 DEFINITION OF A STAGED PROTOCOL EXAM .......................................................................114
K.4 ATTRIBUTES USED IN STAGED PROTOCOL EXAMS.............................................................115
K.5 GUIDELINES................................................................................................................................116
K.5.1 STAGED PROTOCOL EXAM IDENTIFICATION ...............................................................117
K.5.2 STAGE AND VIEW IDENTIFICATION ..............................................................................117
K.5.3 EXTRA-PROTOCOL IMAGE IDENTIFICATION ................................................................119
K.5.4 MULTIPLE IMAGES OF A STAGE-VIEW .........................................................................120
K.5.5 WORKFLOW MANAGEMENT OF STAGED PROTOCOL IMAGES .................................120
Annex L Hemodynamics Report Structure (Informative)...........................................................................124
ANNEX M Vascular Ultrasound Reports (Informative)..............................................................................126
M.1 VASCULAR REPORT STRUCTURE ..........................................................................................126
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M.2 VASCULAR EXAMPLES .............................................................................................................127
M.2.1 Example 1: Renal Vessels ..............................................................................................127
M.2.2 Example 2: Carotids Extracranial....................................................................................128
ANNEX N Echocardiography Procedure Reports (Informative)................................................................130
N.1 CONTENT STRUCTURE.............................................................................................................130
N.1 ECHO PATTERNS.......................................................................................................................130
N.2 MEASUREMENT TERMINOLOGY COMPOSITION...................................................................131
N.3 ILLUSTRATIVE MAPPING TO ASE CONCEPTS .......................................................................132
N.3.1 Aorta ...................................................................................................................................132
N.3.2 Aortic Valve.........................................................................................................................132
N.3.3 Left Ventricle - Linear..........................................................................................................134
N.3.4 Left Ventricle Volumes and Ejection Fraction.....................................................................136
N.3.5 Left Ventricle Output ...........................................................................................................137
N.3.6 Left Ventricular Outflow Tract .............................................................................................138
N.3.7 Left Ventricle Mass .............................................................................................................139
N.3.8 Left Ventricle Miscellaneous ...............................................................................................139
N.3.9 Mitral Valve .........................................................................................................................140
N.3.10 Pulmonary Vein ................................................................................................................142
N.3.11 Left Atrium / Appendage ...................................................................................................143
N.3.12 Right Ventricle ..................................................................................................................144
N.3.13 Pulmonic Valve / Pulmonic Artery.....................................................................................145
N.3.14 Tricuspid Valve .................................................................................................................146
N.3.15 Right Atrium / Inferior Vena Cava.....................................................................................147
N.3.16 Congenital / Pediatric........................................................................................................148
N.4 ENCODING EXAMPLES..............................................................................................................149
N.4.1 Example 1: Patient Characteristics.....................................................................................149
N.4.2 Example 2: LV Dimensions and Fractional Shortening ......................................................149
N.4.3 Example 3: Left Atrium / Aortic Root Ratio .........................................................................150
N.4.4 Example 4: Pressures.........................................................................................................150
N.4.5 Example 5: Cardiac Output.................................................................................................151
N.4.6 Example 6: Wall Scoring.....................................................................................................152
N.5 IVUS REPORT..........................................................................................................................152
ANNEX O Registration (Informative).........................................................................................................154
O.1 SPATIAL REGISTRATION AND SPATIAL FIDUCIALS SOP CLASSES ...................................154
O.2 FUNCTIONAL USE CASES.........................................................................................................155
O.3 SYSTEM INTERACTION .............................................................................................................156
O.4 OVERVIEW OF ENCODING .......................................................................................................158
O.5 MATRIX REGISTRATION............................................................................................................160
O.6 SPATIAL FIDUCIALS...................................................................................................................161
ANNEX P Transforms and Mappings (Informative) ..................................................................................162
ANNEX Q Breast Imaging Report (Informative) ........................................................................................165
Q.1 BREAST IMAGING REPORT CONTENT TREE STRUCTURE..................................................165
Q.2 BREAST IMAGING REPORT EXAMPLES..................................................................................169
Q.2.1 Example 1: Screening Mammogram with Negative Findings.............................................169
Q.2.2 Example 2: Screening Mammogram with Negative Findings.............................................170
Q.2.3 Example 3: Diagnostic Mammogram - Unilateral ...............................................................172
Q.2.4 Example 4: Diagnostic Mammogram and Ultrasound - Unilateral .....................................174
Annex R Configuration Use Cases (Informative) .....................................................................................177
R.1 INSTALL A NEW MACHINE .....................................................................................................177
R.1.1 Configure DHCP..............................................................................................................177
