Digital Imaging and Communications in Medicine (DICOM) Supplement 45: Ultrasound Protocol Supplement

Transcription

1 ASE ACR NEMA Digital Imaging and Communications in Medicine (DICOM) Supplement 45: Ultrasound Protocol Supplement Prepared by: DICOM Standards Committee, Working Group 12 Ultrasound 1300 N. 17 th Street Rosslyn, Virginia USA Version: 0.7

2 ii 8 June, 1999 ii

3 Supplement 45: Ultrasound Protocol Page i Foreword...iii Scope and Field of Application... iv A.1.4 Overview of the Composite IOD Module Content...2 A.6.4 US Image IOD Module Table...4 A.7.4 US Multi-Frame Image IOD Module Table...6 C.8.5.x US Series Module...7 C.8.5.y US Protocol Module REGISTRY OF DICOM DATA ELEMENTS...15

4 ii DOCUMENT HISTORY Document Version Date Content June, 1998 New draft based on February meeting output June, 1998 Added data elements to Part 6. Added note in C.8.5.y US Protocol Module June, 1998 Synchronized with Supplement 36. Added tables with preliminary picklists for microglossary inclusion November, 1998 Added supplement number (45). Added DICOMDIR support for Part 11. Made new modules optional. Defined relationship of ultrasound protocols to DICOM Real-World Model December, 1998 Clean up of Forward, Scope and Field of Application and page numbering December, 1998 Clarify relationship of ultrasound protocols to DICOM Real-World Model June, 1999 Updated with changes from 3/29/99 teleconference. Added informative SDM codes from ASE. OPEN ISSUES Finish defining picklists and context ID s. Get element numbers for new attributes. ii

5 Supplement 45: Ultrasound Protocol Page iii Foreword This draft Supplement to the DICOM Standard was developed according to NEMA Procedures. This Supplement to the Standard is developed in liaison with other standardization organizations including CEN TC251 in Europe, MEDIS-DC and JIRA in Japan, with review also by other organizations including IEEE, HL7 and ANSI in the USA. The DICOM Standard is structured as a multi-part document using the guidelines established in the following document: - ISO/IEC Directives, 1989 Part 3 : Drafting and Presentation of International Standards. This document is a Supplement to the DICOM Standard. It is an extension to PS 3.3, 3.6 and 3.11 of the published DICOM Standard which consists of the following parts: PS Introduction and Overview PS Conformance PS Information Object Definitions PS Service Class Specifications PS Data Structures and Encoding PS Data Dictionary PS Message Exchange PS Network Communication Support for Message Exchange PS Point-to-Point Communication Support for Message Exchange PS 3.10 PS 3.11 PS 3.12 PS 3.13 PS 3.14 Media Storage and File Format for Data Interchange Media Storage Application Profiles Media Formats and Physical Media for Data Interchange Print Management Point-to-Point Communication Support Gray-scale Display Function Standard These parts are related but independent documents.

6 iv Scope and Field of Application This Supplement to the DICOM Standard specifies changes to the DICOM Image Information Object Definition (IOD) for Ultrasound (US) and Ultrasound Multi-frame (USMF) Images. It specifies the new modules necessary to identify images acquired as part of an ultrasound acquisition protocol. Since this document proposes changes to existing Parts of DICOM the reader should have a working understanding of the Standard. This proposed Supplement includes a number of Addenda to existing Parts of DICOM: 1. PS 3.3 Addenda (Extension to Annex A and Annex C) 2. PS 3.6 Addenda (Extension to Section 6) 3. PS 3.11 Addenda (Extension to Annex C) iv

7 Supplement 45: Ultrasound Protocol Page 1 Changes to: NEMA Standards Publication PS Digital Imaging and Communications in Medicine (DICOM) Part 3: Information Object Definitions

8 2 3.X Ultrasound The following definitions are commonly used in the specification of the Ultrasound IOD s. 3.X.1 Acquisition Protocol An Acquisition Protocol is a Procedure Type that defines the particular ultrasound images that will be acquired. Note: These can be well known or locale specific. 3.X.2 Staged Protocol A Staged Protocol is an Acquisition Protocol that is repeated at more than one specific instance of time. Note: These instances commonly occur due to simple events. The introduction of contrast media, drugs or stress to the patient are typical events. Item: Add to PS 3.3 Table A.1-1 A.1.4 Overview of the Composite IOD Module Content Table A.1-1 provides an overview of the Modules used throughout the Composite IODs. This table is for informative purposes only. It is based on the IOD definitions found in the remaining sections of Annex A which are normative. Table A.1-1 COMPOSITE INFORMATION OBJECT MODULES OVERVIEW IODs Modules US USmf Patient M M Patient Summary General Study M M Patient study U U Study Content General Series CR Series NM Series M M US Series U U Frame Of Reference U S Frame of Ref. General Equipment SC Equipment U C M U C M

9 Supplement 45: Ultrasound Protocol Page 3 General Image Image Plane M* M Image Pixel M* M NM Image Pixel Pallet Color L o oku p Ta b le Contrast/ Bolus Cine Multi-frame C C C* C M M NM Multiframe Frame Pointers Mask Display Shutter Device Therapy CR Image CT Image MR Image NM Image NM Isotope NM Detector NM TOMO Acquisition NM Multi- Gated Acquisition NM Phase NM Re co n str u ct io n US Region Calibration U* U US Image M* M US Protocol U U SC Image X-Ray Image

10 4 X-Ray Acquisition X-Ray Collimator X-Ray Table XRF Positioner XRF Tomo Acquisition XA Positioner Bi-Plane Sequence Bi-Plane Image Overlay Identification Overlay Plane U* Multi-frame Overlay Bi-Plane Overlay Curve Identification M* M* Curve M* M* Audio U U Modality LUT VOI LUT U* U LUT Identification SOP Common M* M* Item: Add to PS 3.3 Table A for clarity, those modules that are changed from the existing standard or new are shown in Bold and Underlined A.6.4 US Image IOD Module Table Table A US IMAGE IOD MODULES IE Module Reference Usage

11 Supplement 45: Ultrasound Protocol Page 5 Patient Patient C M Study General Study C M Patient Study C U Series General Series C M Frame of Reference US Series C.8.5.x U Suggested if image is part of an acquisition protocol Frame of Reference C U US Frame of Reference C C - Required if images are spatially related Equipment General Equipment C M Image General Image C M (See A.6.4.1) Image Pixel C M Contrast/bolus C C - Required if contrast media was used in this image Palette Color Lookup table C.7.9 C - Required if Photometic Interpretation (0028,0004) has a value of PALETTE COLOR US Region Calibration C U US Image C M US Staged Protocol C.8.5.y U Suggested if image is part of a staged protocol Overplay Plane C.9.2 U VOI LUT C.11.2 U SOP Common C.12.1 M Curve Curve Identification C.10.1 M (See A.6.4.1) Curve C.10.2 M Audio C.10.3 U SOP Common C.12.1 M A Mutually Exclusive IEs The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactly one of these IEs. A.6.5 US Image IOD Relationship to the DICOM Real-World Model Ultrasound images that make use of the US Series & Protocol Modules have a more specific relationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisition protocol is considered one Requested Procedure and has one Procedure Plan. The Procedure Plan will have one or more Action Items. An ultrasound acquisition protocol will typically consist

12 6 of one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisition protocol was successfully completed, this will result in one Modality Performed Procedure Step. Therefore, all images that are part of this particular instance of an ultrasound acquisition protocol will have the same Procedure Code Sequence (0032,1064). It is recommended that all the images that are part of this particular instance of an ultrasound acquisition protocol have the same Performed Procedure Step ID. In an environment with information system connectivity, the Procedure Code Sequence can be used to identify all the images that were acquired as part of that protocol. If no information system connectivity is available, then Performed Procedure Step ID may be used to identify all the images that were acquired as part of that protocol. It is recommended that each stage should map to a separate series. Item: Add to PS 3.3 Table A for clarity, those modules that are changed from the existing standard or new are shown in Bold and Underlined A.7.4 US Multi-Frame Image IOD Module Table Table A US MULTI-FRAME IMAGE IOD MODULES IE Module Reference Usage Patient Patient C M Study General Study C M Patient Study C U Series General Series C M Frame of Reference US Series C.8.5.x U Suggested if image is part of an acquisition protocol Frame of Reference C U US Frame of Reference C C - Required if images are spatially related Equipment General Equipment C M Image General Image C M (See A.7.4.1) Image Pixel C M Contrast/bolus C C - Required if contrast media was used in this image. Cine C M Multi-frame C M Palette Color Lookup Table C.7.9 C - Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR

13 Supplement 45: Ultrasound Protocol Page 7 US Region Calibration C U US Image C M US Staged Protocol C.8.5.y U Suggested if image is part of a staged protocol VOI LUT C.11.2 U SOP Common C.12.1 M Curve Curve Identification C.10.1 M (see A.7.4.1) Curve C.10.2 M Audio C.10.3 U SOP Common C.12.1 M A Mutually Exclusive IEs The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactly one of these IEs. A.7.5 US Multi-Frame Image IOD Relationship to the DICOM Real-World Model Ultrasound images that make use of the US Series & Protocol Modules have a more specific relationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisition protocol is considered one Requested Procedure and has one Procedure Plan. The Procedure Plan will have one or more Action Items. An ultrasound acquisition protocol will typically consist of one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisition protocol was successfully completed, this will result in one Modality Performed Procedure Step. Therefore, all images that are part of this particular instance of an ultrasound acquisition protocol will have the same Procedure Code Sequence (0032,1064). It is recommended that all the images that are part of this particular instance of an ultrasound acquisition protocol have the same Performed Procedure Step ID. In an environment with information system connectivity, the Procedure Code Sequence can be used to identify all the images that were acquired as part of that protocol. If no information system connectivity is available, then Performed Procedure Step ID may be used to identify all the images that were acquired as part of that protocol. It is recommended that each stage should map to a separate series. Item: Add to PS 3.3 New Sections C.8.5.x and C.8.5.y C.8.5.x US Series Module Table C.8-x contains IOD attributes that describe an ultrasound series.

14 8 Table C.8-x US SERIES MODULE ATTRIBUTES Attribute Name Tag Type Attribute Description Protocol Name (0018,1030) 1C User-defined description of the conditions under which the Series was performed. Required if Protocol Type Sequence (0018,xxxx) has no value. Protocol Type Sequence (0018,xxxx) 2 Sequence of one or more Items that identifies the protocol used to acquire this image. See section C.8.5.x.1.y >Include Code Sequence Macro Table Baseline Context ID is???. >Protocol Type Modifier Sequence (0018,xxxx) 3 Sequence of one or more Items that modifies the primary protocol type used to acquire this image. See section C.8.5.x.1.y >>Include Code Sequence Macro Table Baseline Context ID is???. Performed Procedure Step ID (0040,0253) 1C Identification of that Procedure that has been carried out within this step. Required if image was acquired in an acquisition protocol. C.8.5.x.1 US Series Attributes Descriptions C.8.5.x.1.y Protocol Type Sequence These Data Elements are intended to replace Protocol Name (0018,1030) Data Element. Protocol Type Sequence (0018,xxxx) describes the acquisition protocol used to acquire this image. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX. Note: The existence of this attribute means that this image is part of an acquisition protocol. Note: The following will not be included in the standard. Code Meaning (0008,0104) Transesophageal echocardiography Transthoracic echocardiography Epicardial echocardiography Intravascular echocardiography Intracardiac echocardiography Limited M-mode only echocardiography Limited Doppler only echocardiography Exercise stress echocardiography Maximal stress echocardiography Code Value (0008,0100) P5-B3002 P5-B3003 P5-B3004 P5-B3005 P5-B3006 P5-B301F P5-B303F P5-B3050 P5-B3051

15 Supplement 45: Ultrasound Protocol Page 9 Submaximal stress echocardiography Treadmill exercise stress echocardiography Bruce treadmill stress echocardiography Modified Bruce treadmill stress echocardiography Naughton treadmill stress echocardiography Bicycle exercise stress echocardiography Echocardiography with administered drug stress Dobutamine stress echocardiography High dose dobutamine stress echocardiography Low dose dobutamine stress echocardiography Arbutamine stress echocardiography Dipyridamole stress echocardiography Cardiac pacing echocardiography Adult echocardiography Pediatric echocardiography Intraoperative echocardiography Upright echocardiography Supine echocardiography Contrast echocardiography Contrast left ventricular opacification echocardiography Contrast perfusion echocardiography Contrast Doppler enhancement echocardiography 2D complete echocardiography Limited 2D only echocardiography Fetal echocardiography P5-B3052 P5-B3053 P5-B3054 P5-B3055 P5-B3056 P5-B3058 P5-B3060 P5-B3061 P5-B3062 P5-B3063 P5-B3065 P5-B3066 P5-B3070 P5-B3081 P5-B3082 P5-B3083 P5-B3084 P5-B3085 P5-B3090 P5-B3091 P5-B3092 P5-B3093 P5-B3191 P5-B3192 P5-B8215 Protocol Type Modifier Sequence (0018,xxxx) modifies the primary acquisition protocol stage when the image was acquired. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX. C.8.5.y US Staged Protocol Module Table C.8-y contains IOD attributes that describe an ultrasound staged protocol. Table C.8-y US STAGED PROTOCOL MODULE ATTRIBUTES Attribute Name Tag Type Attribute Description Number of Stages (0008,2124) 2 Number of Stages in this protocol. Number of Views in Stage (0008,212A) 2 Number of views in this Stage.

16 10 Stage Name (0008,2120) 1C A Stage is a particular time slice of a protocol in which a set of images are collected. The names can be free form text. Recommended text for Stress Echo stage names are: PRE-EXERCISE, POST-EXERCISE, PEAK-EXERCISE, RECOVERY, BASELINE, LOW DOSE, PEAK DOSE Required if Stage Type Sequence (0008,xxxx) has no value. Stage Type Sequence (0008,xxxx) 2 Sequence of one or more items that identifies the acquisition protocol stage when the image was acquired. See Section 8.5.y.1.1 >Include Code Sequence Macro Table Baseline Context ID is???. >Stage Type Modifier Sequence (0008,xxxx) 3 Sequence of one or more Items that modifies the primary stage type in this image. See Section 8.5.y.1.1 >>Include Code Sequence Macro Table Baseline Context ID is???. Stage Number (0008,2122) 1 A number that identifies the Stage. Stage Number starts at one. See Section C.8.5.y.1.4 View Number (0008,2128) 2 A number that identifies the View. Can be empty if View Number is unknown or if known, View Number starts at one. See Section C.8.5.y.1.5 Transducer Position Sequence (0008,2240) 2 Sequence of one or more Items that identifies the transducer position used in this image. See section C.8.5.y.1.2. >Include Code Sequence Macro Table Baseline Context ID is 4. > Transducer Position Modifier Sequence (0008,2242) 3 Sequence of one or more Items that modifies the primary transducer position of interest in this image. See Section C.8.5.y.1.2. >>Include Code Sequence Macro Table Baseline Context ID is 5. Transducer Orientation Sequence (0008,2244) 2 Sequence of one or more Items that identifies the Transducer Orientation used in this image. See section C.8.5.y.1.3.

17 Supplement 45: Ultrasound Protocol Page 11 >Include Code Sequence Macro Table Baseline Context ID is 6. > Transducer Orientation Modifier Sequence (0008,2246) 3 Sequence of one or more Items that modifies the primary Transducer Orientation of interest in this image. See Section C.8.5.y.1.3 >>Include Code Sequence Macro Table Baseline Context ID is 7. Note: Images that are part of a staged acquisition protocol should be identified by using Stage Type Sequence (0008,xxxx), Transducer Position Sequence (0008, 2240) and Transducer Orientation Sequence (0008,2244). Stage Number (0008,2122), View Number (0008,2128), Number of Stages (0008,2124), Number of Views in Stage (0008,212A) and Stage Name (0008, 2120) are maintained for backwards compatibility but may produce ambiguous results when used to identify a staged acquisition protocol. C.8.5.y.1 C.8.5.y.1.1 US Staged Protocol Attribute Descriptions Stage Type Sequence These Data Elements are intended to replace Stage Name (0008,2120) Data Element. Stage Type Sequence (0008,xxxx) describes the acquisition protocol stage when the image was acquired. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX Note: The existence of this attribute means that this image is part of an staged protocol. Note: The following will not be included in the standard. The following terms must be defined and a new Context ID created for them: These codes have been defined by SNOMED and are available. There is some debate that SNOMED requires a licensing fee, so these terms need to be defined in such a way that is agreeable to Working Group 6. Code Meaning (0008,0104) Code Value (0008,0100) Image acquisition procedure P Image acquisition after administration of contrast agent P Image acquisition during cardiac pacing P Image acquisition at user-defined cardiac pacing rate P Image acquisition during hand grip maneuver P Image acquisition during Valsalva P Image acquisition during postural maneuver P Pre-procedure image acquisition P Preoperative image acquisition P Intra-procedure image acquisition P Intra-operative image acquisition P Post-procedure image acquisition P Post-operative image acquisition P Image acquisition following first cardiopulmonary bypass P

18 12 Image acquisition following second cardiopulmonary P bypass Image acquisition following third cardiopulmonary bypass P Image acquisition during stress procedure P Image acquisition at baseline P Pre-stress image acquisition P Mid-stress image acquisition P Peak-stress image acquisition P Image acquisition during recovery P Image acquisition after drug administration P Image acquisition at user-defined dobutamine dose P Image acquisition at low-dose dobutamine P Image acquisition at mid-dose dobutamine P Image acquisition at peak dose dobutamine P Image acquisition at dobutamine 5 mcg/kg/min P Image acquisition at dobutamine 10 mcg/kg/min P Image acquisition at dobutamine 20 mcg/kg/min P Image acquisition at dobutamine 30 mcg/kg/min P Image acquisition at dobutamine 40 mcg/kg/min P Image acquisition at dobutamine 50 mcg/kg/min P Image at dobutamine 40 mcg/kg/min plus atropine P5-0131A Image acquisition at dobutamine 50 mcg/kg/min plus P5-0131B atropine Image acquisition at peak Arbutamine dose P Image acquisition at peak dipyridamole P Image acquisition after nitroglycerin P Image acquisition after amyl nitrite P Image acquisition after adenosine P Stage Type Modifier Sequence (0008,xxxx) modifies the primary acquisition protocol stage when the image was acquired. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX. C.8.5.y.1.2 Transducer Position Sequence Transducer Position Sequence (0008,2240) identifies the transducer position used in this image. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 4. Transducer Position Modifier Sequence (0008,2242) modifies the transducer position used in this image. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 5.

19 C.8.5.y.1.3 Transducer Orientation Sequence Supplement 45: Ultrasound Protocol Page 13 Transducer Orientation Sequence (0008,2244) identifies the transducer orientation used in this image. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 6. Transducer Orientation Modifier Sequence (0008,2246) modifies the transducer orientation used in this image. The Coding Scheme Designator (0008,0102) shall be SNM3. The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 7. C.8.5.y.1.4 Stages The Number of Stages (0008,2124) shall be the total number of stages performed in this instance of the protocol. Stage Number (0008,2122) shall be the number that indicates the default order in which the stages are to be presented. Stage Number shall start from 1. C.8.5.y.1.5 Views The View Number (0008,2128) shall be used identify the same view across stages and defines a default order for presentation within and across stages. If a particular view appears in one stage but not in a subsequent stage, then that View Number will not be used during that subsequent stage. View Number shall start from 1. The Number of Views in Stage (0008,212A) shall be used to indicate how many unique View Numbers exist for this stage. The addition of modification of the value for this attribute shall not by itself force a SOP Instance UID change.

20 14 Changes to: NEMA Standards Publication PS Digital Imaging and Communications in Medicine (DICOM) Part 6: Data Dictionary

21 Supplement 45: Ultrasound Protocol Page REGISTRY OF DICOM DATA ELEMENTS Add the following Data Elements to PS 3.6, Section 6. Tag Name VR VM (0008,xxxx) Stage Type Sequence SQ 1 (0008,xxxx) Stage Type Modifier Sequence SQ 1 (0018,xxxx) Protocol Type Sequence SQ 1 (0018,xxxx) Protocol Type Modifier Sequence SQ 1

22 16 Changes to: NEMA Standards Publication PS Digital Imaging and Communications in Medicine (DICOM) Part 11: Media Storage Application Profiles

23 Supplement 45: Ultrasound Protocol Page 17 2 Item: Add to PS 3.11 Section C for clarity, that text which is removed from the existing standard is shown as Strikethrough and that text which is changed or new is shown in Underlined C Additional Keys File Set Creators and Updaters are only required to generate mandatory elements specified in PS Table C.3-4 specifies the additional associated keys that shall be supported. Refer to the Basic Directory IOD in PS 3.3. At each directory record level any additional data elements can be added as keys, but is not required by File Set Readers to be able to use them as keys. Table C.3-4 STD-US-XX-XX-XXXX ADDITIONAL DICOMDIR KEYS Key Attribute Tag Directory Record Type Protocol Type Sequence Type Notes (0018,xxxx) SERIES 2C Sequence of one or more Items that identifies the protocol used to acquire this image. Required if US Series module is included. >Include Code Sequence Macro Table Baseline Context ID is???. >Protocol Type Modifier Sequence See Part 3.3 Section C.8.5.x.1.y (0018,xxxx) SERIES 3 Sequence of one or more Items that modifies the primary protocol type used to acquire this image. >>Include Code Sequence Macro Table Baseline Context ID is???. Performed Procedure Step ID See Part 3.3 Section C.8.5.x.1.y (0040,0253) SERIES 1C Identification of that Procedure that has been carried out within this step. Required if series was part of a performed procedure step. Number of Stages (0008,2124) IMAGE 2C Number of Stages in this protocol. Required if Stage Type Sequence (0008,xxxx) is present. Number of Views in Stage See Part 3.3 Section C.8.5.y.1.4 (0008,212A) IMAGE 2C Number of unique views in this Stage. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.5

24 18 Stage Type Sequence (0008,xxxx) IMAGE 2C Sequence of one or more items that identifies the acquisition protocol stage when the image was acquired. Required US Protocol module is present. >Include Code Sequence Macro Table Baseline Context ID is???. >Stage Type Modifier Sequence See Part 3.3 Section 8.5.y.1.1 (0008,xxxx) IMAGE 3 Sequence of one or more Items that modifies the primary stage type in this image. >>Include Code Sequence Macro Table Baseline Context ID is???. See Part 3.3 Section 8.5.y.1.1 Stage Number (0008,2122) IMAGE 1C A number that identifies the Stage. Stage Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.4 View Number (0008,2128) IMAGE 1C A number that identifies the View. View Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. Transducer Position Sequence See Part 3.3 Section C.8.5.y.1.5 (0008,2240) IMAGE 2C Sequence of one or more Items that identifies the transducer position used in this image. Required if Stage Type Sequence (0008,xxxx) is present. >Include Code Sequence Macro Table Baseline Context ID is 4. > Transducer Position Modifier Sequence See Part 3.3 Section C.8.5.y.1.2. (0008,2242) IMAGE 3 Sequence of one or more Items that modifies the primary transducer position of interest in this image. >>Include Code Sequence Macro Table Baseline Context ID is 5. Transducer Orientation Sequence See Part 3.3 Section C.8.5.y.1.2. (0008,2244) IMAGE 2C Sequence of one or more Items that identifies the Transducer Orientation used in this image. Required if Stage Type Sequence (0008,xxxx) is present. >Include Code Sequence Macro Table Baseline Context ID is 6. See Part 3.3 Section C.8.5.y.1.3.

25 > Transducer Orientation Modifier Sequence Supplement 45: Ultrasound Protocol Page 19 (0008,2246) IMAGE 3 Sequence of one or more Items that modifies the primary Transducer Orientation of interest in this image. >>Include Code Sequence Macro Table Baseline Context ID is 7. See Part 3.3 Section C.8.5.y.1.3 2