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Correction Number DICOM Correction Item CP-626 Log Summary: Type of Modification Clarification Rationale for Correction Name of Standard PS 3.3 2004 + Sup 83 The description of pixel spacing related attributes does not make it entirely clear that the first value (row spacing) is the spacing between the center of adjacent rows, and the second value (column spacing) is the spacing between the center of adjacent columns. It is proposed to clarify and illustrate this, in a similar manner to Pixel Aspect Ratio. It is not expected that this has ever been actually been misinterpreted, since practically all implementations affected by the pixel spacing attributes use square pixels. Sections of documents affected PS 3.3 Correction Wording: Amend PS 3.3 Section C.7.6.2: C.7.6.2 Image Plane Module Table C.7-10 IMAGE PLANE MODULE ATTRIBUTES Pixel Spacing (0028,0030) 1 Physical distance in the patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Add new PS 3.3 Section C.7.6.2.1.3: 1

C.7.6.2.1.3. Pixel Spacing All pixel spacing related attributes are encoded as the physical distance between the centers of each two-dimensional pixel, specified by two numeric values. The first value is the row spacing in mm, that is the spacing between the centers of adjacent rows, or vertical spacing. The second value is the column spacing in mm, that is the spacing between the centers of adjacent columns, or horizontal spacing. To illustrate, consider the following example: Column spacing = 0.25 mm Row spacing = 0.30 mm Pixel Spacing = Row Spacing \ Column Spacing = 0.30 mm \0.25 mm. This description applies to: Pixel Spacing (0028,0030) Imager Pixel Spacing (0018,1164) Nominal Scanned Pixel Spacing (0018,2010) Image Plane Pixel Spacing (3002,0011) Compensator Pixel Spacing (300A,00E9) Detector Element Spacing (0018,7022) Presentation Pixel Spacing (0070,0101) Printer Pixel Spacing (2010,0376) Object Pixel Spacing in Center of Beam (0018,9404) Amend PS 3.3 Section C.7.6.16.2.1: 2

C.7.6.16.2.1 Pixel Measures Macro Table C.7.6.16-2 PIXEL MEASURES MACRO ATTRIBUTES Pixel Measures Sequence (0028,9110) 1 Identifies the physical characteristics of the pixels of this frame. Only a single Item shall be permitted in this sequence. >Pixel Spacing (0028,0030) 1C Physical distance in the patient between the centers of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Note: In the case of CT images with an Acquisition Type (0018,9302) of CONSTANT_ANGLE, the pixel spacing is that in a plane normal to the central ray of the diverging X-ray beam as it passes through the data collection center. Required if Volumetric Properties (0008,9206) is other than DISTORTED or SAMPLED. May be present otherwise. Amend PS 3.3 Section C.7.6.16.2.2.4: C.7.6.16.2.2.4 Concatenations and Stacks In order to allow interoperable operations on stacks, 2 different frames with the same Stack ID (0020,9056) can only have the same In-Stack Position Number (0020,9057) if they have the same values for the following attributes: 1. Dimension Organization UID (0020,9164) or if absent Concatenation UID (0020,9133) to qualify the Stack ID 2. Image Position (Patient) (0020,0032) 3. Image Orientation (Patient) (0020,0037) 4. Rows (0028,0010) first value of Pixel Spacing (0028,0030) (= field of view in the row direction) 5. Columns (0028,0011) second value of Pixel Spacing (0028,0030) (= field of view in the column direction) 6. Slice Thickness (0018,0050) Amend PS 3.3 Section C.8.1.2: 3

C.8.1.2 CR Image Module Table C.8-2 CR IMAGE MODULE ATTRIBUTES Imager Pixel Spacing (0018,1164) 3 Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel. Specified by a numeric pair - row spacing value (delimiter) column spacing value - in mm. See C.7.6.2.1.3 for further In the case of CR, the front plane is defined to be the external surface of the CR plate closest to the patient and radiation source. Amend PS 3.3 Section C.8.4.7: C.8.4.7 NM Image Pixel Module Table C.8-6 NM IMAGE PIXEL MODULE ATTRIBUTES Pixel Spacing (0028,0030) 2 Physical distance in the patient between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing, in mm. See C.7.6.2.1.3 for further Amend PS 3.3 Section C.8.6.3: C.8.6.3 SC Multi-frame Image Module Table C.8-25b SC MULTI-FRAME IMAGE MODULE ATTRIBUTES Nominal Scanned Pixel Spacing (0018,2010) 1C Physical distance on the media being digitized or scanned between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 4

for further Required if Conversion Type (0008,0064) is DF (Digitized Film). May also be present if Conversion Type (0008,0064) is SD (Scanned Document) or SI (Scanned Image). Shall be consistent with Pixel Aspect Ratio(0028,0034), if present. Amend PS 3.3 Section C.8.7.2: C.8.7.2 X-Ray Acquisition Module Table C.8-27 X-RAY ACQUISITION MODULE ATTRIBUTES Imager Pixel Spacing (0018,1164) 3 Physical distance measured at the front plane of the Image Receptor housing between the center of each pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See C.7.6.2.1.3 for further Amend PS 3.3 Section C.8.8.2: C.8.8.2 RT Image Module Table C.8-38 RT IMAGE MODULE ATTRIBUTES Image Plane Pixel Spacing (3002,0011) 2 Physical distance (in mm) between the center of each image pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See C.8.8.2.3 and C.7.6.2.1.3 for further C.8.8.2.3 Image Plane Pixel Spacing and RT Image SID The Image Plane Pixel Spacing (3002,0011) attribute shall always be defined on the image plane, i.e. at the radiation machine source to image plane distance specified by RT Image SID 5

(3002,0026). For images where the source-image distance is undefined or unknown (e.g. DRR images), RT Image SID (3002,0026) shall equal Radiation Machine SAD (3002,0022) and Image Plane Pixel Spacing (3002,0011) shall be defined on this common plane. Amend PS 3.3 Section C.8.8.14: C.8.8.14 RT Beams Module Table C.8-50 RT BEAMS MODULE ATTRIBUTES >>Compensator Pixel Spacing (300A,00E9) 1C Physical distance (in mm) between the center of each pixel projected onto machine isocentric plane. Specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing. See C.7.6.2.1.3 for further Required if Compensator Sequence (300A,00E3) is sent. Amend PS 3.3 Section C.8.11.4: C.8.11.4 DX Detector Module Table C.8-71 DX DETECTOR MODULE ATTRIBUTES Imager Pixel Spacing (0018,1164) 1 Physical distance measured at the front plane of the detector housing between the center of each image pixel specified by a numeric pair - row spacing value(delimiter) column spacing value in mm. See C.7.6.2.1.3 for further Detector Element Physical Size (0018,7020) 3 Physical dimensions of each detector element that comprises the detector matrix, in mm. Expressed as row dimension followed by column. Note: This may not be the same as Detector Element Spacing (0018,7022) due to the presence of spacing material between detector elements. Detector Element Spacing (0018,7022) 3 Physical distance between the center of each detector element, specified by a numeric pair - row spacing value(delimiter) 6

column spacing value in mm. See C.7.6.2.1.3 for further Note: This may not be the same as the Imager Pixel Spacing (0018,1164), and should not be assumed to describe the stored image. Amend PS 3.3 Section C.8.15.3.7: C.8.15.3.7 CT Reconstruction Macro Table C.8-123 CT RECONSTRUCTION MACRO ATTRIBUTES >Reconstruction Pixel Spacing (0018,9322) 1C Physical distance in the patient between the center of each reconstructed pixel, specified by a numeric pair adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Required if Frame Type (0008,9007) Value 1 of this frame is ORIGINAL. May be present otherwise. Amend PS 3.3 Section C.8.17.2: C.8.17.2 Ophthalmic Photography Image Module Table C.8.17.2-1 OPHTHALMIC PHOTOGRAPHY IMAGE MODULE ATTRIBUTES 7

Pixel Spacing (0028,0030) 1C Nominal physical distance at the focal plane (in the retina) between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Note: These values are specified as nominal because the physical distance may vary across the field of the images and the lens correction is likely to be imperfect. Required when Acquisition Device Type Code Sequence (0022,0015) contains an item with the value (SRT, R- 1021A, Fundus Camera ). May be present otherwise. Amend PS 3.3 Section C.10.4: C.10.4 Displayed Area Module 8

Table C.10-4 DISPLAYED AREA MODULE ATTRIBUTES >Presentation Pixel Spacing (0070,0101) 1C Physical distance between the center of each pixel in the referenced image (before spatial transformation), specified by a numeric pair adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Notes: 1. This value may be different from Pixel Spacing (0028,0030) or Imager Pixel Spacing (0018,1164) specified in the referenced image, which are ignored, since some form of calibration may have been performed (for example by reference to an object of known size in the image). 2. If the row and column spacing are different, then the pixel aspect ratio of the image is not 1:1. Required if Presentation Size Mode (0070,0100) is TRUE SIZE, in which case the values will correspond to the physical distance between the center of each pixel on the display device. May be present if Presentation Size Mode (0070,0100) is SCALE TO FIT or MAGNIFY, in which case the values are used to compute the aspect ratio of the image pixels. >Presentation Pixel Aspect Ratio (0070,0102) 1C Ratio of the vertical size and the horizontal size of the pixels in the referenced image, to be used to display the referenced image, specified by a pair of integer values where the first value is the vertical pixel size and the second value is the horizontal pixel size. See C.7.6.3.1.7. Required if Presentation Pixel Spacing (0070,0101) is not present. Notes: 1. This value may be different from the aspect ratio specified by Pixel Aspect Ratio (0028,0034) in the referenced image, or implied by the values of Pixel Spacing (0028,0030) or Imager Pixel Spacing (0018,1164) specified in the referenced image, which are ignored. 2. This value must be specified even if the aspect ratio is 1:1. 9

Amend PS 3.3 Section C.13.13: C.13.13 Printer Configuration Module Table C.13-13 PRINTER CONFIGURATION MODULE Attribute Name Tag Attribute Description >>Printer Pixel Spacing (2010,0376) Physical distance on the printed film between the center of each pixel, specified by a numeric pair - adjacent row spacing (delimiter) adjacent column spacing in mm. See C.7.6.2.1.3 for further Amend PS 3.3 + Sup 83 Section C.8.X.3: C.8.X.3 XA/XRF Acquisition Module Table C.8.X3-1 XA/XRF ACQUISITION MODULE ATTRIBUTES Imager Pixel Spacing (0018,1164) 1 Physical distance measured at the receptor plane of the detector between the centers of each pixel specified by a numeric pair row spacing value (delimiter) column spacing value in mm. See C.7.6.2.1.3 for further Note: These values are the actual pixel spacing distances of the stored pixel values of an image. Amend PS 3.3 + Sup 83 Section C.8.X.3: C.8.X.6.9 X-Ray Projection Pixel Calibration Macro Table C.8.X6-9 specifies the attributes of the X-Ray Projection Pixel Calibration Functional Group macro. Table C.8.X6-9 X-RAY PROJECTION PIXEL CALIBRATION MACRO ATTRIBUTES >Object Pixel Spacing in Center of Beam (0018,9404) 1C Physical distance within the anatomic region of interest in the center of the 10

C.8.X.6.9.2 Object Pixel Spacing in Center of Beam beam and perpendicular to the beam between the center of each pixel, specified by a numeric pair adjacent row spacing (delimiter) adjacent column spacing in mm. See C.8.X.6.9.12 and C.7.6.2.1.3 for further Required if Distance Object to Table Top (0018,9403) is not empty. Note: This value is provided besides the values that are the input parameters of the calibration algorithm. The value provided for the Beam Angle (0018,9449) attribute shall correspond to the other attribute values within this module and according to the mathematic terms listed in section C.8.X.6.9.1. The terms listed will result in infinite result when used with 90-degree beam angles. It is outside the scope of this Standard to define reasonable limits for single input values in the above-mentioned terms, or to define the mathematical accuracy of applications using those terms. Note: It may be reasonable to limit automatic calculations to a narrow range of +/- 60 degrees for Beam Angle and inform users about possible deviations in the calibration result when exceeding such range limits. 11