FocalSim DICOM Conformance Statement. Table of Contents:

FocalSim DICOM Conformance Statement The following is the statement of conformance for the CMS FocalSim product for DICOM 3.0. This conformance statement does not apply to other products. If you have any questions, contact your Customer Support Specialist. Table of Contents: FocalSim... 1 DICOM Conformance Statement... 1 Table of Contents:... 1 Introduction... 5 1. Implementation Model... 6 1.1 Application Flow Diagram... 6 1.1.1 CT/MR/PET Image Import... 6 1.1.2 Secondary Capture Image Export... 7 1.1.3 Plan Export... 7 1.1.4 Structure Set Export... 7 1.1.5 CT/MR/PET/NM Image Export... 8 1.2 Functional Definition of Application Entities (AE)... 8 1.2.1 CT/MR/PET/NM Image Import... 8 1.2.2 CT/MR/PET/NM Image Export... 8 1.2.3 Secondary Capture Image Export... 9 1.2.4 Plan Export... 9 1.2.5 Structure Sets Export... 9 1.2.6 DRR Print... 9 1.3 Sequencing of Real-World Activities... 9 1.3.1 CT/MR/PET/NM Image... 9 1.3.2 Secondary Capture Image Export... 9 1.3.3 Plan, Structure Sets, CT/MR/PET/NM Image Export... 10 2. AE Specifications... 11 2.1 Secondary Capture Storage Client AE Specification... 11 2.1.1 Association Establishment Policies... 11 2.1.1.1 General... 11 2.1.1.2 Number of Associations... 11 2.1.1.3 Asynchronous Nature... 11 2.1.1.4 Implementation Identifying Information... 11 2.1.2 Association Initiation by Real-World Activity... 11 2.1.2.1 Image Storage Operations... 12 1

2.1.2.1.1 Associated Real-World Activity... 12 2.1.2.1.2 Proposed Presentation Contexts... 12 2.1.2.1.2.1 SOP Specific Conformance Statement for the Secondary Capture Image Storage SOP Class... 12 2.1.3 Association Acceptance Policy... 14 2.2 Print Client AE Specification... 14 2.2.1 Association Establishment Policies... 14 2.2.1.1 General... 14 2.2.1.2 Number of Associations... 15 2.2.1.3 Asynchronous Nature... 15 2.2.1.4 Implementation Identifying Information... 15 2.2.2 Association Initiation by Real-World Activity... 15 2.2.2.1 Image Printing Operations... 15 2.2.2.1.1 Associated Real-World Activity... 15 2.2.2.1.2 Proposed Presentation Contexts... 15 2.2.2.1.2.1 SOP Specific Conformance Statement for the Basic Grayscale Print Management Meta SOP Class... 16 Description... 16 2.2.3 Association Acceptance Policy... 17 2.3 RT Plan Client AE Specification... 17 2.3.1 Association Establishment Policies... 17 2.3.1.1 General... 17 2.3.1.2 Number of Associations... 18 2.3.1.3 Asynchronous Nature... 18 2.3.1.4 Implementation Identifying Information... 18 2.3.2 Association Initiation by Real-World Activity... 18 2.3.2.1 Plan Export Operations... 18 2.3.2.1.1 Associated Real-World Activity... 18 2.3.2.1.2 Proposed Presentation Contexts... 18 2.3.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class... 19 Export NONE... 29 2.3.3 Association Acceptance Policy... 30 2.4 RT Structure Set Client AE Specification... 30 2.4.1 Association Establishment Policies... 30 2.4.1.1 General... 30 2.4.1.2 Number of Associations... 30 2.4.1.3 Asynchronous Nature... 31 2.4.1.4 Implementation Identifying Information... 31 2.4.2 Association Initiation by Real-World Activity... 31 2.4.2.1 Structure Set Export Operations... 31 2.4.2.1.1 Associated Real-World Activity... 31 2.4.2.1.2 Proposed Presentation Contexts... 31 2.4.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class... 32 2.5 Image Client AE Specification... 34 2

2.5.1 Association Establishment Policies... 35 2.5.1.1 General... 35 2.5.1.2 Number of Associations... 35 2.5.1.3 Asynchronous Nature... 35 2.5.1.4 Implementation Identifying Information... 35 2.5.2 Association Initiation by Real-World Activity... 35 2.5.2.1 CT Image Export Operations... 35 2.5.2.1.1 Associated Real-World Activity... 35 2.5.2.1.2 Proposed Presentation Contexts... 35 2.5.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class... 36 2.5.2.2 MR Image Export Operations... 39 2.5.2.2.1 Associated Real-World Activity... 39 2.5.2.2.2 Proposed Presentation Contexts... 39 2.5.2.2.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class... 39 Group... 40 2.5.2.3 PET Image Export Operations... 42 2.5.2.3.1 Associated Real-World Activity... 42 2.5.2.3.2 Proposed Presentation Contexts... 42 2.5.2.3.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class... 43 Description... 45 2.6 Storage Server AE Specification... 47 2.6.1 Association Establishment Policies... 47 2.6.1.1 General... 47 2.6.1.2 Number of Associations... 47 2.6.1.3 Asynchronous Nature... 47 2.6.1.4 Implementation Identifying Information... 47 2.6.2 Association Initiation by Real-World Activity... 47 2.6.3 Association Acceptance Policy... 48 2.6.3.1 Echo Check Operation... 48 2.6.3.1.1 Associated Real-World Activity... 48 2.6.3.1.2 Presentation Contexts Accepted... 48 2.6.3.1.3 Presentation Context Acceptance Criterion... 48 2.6.3.1.4 Transfer Syntax Selection Policies... 48 2.6.3.2 Image Storage Operations... 48 2.6.3.2.1 Associated Real-World Activity... 49 2.6.3.2.2 Presentation Contexts Accepted... 49 2.6.3.2.2.1 SOP Specific Conformance Statement for the CT/MR/PET Image Storage SOP Class... 49 3. Communication Profiles... 52 3.1 Supported Communication Stacks... 52 3.1.1 TCP/IP Stack... 52 3.1.1.1 Application Programmer's Interface (API)... 52 3.1.2 Physical Media Supported... 52 3

4. Extensions/Specializations/ Privatization... 53 4.1 Standard Extended/Specialized/Private SOPs... 53 4.2 Private Transfer Syntaxes... 53 5. Configuration... 54 5.1 AE Title/Presentation Address Mapping... 54 5.2 Configurable Parameters... 55 6. Support of Extended Character Sets... 56 4

Introduction FocalSim is a CT Simulation System used to develop treatment plans for cancer patients. FocalSim uses DICOM services to import images and to export images, plans, structure sets, and DRR as secondary capture to other vendors. The FocalSim system supports import of CT, MR, and PET images. It supports export of RT Plans, Structure Sets, DRR secondary capture images, and CT, MRI and PET images Import of CT, MR, PET, and NM images is accomplished by the DICOM server named FocalDICOMService. This enables FocalSim to receive DICOM 3.0 compatible CT, MR, and PET. The server software was developed using the MergeCOM-3 Advanced Software Tool Kit for DICOM V3.0 Services, supplied by Merge Technologies, Inc., Milwaukee, WI. MergeCOM-3 Advanced facilitates the development of DICOM conformant applications but is not an application in itself. Export of structure sets, CT/MRI/PET/NM images, and radiation therapy plans is accomplished through client software inside the DICOM Export Dialog of FocalSim. The DRR Print Dialog of FocalSim is responsible for export of secondary capture images to film printers using the Print Service Class. Client software was also developed using the MergeCOM-3 Advanced Software Tool Kit for DICOM V3.0 Services supplied by Merge Technologies. 5

1. Implementation Model 1.1 Application Flow Diagram 1.1.1 CT/MR/PET Image Import The client machine containing the data to be transferred, initiates the negotiation of an association with the FocalDICOM Server over the network. The FocalDICOM Server application will negotiate with the client and accept the association if it can perform the requested service. If the server accepts the association, CT, MR, PET and/or NM are then transferred from the client to the FocalDICOM Server over the association. When the transfer is complete the client application closes the association. The transferred images are then available to the FocalSim application. This process is illustrated in Figure 1. Merge Toolkit FocalSim SCP Printer SCU FocalDICOMService Disk File Figure 1 The DICOM Import/Export Flow Process 6

1.1.2 Secondary Capture Image Export Secondary capture image transfer is initiated by the FocalSim user selecting "Export to Printer under the DICOM selection in the DRR Print Dialog. The user can then select output to Secondary Capture. The FocalSim client application requests Storage Services of a DICOM v3.0 server over an association. If the server accepts the association, DICOM SC Images are then transferred from the FocalSim client to the server over the association. When the transfer is completed, the client application closes the association. The host name of the network device to which the image is to be sent must be specified in Mergecom.app. When output to "Film" is selected, the FocalSim client application requests Print Services of a DICOM V3.0 server over an association. If the server accepts the association, secondary capture images are then transferred from the FocalSim client to the print server over the association. When the transfer is completed the client application closes the association. 1.1.3 Plan Export The user can select to send the output to a file or to a DICOM 3.0 server over an association. The FocalSim client application requests Storage Services of a DICOM v3.0 server over an association. If the server accepts the association, DICOM RT plans are then transferred from the FocalSim client to the server over the association. When the transfer is completed, the client application closes the association. 1.1.4 Structure Set Export The user can select to send the output to a file or to a DICOM 3.0 server over an association. The FocalSim client application requests Storage Services of a DICOM v3.0 server over an association. If the server accepts the association, DICOM RT Structure Sets are then transferred from the FocalSim client to the server over the association. When the transfer is completed, the client application closes the association. 7

1.1.5 CT/MR/PET/NM Image Export The user can select to send the output to a file or to a DICOM 3.0 server over an association. The FocalSim client application requests Storage Services of a DICOM v3.0 server over an association. If the server accepts the association, DICOM images are then transferred from the FocalSim client to the server over the association. When the transfer is completed, the client application closes the association. Only images that have been imported to FocalSim can be exported. 1.2 Functional Definition of Application Entities (AE) 1.2.1 CT/MR/PET/NM Image Import The FocalDICOM Server accepts storage commands for CT, MR, PETor NM images, receives the data, and places it in a location accessible to FocalSim. If the DICOM header for a 16-bit CT image file defines a pixel padding value, FocalSim will convert all pixels equal to that padding value to the minimum pixel value that can be represented by the data type of that image. It is assumed that the CT manufacturer has selected a padding pixel value that is outside the range of the pixel values that make up the image. Pixel Padding values are ignored for MR, PET, and 8 bit images. 1.2.2 CT/MR/PET/NM Image Export The FocalSim application receives a request to transfer a CT, MR, PET or NM image and send the information either to the file system or to a DICOM server. 8

1.2.3 Secondary Capture Image Export The FocalSim application receives a request to transfer a secondary capture image, generates the secondary capture image from the DRR, overlays beam and customized port outline information, fiducial scales, and annotation text onto the image, and sends the information directly to the network. 1.2.4 Plan Export The export application is invoked for FocalSim to retrieve the plan, convert plan data to the RT Plan Object Definition, and send the information either to the file system or to a DICOM server. 1.2.5 Structure Sets Export The export application is invoked for FocalSim to retrieve the Structure Sets data, convert the structure sets data to the RT Structure Sets Object Definition, and send the information either to the file system or to a DICOM server. 1.2.6 DRR Print The printer application is invoked for FocalSim to export a selected DRR view and send the information either to a DICOM printer, a Windows Printer or to the file system. 1.3 Sequencing of Real-World Activities 1.3.1 CT/MR/PET/NM Image An operator initiates the transfer of data through the client application that initiates the storage command for CT, MR, PET or NM images. The FocalDICOM Server application receives the data and places it in a location accessible to FocalSim. The FocalSim operator initiates a transfer that reads the data and creates a FocalSim patient, or updates existing plan parameters. 1.3.2 Secondary Capture Image Export An operator initiates the export of secondary capture data via the DRR Print Dialog. The server system receives the data and either prints it or stores it. 9

1.3.3 Plan, Structure Sets, CT/MR/PET/NM Image Export An operator initiates the export of RT plan data, Structure Sets data, and/or CT/MR/PET images via the DICOM Export Dialog. The server system (SCP) receives the data and stores it. 10

2. AE Specifications 2.1 Secondary Capture Storage Client AE Specification FocalSim provides Standard Conformance to the following DICOM V3.0 Service Object Pair (SOP) Class as a Service Class User (SCU): SOP Class Name SOP Class UID SC Image Storage 1.2.840.10008.5.1.4.1.1.7 2.1.1 Association Establishment Policies 2.1.1.1 General The (PDU) size proposed in an association request will default to 16K bytes, and is configurable in the [ASSOC_PARMS] section of the mergecom.pro file to be anything from 2K bytes to 512K bytes using the parameter PDU_MAXIMUM_LENGTH. 2.1.1.2 Number of Associations The FocalSim client application will open and use one association at a time. 2.1.1.3 Asynchronous Nature Not supported. 2.1.1.4 Implementation Identifying Information The Implementation Class Unique Identifier (UID) for the FocalSim application is 2.16.840.1.113669.2.1.1. 2.1.2 Association Initiation by Real-World Activity Associations are initiated by the user via the DRR Print Dialog. They may not be aborted by the user. 11

2.1.2.1 Image Storage Operations The FocalSim client application initiates associations for the transfer of secondary capture images to a DICOM Image Storage Server. The client supports transfer of Secondary Capture (SC) image objects. 2.1.2.1.1 Associated Real-World Activity The user initiates the transfer of secondary capture images via the DRR Print Dialog. 2.1.2.1.2 Proposed Presentation Contexts The presentation context that can be proposed by the FocalSim client for the SC Image Storage operation is specified in the table below. Extended negotiation is not supported. Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List SC Image Storage 1.2.840.10008.5.1.4.1.1.7 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None Table 2 Image Storage Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List SC Image Storage 1.2.840.10008.5.1.4.1.1.7 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None 2.1.2.1.2.1 SOP Specific Conformance Statement for the Secondary Capture Image Storage SOP Class The following modules that make up the SC image IOD are sent. 12

Patient Module (C.7.1.1) 0010 0010 Patient s Name 0010 0020 Patient s ID 0010 0030 Patient s Birth Date 0010 0040 Patient s Sex 0010 1000 Other Patient s Ids 0010 1001 Other Patient s Names 0010 4000 Patient Comments General Study Module (C.7.2.1) 0020 000D Study Instance UID 0008 0020 Study Date 0008 0030 Study Time 0008 0090 Referring Physicians Name = UNKNOWN 0020 0010 Study ID 0008 0050 Accession Number = 1 General Series Module (C.7.3.1) 0008 0060 If the image is RT then the tag is "RTIMAGE". If the image is Secondary Capture then the tag is set to "CR". 0020 000E Series Instance UID 0020 0011 Series Number = 1 General Equipment Module (C.7.5.1) 0008 0070 Manufacturer = Computerized Medical Systems 0008 1040 Institutional Department Name 0008 1090 Manufacturer s Model Name = FOCAL SC Equipment Module (C.8.6.1) 0020 0013 Instance (Image) Number = 1 0008 0064 Conversion Type = WSD General Image Module (C.7.6.1) 0008 0008 Image Type = DERIVED/SECONDARY 13

Image Pixel Module (C.7.6.3) 0028 0002 Samples per Pixel = 1 0028 0004 Photometric Interpretation = MONOCHROME2 0028 0006 Planar Configuration = 1 0028 0034 Pixel Aspect Ratio = 1/1 0028 0010 Rows 0028 0011 Columns 0028 0100 Bits Allocated = 8 0028 0101 Bits Stored = 8 0028 0102 High Bit = 7 0028 0103 Pixel Representation = 0 7FE0 0010 Pixel Data SOP Common Module (C.12.1) 0008 0016 SOP Class UID = "1.2.840.10008.5.1.4.1.1.7 0008 0018 SOP Instance UID 2.1.3 Association Acceptance Policy Not applicable. 2.2 Print Client AE Specification FocalSim provides Standard Conformance to the following DICOM V3.0 Service Object Pair (SOP) Class as a Service Class User (SCU): SOP Class Name SOP Class UID Basic Grayscale Print Management Meta SOP Class 1.2.840.10008.5.1.1.9 2.2.1 Association Establishment Policies 2.2.1.1 General The (PDU) size proposed in an association request will default to 16K bytes and is configurable in the [ASSOC_PARMS] section of the mergecom.pro file to be anything from 2K bytes to 512K bytes using the parameter PDU_MAXIMUM_LENGTH. 14

2.2.1.2 Number of Associations The FocalSim client application will open and use one association at a time. 2.2.1.3 Asynchronous Nature Not supported. 2.2.1.4 Implementation Identifying Information The Implementation Class Unique Identifier (UID) for the FocalSim application is 2.16.840.1.113669.2.931128. 2.2.2 Association Initiation by Real-World Activity Associations are initiated by the user via the DRR Print Dialog. They may not be aborted by the user. 2.2.2.1 Image Printing Operations The FocalSim client application initiates associations for the transfer of DRR (secondary capture or RT images) to a DICOM Print Server. 2.2.2.1.1 Associated Real-World Activity The user initiates the transfer of images via the DRR Print Dialog. 2.2.2.1.2 Proposed Presentation Contexts The presentation context that can be proposed by the FocalSim client for the Image Printing operation is specified in the table below. Extended negotiation is not supported. Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name List UID List Neg. Basic Grayscale Print Management 1.2.840.10008.5.1.1.9 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None 15

Table 3 Image Printing Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List Basic Grayscale Print Management 1.2.840.10008.5.1.1.9 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None 2.2.2.1.2.1 SOP Specific Conformance Statement for the Basic Grayscale Print Management Meta SOP Class The following modules that make up the Basic Grayscale Print Management Meta SOP class are sent. Basic Film Session SOP Class Attributes 0000 0002 Affected SOP Class UID = 1.2.840.10008.5.1.1.1 0000 1001 Affected SOP Instance UID 2000 0010 Number of Copies 2000 0020 Print Priority = MED 2000 0030 Medium Type 2000 0040 Film Destination = PROCESSOR 2000 0050 Film Session Label = DICOM Print Basic Film Box SOP Class Attributes 2010 0010 Image Display Format = "STANDARD\1,1 2010 0500 Referenced Film Session Sequence 0008 1150 >Referenced SOP Class UID 0008 1155 >Referenced SOP Instance UID 2010 0040 Film Orientation 2010 0050 Film Size ID 2010 0060 Magnification Type = CUBIC 2010 0100 Border Density = BLACK 2010 0110 Empty Image Density = WHITE 2010 0140 Trim = YES 16

Basic Grayscale Image Box SOP Class Attributes 2020 0010 Image Position = 1 2020 0110 Preformatted Grayscale Image Sequence 0028 0002 Samples Per Pixel = 1 0028 0004 Photometric Interpretation = MONOCHROME2 0028 0010 Rows 0028 0011 Columns 0028 0034 Pixel Aspect Ratio = 1/1 0028 0100 Bits Allocated = 8 0028 0101 Bits Stored = 8 0028 0102 High Bit = 7 0028 0103 Pixel Representation = 0 7FE0 0010 Pixel Data Printer SOP Class Attributes 2010 0120 Min Density = 0 2010 0130 Max Density = 300 2020 0020 Polarity = NORMAL 2.2.3 Association Acceptance Policy Not applicable. 2.3 RT Plan Client AE Specification FocalSim provides Standard Conformance to the following DICOM V3.0 Service Object Pair (SOP) Class as a Service Class User (SCU): SOP Class Name SOP Class UID RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5 2.3.1 Association Establishment Policies 2.3.1.1 General The (PDU) size proposed in an association request will default to 16K bytes and is configurable in the [ASSOC_PARMS] section of the mergecom.pro file to be anything from 2K bytes to 512K bytes using the parameter PDU_MAXIMUM_LENGTH. 17

2.3.1.2 Number of Associations The FocalSim client application will open and use one association at a time. 2.3.1.3 Asynchronous Nature Not supported. 2.3.1.4 Implementation Identifying Information The Implementation Class Unique Identifier (UID) for the FocalSim application is 2.16.840.1.113669.2.1.1 2.3.2 Association Initiation by Real-World Activity Associations are initiated by the user via the DICOM Export Dialog. 2.3.2.1 Plan Export Operations The FocalSim client application initiates associations for the transfer of RT plans. 2.3.2.1.1 Associated Real-World Activity The user initiates the transfer of RT plans via the DICOM Export Dialog. 2.3.2.1.2 Proposed Presentation Contexts The presentation context that can be proposed by the FocalSim client for the RT Plan export operation is specified in the table below. Extended negotiation is not supported. Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List RT Plan Storage 1.2.840.10008.5.1.4.0.0.481.5 DICOM Implicit VR Big Endian 1.2.840.10008.2.2 SCU None Table 4 RT Plan Presentation Contexts 18

Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List RT Plan Storage 1.2.840.10008.5.1.4.1.1.481.5 DICOM Implicit VR Big Endian 1.2.840.10008.2.2 SCU None 2.3.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class The following modules that make up the DICOM RT Plan IOD are sent. Elements that are not supported for export from a FocalSim teletherapy plan are not listed. For several elements, the defined treatment machine parameters are mentioned. For each FocalSim treatment machine, the user should tailor the convention of FocalSim plan data to fit the receiving system's requirements by using these menus. The user can set a different machine name, define a "no wedge" ID, a constant block ID (e.g., custom), Patient Module (C.7.1.1) 0010 0010 Patient s Name (up to 14 characters) 0010 0020 Patient s ID - Primary hospital identification number or code for the patient. (Up to 24 characters) 0010 0030 Patient s Birth Date 0010 0040 Patient s Sex: M for male F for female O for unknown 0010 1000 Other Patient s Ids 0010 1001 Other Patient s Names 0010 4000 Patient Comments General Study Module (C.7.2.1) 0020 000D Study Instance UID - Unique identifier for the Study 0008 0020 Study Date 0008 0030 Study Time 0008 0090 Referring Physicians Name = UNKNOWN 0020 0010 Study ID - User or equipment generated study identifier 0008 0050 Accession Number = 1 19

RT Series Module (C.8.4.3.1) 0008 0060 Modality = RTPLAN 0020 000E Series Instance UID Unique identifier for the Series 0020 0011 Series Number = 1 General Equipment Module (C.7.5.1) 0008 0070 Manufacturer = Computerized Medical Systems 0008 1040 Institutional Department Name 0008 1090 Manufacturer s Model Name = FOCAL RT General Plan Module (C.8.8.9) 300A 0002 RT Plan Label 300A 0003 RT Plan Name (User defined name for treatment plan) 300A 0004 RT Plan Description (User defined description of treatment plan) 300A 0006 RT Plan Date (Date that the treatment plan was last modified). 300A 0007 RT Plan Time (Time that the treatment plan was last modified). 3000A 000C RT Plan Geometry Describes whether RT Plan is based on patient or treatment device geometry; Note: if original DICOM CT images are available, geometry is set to PATIENT; otherwise it s set to TREATMENT_DEVICE 300C 0060 Referenced Structure Set Sequence Only included if RT Plan Geometry is set to PATIENT 0008 1150 >Referenced SOP Class UID 0008 1155 >Referenced SOP Instance UID 0008 1070 Operator s Name (Name of operator(s) creating the treatment plan). Windows logon user ID. 20

300C 0006 >>Referenced Beam Number Uniquely identifies Beam specified by Beam Number (300A,00C0) within Beam Sequence (300A,00B0) in RT Beams Module. Export FocalSim Beam number (an integer value between 1 and 99) 300A 0082 Beam Dose Specification Point Coordinates (x,y,z) of point at which Beam Dose is specified in the patient based coordinate system described in C.7.6.2.1.1 (mm). See Note 3. Export Weight Point Coordinates in (millimeter coordinates to first decimal place) Note 3: (from DICOM Supplement 11) The Beam Dose Specification Point (300A,0082) and Brachy Application Setup Dose Specification Point (300A,00A2) contain the coordinates of the single point used for dose normalization. This point is distinct from the Referenced Dose Reference Sequence (300C,0050) in the RT Beams module and the Brachy Referenced Dose Reference Sequence (300A,0055) in the RT Brachy Application Setups module, which are used for plan evaluation and dose tracking. 300A 0084 Beam Dose Dose (in Gy) at Beam Dose Specification Point (300A,0082) due to current Beam. Export: if plan dose is calculated, export dose in Gy at the weight point per fraction to the third decimal place. 300A 0086 Beam Meterset Machine setting to be delivered for current Beam, specified in Monitor Units (MU) or minutes as defined by Primary Dosimeter Unit (300A,00B3) (in RT Beams Module) for referenced Beam. Note (from DICOM Supplement 11) The Meterset at a given Control Point (see RT Beams Module) is equal to the Beam Meterset (300A,0086) multiplied by the Cumulative Meterset Weight (300A,0134) for the Control Point, divided by the Final Cumulative Meterset Weight (300A,010E). 300A 00A0 Number of Brachy Application Setups = 0 RT Patient Setup Module (C.8.8.12) 300A 0180 Patient Setup Sequence; NOTE: ALWAYS OF LENGTH 1 300A 0182 Patient Setup Number; NOTE: ALWAYS 1 0018 5100 Patient position description. NOTE: This is either HFS (supine) or HFP (prone). It will never be FFS or FFP since FocalSim currently supports only head first treatment. Feet first scans will be converted to head first by the export software. 21

RT Beams Module (C.8.8.14) 300A 00B0 Beam Sequence Introduces sequence of treatment beams for current RT Plan. One or more items may be included in this sequence. 300A 00C0 >Beam Number Identification number of the Beam. This value shall be unique within the RT Plan in which it is created. Export FocalSim Beam number (an integer between 1 and 99) 300A 00C2 >Beam Name - User-defined name for Beam Export FocalSim beam description (up to 24 characters) 300A 00C3 >Beam Description - User-defined description for Beam. Export FocalSim beam description 300A 00C4 >Motion Characteristic of Beam Enumerated Values: STATIC = all beam parameters remain unchanged during delivery DYNAMIC = one or more beam parameters change during delivery 300A 00C6 >Radiation Type Particle type of Beam. Enumerated Values: PHOTON, ELECTRON, NEUTRON, PROTON. Export: PHOTON; only PHOTON supported in FocalSim. 300A 00B2 >Treatment Machine Name User defined name identifying treatment machine used in beam delivery. Export machine ID from FocalSim' s Export customization page. This may be a different machine name than is used on FocalSim 0008 1040 Institutional Department Name Department in the institution where the equipment is located that is to be used for beam delivery. Export FocalSim Clinic Name 300A 00B3 Primary Dosimeter Unit Measurement unit of machine dosimeter. Enumerated Values: MU = Monitor Unit MINUTE = minute Export units identified in FocalSim for this machine 300C 00A0 Reference Tolerance Table Number Uniquely identifies Tolerance Table specified by Tolerance Table Number (300A,0042) within Tolerance Table Sequence in RT Tolerance Tables Module. These tolerances are to be used for verification of treatment machine settings. NOT EXPORTED. 22

300A 00B4 300A 00B6 Source-Axis Distance Radiation source to Gantry rotation axis distance of the equipment that is to be used for beam delivery (mm). Export machine reference distance defined in FocalSim for this machine Beam Limiting Device Sequence Introduces sequence of beam limiting device (collimator) jaw or leaf (element) sets. One or more items may be included in this sequence. Export: a minimum of two and up to three collimator sequences will be sent for each beam- an X jaw pair, a Y jaw pair and MLC, if one exists. MLCX is only MLC currently available MLC in FocalSim. 300A 00B8 RT Beam Limiting Device Type Type of beam limiting device (collimator). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Export: Start with the X jaw and export settings according to plan (asymmetric versus symmetric). Create a second sequence with the Y jaw and finish with the MLCX if one is in the beam. FocalSim will export 3 devices when there is an MLC, even for jaw replacement MLCs. 300A 00BA Source to Beam Limiting Device Distance Radiation source to beam limiting device (collimator) distance of the equipment that is to be used for beam delivery (mm). Export beam s source to collimator distance for the X, Y or MLC collimator as appropriate 300A 00BC Number of Leaf/Jaw Pairs Number of leaf (element) or jaw pairs (equal to 1 for standard beam limiting device jaws). Export 1 if not MLC, if MLC, read value from FocalSim s MLC appropriate machine file 300A 00BE Leaf Position Boundaries Boundaries of beam limiting device (collimator) leaves (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), i.e. X-axis for MLCY, Y-axis for MLCX. Contains N+1 values, where N is the Number of Leaf/Jaw Pairs (300A,00BC), starting from Leaf (Element) Pair 1. Required if Beam Limiting Device Sequence (300A,00B6) is sent and RT Beam Limiting Device Type (300A,00B8) is MLCX or MLCY. See Note 2. Export values from FocalSim s MLC for appropriate machine file 23

300A 00CE Treatment Delivery Type Delivery Type of treatment. Defined Terms: TREATMENT = normal patient treatment OPEN_PORTFILM = portal image acquisition with open field TRMT_PORTFILM = portal image acquisition with treatment port CONTINUATION = continuation of interrupted treatment Export TREATMENT 300A 00D0 Number of Wedges Number of wedges associated with current beam. Export 0. 300A 00D1 Wedge Sequence Introduces sequence of treatment wedges. Required if Number of Wedges (300A,00D0) is non-zero. One or more items may be included in this sequence. NEVER USED Wedges not supported in FocalSim. 300A 00D2 >Wedge Number Identification number of the Wedge. The value of Wedge Number (300A,00D2) shall be unique within the Beam in which it is created. Export 1 if a wedge exists or if the user has entered a "NONE" to map to no wedge; otherwise 0 300A 00D3 >Wedge Type Type of wedge (if any) defined for Beam. Defined Terms (see IEC 788): STANDARD = standard (static) wedge DYNAMIC = moving beam limiting device (collimator) jaw simulating wedge MOTORIZED = single wedge which can be removed from beam remotely The following FocalSim wedge terms are exported as follows: FIXED=STANDARD 300A 00D4 >Wedge ID - User-supplied identifier for Wedge. Export FocalSim wedge ID 300A 00D5 >Wedge Angle - Nominal wedge angle (degrees). Export wedge angle or null for no wedge or STANDARD wedge. 300A 00D6 >Wedge Factor - Nominal wedge factor under machine calibration conditions at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Export wedge correction factor. For NONE export 1.0 24

300A 00D8 >Wedge Orientation - Orientation of wedge, i.e. orientation of IEC WEDGE FILTER coordinate system with respect to IEC BEAM LIMITING DEVICE coordinate system (degrees). For Fixed wedges export offset of wedge heel with respect to IEC BEAM LIMITING DEVICE coordinate system as follows FocalSim Heel In= 180 FocalSim Heel out= 0 FocalSim Heel Left= 270 FocalSim Heel Right= 90 For NONE wedge export 0 For MOTORIZED, export 0 300A 00DA >Source to Wedge Tray Distance - Radiation source to wedge tray attachment edge distance (in mm) for current wedge. Export wedge tray distance parameter from machine file For NONE do not export 300A 00E0 Number of Compensators Always = 0 300A 00ED Number of Boli Always = 0 300A 00F0 Number of Blocks Number of shielding blocks associated with Beam. Export total number of ports and blocks in the beam (FocalSim maximum is 20) 300A 00F2 300A 00F4 Total Block Tray Factor Total block tray transmission for all block trays (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Export machine Composite Tray factor Block Sequence - Introduces sequence of blocks associated with Beam. Required if Number of Blocks (300A,00F0) is non-zero. One or more items may be included in this sequence. 300A 00F5 >Block Tray ID - User-supplied identifier for block tray. Export tray description if defined otherwise null. 300A 00F6 >Source to Block Tray Distance - Radiation Source to attachment edge of block tray assembly (mm). Export source to block tray distance from FocalSim' treatment machine parameters 300A 00F8 >Block Type - Type of block. Enumerated Values: SHIELDING = blocking material is inside contour APERTURE = blocking material is outside contour export APERTURE or SHIELDING as appropriate 300A 00FA >Block Divergence - Indicates presence or otherwise of geometrical divergence. Enumerated Values: PRESENT = block edges are shaped for beam divergence ABSENT = block edges are not shaped for beam divergence PRESENT is currently the only supported type on FocalSim. 25

300A 00FC >Block Number - Identification number of the Block. The value of Block Number (300A,00FC) shall be unique within the Beam in which it is created. Export block number (1-20) 300A 00FE >Block Name - User-defined name for block. Export universal Block ID from FocalSim DICOM data export parameters page if a value has been defined; otherwise export block ID 300A 00E1 >Material ID - User-supplied identifier for material used to manufacture Block. Export Block material for this block if the FocalSim beam algorithm needs it. Otherwise it will be NULL and Block Transmission exported instead. 300A 0100 >Block Thickness - Physical thickness of block (in mm) parallel to radiation beam axis. Required if Material ID (300A,00E1) is non-zero length. Export block thickness value if the FocalSim beam algorithm needs it. Otherwise it will be NULL and Block Transmission exported instead. 300A 0102 >Block Transmission - Transmission through the block (between 0 and 1) at the beam energy specified by the Nominal Beam Energy (300A,0114) of the first Control Point of the Control Point Sequence (300A,0111). Required if Material ID (300A,00E1) is zero length. Export Block transmission as given by HVL value in a Clarkson calculated beam if the FocalSim beam algorithm needs it, otherwise it will be set to NULL and Material ID and Block Thickness will be exported instead. 300A 0104 300A 0106 300A 010E Block Number of Points Number of (x,y) pairs defining the block edge. Export total polygon coordinates count Block Data A data stream of (x,y) pairs that comprise the block edge. The number of pairs shall be equal to Block Number of Points (300A,0104), and the vertices shall be interpreted as a closed polygon. Coordinates are projected onto the machine isocentric plane in the IEC BEAM LIMITING DEVICE coordinate system (mm). Export data stream of polygon coordinates Final Cumulative Meterset Weight Value of Cumulative Meterset Weight (300A,0134) for final Control Point in Control Point Sequence (300A,0111). Required if Cumulative Meterset Weight is non-null in Control Points specified within Control Point Sequence (300A,0111). Export: 1.0 300A 0110 Number of Control Points Number of control points in Beam. Export number of control points. FocalSim will have 2 control points. 300A 0111 Control Point Sequence - Introduces sequence of machine configurations describing treatment beam. Two or more items may be included in this sequence. 300A 0112 >Control Point Index - Index of current Control Point, starting at 0 for first Control Point. 26

300A 0134 300A 0114 >Cumulative Meterset Weight Cumulative weight to current control point. Cumulative Meterset Weight for the first item in Control Point Sequence shall always be zero. Cumulative Meterset Weight for the final item in Control Point Sequence shall always be equal to Final Cumulative Meterset Weight. Export Cumulative meterset weight (cmw) Nominal Beam Energy Nominal Beam Energy at control point (MV/MeV). Export: machine energy at Control Point 0 300A 0116 Wedge Position Sequence Introduces sequence of Wedge positions for current control point. One or more items may be included in this sequence. NOT USED Wedges not supported in FocalSim. 300C 00C0 >Referenced Wedge Number Uniquely references Wedge described by Wedge Number (300A,00D2) in Wedge Sequence (300A,00D1). Export: map 1 if wedge in beam 300A 0118 >Wedge Position Position of Wedge at current Control Point. Enumerated Values: IN, OUT. For FIXED, NONE, EDW and VW, put IN 300A 011A Beam Limiting Device Position Sequence Introduces sequence of beam limiting device (collimator) jaw or leaf (element) positions. Required for first item of Control Point Sequence, or if Beam Limiting Device changes during Beam. One or more items may be included in this sequence. 300A 00B8 >RT Beam Limiting Device Type Type of beam limiting device (collimator). The value of this attribute shall correspond to RT Beam Limiting Device Type (300A,00B8) defined in an item of Beam Limiting Device Sequence (300A,00B6). Enumerated Values: X = symmetric jaw pair in IEC X direction Y = symmetric jaw pair in IEC Y direction ASYMX = asymmetric jaw pair in IEC X direction ASYMY = asymmetric pair in IEC Y direction MLCX = multileaf (multi-element) jaw pair in IEC X direction MLCY = multileaf (multi-element) jaw pair in IEC Y direction Export collimator tag appropriately A minimum of two and up to three collimator sequences will be sent for each beam- an X jaw pair, a Y jaw pair and MLC, if one exists. MLCX is only currently available MLC in FocalSim. 27

300A 011C >Leaf/Jaw Positions Positions of beam limiting device (collimator) leaf (element) or jaw pairs (in mm) in IEC BEAM LIMITING DEVICE coordinate axis appropriate to RT Beam Limiting Device Type (300A,00B8), e.g. X-axis for MLCX, Y- axis for MLCY. Contains 2N values, where N is the Number of Leaf/Jaw Pairs (300A,00BC) in Beam Limiting Device Sequence (300A,00B6). Values shall be listed in IEC leaf (element) subscript order 101, 102,... 1N, 201, 202,... 2N. See Note 2. Export X, Y and MLC jaw positions in the IEC coordinate system 300A 001E Gantry Angle Gantry angle of radiation source, i.e. orientation of IEC GANTRY coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Gantry Angle changes during Beam. Export IEC gantry angle value 300A 011F 300A 0120 Gantry Rotation Direction Direction of Gantry Rotation when viewing gantry from isocenter, for segment following Control Point. Required for first item of Control Point Sequence, or if Gantry Rotation Direction changes during Beam. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Beam Limiting Device Angle Beam Limiting Device angle, i.e. orientation of IEC BEAM LIMITING DEVICE coordinate system with respect to IEC GANTRY coordinate system (degrees). Required for first item of Control Point Sequence, or if Beam Limiting Device Angle changes during Beam. Export FocalSim collimator value 300A 0121 Beam Limiting Device Rotation Direction Direction of Beam Limiting Device Rotation when viewing beam limiting device (collimator) from radiation source, for segment following Control Point. Required for first item of Control Point Sequence, or if Beam Limiting Device Rotation Direction changes during Beam. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Export: NONE 300A 0122 Patient Support Angle Patient Support angle, i.e. orientation of IEC PATIENT SUPPORT (turntable) coordinate system with respect to IEC FIXED REFERENCE coordinate system (degrees). Required for first item of Control Point Sequence, or if Patient Support Angle changes during Beam. Export FocalSim table angle 28

300A 0123 Patient Support Rotation Direction - Direction of Patient Support Rotation when viewing table from above, for segment following Control Point. Required for first item of Control Point Sequence, or if Patient Support Rotation Direction changes during Beam. See C.8.X.14.8. Enumerated Values: CW = clockwise CC = counter-clockwise NONE = no rotation Export: NONE 300A 0125 300A 0126 Table Top Eccentric Angle Table top (non-isocentric) angle. That is, orientation of IEC TABLE TOP ECCENTRIC coordinate system with respect to IEC PATIENT SUPPORT coordinate system (degrees). Required for first item of Control Point Sequence or if Table Top Eccentric Angle changes during Beam. Export 0 Table Top Eccentric Rotation Direction when viewing table from above, for segment following control Point. Required for first item of Control Point Sequence or if Table Top Eccentric Rotation Direction changes during Beam. Enumerated values: CW = Clockwise CC = Counterclockwise NONE = No rotation Export NONE 300A 012C Isocenter Position Isocenter coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Required for first item of Segment Control Point Sequence, or if Segment Isocenter Position changes during Beam. Export FocalSim beam isocenter value in DICOM coordinate system 300A 012E Surface Entry Point - Patient surface entry point coordinates (x,y,z) in the patient based coordinate system described in C.7.6.2.1.1 (mm). Export FocalSim beam entry point in DICOM coordinate system 300A 00130 Source to Surface Distance Source to Patient Surface distance (mm). Export SSD of the beam in DICOM coordinate system. 29

SOP Common Module (C.12.1) 0008 0016 SOP Class UID Export 1.2.840,10008.5.1.4.1.1.481.5 0008 0018 SOP Instance UID Export 1.2.840.10008.5.1.4.1.1.481.5. <FocalSim Document ID> 0008 0005 Specific Character Set Do not export 0008 0012 Instance Creation Date Export date plan exported 0008 0013 Instance Creation Time Export time plan exported 0008 0014 Creator UID Export 2.16.840.1.113669.2.931128 2.3.3 Association Acceptance Policy Not applicable. 2.4 RT Structure Set Client AE Specification FocalSim provides Standard Conformance to the following DICOM V3.0 Service Object Pair (SOP) Class as a Service Class User (SCU): SOP Class Name SOP Class UID RT Structure Set Storage 1.2.840.10008.5.1.4.1.1.481.3 2.4.1 Association Establishment Policies 2.4.1.1 General The (PDU) size proposed in an association request will default to 16K bytes and is configurable in the [ASSOC_PARMS] section of the mergecom.pro file to be anything from 2K bytes to 512K bytes using the parameter PDU_MAXIMUM_LENGTH. 2.4.1.2 Number of Associations The FocalSim client application will open and use one association at a time. 30

2.4.1.3 Asynchronous Nature Not supported. 2.4.1.4 Implementation Identifying Information The Implementation Class Unique Identifier (UID) for the FocalSim application is 2.16.840.1.113669.2.1.1. 2.4.2 Association Initiation by Real-World Activity Associations are initiated by the user via the DICOM Export Dialog. 2.4.2.1 Structure Set Export Operations The FocalSim client application initiates associations for the transfer of RT Structure Sets. 2.4.2.1.1 Associated Real-World Activity The user initiates the transfer of RT structure sets via the DICOM Export Dialog. 2.4.2.1.2 Proposed Presentation Contexts The presentation context that can be proposed by the FocalSim client for the RT Plan export operation is specified in the table below. Extended negotiation is not supported. Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List RT Structure Set Storage 1.2.840.10008.5.1.4.1.1.481.3 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None Table 5 RT Structure Sets Presentation Contexts 31

Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List RT Structure Set Storage 1.2.840.10008.5.1.4.1.1.481.3 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None 2.4.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class The following modules that make up the DICOM RT Structure Sets IOD are sent. Elements that are not supported for export from a FocalSim teletherapy structure set are not listed. For each FocalSim treatment machine, the user should tailor the convention of FocalSim structure sets data to fit the receiving system's requirements by using these menus. The user can set a different machine name, define a "no wedge" ID, a constant block ID (e.g., custom), a tolerance table value, what to call IMRT beams ("static" or dynamic"), and set up export wedge IDs. Patient Module (C.7.1.1) 0010 0010 Patient s Name (up to 14 characters) 0010 0020 Patient s ID - Primary hospital identification number or code for the patient. (Up to 24 characters) 0010 0030 Patient s Birth Date 0010 0040 Patient s Sex: M for male F for female O for unknown 0010 1000 Other Patient s IDs 0010 1001 Other Patient s Names 0010 4000 Patient Comments 32

General Study Module (C.7.2.1) 0020 000D Study Instance UID - Unique identifier for the Study 0008 0020 Study Date 0008 0030 Study Time 0008 0090 Referring Physicians Name = UNKNOWN 0020 0010 Study ID - User or equipment generated study identifier 0008 0050 Accession Number = 1 RT Series Module (C.8.4.3.1) 0008 0060 Modality = RTSTRUCT 0020 000E Series Instance UID - Unique identifier for the Study 0020 0011 Series Number = 1 General Equipment Module (C.7.5.1) 0008 0070 Manufacturer = Computerized Medical Systems 0008 1040 Institutional Department Name 0008 1090 Manufacturer s Model Name = FOCAL Structure Set (C.8.8.5) Note: Items not listed are NOT Exported. 3006 0002 Structure Set Label (User-defined) 3006 0004 Structure Set Name (User-defined) 3006 0008 Structure Set Date date the structure set was last modified. 3006 0009 Structure Set Time time the structure set was last modified 3006 0010 Referenced Frame of Reference Sequence 3006 0012 >RT Referenced Series Sequence 3006 0014 >RT Refeences Study Sequence 3006 0016 >Contour Image Sequence; Note this sequence contains references to ALL images used in the CT study. 3006 0024 >Referenced Frame of Reference UID ROI Contour (C.8.8.6). Note: Items not listed are NOT Exported. 3006 0039 ROI Contour Sequence 3006 0084 >Referenced ROI Number 3006 002A >ROI Display Color 3006 0040 >Contour Sequence 3006 0016 >>Contour image sequence; Note this sequence is always of length 1 and references the singular CT image used to define the contours at this slice location. 3006 0043 >>Contour Geometric Type = CLOSED_PLANAR 33

3006 0046 >>Number of Contour Points 3006 0050 >>Contour Data RT ROI Observations (C.8.8.8) 3006 0080 RT ROI Observations Sequence 3006 0082 Observation Number 3006 0084 Referenced ROI Number 3006 00A4 ROI Interpreted Type This is set to EXTERNAL for contours identified as being skin definition contours in FocalSim. All other ROIs are set to ORGAN. 3006 00A6 ROI Interpreter = NULL SOP Common Module (C.12.1) 0008 0016 SOP Class UID Export 1.2.840,10008.5.1.4.1.1.481.3 0008 0018 SOP Instance UID Export 1.2.840.10008.5.1.4.1.1.481.3. <FocalSim Document ID> 0008 0005 Specific Character Set Do not export 0008 0012 Instance Creation Date Export date plan exported 0008 0013 Instance Creation Time Export time plan exported 0008 0014 Creator UID Export 2.16.840.1.113669.2.931128 2.5 Image Client AE Specification FocalSim provides Standard Conformance to the following DICOM V3.0 Service Object Pair (SOP) Class as a Service Class User (SCU): SOP Class Name SOP Class UID CT Image Storage 1.2.840.10008.5.1.4.1.1.2 MR Image Storage 1.2.840.10008.5.1.4.1.1.4 PET Image Storage 1.2.840.10008.5.1.4.1.1.128 34

2.5.1 Association Establishment Policies 2.5.1.1 General The (PDU) size proposed in an association request will default to 16K bytes and is configurable in the [ASSOC_PARMS] section of the mergecom.pro file to be anything from 2K bytes to 512K bytes using the parameter PDU_MAXIMUM_LENGTH. 2.5.1.2 Number of Associations The FocalSim client application will open and use one association at a time. 2.5.1.3 Asynchronous Nature Not supported. 2.5.1.4 Implementation Identifying Information The Implementation Class Unique Identifier (UID) for the FocalSim application is 2.16.840.1.113669.2.1.1 2.5.2 Association Initiation by Real-World Activity Associations are initiated by the user via the DICOM Export Dialog. 2.5.2.1 CT Image Export Operations The FocalSim client application initiates associations for the transfer of Images. 2.5.2.1.1 Associated Real-World Activity The user initiates the transfer of images via the DICOM Export Dialog. Note that only CT images that have been imported into FocalSim can be exported and their content is unchanged. 2.5.2.1.2 Proposed Presentation Contexts The presentation context that can be proposed by the FocalSim client for the CT Image export operation is specified in the table below. Extended negotiation is not supported. 35

Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name List UID List Neg. CT Image Storage 1.2.840.10008.5.1.4.1.1.2 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None Table 6 CT Image Presentation Contexts Presentation Context Table Abstract Syntax Transfer Syntax Role Ext. Name UID Name UID List Neg. List CT Image Storage 1.2.840.10008.5.1.4.1.1.2 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU None 2.5.2.1.2.1 SOP Specific Conformance Statement for the DICOM/RT SOP Class The following modules that make up the DICOM Image IOD are sent. Elements that are not supported for export from a FocalSim teletherapy structure set are not listed. For several elements, the DICOM export data function or page is mentioned. For each FocalSim treatment machine, the user should tailor the convention of FocalSim structure sets data to fit the receiving system's requirements by using these menus. The user can set a different machine name, define a constant block ID (e.g., custom). 36