Merge PACS

TM

v. 7.0
DICOM CONFORMANCE STATEMENT

Merge Healthcare
900 Walnut Ridge Drive
Hartland, WI 53029
© Copyright 2014-2016 Merge Healthcare Incorporated, an IBM Company.

U.S. GOVERNMENT RESTRICTED RIGHTS:

INDICATIONS FOR USE:

CAUTION:

CANADIAN DEVICE IDENTIFIER:

EMERGO EUROPE Australian Sponsor Manufacturer’s Address

Molenstraat 15 Emergo Australia Merge Healthcare Incorporated
2513 BH, The Hague Level 20, Tower II 900 Walnut Ridge Drive
The Netherlands Darling Park Hartland, WI 53029
201 Sussex Street
Sydney, NSW 2000 Australia

Part Date Revision Description

PAX-35157 11/30/2016 1 Update for 7.0.2.3
 Contents

Chapter 1. Executive Overview .......................................................................................................... 5

Chapter 2. Acronyms and Abbreviations .......................................................................................... 9
Chapter 3. Scope ............................................................................................................................... 10
3.1. How to Use this Document: .............................................................................................. 10
3.2. WARNING to the Reader .................................................................................................. 12

Chapter 4. Implementation Model .................................................................................................... 13

4.1. Application Data Flow Diagram......................................................................................... 13
4.2. Functional Definition of Merge PACS Server AE .............................................................. 14
4.3. Sequencing of Real-World Activities ................................................................................. 15

Chapter 5. AE Specification .............................................................................................................. 16

5.1. Association Establishment Policies................................................................................... 16
General ................................................................................................................ 16
Number of Associations ....................................................................................... 16
Asynchronous Nature .......................................................................................... 16
Implementation Identifying Information ................................................................ 17
5.2. Association Initiation by Real-World Activities .................................................................. 17
Real-World Activity “Web Client Request” ........................................................... 17
a. Proposed Presentation Contexts ......................................................................... 18
b. SOP Specific Conformance for C-FIND SCU ...................................................... 18
c. SOP Specific Conformance for C-MOVE SCU .................................................... 18
Real-World Activity “Routing Request” ................................................................ 19
a. Proposed Presentation Contexts ......................................................................... 19
b. SOP Specific Conformance for C-Store SCU ...................................................... 20
c. SOP Specific Conformance for IAN and BSCN notification SCU ........................ 21
Real-World Activity “Verify Request”.................................................................... 23
5.3. Association Acceptance Policy by Real-World activities .................................................. 23
Real-World activity Remote Store Request ......................................................... 24
a. Accepted Presentation Contexts for CStore SCP................................................ 24
b. Transfer Syntax Selection Policy ......................................................................... 25
c. SOP Specific Conformance for Storage SOP Class SCP ................................... 25
i. Archived Attributes ........................................................................................ 26
ii. Error Handling ............................................................................................... 29
Real-World Activity Remote Query/Retrieve Request ......................................... 31
a. Accepted Presentation Contexts for Q/R SCP .................................................... 31
b. SOP Specific Conformance for FIND SOP Class as a SCP ............................... 32
c. SOP Specific Conformance for MOVE SOP Class.............................................. 35
Real-World Activity Remote Verification Request................................................ 37
5.4. DICOM Print ...................................................................................................................... 37
Proposed Presentation Contexts ......................................................................... 37
SOP Specific Conformance Statement for the SOP Classes of the Basic
Grayscale Print Management Meta SOP Class ................................................................ 37
Conformance for SOP Class Basic Film Session ................................................ 38
Conformance for SOP Class Basic Film Box ....................................................... 38
Conformance for SOP Class Basic Grayscale Image Box .................................. 39
Conformance for SOP Class Printer .................................................................... 39
5.5. Communication Profiles .................................................................................................... 39
Supported Communication Stacks....................................................................... 39

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OSI / Point to point Stack ..................................................................................... 40

TCP/IP Stack........................................................................................................ 40
Physical Media Support ....................................................................................... 40
5.6. Configurable Parameters .................................................................................................. 40
5.7. Support of extended character sets .................................................................................. 41

Chapter 6. Media Interchange........................................................................................................... 42

6.1. Implementation model ....................................................................................................... 42
Application data flow diagram .............................................................................. 42
Functional definitions of AE's ............................................................................... 43
Sequencing of Real-World activities .................................................................... 43
6.2. Application Entity specifications ........................................................................................ 43
Burn CD AE.......................................................................................................... 43
a. File Meta Information for the Application Entity ................................................... 43
b. Real World Activities ............................................................................................ 44
c. Real World Activity: Create CD Request ............................................................. 44
d. Media Storage Application Profiles ...................................................................... 44
e. RWA - Create File-set .......................................................................................... 45
f. DICOM Directory .................................................................................................. 45
g. Media Storage Directory IOD ............................................................................... 45
6.3. Extensions, Specializations, Privatizations of SOP Classes and Transfer Syntaxes ....... 47
6.4. Other Extensions............................................................................................................... 47
6.5. Configuration ..................................................................................................................... 47

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 1
Chapter 1. Executive Overview
The Merge Web/Intranet Image Server is designed to bridge the gap between DICOM devices and the
electronic medical record through the application of Internet standards and technologies. The Merge
Web/Intranet Image Server is an integrated software system that provides access to medical images for
both radiologists and referring physicians with the speed and ease-of-use that is commonly expected of
Web browsers. As such, the Merge Web/Intranet Image Server is installed on a computer that is
configured with connections to both the DICOM network and the Internet (or intranet) of a facility. The
product architecture is optimized to receive all of the imaging studies on a DICOM network as soon as
they are available from the imaging modality and to process the imaging study for storage in a form that
can be readily accessed via either Internet or DICOM standard protocols on-demand. Two or more Merge
Web/Intranet Image Servers can also be configured to effectively and securely route between two DICOM
networks via the Internet. Merge technology enables a scalable and flexible product that can be
configured for both large and small clients, functioning as a stand-alone product or in combination with
PACS and other healthcare information systems. The product can be configured for multiple sites and
customer types with varying degrees of clinical capabilities.

NOTE: Images with non-square acquisition pixels are displayed in Merge PACS as square pixels. All
measurements (lengths, angles, etc.) will take the exact pixel dimensions (both square and non-
square) into account.

The most important characteristic of this device are the supported SOP Classes, the respective roles
(Service Class User or Provider, SCU/SCP or Both) and whether each class is viewable within Merge
PACS or just capable of being stored, a list of which is provided below:

Table 1.1 Supported DICOM SOP Classes

SOP Class Name SOP Class UID Role View

Verification 1.2.840.10008.1.1 Both No
Computed Radiography Image Storage 1.2.840.10008.5.1.4.1.1.1 Both Yes
Digital X-Ray Image Storage For Presentation 1.2.840.10008.5.1.4.1.1.1.1 Both Yes
Digital X-Ray Image Storage For Processing 1.2.840.10008.5.1.4.1.1.1.1.1 Both Yes
Digital Mammography X-Ray Image Storage For 1.2.840.10008.5.1.4.1.1.1.2 Both Yes
Presentation
Digital Mammography X-Ray Image Storage For 1.2.840.10008.5.1.4.1.1.1.2.1 Both Yes
Processing
Digital Intra Oral X-Ray Image Storage For Presentation 1.2.840.10008.5.1.4.1.1.1.3 Both Yes
Digital Intra Oral X-Ray Image Storage For Processing 1.2.840.10008.5.1.4.1.1.1.3.1 Both No
CT Image Storage 1.2.840.10008.5.1.4.1.1.2 Both Yes
Ultrasound Multi-frame Image Storage 1.2.840.10008.5.1.4.1.1.3.1 Both Yes
MR Image Storage 1.2.840.10008.5.1.4.1.1.4 Both Yes

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SOP Class Name SOP Class UID Role View

US Image Storage 1.2.840.10008.5.1.4.1.1.6.1 Both Yes
Secondary Capture Image Storage 1.2.840.10008.5.1.4.1.1.7 Both Yes
Multi-Frame Single Bit Secondary Capture Image 1.2.840.10008.5.1.4.1.1.7.1 Both Yes
Storage
Multi-Frame Grayscale Byte Secondary Capture Image 1.2.840.10008.5.1.4.1.1.7.2 Both Yes
Storage
Multi-Frame Grayscale Word Secondary Capture Image 1.2.840.10008.5.1.4.1.1.7.3 Both Yes
Storage
Multi-Frame True Color Secondary Capture Image 1.2.840.10008.5.1.4.1.1.7.4 Both Yes
Storage
12-lead ECG Waveform 1.2.840.10008.5.1.4.1.1.9.1.1 Both No
General ECG Waveform 1.2.840.10008.5.1.4.1.1.9.1.2 Both No
Ambulatory ECG Waveform 1.2.840.10008.5.1.4.1.1.9.1.3 Both No
Hemodynamic ECG Waveform 1.2.840.10008.5.1.4.1.1.9.2.1 Both No
Cardiac Electrophysiology ECG Waveform 1.2.840.10008.5.1.4.1.1.9.3.1 Both No
Basic Voice Audio Waveform 1.2.840.10008.5.1.4.1.1.9.4.1 Both No
Grayscale Softcopy Presentation State 1.2.840.10008.5.1.4.1.1.11.1 Both Yes
Color Softcopy Presentation State 1.2.840.10008.5.1.4.1.1.11.2 Both No
Pseudo-Color Softcopy Presentation State 1.2.840.10008.5.1.4.1.1.11.3 Both No
Blending Softcopy Presentation State 1.2.840.10008.5.1.4.1.1.11.4 Both No
X-Ray Angiographic Image Storage 1.2.840.10008.5.1.4.1.1.12.1 Both Yes
X-Ray Radio fluoroscopic Image Storage 1.2.840.10008.5.1.4.1.1.12.2 Both Yes
X-Ray Angiographic Bi-plane Image Storage 1.2.840.10008.5.1.4.1.1.12.3 Both Yes
Breast Tomosynthesis Storage 1.2.840.10008.5.1.4.1.1.13.1.3 Both Yes
Nuclear Medicine Image Storage 1.2.840.10008.5.1.4.1.1.20 Both Yes
Raw Data Storage 1.2.840.10008.5.1.4.1.1.66 Both No
No Spatial Registration 1.2.840.10008.5.1.4.1.1.66.1 Both No
Spatial Fiducials 1.2.840.10008.5.1.4.1.1.66.2 Both No
Real World Value Mapping 1.2.840.10008.5.1.4.1.1.67 Both No
VL Endoscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.1 Both Yes
VL Microscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.2 Both Yes
VL Slide Coordinates Microscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.3 Both No
VL Photographic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.4 Both Yes
Stereometric Relationship 1.2.840.10008.5.1.4.1.1.77.1.5.3 Both No
Basic Text SR Storage 1.2.840.10008.5.1.4.1.1.88.11 Both Yes
DICOM Basic Text SR 1.2.840.10008.5.1.4.1.1.88.1 Both Yes
DICOM SR Objects 1.2.840.10008.5.1.4.1.1.88.11 SCU No

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SOP Class Name SOP Class UID Role View

Enhanced Structured Report 1.2.840.10008.5.1.4.1.1.88.22 Both No
Comprehensive Structured Report 1.2.840.10008.5.1.4.1.1.88.33 Both No
Mammography CAD SR 1.2.840.10008.5.1.4.1.1.88.50 Both Yes
Key Object Selection Document 1.2.840.10008.5.1.4.1.1.88.59 Both Yes
Chest CAD Structured Report 1.2.840.10008.5.1.4.1.1.88.65 Both Yes
XRay Radiation Dose Structured Report 1.2.840.10008.5.1.4.1.1.88.67 Both No
ProcedureLog 1.2.840.10008.5.1.4.1.1.88.40 Both No
Encapsulated PDF Storage 1.2.840.10008.5.1.4.1.1.104.1 Both No
Positron Emission Tomography Image Storage 1.2.840.10008.5.1.4.1.1.128 Both Yes
Radiation Therapy Image Storage 1.2.840.10008.5.1.4.1.1.481.1 Both Yes
Radiotherapy Structure Set 1.2.840.10008.5.1.4.1.1.481.3 Both No
Radiation Therapy Beams Treatment Record 1.2.840.10008.5.1.4.1.1.481.4 Both No
Radiation Therapy Plan 1.2.840.10008.5.1.4.1.1.481.5 Both No
Radiation Therapy Brachy Treatment Record 1.2.840.10008.5.1.4.1.1.481.6 Both No
Radiation Therapy Treatment Summary Record 1.2.840.10008.5.1.4.1.1.481.7 Both No
Radiation Therapy Ion Plan 1.2.840.10008.5.1.4.1.1.481.8 Both No
Radiation Therapy Ion Beams Treatment Record 1.2.840.10008.5.1.4.1.1.481.9 Both No
Patient Root Query/Retrieve - Find 1.2.840.10008.5.1.4.1.2.1.1 SCP No
Patient Root Query/Retrieve - Move 1.2.840.10008.5.1.4.1.2.1.2 SCP No
Study Root Query/Retrieve - Find 1.2.840.10008.5.1.4.1.2.2.1 Both No
Study Root Query/Retrieve - Move 1.2.840.10008.5.1.4.1.2.2.2 Both No
Patient/Study Only Query/Retrieve - Find 1.2.840.10008.5.1.4.1.2.3.1 SCP No
Patient/Study Only Query/Retrieve - Move 1.2.840.10008.5.1.4.1.2.3.2 SCP No
Modality Worklist Query 1.2.840.10008.5.1.4.31 Both No
Instance Availability Notification 1.2.840.10008.5.1.4.33 SCU No
Basic Study Content Notification (retired) 1.2.840.10008.1.9 SCU No
Ultrasound Multi-frame Image Storage (retired) 1.2.840.10008.5.1.4.1.1.3 Both No
NM Image Storage (retired) 1.2.840.10008.5.1.4.1.1.5 Both Yes
US Image Storage (retired) 1.2.840.10008.5.1.4.1.1.6 Both Yes
Text SR Storage - Trial (retired) 1.2.840.10008.5.1.4.1.1.88.1 Both No

Table 1.2 DICOM SOP Classes disabled by default

SOP Class Name SOP Class UID Role View

Enhanced CT Storage 1.2.840.10008.5.1.4.1.1.2.1 Both No
Enhanced MR Storage 1.2.840.10008.5.1.4.1.1.4.1 Both No
Standalone Overlay Storage 1.2.840.10008.5.1.4.1.1.8 Both No

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SOP Class Name SOP Class UID Role View

Standalone Curve Storage 1.2.840.10008.5.1.4.1.1.9 Both No
Standalone Modality LUT Storage 1.2.840.10008.5.1.4.1.1.10 Both No
Standalone VOI LUT Storage 1.2.840.10008.5.1.4.1.1.11 Both No
Enhanced XA Storage 1.2.840.10008.5.1.4.1.1.12.1.1 Both No
Enhanced XRF Storage 1.2.840.10008.5.1.4.1.1.12.2.1 Both No
Video Endoscopic Image Storage 1.2.840.10008.5.1.4.1.1.77.1.1.1 Both Yes
General Electric Magnetic Resonance Image Storage 1.2.840.113619.4.2 Both Yes
GE Computed Tomography Image Storage 1.2.840.113619.4.3 Both Yes

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 2
Chapter 2. Acronyms and
Abbreviations
The following acronyms and abbreviations are used throughout this document:

Term Description
ASCII American Standard Code for Information Interchange
AE Application Entity
ANSI American National Standards Institute
BSCN Basic Study Content Notification
CR Computerized radiography
CT Computerized Tomography
DICOM Digital Imaging and Communications in Medicine
IAN Instance Availability Notification
IE Information Entity
IOD Information Object Definition
ISO International Standards Organization
MR Magnetic Resonance
NEMA National Electrical Manufacturers Association
NM Nuclear Medicine
OSI Open Systems Interconnection
PACS Picture Archiving and Communication System
PDU Protocol Data Unit
RF Radio Fluoroscopy
RWA Real World Activities
SC Secondary Capture
SCP Service Class Provider
SCU Service Class User
SOP Service-Object Pair
TCP/IP Transmission Control Protocol/Internet Protocol
UID Unique Identifier
US Ultrasound
VM Value Multiplicity
VR Value Representation
XA X-Ray Angiography

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Chapter 3. Scope
This DICOM Conformance statement documents the conformance of the Merge Web/Intranet Image
Server software with the Digital Imaging and Communications in Medicine (DICOM) standard. This
document is essential in order to evaluate whether or not another DICOM compliant device can
communicate with this software product. This statement is conformant with the recommended format as
described in PS 3.2 of the DICOM Standard 1.

3.1. How to Use this Document:

This statement consists of five important features that one should compare with other devices
in order to determine connectivity:

1. Implementation Model

The Implementation Model describes the functional relationship between the device, the
so-called “real-world activities” which initiate certain DICOM functionality, and the DICOM
services. A DICOM service is implemented on a device by a software process, which is
called an “Application Entity” (AE). Each AE has a unique name called the AE Title,
which is used to identify it to other AE’s. The AE Title is configurable to avoid two devices
with the same name on a network. The “bubble diagram” (Application Data Flow
Diagram) shows the interaction of the AE with the outside world across the dashed line,
i.e., the DICOM interface.

2. AE Specifications

Each AE supports one or more Service-Object-Pair classes or SOP Class, which define
the basic functionality. A SOP class consists of a combination of an Object or Information
model with specific DICOM services. An example of such a SOP Class is the CT Image
Storage Class, which consists of the combination of the DICOM C_STORE command
with the CT Image object. Each of these classes is uniquely identified by an Unique
Identification number (UID), which is issued by the NEMA. In addition, the “role” of the AE
is specified, i.e., User or Provider, which can be compared with acting as a Client or
Server. In DICOM terms, this is called a Service Class User or Service Class Provider
(SCU or SCP).

1 Digital Imaging and Communications in Medicine (DICOM) 3.0, NEMA PS 3.1-14, 1999

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In order to interconnect with another device, the SOP classes as well as their role (SCU
or SCP) have to be matched, i.e., a SCU has to match a SCP at another device with an
identical SOP class. Make sure to compare the SOP Class UID itself, not the description
because there are SOP classes which have the same name, but support a different
(newer) Object, which is identified by a different SOP Class UID.

3. Presentation Context

Each SOP class supports a particular presentation context, which is the combination of
the SOP Class as specified under (2) and the Transfer Syntax. The Transfer Syntax
defines the encoding of the DICOM basic elements, i.e., its attributes and how the data is
represented, i.e., with a data type definition. The encoding of the data type as part of the
message, or Value Representation (VR), can be done in two ways - implicitly or explicitly.
If a device supports Explicit VR transfer syntax, it means that the transmitted data will
include the VR information along with data and attribute tags. Implicit VR means that the
VR information will not be included, and the receiving application must determine the VR
type from the Attribute Tag. For example, when receiving the Attribute “Patient Name” in
Explicit Transfer Syntax, there is an additional type code field (containing “PN” meaning
“Person Name”) to identify the Value Representation. In the case of Implicit Transfer
Syntax, it is assumed to be known by the receiver and not explicitly specified that this
attribute has a type of “Person Name”.

The data can be communicated in the Intel or Motorola Byte ordering, AKA “Little Endian”
or “Big Endian”. This means that for certain 16 bit words; the two 8 bit Bytes might have
to be swapped to be able to interpret the information by a device supporting a different
byte ordering.

Lastly, compression can be applied, such as JPEG, which is specified in the transfer
syntax. The Transfer Syntax of two devices must match in order for them to
communicate.

4. Communication Profiles

This section specifies the communication options. In practice, each device always
supports an Application level interface to the OSI level 4 (Transport layer), i.e., TCP/IP
stack. However, the Physical Media of two devices have to match for connectivity. Note
that matching physical media can be achieved by standard off the shelf devices. For
example, if one device supports standard Ethernet 10BaseT, it can be bridged to a Fast
Ethernet, ATM, or whatever is supported.

5. Supported Attributes

Many devices specify which DICOM attributes they require and/or store in their internal
database. It is important to compare these against the source of the information,
particularly if a device requires certain attributes to accomplish specific functionality such
as 3-D viewing, image processing, etc. A mismatch could have the effect that certain
functionality or applications might fail.

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3.2. WARNING to the Reader

If another device matches this conformance statement based on the comparison with its own
conformance statement, there is a chance, but no guarantee that they interoperate. DICOM
only deals with communication; it does not specify what is needed for certain applications to
run on a device.

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Chapter 4. Implementation Model

4.1. Application Data Flow Diagram

Merge Web/Intranet Image Server software consists of a single Application Entity that deals
with the DICOM communication. There are four functions that are provided by the Application
entity: Web access to images, archiving, auto routing and verification. In addition, the
Application entity also could provide access to scheduling information, however, this is a
separate product offering and not described in this conformance statement.

Figure 4-1: Implementation Model

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The Web Access function is implemented by a Web Client request real-world activity. The
Client initiates a Query that might result in a Retrieve of DICOM objects (such as images)
from other devices, as indicated by the Remote Query SCP and Remote Retrieve SCP in the
figure. The Remote Retrieve will initiate sending the images (Remote Store SCU) to the
Merge Archive.

The Archive function provides a database and storage of images and other DICOM
composite objects. It responds to queries from Remote Query SCU’s, and sends the objects
to Remote Store SCP’s as a result of a request by a Remote Retrieve SCU. In addition, as
mentioned above, it will accept images from any Remote Store SCU’s initiated by the Remote
Retrieve SCP through the web access.

The Auto router will route images to destinations if certain events match specific configurable
rules communicating with a Remote Store SCP. If configured, the Auto router will also send
BSCN and IAN notification messages for each received study.

The verification function will either initiate a Verification of an external device to find out
whether another AE can respond, or will respond to a Verification Request.

Note that spine annotations are saved as graphic annotations in the DICOM tag (0070,0001)
for the key images (KO). However, spine annotations are saved as XML in the private tag
(0x0023, 0x0044) for the Presentation State (PR).

4.2. Functional Definition of Merge PACS Server AE

The following real world activities will cause the Server to initiate an Association:

Activity Description
Web Client request The WEB server will initiate a C-FIND and/or C-MOVE operation to a
remote device (e.g., a departmental or long term archive system)
upon receiving a request by a Web client.
Routing request The AE will route the specified DICOM objects to the specified
destinations, upon the appropriate trigger events by internal
applications.
Remote retrieve request A remote retrieve by another (external) device will cause the AE to
send objects such as images to a destination.
Verification request A verification request will be initiated upon a user action such as for
testing purposes. (Never automatically or gratuitously.)
Study received The Server will send IAN and/or BSCN notification messages.

The following real world activities will require the server to accept an Association:

Activity Description
Archive It will store DICOM objects, such as images, as a Storage SCP, and
also will respond to the C-FIND and C-MOVE requests, functioning
as a SCP. A C-Move will cause the Server to initiate a C-Store to
exchange the DICOM objects to the appropriate destination.

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Activity Description
Verification The server is able respond to a Verification request from an external
device.

4.3. Sequencing of Real-World Activities

There is no sequencing or order between the real world activities within the device.

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Chapter 5. AE Specification

NOTE: Merge PACS can only display images with values of 8 or 16 for Bits Allocated (0028,0100).

5.1. Association Establishment Policies

General

The DICOM standard application context name, which is always proposed, is DICOM 3.0:

Name UID
Application context name 1.2.840.10008.3.1.1.1

The PDU size is configurable and ranges from 4096 - 2**32-1 with as default value 65536.

SOP Class extended negotiation is not supported.

Number of Associations

The maximum number of concurrent associations is limited by the server to the value
specified by the MaximumServerThreadCount configuration item in Storageserver.ini. The
default value for this configuration item is 25. Any association request above this number is
put on hold until another active association is released.

Asynchronous Nature

Asynchronous mode of operation is not supported.

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Implementation Identifying Information

The implementation Information of this application is:

Name UID
Implementation Class UID 1.2.840.113837.7.7.2000
Implementation version name 2.5WIN32-22SEP00

5.2. Association Initiation by Real-World Activities

The following four real-world activities initiate an Association:
• Web Client request
• (External) Remote Retrieve and (internal) Routing request
• A study is received
• Verify request
If a low-level read/write operation to a socket is not returned after a certain time period, the
association will be aborted. This time is configurable (“MAX read/write time”).

The Web client will close an association following the execution of a single C-Find or C-Move
command (which may affect one or more studies).

Associations opened for the purpose of transmitting images to a C-Store SCP when
satisfying routing requests or associations opened for study content notification messages
(IAN or BSCN) will remain open for a configurable number of seconds following the most
recent C-STORE or N-CREATE command executed on the association. A configurable timer
causes the association to be closed after an idle period. The timer starts at the end of each
command executed by the SCU. The timer is disabled upon the start of each command. If the
timer expires before it is disabled, the association will be released by the requester (Merge
Web/Intranet Image Server). The default value for the timer (AssociationIdleTimeout) is 45
seconds.

The association will be released immediately following the execution of a single Verify
request when used for testing purposes.

Real-World Activity “Web Client Request”

As part of the Web Access real-world activity, the Merge Web/Intranet Image Server
application entity initiates an association when it receives a request from a WEB client web
enabled application in the form of a servlet for a Query resulting in a C-FIND and/or Retrieve
using the C-MOVE. The C-MOVE will result in the corresponding C-Store, and therefore, the
application entity will respond to the request for an association of the appropriate remote
application entity.

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a. Proposed Presentation Contexts

Table 5.3 Web Client Request Proposed Presentation Contexts

Abstract Syntax Transfer Syntax Role

SOP CLASS NAME SOP Class UID Name UID

Study Root 1.2.840.10008.5.1.4.1.2.2.1 DICOM Implicit VR Little 1.2.840.10008.1.2 SCU
Query/Retrieve Endian Transfer Syntax
Information Model -
Find DICOM Explicit VR Little 1.2.840.10008.1.2.1
Endian Transfer Syntax
Study Root 1.2.840.10008.5.1.4.1.2.2.2 DICOM Implicit VR Little 1.2.840.10008.1.2 SCU
Query/Retrieve Endian Transfer Syntax
Information Model-
Move DICOM Explicit VR Little 1.2.840.10008.1.2.1
Endian Transfer Syntax

Extended negotiation is not supported; use of relational or hierarchical query can be

configured per destination AE title.

b. SOP Specific Conformance for C-FIND SCU

All DICOM Required and Unique keys are supported. Any attribute cataloged in the database
may be used as a matching or retrieval key. However, for efficient operation, a query must
contain matching value(s) for at least one attribute that is indexed.

Currently indexed attributes include:

Attribute Description
Patient Level PatientID, PatientName
Study Level PatientID, PatientName, AccessionNumber, StudyDate, StudyInstanceUID
Series Level SeriesInstanceUID
Image Level SOPInstanceUID
• Additional indices may be added by support; Attributes returned that were not
requested are ignored.
• All range, wildcard, UID list, sequence, multiple value, etc. matching is implemented
per the DICOM standard.
• PatientName matching normalizes the matching value(s) and matches against the
normalized PatientName stored in the database (normalization consists of eliminating
spaces and punctuation and converting to all upper case).

c. SOP Specific Conformance for C-MOVE SCU

UID list move is supported.

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Real-World Activity “Routing Request”

As part of the routing request real-world activity, the Merge Web/Intranet Image Server
application entity initiates an association when it receives a request from an internal
application or after a study is received.

a. Proposed Presentation Contexts

The auto router acting as an SCU of the Storage, Instance Availability and Study Content
Notification classes proposes whatever abstract syntaxes are necessary to transfer the
instances being routed or to send the notification. If an instance is stored on the Merge
Web/Intranet Image Server in compressed form, the appropriate compressed transfer syntax
will be proposed. In addition, DICOM Explicit VR Little Endian transfer syntax and DICOM
Default Implicit Little Endian Transfer Syntax will always be proposed in separate
presentation contexts. Only a single transfer syntax will ever be proposed per presentation
context. Thus, if an image is stored on the Merge Web/Intranet Image Server in compressed
form, 3 presentation contexts will be proposed. If the image is not compressed, only two
presentation context proposals will result. For Instance Availability Notification and Basic
Study Content Notification service, the Merge Web/Intranet Image Server will propose only
DICOM Implicit VR Little Endian transfer syntax with the appropriate SOP class.

Table 5.4 Supported Transfer Syntaxes for Storage and Instance Availability SCU

Transfer Syntax

Name UID
DICOM Implicit VR Little Endian Transfer Syntax 1.2.840.10008.1.2
DICOM Explicit VR Little Endian Transfer Syntax 1.2.840.10008.1.2.1
Run Length Encoding (RLE) 1.2.840.10008.1.2.5
JPEG Baseline (Lossy) (Process 1) 1.2.840.10008.1.2.4.50
JPEG Extended (Lossy) (Process 2 (8-bit) and Process 4 (12-bit)) 1.2.840.10008.1.2.4.51
JPEG Lossless Non-hierarchical (Process 14) 1.2.840.10008.1.2.4.57
JPEG Default Lossless Non-hierarchical, first-order prediction 1.2.840.10008.1.2.4.70
(Process 14 selection value 1)
JPEG 2000 (Lossless only) 1.2.840.10008.1.2.4.90
JPEG 2000 (Lossy or Lossless) 1.2.840.10008.1.2.4.91

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Table 5.5 Routing Request Proposed Presentation Contexts Per Abstract Syntax

Abstract Syntax Transfer Syntax Role

SOP Class Name SOP Class UID Name UID

1.2.840.10008.xxx (See Note 1) DICOM Explicit VR Little 1.2.840.10008.1.2.1 SCU
Endian Transfer Syntax
1.2.840.10008.xxx (See Note 3) DICOM Implicit VR Little 1.2.840.10008.1.2 SCU
Endian Transfer Syntax
1.2.840.10008.xxx (See Notes 1 and 2) Any Supported 1.2.840.10008.xxxx SCU
Compressed Transfer (See note 2)
Syntax

Note (1): All Storage SOP Classes as specified in the table of Supported DICOM SOP
Classes in Chapter 1 above.

Note (2): A proposal requesting a compressed transfer syntax will be added only if the
instance being transferred exits on the Merge Web/Intranet Image Server in compressed
form. The proposed compressed transfer syntax will be the transfer syntax in which the
instance stored on the Merge Web/Intranet Image Server is encoded.

Note (3): All Storage and Notification SOP Classes as specified in table of Supported DICOM
SOP Classes in Chapter 1 above.

b. SOP Specific Conformance for C-Store SCU

Errors and warnings are logged. If a user using a GUI interface issued the command, the
user is informed.

If not initiated directly by a user, commands encountering errors are retried, e.g., if the
Autorouter encounters a network problem when attempting to connect to a destination for an
instance transmission. The software continues normally (i.e., does not exit).)

The SCU will propose multiple transfer syntaxes as listed above, one transfer syntax per
presentation context. When multiple transfer syntaxes are accepted by the SCP, the SCU will
use the compressed transfer syntax if proposed and accepted. Otherwise the SCU will use
Explicit Little Endian transfer syntax. If a compressed transfer syntax is not proposed or
accepted and Explicit Little Endian transfer syntax is not accepted, then the transfer will be
accomplished using Implicit Little Endian transfer syntax. In the event that a compressed
instance is being transferred but the proposed compressed transfer syntax is not accepted,
the image will be decompressed and transferred using Explicit Little Endian (if accepted) or
Implicit Little Endian transfer syntax. The SCU will not compress instances that are not
already stored in compressed form on the Merge Web/Intranet Image Server. Such instances
will always be transmitted via Explicit or Implicit Little Endian syntax.

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c. SOP Specific Conformance for IAN and BSCN notification SCU

The Merge PACS Server can be configured to send IAN and/or BSCN notification messages
when a configurable amount of time (120 seconds by default) passes after receiving the last
instance of a study from a storage SCU.

Commands encountering errors are retried, e.g., if the Forwarder encounters a network
problem when attempting to connect to a destination for an instance transmission. The
software continues normally (i.e., does not exit).

For IAN messages the server does not interpret the status of the response, any response
status other than success is logged and the message is discarded.

For BSCN messages any response status code between 0 and 3 inclusively is considered
success. When receiving a failure response status the server will retry the BSCN message
for a configurable number of times.

Table 5.6 Content of BSCN C-STORE Request Message

Attribute Name Tag Value Presence

of value
Instance Creation Date 0008,0012 The date when the study became Always
available in the server
Instance Creation Time 0008,0013 The time when the study became Always
available in the server (120
seconds after receiving the last
instance)
SOP Class UID 0008,0016 1.2.840.10008.1.9 Always
SOP Instance UID 0008,0018 Generated by the server Always
Patient’s Name 0010,0010 The patient name from the Always
received study
Patient ID 0010,0020 The patient ID from the received Always
study
Study Instance UID 0020,000D The received study instance UID Always
Study ID 0020,0010 The received study ID Always
Referenced Series Sequence 0008,1115 One item for each series Always
> Series Instance UID 0020,000E The Instance UID of the received Always
series
> Referenced Image Sequence 0008,1140 One item for each instance in the Always
series
>> Retrieve AE Title 0008,0054 The configured AE Title of the Always
Merge Web/Intranet Image
Server
>> Referenced SOP Class UID 0008,1150 The SOP Class UID of the Always
received instance

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Attribute Name Tag Value Presence

of value
>> Referenced SOP Instance UID 0008,1155 The SOP Instance UID of the Always
received instance

Table 5.7 Contents of IAN N-CREATE Request Message

Attribute Name Tag Value Presence

of value
Instance Creation Date 0008,0012 The date when the study became Always
available in the server
Instance Creation Time 0008,0013 The time when the study became Always
available in the server (120
seconds after receiving the last
instance)
SOP Class UID 0008,0016 1.2.840.10008.5.1.4.33 Always
SOP Instance UID 0008,0018 Generated by the server Always
Referenced Performed 0008,1111 Empty sequence (no items) Always
Procedure Step Sequence
Study Instance UID 0020,000D The received study instance UID Always
Referenced Series Sequence 0008,1115 One item for each series Always
> Series Instance UID 0020,000E The Instance UID of the received Always
series
> Referenced SOP Sequence 0008,1199 One item for each instance in the Always
series
>> Instance Availability 0008,0056 ONLINE Always
>> Retrieve AE Title 0008,0054 The configured AE Title of the Always
Merge Web/Intranet Image
Server
>> Referenced SOP Class UID 0008,1150 The SOP Class UID of the Always
received instance
>> Referenced SOP Instance UID 0008,1155 The SOP Instance UID of the Always
received instance

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Real-World Activity “Verify Request”

As part of the verification real-world activity, the Merge Web/Intranet Image Server
application entity initiates an association when it receives an internal request for Verification.

The following table describes the proposed presentation contexts:

Table 5.8 Verify Request Proposed Presentation Contexts

Abstract Syntax Transfer Syntax Role

SOP CLASS SOP Class UID Name UID

NAME
Verification 1.2.840.10008.1.1 DICOM Implicit VR Little Endian 1.2.840.10008.1.2 SCU
Transfer Syntax
DICOM Explicit VR Little Endian 1.2.840.10008.1.2.1
Transfer Syntax

5.3. Association Acceptance Policy by Real-World

activities
The following (external) real-world activities will cause a request for an association
acceptance:

• Remote Store request

• Remote Query/Retrieve request
• Remote Verification request

If a TCP/IP connection is made by a requestor and not followed up by a DICOM association

request within a certain time period, the acceptor will drop the association. This period is
configurable (“ARTIM”).

When the association has been established, there is also a time-out value for a command to
be received. When there is no activity within this time, an ARelease-RQ will be issued to
release the association. This time period is configurable (“MAX Incoming association
lifetime”).

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Real-World activity Remote Store Request

The Store request will happen because of an external Archive request, as a result of a C-
Move by a remote Retrieve SCP typically initiated by a Merge Web/Intranet Image Server
Web client, or as the result of a CStore request by any CStore SCU.

a. Accepted Presentation Contexts for CStore SCP

The default behavior of the CStore SCP is to accept as a SCP all presentation contexts
containing a combination of a supported abstract syntax (see note 1 below) and a supported
transfer syntax:

Table 5.9 Remote Store Request Accepted Presentation Contexts

Abstract Syntax Transfer Syntax

SOP Class Name SOP Class UID Name UID

DICOM Implicit VR Little 1.2.840.10008.1.2
Any configured - see Note (1) Endian Transfer Syntax
1.2.840.10008.xxx DICOM Explicit VR Little 1.2.840.10008.1.2.1
Endian Transfer Syntax
Run Length Encoding (RLE) 1.2.840.10008.1.2.5
JPEG Baseline (Lossy) 1.2.840.10008.1.2.4.50
(Process 1)
JPEG Extended (Lossy) 1.2.840.10008.1.2.4.51
(Process 2 (8-bit) and
Process 4 (12-bit))
JPEG Lossless Non- 1.2.840.10008.1.2.4.57
hierarchical (Process 14)
JPEG Default Lossless Non- 1.2.840.10008.1.2.4.70
hierarchical, first-order
prediction (Process 14
selection value 1)
JPEG 2000 (Lossless only) 1.2.840.10008.1.2.4.90
JPEG 2000 (Lossy or 1.2.840.10008.1.2.4.91
Lossless)

Note (1): When acting as an archive only, the Merge Web/Intranet Image Server can be
configured to accept any proposed storage class. When used for web access as well, the list
of supported SOP Classes as specified in Table 5.2 SOP Classes Supported as SCP applies.

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b. Transfer Syntax Selection Policy

In the event that a single proposed presentation context contains multiple supported transfer
syntaxes, the accepted transfer syntax is chosen according to the following order of
precedence:

1. JPEG2000 Lossless (1.2.840.10008.1.2.4.90).

2. JPEG Default Lossless Non-hierarchical, first-order prediction (Process 14 selection

value 1) (1.2.840.10008.1.2.4.70).

3. JPEG Lossless Non-hierarchical (Process 14) (1.2.840.10008.1.2.4.57).

4. RLE (1.2.840.10008.1.2.5).

5. JPEG 2000 Lossy or Lossless (1.2.840.10008.1.2.4.91).

6. The first encountered supported compressed transfer syntax other than those listed
above.

7. Little Endian Explicit (1.2.840.10008.1.2.1).

8. Implicit Little Endian (1.2.840.10008.1.2).

c. SOP Specific Conformance for Storage SOP Class SCP

The Explicit VR transfer syntax is accepted as the preferred transfer syntax.

A non-null Patient ID (0010, 0020) is strongly recommended. If missing or null, a Patient ID is

generated upon image reception. This will be generated as follows:

Use the Patient Name field if it is non-null, otherwise use “unknown”. When using the Patient
Name, any “\” will be converted to “_”.

Coercion (replacing the attribute when needed for proper identification) will take place in the
image objects without changing the SOP Instance UID, as long as the interpretation is not
affected. For example, Patient name coercion will not result in a new SOP Instance UID.

A new SOP Instance UID will only be generated upon applying lossy compression to an
image.

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The Web clients support the photometric interpretation values listed in the following table:

Table 5.10 Supported Image Types for Viewing

Photometric Interpretation Samples Per Pixel Planar Configuration

MONOCHROME1 1 n/a
MONOCHROME2 1 n/a
RGB 3 00 or 01
YBR_FULL 3 00 or 01
YBR_FULL_422 3 00 or 01
YBR_ICT (Note 1) 3 00 or 01
YBR_RCT (Note 2) 3 00 or 01
PALETTE COLOR 3 00 or 01

Notes:
1: Supported only for images received using JPEG 2000 lossy image compression.
2: Supported only for images received using JPEG 2000 lossless image compression.

Instances specifying an unsupported value for Photometric Interpretation may be rejected.

i. Archived Attributes

The list of attributes cataloged in the local database is configurable. The standard
configuration is as follows:

• All received attributes are stored exactly as received (including private attributes).
• All stored attributes are returned as received when images are retrieved (via C-
Move) or transmitted (via C-Store).
• The cataloged attributes shown below are those attributes that are extracted from the
set of stored attributes and cataloged in the database.
• The cataloged attributes are usable as matching/retrieval values for C-Find. Note that
all attributes (standard or private) are returned when instances are retrieved or
transmitted, not just the ones shown below.
• Received string type attributes exceeding the maximum storage capacity for the
database column used to catalog such attributes are subject to truncation without
warning. Matching/retrieval of truncated attributes will match against and return the
truncated value in a query response. Values returned upon retrieval are unaffected
by truncation. The database is configured by default to provide at least the capacity
to store at least the maximum DICOM attribute length of a single value for all
cataloged attributes. Cataloging for certain attributes provides support for storage of
some longer non-truncated multi-valued attributes. The database can be
reconfigured by Merge Healthcare Support to provide more storage space for certain
attributes. Contact Merge Healthcare Support for details of maximum per-attribute
storage length or reconfiguration assistance.

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Table 5.11 Archive Service - Cataloged Attributes

Attribute Name Notes Attribute (Group, Element)

Study Instance UID K (0020, 000D)
Study Date (0008, 0020)
Study Time (0008, 0030)
Study ID S (0020, 0010)
Study Description (0008, 1030)
Accession Number S (0008, 0050)
Referring Physician (0008, 0090)
Reading Physician (0008, 1060)
Referenced Study Sequence (0008, 1110)
> SOP Class (0008, 1150)
> Study Instance UID (0008, 1155)
Patient Name S, N (0010, 0010)
Patient ID S (0010, 0020)
Issuer of Patient ID S (0010, 0021)
Patient Birth Date S (0010, 0030)
Patient Sex S (0010, 0040)
Patient Age (0010, 1010)
Patient Weight (0010, 1030)
Number of Study Related Series (0020, 1206)
Number of Study Related Images (0020, 1208)
Series Instance UID K (0020, 000E)
Series Number S (0020, 0011)
Series Date (0008, 0021)
Series Time (0008, 0031)
Modality S (0008, 0060)
Institution Name (0008, 0080)
Station Name S (0008, 1010)
Operator Name (0008, 1070)
Series Description (0008, 103E)
Patient Position (0018, 5100)
Position Reference (0020, 1040)
Frame Of Reference UID (0020, 0052)
SOP Instance UID K (0008, 0018)
Image Type S (0008, 0008)

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Attribute Name Notes Attribute (Group, Element)

SOP Class UID S (0008, 0016)
Image Number S (0020, 0013)
Image Date S (0008, 0023)
Image Time S (0008, 0033)
Image Position Patient S (0020, 0032)
Image Orientation Patient S (0020, 0037)
Slice Location S (0020, 1041)
Pixel Spacing S (0028, 0030)
Number of Rows S (0028, 0010)
Number of Columns S (0028, 0011)
Contrast Bolus Agent (0018, 0010)
Sequence Variant (0018, 0021)
Slice Thickness (0018, 0050)
KVP (0018, 0060)
Repetition Time (0018, 0080)
Echo Time (0018, 0081)
Inversion Time (0018, 0082)
Number Of Averages (0018, 0083)
Echo Numbers (0018, 0086)
Spacing Between Slices (0018, 0088)
Data Collection Diameter (0018, 0090)
Percent Phase FOV (0018, 0094)
Trigger Time (0018, 1060)
Gantry Detector Tilt (0018, 1120)
X-Ray Tube Current (0018, 1151)
Flip Angle (0018, 1314)
Photometric Interpretation (0028, 0004)
Bits Allocated (0028, 0100)
Bits Stored (0028, 0101)
Pixel Representation (0028, 0103)
Window Center (0028, 1050)
Window Width (0028, 1051)
Rescale Intercept (0028, 1052)
Rescale Slope (0028, 1053)
Number of Frames (0028, 0008)
Lossy Compression S (0028, 2110)

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Notes:

K - This attribute is used as a unique key.

S - Strict checking is performed on this attribute when an instance is stored. If the instance
being stored has a key that is the same as one already in the database, a duplicate is
assumed. Attributes marked with an S must match the values already in the database. If one
or more strictly-checked attributes do not match, the instance is accepted into the Jail®
holding area rather than into the database. Attributes not marked for strict checking are also
compared. If any of the attributes that are not strictly checked differ from those already in the
database, the stored instance is accepted into the database and a coercion warning is
returned to the SCU. This checking can be disabled server-wide on a per attribute basis if
necessary to accommodate special situations. Contact Merge Healthcare Support for
assistance.

N - This attribute is also stored in a normalized version. Normalization consists of eliminating

spaces and punctuation and converting to all upper case. When matching is performed
against such attributes, the candidate key is normalized and matched against the normalized
version. This effectively implements case-insensitive matching as well as matching that is
insensitive to punctuation and spacing differences.

ii. Error Handling

The following error messages will be generated upon unsuccessful processing of the C-Store
command:

Table 5.12 CStoreRSP Error/Warning Response Codes

Status Code ERROR COMMENT Meaning Invalid

Elements List
Returned?
0111 Rejected attempt to Attempt to store an instance with the No.
update existing SOP same UID as a previous instance but
instance. one or more checked attributes with
different values than instance already
stored in database detected.
Attempted to save the instance to the
"Jail" holding area instead also failed
due to an internal program error, out
of space, etc.
0120 Unable to store: Missing The SOP instance UID attribute was Yes. (0008,
SOP Instance UID. missing from the stored dataset. 0018)
0120 Required non-null data Attempt to store an instance with one Yes. List of the
element(s) missing. or more missing or null type 0 missing or null
attributes detected. Attempted to attributes.
save the instance to the "Jail" holding
area instead also failed due to an
internal program error, out of space,
etc.
A700 Out of storage space. File storage space is exhausted. No.

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Status Code ERROR COMMENT Meaning Invalid

Elements List
Returned?
A700 Error creating directory. Unable to create directory to contain No.
instance file.
0110 Internal SCP error A program error was detected while No.
processing the query (e.g., program
logic error, etc.).
0110 Unable to connect to The SCP is unable to establish a No.
local database. connection to its underlying RDBMS.
B000 Data element(s) differed Warning that the stored instance No.
from previously stored contained the same instance UID as
values an instance already existing in the
database, but that the instance being
stored contained one or more
attributes differing in value from the
instance already stored in the
database. Certain attributes are
strictly checked. A mismatch on the
strictly checked attribute values
results in the stored instance being
placed in the "Jail" holding area. Any
differences in the attributes not strictly
checked result in this warning. Note
that this warning implies coercion,
i.e., the stored instance is being
coerced to match the instance
already in the database with the
same instance UID. The list of
attributes that are strictly checked is
configurable.
C006 Storage error. Unspecified internal error while No.
processing Cstore request.
C018 Error in local database Internal SCP error. Misconfigured No.
configuration (device logical storage device map.
map).
C019 Error accessing SQL Internal SCP error while generating No.
database. filename for instance file.
C020 Error while creating file to Internal program error. Unable to No.
hold SOP instance. create unique filename to contain
instance after repeated attempts.
C021 Internal move file error Program error encountered while No.
(errno = <errno>). performing a file move operation.
<errno> is replaced with the operating
system dependent errno style error
code.
C022 Error saving SOP Internal program error. Attempted to No.
Instance to file (file in overwrite an existing instance file.
use).
C023 Error saving SOP Error while encoding DICOM dataset No.
Instance to file. or writing instance file.

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Status Code ERROR COMMENT Meaning Invalid

Elements List
Returned?
C025 Internal program error in Internal program error. Unexpected
<object:method>. return code from method invocation.
<object.method> is replaced by the
signature of the failed method.
C026 Database error while An error was encountered while No.
cataloging SOP Instance storing instance attributes to the
in database. underlying RDBMS.
C027 Unable to store: Unable The SCP is unable to establish a No.
to connect to local connection to its underlying RDBMS.
database.
C0028 Rejected: Unsupported The instance being stored specified Yes
PhotometricInterpretation an unsupported value for (0028,0004)
(xxxxx) PhotometricInterpretation.

Real-World Activity Remote Query/Retrieve Request

A remote device can submit a query and retrieve for a DICOM image or other composite
object.

a. Accepted Presentation Contexts for Q/R SCP

The default behavior of the Q/R SCP is to accept as SCP for each of the supported SOP
classes all presentation contexts containing the following transfer syntax:

Table 5.13 Remote Query/Retrieve Presentation Contexts

Abstract Syntax Transfer Syntax Role

SOP Class Name SOP Class UID Name UID

Patient Root 1.2.840.10008.5.1.4.1.2.1.1 DICOM Implicit VR 1.2.840.10008.1.2 SCP
Query/Retrieve - Find Little Endian
Transfer Syntax
DICOM Explicit 1.2.840.10008.1.2.1
VR Little Endian
Transfer Syntax
Patient Root 1.2.840.10008.5.1.4.1.2.1.2 DICOM Implicit VR 1.2.840.10008.1.2 SCP
Query/Retrieve - Little Endian
Move Transfer Syntax
DICOM Explicit 1.2.840.10008.1.2.1
VR Little Endian
Transfer Syntax
Study Root 1.2.840.10008.5.1.4.1.2.2.2 DICOM Implicit VR 1.2.840.10008.1.2 SCP
Query/Retrieve - Little Endian
Move Transfer Syntax

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Abstract Syntax Transfer Syntax Role

SOP Class Name SOP Class UID Name UID

DICOM Explicit 1.2.840.10008.1.2.1
VR Little Endian
Transfer Syntax
Patient/Study Only 1.2.840.10008.5.1.4.1.2.3.1 DICOM Implicit VR 1.2.840.10008.1.2 SCP
Query/Retrieve - Find Little Endian
Transfer Syntax
DICOM Explicit 1.2.840.10008.1.2.1
VR Little Endian
Transfer Syntax
Patient/Study Only 1.2.840.10008.5.1.4.1.2.3.2 DICOM Implicit VR 1.2.840.10008.1.2 SCP
Query/Retrieve - Little Endian
Move Transfer Syntax
DICOM Explicit 1.2.840.10008.1.2.1
VR Little Endian
Transfer Syntax

Extended negotiation is not supported; relational query is not accepted.

b. SOP Specific Conformance for FIND SOP Class as a SCP

When performing queries, matching values for Patient Names will be normalized. Spaces and
punctuation are eliminated and all remaining characters are converted to upper case.
Matching is performed against the normalized version of the Patient Name cataloged in the
server’s database. Normalization of the matching value does not affect . Thus, case-, space-,
and punctuation-insensitive matching is performed for Patient Names.

Matching will be performed for all attributes listed in Table 5.12 Archive Service - Cataloged
Attributes (matching against additional attributes is supported if those attributes are
configured for cataloging). Certain attributes are indexed for better query performance. It is
strongly recommended to supply at least one of the indexed attributes as a key. The list of
attributes that are indexed for enhanced query performance is configurable. The standard list
follows:

Table 5.14 Archive Server - Indexed Attributes

Attribute Name Attribute (Group, Element)

Patient Name (0010, 0010)
Patient ID (0010, 0020)
Study Instance UID (0020, 000D)
Study Date (0008, 0020)
Accession Number (0008, 0050)
Series Instance UID (0020, 000E)
SOP Instance UID (0008, 0018)

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Hierarchical query only is supported, i.e., no relational queries. Attributes specified as

matching keys or retrieval keys must be at the requested query level or above. For example,
for a Patient query, only attributes defined in Patient modules are accepted as keys. For a
Study query, Patient or Study attributes are acceptable, etc. Any other attribute in the
database may be used as a matching or retrieval key. It is strongly recommended, but not
required, that all queries contain at least one non-null matching value for one of the indexed
attributes. Indexes may be added by customer support to solve specific site-related query
problems.

All available items matched will be returned. The maximum number of items returned in a
query response is configurable. The default maximum number of items returned in a query
response is 5000. The limit on the maximum number of items returned in a query response
can be disabled. If a query matches more items than the limit, an error response is returned
with Status = 0xA700 and error comment = “Query too broad. Too many items selected.”

The following errors will be returned upon unsuccessful C-FIND processing:

Table 5.15 CFindRSP Error/Warning Response Codes

Status Error Comment Meaning Invalid

Code Elements List
Returned?
0110 Internal SCP error A program error was detected while No.
processing the query (e.g.,
program logic error, etc.).
0110 Unable to connect to local The SCP is unable to establish a No.
database. connection to its underlying
RDBMS.
0120 Missing required keys/values: One or more type 0 attributes were Yes. List of
<list> missing in the request. <list> in the missing or empty
error comment is replaced by a list required
of the missing attributes. attributes.
A700 Query too broad. Too many The number of items matched No.
items selected. exceeded the configurable limit on
maximum number of items returned
in a query response.
C001 Query error. Unspecified error while processing No.
query.
C002 Internal program error at CFind Internal program error in query No.
service provider. processor, e.g., null pointer, etc.
C007 Query/Retrieve level missing The query did not specify the Yes. (0008,
from request. query/retrieve level: attribute (0008, 0052)
0052) was missing or empty.
C008 Unrecognized Q/R level The SCU specified an Yes. (0008,
(<level>) requested. unrecognized (i.e., not "PATIENT", 0052)
"STUDY", "SERIES", or "IMAGE")
query/retrieve level in attribute
(0008, 0052). <level> in the error
comment is replaced by the invalid
value specified by the SCU.

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Status Error Comment Meaning Invalid

Code Elements List
Returned?
C009 Invalid Q/R level (<level>) The query level specified by the Yes. (0008,
requested. SCU is not valid for the query 0052)
model being used (e.g., PATIENT
query level specified while using
the Study Root query model).
<level> in the error comment is
replaced by the invalid value
specified by the SCU.
C010 Internal error - Invalid query Internal program error. The query No.
passed to QueryDatabase(). translator produced an empty SQL
query.
C011 Internal error - Invalid argument Internal program error. The query No.
to QueryDatabase(). translator produced an invalid SQL
query.
C012 Internal error - Invalid database Internal program error. The No.
schema on SCP. configurable database schema
cannot be processed.
C013 Internal SCP error - SQL query Internal program error. The query No.
preparation failed. translator produced an invalid SQL
query or a database error occurred.
C014 Internal SCP error - SQL bind Internal program error. The query No.
failed. translator produced an invalid SQL
query or a database error occurred.
C015 Internal SCP error - SQL query Internal program error. The query No.
error. translator produced an invalid SQL
query or a database error occurred
while executing query.
C016 Internal error - SQL result Internal program error. An error No.
retrieval failure on SCP. occurred while reading query
results from the database.
C017 Internal error - Result set Internal program error. An error No.
encoding failure on SCP. occurred while encoding query
results into DICOM dataset
C018 Error in local database Internal program error. Storage No.
configuration (device map). device map misconfigured.
FE00 Matching terminated due to Cancel No.
request.
FF00 Matching continues. Current match No.
is supplied. Any optional keys were
supported in the same manner as
required keys.
FF01 Matching continues. Current match No.
is supplied. Warning that one or
more optional keys were not
supported for existence and/or
matching for this identifier.

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c. SOP Specific Conformance for MOVE SOP Class

A correct pending move response is returned per instance transferred reporting exactly all
applicable counters.

The following status codes will be returned upon unsuccessful processing of the C-MOVE
command:

Table 5.16 CMoveRSP Error/Warning Response Codes

Status Error Comment Meaning Invalid Elements

Code List Returned?
0110 Internal SCP error A program error was detected while No.
processing the query (e.g.,
program logic error, etc.).
0110 Unable to connect to local The SCP is unable to establish a No.
database. connection to its underlying
RDBMS.
0120 Missing required One or more type 0 attributes were Yes. List of missing or
keys/values: <list> missing in the request. <list> in the empty required
error comment is replaced by a list attributes.
of the missing attributes.
A700 Query too broad. Too The number of items matched No.
many items selected. exceeded the configurable limit on
maximum number of items returned
in a query response.
A801 Move destination Unable to map the specified move No.
unknown. destination AE title to a network
address (IP address/port #). Or, not
configured to move instances to
requested destination.
B000 One or more CSTORE One or more but not all of the No.
sub-operations failed. requested SOP instances were
transmitted successfully.
C001 Query error. Unspecified error while processing No.
query.
C003 Destination for CMOVE The Move Destination attribute No.
not specified in command. (0000, 0600) for a CMove
operation was not present in the
request.
C004 All CSTORE sub- None of the requested SOP No.
operations failed. instances were transmitted
successfully.
C005 Can't connect to MOVE The SCP is unable to establish a No.
destination AE <AETitle>. network connection to the move
destination. <AETitle> is replaced
by the move destination specified
in the request.

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Status Error Comment Meaning Invalid Elements

Code List Returned?
C007 Query/Retrieve level The query did not specify the Yes. (0008, 0052)
missing from request. query/retrieve level: attribute (0008,
0052) was missing or empty.
C008 Unrecognized Q/R level The SCU specified an Yes. (0008, 0052)
(<level>) requested. unrecognized (i.e., not "PATIENT",
"STUDY", "SERIES", or "IMAGE")
query/retrieve level in attribute
(0008, 0052). <level> in the error
comment is replaced by the invalid
value specified by the SCU.
C009 Invalid Q/R level (<level>) The query level specified by the Yes. (0008, 0052)
requested. SCU is not valid for the query
model being used (e.g., PATIENT
query level specified while using
the Study Root query model).
<level> in the error comment is
replaced by the invalid value
specified by the SCU.
C010 Internal error - Invalid Internal program error. The query No.
query passed to translator produced an empty SQL
QueryDatabase(). query.
C011 Internal error - Invalid Internal program error. The query No.
argument to translator produced an invalid SQL
QueryDatabase(). query.
C012 Internal error - Invalid Internal program error. The No.
database schema on configurable database schema
SCP. cannot be processed.
C013 Internal SCP error - SQL Internal program error. The query No.
query preparation failed. translator produced an invalid SQL
query or a database error occurred.
C014 Internal SCP error - SQL Internal program error. The query No.
bind failed. translator produced an invalid SQL
query or a database error occurred.
C015 Internal SCP error - SQL Internal program error. The query No.
query error. translator produced an invalid SQL
query or a database error occurred
while executing query.
C016 Internal error - SQL result Internal program error. An error No.
retrieval failure on SCP. occurred while reading query
results from the database.
C017 Internal error - Result set Internal program error. An error No.
encoding failure on SCP. occurred while encoding query
results into DICOM dataset
C018 Error in local database Internal program error. Storage No.
configuration (device device map misconfigured.
map).

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Real-World Activity Remote Verification Request

Another device can request a verification to the Server.

The default behavior of the Store SCP is to accept as SCP for each of the supported SOP
classes all presentation contexts containing the following transfer syntax:

Table 5.17 Remote Verification Request Presentation Contexts

Abstract Syntax Transfer Syntax Role

SOP Class Name SOP Class UID Name UID

Verification 1.2.840.10008.1.1 DICOM Implicit VR Little 1.2.840.10008.1.2 SCU
Endian Transfer Syntax
DICOM Explicit VR Little 1.2.840.10008.1.2.1
Endian Transfer Syntax

5.4. DICOM Print

Proposed Presentation Contexts

Abstract Syntax Transfer Syntax Role

SOP CLASS NAME SOP Class UID Name UID

Basic Grayscale 1.2.840.1000.8.5.1.1.9 DICOM Implicit VR 1.2.840.10008.1.2 SCU

Print Management Little Endian Transfer
Syntax

SOP Specific Conformance Statement for the SOP Classes of

the Basic Grayscale Print Management Meta SOP Class

Below are the mandatory print SOP classes supported by Merge PACS for the Basic
Grayscale Management Meta class.

Table 5.18 Basic Grayscale Print Management Meta Class: Supported SOP Classes

SOP Class Name SOP Class UID

Basic Film Session 1.2.840.10008.5.1.1.1
Basic Film Box 1.2.840.10008.5.1.1.2
Basic Grayscale Image Box 1.2.840.10008.5.1.1.4
Printer 1.2.840.10008.5.1.1.16

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Conformance for SOP Class Basic Film Session

Merge PACS includes the following N-Create attributes for the Basic Film Session SOP
class:

Table 5.19 Basic Film Session SOP class N-CREATE: Attributes

Description Tag Usage

Number of Copies (2000,0010) A
Print Priority (2000,0020) C
Medium Type (2000,0030) C
Film Destination (2000,0040) C

Conformance for SOP Class Basic Film Box

The table below lists the N-Create attributes for the Basic Film Box SOP class, where A
means the attribute is always sent and C means the attribute is only sent when not empty.

Table 5.20 Basic Film Box SOP class N-CREATE: Attributes

Description Tag Usage

Image Display Format (2010,0010) A
Referenced Film Session Sequence (2010,0500) A
> Referenced SOP Class UID (0008,1150) A
> Referenced SOP Instance UID (0008,1155) A
Film Orientation (2010,0040) C
Film Size ID (2010,0050) C
Magnification Type (2010,0060) C
Maximum Density (2010,0130) C
Configuration Information (2010,0150) C
Smoothing Type (2010,0080) C
Border Density (2010,0100) C
Empty Image Density (2010,0110) C
Minimum Density (2010,0120) C
Trim (2010,0140) C
Resolution (2020,0050) C

The N-Set is currently unused; however, the N-Action is used to print a complete Basic Film
Box SOP instance.

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Conformance for SOP Class Basic Grayscale Image Box

The following attributes are included in Merge PACS N-Set for the Basic Grayscale Image
SOP class. “A” stands for attributes which are always sent to the printer, while “C” stands for
attributes that are only sent when they contain data.

Table 5.21 Basic Grayscale Image SOP Box: N-Set Attributes

Description Tag Usage

Image Position (2020,0010) A
Preformatted Grayscale Image Sequence (2020,0110) A
Requested Image Size (2020,0030) C
> Samples Per Pixel (0028,0002) A
> Photometric Interpretation (0028,0004) A
> Rows (0028,0010) A
> Columns (0028,0011) A
> Pixel Aspect Ratio (0028,0034) A
> Bits Allocated (0028,0100) A
> Bits Stored (0028,0101) A
> High Bit (0028,0102) A
> Pixel Representation (0028,0103) A
> Pixel Data (7FE0,0010) A
Requested Decimate/Crop Behaviour (2020,0040) C

Conformance for SOP Class Printer

Merge PACS uses N-GET for the Printer SOP class to get information from the SCP.

5.5. Communication Profiles

Supported Communication Stacks

DICOM Upper Layer over TCP/IP is supported.

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OSI / Point to point Stack

Neither one is supported.

TCP/IP Stack

The TCP/IP stack is inherited from the underlying operating system

The application makes use of the Berkeley Sockets interface on Unix and of the WinSock
interface on Win32 platforms.

Physical Media Support

DICOM is indifferent to the physical medium over which TCP/IP executes. When a complete
system (hardware as well as software) is provided, Merge Healthcare Support will provide
support for Ethernet (10, 100, or 1000 Mbit/sec). It is strongly recommended to consult your
reseller and/or Merge Healthcare Support for detailed information.

5.6. Configurable Parameters

• Maximum PDU size: (4096 - 2**32-1 (default = 65536)) separately configurable for
incoming and outgoing PDUs, DICOM rules strictly followed
• Time out values are as follows:
Table 5.22 Time Out Values

Value Description
Association request, Reject, This timer starts when a TCP/IP connection has
Release Timer (ARTIM) been made by the requestor and causes a time-out
when no Associate request is received within the
time specified. It is also used to monitor the time for
the receiver to close the connection. The default
value is 180 seconds.
MAX incoming association Time-out for waiting for a command on an open
lifetime association. Default value is 12 hours. A value of 0
sets it to infinity.
MAX read/write time This is used to monitor the time it takes for a
read/write operation on sockets. Default value is 5
minutes, a value of 0 sets it to infinity.

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Value Description
AssociationIdleTimeout This timer is used to time out and release
associations used by the instance autorouter. If an
association opened by the autorouter has been idle
for the specified number of seconds, the association
is released. Default value is 45 seconds. A value of 0
disables idle association timeout.
• Local AE title
• Remote AE Title fields
• List of accepted calling AE titles (default = any)
• AE Title to IP address/port translation for Move Destination
• Local IP address and Netmask (listens on all interfaces; uses IP addresses assigned
to underlying system)
• Responding TCP/IP ports and addresses (listen port configurable; listens on all
interfaces)
• List of accepted abstract syntaxes
• Auto routing rules: (written in standard SQL)
• Auto routing error retry maximum count and retry interval (default = 15 retries at
intervals of 1,5,5,5,5,5,10,10,10,30,30,30,60, 60, and 60 minutes)
• Maximum number of concurrent outgoing associations per destination for auto
routing (default = 2)
• Maximum total concurrent outgoing associations for auto routing (default = 8)
• List of attributes extracted from stored SOP instances and cataloged in RDBMS to
support DICOM Q/R
• Maximum number of items returned in response to a CFind request (default = 5000)
• Maximum number of items returned in response to a CMove request (default = 5000)
• Accepted values for PhotometricInterpretation in (image) instances received by
CStore SCP (default = MONOCHROME1, MONOCHROME2, RGB, YBR_FULL,
YBR_FULL_422, YBR_ICT, YBR_RCT, PALETTE COLOR). Note that configuring
the server to accept any values for PhotometricInterpretation that are not supported
by the web viewer is not recommended. Refer to Table 5.9 Supported Image Types
for Viewing.
• Maximum number of simultaneous associations

5.7. Support of extended character sets

This application supports only ISO_IR 100 (ISO 8859-1 Latin 1) as an extended character
set.

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Chapter 6. Media Interchange

6.1. Implementation model

The implementation model identifies the DICOM Application Entities for Media in specific
implementation and relates the Application Entities to Real-World Activities.

Application data flow diagram

Merge PACS Viewer is to record DICOM Compact Disc Recordable (CD-R) with the studies
selected by the user. It contains options for including Reports, Key Images, PR Objects, CAD
Markings in CD, Merge PACS Viewer on disc and Auto-Launch Patient when CD is loaded.

Merge PACS Viewer burns DICOM files to CD in response to user actions performed through
the “Burn CD” Graphical User Interface (GUI). These actions normally correspond to the
selection of the studies to be copied to the optical medium. Merge PACS Viewer acts as a
File-set Reader (FSC): it stores DICOM files that are compliant with the Part 10 of the DICOM
3.0 standard.

It has the following capabilities:

• Image Conversion (Compression or Decompression, as applicable)

• Support for IHE-compliant media creation
• Full compliance with DICOM Part 10 specification, including DICOMDIR creation and
Group 0002 Meta headers

Request to
Application Entity
burn CD CD-R Storage
Medium

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Functional definitions of AE's

Merge PACS Viewer supports and initializes CD-R media, and writes new DICOM File Sets
onto those media.

Sequencing of Real-World activities

Through the “Burn CD” GUI of the Merge PACS Viewer software application, the operator
selects entries from the patient-study-series-instance hierarchy and initiates the transfer of
DICOM images to the optical medium. The entries appearing in the patient-study-series-
instance hierarchy have been previously received through the DICOM protocol or imported
from local disks.

6.2. Application Entity specifications

This section in the DICOM Conformance Statement specifies a set of Media Application
Entities.

Burn CD AE

Merge PACS Viewer provides Standard Conformance to the Interchange Option of the Media
Storage Service Class:

Supported Application Profile Identifier Real-World Roles

Activities
CT/MR Studies on CD-R STD-CTMR-CD Create File-set FSC
Read File-set FSR
General Purpose CD-R STD-GEN-CD Create File-set FSC
Interchange
Read File-set FSR

a. File Meta Information for the Application Entity

Merge PACS Viewer writes the following Meta Information attributes in the Part 10-compliant
DICOM files it produces:

Name Value
Implementation Class UID 1.2.840.113837.7.7.2000
Implementation Version Name 2.5WIN32-22SEP00

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b. Real World Activities

There is only one real world activity associated with the media creation by Merge PACS
Viewer.

c. Real World Activity: Create CD Request

Merge PACS Viewer acts as an FSC using the interchange option when writing an DICOM
compliant CD. The AEs can create DICOM CD for the following (based on user selection).

• A complete Exam (Study)

• Multiple Exams from the same patient.
• Multiple Exams from different patients

Implicit in the above list is that there is sufficient disk space to store the selected exam(s).
Spanning exams across multiple disks is not supported.

The list of studies to be written is identified by other components of the system like clicking
the Burn CD icon. Burn CD dialog displays this list of study added by the user. The user
initiates the Real-World Activity Create CD by requesting the "Create" operation. Burn CD
gathers the studies to be written and performs any necessary processing, such as
compression. Burn CD tracks space used and space available on the destination media.
When either all selected studies have been gathered and processed or the data to be written
will fill target media, a DICOMDIR is generated (space needed for the DICOMDIR is included
in running space calculations) and the media is written.

Merge PACS Viewer will not write a CD with no studies. User has an option to include Merge
PACS Viewer on disc

d. Media Storage Application Profiles

The Merge PACS Viewer Application Entity supports the STD-GEN-CD Application Profile.
The current version of the Merge PACS Viewer supports Transfer Syntax conversion for most
images: the DICOM images are stored and burnt to CD with the original Transfer Syntax
used during the DICOM Store operation or with the Explicit Little Endian transfer syntax
depending on user preference.

Note the following:

• Spine annotations are saved as graphic annotations in the DICOM tag (0070,0001)
for the key images (KO). However, spine annotations are saved as XML in the private
tag (0x0023, 0x0044) for the Presentation State (PR).
• IHE PDI profile is supported.

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Table 6.1 Supported Application Profiles

Application Profile Identifier Real-World Activity Role SC Option

CT/MR Studies on CD-R STD-CTMR- Read image(s) from FSR Interchange
CD CD
General Purpose CD-R STD_GEN-CD Read image(s) from FSR Interchange
Interchange CD

e. RWA - Create File-set

This Media Application Entity has a File-set Creator functionality which is described here.

For the Real World Activities DICOM Recording the Media AE will write the SOP instances as
provided by the RWA to the record able DICOM medium and a corresponding DICOMDIR is
created.

Table 6.2 Media Storage Application Profile

Application Profile Identifier Real-World Activity Role SC Option

CT/MR Studies on CD-R STD-CTMR- Write image(s) to FSC Interchange
CD CD-R
General Purpose CD-R STD_GEN-CD Write image(s) to FSC Interchange
Interchange CD-R

f. DICOM Directory

The Merge PACS Viewer writes directory records Patient, Study, Series and Image. Images
are referenced via the Image Directory Entry attribute Referenced File ID (0004, 1500).

Merge PACS Viewer does not employ Multi-Referenced Directory Entries.

g. Media Storage Directory IOD

The following tables specify the directory record keys and optional attributes used by Merge
PACS Viewer in the Media Storage Directory IOD (DICOMDIR file):

Table 6.3 Patient Record Keys

Description Tag
Patient's Name (0010,0010)
Patient ID (0010,0020)

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Table 6.2 Study Record Keys

Description Tag
Study Date (0008,0020)
Study Time (0008,0030)
Accession Number (0008,0050)
Study Description (0008,1030)
Study Instance UID (0020,000D)
Study ID (0020,0010)

Table 6.3 Series Record Keys

Description Tag
Modality (0008,0060)
Series Description (0008,103E)
Series Instance UID (0020,000E)
Series Number (0020,0011)

Table 6.4 Instance Record Keys

Description Tag
Image Type (0008,0008)
Instance Number (0020,0013)

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6.3. Extensions, Specializations, Privatizations of SOP

Classes and Transfer Syntaxes
None

6.4. Other Extensions

None

6.5. Configuration
The Merge PACS Viewer software supports several application-level configurations, available
through its GUI. Nevertheless, none of these configuration parameters affects the
conformance of Merge PACS Viewer with media profiles.

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