7.2 DICOM Coded Values#

Note: Codes are added here for now; they may find a new home

7.2.1 CID 4028 - Craniofacial Anatomic Region#

These values are used in the Anatomic Region Sequence (0008,2218) and are a subset of DICOM CID 4028.

When applied to orthodontic photographs, the anatomic region is Mouth for intraoral views, and Head/Neck for extraoral views.

**Table CID 4028. Craniofacial Anatomic Region**#
Code Scheme Designator	Code Value	Code Meaning	Notes
SCT	123851003	Mouth region structure (body structure)	Used for IV-* intraoral views.
SCT	774007	Structure of head and/or neck (body structure)	Used for EV-* extraoral views. This code was selected, because it is the most detailed code that includes the ear as well since the ear is present in both frontal and lateral extra oral views.

7.2.2 CID 247 - Laterality Left-Right Only#

**Table CID 247. Laterality Left-Right Only**#
Code Scheme Designator	Code Value	Code Meaning	Notes
SCT	24028007	Right
SCT	7771000	Left

7.2.3 CID 244 - Laterality#

In DICOM, laterality is used to define body parts which come in pairs, for example knees, ears, eyes, etc. It is not used to describe the side of the body being imaged. For example, an image of the left side of the right eye would have laterality right, even though the image is portraying the left side of the eye. In other words, this is the laterality of (possibly paired) body part examined (as described in Anatomic Region Sequence (0008,2218)).

The values in CID 244 are used in Image Laterality (0020,0062).

Note: The attribute Patient Orientation (0020,0020) should be enough to define the side of the anatomy being viewed. See Section 7.2.5.

**Table CID 244. Laterality**#
DICOM Enumerated Value	SNOMED CODE
L	(77771000,SCT,”Left”)
R	(24028007,SCT,”Right”)
U	(66459002,SCT,”Unilateral”)
B	(51440002,SCT,”Bilateral”)

Note: When creating the DICOM object, DICOM requires an enumerated value (aka string) for this tag. You should therefore always use the string in the DICOM Enumerated Value column of the table above.

7.2.3.1 Choosing the Correct Laterality#

Consider the following logic when choosing laterality.

U	Unilateral	Used for most orthodontic images.
L	Left	Only use if this Series is of Mastoid bone, Maxilla or Temporomandibular joint. For all other anatomic regions containing one or both sides, set to ‘U’.
R	Right	Only use if this Series is of Mastoid bone, Maxilla or Temporomandibular joint. For all other anatomic regions containing one or both sides, set to ‘U’.
B	Both	Only use if this Series is of Mastoid bone, Maxilla or Temporomandibular joint. For all other anatomic regions containing one or both sides, set to ‘U’. This is almost never used. For example, a frontal face smiling photograph, would have Image Laterality of ‘U’. However, an image which would contain both the left Maxilla and the right Maxilla in the same frame (image) (for example making use of mirrors or by merging two images into one) would have an Image Laterality of ‘B’.

The above table was compiled using the following considerations:

Image Laterality (0020,0062) Shall be consistent with any laterality information contained in Primary Anatomic Structure Modifier Sequence (0008,2230). DICOM PS3.3: Section 10.5 General Anatomy Macros discusses the relationship between Image Laterality (0020,0062) and Primary Anatomic Structure Modifier Sequence (0008,2230):
1. “Laterality is often encoded in a separate Attribute, Image Laterality (0020,0062) or Frame Laterality (0020,9072), rather than in Anatomic Region Modifier Sequence (0008,2220) or Primary Anatomic Structure Modifier Sequence (0008,2230).” This means that even thought the Laterality should be encoded in the Anatomic Region Modifier Sequence, it is often encoded in Image Laterality. Since these two shall be consistent, DICOM provides a mapping between the two (see below, one is an enumerated value as CS the other a code sequence).
2. The section references Part 16 Table L-5, a table which defines whether a specific anatomic region is to be considered a paired structure or not. Below, we report a table of those body parts relevant to orthodontic visible light images.
Laterality (0020,0060) (a Series level Attribute) must be absent, because
1. this series could contain images of different Laterality and
2. because Laterality (0020,0060) only allows ‘L’ and ‘R’ enumerated values, which are not sufficient to describe these images.

(excerpt from DICOM PS3.16: Table L-5 with orthodontic domain relevant regions)

SNOMED Code Value	Code Meaning	Paired Structure
60819002	Buccal region of face	N
89545001	Face	N
69536005	Head	N
774007	Head and Neck	N
661005	Jaw region	N
91609006	Mandible	N
59066005	Mastoid bone	Y
70925003	Maxilla	Y
123851003	Mouth	N
89546000	Skull	N
42575006	Sella turcica	N
170887008	Submental	N
53620006	Temporomandibular joint	Y
21974007	Tongue	N

7.2.4 CID 4061 - Head and/or Neck Primary Anatomic Structure#

These values are used in the Primary Anatomic Structure Sequence (0008,2228) and are a subset of DICOM CID 4061.

**Table CID 4061. Head and/or Neck Primary Anatomic Structure**#
Code Scheme Designator	Code Value	Code Meaning	Notes
SCT	89545001	Face	Used for EV-* extraoral views.
SCT	74262004	oral cavity	Used for IV-* intraoral views.
SCT	88176008	Mandibular dental arch	Used for IV-* intraoral views.
SCT	39481002	Maxillary dental arch	Used for IV-* intraoral views.
SCT	261063000	Structure of buccal space	Used for IV-* intraoral views.
SCT	7652006	Structure of frenulum labii	Used for IV-* intraoral views.

7.2.5 Patient Orientation#

These values are used in Patient Orientation (0020,0020).

Meaning	DICOM Enumerated Value	SNOMED Code
Anterior	A	(255549009, SCT, “Anterior”)
Posterior	P	(255551008, SCT, “Posterior”)
Left	L	(7771000, SCT, “Left”)
Right	R	(24028007, SCT, “Right”)

7.2.5.1 Specifying the Correct Patient Orientation#

The following requirements come from DICOM PS3.3: Section C.7.6.1.1.1:

Patient Orientation (0020,0020) relative to the image plane shall be specified by two values that designate the anatomical direction of the positive row axis (left to right) and the positive column axis (top to bottom).

The first entry is the direction of the rows, given by the direction of the last pixel in the first row from the first pixel in that row.
The second entry is the direction of the columns, given by the direction of the last pixel in the first column from the first pixel in that column.

For example: a Right Profile photograph of the face, would have Patient Orientation set to [‘A’,’F’]

7.2.6 Orthognathic Functional Conditions#

These values are used within Acquisition Context (0040,0555) when Concept Name Code in (0040,A043) is (130325, DCM, “Orthognathic Functional Condition”).

**Table CID 4066. Orthognathic Functional Conditions**#
SNOMED Code	Meaning	Notes
SCT 1336028006	Upper and lower lips in relaxed position
SCT 1336029003	Upper and lower lips in closed position
SCT 1332210001	Mouth in partially open position
SCT 262016004	Open Mouth (finding)
SCT 1336026005	Mandible postured forward
SCT 225583004	Smiles (finding)

7.2.7 Orthodontic Finding by Inspection#

These values are used within Acquisition Context (0040,0555) when Concept Name Code in (0040,A043) is (118243007, SCT, “Finding by inspection”).

**Table CID 4067. Orthodontic Finding by Inspection**#
SNOMED Code	Meaning	Notes
SCT 276470008	Skin mark (disorder)	Optional. MAY be present if some kind of skin mark is present. SNOMED-CT children of this code are also allowed, e.g. birthmark, slap mark, …
SCT 341000119102	Tattoo of skin (finding)	Optional. MAY be present if a tattoo is present on the skin within the field of view.
SCT 4356008	Gingival recession (disorder)	Optional. MAY be present.
SCT 710793000	Cant of occlusal plane (observable entity)	Optional. MAY be present.
SCT 1264188003	Local exogenous pigmentation of left buccal mucosa	Optional. MAY be present.
SCT 1264193000	Local exogenous pigmentation of right buccal mucosa	Optional. MAY be present.
SCT 1260043007	Local exogenous pigmentation of mucosa of soft palate	Optional. MAY be present.
SCT 1260047008	Local exogenous pigmentation of mucous membrane of lower lip	Optional. MAY be present.
SCT 1260049006	Local exogenous pigmentation of mucous membrane of upper lip	Optional. MAY be present.

7.2.8 Orthodontic Observable Entity#

These values are used within Acquisition Context (0040,0555) when Concept Name Code in (0040,A043) is (363787002, SCT, “Observable entity”).

**Table CID 4068. Orthodontic Observable Entity**#
SNOMED Code	Meaning	Notes
SCT 110343009	Tongue thrust	Mandatory if encoding IV13.
SCT 193093009	Bell’s palsy (disorder)	Optional.

7.2.9 Dental Occlusion#

These values are used within Acquisition Context (0040,0555) when Concept Name Code in (0040,A043) is (25272006, SCT, “Dental occlusion”).

**Table CID 4069. Dental Occlusion**#
SNOMED Code	Meaning	Notes
SCT 110320000	Centric occlusion (observable entity)	If present, Centric relation cannot be present. See Centric Relation and Centric Occlusion Definition.
SCT 736783005	Centric relation (observable entity)	If present, Centric occlusion cannot be present. See Centric Relation and Centric Occlusion Definition.

7.2.10 Longitudinal Temporal Event Type#

These values are used within Acquisition Context (0040,0555) when Concept Name Code in (0040,A043) is (128741, DCM, “Longitudinal Temporal Event Type”).

The allowed values for this code sequence have been taken from DICOM CID 280 and applied in the Progress Table above

<QUESTION FOR TONI: The last 3 values in this table are not in CID 280. Where did they come from?>

**Table CID 280. Longitudinal Temporal Event Type**#
Code	Meaning	Notes
(C37948, NCIt, “Enrollment”)	Enrollment
(121079, DCM, “Baseline”)	Baseline
SCT 184047000	Patient registration
SCT 1332161000	Orthodontic Treatment started
SCT 1340210007	Orthodontic Treatment stopped

7.2 DICOM Coded Values

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