US Multi-frame ImageCIOD
Secondary Capture ImageCIOD
Multi-frame Single Bit SC ImageCIOD
Multi-frame Grayscale Byte SC ImageCIOD
Multi-frame Grayscale Word SC ImageCIOD
Multi-frame True Color SC ImageCIOD
X-Ray Angiographic ImageCIOD
X-Ray Radiofluoroscopic ImageCIOD
RT Structure SetCIOD
Digital X-Ray ImageCIOD
Digital Mammography X-Ray ImageCIOD
Digital Intra-Oral X-Ray ImageCIOD
RT Beams Treatment RecordCIOD
RT Brachy Treatment RecordCIOD
RT Treatment Summary RecordCIOD
VL Endoscopic ImageCIOD
VL Microscopic ImageCIOD
VL Slide-Coordinates Microscopic ImageCIOD
VL Photographic ImageCIOD
Video Endoscopic ImageCIOD
Video Microscopic ImageCIOD
Video Photographic ImageCIOD
VL Whole Slide Microscopy ImageCIOD
Real-Time Video Endoscopic ImageCIOD
Real-Time Video Photographic ImageCIOD
Grayscale Softcopy Presentation StateCIOD
Color Softcopy Presentation StateCIOD
Pseudo-Color Softcopy Presentation StateCIOD
Blending Softcopy Presentation StateCIOD
Basic Structured DisplayCIOD
XA/XRF Grayscale Softcopy Presentation StateCIOD
Advanced Blending Presentation StateCIOD
PatientMModule - Patient
Clinical Trial SubjectUModule - Patient
General StudyMModule - Study
Patient StudyUModule - Study
Clinical Trial StudyUModule - Study
General SeriesMModule - Series
Presentation SeriesMModule - Series
Clinical Trial SeriesUModule - Series
Frame of ReferenceMModule - Frame of Reference
General EquipmentMModule - Equipment
Enhanced General EquipmentMModule - Equipment
Presentation State IdentificationMModule - Presentation State
Advanced Blending Presentation StateMModule - Presentation State
(0070,1B01) Advanced Blending Sequence1Sequence
(0008,1140) Referenced Image Sequence1CSequence
(0020,000D) Study Instance UID1Unique Identifier
(0020,000E) Series Instance UID1Unique Identifier
(0070,0404) Referenced Spatial Registration Sequence1CSequence
(0008,1115) Referenced Series Sequence1Sequence
(0008,0054) Retrieve AE Title3Application Entity
(0008,1190) Retrieve URL3URL
(0008,1199) Referenced SOP Sequence1Sequence
(0008,1150) Referenced SOP Class UID1Unique Identifier
(0008,1155) Referenced SOP Instance UID1Unique Identifier
(0040,A170) Purpose of Reference Code Sequence3Sequence
(0400,0402) Referenced Digital Signature Sequence3Sequence
(0400,0403) Referenced SOP Instance MAC Sequence3Sequence
(0400,0010) MAC Calculation Transfer Syntax UID1Unique Identifier
(0400,0015) MAC Algorithm1Code String
(0400,0020) Data Elements Signed1Attribute Tag
(0400,0404) MAC1Other Byte String
(0020,000E) Series Instance UID1Unique Identifier
(0040,E011) Retrieve Location UID3Unique Identifier
(0088,0130) Storage Media File-set ID3Short String
(0088,0140) Storage Media File-set UID3Unique Identifier
(0020,000D) Study Instance UID1Unique Identifier
(0070,1B02) Blending Input Number1Unsigned Short
(0070,1B07) Time Series Blending1CCode String
(0070,1B08) Geometry for Display1CCode String
(0070,1B11) Threshold Sequence1CSequence
Advanced Blending Presentation State DisplayMModule - Presentation State
Displayed AreaUModule - Presentation State
Graphic AnnotationUModule - Presentation State
Spatial TransformationCModule - Presentation State
Graphic LayerCModule - Presentation State
Graphic GroupUModule - Presentation State
ICC ProfileMModule - Presentation State
Common Instance ReferenceMModule - Presentation State
SOP CommonMModule - Presentation State
Basic Voice Audio WaveformCIOD
Ambulatory ECGCIOD
Hemodynamic WaveformCIOD
Basic Cardiac Electrophysiology WaveformCIOD
Arterial Pulse WaveformCIOD
Respiratory WaveformCIOD
General Audio WaveformCIOD
Real-Time Audio WaveformCIOD
Basic Text SRCIOD
Enhanced SRCIOD
Comprehensive SRCIOD
Key Object Selection DocumentCIOD
Mammography CAD SRCIOD
Procedure LogCIOD
X-Ray Radiation Dose SRCIOD
Spectacle Prescription ReportCIOD
Macular Grid Thickness and Volume ReportCIOD
Implantation Plan SR DocumentCIOD
Comprehensive 3D SRCIOD
Radiopharmaceutical Radiation Dose SRCIOD
Extensible SRCIOD
Acquisition Context SRCIOD
Simplified Adult Echo SRCIOD
Patient Radiation Dose Structured ReportCIOD
Planned Imaging Agent Administration SRCIOD
Performed Imaging Agent Administration SRCIOD
Rendition Selection DocumentCIOD
Enhanced MR ImageCIOD
MR SpectroscopyCIOD
Enhanced MR Color ImageCIOD
Raw DataCIOD
Enhanced CT ImageCIOD
Spatial RegistrationCIOD
Deformable Spatial RegistrationCIOD
Spatial FiducialsCIOD
Ophthalmic Photography 8 Bit ImageCIOD
Ophthalmic Photography 16 Bit ImageCIOD
Stereometric RelationshipCIOD
Hanging ProtocolCIOD
Encapsulated PDFCIOD
Encapsulated CDACIOD
Real World Value MappingCIOD
Enhanced XA ImageCIOD
Enhanced XRF ImageCIOD
RT Ion Beams Treatment RecordCIOD
Ophthalmic Tomography ImageCIOD
X-Ray 3D Angiographic ImageCIOD
X-Ray 3D Craniofacial ImageCIOD
Breast Tomosynthesis ImageCIOD
Enhanced PET ImageCIOD
Surface SegmentationCIOD
Color PaletteCIOD
Enhanced US VolumeCIOD
Lensometry MeasurementsCIOD
Autorefraction MeasurementsCIOD
Keratometry MeasurementsCIOD
Subjective Refraction MeasurementsCIOD
Visual Acuity MeasurementsCIOD
Ophthalmic Axial MeasurementsCIOD
Intraocular Lens CalculationsCIOD
Generic Implant TemplateCIOD
Implant Assembly TemplateCIOD
Implant Template GroupCIOD
RT Beams Delivery InstructionCIOD
Ophthalmic Visual Field Static Perimetry MeasurementsCIOD
Intravascular Optical Coherence Tomography ImageCIOD
Ophthalmic Thickness MapCIOD
Surface Scan MeshCIOD
Surface Scan Point CloudCIOD
Legacy Converted Enhanced CT ImageCIOD
Legacy Converted Enhanced MR ImageCIOD
Legacy Converted Enhanced PET ImageCIOD
Corneal Topography MapCIOD
Breast Projection X-Ray ImageCIOD
Parametric MapCIOD
Wide Field Ophthalmic Photography Stereographic Projection ImageCIOD
Wide Field Ophthalmic Photography 3D Coordinates ImageCIOD
Tractography ResultsCIOD
RT Brachy Application Setup Delivery InstructionCIOD
Planar MPR Volumetric Presentation StateCIOD
Volume Rendering Volumetric Presentation StateCIOD
Content Assessment ResultsCIOD
CT Performed Procedure ProtocolCIOD
CT Defined Procedure ProtocolCIOD
Protocol ApprovalCIOD
Ophthalmic Optical Coherence Tomography En Face ImageCIOD
Ophthalmic Optical Coherence Tomography B-scan Volume AnalysisCIOD
Encapsulated STLCIOD
Encapsulated OBJCIOD
Encapsulated MTLCIOD
RT Physician IntentCIOD
RT Segment AnnotationCIOD
RT Radiation SetCIOD
C-Arm Photon-Electron RadiationCIOD
Tomotherapeutic RadiationCIOD
Robotic-Arm RadiationCIOD
Basic DirectoryCIOD

Built with by Innolitics, a team of medical imaging software developers.

Data synced with official DICOM standard on 12 May 2020. The DICOM Standard is under continuous maintenance, and the current official version is available at DICOM Parts 3, 4, and 6, © NEMA. Please note that the most recent PDF version of the standard is the official reference, and should checked when making technical decisions.

Data Elements Signed Attribute

TypeRequired (1)
Value Multiplicity1-n
Value RepresentationAttribute Tag (AT)

A list of Data Element Tags in the order they appear at the top level of the referenced SOP Instance that identify the Data Elements used in creating the MAC. See Section C.

Section C.

C. Data Elements Signed

The Data Elements Signed Attribute shall list the Tags of the Data Elements that are included in the MAC calculation. The Tags listed shall reference Data Elements at the same level as the Mac Parameters Sequence (4FFE,0001) Data Element in which the Data Elements Signed Attribute appears. Tags included in Data Elements Signed shall be listed in the order in which they appear within the Data Set.

The following Data Elements shall not be included either implicitly or explicitly in the list of Tags in Data Elements Signed, nor included as part of the MAC calculation:

  • The Length to End (0008,0001) or any Tag with an element number of 0000 (i.e., no Data Set or group lengths may be included in MAC calculations)

  • Tags with a group number less than 0008

  • Tags associated with Data Elements whose VR is UN

  • Tags of Data Elements whose VR is SQ, where any Data Element within that Sequence of Items has a VR of UN recursively

  • Tags with a group number of FFFA (e.g., the Digital Signatures Sequence)

  • MAC Parameters Sequence (4FFE,0001)

  • Data Set Trailing Padding (FFFC,FFFC)

  • Item Delimitation Item (FFFE,E00D)


  1. The Length to End and group lengths can change if non-signed Data Elements change, so it is not appropriate to include them in the MAC calculation.

  2. Since the Data Element Tags that identify a Sequence and the start of each Item are included in the MAC calculation, there is no need to include the Item Delimitation Item Tags.

If any of the Data Element Tags in the list refer to a Sequence of Items, then the Tags of all Data Elements within all Items of that Sequence shall be implicitly included in the list of Data Elements Signed, except those disallowed above. This implicit list shall also include the Item Tag (FFFE,E000) Data Elements that separate the Sequence Items and the Sequence Delimitation Item (FFFE,E0DD).


It is possible to sign individual Items within a Sequence by including the Digital Signatures Macro in that Sequence Item. In fact, this is a highly desirable feature, particular when used in the context of reports. The Digital Signatures Macro is applied at the Data Set level, and Sequences of Items are merely Data Sets embedded within a larger Data Set. Essentially, the Digital Signature Macro may be applied recursively.

An example of nesting Digital Signatures within Data Elements is illustrated in Figure C.12-1.

Figure C.12-1. Example of Nesting Digital Signatures (Informative)

In this example, there is main signature covering the pixel data and a few other Data Elements, plus two individually signed Items within a Sequence.

For Data Elements with a VR OB (e. g. pixel data) that have an undefined length (i.e., the data is encapsulated as described in PS3.5), the Item Data Element Tags that separate the fragments shall implicitly be included in the list of Data Elements Signed (i.e., a Data Element with a VR of OB is encoded in the same fashion as a Sequence of Items).