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The "native image" is that which is being padded to the required rectangular format, e.g., the area within the circular reconstruction perimeter of a CT image, or the subset of the rectangular area that contains useful image information, i.e., which is not to be suppressed, or e.g., is that part of a pseudo-colored image that might be superimposed on top of another image. For other mechanisms, see Section N.2.6 “Advanced Blending Transformations” in PS3.4.

The Pixel Padding Value is explicitly described in order to prevent display applications from taking it into account when determining the dynamic range of an image, since the Pixel Padding Value will be outside the range between the minimum and maximum values of the pixels in the native image

No pixels in the native image will have a value equal to Pixel Padding Value (0028,0120).

When the relationship between pixel value and X-Ray Intensity is unknown, it is recommended that the following values be used to pad with black when the image is unsigned:

and when the image is signed:

For projection radiography, when the relationship between pixel value and X-Ray Intensity is known (for example as defined by Pixel Intensity Relationship (0028,1040) and Pixel Intensity Relationship Sign (0028,1041)), it is recommended that a pixel value equivalent to, or rendered similarly to, air (least X-Ray absorbance) be used for padding. However, if such a value may occur in the native image, the Pixel Padding Value (0028,0120) Attribute itself should not be present.

E.g., for an XRF image obtained with an image intensifier, if air is black then a padded perimeter, if any, should also appear black. Typically though, if unpadded, this area would be collimated with a circular collimator, in which case the pixels would appear natively as white (greatest X-Ray absorbance) and a circular shutter would be necessary to neutralize them as black. Whether collimated areas are detected and treated as padded, or neutralized with shutters is at the discretion of the application. See also the Display Shutter Module Section C.7.6.11.

The conditional requirement for the Pixel Padding Range Limit (0028,0121) in the Image Pixel Module means that it shall not be present unless Pixel Padding Value (0028,0120) is also present.

The range of values to be suppressed between Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) is specified as being inclusive, that is the values themselves as well as all values between are suppressed.

When Pixel Padding Range Limit (0028,0121) is present, but not supported by a rendering application, the constraint that Pixel Padding Value (0028,0120) is closest to the "blackest" value, which is typically the most frequently occurring background pixel, will most often result in an acceptable display, permitting "backward compatibility" in the majority of cases.

For example, if a CT image containing signed values from -1024 to 3191 and a Pixel Padding Value (0028,0120) of -2000 and a Rescale Intercept (0028,1052) of 0 is converted to an unsigned image with a Rescale Intercept (0028,1052) of -1024 by adding 1024 to all pixels and clipping all more negative pixels to 0, then the padding pixels will be indistinguishable from some of the modified native image pixels, and hence Pixel Padding Value (0028,0120) needs to be removed.

If the modification involves lossy compression, which may result in changes to the pixel values, then the application of Pixel Padding Value (0028,0120) and Pixel Padding Range Limit (0028,0121) may result in a different appearance, and hence these Attributes may need different values also.