Digital Imaging and Communications in Medicine (DICOM) s3

ASE • ACR • NEMA

Digital Imaging and Communications in Medicine (DICOM)

Supplement 45: Ultrasound Protocol Supplement

Prepared by:

22 DICOM Standards Committee, Working Group 12 Ultrasound

1300 N. 17th Street

24 Rosslyn, Virginia 22209 USA

26 Version: 0.6

3 December, 1998 2 Supplement 45: Ultrasound Protocol 2 Page i Foreword...... iii 2 Scope and Field of Application...... iv A.1.4 Overview of the Composite IOD Module Content...... 2 4 A.6.4 US Image IOD Module Table...... 4 A.7.4 US Multi-Frame Image IOD Module Table...... 6 6 C.8.5.x US Series Module...... 7 C.8.5.y US Protocol Module...... 9 8 6. REGISTRY OF DICOM DATA ELEMENTS...... 16 ii

DOCUMENT HISTORY

Document Date Content Version 0.1 3 June, 1998 New draft based on 26-27 February meeting output 0.2 4 June, 1998 Added data elements to Part 6. Added note in C.8.5.y US Protocol Module 0.3 8 June, 1998 Synchronized with Supplement 36. Added tables with preliminary picklists for microglossary inclusion. 0.4 30 November, 1998 Added supplement number (45). Added DICOMDIR support for Part 11. Made new modules optional. Defined relationship of ultrasound protocols to DICOM Real-World Model. 0.5 1 December, 1998 Clean up of Forward, Scope and Field of Application and page numbering. 0.6 3 December, 1998 Clarify relationship of ultrasound protocols to DICOM Real-World Model.

OPEN ISSUES

Finish defining picklists. Get element numbers for new attributes.

2 ii Supplement 45: Ultrasound Protocol 2 Page iii

Foreword

2 This draft Supplement to the DICOM Standard was developed according to NEMA Procedures. This Supplement to the Standard is developed in liaison with other standardization organizations including CEN 4 TC251 in Europe, MEDIS-DC and JIRA in Japan, with review also by other organizations including IEEE, HL7 and ANSI in the USA.

6 The DICOM Standard is structured as a multi-part document using the guidelines established in the following document:

8 - ISO/IEC Directives, 1989 Part 3 : Drafting and Presentation of International Standards.

This document is a Supplement to the DICOM Standard. It is an extension to PS 3.3, 3.6 and 3.11 of the 10 published DICOM Standard which consists of the following parts:

PS 3.1 - Introduction and Overview

12 PS 3.2 - Conformance

PS 3.3 - Information Object Definitions

14 PS 3.4 - Service Class Specifications

PS 3.5 - Data Structures and Encoding

16 PS 3.6 - Data Dictionary

PS 3.7 - Message Exchange

18 PS 3.8 - Network Communication Support for Message Exchange

PS 3.9 - Point-to-Point Communication Support for Message Exchange

20 PS 3.10 Media Storage and File Format for Data Interchange

PS 3.11 Media Storage Application Profiles

22 PS 3.12 Media Formats and Physical Media for Data Interchange

PS 3.13 Print Management Point-to-Point Communication Support

24 PS 3.14 Gray-scale Display Function Standard

26 These parts are related but independent documents. iv

Scope and Field of Application

2 This Supplement to the DICOM Standard specifies changes to the DICOM Image Information Object Definition (IOD) for Ultrasound (US) and Ultrasound Multi-frame (USMF) Images. It specifies the new 4 modules necessary to identify images acquired as part of an ultrasound acquisition protocol.

Since this document proposes changes to existing Parts of DICOM the reader should have a working 6 understanding of the Standard.

This proposed Supplement includes a number of Addenda to existing Parts of DICOM:

8 1. PS 3.3 Addenda (Extension to Annex A and Annex C)

2. PS 3.6 Addenda (Extension to Section 6)

10 3. PS 3.11 Addenda (Extension to Annex C)

2 iv Supplement 45: Ultrasound Protocol 2 Page 1

Changes to:

12 NEMA Standards Publication PS 3.3-1998 Digital Imaging and Communications in Medicine (DICOM)

14 Part 3: Information Object Definitions

2 Item: Add to PS 3.3 Table A.1-1

A.1.4 Overview of the Composite IOD Module Content 4 Table A.1-1 provides an overview of the Modules used throughout the Composite IODs. This table is for informative purposes only. It is based on the IOD definitions found in the remaining sections of Annex A 6 which are normative.

Table A.1-1 8 COMPOSITE INFORMATION OBJECT MODULES OVERVIEW IODs US US- Modules mf

Patient M M

Patient Summary

General M M Study

Patient study U U

Study Content

General M M Series

CR Series

NM Series

US Series U U

Frame Of U U Reference

U S Frame of C C Ref.

General M M Equipment

SC Equipment

General M* M Image Image Plane

Image Pixel M* M

NM Image Pixel

Pallet Color C C Lookup Table Contrast/ C* C Bolus

Cine M

Multi-frame M

NM Multi- frame

Frame Pointers

2 Supplement 45: Ultrasound Protocol 2 Page 3

Display Shutter

Device

Therapy

CR Image

CT Image

MR Image

NM Image

NM Isotope

NM Detector

NM TOMO Acquisition

NM Multi- Gated Acquisition

NM Phase

NM Reconstruction

US Region U* U Calibration

US Image M* M

US Protocol U U

SC Image

X-Ray Image

X-Ray Acquisition

X-Ray Collimator

X-Ray Table

XRF Positioner

XRF Tomo Acquisition

XA Positioner

Bi-Plane Sequence

Bi-Plane Image

Overlay Identification

Overlay Plane U*

Multi-frame Overlay

Bi-Plane 4

Overlay

Curve M* M* Identification

Curve M* M*

Audio U U

Modality LUT

VOI LUT U* U

LUT Identification

SOP M* M* Common

Item: Add to PS 3.3 Table A.6.4-1 - for clarity, those modules that are changed from the existing 4 standard or new are shown in Bold and Underlined

A.6.4 US Image IOD Module Table 8 Table A.6.4-1 US IMAGE IOD MODULES IE Module Reference Usage Patient Patient C.7.1.1 M Study General Study C.7.2.1 M Patient Study C.7.2.2 U Series General Series C.7.3.1 M US Series C.8.5.x U – Suggested if image is part of an acquisition protocol Frame of Frame of Reference C.7.4.1 U Reference US Frame of Reference C.8.5.4 C - Required if images are spatially related Equipment General Equipment C.7.5.1 M Image General Image C.7.6.1 M (See A.6.4.1) Image Pixel C.7.6.3 M Contrast/bolus C.7.6.4 C - Required if contrast media was used in this image Palette Color Lookup table C.7.9 C - Required if Photometic Interpretation (0028,0004) has a value of PALETTE COLOR US Region Calibration C.8.5.5 U

US Image C.8.5.6 M US Protocol C.8.5.y U – Suggested if image is part of an acquisition protocol Overplay Plane C.9.2 U VOI LUT C.11.2 U SOP Common C.12.1 M Curve Curve Identification C.10.1 M (See A.6.4.1) Curve C.10.2 M Audio C.10.3 U SOP Common C.12.1 M

2 A.6.4.1 Mutually Exclusive IEs The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactly 4 one of these IEs.

A.6.5 US Image IOD Relationship to the DICOM Real-World Model 6 Ultrasound images that make use of the US Series & Protocol Modules have a more specific relationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisition 8 protocol is considered one Requested Procedure and has one Procedure Plan. The Procedure Plan will have one or more Action Items. An ultrasound acquisition protocol will typically consist 10 of one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisition protocol was successfully completed, this will result in one Modality Performed Procedure Step. 12 Therefore, all images that are part of this particular instance of an ultrasound acquisition protocol will have the same Procedure Code Sequence (0032,1064). It is recommended that all the images 14 that are part of this particular instance of an ultrasound acquisition protocol have the same Performed Procedure Step ID and that each stage be a unique series. In an environment with 16 information system connectivity, the Procedure Code Sequence can be used to identify all the images that were acquired as part of that protocol. If no information system connectivity is 18 available, then Performed Procedure Step ID may be used to identify all the images that were acquired as part of that protocol.

Item: Add to PS 3.3 Table A.7.4-1 - for clarity, those modules that are changed from the existing 22 standard or new are shown in Bold and Underlined

28 A.7.4 US Multi-Frame Image IOD Module Table Table A.7.4-1 30 US MULTI-FRAME IMAGE IOD MODULES IE Module Reference Usage 6

Patient Patient C.7.1.1 M Study General Study C.7.2.1 M Patient Study C.7.2.2 U Series General Series C.7.3.1 M US Series C.8.5.x U – Suggested if image is part of an acquisition protocol Frame of Frame of Reference C.7.4.1 U Reference US Frame of Reference C.8.5.4 C - Required if images are spatially related Equipment General Equipment C.7.5.1 M Image General Image C.7.6.1 M (See A.7.4.1) Image Pixel C.7.6.3 M Contrast/bolus C.7.6.4 C - Required if contrast media was used in this image. Cine C.7.6.5 M Multi-frame C.7.6.6 M Palette Color Lookup Table C.7.9 C - Required if Photometric Interpretation (0028,0004) has a value of PALETTE COLOR US Region Calibration C.8.5.5 U US Image C.8.5.6 M US Protocol C.8.5.y U – Suggested if image is part of an acquisition protocol VOI LUT C.11.2 U SOP Common C.12.1 M Curve Curve Identification C.10.1 M (see A.7.4.1) Curve C.10.2 M

Audio C.10.3 U

SOP Common C.12.1 M

2 A.7.4.1 Mutually Exclusive IEs The Image and Curve IEs are mutually exclusive. Each SOP Instance using this IOD shall contain exactly 4 one of these IEs.

A.7.5 US Multi-Frame Image IOD Relationship to the DICOM Real-World Model 6 Ultrasound images that make use of the US Series & Protocol Modules have a more specific relationship to the DICOM Real-World Model than non-protocol images. An ultrasound acquisition 8 protocol is considered one Requested Procedure and has one Procedure Plan. The Procedure Plan will have one or more Action Items. An ultrasound acquisition protocol will typically consist 10 of one Scheduled Procedure Step containing one or more Action Items. Assuming the acquisition

protocol was successfully completed, this will result in one Modality Performed Procedure Step. 2 Therefore, all images that are part of this particular instance of an ultrasound acquisition protocol will have the same Procedure Code Sequence (0032,1064). It is recommended that all the images 4 that are part of this particular instance of an ultrasound acquisition protocol have the same Performed Procedure Step ID and that each stage be a unique series. In an environment with 6 information system connectivity, the Procedure Code Sequence can be used to identify all the images that were acquired as part of that protocol. If no information system connectivity is 8 available, then Performed Procedure Step ID may be used to identify all the images that were acquired as part of that protocol.

12 Item: Add to PS 3.3 New Sections C.8.5.x and C.8.5.y

14 C.8.5.x US Series Module Table C.8-x contains IOD attributes that describe an ultrasound series.

16 Table C.8-x US SERIES MODULE ATTRIBUTES Attribute Name Tag Type Attribute Description Protocol Name (0018,1030) 3 User-defined description of the conditions under which the Series was performed. Protocol Type Sequence (0018,xxxx) 2 Sequence of one or more Items that identifies the protocol used to acquire this image. See section C.8.5.x.1.y >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. >Protocol Type Modifier Sequence (0018,xxxx) 3 Sequence of one or more Items that modifies the primary protocol type used to acquire this image. See section C.8.5.x.1.y >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. Performed Procedure Step ID (0040,0253) 1C Identification of that Procedure that has been carried out within this step. Required if image was acquired in a Stage protocol. 18

20 C.8.5.x.1 US Series Attributes Descriptions C.8.5.x.1.y Protocol Type Sequence 22 These Data Elements are intended to replace Protocol Name (0018,1030) Data Element.

24 Protocol Type Sequence (0018,xxxx) describes the acquisition protocol used to acquire this image.

The Coding Scheme Designator (0008,0102) shall be SNM3.

26 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX. 8

Note: The following will not be included in the standard.

2 The following terms must be defined and a new Context ID created for them:

Code Value Code Meaning (0008,0100) (0008,0104) TBD Transthoracic G-A19E Trans-esophageal TBD Fetal TBD Epicardial TBD Intravascular TBD Intracardiac TBD Treadmill exercise TBD Bicycle exercise TBD Dobutamine stress TBD Arbutamine stress TBD Dipyridamole stress TBD Pacing 4

Protocol Type Modifier Sequence (0018,xxxx) modifies the primary acquisition protocol stage when the 6 image was acquired.

8 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX.

Code Value Code Meaning (0008,0100) (0008,0104) TBD Adult TBD Pediatric TBD Contrast EBD/LVO TBD Contrast perfusion TBD Contrast Doppler enhancement TBD Contrast NOS TBD Intraoperative TBD Maximal TBD Submaximal TBD Bruce protocol TBD Modified Bruce protocol TBD Naughton protocol TBD High dose TBD Low dose F-10440 Upright F-10340 Supine Position TBD 2D complete TBD Limited 2D only TBD Limited Doppler only TBD Limited M-mode only

2 C.8.5.y US Protocol Module Table C.8-y contains IOD attributes that describe an ultrasound acquisition protocol.

4 Table C.8-y US PROTOCOL MODULE ATTRIBUTES Attribute Name Tag Type Attribute Description Number of Stages (0008,2124) 2C Number of Stages in this protocol. Required if image was acquired in a Stage protocol. Number of Views in Stage (0008,212A) 2C Number of views in this Stage. Required if image was acquired in a Stage protocol. Stage Name (0008,2120) 1C A Stage is a particular time slice of a protocol in which a set of images are collected. The names can be free form text. Recommended text for Stress Echo stage names are: PRE-EXERCISE, POST-EXERCISE, PEAK-EXERCISE, RECOVERY, BASELINE, LOW DOSE, PEAK DOSE 10

Required if image was acquired in a Stage protocol. Stage Type Sequence (0008,xxxx) 2C Sequence of one or more items that identifies the acquisition protocol stage when the image was acquired. Required if image was acquired in a Stage protocol. See Section 8.5.y.1.1 >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. >Stage Type Modifier Sequence (0008,xxxx) 3 Sequence of one or more Items that modifies the primary stage type in this image. See Section 8.5.y.1.1 >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. Stage Number (0008,2122) 1C A number that identifies the Stage. Stage Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. See Section C.8.5.y.1.4 View Number (0008,2128) 1C A number that identifies the View. View Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. See Section C.8.5.y.1.5 Transducer Position Sequence (0008,2240) 2 Sequence of one or more Items that identifies the transducer position used in this image. See section C.8.5.y.1.2. >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 4. > Transducer Position Modifier (0008,2242) 3 Sequence of one or more Items that Sequence modifies the primary transducer position of interest in this image. See Section C.8.5.y.1.2. >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 5. Transducer Orientation Sequence (0008,2244) 2 Sequence of one or more Items that identifies the Transducer Orientation used in this image. See section C.8.5.y.1.3. >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 6. > Transducer Orientation Modifier (0008,2246) 3 Sequence of one or more Items that Sequence modifies the primary Transducer Orientation of interest in this image. See Section C.8.5.y.1.3 >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 7.

2 Note: Images that are part of a staged acquisition protocol should be identified by using Stage Type Sequence (0008,xxxx), Transducer Position Sequence (0008, 2240) and Transducer Orientation Sequence 4 (0008,2244). Stage Number (0008,2122), View Number (0008,2128), Number of Stages (0008,2124), Number of Views in 6 Stage (0008,212A) and Stage Name (0008, 2120) are maintained for backwards compatibility but may produce ambiguous results when used to identify a staged acquisition protocol.

2 C.8.5.y.1 US Protocol Attribute Descriptions C.8.5.y.1.1 Stage Type Sequence 4 These Data Elements are intended to replace Stage Name (0008,2120) Data Element.

Stage Type Sequence (0008,xxxx) describes the acquisition protocol stage when the image was 6 acquired.

8 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX

Code Value Code Meaning (0008,0100) (0008,0104) TBD Baseline TBD Contrast TBD Pre-stress TBD Mid-stress TBD Peak-stress TBD Low-dose TBD Mid-dose TBD Peak dose TBD Recovery TBD Post-drug TBD Pre-procedure TBD Intra-procedure TBD Post-procedure TBD Pacing TBD Preoperative TBD Intra-operative TBD Post-operative TBD Hand grip TBD Valsalva TBD Postural maneuver 12

Stage Type Modifier Sequence (0008,xxxx) modifies the primary acquisition protocol stage when the 14 image was acquired.

16 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID XXX . 12

Code Value Code Meaning (0008,0100) (0008,0104) TBD Dobutamine 5 mcg/kg/min TBD Dobutamine 10 mcg/kg/min TBD Dobutamine 20 mcg/kg/min TBD Dobutamine 30 mcg/kg/min TBD Dobutamine 40 mcg/kg/min TBD Dobutamine 50 mcg/kg/min TBD Dobutamine 40 mcg/kg/min plus atropine TBD Dobutamine 50 mcg/kg/min plus atropine TBD User-defined dobutamine dose TBD Post-pump #1 TBD Post-pump #2 TBD Post-pump #3 TBD Post-pump (unspecified) TBD User-defined pacing rate F-10440 Upright F-10340 Supine Position TBD Pre TBD Peak Arbutamine TBD Peak dipyridamole TBD Nitroglycerin TBD Bicycle TBD Amyl nitrite TBD Adenosine 4

6 C.8.5.y.1.2 Transducer Position Sequence Transducer Position Sequence (0008,2240) identifies the transducer position used in this image.

8 The Coding Scheme Designator (0008,0102) shall be SNM3.

The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 4.

Transducer Position Modifier Sequence (0008,2242) modifies the transducer position used in this image.

2 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 5.

4 C.8.5.y.1.3 Transducer Orientation Sequence Transducer Orientation Sequence (0008,2244) identifies the transducer orientation used in this image.

6 The Coding Scheme Designator (0008,0102) shall be SNM3.

The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 6.

Transducer Orientation Modifier Sequence (0008,2246) modifies the transducer orientation used in this 10 image.

12 The Code Value (0008,0100) shall be drawn from the SNOMED DICOM Microglossary Context ID 7.

14 C.8.5.y.1.4 Stages The Number of Stages (0008,2124) shall be the total number of stages performed in this instance of the 16 protocol. Stage Number (0008,2122) shall be the number that indicates the default order in which the stages are to be presented. Stage Number shall start from 1.

18 C.8.5.y.1.5 Views 20 The View Number (0008,2128) shall be used identify the same view across stages and defines a default order for presentation within and across stages. If a particular view appears in one stage but not in a 22 subsequent stage, then that View Number will not be used during that subsequent stage. View Number shall start from 1. The Number of Views in Stage (0008,212A) shall be used to indicate how many unique 24 View Numbers exist for this stage. 14

Changes to:

14 Part 6: Data Dictionary

2 6. REGISTRY OF DICOM DATA ELEMENTS Add the following Data Elements to PS 3.6, Section 6. 4 Tag Name VR VM

(0008,xxxx) Stage Type Sequence SQ 1

(0008,xxxx) Stage Type Modifier Sequence SQ 1

(0018,xxxx) Protocol Type Sequence SQ 1

(0018,xxxx) Protocol Type Modifier Sequence SQ 1 16

Changes to:

14 Part 11: Media Storage Application Profiles

Item: Add to PS 3.11 Section C.3.3.1 - for clarity, that text which is removed from the existing standard is 4 shown as Strikethrough and that text which is changed or new is shown in Underlined

C.3.3.1 Additional Keys 8 File Set Creators and Updaters are only required to generate mandatory elements specified in PS 3.10. Table C.3-4 specifies the additional associated keys that shall be supported. Refer to the Basic Directory 10 IOD in PS 3.3. At each directory record level any additional data elements can be added as keys, but is not required by File Set Readers to be able to use them as keys.

12 Table C.3-4 STD-US-XX-XX-XXXX ADDITIONAL DICOMDIR KEYS Key Attribute Tag Directory Type Notes Record Type Protocol Type (0018,xxxx) SERIES 2C Sequence of one or more Items that Sequence identifies the protocol used to acquire this image. Required if US Series module is included. See Part 3.3 Section C.8.5.x.1.y >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. >Protocol Type (0018,xxxx) SERIES 3 Sequence of one or more Items that Modifier Sequence modifies the primary protocol type used to acquire this image. See Part 3.3 Section C.8.5.x.1.y >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. Performed (0040,0253) SERIES 1C Identification of that Procedure that Procedure Step ID has been carried out within this step. Required if series was part of a performed procedure step. Number of Stages (0008,2124) IMAGE 2C Number of Stages in this protocol. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.4 Number of Views in (0008,212A) IMAGE 2C Number of unique views in this Stage Stage. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.5 Stage Type (0008,xxxx) IMAGE 2C Sequence of one or more items that Sequence identifies the acquisition protocol stage when the image was acquired. Required US Protocol module is present. See Part 3.3 Section 8.5.y.1.1 >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. 18

>Stage Type (0008,xxxx) IMAGE 3 Sequence of one or more Items that Modifier Sequence modifies the primary stage type in this image. See Part 3.3 Section 8.5.y.1.1 >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is ???. Stage Number (0008,2122) IMAGE 1C A number that identifies the Stage. Stage Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.4 View Number (0008,2128) IMAGE 1C A number that identifies the View. View Number starts at one. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.5 Transducer (0008,2240) IMAGE 2C Sequence of one or more Items that Position Sequence identifies the transducer position used in this image. Required if Stage Type Sequence (0008,xxxx) is present. See Part 3.3 Section C.8.5.y.1.2. >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 4. > Transducer (0008,2242) IMAGE 3 Sequence of one or more Items that Position Modifier modifies the primary transducer Sequence position of interest in this image. See Part 3.3 Section C.8.5.y.1.2. >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 5. Transducer (0008,2244) IMAGE 2C Sequence of one or more Items that Orientation identifies the Transducer Sequence Orientation used in this image. Required if Stage Type Sequence (0008,xxxx) is present.

See Part 3.3 Section C.8.5.y.1.3. >Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 6. > Transducer (0008,2246) IMAGE 3 Sequence of one or more Items that Orientation Modifier modifies the primary Transducer Sequence Orientation of interest in this image. See Part 3.3 Section C.8.5.y.1.3 >>Include ‘Code Sequence Macro‘ Table 8.8-1 Baseline Context ID is 7.