Purpose
The Digital Radiography (DR) module within the ACR Dose Index Registry (DIR) is designed to collect, standardize, and report dose index data for projection radiography. Compared to CT and fluoroscopy, a unique aspect of DR is that the dose indices are event-driven rather than examination-driven. A radiographic examination may consist of two or more anatomical views (e.g. posteroanterior and lateral chest views). Each anatomical view may have its own exposure technique. Therefore, it’s more meaningful and useful to report dose index statistics for each anatomical view separately.
This article explains how view information is parsed from the Radiation Dose Structured Report (RDSR). It also provides a reference table of the current body parts and views displayed in the DIR DR Standardized Dose Index By View report along with their associated ACR Common IDs. These body parts and views represent some of the most common (e.g. chest radiography) or higher kerma-area product (e.g. lumbar spine radiography) procedures.
How View Information is Extracted from RDSRs
The DR module identifies the anatomical view in an acquisition event through a three-step process:
Step 1. Body Part Identification
The body part is currently determined by the ACR Common ID.
The ACR Common ID maps directly to standardized body regions used across all DIR participants.
Step 2a. Primary Method: View Tag Extraction
The system first checks for the Image View tag (TID 111031) in the incoming RDSR.
If the Image View tag is populated, the value is assigned to the corresponding DIR-DR standardized view. Currently defined standardized views can be found in Table I below. The corresponding RDSR code values can be found in Table II, Column 1.
Example:
RDSR Code Value (111031) – ImageView
Value = " antero-posterior " → Assigned to AP view for Chest and Abdomen, or PA/AP for remaining Body regions as described in Table II.
Step 2b. Alternative Method: Acquisition Protocol Parsing
If the Image View tag is empty or not populated, the system will parse the RDSR tag “Acquisition Protocol” (TID 125203).
The Acquisition Protocol Name is passed through a parser that searches for any key word containing view information. The current search words can be found in Table II, Column 2.
The extracted view is matched to a DIR-DR standardized view (Table II, Columns 3-5).
Example:
RSDR Code Value (125203) – AcquisitionProtocol
Value = "Chest_Pediatric_Lat" → Parsed output = Lateral view based on Columns 2 and 3 of Table II if the common ID is associated with the Chest.
Step 3. Incorporate Device Type
The Device Type is determined from the Device Profile. Please ensure your device profiles are complete and up to date. You can check the Data Completeness Dashboard to see which stations, if any, have not had their profiles updated. Possible classifications that currently exist are Fixed or Mobile.
Currently, Chest and Abdomen have views that are segregated by Device Type, while other body parts use combined data from fixed and mobile units (All).
Currently, 26 combinations of body part, device type, and anatomical view are displayed in the DIR DR Standardized Dose Index By View report. They represent some of the most common (e.g. chest radiography) or higher kerma-area product (e.g. lumbar spine radiography) studies (Table I).
Table I. Current DIR-DR standardized views for various body parts and their associated ACR Common IDs and device types
Body Part | ACR Common IDs | Device Type | DIR-DR Standardized View |
Chest | 4013092 RAD, chest 4002930 RAD, chest, preoperative 4002931 RAD, chest, routine admission 4009523 RAD, chest, routine preoperative 4009524 RAD, chest, routine outpatient 4009418 RAD, portable, chest | Fixed | AP |
PA | |||
| Lateral | ||
|
| ||
Mobile | AP | ||
|
| ||
Ribs | 4002245 RAD, chest, ribs | All | PA/AP |
Abdomen | 4002472 RAD, abdomen 4002435 RAD, abdomen-pelvis 4002705 RAD, abdomen-pelvis, incl KUB | Fixed | AP |
Upright | |||
Mobile | AP | ||
Decubitus | |||
C-Spine | 4002235 RAD, spine, cervical | All | PA/AP |
4003064 RAD, spine, cervical, flexion-extension lateral | Lateral | ||
T-Spine | 4002252 RAD, spine, thoracic
| All | PA/AP |
Lateral | |||
L-Spine | 4002241 RAD, spine, lumbar | All | PA/AP |
4002242 RAD, spine, lumbar-sacrum | Lateral | ||
Scoliosis | 4013271 RAD, scoliosis, spine, cervical spine, thoracic spine, lumbar spine | Fixed | PA/AP |
Lateral | |||
Shoulder | 4002736 RAD, upper extremity, shoulder, unilateral | All | PA/AP |
4012789 RAD, upper extremity, shoulder, additional views | |||
Hand
| 4002708 RAD, upper extremity, hand, unilateral | All
| PA/AP |
4012993 RAD, upper extremity, hand, repeat in 10-14 days | Lateral | ||
Knee | 4002240 RAD, lower extremity, knee, unilateral | All
| PA/AP |
Lateral | |||
Foot
| 4002707 RAD, lower extremity, foot, unilateral | All
| PA/AP |
Lateral | |||
Skull
| 4002247 RAD, head, skull
| All | PA/AP |
Lateral |
Notes:
ACR Common IDs in this table will be updated as more standardized views are introduced.
Facilities should verify that their acquisition protocol naming conventions align with the search words in Table II, Column 2, to ensure accurate parsing of anatomical view information.
Table II. Current search words in RDSR tag “Image View” (Column 1) and RDSR tag “Acquisition Protocol” (Column 2) that are mapped to the DIR-DR standardized views for chest, abdomen, and the remaining body parts
Search Word for Image View (TID 111031) | Search Word for Acquisition Protocol (TID 125203) | Current DIR-DR Standardized View | ||
Chest | Abdomen | Remaining Body Parts | ||
antero-posterior | AP | AP | AP | PA/AP |
| AP/PA |
|
| PA/AP |
decubitus | DECU |
| Decubitus (Mobile Only) |
|
DECUB |
|
| ||
DEBCUB |
|
| ||
DECUBITUS |
|
| ||
frontal | FRONTAL |
|
| PA/AP |
lateral | /LAT | Lateral |
| Lateral |
LAT |
| |||
LATERAL |
| |||
postero-anterior | PA | PA |
| PA/AP |
supine | SUPINE |
| AP |
|
 | UPR |
| Upright |
|
upright | UPRIGHT |
|
| |
Notes:
Blanks indicate (body part, view) combinations that are not currently included in the DIR DR Standardized Dose Index By View report.
The acquisition protocol search word is not case-sensitive.
An Example of How Event Level Parsing Works
Consider the common exam order “XR Chest 1-V Portable”. If the technologist were to fill this order by acquiring an AP Chest view in a fixed x-ray room, the dose indices would be mapped to Chest-AP-Fixed. Without event level parsing, it would be categorized with other exams mapped to the same ACR Common ID (e.g., 4009418 RAD, portable, chest), which potentially contains data from both mobile and fixed units.
Summary Workflow
Data ingestion: RDSRs are sent to the ACR DIR.
Body part identification:
Body part determined from ACR Common ID.
View parsing:
Check RDSR tag “Image View” → Use directly if populated.
If empty → Parse RDSR tag “Acquisition Protocol”.
If empty → Data is not included in DIR DR Standardized Dose Index By View report
Dashboard reporting:
Finalized data populates the DIR DR Standardized Dose Index By View report for monitoring and benchmarking.