DICOM Attribute

Image Position (Patient) (0020,0032)

Keyword
ImagePositionPatient
VR
DS
VM
3

Definition

The x, y, and z coordinates of the upper left hand corner (center of the first voxel transmitted) of the image, in mm. See for further explanation.

From NEMA PS3.3 §C.7.6.2.

Attribute Metadata

Tag
(0020,0032)
Keyword
ImagePositionPatient
Name
Image Position (Patient)
Value Representation (VR)
DS
Value Multiplicity (VM)
3
Status
Active
Source
NEMA PS3.6 (table_6-1)

This attribute is part of the current DICOM Standard. Its value representation is DS with multiplicity 3.

Used in 4 Modules

This attribute uses the DS Value Representation. Multiplicity 3 governs how many values may be encoded.

Integration Notes

Real-world integration guidance for engineers implementing this attribute in Mirth Connect, FHIR gateways, HL7 v2 bridges, and cloud DICOM services. Authoritative source data where available; reference examples and operational notes where they add value.

FHIR Mapping

No direct FHIR ImagingStudy mapping published for this attribute. Some tags map indirectly via the Patient, Endpoint, or ImagingSelection resources — Phase 2b will expand coverage to those.

HL7 v2 Equivalent

No standard HL7 v2 equivalent published for this attribute. Imaging-only attributes (Image Pixel data, technical acquisition parameters, modality-specific values) typically have no HL7 v2 carrier.

Cloud DICOM Support

  • AWS HealthImaging Preserved
  • Azure DICOM Preserved
  • Google Cloud Healthcare Preserved

Image Position (Patient) — preserved by all three. Required for multi-frame and 3D viewer registration.

Per-vendor source URLs and verification date in src/content/dicom/cloud-support.json#_meta. Status taxonomy: required (mandated on Store), queryable (QIDO-RS matching key), preserved (stored as-is), promoted (AWS top-level metadata), unsupported (stripped/rejected).

Real-World Sample Values

  • -158.135803\-179.035797\-75.699997 CT_small.dcm
  • -83.9063\-91.2000\6.6406 MR_small.dcm
  • 189.431250000000\199.431250000000\-761.87000000000 rtdose.dcm

Extracted from pydicom test fixtures (MIT, de-identified).

Mirth Connect Example

Image Position (Patient) bounds check for cardiac MR slabs — CardiacMR series often have ImagePosition values outside expected slab bounds —

CardiacMR series often have ImagePosition values outside expected slab bounds — common indicator of patient repositioning mid-series.

// (0020,0032) Image Position (Patient) — multi-value DS xyz in mm
var posStr = String(msg.dataset.attr.(@tag == '00200032').value).split('\\');
var x = parseFloat(posStr[0]); var y = parseFloat(posStr[1]); var z = parseFloat(posStr[2]);
var prevZ = parseFloat(channelMap.get('prev_image_z') || z);
if (Math.abs(z - prevZ) > 50) { // 50mm gap suggests patient repositioning
  channelMap.put('series_jump_warning', 'Z gap ' + Math.abs(z - prevZ).toFixed(1) + 'mm at instance');
}
channelMap.put('prev_image_z', z);

Reference only — validate before production. Snippets are starting points, not turnkey solutions. Always test against your channel's specific message structure and your facility's interface specification. See Mirth Connect User Guide + NEMA PS3.6 + your vendor conformance statement for authoritative specification.

Common Operational Errors

  • medium Image Position (Patient) jumps mid-series indicate patient repositioning

    Diagnosis: MR / CT series shows a slice gap >50mm in z-direction mid-series. Patient was repositioned by tech mid-acquisition. Some 3D reconstruction software fails silently; volumetric measurements are wrong.

    Fix: Alert on perimeter: track previous instance's z-position; if delta > expected slice thickness × 5, log warning and route to QC for review. Notify acquisition tech via email/Slack alert.

Reference only — validate before applying a fix. Scenarios are drawn from common DICOM/HL7 v2 integration patterns; reproduce against your environment before acting on any diagnosis. See NEMA PS3.6 + your vendor conformance statement for authoritative specification. Severity levels: high (data-loss / patient-safety), medium (workflow disruption), low (cosmetic).

DICOM Integration Services

Saga IT builds production DICOM integrations across Mirth Connect, FHIR gateways, and cloud imaging platforms. If you're working with ImagePositionPatient or the broader (0020,0032) context: