DICOM Attribute

Image Orientation (Patient) (0020,0037)

Keyword
ImageOrientationPatient
VR
DS
VM
6

Definition

The direction cosines of the first row and the first column with respect to the patient. See for further explanation.

From NEMA PS3.3 §C.7.6.2.

Attribute Metadata

Tag
(0020,0037)
Keyword
ImageOrientationPatient
Name
Image Orientation (Patient)
Value Representation (VR)
DS
Value Multiplicity (VM)
6
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 6.

Used in 5 Modules

This attribute uses the DS Value Representation. Multiplicity 6 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 Orientation (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

  • 1.000000\0.000000\0.000000\0.000000\1.000000\0.000000 CT_small.dcm
  • 1.0000\0.0000\0.0000\0.0000\1.0000\0.0000 MR_small.dcm
  • 1.00000000000000\0.0\0.0\0.0\1.00000000000000\0.0 rtdose.dcm

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

Mirth Connect Example

JavaScript transformer snippets for the most-queried tags will be added as coverage expands.

Common Operational Errors

Operational error patterns for the most-queried tags will be added as coverage expands.

DICOM Integration Services

Saga IT builds production DICOM integrations across Mirth Connect, FHIR gateways, and cloud imaging platforms. If you're working with ImageOrientationPatient or the broader (0020,0037) context: