fix(pt): resolve Philips PET private SUV bulkdata before scaling (#6096)

* fix(pt): resolve Philips PET private SUV bulkdata before scaling

When a DICOMweb server delivers the Philips PET private tags SUVScaleFactor
(7053,1000) / ActivityConcentrationScaleFactor (7053,1009) as bulkdata, dcmjs
naturalization leaves them as { BulkDataURI } objects. These were fed verbatim
to calculate-suv, which treats the object as a valid value and silently
corrupts the SUV scaling factors.

Resolve these scalar private tags to numbers during ingestion - in both the
lazy (async) and non-lazy (sync) DICOMweb metadata paths, before INSTANCES_ADDED
fires - by decoding the bulkdata (VR-aware: DS/IS text or little-endian FL/FD).
Harden getPTImageIdInstanceMetadata to coerce values to finite numbers (reusing
@ohif/core utils.toNumber) and reject unresolved bulkdata objects so they can
never reach calculate-suv. Share the bulkdata-attach helper between both
metadata paths. Adds unit tests for the bulkdata decoder/resolver and for
getPTImageIdInstanceMetadata.

* refactor(bulkdata): move PET bulkdata resolution to a generic core tag registry

Generalize resolvePETPrivateScalarBulkData into a datasource-agnostic
utils.resolveBulkDataTags in @ohif/core, backed by a static tag registry
seeded with the Philips PET SUV/activity-concentration scalar tags and
extensible via registerResolvedBulkDataTags.

* fix(bulkdata): strip NUL padding and refresh qido auth before resolution

Address review feedback:
- decodeText now strips NUL (0x00) padding, which String.trim() leaves
  intact, so NUL-padded DS/IS values no longer decode as NaN. Adds a
  regression test.
- refresh qidoDicomWebClient.headers before resolveBulkDataTags in both
  series-metadata paths; retrieveBulkData is bound to qidoDicomWebClient,
  matching every other qido op in this file.

* fix(dicomweb): await deferred metadata storage

* fix(dicomweb): support single-part bulkdata responses

extensions/default/src/DicomWebDataSource/index.ts

@@ -25,6 +25,7 @@ import {
 } from '../utils/dicomWriter';
 import { getGetThumbnailSrc, ThumbnailContext } from './retrieveThumbnail';
 import { getRenderedURL } from './retrieveRendered';
+import retrieveBulkData from './retrieveBulkData';
 
 const { DicomMetaDictionary, DicomDict } = dcmjs.data;
 
@@ -147,6 +148,54 @@ function createDicomWebApi(dicomWebConfig: DicomWebConfig, servicesManager) {
   // this is part of hte base standard.
   dicomWebConfig.bulkDataURI ||= { enabled: true };
 
+  /**
+   * Adds the retrieve bulkdata function to naturalized DICOM data.
+   * This is done recursively, for sub-sequences. Shared by both the lazy
+   * (async) and non-lazy (sync) series-metadata retrieval paths.
+   */
+  const addRetrieveBulkDataNaturalized = (naturalized, instance = naturalized) => {
+    if (!naturalized) {
+      return naturalized;
+    }
+    for (const key of Object.keys(naturalized)) {
+      const value = naturalized[key];
+
+      if (Array.isArray(value) && typeof value[0] === 'object') {
+        // Fix recursive values
+        const validValues = value.filter(Boolean);
+        validValues.forEach(child => addRetrieveBulkDataNaturalized(child, instance));
+        continue;
+      }
+
+      // The value.Value will be set with the bulkdata read value
+      // in which case it isn't necessary to re-read this.
+      if (value && value.BulkDataURI && !value.Value) {
+        // handle the scenarios where bulkDataURI is relative path
+        fixBulkDataURI(value, instance, dicomWebConfig);
+        // Provide a method to fetch bulkdata
+        value.retrieveBulkData = retrieveBulkData.bind(qidoDicomWebClient, value);
+      }
+    }
+    return naturalized;
+  };
+
+  /**
+   * naturalizes the dataset, and adds a retrieve bulkdata method
+   * to any values containing BulkDataURI.
+   * @param {*} instance
+   * @returns naturalized dataset, with retrieveBulkData methods
+   */
+  const addRetrieveBulkData = instance => {
+    const naturalized = naturalizeDataset(instance);
+
+    // if we know the server doesn't use bulkDataURI, then don't
+    if (!dicomWebConfig.bulkDataURI?.enabled) {
+      return naturalized;
+    }
+
+    return addRetrieveBulkDataNaturalized(naturalized);
+  };
+
   const implementation = {
     initialize: ({ params, query }) => {
       if (dicomWebConfig.onConfiguration && typeof dicomWebConfig.onConfiguration === 'function') {
@@ -501,8 +550,16 @@ function createDicomWebApi(dicomWebConfig: DicomWebConfig, servicesManager) {
         dicomWebConfig
       );
 
-      // first naturalize the data
-      const naturalizedInstancesMetadata = data.map(naturalizeDataset);
+      // first naturalize the data, attaching bulkdata retrieve methods so that
+      // bulkdata-valued tags can be resolved (matching the lazy-load path).
+      const naturalizedInstancesMetadata = data.map(addRetrieveBulkData);
+
+      // Resolve the registered bulkdata tags (e.g. the Philips SUV Scale
+      // Factor) delivered as bulkdata into plain numbers BEFORE
+      // INSTANCES_ADDED fires. retrieveBulkData is bound to qidoDicomWebClient,
+      // so refresh its auth headers first (matching every other qido op here).
+      qidoDicomWebClient.headers = getAuthorizationHeader();
+      await utils.resolveBulkDataTags(naturalizedInstancesMetadata);
 
       const seriesSummaryMetadata = {};
       const instancesPerSeries = {};
@@ -576,57 +633,19 @@ function createDicomWebApi(dicomWebConfig: DicomWebConfig, servicesManager) {
           dicomWebConfig
         );
 
-      /**
-       * Adds the retrieve bulkdata function to naturalized DICOM data.
-       * This is done recursively, for sub-sequences.
-       */
-      const addRetrieveBulkDataNaturalized = (naturalized, instance = naturalized) => {
-        if (!naturalized) {
-          return naturalized;
-        }
-        for (const key of Object.keys(naturalized)) {
-          const value = naturalized[key];
-
-          if (Array.isArray(value) && typeof value[0] === 'object') {
-            // Fix recursive values
-            const validValues = value.filter(Boolean);
-            validValues.forEach(child => addRetrieveBulkDataNaturalized(child, instance));
-            continue;
-          }
-
-          // The value.Value will be set with the bulkdata read value
-          // in which case it isn't necessary to re-read this.
-          if (value && value.BulkDataURI && !value.Value) {
-            // handle the scenarios where bulkDataURI is relative path
-            fixBulkDataURI(value, instance, dicomWebConfig);
-            // Provide a method to fetch bulkdata
-            value.retrieveBulkData = retrieveBulkData.bind(qidoDicomWebClient, value);
-          }
-        }
-        return naturalized;
-      };
-
-      /**
-       * naturalizes the dataset, and adds a retrieve bulkdata method
-       * to any values containing BulkDataURI.
-       * @param {*} instance
-       * @returns naturalized dataset, with retrieveBulkData methods
-       */
-      const addRetrieveBulkData = instance => {
-        const naturalized = naturalizeDataset(instance);
-
-        // if we know the server doesn't use bulkDataURI, then don't
-        if (!dicomWebConfig.bulkDataURI?.enabled) {
-          return naturalized;
-        }
-
-        return addRetrieveBulkDataNaturalized(naturalized);
-      };
-
       // Async load series, store as retrieved
-      function storeInstances(instances) {
+      async function storeInstances(instances) {
         const naturalizedInstances = instances.map(addRetrieveBulkData);
 
+        // Resolve the registered bulkdata tags (e.g. the Philips SUV Scale
+        // Factor) that the server delivered as bulkdata into plain numbers
+        // BEFORE INSTANCES_ADDED fires, so SUV scaling and every other
+        // subscriber read a fully-resolved value rather than an unresolved
+        // { BulkDataURI }. retrieveBulkData is bound to qidoDicomWebClient, so
+        // refresh its auth headers first (matching every other qido op here).
+        qidoDicomWebClient.headers = getAuthorizationHeader();
+        await utils.resolveBulkDataTags(naturalizedInstances);
+
         // Adding instanceMetadata to OHIF MetadataProvider
         naturalizedInstances.forEach(instance => {
           setNonEnumerableInstanceProperty(instance, 'wadoRoot', dicomWebConfig.wadoRoot);
@@ -678,20 +697,44 @@ function createDicomWebApi(dicomWebConfig: DicomWebConfig, servicesManager) {
 
       DicomMetadataStore.addSeriesMetadata(seriesSummaryMetadata, madeInClient);
 
+      let completedSeriesCount = 0;
       const seriesDeliveredPromises = seriesPromises.map(promise => {
-        if (!returnPromises) {
-          promise?.start();
-        }
-        return promise.then(instances => {
-          storeInstances(instances);
-        });
+        let deliveredPromise;
+
+        return {
+          metadata: promise.metadata,
+          start: () => {
+            if (!deliveredPromise) {
+              deliveredPromise = promise.start().then(async instances => {
+                await storeInstances(instances);
+
+                completedSeriesCount++;
+                if (returnPromises && completedSeriesCount === seriesPromises.length) {
+                  setSuccessFlag();
+                }
+
+                return instances;
+              });
+            }
+
+            return deliveredPromise;
+          },
+        };
       });
 
       if (returnPromises) {
-        Promise.all(seriesDeliveredPromises).then(() => setSuccessFlag());
-        return seriesPromises;
+        if (!seriesDeliveredPromises.length) {
+          setSuccessFlag();
+        }
+
+        // The route starts only the series required by the hanging protocol,
+        // then starts the remainder in the background. Return wrappers whose
+        // start() resolves after async metadata post-processing has stored the
+        // instances and fired INSTANCES_ADDED; resolving the raw retrieval here
+        // races hanging-protocol application against display-set creation.
+        return seriesDeliveredPromises;
       } else {
-        await Promise.all(seriesDeliveredPromises);
+        await Promise.all(seriesDeliveredPromises.map(promise => promise.start()));
         setSuccessFlag();
       }
 
@@ -761,34 +804,4 @@ function createDicomWebApi(dicomWebConfig: DicomWebConfig, servicesManager) {
   return IWebApiDataSource.create(implementation);
 }
 
-/**
- * A bindable function that retrieves the bulk data against this as the
- * dicomweb client, and on the given value element.
- *
- * @param value - a bind value that stores the retrieve value to short circuit the
- *    next retrieve instance.
- * @param options - to allow specifying the content type.
- */
-function retrieveBulkData(value, options = {}) {
-  const { mediaType } = options;
-  const useOptions = {
-    // The bulkdata fetches work with either multipart or
-    // singlepart, so set multipart to false to let the server
-    // decide which type to respond with.
-    multipart: false,
-    BulkDataURI: value.BulkDataURI,
-    mediaTypes: mediaType ? [{ mediaType }, { mediaType: 'application/octet-stream' }] : undefined,
-    ...options,
-  };
-  return this.retrieveBulkData(useOptions).then(val => {
-    // There are DICOM PDF cases where the first ArrayBuffer in the array is
-    // the bulk data and DICOM video cases where the second ArrayBuffer is
-    // the bulk data. Here we play it safe and do a find.
-    const ret =
-      (val instanceof Array && val.find(arrayBuffer => arrayBuffer?.byteLength)) || undefined;
-    value.Value = ret;
-    return ret;
-  });
-}
-
 export { createDicomWebApi };

extensions/default/src/DicomWebDataSource/retrieveBulkData.test.ts

@@ -0,0 +1,35 @@
+import retrieveBulkData from './retrieveBulkData';
+
+describe('retrieveBulkData', () => {
+  it('returns and caches a single-part ArrayBuffer response', async () => {
+    const buffer = new Uint8Array([1]).buffer;
+    const client = {
+      retrieveBulkData: jest.fn().mockResolvedValue(buffer),
+    };
+    const value: { BulkDataURI: string; Value?: ArrayBuffer } = {
+      BulkDataURI: 'https://example.com/bulk/70531000',
+    };
+
+    await expect(retrieveBulkData.call(client, value)).resolves.toBe(buffer);
+    expect(value.Value).toBe(buffer);
+    expect(client.retrieveBulkData).toHaveBeenCalledWith(
+      expect.objectContaining({
+        multipart: false,
+        BulkDataURI: value.BulkDataURI,
+      })
+    );
+  });
+
+  it('still selects the non-empty buffer from a multipart response', async () => {
+    const buffer = new Uint8Array([2]).buffer;
+    const client = {
+      retrieveBulkData: jest.fn().mockResolvedValue([new ArrayBuffer(0), buffer]),
+    };
+    const value: { BulkDataURI: string; Value?: ArrayBuffer } = {
+      BulkDataURI: 'https://example.com/bulk/70531009',
+    };
+
+    await expect(retrieveBulkData.call(client, value)).resolves.toBe(buffer);
+    expect(value.Value).toBe(buffer);
+  });
+});

extensions/default/src/DicomWebDataSource/retrieveBulkData.ts

@@ -0,0 +1,31 @@
+/**
+ * A bindable function that retrieves bulkdata against `this` DICOMweb client
+ * and caches the resolved buffer on the given value element.
+ *
+ * @param value - A bound value that stores the retrieved buffer.
+ * @param options - Options such as the requested content type.
+ */
+export default function retrieveBulkData(value, options = {}) {
+  const { mediaType } = options;
+  const useOptions = {
+    // The bulkdata fetches work with either multipart or singlepart, so set
+    // multipart to false to let the server decide which type to respond with.
+    multipart: false,
+    BulkDataURI: value.BulkDataURI,
+    mediaTypes: mediaType ? [{ mediaType }, { mediaType: 'application/octet-stream' }] : undefined,
+    ...options,
+  };
+
+  return this.retrieveBulkData(useOptions).then(val => {
+    // Single-part clients return a bare ArrayBuffer. Multipart clients return
+    // an array; DICOM PDF/video payloads may occupy different positions, so
+    // select the first non-empty part in that response shape.
+    const ret = Array.isArray(val)
+      ? val.find(arrayBuffer => arrayBuffer?.byteLength)
+      : val?.byteLength
+        ? val
+        : undefined;
+    value.Value = ret;
+    return ret;
+  });
+}

extensions/default/src/getPTImageIdInstanceMetadata.test.ts

@@ -0,0 +1,102 @@
+const mockGet = jest.fn();
+
+// Minimal @ohif/core mock: the real utils.toNumber (used by coerceNumber) and a
+// stubbed MetadataProvider.get.
+jest.mock('@ohif/core', () => {
+  const toNumber = (val: unknown) =>
+    Array.isArray(val)
+      ? val.map(v => (v !== undefined ? Number(v) : v))
+      : val !== undefined
+        ? Number(val)
+        : val;
+  const core = {
+    classes: { MetadataProvider: { get: (...args: unknown[]) => mockGet(...args) } },
+    utils: { toNumber },
+  };
+  return { __esModule: true, default: core, utils: core.utils };
+});
+
+import getPTImageIdInstanceMetadata from './getPTImageIdInstanceMetadata';
+
+// A valid PT instance with the radiopharmaceutical sequence in dcmjs array form.
+const baseInstance = () => ({
+  Modality: 'PT',
+  Units: 'CNTS',
+  CorrectedImage: ['DECY', 'ATTN'],
+  SeriesDate: '20130606',
+  SeriesTime: '120000',
+  AcquisitionDate: '20130606',
+  AcquisitionTime: '120000',
+  DecayCorrection: 'START',
+  PatientWeight: 70,
+  RadiopharmaceuticalInformationSequence: [
+    {
+      RadionuclideHalfLife: 6586.2,
+      RadionuclideTotalDose: 370000000,
+      RadiopharmaceuticalStartTime: '110000',
+    },
+  ],
+});
+
+afterEach(() => mockGet.mockReset());
+
+describe('getPTImageIdInstanceMetadata', () => {
+  it('throws when no metadata is available', () => {
+    mockGet.mockReturnValue(undefined);
+    expect(() => getPTImageIdInstanceMetadata('img:1')).toThrow('dicom metadata are required');
+  });
+
+  it('throws when required metadata is missing', () => {
+    const inst = baseInstance();
+    delete inst.Units;
+    mockGet.mockReturnValue(inst);
+    expect(() => getPTImageIdInstanceMetadata('img:1')).toThrow('required metadata are missing');
+  });
+
+  it('reads RadionuclideHalfLife/TotalDose from the array-shaped sequence (firstSequenceItem)', () => {
+    mockGet.mockReturnValue(baseInstance());
+    const result = getPTImageIdInstanceMetadata('img:1');
+    expect(result.RadionuclideHalfLife).toBe(6586.2);
+    expect(result.RadionuclideTotalDose).toBe(370000000);
+  });
+
+  it('still reads the sequence when flattened to a single object', () => {
+    const inst = baseInstance();
+    // some servers/paths deliver a flattened (non-array) sequence
+    inst.RadiopharmaceuticalInformationSequence =
+      inst.RadiopharmaceuticalInformationSequence[0];
+    mockGet.mockReturnValue(inst);
+    expect(getPTImageIdInstanceMetadata('img:1').RadionuclideHalfLife).toBe(6586.2);
+  });
+
+  it('populates PhilipsPETPrivateGroup when the private tags are numbers', () => {
+    const inst = baseInstance();
+    inst['70531000'] = 0.00038;
+    inst['70531009'] = 1.881732;
+    mockGet.mockReturnValue(inst);
+    const result = getPTImageIdInstanceMetadata('img:1');
+    expect(result.PhilipsPETPrivateGroup).toEqual({
+      SUVScaleFactor: 0.00038,
+      ActivityConcentrationScaleFactor: 1.881732,
+    });
+  });
+
+  it('drops an unresolved bulkdata { BulkDataURI } private tag (coerceNumber backstop)', () => {
+    const inst = baseInstance();
+    inst['70531000'] = { BulkDataURI: 'http://x/bulk/70531000' };
+    inst['70531009'] = { BulkDataURI: 'http://x/bulk/70531009' };
+    mockGet.mockReturnValue(inst);
+    // Neither tag coerces to a number, so the group is not attached at all -
+    // an object can never reach calculate-suv.
+    expect(getPTImageIdInstanceMetadata('img:1').PhilipsPETPrivateGroup).toBeUndefined();
+  });
+
+  it('coerces a numeric DS string private tag to a number', () => {
+    const inst = baseInstance();
+    inst['70531000'] = '0.00038';
+    mockGet.mockReturnValue(inst);
+    expect(getPTImageIdInstanceMetadata('img:1').PhilipsPETPrivateGroup.SUVScaleFactor).toBe(
+      0.00038
+    );
+  });
+});

extensions/default/src/getPTImageIdInstanceMetadata.ts

@@ -1,6 +1,6 @@
-import OHIF from '@ohif/core';
+import OHIF, { utils } from '@ohif/core';
 
-import type { InstanceMetadata, PhilipsPETPrivateGroup } from '@cornerstonejs/calculate-suv/src/types';
+import type { InstanceMetadata, PhilipsPETPrivateGroup } from '@cornerstonejs/calculate-suv';
 
 const metadataProvider = OHIF.classes.MetadataProvider;
 
@@ -11,21 +11,25 @@ export default function getPTImageIdInstanceMetadata(imageId: string): InstanceM
     throw new Error('dicom metadata are required');
   }
 
+  const radiopharmaceuticalInfo = firstSequenceItem<Record<string, unknown>>(
+    dicomMetaData.RadiopharmaceuticalInformationSequence
+  );
+  const radionuclideHalfLife = coerceNumber(radiopharmaceuticalInfo?.RadionuclideHalfLife);
+  const radionuclideTotalDose = coerceNumber(radiopharmaceuticalInfo?.RadionuclideTotalDose);
+
   if (
     dicomMetaData.SeriesDate === undefined ||
     dicomMetaData.SeriesTime === undefined ||
     dicomMetaData.CorrectedImage === undefined ||
     dicomMetaData.Units === undefined ||
-    !dicomMetaData.RadiopharmaceuticalInformationSequence ||
-    dicomMetaData.RadiopharmaceuticalInformationSequence.RadionuclideHalfLife === undefined ||
-    dicomMetaData.RadiopharmaceuticalInformationSequence.RadionuclideTotalDose === undefined ||
+    !radiopharmaceuticalInfo ||
+    radionuclideHalfLife === undefined ||
+    radionuclideTotalDose === undefined ||
     dicomMetaData.DecayCorrection === undefined ||
     dicomMetaData.AcquisitionDate === undefined ||
     dicomMetaData.AcquisitionTime === undefined ||
-    (dicomMetaData.RadiopharmaceuticalInformationSequence.RadiopharmaceuticalStartDateTime ===
-      undefined &&
-      dicomMetaData.RadiopharmaceuticalInformationSequence.RadiopharmaceuticalStartTime ===
-        undefined)
+    (radiopharmaceuticalInfo.RadiopharmaceuticalStartDateTime === undefined &&
+      radiopharmaceuticalInfo.RadiopharmaceuticalStartTime === undefined)
   ) {
     throw new Error('required metadata are missing');
   }
@@ -37,73 +41,84 @@ export default function getPTImageIdInstanceMetadata(imageId: string): InstanceM
   const instanceMetadata: InstanceMetadata = {
     CorrectedImage: dicomMetaData.CorrectedImage,
     Units: dicomMetaData.Units,
-    RadionuclideHalfLife: dicomMetaData.RadiopharmaceuticalInformationSequence.RadionuclideHalfLife,
-    RadionuclideTotalDose:
-      dicomMetaData.RadiopharmaceuticalInformationSequence.RadionuclideTotalDose,
-    RadiopharmaceuticalStartDateTime:
-      dicomMetaData.RadiopharmaceuticalInformationSequence.RadiopharmaceuticalStartDateTime,
-    RadiopharmaceuticalStartTime:
-      dicomMetaData.RadiopharmaceuticalInformationSequence.RadiopharmaceuticalStartTime,
+    RadionuclideHalfLife: radionuclideHalfLife,
+    RadionuclideTotalDose: radionuclideTotalDose,
+    RadiopharmaceuticalStartDateTime: radiopharmaceuticalInfo.RadiopharmaceuticalStartDateTime,
+    RadiopharmaceuticalStartTime: radiopharmaceuticalInfo.RadiopharmaceuticalStartTime,
     DecayCorrection: dicomMetaData.DecayCorrection,
-    PatientWeight: dicomMetaData.PatientWeight,
+    PatientWeight: coerceNumber(dicomMetaData.PatientWeight),
     SeriesDate: dicomMetaData.SeriesDate,
     SeriesTime: dicomMetaData.SeriesTime,
     AcquisitionDate: dicomMetaData.AcquisitionDate,
     AcquisitionTime: dicomMetaData.AcquisitionTime,
   };
 
-  if (
-    dicomMetaData['70531000'] ||
-    dicomMetaData['70531000'] !== undefined ||
-    dicomMetaData['70531009'] ||
-    dicomMetaData['70531009'] !== undefined
-  ) {
+  // Philips PET private group. Only populated with values that coerce to real
+  // numbers; an unresolved bulkdata object yields undefined and is dropped so it
+  // can never corrupt the SUV calculation. SUVScaleFactor is (7053,1000) and
+  // ActivityConcentrationScaleFactor is (7053,1009). These are resolved from
+  // bulkdata upstream during ingestion (utils.resolveBulkDataTags).
+  const suvScaleFactor = coerceNumber(dicomMetaData['70531000']);
+  const activityConcentrationScaleFactor = coerceNumber(dicomMetaData['70531009']);
+  if (suvScaleFactor !== undefined || activityConcentrationScaleFactor !== undefined) {
     const philipsPETPrivateGroup: PhilipsPETPrivateGroup = {
-      SUVScaleFactor: dicomMetaData['70531000'],
-      ActivityConcentrationScaleFactor: dicomMetaData['70531009'],
+      SUVScaleFactor: suvScaleFactor,
+      ActivityConcentrationScaleFactor: activityConcentrationScaleFactor,
     };
     instanceMetadata.PhilipsPETPrivateGroup = philipsPETPrivateGroup;
   }
 
-  if (dicomMetaData['0009100d'] && dicomMetaData['0009100d'] !== undefined) {
+  if (dicomMetaData['0009100d'] !== undefined) {
     instanceMetadata.GEPrivatePostInjectionDateTime = dicomMetaData['0009100d'];
   }
 
-  if (dicomMetaData.FrameReferenceTime && dicomMetaData.FrameReferenceTime !== undefined) {
-    instanceMetadata.FrameReferenceTime = dicomMetaData.FrameReferenceTime;
+  const frameReferenceTime = coerceNumber(dicomMetaData.FrameReferenceTime);
+  if (frameReferenceTime !== undefined) {
+    instanceMetadata.FrameReferenceTime = frameReferenceTime;
   }
 
-  if (dicomMetaData.ActualFrameDuration && dicomMetaData.ActualFrameDuration !== undefined) {
-    instanceMetadata.ActualFrameDuration = dicomMetaData.ActualFrameDuration;
+  const actualFrameDuration = coerceNumber(dicomMetaData.ActualFrameDuration);
+  if (actualFrameDuration !== undefined) {
+    instanceMetadata.ActualFrameDuration = actualFrameDuration;
   }
 
-  if (dicomMetaData.PatientSex && dicomMetaData.PatientSex !== undefined) {
+  if (dicomMetaData.PatientSex !== undefined) {
     instanceMetadata.PatientSex = dicomMetaData.PatientSex;
   }
 
-  if (dicomMetaData.PatientSize && dicomMetaData.PatientSize !== undefined) {
-    instanceMetadata.PatientSize = dicomMetaData.PatientSize;
+  const patientSize = coerceNumber(dicomMetaData.PatientSize);
+  if (patientSize !== undefined) {
+    instanceMetadata.PatientSize = patientSize;
   }
 
   return instanceMetadata;
 }
 
-function convertInterfaceTimeToString(time): string {
-  const hours = `${time.hours || '00'}`.padStart(2, '0');
-  const minutes = `${time.minutes || '00'}`.padStart(2, '0');
-  const seconds = `${time.seconds || '00'}`.padStart(2, '0');
-
-  const fractionalSeconds = `${time.fractionalSeconds || '000000'}`.padEnd(6, '0');
-
-  const timeString = `${hours}${minutes}${seconds}.${fractionalSeconds}`;
-  return timeString;
-}
-
-function convertInterfaceDateToString(date): string {
-  const month = `${date.month}`.padStart(2, '0');
-  const day = `${date.day}`.padStart(2, '0');
-  const dateString = `${date.year}${month}${day}`;
-  return dateString;
-}
-
 export { getPTImageIdInstanceMetadata };
+
+/**
+ * Coerces a naturalized DICOM value into a finite number, or returns undefined.
+ *
+ * Delegates to OHIF's `utils.toNumber` and then requires a finite scalar, so an
+ * object value - such as an unresolved bulkdata reference `{ BulkDataURI }` or
+ * an array - becomes undefined. This is the final backstop ensuring such a value
+ * can never reach calculate-suv (which treats it as truthy and silently corrupts
+ * the SUV factors). Bulkdata is meant to be resolved upstream during ingestion
+ * (see utils.resolveBulkDataTags); this guard catches anything that slips
+ * through.
+ */
+function coerceNumber(value: unknown): number | undefined {
+  const n = utils.toNumber(value);
+  return typeof n === 'number' && Number.isFinite(n) ? n : undefined;
+}
+
+/**
+ * Returns the first item of a DICOM sequence, tolerating either the dcmjs
+ * naturalized array shape or an already-flattened single-object shape.
+ */
+function firstSequenceItem<T = Record<string, unknown>>(seq: unknown): T | undefined {
+  if (seq == null || typeof seq !== 'object') {
+    return undefined;
+  }
+  return (Array.isArray(seq) ? seq[0] : seq) as T;
+}