Standard ACR-NEMA/DICOM fashion to store overlays : In a bytes, 8 pixels are concerned (Overlay Bits Allocated = [1] ) Overlay Data length = 29282 (Overlay Rows * Overlay Columns)/8 D 6000|0010 lg : x(2) 2 [US] [Overlay Rows] [484] D 6000|0011 lg : x(2) 2 [US] [Overlay Columns] [484] D 6000|0015 lg : x(2) 2 [IS][Number of Frames in Overlay] [1 ] D 6000|0022 lg : x(1e) 30 [LO] [Overlay Description] [Siemens MedCom Object Graphics] D 6000|0040 lg : x(2) 2 [CS] [Overlay Type] [G ] D 6000|0050 lg : x(4) 4 [SS] [Overlay Origin] [1\1] D 6000|0051 lg : x(2) 2 [US] [Image Frame Origin] [1] D 6000|0100 lg : x(2) 2 [US] [Overlay Bits Allocated] [1] D 6000|0102 lg : x(2) 2 [US] [Overlay Bit Position] [0] D 6000|3000 lg : x(7262) 29282 [OW] [Overlay Data] [gdcm::NotLoaded] Get the Data, expand them ! Hope there is never some oddities in Number of Frames in Overlay, Overlay Origin,Overlay Bit Position, etc .