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HL7 CDA (Clinical Document Architecture) also has a subset of mechanisms similar to (and intended to be compatible with) DICOM for referencing image-related spatial coordinates as observations; it allows for a circle, ellipse, polyline or point to be defined as integer pixel-relative coordinates referencing an external multi-media image object, which may be of a consumer rather than medical image format (e.g., a GIF, PNG or JPEG).