Hi David thanks for the reply. Maybe I need to back up and broaden my question to just what exactly can cause this tag to change from Original\Primary -> Original\Secondary?
My interpretation of the Value 1 'Pixel Characteristics' of this tag was that any pixel value change would be covered by 'Derived' and that the definition for 'Original' (- is the image an ORIGINAL Image; an image whose pixel values are based on original or source data) meant that the pixel values are directly transferred from the original, but I suppose the phrase 'based on' makes this suspect.
As far as I can tell, these are not secondary captures (none of the associated tags present, e.g. Conversion Type or Secondary Capture Device ID) nor MPRs (no relevant tags present there either).
The most consistent thing I'm noticing is that these images usually have been written to physical media (e.g. CD/DVD) - but it doesn't seem to be the case that this always causes the Secondary type either, so maybe I'm wrong in thinking that could be a cause.
Maybe I need to just catch one of these as it comes in and track down the radiology center and try to follow their whole process to see what's causing the change?