DICOM: What's the point of SOPInstanceUID tag?

This question was from quite a while ago, but I thought I'd add that, ignoring QR altogether, a SeriesInstanceUID is a globally unique identifier for a single series. SOPInstanceUID is a globally unique identifier for a DICOM file. A series can have multiple DICOM files, so each would share that same SeriesInstanceUID, but each file would have it's own SOPInstanceUID.

As you probably know, DICOM has a hierarchy of identifiers for each individual SOP (Service Object Pair) Instance (Patient ID / Study Instance UID / Series Instance UID / SOP Instance UID). This hierarchy is built into the Query/Retrieve mechanism in DICOM, and is also used to identify specific SOP Instances.

In the specific case you're mentioning, I believe there could be the possibility of multiple RT Structure Sets within a Series/Study. The individual SOP Instance must be referenced so that you know which Structure Set the RT Plan is referencing.

As for products supporting retrieving by SOP Instance UID, unfortunately, relational queries are not widely supported in DICOM Query/Retrieve SCPs, as you've discovered, and some DICOM servers do not support Image level queries. In this specific case, you could query at the series level specifically for the RTSTRUCT modality, and only retrieve the Series that have this modality, thus narrowing down which data you need to download to just the RT Structure Sets.

SOPInstanceUID represent separate uid of the Dicom Image File. Study, series and sopinstace uids are based on data model. StudyUID give you the particular study information. In which different series devided. Series instance uid used for for this. And SOP instance uid represent seperate Dicom image. It's hierarchy structure. I also never used SOPInstanceUID when i developed PACS workstation in Java. As per my experience, Study & Series uids are enough for represent patient's data. But still SOPInstanceUID gives unique identity to dicom image.