Manifest-based Access to DICOM Objects (MADO)
0.1.0 - trial-use

Manifest-based Access to DICOM Objects (MADO), published by IHE Radiology Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/RAD.MADO/ and changes regularly. See the Directory of published versions

## Manifest Envelopes for IHE-MHD

When distributing a MADO imaging manifest in an IHE-ITI-MHD environment the `DocumentReference` profiles defined below:

- FHIR Imaging Study Manifest SHALL be packaged with an envelope defined in MADO FHIR DocumentReference.
- DICOM KOS Manifest envelopes SHALL be packaged with an envelope defined in MADO DICOM KOS DocumentReference.

An IHE-MHD infrastructure may choose to provide one manifest format and implement a mapping service to the alternate format. When such a mapping service is provided, the `address` field in the alternate `DocumentReference` includes a fully populated url to the mapping service that, when called, will return the manifest in the alternate format.

In the case the manifest is available in multiple formats, the Document Consumer SHOULD show to the user a single entry.

As is stated in section X.6.1, Manifest Creators will create the manifest in the format of their choice. The selection is made at deployment time.

The figure below shows the `MHD DocumentReference`s including the most relevant restrictions and its relationship with the manifests and each other.

Figure: IHE-MHD envelope

The main choices illustrated in the figure are:

- There are two different `DocumentReferences`, one for the FHIR ImagingStudy and one for the DICOM KOS representation. When both are present, the relatesTo field points to the other representation.
- FHIR Imaging Study manifest:
  - A FHIR manifest is represented as a FHIR json encoded FHIR `Bundle` following the profile MADO FHIR Bundle. This Bundle contains the `ImagingStudy` resource as well other resources such as the `Patient` and various `Endpoint`s.
  - The FHIR DocumentReference SHALL include the identifier of the MADO FHIR Bundle as `masterIdentifier`.
- DICOM KOS manifest:
  - A KOS manifest is represented as a `application/dicom` encoded DICOM instance (see 8.7.3.1 Instance Media Types) following the MADO KOS profile.
  - The DICOM KOS manifest DocumentReference SHALL include the `SOPInstanceUid` of the KOS instance as `masterIdentifier`.
- The `masterIdentifier` SHALL be part of the `identifier` list as well.

The FHIR-manifest can be translated into the KOS-manifest and vice-versa, allowing applications to provide alternate representations when needed (see Mapping).

### Related FHIR profiles

Title | Description
MADO MHD DocumentReference Profile for DICOM KOS Imaging Manifests | MADO specific profile for the IHE-MHD Document Reference for MADO DICOM KOS Manifests that includes the MADO specific content format, the extensions related to body-site and modality, and the definition on where `StudyInstanceUID` and `AccessionNumber` are stored. This profile requires `context.period` and copies most of the restrictions defined in the MHD DocumentReference Comprehensive profiles (except `securityLabel`).
MADO MHD DocumentReference Profile for FHIR Imaging Manifests | MADO specific profile for the IHE-MHD Document Reference for MADO FHIR Manifests that includes the MADO specific content format, the extensions related to body-site and modality, and the definition on where `StudyInstanceUID` and `AccessionNumber` are stored. This profile requires `context.period` and copies most of the restrictions defined in the MHD DocumentReference Comprehensive profiles (except `securityLabel`).

### Capability Statements for MADO MHD Actors

Title | Description
MADO Document Consumer (client) | IHE RAD Manifest based Access to DICOM Objects(MADO) - Document Consumer (client). It extends MHD Document Consumer (client). Please note that this CapabilityStatement representation only shows the delta of this instance with the MHD Document Responder (client). All the functionality specified by the Document Consumer (client) SHALL also be supported.
MADO Document Responder (server) | IHE RAD Manifest based Access to DICOM Objects(MADO) - Document Responder (server). It extends MHD Document Responder (client). Please note that this CapabilityStatement representation only shows the delta of this instance with the MHD Document Responder (client). All the functionality specified by the Document Consumer (client) SHALL also be supported.

#### Imaging specific search parameters

Imaging specific search parameters include:

Name | Title | Description
DocumentReferenceAccessionNumber |  | Searches for document references with a specific Accession Number.
DocumentReferenceAnatomicalRegion |  | Searches for document references with a specific anatomical region.
DocumentReferenceModality |  | Searches for document references with a specific modality.
DocumentReferenceStudyInstanceUid |  | Searches for document references with a specific Study Instance UID.

The expression below uses these search parameters to search for a FHIR manifest with StudyInstanceUid=324.232.5.5.324.2.

    DocumentReference/?study-instance-uid=urn:oid:324.232.5.5.324.2&format=urn:ihe:rad:MADO:fhir-manifest:2026

This uses the optional study-instance-uid search parameter. An alternative with standard search params would be. As the study instance uid is an OID, in the identifier it is prefixed with `urn:oid:`.

    DocumentReference/?related:identifier=urn:oid:324.232.5.5.324.2&format=urn:ihe:rad:MADO:fhir-manifest:2026

A similar query searching for DICOM KOS Manifests with accession number `12345` would look like:

    DocumentReference/?related:identifier="12345"&format=1.2.840.10008.5.1.4.1.1.88.59

an alternative using the `accession-number` query is:

    DocumentReference/?accession-number="12345"&format=1.2.840.10008.5.1.4.1.1.88.59

### DocumentReference examples

The list below presents various examples of MADO DocumentReferences.

Name | Title | Description
DocumentReference Example for FHIR manifests |  | DocumentReference Example for FHIR manifests
DocumentReference Example for FHIR manifests with transform |  | DocumentReference Example for FHIR manifests with transform service called to transform the KOS manifest into a FHIR manifest
DocumentReference Example for DICOM KOS manifests |  | DocumentReference Example for DICOM KOS manifests
DocumentReference Example for DICOM KOS manifests and no related reference to the FHIR manifest example |  | DocumentReference Example for DICOM KOS manifests with no related reference to the FHIR manifest example
DocumentReference Example for DICOM KOS manifests |  | DocumentReference Example for DICOM KOS manifests
mado-documentreference-fhir--2047166866 |  | Imaging Manifest for Imaging Study urn:oid:1.2.250.1.59.40211.22756022.2.1.101
mado-documentreference-fhir--2047166865 |  | Imaging Manifest for Imaging Study urn:oid:1.2.250.1.59.40211.22756022.2.1.102
mado-documentreference-kos--2047166866 |  | Imaging Manifest for Imaging Study urn:oid:1.2.250.1.59.40211.22756022.2.1.101
mado-documentreference-kos--2047166865 |  | Imaging Manifest for Imaging Study urn:oid:1.2.250.1.59.40211.22756022.2.1.102

The DocumentReference Example for FHIR manifests with transform example contains a FHIR MADO DocumentReference. The content section does not point to a FHIR file but to a transform service. The `content.attachment` section is presented below

    {
      "contentType" : "application/fhir+json",
      "language" : "de-DE",
      "url" : "http://kos2FhirTranformService.example.com/transform?url=http://mhdserver.example.com/Binary/mado-kos-manifest-binary",
      "creation" : "2025-05-08T00:00:00Z"
    }

The url points to a transform service and passes the link to the KOS manifest. This is just one example of such service. This specification does not specify the interface. Alternative implementations could could pass the StudyInstanceUID and wado URL parameters, or some other set of data.