# FHIR Imaging Manifest - Manifest-based Access to DICOM Objects (MADO) v0.1.0

* [**Table of Contents**](toc.md)
* [**Volume 3**](volume-3.md)
* **FHIR Imaging Manifest**

## FHIR Imaging Manifest

The MADO FHIR imaging manifest represents a summary of the data stored in a DICOM imaging study. It contains the information stored in a PACS expressed in FHIR. This page defines the FHIR encoding of such manifest. It is the '**document**' that is searched for and provides the URL's that allow download of the imaging content.

This section specifies the structure and format of an Imaging Study Manifest for the MADO Profile using the DICOM standards. It is based on the DICOM Key Object Selection (KOS) Document Information Object Definition (IOD) as specified in DICOM PS3.3 Section A.35.4 Key Object Selection Document IOD.

### FHIR Manifest overview

The figure below presents an overview of the data that is part of the imaging-manifest. In order to keep the diagram readable, not all references are included.

**Figure: FHIR Manifest Overview**

The manifest is a FHIR bundle that SHALL conform to the [MADO FHIR Bundle](./StructureDefinition-MadoFhirBundle.md) profile. This [`Bundle`](https://www.hl7.org/fhir/R5/Bundle.html) includes the [MADO FHIR ImagingStudy](./StructureDefinition-MadoImagingStudy.md) resource, the [MADO Patient](./StructureDefinition-MadoPatient.md), [MADO Creator](./StructureDefinition-MadoCreator.md) and [MADO Creator Organization](./StructureDefinition-MadoCreatorOrganization.md), the [MADO Requested Procedure](./StructureDefinition-MadoRequestedProcedure.md), and the [MADO FHIR WADO Endpoint](./StructureDefinition-MadoWadoEndpoint.md) and [MADO FHIR WebViewer Endpoint](./StructureDefinition-MadoWebViewerEndpoint.md)s.

The profiles for the [MADO FHIR Bundle](./StructureDefinition-MadoFhirBundle.md) and the resources it contains have fields marked as `Must Support` (`MS`) (marked with an S in the **Flags** column), which SHALL be populated if the value is known.

The [MADO Patient](./StructureDefinition-MadoPatient.md) resource holds the patient information.

The [MADO Creator](./StructureDefinition-MadoCreator.md) and [MADO Creator Organization](./StructureDefinition-MadoCreatorOrganization.md) resources provide information on the device and organization that created the manifest.

The [MADO Requested Procedure](./StructureDefinition-MadoRequestedProcedure.md) provides information on the order for the imaging study, including the order specific identifiers: Accession Number, Placer Number and Filler number.

[`Endpoint`](https://www.hl7.org/fhir/R5/Endpoint.html) resources contain the information that allows the client to access the DICOM data. The current model identifies different [`Endpoint`](https://www.hl7.org/fhir/R5/Endpoint.html)s:

* On study level, the manifest MAY contain: 
* The [MADO FHIR WebViewer Endpoint](./StructureDefinition-MadoWebViewerEndpoint.md) which provides a web based endpoint. The `address` defined in the endpoint, opens a webviewer on the study.
 
* For each series, the manifest SHALL contain: 
* The [MADO FHIR WADO Endpoint](./StructureDefinition-MadoWadoEndpoint.md) which `address` field holds the WADO base url that allows access to the series information (see [IHE RAD TF-2](https://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Vol2.pdf): 4.107 WADO-RS Retrieve [RAD-107]).
 

### Related FHIR profiles

The following links are provided for convenience.

| | |
| :--- | :--- |
| Title | Description |
| [MADO Accession Number Identifier](StructureDefinition-MadoAccessionNumberIdentifier.md) | Profile for the Accession Number Identifier used in the MADO context. This profile is used for the Identifier that represents the Accession Number in the MADO context. It includes additional constraints and extensions specific to the MADO context, such as the value set for the type of identifier and the fixed value for the system of the identifier.The combination of the `Identifier.value` of the identifier and the `Identifier.system` of the identifier should be globally unique. The `Identifier.value` of the identifier should be locally unique within the context of the system that assigns the accession number.the `Identifier.system` SHALL be consistent with the content of the DICOM sequence "Issuer of Accession Number Sequence" (0008,0051). |
| [Extension: Anatomical Region](StructureDefinition-MadoAnatomicalRegionExtension.md) | The anatomical region in an ImagingStudy instance. This is additional information next to ImagingStudy.series.bodySite. |
| [MADO Creator](StructureDefinition-MadoCreator.md) | A profile for the Device resource that represents the creator of an ImagingStudy in the MADO context. |
| [Extension: Creator of the MADO](StructureDefinition-MadoCreatorExtension.md) | The creator of the MADO, which is the device that created the ImagingStudy resource in the MADO context. |
| [MADO Creator Organization](StructureDefinition-MadoCreatorOrganization.md) | Profile on Organization that specifies the required elements for the organization that creates MADO manifests. |
| [MADO Imaging Study Manifest FHIR Bundle](StructureDefinition-MadoFhirBundle.md) | Profile for FHIR Bundles used as a imaging study Manifest in the MADO context. It includes constraints and extensions specific to imaging study manifests, such as the type of study, the clinical specialty, and the anatomical region of interest. |
| [MADO Imaging Study](StructureDefinition-MadoImagingStudy.md) | Profile for ImagingStudy resources that represent the imaging studies manifest in the MADO context. It includes additional constraints and extensions specific to the MADO context, such as the study modality, the clinical specialty, the anatomical region of interest, the presence of significant images.In the case significant images are present, an instance referenced in the `ImagingStudy` is a Key Object Selection document [TID 2010](https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_tid_2010.html), the `ImagingStudy.series.instance.extension[ko-document-title]` SHALL contain the Document Title code of the referenced document, and the `ImagingStudy.series.instance.description` field contains the contents of the KeyObjectSelectionDescription field. |
| [Extension: MADO Document Title of Key Object Selection documents](StructureDefinition-MadoKeyObjectDocumentTitle.md) | The document title code of the Key Object Selection document [TID 2010](https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_tid_2010.html) this instance refers to. |
| [Extension: Number of Frames](StructureDefinition-MadoNumberOfFrames.md) | The number of frames in an ImagingStudy instance. |
| [MADO Patient](StructureDefinition-MadoPatient.md) | Profile on Patient that specifies the required elements for the patient that is the subject of the manifest. |
| [MADO Provenance](StructureDefinition-MadoProvenance.md) | The purpose of this resource is to indicate information about the system that created the manifest. Additionally, it can be used to sign the content of the Bundle.In DICOM KOS this information (and the referred MadoCreator) corresponds to the Institution Name, Institution Id, Manufacturer Name in the General Equipment module. |
| [MADO Referenced Accession Number Identifier](StructureDefinition-MadoReferencedAccessionNumberIdentifier.md) | Profile for the Reference that contains the Accession Number Identifier used in the MADO context. This profile is used for the Reference that contains the Identifier that represents the Accession Number in the MADO context. It includes additional constraints and extensions specific to the MADO context, such as the value set for the type of identifier and the fixed value for the system of the identifier. |
| [MADO Referenced Study Instance UID Identifier](StructureDefinition-MadoReferencedStudyInstanceUidIdentifier.md) | Profile for the Reference that contains the Study Instance UID Identifier used in the MADO context. This profile is used for the Reference that contains the Identifier that represents the Study Instance UID in the MADO context. It includes additional constraints and extensions specific to the MADO context, such as the value set for the type of identifier and the fixed value for the system of the identifier. |
| [Extension: Representative Instance](StructureDefinition-MadoRepresentativeInstanceExtension.md) | An extension to indicate that a referenced instance on and ImagingStudy series is a representative instance for that series. This extension is used in the MADO context to indicate that a referenced instance on an ImagingStudy series is a representative instance for that series, which can be used for display purposes in the MADO context. |
| [MADO Requested Procedure](StructureDefinition-MadoRequestedProcedure.md) | A profile for the ServiceRequest resource that represents the Requested Procedure (see 6.X.2.8.1 Referenced Request Macro Description). |
| [Extension: Retrieve Location UID](StructureDefinition-MadoRetrieveLocationUIDExtension.md) | The location UID of the source of the WADO URL. See XC-WADO and https://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_A.35.4.3.html#table_A.35.4-1. |
| [MADO Study Instance UID Identifier](StructureDefinition-MadoStudyInstanceUidIdentifier.md) | Profile for the Study Instance UID Identifier used in the MADO context. This profile is used for the Identifier that represents the Study Instance UID in the MADO context. It includes additional constraints and extensions specific to the MADO context, such as the value set for the type of identifier and the fixed value for the system of the identifier. |
| [Endpoint: MADO WADO endpoint](StructureDefinition-MadoWadoEndpoint.md) | This profile defines a WADO endpoint for accessing imaging study content. [MADO WADO Endpoint](Endpoint-wado-endpoint-with-url.md) holds an example of a endpoint with a `RetrieveLocationUid` and an address.This profile supports two cases (see X.4.1.2 Intra-community Sharing Infrastructure):1. The case where`address`is provided in addition to a`RetrieveLocationUID`.
1. The case when only the`RetrieveLocationUID`is known and the`address`is unknown (see example[EndpointWadoExampleNoAddress](Endpoint-EndpointWadoExampleNoAddress.md)). In this case:
1. The`address`SHALL be set to "http://notspecified"
1. A[`Data Absent Reason Exception`](http://hl7.org/fhir/StructureDefinition/data-absent-reason)with the value`unknown`SHALL be added to indicate that the address is missing.

Note that we do not require population of the `payloadMimeType` as this information is not present in the DICOM KOS. As is defined in section 6.X.6.6.2, in MADO, only the `dicom` mimetype is required. |
| [Endpoint: MADO profile for Web Viewer endpoints](StructureDefinition-MadoWebViewerEndpoint.md) | This profile defines the Web Viewer endpoint for accessing imaging study content. The URL in the Endpoint SHALL be a fully populated URL that contains all the information required to the launch the viewer to this study.The `address` field in the endpoint corresponds to the `Display URI` in the DICOM KOS manifest (see 6.X.2.13 Hierarchical SOP Instance Reference Macro).The endpoint MAY be encoded using the format defined in [IHE-RAD-IID](https://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_Suppl_IID.pdf). |

### Examples

The sections below show the various MADO data elements that are generated based based on a DICOM study.

The `Binary` resource contains the DICOM KOS Manifest for the study. The `Bundle` resource the FHIR Imaging Study Manifest. The `DocumentReference` instances provide MHD DocumentReference instances that point to these manifests.

#### Study A

Based on the DICOM study A, ([Study_A.zip](Study_A.zip)), the following resources are created:

| | |
| :--- | :--- |
| Type | Id |
| Binary | [dicom-kos-mado--2047166865](Binary-dicom-kos-mado--2047166865.md) |
| Bundle | [mado-bundle--2047166865](Bundle-mado-bundle--2047166865.md) |
| DocumentReference | [mado-documentreference-fhir--2047166865](DocumentReference-mado-documentreference-fhir--2047166865.md) |
| DocumentReference | [mado-documentreference-kos--2047166865](DocumentReference-mado-documentreference-kos--2047166865.md) |

#### Study B

Based on the DICOM study A, ([Study_B.zip](Study_B.zip)), the following resources are created:

| | |
| :--- | :--- |
| Type | Id |
| Binary | [dicom-kos-mado--2047166866](Binary-dicom-kos-mado--2047166866.md) |
| Bundle | [mado-bundle--2047166866](Bundle-mado-bundle--2047166866.md) |
| DocumentReference | [mado-documentreference-fhir--2047166866](DocumentReference-mado-documentreference-fhir--2047166866.md) |
| DocumentReference | [mado-documentreference-kos--2047166866](DocumentReference-mado-documentreference-kos--2047166866.md) |

