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10.4 Resource ImagingStudy - Content

Imaging Integration Work GroupMaturity Level: 3 Trial Use Compartments: Patient

Representation of the content produced in a DICOM imaging study. A study comprises a set of series, each of which includes a set of Service-Object Pair Instances (SOP Instances - images or other data) acquired or produced in a common context. A series is of only one modality (e.g. X-ray, CT, MR, ultrasound), but a study may have multiple series of different modalities.

ImagingStudy provides information on a DICOM imaging study, and the series and imaging objects in that study. It also provides information on how to retrieve that information (in a native DICOM format, or in a rendered format, such as JPEG). ImagingStudy is used to make available information about all parts of a single DICOM study.

This resource provides mappings of its elements to DICOM attributes. DICOM attributes are identified by a 32-bit tag, presented in canonical form as two four-digit hexadecimal values within parentheses and separated by a comma, e.g. (0008,103E). The name and value representation (data type) of each attribute can be found in DICOM Part 6 Data Dictionary . The use of the attributes in the context of information objects, including detailed description of use, can be found in DICOM Part 3 Information Object Definitions . Attributes used in the DICOM query information models, such as "Number of Instances in Study", can be found in DICOM Part 4 Annex C .

ImagingStudy provides access to significant DICOM information but will only eliminate the need for DICOM query (e.g., QIDO-RS) in the simplest cases. The DICOM instances are not stored in the ImagingStudy resource; use of a DICOM WADO-RS server or other storage mechanism is needed.

Only a single DICOM study may be referenced from one ImagingStudy. In many cases, only one ImagingStudy will reference a particular DICOM study, but this is not required.

ImagingStudy is used for DICOM imaging and associated information. Use Media to track non-DICOM images, video, or audio. Binary can be used to store arbitrary content. DocumentReference allow indexing and retrieval of clinical “documents” with relevant metadata.

This resource is referenced by ChargeItem, ClinicalImpression, DiagnosticReport and Observation

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy TUDomainResourceA set of images produced in single study (one or more series of references images)
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierIdentifiers for the whole study
... status ?!Σ1..1coderegistered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus (Required)
... modality Σ0..*CodingAll series modality if actual acquisition modalities
AcquisitionModality (Extensible)
... subject Σ1..1Reference(Patient | Device | Group)Who or what is the subject of the study
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating context
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Request fulfilled
... referrer Σ0..1Reference(Practitioner)Referring physician
... interpreter Σ0..*Reference(Practitioner)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedureReference Σ0..1Reference(Procedure)The performed Procedure reference
... procedureCode Σ0..*CodeableConceptThe performed procedure code
ImagingProcedureCode (Extensible)
... location Σ0..1Reference(Location)Where ImagingStudy occurred
... reasonCode Σ0..*CodeableConceptWhy the study was requested
Procedure Reason Codes (Example)
... reasonReference Σ0..*Reference(Condition | Observation | Media | DiagnosticReport | DocumentReference)Why was study performed
... note Σ0..*AnnotationUser-defined comments
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... identifier Σ1..1IdentifierFormal DICOM identifier for this series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
AcquisitionModality (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... specimen Σ0..*Reference(Specimen)Specimen imaged
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*BackboneElementWho performed the series
..... function Σ0..1CodeableConceptType of performance
ImagingStudy series performer function (Required)
..... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... identifier 1..1IdentifierFormal DICOM identifier for this instance
..... number 0..1unsignedIntThe number of this instance in the series
..... sopClass 1..1CodingDICOM class type
sopClass (Extensible)
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)DICOM Study Instance UID, and Accession Numberidentifier : Identifier [0..*]The current state of the ImagingStudy (this element modifies the meaning of other elements)status : code [1..1] « The status of the ImagingStudy. (Strength=Required)ImagingStudyStatus! »A list of all the series.modality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modality : Coding [0..*] « Type of acquired data in the instance. (Strength=Extensible)AcquisitionModality+ »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The encounter or episode at which the request is initiatedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Date and time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] « Practitioner »The network service providing access (e.g., query, view, or retrieval) for the study. See implementation notes for information about using DICOM endpoints. A study-level endpoint applies to each series in the study, unless overridden by a series-level endpoint with the same Endpoint.connectionTypeendpoint : Reference [0..*] « Endpoint »Number of Series in the Study. This value given may be larger than the number of series elements this Resource contains due to resource availability, security, or other factors. This element should be present if any series elements are presentnumberOfSeries : unsignedInt [0..1]Number of SOP Instances in Study. This value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1]A reference to the performed ProcedureprocedureReference : Reference [0..1] « Procedure »The code for the performed procedure typeprocedureCode : CodeableConcept [0..*] « The performed procedure type. (Strength=Extensible)ImagingProcedureCode+ »The principal physical location where the ImagingStudy was performedlocation : Reference [0..1] « Location »Description of clinical condition indicating why the ImagingStudy was requestedreasonCode : CodeableConcept [0..*] « The reason for the study. (Strength=Example)ProcedureReasonCodes?? »Indicates another resource whose existence justifies this StudyreasonReference : Reference [0..*] « Condition|Observation|Media| DiagnosticReport|DocumentReference »Per the recommended DICOM mapping, this element is derived from the Study Description attribute (0008,1030). Observations or findings about the imaging study should be recorded in another resource, e.g. Observation, and not in this elementnote : Annotation [0..*]The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performeddescription : string [0..1]SeriesFormal identifier for this seriesidentifier : Identifier [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] « Type of acquired data in the instance. (Strength=Extensible)AcquisitionModality+ »A description of the seriesdescription : string [0..1]Number of SOP Instances in the Study. The value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1]The network service providing access (e.g., query, view, or retrieval) for this series. See implementation notes for information about using DICOM endpoints. A series-level endpoint, if present, has precedence over a study-level endpoint with the same Endpoint.connectionTypeendpoint : Reference [0..*] « Endpoint »The anatomic structures examined. See DICOM Part 16 Annex L (http://dicom.nema.org/medical/dicom/current/output/chtml/part16/chapter_L.html) for DICOM to SNOMED-CT mappings. The bodySite may indicate the laterality of body part imaged; if so, it shall be consistent with any content of ImagingStudy.series.lateralitybodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMEDCTBodyStructures?? »The laterality of the (possibly paired) anatomic structures examined. E.g., the left knee, both lungs, or unpaired abdomen. If present, shall be consistent with any laterality information indicated in ImagingStudy.series.bodySitelaterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? »The specimen imaged, e.g., for whole slide imaging of a biopsyspecimen : Reference [0..*] « Specimen »The date and time the series was startedstarted : dateTime [0..1]PerformerDistinguishes the type of involvement of the performer in the seriesfunction : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Required)ImagingStudySeriesPerformerFu...! »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »InstanceFormal identifier for this image or other contentidentifier : Identifier [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : Coding [1..1] « The sopClass for the instance. (Strength=Extensible)sopClass+ »The description of the instancetitle : string [0..1]Indicates who or what performed the series and how they were involvedperformer[0..*]A single SOP instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All series modality if actual acquisition modalities  --></modality>
 <subject><!-- 1..1 Reference(Patient|Device|Group) Who or what is the subject of the study --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(CarePlan|ServiceRequest|Appointment|
   AppointmentResponse|Task) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner) Who interpreted images --></interpreter>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <numberOfSeries value="[unsignedInt]"/><!-- 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Study Related Instances -->
 <procedureReference><!-- 0..1 Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code  --></procedureCode>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|Media|
   DiagnosticReport|DocumentReference) Why was study performed --></reasonReference>
 <note><!-- 0..* Annotation User-defined comments --></note>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <identifier><!-- 1..1 Identifier Formal DICOM identifier for this series --></identifier>
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series  --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <specimen><!-- 0..* Reference(Specimen) Specimen imaged --></specimen>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization|CareTeam|
     Patient|Device|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <identifier><!-- 1..1 Identifier Formal DICOM identifier for this instance --></identifier>
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All series modality if actual acquisition modalities 
  "subject" : { Reference(Patient|Device|Group) }, // R!  Who or what is the subject of the study
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(CarePlan|ServiceRequest|Appointment|
   AppointmentResponse|Task) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedureReference" : { Reference(Procedure) }, // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "reasonReference" : [{ Reference(Condition|Observation|Media|
   DiagnosticReport|DocumentReference) }], // Why was study performed
  "note" : [{ Annotation }], // User-defined comments
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "identifier" : { Identifier }, // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series 
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(Practitioner|PractitionerRole|Organization|CareTeam|
     Patient|Device|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // A single SOP instance from the series
      "identifier" : { Identifier }, // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : { Coding }, // R!  DICOM class type 
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.subject [ Reference(Patient|Device|Group) ]; # 1..1 Who or what is the subject of the study
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(CarePlan|ServiceRequest|Appointment|AppointmentResponse|Task) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ], ... ; # 0..* Who interpreted images
  fhir:ImagingStudy.endpoint [ Reference(Endpoint) ], ... ; # 0..* Study access endpoint
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 0..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 0..1 Number of Study Related Instances
  fhir:ImagingStudy.procedureReference [ Reference(Procedure) ]; # 0..1 The performed Procedure reference
  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reasonCode [ CodeableConcept ], ... ; # 0..* Why the study was requested
  fhir:ImagingStudy.reasonReference [ Reference(Condition|Observation|Media|DiagnosticReport|DocumentReference) ], ... ; # 0..* Why was study performed
  fhir:ImagingStudy.note [ Annotation ], ... ; # 0..* User-defined comments
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.identifier [ Identifier ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 0..1 Number of Series Related Instances
    fhir:ImagingStudy.series.endpoint [ Reference(Endpoint) ], ... ; # 0..* Series access endpoint
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.specimen [ Reference(Specimen) ], ... ; # 0..* Specimen imaged
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(Practitioner|PractitionerRole|Organization|CareTeam|Patient|Device|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.identifier [ Identifier ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ Coding ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since R3

ImagingStudy
ImagingStudy.status
  • Added Element
ImagingStudy.modality
  • Renamed from modalityList to modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
ImagingStudy.subject
  • Renamed from patient to subject
  • Type Reference: Added Target Types Device, Group
ImagingStudy.basedOn
  • Type Reference: Added Target Types ServiceRequest, Appointment, AppointmentResponse, Task
  • Type Reference: Removed Target Types ReferralRequest, ProcedureRequest
ImagingStudy.procedureReference
  • Max Cardinality changed from * to 1
ImagingStudy.procedureCode
  • Add Binding http://www.rsna.org/RadLex_Playbook.aspx (extensible)
ImagingStudy.location
  • Added Element
ImagingStudy.reasonCode
  • Added Element
ImagingStudy.reasonReference
  • Added Element
ImagingStudy.note
  • Added Element
ImagingStudy.series.identifier
  • Renamed from uid to identifier
  • Type changed from oid to Identifier
ImagingStudy.series.modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
ImagingStudy.series.specimen
  • Added Element
ImagingStudy.series.performer
  • Type changed from Reference(Practitioner) to BackboneElement
ImagingStudy.series.performer.function
  • Added Element
ImagingStudy.series.performer.actor
  • Added Element
ImagingStudy.series.instance.identifier
  • Renamed from uid to identifier
  • Type changed from oid to Identifier
ImagingStudy.series.instance.sopClass
  • Type changed from oid to Coding
  • Add Binding http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 (extensible)
ImagingStudy.uid
  • deleted
ImagingStudy.accession
  • deleted
ImagingStudy.availability
  • deleted
ImagingStudy.reason
  • deleted
ImagingStudy.series.availability
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests of which 2 fail to execute.)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy TUDomainResourceA set of images produced in single study (one or more series of references images)
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierIdentifiers for the whole study
... status ?!Σ1..1coderegistered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus (Required)
... modality Σ0..*CodingAll series modality if actual acquisition modalities
AcquisitionModality (Extensible)
... subject Σ1..1Reference(Patient | Device | Group)Who or what is the subject of the study
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating context
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Request fulfilled
... referrer Σ0..1Reference(Practitioner)Referring physician
... interpreter Σ0..*Reference(Practitioner)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedureReference Σ0..1Reference(Procedure)The performed Procedure reference
... procedureCode Σ0..*CodeableConceptThe performed procedure code
ImagingProcedureCode (Extensible)
... location Σ0..1Reference(Location)Where ImagingStudy occurred
... reasonCode Σ0..*CodeableConceptWhy the study was requested
Procedure Reason Codes (Example)
... reasonReference Σ0..*Reference(Condition | Observation | Media | DiagnosticReport | DocumentReference)Why was study performed
... note Σ0..*AnnotationUser-defined comments
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... identifier Σ1..1IdentifierFormal DICOM identifier for this series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
AcquisitionModality (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... specimen Σ0..*Reference(Specimen)Specimen imaged
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*BackboneElementWho performed the series
..... function Σ0..1CodeableConceptType of performance
ImagingStudy series performer function (Required)
..... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... identifier 1..1IdentifierFormal DICOM identifier for this instance
..... number 0..1unsignedIntThe number of this instance in the series
..... sopClass 1..1CodingDICOM class type
sopClass (Extensible)
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)DICOM Study Instance UID, and Accession Numberidentifier : Identifier [0..*]The current state of the ImagingStudy (this element modifies the meaning of other elements)status : code [1..1] « The status of the ImagingStudy. (Strength=Required)ImagingStudyStatus! »A list of all the series.modality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modality : Coding [0..*] « Type of acquired data in the instance. (Strength=Extensible)AcquisitionModality+ »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The encounter or episode at which the request is initiatedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Date and time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] « Practitioner »The network service providing access (e.g., query, view, or retrieval) for the study. See implementation notes for information about using DICOM endpoints. A study-level endpoint applies to each series in the study, unless overridden by a series-level endpoint with the same Endpoint.connectionTypeendpoint : Reference [0..*] « Endpoint »Number of Series in the Study. This value given may be larger than the number of series elements this Resource contains due to resource availability, security, or other factors. This element should be present if any series elements are presentnumberOfSeries : unsignedInt [0..1]Number of SOP Instances in Study. This value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1]A reference to the performed ProcedureprocedureReference : Reference [0..1] « Procedure »The code for the performed procedure typeprocedureCode : CodeableConcept [0..*] « The performed procedure type. (Strength=Extensible)ImagingProcedureCode+ »The principal physical location where the ImagingStudy was performedlocation : Reference [0..1] « Location »Description of clinical condition indicating why the ImagingStudy was requestedreasonCode : CodeableConcept [0..*] « The reason for the study. (Strength=Example)ProcedureReasonCodes?? »Indicates another resource whose existence justifies this StudyreasonReference : Reference [0..*] « Condition|Observation|Media| DiagnosticReport|DocumentReference »Per the recommended DICOM mapping, this element is derived from the Study Description attribute (0008,1030). Observations or findings about the imaging study should be recorded in another resource, e.g. Observation, and not in this elementnote : Annotation [0..*]The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performeddescription : string [0..1]SeriesFormal identifier for this seriesidentifier : Identifier [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] « Type of acquired data in the instance. (Strength=Extensible)AcquisitionModality+ »A description of the seriesdescription : string [0..1]Number of SOP Instances in the Study. The value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1]The network service providing access (e.g., query, view, or retrieval) for this series. See implementation notes for information about using DICOM endpoints. A series-level endpoint, if present, has precedence over a study-level endpoint with the same Endpoint.connectionTypeendpoint : Reference [0..*] « Endpoint »The anatomic structures examined. See DICOM Part 16 Annex L (http://dicom.nema.org/medical/dicom/current/output/chtml/part16/chapter_L.html) for DICOM to SNOMED-CT mappings. The bodySite may indicate the laterality of body part imaged; if so, it shall be consistent with any content of ImagingStudy.series.lateralitybodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMEDCTBodyStructures?? »The laterality of the (possibly paired) anatomic structures examined. E.g., the left knee, both lungs, or unpaired abdomen. If present, shall be consistent with any laterality information indicated in ImagingStudy.series.bodySitelaterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? »The specimen imaged, e.g., for whole slide imaging of a biopsyspecimen : Reference [0..*] « Specimen »The date and time the series was startedstarted : dateTime [0..1]PerformerDistinguishes the type of involvement of the performer in the seriesfunction : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Required)ImagingStudySeriesPerformerFu...! »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson »InstanceFormal identifier for this image or other contentidentifier : Identifier [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : Coding [1..1] « The sopClass for the instance. (Strength=Extensible)sopClass+ »The description of the instancetitle : string [0..1]Indicates who or what performed the series and how they were involvedperformer[0..*]A single SOP instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All series modality if actual acquisition modalities  --></modality>
 <subject><!-- 1..1 Reference(Patient|Device|Group) Who or what is the subject of the study --></subject>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(CarePlan|ServiceRequest|Appointment|
   AppointmentResponse|Task) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner) Who interpreted images --></interpreter>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <numberOfSeries value="[unsignedInt]"/><!-- 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Study Related Instances -->
 <procedureReference><!-- 0..1 Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code  --></procedureCode>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|Observation|Media|
   DiagnosticReport|DocumentReference) Why was study performed --></reasonReference>
 <note><!-- 0..* Annotation User-defined comments --></note>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <identifier><!-- 1..1 Identifier Formal DICOM identifier for this series --></identifier>
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series  --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <specimen><!-- 0..* Reference(Specimen) Specimen imaged --></specimen>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(Practitioner|PractitionerRole|Organization|CareTeam|
     Patient|Device|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <identifier><!-- 1..1 Identifier Formal DICOM identifier for this instance --></identifier>
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All series modality if actual acquisition modalities 
  "subject" : { Reference(Patient|Device|Group) }, // R!  Who or what is the subject of the study
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(CarePlan|ServiceRequest|Appointment|
   AppointmentResponse|Task) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedureReference" : { Reference(Procedure) }, // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "reasonReference" : [{ Reference(Condition|Observation|Media|
   DiagnosticReport|DocumentReference) }], // Why was study performed
  "note" : [{ Annotation }], // User-defined comments
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "identifier" : { Identifier }, // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series 
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(Practitioner|PractitionerRole|Organization|CareTeam|
     Patient|Device|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // A single SOP instance from the series
      "identifier" : { Identifier }, // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : { Coding }, // R!  DICOM class type 
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.subject [ Reference(Patient|Device|Group) ]; # 1..1 Who or what is the subject of the study
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(CarePlan|ServiceRequest|Appointment|AppointmentResponse|Task) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ], ... ; # 0..* Who interpreted images
  fhir:ImagingStudy.endpoint [ Reference(Endpoint) ], ... ; # 0..* Study access endpoint
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 0..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 0..1 Number of Study Related Instances
  fhir:ImagingStudy.procedureReference [ Reference(Procedure) ]; # 0..1 The performed Procedure reference
  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reasonCode [ CodeableConcept ], ... ; # 0..* Why the study was requested
  fhir:ImagingStudy.reasonReference [ Reference(Condition|Observation|Media|DiagnosticReport|DocumentReference) ], ... ; # 0..* Why was study performed
  fhir:ImagingStudy.note [ Annotation ], ... ; # 0..* User-defined comments
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.identifier [ Identifier ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 0..1 Number of Series Related Instances
    fhir:ImagingStudy.series.endpoint [ Reference(Endpoint) ], ... ; # 0..* Series access endpoint
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.specimen [ Reference(Specimen) ], ... ; # 0..* Specimen imaged
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(Practitioner|PractitionerRole|Organization|CareTeam|Patient|Device|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.identifier [ Identifier ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ Coding ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since Release 3

ImagingStudy
ImagingStudy.status
  • Added Element
ImagingStudy.modality
  • Renamed from modalityList to modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
ImagingStudy.subject
  • Renamed from patient to subject
  • Type Reference: Added Target Types Device, Group
ImagingStudy.basedOn
  • Type Reference: Added Target Types ServiceRequest, Appointment, AppointmentResponse, Task
  • Type Reference: Removed Target Types ReferralRequest, ProcedureRequest
ImagingStudy.procedureReference
  • Max Cardinality changed from * to 1
ImagingStudy.procedureCode
  • Add Binding http://www.rsna.org/RadLex_Playbook.aspx (extensible)
ImagingStudy.location
  • Added Element
ImagingStudy.reasonCode
  • Added Element
ImagingStudy.reasonReference
  • Added Element
ImagingStudy.note
  • Added Element
ImagingStudy.series.identifier
  • Renamed from uid to identifier
  • Type changed from oid to Identifier
ImagingStudy.series.modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html
ImagingStudy.series.specimen
  • Added Element
ImagingStudy.series.performer
  • Type changed from Reference(Practitioner) to BackboneElement
ImagingStudy.series.performer.function
  • Added Element
ImagingStudy.series.performer.actor
  • Added Element
ImagingStudy.series.instance.identifier
  • Renamed from uid to identifier
  • Type changed from oid to Identifier
ImagingStudy.series.instance.sopClass
  • Type changed from oid to Coding
  • Add Binding http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 (extensible)
ImagingStudy.uid
  • deleted
ImagingStudy.accession
  • deleted
ImagingStudy.availability
  • deleted
ImagingStudy.reason
  • deleted
ImagingStudy.series.availability
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests of which 2 fail to execute.)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions & the dependency analysis

PathDefinitionTypeReference
ImagingStudy.status The status of the ImagingStudy.RequiredImagingStudyStatus
ImagingStudy.modality
ImagingStudy.series.modality
Type of acquired data in the instance.ExtensibleAcquisitionModality
ImagingStudy.procedureCode The performed procedure type.Extensiblehttp://www.rsna.org/RadLex_Playbook.aspx
ImagingStudy.reasonCode The reason for the study.ExampleProcedureReasonCodes
ImagingStudy.series.bodySite Codes describing anatomical locations. May include laterality.ExampleSNOMEDCTBodyStructures
ImagingStudy.series.laterality Codes describing body site laterality (left, right, etc.).ExampleLaterality
ImagingStudy.series.performer.function The type of involvement of the performer.RequiredImagingStudySeriesPerformerFunction
ImagingStudy.series.instance.sopClass The sopClass for the instance.Extensiblehttp://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1

A referenced DICOM SOP instance could be:

  • A single- or multi-frame, still or video image captured by a variety of imaging modalities, such as X-ray, MR, and ultrasound;
  • A set of various presentation parameters, including annotation and markup;
  • A set of measurements or a report, including radiation dose report and CAD analysis;
  • An encapsulated PDF or CDA document;
  • A list of instances, such as key “of interest” images, or instances to be “deleted”; or
  • Other DICOM content.

UID values follow the FHIR convention of expressing UIDs as URNs. For example, the DICOM Study Instance UID of 1.2.250.1.59.40211.12345678.678910 is expressed as “urn:oid:1.2.250.1.59.40211.12345678.678910”.

The ImagingStudy.endpoint elements and ImagingStudy.series.endpoint elements indicate network services that can be used to access the studies, series, or instances; for example, a DICOM WADO-RS server. An ImagingStudy.series.endpoint of a particular Endpoint.connectionType provides that service for that series, and all contained instances. An ImagingStudy.endpoint of a particular connection type provides that service for all series in that study that do not have a specified Endpoint of that type, and their contained instances. That is, an ImagingStudy.series.endpoint overrides an ImagingStudy.endpoint of the same connection type. Systems can determine if a particular study, series, or instance is available or offline by interacting with the endpoint. Since each study, or individual series of a study can be stored on different imaging archive servers, per-series endpoints are required. For the identified services and use cases, all instances within a series would be stored together, and thus instance-level endpoints are not defined.

Different Endpoint connection types may have different capabilities, protocols or requirements; and the specified Endpoint.url may require manipulation. For the details on use of imaging-related Endpoint connection types, See below for details.

An Endpoint.connectionType of code dicom-wado-rsi, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-RS service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Sub-services, such as study, shall not be specified. The path shall not contain a trailing slash.

The DICOM WADO-RS (Web Access to DICOM Objects, RESTful mode) service uses a RESTful approach to instance retrieval. This service allows for retrieval of native DICOM SOP instances, or instances “rendered” into other formats, including JPEG and MPEG. The media type of a response is specified by the request Accept header (preferred); or, by the accept query parameters. Supported media types depend on the capabilities of the WADO-RS server and the classification of the instance as “single frame,” “multi-frame,” “video,” “text,” or “other.” The WADO-RS service also allows retrieval of study or series level information.

The path to retrieve a DICOM instance is constructed by appending the appropriate sub-resource paths to the Endpoint.address value.

For example, a native DICOM PS3.10 instance file can be retrieved (if consistent with the Accept header) by performing a GET on a URL constructed from a Endpoint.address of “https://pacs.hospital.org/wado-rs”, the study.uid value of “urn:oid:1.2.250.1.59.40211.12345678.678910”, study.series.uid value of “urn:oid:1.2.250.1.59.40211.789001276.14556172.67789”, and study.series.instance.uid value of “urn:oid:1.2.250.1.59.40211.2678810.87991027.899772.2”:


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/series/1.2.250.1.59.40211.789001276.14556172.67789/instances/1.2.250.1.59.40211.2678810.87991027.899772.2

Query parameters on the "rendered" sub-resource can control other aspects of the rendering including: the rendered dimensions, the quality (compression ratio), the region of interest to render, the brightness/contrast (window center/width) adjustments, and whether to “burn” patient or study demographics into the rendered result. Specific frames of a multi-frame instance may be retrieved using the frames sub-resource.

For example, provided the Accept header indicates a preference for image/jpeg, the example above can be extended with parameters that cause a JPEG thumbnail (100 columns by 100 rows) of a region extending from the top-left corner of the original image, across 1000 and down 3000 pixels, to be retrieved (additional sub-resource and parameters emphasized):


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/series/1.2.250.1.59.40211.789001276.14556172.67789/instances/1.2.250.1.59.40211.2678810.87991027.899772.2/rendered?viewport=100,100,0,0,1000,3000

For further details on DICOM WADO-RS capabilities including additional rendering parameters, see DICOM PS 3.18 .

An Endpoint.connectionType of code dicom-wado-uri, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-URI service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Neither a question mark (?) nor any query parameters shall be included.

The DICOM WADO-URI (Web Access to DICOM Objects, URI mode) service uses HTTP query parameter syntax. This service allows for retrieval of native DICOM instances, or instances “rendered” into other formats, including JPEG and MPEG. The media type of a response is specified by the request Accept header (preferred); or, by the contentType query parameter. Supported media types depend on the classification of the instance as “single frame,” “multi-frame,” “video,” “text,” or “other.”

The query to retrieve a DICOM instance is constructed by appending the appropriate query parameters to the Endpoint.address.url.

For example, a native DICOM PS3.10 instance file can be retrieved (if consistent with the Accept header) by performing a GET on a URL constructed from an Endpoint.address.url of “https://pacs.hospital.org/wado-uri”, the study.uid value of “urn:oid:1.2.250.1.59.40211.12345678.678910”, study.series.uid value of “urn:oid:1.2.250.1.59.40211.789001276.14556172.67789”, and study.series.instance.uid value of “urn:oid:1.2.250.1.59.40211.2678810.87991027.899772.2”:


https://pacs.hospital.org/wado-uri?requestType=WADO&studyUID=1.2.250.1.59.40211.12345678.678910&seriesUID=1.2.250.1.59.40211.789001276.14556172.67789&objectUID=1.2.250.1.59.40211.2678810.87991027.899772.2

Additional query parameters can control other aspects of the rendering including rendered dimensions, quality (compression ratio), the region of interest within the image to render, brightness/contrast (window center/width) adjustments, whether to “burn” patient or study demographics into the rendered result, and which frame of a multi-frame instance to retrieve.

For example, provided the Accept header indicates a preference for image/jpeg, the example above can be extended with parameters that cause a JPEG thumbnail (100 columns by 100 rows) of the left half of the image to be retrieved (additional parameters emphasized):


https://pacs.hospital.org/wado-uri?requestType=WADO&studyUID=1.2.250.1.59.40211.12345678.678910&seriesUID=1.2.250.1.59.40211.789001276.14556172.67789&objectUID=1.2.250.1.59.40211.2678810.87991027.899772.2&rows=100&columns=100&region=0,0,0.5,1 

For further details on DICOM WADO-URI capabilities including additional rendering parameters, see DICOM PS 3.18 .

An Endpoint.connectionType of code ihe-iid, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies an IHE Invoke Image Display (IID) service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Neither the question mark (“?”) nor any query parameters shall be included.

The IHE Invoke Image Display (IID) service provides a standardized mechanism to launch a viewer in a particular study context. (IID also supports invoking a particular patient context, but that is not profiled here.) An IID-type Endpoint should be used only at the study level. As well as invoking the viewer on a particular study, query parameters can request particular viewer capabilities, image quality, and more.

To launch a viewer, append the appropriate query parameters to Endpoint.address value.

For example, given an Endpoint.address of https://pacs.hospital.org/IHEInvokeImageDisplay, to invoke a diagnostic quality viewer on the study with study.uid value of “urn:uri:1.2.250.1.59.40211.12345678.678910”, the following URL would be constructed:


https://pacs.hospital.org/IHEInvokeImageDisplay?requestType=STUDY&studyUID=1.2.250.1.59.40211.12345678.678910&diagnosticQuality=true

For further details on IHE Invoke Image Display capabilities including additional parameters, see the IHE Technical Frameworks , or the introduction on the IHE IID Profile Wiki .

Amy, a family physician, would like to see a list of available studies for her patient, Alex. Her EHR client makes a FHIR call for all ImagingStudy objects available for Alex. In the response, she is able to see the study date, procedure, modality, and accession number, for each study returned. There is enough information provided in the response to obtain a thumbnail via a WADO-RS call, or to launch a viewer using an IHE Radiology - Invoke Image Display (IID) profile call using the url elements found in the ImagingStudy.

Joe Angina complains of shortness of breath and occasional chest pain to his primary care physician, Dr. Pat Down at Local MultiClinic, who orders a stress echocardiogram; the order is created as a FHIR Task resource to manage the workflow, with a link to a ServiceRequest resource with the details of the request. The order is scheduled and assigned to cardiologist Dr. Art Skann, also at Local MultiClinic.

On the scheduled day of the exam, Joe arrives at the echo lab to meet with Dr. Skann and have the study done. Dr. Skann’s workstation shows the daily list of Task, and he follows the link to retrieve the ServiceRequest. (He may follow the links through the referenced Patient resource to access Joe’s electronic medical record, but that is not the concern of this storyboard.)

The Task and ServiceRequest has been transcoded to a DICOM Modality Worklist Scheduled Procedure Step, and in the echo lab the equipment has downloaded the Modality Worklist. The study is performed, and the acquired images and sonographer’s preliminary measurements are stored in the Local MultiClinic Picture Archiving and Communication System (PACS). The PACS creates an ImagingStudy resource for each study it manages.

Dr. Skann interprets the study on a PACS workstation, and he selects two key image frames to be included in the diagnostic report; this selection is stored back to the PACS as a DICOM Key Object Selection with the title "For Report Attachment", and the PACS makes it available (transcodes it) as a FHIR ImagingStudy resource. Dr. Skann dictates the report using a structured data entry report writing program, including a recommendation for a cardiac catheterization procedure, and signs it. The report writing program formats the report as a CDA document, retrieves the ImagingStudy resource, and inserts the referenced key images into the report.

Dr. Down meets again with Joe, and they review the results of the stress test. Joe has a question about the findings that the key images in the report do not show, so Dr. Down uses the Local MultiClinic EMR to query the PACS for the full ImagingStudy resource and uses the references there to open an image display for the full study. Joe agrees to proceed to catheterization, and Dr. Down sends a referral to the Ginormous University Hospital cath department and triggers the PACS to share the echo study through the Metropolitan Health Information Exchange.

The PACS creates an imaging study as an ImagingStudy resource, which includes all the images but excludes the sonographer’s preliminary measurements (which as a matter of policy are not shared outside the Local MultiClinic). The imaging study is published to the Metro HIE. (In accordance with IHE XDS-I , the images themselves are not directly published to the HIE, but available for on-demand retrieval from the PACS.)

At Ginormous Hospital, Dr. Cora Plummer receives the cath referral, and looks up the study in the Metro HIE registry. She retrieves the study ImagingStudy, and uses it to access the shared images, which she uses to prepare for the cath procedure.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
accessiontokenThe accession identifier for the studyImagingStudy.identifier
basedonreferenceThe order for the imageImagingStudy.basedOn
(Appointment, AppointmentResponse, CarePlan, Task, ServiceRequest)
bodysitetokenThe body site studiedImagingStudy.series.bodySite
contextreferenceThe context of the studyImagingStudy.context
(EpisodeOfCare, Encounter)
dicom-classtokenThe type of the instanceImagingStudy.series.instance.sopClass
endpointreferenceThe endpoint for the study or seriesImagingStudy.endpoint | ImagingStudy.series.endpoint
(Endpoint)
identifiertokenOther identifiers for the StudyImagingStudy.identifier30 Resources
inst-idtokenThe instance unique identifierImagingStudy.series.instance.identifier
modalitytokenThe modality of the seriesImagingStudy.series.modality
patientreferenceWho the study is aboutImagingStudy.subject.where(resolve() is Patient)
(Patient)
29 Resources
performerreferenceThe person who performed the studyImagingStudy.series.performer.actor
(Practitioner, Organization, CareTeam, Device, Patient, PractitionerRole, RelatedPerson)
reasontokenThe reason for the studyImagingStudy.reasonCode
seriestokenThe identifier of the series of imagesImagingStudy.series.identifier
starteddateWhen the study was startedImagingStudy.started
statustokenThe status of the studyImagingStudy.status
studytokenThe study identifier for the imageImagingStudy.identifier
subjectreferenceWho the study is aboutImagingStudy.subject
(Group, Device, Patient)