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10.5 Resource ImagingStudy - Content

Imaging Integration icon Work GroupMaturity Level: 4 Trial UseSecurity Category: Patient Compartments: Group, 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 modality values.

The ImagingStudy resource provides information on available imaging data.

An ImagingStudy provides information on a single 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).

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 icon. 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 icon. Attributes used in the DICOM query information models, such as "Number of Instances in Study", can be found in DICOM Part 4 Annex C icon.

ImagingStudy provides access to significant DICOM information but will only eliminate the need for DICOM query (e.g., a DICOMweb search transaction) in the simplest cases. The DICOM instances are not stored in the ImagingStudy resource; use of a DICOM service is needed (e.g., a DICOMweb retrieve transaction).

One ImagingStudy SHALL reference one DICOM Study.

This resource may change as additional information is added to the related DICOM Study.

See notes for guidance on how imaging study element values can be populated and when imaging studies may be created and updated.

The ImagingStudy resource is used to store details of an entire DICOM Study and its relationships to other resources, such as Patient, ServiceRequest, and Encounter.

The ImagingSelection resource is used to reference to a subset of a study. Instances of this resource are created for specific clinical purposes and are unlikely to change once created.

An Observation MAY be related to a set of images in the following ways.

The DocumentReference resource is used to store non-DICOM images, video, or audio with relevant metadata. The DocumentReference resource might be appropriate for including a rendered DICOM image in cases where only the image is needed and not the full image context.

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ImagingStudy TU DomainResource A set of images or image-related data produced in single study
+ Rule: series SHALL only be present if an identifier is present with a system of urn:dicom:uid
+ Rule: At most, a single identifier SHALL be present with a system of urn:dicom:uid
+ Rule: If numberOfSeries and series are both present, the numberOfSeries value SHALL match the number of series elements
+ Rule: If numberOfInstances and series.instance are both present, the numberOfInstances value SHALL match the total number of series.instance elements
+ Rule: If numberOfInstances and series.numberOfInstances are both present, the numberOfInstances value SHALL be the sum of the series.numberOfInstance values.
+ Rule: For each series element, if numberOfInstances and instance are both present, the numberOfInstances value SHALL match the number of instance elements
+ Rule: If modality is present, modality SHALL equal all of the distinct values of series.modality

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣC 0..* Identifier Business identifier for imaging study

... status ?!Σ 1..1 code registered | available | cancelled | entered-in-error | unknown | inactive
Binding: Imaging Study Status (Required)
... modality ΣC 0..* CodeableConcept The distinct values for series' modalities
Binding: Modality icon (Extensible)

... encounter Σ 0..1 Reference(Encounter) Encounter with which this imaging study is associated
... started Σ 0..1 dateTime When the study was started
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | Appointment | Task) Fulfills plan or order

... partOf Σ 0..* Reference(Procedure) Imaging performed procedure(s)

... referrer Σ 0..1 Reference(Practitioner | PractitionerRole) Referring physician
... endpoint Σ 0..* Reference(Endpoint) Study access endpoint

... location Σ 0..1 Reference(Location) Where imaging study occurred
... reason Σ 0..* CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference) Why was imaging study performed?
Binding: Procedure Reason Codes (Example)

... note Σ 0..* Annotation Comments made about the imaging study

... description Σ 0..1 string Study Description or Classification
... numberOfSeries ΣC 0..1 unsignedInt Number of Study Related Series
... numberOfInstances ΣC 0..1 unsignedInt Number of Study Related Instances
... series ΣC 0..* BackboneElement The set of Series belonging to the study

.... uid Σ 1..1 id DICOM Series Instance UID
.... number Σ 0..1 unsignedInt Numeric identifier of this series
.... modality ΣC 1..1 CodeableConcept The modality used for this series
Binding: Modality icon (Extensible)
.... description Σ 0..1 string Series Description or Classification
.... numberOfInstances ΣC 0..1 unsignedInt Number of Series Related Instances
.... endpoint Σ 0..* Reference(Endpoint) Series access endpoint

.... bodySite Σ 0..1 CodeableReference(BodyStructure) Body part examined
Binding: SNOMED CT Body Structures (Example)
.... laterality Σ 0..1 CodeableConcept Body part laterality
Binding: Laterality icon (Example)
.... specimen Σ 0..* Reference(Specimen) Specimen imaged

.... started Σ 0..1 dateTime When the series started
.... performer Σ 0..* BackboneElement Who performed the series

..... function Σ 0..1 CodeableConcept Type of performance
Binding: ImagingStudy series performer function (Extensible)
..... actor Σ 1..1 Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService) Who performed the series
.... instance C 0..* BackboneElement A single SOP instance from the series

..... uid 1..1 id DICOM SOP Instance UID
..... sopClass 1..1 oid DICOM class type
..... number 0..1 unsignedInt The number of this instance in the series
..... title 0..1 string Name or tile of the instance

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

ImagingStudy (DomainResource)Business identifiers assigned to this imaging study by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. Typically this will include the DICOM Study Instance UIDidentifier : Identifier [0..*] « This element has or is affected by some invariantsC »The current state of the imaging study. This is distinct from the status of any service request or task associated with the imaging study (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingStudyStatus! »All the distinct values of series.modality. This may be either an acquisition or a non-acquisition modalitymodality : CodeableConcept [0..*] « null (Strength=Extensible)Modality+ » « This element has or is affected by some invariantsC »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The healthcare event (e.g. a patient and healthcare provider interaction) during which the imaging data represented by this imaging study was acquiredencounter : Reference [0..1] « Encounter »Date and time the study startedstarted : dateTime [0..1]A plan or order that is fulfilled in whole or in part by this imaging studybasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| Task »The performed procedure(s) during which the data associated with this imaging study was createdpartOf : Reference [0..*] « Procedure »The referring physicianreferrer : Reference [0..1] « Practitioner|PractitionerRole »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 »The principal physical location where the imaging study was performedlocation : Reference [0..1] « Location »Describes why the imaging study occurred in coded or textual form or indicates another resource whose existence justifies this imaging studyreason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference; null (Strength=Example)ProcedureReasonCodes?? »Comments made about the imaging study by the performer, subject or other participantsnote : Annotation [0..*]Description or classification of the imaging studydescription : string [0..1]Number of known Series in the Study. This value might be present even if the ImagingStudy.series element is empty or only partially populatednumberOfSeries : unsignedInt [0..1] « This element has or is affected by some invariantsC »Number of known SOP Instances in Study. This value might be present even if the ImagingStudy.series.instance elements are empty or only partially populatednumberOfInstances : unsignedInt [0..1] « This element has or is affected by some invariantsC »SeriesThe DICOM Series Instance UID of the seriesuid : id [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The distinct modality for this series. This may be either an acquisition modality (e.g., CT, MR) or a non-acquisition modality (e.g., segmentation, presentation state)modality : CodeableConcept [1..1] « null (Strength=Extensible)Modality+ » « This element has or is affected by some invariantsC »Description or classification of the seriesdescription : string [0..1]Number of SOP Instances in the Series. The value given MAY be larger than the number of instance elements this series contains due to resource availability, security, or other factors. This element SHOULD be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1] « This element has or is affected by some invariantsC »The network service providing access for the study. See implementation notes for information about [using DICOM endpoints](imagingstudy.html#endpoints)endpoint : 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 : CodeableReference [0..1] « BodyStructure; 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 : CodeableConcept [0..1] « null (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] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson| HealthcareService »InstanceThe DICOM SOP Instance UID for this image or other DICOM contentuid : id [1..1]DICOM instance typesopClass : oid [1..1]The number of the instance assigned by the creator of the series. MAY or MAY NOT correspond to intended display ordernumber : unsignedInt [0..1]The title 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..*]The set of Series belonging to the study. Each Series contains a set of SOP Instances, which could be images, waveforms, 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><!-- I 0..* Identifier Business identifier for imaging study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown | inactive -->
 <modality><!-- I 0..* CodeableConcept The distinct values for series' modalities icon --></modality>
 <subject><!-- 1..1 Reference(Device|Group|Patient) Who or what is the subject of the study --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter with which this imaging study is associated --></encounter>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(Appointment|CarePlan|ServiceRequest|Task) Fulfills plan or order --></basedOn>
 <partOf><!-- 0..* Reference(Procedure) Imaging performed procedure(s) --></partOf>
 <referrer><!-- 0..1 Reference(Practitioner|PractitionerRole) Referring physician --></referrer>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <location><!-- 0..1 Reference(Location) Where imaging study occurred --></location>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation)  Why was imaging study performed? --></reason>
 <note><!-- 0..* Annotation Comments made about the imaging study --></note>
 <description value="[string]"/><!-- 0..1 Study Description or Classification -->
 <numberOfSeries value="[unsignedInt]"/><!-- I 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- I 0..1 Number of Study Related Instances -->
 <series>  <!-- I 0..* The set of Series belonging to the study -->
  <uid value="[id]"/><!-- 1..1 DICOM Series Instance UID -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- I 1..1 CodeableConcept The modality used for this series icon --></modality>
  <description value="[string]"/><!-- 0..1 Series Description or Classification -->
  <numberOfInstances value="[unsignedInt]"/><!-- I 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 CodeableReference(BodyStructure) Body part examined --></bodySite>
  <laterality><!-- 0..1 CodeableConcept Body part laterality icon --></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(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- I 0..* A single SOP instance from the series -->
   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <title value="[string]"/><!-- 0..1 Name or tile of the 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 }], // I Business identifier for imaging study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown | inactive
  "modality" : [{ CodeableConcept }], // I The distinct values for series' modalities icon
  "subject" : { Reference(Device|Group|Patient) }, // R!  Who or what is the subject of the study
  "encounter" : { Reference(Encounter) }, // Encounter with which this imaging study is associated
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(Appointment|CarePlan|ServiceRequest|Task) }], // Fulfills plan or order
  "partOf" : [{ Reference(Procedure) }], // Imaging performed procedure(s)
  "referrer" : { Reference(Practitioner|PractitionerRole) }, // Referring physician
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "location" : { Reference(Location) }, // Where imaging study occurred
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], //  Why was imaging study performed?
  "note" : [{ Annotation }], // Comments made about the imaging study
  "description" : "<string>", // Study Description or Classification
  "numberOfSeries" : "<unsignedInt>", // I Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // I Number of Study Related Instances
  "series" : [{ // I The set of Series belonging to the study
    "uid" : "<id>", // R!  DICOM Series Instance UID
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { CodeableConcept }, // I R!  The modality used for this series icon
    "description" : "<string>", // Series Description or Classification
    "numberOfInstances" : "<unsignedInt>", // I Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { CodeableReference(BodyStructure) }, // Body part examined
    "laterality" : { CodeableConcept }, // Body part laterality icon
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // I A single SOP instance from the series
      "uid" : "<id>", // R!  DICOM SOP Instance UID
      "sopClass" : "<oid>", // R!  DICOM class type
      "number" : "<unsignedInt>", // The number of this instance in the series
      "title" : "<string>" // Name or tile of the 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:identifier  ( [ Identifier ] ... ) ; # 0..* I Business identifier for imaging study
  fhir:status [ code ] ; # 1..1 registered | available | cancelled | entered-in-error | unknown | inactive
  fhir:modality  ( [ CodeableConcept ] ... ) ; # 0..* I The distinct values for series' modalities
  fhir:subject [ Reference(Device|Group|Patient) ] ; # 1..1 Who or what is the subject of the study
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter with which this imaging study is associated
  fhir:started [ dateTime ] ; # 0..1 When the study was started
  fhir:basedOn  ( [ Reference(Appointment|CarePlan|ServiceRequest|Task) ] ... ) ; # 0..* Fulfills plan or order
  fhir:partOf  ( [ Reference(Procedure) ] ... ) ; # 0..* Imaging performed procedure(s)
  fhir:referrer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Referring physician
  fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* Study access endpoint
  fhir:location [ Reference(Location) ] ; # 0..1 Where imaging study occurred
  fhir:reason  ( [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ] ... ) ; # 0..*  Why was imaging study performed?
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the imaging study
  fhir:description [ string ] ; # 0..1 Study Description or Classification
  fhir:numberOfSeries [ unsignedInt ] ; # 0..1 I Number of Study Related Series
  fhir:numberOfInstances [ unsignedInt ] ; # 0..1 I Number of Study Related Instances
  fhir:series ( [ # 0..* I The set of Series belonging to the study
    fhir:uid [ id ] ; # 1..1 DICOM Series Instance UID
    fhir:number [ unsignedInt ] ; # 0..1 Numeric identifier of this series
    fhir:modality [ CodeableConcept ] ; # 1..1 I The modality used for this series
    fhir:description [ string ] ; # 0..1 Series Description or Classification
    fhir:numberOfInstances [ unsignedInt ] ; # 0..1 I Number of Series Related Instances
    fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* Series access endpoint
    fhir:bodySite [ CodeableReference(BodyStructure) ] ; # 0..1 Body part examined
    fhir:laterality [ CodeableConcept ] ; # 0..1 Body part laterality
    fhir:specimen  ( [ Reference(Specimen) ] ... ) ; # 0..* Specimen imaged
    fhir:started [ dateTime ] ; # 0..1 When the series started
    fhir:performer ( [ # 0..* Who performed the series
      fhir:function [ CodeableConcept ] ; # 0..1 Type of performance
      fhir:actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 1..1 Who performed the series
    ] ... ) ;
    fhir:instance ( [ # 0..* I A single SOP instance from the series
      fhir:uid [ id ] ; # 1..1 DICOM SOP Instance UID
      fhir:sopClass [ oid ] ; # 1..1 DICOM class type
      fhir:number [ unsignedInt ] ; # 0..1 The number of this instance in the series
      fhir:title [ string ] ; # 0..1 Name or tile of the instance
    ] ... ) ;
  ] ... ) ;
]

Changes from both R4 and R4B

ImagingStudy
ImagingStudy.status
  • Add code inactive
ImagingStudy.modality
ImagingStudy.basedOn
  • Type Reference: Removed Target Type AppointmentResponse
ImagingStudy.partOf
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.modality
ImagingStudy.series.bodySite
  • Type changed from Coding to CodeableReference
ImagingStudy.series.laterality
  • Type changed from Coding to CodeableConcept
ImagingStudy.series.performer.actor
  • Type Reference: Added Target Type HealthcareService
ImagingStudy.series.instance.sopClass
  • Type changed from Coding to oid
  • Remove Binding `http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1` (extensible)
ImagingStudy.interpreter
  • Deleted (-> series.performer)
ImagingStudy.procedureReference
  • Deleted (-> procedure)
ImagingStudy.procedureCode
  • Deleted (-> procedure)
ImagingStudy.reasonCode
  • Deleted (-> reason)
ImagingStudy.reasonReference
  • Deleted (-> reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraints    Filter: Filtersdoco
.. ImagingStudy TU DomainResource A set of images or image-related data produced in single study
+ Rule: series SHALL only be present if an identifier is present with a system of urn:dicom:uid
+ Rule: At most, a single identifier SHALL be present with a system of urn:dicom:uid
+ Rule: If numberOfSeries and series are both present, the numberOfSeries value SHALL match the number of series elements
+ Rule: If numberOfInstances and series.instance are both present, the numberOfInstances value SHALL match the total number of series.instance elements
+ Rule: If numberOfInstances and series.numberOfInstances are both present, the numberOfInstances value SHALL be the sum of the series.numberOfInstance values.
+ Rule: For each series element, if numberOfInstances and instance are both present, the numberOfInstances value SHALL match the number of instance elements
+ Rule: If modality is present, modality SHALL equal all of the distinct values of series.modality

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier ΣC 0..* Identifier Business identifier for imaging study

... status ?!Σ 1..1 code registered | available | cancelled | entered-in-error | unknown | inactive
Binding: Imaging Study Status (Required)
... modality ΣC 0..* CodeableConcept The distinct values for series' modalities
Binding: Modality icon (Extensible)

... encounter Σ 0..1 Reference(Encounter) Encounter with which this imaging study is associated
... started Σ 0..1 dateTime When the study was started
... basedOn Σ 0..* Reference(CarePlan | ServiceRequest | Appointment | Task) Fulfills plan or order

... partOf Σ 0..* Reference(Procedure) Imaging performed procedure(s)

... referrer Σ 0..1 Reference(Practitioner | PractitionerRole) Referring physician
... endpoint Σ 0..* Reference(Endpoint) Study access endpoint

... location Σ 0..1 Reference(Location) Where imaging study occurred
... reason Σ 0..* CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference) Why was imaging study performed?
Binding: Procedure Reason Codes (Example)

... note Σ 0..* Annotation Comments made about the imaging study

... description Σ 0..1 string Study Description or Classification
... numberOfSeries ΣC 0..1 unsignedInt Number of Study Related Series
... numberOfInstances ΣC 0..1 unsignedInt Number of Study Related Instances
... series ΣC 0..* BackboneElement The set of Series belonging to the study

.... uid Σ 1..1 id DICOM Series Instance UID
.... number Σ 0..1 unsignedInt Numeric identifier of this series
.... modality ΣC 1..1 CodeableConcept The modality used for this series
Binding: Modality icon (Extensible)
.... description Σ 0..1 string Series Description or Classification
.... numberOfInstances ΣC 0..1 unsignedInt Number of Series Related Instances
.... endpoint Σ 0..* Reference(Endpoint) Series access endpoint

.... bodySite Σ 0..1 CodeableReference(BodyStructure) Body part examined
Binding: SNOMED CT Body Structures (Example)
.... laterality Σ 0..1 CodeableConcept Body part laterality
Binding: Laterality icon (Example)
.... specimen Σ 0..* Reference(Specimen) Specimen imaged

.... started Σ 0..1 dateTime When the series started
.... performer Σ 0..* BackboneElement Who performed the series

..... function Σ 0..1 CodeableConcept Type of performance
Binding: ImagingStudy series performer function (Extensible)
..... actor Σ 1..1 Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService) Who performed the series
.... instance C 0..* BackboneElement A single SOP instance from the series

..... uid 1..1 id DICOM SOP Instance UID
..... sopClass 1..1 oid DICOM class type
..... number 0..1 unsignedInt The number of this instance in the series
..... title 0..1 string Name or tile of the instance

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

ImagingStudy (DomainResource)Business identifiers assigned to this imaging study by the performer and/or other systems. These identifiers remain constant as the resource is updated and propagates from server to server. Typically this will include the DICOM Study Instance UIDidentifier : Identifier [0..*] « This element has or is affected by some invariantsC »The current state of the imaging study. This is distinct from the status of any service request or task associated with the imaging study (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingStudyStatus! »All the distinct values of series.modality. This may be either an acquisition or a non-acquisition modalitymodality : CodeableConcept [0..*] « null (Strength=Extensible)Modality+ » « This element has or is affected by some invariantsC »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The healthcare event (e.g. a patient and healthcare provider interaction) during which the imaging data represented by this imaging study was acquiredencounter : Reference [0..1] « Encounter »Date and time the study startedstarted : dateTime [0..1]A plan or order that is fulfilled in whole or in part by this imaging studybasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| Task »The performed procedure(s) during which the data associated with this imaging study was createdpartOf : Reference [0..*] « Procedure »The referring physicianreferrer : Reference [0..1] « Practitioner|PractitionerRole »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 »The principal physical location where the imaging study was performedlocation : Reference [0..1] « Location »Describes why the imaging study occurred in coded or textual form or indicates another resource whose existence justifies this imaging studyreason : CodeableReference [0..*] « Condition|Observation| DiagnosticReport|DocumentReference; null (Strength=Example)ProcedureReasonCodes?? »Comments made about the imaging study by the performer, subject or other participantsnote : Annotation [0..*]Description or classification of the imaging studydescription : string [0..1]Number of known Series in the Study. This value might be present even if the ImagingStudy.series element is empty or only partially populatednumberOfSeries : unsignedInt [0..1] « This element has or is affected by some invariantsC »Number of known SOP Instances in Study. This value might be present even if the ImagingStudy.series.instance elements are empty or only partially populatednumberOfInstances : unsignedInt [0..1] « This element has or is affected by some invariantsC »SeriesThe DICOM Series Instance UID of the seriesuid : id [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The distinct modality for this series. This may be either an acquisition modality (e.g., CT, MR) or a non-acquisition modality (e.g., segmentation, presentation state)modality : CodeableConcept [1..1] « null (Strength=Extensible)Modality+ » « This element has or is affected by some invariantsC »Description or classification of the seriesdescription : string [0..1]Number of SOP Instances in the Series. The value given MAY be larger than the number of instance elements this series contains due to resource availability, security, or other factors. This element SHOULD be present if any instance elements are presentnumberOfInstances : unsignedInt [0..1] « This element has or is affected by some invariantsC »The network service providing access for the study. See implementation notes for information about [using DICOM endpoints](imagingstudy.html#endpoints)endpoint : 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 : CodeableReference [0..1] « BodyStructure; 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 : CodeableConcept [0..1] « null (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] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson| HealthcareService »InstanceThe DICOM SOP Instance UID for this image or other DICOM contentuid : id [1..1]DICOM instance typesopClass : oid [1..1]The number of the instance assigned by the creator of the series. MAY or MAY NOT correspond to intended display ordernumber : unsignedInt [0..1]The title 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..*]The set of Series belonging to the study. Each Series contains a set of SOP Instances, which could be images, waveforms, 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><!-- I 0..* Identifier Business identifier for imaging study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown | inactive -->
 <modality><!-- I 0..* CodeableConcept The distinct values for series' modalities icon --></modality>
 <subject><!-- 1..1 Reference(Device|Group|Patient) Who or what is the subject of the study --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter with which this imaging study is associated --></encounter>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(Appointment|CarePlan|ServiceRequest|Task) Fulfills plan or order --></basedOn>
 <partOf><!-- 0..* Reference(Procedure) Imaging performed procedure(s) --></partOf>
 <referrer><!-- 0..1 Reference(Practitioner|PractitionerRole) Referring physician --></referrer>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <location><!-- 0..1 Reference(Location) Where imaging study occurred --></location>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation)  Why was imaging study performed? --></reason>
 <note><!-- 0..* Annotation Comments made about the imaging study --></note>
 <description value="[string]"/><!-- 0..1 Study Description or Classification -->
 <numberOfSeries value="[unsignedInt]"/><!-- I 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- I 0..1 Number of Study Related Instances -->
 <series>  <!-- I 0..* The set of Series belonging to the study -->
  <uid value="[id]"/><!-- 1..1 DICOM Series Instance UID -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- I 1..1 CodeableConcept The modality used for this series icon --></modality>
  <description value="[string]"/><!-- 0..1 Series Description or Classification -->
  <numberOfInstances value="[unsignedInt]"/><!-- I 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 CodeableReference(BodyStructure) Body part examined --></bodySite>
  <laterality><!-- 0..1 CodeableConcept Body part laterality icon --></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(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- I 0..* A single SOP instance from the series -->
   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <title value="[string]"/><!-- 0..1 Name or tile of the 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 }], // I Business identifier for imaging study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown | inactive
  "modality" : [{ CodeableConcept }], // I The distinct values for series' modalities icon
  "subject" : { Reference(Device|Group|Patient) }, // R!  Who or what is the subject of the study
  "encounter" : { Reference(Encounter) }, // Encounter with which this imaging study is associated
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(Appointment|CarePlan|ServiceRequest|Task) }], // Fulfills plan or order
  "partOf" : [{ Reference(Procedure) }], // Imaging performed procedure(s)
  "referrer" : { Reference(Practitioner|PractitionerRole) }, // Referring physician
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "location" : { Reference(Location) }, // Where imaging study occurred
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], //  Why was imaging study performed?
  "note" : [{ Annotation }], // Comments made about the imaging study
  "description" : "<string>", // Study Description or Classification
  "numberOfSeries" : "<unsignedInt>", // I Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // I Number of Study Related Instances
  "series" : [{ // I The set of Series belonging to the study
    "uid" : "<id>", // R!  DICOM Series Instance UID
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { CodeableConcept }, // I R!  The modality used for this series icon
    "description" : "<string>", // Series Description or Classification
    "numberOfInstances" : "<unsignedInt>", // I Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { CodeableReference(BodyStructure) }, // Body part examined
    "laterality" : { CodeableConcept }, // Body part laterality icon
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // I A single SOP instance from the series
      "uid" : "<id>", // R!  DICOM SOP Instance UID
      "sopClass" : "<oid>", // R!  DICOM class type
      "number" : "<unsignedInt>", // The number of this instance in the series
      "title" : "<string>" // Name or tile of the 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:identifier  ( [ Identifier ] ... ) ; # 0..* I Business identifier for imaging study
  fhir:status [ code ] ; # 1..1 registered | available | cancelled | entered-in-error | unknown | inactive
  fhir:modality  ( [ CodeableConcept ] ... ) ; # 0..* I The distinct values for series' modalities
  fhir:subject [ Reference(Device|Group|Patient) ] ; # 1..1 Who or what is the subject of the study
  fhir:encounter [ Reference(Encounter) ] ; # 0..1 Encounter with which this imaging study is associated
  fhir:started [ dateTime ] ; # 0..1 When the study was started
  fhir:basedOn  ( [ Reference(Appointment|CarePlan|ServiceRequest|Task) ] ... ) ; # 0..* Fulfills plan or order
  fhir:partOf  ( [ Reference(Procedure) ] ... ) ; # 0..* Imaging performed procedure(s)
  fhir:referrer [ Reference(Practitioner|PractitionerRole) ] ; # 0..1 Referring physician
  fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* Study access endpoint
  fhir:location [ Reference(Location) ] ; # 0..1 Where imaging study occurred
  fhir:reason  ( [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ] ... ) ; # 0..*  Why was imaging study performed?
  fhir:note  ( [ Annotation ] ... ) ; # 0..* Comments made about the imaging study
  fhir:description [ string ] ; # 0..1 Study Description or Classification
  fhir:numberOfSeries [ unsignedInt ] ; # 0..1 I Number of Study Related Series
  fhir:numberOfInstances [ unsignedInt ] ; # 0..1 I Number of Study Related Instances
  fhir:series ( [ # 0..* I The set of Series belonging to the study
    fhir:uid [ id ] ; # 1..1 DICOM Series Instance UID
    fhir:number [ unsignedInt ] ; # 0..1 Numeric identifier of this series
    fhir:modality [ CodeableConcept ] ; # 1..1 I The modality used for this series
    fhir:description [ string ] ; # 0..1 Series Description or Classification
    fhir:numberOfInstances [ unsignedInt ] ; # 0..1 I Number of Series Related Instances
    fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* Series access endpoint
    fhir:bodySite [ CodeableReference(BodyStructure) ] ; # 0..1 Body part examined
    fhir:laterality [ CodeableConcept ] ; # 0..1 Body part laterality
    fhir:specimen  ( [ Reference(Specimen) ] ... ) ; # 0..* Specimen imaged
    fhir:started [ dateTime ] ; # 0..1 When the series started
    fhir:performer ( [ # 0..* Who performed the series
      fhir:function [ CodeableConcept ] ; # 0..1 Type of performance
      fhir:actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 1..1 Who performed the series
    ] ... ) ;
    fhir:instance ( [ # 0..* I A single SOP instance from the series
      fhir:uid [ id ] ; # 1..1 DICOM SOP Instance UID
      fhir:sopClass [ oid ] ; # 1..1 DICOM class type
      fhir:number [ unsignedInt ] ; # 0..1 The number of this instance in the series
      fhir:title [ string ] ; # 0..1 Name or tile of the instance
    ] ... ) ;
  ] ... ) ;
]

Changes from both R4 and R4B

ImagingStudy
ImagingStudy.status
  • Add code inactive
ImagingStudy.modality
ImagingStudy.basedOn
  • Type Reference: Removed Target Type AppointmentResponse
ImagingStudy.partOf
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.modality
ImagingStudy.series.bodySite
  • Type changed from Coding to CodeableReference
ImagingStudy.series.laterality
  • Type changed from Coding to CodeableConcept
ImagingStudy.series.performer.actor
  • Type Reference: Added Target Type HealthcareService
ImagingStudy.series.instance.sopClass
  • Type changed from Coding to oid
  • Remove Binding `http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1` (extensible)
ImagingStudy.interpreter
  • Deleted (-> series.performer)
ImagingStudy.procedureReference
  • Deleted (-> procedure)
ImagingStudy.procedureCode
  • Deleted (-> procedure)
ImagingStudy.reasonCode
  • Deleted (-> reason)
ImagingStudy.reasonReference
  • Deleted (-> reason)

See the Full Difference for further information

This analysis is available for R4 as XML or JSON and for R4B as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

Path ValueSet Type Documentation
ImagingStudy.status ImagingStudyStatus Required

The status of the ImagingStudy.

ImagingStudy.modality Modality icon Extensible

Transitive closure of CID 33 Modality

ImagingStudy.reason ProcedureReasonCodes Example

This example value set defines the set of codes that can be used to indicate a reason for a procedure.

ImagingStudy.series.modality Modality icon Extensible

Transitive closure of CID 33 Modality

ImagingStudy.series.bodySite SNOMEDCTBodyStructures Example

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).

ImagingStudy.series.laterality Laterality icon Example

Transitive closure of CID 244 Laterality

ImagingStudy.series.performer.function ImagingStudySeriesPerformerFunction Extensible

Performer function of an agent in an imaging study series

UniqueKeyLevelLocationDescriptionExpression
img ist-1Rule (base)series SHALL only be present if an identifier is present with a system of urn:dicom:uidseries.exists() implies identifier.where(system = 'urn:dicom:uid').exists()
img ist-2Rule (base)At most, a single identifier SHALL be present with a system of urn:dicom:uididentifier.where(system = 'urn:dicom:uid').count() < 2
img ist-3Rule (base)If numberOfSeries and series are both present, the numberOfSeries value SHALL match the number of series elementsnumberOfSeries.exists() and series.exists() implies numberOfSeries = series.count()
img ist-4Rule (base)If numberOfInstances and series.instance are both present, the numberOfInstances value SHALL match the total number of series.instance elementsnumberOfInstances.exists() and series.exists() implies numberOfInstances = series.instance.count()
img ist-5Rule (base)If numberOfInstances and series.numberOfInstances are both present, the numberOfInstances value SHALL be the sum of the series.numberOfInstance values.numberOfInstances.exists() and series.numberOfInstances.exists() implies numberOfInstances = series.numberOfInstances.aggregate($total + $this.toInteger(), 0)
img ist-6Rule (base)For each series element, if numberOfInstances and instance are both present, the numberOfInstances value SHALL match the number of instance elementsnumberOfInstances.exists() and series.exists() implies numberOfInstances = series.instance.count()
img ist-7Rule (base)If modality is present, modality SHALL equal all of the distinct values of series.modalitymodality.exists() implies modality.distinct() = series.modality.distinct()

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.

DICOM Series Instance UID and SOP Instance UID use the id datatype, and are encoded directly. For example, an image with SOP Instance UID of 2.16.124.113543.1154777499.30246.19789.3503430045.1.1 is encoded in ImagingStudy.series.instance.uid as “2.16.124.113543.1154777499.30246.19789.3503430045.1.1”.

The ImagingStudy's DICOM Study Instance UID is encoded in the ImagingStudy.identifier element, which is of the Identifier datatype. When encoding a DICOM UID in an Identifier datatype, use the Identifier system of “urn:dicom:uid”, and prefix the UID value with “urn:oid:”. Therefore, an ImagingStudy with DICOM Study Instance UID of 2.16.124.113543.1154777499.30246.19789.3503430046 is encoded as:


	"identifier":{
		"system":"urn:dicom:uid",
		"value":"urn:oid:2.16.124.113543.1154777499.30246.19789.3503430046"
	} 

The study accession number is encoded as Reference.identifier element using the ACSN identifier type, e.g.:


"basedOn": [
  "reference": {
    "identifier":{
        "type" : {
            "coding" : [
                {
                    "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                    "code" : "ACSN"
                }
            ]
        },
        "system":"http://ginormoushospital.org/accession",
        "value":"GH334103"
    }
  }
]

The ImagingStudy.endpoint elements and ImagingStudy.series.endpoint elements indicate network services that can be used to access the studies, series, and 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. Furthermore, the specified Endpoint.address identifies the DICOM Web Service Base URI (see DICOM PS 3.18 Section 8.2 icon ). The URL needed to retrieve image data may need to be constructed from this base URL. See below for the details on use of imaging-related Endpoint connection types.

An Endpoint.connectionType of code dicom-wado-rs, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-RS service.

The DICOM WADO-RS (Web Access to DICOM Objects, RESTful mode) service uses a RESTful approach to study, series, and 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 path to retrieve a DICOM instance is constructed by appending the appropriate sub-resource paths to the Endpoint.address value.

For example, using the following information in a fictional ImagingStudy resource:

  • the WADO-RS service base url of https://pacs.hospital.org/wado-rs found in an ImagingStudy.endpoint.address,
  • the DICOM Study Instance UID of 1.2.250.1.59.40211.12345678.678910 found in an ImagingStudy.identifier having Identifier.system of “urn:dicom:uid”,
  • the DICOM Series Instance UID of 1.2.250.1.59.40211.789001276.14556172.67789 found in ImagingStudy.series.uid, and
  • the DICOM SOP Instance UID of 1.2.250.1.59.40211.2678810.87991027.899772.2 found in ImagingStudy.series.instance.uid
we can construct the WADO-RS URL to issue an HTTP GET for a native DICOM PS3.10 instance file (if consistent with the Accept header):


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 (rendered to a size of 400 columns by 400 rows) of a region extending from the top-left corner of the original image to 1000 pixels across and 3000 pixels right, 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=400,400,0,0,1000,3000

If the specified WADO-RS service supports the DICOMweb thumbnail resource, a representative image of the study can be requested, for example, to display alongside the study. The URL would look as follows:


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/thumbnail

For further details on DICOM WADO-RS capabilities including additional rendering parameters, see DICOM PS 3.18 Section 10.4 icon.

An Endpoint.connectionType of code dicom-wado-uri, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-URI service.

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 value.

For example, using the following information in a fictional ImagingStudy resource:

  • the WADO-URI service base url of https://pacs.hospital.org/wado-uri found in an ImagingStudy.endpoint.address,
  • the DICOM Study Instance UID of 1.2.250.1.59.40211.12345678.678910 found in an ImagingStudy.identifier having Identifier.system of urn:dicom:uid,
  • the DICOM Series Instance UID of 1.2.250.1.59.40211.789001276.14556172.67789 found in ImagingStudy.series.uid, and
  • the DICOM SOP Instance UID of 1.2.250.1.59.40211.2678810.87991027.899772.2 found in ImagingStudy.series.instance.uid
we can construct the WADO-URI URL to issue an HTTP GET for a native DICOM PS3.10 instance file (if consistent with the Accept header):


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 Chapter 9 icon.

Some imaging uses MAY require information beyond what is present in an ImagingStudy resource. Many of the DICOM patient and study level attributes are found in the FHIR Patient, Procedure, or other resources which are referenced from an ImagingStudy instance. Other DICOM content MAY be transformed into other FHIR resources, such as DiagnosticReports or Observations, which are not directly referenced, but MAY be easily found.

Although many ImagingStudy consumers are expected to need only the DICOM information contained in FHIR resources, some MAY need additional DICOM attributes. For these cases, which by their nature involve more imaging-aware consumers, the most flexible solution is to leverage the DICOM WADO-RS metadata-only endpoint to retrieve an XML or JSON representation of the DICOM study, series, instance, or frame information.

A benefit of using the metadata endpoint in this way is that the ImagingStudy creator does not need to know each of the attributes that each of the (current or future) ImagingStudy consumers is (or will be) interested in.

A client retrieves the following ImagingStudy:

{
  "resourceType": "ImagingStudy",
  "id": "example-xr",
  "identifier": [
    {
      "use": "official",
      "system": "urn:dicom:uid",
      "value": "urn:oid:2.16.124.113543.6003.1154777499.30246.19789.3503430046"
    }
  ],
  ...
  "series": [
    {
      "uid": "2.16.124.113543.6003.1154777499.30246.19789.3503430045.1",
      ...
      "endpoint": [
        {
          "reference": "Endpoint/example-wadors"
        }
      ]
      ...
    }
    ...
  ]
}

(See Example XR for full example)

The client retrieves the referenced Endpoint (see Example WADO-RS) and extracts the WADO-RS URL:

https://pacs.hospital.org/wado-rs
.

The client uses the WADO-RS URL, the identifier.value and the series.uid to construct a WADO-RS metadata request:

GET https://pacs.hospital.org/wado-rs/studies/2.16.124.113543.6003.1154777499.30246.19789.3503430046/series/2.16.124.113543.6003.1154777499.30246.19789.3503430045.1/metadata HTTP/1.1
Accept: application/dicom+json

The WADO-RS server then returns the complete DICOM metadata for the requested series.

Note: reporting workflow is not described in this use case.

  1. Hospital ordering system creates a ServiceRequest and related resources ordering an echocardiogram for a patient, linked to a Patient resource
  2. Radiology Information System creates DICOM Modality Worklist (MWL) entry based on the service request and related patient information
    • Patient identifiers and demographics
    • Accession Number
    • Procedure to be performed
    • Study Instance UID
  3. Ultrasound technologist queries MWL entry and selects relevant entry
  4. Patient is scanned and ultrasound device creates an echocardiogram with patient demographics and order information based on the MWL entry
  5. Echocardiogram is sent to image archive and stored
  6. Image archive creates an ImagingStudy
    • subject is current Patient
    • basedOn includes current ServiceRequest
    • identifier is Study Instance UID
    • endpoint points to image archive WADO-RS service
    • modality is US
  7. Image archive notifies EMR of imaging study
  8. Radiology reading workstation retrieves study images from image archive
  9. Radiologist reads study and selects several images as "key images"
  10. Radiology reading workstation sends DICOM Key Object Selection (KOS) to image archive
  11. Image archive updates imaging study to include KOS
    • modality is now US,KOS
    • KOS series added
  12. Imaging study available to EMR clients

  1. EMR client searches for imaging studies for a patient:
    • Search parameters:
      • status=available
      • subject.identifier=[identifier for selected patient]
  2. Image archive returns matching imaging studies, each containing:
    • Study Instance UID (ImagingStudy.identifier)
    • Accession Number (ImagingStudy.basedOn.identifier)
    • Procedure codes (ImagingStudy.procedure)
    • Imaging modalities in study (ImagingStudy.modality)
    • WADO-RS endpoint (ImagingStudy.endpoint) pointing to image archive hosting DICOM study
  3. EMR user selects relevant imaging study based on search results
  4. EMR client launches enterprise image viewer
    • Passes WADO-RS endpoint and Study Instance UID
  5. Enterprise image viewer loads image data from image archive
    • Makes WADO-RS call to endpoint with specified Study Instance UID

Depending on the modality and procedure type, a DICOM study can range from having one or two instances instance (as in many X-ray procedures) to several thousand instances (for some CT exams) or even tens of thousands (for functional MRI studies). The number of series within a study has far less variability, and is usually under twenty, although post-processing, computer-aided detection, and AI applications MAY cause modest increases. An ImagingStudy resource describing a large DICOM study would itself be of significant size.

Issuing narrowly-tailored queries can help a client avoid search results containing many ImagingStudy resources. The _summary=true query parameter will omit several resource elements, including all instance-level elements; this can be used to examine search results before retrieving the full instances. If a server limits the byte size of search bundle, this MAY impact the number of ImagingStudy resources returned per search result page; a client can use the _count query parameter to influence the number of resources per search result page.

Although not reflected in the ImagingStudy resource, the size of an individual referenced instance MAY be anywhere from a few kilobytes (a compressed 256x256 pixel MR or 640x480 pixel ultrasound image) to a gigabyte or more (for digital breast tomography imaging). When retrieving the referenced content of an ImagingStudy, applications may consider methods to reduce transfer time, such as:

  • Loading only specific instances or series
  • Specifying compressed Transfer Syntaxes
  • etc.

The ImagingStudy resource can be hosted by an image archive application - such as a PACS or Vendor-Neutral Archive - or a more general healthcare informatics application such as an EMR. In some cases it MAY be hosted in both locations.

However, the image archive is typically the source of truth for the content of the ImagingStudy.

Depending on where the ImagingStudy resource is hosted, there are several available mechanisms for keeping the two applications consistent.

In this scenario, the image archive:

  • Hosts FHIR ImagingStudy resources
  • Hosts DICOM / DICOMweb endpoints
  • Ensures consistency between the FHIR and DICOM metadata
  • Ensures consistency between ImagingStudy and key related resources
    • Patient, ServiceRequest, etc.

The image archive could share ImagingStudy information by:

  • EMR performing on-demand FHIR ImagingStudy searches
    • Typically using the Accession Number associated with a service request. e.g., GET http://example.org/fhir/ImagingStudy?basedOn=ServiceRequest/123&status=available
  • Subscription to ImagingStudy resources
    • e.g. Requesting notification when ImagingStudy.status=available
  • Legacy mechanisms, such as:
    • HL7 v2 messages
    • DICOM Instance Availability notification

In this scenario, the image archive:

  • Hosts DICOM / DICOMweb endpoints
  • Ensures consistency between DICOM and key FHIR resources
    • Patient, ServiceRequest, etc.

while the EMR:

  • Hosts FHIR ImagingStudy resources
  • Ensures consistency between ImagingStudy and key related resources
    • Patient, ServiceRequest, etc.

The image archive could share ImagingStudy information by:

  • EMR performing on-demand DICOM / DICOMweb searches
    • Typically using Accession Number
    • Response would be converted from DICOM to FHIR
      • ImagingStudy is intended to support mapping to and from DICOM / DICOMweb search responses
  • Image archive creating / updating ImagingStudy resources hosted in EMR
    • Either via PUT method or by posting a Bundle
  • Subscription to ImagingStudy resources
    • As above example
  • Legacy mechanisms, such as:
    • HL7 v2 messages
    • DICOM Instance Availability notification

In this scenario, the image archive:

  • Hosts FHIR ImagingStudy resources
  • Hosts DICOM / DICOMweb endpoints
  • Ensures consistency between the FHIR and DICOM metadata
  • Ensures consistency between ImagingStudy and key related resources
    • Patient, ServiceRequest, etc.

while the EMR:

  • Hosts FHIR ImagingStudy resources
  • Ensures consistency between ImagingStudy and key related resources
    • Patient, ServiceRequest, etc.

Mechanisms for ensuring consistency between two systems holding representations of the same data are still in development.

As the image archive is the "source of truth", the above methods MAY still be applicable. See Provenance resource.

Typically, an ImagingStudy is a FHIR representation of imaging data that is stored in a DICOM device, such as an image archive (e.g. PACS). The value of the status element reflects the status of this representation and does not necessarily reflect the status of either the underlying imaging data or any ServiceRequest or Task resources that resulted in the ImagingStudy being created.

In some cases, the ImagingStudy MAY be created before any images have been acquired. In this case, the .status will have a value of registered.

After at least some images have been acquired and the ImagingStudy has been updated to reflect tht, the ImagingStudy will have a status of available. At this stage the ImagingStudy MAY be presented to viewing applications.

If the ImagingStudy is cancelled before images are acquired its status SHOULD be set to cancelled.

If the ImagingStudy is incorrect - e.g., due to images being acquired with the wrong modality worklist entry selected - it MAY be corrected with an update operation or set to entered-in-error and replaced with a new ImagingStudy.

Additional DICOM images, key object notes, etc. MAY be created later, so a status of complete is not meaningful for an ImagingStudy. For this reason, this status is not defined for an ImagingStudy.

Any applications waiting for the completion of an imaging-related ServiceRequest or Task SHOULD track the progress of those resources directly.

An ImagingStudy may be created to represent the content of:

The set of ImagingStudy elements is broadly aligned with these three information models.

In DICOM, a Study may be related to two types of "procedures": requested procedures and performed procedures.

In the FHIR model, "requested procedures" are represented by the ActivityDefinition resource while "performed procedures" are represented by the Procedure resource.

Therefore, the requested procedure associated with a particular imaging study would typically be the encoded as the ServiceRequest.code that the imaging study is basedOn, where that code may contain a coded value or may reference an ActivityDefinition resource.

Similarly, the performed procedure would be encoded as the Procedure that the imaging study is partOf.

Searching for an imaging study by its requested procedure can be done by including based-on as a search parameters, and by its performed procedure by including procedure as a search parameters.

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

Name Type Description Expression In Common
based-on reference The order for the image such as Accession Number ImagingStudy.basedOn
(Appointment, CarePlan, Task, ServiceRequest)
body-site token The body site code studied ImagingStudy.series.bodySite.concept
body-structure reference The body structure resource associated with the ImagingStudy ImagingStudy.series.bodySite.reference
dicom-class uri The type of the instance ImagingStudy.series.instance.sopClass
encounter reference The context of the study ImagingStudy.encounter
(Encounter)
28 Resources
endpoint reference The endpoint for the study or series ImagingStudy.endpoint | ImagingStudy.series.endpoint
(Endpoint)
identifier token Identifiers for the Study, such as DICOM Study Instance UID ImagingStudy.identifier 65 Resources
instance token SOP Instance UID for an instance ImagingStudy.series.instance.uid
modality token The modality of the series ImagingStudy.series.modality
patient reference Who the study is about ImagingStudy.subject.where(resolve() is Patient)
(Patient)
65 Resources
performer reference The person who performed the study ImagingStudy.series.performer.actor
(Practitioner, Organization, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson)
procedure reference The performed procedure for the study ImagingStudy.partOf
(Procedure)
reason-concept D token The reason code for the study ImagingStudy.reason.concept
reason-reference D reference The resource reference describing the reason for the study ImagingStudy.reason.reference
referrer reference The referring physician ImagingStudy.referrer
(Practitioner, PractitionerRole)
series token DICOM Series Instance UID for a series ImagingStudy.series.uid
started date When the study was started ImagingStudy.started
status token The status of the study ImagingStudy.status
subject reference Who the study is about ImagingStudy.subject
(Group, Device, Patient)