FHIR Imaging ServiceRequest Profile IG
0.1.0 - ci-build International flag

FHIR Imaging ServiceRequest Profile IG, published by HL7 International / Imaging Integration. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/imaging-service-request-ig/ and changes regularly. See the Directory of published versions

Resource Profile: ImagingStudyRequestedProcedureProfile - Detailed Descriptions

Draft as of 2025-03-26

Definitions for the requested-procedure-imaging-study resource profile.

Guidance on how to interpret the contents of this table can be found here

0. ImagingStudy
Definition

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.

ShortA set of images produced in single study (one or more series of references images)
Control0..*
Is Modifierfalse
Must Supportfalse
Summaryfalse
Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
dom-6: A resource should have narrative for robust management (text.`div`.exists())
2. ImagingStudy.implicitRules
Definition

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

ShortA set of rules under which this content was created
Comments

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

Control0..1
Typeuri
Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
Must Supportfalse
Summarytrue
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
4. ImagingStudy.contained
Definition

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

ShortContained, inline Resources
Comments

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

Control0..*
This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
TypeResource
Is Modifierfalse
Must Supportfalse
Summaryfalse
Alternate Namesinline resources, anonymous resources, contained resources
6. ImagingStudy.modifierExtension
Definition

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

ShortExtensions that cannot be ignored
Comments

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Control0..*
TypeExtension
Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
Must Supportfalse
Summarytrue
Requirements

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Alternate Namesextensions, user content
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
8. ImagingStudy.identifier
Definition

Identifiers for the ImagingStudy such as DICOM Study Instance UID.

ShortIdentifiers for the whole study
Comments

See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.


See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.

NoteThis is a business identifier, not a resource identifier (see discussion)
Control10..*
TypeIdentifier
Is Modifierfalse
Must Supportfalse
Summarytrue
Requirements

If one or more series elements are present in the ImagingStudy, then there shall be one DICOM Study UID identifier (see DICOM PS 3.3 C.7.2.

Alternate NamesStudyInstanceUID
Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
SlicingThis element introduces a set of slices on ImagingStudy.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ system
  • 10. ImagingStudy.identifier:studyInstanceUid
    Slice NamestudyInstanceUid
    Definition

    Identifiers for the ImagingStudy such as DICOM Study Instance UID.

    ShortIdentifiers for the whole study
    Comments

    See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.


    See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.

    NoteThis is a business identifier, not a resource identifier (see discussion)
    Control10..1*
    TypeIdentifier
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    If one or more series elements are present in the ImagingStudy, then there shall be one DICOM Study UID identifier (see DICOM PS 3.3 C.7.2.

    Alternate NamesStudyInstanceUID
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    12. ImagingStudy.identifier:studyInstanceUid.use
    Definition

    The purpose of this identifier.

    Shortusual | official | temp | secondary | old (If known)
    Comments

    Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

    Control0..1
    BindingThe codes SHALL be taken from IdentifierUsehttp://hl7.org/fhir/ValueSet/identifier-use|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/identifier-use|6.0.0-ballot2)

    Identifies the purpose for this identifier, if known .

    Typecode
    Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Requirements

    Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    14. ImagingStudy.identifier:studyInstanceUid.system
    Definition

    Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.

    ShortThe namespace for the identifier value
    Comments

    Identifier.system is always case sensitive.

    Control10..1
    Typeuri
    Is Modifierfalse
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Summaryfalse
    Requirements

    There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

    Pattern Valueurn:dicom:uid
    Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    16. ImagingStudy.status
    Definition

    The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy.

    Shortregistered | available | cancelled | entered-in-error | unknown
    Comments

    Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

    Control1..1
    BindingThe codes SHALL be taken from ImagingStudyStatushttp://hl7.org/fhir/ValueSet/imagingstudy-status|6.0.0-ballot2
    (required to http://hl7.org/fhir/ValueSet/imagingstudy-status|6.0.0-ballot2)

    The status of the ImagingStudy.

    Typecode
    Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
    Must Supportfalse
    Summarytrue
    Pattern Valueregistered
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    18. ImagingStudy.subject
    Definition

    The subject, typically a patient, of the imaging study.

    ShortWho or what is the subject of the study
    Comments

    QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group.

    Control1..1
    TypeReference(Patient - DICOM MWL Patient Mapping, Patient, Device, Group)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    20. ImagingStudy.encounter
    Definition

    The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made.

    ShortEncounter with which this imaging study is associated
    Comments

    This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission test).

    Control0..1
    TypeReference(Encounter - DICOM MWL Visit Mapping, Encounter)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    22. ImagingStudy.basedOn
    Definition

    A list of the diagnostic requests that resulted in this imaging study being performed.

    ShortRequest fulfilled
    Control10..*
    TypeReference(CarePlan, ServiceRequest, Appointment, AppointmentResponse, Task)
    Is Modifierfalse
    Must Supportfalse
    Summarytrue
    Requirements

    To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). If the ImagingStudy is associated with an Accession Number, this field should include a reference to that value in the form:

    • type = ServiceRequest
    • identifier.value = (Accession Number Value)
    • identifier.type = ACSN A reference value pointing to a ServiceRequest resource is allowed but is not required.
    Alternate NamesAccessionNumber
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    SlicingThis element introduces a set of slices on ImagingStudy.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
    • type @ reference
    • 24. ImagingStudy.basedOn:imagingServiceRequestRef
      Slice NameimagingServiceRequestRef
      Definition

      A list of the diagnostic requests that resulted in this imaging study being performed.

      ShortRequest fulfilled
      Control10..1*
      TypeReference(ServiceRequest - DICOM MWL Imaging Service Request Mapping, CarePlan, ServiceRequest, Appointment, AppointmentResponse, Task)
      Is Modifierfalse
      Must Supportfalse
      Summarytrue
      Requirements

      To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). If the ImagingStudy is associated with an Accession Number, this field should include a reference to that value in the form:

      • type = ServiceRequest
      • identifier.value = (Accession Number Value)
      • identifier.type = ACSN A reference value pointing to a ServiceRequest resource is allowed but is not required.
      Alternate NamesAccessionNumber
      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))

      Guidance on how to interpret the contents of this table can be found here

      0. ImagingStudy
      2. ImagingStudy.identifier
      NoteThis is a business identifier, not a resource identifier (see discussion)
      Control1..?
      SlicingThis element introduces a set of slices on ImagingStudy.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
      • value @ system
      • 4. ImagingStudy.identifier:studyInstanceUid
        Slice NamestudyInstanceUid
        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control1..1
        6. ImagingStudy.identifier:studyInstanceUid.system
        Control1..?
        Pattern Valueurn:dicom:uid
        8. ImagingStudy.status
        Pattern Valueregistered
        10. ImagingStudy.subject
        TypeReference(Patient - DICOM MWL Patient Mapping)
        12. ImagingStudy.encounter
        TypeReference(Encounter - DICOM MWL Visit Mapping)
        14. ImagingStudy.basedOn
        Control1..?
        SlicingThis element introduces a set of slices on ImagingStudy.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • type @ reference
        • 16. ImagingStudy.basedOn:imagingServiceRequestRef
          Slice NameimagingServiceRequestRef
          Control1..1
          TypeReference(ServiceRequest - DICOM MWL Imaging Service Request Mapping)

          Guidance on how to interpret the contents of this table can be found here

          0. ImagingStudy
          Definition

          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.

          ShortA set of images produced in single study (one or more series of references images)
          Control0..*
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Invariantsdom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources (contained.contained.empty())
          dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource (contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().ofType(canonical) | %resource.descendants().ofType(uri) | %resource.descendants().ofType(url))) or descendants().where(reference = '#').exists() or descendants().where(ofType(canonical) = '#').exists() or descendants().where(ofType(canonical) = '#').exists()).not()).trace('unmatched', id).empty())
          dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated (contained.meta.versionId.empty() and contained.meta.lastUpdated.empty())
          dom-5: If a resource is contained in another resource, it SHALL NOT have a security label (contained.meta.security.empty())
          dom-6: A resource should have narrative for robust management (text.`div`.exists())
          2. ImagingStudy.id
          Definition

          The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

          ShortLogical id of this artifact
          Comments

          Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

          Control0..1
          Typeid
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          4. ImagingStudy.meta
          Definition

          The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

          ShortMetadata about the resource
          Control0..1
          TypeMeta
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          6. ImagingStudy.implicitRules
          Definition

          A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

          ShortA set of rules under which this content was created
          Comments

          Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

          Control0..1
          Typeuri
          Is Modifiertrue because This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies its meaning or interpretation
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summarytrue
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          8. ImagingStudy.language
          Definition

          The base language in which the resource is written.

          ShortLanguage of the resource content
          Comments

          Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

          Control0..1
          BindingThe codes SHALL be taken from AllLanguages
          (required to http://hl7.org/fhir/ValueSet/all-languages|6.0.0-ballot2)

          IETF language tag for a human language

          Typecode
          Is Modifierfalse
          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
          Must Supportfalse
          Summaryfalse
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          10. ImagingStudy.text
          Definition

          A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

          ShortText summary of the resource, for human interpretation
          Comments

          Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

          Control0..1
          This element is affected by the following invariants: dom-6
          TypeNarrative
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Alternate Namesnarrative, html, xhtml, display
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          12. ImagingStudy.contained
          Definition

          These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

          ShortContained, inline Resources
          Comments

          This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

          Control0..*
          This element is affected by the following invariants: dom-2, dom-4, dom-3, dom-5
          TypeResource
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Alternate Namesinline resources, anonymous resources, contained resources
          14. ImagingStudy.extension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

          ShortAdditional content defined by implementations
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifierfalse
          Must Supportfalse
          Summaryfalse
          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          16. ImagingStudy.modifierExtension
          Definition

          May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

          Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

          ShortExtensions that cannot be ignored
          Comments

          There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

          Control0..*
          TypeExtension
          Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
          Must Supportfalse
          Summarytrue
          Requirements

          Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

          Alternate Namesextensions, user content
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          18. ImagingStudy.identifier
          Definition

          Identifiers for the ImagingStudy such as DICOM Study Instance UID.

          ShortIdentifiers for the whole study
          Comments

          See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.

          NoteThis is a business identifier, not a resource identifier (see discussion)
          Control1..*
          TypeIdentifier
          Is Modifierfalse
          Must Supportfalse
          Summarytrue
          Requirements

          If one or more series elements are present in the ImagingStudy, then there shall be one DICOM Study UID identifier (see DICOM PS 3.3 C.7.2.

          Alternate NamesStudyInstanceUID
          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
          SlicingThis element introduces a set of slices on ImagingStudy.identifier. The slices areUnordered and Open, and can be differentiated using the following discriminators:
          • value @ system
          • 20. ImagingStudy.identifier:studyInstanceUid
            Slice NamestudyInstanceUid
            Definition

            Identifiers for the ImagingStudy such as DICOM Study Instance UID.

            ShortIdentifiers for the whole study
            Comments

            See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.

            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control1..1
            TypeIdentifier
            Is Modifierfalse
            Must Supportfalse
            Summarytrue
            Requirements

            If one or more series elements are present in the ImagingStudy, then there shall be one DICOM Study UID identifier (see DICOM PS 3.3 C.7.2.

            Alternate NamesStudyInstanceUID
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            22. ImagingStudy.identifier:studyInstanceUid.id
            Definition

            Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

            ShortUnique id for inter-element referencing
            Control0..1
            This element is affected by the following invariants: ele-1
            Typeid
            Is Modifierfalse
            XML FormatIn the XML format, this property is represented as an attribute.
            Summaryfalse
            24. ImagingStudy.identifier:studyInstanceUid.extension
            Definition

            May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

            ShortAdditional content defined by implementations
            Comments

            There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

            Control0..*
            TypeExtension
            Is Modifierfalse
            Summaryfalse
            Alternate Namesextensions, user content
            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
            SlicingThis element introduces a set of slices on ImagingStudy.identifier.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • value @ url
            • 26. ImagingStudy.identifier:studyInstanceUid.use
              Definition

              The purpose of this identifier.

              Shortusual | official | temp | secondary | old (If known)
              Comments

              Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

              Control0..1
              BindingThe codes SHALL be taken from IdentifierUse
              (required to http://hl7.org/fhir/ValueSet/identifier-use|6.0.0-ballot2)

              Identifies the purpose for this identifier, if known .

              Typecode
              Is Modifiertrue because This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              28. ImagingStudy.identifier:studyInstanceUid.type
              Definition

              A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

              ShortDescription of identifier
              Comments

              This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

              Control0..1
              BindingUnless not suitable, these codes SHALL be taken from IdentifierTypeCodes
              (extensible to http://hl7.org/fhir/ValueSet/identifier-type)

              A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

              TypeCodeableConcept
              Is Modifierfalse
              Summaryfalse
              Requirements

              Allows users to make use of identifiers when the identifier system is not known.

              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              30. ImagingStudy.identifier:studyInstanceUid.system
              Definition

              Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.

              ShortThe namespace for the identifier value
              Comments

              Identifier.system is always case sensitive.

              Control1..1
              Typeuri
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Requirements

              There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

              Pattern Valueurn:dicom:uid
              Example<br/><b>General</b>:http://www.acme.com/identifiers/patient
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              32. ImagingStudy.identifier:studyInstanceUid.value
              Definition

              The portion of the identifier typically relevant to the user and which is unique within the context of the system.

              ShortThe value that is unique
              Comments

              If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

              Control0..1
              This element is affected by the following invariants: ident-1
              Typestring
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Summaryfalse
              Example<br/><b>General</b>:123456
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              34. ImagingStudy.identifier:studyInstanceUid.period
              Definition

              Time period during which identifier is/was valid for use.

              ShortTime period when id is/was valid for use
              Control0..1
              TypePeriod
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              36. ImagingStudy.identifier:studyInstanceUid.assigner
              Definition

              Organization that issued/manages the identifier.

              ShortOrganization that issued id (may be just text)
              Comments

              The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

              Control0..1
              TypeReference(Organization)
              Is Modifierfalse
              Summaryfalse
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              38. ImagingStudy.status
              Definition

              The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy.

              Shortregistered | available | cancelled | entered-in-error | unknown
              Comments

              Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

              Control1..1
              BindingThe codes SHALL be taken from ImagingStudyStatus
              (required to http://hl7.org/fhir/ValueSet/imagingstudy-status|6.0.0-ballot2)

              The status of the ImagingStudy.

              Typecode
              Is Modifiertrue because This element is labeled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Pattern Valueregistered
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              40. ImagingStudy.modality
              Definition

              A list of all the distinct values of series.modality. This may include both acquisition and non-acquisition modalities.

              ShortAll of the distinct values for series' modalities
              Control0..*
              BindingUnless not suitable, these codes SHALL be taken from Modality
              (extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

              Type of acquired data in the instance.

              TypeCodeableConcept
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Alternate NamesModalitiesInStudy
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              42. ImagingStudy.subject
              Definition

              The subject, typically a patient, of the imaging study.

              ShortWho or what is the subject of the study
              Comments

              QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group.

              Control1..1
              TypeReference(Patient - DICOM MWL Patient Mapping)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              44. ImagingStudy.encounter
              Definition

              The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made.

              ShortEncounter with which this imaging study is associated
              Comments

              This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission test).

              Control0..1
              TypeReference(Encounter - DICOM MWL Visit Mapping)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              46. ImagingStudy.started
              Definition

              Date and time the study started.

              ShortWhen the study was started
              Control0..1
              TypedateTime
              Is Modifierfalse
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Must Supportfalse
              Summarytrue
              Alternate NamesStudyDate, StudyTime
              Example<br/><b>General</b>:2011-01-01T11:01:20+03:00
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              48. ImagingStudy.basedOn
              Definition

              A list of the diagnostic requests that resulted in this imaging study being performed.

              ShortRequest fulfilled
              Control1..*
              TypeReference(CarePlan, ServiceRequest, Appointment, AppointmentResponse, Task)
              Is Modifierfalse
              Must Supportfalse
              Summarytrue
              Requirements

              To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). If the ImagingStudy is associated with an Accession Number, this field should include a reference to that value in the form:

              • type = ServiceRequest
              • identifier.value = (Accession Number Value)
              • identifier.type = ACSN A reference value pointing to a ServiceRequest resource is allowed but is not required.
              Alternate NamesAccessionNumber
              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
              SlicingThis element introduces a set of slices on ImagingStudy.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • type @ reference
              • 50. ImagingStudy.basedOn:imagingServiceRequestRef
                Slice NameimagingServiceRequestRef
                Definition

                A list of the diagnostic requests that resulted in this imaging study being performed.

                ShortRequest fulfilled
                Control1..1
                TypeReference(ServiceRequest - DICOM MWL Imaging Service Request Mapping)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). If the ImagingStudy is associated with an Accession Number, this field should include a reference to that value in the form:

                • type = ServiceRequest
                • identifier.value = (Accession Number Value)
                • identifier.type = ACSN A reference value pointing to a ServiceRequest resource is allowed but is not required.
                Alternate NamesAccessionNumber
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                52. ImagingStudy.partOf
                Definition

                A larger event of which this particular ImagingStudy is a component or step. For example, an ImagingStudy as part of a procedure.

                ShortPart of referenced event
                Comments

                To link an ImagingStudy to an Encounter use encounter.

                Control0..*
                TypeReference(Procedure)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                54. ImagingStudy.referrer
                Definition

                The requesting/referring physician.

                ShortReferring physician
                Control0..1
                TypeReference(Practitioner, PractitionerRole)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Alternate NamesReferringPhysiciansName
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                56. ImagingStudy.endpoint
                Definition

                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.connectionType.

                ShortStudy access endpoint
                Comments

                Typical endpoint types include DICOM WADO-RS, which is used to retrieve DICOM instances in native or rendered (e.g., JPG, PNG), formats using a RESTful API; DICOM WADO-URI, which can similarly retrieve native or rendered instances, except using an HTTP query-based approach; DICOM QIDO-RS, which allows RESTful query for DICOM information without retrieving the actual instances; or IHE Invoke Image Display (IID), which provides standard invocation of an imaging web viewer. See Imaging Study Implementation Notes on Endpoints.

                Control0..*
                TypeReference(Endpoint)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                Access methods for viewing (e.g., IHE's IID profile) or retrieving (e.g., DICOM's WADO-URI and WADO-RS) the study or the study's series or instances. The study-level baseLocation applies to each series in the study, unless overridden in series by a series-level baseLocation of the same type.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                58. ImagingStudy.numberOfSeries
                Definition

                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 present.

                ShortNumber of Study Related Series
                Control0..1
                TypeunsignedInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesNumberOfStudyRelatedSeries
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                60. ImagingStudy.numberOfInstances
                Definition

                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 present.

                ShortNumber of Study Related Instances
                Control0..1
                TypeunsignedInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesNumberOfStudyRelatedInstances
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                62. ImagingStudy.procedure
                Definition

                This field corresponds to the DICOM Procedure Code Sequence (0008,1032). This is different from the FHIR Procedure resource that may include the ImagingStudy.

                ShortThe performed procedure or code
                Control0..*
                BindingThe codes SHOULD be taken from LOINC loinc-rsna-radiology-playbook
                (preferred to http://loinc.org/vs/loinc-rsna-radiology-playbook)

                Use of RadLex is preferred

                TypeCodeableReference(PlanDefinition, ActivityDefinition)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                64. ImagingStudy.location
                Definition

                The principal physical location where the ImagingStudy was performed.

                ShortWhere ImagingStudy occurred
                Control0..1
                TypeReference(Location)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                Ties the event to where the records are likely kept and provides context around the event occurrence (e.g. if it occurred inside or outside a dedicated healthcare setting).

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                66. ImagingStudy.reason
                Definition

                Description of clinical condition indicating why the ImagingStudy was requested, and/or Indicates another resource whose existence justifies this Study.

                ShortWhy the study was requested / performed
                Control0..*
                BindingFor example codes, see ProcedureReasonCodes
                (example to http://hl7.org/fhir/ValueSet/procedure-reason)

                The reason for the study.

                TypeCodeableReference(Condition, Observation, DiagnosticReport, DocumentReference)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                68. ImagingStudy.note
                Definition

                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 element.

                ShortUser-defined comments
                Control0..*
                TypeAnnotation
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                70. ImagingStudy.description
                Definition

                The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed.

                ShortInstitution-generated description
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesStudyDescription
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                72. ImagingStudy.series
                Definition

                Each study has one or more series of images or other content.

                ShortEach study has one or more series of instances
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                74. ImagingStudy.series.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                76. ImagingStudy.series.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                78. ImagingStudy.series.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                80. ImagingStudy.series.uid
                Definition

                The DICOM Series Instance UID for the series.

                ShortDICOM Series Instance UID for the series
                Comments

                See DICOM PS3.3 C.7.3.

                Control1..1
                Typeid
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Requirements

                DICOM Series Instance UID.

                Alternate NamesSeriesInstanceUID
                Example<br/><b>General</b>:2.16.124.113543.6003.2588828330.45298.17418.2723805630
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                82. ImagingStudy.series.number
                Definition

                The numeric identifier of this series in the study.

                ShortNumeric identifier of this series
                Control0..1
                TypeunsignedInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesSeriesNumber
                Example<br/><b>General</b>:3
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                84. ImagingStudy.series.modality
                Definition

                The distinct modality for this series. This may include both acquisition and non-acquisition modalities.

                ShortThe modality used for this series
                Control1..1
                BindingUnless not suitable, these codes SHALL be taken from Modality
                (extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

                Type of acquired data in the instance.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Alternate NamesModality
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                86. ImagingStudy.series.description
                Definition

                A description of the series.

                ShortA short human readable summary of the series
                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesSeriesDescription
                Example<br/><b>General</b>:CT Surview 180
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                88. ImagingStudy.series.numberOfInstances
                Definition

                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 present.

                ShortNumber of Series Related Instances
                Control0..1
                TypeunsignedInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Alternate NamesNumberOfSeriesRelatedInstances
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                90. ImagingStudy.series.endpoint
                Definition

                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.connectionType.

                ShortSeries access endpoint
                Comments

                Typical endpoint types include DICOM WADO-RS, which is used to retrieve DICOM instances in native or rendered (e.g., JPG, PNG) formats using a RESTful API; DICOM WADO-URI, which can similarly retrieve native or rendered instances, except using an HTTP query-based approach; and DICOM QIDO-RS, which allows RESTful query for DICOM information without retrieving the actual instances. See Imaging Study Implementation Notes on Endpoints.

                Control0..*
                TypeReference(Endpoint)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                Access methods for retrieving (e.g., DICOM's WADO-URI and WADO-RS) the series or the series' instances. A baseLocation specified at the series level has precedence over a baseLocation of the same type specified at the study level.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                92. ImagingStudy.series.bodySite
                Definition

                The anatomic structures examined. See DICOM Part 16 Annex L 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.laterality.

                ShortBody part examined
                Control0..1
                BindingFor example codes, see SNOMEDCTBodyStructures
                (example to http://hl7.org/fhir/ValueSet/body-site)

                SNOMED CT Body site concepts

                TypeCodeableReference(BodyStructure)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Alternate NamesBodyPartExamined
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                94. ImagingStudy.series.laterality
                Definition

                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.bodySite.

                ShortBody part laterality
                Control0..1
                BindingFor example codes, see Laterality
                (example to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_244.html)

                Codes describing body site laterality (left, right, etc.).

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                96. ImagingStudy.series.specimen
                Definition

                The specimen imaged, e.g., for whole slide imaging of a biopsy.

                ShortSpecimen imaged
                Control0..*
                TypeReference(Specimen)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                98. ImagingStudy.series.started
                Definition

                The date and time the series was started.

                ShortWhen the series started
                Control0..1
                TypedateTime
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                100. ImagingStudy.series.performer
                Definition

                Indicates who or what performed the series and how they were involved.

                ShortWho performed the series
                Comments

                If the person who performed the series is not known, their Organization may be recorded. A patient, or related person, may be the performer, e.g. for patient-captured images.

                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                The performer is recorded at the series level, since each series in a study may be performed by a different performer, at different times, and using different devices. A series may be performed by multiple performers.

                Alternate NamesPerformingPhysicianName, OperatorName
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                102. ImagingStudy.series.performer.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                104. ImagingStudy.series.performer.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                106. ImagingStudy.series.performer.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                108. ImagingStudy.series.performer.function
                Definition

                Distinguishes the type of involvement of the performer in the series.

                ShortType of performance
                Control0..1
                BindingUnless not suitable, these codes SHALL be taken from ImagingStudySeriesPerformerFunction
                (extensible to http://hl7.org/fhir/ValueSet/series-performer-function)

                The type of involvement of the performer.

                TypeCodeableConcept
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Requirements

                Allows disambiguation of the types of involvement of different performers.

                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                110. ImagingStudy.series.performer.actor
                Definition

                Indicates who or what performed the series.

                ShortWho performed the series
                Control1..1
                TypeReference(Practitioner, PractitionerRole, Organization, CareTeam, Patient, Device, RelatedPerson, HealthcareService)
                Is Modifierfalse
                Must Supportfalse
                Summarytrue
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                112. ImagingStudy.series.instance
                Definition

                A single SOP instance within the series, e.g. an image, or presentation state.

                ShortA single SOP instance from the series
                Control0..*
                TypeBackboneElement
                Is Modifierfalse
                Must Supportfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                114. ImagingStudy.series.instance.id
                Definition

                Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

                ShortUnique id for inter-element referencing
                Control0..1
                This element is affected by the following invariants: ele-1
                Typestring
                Is Modifierfalse
                XML FormatIn the XML format, this property is represented as an attribute.
                Summaryfalse
                116. ImagingStudy.series.instance.extension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

                ShortAdditional content defined by implementations
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifierfalse
                Summaryfalse
                Alternate Namesextensions, user content
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                118. ImagingStudy.series.instance.modifierExtension
                Definition

                May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

                Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

                ShortExtensions that cannot be ignored even if unrecognized
                Comments

                There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

                Control0..*
                TypeExtension
                Is Modifiertrue because Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
                Summarytrue
                Requirements

                Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

                Alternate Namesextensions, user content, modifiers
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                120. ImagingStudy.series.instance.uid
                Definition

                The DICOM SOP Instance UID for this image or other DICOM content.

                ShortDICOM SOP Instance UID
                Comments

                See DICOM PS3.3 C.12.1.

                Control1..1
                Typeid
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Requirements

                DICOM SOP Instance UID.

                Alternate NamesSOPInstanceUID
                Example<br/><b>General</b>:2.16.124.113543.6003.189642796.63084.16748.2599092903
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                122. ImagingStudy.series.instance.sopClass
                Definition

                DICOM instance type.

                ShortDICOM class type
                Control1..1
                Typeoid
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Alternate NamesSOPClassUID
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                124. ImagingStudy.series.instance.number
                Definition

                The number of instance in the series.

                ShortThe number of this instance in the series
                Control0..1
                TypeunsignedInt
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Alternate NamesInstanceNumber
                Example<br/><b>General</b>:1
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                126. ImagingStudy.series.instance.title
                Definition

                The description of the instance.

                ShortDescription of instance
                Comments

                Particularly for post-acquisition analytic objects, such as SR, presentation states, value mapping, etc.

                Control0..1
                Typestring
                Is Modifierfalse
                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                Must Supportfalse
                Summaryfalse
                Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))