A selection of DICOM SOP instances and/or frames within a single Study and Series. This might include additional specifics such as an image region, an Observation UID or a Segmentation Number, allowing linkage to an Observation Resource or transferring this information along with the ImagingStudy Resource.

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.

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.

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.

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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

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).

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.

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.

The current state of the imaging selection. This is distinct from the status of any imaging study, service request, or task associated with the imaging selection.

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

The status of the ImagingSelection.

Identifies the type of imaging selection.

For example codes, see KeyObjectSelectionDocumentTitle http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_7010.html
(example to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_7010.html)

Key Object Selection Document Title.

Identifies the type of content and the structure of the imaging selection.

The patient, or group of patients, location, device, organization, procedure or practitioner this imaging selection is about and into whose or what record the imaging selection is placed.

The imaging study from which the imaging selection is made.

The Series Instance UID for the DICOM Series from which the images were selected.

See DICOM PS3.3 C.7.3.

Must correspond to a Series that is part of the DICOM study identified by the studyUid element.

Each imaging selection includes one or more selected DICOM SOP instances.

If this element is not present and ImagingSelection.seriesUid is present, all instances in the specified series are included in the selection.

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).

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.

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.

The SOP Instance UID for the selected DICOM instance.

See DICOM PS3.3 C.12.1.

DICOM SOP Instance UID. Must correspond to a SOP Instance that is part of the DICOM series identified by the seriesUID element.

Each imaging selection might includes a 3D image region, specified by a region type and a set of 3D coordinates.

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).

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.

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.

Specifies the type of image region.

See DICOM PS3.3 C.18.9.1.2.

The type of image region.

The coordinates describing the image region. Encoded as an ordered set of (x,y,z) triplets (in mm and MAY be negative) that define a region of interest in the patient-relative Reference Coordinate System defined by ImagingSelection.frameOfReferenceUid element.

For a description of how 3D coordinates are encoded, see DICOM PS3.3 C.18.9.

The number of values SHALL be a multiple of three.

A selection of DICOM SOP instances and/or frames within a single Study and Series. This might include additional specifics such as an image region, an Observation UID or a Segmentation Number, allowing linkage to an Observation Resource or transferring this information along with the ImagingStudy Resource.

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

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.

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.

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.

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.

The base language in which the resource is written.

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).

IETF language tag for a human language

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.

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.

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.

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. Contained resources may be a resource type defined in the FHIR specification, or an additional resource.

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.

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.

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).

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.

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.

Unique identifiers assigned to this imaging selection.

This is a business identifiers, not a resource identifier -- see discussion under Business Identifiers.

Allows imaging selections to be distinguished and referenced.

The current state of the imaging selection. This is distinct from the status of any imaging study, service request, or task associated with the imaging selection.

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

The status of the ImagingSelection.

Classifies the general purpose of the imaging selection.

The codes SHOULD be taken from KeyObjectSelectionDocumentTitle
(preferred to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_7010.html)

Key Object Selection Document Title.

Used for filtering what imaging selections are retrieved and displayed.

Identifies the type of imaging selection.

For example codes, see KeyObjectSelectionDocumentTitle
(example to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_7010.html)

Key Object Selection Document Title.

Identifies the type of content and the structure of the imaging selection.

The patient, or group of patients, location, device, organization, procedure or practitioner this imaging selection is about and into whose or what record the imaging selection is placed.

The date and time this imaging selection was created.

Selectors of the instances – human or machine.

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

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.

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.

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).

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.

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.

Distinguishes the type of involvement of the performer.

The type of involvement of the performer.

Allows disambiguation of the types and involvement of different performers.

Author - human or machine.

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

The imaging study from which the imaging selection is made.

The Study Instance UID for the DICOM Study from which the images were selected.

See DICOM PS3.3 C.7.2.

The Series Instance UID for the DICOM Series from which the images were selected.

See DICOM PS3.3 C.7.3.

Must correspond to a Series that is part of the DICOM study identified by the studyUid element.

The Series Number for the DICOM Series from which the images were selected.

See DICOM PS3.3 C.7.3.

DICOM Series Number. Must correspond to the series identified by the seriesUid element.

Uniquely identifies groups of composite instances that have the same coordinate system that conveys spatial and/or temporal information.

See DICOM PS3.3 C.7.4.1.

The anatomic structures examined. See DICOM Part 16 Annex L for DICOM to SNOMED-CT mappings.

SNOMED CT Body site concepts

The actual focus of an imaging selection when it is another imaging selection resource and not the patient of record.

An imaging selection MAY reference a DICOM resource that itself references other DICOM resources. e.g. a presentation state references a set of source images or frames.

The network services providing retrieval access to the selected images, frames, etc. See implementation notes for information about using DICOM endpoints.

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.

Access methods for retrieving (e.g., DICOM's WADO-URI and WADO-RS) the selected images, frames, etc.

Each imaging selection includes one or more selected DICOM SOP instances.

If this element is not present and ImagingSelection.seriesUid is present, all instances in the specified series are included in the selection.

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

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.

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.

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).

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.

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.

The SOP Instance UID for the selected DICOM instance.

See DICOM PS3.3 C.12.1.

DICOM SOP Instance UID. Must correspond to a SOP Instance that is part of the DICOM series identified by the seriesUID element.

The Instance Number for the selected DICOM instance.

See DICOM PS3.3 C.7.6.1. Note: A multiframe instance has a single instance number with each frame identified by a frame number.

DICOM Instance Number. Must correspond to the SOP Instance identified by the uid element.

The SOP Class UID for the selected DICOM instance.

See DICOM PS3.3 C.12.1.

DICOM SOP Class UID.

Selected subset of the SOP Instance. The type of the subset item is determined by the instance.sopClass value. May be one of:

• A list of frame numbers selected from a multiframe SOP Instance (See DICOM PS 3.3 Table 10.3).
• A list of Referenced Content Item Identifier values selected from a DICOM SR or other structured document SOP Instance (See DICOM PS 3.3 C.17.3.2.5).
• A list of segment numbers selected from a segmentation SOP Instance (See DICOM PS 3.3 Table C.8.20-4).
• A list of Region of Interest (ROI) numbers selected from a radiotherapy structure set SOP Instance (See DICOM PS 3.3 C.8.8.5).

Each imaging selection instance or frame list might includes an image region, specified by a region type and a set of 2D coordinates.

Shall not be present if the parent imagingSelection.instance is not an image. If the parent imagingSelection.instance contains a subset element of type frame, the image region applies to all frames in the subset list.

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

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.

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.

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).

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.

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.

Specifies the type of image region.

See DICOM PS3.3 C.10.5.1.2.

The type of image region.

The coordinates describing the image region. Encoded as a set of (column, row) pairs that denote positions in the selected image / frames specified with sub-pixel resolution. The origin at the TLHC of the TLHC pixel is 0.0\0.0, the BRHC of the TLHC pixel is 1.0\1.0, and the BRHC of the BRHC pixel is the number of columns\rows in the image / frames. The values SHALL be within the range 0\0 to the number of columns\rows in the image / frames.

For a description of how 2D coordinates are encoded, see DICOM PS 3.3 C.18.6.

The number of values SHALL be a multiple of two.

Each imaging selection might includes a 3D image region, specified by a region type and a set of 3D coordinates.

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

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.

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.

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).

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.

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.

Specifies the type of image region.

See DICOM PS3.3 C.18.9.1.2.

The type of image region.

The coordinates describing the image region. Encoded as an ordered set of (x,y,z) triplets (in mm and MAY be negative) that define a region of interest in the patient-relative Reference Coordinate System defined by ImagingSelection.frameOfReferenceUid element.

For a description of how 3D coordinates are encoded, see DICOM PS3.3 C.18.9.

The number of values SHALL be a multiple of three.