Generated Narrative: StructureDefinition ImagingStudy-twpas Name Flags Card. Type Description & Constraints ImagingStudy TWCoreImagingStudy #xD; meta 1..1 Meta 此ImagingStudy Resource的metadata #xD; profile 1..1 canonical(StructureDefinition) Profiles this resource claims to conform to Required Pattern: https://nhicore.nhi.gov.tw/pas/StructureDefinition/ImagingStudy-twpas #xD; Slices for identifier 1..* Identifier 整項影像檢查的識別碼 Slice: Unordered, Closed by value:system #xD; identifier:study-uid S 1..1 Identifier 整項影像檢查的識別碼。上傳至健保署時，必要填寫 DICOM 檢查實例 UID (Study Instance UID) #xD; system S 1..1 uri The namespace for the identifier value Required Pattern: urn:dicom:uid #xD; value SC 1..1 string The value that is unique Constraints: StudyUID Example General: urn:oid:2.16.886.2102.54.4546465747.465465465 Example General: urn:oid:2.16.886.2102.54.4546465747.0.46546546 #xD; modality 0..* Coding 列出所有系列中用於實際影像獲取的儀器類型 Binding: HL7-AcquisitionModality值集 (extensible) #xD; subject 1..1 Reference(病人資訊-Patient TWPAS) 誰或什麼是影像檢查的對象 #xD; series 1..* BackboneElement 每項影像檢查有一個或多個系列(series)的實例 #xD; modality 1..1 Coding 此系列實例所使用的成像儀器 Binding: HL7-AcquisitionModality值集 (extensible) #xD; bodySite S 0..1 Coding 影像檢查的身體部位 Binding: SNOMEDCT-健保事前審查-身體部位值集 (required) #xD; instance #xD; uid 1..1 id DICOM影像。1.填寫DICOM欄位至ImagingStudy: Study Instance UID, Series Instance UID, SOP Instance, Modality, SOP Class UID。2.其餘資訊需額外填寫，包含: Status，影像檢查的身體部位 (SNOMED CT)、Procedure Code等。3.上傳影像需打包成DICOMDIR且壓縮成DCF。 #xD; Documentation for this format
此DICOM影像-ImagingStudy TWPAS Profile說明本IG如何進一步定義臺灣核心-影像檢查(TW Core ImagingStudy) Profile以呈現事前審查中疾病資訊之影像報告的影像檢查的身體部位及DICOM影像
在單一檢查中產生的一組影像【一個或多個系列(series)的參照影像】
DICOM影像檢查中產生的內容。每項檢查包含若干系列(series)，每一系列只使用一種影像儀器（例如X光、電腦斷層掃描CT、核磁共振MR、超音波等），每個系列由在相同背景下獲得或製作的服務-物件對實例（Service-Object Pair Instances，簡稱SOP實例，包含影像或其他類型的資料）所組成。但一項檢查中可能包括多個使用不同影像儀器的系列。
If the resource is contained in another resource, it SHALL NOT contain nested Resources
not(parent::f:contained and f:contained)
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().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))
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()
not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))
If a resource is contained in another resource, it SHALL NOT have a security label
When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time.
A resource should have narrative for robust management
Act[classCode=COMPOSITION, moodCode=EVN]
Reference IHE radiology TF vol 2 table 4.14-1
不重複的ID用以識別儲存在特定FHIR Server中的ImagingStudy紀錄，通常又稱為邏輯性ID。
一個resource使用新增操作（create operation）提交給伺服器時，此resource沒有id，它的id在resource被創建後由伺器分配/指定。
關於resource的metadata。這是由基礎建設維護的內容。內容的更改可能並不總是與resource的版本更改相關聯。
All FHIR elements must have a @value or children
hasValue() or (children().count() > id.count())
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Extensions are always sliced by (at least) url
Additional content defined by implementations
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 manageable, 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.
Must have either extensions or value[x], not both
exists(f:extension)!=exists(f:*[starts-with(local-name(.), "value")])
The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.
The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.
When the resource last changed - e.g. when the version changed.
This value is always populated except when the resource is first being created. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a [read](http://hl7.org/fhir/R4/http.html#read) interaction.
Identifies where the resource comes from
A uri that identifies the source system of the resource. This provides a minimal amount of [Provenance](http://hl7.org/fhir/R4/provenance.html#) information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.
In the provenance resource, this corresponds to Provenance.entity.what[x]. The exact use of the source (and the implied Provenance.entity.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.
Profiles this resource claims to conform to
A list of profiles (references to [StructureDefinition](http://hl7.org/fhir/R4/structuredefinition.html#) resources) that this resource claims to conform to. The URL is a reference to [StructureDefinition.url](http://hl7.org/fhir/R4/structuredefinition-definitions.html#StructureDefinition.url).
It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.
Security Labels applied to this resource
Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.
The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.
Security Labels from the Healthcare Privacy and Security Classification System.
Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.
The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.
Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".
構建resource時遵循的一系列規則的參照，在處理內容時必須理解這些規則。通常這是對IG所定義之特殊規則及其他profiles的參照。
宣告這套規則限制了內容只能被有限的交易夥伴所理解。這從本質上限制了資料的長期有用性。然而，現有的健康生態體系高度分裂，還沒有準備好以普遍可計算的方式定義、收集和交換資料。只要有可能，實作者和/或規範編寫者應該避免使用這個資料項目。通常在使用時，此URL是對IG的參照，此IG將這些特殊規則與其他profiles、value sets等一起定義為其敘述的一部分。
This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation
提供語言是為了支援索引和可存取性（通常，文字表述轉語音等服務使用此語言標籤）。html lanuage tag適用於此敘述。resource上的語言標籤可用於指定從resource中的資料所產成的其他表述之語言。不是所有的內容都必須使用此語言。不應該假定Resource.language自動適用於敘述。如果指定語言，它也應該被指定在html中的div資料項目（關於xml:lang和html lang屬性之間的關係，見HTML5中的規則）。
人類語言；鼓勵使用CommonLanguages代碼表中的代碼，但不強制一定要使用此代碼表，你也可使用其他代碼表的代碼或單純以文字表示。
人可讀的敘述，包含resource的摘要，可用於向人表述resource的內容。敘述不需要對所有的結構化資料進行編碼，但需要包含足夠的細節使人在閱讀敘述時理解「臨床安全性」。resource定義有哪些內容應該在敘述中表示，以確保臨床安全。
內嵌（contained）的resource沒有敘述，非內嵌（contained）的resource則 **建議應該（SHOULD）** 有敘述。有時resource可能只有文字表述，很少或沒有額外的結構化資料（只要滿足所有minOccurs=1的資料項目）。這可能出現在舊系統的資料，當資訊以 「文字表述區塊（text blob） 」的形式被取得，或者文字表述是原始輸入或說明，而編碼資訊稍後再添加。
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
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.
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 manageable, 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.
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 manageable, 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).
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](http://hl7.org/fhir/R4/extensibility.html#modifierExtension).
Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them
ImagingStudy的識別碼，如DICOM檢查實例UID (Study Instance UID)和檢查單號(Accession Number)。
有關DICOM檢查實例UID的編碼，請參閱「影像檢查實作說明(Imaging Study Implementation Notes)」下的討論。檢查單號(Accession Number)應使用ACSN識別碼類型 (Identifier type)。
如果此 ImagingStudy 中存在一個或多個 series 資料項目，那麼就應該有一個DICOM Study UID識別碼（見[DICOM PS 3.3 C.7.2 .](https://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html)
.id and .inboundRelationship[typeCode=COMP].source[classCode=ACSN, moodCode=EVN].id
StudyInstanceUID (0020,000D) | Accession Number and Issuer (0080,0050)+(0080,0051) | Study ID (0020,0010)
整項影像檢查的識別碼。上傳至健保署時，必要填寫 DICOM 檢查實例 UID (Study Instance UID)
usual | official | temp | secondary | old (If known)
Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.
Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.
This is labeled as "Is Modifier" because applications should not mistake a temporary id for a permanent one.
Identifies the purpose for this identifier, if known .
A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.
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.
Allows users to make use of identifiers when the identifier system is not known.
A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.
Establishes the namespace for the value - that is, a URL that describes a set values that are unique.
Identifier.system is always case sensitive.
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.
The portion of the identifier typically relevant to the user and which is unique within the context of the system.
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 [Rendered Value extension](http://hl7.org/fhir/R4/extension-rendered-value.html). 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.
以`urn:oid:`開頭，後接一串由數字`0`-`9`及`.`組成的字串。第一個數字須為個位數，每個數字不得為`0`開頭（除非為單一的`0`），整體(不含`urn:oid:`)長度不得超過64 bytes。
II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root)
Time period when id is/was valid for use
Time period during which identifier is/was valid for use.
Role.effectiveTime or implied by context
Organization that issued id (may be just text)
Organization that issued/manages the identifier.
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.
II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper
registered | available | cancelled | entered-in-error | unknown
「未知」並不意味著「其他」類型；必須符合已確定的某種狀態。當創建系統不確定當前狀態時，會使用「未知」這一選項。
This element is labelled 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
影像檢查的當前狀態；應填入所綁定值集中的其中一個代碼。
列出所有系列中用於實際影像獲取的儀器類型
列出所有系列中用於實際影像獲取的儀器類型，即在DICOM Context Group 29（值集的唯一識別碼為1.2.840.10008.6.1.19）中定義的類型。
影像檢查的對象，若為品質保證的標準對照物（QA幻影）可用 Device 作記錄。若其檢查對象是多隻小動物（如多隻老鼠），則可以將它們作為 Group 來進行記錄。
進行此影像檢查的健康照護事件（例如：病人與健康照護服務提供者的互動）。
病人接受影像檢查時所在的就醫情境。不過，有些相關事件可能在病人就醫前或完成就醫後發生，但這些事件仍與就醫情境有關（例如：病人入院前的檢查）。
inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
導致進行此影像檢查的診斷報告清單
支援分組處置（一項影像檢查支援多個醫令處置，如胸腔/腹部/骨盆CT）。
.outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO]
.outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO].participation[typeCode=AUT].role
誰閱讀了檢查報告並解讀了影像或其他內容
提供影像檢查資料存取的網路服務，包括查詢、觀看或下載影像檢查資料。更多有關如何使用DICOM端點的詳細資訊，請查看實作指引。整體檢查的網絡連接設定（端點）適用於檢查中的每一個影像系列。但如果某個影像系列有自己特定的網路連接設定(稱為系統端點)，且這個設定的類型（Endpoint.connectionType）與整體檢查的端點相同，則該系列將依據其自身的設定進行連接。
常見的端點類型包括：DICOM WADO-RS，它透過RESTful API以原始或轉換後的格式（如JPG、PNG）來查DICOM影像檔案；DICOM WADO-URI，這也能查詢原始或轉換後的影像，但它是透過HTTP查詢方式實現；DICOM QIDO-RS，它允許使用RESTful查詢方式來獲取DICOM資訊，而無需下載影像檔案本身；還有IHE Invoke Image Display（IID），這是一種標準的網路影像查看器(viewer)啟動方式。
說明了如何查看（例如：使用IHE的IID profile）或查詢（例如：使用DICOM的WADO-URI和WADO-RS）影像檢查、其影像系列或單個影像的方法。整體檢查的基礎位置設定（baseLocation）通常適用於檢查中的所有影像系列。但如果某個影像系列有自己的基礎位置設定（稱為系列級baseLocation），且這個設定與整體檢查的設定類型相同，則該系列將按照自己的設定進行操作。
在醫學影像檢查中，顯示的series數量有時會比Resource實際包含的更多。這可能是由於Resource的限制、安全問題或其他因素所致。如果Resource中包含至少一個series的資料項目，那麼這個series數量就應當被明確標出。
.outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=OBSSER, moodCode=EVN].repeatNumber
在醫學影像檢查中，顯示的SOP instances數量有時會比Resource實際包含的更多。這可能是由於instance的限制、安全問題或其他因素所致。如果Resource中包含至少一個instance的資料項目，那麼這個資料項目就應該被包含在內。
.outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber
.outboundRelationship[typeCode=COMP].target[classCode=PROC, moodCode=EVN]
Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination.
此資料項目為可擴充綁定預設國際標準值集，但實作者可視實務專案需求只綁定以下slices中的任一值集。目前未只限定綁定預設值集是因為尚無slice值集與預設國際標準值集的代碼對應表，待後續有相對的代碼對應表後將建議採用國際標準值集作為唯一綁定值集並針對該值集進行擴充與管理，以利進行跨國與跨系統之資料交換。
fhir:CodeableConcept rdfs:subClassOf dt:CD
唯一可識別ID，以供資料項目間相互參照。
resource中資料項目的唯一ID（用於內部參照）。這可以是任何不含空格的字串。
代碼可以在列舉清單（enumerations）或代碼清單（code lists）中非常隨意地定義，直至有非常正式的定義，例如：SNOMED CT—更多資訊見HL7 v3核心原則（Core Principles ）。編碼的排序是未定義的因而 **必須沒有（SHALL NOT）** 被用來推斷意義。一般來說，最多只有一個編碼值（coding values）會被標記為UserSelected = true。
允許代碼系統中的替代編碼，以及翻譯到其他編碼系統。
CE/CNE/CWE subset one of the sets of component 1-3 or 4-6
應填入所綁定值集中的其中一個代碼。
代碼可以在列舉清單（enumerations）或代碼清單（code lists）中非常隨意地定義，直至有非常正式的定義，如SNOMED CT—更多資訊見HL7 v3核心原則（Core Principles）。編碼的排序是未定義的因而 **必須沒有（SHALL NOT）** 被用來推斷意義。一般來說，最多只有一個編碼值（coding values）會被標記為UserSelected = true。
此為臺灣健保署2021年中文版ICD-10-PCS，可免費使用，可依情境選用此代碼。
此為臺灣健保署2023年中文版ICD-10-PCS，可免費使用，可依情境選用此代碼。
輸入資料的使用者所見／所選／所說的人類可讀文字表述，和（或）其代表使用者的預期含義。
很多時候，此文字表述與其中一個代碼的顯示名稱相同。
專門術語中的代碼並不總是能捕捉人類使用的細微差別的正確意義，或者根本就沒有合適的代碼；這些情況下，文字表述被用來捕捉來源的全部意義。
C*E.9. But note many systems use C*E.2 for this
fhir:CodeableConcept.text rdfs:subPropertyOf dt:CD.originalText
將事件與可能保存記錄的地點相關聯，並提供圍繞事件發生的背景資訊（例如：事件是發生在專門的醫療環境內或外）。
說明為什麼要求進行影像檢查的臨床情況
應填入所綁定值集中適合的代碼，確定無適合的代碼才可以使用其他值集的代碼來表示。
這表示有另外一個Resource，其存在是進行這項檢查的合理原因。
按照建議的DICOM對應關係，這個資料項目是來自影像檢查描述屬性（0008,1030）。有關影像檢查的觀察或發現應該記錄在別的Resource裡，比如說Observation，而不是在這個資料項目。
影像管理員(Imaging Manager)對此影像檢查的描述，它是由醫療機構自己生成的，用來描述或分類此影像檢查（元件）的內容。
每項影像檢查有一個或多個系列(series)的實例
每項影像檢查有一個或多個系列的影像或其他內容
.outboundRelationship[typeCode=COMP].target[classCode=OBSSER, moodCode=EVN]
Extensions that cannot be ignored even if unrecognized
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 manageable, 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).
Modifier extensions are expected to modify the meaning or interpretation of the element that contains them
[見DICOM PS3.3 C.7.3](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.3.html)
此影像檢查中此系列的數字識別碼
.inboundRelationship[type=COMP, source[classCode=COMPOSITION, moodCode=EVN]].sequenceNumber
對此系列的一個簡短且易於閱讀的摘要
說明了如何查詢（例如：使用DICOM的WADO-URI和WADO-RS）其影像系列或單個系列的方法。整體檢查的基礎位置設定（baseLocation）通常適用於檢查中的所有影像系列。但如果某個影像系列有自己的基礎位置設定（稱為系列級baseLocation），且這個設定與整體檢查的設定類型相同，則該系列將按照自己的設定進行操作。
要進行影像檢查的檢體，例如：活體組織切片的整片掃描成像的檢體。
指明誰或什麼執行了這個系列，以及他們是如何參與的。
如果不確定是誰執行了此系列，可以記錄這位執行者所在的機構。有時，病人本人或與病人有關的人士也可能是影像的拍攝者，比如在病人自己拍攝的影像。
執行者的資訊是記錄在每個系列的層面上，因為在一次檢查中，不同的系列可能會由不同的執行者在不同的時間點使用不同的設備來進行。而且一個系列有可能由多位執行者共同完成。
區分執行者在此系列中的參與類型
系列中的單一SOP實例，例如：影像或表現狀態。
.outboundRelationship[typeCode=COMP].target[classCode=DGIMG, moodCode=EVN]
DICOM影像。1.填寫DICOM欄位至ImagingStudy: Study Instance UID, Series Instance UID, SOP Instance, Modality, SOP Class UID。2.其餘資訊需額外填寫，包含: Status，影像檢查的身體部位 (SNOMED CT)、Procedure Code等。3.上傳影像需打包成DICOMDIR且壓縮成DCF。
[見DICOM PS3.3 C.12.1](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.12.html#sect_C.12.1)
.inboundRelationship[typeCode=COMP]. source[classCode=OBS, moodCode=EVN, code="sop class"].value
.inboundRelationship[typeCode=COMP, source[classCode=OBSSER, moodCode=EVN]].sequenceNumber
特別是對於取得後的分析物件，例如：SR、表現狀態、值對應等。