SMART Imaging Access
0.1.0 - ci-build International flag

SMART Imaging Access, published by Argonaut Project. 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/argonautproject/smart-imaging/ and changes regularly. See the Directory of published versions

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Official URL: http://fhir.org/argonaut/smart-imaging/ImplementationGuide/fhir.argonaut.smart-imaging Version: 0.1.0
Draft as of 2026-08-21 Computable Name: SmartImagingAccess

Apps can already use SMART App Launch to get a patient's clinical data from an EHR. SMART Imaging Access extends that same authorization to imaging: with one approval from the user, an app can find a patient's imaging studies and download the DICOM data — no separate imaging login, no second consent screen.

This helps patients gather their own records, supports second opinions, streamlines research data donation, and lets clinicians pull studies into their preferred viewers.

System map: an app talks to the EHR for authorization and clinical data, and to the Imaging Server for study metadata and DICOM data

How it works

  1. Discover — The app finds the EHR's imaging endpoint, either from the EHR's .well-known/smart-configuration or out-of-band configuration. (Discovery)
  2. Authorize — The app completes a normal SMART App Launch flow with the EHR and receives an access token with patient context. (Authorization)
  3. Query clinical data (optional) — The app uses the token against the EHR's clinical FHIR server as usual — for example, to fetch the Patient resource or imaging DiagnosticReports.
  4. Find studies — The app searches the imaging endpoint for the patient's ImagingStudy resources, each of which links to a WADO-RS endpoint. (Finding studies)
  5. Fetch images — The app retrieves DICOM data from the WADO-RS endpoint, presenting the same access token. (Retrieving images)

Actors

This guide uses three actor names throughout:

  • App — a user-facing application (patient- or provider-facing) that has completed SMART App Launch with the EHR.
  • EHR — the clinical system: a SMART on FHIR authorization server, a token introspection endpoint, and a clinical FHIR server.
  • Imaging Server — the imaging system: a FHIR endpoint serving ImagingStudy resources, plus one or more DICOM WADO-RS endpoints. It may be part of the EHR, a PACS-vendor service, or a standalone proxy in front of a PACS.

These are roles, not deployment requirements. The ImagingStudy resources may live in the EHR's own FHIR server; the WADO-RS endpoint may be a thin proxy over an existing PACS; any combination works as long as the interfaces behave as described.

Scope

In scope:

  • Discovering an imaging endpoint associated with an EHR
  • Reusing the EHR-issued SMART access token for imaging requests, with server-side validation (for example, via SMART Token Introspection)
  • Searching ImagingStudy by patient and retrieving DICOM data via WADO-RS

Out of scope (for now):

  • Writing or uploading imaging data
  • Token exchange for imaging-scoped tokens — deployments that need this may layer it on; future versions may define optional metadata for it
  • DICOM capabilities beyond the minimum retrieval requirements in Retrieving images

History

This guide grew out of the Sync for Science (S4S) Imaging specification, developed by the SMART team for the NIH All of Us research program, and continues under the Argonaut Project.

Dependencies

Package hl7.fhir.uv.extensions.r4#5.3.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, May 16, 2026 18:32+1000+10:00)

Package hl7.fhir.uv.extensions.r4#1.0.0

This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00)

Package hl7.fhir.uv.tools.r4#1.1.2

This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Mar 24, 2026 11:13+1100+11:00)

There are no Global profiles defined

Cross-version analysis

This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (fhir.argonaut.smart-imaging.r4) and R4B (fhir.argonaut.smart-imaging.r4b) are available.

Intellectual property statements

This publication includes IP covered under the following statements.