HL7 Europe Imaging Report R5, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 1.0.0-beta built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/imaging-r5/ and changes regularly. See the Directory of published versions
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Acknowledgment
The development of this Implementation Guide version has been supported by the
Xt-EHR Joint Action.
Xt-EHR provided expertise, alignment with European health policy priorities,
and validation of specifications to enable consistency with EHDS requirements.
This is a ballot preview version:
this Implementation Guide is published for
review and discussion purposes only.
The content is subject to change and is provided as-is, without warranty of any kind and without liability for its use.
Scope
This implementation guide specifies imaging study data in the European context, as defined in eHN Imaging Studies and Reports and refined by Xt-EHR Imaging Logical Model, as a FHIR model. It defines:
- The structure and contents of a FHIR imaging studies and reports.
- Different options for publishing and searching for such studies and reports.
- Discovery of available mechanisms to access the imaging data.
The specification is to be used in a variety of deployment models, which includes the EHDS use cases: exchange data within healthcare organizations, across nations/regions and cross border information exchange. In all of these use cases it is important that it is compatible with the existing ecosystem.
Current approaches within Europe use different approaches to information exchange:
- Document based exchange, the document is represented as a FHIR Document Bundle.
- REST API based access to documents, a
Composition and DiagnosticReport for each document including instances of the referred resources
- REST API based access to resources, as the previous but the (important) resources are harmonized, meaning that all documents point to the same
Patient, Organization and other resources.
The specification is being designed in such a way that it can be used in all of these deployment scenarios.
Timeline:
- Feb 2025, kick-off during HL7-EU WGM.
- May 2025, first planned ballot to be tested during May 2025 HL7 WGM in Madrid.
- June 2025, testing in IHE-EU plug-a-thon in Vienna/
- August 2025, snapshot for XtEHR 7.2 consultation
- Februari 2026, snapshot for IHEeu XtEHR projecthaton
- March 2026, R4 ballot
Purpose
The goal of this Implementation Guide is to define an European standard for the Imaging Report to facilitate the harmonization among the national initiatives and prepare the ground for the European EHR eXchange Format (E-EHRxF).
The development of this implementation guide is promoted by HL7 Europe, but realized in collaboration with several other European and national organizations and projects. The aspiration of this guide is to be used as basis for European National Guides, the European EHRxF ,and - consequently - by MyHealth@EU for the EU cross-border services.
FHIR specific Dependencies
Package hl7.fhir.uv.extensions.r4#5.2.0
This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00)
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Package hl7.fhir.uv.ipa#1.1.0
This IG describes how an application acting on behalf of a patient can access information about the patient from an clinical records system using a FHIR based API. The clinical records system may be supporting a clinical care provider (e.g. a hospital, or a general practitioner), or a health data exchange, including a national health record system. (built Wed, Mar 19, 2025 14:34+0000+00:00)
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Package hl7.fhir.eu.extensions.r5#1.2.0
This guide lists the extensions specified for the European REALM. (built Fri, Dec 19, 2025 11:52+0100+01:00)
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Package ihe.pharm.mpd#1.0.0-comment-2
ImplementationGuide for IHE Pharmacy Medication Prescription and Dispense (MPD) profile (built Tue, May 27, 2025 16:32+0200+02:00)
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Package hl7.fhir.eu.base-r5#current
This guide collects base and core profiles to be used in the European context. It also includes common artifacts, such as the profiles describing the European Health Insurance Card. (built Mon, Mar 2, 2026 17:38+0000+00:00)
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Package hl7.fhir.uv.extensions#5.3.0-ballot
This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Fri, Aug 1, 2025 13:17+1000+10:00)
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Package hl7.fhir.eu.extensions.r4#1.2.0
This guide lists the extensions specified for the European REALM. (built Fri, Dec 19, 2025 11:52+0100+01:00)
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Package hl7.fhir.uv.xver-r5.r4#0.0.1-snapshot-2
The cross-version extensions available in FHIR R4 from FHIR R5 (built Sat, Sep 13, 2025 16:55-0400-04:00)
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Package ihe.pharm.mpd.r4#1.0.0-comment-2
ImplementationGuide for IHE Pharmacy Medication Prescription and Dispense (MPD) profile (built Tue, May 27, 2025 16:32+0200+02:00)
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Package hl7.fhir.eu.base#current
This guide collects base and core profiles to be used in the European context. It also includes common artifacts, such as the profiles describing the European Health Insurance Card. (built Mon, Mar 2, 2026 17:37+0000+00:00)
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Package hl7.fhir.uv.ips#1.1.0
International Patient Summary (IPS) FHIR Implementation Guide (built Tue, Nov 22, 2022 03:24+0000+00:00)
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Package hl7.fhir.eu.extensions#current
This guide lists the extensions specified for the European REALM. (built Tue, Mar 3, 2026 08:56+0000+00:00)
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Package hl7.fhir.eu.laboratory#current
This guide describes how the Laboratory Report can be represented in the European REALM. (built Mon, Feb 23, 2026 14:45+0000+00:00)
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Package hl7.fhir.eu.eu-health-data-api#current
This Implementation Guide defines FHIR-based APIs for accessing and exchanging health data in the European Health Data Space (EHDS). It composes existing IHE and HL7 specifications — MHD for document exchange, SMART Backend Services for authorization, PDQm for patient matching, and IPA for resource access — into a unified conformance target for EHR systems across Europe. (built Wed, Feb 25, 2026 17:15+0000+00:00)
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Package ihe.iti.balp#1.1.4
The Basic Audit Log Patterns (BALP) Implementation Guide is a Content Profile that defines some basic and reusable AuditEvent patterns. This includes basic audit log profiles for FHIR RESTful operations to be used when there is not a more specific audit event defined. A focus is enabling Privacy centric AuditEvent logs that hold well formed indication of the Patient when they are the subject of the activity being recorded in the log. Where a more specific audit event can be defined it should be derived off of these basic patterns. (built Fri, Oct 31, 2025 12:53-0500-05:00)
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Package ihe.iti.mhd#4.2.3
ImplementationGuide for IHE IT Infrastructure Technical Framework Supplement Mobile access to Health Documents (MHD) (built Fri, Oct 31, 2025 14:32-0500-05:00)
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Package hl7.fhir.uv.tools.r5#0.9.0
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, Dec 16, 2025 23:18+1100+11:00)
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Cross Version Analysis
Global Profiles
There are no Global profiles defined
IP statements
This publication includes IP covered under the following statements.
- Copyright HL7 Europe. Licensed under Creative Commons public domain (CC0 1.0).
Show Usage
- EEHRxF Document Priority Category CodeSystem: Bundle/bundle-report-minimal-metadata-unstructured, Bundle/bundle-report-semi-structured... Show 13 more, Bundle/bundle-report-structured, Composition/CompositionSemiStructured, Composition/CompositionStructured, CompositionEuImaging, DiagnosticReport/DiagnosticReportMinimalMetadata, DiagnosticReport/DiagnosticReportSemiStructured, DiagnosticReport/DiagnosticReportStructured, DiagnosticReportEuImaging, DiagnosticReportEuImagingMinimalMetadata, DocumentReference/DocumentReferenceSemiStructured, DocumentReference/DocumentReferenceStructuredReport, DocumentReference/RenderableFormatWithBasicMetadata and DocumentReferenceImagingReport
- ValueSet: Diagnostic Report Support Info Code System: DiagnosticReportSupportingInfoVCodes
- ValueSet: Missing DICOM Terminology: Bundle/bundle-report-semi-structured, Bundle/bundle-report-structured... Show 8 more, DocumentReferenceKeyImageEuImaging, ImagingStudy/ImagingStudStructuredReport, ImagingStudy/ImagingStudySemiStructuredReport1, ImagingStudy/ImagingStudySemiStructuredReport2, ObservationFindingEuImaging, ObservationRadiationDoseEuImaging, SopInstanceUidIdentifierEuImaging and StudyInstanceUidIdentifierEuImaging
- The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
Show Usage
- These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
Show Usage
- This material contains content from LOINC. LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.
Show Usage
- LOINC: Bundle/bundle-report-minimal-metadata-unstructured, Bundle/bundle-report-semi-structured... Show 56 more, Bundle/bundle-report-structured, Composition/CompositionSemiStructured, Composition/CompositionStructured, CompositionEuImaging, DiagnosticReport/DiagnosticReportMinimalMetadata, DiagnosticReport/DiagnosticReportSemiStructured, DiagnosticReport/DiagnosticReportStructured, DiagnosticReportEuImaging, DiagnosticReportEuImagingMinimalMetadata, DocumentReference/DocumentReferenceSemiStructured, DocumentReference/DocumentReferenceStructuredReport, DocumentReference/RenderableFormatWithBasicMetadata, DocumentReferenceImagingReport, DocumentReferenceKeyImageEuImaging, Hl7EuImagingSectionValueSet, ImagingReportTypesEuVSEuImaging, Observation/BPObservation, Observation/HRObservation, Observation/HeightObservation, Observation/RestWmsi01, Observation/RestWmsi02, Observation/RestWmsi03, Observation/RestWmsi04, Observation/RestWmsi05, Observation/RestWmsi06, Observation/RestWmsi07, Observation/RestWmsi08, Observation/RestWmsi09, Observation/RestWmsi10, Observation/RestWmsi11, Observation/RestWmsi12, Observation/RestWmsi13, Observation/RestWmsi14, Observation/RestWmsi15, Observation/RestWmsi16, Observation/RestWmsi17, Observation/StressWmsi01, Observation/StressWmsi02, Observation/StressWmsi03, Observation/StressWmsi04, Observation/StressWmsi05, Observation/StressWmsi06, Observation/StressWmsi07, Observation/StressWmsi08, Observation/StressWmsi09, Observation/StressWmsi10, Observation/StressWmsi11, Observation/StressWmsi12, Observation/StressWmsi13, Observation/StressWmsi14, Observation/StressWmsi15, Observation/StressWmsi16, Observation/StressWmsi17, Observation/WeightObservation, ObservationRadiationDoseEuImaging and SectionEmptyReasonEuImaging
- This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
Show Usage
- SNOMED Clinical Terms® (SNOMED CT®): AnatomicalRegionExtension, Bundle/bundle-report-semi-structured... Show 18 more, Bundle/bundle-report-structured, DeviceEuImaging, DeviceEuImagingType, DiagnosticReport/DiagnosticReportStructured, DocumentReference/DocumentReferenceSemiStructured, DocumentReference/DocumentReferenceStructuredReport, DocumentReference/RenderableFormatWithBasicMetadata, DocumentReferenceImagingReport, ImagingStudy/ImagingStudStructuredReport, ImagingStudy/ImagingStudySemiStructuredReport1, ImagingStudy/ImagingStudySemiStructuredReport2, ObservationGestationalAgeEuImaging, PractitionerRole/PractitionerRoleSemiStructuredReportAuthor, PractitionerRole/PractitionerRoleStructuredReportAuthor, ProcedureEuImaging, ProcedureEuImagingType, ServiceRequestOrderEuImaging and ValueSetAnatomicalRegion
- This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
Show Usage
- List Empty Reasons: Bundle/bundle-report-semi-structured, Bundle/bundle-report-structured... Show 4 more, Composition/CompositionSemiStructured, Composition/CompositionStructured, CompositionEuImaging and SectionEmptyReasonEuImaging
- Observation Category Codes: Bundle/bundle-report-structured, Observation/BPObservation, Observation/HRObservation, Observation/HeightObservation and Observation/WeightObservation
- diagnosticServiceSectionId: Bundle/bundle-report-semi-structured, Bundle/bundle-report-structured... Show 7 more, Composition/CompositionSemiStructured, Composition/CompositionStructured, CompositionEuImaging, DiagnosticReport/DiagnosticReportSemiStructured, DiagnosticReport/DiagnosticReportStructured, DiagnosticReportEuImaging and DiagnosticReportEuImagingMinimalMetadata
- identifierType: AccessionNumberIdentifierEuImaging, Bundle/bundle-report-minimal-metadata-unstructured... Show 9 more, Bundle/bundle-report-semi-structured, Bundle/bundle-report-structured, Composition/CompositionStructured, DiagnosticReport/DiagnosticReportMinimalMetadata, DiagnosticReport/DiagnosticReportSemiStructured, DiagnosticReport/DiagnosticReportStructured, ImagingStudy/ImagingStudStructuredReport, ImagingStudy/ImagingStudySemiStructuredReport1 and ImagingStudy/ImagingStudySemiStructuredReport2
- ParticipationType: Bundle/bundle-report-semi-structured, Bundle/bundle-report-structured... Show 5 more, ImagingStudy/ImagingStudStructuredReport, ImagingStudy/ImagingStudySemiStructuredReport1, ImagingStudy/ImagingStudySemiStructuredReport2, ImagingStudyEuImaging and ImagingStudyEuImagingPerformerTypeVS