HL7 Europe Imaging Study Report
0.1.1-build - ci-build 150

HL7 Europe Imaging Study Report, published by HL7 Europe. This guide is not an authorized publication; it is the continuous build for version 0.1.1-build built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/imaging/ and changes regularly. See the Directory of published versions

Resource Profile: ImImagingStudy - Detailed Descriptions

Page standards status: Draft Maturity Level: 1

Definitions for the ImImagingStudy resource profile.

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

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())
im-imagingstudy-01: A DICOM instance UID must start with 'urn:oid:' (identifier.where(system='urn:dicom:uid').value.startsWith('urn:oid:'))
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.extension
Definition

An Extension


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.

ShortExtensionAdditional 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()))
ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
SlicingThis element introduces a set of slices on ImagingStudy.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
  • value @ url
  • 8. ImagingStudy.extension:status-reason
    Slice Namestatus-reason
    Definition

    Captures the reason for the current state of the resource. Note that any change to the state requires the removal of any existing statusReasons, and, if appropriate, populating new statusReasons.

    ShortWhy was the status changed?
    Comments

    This is generally only used for 'exception' statuses such as 'suspended' or 'cancelled'. The reason why the resource was created at all is captured in reasonCode, not here. (Distinct reason codes for different statuses can be enforced using invariants if they are universal bindings).

    Must only be used on resources with a 'status' element that do not already have a statusReason.

    Control0..1
    TypeExtension(Workflow Status Reason) (Extension Type: CodeableConcept)
    Is Modifierfalse
    Must Supportfalse
    Summaryfalse
    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    10. 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()))
    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
    12. 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
    • 14. 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(Identifier: Study Instance UID)
      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()))
      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|5.0.0
      (required to http://hl7.org/fhir/ValueSet/imagingstudy-status|5.0.0)

      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
      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 (EU core), Device, 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.basedOn
      Definition

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

      ShortRequest fulfilled
      Control0..*
      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 @ $this
      • 22. ImagingStudy.basedOn:imorderaccession
        Slice Nameimorderaccession
        Definition

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

        ShortRequest fulfilled
        Control0..1*
        TypeReference(ServiceRequest: Imaging Order, 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()))
        24. ImagingStudy.basedOn:imorderaccession.reference
        Definition

        A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

        ShortLiteral reference, Relative, internal or absolute URL
        Comments

        Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

        Control0..1
        This element is affected by the following invariants: ref-2, ref-1
        Typestring
        Is Modifierfalse
        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
        Summarytrue
        Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
        26. ImagingStudy.basedOn:imorderaccession.identifier
        Definition

        An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

        ShortLogical reference, when literal reference is not known
        Comments

        When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

        When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

        Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

        Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

        This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

        NoteThis is a business identifier, not a resource identifier (see discussion)
        Control10..1
        This element is affected by the following invariants: ref-2
        TypeIdentifier(Identifier: Accession Number)
        Is Modifierfalse
        Summarytrue
        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 foundhere

        0. ImagingStudy
        Invariantsim-imagingstudy-01: A DICOM instance UID must start with 'urn:oid:' (identifier.where(system='urn:dicom:uid').value.startsWith('urn:oid:'))
        2. ImagingStudy.extension
        SlicingThis element introduces a set of slices on ImagingStudy.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
        • value @ url
        • 4. ImagingStudy.extension:status-reason
          Slice Namestatus-reason
          Control0..1
          TypeExtension(Workflow Status Reason) (Extension Type: CodeableConcept)
          6. 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
          • 8. ImagingStudy.identifier:studyInstanceUid
            Slice NamestudyInstanceUid
            NoteThis is a business identifier, not a resource identifier (see discussion)
            Control1..1
            TypeIdentifier(Identifier: Study Instance UID)
            10. ImagingStudy.subject
            TypeReference(Patient (EU core), Device)
            12. ImagingStudy.basedOn
            SlicingThis element introduces a set of slices on ImagingStudy.basedOn. The slices areUnordered and Open, and can be differentiated using the following discriminators:
            • type @ $this
            • 14. ImagingStudy.basedOn:imorderaccession
              Slice Nameimorderaccession
              Control0..1
              TypeReference(ServiceRequest: Imaging Order)
              16. ImagingStudy.basedOn:imorderaccession.identifier
              NoteThis is a business identifier, not a resource identifier (see discussion)
              Control1..?
              TypeIdentifier(Identifier: Accession Number)
              18. ImagingStudy.series
              20. ImagingStudy.series.performer
              SlicingThis element introduces a set of slices on ImagingStudy.series.performer. The slices areUnordered and Open, and can be differentiated using the following discriminators:
              • value @ function
              • 22. ImagingStudy.series.performer.function
                BindingUnless not suitable, these codes SHALL be taken from Imaging Study Performer Type Value Set
                (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                24. ImagingStudy.series.performer:performer
                Slice Nameperformer
                ShortThe practitioner that did the imaging.
                Control0..1
                26. ImagingStudy.series.performer:performer.function
                Control1..?
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                    "code" : "PRF"
                  }]
                }
                28. ImagingStudy.series.performer:performer.actor
                TypeReference(PractitionerRole (EU core))
                30. ImagingStudy.series.performer:device
                Slice Namedevice
                ShortThe device that did the imaging.
                Control0..1
                32. ImagingStudy.series.performer:device.function
                Control1..?
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                    "code" : "DEV"
                  }]
                }
                34. ImagingStudy.series.performer:device.actor
                TypeReference(Device: Imaging Device)
                36. ImagingStudy.series.performer:custodian
                Slice Namecustodian
                ShortThe custodian of the report.
                Control0..1
                38. ImagingStudy.series.performer:custodian.function
                Control1..?
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                    "code" : "CST"
                  }]
                }
                40. ImagingStudy.series.performer:custodian.actor
                TypeReference(Organization (EU core))
                42. ImagingStudy.series.performer:organization
                Slice Nameorganization
                ShortThe organization where the imaging was performed.
                Control0..1
                44. ImagingStudy.series.performer:organization.function
                Control1..?
                Pattern Value{
                  "coding" : [{
                    "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                    "code" : "LOC"
                  }]
                }
                46. ImagingStudy.series.performer:organization.actor
                TypeReference(Organization (EU core))
                48. ImagingStudy.series.instance
                50. ImagingStudy.series.instance.extension
                SlicingThis element introduces a set of slices on ImagingStudy.series.instance.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                • value @ url
                • 52. ImagingStudy.series.instance.extension:instance-description
                  Slice Nameinstance-description
                  Control0..1
                  TypeExtension(Instance Description) (Extension Type: string)
                  54. ImagingStudy.series.instance.extension:number-of-frames
                  Slice Namenumber-of-frames
                  Control0..1
                  TypeExtension(Number of Frames) (Extension Type: integer)

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

                  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())
                  im-imagingstudy-01: A DICOM instance UID must start with 'urn:oid:' (identifier.where(system='urn:dicom:uid').value.startsWith('urn:oid:'))
                  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|5.0.0)

                  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

                  An Extension

                  ShortExtension
                  Control0..*
                  TypeExtension
                  Is Modifierfalse
                  Must Supportfalse
                  Summaryfalse
                  Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                  ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                  SlicingThis element introduces a set of slices on ImagingStudy.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                  • value @ url
                  • 16. ImagingStudy.extension:status-reason
                    Slice Namestatus-reason
                    Definition

                    Captures the reason for the current state of the resource. Note that any change to the state requires the removal of any existing statusReasons, and, if appropriate, populating new statusReasons.

                    ShortWhy was the status changed?
                    Comments

                    This is generally only used for 'exception' statuses such as 'suspended' or 'cancelled'. The reason why the resource was created at all is captured in reasonCode, not here. (Distinct reason codes for different statuses can be enforced using invariants if they are universal bindings).

                    Must only be used on resources with a 'status' element that do not already have a statusReason.

                    Control0..1
                    TypeExtension(Workflow Status Reason) (Extension Type: CodeableConcept)
                    Is Modifierfalse
                    Must Supportfalse
                    Summaryfalse
                    Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    18. 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()))
                    ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                    20. 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
                    • 22. 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(Identifier: Study Instance UID)
                      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()))
                      24. 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|5.0.0)

                      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
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      26. 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()))
                      28. 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 (EU core), Device)
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      30. 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)
                      Is Modifierfalse
                      Must Supportfalse
                      Summarytrue
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      32. 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
                      ExampleGeneral: 2011-01-01T11:01:20+03:00
                      Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                      34. ImagingStudy.basedOn
                      Definition

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

                      ShortRequest fulfilled
                      Control0..*
                      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 @ $this
                      • 36. ImagingStudy.basedOn:imorderaccession
                        Slice Nameimorderaccession
                        Definition

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

                        ShortRequest fulfilled
                        Control0..1
                        TypeReference(ServiceRequest: Imaging Order)
                        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()))
                        38. ImagingStudy.basedOn:imorderaccession.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
                        40. ImagingStudy.basedOn:imorderaccession.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()))
                        ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                        SlicingThis element introduces a set of slices on ImagingStudy.basedOn.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                        • value @ url
                        • 42. ImagingStudy.basedOn:imorderaccession.reference
                          Definition

                          A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

                          ShortLiteral reference, Relative, internal or absolute URL
                          Comments

                          Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

                          Control0..1
                          This element is affected by the following invariants: ref-2, ref-1
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          44. ImagingStudy.basedOn:imorderaccession.type
                          Definition

                          The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

                          The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

                          ShortType the reference refers to (e.g. "Patient") - must be a resource in resources
                          Comments

                          This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

                          Control0..1
                          BindingUnless not suitable, these codes SHALL be taken from ResourceType
                          (extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

                          Aa resource (or, for logical models, the URI of the logical model).

                          Typeuri
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          46. ImagingStudy.basedOn:imorderaccession.identifier
                          Definition

                          An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

                          ShortLogical reference, when literal reference is not known
                          Comments

                          When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

                          When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

                          Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

                          Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

                          This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

                          NoteThis is a business identifier, not a resource identifier (see discussion)
                          Control1..1
                          This element is affected by the following invariants: ref-2
                          TypeIdentifier(Identifier: Accession Number)
                          Is Modifierfalse
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          48. ImagingStudy.basedOn:imorderaccession.display
                          Definition

                          Plain text narrative that identifies the resource in addition to the resource reference.

                          ShortText alternative for the resource
                          Comments

                          This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

                          Control0..1
                          This element is affected by the following invariants: ref-2
                          Typestring
                          Is Modifierfalse
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Summarytrue
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          50. 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()))
                          52. 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()))
                          54. 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.

                          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()))
                          56. 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()))
                          58. 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()))
                          60. 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()))
                          62. 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()))
                          64. 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|5.0.0)

                          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()))
                          66. 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()))
                          68. 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()))
                          70. 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()))
                          72. 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
                          74. 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()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          76. 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()))
                          ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                          78. 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
                          ExampleGeneral: 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()))
                          80. 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
                          ExampleGeneral: 3
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          82. 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()))
                          84. 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
                          ExampleGeneral: CT Surview 180
                          Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                          86. 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()))
                          88. 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.

                          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()))
                          90. ImagingStudy.series.bodySite
                          Definition

                          The anatomic structures examined. See DICOM Part 16 Annex L (http://dicom.nema.org/medical/dicom/current/output/chtml/part16/chapter_L.html) 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|5.0.0)

                          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()))
                          92. 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()))
                          94. 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()))
                          96. 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()))
                          98. 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()))
                          SlicingThis element introduces a set of slices on ImagingStudy.series.performer. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                          • value @ function
                          • 100. 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
                            102. 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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            104. 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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            106. 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 Imaging Study Performer Type Value Set
                            (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                            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()))
                            108. 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()))
                            110. ImagingStudy.series.performer:performer
                            Slice Nameperformer
                            Definition

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

                            ShortThe practitioner that did the imaging.
                            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..1
                            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()))
                            112. ImagingStudy.series.performer: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
                            114. ImagingStudy.series.performer: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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            116. ImagingStudy.series.performer: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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            118. ImagingStudy.series.performer:performer.function
                            Definition

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

                            ShortType of performance
                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Imaging Study Performer Type Value Set
                            (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            Allows disambiguation of the types of involvement of different performers.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                                "code" : "PRF"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            120. ImagingStudy.series.performer:performer.actor
                            Definition

                            Indicates who or what performed the series.

                            ShortWho performed the series
                            Control1..1
                            TypeReference(PractitionerRole (EU core))
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            122. ImagingStudy.series.performer:device
                            Slice Namedevice
                            Definition

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

                            ShortThe device that did the imaging.
                            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..1
                            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()))
                            124. ImagingStudy.series.performer:device.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
                            126. ImagingStudy.series.performer:device.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            128. ImagingStudy.series.performer:device.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            130. ImagingStudy.series.performer:device.function
                            Definition

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

                            ShortType of performance
                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Imaging Study Performer Type Value Set
                            (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            Allows disambiguation of the types of involvement of different performers.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                                "code" : "DEV"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            132. ImagingStudy.series.performer:device.actor
                            Definition

                            Indicates who or what performed the series.

                            ShortWho performed the series
                            Control1..1
                            TypeReference(Device: Imaging Device)
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            134. ImagingStudy.series.performer:custodian
                            Slice Namecustodian
                            Definition

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

                            ShortThe custodian of the report.
                            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..1
                            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()))
                            136. ImagingStudy.series.performer:custodian.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
                            138. ImagingStudy.series.performer:custodian.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            140. ImagingStudy.series.performer:custodian.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            142. ImagingStudy.series.performer:custodian.function
                            Definition

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

                            ShortType of performance
                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Imaging Study Performer Type Value Set
                            (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            Allows disambiguation of the types of involvement of different performers.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                                "code" : "CST"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            144. ImagingStudy.series.performer:custodian.actor
                            Definition

                            Indicates who or what performed the series.

                            ShortWho performed the series
                            Control1..1
                            TypeReference(Organization (EU core))
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            146. ImagingStudy.series.performer:organization
                            Slice Nameorganization
                            Definition

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

                            ShortThe organization where the imaging was performed.
                            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..1
                            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()))
                            148. ImagingStudy.series.performer:organization.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
                            150. ImagingStudy.series.performer:organization.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            152. ImagingStudy.series.performer:organization.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()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            154. ImagingStudy.series.performer:organization.function
                            Definition

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

                            ShortType of performance
                            Control1..1
                            BindingUnless not suitable, these codes SHALL be taken from Imaging Study Performer Type Value Set
                            (extensible to http://hl7.eu/fhir/imaging-r5/ValueSet/im-imaging-study-performer-type)
                            TypeCodeableConcept
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Requirements

                            Allows disambiguation of the types of involvement of different performers.

                            Pattern Value{
                              "coding" : [{
                                "system" : "http://terminology.hl7.org/CodeSystem/v3-ParticipationType",
                                "code" : "LOC"
                              }]
                            }
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            156. ImagingStudy.series.performer:organization.actor
                            Definition

                            Indicates who or what performed the series.

                            ShortWho performed the series
                            Control1..1
                            TypeReference(Organization (EU core))
                            Is Modifierfalse
                            Must Supportfalse
                            Summarytrue
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            158. 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()))
                            160. 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
                            162. ImagingStudy.series.instance.extension
                            Definition

                            An Extension

                            ShortExtension
                            Control0..*
                            TypeExtension
                            Is Modifierfalse
                            Summaryfalse
                            Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                            ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                            SlicingThis element introduces a set of slices on ImagingStudy.series.instance.extension. The slices areUnordered and Open, and can be differentiated using the following discriminators:
                            • value @ url
                            • 164. ImagingStudy.series.instance.extension:instance-description
                              Slice Nameinstance-description
                              Definition

                              A description of the instance in an ImagingStudy.

                              ShortInstance Description
                              Control0..1
                              TypeExtension(Instance Description) (Extension Type: string)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              166. ImagingStudy.series.instance.extension:number-of-frames
                              Slice Namenumber-of-frames
                              Definition

                              The number of frames in an ImagingStudy instance as required by Xt-EHR logical ImagingStudy logical model.

                              ShortNumber of Frames
                              Control0..1
                              TypeExtension(Number of Frames) (Extension Type: integer)
                              Is Modifierfalse
                              Summaryfalse
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              168. 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()))
                              ext-1: Must have either extensions or value[x], not both (extension.exists() != value.exists())
                              170. 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
                              ExampleGeneral: 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()))
                              172. ImagingStudy.series.instance.sopClass
                              Definition

                              DICOM instance type.

                              ShortDICOM class type
                              Control1..1
                              BindingUnless not suitable, these codes SHALL be taken from http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1
                              (extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1)

                              The sopClass for the instance.

                              TypeCoding
                              Is Modifierfalse
                              Must Supportfalse
                              Summaryfalse
                              Alternate NamesSOPClassUID
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              174. 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
                              ExampleGeneral: 1
                              Invariantsele-1: All FHIR elements must have a @value or children (hasValue() or (children().count() > id.count()))
                              176. 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()))