Release 5 Draft Ballot

This is the Continuous Integration Build of FHIR (will be incorrect/inconsistent at times).
See the Directory of published versions

10.4 Resource ImagingStudy - Content

Imaging Integration Work GroupMaturity Level: 4 Trial UseSecurity Category: Patient Compartments: Patient

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.

ImagingStudy provides information on a DICOM imaging study, and the series and imaging objects in that study. It also provides information on how to retrieve that information (in a native DICOM format, or in a rendered format, such as JPEG). ImagingStudy is used to make available information about all parts of a single DICOM study.

This resource provides mappings of its elements to DICOM attributes. DICOM attributes are identified by a 32-bit tag, presented in canonical form as two four-digit hexadecimal values within parentheses and separated by a comma, e.g. (0008,103E). The name and value representation (data type) of each attribute can be found in DICOM Part 6 Data Dictionary . The use of the attributes in the context of information objects, including detailed description of use, can be found in DICOM Part 3 Information Object Definitions . Attributes used in the DICOM query information models, such as "Number of Instances in Study", can be found in DICOM Part 4 Annex C .

ImagingStudy provides access to significant DICOM information but will only eliminate the need for DICOM query (e.g., QIDO-RS) in the simplest cases. The DICOM instances are not stored in the ImagingStudy resource; use of a DICOM WADO-RS server or other storage mechanism is needed.

An ImagingStudy SHALL reference one DICOM Study, and MAY reference a subset of that Study. More than one ImagingStudy MAY reference the same DICOM Study or different subsets of the same DICOM Study.

ImagingStudy is used for DICOM imaging and associated information. Use DocumentReference to track non-DICOM images, video, or audio. Binary can be used to store arbitrary content. DocumentReference allow indexing and retrieval of clinical “documents” with relevant metadata.

This resource is referenced by ChargeItem, DiagnosticReport, ImagingSelection and Observation.

This resource implements the Event pattern.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy TUDomainResourceA set of images produced in single study (one or more series of references images)
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierIdentifiers for the whole study
... status ?!Σ1..1coderegistered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus (Required)
... modality Σ0..*CodingAll of the distinct values for series' modalities
ImagingModality (Extensible)
... encounter Σ0..1Reference(Encounter)Encounter with which this imaging study is associated
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Request fulfilled
... referrer Σ0..1Reference(Practitioner | PractitionerRole)Referring physician
... interpreter Σ0..*Reference(Practitioner | PractitionerRole)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedure Σ0..*CodeableReference(Procedure)The performed procedure or code
ImagingProcedureCode (Preferred)
... location Σ0..1Reference(Location)Where ImagingStudy occurred
... reason Σ0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Why the study was requested / performed
Procedure Reason Codes (Example)
... note Σ0..*AnnotationUser-defined comments
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... uid Σ1..1idDICOM Series Instance UID for the series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality used for this series
ImagingModality (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... specimen Σ0..*Reference(Specimen)Specimen imaged
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*BackboneElementWho performed the series
..... function Σ0..1CodeableConceptType of performance
ImagingStudy series performer function (Extensible)
..... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... uid 1..1idDICOM SOP Instance UID
..... sopClass 1..1CodingDICOM class type
sopClass (Extensible)
..... number 0..1unsignedIntThe number of this instance in the series
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Identifiers for the ImagingStudy such as DICOM Study Instance UIDidentifier : Identifier [0..*]The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingStudyStatus! »A list of all the distinct values of series.modality. This may include both acquisition and non-acquisition modalitiesmodality : Coding [0..*] « null (Strength=Extensible)ImagingModality+ »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is madeencounter : Reference [0..1] « Encounter »Date and time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner|PractitionerRole »Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] « Practitioner|PractitionerRole »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.connectionTypeendpoint : Reference [0..*] « Endpoint »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 presentnumberOfSeries : unsignedInt [0..1]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 presentnumberOfInstances : unsignedInt [0..1]The procedure or code from which this ImagingStudy was part ofprocedure : DataType [0..*] « Procedure; null (Strength=Preferred)ImagingProcedureCode? »The principal physical location where the ImagingStudy was performedlocation : Reference [0..1] « Location »Description of clinical condition indicating why the ImagingStudy was requested, and/or Indicates another resource whose existence justifies this Studyreason : DataType [0..*] « Condition|Observation|DiagnosticReport| DocumentReference; null (Strength=Example)ProcedureReasonCodes?? »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 elementnote : Annotation [0..*]The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performeddescription : string [0..1]SeriesThe DICOM Series Instance UID for the seriesuid : id [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The distinct modality for this series. This may include both acquisition and non-acquisition modalitiesmodality : Coding [1..1] « null (Strength=Extensible)ImagingModality+ »A description of the seriesdescription : string [0..1]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 presentnumberOfInstances : unsignedInt [0..1]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.connectionTypeendpoint : Reference [0..*] « Endpoint »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.lateralitybodySite : Coding [0..1] « null (Strength=Example)SNOMEDCTBodyStructures?? »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.bodySitelaterality : Coding [0..1] « null (Strength=Example)Laterality?? »The specimen imaged, e.g., for whole slide imaging of a biopsyspecimen : Reference [0..*] « Specimen »The date and time the series was startedstarted : dateTime [0..1]PerformerDistinguishes the type of involvement of the performer in the seriesfunction : CodeableConcept [0..1] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson| HealthcareService »InstanceThe DICOM SOP Instance UID for this image or other DICOM contentuid : id [1..1]DICOM instance typesopClass : Coding [1..1] « null (Strength=Extensible)sopClass+ »The number of instance in the seriesnumber : unsignedInt [0..1]The description of the instancetitle : string [0..1]Indicates who or what performed the series and how they were involvedperformer[0..*]A single SOP instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All of the distinct values for series' modalities  --></modality>
 <subject><!-- 1..1 Reference(Device|Group|Patient) Who or what is the subject of the study --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter with which this imaging study is associated --></encounter>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner|PractitionerRole) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner|PractitionerRole) Who interpreted images --></interpreter>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <numberOfSeries value="[unsignedInt]"/><!-- 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Study Related Instances -->
 <procedure><!-- 0..* CodeableReference(Procedure) The performed procedure or code  --></procedure>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Why the study was requested / performed --></reason>
 <note><!-- 0..* Annotation User-defined comments --></note>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[id]"/><!-- 1..1 DICOM Series Instance UID for the series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality used for this series  --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality  --></laterality>
  <specimen><!-- 0..* Reference(Specimen) Specimen imaged --></specimen>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All of the distinct values for series' modalities 
  "subject" : { Reference(Device|Group|Patient) }, // R!  Who or what is the subject of the study
  "encounter" : { Reference(Encounter) }, // Encounter with which this imaging study is associated
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) }], // Request fulfilled
  "referrer" : { Reference(Practitioner|PractitionerRole) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner|PractitionerRole) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedure" : [{ CodeableReference(Procedure) }], // The performed procedure or code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Why the study was requested / performed
  "note" : [{ Annotation }], // User-defined comments
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<id>", // R!  DICOM Series Instance UID for the series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality used for this series 
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality 
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<id>", // R!  DICOM SOP Instance UID
      "sopClass" : { Coding }, // R!  DICOM class type 
      "number" : "<unsignedInt>", // The number of this instance in the series
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All of the distinct values for series' modalities
  fhir:ImagingStudy.subject [ Reference(Device|Group|Patient) ]; # 1..1 Who or what is the subject of the study
  fhir:ImagingStudy.encounter [ Reference(Encounter) ]; # 0..1 Encounter with which this imaging study is associated
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(Appointment|AppointmentResponse|CarePlan|ServiceRequest|Task) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner|PractitionerRole) ], ... ; # 0..* Who interpreted images
  fhir:ImagingStudy.endpoint [ Reference(Endpoint) ], ... ; # 0..* Study access endpoint
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 0..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 0..1 Number of Study Related Instances
  fhir:ImagingStudy.procedure [ CodeableReference(Procedure) ], ... ; # 0..* The performed procedure or code
  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Why the study was requested / performed
  fhir:ImagingStudy.note [ Annotation ], ... ; # 0..* User-defined comments
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.uid [ id ]; # 1..1 DICOM Series Instance UID for the series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality used for this series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 0..1 Number of Series Related Instances
    fhir:ImagingStudy.series.endpoint [ Reference(Endpoint) ], ... ; # 0..* Series access endpoint
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.specimen [ Reference(Specimen) ], ... ; # 0..* Specimen imaged
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ id ]; # 1..1 DICOM SOP Instance UID
      fhir:ImagingStudy.series.instance.sopClass [ Coding ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since R3

ImagingStudy
ImagingStudy.status
  • Change value set from http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 to http://hl7.org/fhir/ValueSet/imagingstudy-status|4.6.0
ImagingStudy.modality
  • Change value set from http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.procedure
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.modality
  • Change value set from http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.series.performer.actor
  • Type Reference: Added Target Type HealthcareService
ImagingStudy.procedureReference
  • deleted
ImagingStudy.procedureCode
  • deleted
ImagingStudy.reasonCode
  • deleted
ImagingStudy.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 1 fail round-trip testing and 2 r3 resources are invalid (0 errors).)

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy TUDomainResourceA set of images produced in single study (one or more series of references images)
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierIdentifiers for the whole study
... status ?!Σ1..1coderegistered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus (Required)
... modality Σ0..*CodingAll of the distinct values for series' modalities
ImagingModality (Extensible)
... encounter Σ0..1Reference(Encounter)Encounter with which this imaging study is associated
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Request fulfilled
... referrer Σ0..1Reference(Practitioner | PractitionerRole)Referring physician
... interpreter Σ0..*Reference(Practitioner | PractitionerRole)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedure Σ0..*CodeableReference(Procedure)The performed procedure or code
ImagingProcedureCode (Preferred)
... location Σ0..1Reference(Location)Where ImagingStudy occurred
... reason Σ0..*CodeableReference(Condition | Observation | DiagnosticReport | DocumentReference)Why the study was requested / performed
Procedure Reason Codes (Example)
... note Σ0..*AnnotationUser-defined comments
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... uid Σ1..1idDICOM Series Instance UID for the series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality used for this series
ImagingModality (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... specimen Σ0..*Reference(Specimen)Specimen imaged
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*BackboneElementWho performed the series
..... function Σ0..1CodeableConceptType of performance
ImagingStudy series performer function (Extensible)
..... actor Σ1..1Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... uid 1..1idDICOM SOP Instance UID
..... sopClass 1..1CodingDICOM class type
sopClass (Extensible)
..... number 0..1unsignedIntThe number of this instance in the series
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Identifiers for the ImagingStudy such as DICOM Study Instance UIDidentifier : Identifier [0..*]The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingStudyStatus! »A list of all the distinct values of series.modality. This may include both acquisition and non-acquisition modalitiesmodality : Coding [0..*] « null (Strength=Extensible)ImagingModality+ »The subject, typically a patient, of the imaging studysubject : Reference [1..1] « Patient|Device|Group »The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is madeencounter : Reference [0..1] « Encounter »Date and time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner|PractitionerRole »Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] « Practitioner|PractitionerRole »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.connectionTypeendpoint : Reference [0..*] « Endpoint »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 presentnumberOfSeries : unsignedInt [0..1]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 presentnumberOfInstances : unsignedInt [0..1]The procedure or code from which this ImagingStudy was part ofprocedure : DataType [0..*] « Procedure; null (Strength=Preferred)ImagingProcedureCode? »The principal physical location where the ImagingStudy was performedlocation : Reference [0..1] « Location »Description of clinical condition indicating why the ImagingStudy was requested, and/or Indicates another resource whose existence justifies this Studyreason : DataType [0..*] « Condition|Observation|DiagnosticReport| DocumentReference; null (Strength=Example)ProcedureReasonCodes?? »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 elementnote : Annotation [0..*]The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performeddescription : string [0..1]SeriesThe DICOM Series Instance UID for the seriesuid : id [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The distinct modality for this series. This may include both acquisition and non-acquisition modalitiesmodality : Coding [1..1] « null (Strength=Extensible)ImagingModality+ »A description of the seriesdescription : string [0..1]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 presentnumberOfInstances : unsignedInt [0..1]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.connectionTypeendpoint : Reference [0..*] « Endpoint »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.lateralitybodySite : Coding [0..1] « null (Strength=Example)SNOMEDCTBodyStructures?? »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.bodySitelaterality : Coding [0..1] « null (Strength=Example)Laterality?? »The specimen imaged, e.g., for whole slide imaging of a biopsyspecimen : Reference [0..*] « Specimen »The date and time the series was startedstarted : dateTime [0..1]PerformerDistinguishes the type of involvement of the performer in the seriesfunction : CodeableConcept [0..1] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Indicates who or what performed the seriesactor : Reference [1..1] « Practitioner|PractitionerRole| Organization|CareTeam|Patient|Device|RelatedPerson| HealthcareService »InstanceThe DICOM SOP Instance UID for this image or other DICOM contentuid : id [1..1]DICOM instance typesopClass : Coding [1..1] « null (Strength=Extensible)sopClass+ »The number of instance in the seriesnumber : unsignedInt [0..1]The description of the instancetitle : string [0..1]Indicates who or what performed the series and how they were involvedperformer[0..*]A single SOP instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All of the distinct values for series' modalities  --></modality>
 <subject><!-- 1..1 Reference(Device|Group|Patient) Who or what is the subject of the study --></subject>
 <encounter><!-- 0..1 Reference(Encounter) Encounter with which this imaging study is associated --></encounter>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner|PractitionerRole) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner|PractitionerRole) Who interpreted images --></interpreter>
 <endpoint><!-- 0..* Reference(Endpoint) Study access endpoint --></endpoint>
 <numberOfSeries value="[unsignedInt]"/><!-- 0..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Study Related Instances -->
 <procedure><!-- 0..* CodeableReference(Procedure) The performed procedure or code  --></procedure>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reason><!-- 0..* CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) Why the study was requested / performed --></reason>
 <note><!-- 0..* Annotation User-defined comments --></note>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[id]"/><!-- 1..1 DICOM Series Instance UID for the series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality used for this series  --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 0..1 Number of Series Related Instances -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality  --></laterality>
  <specimen><!-- 0..* Reference(Specimen) Specimen imaged --></specimen>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All of the distinct values for series' modalities 
  "subject" : { Reference(Device|Group|Patient) }, // R!  Who or what is the subject of the study
  "encounter" : { Reference(Encounter) }, // Encounter with which this imaging study is associated
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) }], // Request fulfilled
  "referrer" : { Reference(Practitioner|PractitionerRole) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner|PractitionerRole) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedure" : [{ CodeableReference(Procedure) }], // The performed procedure or code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reason" : [{ CodeableReference(Condition|DiagnosticReport|DocumentReference|
   Observation) }], // Why the study was requested / performed
  "note" : [{ Annotation }], // User-defined comments
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<id>", // R!  DICOM Series Instance UID for the series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality used for this series 
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality 
    "specimen" : [{ Reference(Specimen) }], // Specimen imaged
    "started" : "<dateTime>", // When the series started
    "performer" : [{ // Who performed the series
      "function" : { CodeableConcept }, // Type of performance
      "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
     Patient|Practitioner|PractitionerRole|RelatedPerson) } // R!  Who performed the series
    }],
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<id>", // R!  DICOM SOP Instance UID
      "sopClass" : { Coding }, // R!  DICOM class type 
      "number" : "<unsignedInt>", // The number of this instance in the series
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All of the distinct values for series' modalities
  fhir:ImagingStudy.subject [ Reference(Device|Group|Patient) ]; # 1..1 Who or what is the subject of the study
  fhir:ImagingStudy.encounter [ Reference(Encounter) ]; # 0..1 Encounter with which this imaging study is associated
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(Appointment|AppointmentResponse|CarePlan|ServiceRequest|Task) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner|PractitionerRole) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner|PractitionerRole) ], ... ; # 0..* Who interpreted images
  fhir:ImagingStudy.endpoint [ Reference(Endpoint) ], ... ; # 0..* Study access endpoint
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 0..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 0..1 Number of Study Related Instances
  fhir:ImagingStudy.procedure [ CodeableReference(Procedure) ], ... ; # 0..* The performed procedure or code
  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reason [ CodeableReference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Why the study was requested / performed
  fhir:ImagingStudy.note [ Annotation ], ... ; # 0..* User-defined comments
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.uid [ id ]; # 1..1 DICOM Series Instance UID for the series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality used for this series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 0..1 Number of Series Related Instances
    fhir:ImagingStudy.series.endpoint [ Reference(Endpoint) ], ... ; # 0..* Series access endpoint
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.specimen [ Reference(Specimen) ], ... ; # 0..* Specimen imaged
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ id ]; # 1..1 DICOM SOP Instance UID
      fhir:ImagingStudy.series.instance.sopClass [ Coding ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since Release 3

ImagingStudy
ImagingStudy.status
  • Change value set from http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 to http://hl7.org/fhir/ValueSet/imagingstudy-status|4.6.0
ImagingStudy.modality
  • Change value set from http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.procedure
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.modality
  • Change value set from http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.series.performer.actor
  • Type Reference: Added Target Type HealthcareService
ImagingStudy.procedureReference
  • deleted
ImagingStudy.procedureCode
  • deleted
ImagingStudy.reasonCode
  • deleted
ImagingStudy.reasonReference
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 1 fail round-trip testing and 2 r3 resources are invalid (0 errors).)

 

See the Profiles & Extensions and the alternate definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis a

PathDefinitionTypeReference
ImagingStudy.status RequiredImagingStudyStatus
ImagingStudy.modality Extensiblehttp://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.procedure Preferredhttp://loinc.org/download/loincrsna-radiology-playbook-file/
ImagingStudy.reason ExampleProcedureReasonCodes
ImagingStudy.series.modality Extensiblehttp://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.series.bodySite ExampleSNOMEDCTBodyStructures
ImagingStudy.series.laterality Examplehttp://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_244.html
ImagingStudy.series.performer.function ExtensibleImagingStudySeriesPerformerFunction
ImagingStudy.series.instance.sopClass Extensiblehttp://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1

A referenced DICOM SOP instance could be:

  • A single- or multi-frame, still or video image captured by a variety of imaging modalities, such as X-ray, MR, and ultrasound;
  • A set of various presentation parameters, including annotation and markup;
  • A set of measurements or a report, including radiation dose report and CAD analysis;
  • An encapsulated PDF or CDA document;
  • A list of instances, such as key “of interest” images, or instances to be “deleted”; or
  • Other DICOM content.

DICOM Series Instance UID and SOP Instance UID use the id datatype, and are encoded directly. For example, an image with SOP Instance UID of 2.16.124.113543.1154777499.30246.19789.3503430045.1.1 is encoded in ImagingStudy.series.instance.uid as “2.16.124.113543.1154777499.30246.19789.3503430045.1.1”.

The ImagingStudy’s DICOM Study Instance UID is encoded in the ImagingStudy.identifier element, which is of the Identifier datatype. When encoding a DICOM UID in an Identifier datatype, use the Identifier system of “urn:dicom:uid”, and prefix the UID value with “urn:oid:”. Therefore, an ImagingStudy with DICOM Study Instance UID of 2.16.124.113543.1154777499.30246.19789.3503430046 is encoded as:


	"identifier":{
		"system":"urn:dicom:uid",
		"value":"urn:oid:2.16.124.113543.1154777499.30246.19789.3503430046"
	} 

The study accession number can also be encoded as an Reference.Identifier using the ServiceRequest Reference type and the “ACSN” identifier type, as follows:


"basedOn": [
    "reference": {
        "type": "ServiceRequest",
        "identifier":{
            "type" : {
                "coding" : [
                    {
                        "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "code" : "ACSN"
                    }
                ]
            },
            "system":"http://ginormoushospital.org/accession",
            "value":"GH334103"
        }
    }
]

The ImagingStudy.endpoint elements and ImagingStudy.series.endpoint elements indicate network services that can be used to access the studies, series, or instances; for example, a DICOM WADO-RS server. An ImagingStudy.series.endpoint of a particular Endpoint.connectionType provides that service for that series, and all contained instances. An ImagingStudy.endpoint of a particular connection type provides that service for all series in that study that do not have a specified Endpoint of that type, and their contained instances. That is, an ImagingStudy.series.endpoint overrides an ImagingStudy.endpoint of the same connection type. Systems can determine if a particular study, series, or instance is available or offline by interacting with the endpoint. Since each study, or individual series of a study can be stored on different imaging archive servers, per-series endpoints are required. For the identified services and use cases, all instances within a series would be stored together, and thus instance-level endpoints are not defined.

Different Endpoint connection types may have different capabilities, protocols or requirements; and the specified Endpoint.address may require manipulation. See below for the details on use of imaging-related Endpoint connection types.

An Endpoint.connectionType of code dicom-wado-rs, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-RS service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Sub-services, such as study, shall not be specified. The path shall not contain a trailing slash.

The DICOM WADO-RS (Web Access to DICOM Objects, RESTful mode) service uses a RESTful approach to instance retrieval. This service allows for retrieval of native DICOM SOP instances, or instances “rendered” into other formats, including JPEG and MPEG. The media type of a response is specified by the request Accept header (preferred); or, by the accept query parameters. Supported media types depend on the capabilities of the WADO-RS server and the classification of the instance as “single frame,” “multi-frame,” “video,” “text,” or “other.” The WADO-RS service also allows retrieval of study or series level information.

The path to retrieve a DICOM instance is constructed by appending the appropriate sub-resource paths to the Endpoint.address value.

For example, using the following information in a fictional ImagingStudy resource:

  • the WADO-RS service base url of “https://pacs.hospital.org/wado-rs” found in an ImagingStudy.endpoint.address,
  • the DICOM Study Instance UID of “1.2.250.1.59.40211.12345678.678910” found in an ImagingStudy.identifier having Identifier.system of “urn:dicom:uid”,
  • the DICOM Series Instance UID of “1.2.250.1.59.40211.789001276.14556172.67789” found in ImagingStudy.series.uid, and
  • the DICOM SOP Instance UID of “1.2.250.1.59.40211.2678810.87991027.899772.2” found in ImagingStudy.series.instance.uid
we can construct the WADO-RS URL to issue an HTTP GET for a native DICOM PS3.10 instance file (if consistent with the Accept header):


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/series/1.2.250.1.59.40211.789001276.14556172.67789/instances/1.2.250.1.59.40211.2678810.87991027.899772.2

Query parameters on the "rendered" sub-resource can control other aspects of the rendering including: the rendered dimensions, the quality (compression ratio), the region of interest to render, the brightness/contrast (window center/width) adjustments, and whether to “burn” patient or study demographics into the rendered result. Specific frames of a multi-frame instance may be retrieved using the frames sub-resource.

For example, provided the Accept header indicates a preference for image/jpeg, the example above can be extended with parameters that cause a JPEG (rendered to a size of 400 columns by 400 rows) of a region extending from the top-left corner of the original image to 1000 pixels across and 3000 pixels right, to be retrieved (additional sub-resource and parameters emphasized):


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/series/1.2.250.1.59.40211.789001276.14556172.67789/instances/1.2.250.1.59.40211.2678810.87991027.899772.2/rendered?viewport=400,400,0,0,1000,3000

If the WADO-RS service supports the DICOMweb thumbnail resource, a representative image can be requested, for example, to display alongside the study. The URL would look as follows:


https://pacs.hospital.org/wado-rs/studies/1.2.250.1.59.40211.12345678.678910/thumbnail

For further details on DICOM WADO-RS capabilities including additional rendering parameters, see DICOM PS 3.18 .

An Endpoint.connectionType of code dicom-wado-uri, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies a DICOM WADO-URI service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Neither a question mark (“?”) nor any query parameters shall be included.

The DICOM WADO-URI (Web Access to DICOM Objects, URI mode) service uses HTTP query parameter syntax. This service allows for retrieval of native DICOM instances, or instances “rendered” into other formats, including JPEG and MPEG. The media type of a response is specified by the request Accept header (preferred); or, by the contentType query parameter. Supported media types depend on the classification of the instance as “single frame,” “multi-frame,” “video,” “text,” or “other.”

The query to retrieve a DICOM instance is constructed by appending the appropriate query parameters to the Endpoint.address value.

For example, using the following information in a fictional ImagingStudy resource:

  • the WADO-URI service base url of “https://pacs.hospital.org/wado-uri” found in an ImagingStudy.endpoint.address,
  • the DICOM Study Instance UID of 1.2.250.1.59.40211.12345678.678910” found in an ImagingStudy.identifier having Identifier.system of “urn:dicom:uid”,
  • the DICOM Series Instance UID of “1.2.250.1.59.40211.789001276.14556172.67789” found in ImagingStudy.series.uid, and
  • the DICOM SOP Instance UID of “1.2.250.1.59.40211.2678810.87991027.899772.2” found in ImagingStudy.series.instance.uid
we can construct the WADO-URI URL to issue an HTTP GET for a native DICOM PS3.10 instance file (if consistent with the Accept header):


https://pacs.hospital.org/wado-uri?requestType=WADO&studyUID=1.2.250.1.59.40211.12345678.678910&seriesUID=1.2.250.1.59.40211.789001276.14556172.67789&objectUID=1.2.250.1.59.40211.2678810.87991027.899772.2

Additional query parameters can control other aspects of the rendering including rendered dimensions, quality (compression ratio), the region of interest within the image to render, brightness/contrast (window center/width) adjustments, whether to “burn” patient or study demographics into the rendered result, and which frame of a multi-frame instance to retrieve.

For example, provided the Accept header indicates a preference for image/jpeg, the example above can be extended with parameters that cause a JPEG thumbnail (100 columns by 100 rows) of the left half of the image to be retrieved (additional parameters emphasized):


https://pacs.hospital.org/wado-uri?requestType=WADO&studyUID=1.2.250.1.59.40211.12345678.678910&seriesUID=1.2.250.1.59.40211.789001276.14556172.67789&objectUID=1.2.250.1.59.40211.2678810.87991027.899772.2&rows=100&columns=100&region=0,0,0.5,1 

For further details on DICOM WADO-URI capabilities including additional rendering parameters, see DICOM PS 3.18 .

An Endpoint.connectionType of code ihe-iid, system http://terminology.hl7.org/CodeSystem/endpoint-connection-type, identifies an IHE Invoke Image Display (IID) service. The Endpoint.address identifies the HTTP(S) service base url. That is, only the scheme, authority and path are included. Neither a question mark (“?”) nor any query parameters shall be included.

The IHE Invoke Image Display (IID) service provides a standardized mechanism to launch a viewer in a particular study context. (IID also supports invoking a particular patient context, but that is not profiled here.) An IID-type Endpoint should be used only at the study level. As well as invoking the viewer on a particular study, query parameters can request particular viewer capabilities, image quality, and more.

To launch a viewer, append the appropriate query parameters to Endpoint.address value.

For example, using the following information in a fictional ImagingStudy resource:

  • the WADO-URI service base url of “https://pacs.hospital.org/IHEInvokeImageDisplay” found in an ImagingStudy.endpoint.address,
  • the DICOM Study Instance UID of “urn:oid:1.2.250.1.59.40211.12345678.678910” found in an ImagingStudy.identifier having Identifier.system of “urn:dicom:uid”,
we can construct the IID URL to invoke a diagnostic quality viewer on the indicated study:


https://pacs.hospital.org/IHEInvokeImageDisplay?requestType=STUDY&studyUID=1.2.250.1.59.40211.12345678.678910&diagnosticQuality=true

For further details on IHE Invoke Image Display capabilities including additional parameters, see the IHE Technical Frameworks , or the introduction on the IHE IID Profile Wiki .

Some imaging uses may require information beyond what is present in an ImagingStudy resource. Many of the DICOM patient and study level attributes are found in the FHIR Patient, Procedure, or other resources which are referenced from an ImagingStudy instance. Other DICOM content may be transformed into other FHIR resources, such as DiagnosticReports or Observations, which are not directly referenced, but may be easily found.

Although many ImagingStudy consumers are expected to need only the DICOM information contained in FHIR resources, some may need additional DICOM attributes. For these cases, which by their nature involve more imaging-aware consumers, the most flexible solution is to leverage the DICOM WADO-RS metadata-only endpoint to retrieve an XML or JSON representation of the DICOM study, series, instance, or frame information.

A benefit of using the metadata endpoint in this way is that the ImagingStudy creator does not need to know each of the attributes that each of the (current or future) ImagingStudy consumers is (or will be) interested in.

A client retrieves the following ImagingStudy:

{
  "resourceType": "ImagingStudy",
  "id": "example-xr",
  "identifier": [
    {
      "use": "official",
      "system": "urn:dicom:uid",
      "value": "urn:oid:2.16.124.113543.6003.1154777499.30246.19789.3503430046"
    }
  ],
  ...
  "series": [
    {
      "uid": "2.16.124.113543.6003.1154777499.30246.19789.3503430045.1",
      ...
      "endpoint": [
        {
          "reference": "Endpoint/example-wadors"
        }
      ]
      ...
    }
    ...
  ]
}

(See Example XR for full example)

The client retrieves the referenced Endpoint (see Example WADO-RS) and extracts the WADO-RS URL:

https://pacs.hospital.org/wado-rs
.

The client uses the WADO-RS URL, the identifier.value and the series.uid to construct a WADO-RS metadata request:

GET https://pacs.hospital.org/wado-rs/studies/2.16.124.113543.6003.1154777499.30246.19789.3503430046/series/2.16.124.113543.6003.1154777499.30246.19789.3503430045.1/metadata HTTP/1.1
Accept: application/dicom+json

The WADO-RS server then returns the complete DICOM metadata for the requested series.

Amy, a family physician, would like to see a list of available studies for her patient, Alex, filtered by ImagingStudy.status=available to exclude studies without images. Her EHR client makes a FHIR call for all ImagingStudy objects available for Alex. In the response, she is able to see the study date, procedure, modality, and accession number, for each study returned. There is enough information provided in the response to obtain a thumbnail via a WADO-RS call, or to launch a viewer using an IHE Radiology - Invoke Image Display (IID) profile call using the url elements found in the ImagingStudy.

Joe Angina complains of shortness of breath and occasional chest pain to his primary care physician, Dr. Pat Down at Local MultiClinic, who orders a stress echocardiogram; the order is created as a FHIR Task resource to manage the workflow, with a link to a ServiceRequest resource with the details of the request. The order is scheduled and assigned to cardiologist Dr. Art Skann, also at Local MultiClinic.

On the scheduled day of the exam, Joe arrives at the echo lab to meet with Dr. Skann and have the study done. Dr. Skann’s workstation shows the daily list of Task, and he follows the link to retrieve the ServiceRequest. (He may follow the links through the referenced Patient resource to access Joe’s electronic medical record, but that is not the concern of this storyboard.)

The Task and ServiceRequest has been transcoded to a DICOM Modality Worklist Scheduled Procedure Step, and in the echo lab the equipment has downloaded the Modality Worklist. The study is performed, and the acquired images and sonographer’s preliminary measurements are stored in the Local MultiClinic Picture Archiving and Communication System (PACS). The PACS creates an ImagingStudy resource for each study it manages.

Dr. Skann interprets the study on a PACS workstation, and he selects two key image frames to be included in the diagnostic report; this selection is stored back to the PACS as a DICOM Key Object Selection with the title "For Report Attachment", and the PACS makes it available (transcodes it) as a FHIR ImagingStudy resource. Dr. Skann dictates the report using a structured data entry report writing program, including a recommendation for a cardiac catheterization procedure, and signs it. The report writing program formats the report as a CDA document, retrieves the ImagingStudy resource, and inserts the referenced key images into the report.

Dr. Down meets again with Joe, and they review the results of the stress test. Joe has a question about the findings that the key images in the report do not show, so Dr. Down uses the Local MultiClinic EMR to query the PACS for the full ImagingStudy resource and uses the references there to open an image display for the full study. Joe agrees to proceed to catheterization, and Dr. Down sends a referral to the Ginormous University Hospital cath department and triggers the PACS to share the echo study through the Metropolitan Health Information Exchange.

The PACS creates an imaging study as an ImagingStudy resource, which includes all the images but excludes the sonographer’s preliminary measurements (which as a matter of policy are not shared outside the Local MultiClinic). The imaging study is published to the Metro HIE. (In accordance with IHE XDS-I , the images themselves are not directly published to the HIE, but available for on-demand retrieval from the PACS.)

At Ginormous Hospital, Dr. Cora Plummer receives the cath referral, and looks up the study in the Metro HIE registry. She retrieves the study ImagingStudy, and uses it to access the shared images, which she uses to prepare for the cath procedure.

Depending on the modality and procedure type, a DICOM study can range from having one or two instances instance (as in many X-ray procedures) to several thousand instances (for some CT exams). The number of series within a study has far less variability, and is usually under twenty, although post-processing, computer-aided detection, and AI applications may cause modest increases. An ImagingStudy resource describing a large DICOM study would itself be of significant size.

Issuing narrowly-tailored queries can help a client avoid search results containing many ImagingStudy resources. The _summary=true query parameter will omit several resource elements, including all instance-level elements; this can be used to examine search results before retrieving the full instances. If a server limits the byte size of search bundle, this may impact the number of ImagingStudy resources returned per search result page; a client can use the _count query parameter to influence the number of resources per search result page.

When populating an ImagingStudy resource, storing an update for each DICOM instance in the study could result in sending previously sent information repeatedly--an issue that grows as the study size increases. It might also result in a server maintaining thousands of versions of the resource. Repeated, rapid updates of an ImagingStudy may lead to resource contention.

Although not reflected in the ImagingStudy resource, the size of an individual referenced instance may be anywhere from a few kilobytes (a compressed 256x256 pixel MR or 640x480 pixel ultrasound image) to a gigabyte or more (for digital breast tomography imaging). When retrieving the referenced content of an ImagingStudy, consider whether all DICOM instances are needed, whether DICOM instances are used concurrently or sequentially, and what rendering or Transfer Syntax is appropriate for the use case.

Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
basedonreferenceThe order for the image, such as Accession Number associated with a ServiceRequestImagingStudy.basedOn
(Appointment, AppointmentResponse, CarePlan, Task, ServiceRequest)
bodysitetokenThe body site studiedImagingStudy.series.bodySite
dicom-classtokenThe type of the instanceImagingStudy.series.instance.sopClass
encounterreferenceThe context of the studyImagingStudy.encounter
(Encounter)
endpointreferenceThe endpoint for the study or seriesImagingStudy.endpoint | ImagingStudy.series.endpoint
(Endpoint)
identifiertokenIdentifiers for the Study, such as DICOM Study Instance UIDImagingStudy.identifier
instance NtokenSOP Instance UID for an instanceImagingStudy.series.instance.uid
interpreterreferenceWho interpreted the imagesImagingStudy.interpreter
(Practitioner, PractitionerRole)
modalitytokenThe modality of the seriesImagingStudy.series.modality
patientreferenceWho the study is aboutImagingStudy.subject.where(resolve() is Patient)
(Group, Device, Patient)
performerreferenceThe person who performed the studyImagingStudy.series.performer.actor
(Practitioner, Organization, CareTeam, Device, Patient, HealthcareService, PractitionerRole, RelatedPerson)
reasontokenThe reason for the study
referrerreferenceThe referring physicianImagingStudy.referrer
(Practitioner, PractitionerRole)
series NtokenDICOM Series Instance UID for a seriesImagingStudy.series.uid
started NdateWhen the study was startedImagingStudy.started
status NtokenThe status of the studyImagingStudy.status
subjectreferenceWho the study is aboutImagingStudy.subject
(Group, Device, Patient)