Current Build

10.3 Resource ImagingStudy - Content

Imaging Integration Work GroupMaturity Level: 3 Trial UseCompartments: 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.

Only a single DICOM study may be referenced from one ImagingStudy. In many cases, only one ImagingStudy will reference a particular DICOM study, but this is not required.

In contrast to ImagingManifest, this resource represents all of the known imaging objects from a single study. Imaging Manifest represents selected instances from multiple studies for one patient.

ImagingStudy is used for DICOM imaging and associated information. Use Media 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, ClinicalImpression, DiagnosticReport and ImagingManifest

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy DomainResourceA 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
... uid Σ1..1oidFormal DICOM identifier for the study
... accession Σ0..1IdentifierRelated workflow identifier ("Accession Number")
... identifier Σ0..*IdentifierOther identifiers for the study
... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
... modalityList Σ0..*CodingAll series modality if actual acquisition modalities
Acquisition Modality Codes (Extensible)
... patient Σ1..1Reference(Patient)Who the images are of
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating context
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled
... referrer Σ0..1Reference(Practitioner)Referring physician
... interpreter Σ0..*Reference(Practitioner)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedureReference Σ0..*Reference(Procedure)The performed Procedure reference
... procedureCode Σ0..*CodeableConceptThe performed procedure code
Procedure Codes (SNOMED CT) (Example)
... reason Σ0..1CodeableConceptWhy the study was requested
Procedure Reason Codes (Example)
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... uid Σ1..1oidFormal DICOM identifier for this series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
Acquisition Modality Codes (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*Reference(Practitioner)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... uid 1..1oidFormal DICOM identifier for this instance
..... number 0..1unsignedIntThe number of this instance in the series
..... sopClass 1..1oidDICOM class type
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Formal identifier for the studyuid : oid [1..1]Accession Number is an identifier related to some aspect of imaging workflow and data management. Usage may vary across different institutions. See for instance [IHE Radiology Technical Framework Volume 1 Appendix A](http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Rev13.0_Vol1_FT_2014-07-30.pdf)accession : Identifier [0..1]Other identifiers for the studyidentifier : Identifier [0..*]Availability of study (online, offline, or nearline)availability : code [0..1] Availability of the resource (Strength=Required)InstanceAvailability! A list of all the Series.ImageModality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modalityList : Coding [0..*] Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + The patient imaged in the studypatient : Reference [1..1] Patient The encounter or episode at which the request is initiatedcontext : Reference [0..1] Encounter|EpisodeOfCare 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..*] ReferralRequest|CarePlan| ProcedureRequest The requesting/referring physicianreferrer : Reference [0..1] Practitioner Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] Practitioner 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.typeendpoint : 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]A reference to the performed ProcedureprocedureReference : Reference [0..*] Procedure The code for the performed procedure typeprocedureCode : CodeableConcept [0..*] The performed procedure type (Strength=Example)Procedure Codes (SNOMED CT)?? Description of clinical condition indicating why the ImagingStudy was requestedreason : CodeableConcept [0..1] The reason for the study (Strength=Example)Procedure Reason ?? Institution-generated description or classification of the Study performeddescription : string [0..1]SeriesFormal identifier for this seriesuid : oid [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + 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]Availability of series (online, offline or nearline)availability : code [0..1] Availability of the resource (Strength=Required)InstanceAvailability! 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.typeendpoint : 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] Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMED CT Body Structures?? 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] Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? The date and time the series was startedstarted : dateTime [0..1]The physician or operator (often the radiology technician) who performed the series. The performer is recorded at the series level, since each series in a study may be performed by a different practitioner, at different times, and using different devices. A series may be performed by multiple practitionersperformer : Reference [0..*] Practitioner InstanceFormal identifier for this image or other contentuid : oid [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : oid [1..1]The description of the instancetitle : string [0..1]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 -->
 <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner) 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 -->
 <procedureReference><!-- 0..* Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code --></procedureCode>
 <reason><!-- 0..1 CodeableConcept Why the study was requested --></reason>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the 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 -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer><!-- 0..* Reference(Practitioner) Who performed the series --></performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this instance -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <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
  "uid" : "<oid>", // R!  Formal DICOM identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedureReference" : [{ Reference(Procedure) }], // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code
  "reason" : { CodeableConcept }, // Why the study was requested
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<oid>", // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "performer" : [{ Reference(Practitioner) }], // Who performed the series
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<oid>", // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : "<oid>", // R!  DICOM class type
      "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.uid [ oid ]; # 1..1 Formal DICOM identifier for the study
  fhir:ImagingStudy.accession [ Identifier ]; # 0..1 Related workflow identifier ("Accession Number")
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Other identifiers for the study
  fhir:ImagingStudy.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  fhir:ImagingStudy.modalityList [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.patient [ Reference(Patient) ]; # 1..1 Who the images are of
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ], ... ; # 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.procedureReference [ Reference(Procedure) ], ... ; # 0..* The performed Procedure reference
  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:ImagingStudy.reason [ CodeableConcept ]; # 0..1 Why the study was requested
  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 [ oid ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the 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.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    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.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ Reference(Practitioner) ], ... ; # 0..* Who performed the series
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ oid ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ oid ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2

ImagingStudy
ImagingStudy.context
  • Renamed from order to context
  • Max Cardinality changed from * to 1
  • Remove Reference(DiagnosticOrder), Add Reference(Encounter), Add Reference(EpisodeOfCare)
ImagingStudy.basedOn
  • Added Element
ImagingStudy.interpreter
  • Max Cardinality changed from 1 to *
ImagingStudy.endpoint
  • Added Element
ImagingStudy.numberOfSeries
  • Min Cardinality changed from 1 to 0
ImagingStudy.numberOfInstances
  • Min Cardinality changed from 1 to 0
ImagingStudy.procedureReference
  • Renamed from procedure to procedureReference
ImagingStudy.procedureCode
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.numberOfInstances
  • Min Cardinality changed from 1 to 0
ImagingStudy.series.endpoint
  • Added Element
ImagingStudy.series.performer
  • Added Element
ImagingStudy.url
  • deleted
ImagingStudy.series.url
  • deleted
ImagingStudy.series.instance.type
  • deleted
ImagingStudy.series.instance.content
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 1 r3 resources are invalid (2 errors).).

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy DomainResourceA 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
... uid Σ1..1oidFormal DICOM identifier for the study
... accession Σ0..1IdentifierRelated workflow identifier ("Accession Number")
... identifier Σ0..*IdentifierOther identifiers for the study
... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
... modalityList Σ0..*CodingAll series modality if actual acquisition modalities
Acquisition Modality Codes (Extensible)
... patient Σ1..1Reference(Patient)Who the images are of
... context Σ0..1Reference(Encounter | EpisodeOfCare)Originating context
... started Σ0..1dateTimeWhen the study was started
... basedOn Σ0..*Reference(ReferralRequest | CarePlan | ProcedureRequest)Request fulfilled
... referrer Σ0..1Reference(Practitioner)Referring physician
... interpreter Σ0..*Reference(Practitioner)Who interpreted images
... endpoint Σ0..*Reference(Endpoint)Study access endpoint
... numberOfSeries Σ0..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ0..1unsignedIntNumber of Study Related Instances
... procedureReference Σ0..*Reference(Procedure)The performed Procedure reference
... procedureCode Σ0..*CodeableConceptThe performed procedure code
Procedure Codes (SNOMED CT) (Example)
... reason Σ0..1CodeableConceptWhy the study was requested
Procedure Reason Codes (Example)
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... uid Σ1..1oidFormal DICOM identifier for this series
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
Acquisition Modality Codes (Extensible)
.... description Σ0..1stringA short human readable summary of the series
.... numberOfInstances Σ0..1unsignedIntNumber of Series Related Instances
.... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
.... endpoint Σ0..*Reference(Endpoint)Series access endpoint
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... started Σ0..1dateTimeWhen the series started
.... performer Σ0..*Reference(Practitioner)Who performed the series
.... instance 0..*BackboneElementA single SOP instance from the series
..... uid 1..1oidFormal DICOM identifier for this instance
..... number 0..1unsignedIntThe number of this instance in the series
..... sopClass 1..1oidDICOM class type
..... title 0..1stringDescription of instance

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Formal identifier for the studyuid : oid [1..1]Accession Number is an identifier related to some aspect of imaging workflow and data management. Usage may vary across different institutions. See for instance [IHE Radiology Technical Framework Volume 1 Appendix A](http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Rev13.0_Vol1_FT_2014-07-30.pdf)accession : Identifier [0..1]Other identifiers for the studyidentifier : Identifier [0..*]Availability of study (online, offline, or nearline)availability : code [0..1] Availability of the resource (Strength=Required)InstanceAvailability! A list of all the Series.ImageModality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modalityList : Coding [0..*] Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + The patient imaged in the studypatient : Reference [1..1] Patient The encounter or episode at which the request is initiatedcontext : Reference [0..1] Encounter|EpisodeOfCare 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..*] ReferralRequest|CarePlan| ProcedureRequest The requesting/referring physicianreferrer : Reference [0..1] Practitioner Who read the study and interpreted the images or other contentinterpreter : Reference [0..*] Practitioner 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.typeendpoint : 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]A reference to the performed ProcedureprocedureReference : Reference [0..*] Procedure The code for the performed procedure typeprocedureCode : CodeableConcept [0..*] The performed procedure type (Strength=Example)Procedure Codes (SNOMED CT)?? Description of clinical condition indicating why the ImagingStudy was requestedreason : CodeableConcept [0..1] The reason for the study (Strength=Example)Procedure Reason ?? Institution-generated description or classification of the Study performeddescription : string [0..1]SeriesFormal identifier for this seriesuid : oid [1..1]The numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + 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]Availability of series (online, offline or nearline)availability : code [0..1] Availability of the resource (Strength=Required)InstanceAvailability! 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.typeendpoint : 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] Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMED CT Body Structures?? 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] Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? The date and time the series was startedstarted : dateTime [0..1]The physician or operator (often the radiology technician) who performed the series. The performer is recorded at the series level, since each series in a study may be performed by a different practitioner, at different times, and using different devices. A series may be performed by multiple practitionersperformer : Reference [0..*] Practitioner InstanceFormal identifier for this image or other contentuid : oid [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : oid [1..1]The description of the instancetitle : string [0..1]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 -->
 <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|ProcedureRequest) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..* Reference(Practitioner) 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 -->
 <procedureReference><!-- 0..* Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code --></procedureCode>
 <reason><!-- 0..1 CodeableConcept Why the study was requested --></reason>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the 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 -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <performer><!-- 0..* Reference(Practitioner) Who performed the series --></performer>
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this instance -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <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
  "uid" : "<oid>", // R!  Formal DICOM identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|ProcedureRequest) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : [{ Reference(Practitioner) }], // Who interpreted images
  "endpoint" : [{ Reference(Endpoint) }], // Study access endpoint
  "numberOfSeries" : "<unsignedInt>", // Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // Number of Study Related Instances
  "procedureReference" : [{ Reference(Procedure) }], // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code
  "reason" : { CodeableConcept }, // Why the study was requested
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<oid>", // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "performer" : [{ Reference(Practitioner) }], // Who performed the series
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<oid>", // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : "<oid>", // R!  DICOM class type
      "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.uid [ oid ]; # 1..1 Formal DICOM identifier for the study
  fhir:ImagingStudy.accession [ Identifier ]; # 0..1 Related workflow identifier ("Accession Number")
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Other identifiers for the study
  fhir:ImagingStudy.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  fhir:ImagingStudy.modalityList [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.patient [ Reference(Patient) ]; # 1..1 Who the images are of
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(ReferralRequest|CarePlan|ProcedureRequest) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ], ... ; # 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.procedureReference [ Reference(Procedure) ], ... ; # 0..* The performed Procedure reference
  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:ImagingStudy.reason [ CodeableConcept ]; # 0..1 Why the study was requested
  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 [ oid ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the 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.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    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.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.performer [ Reference(Practitioner) ], ... ; # 0..* Who performed the series
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ oid ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ oid ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2

ImagingStudy
ImagingStudy.context
  • Renamed from order to context
  • Max Cardinality changed from * to 1
  • Remove Reference(DiagnosticOrder), Add Reference(Encounter), Add Reference(EpisodeOfCare)
ImagingStudy.basedOn
  • Added Element
ImagingStudy.interpreter
  • Max Cardinality changed from 1 to *
ImagingStudy.endpoint
  • Added Element
ImagingStudy.numberOfSeries
  • Min Cardinality changed from 1 to 0
ImagingStudy.numberOfInstances
  • Min Cardinality changed from 1 to 0
ImagingStudy.procedureReference
  • Renamed from procedure to procedureReference
ImagingStudy.procedureCode
  • Added Element
ImagingStudy.reason
  • Added Element
ImagingStudy.series.numberOfInstances
  • Min Cardinality changed from 1 to 0
ImagingStudy.series.endpoint
  • Added Element
ImagingStudy.series.performer
  • Added Element
ImagingStudy.url
  • deleted
ImagingStudy.series.url
  • deleted
ImagingStudy.series.instance.type
  • deleted
ImagingStudy.series.instance.content
  • deleted

See the Full Difference for further information

This analysis is available as XML or JSON.

See R2 <--> R3 Conversion Maps (status = 2 tests that all execute ok. 2 fail round-trip testing and 1 r3 resources are invalid (2 errors).).

 

Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)

PathDefinitionTypeReference
ImagingStudy.availability
ImagingStudy.series.availability
Availability of the resourceRequiredInstanceAvailability
ImagingStudy.modalityList
ImagingStudy.series.modality
Type of acquired data in the instanceExtensibleAcquisition Modality Codes
ImagingStudy.procedureCode The performed procedure typeExampleProcedure Codes (SNOMED CT)
ImagingStudy.reason The reason for the studyExampleProcedure Reason Codes
ImagingStudy.series.bodySite Codes describing anatomical locations. May include laterality.ExampleSNOMED CT Body Structures
ImagingStudy.series.laterality Codes describing body site laterality (left, right, etc.).ExampleLaterality

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.

UID values follow the FHIR convention of expressing UIDs as URNs. For example, the DICOM Study Instance UID of 1.2.250.1.59.40211.12345678.678910 is expressed as “urn:oid:1.2.250.1.59.40211.12345678.678910”.

The ImagingManifest.study.endpoint elements and ImagingManifest.study.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 ImagingManifest.study.series.endpoint of a particular Endpoint.connectionType provides that service for that series, and all contained instances. An ImagingManifest.study.endpoint of a particularconnection 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 ImagingManifest.study.series.endpoint overrides a ImagingManifest.study.endpoint of the same connection type. (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.url may require manipulation. For the details on use of imaging-related Endpoint connection types, See below for details.

An Endpoint.connectionType of code dicom-wado-rsi, system http://hl7.org/fhir/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, a native DICOM PS3.10 instance file can be retrieved (if consistent with the Accept header) by performing a GET on a URL constructed from a Endpoint.address of “https://pacs.hospital.org/wado-rs”, the study.uid value of “urn:oid:1.2.250.1.59.40211.12345678.678910”, study.series.uid value of “urn:oid:1.2.250.1.59.40211.789001276.14556172.67789”, and study.series.instance.uid value of “urn:oid:1.2.250.1.59.40211.2678810.87991027.899772.2”:


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 thumbnail (100 columns by 100 rows) of a region extending from the top-left corner of the original image, across 1000 and down 3000 pixels, 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=100,100,0,0,1000,3000

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://hl7.org/fhir/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 quetstion 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.url.

For example, a native DICOM PS3.10 instance file can be retrieved (if consistent with the Accept header) by performing a GET on a URL constructed from a Endpoint.address.url of “https://pacs.hospital.org/wado-uri”, the study.uid value of “urn:oid:1.2.250.1.59.40211.12345678.678910”, study.series.uid value of “urn:oid:1.2.250.1.59.40211.789001276.14556172.67789”, and study.series.instance.uid value of “urn:oid:1.2.250.1.59.40211.2678810.87991027.899772.2”:


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://hl7.org/fhir/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 the 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, given an Endpoint.address of https://pacs.hospital.org/IHEInvokeImageDisplay, to invoke a diagnostic quality viewer on the study with study.uid value of “urn:uri:1.2.250.1.59.40211.12345678.678910”, the following URL would be constructed:


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 .

Amy, a family physician, would like to see a list of available studies for her patient, Alex. 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 ProcedureRequest 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 ProcedureRequest. (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 ProcedureRequest 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 ImagingManifest 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 ImagingManifest 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 a manifest of the study as an ImagingManifest 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 manifest 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 manifest ImagingManifest, and uses it to access the shared images, which she uses to prepare for the cath procedure.

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

NameTypeDescriptionExpressionIn Common
accessiontokenThe accession identifier for the studyImagingStudy.accession
basedonreferenceThe order for the imageImagingStudy.basedOn
(ReferralRequest, CarePlan, ProcedureRequest)
bodysitetokenThe body site studiedImagingStudy.series.bodySite
contextreferenceThe context of the studyImagingStudy.context
(EpisodeOfCare, Encounter)
dicom-classuriThe type of the instanceImagingStudy.series.instance.sopClass
endpointreferenceThe endpoint for te study or seriesImagingStudy.endpoint | ImagingStudy.series.endpoint
(Endpoint)
identifiertokenOther identifiers for the StudyImagingStudy.identifier26 Resources
modalitytokenThe modality of the seriesImagingStudy.series.modality
patientreferenceWho the study is aboutImagingStudy.patient
(Patient)
31 Resources
performerreferenceThe person who performed the studyImagingStudy.series.performer
(Practitioner)
reasontokenThe reason for the studyImagingStudy.reason
seriesuriThe identifier of the series of imagesImagingStudy.series.uid
starteddateWhen the study was startedImagingStudy.started
studyuriThe study identifier for the imageImagingStudy.uid
uiduriThe instance unique identifierImagingStudy.series.instance.uid