Release 4 Current Build
This page is part of the FHIR Specification (v4.0.1: R4 - Mixed Normative and STU ). This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

10.4 Resource ImagingStudy - Content

Imaging Integration Work Group Maturity Level : 3   Trial Use Security 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 Media 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 , ClinicalImpression , DiagnosticReport and Observation .

This resource implements the Event pattern.

Structure

Name Flags Card. Type Description & Constraints doco
. . ImagingStudy TU DomainResource A 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 Σ 0..* Identifier Identifiers for the whole study
. . . status ?! Σ 1..1 code registered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus ( Required )
. . . modality Σ 0..* Coding All series modality if actual acquisition of the distinct values for series' modalities
AcquisitionModality ImagingModality ( Extensible )
. . . subject Σ 1..1 Reference ( Patient | Device | Group ) Who or what is the subject of the study
. . . encounter Σ 0..1 Reference ( Encounter ) Encounter with which this imaging study is associated
. . . started Σ 0..1 dateTime When the study was started
. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task ) Request fulfilled
. . . referrer Σ 0..1 Reference ( Practitioner | PractitionerRole ) Referring physician
. . . interpreter Σ 0..* Reference ( Practitioner | PractitionerRole ) Who interpreted images
. . . endpoint Σ 0..* Reference ( Endpoint ) Study access endpoint
. . . numberOfSeries Σ 0..1 unsignedInt Number of Study Related Series
. . . numberOfInstances Σ 0..1 unsignedInt Number of Study Related Instances
. . procedureReference . procedure Σ 0..1 0..* Reference ( Procedure BackboneElement ) The performed Procedure reference procedure or code
. . procedureCode . . value[x] Σ 0..* 1..1 CodeableConcept The performed procedure code Procedure
ImagingProcedureCode ( Extensible )
. . . . . valueReference Reference ( Procedure )
..... valueCodeableConcept CodeableConcept
. . . location Σ 0..1 Reference ( Location ) Where ImagingStudy occurred
. . . reasonCode Σ 0..* CodeableConcept Why the study was requested
Procedure Reason Codes ( Example )
. . . reasonReference Σ 0..* Reference ( Condition | Observation | Media | DiagnosticReport | DocumentReference ) Why was study performed
. . . note Σ 0..* Annotation User-defined comments
. . . description Σ 0..1 string Institution-generated description
. . . series Σ 0..* BackboneElement Each study has one or more series of instances
. . . . uid Σ 1..1 id DICOM Series Instance UID for the series
. . . . number Σ 0..1 unsignedInt Numeric identifier of this series
. . . . modality Σ 1..1 Coding The modality of the instances in the used for this series
AcquisitionModality ImagingModality ( Extensible )
. . . . description Σ 0..1 string A short human readable summary of the series
. . . . numberOfInstances Σ 0..1 unsignedInt Number of Series Related Instances
. . . . endpoint Σ 0..* Reference ( Endpoint ) Series access endpoint
. . . . bodySite Σ 0..1 Coding Body part examined
SNOMED CT Body Structures ( Example )
. . . . laterality Σ 0..1 Coding Body part laterality
Bodysite Laterality ( Example )
. . . . specimen Σ 0..* Reference ( Specimen ) Specimen imaged
. . . . started Σ 0..1 dateTime When the series started
. . . . performer Σ 0..* BackboneElement Who performed the series
. . . . . function Σ 0..1 CodeableConcept Type of performance
ImagingStudy series performer function ( Extensible )
. . . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService ) Who performed the series
. . . . instance 0..* BackboneElement A single SOP instance from the series
. . . . . uid 1..1 id DICOM SOP Instance UID
. . . . . sopClass 1..1 Coding DICOM class type
sopClass ( Extensible )
. . . . . number 0..1 unsignedInt The number of this instance in the series
. . . . . title 0..1 string Description of instance

doco Documentation for this format

UML Diagram ( Legend )

ImagingStudy ( DomainResource ) Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number identifier : Identifier [0..*] The current state of the ImagingStudy (this element modifies the meaning of other elements) status : code [1..1] « The status of the ImagingStudy. (Strength=Required) ImagingStudyStatus ! » A list of all the series.modality distinct 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) of series.modality. This may include both aquisition and non-aquisition modalities modality : Coding [0..*] « Type of acquired data in the instance. (Strength=Extensible) AcquisitionModality ImagingModality + » The subject, typically a patient, of the imaging study subject : Reference [1..1] « Patient | Device | Group » The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made encounter : Reference [0..1] « Encounter » Date and time the study started started : dateTime [0..1] A list of the diagnostic requests that resulted in this imaging study being performed basedOn : Reference [0..*] « CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task » The requesting/referring physician referrer : Reference [0..1] « Practitioner | PractitionerRole » Who read the study and interpreted the images or other content interpreter : 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.connectionType endpoint : 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 present numberOfSeries : 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 present numberOfInstances : unsignedInt [0..1] The procedure which this ImagingStudy was part of procedureReference : Reference [0..1] « Procedure » The code for the performed procedure type procedureCode : CodeableConcept [0..*] « The performed procedure type. (Strength=Extensible) ImagingProcedureCode + » The principal physical location where the ImagingStudy was performed location : Reference [0..1] « Location » Description of clinical condition indicating why the ImagingStudy was requested reasonCode : CodeableConcept [0..*] « The reason for the study. (Strength=Example) ProcedureReasonCodes ?? » Indicates another resource whose existence justifies this Study reasonReference : Reference [0..*] « Condition | Observation | Media | DiagnosticReport | DocumentReference » Per the recommended DICOM mapping, this element is derived from the Study Description attribute (0008,1030). Observations or findings about the imaging study should be recorded in another resource, e.g. Observation, and not in this element note : Annotation [0..*] The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed description : string [0..1] Procedure The procedure which this ImagingStudy was part of value[x] : Type [1..1] « Reference ( Procedure )| CodeableConcept ; The performed procedure type. (Strength=Extensible) ImagingProcedureCode + » Series The DICOM Series Instance UID for the series uid : id [1..1] The numeric identifier of this series in the study number : unsignedInt [0..1] The distinct modality of for this series sequence series. This may include both aquisition and non-aquisition modalities modality : Coding [1..1] « Type of acquired data in the instance. (Strength=Extensible) AcquisitionModality ImagingModality + » A description of the series description : 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 present numberOfInstances : 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.connectionType endpoint : 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.laterality bodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (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.bodySite laterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example) Laterality ?? » The specimen imaged, e.g., for whole slide imaging of a biopsy specimen : Reference [0..*] « Specimen » The date and time the series was started started : dateTime [0..1] Performer Distinguishes the type of involvement of the performer in the series function : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Extensible) ImagingStudySeriesPerformerFu... + » Indicates who or what performed the series actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService » Instance The DICOM SOP Instance UID for this image or other DICOM content uid : id [1..1] DICOM instance type sopClass : Coding [1..1] « The sopClass for the instance. (Strength=Extensible) sopClass + » The number of instance in the series number : unsignedInt [0..1] The description of the instance title : string [0..1] The procedure or code from which this ImagingStudy was part of procedure [0..*] Indicates who or what performed the series and how they were involved performer [0..*] A single SOP instance within the series, e.g. an image, or presentation state instance [0..*] Each study has one or more series of images or other content series [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>
 <</subject>

 <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>

 <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 -->
 <</procedureReference>
 <</procedureCode>

 <procedure>  <!-- 0..* The performed procedure or code -->
  <value[x]><!-- 1..1 Reference(Procedure)|CodeableConcept The performed Procedure  --></value[x]>
 </procedure>

 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <|
   </reasonReference>

 <reasonReference><!-- 0..* Reference(Condition|DiagnosticReport|
   DocumentReference|Observation) Why was study performed --></reasonReference>
 <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>

  <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>

   <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>

   <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" : [{ // The performed procedure or code
    // value[x]: The performed Procedure. One of these 2:
    "valueReference" : { Reference(Procedure) }
    "valueCodeableConcept" : { CodeableConcept }
  }],

  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "|
   

  "reasonReference" : [{ Reference(Condition|DiagnosticReport|
   DocumentReference|Observation) }], // Why was study 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:
  fhir:

  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:

  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:
  fhir:

  fhir:ImagingStudy.procedure [ # 0..* The performed procedure or code
    # ImagingStudy.procedure.value[x] : 1..1 The performed Procedure. One of these 2
      fhir:ImagingStudy.procedure.valueReference [ Reference(Procedure) ]
      fhir:ImagingStudy.procedure.valueCodeableConcept [ CodeableConcept ]
  ], ...;

  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reasonCode [ CodeableConcept ], ... ; # 0..* Why the study was requested
  fhir:

  fhir:ImagingStudy.reasonReference [ Reference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Why was study 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:

    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:

      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
  • Added Mandatory Element ImagingStudy.modality Renamed from modalityList to modality Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html ImagingStudy.subject Renamed from patient http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 to subject Type Reference: Added Target Types Device, Group ImagingStudy.encounter Added Element ImagingStudy.basedOn Type Reference: Added Target Types ServiceRequest, Appointment, AppointmentResponse, Task Type Reference: Removed Target Types ReferralRequest, ProcedureRequest ImagingStudy.referrer Type Reference: Added Target Type PractitionerRole ImagingStudy.interpreter Type Reference: Added Target Type PractitionerRole http://hl7.org/fhir/ValueSet/imagingstudy-status|4.1.0
ImagingStudy.procedureReference ImagingStudy.modality
  • Max Cardinality changed Change value set from * http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to 1 ImagingStudy.procedureCode Add Binding http://www.rsna.org/RadLex_Playbook.aspx (extensible) ImagingStudy.location Added Element ImagingStudy.reasonCode Added Element http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.reasonReference ImagingStudy.procedure
  • Added Element
ImagingStudy.note ImagingStudy.procedure.value[x]
  • Added Mandatory Element
ImagingStudy.series.uid ImagingStudy.reasonReference
  • Type changed from oid to id Reference: Removed Target Type Media
ImagingStudy.series.modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html ImagingStudy.series.specimen Added Element ImagingStudy.series.performer Type changed from Reference(Practitioner) to BackboneElement ImagingStudy.series.performer.function Added Element ImagingStudy.series.performer.actor Added Mandatory Element http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.series.instance.uid ImagingStudy.series.performer.actor
  • Type changed from oid to id ImagingStudy.series.instance.sopClass Reference: Added Target Type changed from oid to Coding Add Binding http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 (extensible) ImagingStudy.uid deleted ImagingStudy.accession deleted ImagingStudy.availability deleted ImagingStudy.context deleted HealthcareService
ImagingStudy.reason ImagingStudy.procedureReference
  • deleted
ImagingStudy.series.availability ImagingStudy.procedureCode
  • 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

Name Flags Card. Type Description & Constraints doco
. . ImagingStudy TU DomainResource A 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 Σ 0..* Identifier Identifiers for the whole study
. . . status ?! Σ 1..1 code registered | available | cancelled | entered-in-error | unknown
ImagingStudyStatus ( Required )
. . . modality Σ 0..* Coding All series modality if actual acquisition of the distinct values for series' modalities
AcquisitionModality ImagingModality ( Extensible )
. . . subject Σ 1..1 Reference ( Patient | Device | Group ) Who or what is the subject of the study
. . . encounter Σ 0..1 Reference ( Encounter ) Encounter with which this imaging study is associated
. . . started Σ 0..1 dateTime When the study was started
. . . basedOn Σ 0..* Reference ( CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task ) Request fulfilled
. . . referrer Σ 0..1 Reference ( Practitioner | PractitionerRole ) Referring physician
. . . interpreter Σ 0..* Reference ( Practitioner | PractitionerRole ) Who interpreted images
. . . endpoint Σ 0..* Reference ( Endpoint ) Study access endpoint
. . . numberOfSeries Σ 0..1 unsignedInt Number of Study Related Series
. . . numberOfInstances Σ 0..1 unsignedInt Number of Study Related Instances
. . procedureReference . procedure Σ 0..1 0..* Reference ( Procedure BackboneElement ) The performed Procedure reference procedure or code
. . procedureCode . . value[x] Σ 0..* 1..1 CodeableConcept The performed procedure code Procedure
ImagingProcedureCode ( Extensible )
. . . . . valueReference Reference ( Procedure )
..... valueCodeableConcept CodeableConcept
. . . location Σ 0..1 Reference ( Location ) Where ImagingStudy occurred
. . . reasonCode Σ 0..* CodeableConcept Why the study was requested
Procedure Reason Codes ( Example )
. . . reasonReference Σ 0..* Reference ( Condition | Observation | Media | DiagnosticReport | DocumentReference ) Why was study performed
. . . note Σ 0..* Annotation User-defined comments
. . . description Σ 0..1 string Institution-generated description
. . . series Σ 0..* BackboneElement Each study has one or more series of instances
. . . . uid Σ 1..1 id DICOM Series Instance UID for the series
. . . . number Σ 0..1 unsignedInt Numeric identifier of this series
. . . . modality Σ 1..1 Coding The modality of the instances in the used for this series
AcquisitionModality ImagingModality ( Extensible )
. . . . description Σ 0..1 string A short human readable summary of the series
. . . . numberOfInstances Σ 0..1 unsignedInt Number of Series Related Instances
. . . . endpoint Σ 0..* Reference ( Endpoint ) Series access endpoint
. . . . bodySite Σ 0..1 Coding Body part examined
SNOMED CT Body Structures ( Example )
. . . . laterality Σ 0..1 Coding Body part laterality
Bodysite Laterality ( Example )
. . . . specimen Σ 0..* Reference ( Specimen ) Specimen imaged
. . . . started Σ 0..1 dateTime When the series started
. . . . performer Σ 0..* BackboneElement Who performed the series
. . . . . function Σ 0..1 CodeableConcept Type of performance
ImagingStudy series performer function ( Extensible )
. . . . . actor Σ 1..1 Reference ( Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService ) Who performed the series
. . . . instance 0..* BackboneElement A single SOP instance from the series
. . . . . uid 1..1 id DICOM SOP Instance UID
. . . . . sopClass 1..1 Coding DICOM class type
sopClass ( Extensible )
. . . . . number 0..1 unsignedInt The number of this instance in the series
. . . . . title 0..1 string Description of instance

doco Documentation for this format

UML Diagram ( Legend )

ImagingStudy ( DomainResource ) Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number identifier : Identifier [0..*] The current state of the ImagingStudy (this element modifies the meaning of other elements) status : code [1..1] « The status of the ImagingStudy. (Strength=Required) ImagingStudyStatus ! » A list of all the series.modality distinct 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) of series.modality. This may include both aquisition and non-aquisition modalities modality : Coding [0..*] « Type of acquired data in the instance. (Strength=Extensible) AcquisitionModality ImagingModality + » The subject, typically a patient, of the imaging study subject : Reference [1..1] « Patient | Device | Group » The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made encounter : Reference [0..1] « Encounter » Date and time the study started started : dateTime [0..1] A list of the diagnostic requests that resulted in this imaging study being performed basedOn : Reference [0..*] « CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task » The requesting/referring physician referrer : Reference [0..1] « Practitioner | PractitionerRole » Who read the study and interpreted the images or other content interpreter : 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.connectionType endpoint : 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 present numberOfSeries : 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 present numberOfInstances : unsignedInt [0..1] The procedure which this ImagingStudy was part of procedureReference : Reference [0..1] « Procedure » The code for the performed procedure type procedureCode : CodeableConcept [0..*] « The performed procedure type. (Strength=Extensible) ImagingProcedureCode + » The principal physical location where the ImagingStudy was performed location : Reference [0..1] « Location » Description of clinical condition indicating why the ImagingStudy was requested reasonCode : CodeableConcept [0..*] « The reason for the study. (Strength=Example) ProcedureReasonCodes ?? » Indicates another resource whose existence justifies this Study reasonReference : Reference [0..*] « Condition | Observation | Media | DiagnosticReport | DocumentReference » Per the recommended DICOM mapping, this element is derived from the Study Description attribute (0008,1030). Observations or findings about the imaging study should be recorded in another resource, e.g. Observation, and not in this element note : Annotation [0..*] The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed description : string [0..1] Procedure The procedure which this ImagingStudy was part of value[x] : Type [1..1] « Reference ( Procedure )| CodeableConcept ; The performed procedure type. (Strength=Extensible) ImagingProcedureCode + » Series The DICOM Series Instance UID for the series uid : id [1..1] The numeric identifier of this series in the study number : unsignedInt [0..1] The distinct modality of for this series sequence series. This may include both aquisition and non-aquisition modalities modality : Coding [1..1] « Type of acquired data in the instance. (Strength=Extensible) AcquisitionModality ImagingModality + » A description of the series description : 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 present numberOfInstances : 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.connectionType endpoint : 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.laterality bodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (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.bodySite laterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example) Laterality ?? » The specimen imaged, e.g., for whole slide imaging of a biopsy specimen : Reference [0..*] « Specimen » The date and time the series was started started : dateTime [0..1] Performer Distinguishes the type of involvement of the performer in the series function : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Extensible) ImagingStudySeriesPerformerFu... + » Indicates who or what performed the series actor : Reference [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson | HealthcareService » Instance The DICOM SOP Instance UID for this image or other DICOM content uid : id [1..1] DICOM instance type sopClass : Coding [1..1] « The sopClass for the instance. (Strength=Extensible) sopClass + » The number of instance in the series number : unsignedInt [0..1] The description of the instance title : string [0..1] The procedure or code from which this ImagingStudy was part of procedure [0..*] Indicates who or what performed the series and how they were involved performer [0..*] A single SOP instance within the series, e.g. an image, or presentation state instance [0..*] Each study has one or more series of images or other content series [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>
 <</subject>

 <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>

 <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 -->
 <</procedureReference>
 <</procedureCode>

 <procedure>  <!-- 0..* The performed procedure or code -->
  <value[x]><!-- 1..1 Reference(Procedure)|CodeableConcept The performed Procedure  --></value[x]>
 </procedure>

 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <|
   </reasonReference>

 <reasonReference><!-- 0..* Reference(Condition|DiagnosticReport|
   DocumentReference|Observation) Why was study performed --></reasonReference>
 <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>

  <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>

   <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>

   <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" : [{ // The performed procedure or code
    // value[x]: The performed Procedure. One of these 2:
    "valueReference" : { Reference(Procedure) }
    "valueCodeableConcept" : { CodeableConcept }
  }],

  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "|
   

  "reasonReference" : [{ Reference(Condition|DiagnosticReport|
   DocumentReference|Observation) }], // Why was study 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:
  fhir:

  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:

  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:
  fhir:

  fhir:ImagingStudy.procedure [ # 0..* The performed procedure or code
    # ImagingStudy.procedure.value[x] : 1..1 The performed Procedure. One of these 2
      fhir:ImagingStudy.procedure.valueReference [ Reference(Procedure) ]
      fhir:ImagingStudy.procedure.valueCodeableConcept [ CodeableConcept ]
  ], ...;

  fhir:ImagingStudy.location [ Reference(Location) ]; # 0..1 Where ImagingStudy occurred
  fhir:ImagingStudy.reasonCode [ CodeableConcept ], ... ; # 0..* Why the study was requested
  fhir:

  fhir:ImagingStudy.reasonReference [ Reference(Condition|DiagnosticReport|DocumentReference|Observation) ], ... ; # 0..* Why was study 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:

    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:

      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
  • Added Mandatory Element ImagingStudy.modality Renamed from modalityList to modality Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html ImagingStudy.subject Renamed from patient http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 to subject Type Reference: Added Target Types Device, Group ImagingStudy.encounter Added Element ImagingStudy.basedOn Type Reference: Added Target Types ServiceRequest, Appointment, AppointmentResponse, Task Type Reference: Removed Target Types ReferralRequest, ProcedureRequest ImagingStudy.referrer Type Reference: Added Target Type PractitionerRole ImagingStudy.interpreter Type Reference: Added Target Type PractitionerRole http://hl7.org/fhir/ValueSet/imagingstudy-status|4.1.0
ImagingStudy.procedureReference ImagingStudy.modality
  • Max Cardinality changed Change value set from * http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html to 1 ImagingStudy.procedureCode Add Binding http://www.rsna.org/RadLex_Playbook.aspx (extensible) ImagingStudy.location Added Element ImagingStudy.reasonCode Added Element http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.reasonReference ImagingStudy.procedure
  • Added Element
ImagingStudy.note ImagingStudy.procedure.value[x]
  • Added Mandatory Element
ImagingStudy.series.uid ImagingStudy.reasonReference
  • Type changed from oid to id Reference: Removed Target Type Media
ImagingStudy.series.modality
  • Change value set from http://hl7.org/fhir/ValueSet/dicom-cid29 to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html ImagingStudy.series.specimen Added Element ImagingStudy.series.performer Type changed from Reference(Practitioner) to BackboneElement ImagingStudy.series.performer.function Added Element ImagingStudy.series.performer.actor Added Mandatory Element http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.series.instance.uid ImagingStudy.series.performer.actor
  • Type changed from oid to id ImagingStudy.series.instance.sopClass Reference: Added Target Type changed from oid to Coding Add Binding http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 (extensible) ImagingStudy.uid deleted ImagingStudy.accession deleted ImagingStudy.availability deleted ImagingStudy.context deleted HealthcareService
ImagingStudy.reason ImagingStudy.procedureReference
  • deleted
ImagingStudy.series.availability ImagingStudy.procedureCode
  • 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

Path Definition Type Reference
ImagingStudy.status The status of the ImagingStudy. Required ImagingStudyStatus
ImagingStudy.modality
ImagingStudy.series.modality
Type of acquired data in the instance. Extensible AcquisitionModality http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
ImagingStudy.procedureCode ImagingStudy.procedure.value[x] The performed procedure type. Extensible http://www.rsna.org/RadLex_Playbook.aspx http://loinc.org/download/loincrsna-radiology-playbook-file/
ImagingStudy.reasonCode The reason for the study. Example ProcedureReasonCodes
ImagingStudy.series.bodySite Codes describing anatomical locations. May include laterality. Example SNOMEDCTBodyStructures
ImagingStudy.series.laterality Codes describing body site laterality (left, right, etc.). Example Laterality
ImagingStudy.series.performer.function The type of involvement of the performer. Extensible ImagingStudySeriesPerformerFunction
ImagingStudy.series.instance.sopClass The sopClass for the instance. Extensible http://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 Identifier using the “ACSN” identifier type, as follows:

  "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 thumbnail (100 (rendered to a size of 400 columns by 100 400 rows) of a region extending from the top-left corner of the original image, across image to 1000 pixels across and down 3000 pixels, 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

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 .

10.4.3.2.2

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 .

10.4.3.2.3

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 .

10.4.3.3 10.4.3.3.1

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 .

10.4.3.3.2

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.

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

Name Type Description Expression In Common
basedon reference The order for the image ImagingStudy.basedOn
( Appointment , AppointmentResponse , CarePlan , Task , ServiceRequest )
bodysite token The body site studied ImagingStudy.series.bodySite
dicom-class token The type of the instance ImagingStudy.series.instance.sopClass
encounter reference The context of the study ImagingStudy.encounter
( Encounter )
endpoint reference The endpoint for the study or series ImagingStudy.endpoint | ImagingStudy.series.endpoint
( Endpoint )
identifier token Identifiers for the Study, such as DICOM Study Instance UID and Accession number ImagingStudy.identifier 30 Resources
instance token SOP Instance UID for an instance ImagingStudy.series.instance.uid
interpreter reference Who interpreted the images ImagingStudy.interpreter
( Practitioner , PractitionerRole )
modality token The modality of the series ImagingStudy.series.modality
patient reference Who the study is about ImagingStudy.subject.where(resolve() is Patient)
( Patient )
33 Resources
performer reference The person who performed the study ImagingStudy.series.performer.actor
( Practitioner , Organization , CareTeam , Device , Patient , HealthcareService , PractitionerRole , RelatedPerson )
reason token The reason for the study ImagingStudy.reasonCode
referrer reference The referring physician ImagingStudy.referrer
( Practitioner , PractitionerRole )
series token DICOM Series Instance UID for a series ImagingStudy.series.uid
started date When the study was started ImagingStudy.started
status token The status of the study ImagingStudy.status
subject reference Who the study is about ImagingStudy.subject
( Group , Device , Patient )