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10.3 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, 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 An ImagingStudy SHALL reference one ImagingStudy. In many cases, only DICOM Study, and MAY reference a subset of that Study. More than one ImagingStudy will MAY reference a particular the same DICOM study, but this is not required. Study or different subsets of the same DICOM Study.

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 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
. . uid Σ 1..1 oid Formal DICOM identifier for the study accession Σ 0..1 Identifier Related workflow identifier ("Accession Number") . identifier Σ 0..* Identifier Other identifiers Identifiers for the whole study
. . . availability status ?! Σ 0..1 1..1 code ONLINE registered | OFFLINE available | NEARLINE cancelled | UNAVAILABLE entered-in-error | unknown
InstanceAvailability ImagingStudyStatus ( Required )
. . . modalityList modality Σ 0..* Coding All series modality if actual acquisition modalities
Acquisition Modality Codes AcquisitionModality ( Extensible )
. . . patient subject Σ 1..1 Reference ( Patient | Device | Group ) Who or what is the images are subject of the study
. . . context encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Originating context Encounter with which this imaging study is associated
. . . started Σ 0..1 dateTime When the study was started
. . . basedOn Σ 0..* Reference ( ReferralRequest | CarePlan | ProcedureRequest 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 Σ 0..* 0..1 Reference ( Procedure ) The performed Procedure reference
. . . procedureCode Σ 0..* CodeableConcept The performed procedure code
Procedure Codes (SNOMED CT) ImagingProcedureCode ( Example Extensible )
. . reason . 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 oid id Formal DICOM identifier Series Instance UID for this the series
. . . . number Σ 0..1 unsignedInt Numeric identifier of this series
. . . . modality Σ 1..1 Coding The modality of the instances in the series
Acquisition Modality Codes AcquisitionModality ( Extensible )
. . . . description Σ 0..1 string A short human readable summary of the series
. . . . numberOfInstances Σ 0..1 unsignedInt Number of Series Related Instances
. . . availability Σ 0..1 code ONLINE | OFFLINE | NEARLINE | UNAVAILABLE InstanceAvailability ( Required ) . 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
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 ) Who performed the series
. . . . instance 0..* BackboneElement A single SOP instance from the series
. . . . . uid 1..1 oid id Formal DICOM identifier for this instance SOP Instance UID
. . . . number . sopClass 0..1 1..1 unsignedInt Coding The number of this instance in the series DICOM class type
sopClass ( Extensible )
. . . . . sopClass number 1..1 0..1 oid unsignedInt DICOM class type 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 ) Formal identifier Identifiers for the study uid : oid [1..1] ImagingStudy such as DICOM Study Instance UID, and 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 study identifier : Identifier [0..*] Availability The current state of study (online, offline, or nearline) the ImagingStudy (this element modifies the meaning of other elements) availability status : code [0..1] [1..1] « Availability The status of the resource ImagingStudy. (Strength=Required) InstanceAvailability ImagingStudyStatus ! » A list of all the Series.ImageModality series.modality 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 modality : Coding [0..*] « Type of acquired data in the instance instance. (Strength=Extensible) Acquisition Modality AcquisitionModality + » The patient imaged in subject, typically a patient, of the imaging study patient subject : Reference [1..1] « Patient | Device | Group » The encounter or episode at healthcare event (e.g. a patient and healthcare provider interaction) during which the request this ImagingStudy is initiated made context encounter : Reference [0..1] « Encounter | EpisodeOfCare » 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..*] ReferralRequest « CarePlan | CarePlan ServiceRequest | Appointment | ProcedureRequest 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.type 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] A reference to the performed Procedure The procedure which this ImagingStudy was part of procedureReference : Reference [0..*] [0..1] « Procedure » The code for the performed procedure type procedureCode : CodeableConcept [0..*] « The performed procedure type (Strength=Example) type. (Strength=Extensible) Procedure Codes (SNOMED CT) 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 reason reasonCode : CodeableConcept [0..1] [0..*] « The reason for the study study. (Strength=Example) Procedure Reason 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] Series Formal identifier The DICOM Series Instance UID for this the series uid : oid id [1..1] The numeric identifier of this series in the study number : unsignedInt [0..1] The modality of this series sequence modality : Coding [1..1] « Type of acquired data in the instance instance. (Strength=Extensible) Acquisition Modality AcquisitionModality + » 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] 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.type 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) SNOMED CT Body Structures 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 The physician or operator (often Distinguishes the radiology technician) who performed type of involvement of the series. The performer is recorded at in the series level, since each series in a study may be function : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Extensible) ImagingStudySeriesPerformerFu... + » Indicates who or what performed by a different practitioner, at different times, and using different devices. A the series may be performed by multiple practitioners performer actor : Reference [0..*] [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson » Instance Formal identifier The DICOM SOP Instance UID for this image or other DICOM content uid : oid id [1..1] The number of DICOM instance in the series type number sopClass : unsignedInt Coding [0..1] [1..1] « The sopClass for the instance. (Strength=Extensible) sopClass + » DICOM The number of instance type in the series sopClass number : oid unsignedInt [1..1] [0..1] The description of the instance title : string [0..1] 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 -->
 <
 <</accession>
 <</identifier>
 <
 <</modalityList>
 <</patient>
 <</context>

 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All series modality if actual acquisition 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>
 <</referrer>
 <</interpreter>
 <</endpoint>

 <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>
 <</reason>
 <

 <procedureReference><!-- 0..1 Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code  --></procedureCode>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|DiagnosticReport|
   DocumentReference|Media|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 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 -->
  <
  <</endpoint>

  <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>

  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
     PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>

  <instance>  <!-- 0..* A single SOP instance from the series -->
   <

   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>

   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <

   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "

  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All series modality if actual acquisition 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
  "
  "
  "
  "

  "procedureReference" : { Reference(Procedure) }, // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "reasonReference" : [{ Reference(Condition|DiagnosticReport|
   DocumentReference|Media|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 of the instances in the 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|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:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All series modality if actual acquisition 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:
  fhir:
  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:ImagingStudy.procedureReference [ Reference(Procedure) ]; # 0..1 The performed Procedure reference

  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:
  fhir:

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

    fhir:ImagingStudy.series.uid [ id ]; # 1..1 DICOM Series Instance UID for the series

    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality 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:
    fhir:

    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:

    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;

    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:

      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:

      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2 R3

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 ImagingStudy.status
  • Min Cardinality changed Change value set from 1 http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 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 http://hl7.org/fhir/ValueSet/imagingstudy-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 1 fail round-trip testing and 1 2 r3 resources are invalid (2 (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
. . uid Σ 1..1 oid Formal DICOM identifier for the study accession Σ 0..1 Identifier Related workflow identifier ("Accession Number") . identifier Σ 0..* Identifier Other identifiers Identifiers for the whole study
. . . availability status ?! Σ 0..1 1..1 code ONLINE registered | OFFLINE available | NEARLINE cancelled | UNAVAILABLE entered-in-error | unknown
InstanceAvailability ImagingStudyStatus ( Required )
. . . modalityList modality Σ 0..* Coding All series modality if actual acquisition modalities
Acquisition Modality Codes AcquisitionModality ( Extensible )
. . . patient subject Σ 1..1 Reference ( Patient | Device | Group ) Who or what is the images are subject of the study
. . . context encounter Σ 0..1 Reference ( Encounter | EpisodeOfCare ) Originating context Encounter with which this imaging study is associated
. . . started Σ 0..1 dateTime When the study was started
. . . basedOn Σ 0..* Reference ( ReferralRequest | CarePlan | ProcedureRequest 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 Σ 0..* 0..1 Reference ( Procedure ) The performed Procedure reference
. . . procedureCode Σ 0..* CodeableConcept The performed procedure code
Procedure Codes (SNOMED CT) ImagingProcedureCode ( Example Extensible )
. . reason . 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 oid id Formal DICOM identifier Series Instance UID for this the series
. . . . number Σ 0..1 unsignedInt Numeric identifier of this series
. . . . modality Σ 1..1 Coding The modality of the instances in the series
Acquisition Modality Codes AcquisitionModality ( Extensible )
. . . . description Σ 0..1 string A short human readable summary of the series
. . . . numberOfInstances Σ 0..1 unsignedInt Number of Series Related Instances
. . . availability Σ 0..1 code ONLINE | OFFLINE | NEARLINE | UNAVAILABLE InstanceAvailability ( Required ) . 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
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 ) Who performed the series
. . . . instance 0..* BackboneElement A single SOP instance from the series
. . . . . uid 1..1 oid id Formal DICOM identifier for this instance SOP Instance UID
. . . . number . sopClass 0..1 1..1 unsignedInt Coding The number of this instance in the series DICOM class type
sopClass ( Extensible )
. . . . . sopClass number 1..1 0..1 oid unsignedInt DICOM class type 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 ) Formal identifier Identifiers for the study uid : oid [1..1] ImagingStudy such as DICOM Study Instance UID, and 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 study identifier : Identifier [0..*] Availability The current state of study (online, offline, or nearline) the ImagingStudy (this element modifies the meaning of other elements) availability status : code [0..1] [1..1] « Availability The status of the resource ImagingStudy. (Strength=Required) InstanceAvailability ImagingStudyStatus ! » A list of all the Series.ImageModality series.modality 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 modality : Coding [0..*] « Type of acquired data in the instance instance. (Strength=Extensible) Acquisition Modality AcquisitionModality + » The patient imaged in subject, typically a patient, of the imaging study patient subject : Reference [1..1] « Patient | Device | Group » The encounter or episode at healthcare event (e.g. a patient and healthcare provider interaction) during which the request this ImagingStudy is initiated made context encounter : Reference [0..1] « Encounter | EpisodeOfCare » 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..*] ReferralRequest « CarePlan | CarePlan ServiceRequest | Appointment | ProcedureRequest 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.type 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] A reference to the performed Procedure The procedure which this ImagingStudy was part of procedureReference : Reference [0..*] [0..1] « Procedure » The code for the performed procedure type procedureCode : CodeableConcept [0..*] « The performed procedure type (Strength=Example) type. (Strength=Extensible) Procedure Codes (SNOMED CT) 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 reason reasonCode : CodeableConcept [0..1] [0..*] « The reason for the study study. (Strength=Example) Procedure Reason 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] Series Formal identifier The DICOM Series Instance UID for this the series uid : oid id [1..1] The numeric identifier of this series in the study number : unsignedInt [0..1] The modality of this series sequence modality : Coding [1..1] « Type of acquired data in the instance instance. (Strength=Extensible) Acquisition Modality AcquisitionModality + » 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] 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.type 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) SNOMED CT Body Structures 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 The physician or operator (often Distinguishes the radiology technician) who performed type of involvement of the series. The performer is recorded at in the series level, since each series in a study may be function : CodeableConcept [0..1] « The type of involvement of the performer. (Strength=Extensible) ImagingStudySeriesPerformerFu... + » Indicates who or what performed by a different practitioner, at different times, and using different devices. A the series may be performed by multiple practitioners performer actor : Reference [0..*] [1..1] « Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson » Instance Formal identifier The DICOM SOP Instance UID for this image or other DICOM content uid : oid id [1..1] The number of DICOM instance in the series type number sopClass : unsignedInt Coding [0..1] [1..1] « The sopClass for the instance. (Strength=Extensible) sopClass + » DICOM The number of instance type in the series sopClass number : oid unsignedInt [1..1] [0..1] The description of the instance title : string [0..1] 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 -->
 <
 <</accession>
 <</identifier>
 <
 <</modalityList>
 <</patient>
 <</context>

 <identifier><!-- 0..* Identifier Identifiers for the whole study --></identifier>
 <status value="[code]"/><!-- 1..1 registered | available | cancelled | entered-in-error | unknown -->
 <modality><!-- 0..* Coding All series modality if actual acquisition 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>
 <</referrer>
 <</interpreter>
 <</endpoint>

 <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>
 <</reason>
 <

 <procedureReference><!-- 0..1 Reference(Procedure) The performed Procedure reference --></procedureReference>
 <procedureCode><!-- 0..* CodeableConcept The performed procedure code  --></procedureCode>
 <location><!-- 0..1 Reference(Location) Where ImagingStudy occurred --></location>
 <reasonCode><!-- 0..* CodeableConcept Why the study was requested --></reasonCode>
 <reasonReference><!-- 0..* Reference(Condition|DiagnosticReport|
   DocumentReference|Media|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 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 -->
  <
  <</endpoint>

  <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>

  <performer>  <!-- 0..* Who performed the series -->
   <function><!-- 0..1 CodeableConcept Type of performance --></function>
   <actor><!-- 1..1 Reference(CareTeam|Device|Organization|Patient|Practitioner|
     PractitionerRole|RelatedPerson) Who performed the series --></actor>
  </performer>

  <instance>  <!-- 0..* A single SOP instance from the series -->
   <

   <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
   <sopClass><!-- 1..1 Coding DICOM class type  --></sopClass>

   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <

   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "
  "
  "
  "
  "
  "
  "

  "identifier" : [{ Identifier }], // Identifiers for the whole study
  "status" : "<code>", // R!  registered | available | cancelled | entered-in-error | unknown
  "modality" : [{ Coding }], // All series modality if actual acquisition 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
  "
  "
  "
  "

  "procedureReference" : { Reference(Procedure) }, // The performed Procedure reference
  "procedureCode" : [{ CodeableConcept }], // The performed procedure code 
  "location" : { Reference(Location) }, // Where ImagingStudy occurred
  "reasonCode" : [{ CodeableConcept }], // Why the study was requested
  "reasonReference" : [{ Reference(Condition|DiagnosticReport|
   DocumentReference|Media|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 of the instances in the 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|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:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:
  fhir:

  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Identifiers for the whole study
  fhir:ImagingStudy.status [ code ]; # 1..1 registered | available | cancelled | entered-in-error | unknown
  fhir:ImagingStudy.modality [ Coding ], ... ; # 0..* All series modality if actual acquisition 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:
  fhir:
  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:ImagingStudy.procedureReference [ Reference(Procedure) ]; # 0..1 The performed Procedure reference

  fhir:ImagingStudy.procedureCode [ CodeableConcept ], ... ; # 0..* The performed procedure code
  fhir:
  fhir:

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

    fhir:ImagingStudy.series.uid [ id ]; # 1..1 DICOM Series Instance UID for the series

    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality 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:
    fhir:

    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:

    fhir:ImagingStudy.series.performer [ # 0..* Who performed the series
      fhir:ImagingStudy.series.performer.function [ CodeableConcept ]; # 0..1 Type of performance
      fhir:ImagingStudy.series.performer.actor [ Reference(CareTeam|Device|Organization|Patient|Practitioner|PractitionerRole|RelatedPerson) ]; # 1..1 Who performed the series
    ], ...;

    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:

      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:

      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2 Release 3

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 ImagingStudy.status
  • Min Cardinality changed Change value set from 1 http://hl7.org/fhir/ValueSet/imagingstudy-status|4.0.0 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 http://hl7.org/fhir/ValueSet/imagingstudy-status|4.1.0

See the Full Difference for further information

This analysis is available as XML or JSON .

See R2 <--> R3 <--> R4 Conversion Maps (status = 2 tests that all execute ok. 2 1 fail round-trip testing and 1 2 r3 resources are invalid (2 (0 errors). ). )

 

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

ImagingStudy.availability ImagingStudy.series.availability ImagingStudy.modalityList
Path Definition Type Reference
ImagingStudy.status Availability The status of the resource ImagingStudy. Required InstanceAvailability ImagingStudyStatus
ImagingStudy.modality
ImagingStudy.series.modality
Type of acquired data in the instance instance. Extensible Acquisition Modality Codes AcquisitionModality
ImagingStudy.procedureCode The performed procedure type type. Example Extensible Procedure Codes (SNOMED CT) http://www.rsna.org/RadLex_Playbook.aspx
ImagingStudy.reason ImagingStudy.reasonCode The reason for the study study. Example Procedure Reason Codes ProcedureReasonCodes
ImagingStudy.series.bodySite Codes describing anatomical locations. May include laterality. Example SNOMED CT Body Structures 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

10.3.3.2

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 values follow and SOP Instance UID use the FHIR convention of expressing UIDs as URNs. 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 1.2.250.1.59.40211.12345678.678910 2.16.124.113543.1154777499.30246.19789.3503430046 is expressed 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 “urn:oid:1.2.250.1.59.40211.12345678.678910” . 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 ImagingManifest.study.endpoint ImagingStudy.endpoint elements and ImagingManifest.study.series.endpoint 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 ImagingManifest.study.series.endpoint ImagingStudy.series.endpoint of a particular Endpoint.connectionType provides that service for that series, and all contained instances. An ImagingManifest.study.endpoint ImagingStudy.endpoint of a particularconnection 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 ImagingManifest.study.series.endpoint ImagingStudy.series.endpoint overrides a ImagingManifest.study.endpoint an ImagingStudy.endpoint of the same connection type. (Since 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.) defined.

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

An Endpoint.connectionType of code dicom-wado-rsi dicom-wado-rs , system http://hl7.org/fhir/endpoint-connection-type 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, 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 using the Accept header) by performing a GET on a URL constructed from following information in a Endpoint.address fictional ImagingStudy resource:

  • the WADO-RS service base url of “https://pacs.hospital.org/wado-rs” found in an ImagingStudy.endpoint.address ,
  • the study.uid value DICOM Study Instance UID of “urn:oid:1.2.250.1.59.40211.12345678.678910” “1.2.250.1.59.40211.12345678.678910” found in an ImagingStudy.identifier having Identifier.system of “urn:dicom:uid” , study.series.uid value
  • the DICOM Series Instance UID of “urn:oid:1.2.250.1.59.40211.789001276.14556172.67789” “1.2.250.1.59.40211.789001276.14556172.67789” found in ImagingStudy.series.uid , and study.series.instance.uid value
  • the DICOM SOP Instance UID of “urn:oid:1.2.250.1.59.40211.2678810.87991027.899772.2” : “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 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 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 quetstion 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.url . Endpoint.address value.

For example, a native DICOM PS3.10 instance file can be retrieved (if consistent with using the Accept header) by performing a GET on a URL constructed from following information in a Endpoint.address.url fictional ImagingStudy resource:

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

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

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

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

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

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

An Endpoint.connectionType of code ihe-iid , system http://hl7.org/fhir/endpoint-connection-type 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 the 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, given using the following information in a fictional ImagingStudy resource:

  • the WADO-URI service base url of “https://pacs.hospital.org/IHEInvokeImageDisplay” found in an Endpoint.address 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 https://pacs.hospital.org/IHEInvokeImageDisplay “urn:dicom:uid” ,
we can construct the IID URL 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: 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 .

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 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 ProcedureRequest 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 ProcedureRequest 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 ImagingManifest 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 ImagingManifest 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, 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, department and triggers the PACS to share the echo study through the Metropolitan Health Information Exchange.

The PACS creates a manifest of the an imaging study as an ImagingManifest 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 manifest 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 manifest ImagingManifest 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
accession token The accession identifier for the study ImagingStudy.accession basedon reference The order for the image ImagingStudy.basedOn
( ReferralRequest Appointment , AppointmentResponse , CarePlan , ProcedureRequest Task , ServiceRequest )
bodysite token The body site studied ImagingStudy.series.bodySite
context dicom-class reference token The context type of the study instance ImagingStudy.context ( EpisodeOfCare , Encounter ) ImagingStudy.series.instance.sopClass
dicom-class encounter uri reference The type context of the instance study ImagingStudy.series.instance.sopClass ImagingStudy.encounter
( Encounter )
endpoint reference The endpoint for te the study or series ImagingStudy.endpoint | ImagingStudy.series.endpoint
( Endpoint )
identifier token Other identifiers Identifiers for the Study, such as DICOM Study Instance UID and Accession number ImagingStudy.identifier 26 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.patient ImagingStudy.subject.where(resolve() is Patient)
( Patient )
31 33 Resources
performer reference The person who performed the study ImagingStudy.series.performer ImagingStudy.series.performer.actor
( Practitioner , Organization , CareTeam , Device , Patient , PractitionerRole , RelatedPerson )
reason token The reason for the study ImagingStudy.reason ImagingStudy.reasonCode
referrer reference The referring physician ImagingStudy.referrer
( Practitioner , PractitionerRole )
series uri token The identifier of the DICOM Series Instance UID for a series of images ImagingStudy.series.uid
started date When the study was started ImagingStudy.started
study status uri token The study identifier for status of the image study ImagingStudy.uid ImagingStudy.status
uid subject uri reference The instance unique identifier Who the study is about ImagingStudy.series.instance.uid ImagingStudy.subject
( Group , Device , Patient )