Connectathon 11 Snapshot

This page is part of the FHIR Specification (v1.2.0: STU 3 Draft). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

4.32 Resource ImagingObjectSelection - Content

Imaging Integration

Work Group

Maturity Level: 1

Compartments: Device, Patient, Practitioner, RelatedPerson

A manifest of a set of DICOM Service-Object Pair Instances (SOP Instances). The referenced SOP Instances (images or other content) are for a single patient, and may be from one or more studies. The referenced SOP Instances have been selected for a purpose, such as quality assurance, conference, or consult. Reflecting that range of purposes, typical ImagingObjectSelection resources may include all SOP Instances in a study (perhaps for sharing through a Health Information Exchange); key images from multiple studies (for reference by a referring or treating physician); a multi-frame ultrasound instance ("cine" video clip) and a set of measurements taken from that instance (for inclusion in a teaching file); and so on.

4.32.1 Scope and Usage

This resource summarizes a set of images or other instances gathered for some specified purpose, and provides references to where the images are available using WADO-RS. This resource is used to make available information concerning images etc. that are intended to be exchanged into other clinical contexts such as diagnostic reports, Care Plans, etc.

This resource is referenced by diagnosticreport

Structure

Name	Flags	Card.	Type	Description & Constraints
ImagingObjectSelection	Σ		DomainResource	Key Object Selection
uid	Σ	1..1	oid	Instance UID
patient	Σ	1..1	Reference(Patient)	Patient of the selected objects
title	Σ	1..1	CodeableConcept	Reason for selection KOStitle (Required)
description	Σ	0..1	string	Description text
author	Σ	0..1	Reference(Practitioner \| Device \| Organization \| Patient \| RelatedPerson)	Author (human or machine)
authoringTime	Σ	0..1	dateTime	Authoring time of the selection
study	Σ	1..*	BackboneElement	Study identity of the selected instances
uid	Σ	1..1	oid	Study instance UID
url	Σ	0..1	uri	Retrieve study URL
imagingStudy	Σ	0..1	Reference(ImagingStudy)	Reference to ImagingStudy
series	Σ	1..*	BackboneElement	Series identity of the selected instances
uid	Σ	0..1	oid	Series instance UID
url	Σ	0..1	uri	Retrieve series URL
instance	Σ	1..*	BackboneElement	The selected instance
sopClass	Σ	1..1	oid	SOP class UID of instance
uid	Σ	1..1	oid	Selected instance UID
url	Σ	1..1	uri	Retrieve instance URL
frames	Σ	0..*	BackboneElement	The frame set
frameNumbers	Σ	1..*	unsignedInt	Frame numbers
url	Σ	1..1	uri	Retrieve frame URL
Documentation for this format

UML Diagram

XML Template

<ImagingObjectSelection xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Instance UID -->
 <patient><!-- 1..1 Reference(Patient) Patient of the selected objects --></patient>
 <title><!-- 1..1 CodeableConcept Reason for selection --></title>
 <description value="[string]"/><!-- 0..1 Description text -->
 <author><!-- 0..1 Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) Author (human or machine) --></author>
 <authoringTime value="[dateTime]"/><!-- 0..1 Authoring time of the selection -->
 <study>  <!-- 1..* Study identity of the selected instances -->
  <uid value="[oid]"/><!-- 1..1 Study instance UID -->
  <url value="[uri]"/><!-- 0..1 Retrieve study URL -->
  <imagingStudy><!-- 0..1 Reference(ImagingStudy) Reference to ImagingStudy --></imagingStudy>
  <series>  <!-- 1..* Series identity of the selected instances -->
   <uid value="[oid]"/><!-- 0..1 Series instance UID -->
   <url value="[uri]"/><!-- 0..1 Retrieve series URL -->
   <instance>  <!-- 1..* The selected instance -->
    <sopClass value="[oid]"/><!-- 1..1 SOP class UID of instance -->
    <uid value="[oid]"/><!-- 1..1 Selected instance UID -->
    <url value="[uri]"/><!-- 1..1 Retrieve instance URL -->
    <frames>  <!-- 0..* The frame set -->
     <frameNumbers value="[unsignedInt]"/><!-- 1..* Frame numbers -->
     <url value="[uri]"/><!-- 1..1 Retrieve frame URL -->
    </frames>
   </instance>
  </series>
 </study>
</ImagingObjectSelection>

JSON Template

{
  "resourceType" : "ImagingObjectSelection",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Instance UID
  "patient" : { Reference(Patient) }, // R!  Patient of the selected objects
  "title" : { CodeableConcept }, // R!  Reason for selection
  "description" : "<string>", // Description text
  "author" : { Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) }, // Author (human or machine)
  "authoringTime" : "<dateTime>", // Authoring time of the selection
  "study" : [{ // R!  Study identity of the selected instances
    "uid" : "<oid>", // R!  Study instance UID
    "url" : "<uri>", // Retrieve study URL
    "imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
    "series" : [{ // R!  Series identity of the selected instances
      "uid" : "<oid>", // Series instance UID
      "url" : "<uri>", // Retrieve series URL
      "instance" : [{ // R!  The selected instance
        "sopClass" : "<oid>", // R!  SOP class UID of instance
        "uid" : "<oid>", // R!  Selected instance UID
        "url" : "<uri>", // R!  Retrieve instance URL
        "frames" : [{ // The frame set
          "frameNumbers" : ["<unsignedInt>"], // R!  Frame numbers
          "url" : "<uri>" // R!  Retrieve frame URL
        }]
      }]
    }]
  }]
}

Structure

Name	Flags	Card.	Type	Description & Constraints
ImagingObjectSelection	Σ		DomainResource	Key Object Selection
uid	Σ	1..1	oid	Instance UID
patient	Σ	1..1	Reference(Patient)	Patient of the selected objects
title	Σ	1..1	CodeableConcept	Reason for selection KOStitle (Required)
description	Σ	0..1	string	Description text
author	Σ	0..1	Reference(Practitioner \| Device \| Organization \| Patient \| RelatedPerson)	Author (human or machine)
authoringTime	Σ	0..1	dateTime	Authoring time of the selection
study	Σ	1..*	BackboneElement	Study identity of the selected instances
uid	Σ	1..1	oid	Study instance UID
url	Σ	0..1	uri	Retrieve study URL
imagingStudy	Σ	0..1	Reference(ImagingStudy)	Reference to ImagingStudy
series	Σ	1..*	BackboneElement	Series identity of the selected instances
uid	Σ	0..1	oid	Series instance UID
url	Σ	0..1	uri	Retrieve series URL
instance	Σ	1..*	BackboneElement	The selected instance
sopClass	Σ	1..1	oid	SOP class UID of instance
uid	Σ	1..1	oid	Selected instance UID
url	Σ	1..1	uri	Retrieve instance URL
frames	Σ	0..*	BackboneElement	The frame set
frameNumbers	Σ	1..*	unsignedInt	Frame numbers
url	Σ	1..1	uri	Retrieve frame URL
Documentation for this format

UML Diagram

XML Template

<ImagingObjectSelection xmlns="http://hl7.org/fhir"> 
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Instance UID -->
 <patient><!-- 1..1 Reference(Patient) Patient of the selected objects --></patient>
 <title><!-- 1..1 CodeableConcept Reason for selection --></title>
 <description value="[string]"/><!-- 0..1 Description text -->
 <author><!-- 0..1 Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) Author (human or machine) --></author>
 <authoringTime value="[dateTime]"/><!-- 0..1 Authoring time of the selection -->
 <study>  <!-- 1..* Study identity of the selected instances -->
  <uid value="[oid]"/><!-- 1..1 Study instance UID -->
  <url value="[uri]"/><!-- 0..1 Retrieve study URL -->
  <imagingStudy><!-- 0..1 Reference(ImagingStudy) Reference to ImagingStudy --></imagingStudy>
  <series>  <!-- 1..* Series identity of the selected instances -->
   <uid value="[oid]"/><!-- 0..1 Series instance UID -->
   <url value="[uri]"/><!-- 0..1 Retrieve series URL -->
   <instance>  <!-- 1..* The selected instance -->
    <sopClass value="[oid]"/><!-- 1..1 SOP class UID of instance -->
    <uid value="[oid]"/><!-- 1..1 Selected instance UID -->
    <url value="[uri]"/><!-- 1..1 Retrieve instance URL -->
    <frames>  <!-- 0..* The frame set -->
     <frameNumbers value="[unsignedInt]"/><!-- 1..* Frame numbers -->
     <url value="[uri]"/><!-- 1..1 Retrieve frame URL -->
    </frames>
   </instance>
  </series>
 </study>
</ImagingObjectSelection>

JSON Template

{
  "resourceType" : "ImagingObjectSelection",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Instance UID
  "patient" : { Reference(Patient) }, // R!  Patient of the selected objects
  "title" : { CodeableConcept }, // R!  Reason for selection
  "description" : "<string>", // Description text
  "author" : { Reference(Practitioner|Device|Organization|Patient|
   RelatedPerson) }, // Author (human or machine)
  "authoringTime" : "<dateTime>", // Authoring time of the selection
  "study" : [{ // R!  Study identity of the selected instances
    "uid" : "<oid>", // R!  Study instance UID
    "url" : "<uri>", // Retrieve study URL
    "imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
    "series" : [{ // R!  Series identity of the selected instances
      "uid" : "<oid>", // Series instance UID
      "url" : "<uri>", // Retrieve series URL
      "instance" : [{ // R!  The selected instance
        "sopClass" : "<oid>", // R!  SOP class UID of instance
        "uid" : "<oid>", // R!  Selected instance UID
        "url" : "<uri>", // R!  Retrieve instance URL
        "frames" : [{ // The frame set
          "frameNumbers" : ["<unsignedInt>"], // R!  Frame numbers
          "url" : "<uri>" // R!  Retrieve frame URL
        }]
      }]
    }]
  }]
}

Alternate definitions: Schema/Schematron, Resource Profile (XML, JSON), Questionnaire

4.32.2.1 Terminology Bindings

Path	Definition	Type	Reference
ImagingObjectSelection.title	The document title code of key object selection	Required	KOStitle

Path

Definition

Type

Reference

ImagingObjectSelection.title

The document title code of key object selection

Required

KOStitle

4.32.2.2 Use Case

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 Order resource to manage the workflow, with a link to a DiagnosticOrder 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 Orders, and he follows the link to retrieve the DiagnosticOrder. (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 Order/DiagnosticOrder 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 ImagingObjectSelection 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 ImagingObjectSelection resource, and inserts the referenced key images into the report.

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

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

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

4.32.3 Search Parameters

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	Paths
author	reference	Author of key DICOM object selection	ImagingObjectSelection.author (Device, Patient, Organization, Practitioner, RelatedPerson)
authoring-time	date	Time of key DICOM object selection authoring	ImagingObjectSelection.authoringTime
identifier	uri	UID of key DICOM object selection	ImagingObjectSelection.uid
patient	reference	Subject of key DICOM object selection	ImagingObjectSelection.patient (Patient)
selected-study	uri	Study selected in key DICOM object selection	ImagingObjectSelection.study.uid
title	token	Title of key DICOM object selection	ImagingObjectSelection.title