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4.34 Resource ImagingStudy - Content

Imaging Integration Work Group

Maturity Level: 2

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.

This resource is referenced by DiagnosticReport, ImagingExcerpt and ImagingObjectSelection

4.34.2 Resource Content

 

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

4.34.2.1 Terminology Bindings

Path	Definition	Type	Reference
ImagingStudy.availability ImagingStudy.series.availability	Availability of the resource	Required	InstanceAvailability
ImagingStudy.modalityList ImagingStudy.series.modality	Type of acquired data in the instance	Extensible	Acquisition Modality Codes
ImagingStudy.series.bodySite	Codes describing anatomical locations. May include laterality.	Example	SNOMED CT Body Structures
ImagingStudy.series.laterality	Codes describing body site laterality (left, right, etc.).	Example	Laterality

4.34.2.2 Implementation Notes

• Instances can be images, but they can also be DICOM structured documents or other DICOM classes.
• This resource follows DICOM practice in using OIDs for elements such as instance type rather than codes.
• Each instance has an Attachment. Multiple Attachments can represent the same information, but using different approaches. The ImagingStudy.content.url could be a reference to a WADO-RS service that makes the instance available. The ImagingStudy.content.url could be a reference to a FHIR resource (Media, Composition, etc.).
• The use of ImagingStudy.content.data is discouraged with preference of url.

4.34.2.3 Use Case

4.34.2.3.1 EHR access to imaging studies

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.

4.34.2.3.2 Comprehensive Imaging Scheduled Workflow

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 Order, 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 and 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.

4.34.3 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
accession	token	The accession identifier for the study	ImagingStudy.accession
bodysite	token	The body site studied	ImagingStudy.series.bodySite
dicom-class	uri	The type of the instance	ImagingStudy.series.instance.sopClass
identifier	token	Other identifiers for the Study	ImagingStudy.identifier
modality	token	The modality of the series	ImagingStudy.series.modality
order	reference	The order for the image	ImagingStudy.order (DiagnosticOrder)
patient	reference	Who the study is about	ImagingStudy.patient (Patient)
series	uri	The identifier of the series of images	ImagingStudy.series.uid
started	date	When the study was started	ImagingStudy.started
study	uri	The study identifier for the image	ImagingStudy.uid
uid	uri	The instance unique identifier	ImagingStudy.series.instance.uid