STU 3 Ballot

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10.7 Resource ImagingStudy - Content

Imaging Integration Work GroupMaturity Level: 2Compartments: 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.

10.7.1 Scope and Usage

ImagingStudy provides information on a DICOM imaging study, and the series and imaging objects in that study. It also provides information on how to retrieve that information (in a native DICOM format, or in a rendered format, such as JPEG). ImagingStudy is used to make available information about all parts of a single DICOM study.

This resource provides mappings of its elements to DICOM attributes. DICOM attributes are identified by a 32-bit tag, presented in canonical form as two four-digit hexadecimal values within parentheses and separated by a comma, e.g. (0008,103E). The name and value representation (data type) of each attribute can be found in DICOM Part 6 Data Dictionary . The use of the attributes in the context of information objects, including detailed description of use, can be found in DICOM Part 3 Information Object Definitions . Attributes used in the DICOM query information models, such as "Number of Instances in Study", can be found in DICOM Part 4 Annex C .

ImagingStudy provides access to significant DICOM information, but will only eliminate the need for DICOM query (e.g., QIDO-RS) in the simplest cases. The DICOM instances are not stored in the ImagingStudy resource; use of a DICOM WADO-RS server or other storage mechanism is needed.

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

10.7.2 Boundaries and Relationships

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 ClinicalImpression, DiagnosticReport and ImagingManifest

10.7.3 Resource Content

Structure

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

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Formal identifier for the studyuid : oid [1..1]Accession Number is an identifier related to some aspect of imaging workflow and data management. Usage may vary across different institutions. See for instance [IHE Radiology Technical Framework Volume 1 Appendix A](http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Rev13.0_Vol1_FT_2014-07-30.pdf)accession : Identifier [0..1]Other identifiers for the studyidentifier : Identifier [0..*]Availability of study (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »A list of all the Series.ImageModality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modalityList : Coding [0..*] « Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + »The patient imaged in the studypatient : Reference [1..1] « Patient »The encounter at which the request is initiatedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Date and Time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « ReferralRequest|CarePlan| DiagnosticRequest|ProcedureRequest »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Who read the study and interpreted the images or other contentinterpreter : Reference [0..1] « Practitioner »Number of Series in StudynumberOfSeries : unsignedInt [1..1]Number of SOP Instances in StudynumberOfInstances : unsignedInt [1..1]Type of procedure performedprocedure : Reference [0..*] « Procedure »Description of clinical codition indicating why the ImagingStudy was requestedreason : CodeableConcept [0..1]Institution-generated description or classification of the Study performeddescription : string [0..1]StudyBaseLocationThe service type for accessing (e.g., retrieving, viewing) the DICOM instancestype : Coding [1..1] « The type of the service endpoint (Strength=Extensible)dWebType+ »The service URL for accessing the study. The interpretation of the URL depends on the type of the service specified in ImagingManifest.study.baseLocation.typeurl : uri [1..1]SeriesFormal identifier for this seriesuid : oid [1..1]The Numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] « Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + »A description of the seriesdescription : string [0..1]Number of SOP Instances in SeriesnumberOfInstances : unsignedInt [1..1]Availability of series (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »Body part examined. See DICOM Part 16 Annex L for the mapping from DICOM to Snomed CTbodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMED CT Body Structures?? »Laterality if body site is paired anatomic structure and laterality is not pre-coordinated in body site codelaterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? »The date and time the series was startedstarted : dateTime [0..1]SeriesBaseLocationThe service type for accessing (e.g., retrieving) the DICOM instancestype : Coding [1..1] « The type of the service endpoint (Strength=Extensible)dWebType+ »The service URL for accessing the study. The interpretation of the URL depends on the type of the service specified in ImagingManifest.study.series.baseLocation.typeurl : uri [1..1]InstanceFormal identifier for this image or other contentuid : oid [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : oid [1..1]The description of the instancetitle : string [0..1]Methods of accessing (e.g., retrieving, viewing) the studybaseLocation[0..*]Methods of accessing (e.g. retrieving) the seriesbaseLocation[0..*]A single SOP Instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticRequest|
   ProcedureRequest) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..1 Reference(Practitioner) Who interpreted images --></interpreter>
 <baseLocation>  <!-- 0..* Study access service endpoint -->
  <type><!-- 1..1 Coding WADO-RS | WADO-URI | IID --></type>
  <url value="[uri]"/><!-- 1..1 Study access URL -->
 </baseLocation>
 <numberOfSeries value="[unsignedInt]"/><!-- 1..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Study Related Instances -->
 <procedure><!-- 0..* Reference(Procedure) Type of procedure performed --></procedure>
 <reason><!-- 0..1 CodeableConcept Reason for study --></reason>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Series Related Instances -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <baseLocation>  <!-- 0..* Series access endpoint -->
   <type><!-- 1..1 Coding WADO-RS | WADO-URI | IID --></type>
   <url value="[uri]"/><!-- 1..1 Series access URL -->
  </baseLocation>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this instance -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Formal DICOM identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticRequest|
   ProcedureRequest) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : { Reference(Practitioner) }, // Who interpreted images
  "baseLocation" : [{ // Study access service endpoint
    "type" : { Coding }, // R!  WADO-RS | WADO-URI | IID
    "url" : "<uri>" // R!  Study access URL
  }],
  "numberOfSeries" : "<unsignedInt>", // R!  Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // R!  Number of Study Related Instances
  "procedure" : [{ Reference(Procedure) }], // Type of procedure performed
  "reason" : { CodeableConcept }, // Reason for study
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<oid>", // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // R!  Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "baseLocation" : [{ // Series access endpoint
      "type" : { Coding }, // R!  WADO-RS | WADO-URI | IID
      "url" : "<uri>" // R!  Series access URL
    }],
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<oid>", // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : "<oid>", // R!  DICOM class type
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.uid [ oid ]; # 1..1 Formal DICOM identifier for the study
  fhir:ImagingStudy.accession [ Identifier ]; # 0..1 Related workflow identifier ("Accession Number")
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Other identifiers for the study
  fhir:ImagingStudy.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  fhir:ImagingStudy.modalityList [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.patient [ Reference(Patient) ]; # 1..1 Who the images are of
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(ReferralRequest|CarePlan|DiagnosticRequest|ProcedureRequest) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ]; # 0..1 Who interpreted images
  fhir:ImagingStudy.baseLocation [ # 0..* Study access service endpoint
    fhir:ImagingStudy.baseLocation.type [ Coding ]; # 1..1 WADO-RS | WADO-URI | IID
    fhir:ImagingStudy.baseLocation.url [ uri ]; # 1..1 Study access URL
  ], ...;
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 1..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 1..1 Number of Study Related Instances
  fhir:ImagingStudy.procedure [ Reference(Procedure) ], ... ; # 0..* Type of procedure performed
  fhir:ImagingStudy.reason [ CodeableConcept ]; # 0..1 Reason for study
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.uid [ oid ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 1..1 Number of Series Related Instances
    fhir:ImagingStudy.series.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    fhir:ImagingStudy.series.baseLocation [ # 0..* Series access endpoint
      fhir:ImagingStudy.series.baseLocation.type [ Coding ]; # 1..1 WADO-RS | WADO-URI | IID
      fhir:ImagingStudy.series.baseLocation.url [ uri ]; # 1..1 Series access URL
    ], ...;
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ oid ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ oid ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2

ImagingStudy
ImagingStudy.context Renamed from order to context
Max Cardinality changed from * to 1
Remove Reference(DiagnosticOrder), Add Reference(Encounter), Add Reference(EpisodeOfCare)
ImagingStudy.basedOn added
ImagingStudy.baseLocation Renamed from url to baseLocation
Max Cardinality changed from 1 to *
Type changed from uri to BackboneElement
ImagingStudy.baseLocation.type added
ImagingStudy.baseLocation.url added
ImagingStudy.reason added
ImagingStudy.series.baseLocation Renamed from url to baseLocation
Max Cardinality changed from 1 to *
Type changed from uri to BackboneElement
ImagingStudy.series.baseLocation.type added
ImagingStudy.series.baseLocation.url added
ImagingStudy.series.instance.type deleted
ImagingStudy.series.instance.content deleted

See the Full Difference for further information

Structure

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

doco Documentation for this format

UML Diagram (Legend)

ImagingStudy (DomainResource)Formal identifier for the studyuid : oid [1..1]Accession Number is an identifier related to some aspect of imaging workflow and data management. Usage may vary across different institutions. See for instance [IHE Radiology Technical Framework Volume 1 Appendix A](http://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_TF_Rev13.0_Vol1_FT_2014-07-30.pdf)accession : Identifier [0..1]Other identifiers for the studyidentifier : Identifier [0..*]Availability of study (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »A list of all the Series.ImageModality values that are actual acquisition modalities, i.e. those in the DICOM Context Group 29 (value set OID 1.2.840.10008.6.1.19)modalityList : Coding [0..*] « Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + »The patient imaged in the studypatient : Reference [1..1] « Patient »The encounter at which the request is initiatedcontext : Reference [0..1] « Encounter|EpisodeOfCare »Date and Time the study startedstarted : dateTime [0..1]A list of the diagnostic requests that resulted in this imaging study being performedbasedOn : Reference [0..*] « ReferralRequest|CarePlan| DiagnosticRequest|ProcedureRequest »The requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Who read the study and interpreted the images or other contentinterpreter : Reference [0..1] « Practitioner »Number of Series in StudynumberOfSeries : unsignedInt [1..1]Number of SOP Instances in StudynumberOfInstances : unsignedInt [1..1]Type of procedure performedprocedure : Reference [0..*] « Procedure »Description of clinical codition indicating why the ImagingStudy was requestedreason : CodeableConcept [0..1]Institution-generated description or classification of the Study performeddescription : string [0..1]StudyBaseLocationThe service type for accessing (e.g., retrieving, viewing) the DICOM instancestype : Coding [1..1] « The type of the service endpoint (Strength=Extensible)dWebType+ »The service URL for accessing the study. The interpretation of the URL depends on the type of the service specified in ImagingManifest.study.baseLocation.typeurl : uri [1..1]SeriesFormal identifier for this seriesuid : oid [1..1]The Numeric identifier of this series in the studynumber : unsignedInt [0..1]The modality of this series sequencemodality : Coding [1..1] « Type of acquired data in the instance (Strength=Extensible)Acquisition Modality + »A description of the seriesdescription : string [0..1]Number of SOP Instances in SeriesnumberOfInstances : unsignedInt [1..1]Availability of series (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »Body part examined. See DICOM Part 16 Annex L for the mapping from DICOM to Snomed CTbodySite : Coding [0..1] « Codes describing anatomical locations. May include laterality. (Strength=Example)SNOMED CT Body Structures?? »Laterality if body site is paired anatomic structure and laterality is not pre-coordinated in body site codelaterality : Coding [0..1] « Codes describing body site laterality (left, right, etc.). (Strength=Example)Laterality?? »The date and time the series was startedstarted : dateTime [0..1]SeriesBaseLocationThe service type for accessing (e.g., retrieving) the DICOM instancestype : Coding [1..1] « The type of the service endpoint (Strength=Extensible)dWebType+ »The service URL for accessing the study. The interpretation of the URL depends on the type of the service specified in ImagingManifest.study.series.baseLocation.typeurl : uri [1..1]InstanceFormal identifier for this image or other contentuid : oid [1..1]The number of instance in the seriesnumber : unsignedInt [0..1]DICOM instance typesopClass : oid [1..1]The description of the instancetitle : string [0..1]Methods of accessing (e.g., retrieving, viewing) the studybaseLocation[0..*]Methods of accessing (e.g. retrieving) the seriesbaseLocation[0..*]A single SOP Instance within the series, e.g. an image, or presentation stateinstance[0..*]Each study has one or more series of images or other contentseries[0..*]

XML Template

<ImagingStudy xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <context><!-- 0..1 Reference(Encounter|EpisodeOfCare) Originating context --></context>
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <basedOn><!-- 0..* Reference(ReferralRequest|CarePlan|DiagnosticRequest|
   ProcedureRequest) Request fulfilled --></basedOn>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician --></referrer>
 <interpreter><!-- 0..1 Reference(Practitioner) Who interpreted images --></interpreter>
 <baseLocation>  <!-- 0..* Study access service endpoint -->
  <type><!-- 1..1 Coding WADO-RS | WADO-URI | IID --></type>
  <url value="[uri]"/><!-- 1..1 Study access URL -->
 </baseLocation>
 <numberOfSeries value="[unsignedInt]"/><!-- 1..1 Number of Study Related Series -->
 <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Study Related Instances -->
 <procedure><!-- 0..* Reference(Procedure) Type of procedure performed --></procedure>
 <reason><!-- 0..1 CodeableConcept Reason for study --></reason>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this series -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series --></modality>
  <description value="[string]"/><!-- 0..1 A short human readable summary of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Series Related Instances -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <baseLocation>  <!-- 0..* Series access endpoint -->
   <type><!-- 1..1 Coding WADO-RS | WADO-URI | IID --></type>
   <url value="[uri]"/><!-- 1..1 Series access URL -->
  </baseLocation>
  <bodySite><!-- 0..1 Coding Body part examined --></bodySite>
  <laterality><!-- 0..1 Coding Body part laterality --></laterality>
  <started value="[dateTime]"/><!-- 0..1 When the series started -->
  <instance>  <!-- 0..* A single SOP instance from the series -->
   <uid value="[oid]"/><!-- 1..1 Formal DICOM identifier for this instance -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "uid" : "<oid>", // R!  Formal DICOM identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "context" : { Reference(Encounter|EpisodeOfCare) }, // Originating context
  "started" : "<dateTime>", // When the study was started
  "basedOn" : [{ Reference(ReferralRequest|CarePlan|DiagnosticRequest|
   ProcedureRequest) }], // Request fulfilled
  "referrer" : { Reference(Practitioner) }, // Referring physician
  "interpreter" : { Reference(Practitioner) }, // Who interpreted images
  "baseLocation" : [{ // Study access service endpoint
    "type" : { Coding }, // R!  WADO-RS | WADO-URI | IID
    "url" : "<uri>" // R!  Study access URL
  }],
  "numberOfSeries" : "<unsignedInt>", // R!  Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // R!  Number of Study Related Instances
  "procedure" : [{ Reference(Procedure) }], // Type of procedure performed
  "reason" : { CodeableConcept }, // Reason for study
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "uid" : "<oid>", // R!  Formal DICOM identifier for this series
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "description" : "<string>", // A short human readable summary of the series
    "numberOfInstances" : "<unsignedInt>", // R!  Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "baseLocation" : [{ // Series access endpoint
      "type" : { Coding }, // R!  WADO-RS | WADO-URI | IID
      "url" : "<uri>" // R!  Series access URL
    }],
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "instance" : [{ // A single SOP instance from the series
      "uid" : "<oid>", // R!  Formal DICOM identifier for this instance
      "number" : "<unsignedInt>", // The number of this instance in the series
      "sopClass" : "<oid>", // R!  DICOM class type
      "title" : "<string>" // Description of instance
    }]
  }]
}

Turtle Template

@prefix fhir: <http://hl7.org/fhir/> .doco


[ a fhir:ImagingStudy;
  fhir:nodeRole fhir:treeRoot; # if this is the parser root

  # from Resource: .id, .meta, .implicitRules, and .language
  # from DomainResource: .text, .contained, .extension, and .modifierExtension
  fhir:ImagingStudy.uid [ oid ]; # 1..1 Formal DICOM identifier for the study
  fhir:ImagingStudy.accession [ Identifier ]; # 0..1 Related workflow identifier ("Accession Number")
  fhir:ImagingStudy.identifier [ Identifier ], ... ; # 0..* Other identifiers for the study
  fhir:ImagingStudy.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
  fhir:ImagingStudy.modalityList [ Coding ], ... ; # 0..* All series modality if actual acquisition modalities
  fhir:ImagingStudy.patient [ Reference(Patient) ]; # 1..1 Who the images are of
  fhir:ImagingStudy.context [ Reference(Encounter|EpisodeOfCare) ]; # 0..1 Originating context
  fhir:ImagingStudy.started [ dateTime ]; # 0..1 When the study was started
  fhir:ImagingStudy.basedOn [ Reference(ReferralRequest|CarePlan|DiagnosticRequest|ProcedureRequest) ], ... ; # 0..* Request fulfilled
  fhir:ImagingStudy.referrer [ Reference(Practitioner) ]; # 0..1 Referring physician
  fhir:ImagingStudy.interpreter [ Reference(Practitioner) ]; # 0..1 Who interpreted images
  fhir:ImagingStudy.baseLocation [ # 0..* Study access service endpoint
    fhir:ImagingStudy.baseLocation.type [ Coding ]; # 1..1 WADO-RS | WADO-URI | IID
    fhir:ImagingStudy.baseLocation.url [ uri ]; # 1..1 Study access URL
  ], ...;
  fhir:ImagingStudy.numberOfSeries [ unsignedInt ]; # 1..1 Number of Study Related Series
  fhir:ImagingStudy.numberOfInstances [ unsignedInt ]; # 1..1 Number of Study Related Instances
  fhir:ImagingStudy.procedure [ Reference(Procedure) ], ... ; # 0..* Type of procedure performed
  fhir:ImagingStudy.reason [ CodeableConcept ]; # 0..1 Reason for study
  fhir:ImagingStudy.description [ string ]; # 0..1 Institution-generated description
  fhir:ImagingStudy.series [ # 0..* Each study has one or more series of instances
    fhir:ImagingStudy.series.uid [ oid ]; # 1..1 Formal DICOM identifier for this series
    fhir:ImagingStudy.series.number [ unsignedInt ]; # 0..1 Numeric identifier of this series
    fhir:ImagingStudy.series.modality [ Coding ]; # 1..1 The modality of the instances in the series
    fhir:ImagingStudy.series.description [ string ]; # 0..1 A short human readable summary of the series
    fhir:ImagingStudy.series.numberOfInstances [ unsignedInt ]; # 1..1 Number of Series Related Instances
    fhir:ImagingStudy.series.availability [ code ]; # 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    fhir:ImagingStudy.series.baseLocation [ # 0..* Series access endpoint
      fhir:ImagingStudy.series.baseLocation.type [ Coding ]; # 1..1 WADO-RS | WADO-URI | IID
      fhir:ImagingStudy.series.baseLocation.url [ uri ]; # 1..1 Series access URL
    ], ...;
    fhir:ImagingStudy.series.bodySite [ Coding ]; # 0..1 Body part examined
    fhir:ImagingStudy.series.laterality [ Coding ]; # 0..1 Body part laterality
    fhir:ImagingStudy.series.started [ dateTime ]; # 0..1 When the series started
    fhir:ImagingStudy.series.instance [ # 0..* A single SOP instance from the series
      fhir:ImagingStudy.series.instance.uid [ oid ]; # 1..1 Formal DICOM identifier for this instance
      fhir:ImagingStudy.series.instance.number [ unsignedInt ]; # 0..1 The number of this instance in the series
      fhir:ImagingStudy.series.instance.sopClass [ oid ]; # 1..1 DICOM class type
      fhir:ImagingStudy.series.instance.title [ string ]; # 0..1 Description of instance
    ], ...;
  ], ...;
]

Changes since DSTU2

ImagingStudy
ImagingStudy.context Renamed from order to context
Max Cardinality changed from * to 1
Remove Reference(DiagnosticOrder), Add Reference(Encounter), Add Reference(EpisodeOfCare)
ImagingStudy.basedOn added
ImagingStudy.baseLocation Renamed from url to baseLocation
Max Cardinality changed from 1 to *
Type changed from uri to BackboneElement
ImagingStudy.baseLocation.type added
ImagingStudy.baseLocation.url added
ImagingStudy.reason added
ImagingStudy.series.baseLocation Renamed from url to baseLocation
Max Cardinality changed from 1 to *
Type changed from uri to BackboneElement
ImagingStudy.series.baseLocation.type added
ImagingStudy.series.baseLocation.url added
ImagingStudy.series.instance.type deleted
ImagingStudy.series.instance.content deleted

See the Full Difference for further information

 

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

10.7.3.1 Terminology Bindings

PathDefinitionTypeReference
ImagingStudy.availability
ImagingStudy.series.availability 		Availability of the resourceRequiredInstanceAvailability
ImagingStudy.modalityList
ImagingStudy.series.modality 		Type of acquired data in the instanceExtensibleAcquisition Modality Codes
ImagingStudy.baseLocation.type
ImagingStudy.series.baseLocation.type 		The type of the service endpointExtensibledWebType
ImagingStudy.reason The reason for the studyUnknownNo details provided yet
ImagingStudy.series.bodySite Codes describing anatomical locations. May include laterality.ExampleSNOMED CT Body Structures
ImagingStudy.series.laterality Codes describing body site laterality (left, right, etc.).ExampleLaterality

10.7.3.2 Implementation Notes

A referenced DICOM SOP instance could be:

  • A single- or multi-frame, still or video image captured by a variety of imaging modalities, such as X-ray, MR, and ultrasound;
  • A set of various presentation parameters, including annotation and markup;
  • A set of measurements or a report, including radiation dose report and CAD analysis;
  • An encapsulated PDF or CDA document;
  • A list of instances, such as key “of interest” images, or instances to be “deleted”; or
  • Other DICOM content.

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

ImagingStudy.baseLocation and ImagingStudy.series.baseLocation can each list multiple methods to retrieve the study, series or instances. If a study-level baseLocation of a particular type is present, it shall be applicable to all listed series and instances in the study, unless overridden by a series-level baseLocation of that type. (Series-level locations can be provided because all series of a study are not guaranteed to be on the same server. For the identified retrieval mechanisms, the services supporting instance-level retrieval do not differ from the series-level services, thus instance-level baseLocation is not defined.)

The form, requirements, and necessary manipulation of the baseLocation.url depend on service identified in baseLocation.type:

See ImagingManifest Implementation Notes for details on use of baseLocation

10.7.3.3 Use Case

10.7.3.3.1 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.

10.7.3.3.2 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 Task resource to manage the workflow, with a link to a DiagnosticRequest 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 DiagnosticRequest. (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 DiagnosticRequest has been transcoded to a DICOM Modality Worklist Scheduled Procedure Step, and in the echo lab the equipment has downloaded the Modality Worklist. The study is performed, and the acquired images and sonographer’s preliminary measurements are stored in the Local MultiClinic Picture Archiving and Communication System (PACS). The PACS creates an ImagingStudy resource for each study it manages.

Dr. Skann interprets the study on a PACS workstation, and he selects two key image frames to be included in the diagnostic report; this selection is stored back to the PACS as a DICOM Key Object Selection with the title "For Report Attachment", and the PACS makes it available (transcodes it) as a FHIR ImagingManifest resource. Dr. Skann dictates the report using a structured data entry report writing program, including a recommendation for a cardiac catheterization procedure, and signs it. The report writing program formats the report as a CDA document, retrieves the ImagingManifest resource, and inserts the referenced key images into the report.

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

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

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

10.7.4 Search Parameters

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

NameTypeDescriptionPaths
accessiontokenThe accession identifier for the studyImagingStudy.accession
basedonreferenceThe order for the imageImagingStudy.basedOn
(ReferralRequest, CarePlan, ProcedureRequest, DiagnosticRequest)
bodysitetokenThe body site studiedImagingStudy.series.bodySite
contextreferenceThe context of the studyImagingStudy.context
(EpisodeOfCare, Encounter)
dicom-classuriThe type of the instanceImagingStudy.series.instance.sopClass
identifiertokenOther identifiers for the StudyImagingStudy.identifier
modalitytokenThe modality of the seriesImagingStudy.series.modality
patientreferenceWho the study is aboutImagingStudy.patient
(Patient)
reasontokenThe reason for the studyImagingStudy.reason
seriesuriThe identifier of the series of imagesImagingStudy.series.uid
starteddateWhen the study was startedImagingStudy.started
studyuriThe study identifier for the imageImagingStudy.uid
uiduriThe instance unique identifierImagingStudy.series.instance.uid