R5 Final QA

This page is part of the FHIR Specification (v5.0.0-draft-final: Final QA Preview for R5 - see ballot notes). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions

10.6 Resource ImagingSelection - Content

Imaging Integration icon Work GroupMaturity Level: 1 Trial UseSecurity Category: Patient Compartments: Patient

A selection of DICOM SOP instances and/or frames within a single Study and Series. This might include additional specifics such as an image region, an Observation UID or a Segmentation Number, allowing linkage to an Observation Resource or transferring this information along with the ImagingStudy Resource.

10.6.1 Scope and Usage

This resource is an event resource from a FHIR workflow perspective - see Workflow.

A selection of data from an ImagingStudy. The selection may be:

  • All DICOM SOP Instances in a single DICOM Series
  • A set of DICOM SOP Instances within a single DICOM Series
  • A set of frames within one or more DICOM multiframe image SOP Instances
  • A set of segments within one or more DICOM segmentation SOP Instances
  • A set of content items within one or more DICOM Structured Report SOP Instances
  • ...

May also represent regions within the ImagingStudy frame of reference, including:

  • A 2D region within one or more DICOM image SOP Instances
  • A 3D region within a DICOM Frame of Reference

Uses for ImagingSelection resources include:

  • Identifying a specific set of images or frames as the focus of an Observation
  • Identifying a spatial region or volume as the focus of an Observation
  • Identifying the set of image coordinates as the focus of a measurement represented by an Observation
  • Identifying a node in a DICOM Structured Report SOP Instance from which an Observation is derived
  • Identifying images, frames or presentation states selected as part of shared application context in a context-sharing environment
  • Identifying a specific set of images, frames or presentation states to be presented

All DICOM SOP Instances referenced in a single ImagingSelection resource shall be part of the same DICOM Series (and therefore also the same DICOM Study). In order to reference SOP Instances in multiple Studies or Series it is necessary to create multiple ImagingSelection resources.

10.6.2 Boundaries and Relationships

An Observation references an ImagingSelection to specify the set of DICOM images, frames, waveforms or documents used to make the Observation. By contrast, an Observation references an ImagingStudy if it does not depend on any specific set of images, frames, waveforms or documents.

An Observation references an ImagingSelection to specify an image region corresponding to the measurement value expressed in the Observation.

While an ImagingSelection is restricted to a single DICOM Series, a single Observation references multiple ImagingSelection resources if it relates to multiple Studies and / or Series – for example, to reference multiple images over different cardiac phases or a PET and a CT image.

A DiagnosticReport might directly reference an ImagingSelection that includes one or more Observations derived from ImagingSelection resources.

In contrast with a DocumentReference, an ImagingSelection includes the ability to specify a region within an image, an observation node within a DICOM Structured Reporting (SR) and the ability to specify one or more Endpoint resources for retrieval of the referenced images, frames, waveforms or documents. Additionally, DocumentReference has limited ability to reference multiple images or frames and can only specify the Study, Series and SOP Instance UIDs implicitly via the URL.

DocumentReference might be appropriate for including a rendered DICOM image in cases where the full image context is not important.

10.6.3 References to this Resource

10.6.4 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingSelection TUDomainResourceA selection of DICOM SOP instances and/or frames

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness Identifier for Imaging Selection

... status ?!Σ1..1codeavailable | entered-in-error | unknown
Binding: Imaging Selection Status (Required)
... subject Σ0..1Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | Specimen)Subject of the selected instances
... performer Σ0..*BackboneElementSelector of the instances (human or machine)

.... function Σ0..1CodeableConceptType of performer
Binding: ImagingStudy series performer function (Extensible)
.... actor Σ0..1Reference(Practitioner | PractitionerRole | Device | Organization | CareTeam | Patient | RelatedPerson | HealthcareService)Author (human or machine)
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Associated request

... category Σ0..*CodeableConceptClassifies the imaging selection
Binding: KeyObjectSelectionDocumentTitle icon (Example)

... code Σ1..1CodeableConceptImaging Selection purpose text or code
Binding: KeyObjectSelectionDocumentTitle icon (Example)
... studyUid Σ0..1idDICOM Study Instance UID
... derivedFrom Σ0..*Reference(ImagingStudy | DocumentReference)The imaging study from which the imaging selection is derived

... endpoint Σ0..*Reference(Endpoint)The network service providing retrieval for the images referenced in the imaging selection

... seriesUid Σ0..1idDICOM Series Instance UID
... seriesNumber Σ0..1unsignedIntDICOM Series Number
... frameOfReferenceUid Σ0..1idThe Frame of Reference UID for the selected images
... bodySite Σ0..1CodeableReference(BodyStructure)Body part examined
Binding: SNOMED CT Body Structures (Example)
... focus Σ0..*Reference(ImagingSelection)Related resource that is the focus for the imaging selection

... instance Σ0..*BackboneElementThe selected instances

.... uid Σ1..1idDICOM SOP Instance UID
.... number Σ0..1unsignedIntDICOM Instance Number
.... sopClass 0..1CodingDICOM SOP Class UID
Binding: sopClass icon (Extensible)
.... subset 0..*stringThe selected subset of the SOP Instance

.... imageRegion2D 0..*BackboneElementA specific 2D region in a DICOM image / frame

..... regionType 1..1codepoint | polyline | interpolated | circle | ellipse
Binding: Imaging Selection2 D Graphic Type (Required)
..... coordinate 1..*decimalSpecifies the coordinates that define the image region
This repeating element order: The values are an ordered set of (x, y) coordinates.
.... imageRegion3D 0..*BackboneElementA specific 3D region in a DICOM frame of reference

..... regionType 1..1codepoint | multipoint | polyline | polygon | ellipse | ellipsoid
Binding: Imaging Selection3 D Graphic Type (Required)
..... coordinate 1..*decimalSpecifies the coordinates that define the image region
This repeating element order: The values are an ordered set of (x, y, z) coordinates.

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

ImagingSelection (DomainResource)A unique identifier assigned to this imaging selectionidentifier : Identifier [0..*]The current state of the ImagingSelection resource. This is not the status of any ImagingStudy, ServiceRequest, or Task resources associated with the ImagingSelection (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingSelectionStatus! »The patient, or group of patients, location, device, organization, procedure or practitioner this imaging selection is about and into whose or what record the imaging selection is placedsubject : Reference [0..1] « Patient|Group|Device|Location| Organization|Procedure|Practitioner|Medication|Substance| Specimen »The date and time this imaging selection was createdissued : instant [0..1]A list of the diagnostic requests that resulted in this imaging selection being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »Classifies the imaging selectioncategory : CodeableConcept [0..*] « null (Strength=Example)KeyObjectSelectionDocumentTit...?? »Reason for referencing the selected contentcode : CodeableConcept [1..1] « null (Strength=Example)KeyObjectSelectionDocumentTit...?? »The Study Instance UID for the DICOM Study from which the images were selectedstudyUid : id [0..1]The imaging study from which the imaging selection is madederivedFrom : Reference [0..*] « ImagingStudy|DocumentReference »The network service providing retrieval access to the selected images, frames, etc. See implementation notes for information about using DICOM endpointsendpoint : Reference [0..*] « Endpoint »The Series Instance UID for the DICOM Series from which the images were selectedseriesUid : id [0..1]The Series Number for the DICOM Series from which the images were selectedseriesNumber : unsignedInt [0..1]The Frame of Reference UID identifying the coordinate system that conveys spatial and/or temporal information for the selected images or framesframeOfReferenceUid : id [0..1]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 mappingsbodySite : CodeableReference [0..1] « BodyStructure; null (Strength=Example) SNOMEDCTBodyStructures?? »The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focusfocus : Reference [0..*] « ImagingSelection »PerformerDistinguishes the type of involvement of the performerfunction : CodeableConcept [0..1] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Author – human or machineactor : Reference [0..1] « Practitioner|PractitionerRole|Device| Organization|CareTeam|Patient|RelatedPerson|HealthcareService »InstanceThe SOP Instance UID for the selected DICOM instanceuid : id [1..1]The Instance Number for the selected DICOM instancenumber : unsignedInt [0..1]The SOP Class UID for the selected DICOM instancesopClass : Coding [0..1] « null (Strength=Extensible)sopClass+ »Selected subset of the SOP Instance. The content and format of the subset item is determined by the SOP Class of the selected instance. May be one of: - A list of frame numbers selected from a multiframe SOP Instance. - A list of Content Item Observation UID values selected from a DICOM SR or other structured document SOP Instance. - A list of segment numbers selected from a segmentation SOP Instance. - A list of Region of Interest (ROI) numbers selected from a radiotherapy structure set SOP Instancesubset : string [0..*]ImageRegion2DSpecifies the type of image regionregionType : code [1..1] « null (Strength=Required)ImagingSelection2DGraphicType! »The coordinates describing the image region. Encoded as a set of (column, row) pairs that denote positions in the selected image / frames specified with sub-pixel resolution. The origin at the TLHC of the TLHC pixel is 0.0\0.0, the BRHC of the TLHC pixel is 1.0\1.0, and the BRHC of the BRHC pixel is the number of columns\rows in the image / frames. The values must be within the range 0\0 to the number of columns\rows in the image / framescoordinate : decimal [1..*]ImageRegion3DSpecifies the type of image regionregionType : code [1..1] « null (Strength=Required)ImagingSelection3DGraphicType! »The coordinates describing the image region. Encoded as an ordered set of (x,y,z) triplets (in mm and may be negative) that define a region of interest in the patient-relative Reference Coordinate System defined by ImagingSelection.frameOfReferenceUid elementcoordinate : decimal [1..*]Selector of the instances – human or machineperformer[0..*]Each imaging selection instance or frame list might includes an image region, specified by a region type and a set of 2D coordinates. If the parent imagingSelection.instance contains a subset element of type frame, the image region applies to all frames in the subset listimageRegion2D[0..*]Each imaging selection might includes a 3D image region, specified by a region type and a set of 3D coordinatesimageRegion3D[0..*]Each imaging selection includes one or more selected DICOM SOP instancesinstance[0..*]

XML Template

<ImagingSelection xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for Imaging Selection --></identifier>
 <status value="[code]"/><!-- 1..1 available | entered-in-error | unknown -->
 <subject><!-- 0..1 Reference(Device|Group|Location|Medication|Organization|
   Patient|Practitioner|Procedure|Specimen|Substance) Subject of the selected instances --></subject>
 <issued value="[instant]"/><!-- 0..1 Date / Time when this imaging selection was created -->
 <performer>  <!-- 0..* Selector of the instances (human or machine) -->
  <function><!-- 0..1 CodeableConcept Type of performer --></function>
  <actor><!-- 0..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Author (human or machine) --></actor>
 </performer>
 <basedOn><!-- 0..* Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) Associated request --></basedOn>
 <category><!-- 0..* CodeableConcept Classifies the imaging selection icon --></category>
 <code><!-- 1..1 CodeableConcept Imaging Selection purpose text or code icon --></code>
 <studyUid value="[id]"/><!-- 0..1 DICOM Study Instance UID -->
 <derivedFrom><!-- 0..* Reference(DocumentReference|ImagingStudy) The imaging study from which the imaging selection is derived --></derivedFrom>
 <endpoint><!-- 0..* Reference(Endpoint) The network service providing retrieval for the images referenced in the imaging selection --></endpoint>
 <seriesUid value="[id]"/><!-- 0..1 DICOM Series Instance UID -->
 <seriesNumber value="[unsignedInt]"/><!-- 0..1 DICOM Series Number -->
 <frameOfReferenceUid value="[id]"/><!-- 0..1 The Frame of Reference UID for the selected images -->
 <bodySite><!-- 0..1 CodeableReference(BodyStructure) Body part examined --></bodySite>
 <focus><!-- 0..* Reference(ImagingSelection) Related resource that is the focus for the imaging selection --></focus>
 <instance>  <!-- 0..* The selected instances -->
  <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
  <number value="[unsignedInt]"/><!-- 0..1 DICOM Instance Number -->
  <sopClass><!-- 0..1 Coding DICOM SOP Class UID icon --></sopClass>
  <subset value="[string]"/><!-- 0..* The selected subset of the SOP Instance -->
  <imageRegion2D>  <!-- 0..* A specific 2D region in a DICOM image / frame -->
   <regionType value="[code]"/><!-- 1..1 point | polyline | interpolated | circle | ellipse -->
   <coordinate value="[decimal]"/><!-- 1..* Specifies the coordinates that define the image region -->
  </imageRegion2D>
  <imageRegion3D>  <!-- 0..* A specific 3D region in a DICOM frame of reference -->
   <regionType value="[code]"/><!-- 1..1 point | multipoint | polyline | polygon | ellipse | ellipsoid -->
   <coordinate value="[decimal]"/><!-- 1..* Specifies the coordinates that define the image region -->
  </imageRegion3D>
 </instance>
</ImagingSelection>

JSON Template

{doco
  "resourceType" : "ImagingSelection",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for Imaging Selection
  "status" : "<code>", // R!  available | entered-in-error | unknown
  "subject" : { Reference(Device|Group|Location|Medication|Organization|
   Patient|Practitioner|Procedure|Specimen|Substance) }, // Subject of the selected instances
  "issued" : "<instant>", // Date / Time when this imaging selection was created
  "performer" : [{ // Selector of the instances (human or machine)
    "function" : { CodeableConcept }, // Type of performer
    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) } // Author (human or machine)
  }],
  "basedOn" : [{ Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) }], // Associated request
  "category" : [{ CodeableConcept }], // Classifies the imaging selection icon
  "code" : { CodeableConcept }, // R!  Imaging Selection purpose text or code icon
  "studyUid" : "<id>", // DICOM Study Instance UID
  "derivedFrom" : [{ Reference(DocumentReference|ImagingStudy) }], // The imaging study from which the imaging selection is derived
  "endpoint" : [{ Reference(Endpoint) }], // The network service providing retrieval for the images referenced in the imaging selection
  "seriesUid" : "<id>", // DICOM Series Instance UID
  "seriesNumber" : "<unsignedInt>", // DICOM Series Number
  "frameOfReferenceUid" : "<id>", // The Frame of Reference UID for the selected images
  "bodySite" : { CodeableReference(BodyStructure) }, // Body part examined
  "focus" : [{ Reference(ImagingSelection) }], // Related resource that is the focus for the imaging selection
  "instance" : [{ // The selected instances
    "uid" : "<id>", // R!  DICOM SOP Instance UID
    "number" : "<unsignedInt>", // DICOM Instance Number
    "sopClass" : { Coding }, // DICOM SOP Class UID icon
    "subset" : ["<string>"], // The selected subset of the SOP Instance
    "imageRegion2D" : [{ // A specific 2D region in a DICOM image / frame
      "regionType" : "<code>", // R!  point | polyline | interpolated | circle | ellipse
      "coordinate" : [<decimal>] // R!  Specifies the coordinates that define the image region
    }],
    "imageRegion3D" : [{ // A specific 3D region in a DICOM frame of reference
      "regionType" : "<code>", // R!  point | multipoint | polyline | polygon | ellipse | ellipsoid
      "coordinate" : [<decimal>] // R!  Specifies the coordinates that define the image region
    }]
  }]
}

Turtle Template

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


[ a fhir:ImagingSelection;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for Imaging Selection
  fhir:status [ code ] ; # 1..1 available | entered-in-error | unknown
  fhir:subject [ Reference(Device|Group|Location|Medication|Organization|Patient|Practitioner|Procedure|
  Specimen|Substance) ] ; # 0..1 Subject of the selected instances
  fhir:issued [ instant ] ; # 0..1 Date / Time when this imaging selection was created
  fhir:performer ( [ # 0..* Selector of the instances (human or machine)
    fhir:function [ CodeableConcept ] ; # 0..1 Type of performer
    fhir:actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Author (human or machine)
  ] ... ) ;
  fhir:basedOn  ( [ Reference(Appointment|AppointmentResponse|CarePlan|ServiceRequest|Task) ] ... ) ; # 0..* Associated request
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Classifies the imaging selection
  fhir:code [ CodeableConcept ] ; # 1..1 Imaging Selection purpose text or code
  fhir:studyUid [ id ] ; # 0..1 DICOM Study Instance UID
  fhir:derivedFrom  ( [ Reference(DocumentReference|ImagingStudy) ] ... ) ; # 0..* The imaging study from which the imaging selection is derived
  fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* The network service providing retrieval for the images referenced in the imaging selection
  fhir:seriesUid [ id ] ; # 0..1 DICOM Series Instance UID
  fhir:seriesNumber [ unsignedInt ] ; # 0..1 DICOM Series Number
  fhir:frameOfReferenceUid [ id ] ; # 0..1 The Frame of Reference UID for the selected images
  fhir:bodySite [ CodeableReference(BodyStructure) ] ; # 0..1 Body part examined
  fhir:focus  ( [ Reference(ImagingSelection) ] ... ) ; # 0..* Related resource that is the focus for the imaging selection
  fhir:instance ( [ # 0..* The selected instances
    fhir:uid [ id ] ; # 1..1 DICOM SOP Instance UID
    fhir:number [ unsignedInt ] ; # 0..1 DICOM Instance Number
    fhir:sopClass [ Coding ] ; # 0..1 DICOM SOP Class UID
    fhir:subset  ( [ string ] ... ) ; # 0..* The selected subset of the SOP Instance
    fhir:imageRegion2D ( [ # 0..* A specific 2D region in a DICOM image / frame
      fhir:regionType [ code ] ; # 1..1 point | polyline | interpolated | circle | ellipse
      fhir:coordinate  ( [ decimal ] ... ) ; # 1..* Specifies the coordinates that define the image region
    ] ... ) ;
    fhir:imageRegion3D ( [ # 0..* A specific 3D region in a DICOM frame of reference
      fhir:regionType [ code ] ; # 1..1 point | multipoint | polyline | polygon | ellipse | ellipsoid
      fhir:coordinate  ( [ decimal ] ... ) ; # 1..* Specifies the coordinates that define the image region
    ] ... ) ;
  ] ... ) ;
]

Changes since R4

This resource did not exist in Release 3

This analysis is available as XML or JSON.

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingSelection TUDomainResourceA selection of DICOM SOP instances and/or frames

Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
... identifier Σ0..*IdentifierBusiness Identifier for Imaging Selection

... status ?!Σ1..1codeavailable | entered-in-error | unknown
Binding: Imaging Selection Status (Required)
... subject Σ0..1Reference(Patient | Group | Device | Location | Organization | Procedure | Practitioner | Medication | Substance | Specimen)Subject of the selected instances
... performer Σ0..*BackboneElementSelector of the instances (human or machine)

.... function Σ0..1CodeableConceptType of performer
Binding: ImagingStudy series performer function (Extensible)
.... actor Σ0..1Reference(Practitioner | PractitionerRole | Device | Organization | CareTeam | Patient | RelatedPerson | HealthcareService)Author (human or machine)
... basedOn Σ0..*Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task)Associated request

... category Σ0..*CodeableConceptClassifies the imaging selection
Binding: KeyObjectSelectionDocumentTitle icon (Example)

... code Σ1..1CodeableConceptImaging Selection purpose text or code
Binding: KeyObjectSelectionDocumentTitle icon (Example)
... studyUid Σ0..1idDICOM Study Instance UID
... derivedFrom Σ0..*Reference(ImagingStudy | DocumentReference)The imaging study from which the imaging selection is derived

... endpoint Σ0..*Reference(Endpoint)The network service providing retrieval for the images referenced in the imaging selection

... seriesUid Σ0..1idDICOM Series Instance UID
... seriesNumber Σ0..1unsignedIntDICOM Series Number
... frameOfReferenceUid Σ0..1idThe Frame of Reference UID for the selected images
... bodySite Σ0..1CodeableReference(BodyStructure)Body part examined
Binding: SNOMED CT Body Structures (Example)
... focus Σ0..*Reference(ImagingSelection)Related resource that is the focus for the imaging selection

... instance Σ0..*BackboneElementThe selected instances

.... uid Σ1..1idDICOM SOP Instance UID
.... number Σ0..1unsignedIntDICOM Instance Number
.... sopClass 0..1CodingDICOM SOP Class UID
Binding: sopClass icon (Extensible)
.... subset 0..*stringThe selected subset of the SOP Instance

.... imageRegion2D 0..*BackboneElementA specific 2D region in a DICOM image / frame

..... regionType 1..1codepoint | polyline | interpolated | circle | ellipse
Binding: Imaging Selection2 D Graphic Type (Required)
..... coordinate 1..*decimalSpecifies the coordinates that define the image region
This repeating element order: The values are an ordered set of (x, y) coordinates.
.... imageRegion3D 0..*BackboneElementA specific 3D region in a DICOM frame of reference

..... regionType 1..1codepoint | multipoint | polyline | polygon | ellipse | ellipsoid
Binding: Imaging Selection3 D Graphic Type (Required)
..... coordinate 1..*decimalSpecifies the coordinates that define the image region
This repeating element order: The values are an ordered set of (x, y, z) coordinates.

doco Documentation for this format icon

See the Extensions for this resource

UML Diagram (Legend)

ImagingSelection (DomainResource)A unique identifier assigned to this imaging selectionidentifier : Identifier [0..*]The current state of the ImagingSelection resource. This is not the status of any ImagingStudy, ServiceRequest, or Task resources associated with the ImagingSelection (this element modifies the meaning of other elements)status : code [1..1] « null (Strength=Required)ImagingSelectionStatus! »The patient, or group of patients, location, device, organization, procedure or practitioner this imaging selection is about and into whose or what record the imaging selection is placedsubject : Reference [0..1] « Patient|Group|Device|Location| Organization|Procedure|Practitioner|Medication|Substance| Specimen »The date and time this imaging selection was createdissued : instant [0..1]A list of the diagnostic requests that resulted in this imaging selection being performedbasedOn : Reference [0..*] « CarePlan|ServiceRequest|Appointment| AppointmentResponse|Task »Classifies the imaging selectioncategory : CodeableConcept [0..*] « null (Strength=Example)KeyObjectSelectionDocumentTit...?? »Reason for referencing the selected contentcode : CodeableConcept [1..1] « null (Strength=Example)KeyObjectSelectionDocumentTit...?? »The Study Instance UID for the DICOM Study from which the images were selectedstudyUid : id [0..1]The imaging study from which the imaging selection is madederivedFrom : Reference [0..*] « ImagingStudy|DocumentReference »The network service providing retrieval access to the selected images, frames, etc. See implementation notes for information about using DICOM endpointsendpoint : Reference [0..*] « Endpoint »The Series Instance UID for the DICOM Series from which the images were selectedseriesUid : id [0..1]The Series Number for the DICOM Series from which the images were selectedseriesNumber : unsignedInt [0..1]The Frame of Reference UID identifying the coordinate system that conveys spatial and/or temporal information for the selected images or framesframeOfReferenceUid : id [0..1]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 mappingsbodySite : CodeableReference [0..1] « BodyStructure; null (Strength=Example) SNOMEDCTBodyStructures?? »The actual focus of an observation when it is not the patient of record representing something or someone associated with the patient such as a spouse, parent, fetus, or donor. For example, fetus observations in a mother's record. The focus of an observation could also be an existing condition, an intervention, the subject's diet, another observation of the subject, or a body structure such as tumor or implanted device. An example use case would be using the Observation resource to capture whether the mother is trained to change her child's tracheostomy tube. In this example, the child is the patient of record and the mother is the focusfocus : Reference [0..*] « ImagingSelection »PerformerDistinguishes the type of involvement of the performerfunction : CodeableConcept [0..1] « null (Strength=Extensible)ImagingStudySeriesPerformerFu...+ »Author – human or machineactor : Reference [0..1] « Practitioner|PractitionerRole|Device| Organization|CareTeam|Patient|RelatedPerson|HealthcareService »InstanceThe SOP Instance UID for the selected DICOM instanceuid : id [1..1]The Instance Number for the selected DICOM instancenumber : unsignedInt [0..1]The SOP Class UID for the selected DICOM instancesopClass : Coding [0..1] « null (Strength=Extensible)sopClass+ »Selected subset of the SOP Instance. The content and format of the subset item is determined by the SOP Class of the selected instance. May be one of: - A list of frame numbers selected from a multiframe SOP Instance. - A list of Content Item Observation UID values selected from a DICOM SR or other structured document SOP Instance. - A list of segment numbers selected from a segmentation SOP Instance. - A list of Region of Interest (ROI) numbers selected from a radiotherapy structure set SOP Instancesubset : string [0..*]ImageRegion2DSpecifies the type of image regionregionType : code [1..1] « null (Strength=Required)ImagingSelection2DGraphicType! »The coordinates describing the image region. Encoded as a set of (column, row) pairs that denote positions in the selected image / frames specified with sub-pixel resolution. The origin at the TLHC of the TLHC pixel is 0.0\0.0, the BRHC of the TLHC pixel is 1.0\1.0, and the BRHC of the BRHC pixel is the number of columns\rows in the image / frames. The values must be within the range 0\0 to the number of columns\rows in the image / framescoordinate : decimal [1..*]ImageRegion3DSpecifies the type of image regionregionType : code [1..1] « null (Strength=Required)ImagingSelection3DGraphicType! »The coordinates describing the image region. Encoded as an ordered set of (x,y,z) triplets (in mm and may be negative) that define a region of interest in the patient-relative Reference Coordinate System defined by ImagingSelection.frameOfReferenceUid elementcoordinate : decimal [1..*]Selector of the instances – human or machineperformer[0..*]Each imaging selection instance or frame list might includes an image region, specified by a region type and a set of 2D coordinates. If the parent imagingSelection.instance contains a subset element of type frame, the image region applies to all frames in the subset listimageRegion2D[0..*]Each imaging selection might includes a 3D image region, specified by a region type and a set of 3D coordinatesimageRegion3D[0..*]Each imaging selection includes one or more selected DICOM SOP instancesinstance[0..*]

XML Template

<ImagingSelection xmlns="http://hl7.org/fhir"> doco
 <!-- from Resource: id, meta, implicitRules, and language -->
 <!-- from DomainResource: text, contained, extension, and modifierExtension -->
 <identifier><!-- 0..* Identifier Business Identifier for Imaging Selection --></identifier>
 <status value="[code]"/><!-- 1..1 available | entered-in-error | unknown -->
 <subject><!-- 0..1 Reference(Device|Group|Location|Medication|Organization|
   Patient|Practitioner|Procedure|Specimen|Substance) Subject of the selected instances --></subject>
 <issued value="[instant]"/><!-- 0..1 Date / Time when this imaging selection was created -->
 <performer>  <!-- 0..* Selector of the instances (human or machine) -->
  <function><!-- 0..1 CodeableConcept Type of performer --></function>
  <actor><!-- 0..1 Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) Author (human or machine) --></actor>
 </performer>
 <basedOn><!-- 0..* Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) Associated request --></basedOn>
 <category><!-- 0..* CodeableConcept Classifies the imaging selection icon --></category>
 <code><!-- 1..1 CodeableConcept Imaging Selection purpose text or code icon --></code>
 <studyUid value="[id]"/><!-- 0..1 DICOM Study Instance UID -->
 <derivedFrom><!-- 0..* Reference(DocumentReference|ImagingStudy) The imaging study from which the imaging selection is derived --></derivedFrom>
 <endpoint><!-- 0..* Reference(Endpoint) The network service providing retrieval for the images referenced in the imaging selection --></endpoint>
 <seriesUid value="[id]"/><!-- 0..1 DICOM Series Instance UID -->
 <seriesNumber value="[unsignedInt]"/><!-- 0..1 DICOM Series Number -->
 <frameOfReferenceUid value="[id]"/><!-- 0..1 The Frame of Reference UID for the selected images -->
 <bodySite><!-- 0..1 CodeableReference(BodyStructure) Body part examined --></bodySite>
 <focus><!-- 0..* Reference(ImagingSelection) Related resource that is the focus for the imaging selection --></focus>
 <instance>  <!-- 0..* The selected instances -->
  <uid value="[id]"/><!-- 1..1 DICOM SOP Instance UID -->
  <number value="[unsignedInt]"/><!-- 0..1 DICOM Instance Number -->
  <sopClass><!-- 0..1 Coding DICOM SOP Class UID icon --></sopClass>
  <subset value="[string]"/><!-- 0..* The selected subset of the SOP Instance -->
  <imageRegion2D>  <!-- 0..* A specific 2D region in a DICOM image / frame -->
   <regionType value="[code]"/><!-- 1..1 point | polyline | interpolated | circle | ellipse -->
   <coordinate value="[decimal]"/><!-- 1..* Specifies the coordinates that define the image region -->
  </imageRegion2D>
  <imageRegion3D>  <!-- 0..* A specific 3D region in a DICOM frame of reference -->
   <regionType value="[code]"/><!-- 1..1 point | multipoint | polyline | polygon | ellipse | ellipsoid -->
   <coordinate value="[decimal]"/><!-- 1..* Specifies the coordinates that define the image region -->
  </imageRegion3D>
 </instance>
</ImagingSelection>

JSON Template

{doco
  "resourceType" : "ImagingSelection",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "identifier" : [{ Identifier }], // Business Identifier for Imaging Selection
  "status" : "<code>", // R!  available | entered-in-error | unknown
  "subject" : { Reference(Device|Group|Location|Medication|Organization|
   Patient|Practitioner|Procedure|Specimen|Substance) }, // Subject of the selected instances
  "issued" : "<instant>", // Date / Time when this imaging selection was created
  "performer" : [{ // Selector of the instances (human or machine)
    "function" : { CodeableConcept }, // Type of performer
    "actor" : { Reference(CareTeam|Device|HealthcareService|Organization|
    Patient|Practitioner|PractitionerRole|RelatedPerson) } // Author (human or machine)
  }],
  "basedOn" : [{ Reference(Appointment|AppointmentResponse|CarePlan|
   ServiceRequest|Task) }], // Associated request
  "category" : [{ CodeableConcept }], // Classifies the imaging selection icon
  "code" : { CodeableConcept }, // R!  Imaging Selection purpose text or code icon
  "studyUid" : "<id>", // DICOM Study Instance UID
  "derivedFrom" : [{ Reference(DocumentReference|ImagingStudy) }], // The imaging study from which the imaging selection is derived
  "endpoint" : [{ Reference(Endpoint) }], // The network service providing retrieval for the images referenced in the imaging selection
  "seriesUid" : "<id>", // DICOM Series Instance UID
  "seriesNumber" : "<unsignedInt>", // DICOM Series Number
  "frameOfReferenceUid" : "<id>", // The Frame of Reference UID for the selected images
  "bodySite" : { CodeableReference(BodyStructure) }, // Body part examined
  "focus" : [{ Reference(ImagingSelection) }], // Related resource that is the focus for the imaging selection
  "instance" : [{ // The selected instances
    "uid" : "<id>", // R!  DICOM SOP Instance UID
    "number" : "<unsignedInt>", // DICOM Instance Number
    "sopClass" : { Coding }, // DICOM SOP Class UID icon
    "subset" : ["<string>"], // The selected subset of the SOP Instance
    "imageRegion2D" : [{ // A specific 2D region in a DICOM image / frame
      "regionType" : "<code>", // R!  point | polyline | interpolated | circle | ellipse
      "coordinate" : [<decimal>] // R!  Specifies the coordinates that define the image region
    }],
    "imageRegion3D" : [{ // A specific 3D region in a DICOM frame of reference
      "regionType" : "<code>", // R!  point | multipoint | polyline | polygon | ellipse | ellipsoid
      "coordinate" : [<decimal>] // R!  Specifies the coordinates that define the image region
    }]
  }]
}

Turtle Template

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


[ a fhir:ImagingSelection;
  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:identifier  ( [ Identifier ] ... ) ; # 0..* Business Identifier for Imaging Selection
  fhir:status [ code ] ; # 1..1 available | entered-in-error | unknown
  fhir:subject [ Reference(Device|Group|Location|Medication|Organization|Patient|Practitioner|Procedure|
  Specimen|Substance) ] ; # 0..1 Subject of the selected instances
  fhir:issued [ instant ] ; # 0..1 Date / Time when this imaging selection was created
  fhir:performer ( [ # 0..* Selector of the instances (human or machine)
    fhir:function [ CodeableConcept ] ; # 0..1 Type of performer
    fhir:actor [ Reference(CareTeam|Device|HealthcareService|Organization|Patient|Practitioner|
  PractitionerRole|RelatedPerson) ] ; # 0..1 Author (human or machine)
  ] ... ) ;
  fhir:basedOn  ( [ Reference(Appointment|AppointmentResponse|CarePlan|ServiceRequest|Task) ] ... ) ; # 0..* Associated request
  fhir:category  ( [ CodeableConcept ] ... ) ; # 0..* Classifies the imaging selection
  fhir:code [ CodeableConcept ] ; # 1..1 Imaging Selection purpose text or code
  fhir:studyUid [ id ] ; # 0..1 DICOM Study Instance UID
  fhir:derivedFrom  ( [ Reference(DocumentReference|ImagingStudy) ] ... ) ; # 0..* The imaging study from which the imaging selection is derived
  fhir:endpoint  ( [ Reference(Endpoint) ] ... ) ; # 0..* The network service providing retrieval for the images referenced in the imaging selection
  fhir:seriesUid [ id ] ; # 0..1 DICOM Series Instance UID
  fhir:seriesNumber [ unsignedInt ] ; # 0..1 DICOM Series Number
  fhir:frameOfReferenceUid [ id ] ; # 0..1 The Frame of Reference UID for the selected images
  fhir:bodySite [ CodeableReference(BodyStructure) ] ; # 0..1 Body part examined
  fhir:focus  ( [ Reference(ImagingSelection) ] ... ) ; # 0..* Related resource that is the focus for the imaging selection
  fhir:instance ( [ # 0..* The selected instances
    fhir:uid [ id ] ; # 1..1 DICOM SOP Instance UID
    fhir:number [ unsignedInt ] ; # 0..1 DICOM Instance Number
    fhir:sopClass [ Coding ] ; # 0..1 DICOM SOP Class UID
    fhir:subset  ( [ string ] ... ) ; # 0..* The selected subset of the SOP Instance
    fhir:imageRegion2D ( [ # 0..* A specific 2D region in a DICOM image / frame
      fhir:regionType [ code ] ; # 1..1 point | polyline | interpolated | circle | ellipse
      fhir:coordinate  ( [ decimal ] ... ) ; # 1..* Specifies the coordinates that define the image region
    ] ... ) ;
    fhir:imageRegion3D ( [ # 0..* A specific 3D region in a DICOM frame of reference
      fhir:regionType [ code ] ; # 1..1 point | multipoint | polyline | polygon | ellipse | ellipsoid
      fhir:coordinate  ( [ decimal ] ... ) ; # 1..* Specifies the coordinates that define the image region
    ] ... ) ;
  ] ... ) ;
]

Changes since Release 4

This resource did not exist in Release 3

This analysis is available as XML or JSON.

 

Additional definitions: Master Definition XML + JSON, XML Schema/Schematron + JSON Schema, ShEx (for Turtle) + see the extensions, the spreadsheet version & the dependency analysis

10.6.4.1 Terminology Bindings

PathValueSetTypeDocumentation
ImagingSelection.status ImagingSelectionStatus Required

The status of the ImagingSelection.
ImagingSelection.performer.function ImagingStudySeriesPerformerFunction Extensible

Performer function of an agent in an imaging study series
ImagingSelection.category KeyObjectSelectionDocumentTitle icon Example

Transitive closure of CID 7010 KeyObjectSelectionDocumentTitle
ImagingSelection.code KeyObjectSelectionDocumentTitle icon Example

Transitive closure of CID 7010 KeyObjectSelectionDocumentTitle
ImagingSelection.bodySite SNOMEDCTBodyStructures Example

This value set includes all codes from SNOMED CT icon where concept is-a 442083009 (Anatomical or acquired body site (body structure)).
ImagingSelection.instance.sopClass http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 icon Extensible
ImagingSelection.instance.imageRegion2D.regionType ImagingSelection2DGraphicType Required

The type of 2D coordinates describing a 2D image region.
ImagingSelection.instance.imageRegion3D.regionType ImagingSelection3DGraphicType Required

The type of coordinates describing a 3D image region.

10.6.4.2 Implementation Notes

10.6.4.2.1 Imaging Selection Subsets

Some DICOM SOP Instances contain multiple sub-resources, such as frames, segments, etc.

An Imaging Selection resource may specify the subset of these that are included in the selection using the instance.subset element.

The defined types of subsets are:

  • Frames selected from a multiframe SOP Instance
  • Content Item Observation UIDs selected from a DICOM SR or other structured document SOP Instance
  • Segments selected from a segmentation SOP Instance
  • Regions of interest selected from a radiotherapy structure set SOP Instance

The type of subset is determined by the SOP Class of the parent instance.

Subsets can only reference sub-resources that are already defined within the selected DICOM SOP Instance.

10.6.5 Search Parameters

Search parameters for this resource. See also the full list of search parameters for this resource, and check the Extensions registry for search parameters on extensions related to this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.

NameTypeDescriptionExpressionIn Common
based-onreferenceThe request associated with an imaging selectionImagingSelection.basedOn
(Appointment, AppointmentResponse, CarePlan, Task, ServiceRequest)
body-sitetokenThe body site code associated with the imaging selectionImagingSelection.bodySite.concept
body-structurereferenceThe body structure associated with the imaging selectionImagingSelection.bodySite.reference
codetokenThe imaging selection statusImagingSelection.status22 Resources
derived-fromreferenceThe imaging study from which the imaging selection was derivedImagingSelection.derivedFrom
(ImagingStudy, DocumentReference)
identifiertokenIdentifiers for the imaging selectionImagingSelection.identifier65 Resources
issueddateThe date / time the imaging selection was createdImagingSelection.issued
patientreferenceWho the study is aboutImagingSelection.subject.where(resolve() is Patient)
(Patient)		66 Resources
statustokenThe status of the imaging selectionImagingSelection.status
study-uidtokenThe DICOM Study Instance UID from which the images were selectedImagingSelection.studyUid
subjectreferenceThe subject of the Imaging Selection, such as the associated PatientImagingSelection.subject
(Practitioner, Group, Specimen, Organization, Device, Medication, Patient, Procedure, Substance, Location)