DSTU2

This page is part of the FHIR Specification (v1.0.2: DSTU 2). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3 R2

4.23 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.

4.23.1 Scope and Usage

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 .

This resource is referenced by DiagnosticReport and ImagingObjectSelection

4.23.2 Resource Content

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy ΣDomainResourceA set of images produced in single study (one or more series of references images)
... started Σ0..1dateTimeWhen the study was started
... patient Σ1..1Reference(Patient)Who the images are of
... uid Σ1..1oidFormal identifier for the study
... accession Σ0..1IdentifierRelated workflow identifier ("Accession Number")
... identifier Σ0..*IdentifierOther identifiers for the study
... order Σ0..*Reference(DiagnosticOrder)Order(s) that caused this study to be performed
... modalityList Σ0..*CodingAll series modality if actual acquisition modalities
Acquisition Modality Codes (Extensible)
... referrer Σ0..1Reference(Practitioner)Referring physician (0008,0090)
... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056)
InstanceAvailability (Required)
... url Σ0..1uriRetrieve URI
... numberOfSeries Σ1..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ1..1unsignedIntNumber of Study Related Instances
... procedure Σ0..*Reference(Procedure)Type of procedure performed
... interpreter Σ0..1Reference(Practitioner)Who interpreted images
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
Acquisition Modality Codes (Extensible)
.... uid Σ1..1oidFormal identifier for this series
.... description Σ0..1stringA description of the series
.... numberOfInstances Σ1..1unsignedIntNumber of Series Related Instances
.... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
.... url Σ0..1uriLocation of the referenced instance(s)
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... started Σ0..1dateTimeWhen the series started
.... instance Σ0..*BackboneElementA single SOP instance from the series
..... number Σ0..1unsignedIntThe number of this instance in the series
..... uid Σ1..1oidFormal identifier for this instance
..... sopClass Σ1..1oidDICOM class type
..... type Σ0..1stringType of instance (image etc.)
..... title Σ0..1stringDescription of instance
..... content Σ0..*AttachmentContent of the instance

doco Documentation for this format

UML Diagram

ImagingStudy (DomainResource)Date and Time the study startedstarted : dateTime [0..1]The patient imaged in the studypatient : Reference [1..1] « Patient »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..*]A list of the diagnostic orders that resulted in this imaging study being performedorder : Reference [0..*] « DiagnosticOrder »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 requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Availability of study (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »WADO-RS resource where Study is availableurl : uri [0..1]Number of Series in StudynumberOfSeries : unsignedInt [1..1]Number of SOP Instances in StudynumberOfInstances : unsignedInt [1..1]Type of procedure performedprocedure : Reference [0..*] « Procedure »Who read the study and interpreted the images or other contentinterpreter : Reference [0..1] « Practitioner »Institution-generated description or classification of the Study performeddescription : string [0..1]SeriesThe 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 + »Formal identifier for this seriesuid : oid [1..1]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! »URI/URL specifying the location of the referenced series using WADO-RSurl : uri [0..1]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]InstanceThe number of instance in the seriesnumber : unsignedInt [0..1]Formal identifier for this image or other contentuid : oid [1..1]DICOM instance typesopClass : oid [1..1]A human-friendly SOP Class nametype : string [0..1]The description of the instancetitle : string [0..1]Content of the instance or a rendering thereof (e.g. a JPEG of an image, or an XML of a structured report). May be represented for example by inline encoding; by a URL reference to a WADO-RS service that makes the instance available; or to a FHIR Resource (e.g. Media, Document, etc.). Multiple content attachments may be used for alternate representations of the instancecontent : Attachment [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 -->
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <uid value="[oid]"/><!-- 1..1 Formal identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <order><!-- 0..* Reference(DiagnosticOrder) Order(s) that caused this study to be performed --></order>
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician (0008,0090) --></referrer>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056) -->
 <url value="[uri]"/><!-- 0..1 Retrieve URI -->
 <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>
 <interpreter><!-- 0..1 Reference(Practitioner) Who interpreted images --></interpreter>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series --></modality>
  <uid value="[oid]"/><!-- 1..1 Formal identifier for this series -->
  <description value="[string]"/><!-- 0..1 A description of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Series Related Instances -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <url value="[uri]"/><!-- 0..1 Location of the referenced instance(s) -->
  <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 -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <uid value="[oid]"/><!-- 1..1 Formal identifier for this instance -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <type value="[string]"/><!-- 0..1 Type of instance (image etc.) -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
   <content><!-- 0..* Attachment Content of the instance --></content>
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "started" : "<dateTime>", // When the study was started
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "uid" : "<oid>", // R!  Formal identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "order" : [{ Reference(DiagnosticOrder) }], // Order(s) that caused this study to be performed
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "referrer" : { Reference(Practitioner) }, // Referring physician (0008,0090)
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056)
  "url" : "<uri>", // Retrieve URI
  "numberOfSeries" : "<unsignedInt>", // R!  Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // R!  Number of Study Related Instances
  "procedure" : [{ Reference(Procedure) }], // Type of procedure performed
  "interpreter" : { Reference(Practitioner) }, // Who interpreted images
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "uid" : "<oid>", // R!  Formal identifier for this series
    "description" : "<string>", // A description of the series
    "numberOfInstances" : "<unsignedInt>", // R!  Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "url" : "<uri>", // Location of the referenced instance(s)
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "instance" : [{ // A single SOP instance from the series
      "number" : "<unsignedInt>", // The number of this instance in the series
      "uid" : "<oid>", // R!  Formal identifier for this instance
      "sopClass" : "<oid>", // R!  DICOM class type
      "type" : "<string>", // Type of instance (image etc.)
      "title" : "<string>", // Description of instance
      "content" : [{ Attachment }] // Content of the instance
    }]
  }]
}

Structure

NameFlagsCard.TypeDescription & Constraintsdoco
.. ImagingStudy ΣDomainResourceA set of images produced in single study (one or more series of references images)
... started Σ0..1dateTimeWhen the study was started
... patient Σ1..1Reference(Patient)Who the images are of
... uid Σ1..1oidFormal identifier for the study
... accession Σ0..1IdentifierRelated workflow identifier ("Accession Number")
... identifier Σ0..*IdentifierOther identifiers for the study
... order Σ0..*Reference(DiagnosticOrder)Order(s) that caused this study to be performed
... modalityList Σ0..*CodingAll series modality if actual acquisition modalities
Acquisition Modality Codes (Extensible)
... referrer Σ0..1Reference(Practitioner)Referring physician (0008,0090)
... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056)
InstanceAvailability (Required)
... url Σ0..1uriRetrieve URI
... numberOfSeries Σ1..1unsignedIntNumber of Study Related Series
... numberOfInstances Σ1..1unsignedIntNumber of Study Related Instances
... procedure Σ0..*Reference(Procedure)Type of procedure performed
... interpreter Σ0..1Reference(Practitioner)Who interpreted images
... description Σ0..1stringInstitution-generated description
... series Σ0..*BackboneElementEach study has one or more series of instances
.... number Σ0..1unsignedIntNumeric identifier of this series
.... modality Σ1..1CodingThe modality of the instances in the series
Acquisition Modality Codes (Extensible)
.... uid Σ1..1oidFormal identifier for this series
.... description Σ0..1stringA description of the series
.... numberOfInstances Σ1..1unsignedIntNumber of Series Related Instances
.... availability Σ0..1codeONLINE | OFFLINE | NEARLINE | UNAVAILABLE
InstanceAvailability (Required)
.... url Σ0..1uriLocation of the referenced instance(s)
.... bodySite Σ0..1CodingBody part examined
SNOMED CT Body Structures (Example)
.... laterality Σ0..1CodingBody part laterality
Laterality (Example)
.... started Σ0..1dateTimeWhen the series started
.... instance Σ0..*BackboneElementA single SOP instance from the series
..... number Σ0..1unsignedIntThe number of this instance in the series
..... uid Σ1..1oidFormal identifier for this instance
..... sopClass Σ1..1oidDICOM class type
..... type Σ0..1stringType of instance (image etc.)
..... title Σ0..1stringDescription of instance
..... content Σ0..*AttachmentContent of the instance

doco Documentation for this format

UML Diagram

ImagingStudy (DomainResource)Date and Time the study startedstarted : dateTime [0..1]The patient imaged in the studypatient : Reference [1..1] « Patient »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..*]A list of the diagnostic orders that resulted in this imaging study being performedorder : Reference [0..*] « DiagnosticOrder »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 requesting/referring physicianreferrer : Reference [0..1] « Practitioner »Availability of study (online, offline or nearline)availability : code [0..1] « Availability of the resource (Strength=Required)InstanceAvailability! »WADO-RS resource where Study is availableurl : uri [0..1]Number of Series in StudynumberOfSeries : unsignedInt [1..1]Number of SOP Instances in StudynumberOfInstances : unsignedInt [1..1]Type of procedure performedprocedure : Reference [0..*] « Procedure »Who read the study and interpreted the images or other contentinterpreter : Reference [0..1] « Practitioner »Institution-generated description or classification of the Study performeddescription : string [0..1]SeriesThe 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 + »Formal identifier for this seriesuid : oid [1..1]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! »URI/URL specifying the location of the referenced series using WADO-RSurl : uri [0..1]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]InstanceThe number of instance in the seriesnumber : unsignedInt [0..1]Formal identifier for this image or other contentuid : oid [1..1]DICOM instance typesopClass : oid [1..1]A human-friendly SOP Class nametype : string [0..1]The description of the instancetitle : string [0..1]Content of the instance or a rendering thereof (e.g. a JPEG of an image, or an XML of a structured report). May be represented for example by inline encoding; by a URL reference to a WADO-RS service that makes the instance available; or to a FHIR Resource (e.g. Media, Document, etc.). Multiple content attachments may be used for alternate representations of the instancecontent : Attachment [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 -->
 <started value="[dateTime]"/><!-- 0..1 When the study was started -->
 <patient><!-- 1..1 Reference(Patient) Who the images are of --></patient>
 <uid value="[oid]"/><!-- 1..1 Formal identifier for the study -->
 <accession><!-- 0..1 Identifier Related workflow identifier ("Accession Number") --></accession>
 <identifier><!-- 0..* Identifier Other identifiers for the study --></identifier>
 <order><!-- 0..* Reference(DiagnosticOrder) Order(s) that caused this study to be performed --></order>
 <modalityList><!-- 0..* Coding All series modality if actual acquisition modalities --></modalityList>
 <referrer><!-- 0..1 Reference(Practitioner) Referring physician (0008,0090) --></referrer>
 <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056) -->
 <url value="[uri]"/><!-- 0..1 Retrieve URI -->
 <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>
 <interpreter><!-- 0..1 Reference(Practitioner) Who interpreted images --></interpreter>
 <description value="[string]"/><!-- 0..1 Institution-generated description -->
 <series>  <!-- 0..* Each study has one or more series of instances -->
  <number value="[unsignedInt]"/><!-- 0..1 Numeric identifier of this series -->
  <modality><!-- 1..1 Coding The modality of the instances in the series --></modality>
  <uid value="[oid]"/><!-- 1..1 Formal identifier for this series -->
  <description value="[string]"/><!-- 0..1 A description of the series -->
  <numberOfInstances value="[unsignedInt]"/><!-- 1..1 Number of Series Related Instances -->
  <availability value="[code]"/><!-- 0..1 ONLINE | OFFLINE | NEARLINE | UNAVAILABLE -->
  <url value="[uri]"/><!-- 0..1 Location of the referenced instance(s) -->
  <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 -->
   <number value="[unsignedInt]"/><!-- 0..1 The number of this instance in the series -->
   <uid value="[oid]"/><!-- 1..1 Formal identifier for this instance -->
   <sopClass value="[oid]"/><!-- 1..1 DICOM class type -->
   <type value="[string]"/><!-- 0..1 Type of instance (image etc.) -->
   <title value="[string]"/><!-- 0..1 Description of instance -->
   <content><!-- 0..* Attachment Content of the instance --></content>
  </instance>
 </series>
</ImagingStudy>

JSON Template

{doco
  "resourceType" : "ImagingStudy",
  // from Resource: id, meta, implicitRules, and language
  // from DomainResource: text, contained, extension, and modifierExtension
  "started" : "<dateTime>", // When the study was started
  "patient" : { Reference(Patient) }, // R!  Who the images are of
  "uid" : "<oid>", // R!  Formal identifier for the study
  "accession" : { Identifier }, // Related workflow identifier ("Accession Number")
  "identifier" : [{ Identifier }], // Other identifiers for the study
  "order" : [{ Reference(DiagnosticOrder) }], // Order(s) that caused this study to be performed
  "modalityList" : [{ Coding }], // All series modality if actual acquisition modalities
  "referrer" : { Reference(Practitioner) }, // Referring physician (0008,0090)
  "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE (0008,0056)
  "url" : "<uri>", // Retrieve URI
  "numberOfSeries" : "<unsignedInt>", // R!  Number of Study Related Series
  "numberOfInstances" : "<unsignedInt>", // R!  Number of Study Related Instances
  "procedure" : [{ Reference(Procedure) }], // Type of procedure performed
  "interpreter" : { Reference(Practitioner) }, // Who interpreted images
  "description" : "<string>", // Institution-generated description
  "series" : [{ // Each study has one or more series of instances
    "number" : "<unsignedInt>", // Numeric identifier of this series
    "modality" : { Coding }, // R!  The modality of the instances in the series
    "uid" : "<oid>", // R!  Formal identifier for this series
    "description" : "<string>", // A description of the series
    "numberOfInstances" : "<unsignedInt>", // R!  Number of Series Related Instances
    "availability" : "<code>", // ONLINE | OFFLINE | NEARLINE | UNAVAILABLE
    "url" : "<uri>", // Location of the referenced instance(s)
    "bodySite" : { Coding }, // Body part examined
    "laterality" : { Coding }, // Body part laterality
    "started" : "<dateTime>", // When the series started
    "instance" : [{ // A single SOP instance from the series
      "number" : "<unsignedInt>", // The number of this instance in the series
      "uid" : "<oid>", // R!  Formal identifier for this instance
      "sopClass" : "<oid>", // R!  DICOM class type
      "type" : "<string>", // Type of instance (image etc.)
      "title" : "<string>", // Description of instance
      "content" : [{ Attachment }] // Content of the instance
    }]
  }]
}

 

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

4.23.2.1 Terminology Bindings

PathDefinitionTypeReference
ImagingStudy.modalityList
ImagingStudy.series.modality
Type of acquired data in the instanceExtensibleAcquisition Modality Codes
ImagingStudy.availability
ImagingStudy.series.availability
Availability of the resourceRequiredInstanceAvailability
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

4.23.2.2 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.

4.23.2.3 Use Case

Joe Angina complains of shortness of breath and occasional chest pain to his primary care physician, Dr. Pat Down at Local MultiClinic, who orders a stress echocardiogram; the order is created as a FHIR Order resource to manage the workflow, with a link to a DiagnosticOrder resource with the details of the request. The order is scheduled and assigned to cardiologist Dr. Art Skann, also at Local MultiClinic.

On the scheduled day of the exam, Joe arrives at the echo lab to meet with Dr. Skann and have the study done. Dr. Skann’s workstation shows the daily list of Orders, and he follows the link to retrieve the DiagnosticOrder. (He may follow the links through the referenced Patient resource to access Joe’s electronic medical record, but that is not the concern of this storyboard.)

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

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

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

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

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

4.23.3 Search Parameters

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

NameTypeDescriptionPaths
accessiontokenThe accession identifier for the studyImagingStudy.accession
bodysitetokenThe body site studiedImagingStudy.series.bodySite
dicom-classuriThe type of the instanceImagingStudy.series.instance.sopClass
modalitytokenThe modality of the seriesImagingStudy.series.modality
orderreferenceThe order for the imageImagingStudy.order
(DiagnosticOrder)
patientreferenceWho the study is aboutImagingStudy.patient
(Patient)
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