FHIR Release 3 (STU)
DiagnosticsThis page is part of the FHIR Specification (v3.0.2: STU 3). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions 
| Imaging Integration Work Group | Maturity Level: 1 | Trial Use | Compartments: Device, Patient, Practitioner, RelatedPerson |
A text description of the DICOM SOP instances selected in the ImagingManifest; or the reason for, or significance of, the selection.
This resource provides information on a selected set of imaging objects, along with information on how to retrieve those instances (either in native DICOM format, or in a rendered format, such as JPEG), or launch an image viewer. The ImagingManifest is used to make available information concerning images etc. that are intended to be exchanged into other clinical contexts such as diagnostic reports, Care Plans, etc.
ImagingManifest provides a FHIR transformation of a DICOM Key Object Selection file as profiled by the IHE’s XDS-I profile. Although ImagingManifest can address certain uses outside XDS-I (such as launching a viewer), it does not provide the full capabilities of a general DICOM Key Object Selection.
More than one ImagingManifest may reference instances from a particular DICOM study (and ImagingStudy). A particular ImagingManifest may reference instances from more than one DICOM study (and ImagingStudy). An ImagingManifest may reference all instances, or only selected instances from a study.
In distinction to ImagingStudy, this resource is a set of specifically selected objects, potentially from multiple studies on the same patient. ImagingStudy is intended as the resource that identifies a single complete study in itself.
This resource corresponds to a subset of the DICOM Key Object Selection (KOS) SOP Class, and provides a FHIR access to the content of KOS SOP Instances. The content is closely based on the definitions of the equivalent DICOM constructs, and informed by usage patterns already established through DICOM implementation practices, including IHE KIN, TCE, and XDS-I profiles.
The DICOM access methods provide access using the rich controls of the DICOM access methodology indicated. A DICOM capable client may use these access methods to gain full access to the DICOM objects and header.
This resource is referenced by diagnosticreport
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
  ImagingManifest | DomainResource | Key Object Selection Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | ||
  identifier | Σ | 0..1 | Identifier | SOP Instance UID |
 patient | Σ | 1..1 | Reference(Patient) | Patient of the selected objects |
 authoringTime | Σ | 0..1 | dateTime | Time when the selection of instances was made |
| author | Σ | 0..1 | Reference(Practitioner | Device | Organization | Patient | RelatedPerson) | Author (human or machine) |
| description | Σ | 0..1 | string | Description text |
  study | Σ | 1..* | BackboneElement | Study identity of the selected instances |
 uid | Σ | 1..1 | oid | Study instance UID |
| imagingStudy | Σ | 0..1 | Reference(ImagingStudy) | Reference to ImagingStudy |
| endpoint | Σ | 0..* | Reference(Endpoint) | Study access service endpoint |
| series | Σ | 1..* | BackboneElement | Series identity of the selected instances |
| uid | Σ | 1..1 | oid | Series instance UID |
| endpoint | Σ | 0..* | Reference(Endpoint) | Series access endpoint |
| instance | Σ | 1..* | BackboneElement | The selected instance |
| sopClass | Σ | 1..1 | oid | SOP class UID of instance |
| uid | Σ | 1..1 | oid | Selected instance UID |
| Documentation for this format | ||||
UML Diagram (Legend)
XML Template
<ImagingManifest xmlns="http://hl7.org/fhir"><!-- from Resource: id, meta, implicitRules, and language --> <!-- from DomainResource: text, contained, extension, and modifierExtension --> <identifier><!-- 0..1 Identifier SOP Instance UID --></identifier> <patient><!-- 1..1 Reference(Patient) Patient of the selected objects --></patient> <authoringTime value="[dateTime]"/><!-- 0..1 Time when the selection of instances was made --> <author><!-- 0..1 Reference(Practitioner|Device|Organization|Patient| RelatedPerson) Author (human or machine) --></author> <description value="[string]"/><!-- 0..1 Description text --> <study> <!-- 1..* Study identity of the selected instances --> <uid value="[oid]"/><!-- 1..1 Study instance UID --> <imagingStudy><!-- 0..1 Reference(ImagingStudy) Reference to ImagingStudy --></imagingStudy> <endpoint><!-- 0..* Reference(Endpoint) Study access service endpoint --></endpoint> <series> <!-- 1..* Series identity of the selected instances --> <uid value="[oid]"/><!-- 1..1 Series instance UID --> <endpoint><!-- 0..* Reference(Endpoint) Series access endpoint --></endpoint> <instance> <!-- 1..* The selected instance --> <sopClass value="[oid]"/><!-- 1..1 SOP class UID of instance --> <uid value="[oid]"/><!-- 1..1 Selected instance UID --> </instance> </series> </study> </ImagingManifest>
JSON Template
{
"resourceType" : "ImagingManifest",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : { Identifier }, // SOP Instance UID
"patient" : { Reference(Patient) }, // R! Patient of the selected objects
"authoringTime" : "<dateTime>", // Time when the selection of instances was made
"author" : { Reference(Practitioner|Device|Organization|Patient|
RelatedPerson) }, // Author (human or machine)
"description" : "<string>", // Description text
"study" : [{ // R! Study identity of the selected instances
"uid" : "<oid>", // R! Study instance UID
"imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
"endpoint" : [{ Reference(Endpoint) }], // Study access service endpoint
"series" : [{ // R! Series identity of the selected instances
"uid" : "<oid>", // R! Series instance UID
"endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
"instance" : [{ // R! The selected instance
"sopClass" : "<oid>", // R! SOP class UID of instance
"uid" : "<oid>" // R! Selected instance UID
}]
}]
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Structure
| Name | Flags | Card. | Type | Description & Constraints |
|---|---|---|---|---|
| ImagingManifest | DomainResource | Key Object Selection Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension | ||
| identifier | Σ | 0..1 | Identifier | SOP Instance UID |
| patient | Σ | 1..1 | Reference(Patient) | Patient of the selected objects |
| authoringTime | Σ | 0..1 | dateTime | Time when the selection of instances was made |
| author | Σ | 0..1 | Reference(Practitioner | Device | Organization | Patient | RelatedPerson) | Author (human or machine) |
| description | Σ | 0..1 | string | Description text |
| study | Σ | 1..* | BackboneElement | Study identity of the selected instances |
| uid | Σ | 1..1 | oid | Study instance UID |
| imagingStudy | Σ | 0..1 | Reference(ImagingStudy) | Reference to ImagingStudy |
| endpoint | Σ | 0..* | Reference(Endpoint) | Study access service endpoint |
| series | Σ | 1..* | BackboneElement | Series identity of the selected instances |
| uid | Σ | 1..1 | oid | Series instance UID |
| endpoint | Σ | 0..* | Reference(Endpoint) | Series access endpoint |
| instance | Σ | 1..* | BackboneElement | The selected instance |
| sopClass | Σ | 1..1 | oid | SOP class UID of instance |
| uid | Σ | 1..1 | oid | Selected instance UID |
| Documentation for this format | ||||
XML Template
<ImagingManifest xmlns="http://hl7.org/fhir">
JSON Template
{
"resourceType" : "ImagingManifest",
// from Resource: id, meta, implicitRules, and language
// from DomainResource: text, contained, extension, and modifierExtension
"identifier" : { Identifier }, // SOP Instance UID
"patient" : { Reference(Patient) }, // R! Patient of the selected objects
"authoringTime" : "<dateTime>", // Time when the selection of instances was made
"author" : { Reference(Practitioner|Device|Organization|Patient|
RelatedPerson) }, // Author (human or machine)
"description" : "<string>", // Description text
"study" : [{ // R! Study identity of the selected instances
"uid" : "<oid>", // R! Study instance UID
"imagingStudy" : { Reference(ImagingStudy) }, // Reference to ImagingStudy
"endpoint" : [{ Reference(Endpoint) }], // Study access service endpoint
"series" : [{ // R! Series identity of the selected instances
"uid" : "<oid>", // R! Series instance UID
"endpoint" : [{ Reference(Endpoint) }], // Series access endpoint
"instance" : [{ // R! The selected instance
"sopClass" : "<oid>", // R! SOP class UID of instance
"uid" : "<oid>" // R! Selected instance UID
}]
}]
}]
}
Turtle Template
@prefix fhir: <http://hl7.org/fhir/> .
Alternate definitions: Master Definition (XML, JSON), XML Schema/Schematron (for ) + JSON Schema, ShEx (for Turtle)
A referenced DICOM SOP instance could be:
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”.
The ImagingManifest.study.endpoint elements and ImagingManifest.study.series.endpoint elements indicate network services that can be used to access the studies, series, or instances; for example, a DICOM WADO-RS server. An ImagingManifest.study.series.endpoint of a particular Endpoint.connectionType provides that service for that series, and all contained instances. An ImagingManifest.study.endpoint of a particularconnection type provides that service for all series in that study that do not have a specified Endpoint of that type, and their contained instances. That is, an ImagingManifest.study.series.endpoint overrides a ImagingManifest.study.endpoint of the same connection type. (Since each study, or individual series of a study can be stored on different imaging archive servers, per-series endpoints are required. For the identified services and use cases, all instances within a series would be stored together, and thus instance-level endpoints are not defined.)
Different Endpoint connection types may have different capabilities, protocols or requirements; and the specified Endpoint.url may require manipulation. For the details on use of imaging-related Endpoint connection types, See ImagingStudy Implementation Notes for details.
Amy, a family physician, is accessing a cross-enterprise document registry that contains
radiology objects (IHE Radiology XDS-I ), to discover studies for her patient, Alex.
Her EHR client makes a FHIR call for all ImagingManifest objects available for
Alex. In the response, she is able to get study identifiers for each study that has
been published to the registry.
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 ImagingManifest.
In each result, there is a reference to
the ImagingStudy FHIR object which can provide more information about each study.
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 ProcedureRequest 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 ProcedureRequest. (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 ProcedureRequest 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.
Search parameters for this resource. The common parameters also apply. See Searching for more information about searching in REST, messaging, and services.
| Name | Type | Description | Expression | In Common |
| author | reference | Author of the ImagingManifest (or a DICOM Key Object Selection which it represents) | ImagingManifest.author (Practitioner, Organization, Device, Patient, RelatedPerson) | |
| authoring-time | date | Time of the ImagingManifest (or a DICOM Key Object Selection which it represents) authoring | ImagingManifest.authoringTime | |
| endpoint | reference | The endpoint for the study or series | ImagingManifest.study.endpoint | ImagingManifest.study.series.endpoint (Endpoint) | |
| identifier | token | UID of the ImagingManifest (or a DICOM Key Object Selection which it represents) | ImagingManifest.identifier | |
| imaging-study | reference | ImagingStudy resource selected in the ImagingManifest (or a DICOM Key Object Selection which it represents) | ImagingManifest.study.imagingStudy (ImagingStudy) | |
| patient | reference | Subject of the ImagingManifest (or a DICOM Key Object Selection which it represents) | ImagingManifest.patient (Patient) | 31 Resources |
| selected-study | uri | Study selected in the ImagingManifest (or a DICOM Key Object Selection which it represents) | ImagingManifest.study.uid |
®© HL7.org 2011+. FHIR Release 3 (STU; v3.0.2-11200) generated on Thurs, Oct 24, 2019 11:53+1100. QA Page
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