This page is part of the DICOM® SR to FHIR Resource Mapping IG (v1.0.0-ballot: STU1 Ballot 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. . For a full list of available versions, see the Directory of published versions

Background

This chapter describes the scope of this guide, provides background information, key concepts, and describes the use cases supported by this implementation guide.

1. Problem - Description of the Problem
2. Scope - Scope of the IG
3. Intended Readers - Intended readers of the IG
4. Use cases - Key use cases covered by the IG
5. Excluded use cases - Excluded use cases
6. FHIR Version 4 compatibility - Compatibility with FHIR R4
7. Glossary - Glossary of terms used in this IG
8. References - Useful references
9. IG Dependencies - Dependencies on other IGs
10. Global Profiles - Global profiles used in this IG
11. Copyrights - Copyrights and acknowledgments

Problem

DICOM® Structured Report (DICOM® SR) is a standard for recording clinical imaging observations made regarding a diagnostic or interventional imaging procedure. Imaging Observations are made by humans, such as a sonographer making measurements on recently acquired ultrasound image, a Radiologist recording observations on suspected lesions, or by a machine, such as an automated AI Algorithm providing qualitative and quantitative observations.

DICOM® SR is widely adopted by Imaging-based devices and IT systems. Non-imaging based Healthcare IT Systems, generally, do not support DICOM® SR. Non-imaging healthcare systems support HL7 standards, such as FHIR. HL7 has defined Observations as the standardized method for recording clinical observations. Bridging the two standards for clinical imaging observations is necessary for interoperability between these type of systems.

Scope

The standards for recording clinical observations, DICOM® SR and HL7 FHIR Observation resource are bridged by this IG by the transformation of the DICOM SR attributes to the HL7 FHIR Observation Resource.

DICOM SR defines a multitude of templates for capturing Diagnostic imaging Observations. The input for this IG is limited to the DICOM SR template TID-1500 (Measurement Report). The mapping is limited the content within the tree structure.

The transformation described is one direction. Reconstruction of a complete DICOM SR is not expected to be re-constructed from a set of FHIR resources using this IG.

DICOM SR mapping is limited to the Observation Resource and a small set of related resources. The resultant mapping is provided, as a minimum, a composition or bundle of Observations. Depending on the use case, the observations may be a Diagnostic Report. Use case-specific requirements to construct a diagnostic report(e.g. Mammography) may require the transformation described by this IG. However, the specification of those use cases is not in scope for this IG.

Therefore, Observations created according to this IG may not include all context relevant to their interpretation.

Intended Readers

This Implementation Guide is intended for

• clinical users of structured imaging data,
• implementers of other health information systems wishing to use imaging data encapsulated using DICOM SR.
• imaging device, image analysis and AI algorithm developers and imaging gateway system developers creating DICOM SR.

Use cases

Two use cases were identified.

Use case 1: Extracting imaging results for use in reporting

Use case 2: Extracting imaging results for FHIRcast content sharing

Excluded use cases

The following use cases are not covered by this Implementation Guide:

• DICOM SR templates other than TID1500
• Creating a FHIR DiagnosticReport or Composition from a DICOM SR
• Creating HL7 v2 or v3 results from a DICOM SR

FHIR Version 4 compatibility

This implementation guide is based on FHIR R5 and makes extensive use of the ImagingSelection resource, which is not present in FHIR R4.

However, the core mapping of DICOM SR to FHIR Observation resources is compatible with FHIR R4.

The ImagingSelection resource is used to provide specific imaging context for imaging observations, but their exclusion should not affect the usability of the created observations to most downstream systems.

Glossary

The following terms and acronyms are used within the DICOM SR IG:

Term	Definition
AIR	AI Results
ATNA	Audit Trail and Node Authentication
CID	Context Identifier
DICOM	Digital Imaging and Communications in Medicine
DLP	Dose Length Product
EHR	Electronic Health Record
EMR	Electronic Medical Record
FHIR	Fast Healthcare Interoperability Resources
HL7	Health Level Seven
IG	Implementation Guide
IHE	Integrating the Healthcare Enterprise
IOD	Information Object Definition
RIS	Radiology Information System
SR	Structured Report
TID	Template ID
TLS	Transport Layer Security
UID	Unique identifier
URL	Uniform Resource Locator
URN	Uniform Resource Name

References

1. DICOM,DICOM PS3.16: Content Mapping Resource
2. DICOM,TID 1500. Measurement Report
3. IHE Radiology (RAD), Technical Framework Supplement, AI Results (AIR)
4. D. Clunie, DICOM Structured Reporting

IG Dependencies

This IG Contains the following dependencies on other IGs.

Global Profiles

There are no Global profiles defined

Copyrights

This publication includes IP covered under the following statements.

• Copyright 2014 – The Radiological Society of North America (RSNA), all rights reserved. Licensed under RadLex License Version 2.0. You may obtain a copy of the license at: http://www.rsna.org/radlexdownloads/This work is distributed under the above noted license on an “AS IS” basis, WITHOUT WARRANTIES OF ANY KIND, either express or implied. Please see the license for complete terms and conditions.Subject to the terms and conditions of this Agreement, Licensor hereby grants to You a worldwide, non-exclusive, no-charge, royalty-free copyright license to reproduce, prepare Adaptations of, publicly display, publicly perform, sublicense, and distribute the Work and such Adaptations in any medium.RadLex is licensed freely for commercial and non-commercial users. Review and download the license: http://www.rsna.org/uploadedFiles/RSNA/Content/Informatics/RadLex_License_Agreement_and_Terms_of_Use_V2_Final.pdf
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  • RadLex radiology lexicon: Observation/qualitative-evaluation-002
• The UCUM codes, UCUM table (regardless of format), and UCUM Specification are copyright 1999-2009, Regenstrief Institute, Inc. and the Unified Codes for Units of Measures (UCUM) Organization. All rights reserved. https://ucum.org/trac/wiki/TermsOfUse
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  • Unified Code for Units of Measure (UCUM): Observation/derived-imaging-measurement, Observation/imaging-measurement-001, Observation/imaging-measurement-002 and Observation/imaging-measurement-003
• These codes are excerpted from Digital Imaging and Communications in Medicine (DICOM) Standard, Part 16: Content Mapping Resource, Copyright © 2011 by the National Electrical Manufacturers Association.
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  • DICOM Controlled Terminology Definitions: BodyStructure/measurement-report-tracking-identifier, BodyStructureTrackingIdentifiers... Show 32 more, DICOMDocumentIEToFHIRMapping, DICOMImagingMeasurementGroupToFHIRMapping, DerivedImagingMeasurementProfile, DiagnosticReport/dicom-sr-measurement-report, ImagingMeasurement, ImagingMeasurementGroup, ImagingObservationProfile, ImagingQualitativeEvaluation, ImagingSelection/measurement-report-2d-image-region, ImagingSelection/measurement-report-3d-image-region, ImagingSelection/measurement-report-illustration-of-roi, ImagingSelection/measurement-report-referenced-real-world-value-map, ImagingSelection/measurement-report-referenced-segment, ImagingSelection/measurement-report-referenced-segmentation-frame, ImagingSelection/measurement-report-region-in-space, ImagingSelection/measurement-report-visual-explanation, ImagingSelection/measurement-report-volume-surface, ImagingSelection2dImageRegion, ImagingSelection3dImageRegion, ImagingSelectionIllustrationOfROI, ImagingSelectionObservationImagingSelection, ImagingSelectionRealWorldValueMap, ImagingSelectionReferencedSegment, ImagingSelectionReferencedSegmentationFrame, ImagingSelectionRegionInSpace, ImagingSelectionVisualExplanation, ImagingSelectionVolumeSurface, Observation/derived-imaging-measurement, Observation/imaging-measurement-001, Observation/imaging-measurement-002, Observation/imaging-measurement-003 and Observation/imaging-measurement-group
• This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed or info@snomed.org.
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  • SNOMED Clinical Terms® (SNOMED CT®): BodyStructure/measurement-report-finding-site, Observation/imaging-measurement-001... Show 4 more, Observation/imaging-measurement-002, Observation/imaging-measurement-003, Observation/imaging-measurement-group and Observation/imaging-observation
• This material derives from the HL7 Terminology (THO). THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html
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  • identifierType: DerivedImagingMeasurementProfile, Device/measurement-report-general-equipment... Show 16 more, ImagingMeasurement, ImagingMeasurementGroup, ImagingObservationProfile, ImagingQualitativeEvaluation, ImagingSelection2dImageRegion, ImagingSelection3dImageRegion, ImagingSelectionIllustrationOfROI, ImagingSelectionObservationImagingSelection, ImagingSelectionRealWorldValueMap, ImagingSelectionReferencedSegment, ImagingSelectionReferencedSegmentationFrame, ImagingSelectionRegionInSpace, ImagingSelectionVisualExplanation, ImagingSelectionVolumeSurface, Patient/measurement-report-patient and ServiceRequest/measurement-report-service-request