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.

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

DSTU2: ImagingStudy.availability (new:code)

Element ImagingStudy.availability has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.availability has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.url (new:uri)

Element ImagingStudy.url has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.url has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.procedure (new:Reference(Procedure))

Element ImagingStudy.procedure has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.procedure has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). For the Procedure.code, LOINC radiology orderables would be a good value set to use.

DSTU2: ImagingStudy.interpreter (new:Reference(Practitioner))

Element ImagingStudy.interpreter has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.interpreter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy.

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

The status of the ImagingStudy.

The subject, typically a patient, of the imaging study.

QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group.

An Extension

DSTU2: ImagingStudy.patient additional types from child elements (display, reference)

Element ImagingStudy.patient is mapped to FHIR R5 element ImagingStudy.subject as SourceIsBroaderThanTarget. The mappings for ImagingStudy.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.patient with unmapped reference targets: Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

DSTU2: ImagingStudy.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element ImagingStudy.meta is mapped to FHIR R5 element ImagingStudy.meta as SourceIsBroaderThanTarget. The mappings for ImagingStudy.meta do not cover the following types: Meta. The mappings for ImagingStudy.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

DSTU2: ImagingStudy.text additional types (Narrative) additional types from child elements (div, status)

Element ImagingStudy.text is mapped to FHIR R5 element ImagingStudy.text as SourceIsBroaderThanTarget. The mappings for ImagingStudy.text do not cover the following types: Narrative. The mappings for ImagingStudy.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

DSTU2: ImagingStudy.availability (new:code)

Element ImagingStudy.availability has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.availability has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.url (new:uri)

Element ImagingStudy.url has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.url has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.procedure (new:Reference(Procedure))

Element ImagingStudy.procedure has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.procedure has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). For the Procedure.code, LOINC radiology orderables would be a good value set to use.

DSTU2: ImagingStudy.interpreter (new:Reference(Practitioner))

Element ImagingStudy.interpreter has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.interpreter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.uid additional types (oid) additional types from child elements (value)

Element ImagingStudy.uid is mapped to FHIR R5 element ImagingStudy.identifier as RelatedTo. The mappings for ImagingStudy.uid do not cover the following types: oid. The mappings for ImagingStudy.uid do not cover the following types based on type expansion: value.

DSTU2: ImagingStudy.accession additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element ImagingStudy.accession is mapped to FHIR R5 element ImagingStudy.identifier as RelatedTo. The mappings for ImagingStudy.accession do not cover the following types: Identifier. The mappings for ImagingStudy.accession do not cover the following types based on type expansion: assigner, period, system, type, use, value.

DSTU2: ImagingStudy.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element ImagingStudy.identifier is mapped to FHIR R5 element ImagingStudy.identifier as SourceIsBroaderThanTarget. The mappings for ImagingStudy.identifier do not cover the following types: Identifier. The mappings for ImagingStudy.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

DSTU2: ImagingStudy.patient additional types from child elements (display, reference)

Element ImagingStudy.patient is mapped to FHIR R5 element ImagingStudy.subject as SourceIsBroaderThanTarget. The mappings for ImagingStudy.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.patient with unmapped reference targets: Patient.

DSTU2: ImagingStudy.order additional types from child elements (display, reference)

Element ImagingStudy.order is mapped to FHIR R5 element ImagingStudy.encounter as SourceIsBroaderThanTarget. The mappings for ImagingStudy.order do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.order with unmapped reference targets: DiagnosticOrder.

DSTU2: ImagingStudy.referrer additional types from child elements (display, reference)

Element ImagingStudy.referrer is mapped to FHIR R5 element ImagingStudy.referrer as RelatedTo. The mappings for ImagingStudy.referrer do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.referrer with unmapped reference targets: Practitioner.

DSTU2: ImagingStudy.series.availability (new:code)

Element ImagingStudy.series.availability has a context of ImagingStudy.series based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.availability has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.series.url (new:uri)

Element ImagingStudy.series.url has a context of ImagingStudy.series based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.url has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.series.bodySite additional types (Coding) additional types from child elements (code, display, system, userSelected, version)

Element ImagingStudy.series.bodySite is mapped to FHIR R5 element ImagingStudy.series.bodySite as SourceIsBroaderThanTarget. The mappings for ImagingStudy.series.bodySite do not cover the following types: Coding. The mappings for ImagingStudy.series.bodySite do not cover the following types based on type expansion: code, display, system, userSelected, version.

DSTU2: ImagingStudy.series.instance.type (new:string)

Element ImagingStudy.series.instance.type has a context of ImagingStudy.series.instance based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.instance.type has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). E.g. 'CT image', 'MR multi-frame', 'blending presentation'.

DSTU2: ImagingStudy.series.instance.content (new:Attachment)

Element ImagingStudy.series.instance.content has a context of ImagingStudy.series.instance based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.instance.content has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Use of Attachment.data is discouraged.

DSTU2: ImagingStudy.series.instance.sopClass additional types (oid) additional types from child elements (value)

Element ImagingStudy.series.instance.sopClass is mapped to FHIR R5 element ImagingStudy.series.instance.sopClass as SourceIsBroaderThanTarget. The mappings for ImagingStudy.series.instance.sopClass do not cover the following types: oid. The mappings for ImagingStudy.series.instance.sopClass do not cover the following types based on type expansion: value.

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.

The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.

Within the context of the FHIR RESTful interactions, the resource has an id except for cases like the create and conditional update. Otherwise, the use of the resouce id depends on the given use case.

The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.meta additional types (Meta) additional types from child elements (lastUpdated, profile, security, tag, versionId)

Element ImagingStudy.meta is mapped to FHIR R5 element ImagingStudy.meta as SourceIsBroaderThanTarget. The mappings for ImagingStudy.meta do not cover the following types: Meta. The mappings for ImagingStudy.meta do not cover the following types based on type expansion: lastUpdated, profile, security, tag, versionId.

The version specific identifier, as it appears in the version portion of the URL. This value changes when the resource is created, updated, or deleted.

The server assigns this value, and ignores what the client specifies, except in the case that the server is imposing version integrity on updates/deletes.

When the resource last changed - e.g. when the version changed.

This element is generally omitted in instances submitted in a PUT or POST. Instead, it is populated in the response instance and when retrieving information using a GET. The server / resource manager sets this value; what a client provides is irrelevant. This is equivalent to the HTTP Last-Modified and SHOULD have the same value on a read interaction.

A uri that identifies the source system of the resource. This provides a minimal amount of Provenance information that can be used to track or differentiate the source of information in the resource. The source may identify another FHIR server, document, message, database, etc.

The exact use of the source (and the possible implied Provenance.entity.role and agent.role) is left to implementer discretion. Only one nominated source is allowed; for additional provenance details, a full Provenance resource should be used. The source may correspond to Provenance.entity.what[x] or Provenance.agent.who[x], though it may be a more general or abstract reference.

This element can be used to indicate where the current master source of a resource that has a canonical URL if the resource is no longer hosted at the canonical URL.

A list of profiles (references to StructureDefinition resources) that this resource claims to conform to. The URL is a reference to StructureDefinition.url.

It is up to the server and/or other infrastructure of policy to determine whether/how these claims are verified and/or updated over time. The list of profile URLs is a set.

Security labels applied to this resource. These tags connect specific resources to the overall security policy and infrastructure.

The security labels can be updated without changing the stated version of the resource. The list of security labels is a set. Uniqueness is based the system/code, and version and display are ignored.

Unless not suitable, these codes SHALL be taken from AllSecurityLabels
(extensible to http://hl7.org/fhir/ValueSet/security-labels|5.0.0)

Security Labels from the Healthcare Privacy and Security Classification System.

Tags applied to this resource. Tags are intended to be used to identify and relate resources to process and workflow, and applications are not required to consider the tags when interpreting the meaning of a resource.

The tags can be updated without changing the stated version of the resource. The list of tags is a set. Uniqueness is based the system/code, and version and display are ignored.

Codes that represent various types of tags, commonly workflow-related; e.g. "Needs review by Dr. Jones".

A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.

Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of its narrative along with other profiles, value sets, etc.

The base language in which the resource is written.

Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).

IETF language tag for a human language

A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.

Contained resources do not have a narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.text additional types (Narrative) additional types from child elements (div, status)

Element ImagingStudy.text is mapped to FHIR R5 element ImagingStudy.text as SourceIsBroaderThanTarget. The mappings for ImagingStudy.text do not cover the following types: Narrative. The mappings for ImagingStudy.text do not cover the following types based on type expansion: div, status. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative.

The status of the narrative - whether it's entirely generated (from just the defined data or the extensions too), or whether a human authored it and it may contain additional data.

The status of a resource narrative.

The actual narrative content, a stripped down version of XHTML.

The contents of the html element are an XHTML fragment containing only the basic html formatting elements described in chapters 7-11 and 15 of the HTML 4.0 standard, <a> elements (either name or href), images and internally contained stylesheets. The XHTML content SHALL NOT contain a head, a body, external stylesheet references, scripts, forms, base/link/xlink, frames, iframes and objects.

These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, nor can they have their own independent transaction scope. This is allowed to be a Parameters resource if and only if it is referenced by a resource that provides context/meaning.

This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags in their meta elements, but SHALL NOT have security labels.

An Extension

DSTU2: ImagingStudy.availability (new:code)

Element ImagingStudy.availability has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.availability has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.url (new:uri)

Element ImagingStudy.url has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.url has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.procedure (new:Reference(Procedure))

Element ImagingStudy.procedure has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.procedure has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). For the Procedure.code, LOINC radiology orderables would be a good value set to use.

DSTU2: ImagingStudy.interpreter (new:Reference(Practitioner))

Element ImagingStudy.interpreter has a context of ImagingStudy based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.interpreter has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Identifiers for the ImagingStudy such as DICOM Study Instance UID.

See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID.

If one or more series elements are present in the ImagingStudy, then there shall be one DICOM Study UID identifier (see DICOM PS 3.3 C.7.2.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.uid additional types (oid) additional types from child elements (value)

Element ImagingStudy.uid is mapped to FHIR R5 element ImagingStudy.identifier as RelatedTo. The mappings for ImagingStudy.uid do not cover the following types: oid. The mappings for ImagingStudy.uid do not cover the following types based on type expansion: value.

DSTU2: ImagingStudy.accession additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element ImagingStudy.accession is mapped to FHIR R5 element ImagingStudy.identifier as RelatedTo. The mappings for ImagingStudy.accession do not cover the following types: Identifier. The mappings for ImagingStudy.accession do not cover the following types based on type expansion: assigner, period, system, type, use, value.

DSTU2: ImagingStudy.identifier additional types (Identifier) additional types from child elements (assigner, period, system, type, use, value)

Element ImagingStudy.identifier is mapped to FHIR R5 element ImagingStudy.identifier as SourceIsBroaderThanTarget. The mappings for ImagingStudy.identifier do not cover the following types: Identifier. The mappings for ImagingStudy.identifier do not cover the following types based on type expansion: assigner, period, system, type, use, value.

The purpose of this identifier.

Applications can assume that an identifier is permanent unless it explicitly says that it is temporary.

Identifies the purpose for this identifier, if known .

Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers.

A coded type for the identifier that can be used to determine which identifier to use for a specific purpose.

This element deals only with general categories of identifiers. It SHOULD not be used for codes that correspond 1..1 with the Identifier.system. Some identifiers may fall into multiple categories due to common usage. Where the system is known, a type is unnecessary because the type is always part of the system definition. However systems often need to handle identifiers where the system is not known. There is not a 1:1 relationship between type and system, since many different systems have the same type.

A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

Allows users to make use of identifiers when the identifier system is not known.

Establishes the namespace for the value - that is, an absolute URL that describes a set values that are unique.

Identifier.system is always case sensitive.

There are many sets of identifiers. To perform matching of two identifiers, we need to know what set we're dealing with. The system identifies a particular set of unique identifiers.

The portion of the identifier typically relevant to the user and which is unique within the context of the system.

If the value is a full URI, then the system SHALL be urn:ietf:rfc:3986. The value's primary purpose is computational mapping. As a result, it may be normalized for comparison purposes (e.g. removing non-significant whitespace, dashes, etc.) A value formatted for human display can be conveyed using the http://hl7.org/fhir/StructureDefinition/rendered-value). Identifier.value is to be treated as case sensitive unless knowledge of the Identifier.system allows the processer to be confident that non-case-sensitive processing is safe.

Time period during which identifier is/was valid for use.

Organization that issued/manages the identifier.

The Identifier.assigner may omit the .reference element and only contain a .display element reflecting the name or other textual information about the assigning organization.

The current state of the ImagingStudy resource. This is not the status of any ServiceRequest or Task resources associated with the ImagingStudy.

Unknown does not represent "other" - one of the defined statuses must apply. Unknown is used when the authoring system is not sure what the current status is.

The status of the ImagingStudy.

A list of all the distinct values of series.modality. This may include both acquisition and non-acquisition modalities.

Unless not suitable, these codes SHALL be taken from Modality
(extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

Type of acquired data in the instance.

The subject, typically a patient, of the imaging study.

QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.patient additional types from child elements (display, reference)

Element ImagingStudy.patient is mapped to FHIR R5 element ImagingStudy.subject as SourceIsBroaderThanTarget. The mappings for ImagingStudy.patient do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.patient with unmapped reference targets: Patient.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made.

This will typically be the encounter the event occurred within, but some events may be initiated prior to or after the official completion of an encounter but still be tied to the context of the encounter (e.g. pre-admission test).

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.order additional types from child elements (display, reference)

Element ImagingStudy.order is mapped to FHIR R5 element ImagingStudy.encounter as SourceIsBroaderThanTarget. The mappings for ImagingStudy.order do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.order with unmapped reference targets: DiagnosticOrder.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

Date and time the study started.

A list of the diagnostic requests that resulted in this imaging study being performed.

To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). If the ImagingStudy is associated with an Accession Number, this field should include a reference to that value in the form:

• type = ServiceRequest
• identifier.value = (Accession Number Value)
• identifier.type = ACSN A reference value pointing to a ServiceRequest resource is allowed but is not required.

A larger event of which this particular ImagingStudy is a component or step. For example, an ImagingStudy as part of a procedure.

To link an ImagingStudy to an Encounter use encounter.

The requesting/referring physician.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.referrer additional types from child elements (display, reference)

Element ImagingStudy.referrer is mapped to FHIR R5 element ImagingStudy.referrer as RelatedTo. The mappings for ImagingStudy.referrer do not cover the following types based on type expansion: display, reference. The standard extension alternate-reference has been mapped as the representation of FHIR DSTU2 element ImagingStudy.referrer with unmapped reference targets: Practitioner.

A reference to a location at which the other resource is found. The reference may be a relative reference, in which case it is relative to the service base URL, or an absolute URL that resolves to the location where the resource is found. The reference may be version specific or not. If the reference is not to a FHIR RESTful server, then it should be assumed to be version specific. Internal fragment references (start with '#') refer to contained resources.

Using absolute URLs provides a stable scalable approach suitable for a cloud/web context, while using relative/logical references provides a flexible approach suitable for use when trading across closed eco-system boundaries. Absolute URLs do not need to point to a FHIR RESTful server, though this is the preferred approach. If the URL conforms to the structure "[type]/[id]" then it should be assumed that the reference is to a FHIR RESTful server.

The expected type of the target of the reference. If both Reference.type and Reference.reference are populated and Reference.reference is a FHIR URL, both SHALL be consistent.

The type is the Canonical URL of Resource Definition that is the type this reference refers to. References are URLs that are relative to http://hl7.org/fhir/StructureDefinition/ e.g. "Patient" is a reference to http://hl7.org/fhir/StructureDefinition/Patient. Absolute URLs are only allowed for logical models (and can only be used in references in logical models, not resources).

This element is used to indicate the type of the target of the reference. This may be used which ever of the other elements are populated (or not). In some cases, the type of the target may be determined by inspection of the reference (e.g. a known RESTful URL) or by resolving the target of the reference.

Unless not suitable, these codes SHALL be taken from ResourceType
(extensible to http://hl7.org/fhir/ValueSet/resource-types|5.0.0)

Aa resource (or, for logical models, the URI of the logical model).

An identifier for the target resource. This is used when there is no way to reference the other resource directly, either because the entity it represents is not available through a FHIR server, or because there is no way for the author of the resource to convert a known identifier to an actual location. There is no requirement that a Reference.identifier point to something that is actually exposed as a FHIR instance, but it SHALL point to a business concept that would be expected to be exposed as a FHIR instance, and that instance would need to be of a FHIR resource type allowed by the reference.

When an identifier is provided in place of a reference, any system processing the reference will only be able to resolve the identifier to a reference if it understands the business context in which the identifier is used. Sometimes this is global (e.g. a national identifier) but often it is not. For this reason, none of the useful mechanisms described for working with references (e.g. chaining, includes) are possible, nor should servers be expected to be able resolve the reference. Servers may accept an identifier based reference untouched, resolve it, and/or reject it - see CapabilityStatement.rest.resource.referencePolicy.

When both an identifier and a literal reference are provided, the literal reference is preferred. Applications processing the resource are allowed - but not required - to check that the identifier matches the literal reference

Applications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.

Reference is intended to point to a structure that can potentially be expressed as a FHIR resource, though there is no need for it to exist as an actual FHIR resource instance - except in as much as an application wishes to actual find the target of the reference. The content referred to be the identifier must meet the logical constraints implied by any limitations on what resource types are permitted for the reference. For example, it would not be legitimate to send the identifier for a drug prescription if the type were Reference(Observation|DiagnosticReport). One of the use-cases for Reference.identifier is the situation where no FHIR representation exists (where the type is Reference (Any).

This element only allows for a single identifier. In the case where additional identifers are required, use the http://hl7.org/fhir/StructureDefinition/additionalIdentifier extension.

Plain text narrative that identifies the resource in addition to the resource reference.

This is generally not the same as the Resource.text of the referenced resource. The purpose is to identify what's being referenced, not to fully describe it.

The network service providing access (e.g., query, view, or retrieval) for the study. See implementation notes for information about using DICOM endpoints. A study-level endpoint applies to each series in the study, unless overridden by a series-level endpoint with the same Endpoint.connectionType.

Typical endpoint types include DICOM WADO-RS, which is used to retrieve DICOM instances in native or rendered (e.g., JPG, PNG), formats using a RESTful API; DICOM WADO-URI, which can similarly retrieve native or rendered instances, except using an HTTP query-based approach; DICOM QIDO-RS, which allows RESTful query for DICOM information without retrieving the actual instances; or IHE Invoke Image Display (IID), which provides standard invocation of an imaging web viewer.

Access methods for viewing (e.g., IHE’s IID profile) or retrieving (e.g., DICOM’s WADO-URI and WADO-RS) the study or the study’s series or instances. The study-level baseLocation applies to each series in the study, unless overridden in series by a series-level baseLocation of the same type.

Number of Series in the Study. This value given may be larger than the number of series elements this Resource contains due to resource availability, security, or other factors. This element should be present if any series elements are present.

Number of SOP Instances in Study. This value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are present.

This field corresponds to the DICOM Procedure Code Sequence (0008,1032). This is different from the FHIR Procedure resource that may include the ImagingStudy.

Use of RadLex is preferred

The principal physical location where the ImagingStudy was performed.

Ties the event to where the records are likely kept and provides context around the event occurrence (e.g. if it occurred inside or outside a dedicated healthcare setting).

Description of clinical condition indicating why the ImagingStudy was requested, and/or Indicates another resource whose existence justifies this Study.

The reason for the study.

Per the recommended DICOM mapping, this element is derived from the Study Description attribute (0008,1030). Observations or findings about the imaging study should be recorded in another resource, e.g. Observation, and not in this element.

The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed.

Each study has one or more series of images or other content.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.series.availability (new:code)

Element ImagingStudy.series.availability has a context of ImagingStudy.series based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.availability has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

DSTU2: ImagingStudy.series.url (new:uri)

Element ImagingStudy.series.url has a context of ImagingStudy.series based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.url has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element).

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The DICOM Series Instance UID for the series.

See DICOM PS3.3 C.7.3.

DICOM Series Instance UID.

The numeric identifier of this series in the study.

The distinct modality for this series. This may include both acquisition and non-acquisition modalities.

Unless not suitable, these codes SHALL be taken from Modality
(extensible to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html)

Type of acquired data in the instance.

A description of the series.

Number of SOP Instances in the Study. The value given may be larger than the number of instance elements this resource contains due to resource availability, security, or other factors. This element should be present if any instance elements are present.

The network service providing access (e.g., query, view, or retrieval) for this series. See implementation notes for information about using DICOM endpoints. A series-level endpoint, if present, has precedence over a study-level endpoint with the same Endpoint.connectionType.

Typical endpoint types include DICOM WADO-RS, which is used to retrieve DICOM instances in native or rendered (e.g., JPG, PNG) formats using a RESTful API; DICOM WADO-URI, which can similarly retrieve native or rendered instances, except using an HTTP query-based approach; and DICOM QIDO-RS, which allows RESTful query for DICOM information without retrieving the actual instances.

Access methods for retrieving (e.g., DICOM’s WADO-URI and WADO-RS) the series or the series’ instances. A baseLocation specified at the series level has precedence over a baseLocation of the same type specified at the study level.

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 mappings. The bodySite may indicate the laterality of body part imaged; if so, it shall be consistent with any content of ImagingStudy.series.laterality.

SNOMED CT Body site concepts

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.series.bodySite additional types (Coding) additional types from child elements (code, display, system, userSelected, version)

Element ImagingStudy.series.bodySite is mapped to FHIR R5 element ImagingStudy.series.bodySite as SourceIsBroaderThanTarget. The mappings for ImagingStudy.series.bodySite do not cover the following types: Coding. The mappings for ImagingStudy.series.bodySite do not cover the following types based on type expansion: code, display, system, userSelected, version.

A reference to a concept - e.g. the information is identified by its general class to the degree of precision found in the terminology.

A reference to a resource the provides exact details about the information being referenced.

The laterality of the (possibly paired) anatomic structures examined. E.g., the left knee, both lungs, or unpaired abdomen. If present, shall be consistent with any laterality information indicated in ImagingStudy.series.bodySite.

For example codes, see Laterality
(example to http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_244.html)

Codes describing body site laterality (left, right, etc.).

The specimen imaged, e.g., for whole slide imaging of a biopsy.

The date and time the series was started.

Indicates who or what performed the series and how they were involved.

If the person who performed the series is not known, their Organization may be recorded. A patient, or related person, may be the performer, e.g. for patient-captured images.

The performer is recorded at the series level, since each series in a study may be performed by a different performer, at different times, and using different devices. A series may be performed by multiple performers.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

Distinguishes the type of involvement of the performer in the series.

The type of involvement of the performer.

Allows disambiguation of the types of involvement of different performers.

Indicates who or what performed the series.

A single SOP instance within the series, e.g. an image, or presentation state.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.series.instance.type (new:string)

Element ImagingStudy.series.instance.type has a context of ImagingStudy.series.instance based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.instance.type has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). E.g. 'CT image', 'MR multi-frame', 'blending presentation'.

DSTU2: ImagingStudy.series.instance.content (new:Attachment)

Element ImagingStudy.series.instance.content has a context of ImagingStudy.series.instance based on following the parent source element upwards and mapping to ImagingStudy. Element ImagingStudy.series.instance.content has no mapping targets in FHIR R5. Typically, this is because the element has been added (is a new element). Use of Attachment.data is discouraged.

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and managable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

The DICOM SOP Instance UID for this image or other DICOM content.

See DICOM PS3.3 C.12.1.

DICOM SOP Instance UID.

DICOM instance type.

The sopClass for the instance.

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

An Extension

DSTU2: ImagingStudy.series.instance.sopClass additional types (oid) additional types from child elements (value)

Element ImagingStudy.series.instance.sopClass is mapped to FHIR R5 element ImagingStudy.series.instance.sopClass as SourceIsBroaderThanTarget. The mappings for ImagingStudy.series.instance.sopClass do not cover the following types: oid. The mappings for ImagingStudy.series.instance.sopClass do not cover the following types based on type expansion: value.

The identification of the code system that defines the meaning of the symbol in the code.

The URI may be an OID (urn:oid:...) or a UUID (urn:uuid:...). OIDs and UUIDs SHALL be references to the HL7 OID registry. Otherwise, the URI should come from HL7's list of FHIR defined special URIs or it should be an absolute reference to some definition that establishes the system clearly and unambiguously.

Need to be unambiguous about the source of the definition of the symbol.

The version of the code system which was used when choosing this code. Note that a well-maintained code system does not need the version reported, because the meaning of codes is consistent across versions. However this cannot consistently be assured, and when the meaning is not guaranteed to be consistent, the version SHOULD be exchanged.

Where the terminology does not clearly define what string should be used to identify code system versions, the recommendation is to use the date (expressed in FHIR date format) on which that version was officially published as the version date.

A symbol in syntax defined by the system. The symbol may be a predefined code or an expression in a syntax defined by the coding system (e.g. post-coordination).