ImagingStudy

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.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Identifiers for the whole study Details Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number. See discussion under [Imaging Study Implementation Notes](imagingstudy.html#notes) for encoding of DICOM Study Instance UID. Accession Number should use ACSN Identifier type.
status	✓	code	registered | available | cancelled | entered-in-error | unknown Details The current state of 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.
modality		Coding[]	All series modality if actual acquisition modalities Details A list of all the series.modality 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).
subject	✓	Reference< Patient | Device | Group >	Who or what is the subject of the study Details 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.
encounter		Reference<Encounter>	Encounter with which this imaging study is associated Details 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).
started		dateTime	When the study was started Details Date and time the study started.
basedOn		Reference< CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task >[]	Request fulfilled Details A list of the diagnostic requests that resulted in this imaging study being performed.
referrer		Reference<Practitioner | PractitionerRole>	Referring physician Details The requesting/referring physician.
interpreter		Reference<Practitioner | PractitionerRole>[]	Who interpreted images Details Who read the study and interpreted the images or other content.
endpoint		Reference<Endpoint>[]	Study access endpoint Details 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.
numberOfSeries		unsignedInt	Number of Study Related Series Details 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.
numberOfInstances		unsignedInt	Number of Study Related Instances Details 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.
procedureReference		Reference<Procedure>	The performed Procedure reference Details The procedure which this ImagingStudy was part of.
procedureCode		CodeableConcept[]	The performed procedure code Details The code for the performed procedure type.
location		Reference<Location>	Where ImagingStudy occurred Details The principal physical location where the ImagingStudy was performed.
reasonCode		CodeableConcept[]	Why the study was requested Details Description of clinical condition indicating why the ImagingStudy was requested.
reasonReference		Reference< Condition | Observation | Media | DiagnosticReport | DocumentReference >[]	Why was study performed Details Indicates another resource whose existence justifies this Study.
note		Annotation[]	User-defined comments Details 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.
description		string	Institution-generated description Details The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed.
series		ImagingStudySeries[]	Each study has one or more series of instances Details Each study has one or more series of images or other content.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details 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 manageable, 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 manageable, 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.
uid	✓	id	DICOM Series Instance UID for the series Details The DICOM Series Instance UID for the series. See [DICOM PS3.3 C.7.3](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.3.html).
number		unsignedInt	Numeric identifier of this series Details The numeric identifier of this series in the study.
modality	✓	Coding	The modality of the instances in the series Details The modality of this series sequence.
description		string	A short human readable summary of the series Details A description of the series.
numberOfInstances		unsignedInt	Number of Series Related Instances Details 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.
endpoint		Reference<Endpoint>[]	Series access endpoint Details 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.
bodySite		Coding	Body part examined Details 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.
laterality		Coding	Body part laterality Details 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.
specimen		Reference<Specimen>[]	Specimen imaged Details The specimen imaged, e.g., for whole slide imaging of a biopsy.
started		dateTime	When the series started Details The date and time the series was started.
performer		ImagingStudySeriesPerformer[]	Who performed the series Details 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.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details 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 manageable, 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 manageable, 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.
function		CodeableConcept	Type of performance Details Distinguishes the type of involvement of the performer in the series.
actor	✓	Reference< Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson >	Who performed the series Details Indicates who or what performed the series.
instance		ImagingStudySeriesInstance[]	A single SOP instance from the series Details A single SOP instance within the series, e.g. an image, or presentation state.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details 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 manageable, 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.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details 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 manageable, 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.
uid	✓	id	DICOM SOP Instance UID Details The DICOM SOP Instance UID for this image or other DICOM content. See [DICOM PS3.3 C.12.1](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.12.html#sect_C.12.1).
sopClass	✓	Coding	DICOM class type Details DICOM instance type.
number		unsignedInt	The number of this instance in the series Details The number of instance in the series.
title		string	Description of instance Details The description of the instance. Particularly for post-acquisition analytic objects, such as SR, presentation states, value mapping, etc.

Search Parameters

Name	Type	Description	Expression
identifier	token	Identifiers for the Study, such as DICOM Study Instance UID and Accession number	ImagingStudy.identifier
patient	reference	Who the study is about	ImagingStudy.subject.where(resolve() is Patient)
basedon	reference	The order for the image	ImagingStudy.basedOn
bodysite	token	The body site studied	ImagingStudy.series.bodySite
dicom-class	token	The type of the instance	ImagingStudy.series.instance.sopClass
encounter	reference	The context of the study	ImagingStudy.encounter
endpoint	reference	The endpoint for the study or series	ImagingStudy.endpoint | ImagingStudy.series.endpoint
instance	token	SOP Instance UID for an instance	ImagingStudy.series.instance.uid
interpreter	reference	Who interpreted the images	ImagingStudy.interpreter
modality	token	The modality of the series	ImagingStudy.series.modality
performer	reference	The person who performed the study	ImagingStudy.series.performer.actor
reason	token	The reason for the study	ImagingStudy.reasonCode
referrer	reference	The referring physician	ImagingStudy.referrer
series	token	DICOM Series Instance UID for a series	ImagingStudy.series.uid
started	date	When the study was started	ImagingStudy.started
status	token	The status of the study	ImagingStudy.status
subject	reference	Who the study is about	ImagingStudy.subject

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details 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.
implicitRules		uri	A set of rules under which this content was created Details 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 it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details 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).
text		Narrative	Text summary of the resource, for human interpretation Details 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 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.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. 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.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, 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.
modifierExtension		Extension[]	Extensions that cannot be ignored Details 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 manageable, 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.

Usage

ImagingStudy provides information on a DICOM imaging study, and the series and imaging objects in that study. It also provides information on how to retrieve that information (in a native DICOM format, or in a rendered format, such as JPEG). ImagingStudy is used to make available information about all parts of a single DICOM study.

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 .

ImagingStudy provides access to significant DICOM information but will only eliminate the need for DICOM query (e.g., QIDO-RS) in the simplest cases. The DICOM instances are not stored in the ImagingStudy resource; use of a DICOM WADO-RS server or other storage mechanism is needed.

An ImagingStudy SHALL reference one DICOM Study, and MAY reference a subset of that Study. More than one ImagingStudy MAY reference the same DICOM Study or different subsets of the same DICOM Study.

Relationships

ImagingStudy is used for DICOM imaging and associated information. Use Media to track non-DICOM images, video, or audio. Binary can be used to store arbitrary content. DocumentReference allow indexing and retrieval of clinical “documents” with relevant metadata.

Referenced By

• ChargeItem
• ClinicalImpression
• DiagnosticReport
• Observation