Implementation Guide DIFUTURE

TrustcenterImagingStudy

The resource TrustcenterImagingStudy is a modified resource of the profile ImagingStudy and represents e.g. a set of clinical images (CT, X-ray, etc.) of a study. It consists of the elements identifier, status and subject. If a summary is requested with the command summary=true, all these elements will be displayed.

Properties and constraints

There must be at least one (1..*) identifier of type Identifier. This can and must be specialized in this case by specifying exactly one (1..1) officialIdentifier (fixed values: use = official). However, other identifiers can be defined, e.g. with the use usual, temp, secondary or old. In addition, the officialIdentifier is marked as must support therefore the later implementation should be able to process this meaningfully.

The attributes status or subject of type code or Reference (data type that references an existing resource, such as patient), respectively, are already stipulated by the super resource and must be specified exactly once. The first specifies the status of the study and its values must come from a specific value set (binding-strength = required). Here, they come from the set imagingstudy-status. The latter specifies what the study refers to (often a patient). The instance can be specified in different ways, e.g. as reference, type or identifier.

TrustcenterImagingStudy (ImagingStudy)	I		ImagingStudy	There are no (further) constraints on this element Element id ImagingStudy Short description A set of images produced in single study (one or more series of references images) Definition 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. Data type ImagingStudy Constraints dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources `contained.contained.empty()` dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated `contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()` dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource `contained.where((('#'+id in (%resource.descendants().reference \| %resource.descendants().as(canonical) \| %resource.descendants().as(uri) \| %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()` dom-6: A resource should have narrative for robust management text.`div`.exists() dom-5: If a resource is contained in another resource, it SHALL NOT have a security label `contained.meta.security.empty()` Mappings rim: Entity. Role, or Act workflow: Event rim: Act[classCode=COMPOSITION, moodCode=EVN] dicom: Reference IHE radiology TF vol 2 table 4.14-1
id	Σ	0..1	string	There are no (further) constraints on this element Element id ImagingStudy.id Short description Logical id of this artifact Definition The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. Comments The only time that a resource does not have an id is when it is being submitted to the server using a create operation. Data type string
meta	Σ	0..1	Meta	There are no (further) constraints on this element Element id ImagingStudy.meta Short description Metadata about the resource Definition 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. Data type Meta Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
implicitRules	Σ ?!	0..1	uri	There are no (further) constraints on this element Element id ImagingStudy.implicitRules Short description A set of rules under which this content was created Definition 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. Comments 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. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
language		0..1	codeBinding	There are no (further) constraints on this element Element id ImagingStudy.language Short description Language of the resource content Definition The base language in which the resource is written. Comments 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). Data type code Binding A human language. CommonLanguages (preferred) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a
text		0..1	Narrative	There are no (further) constraints on this element Element id ImagingStudy.text Short description Text summary of the resource, for human interpretation Alternate names narrative, html, xhtml, display Definition 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. Comments 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. Data type Narrative Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A rim: Act.text?
contained		0..*	Resource	There are no (further) constraints on this element Element id ImagingStudy.contained Short description Contained, inline Resources Alternate names inline resources, anonymous resources, contained resources Definition 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. Comments 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. Data type Resource Mappings rim: Entity. Role, or Act rim: N/A
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ImagingStudy.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
modifierExtension	?! I	0..*	Extension	There are no (further) constraints on this element Element id ImagingStudy.modifierExtension Short description Extensions that cannot be ignored Alternate names extensions, user content Definition 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). Requirements 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
identifier	Σ	1..*	Identifier	Element id ImagingStudy.identifier Short description Identifiers for the whole study Alternate names StudyInstanceUID, AccessionNumber Definition Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number. Requirements 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. Comments See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID. Accession Number should use ACSN Identifier type. Data type Identifier Sliced: Unordered, Open, by use(Value) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id and .inboundRelationship[typeCode=COMP].source[classCode=ACSN, moodCode=EVN].id dicom: StudyInstanceUID (0020,000D) \| Accession Number and Issuer (0080,0050)+(0080,0051) \| Study ID (0020,0010)
officialIdentifier	S Σ	1..1	Identifier	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier Short description Identifiers for the whole study Alternate names StudyInstanceUID, AccessionNumber Definition Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number. Requirements 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. Comments See discussion under Imaging Study Implementation Notes for encoding of DICOM Study Instance UID. Accession Number should use ACSN Identifier type. Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier workflow: Event.identifier w5: FiveWs.identifier rim: .id and .inboundRelationship[typeCode=COMP].source[classCode=ACSN, moodCode=EVN].id dicom: StudyInstanceUID (0020,000D) \| Accession Number and Issuer (0080,0050)+(0080,0051) \| Study ID (0020,0010)
id		0..1	string	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
use	Σ ?!	1..1	codeBindingFixed Value	Element id ImagingStudy.identifier:officialIdentifier.use Short description usual \| official \| temp \| secondary \| old (If known) Definition The purpose of this identifier. Requirements Allows the appropriate identifier for a particular context of use to be selected from among a set of identifiers. Comments Applications can assume that an identifier is permanent unless it explicitly says that it is temporary. Data type code Binding Identifies the purpose for this identifier, if known . IdentifierUse (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Fixed value official Mappings rim: n/a v2: N/A rim: Role.code or implied by context
type	Σ	0..1	CodeableConceptBinding	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.type Short description Description of identifier Definition A coded type for the identifier that can be used to determine which identifier to use for a specific purpose. Requirements Allows users to make use of identifiers when the identifier system is not known. Comments 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. Data type CodeableConcept Binding A coded type for an identifier that can be used to determine which identifier to use for a specific purpose. Identifier Type Codes (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD v2: CX.5 rim: Role.code or implied by context
system	Σ	0..1	uri	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.system Short description The namespace for the identifier value Definition Establishes the namespace for the value - that is, a URL that describes a set values that are unique. Requirements 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. Comments Identifier.system is always case sensitive. Data type uri Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General http://www.acme.com/identifiers/patient Mappings rim: n/a v2: CX.4 / EI-2-4 rim: II.root or Role.id.root servd: ./IdentifierType
value	Σ	0..1	string	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.value Short description The value that is unique Definition The portion of the identifier typically relevant to the user and which is unique within the context of the system. Comments 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 Rendered Value extension. 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. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 123456 Mappings rim: n/a v2: CX.1 / EI.1 rim: II.extension or II.root if system indicates OID or GUID (Or Role.id.extension or root) servd: ./Value
period	Σ I	0..1	Period	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.period Short description Time period when id is/was valid for use Definition Time period during which identifier is/was valid for use. Comments A Period specifies a range of time; the context of use will specify whether the entire range applies (e.g. "the patient was an inpatient of the hospital for this time range") or one value from the range applies (e.g. "give to the patient between these two times"). Period is not used for a duration (a measure of elapsed time). See Duration. Data type Period Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` per-1: If present, start SHALL have a lower value than end `start.hasValue().not() or end.hasValue().not() or (start <= end)` Mappings rim: n/a v2: DR rim: IVL<TS>[lowClosed="true" and highClosed="true"] or URG<TS>[lowClosed="true" and highClosed="true"] v2: CX.7 + CX.8 rim: Role.effectiveTime or implied by context servd: ./StartDate and ./EndDate
assigner	Σ I	0..1	Reference(Organization)	There are no (further) constraints on this element Element id ImagingStudy.identifier:officialIdentifier.assigner Short description Organization that issued id (may be just text) Definition Organization that issued/manages the identifier. Comments 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. Data type Reference(Organization) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) v2: CX.4 / (CX.4,CX.9,CX.10) rim: II.assigningAuthorityName but note that this is an improper use by the definition of the field. Also Role.scoper servd: ./IdentifierIssuingAuthority
status	Σ ?!	1..1	codeBinding	There are no (further) constraints on this element Element id ImagingStudy.status Short description registered \| available \| cancelled \| entered-in-error \| unknown Definition The current state of the ImagingStudy. Comments 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. Data type code Binding The status of the ImagingStudy. ImagingStudyStatus (required) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a workflow: Event.status w5: FiveWs.status v2: Varies by domain rim: .status
modality	Σ	0..0	CodingBinding	There are no (further) constraints on this element Element id ImagingStudy.modality Short description All series modality if actual acquisition modalities Alternate names ModalitiesInStudy Definition 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). Comments Codes may be defined very casually in enumerations or code lists, up to very formal definitions such as SNOMED CT - see the HL7 v3 Core Principles for more information. Data type Coding Binding Type of acquired data in the instance. http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE subset one of the sets of component 1-3 or 4-6 rim: CV orim: fhir:Coding rdfs:subClassOf dt:CDCoding w5: FiveWs.class rim: .code dicom: (0008,0061)
subject	Σ I	1..1	Reference(Patient \| Device \| Group)	There are no (further) constraints on this element Element id ImagingStudy.subject Short description Who or what is the subject of the study Definition The subject, typically a patient, of the imaging study. Comments QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group. Data type Reference(Patient \| Device \| Group) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.subject w5: FiveWs.subject[x] rim: .participation[typeCode=SBJ].role dicom: (0010/) w5:* FiveWs.subject
id		0..1	string	There are no (further) constraints on this element Element id ImagingStudy.subject.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id ImagingStudy.subject.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition 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. Comments 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. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
reference	Σ I	0..1	string	There are no (further) constraints on this element Element id ImagingStudy.subject.reference Short description Literal reference, Relative, internal or absolute URL Definition 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. Comments 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. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
type	Σ	0..1	uriBinding	There are no (further) constraints on this element Element id ImagingStudy.subject.type Short description Type the reference refers to (e.g. "Patient") Definition 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). Comments 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 RESTful URL) or by resolving the target of the reference; if both the type and a reference is provided, the reference SHALL resolve to a resource of the same type as that specified. Data type uri Binding Aa resource (or, for logical models, the URI of the logical model). ResourceType (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
identifier	Σ	0..1	Identifier	There are no (further) constraints on this element Element id ImagingStudy.subject.identifier Short description Logical reference, when literal reference is not known Definition 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. Comments 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). Data type Identifier Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CX / EI (occasionally, more often EI maps to a resource id or a URL) rim: II - The Identifier class is a little looser than the v3 type II because it allows URIs as well as registered OIDs or GUIDs. Also maps to Role[classCode=IDENT] servd: Identifier rim: .identifier
display	Σ	0..0	string	There are no (further) constraints on this element Element id ImagingStudy.subject.display Short description Text alternative for the resource Definition Plain text narrative that identifies the resource in addition to the resource reference. Comments 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. Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: N/A
encounter	Σ I	0..0	Reference(Encounter)	There are no (further) constraints on this element Element id ImagingStudy.encounter Short description Encounter with which this imaging study is associated Definition The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made. Comments 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). Data type Reference(Encounter) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.encounter w5: FiveWs.context rim: inboundRelationship[typeCode=COMP].source[classCode=ENC, moodCode=EVN]
started	Σ	0..0	dateTime	There are no (further) constraints on this element Element id ImagingStudy.started Short description When the study was started Alternate names StudyDate, StudyTime Definition Date and time the study started. Data type dateTime Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Examples General 2011-01-01T11:01:20+03:00 Mappings rim: n/a workflow: Event.occurrence[x] w5: FiveWs.init rim: .effectiveTime dicom: (0008,0020)+(0008,0030)
basedOn	Σ I	0..0	Reference(CarePlan \| ServiceRequest \| Appointment \| AppointmentResponse \| Task)	There are no (further) constraints on this element Element id ImagingStudy.basedOn Short description Request fulfilled Definition A list of the diagnostic requests that resulted in this imaging study being performed. Requirements To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT). Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(CarePlan \| ServiceRequest \| Appointment \| AppointmentResponse \| Task) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.basedOn w5: FiveWs.cause rim: .outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO] dicom: (0032,1064)
referrer	Σ I	0..0	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ImagingStudy.referrer Short description Referring physician Alternate names ReferringPhysiciansName Definition The requesting/referring physician. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.cause rim: .outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO].participation[typeCode=AUT].role dicom: (0008,0090)+(0008,0096)
interpreter	Σ I	0..0	Reference(Practitioner \| PractitionerRole)	There are no (further) constraints on this element Element id ImagingStudy.interpreter Short description Who interpreted images Alternate names Name of Physician(s) Reading Study Definition Who read the study and interpreted the images or other content. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Practitioner \| PractitionerRole) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) w5: FiveWs.witness rim: .participation[typeCode=PRF].role dicom: (0008,1060)
endpoint	Σ I	0..0	Reference(Endpoint)	There are no (further) constraints on this element Element id ImagingStudy.endpoint Short description Study access endpoint Definition 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. Requirements 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. Comments 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. Data type Reference(Endpoint) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) rim: Not supported
numberOfSeries	Σ	0..0	unsignedInt	There are no (further) constraints on this element Element id ImagingStudy.numberOfSeries Short description Number of Study Related Series Alternate names NumberOfStudyRelatedSeries Definition 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. Comments 32 bit number; for values larger than this, use decimal Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=OBSSER, moodCode=EVN].repeatNumber dicom: (0020,1206)
numberOfInstances	Σ	0..0	unsignedInt	There are no (further) constraints on this element Element id ImagingStudy.numberOfInstances Short description Number of Study Related Instances Alternate names NumberOfStudyRelatedInstances Definition 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. Comments 32 bit number; for values larger than this, use decimal Data type unsignedInt Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber dicom: (0020,1208)
procedureReference	Σ I	0..0	Reference(Procedure)	There are no (further) constraints on this element Element id ImagingStudy.procedureReference Short description The performed Procedure reference Definition The procedure which this ImagingStudy was part of. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Procedure) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.partOf rim: .outboundRelationship[typeCode=COMP].target[classCode=PROC, moodCode=EVN] dicom: (0008,1032)
procedureCode	Σ	0..0	CodeableConceptBinding	There are no (further) constraints on this element Element id ImagingStudy.procedureCode Short description The performed procedure code Alternate names ProcedureCodeSequence Definition The code for the performed procedure type. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding The performed procedure type. http://www.rsna.org/RadLex_Playbook.aspx (extensible) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.code rim: .outboundRelationship[typeCode=COMP].target[classCode=PROC, moodCode=EVN] dicom: (0008,1032)
location	Σ I	0..0	Reference(Location)	There are no (further) constraints on this element Element id ImagingStudy.location Short description Where ImagingStudy occurred Definition The principal physical location where the ImagingStudy was performed. Requirements 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). Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Location) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.location w5: FiveWs.where[x] v2: EVN.7 rim: .participation[typeCode=LOC].role dicom: (0008,1040) \| (0040,0243)
reasonCode	Σ	0..0	CodeableConcept	There are no (further) constraints on this element Element id ImagingStudy.reasonCode Short description Why the study was requested Definition Description of clinical condition indicating why the ImagingStudy was requested. Comments Not all terminology uses fit this general pattern. In some cases, models should not use CodeableConcept and use Coding directly and provide their own structure for managing text, codings, translations and the relationship between elements and pre- and post-coordination. Data type CodeableConcept Binding The reason for the study. ProcedureReasonCodes (example) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: CE/CNE/CWE rim: CD orim: fhir:CodeableConcept rdfs:subClassOf dt:CD workflow: Event.reasonCode w5: FiveWs.why[x] rim: .reasonCode dicom: (0040,1002)
reasonReference	Σ I	0..0	Reference(Condition \| Observation \| Media \| DiagnosticReport \| DocumentReference)	There are no (further) constraints on this element Element id ImagingStudy.reasonReference Short description Why was study performed Definition Indicates another resource whose existence justifies this Study. Comments References SHALL be a reference to an actual FHIR resource, and SHALL be resolveable (allowing for access control, temporary unavailability, etc.). Resolution can be either by retrieval from the URL, or, where applicable by resource type, by treating an absolute reference as a canonical URL and looking it up in a local registry/repository. Data type Reference(Condition \| Observation \| Media \| DiagnosticReport \| DocumentReference) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ref-1: SHALL have a contained resource if a local reference is provided `reference.startsWith('#').not() or (reference.substring(1).trace('url') in %rootResource.contained.id.trace('ids'))` Mappings rim: n/a rim: The target of a resource reference is a RIM entry point (Act, Role, or Entity) workflow: Event.reasonReference w5: FiveWs.why[x] v2: EVN.4 or by domain rim: .outboundRelationship[typeCode=RSON].target
note	Σ	0..0	Annotation	There are no (further) constraints on this element Element id ImagingStudy.note Short description User-defined comments Definition 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. Comments For systems that do not have structured annotations, they can simply communicate a single annotation with no author or time. This element may need to be included in narrative because of the potential for modifying information. Annotations SHOULD NOT be used to communicate "modifying" information that could be computable. (This is a SHOULD because enforcing user behavior is nearly impossible). Data type Annotation Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: N/A rim: Act workflow: Event.note rim: unknown
description	Σ	0..0	string	There are no (further) constraints on this element Element id ImagingStudy.description Short description Institution-generated description Alternate names StudyDescription Definition The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .text dicom: (0008,1030)
series	Σ	0..0	BackboneElement	There are no (further) constraints on this element Element id ImagingStudy.series Short description Each study has one or more series of instances Definition Each study has one or more series of images or other content. Data type BackboneElement Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a rim: .outboundRelationship[typeCode=COMP].target[classCode=OBSSER, moodCode=EVN]