Medizininformatik Initiative - Implementation Guide - Modul Bildgebung v2026

Extension Schichtdicke auf Serienebene

Diese Extension Schichtdicke ermöglicht es, die Schichtdicke der einzelnen Instanzen in der Bildserie anzugeben. Dies soll vorrangig dafür genutzt werden, wenn aus Kapazitätsgründen die Instanzebene der ImagingStudy nicht umgesetzt wird. Wenn die Instanzebene umgesetzt wird, soll die Schichtdicke in dieser Ebene befüllt werden (siehe Extension-Instanzdetails) Achtung: Da sliceThickness laut DICOM-Standard ein Instanz-Element ist, muss bei der Befüllung auf Serienebene sichergestellt werden, dass die Schichtdicke über die betrachtete Serie hinweg in alles Instanzen konstant ist!

Relevante DICOM-Tags sind:

Schichtdicke [(0018, 0050) SliceThickness] in [mm]

Name	Status	Version	Canonical	Basis
MII_EX_Bildgebung_Schichtdicke	active	2027.0.0-ballot	https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-serie-schichtdicke	http://hl7.org/fhir/StructureDefinition/Extension

Inhalt

MII_EX_Bildgebung_Schichtdicke (Extension)	C		Extension	There are no (further) constraints on this element Element id Extension Short description Optional Extensions Element Definition Optional Extension Element - found in all resources. Data type Extension Conditions The cardinality or value of this element may be affected by these constraints: ele-1 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
id		0..1	string	There are no (further) constraints on this element Element id Extension.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	C	0..0	Extension	There are no (further) constraints on this element Element id Extension.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 Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 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
url		1..1	uriFixed Value	Element id Extension.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-serie-schichtdicke Mappings rim: N/A
value[x]	S C	1..1	SimpleQuantity	Element id Extension.value[x] Short description A fixed quantity (no comparator) Definition The comparator is not used on a SimpleQuantity Comments The context of use may frequently define what kind of quantity this is and therefore what kind of units can be used. The context of use may also restrict the values for the comparator. Data type SimpleQuantity Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` qty-3: If a code for the unit is present, the system SHALL also be present `code.empty() or system.exists()` sqty-1: The comparator is not used on a SimpleQuantity `comparator.empty()` Mappings rim: n/a rim: N/A v2: SN (see also Range) or CQ rim: PQ, IVL<PQ>, MO, CO, depending on the values
id		0..1	string	There are no (further) constraints on this element Element id Extension.value[x].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	C	0..*	Extension	There are no (further) constraints on this element Element id Extension.value[x].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 Slicing Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Conditions The cardinality or value of this element may be affected by these constraints: ele-1 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
value	Σ	0..1	decimal	There are no (further) constraints on this element Element id Extension.value[x].value Short description Numerical value (with implicit precision) Definition The value of the measured amount. The value includes an implicit precision in the presentation of the value. Requirements Precision is handled implicitly in almost all cases of measurement. Comments The implicit precision in the value should always be honored. Monetary values have their own rules for handling precision (refer to standard accounting text books). Data type decimal Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.2 / CQ - N/A rim: PQ.value, CO.value, MO.value, IVL.high or IVL.low depending on the value
comparator	Σ ?!	0..0	codeBinding	There are no (further) constraints on this element Element id Extension.value[x].comparator Short description < \| <= \| >= \| > - how to understand the value Definition Not allowed to be used in this context Requirements Need a framework for handling measures where the value is <5ug/L or >400mg/L due to the limitations of measuring methodology. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Meaning when missing If there is no comparator, then there is no modification of the value Data type code Binding How the Quantity should be understood and represented. QuantityComparator (required) Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: n/a v2: SN.1 / CQ.1 rim: IVL properties
unit	Σ	0..1	stringPattern	Element id Extension.value[x].unit Short description Unit representation Definition A human-readable form of the unit. Requirements There are many representations for units of measure and in many contexts, particular representations are fixed and required. I.e. mcg for micrograms. Comments Note that FHIR strings SHALL NOT exceed 1MB in size Data type string Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern millimeter Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.unit
system	Σ C	0..1	uriPattern	Element id Extension.value[x].system Short description System that defines coded unit form Definition The identification of the system that provides the coded form of the unit. Requirements Need to know the system that defines the coded form of the unit. Comments see http://en.wikipedia.org/wiki/Uniform_resource_identifier Data type uri Conditions The cardinality or value of this element may be affected by these constraints: ele-1, qty-3 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern http://unitsofmeasure.org Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: CO.codeSystem, PQ.translation.codeSystem
code	Σ	0..1	codePattern	Element id Extension.value[x].code Short description Coded form of the unit Definition A computer processable form of the unit in some unit representation system. Requirements Need a computable form of the unit that is fixed across all forms. UCUM provides this for quantities, but SNOMED CT provides many units of interest. Comments The preferred system is UCUM, but SNOMED CT can also be used (for customary units) or ISO 4217 for currency. The context of use may additionally require a code from a particular system. Data type code Conditions The cardinality or value of this element may be affected by these constraints: ele-1 Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Pattern mm Mappings rim: n/a v2: (see OBX.6 etc.) / CQ.2 rim: PQ.code, MO.currency, PQ.translation.code

Die Extension ermöglicht es, die Schichtdicke auf Serien-Ebene anzugeben, anstelle der individuellen Angabe auf Instanz-Ebene.

Feldname
Extension.value[x]

<system value="http://hl7.org/fhir/spdx-license" />
<code value="CC-BY-4.0" />
<display value="Creative Commons Attribution 4.0 International" />

</coding>

</valueCodeableConcept>

</extension>

</extension>

</extension>

</name>

</extension>

</extension>

</title>

</telecom>

</contact>

</extension>

</extension>

</description>

</context>

</element>

</element>

<path value="Extension.value[x]" />
<min value="1" />
<type>
<code value="Quantity" />
<profile value="http://hl7.org/fhir/StructureDefinition/SimpleQuantity" />
</type>
<mustSupport value="true" />

</element>

</element>

</element>

</element>

</differential>

</StructureDefinition>

{

"resourceType": "StructureDefinition",
"id": "mii-ex-bildgebung-serie-schichtdicke",
"extension": [
{
"url": "https://www.medizininformatik-initiative.de/fhir/modul-meta/StructureDefinition/mii-ex-meta-license-codeable",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/spdx-license",
"code": "CC-BY-4.0",
"display": "Creative Commons Attribution 4.0 International"
}
]
}
}
],
"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-serie-schichtdicke",
"version": "2027.0.0-ballot",
"name": "MII_EX_Bildgebung_Schichtdicke",
"_name": {
"extension": [
{
"extension": [
{
"url": "lang",
"valueCode": "en-US"
},
{
"url": "content",
"valueString": "MII_EX_ImagingStudy"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/translation"
}
]
},
"title": "MII EX Bildgebung Schichtdicke",
"_title": {
"extension": [
{
"extension": [
{
"url": "lang",
"valueCode": "en-US"
},
{
"url": "content",
"valueString": "MII_EX_ImagingStudy"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/translation"
}
]
},
"status": "active",
"experimental": false,
"publisher": "Medizininformatik Initiative",
"contact": [
{
"telecom": [
{
"system": "url",
"value": "https://www.medizininformatik-initiative.de"
}
]
}
],
"description": "Die Extension ermöglicht es, die Schichtdicke auf Serien-Ebene anzugeben, anstelle der individuellen Angabe auf Instanz-Ebene.",
"_description": {
"extension": [
{
"extension": [
{
"url": "lang",
"valueCode": "en-US"
},
{
"url": "content",
"valueString": "The extension allows specifying the slice thickness at the series level instead of the individual values at instance level."
}
],
"url": "http://hl7.org/fhir/StructureDefinition/translation"
}
]
},
"fhirVersion": "4.0.1",
"kind": "complex-type",
"abstract": false,
"context": [
{
"type": "element",
"expression": "ImagingStudy.series"
}
],
"type": "Extension",
"baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
"derivation": "constraint",
"differential": {
"element": [
{
"id": "Extension.extension",
"path": "Extension.extension",
"max": "0"
},
{
"id": "Extension.url",
"path": "Extension.url",
"fixedUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-serie-schichtdicke"
},
{
"id": "Extension.value[x]",
"path": "Extension.value[x]",
"min": 1,
"type": [
{
"code": "Quantity",
"profile": [
"http://hl7.org/fhir/StructureDefinition/SimpleQuantity"
]
}
],
"mustSupport": true
},
{
"id": "Extension.value[x].unit",
"path": "Extension.value[x].unit",
"patternString": "millimeter"
},
{
"id": "Extension.value[x].system",
"path": "Extension.value[x].system",
"patternUri": "http://unitsofmeasure.org"
},
{
"id": "Extension.value[x].code",
"path": "Extension.value[x].code",
"patternCode": "mm"
}
]
}

}

MII EX Bildgebung Schichtdicke

Beispiele

Hinweis
	Aus Gründen der Übersichtlichkeit wurde in diesem Beispiel darauf verzichtet, alle dazugehörigen Serien bzw. Instanzen mit einzubinden. Natürlich ist es bei der Implementierung vorgesehen, dass alle zur jeweiligen Studie gehörenden Serien und Instanzen auch in der resultierenden FHIR-Ressource enthalten sind - dafür wird dann einfach die Sequenz "series" bzw "instance" für jede Serie bzw. Instanz wiederholt und mit den entsprechenden Werten befüllt.

Hinweis

Aus Gründen der Übersichtlichkeit wurde in diesem Beispiel darauf verzichtet, alle dazugehörigen Serien bzw. Instanzen mit einzubinden. Natürlich ist es bei der Implementierung vorgesehen, dass alle zur jeweiligen Studie gehörenden Serien und Instanzen auch in der resultierenden FHIR-Ressource enthalten sind - dafür wird dann einfach die Sequenz "series" bzw "instance" für jede Serie bzw. Instanz wiederholt und mit den entsprechenden Werten befüllt.

Beispiele von ImagingStudy-Ressourcen mit der Extension für Schichtdicke in der Serie:

Beispiel eines MRTs:

{

"resourceType": "ImagingStudy",

"id": "mii-exa-bildgebung-bildgebungsstudie-mr-series",

"meta": {

"profile": [

"https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-pr-bildgebung-bildgebungsstudie"

]

"extension": [

{

"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-bildgebungsgrund",

"valueString": "Verdacht auf Kreuzbandruptur"

}

"status": "available",

"modality": [

{

"system": "http://dicom.nema.org/resources/ontology/DCM",
"code": "MR",
"display": "Magnetic Resonance"

}

"subject": {

"reference": "Patient/PatExample",

"identifier": {

"type": {

"coding": [

{

"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical record number"

}

]

"system": "https://system-url",

"value": "study-uid"

}

"encounter": {

"reference": "Encounter/EncExample"

"basedOn": [

{

"reference": "ServiceRequest/mii-exa-bildgebung-anforderung-bildgebung"

}

"numberOfSeries": 11,

"numberOfInstances": 294,

"procedureReference": {

"reference": "Procedure/mii-exa-bildgebung-bildgebungsprozedur"

"reasonReference": [

{

"reference": "Condition/CondExample"

}

"description": "Knie DOT",

"series": [

{

"extension": [

{

"extension": [

{

"url": "magneticFieldStrength",

"valueQuantity": {

"value": 3,

"unit": "tesla"

}

{

"url": "scanningSequence",

"valueCodeableConcept": {

"coding": [

{

"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/CodeSystem/mii-cs-bildgebung-scanning-sequence",

"code": "SE"

}

]

}

{

"url": "scanningSequenceVariant",

"valueCodeableConcept": {

"coding": [

{

"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/CodeSystem/mii-cs-bildgebung-scanning-sequence-variant",

"code": "SP"

{

"system": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/CodeSystem/mii-cs-bildgebung-scanning-sequence-variant",

"code": "SK"

}

]

}

{

"url": "echoTime",

"valueQuantity": {

"value": 388,

"unit": "milliseconds"

}

{

"url": "repetitionTime",

"valueQuantity": {

"value": 5000,

"unit": "milliseconds"

}

{

"url": "inversionTime",

"valueQuantity": {

"value": 900,

"unit": "milliseconds"

}

{

"url": "flipAngle",

"valueQuantity": {

"value": 130,

"unit": "plane angle degree"

}

"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-mr"

{

"extension": [

{

"url": "contrastBolus",

"valueBoolean": false

}

"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel"

{

"url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-serie-schichtdicke",

"valueQuantity": {

"value": 4,

"unit": "millimeter"

}

"uid": "series-example-uid",

"number": 9,

"modality": {

"system": "http://dicom.nema.org/resources/ontology/DCM",
"code": "MR",
"display": "Magnetic Resonance"

"description": "pd_tse_sag",

"numberOfInstances": 28,

"bodySite": {

"system": "http://snomed.info/sct",
"code": "72696002",
"display": "Knee region structure (body structure)"

"laterality": {

"system": "http://snomed.info/sct",
"code": "24028007",
"display": "Right"

"started": "2024-07-19T12:03:30+02:00",

"performer": [

{

"actor": {

"reference": "Device/mii-exa-bildgebung-geraet"

}

]

}

]

}