CA Core+ v1.1.0 DFT-preBallot
1.1.0-DFT-preBallot 
DFT-preBallot - The specification is a DFT-preBallot version of CA Core+ for collecting community feedback. For a full list of available versions, see the Directory of published versions
ImagingStudy (CA-Core)
Links
Profile
Derived from
http://hl7.org/fhir/StructureDefinition/ImagingStudy
Examples
Description
This profile applies constraints to the ImagingStudy resource for CA Core to support the effective structured sharing of diagnostic imaging studies.
References to this resource
ObservationResultsRadiologyCACore
CFMM: 2
Resource Content
| ImagingStudyCACore (ImagingStudy) | C | ImagingStudy | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | SO Σ | 0..* | Identifier |
| status | Σ ?! | 1..1 | codeBinding |
| modality | Σ | 0..* | CodingBinding |
| subject | SO Σ | 1..1 | Reference(PatientCACore | Device | Group) |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| reference | SO Σ C | 1..1 | string |
| type | Σ | 0..1 | uriBinding |
| identifier | Σ | 0..1 | Identifier |
| display | Σ | 0..1 | string |
| encounter | Σ | 0..1 | Reference(Encounter) |
| started | SO Σ | 0..1 | dateTime |
| basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task) |
| referrer | Σ | 0..1 | Reference(Practitioner | PractitionerRole) |
| interpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole) |
| endpoint | Σ | 0..* | Reference(Endpoint) |
| numberOfSeries | Σ | 0..1 | unsignedInt |
| numberOfInstances | Σ | 0..1 | unsignedInt |
| procedureReference | Σ | 0..1 | Reference(Procedure) |
| procedureCode | SO Σ | 0..* | CodeableConceptBinding |
| location | Σ | 0..1 | Reference(Location) |
| reasonCode | Σ | 0..* | CodeableConcept |
| reasonReference | Σ | 0..* | Reference(Condition | Observation | Media | DiagnosticReport | DocumentReference) |
| note | Σ | 0..* | Annotation |
| description | Σ | 0..1 | string |
| series | SO Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| uid | SO Σ | 1..1 | id |
| number | Σ | 0..1 | unsignedInt |
| modality | Σ | 1..1 | CodingBinding |
| description | Σ | 0..1 | string |
| numberOfInstances | Σ | 0..1 | unsignedInt |
| endpoint | Σ | 0..* | Reference(Endpoint) |
| bodySite | Σ | 0..1 | Coding |
| laterality | Σ | 0..1 | Coding |
| specimen | Σ | 0..* | Reference(Specimen) |
| started | Σ | 0..1 | dateTime |
| performer | Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| function | Σ | 0..1 | CodeableConceptBinding |
| actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson) |
| instance | SO | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| uid | 1..1 | id | |
| sopClass | SO | 1..1 | CodingBinding |
| number | 0..1 | unsignedInt | |
| title | 0..1 | string |
| ImagingStudyCACore (ImagingStudy) | C | ImagingStudy | |
| id | Σ | 0..1 | string |
| meta | Σ | 0..1 | Meta |
| implicitRules | Σ ?! | 0..1 | uri |
| language | 0..1 | codeBinding | |
| text | 0..1 | Narrative | |
| contained | 0..* | Resource | |
| extension | C | 0..* | Extension |
| modifierExtension | ?! C | 0..* | Extension |
| identifier | SO Σ | 0..* | Identifier |
| status | Σ ?! | 1..1 | codeBinding |
| modality | Σ | 0..* | CodingBinding |
| subject | SO Σ | 1..1 | Reference(PatientCACore | Device | Group) |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| reference | SO Σ C | 1..1 | string |
| type | Σ | 0..1 | uriBinding |
| identifier | Σ | 0..1 | Identifier |
| display | Σ | 0..1 | string |
| encounter | Σ | 0..1 | Reference(Encounter) |
| started | SO Σ | 0..1 | dateTime |
| basedOn | Σ | 0..* | Reference(CarePlan | ServiceRequest | Appointment | AppointmentResponse | Task) |
| referrer | Σ | 0..1 | Reference(Practitioner | PractitionerRole) |
| interpreter | Σ | 0..* | Reference(Practitioner | PractitionerRole) |
| endpoint | Σ | 0..* | Reference(Endpoint) |
| numberOfSeries | Σ | 0..1 | unsignedInt |
| numberOfInstances | Σ | 0..1 | unsignedInt |
| procedureReference | Σ | 0..1 | Reference(Procedure) |
| procedureCode | SO Σ | 0..* | CodeableConceptBinding |
| location | Σ | 0..1 | Reference(Location) |
| reasonCode | Σ | 0..* | CodeableConcept |
| reasonReference | Σ | 0..* | Reference(Condition | Observation | Media | DiagnosticReport | DocumentReference) |
| note | Σ | 0..* | Annotation |
| description | Σ | 0..1 | string |
| series | SO Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| uid | SO Σ | 1..1 | id |
| number | Σ | 0..1 | unsignedInt |
| modality | Σ | 1..1 | CodingBinding |
| description | Σ | 0..1 | string |
| numberOfInstances | Σ | 0..1 | unsignedInt |
| endpoint | Σ | 0..* | Reference(Endpoint) |
| bodySite | Σ | 0..1 | Coding |
| laterality | Σ | 0..1 | Coding |
| specimen | Σ | 0..* | Reference(Specimen) |
| started | Σ | 0..1 | dateTime |
| performer | Σ | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| function | Σ | 0..1 | CodeableConceptBinding |
| actor | Σ | 1..1 | Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | Device | RelatedPerson) |
| instance | SO | 0..* | BackboneElement |
| id | 0..1 | string | |
| extension | C | 0..* | Extension |
| modifierExtension | Σ ?! C | 0..* | Extension |
| uid | 1..1 | id | |
| sopClass | SO | 1..1 | CodingBinding |
| number | 0..1 | unsignedInt | |
| title | 0..1 | string |
</extension>
</telecom>
</telecom>
</contact>
<description value="This profile applies constraints to the ImagingStudy resource for CA Core to support the effective structured sharing of diagnostic imaging studies." />
</jurisdiction>
<copyright value="Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy)." />
<short value="A set of images produced in single study (one or more series of references images)" />
<definition value="Representation of the content produced in a DICOM imaging study. A study comprises a set of series, each of which includes a set of Service-Object Pair Instances (SOP Instances - images or other data) acquired or produced in a common context. A series is of only one modality (e.g. X-ray, CT, MR, ultrasound), but a study may have multiple series of different modalities." />
</base>
<human value="If the resource is contained in another resource, it SHALL NOT contain nested Resources" />
</constraint>
<human value="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" />
<expression value="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()" />
<xpath value="not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated" />
<xpath value="not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))" />
</constraint>
<human value="If a resource is contained in another resource, it SHALL NOT have a security label" />
</constraint>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/elementdefinition-bestpractice-explanation">
<valueMarkdown value="When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time." />
</extension>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes." />
<comment value="The only time that a resource does not have an id is when it is being submitted to the server using a create operation." />
</base>
</extension>
</type>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation" />
</element>
<comment value="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)." />
</base>
</type>
</constraint>
</extension>
</extension>
</extension>
</binding>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them" />
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number." />
<comment value="See discussion under [Imaging Study Implementation Notes](imagingstudy.html#notes) for encoding of DICOM Study Instance UID. Accession Number should use ACSN Identifier type." />
<requirements value="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](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
<map value="StudyInstanceUID (0020,000D) | Accession Number and Issuer (0080,0050)+(0080,0051) | Study ID (0020,0010)" />
</mapping>
</element>
<comment value="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." />
</base>
</type>
</constraint>
<isModifierReason value="This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid" />
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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)." />
</base>
</type>
</constraint>
</extension>
<valueSet value="http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html" />
</binding>
</mapping>
</mapping>
</mapping>
</element>
<valueString value="dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.2.2.html" />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<comment value="QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group." />
</base>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
</discriminator>
</slicing>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="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.\n\nThe 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)." />
<comment value="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." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</element>
<definition value="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." />
<comment value="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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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)." />
</base>
</type>
</constraint>
</mapping>
</element>
</extension>
<definition value="Plain text narrative that identifies the resource in addition to the resource reference." />
<comment value="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." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made." />
<comment value="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)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<valueString value="dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html#sect_C.7.2.1" />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</base>
</type>
</example>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="A list of the diagnostic requests that resulted in this imaging study being performed." />
<requirements value="To support grouped procedures (one imaging study supporting multiple ordered procedures, e.g. chest/abdomen/pelvis CT)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
<map value=".outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO].participation[typeCode=AUT].role" />
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
<requirements value="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." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
<map value=".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=OBSSER, moodCode=EVN].repeatNumber" />
</mapping>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
<map value=".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber" />
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</base>
</type>
</constraint>
</extension>
</extension>
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips" />
</extension>
</extension>
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</element>
<requirements value="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)." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Description of clinical condition indicating why the ImagingStudy was requested." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<definition value="The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<comment value="See [DICOM PS3.3 C.7.3](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.3.html)." />
</base>
</type>
</example>
</constraint>
</mapping>
</mapping>
</element>
</base>
</type>
</example>
</constraint>
<map value=".inboundRelationship[type=COMP, source[classCode=COMPOSITION, moodCode=EVN]].sequenceNumber" />
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</extension>
<valueSet value="http://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_29.html" />
</binding>
</mapping>
</mapping>
</element>
</base>
</type>
</example>
</constraint>
</mapping>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
<map value=".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber" />
</mapping>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
<requirements value="Access methods for retrieving (e.g., DICOM’s WADO-URI and WADO-RS) the series or the series’ instances. A baseLocation specified at the series level has precedence over a baseLocation of the same type specified at the study level." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</element>
<definition value="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." />
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
<comment value="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." />
<requirements value="The performer is recorded at the series level, since each series in a study may be performed by a different performer, at different times, and using different devices. A series may be performed by multiple performers." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
</base>
</type>
</constraint>
</extension>
</binding>
</mapping>
</element>
</base>
</type>
</constraint>
</mapping>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<definition value="A single SOP instance within the series, e.g. an image, or presentation state." />
</base>
</type>
</constraint>
</mapping>
</element>
<definition value="Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces." />
</base>
</extension>
</type>
</mapping>
</element>
<definition value="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." />
<comment value="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." />
</base>
</type>
</constraint>
</constraint>
</mapping>
</element>
<definition value="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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself)." />
<comment value="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." />
<requirements value="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](extensibility.html#modifierExtension)." />
</base>
</type>
</constraint>
</constraint>
<isModifierReason value="Modifier extensions are expected to modify the meaning or interpretation of the element that contains them" />
</mapping>
</element>
<comment value="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)." />
</base>
</type>
</example>
</constraint>
</mapping>
</mapping>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</base>
</type>
</constraint>
</extension>
<valueSet value="http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1" />
</binding>
<map value=".inboundRelationship[typeCode=COMP]. source[classCode=OBS, moodCode=EVN, code="sop class"].value" />
</mapping>
</mapping>
</element>
</base>
</type>
</example>
</constraint>
<map value=".inboundRelationship[typeCode=COMP, source[classCode=OBSSER, moodCode=EVN]].sequenceNumber" />
</mapping>
</mapping>
</element>
<comment value="Particularly for post-acquisition analytic objects, such as SR, presentation states, value mapping, etc." />
</base>
</type>
</constraint>
</mapping>
</mapping>
</element>
</snapshot>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
<valueString value="dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.2.2.html" />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<targetProfile value="http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core" />
</type>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
<valueString value="dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html#sect_C.7.2.1" />
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<valueCanonical value="http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips" />
</extension>
</extension>
</extension>
</binding>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
</element>
</extension>
</extension>
</extension>
</extension>
</extension>
</extension>
<valueSet value="http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1" />
</binding>
</element>
</differential>
</StructureDefinition>
{
],
{
{
},
{
}
]
}
],
"description": "This profile applies constraints to the ImagingStudy resource for CA Core to support the effective structured sharing of diagnostic imaging studies.",
],
"copyright": "Copyright © 2025+ Canada Health Infoway. All rights reserved. [Terms of Use and License Agreements](https://ic.infoway-inforoute.ca/en/about/tou). [Privacy Policy](https://www.infoway-inforoute.ca/en/legal/privacy-policy).",
{
"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.",
},
{
},
{
"human": "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",
"expression": "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()",
"xpath": "not(exists(for $id in f:contained/*/f:id/@value return $contained[not(parent::*/descendant::f:reference/@value=concat('#', $contained/*/id/@value) or descendant::f:reference[@value='#'])]))",
},
{
"human": "If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated",
"xpath": "not(exists(f:contained/*/f:meta/f:versionId)) and not(exists(f:contained/*/f:meta/f:lastUpdated))",
},
{
},
{
{
},
{
"valueMarkdown": "When a resource has no narrative, only systems that fully understand the data can display the resource to a human safely. Including a human readable representation in the resource makes for a much more robust eco-system and cheaper handling of resources by intermediary systems. Some ecosystems restrict distribution of resources to only those systems that do fully understand the resources, and as a consequence implementers may believe that the narrative is superfluous. However experience shows that such eco-systems often open up to new participants over time."
}
],
}
],
{
},
{
},
{
},
{
}
]
},
{
"definition": "The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.",
"comment": "The only time that a resource does not have an id is when it is being submitted to the server using a create operation.",
},
{
{
}
],
}
],
},
{
"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.",
},
],
{
}
],
},
{
"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.",
"comment": "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.",
},
],
{
}
],
"isModifierReason": "This element is labeled as a modifier because the implicit rules may provide additional knowledge about the resource that modifies it's meaning or interpretation",
},
{
"comment": "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).",
},
],
{
}
],
{
},
{
},
{
}
],
}
},
{
"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.",
"comment": "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.",
"narrative",
"html",
"xhtml",
"display"
],
},
],
{
}
],
]
},
{
"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.",
"comment": "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.",
"inline resources",
"anonymous resources",
"contained resources"
],
},
],
]
},
{
"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.",
"comment": "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.",
"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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the resource that contains them",
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"definition": "Identifiers for the ImagingStudy such as DICOM Study Instance UID, and Accession Number.",
"comment": "See discussion under [Imaging Study Implementation Notes](imagingstudy.html#notes) for encoding of DICOM Study Instance UID. Accession Number should use ACSN Identifier type.",
"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](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html).",
"StudyInstanceUID",
"AccessionNumber"
],
},
],
{
}
],
{
},
{
},
{
},
{
"map": "StudyInstanceUID (0020,000D) | Accession Number and Issuer (0080,0050)+(0080,0051) | Study ID (0020,0010)"
}
]
},
{
"comment": "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.",
},
],
{
}
],
"isModifierReason": "This element is labelled as a modifier because it is a status element that contains status entered-in-error which means that the resource should not be treated as valid",
{
}
],
},
{
},
{
},
{
},
{
}
]
},
{
"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).",
"ModalitiesInStudy"
],
},
],
{
}
],
{
}
],
},
{
},
{
},
{
}
]
},
{
{
"valueString": "dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.2.2.html"
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"comment": "QA phantoms can be recorded with a Device; multiple subjects (such as mice) can be recorded with a Group.",
},
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/Group"
]
}
],
{
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
],
},
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"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.",
"comment": "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.",
},
],
"ref-1"
],
{
}
],
]
},
{
"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.\n\nThe 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).",
"comment": "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.",
},
],
{
}
],
{
}
],
},
]
},
{
"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.",
"comment": "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. \n\nWhen 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\n\nApplications converting a logical reference to a literal reference may choose to leave the logical reference present, or remove it.\n\nReference 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).",
},
],
{
}
],
]
},
{
{
}
],
"definition": "Plain text narrative that identifies the resource in addition to the resource reference.",
"comment": "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.",
},
],
{
}
],
]
},
{
"definition": "The healthcare event (e.g. a patient and healthcare provider interaction) during which this ImagingStudy is made.",
"comment": "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).",
},
],
{
}
],
{
},
{
},
{
}
]
},
{
{
"valueString": "dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html#sect_C.7.2.1"
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"StudyDate",
"StudyTime"
],
},
],
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"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).",
},
{
"http://hl7.org/fhir/StructureDefinition/CarePlan",
"http://hl7.org/fhir/StructureDefinition/ServiceRequest",
"http://hl7.org/fhir/StructureDefinition/Appointment",
"http://hl7.org/fhir/StructureDefinition/AppointmentResponse",
"http://hl7.org/fhir/StructureDefinition/Task"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"ReferringPhysiciansName"
],
},
{
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
{
}
],
{
},
{
"map": ".outboundRelationship[typeCode=FLFS].target[classCode=DGIMG, moodCode=RQO].participation[typeCode=AUT].role"
},
{
}
]
},
{
"Name of Physician(s) Reading Study"
],
},
{
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole"
]
}
],
{
}
],
{
},
{
},
{
}
]
},
{
"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.",
"comment": "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.",
"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.",
},
],
{
}
],
]
},
{
"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.",
"NumberOfStudyRelatedSeries"
],
},
],
{
}
],
{
"map": ".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=OBSSER, moodCode=EVN].repeatNumber"
},
{
}
]
},
{
"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.",
"NumberOfStudyRelatedInstances"
],
},
],
{
}
],
{
"map": ".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber"
},
{
}
]
},
{
},
],
{
}
],
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"ProcedureCodeSequence"
],
},
],
{
}
],
{
},
{
{
},
{
},
{
}
],
}
],
},
{
},
{
},
{
}
]
},
{
"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).",
},
],
{
}
],
{
},
{
},
{
},
{
},
{
}
]
},
{
},
],
{
}
],
{
}
],
},
{
},
{
},
{
},
{
}
]
},
{
},
{
"http://hl7.org/fhir/StructureDefinition/Condition",
"http://hl7.org/fhir/StructureDefinition/Observation",
"http://hl7.org/fhir/StructureDefinition/Media",
"http://hl7.org/fhir/StructureDefinition/DiagnosticReport",
"http://hl7.org/fhir/StructureDefinition/DocumentReference"
]
}
],
{
}
],
{
},
{
},
{
},
{
}
]
},
{
"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.",
},
],
{
}
],
]
},
{
"definition": "The Imaging Manager description of the study. Institution-generated description or classification of the Study (component) performed.",
"StudyDescription"
],
},
],
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
],
{
}
],
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"comment": "See [DICOM PS3.3 C.7.3](http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.3.html).",
"SeriesInstanceUID"
],
},
],
],
{
}
],
]
},
{
"SeriesNumber"
],
},
],
],
{
}
],
{
"map": ".inboundRelationship[type=COMP, source[classCode=COMPOSITION, moodCode=EVN]].sequenceNumber"
},
{
}
]
},
{
"Modality"
],
},
],
{
}
],
{
}
],
},
]
},
{
"SeriesDescription"
],
},
],
],
{
}
],
]
},
{
"definition": "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.",
"NumberOfSeriesRelatedInstances"
],
},
],
{
}
],
{
"map": ".outboundRelationship[typeCode=COMP, subsetCode=SUMM].target[classCode=DGIMG, moodCode=EVN].repeatNumber"
},
{
}
]
},
{
"definition": "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.",
"comment": "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.",
"requirements": "Access methods for retrieving (e.g., DICOM’s WADO-URI and WADO-RS) the series or the series’ instances. A baseLocation specified at the series level has precedence over a baseLocation of the same type specified at the study level.",
},
],
{
}
],
]
},
{
"definition": "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.",
"BodyPartExamined"
],
},
],
{
}
],
{
}
],
},
]
},
{
"definition": "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.",
},
],
{
}
],
{
}
],
},
]
},
{
},
],
{
}
],
{
},
{
}
]
},
{
},
],
{
}
],
{
},
{
}
]
},
{
"comment": "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.",
"requirements": "The performer is recorded at the series level, since each series in a study may be performed by a different performer, at different times, and using different devices. A series may be performed by multiple performers.",
"PerformingPhysicianName",
"OperatorName"
],
},
],
{
}
],
{
},
{
},
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
},
],
{
}
],
{
}
],
},
]
},
{
},
{
"http://hl7.org/fhir/StructureDefinition/Practitioner",
"http://hl7.org/fhir/StructureDefinition/PractitionerRole",
"http://hl7.org/fhir/StructureDefinition/Organization",
"http://hl7.org/fhir/StructureDefinition/CareTeam",
"http://hl7.org/fhir/StructureDefinition/Patient",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/RelatedPerson"
]
}
],
{
}
],
{
},
{
},
{
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
],
{
}
],
{
}
]
},
{
"xmlAttr"
],
"definition": "Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.",
},
{
{
}
],
}
],
]
},
{
"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.",
"comment": "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.",
"extensions",
"user content"
],
},
],
{
},
{
}
],
]
},
{
"definition": "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.\n\nModifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).",
"comment": "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.",
"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](extensibility.html#modifierExtension).",
"extensions",
"user content",
"modifiers"
],
},
],
{
},
{
}
],
"isModifierReason": "Modifier extensions are expected to modify the meaning or interpretation of the element that contains them",
]
},
{
"comment": "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).",
"SOPInstanceUID"
],
},
],
],
{
}
],
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"SOPClassUID"
],
},
],
{
}
],
{
}
],
"valueSet": "http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1"
},
{
"map": ".inboundRelationship[typeCode=COMP]. source[classCode=OBS, moodCode=EVN, code=\"sop class\"].value"
},
{
}
]
},
{
"InstanceNumber"
],
},
],
],
{
}
],
{
},
{
}
]
},
{
"comment": "Particularly for post-acquisition analytic objects, such as SR, presentation states, value mapping, etc.",
},
],
{
}
],
{
},
{
}
]
}
]
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
"valueString": "dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.2.2.html"
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
"http://fhir.infoway-inforoute.ca/cacore/StructureDefinition/patient-ca-core",
"http://hl7.org/fhir/StructureDefinition/Device",
"http://hl7.org/fhir/StructureDefinition/Group"
]
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
"valueString": "dicom=http://dicom.nema.org/medical/dicom/current/output/chtml/part03/sect_C.7.2.html#sect_C.7.2.1"
},
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
{
},
{
{
},
{
},
{
}
],
}
],
}
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
},
{
{
{
},
{
}
],
},
{
{
},
{
}
],
}
],
"valueSet": "http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1"
}
}
]
}
}
Terminology bindings
| Path | Conformance | ValueSet |
|---|---|---|
| ImagingStudy.procedureCode | extensible | http://www.rsna.org/RadLex_Playbook.aspx |
| ImagingStudy.series.instance.sopClass | extensible | http://dicom.nema.org/medical/dicom/current/output/chtml/part04/sect_B.5.html#table_B.5-1 |
Additional Terminology Bindings
These bindings may be used in lieu of the primary bindings in the table above.
| Path | Conformance | AdditionalValueSet |
|---|---|---|
| ImagingStudy.procedureCode | candidate | http://hl7.org/fhir/uv/ips/ValueSet/results-radiology-observations-uv-ips |
Mappings to CACDI
The following tables list how the data elements from CA Core+ map to CACDI. For more information visit Mapping Logic.