Manifest-based Access to DICOM Objects (MADO) Profile (FHIR-R5 elements)
0.2.0-snapshot1 - draft 150

This page is part of the Manifest-based Access to DICOM Objects (MADO) Profile (FHIR-R5 elements) (v0.2.0-snapshot1: QA Preview) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

FHIR Imaging Manifest

The imaging manifest represents a summary of the data stored in a DICOM imaging study as is stored in a PACS. In document based deployments, it is the 'document' that is searched for and provides the URL's that allow download of the imaging content. It is the data that is provided by a PACS system. The figure below presents an overview of the data that is part of the imaging-manifest.

In order to keep the diagram readable, not all references are included.

Overview

fhir-manifest-overview.drawio.png
Figure: FHIR Manifest Overview

The manifest is a FHIR bundle that includes the ImagingStudy resource and at least one Endpoint. The Endpoint resources contain the information that allows the client to access the DICOM data. The current model identifies two different Endpoints. One that defines an DICOMweb-WADO which will allow download of the imaging data as well as extraction of thumbnails and retrieve the image data in other formats (e.g., jpeg). The other Endpoint defines the information needed to launch an IHE-IID based viewer.

Besides the ImagingStudy and Endpoint resources, it is also recommended to include additional resources that reflect information present in DICOM such as information on the patient, performer, procedure and imaging device.

The mapping from DICOM to these resources is defined in the mapping sections of the resources.

Manifest Profiles

These profiles define constraints on FHIR resources for systems conforming to this implementation guide.

The imaging specific obligations are specified in:

NameTitleDescription
ImAccessionNumberIdentifier

Identifier: Accession Number

This profile on Identifier represents the Accession Number for the Imaging Order.

Within a Hospital Information System environment, accession numbers will usually uniquely identify a manifest or report but are not required to always map 1:1 with a report or manifest due to certain imaging workflows. The imaging report may not be uniquely identified by accession number in an overread scenario (two radiologists reading a single imaging study). The manifest may not be uniquely identified by accession number in the case that the RIS imaging request (accession number assigner) requires two imaging modalities to perform the exam, and thus produces two image manifests.

In order to ensure uniqueness across Hospital Information Systems, accession numbers are required to have a system value that identifies the namespace for the issuing authority (ensuring their global uniqueness).

ImIheIidViewerEndpoint

EndPoint: IDD Image Viewer

This profile defines a placeholder for an Endpoint for a viewer that can be used to access the study, serie it is present on. The application is based on IHE-IID.

ImImageViewerEndpoint

EndPoint: Image Viewer

An Endpoint holding the URL of an image viewer that can be used to see the DICOM Study it is present on.

It is RECOMMENDED that the URL to the viewer is formatted according to IHE-IID, but other formats are possible as well.

ImImagingDevice

Device: Imaging Acquisition Device

The device the made the image.

ImImagingSelection

Imaging Selection

Imaging Selection

ImImagingStudy

ImagingStudy: Manifest Imaging Study

This profile represents an imaging study instance.

ImImagingStudyInstanceDescription

Extension: Instance Description

A description of the instance in an ImagingStudy.

ImImagingStudyManifest

Bundle: Imaging Manifest

This profile represents a manifest of an imaging study. It holds the ImagingStudy resource that mirrors the information in the DICOM study allow with other resources that are required to express the information in DICOM in FHIR.

ImKeyImageImagingSelection

ImagingSelection: Key image

Key images represented as an ImagingSelection, it refers to minimal 1 instance.

ImManifestDocumentReference

Manifest DocumentReference for MHD deployments

A DocumentReference profile for the Manifest DocumentReference used in MHD deployments.

ImOrder

ServiceRequest: Imaging Order

This profile on ServiceRequest represents the order for the Imaging Study and report.

ImPatient

Patient: Imaging Patient

This profile on Patient represents the Imaging Patient.

ImProcedure

Procedure: Image Acquisition Procedure

This profile on Procedure represents the imaging procedure.

ImSopInstanceUidIdentifier

Identifier: Imaging SOP Class UID Identifier

This profile on Identifier represents the SOP Class UID (0008,0018) for the Imaging Order.

ImSrInstanceImagingSelection

Imaging Selection: DICOM SR instance reference

Imaging Selection referring to a DICOM SR instance

ImStudyInstanceUidIdentifier

Identifier: Study Instance UID

This profile on Identifier represents the Study Instance UID (0020,000D) for the Imaging Order.

ImWadoRsEndpoint

Endpoint: WADO

This profile defines the WADO endpoint for accessing imaging study content.

ImXcWadoEndpoint

Endpoint: IHE-XC-WADO

This profile defines the XC-WADO endpoint for accessing imaging study content.