Enterprise Imaging (Proof of Concept)
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Enterprise Imaging (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Imaging in the Cancer Pathway

Imaging and pathology meet at several points on the cancer pathway. The Cancer Pathology Report IG covers this from the pathology side on its Imaging and Radiology page; this page gives the imaging side.

References

Where Imaging Meets Pathology

Point Imaging Pathology
Detection Imaging (or endoscopy) usually finds the lesion, often after screening or an urgent suspected cancer referral No specimen yet
Specimen collection Image-guided biopsy by interventional radiology (ultrasound, CT, stereotactic); biopsy at endoscopy Histopathology request (LAB-1), with the imaging report as supporting information
Staging Clinical stage (cTNM), mostly from CT, MRI and PET-CT Pathological stage (pTNM, ypTNM) in the pathology report
MDT Imaging reviewed by radiologist Radiology-pathology correlation; discordance can lead to repeat biopsy or further imaging
Specimen imaging Specimen radiography of excisions Informs gross description; digital pathology for slides - see Other Imaging Specialties 
flowchart LR
    REF["Referral / screening"] --> IMG["Imaging<br/>(RIS / PACS)"]
    REF --> ENDO["Endoscopy<br/>(ERS)"]
    IMG -->|imaging report| BX["Image-guided biopsy<br/>(interventional radiology)"]
    ENDO -->|biopsy| LIMS["Histopathology<br/>(LIMS)"]
    BX -->|specimen| LIMS
    IMG -->|imaging report, cTNM| MDT["MDT"]
    ENDO -->|endoscopy report| MDT
    LIMS -->|Cancer Pathology Report, pTNM| MDT
    MDT -->|diagnosis, stage, treatment decision| EPR["EPR"]

COSD Imaging

COSD records imaging in its own Core - Imaging section, separate from COSD Pathology. In COSD v10:

Item Notes
CR1610 Imaging Code (NICIP) Imaging procedure, NICIP code (up to 6 characters); one per imaging event
CR3110 Imaging Code (SNOMED CT) Alternative to NICIP
CR0340 Imaging Anatomical Site Body site imaged
CR0350 Lesion Size (Radiological) Retired in v10
Image-guided procedures Recorded in the COSD Diagnostic Procedures section (OPCS), not in Imaging

The full item list, formats and any other items in the group are To confirm against the COSD v10 user guide.

FHIR

  • The imaging report is a DiagnosticReport with category RAD; it can be referenced from the histopathology request (ServiceRequest.supportingInfo).
  • Condition.evidence and Condition.stage.assessment on the cancer condition can reference both imaging and pathology reports. This belongs to the condition, not to either report.

See FHIR Resources.