Enterprise Imaging (Proof of Concept)
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FHIR Resources

This page shows the FHIR resources used for imaging orders, studies and reports. This guide's profiles are derived from HL7 Europe Imaging Report, the imaging counterpart of HL7 Europe Laboratory Report, which the Cancer Pathology Report IG is built on.

Profiles

Artefact Based on Use
Radiology Report (logical model) RCR report data items Content of a radiology report, with indicative HL7 v2, DICOM and FHIR mappings
Patient patient-eu-core NW core Patient (copied from the NW GMSA FHIR IG) - NHS number and MRN identifiers. All this guide's profiles reference it
Radiology Service Request ServiceRequestOrderEuImaging Imaging request: NICIP code (required) with SNOMED CT map, accession number
Radiology Imaging Study ImagingStudyEuImaging DICOM study metadata, with DICOM tags in the element descriptions
Radiology Diagnostic Report DiagnosticReportEuImaging The radiology report; code carries the NICIP examination code and/or LOINC report type, as in Interweave
Radiological Accession Number AccessionNumberIdentifierEuImaging Accession number, issuer identified by ODS code
Imaging Order (O19) (message definition) FHIR Messaging FHIR Message equivalent of OMG^O19 - RAD-2 and RAD-3, focus Radiology Service Request
Procedure Scheduled (O23) (message definition) FHIR Messaging FHIR Message equivalent of OMI^O23 - RAD-4 / RAD-13, focus Radiology Service Request and scheduled Radiology Imaging Study
Imaging Result (R01) (message definition) FHIR Messaging FHIR Message equivalent of ORU^R01 - RAD-128, focus Radiology Diagnostic Report
Bundle Message, MessageHeader Bundle, MessageHeader FHIR Messaging, copied from the NW GMSA FHIR IG; eventCoding is the HL7 v2 trigger event
NICIP (Interweave) (value set) Interweave NICIP CodeSystem NICIP codes for ServiceRequest.code and DiagnosticReport.code
UK Imaging Procedure (value set) SNOMED CT UK refset 999001111000000105 Imaging procedure codes

DiagnosticReportEuImaging requires a CompositionEuImaging (the composition extension), so a report conforming to these profiles is also a FHIR document. Whether NHS reports, mostly sent today as HL7 v2 ORU with a text report, can meet this is Open.

Examples

A staging CT of the thorax, abdomen and pelvis at Manchester University NHS Foundation Trust (R0A), for the NW GMSA test patient MANCHESTER Sansa (see the NW GMSA test patients). Practitioners, identifiers and report text are fictional.

Example Profile
Radiology Service Request, and as a new order Radiology Service Request
Imaging Order (O19), new order and status change, Procedure Scheduled (O23), Imaging Result (R01) Bundle Message
Scheduled request and scheduled study (RAD-4) Radiology Service Request, Radiology Imaging Study
Radiology Imaging Study, with a WADO-RS Endpoint Radiology Imaging Study
Radiology Diagnostic Report, with the report PDF Radiology Diagnostic Report
Composition CompositionEuImaging

Following the NW GMSA convention, the report PDF is referenced by DiagnosticReport.presentedForm.url (Binary/RadiologyReportPDF) rather than embedded in presentedForm.data.

The accession number system in the examples (http://example.org/R0A/accession-number) is a placeholder, because the convention is Open.

References

Resources

erDiagram
    ServiceRequest ||--o{ ImagingStudy : "basedOn"
    ServiceRequest ||--o{ DiagnosticReport : "basedOn"
    DiagnosticReport }o--o{ ImagingStudy : "imagingStudy"
    DiagnosticReport ||--o{ Observation : "result (findings)"
    DiagnosticReport ||--o| Composition : "composition (EU imaging)"
    ImagingStudy ||--o{ Endpoint : "endpoint (WADO-RS, ...)"
    ImagingStudy }o--|| Patient : "subject"
    DiagnosticReport }o--|| Patient : "subject"
    ServiceRequest }o--|| Patient : "subject"
Resource Use Key elements
ServiceRequest The imaging (or endoscopy) request from the Order Placer identifier (placer order number, accession number), code (NICIP / SNOMED CT procedure), reasonCode, supportingInfo
ImagingStudy Metadata of the DICOM study - not the pixel data identifier (Study Instance UID, accession number), modality, series, endpoint
Endpoint Where the images can be retrieved connectionType (for example DICOM WADO-RS), address
DiagnosticReport The imaging or endoscopy report category (for example RAD), code (report type, LOINC), imagingStudy, result, conclusion, presentedForm
Observation Coded findings code, value[x], bodySite
DocumentReference The report as a document (for example PDF), or a key image type, content.attachment

For document sharing metadata (IHE XDS DocumentEntry / MHD) see the NW GMSA DocumentReference profile. It links to the imaging report through context.related, and the accession number and order identifiers stay on the DiagnosticReport.

Imaging Study and Imaging Report

The EU eHealth Network guideline on medical imaging studies and reports separates the two:

Term Definition (summarised)
Imaging study A set of objects, including images, made for a specific purpose, usually in response to a request. It does not include the imaging report. Not the same as the FHIR ImagingStudy resource, which holds only the study metadata
Imaging report The observations and interpretation of one or more imaging studies: reason for the request, relevant clinical information, modality and procedure, body site, findings, conclusion and advice

Imaging Report Data Items

The Royal College of Radiologists' Radiology reporting networks: understanding the technical options (March 2022; no longer at this address on the RCR website as of November 2026 - current status To confirm) describes the data a radiology report carries between RIS, PACS and reporting networks. An earlier NHS England draft radiology IG, written for the National Imaging Registry, mapped these items to FHIR DiagnosticReport following the HL7 v2-to-FHIR ORU^R01 mapping. The table below is based on that draft. It has not been checked against the RCR text (To confirm), and the HL7 v2 and DICOM columns are indicative.

Data item FHIR DiagnosticReport HL7 v2 (ORU) DICOM NHS Data Dictionary
Report identifier identifier OBR-3 Filler Order Number    
Patient subject (NHS number) PID-3 Patient Identifier List, PID-5 Patient Name (0010,0020) Patient ID NHS NUMBER
Accession number basedOn (ServiceRequest identifier) ORC-3 / OBR-3 Filler Order Number (0008,0050) Accession Number, (0008,0051) Issuer of Accession Number RADIOLOGICAL ACCESSION NUMBER
Visit number encounter PV1-19 Visit Number    
Examination (NICIP) code OBR-4 Universal Service Identifier (0008,1032) Procedure Code Sequence IMAGING CODE (NICIP)
Diagnostic service section category OBR-24 Diagnostic Serv Sect ID    
Examination completed effectiveDateTime or effectivePeriod OBR-7 Observation Date/Time, OBR-8 Observation End Date/Time    
Final report issued issued OBR-22 Results Rpt/Status Chng - Date/Time    
Imaging site performer (Organization, ODS code) PV1-3 Assigned Patient Location (facility) (0008,0082) Institution Code Sequence SITE CODE (OF IMAGING)
Operator (radiographer) performer (Practitioner) OBR-34 Technician (0008,1070) Operators' Name, (0008,1072) Operator Identification Sequence  
Primary reporter resultsInterpreter (Practitioner) OBR-32 Principal Result Interpreter (0008,1060) Name of Physician(s) Reading Study, (0008,1062) Physician(s) Reading Study Identification Sequence  
Secondary reporter resultsInterpreter (Practitioner) OBR-33 Assistant Result Interpreter (0008,1062)  
Report text (narrative, clinical history, radiographer comments) presentedForm, or a FHIR document (composition) OBX-5, NTE-3 DICOM Structured Report  
Conclusion conclusion     Open - whether the RCR data set separates it

Notes:

  • Practitioners are identified by professional registration number: GMC for radiologists, HCPC for radiographers, NMC for nurses. The NHS Data Dictionary CONSULTANT CODE gives the formats. The draft distinguished the primary and secondary roles with the performerFunction extension (v3 ParticipationType PPRF / SPRF).
  • Imaging site: the NHS Data Dictionary SITE CODE (OF IMAGING) is a site code, not an organisation code. Which to use in performer is Open.
  • category carries the HL7 v2 diagnostic service section (for example RAD, see Terminology). The DICOM modality, (0008,0060), belongs on ImagingStudy.modality.
  • IHE RAD IMR DiagnosticReport and HL7 Europe DiagnosticReportEuImaging should be compared with this list before any profile is written (Open).

Imaging Study Data Items

ImagingStudy holds study metadata from the DICOM General Study module (Part 3, C.7.2.1). Indicative mapping:

DICOM attribute Tag FHIR ImagingStudy
Study Instance UID (0020,000D) identifier (urn:dicom:uid)
Accession Number, Issuer of Accession Number (0008,0050), (0008,0051) identifier (type ACSN), basedOn
Study Date, Study Time (0008,0020), (0008,0030) started
Study Description (0008,1030) description
Procedure Code Sequence (0008,1032) procedureCode (NICIP / SNOMED CT)
Referring Physician's Name (0008,0090) referrer
Name of Physician(s) Reading Study (0008,1060) interpreter
Reason For Performed Procedure Code Sequence (0040,1012) reasonCode
Patient ID (0010,0020) subject
Modality (series) (0008,0060) series.modality
Series Instance UID (0020,000E) series.uid
SOP Instance UID (0008,0018) series.instance.uid

Accession Number

The accession number links the request, the DICOM study and the report. It is defined by the NHS Data Dictionary as RADIOLOGICAL ACCESSION NUMBER. Indicative representation:

Standard Value Issuing organisation
DICOM (0008,0050) Accession Number (0008,0051) Issuer of Accession Number Sequence
HL7 v2 CX.1, with CX.5 identifier type ACSN CX.6 assigning facility (ODS code)
FHIR Identifier.value, with Identifier.type = http://terminology.hl7.org/CodeSystem/v2-0203#ACSN Identifier.system unique to the issuing organisation; Identifier.assigner (ODS code)

Accession numbers are only unique within the issuing RIS, so the system (or issuer) is required when they are shared between organisations. A convention for the system URI is Open. HL7 Europe Imaging Report has an AccessionNumberIdentifierEuImaging profile (see below).

HL7 Europe Imaging Report Profiles

Selected profiles from hl7.fhir.eu.imaging 1.0.0-ballot:

Profile Resource
ServiceRequestOrderEuImaging ServiceRequest
ImagingStudyEuImaging ImagingStudy
DiagnosticReportEuImaging DiagnosticReport
CompositionEuImaging Composition (the report as a FHIR document)
BundleReportEuImaging Bundle (document)
ObservationFindingEuImaging Observation
ProcedureEuImaging Procedure
DocumentReferenceImagingReport DocumentReference
AccessionNumberIdentifierEuImaging, StudyInstanceUidIdentifierEuImaging Identifier datatype profiles

The package is a ballot version and depends on hl7.fhir.eu.base 2.0.0-ballot, ihe.iti.mhd, fhir.dicom and the R5 cross-version package. The Cancer Pathology Report IG uses hl7.fhir.eu.base 2.0.1. This guide depends on hl7.fhir.eu.imaging 1.0.0-ballot, and will move to the published version when it is available.

Comparison with the Pathology Report

  Pathology (Cancer Pathology Report IG) Imaging (this guide)
Base IG HL7 Europe Laboratory Report HL7 Europe Imaging Report
Report DiagnosticReport-eu-lab DiagnosticReportEuImaging
What was examined Specimen ImagingStudy (no specimen)
Workflow IHE PaLM Laboratory Testing Workflow (LTW) IHE RAD Scheduled Workflow (SWF.b)
Request identifier Placer / filler order number Placer order number, accession number