This material contains content that is copyright of SNOMED International. Implementers of these specifications must have the appropriate SNOMED CT Affiliate license - for more information contact https://www.snomed.org/get-snomed
or info@snomed.org
.
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 ( src
)
Proof of concept.
This implementation guide is a demonstration only. It is
not
an authoritative source, is not endorsed by NHS England, IHE or HL7, and
must not be used for implementation or clinical purposes. It is background for the
Cancer Pathology Report
proof of concept.
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.
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.
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.
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.
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.
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
.
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.
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:
IHE Endoscopy (ENDO) Domain
- three trial implementation profiles (2018): Endoscopy Ordering Workflow (EWF), Endoscopy Image Archiving (EIA), and Endoscopy Report and Pathology Order (ERPO)
The National Endoscopy Database (NED)
collects
procedure data from endoscopy units across the UK. The ERS uploads each procedure
to NED through a web service supplied by the ERS vendor. JAG reports that more
than 15 million procedures have been uploaded since 2015, from over 530 sites.
NED upload and JAG accreditation are related but separate processes.
The IHE Endoscopy Report and Pathology Order (ERPO)
profile covers creating
the endoscopy report and placing pathology orders
from it. In the
Cancer Pathology Report
IG
the endoscopist is the specimen collector
, and the pathology request is a
Placer Order Management [LAB-1]
interaction. Whether the request is placed from the ERS or from the EPR is a
local decision - To confirm
for each trust.
The IHE Endoscopy Report and Pathology Order (ERPO)
profile covers creating
the endoscopy report and placing pathology orders
from it. In the
Cancer Pathology Report
IG
the endoscopist is the specimen collector
, and the pathology request is a
Placer Order Management [LAB-1]
interaction. Whether the request is placed from the ERS or from the EPR is a
local decision - To confirm
for each trust.
Pathology is part of diagnostics
but is not usually counted as imaging, apart
from digital pathology
. The pathology report is covered by the
Cancer Pathology Report
IG.
Imaging and pathology meet in the cancer pathway - see
Imaging in the Cancer Pathway
.
The NHS England National Imaging Registry
lets authorised users find and retrieve a patient's diagnostic imaging and
reports held by other organisations in England, for direct care. The data stays
with the originating organisation. Its API offers FHIR, IHE XCA/XDS and DICOMweb
interfaces. NHS England lists pathology as a possible future diagnostic area.
Images are retrieved with DICOMweb
WADO-RS
(IHE RAD WADO-RS Retrieve [RAD-107]). A DICOM Key Object Selection (KOS)
document can act as a manifest listing the instances in a study. Which of these
the National Imaging Registry uses in production is To confirm
. The
document sharing metadata (registry entries) for reports is covered by the NW
GMSA DocumentReference
profile.
Images are retrieved with DICOMweb
WADO-RS
(IHE RAD WADO-RS Retrieve [RAD-107]). A DICOM Key Object Selection (KOS)
document can act as a manifest listing the instances in a study. Which of these
the National Imaging Registry uses in production is To confirm
. The
document sharing metadata (registry entries) for reports is covered by the NW
GMSA DocumentReference
profile.
The FHIR equivalent of OMG^O19
is the Imaging Order (O19)
message: a Bundle Message
whose
MessageHeader
has eventCoding
v2-0003 O19
and whose focus is the Radiology Service Request
.
The same message is used for RAD-2 and RAD-3
, following the
Patient Care Coordination
proof of concept, where a referral ( REF_I12
or OMG^O19
) becomes one O19 FHIR
Message whatever the HL7 v2 source. ORG^O20
is a FHIR response message
( MessageHeader.response
).
GIRFT recommends Order Comms as the standard method for all imaging requests and wider use of RCR iRefer
(CDS-enabled). NICE QS124
statement 1 and NG12
- direct access to CT, MRI, ultrasound and X-ray for suspected cancer
GIRFT recommends Order Comms as the standard method for all imaging requests and wider use of RCR iRefer
(CDS-enabled). NICE QS124
statement 1 and NG12
- direct access to CT, MRI, ultrasound and X-ray for suspected cancer
GIRFT recommends Order Comms as the standard method for all imaging requests and wider use of RCR iRefer
(CDS-enabled). NICE QS124
statement 1 and NG12
- direct access to CT, MRI, ultrasound and X-ray for suspected cancer
GIRFT: separate urgent ("hot") from pre-booked ("cold") work, online booking and extended hours. NHS England diagnostic waiting times (DM01)
- request to test
GIRFT Radiology national specialty report
(November 2020) - including recommendation 9: all trusts to meet RCR IT standards, Order Comms as the standard request method, new PACS/RIS to meet RCR standards for image and report sharing
Each NICIP code is mapped to SNOMED CT (the UK Diagnostic Imaging Procedure
subset). NICIP, with and without SNOMED CT maps, is distributed through
TRUD
, with releases on 1 April and 1 October.
This guide codes NICIP with the Interweave NICIP CodeSystem - the NICIP code is
required on the request and used on the report, as in the
Interweave FHIR IG
.
See Terminology
.
The accession number issued by a RIS for an imaging request - NHS Data
Dictionary RADIOLOGICAL ACCESSION NUMBER
.
Based on HL7 Europe Imaging AccessionNumberIdentifierEuImaging
(type ACSN
).
DICOM (0008,0050) Accession Number, with the issuer in (0008,0051); HL7 v2 CX
with CX.5 ACSN
and CX.6 the assigning facility.
The data items of a radiology report shared between RIS, PACS and reporting
networks, based on the Royal College of Radiologists'
Radiology reporting networks: understanding the technical options
(March 2022), as mapped in an earlier NHS England draft radiology IG for the
National Imaging Registry. The items have not
been checked against the RCR
text, and cardinalities are this guide's assumption ( To confirm
).
National Interim Clinical Imaging Procedure (NICIP) codes, from the Interweave
NICIP CodeSystem ( https://fhir.interweavedigital.nhs.uk/CodeSystem/Interweave-NICIP
,
version 0.0.1, 4833 codes). Copied from the Interweave FHIR IG
.
The authoritative NICIP release is distributed by NHS England through TRUD.
This guide gives background on imaging
in NHS trusts for the
Cancer Pathology Report
IG.
That IG covers the pathology report; imaging has its own systems, workflows and
reports, and it meets pathology at several points on the cancer pathway - see
Imaging in the Cancer Pathway
.
This guide describes
systems, actors and standards. Its first FHIR
profiles, for the radiology request, study and report, are derived from
HL7 Europe Imaging Report
- see
FHIR Resources
.
National standard for imaging department systems in England; distributed through TRUD; used by the Diagnostic Imaging Dataset and COSD (CR1610). This guide uses the Interweave NICIP CodeSystem https://fhir.interweavedigital.nhs.uk/CodeSystem/Interweave-NICIP
(copied, 4833 codes) and value set NICIP (Interweave)
, following the Interweave FHIR IG
. Required on ServiceRequest.code
; used on DiagnosticReport.code
