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---
tags: USCDI v3
title: Diagnostic Imaging (what are we missing?)
---
# Diagnostic Imaging (what are we missing?)
> ...[US Core] profiles provide access to the results of the clinical imaging exam (order, observations and report) but all links to the source of the information are lost. This makes it hard if not impossible to link information retrieved through US core to the source imaging data and/or to cross link the information in US core to other data sources referring to the same imaging studies.
We agree...
First a bit of background....
:::info
----*the following summary was generated by ChatGPT*----
DICOM is a way to store and share medical pictures and information.
- A DICOM Study is like a big folder with lots of pictures and information taken during a single medical checkup.
- A DICOM Series is like a smaller folder inside the big folder, with pictures and information that were taken during a specific part of the checkup, like when the doctor takes pictures of your heart.
- A DICOM SOP Instance is like a single picture that is saved in the smaller folder. Each picture has a special name that tells the computer which picture it is.
So, imagine you went to the doctor for a checkup, and they took pictures of your body, your heart, and your bones. The pictures of your body would be in one big folder called a DICOM Study. Inside that big folder, there would be smaller folders called DICOM Series, with one for the pictures of your body, one for the pictures of your heart, and one for the pictures of your bones. Inside each of those smaller folders, there would be individual pictures called DICOM SOP Instances, which are like the individual photos taken during your checkup.
----*from the FHIR Specification*----
[ImagingStudy](https://hl7.org/fhir/imagingstudy.html) provides information on a DICOM imaging study, and the series and imaging objects in that study. It also provides information on how to retrieve that information (in a native DICOM format, or in a rendered format, such as JPEG). ImagingStudy is used to make available information about all parts of a single DICOM study.
:::
see [FHIR Implementation Notes for Imaging Study](https://hl7.org/fhir/imagingstudy.html#notes)
- referenced DICOM images *Series* and *SOP* and *STUDIES* are encoded in ImagingStudy as ids
### Use Case
```flow
st=>start: Start
e=>end: End
op=>operation: lil' Johny falls off bike :-(
op1=>operation: lil' Johny Gets Leg X-Ray
op2=>operation: The PACS creates
an ImagingStudy Resource
(STUDY, SERIES and SOP ids)
op3=>operation: Doc dictates report
"lil' Johny broke his leg"
and selects images
for DiagnosticReport
st->op->op1->op2->op3->cond
```
#### FHIR Representation
```graphviz
digraph hierarchy {
nodesep=1.0 // increases the separation between nodes
node [color=Red,fontname=Courier,shape=box] //All nodes will this shape and colour
edge [color=Blue, style=dashed] //All the lines look like this
DiagnosticReport->"Patient\nlil' Johny"[label="subject"]
DiagnosticReport->"Practitioner\nDoc"[label="performer"]
"ImagingStudy\nSTUDY, SERIES and SOP ids"[style=filled, color=red, fillcolor=yellow]
DiagnosticReport->"ImagingStudy\nSTUDY, SERIES and SOP ids"[label="imagingStudy",color=Red, style=solid]
"Media\n???"[style=filled, color=black, fillcolor=grey]
DiagnosticReport->"Media\n???"[label="media.link",color=Red, style=solid]
DiagnosticReport->"Report\n'lil' Johny broke his leg"[label="presentedForm"]
"ImagingStudy\nSTUDY, SERIES and SOP ids"->"ServiceRequest"[label="baseOn"]
}
```
### Our Proposal is to Create an Imaging DiagnosticReport based upon the Report and Notes DiagnosticReport with the following elements:
- imagingStudy`element` as a MS 0.\*.
- Refer to the base FHIR ImagingStudy resource at this time.
- A mandatory `category` "Imaging" slice of `LP29684-5` (Radiology) (inherited from Profile for Report and Note Exchange)
- `code` binding: US Core Imaging Test Codes
- extensible
- Radiology LOINC codes (intensional definition or from VSAC)
- MS `result` reference choice to US Core Observation Clinical Result Profile
### And Make these Changes to Report and Notes DiagnosticReport Profile
- Change binding in Report and Notes DiagnosticReport
- extensible
- Lab + Clinical LOINC (intensional definition or from VSAC) :man-shrugging:
- **Remove MS from `media` Report and Notes DiagnosticReport** :grimacing:
- Remove all MS `result` reference choice in Report and Notes DiagnosticReport) :man-shrugging:
RE:
>US core defines requirements related to imaging related reports in US core is described in section 12.119.1.1 (http://build.fhir.org/ig/HL7/US-Core/StructureDefinition-us-core-diagnosticreport-note.html#mandatory-and-must-support-data-elements). There is no section in the spec that specifies requirements related the imaging specific ServiceRequests (beyond category)
We agree US Core does not provide guidance linking the ServiceRequest to the "Service" (DiagnosticReport,Procedure...). However, we think this is not part of Core at this time and anticipate Domain Specific implementation guides to provide additional guidance and implementation experience to inform what if any guidance would be needed in a future version.