Radiology (Sandbox)
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Requirement Specification

This is for collaboration and discussion purposes and is subject to change.

This is not an Implementation Guide

Radiology (Sandbox) - Local Development build (v0.0.1-current) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

ExampleScenario: Finding Imaging Reports and Images - Federated (IHE)

Official URL: https://fhir.nhs.uk/England/RAD/ExampleScenario/FindingImagingReportsStudiesAndImagesFederated Version: 0.0.1-current
Draft as of 2024-10-24 Computable Name: FindingImagingReportsStudiesAndImagesFederated
Process Diagram Image

Process Diagram


DocumentConsumerDocument RegistryDocument RepositoryImage RepositoryQuery for patient image and/or reportRetrieve selected imaging reportRetrieve selected imaging study (and image instances)

Actor Diagram


Actors

Generated Narrative: ExampleScenario FindingImagingReportsStudiesAndImagesFederated

NameTypeDescription
Document Consumer System

The Document Consumer Actor queries for documents meeting certain criteria, and may retrieve selected documents.

Document Registry System

The Document Registry Actor maintains metadata about each registered document in a document entry. This includes a link to the Document in the Repository where it is stored. The Document Registry responds to queries from Document Consumer actors about documents meeting specific criteria.

Responding Gateway System

In NIR this is also known as Imaging Network. This is an infrastrcture service which enables federation.

Document Repository System

The Document Repository is responsible for both the persistent storage of these documents (e.g. Imaging Report)

Imaging Repository System

The Imaging Repository is responsible for both the persistent storage of DICOM Images and Imaging Studies, these may also contain Imaging Reports. This is also known as a PACS.

Diagram

FindingImagingReportsStudiesAndImagesFederatedDocument ConsumerDocument ConsumerDocument RegistryDocument RegistryResponding GatewayResponding GatewayDocument RepositoryDocument RepositoryImaging RepositoryImaging RepositoryQuery for patient image and/or reportdetailsSearch for Document Entries - Imaging studies and reportsdetailsSearch for Document Entires(payload)For each Network/Gateway - Search for Document Entries via IHE XCA Cross-Community Access (XCA)detailsSearch for Document Entries in other networks(payload)response(payload)Aggregate and Return Search Results - Imaging studies and reportsdetailsReturn Document Entry search resultsactivate userresponse(payload)Option - Retrieve selected imaging reportdetailsRetrieve Imaging Report(payload)response(payload)Option - Retrieve selected imaging studydetailsRetrieve Imaging Study(payload)response(payload)Retrieve selected image - OptionaldetailsRetrieve Image(payload)response(payload)

Processes

Generated Narrative: ExampleScenario FindingImagingReportsStudiesAndImagesFederated

Process: Query for patient image and/or report

IHE XCA implements an Aggregator pattern. Each Responding Gateway is asked to same query that the Document Registry originally received, in our example this is HL7 FHIR RESTful query (this is also IHE MHD - Find Document References ITI-67) and this has been converted to IHE XML as an AdHocQueryRequest. Document Entry is a FHIR DocumentReference profile based on the NHS Data Dictionary definitions contained in IHE Europe - Metadata for exchange medical documents and images, this also contains mappings between IHE XDS Document Entry and IHE MHD/HL7 FHIR DocumentReference.

Process: Search for Document Entries - Imaging studies and reports
StepNameDescriptionInitiatorReceiverRequestResponse
1 See subprocess below
2 See subprocess below
3 See subprocess below
StepNameDescriptionInitiatorReceiverRequestResponse
1.1 Search for Document Entires - search-type (Details: FHIR Restful Interactions code search-type) Document Consumer Document Registry Search for Document Entries - Imaging studies and reports
Process: For each Network/Gateway - Search for Document Entries via IHE XCA Cross-Community Access (XCA)
StepNameDescriptionInitiatorReceiverRequestResponse
2.1 Search for Document Entries in other networks - search-type (Details: FHIR Restful Interactions code search-type) Document Registry Responding Gateway XCA Query XCA Query Response
Process: Aggregate and Return Search Results - Imaging studies and reports
StepNameDescriptionInitiatorReceiverRequestResponse
3.1 Return Document Entry search results - search-type (Details: FHIR Restful Interactions code search-type) Document Registry Document Consumer Return Document Entry search results
Process: Option - Retrieve selected imaging report

This is an optional step. The Document Consumer may choose to retrieve the Imaging Report. At present this is a Royal College of Radiologists HL7 ORU converted to a FHIR DiagnosticReport profile as Imaging Report, this also contains mappings between HL7 ORU and FHIR DiagnosticReport. Other options are being discussed by HL7 Europe such as a EU Medical imaging studies and reports which is likely to be a derivative of HL7 IPS, like the HL7 Europe Laboratory Report.

StepNameDescriptionInitiatorReceiverRequestResponse
1 Retrieve Imaging Report - read (Details: FHIR Restful Interactions code read) Document Consumer Document Repository Read DiagnosticReport Return DiagnosticReport
Process: Option - Retrieve selected imaging study

This is an optional step. The Document Consumer may choose to retrieve the Imaging Study. At present this is a DICOM KOS which contains DICOM modalities to used for retrieval of the Image Instances. Other options include using FHIR ImagingStudy which is a FHIR version of the DICOM KOS.

Process: Retrieve selected image - Optional
StepNameDescriptionInitiatorReceiverRequestResponse
1 Retrieve Imaging Study - read (Details: FHIR Restful Interactions code read) Document Consumer Imaging Repository Read ImagingStudy Return ImagingStudy
2 See subprocess below
StepNameDescriptionInitiatorReceiverRequestResponse
2.1 Retrieve Image - read (Details: FHIR Restful Interactions code read) Document Consumer Imaging Repository Read Image Instance Return Image Instance

Instances

Generated Narrative: ExampleScenario FindingImagingReportsStudiesAndImagesFederated

NameTypeContentDescription
Search for Document Entries - Imaging studies and reports Binary

See Finding and Retrieving Document Entries (IHE MHD) for API base contract. E.g.

GET https://example.nhs.uk/FHIR/R4/DocumentReference?patient:identifier=https://fhir.nhs.uk/Id/nhs-number|9912003888&category=http://snomed.info/sct|721981007,http://snomed.info/sct|4201000179104

The equivalent in an IHE XDS environment is Registry Stored Query [ITI-18]

Note: At present category and type which are common search parameters in IHE XDS, MHD and HL7 IPA, are not fully defined in UKCore-DocumentReference for widespread English NHS use, the codes used in the examples are broadly based on the elaboration of Document Entry

Return Document Entry search results Bundle
  • Search Results
 here
XCA Query Binary
XCA Query Response Binary

Example Response AdHocQueryReponse XML

Read DiagnosticReport Binary

See Find and Retrieve Imaging Reports for API overview. E.g.

GET https://example.nhs.uk/FHIR/R4//DiagnosticReport/ABCD

The equivalent in an IHE XDS environment is Retrieve Document Set [ITI-43]

Return DiagnosticReport DiagnosticReport
  • Retrieve Diagnostic Report
 here
Read ImagingStudy Binary
Return ImagingStudy Binary

DICOM Key Object Selection (KOS) is a manifest, which includes references to images which are used to find and retrieve the DICOM Image Instance

Read Image Instance Binary
Return Image Instance Binary

DICOM Image Instance