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

• Narrative Content
• XML
• JSON

: Finding Imaging Reports and Images - Federated (IHE) - XML Representation

Draft as of 2024-10-24

Raw xml | Download

<ExampleScenario xmlns="http://hl7.org/fhir">
  <id value="FindingImagingReportsStudiesAndImagesFederated"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: ExampleScenario FindingImagingReportsStudiesAndImagesFederated</b></p><a name="FindingImagingReportsStudiesAndImagesFederated"> </a><a name="hcFindingImagingReportsStudiesAndImagesFederated"> </a><a name="FindingImagingReportsStudiesAndImagesFederated-en-US"> </a><p><b>url</b>: <a href="ExampleScenario-FindingImagingReportsStudiesAndImagesFederated.html">FindingImagingReportsStudiesAndImagesFederated</a></p><p><b>version</b>: 0.0.1-current</p><p><b>name</b>: FindingImagingReportsStudiesAndImagesFederated</p><p><b>status</b>: Draft</p><p><b>date</b>: 2024-10-24 15:09:54+0000</p><p><b>publisher</b>: NHS England</p><p><b>contact</b>: <a href="https://www.ihe.net/ihe_domains/it_infrastructure/">https://www.ihe.net/ihe_domains/it_infrastructure/</a>, <a href="mailto:iti@ihe.net">iti@ihe.net</a>, NHS England: <a href="mailto:iti@ihe.net">iti@ihe.net</a></p><p><b>jurisdiction</b>: <span title="Codes:{http://unstats.un.org/unsd/methods/m49/m49.htm 001}">Global (Whole world)</span></p><blockquote><p><b>actor</b></p><p><b>actorId</b>: user</p><p><b>type</b>: System</p><p><b>name</b>: Document Consumer</p><p><b>description</b>: </p><div><p>The <a href="ActorDefinition-DocumentConsumer.html">Document Consumer</a> Actor queries for documents meeting certain criteria, and may retrieve selected documents.</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: xds</p><p><b>type</b>: System</p><p><b>name</b>: Document Registry</p><p><b>description</b>: </p><div><p>The <a href="ActorDefinition-DocumentRegistry.html">Document Registry</a> 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.</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: xca</p><p><b>type</b>: System</p><p><b>name</b>: Responding Gateway</p><p><b>description</b>: </p><div><p>In NIR this is also known as <strong>Imaging Network</strong>. This is an infrastrcture service which enables federation.</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: docs</p><p><b>type</b>: System</p><p><b>name</b>: Document Repository</p><p><b>description</b>: </p><div><p>The <a href="ActorDefinition-DocumentRepository.html">Document Repository</a> is responsible for both the persistent storage of these documents (e.g. Imaging Report)</p>
</div></blockquote><blockquote><p><b>actor</b></p><p><b>actorId</b>: image</p><p><b>type</b>: System</p><p><b>name</b>: Imaging Repository</p><p><b>description</b>: </p><div><p>The <a href="ActorDefinition-ImagingRepository.html">Imaging Repository</a> 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.</p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHESearchDocumentEntries</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Search for Document Entries - Imaging studies and reports</p><p><b>description</b>: </p><div><p>See <a href="CapabilityStatement-FindDocumentsMHD.html">Finding and Retrieving Document Entries (IHE MHD)</a> for API base contract. E.g.</p>
<pre><code>GET https://example.nhs.uk/FHIR/R4/DocumentReference?patient:identifier=https://fhir.nhs.uk/Id/nhs-number|9912003888&amp;category=http://snomed.info/sct|721981007,http://snomed.info/sct|4201000179104
</code></pre>
<p>The equivalent in an IHE XDS environment is <a href="https://profiles.ihe.net/ITI/TF/Volume2/ITI-18.html#3.18">Registry Stored Query [ITI-18]</a></p>
<p>Note: At present <code>category</code> and <code>type</code> which are common search parameters in IHE XDS, MHD and <a href="https://build.fhir.org/ig/HL7/fhir-ipa/index.html">HL7 IPA</a>, are not fully defined in <a href="https://simplifier.net/hl7fhirukcorer4/ukcore-documentreference">UKCore-DocumentReference</a> for widespread English NHS use, the codes used in the examples are broadly based on the elaboration of <a href="StructureDefinition-DocumentEntry.html">Document Entry</a></p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHESearchResultsDocumentEntries</p><p><b>resourceType</b>: Bundle</p><p><b>name</b>: Return Document Entry search results</p><blockquote><p><b>version</b></p><p><b>Extension Definition for ExampleScenario.instance.version.title for Version 5.0</b>: Search Results</p><p><b>Extension Definition for ExampleScenario.instance.version.content for Version 5.0</b>: <a href="Bundle-MHDSearchResultsDocuments.html">Bundle: type = searchset; total = 1</a></p><p><b>versionId</b>: 1</p></blockquote></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: XCAQuery</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: XCA Query</p><p><b>description</b>: </p><div><p>Example Response <a href="AdHocQueryRequest.xml">AdHocQueryRequest XML</a></p>
<p>See <a href="https://profiles.ihe.net/ITI/TF/Volume1/ch-18.html">IHE Cross-Community Access (XCA)</a></p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: XCAResponse</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: XCA Query Response</p><p><b>description</b>: </p><div><p>Example Response <a href="AdHocQueryReponse.xml">AdHocQueryReponse XML</a></p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHEReadDiagnosticReport</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Read DiagnosticReport</p><p><b>description</b>: </p><div><p>See <a href="CapabilityStatement-FindAndRetrieveImagingReports.html">Find and Retrieve Imaging Reports</a> for API overview. E.g.</p>
<pre><code>GET https://example.nhs.uk/FHIR/R4//DiagnosticReport/ABCD
</code></pre>
<p>The equivalent in an IHE XDS environment is <a href="https://profiles.ihe.net/ITI/TF/Volume2/ITI-43.html#3.43">Retrieve Document Set [ITI-43]</a></p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHEViewDiagnosticReport</p><p><b>resourceType</b>: DiagnosticReport</p><p><b>name</b>: Return DiagnosticReport</p><blockquote><p><b>version</b></p><p><b>Extension Definition for ExampleScenario.instance.version.title for Version 5.0</b>: Retrieve Diagnostic Report</p><p><b>Extension Definition for ExampleScenario.instance.version.content for Version 5.0</b>: <a href="DiagnosticReport-DiagnosticReportImagingReportRCR.html">Diagnostic Report for 'MRA Upper limb Rt' for '-&gt;display: string (PrimitiveType/DiagnosticReport.subject.display): element = string -&gt; display=string[Richard SMITH]'</a></p><p><b>versionId</b>: 1</p></blockquote></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHEReadImagingStudy</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Read ImagingStudy</p><p><b>description</b>: </p><div><p><a href="https://wiki.ihe.net/index.php/Web-based_Image_Access">IHE WADO Retrieve (WADO-RS)</a>. See also <a href="CapabilityStatement-RetrieveImagingStudy.html">Retrieve Imaging Study</a> for API overview</p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHERetrieveImagingStudy</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Return ImagingStudy</p><p><b>description</b>: </p><div><p><a href="https://www.dicomstandard.org/News-dir/ftsup/docs/sups/sup59.pdf">DICOM Key Object Selection (KOS)</a> is a manifest, which includes references to images which are used to find and retrieve the DICOM Image Instance</p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHEReadImageInstance</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Read Image Instance</p><p><b>description</b>: </p><div><p><a href="https://wiki.ihe.net/index.php/Web-based_Image_Access">IHE WADO Retrieve (WADO-RS)</a>. See also <a href="CapabilityStatement-RetrieveImageInstances.html">Retrieve Image Instances</a> for API overview</p>
</div></blockquote><blockquote><p><b>instance</b></p><p><b>resourceId</b>: IHERetrieveImage</p><p><b>resourceType</b>: Binary</p><p><b>name</b>: Return Image Instance</p><p><b>description</b>: </p><div><p>DICOM Image Instance</p>
</div></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Query for patient image and/or report</p><p><b>description</b>: </p><div><p>IHE XCA implements an <a href="https://www.enterpriseintegrationpatterns.com/patterns/conversation/Aggregator.html">Aggregator</a> pattern. Each <strong>Responding Gateway</strong> is asked to same query that the <strong>Document Registry</strong> originally received, in our example this is HL7 FHIR RESTful query (this is also IHE MHD - <a href="https://profiles.ihe.net/ITI/MHD/ITI-67.html">Find Document References ITI-67</a>) and this has been converted to IHE XML as an <code>AdHocQueryRequest</code>. <a href="StructureDefinition-DocumentEntry.html">Document Entry</a> is a FHIR DocumentReference profile based on the NHS Data Dictionary definitions contained in <a href="https://www.ihe-europe.net/sites/default/files/2017-11/IHE_ITI_XDS_Metadata_Guidelines_v1.0.pdf">IHE Europe - Metadata for exchange medical documents and images</a>, this also contains mappings between IHE XDS Document Entry and IHE MHD/HL7 FHIR DocumentReference.</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>process</b></p><p><b>title</b>: Search for Document Entries - Imaging studies and reports</p><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: search-type</p><p><b>name</b>: Search for Document Entires</p><p><b>initiator</b>: user</p><p><b>receiver</b>: xds</p><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHESearchDocumentEntries</td></tr></table></blockquote></blockquote></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>process</b></p><p><b>title</b>: For each Network/Gateway - Search for Document Entries via IHE XCA Cross-Community Access (XCA)</p><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: search-type</p><p><b>name</b>: Search for Document Entries in other networks</p><p><b>initiator</b>: xds</p><p><b>receiver</b>: xca</p><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>XCAQuery</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>XCAResponse</td></tr></table></blockquote></blockquote></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>process</b></p><p><b>title</b>: Aggregate and Return Search Results - Imaging studies and reports</p><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: search-type</p><p><b>name</b>: Return Document Entry search results</p><p><b>initiator</b>: xds</p><p><b>receiver</b>: user</p><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHESearchResultsDocumentEntries</td></tr></table></blockquote></blockquote></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Option - Retrieve selected imaging report</p><p><b>description</b>: </p><div><p>This is an optional step. The <strong>Document Consumer</strong> may choose to retrieve the <strong>Imaging Report</strong>. At present this is a <a href="https://www.rcr.ac.uk/media/wwtp2mif/rcr-publications_radiology-reporting-networks-understanding-the-technical-options_march-2022.pdf">Royal College of Radiologists HL7 ORU</a> converted to a FHIR DiagnosticReport profile as <a href="StructureDefinition-ImagingReport.html">Imaging Report</a>, this also contains mappings between HL7 ORU and FHIR DiagnosticReport. Other options are being discussed by HL7 Europe such as a <a href="https://health.ec.europa.eu/document/download/0079ad26-8f8f-435b-9472-3cd8625f4220_en?filename=ehn_mi_guidelines_en.pdf">EU Medical imaging studies and reports</a> which is likely to be a derivative of <a href="https://build.fhir.org/ig/HL7/fhir-ips/index.html">HL7 IPS</a>, like the <a href="https://build.fhir.org/ig/hl7-eu/laboratory/">HL7 Europe Laboratory Report</a>.</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: read</p><p><b>name</b>: Retrieve Imaging Report</p><p><b>initiator</b>: user</p><p><b>receiver</b>: docs</p><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHEReadDiagnosticReport</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHEViewDiagnosticReport</td></tr></table></blockquote></blockquote></blockquote><blockquote><p><b>process</b></p><p><b>title</b>: Option - Retrieve selected imaging study</p><p><b>description</b>: </p><div><p>This is an optional step. The <strong>Document Consumer</strong> may choose to retrieve the Imaging Study. At present this is a <a href="https://dicom.nema.org/dicom/supps/sup59_lb.pdf">DICOM KOS</a> 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.</p>
</div><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: read</p><p><b>name</b>: Retrieve Imaging Study</p><p><b>initiator</b>: user</p><p><b>receiver</b>: image</p><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHEReadImagingStudy</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHERetrieveImagingStudy</td></tr></table></blockquote></blockquote><blockquote><p><b>step</b></p><blockquote><p><b>process</b></p><p><b>title</b>: Retrieve selected image - Optional</p><blockquote><p><b>step</b></p><blockquote><p><b>operation</b></p><p><b>number</b>: 1</p><p><b>type</b>: read</p><p><b>name</b>: Retrieve Image</p><p><b>initiator</b>: user</p><p><b>receiver</b>: image</p><h3>Requests</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHEReadImageInstance</td></tr></table><h3>Responses</h3><table class="grid"><tr><td style="display: none">-</td><td><b>ResourceId</b></td></tr><tr><td style="display: none">*</td><td>IHERetrieveImage</td></tr></table></blockquote></blockquote></blockquote></blockquote></blockquote></div>
  </text>
  <url
       value="https://fhir.nhs.uk/England/RAD/ExampleScenario/FindingImagingReportsStudiesAndImagesFederated"/>
  <version value="0.0.1-current"/>
  <name value="FindingImagingReportsStudiesAndImagesFederated"/>
  <status value="draft"/>
  <date value="2024-10-24T15:09:54+00:00"/>
  <publisher value="NHS England"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.ihe.net/ihe_domains/it_infrastructure/"/>
    </telecom>
  </contact>
  <contact>
    <telecom>
      <system value="email"/>
      <value value="iti@ihe.net"/>
    </telecom>
  </contact>
  <contact>
    <name value="NHS England"/>
    <telecom>
      <system value="email"/>
      <value value="iti@ihe.net"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <actor>
    <actorId value="user"/>
    <type value="entity"/>
    <name value="Document Consumer"/>
    <description
                 value="The [Document Consumer](ActorDefinition-DocumentConsumer.html) Actor queries for documents meeting certain criteria, and may retrieve selected documents."/>
  </actor>
  <actor>
    <actorId value="xds"/>
    <type value="entity"/>
    <name value="Document Registry"/>
    <description
                 value="The [Document Registry](ActorDefinition-DocumentRegistry.html) 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."/>
  </actor>
  <actor>
    <actorId value="xca"/>
    <type value="entity"/>
    <name value="Responding Gateway"/>
    <description
                 value="In NIR this is also known as **Imaging Network**. This is an infrastrcture service which enables federation."/>
  </actor>
  <actor>
    <actorId value="docs"/>
    <type value="entity"/>
    <name value="Document Repository"/>
    <description
                 value="The [Document Repository](ActorDefinition-DocumentRepository.html) is responsible for both the persistent storage of these documents (e.g. Imaging Report)"/>
  </actor>
  <actor>
    <actorId value="image"/>
    <type value="entity"/>
    <name value="Imaging Repository"/>
    <description
                 value="The [Imaging Repository](ActorDefinition-ImagingRepository.html) 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."/>
  </actor>
  <instance>
    <resourceId value="IHESearchDocumentEntries"/>
    <resourceType value="Binary"/>
    <name value="Search for Document Entries - Imaging studies and reports"/>
    <description
                 value=" See [Finding and Retrieving Document Entries (IHE MHD)](CapabilityStatement-FindDocumentsMHD.html) for API base contract. E.g. 
```
GET https://example.nhs.uk/FHIR/R4/DocumentReference?patient:identifier=https://fhir.nhs.uk/Id/nhs-number|9912003888&amp;category=http://snomed.info/sct|721981007,http://snomed.info/sct|4201000179104
```

The equivalent in an IHE XDS environment is [Registry Stored Query [ITI-18]](https://profiles.ihe.net/ITI/TF/Volume2/ITI-18.html#3.18)

Note: At present `category` and `type` which are common search parameters in IHE XDS, MHD and [HL7 IPA](https://build.fhir.org/ig/HL7/fhir-ipa/index.html), are not fully defined in [UKCore-DocumentReference](https://simplifier.net/hl7fhirukcorer4/ukcore-documentreference) for widespread English NHS use, the codes used in the examples are broadly based on the elaboration of [Document Entry](StructureDefinition-DocumentEntry.html) "/>
  </instance>
  <instance>
    <resourceId value="IHESearchResultsDocumentEntries"/>
    <resourceType value="Bundle"/>
    <name value="Return Document Entry search results"/>
    <version>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.title">
        <valueString value="Search Results"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.content">
        <valueReference>🔗 
          <reference value="Bundle/MHDSearchResultsDocuments"/>
        </valueReference>
      </extension>
      <versionId value="1"/>
    </version>
  </instance>
  <instance>
    <resourceId value="XCAQuery"/>
    <resourceType value="Binary"/>
    <name value="XCA Query"/>
    <description
                 value=" Example Response [AdHocQueryRequest XML](AdHocQueryRequest.xml) 

 See [IHE Cross-Community Access (XCA)](https://profiles.ihe.net/ITI/TF/Volume1/ch-18.html) "/>
  </instance>
  <instance>
    <resourceId value="XCAResponse"/>
    <resourceType value="Binary"/>
    <name value="XCA Query Response"/>
    <description
                 value=" Example Response [AdHocQueryReponse XML](AdHocQueryReponse.xml)  "/>
  </instance>
  <instance>
    <resourceId value="IHEReadDiagnosticReport"/>
    <resourceType value="Binary"/>
    <name value="Read DiagnosticReport"/>
    <description
                 value=" See [Find and Retrieve Imaging Reports](CapabilityStatement-FindAndRetrieveImagingReports.html) 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]](https://profiles.ihe.net/ITI/TF/Volume2/ITI-43.html#3.43) "/>
  </instance>
  <instance>
    <resourceId value="IHEViewDiagnosticReport"/>
    <resourceType value="DiagnosticReport"/>
    <name value="Return DiagnosticReport"/>
    <version>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.title">
        <valueString value="Retrieve Diagnostic Report"/>
      </extension>
      <extension
                 url="http://hl7.org/fhir/5.0/StructureDefinition/extension-ExampleScenario.instance.version.content">
        <valueReference>🔗 
          <reference
                     value="DiagnosticReport/DiagnosticReportImagingReportRCR"/>
        </valueReference>
      </extension>
      <versionId value="1"/>
    </version>
  </instance>
  <instance>
    <resourceId value="IHEReadImagingStudy"/>
    <resourceType value="Binary"/>
    <name value="Read ImagingStudy"/>
    <description
                 value="[IHE WADO Retrieve (WADO-RS)](https://wiki.ihe.net/index.php/Web-based_Image_Access). See also [Retrieve Imaging Study](CapabilityStatement-RetrieveImagingStudy.html) for API overview "/>
  </instance>
  <instance>
    <resourceId value="IHERetrieveImagingStudy"/>
    <resourceType value="Binary"/>
    <name value="Return ImagingStudy"/>
    <description
                 value="[DICOM Key Object Selection (KOS)](https://www.dicomstandard.org/News-dir/ftsup/docs/sups/sup59.pdf) is a manifest, which includes references to images which are used to find and retrieve the DICOM Image Instance "/>
  </instance>
  <instance>
    <resourceId value="IHEReadImageInstance"/>
    <resourceType value="Binary"/>
    <name value="Read Image Instance"/>
    <description
                 value="[IHE WADO Retrieve (WADO-RS)](https://wiki.ihe.net/index.php/Web-based_Image_Access). See also [Retrieve Image Instances](CapabilityStatement-RetrieveImageInstances.html) for API overview "/>
  </instance>
  <instance>
    <resourceId value="IHERetrieveImage"/>
    <resourceType value="Binary"/>
    <name value="Return Image Instance"/>
    <description value="DICOM Image Instance"/>
  </instance>
  <process>
    <title value="Query for patient image and/or report"/>
    <description
                 value="IHE XCA implements an [Aggregator](https://www.enterpriseintegrationpatterns.com/patterns/conversation/Aggregator.html) 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](https://profiles.ihe.net/ITI/MHD/ITI-67.html)) and this has been converted to IHE XML as an `AdHocQueryRequest`. [Document Entry](StructureDefinition-DocumentEntry.html) is a FHIR DocumentReference profile based on the NHS Data Dictionary definitions contained in [IHE Europe - Metadata for exchange medical documents and images](https://www.ihe-europe.net/sites/default/files/2017-11/IHE_ITI_XDS_Metadata_Guidelines_v1.0.pdf), this also contains mappings between IHE XDS Document Entry and IHE MHD/HL7 FHIR DocumentReference."/>
    <step>
      <process>
        <title
               value="Search for Document Entries - Imaging studies and reports"/>
        <step>
          <operation>
            <number value="1"/>
            <type value="search-type"/>
            <name value="Search for Document Entires"/>
            <initiator value="user"/>
            <receiver value="xds"/>
            <request>
              <resourceId value="IHESearchDocumentEntries"/>
            </request>
          </operation>
        </step>
      </process>
    </step>
    <step>
      <process>
        <title
               value="For each Network/Gateway - Search for Document Entries via IHE XCA Cross-Community Access (XCA)"/>
        <step>
          <operation>
            <number value="1"/>
            <type value="search-type"/>
            <name value="Search for Document Entries in other networks"/>
            <initiator value="xds"/>
            <receiver value="xca"/>
            <request>
              <resourceId value="XCAQuery"/>
            </request>
            <response>
              <resourceId value="XCAResponse"/>
            </response>
          </operation>
        </step>
      </process>
    </step>
    <step>
      <process>
        <title
               value="Aggregate and Return Search Results - Imaging studies and reports"/>
        <step>
          <operation>
            <number value="1"/>
            <type value="search-type"/>
            <name value="Return Document Entry search results"/>
            <initiator value="xds"/>
            <receiver value="user"/>
            <response>
              <resourceId value="IHESearchResultsDocumentEntries"/>
            </response>
          </operation>
        </step>
      </process>
    </step>
  </process>
  <process>
    <title value="Option - Retrieve selected imaging report"/>
    <description
                 value="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](https://www.rcr.ac.uk/media/wwtp2mif/rcr-publications_radiology-reporting-networks-understanding-the-technical-options_march-2022.pdf) converted to a FHIR DiagnosticReport profile as [Imaging Report](StructureDefinition-ImagingReport.html), 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](https://health.ec.europa.eu/document/download/0079ad26-8f8f-435b-9472-3cd8625f4220_en?filename=ehn_mi_guidelines_en.pdf) which is likely to be a derivative of [HL7 IPS](https://build.fhir.org/ig/HL7/fhir-ips/index.html), like the [HL7 Europe Laboratory Report](https://build.fhir.org/ig/hl7-eu/laboratory/)."/>
    <step>
      <operation>
        <number value="1"/>
        <type value="read"/>
        <name value="Retrieve Imaging Report"/>
        <initiator value="user"/>
        <receiver value="docs"/>
        <request>
          <resourceId value="IHEReadDiagnosticReport"/>
        </request>
        <response>
          <resourceId value="IHEViewDiagnosticReport"/>
        </response>
      </operation>
    </step>
  </process>
  <process>
    <title value="Option - Retrieve selected imaging study"/>
    <description
                 value="This is an optional step. The **Document Consumer** may choose to retrieve the Imaging Study. At present this is a [DICOM KOS](https://dicom.nema.org/dicom/supps/sup59_lb.pdf) 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."/>
    <step>
      <operation>
        <number value="1"/>
        <type value="read"/>
        <name value="Retrieve Imaging Study"/>
        <initiator value="user"/>
        <receiver value="image"/>
        <request>
          <resourceId value="IHEReadImagingStudy"/>
        </request>
        <response>
          <resourceId value="IHERetrieveImagingStudy"/>
        </response>
      </operation>
    </step>
    <step>
      <process>
        <title value="Retrieve selected image - Optional"/>
        <step>
          <operation>
            <number value="1"/>
            <type value="read"/>
            <name value="Retrieve Image"/>
            <initiator value="user"/>
            <receiver value="image"/>
            <request>
              <resourceId value="IHEReadImageInstance"/>
            </request>
            <response>
              <resourceId value="IHERetrieveImage"/>
            </response>
          </operation>
        </step>
      </process>
    </step>
  </process>
</ExampleScenario>