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Latest version of ImagingManifest in STU3 prior to removal in R4 can be found at

See also

Use Cases:

  • Link to a specific set of images / frames, such as in a DiagnosticReport or Observation
  • Link a "summary" Observation to an SR or an SR Observation
    • e.g. communicate core of AI result to EMR while maintaining a link to more detailed object
  • Exchange of information between FHIRCast-synchronized systems
    • e.g. volume to be loaded
  • Key image note


  • rename
  • remove short name
  • Definition: a selection of DICOM SOP instances and/or frames within a single Study and Series.
  • identifier
    • confirm cardinality (probably 0..*)
    • this should not be a UID or tied to SOP Instance UID since this is specifically not a KOS. Need to figure out what a more appropriate identifier would be.
    • Do we need a separate identifier, or just an id?
  • clear short name
  • definition:
  • patient
    • change to subject, and align with ImagingStudy.
  • authoringTime
    • change to issued (as per Observation)
  • author
    • change to performer (as per DiagnosticReport and Observation)
    • add PractitionerRole.
  • title
    • change valueset name from KOStitle. Figure out what the actual value set should be (don't use a DICOM CID).
    • Still needed?
  • study
    • Remove, and promote all subitems to top level.
  • uid
    • Rename to studyUid and change type to id (or is it Identifier?)
  • imagingStudy
    • rename to studyReference (?) or basedOn (?) derivedFrom?
  • endpoint (study-level)
    • all ok
  • series
    • Remove and promote all subitems to top level.
  • uid
    • rename to seriesUid. confirm type as id?
  • endpoint (series)
    • remove
  • instance
    • ok.
  • sopClass
    • change to 0..1
  • uid
    • confirm type as id?
  • frameNumber
    • ok.
  • Review summary elements.
  • Review against event pattern
  • Review against w5
  • Consider how to pass a reference to a measurement
    • Add Observation UID?
    • Separate object?



.. ImagingReference

DomainResourceKey Object Selection
Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
Σ0..1IdentifierSOP Instance UID

... subject

Σ1..1Reference(Patient)Patient of the selected objects

... issued

Σ0..1dateTimeTime when the selection of instances was made

... performer

Σ0..1Reference(Practitioner | Practitioner Role | Device | Organization | Patient | RelatedPerson)Author (human or machine)
Σ0..1string / CodeableConceptDescription text
Σ1..1oidStudy instance UID
Σ0..1Reference(ImagingStudy)Reference to ImagingStudy
Σ0..*Reference(Endpoint)Study access service endpoint
Σ1..1oidSeries instance UID
Σ0..*BackboneElementThe selected instances. If no instances are included the entire series is selected.
Σ0..1oidSOP class UID of instances

..     .. uid

Σ1..1Selected instance UIDs

           .. frameNumber

Σ0..*integerSelected frames

           .. observationUid

Σ0..*oidSelected observations in a DICOM SR

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