Generated Narrative: StructureDefinition EHDSImagingReportBody Name Flags Card. Type Description & Constraints EHDSImagingReportBody 0..* Base Imaging report body model Instances of this logical model can be the target of a Reference orderInformation 0..* Base B.1.1 - Order information orderId 1..* Identifier B.1.1.1 - Order Id orderDateAndTime 0..1 dateTime B.1.1.2 - Order date and time orderPlacer[x] 0..1 B.1.1.3 - Order placer orderPlacerEHDSHealthProfessional EHDSHealthProfessional orderPlacerEHDSOrganization EHDSOrganization orderPlacerEHDSPatient EHDSPatient orderReasonText 0..* string B.1.1.4 - Order reason text orderReason 0..* Reference(Condition model | Observation model) B.1.1.5 - Order reason clinicalQuestion 0..1 string B.1.1.6 - Clinical question <a href="StructureDefinition-EHDSImagingReportBody-definitions.html#EHDSImagingReportBody.orderInformation.supportingInformation" title="Additional clinical information about the patient or specimen that may affect service delivery or interpretation. This information includes diagnosis, clinical findings and other observations. This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the metal implants present in patien's body.">supportingInformation 0..* Base B.1.1.7 - Supporting information observation 0..* EHDSObservation B.1.1.7.1 - Observation condition 0..* EHDSCondition B.1.1.7.2 - Condition medicationAdministration 0..* EHDSMedicationAdministration B.1.1.7.3 - Medication Administration devices 0..* EHDSDevice B.1.1.7.4 - Devices pregnancyStatus 0..1 CodeableConcept B.1.1.7.5 - Pregnancy status Binding Description (No ValueSet): (preferred): SNOMED CT gestationalAge 0..1 Quantity B.1.1.7.6 - Gestational age <a href="StructureDefinition-EHDSImagingReportBody-definitions.html#EHDSImagingReportBody.orderInformation.supportingInformation.sexForClinicalUse" title="A Sex Parameter for Clinical Use is a parameter that provides guidance on how a recipient should apply settings or reference ranges that are derived from observable information such as an organ inventory, recent hormone lab tests, genetic testing, menstrual status, obstetric history, etc.. This property is intended for use in clinical decision making, and indicates that treatment or diagnostic tests should consider best practices associated with the relevant reference population">sexForClinicalUse 0..* CodeableConcept B.1.1.7.7 - Sex for clinical use Binding Description (No ValueSet): (preferred): HL7 sex-parameter-for-clinical-use otherSupportingInformation 0..* Resource B.1.1.7.8 - Other supporting information specimen 0..* EHDSSpecimen B.1.2 - Specimen serviceRequest 0..* EHDSServiceRequest B.1.3 - Service request exposureInformation 0..1 Base B.1.4 - Exposure information effectiveDose 0..* Quantity B.1.4.1 - Effective dose Binding Description (No ValueSet): (preferred): UCUM (for units) equivalentDoseInformation 1..1 Base B.1.4.2 - Equivalent dose information <a href="StructureDefinition-EHDSImagingReportBody-definitions.html#EHDSImagingReportBody.exposureInformation.equivalentDoseInformation.equivalentDose" title="Equivalent dose is a measure of the radiation dose to tissue where an attempt has been made to allow for the different relative biological effects of different types of ionizing radiation. Equivalent dose is based on the absorbed dose per organ, adjusted to account for the effectiveness of the type of radiation [mSv].">equivalentDose 1..1 Quantity B.1.4.2.1 - Equivalent dose Binding Description (No ValueSet): (preferred): UCUM (for units) tissueType 1..1 CodeableConcept B.1.4.2.2 - Tissue type Binding Description (No ValueSet): (preferred): SNOMED CT examinationReport 1..1 Base B.1.5 - Examination Report modality 1..* CodeableConcept B.1.5.1 - Modality Binding Description (No ValueSet): (preferred): DICOM Modality bodyPart 0..* Base B.1.5.2 - Body part bodyLocation 0..1 CodeableConcept B.1.5.2.1 - Body location Binding Description (No ValueSet): (preferred): SNOMED CT, ICD-O-3 laterality 0..1 CodeableConcept B.1.5.2.2 - Laterality Binding Description (No ValueSet): (preferred): SNOMED CT imagingProcedures 0..* EHDSProcedure B.1.5.3 - Imaging procedures medication 0..* EHDSMedicationAdministration B.1.5.4 - Medication adverseReaction 0..* EHDSAllergyIntolerance B.1.5.5 - Adverse reaction resultData 0..1 Base B.1.5.6 - Result data resultText 1..1 string B.1.5.6.1 - Result text observationResults 0..* EHDSObservation B.1.5.6.2 - Observation results conclusion 1..1 Base B.1.5.7 - Conclusion impression 1..1 string B.1.5.7.1 - Impression conditionOrFinding[x] 0..* B.1.5.7.2 - Condition or finding conditionOrFindingEHDSCondition EHDSCondition conditionOrFindingEHDSObservation EHDSObservation recommendation 0..1 Base B.1.6 - Recommendation description 1..1 string B.1.6.1 - Description carePlan 0..* EHDSCarePlan B.1.6.2 - Care plan comparisonStudy 0..* Reference(Imaging report model) B.1.7 - Comparison Study Documentation for this format
B.1 - EHDS refined base model for Imaging report body
Order Information (Imaging Result Report could respond to multiple service orders)
An identifier of the imaging service order. Imaging Result Report may respond to multiple orders.
The person/organization \"authorised\" to place the order. Order placer could be either a health professional, health professional organization or the patient himself.
An explanation or justification for why this service is being requested in textual form.
An explanation or justification for why this service is being requested in coded form.
Specification of clinical question (goal of the investigation) to be answered by the imaging investigation.
Additional clinical information about the patient or specimen that may affect service delivery or interpretation. This information includes diagnosis, clinical findings and other observations. This includes observations explicitly requested by the producer (filler) to provide context or supporting information needed to complete the order. For example, reporting the metal implants present in patien's body.
Clinical findings and other observations. E.g., hight and weights of the patient.
Condition that may influence the service or result interpretation.
Medication administered before ordering the service.
List of implants or devices that affect the course of the examination or its interpretation.For example, reporting metal implants present in the patient's body.
Pregnancy status when the imaging examination was performed. E.g., pregnant, not pregnant, unknown.
Duration of the pregnancy on the day on which the patient was asked or at the delivery. The duration can be given in weeks (wk) and/or days (d).
A Sex Parameter for Clinical Use is a parameter that provides guidance on how a recipient should apply settings or reference ranges that are derived from observable information such as an organ inventory, recent hormone lab tests, genetic testing, menstrual status, obstetric history, etc.. This property is intended for use in clinical decision making, and indicates that treatment or diagnostic tests should consider best practices associated with the relevant reference population
B.1.1.7.8 - Other supporting information
Any other type of relevant supporting information
Specimen information. Note: A specimen (not attached to a body) can be used for diagnostic, forensic and medical research purposes.
Specification of requested service or services
Information on total exposure to ionising radiation.
Sum of equivalent doses to all organs, from external and/or internal exposures, each adjusted to account for the sensitivity of the organ to radiation. [mSv]
Equivalent dose is based on the absorbed dose per organ, adjusted to account for the effectiveness of the type of radiation [mSv].
Equivalent dose is a measure of the radiation dose to tissue where an attempt has been made to allow for the different relative biological effects of different types of ionizing radiation. Equivalent dose is based on the absorbed dose per organ, adjusted to account for the effectiveness of the type of radiation [mSv].
Type of the tissue for which do dosage was enumerated.
Imaging modality (or modalities) used during imaging investigation (DICOM CID029).
Body side of the body location, if needed to distinguish from a similar location on the other side of the body.
Procedure performed during imaging study.
Information about medication administered (contrast, sedation, stress agents), etc.
Adverse reactions manifested during imaging investigation.
Comments and narrative representation of the observation results and findings.
Observation details (report could consist of multiple observations)
A concise and clinically contextualised summary including interpretation/impression of the diagnostic report.
Narrative description of the clinical conclusion (impression).
Condition or finding from imaging investigation.
Recommendations for additional imaging tests or other actions
Narrative description of the recommended activities including additional test, medication etc.
A complex and structured information about recommended goals, activities and objectives in the form of one or more formal care plan.
Documentation (reference) of a prior Imaging Report to which the current images were compared.