Extension Kontrastmittelgabe auf Serienebene

Diese Extension Kontrastmitelgabe ermöglicht es, die Verwendung von Kontrastmitteln in der BildSerie anzugeben und gleichzeitig mit einer Referenz auf das KDS-Modul Medikation(MedicationStatement) Details anzulegen. Der hier verwendete DICOM Tag bildet einen boolschen Wert ab.

Relevante DICOM-Tags sind:

Contrast/Bolus Agent [(0018,0010) contrastBolus]
NameStatusVersionCanonicalBasis
MII_EX_Bildgebung_Kontrastmittelactive2025.0.0-ballothttps://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittelhttp://hl7.org/fhir/StructureDefinition/Extension

Inhalt

id0..1string
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueBooleanboolean
id0..1string
extensionI0..0Extension
url1..1uriFixed Value
valueReferenceReference()
url1..1uriFixed Value

Die Extension ermöglicht es, die Gabe von Kontrastmitteln auf Serien-Ebene anzugeben.

Feldname
Extension.extension:contrastBolus
<StructureDefinition xmlns="http://hl7.org/fhir">
    <id value="mii-ex-bildgebung-kontrastmittel" />
    <url value="https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel" />
    <version value="2025.0.0-ballot" />
    <name value="MII_EX_Bildgebung_Kontrastmittel">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
            <extension url="lang">
                <valueCode value="en-US" />
            </extension>
            <extension url="content">
                <valueString value="MII_EX_ImagingStudy" />
            </extension>
        </extension>
    </name>
    <title value="MII EX Bildgebung Kontrastmittel">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
            <extension url="lang">
                <valueCode value="en-US" />
            </extension>
            <extension url="content">
                <valueString value="MII_EX_ImagingStudy" />
            </extension>
        </extension>
    </title>
    <status value="active" />
    <experimental value="false" />
    <publisher value="Medizininformatik Initiative" />
    <contact>
        <telecom>
            <system value="url" />
            <value value="https://www.medizininformatik-initiative.de" />
        </telecom>
    </contact>
    <description value="Die Extension erm&#246;glicht es, die Gabe von Kontrastmitteln auf Serien-Ebene anzugeben.">
        <extension url="http://hl7.org/fhir/StructureDefinition/translation">
            <extension url="lang">
                <valueCode value="en-US" />
            </extension>
            <extension url="content">
                <valueString value="The extension allows specifying the administration of contrast agents at the series level." />
            </extension>
        </extension>
    </description>
    <fhirVersion value="4.0.1" />
    <kind value="complex-type" />
    <abstract value="false" />
    <context>
        <type value="element" />
        <expression value="ImagingStudy.series" />
    </context>
    <type value="Extension" />
    <baseDefinition value="http://hl7.org/fhir/StructureDefinition/Extension" />
    <derivation value="constraint" />
    <differential>
        <element id="Extension.extension">
            <path value="Extension.extension" />
            <min value="1" />
        </element>
        <element id="Extension.extension:contrastBolus">
            <path value="Extension.extension" />
            <sliceName value="contrastBolus" />
            <min value="1" />
            <max value="1" />
            <mustSupport value="true" />
        </element>
        <element id="Extension.extension:contrastBolus.extension">
            <path value="Extension.extension.extension" />
            <max value="0" />
        </element>
        <element id="Extension.extension:contrastBolus.url">
            <path value="Extension.extension.url" />
            <fixedUri value="contrastBolus" />
        </element>
        <element id="Extension.extension:contrastBolus.value[x]">
            <path value="Extension.extension.value[x]" />
            <type>
                <code value="boolean" />
            </type>
        </element>
        <element id="Extension.extension:contrastBolusDetails">
            <path value="Extension.extension" />
            <sliceName value="contrastBolusDetails" />
            <min value="0" />
            <max value="*" />
        </element>
        <element id="Extension.extension:contrastBolusDetails.extension">
            <path value="Extension.extension.extension" />
            <max value="0" />
        </element>
        <element id="Extension.extension:contrastBolusDetails.url">
            <path value="Extension.extension.url" />
            <fixedUri value="contrastBolusDetails" />
        </element>
        <element id="Extension.extension:contrastBolusDetails.value[x]">
            <path value="Extension.extension.value[x]" />
            <type>
                <code value="Reference" />
            </type>
        </element>
        <element id="Extension.url">
            <path value="Extension.url" />
            <fixedUri value="https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel" />
        </element>
        <element id="Extension.value[x]">
            <path value="Extension.value[x]" />
            <max value="0" />
        </element>
    </differential>
</StructureDefinition>
{
    "resourceType": "StructureDefinition",
    "id": "mii-ex-bildgebung-kontrastmittel",
    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel",
    "version": "2025.0.0-ballot",
    "name": "MII_EX_Bildgebung_Kontrastmittel",
    "_name": {
        "extension":  [
            {
                "url": "http://hl7.org/fhir/StructureDefinition/translation",
                "extension":  [
                    {
                        "url": "lang",
                        "valueCode": "en-US"
                    },
                    {
                        "url": "content",
                        "valueString": "MII_EX_ImagingStudy"
                    }
                ]
            }
        ]
    },
    "title": "MII EX Bildgebung Kontrastmittel",
    "_title": {
        "extension":  [
            {
                "url": "http://hl7.org/fhir/StructureDefinition/translation",
                "extension":  [
                    {
                        "url": "lang",
                        "valueCode": "en-US"
                    },
                    {
                        "url": "content",
                        "valueString": "MII_EX_ImagingStudy"
                    }
                ]
            }
        ]
    },
    "status": "active",
    "experimental": false,
    "publisher": "Medizininformatik Initiative",
    "contact":  [
        {
            "telecom":  [
                {
                    "system": "url",
                    "value": "https://www.medizininformatik-initiative.de"
                }
            ]
        }
    ],
    "description": "Die Extension ermöglicht es, die Gabe von Kontrastmitteln auf Serien-Ebene anzugeben.",
    "_description": {
        "extension":  [
            {
                "url": "http://hl7.org/fhir/StructureDefinition/translation",
                "extension":  [
                    {
                        "url": "lang",
                        "valueCode": "en-US"
                    },
                    {
                        "url": "content",
                        "valueString": "The extension allows specifying the administration of contrast agents at the series level."
                    }
                ]
            }
        ]
    },
    "fhirVersion": "4.0.1",
    "kind": "complex-type",
    "abstract": false,
    "context":  [
        {
            "type": "element",
            "expression": "ImagingStudy.series"
        }
    ],
    "type": "Extension",
    "baseDefinition": "http://hl7.org/fhir/StructureDefinition/Extension",
    "derivation": "constraint",
    "differential": {
        "element":  [
            {
                "id": "Extension.extension",
                "path": "Extension.extension",
                "min": 1
            },
            {
                "id": "Extension.extension:contrastBolus",
                "path": "Extension.extension",
                "sliceName": "contrastBolus",
                "min": 1,
                "max": "1",
                "mustSupport": true
            },
            {
                "id": "Extension.extension:contrastBolus.extension",
                "path": "Extension.extension.extension",
                "max": "0"
            },
            {
                "id": "Extension.extension:contrastBolus.url",
                "path": "Extension.extension.url",
                "fixedUri": "contrastBolus"
            },
            {
                "id": "Extension.extension:contrastBolus.value[x]",
                "path": "Extension.extension.value[x]",
                "type":  [
                    {
                        "code": "boolean"
                    }
                ]
            },
            {
                "id": "Extension.extension:contrastBolusDetails",
                "path": "Extension.extension",
                "sliceName": "contrastBolusDetails",
                "min": 0,
                "max": "*"
            },
            {
                "id": "Extension.extension:contrastBolusDetails.extension",
                "path": "Extension.extension.extension",
                "max": "0"
            },
            {
                "id": "Extension.extension:contrastBolusDetails.url",
                "path": "Extension.extension.url",
                "fixedUri": "contrastBolusDetails"
            },
            {
                "id": "Extension.extension:contrastBolusDetails.value[x]",
                "path": "Extension.extension.value[x]",
                "type":  [
                    {
                        "code": "Reference"
                    }
                ]
            },
            {
                "id": "Extension.url",
                "path": "Extension.url",
                "fixedUri": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel"
            },
            {
                "id": "Extension.value[x]",
                "path": "Extension.value[x]",
                "max": "0"
            }
        ]
    }
}

Beispiele

Hinweis
Warning Aus Gründen der Übersichtlichkeit wurde in diesem Beispiel darauf verzichtet, alle dazugehörigen Serien bzw. Instanzen mit einzubinden. Natürlich ist es bei der Implkementierung vorgesehen, dass alle zur jeweiligen Studie gehörenden Serien und Instanzen auch in der resultierenden FHIR-Ressource enthalten sind - dafür wird dann einfach die Sequenz "series" bzw "instance" für jede Serie bzw. Instanz wiederholt und mit den entsprechenden Werten befüllt.

Beispiele von ImagingStudy-Ressourcen mit der Extension für Kontrastmittelgabe:

Beispiel eines CTs:

{
    "resourceType": "ImagingStudy",
    "id": "mii-exa-bildgebung-bildgebungsstudie-ct",
    "meta": {
        "profile":  [
            "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-pr-bildgebung-bildgebungsstudie"
        ]
    },
    "extension":  [
        {
            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-bildgebungsgrund",
            "valueString": "Verdacht auf Karzinom"
        }
    ],
    "series":  [
        {
            "extension":  [
                {
                    "extension":  [
                        {
                            "valueQuantity": {
                                "unit": "milligray",
                                "value": 4.04
                            },
                            "url": "CTDIvol"
                        },
                        {
                            "valueQuantity": {
                                "unit": "kilovolt",
                                "value": 110
                            },
                            "url": "KVP"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliampere second",
                                "value": 38
                            },
                            "url": "exposure"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliseconds",
                                "value": 600
                            },
                            "url": "exposureTime"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliampere",
                                "value": 96
                            },
                            "url": "xRayTubeCurrent"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-ct"
                },
                {
                    "extension":  [
                        {
                            "url": "manufacturer",
                            "valueString": "Beispielhersteller"
                        },
                        {
                            "url": "manufacturerModelName",
                            "valueString": "Beispielmodell"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-geraet-hersteller"
                },
                {
                    "extension":  [
                        {
                            "url": "contrastBolus",
                            "valueBoolean": true
                        },
                        {
                            "url": "contrastBolusDetails",
                            "valueReference": {
                                "reference": "MedicationAdministration/mii-exa-bildgebung-kontrastmittelgabe"
                            }
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel"
                }
            ],
            "instance":  [
                {
                    "extension":  [
                        {
                            "extension":  [
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 1.36
                                    },
                                    "url": "pixelSpacingX"
                                },
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 1.36
                                    },
                                    "url": "pixelSpacingY"
                                },
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 4
                                    },
                                    "url": "sliceThickness"
                                },
                                {
                                    "url": "imageType",
                                    "valueString": "[DERIVED, PRIMARY]"
                                }
                            ],
                            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-instanz-details"
                        }
                    ],
                    "uid": "instance-example-uid",
                    "sopClass": {
                        "code": "urn:oid:1.2.840.10008.5.1.4.1.1.2",
                        "system": "urn:ietf:rfc:3986"
                    },
                    "number": 31
                }
            ],
            "uid": "series-example-uid",
            "number": 1,
            "modality": {
                "code": "CT",
                "system": "http://dicom.nema.org/resources/ontology/DCM",
                "display": "Computed Tomography"
            },
            "description": "AC LD CT Whole Body 4.0 HD Field of View",
            "numberOfInstances": 195,
            "bodySite": {
                "code": "51185008",
                "system": "http://snomed.info/sct",
                "display": "Thoracic structure (body structure)"
            },
            "laterality": {
                "code": "7771000",
                "system": "http://snomed.info/sct",
                "display": "Left"
            },
            "started": "2024-07-19T12:03:30+02:00"
        }
    ],
    "status": "available",
    "modality":  [
        {
            "code": "CT",
            "system": "http://dicom.nema.org/resources/ontology/DCM",
            "display": "Computed Tomography"
        }
    ],
    "subject": {
        "reference": "Patient/PatExample",
        "identifier": {
            "type": {
                "coding":  [
                    {
                        "code": "MR",
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "display": "Medical record number"
                    }
                ]
            },
            "system": "https://system-url",
            "value": "study-uid"
        }
    },
    "encounter": {
        "reference": "Encounter/EncExample"
    },
    "basedOn":  [
        {
            "reference": "ServiceRequest/mii-exa-bildgebung-anforderung-bildgebung"
        }
    ],
    "numberOfSeries": 2,
    "numberOfInstances": 390,
    "procedureReference": {
        "reference": "Procedure/mii-exa-bildgebung-bildgebungsprozedur"
    },
    "reasonReference":  [
        {
            "reference": "Condition/CondExample"
        }
    ],
    "description": "whole body aquisition"
}

Beispiel eines MRTs:

{
    "resourceType": "ImagingStudy",
    "id": "mii-exa-bildgebung-bildgebungsstudie-mr",
    "meta": {
        "profile":  [
            "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-pr-bildgebung-bildgebungsstudie"
        ]
    },
    "extension":  [
        {
            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-bildgebungsgrund",
            "valueString": "Verdacht auf Kreuzbandruptur"
        }
    ],
    "series":  [
        {
            "extension":  [
                {
                    "extension":  [
                        {
                            "valueQuantity": {
                                "unit": "tesla",
                                "value": 3
                            },
                            "url": "magneticFieldStrength"
                        },
                        {
                            "url": "scanningSequence",
                            "valueString": "SE"
                        },
                        {
                            "url": "scanningSequenceVariant",
                            "valueString": "SP, SK"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-mr"
                },
                {
                    "extension":  [
                        {
                            "url": "manufacturer",
                            "valueString": "Siemens Healthineers"
                        },
                        {
                            "url": "manufacturerModelName",
                            "valueString": "MAGNETOM Vida"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-geraet-hersteller"
                },
                {
                    "extension":  [
                        {
                            "url": "contrastBolus",
                            "valueBoolean": false
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel"
                }
            ],
            "instance":  [
                {
                    "extension":  [
                        {
                            "extension":  [
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 0.260417
                                    },
                                    "url": "pixelSpacingX"
                                },
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 0.260417
                                    },
                                    "url": "pixelSpacingY"
                                },
                                {
                                    "valueQuantity": {
                                        "unit": "millimeter",
                                        "value": 3
                                    },
                                    "url": "sliceThickness"
                                },
                                {
                                    "url": "imageType",
                                    "valueString": "[ORIGINAL, PRIMARY]"
                                }
                            ],
                            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-instanz-details"
                        }
                    ],
                    "uid": "instance-example-uid",
                    "sopClass": {
                        "code": "urn:oid:1.2.840.10008.5.1.4.1.1.4",
                        "system": "urn:ietf:rfc:3986"
                    },
                    "number": 28
                }
            ],
            "uid": "series-example-uid",
            "number": 9,
            "modality": {
                "code": "MR",
                "system": "http://dicom.nema.org/resources/ontology/DCM",
                "display": "Magnetic Resonance"
            },
            "description": "pd_tse_sag",
            "numberOfInstances": 28,
            "bodySite": {
                "code": "72696002",
                "system": "http://snomed.info/sct",
                "display": "Knee region structure (body structure)"
            },
            "laterality": {
                "code": "24028007",
                "system": "http://snomed.info/sct",
                "display": "Right"
            },
            "started": "2024-07-19T12:03:30+02:00"
        }
    ],
    "status": "available",
    "modality":  [
        {
            "code": "MR",
            "system": "http://dicom.nema.org/resources/ontology/DCM",
            "display": "Magnetic Resonance"
        }
    ],
    "subject": {
        "reference": "Patient/PatExample",
        "identifier": {
            "type": {
                "coding":  [
                    {
                        "code": "MR",
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
                        "display": "Medical record number"
                    }
                ]
            },
            "system": "https://system-url",
            "value": "study-uid"
        }
    },
    "encounter": {
        "reference": "Encounter/EncExample"
    },
    "basedOn":  [
        {
            "reference": "ServiceRequest/mii-exa-bildgebung-anforderung-bildgebung"
        }
    ],
    "numberOfSeries": 11,
    "numberOfInstances": 294,
    "procedureReference": {
        "reference": "Procedure/mii-exa-bildgebung-bildgebungsprozedur"
    },
    "reasonReference":  [
        {
            "reference": "Condition/CondExample"
        }
    ],
    "description": "Knie DOT"
}

Beispiel eine Röntgenbilds:

{
    "resourceType": "ImagingStudy",
    "id": "mii-exa-bildgebung-bildgebungsstudie-cr",
    "meta": {
        "profile":  [
            "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-pr-bildgebung-bildgebungsstudie"
        ]
    },
    "extension":  [
        {
            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-bildgebungsgrund",
            "valueString": "Verdacht auf Karzinom"
        }
    ],
    "series":  [
        {
            "extension":  [
                {
                    "extension":  [
                        {
                            "valueQuantity": {
                                "unit": "kilovolt",
                                "value": 110
                            },
                            "url": "KVP"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliampere second",
                                "value": 38
                            },
                            "url": "exposure"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliseconds",
                                "value": 600
                            },
                            "url": "exposureTime"
                        },
                        {
                            "valueQuantity": {
                                "unit": "milliampere",
                                "value": 96
                            },
                            "url": "xRayTubeCurrent"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-modalitaet-mg-cr-dx"
                },
                {
                    "extension":  [
                        {
                            "url": "manufacturer",
                            "valueString": "SIEMENS"
                        },
                        {
                            "url": "manufacturerModelName",
                            "valueString": "Fluorospot Compact FD"
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-geraet-hersteller"
                },
                {
                    "extension":  [
                        {
                            "url": "contrastBolus",
                            "valueBoolean": false
                        }
                    ],
                    "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-kontrastmittel"
                }
            ],
            "instance":  [
                {
                    "extension":  [
                        {
                            "extension":  [
                                {
                                    "url": "imageType",
                                    "valueString": "[ORIGINAL,PRIMARY,RAD]"
                                }
                            ],
                            "url": "https://www.medizininformatik-initiative.de/fhir/ext/modul-bildgebung/StructureDefinition/mii-ex-bildgebung-instanz-details"
                        }
                    ],
                    "uid": "instance-example-uid",
                    "sopClass": {
                        "code": "urn:oid:1.2.840.10008.5.1.4.1.1.1",
                        "system": "urn:ietf:rfc:3986"
                    },
                    "number": 1
                }
            ],
            "uid": "series-example-uid",
            "number": 1,
            "modality": {
                "code": "CR",
                "system": "http://dicom.nema.org/resources/ontology/DCM",
                "display": "Computed Radiography"
            },
            "description": "X Thorax a.p. liegend",
            "numberOfInstances": 1,
            "bodySite": {
                "code": "43799004",
                "system": "http://snomed.info/sct",
                "display": "Thoracic structure (body structure)"
            },
            "laterality": {
                "code": "66459002",
                "system": "http://snomed.info/sct",
                "display": "Unilateral"
            },
            "started": "2024-07-19T12:03:30+02:00"
        }
    ],
    "status": "available",
    "modality":  [
        {
            "code": "CR",
            "system": "http://dicom.nema.org/resources/ontology/DCM",
            "display": "Computed Radiography"
        }
    ],
    "subject": {
        "reference": "Patient/PatExample",
        "identifier": {
            "type": {
                "coding":  [
                    {
                        "code": "MR",
                        "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
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                    }
                ]
            },
            "system": "https://system-url",
            "value": "study-uid"
        }
    },
    "encounter": {
        "reference": "Encounter/EncExample"
    },
    "basedOn":  [
        {
            "reference": "ServiceRequest/mii-exa-bildgebung-anforderung-bildgebung"
        }
    ],
    "numberOfSeries": 1,
    "numberOfInstances": 1,
    "procedureReference": {
        "reference": "Procedure/mii-exa-bildgebung-bildgebungsprozedur"
    },
    "reasonReference":  [
        {
            "reference": "Condition/CondExample"
        }
    ],
    "description": "Thorax auf Station;"
}