X.3.5 Structured Entries
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### X.3.5 Structured Entries

The Current Requested Procedure Evidence Sequence (0040,A375) of the KO instance lists all the SOP Instances referenced in the IMAGE content items in their hierarchical Study/Series/Instance context. It is recommended that this list be transcoded to CDA Entries in a Section with Section.Title "DICOM Object Catalog" and a Section.Code of 121181 from the DICOM Controlled Terminology (see PS3.16).

### Note

1. Structured Entries are not defined in CDA Release 1.

2. Since the image hypertext links in the Section narrative may refer to both an image and a softcopy presentation state, as well as possibly being constrained to specific frame numbers, in general there is not a simple mapping from the <linkHtml> to an entry. Therefore it is not expected that there would be ID reference links between the <linkHtml> and related entries.

The purpose of the Structured Entries is to allow DICOM-aware applications to access the referenced images in their hierarchical context.

The encoding of the DICOM Object References in CDA Entries is shown in Figure X.3-1 and Tables X.3-2 through X.3-6. All of the mandatory data elements for the Entries are available in the Current Requested Procedure Evidence Sequence; optional elements (e.g., instance DateTimes) may also be included if known by the encoding application.

Figure X.3-1. CDA Section with DICOM Object References

### Note

The format of Figure X.3-1 follows the conventions of HL7 v3 Reference Information Model diagrams.

Table X.3-2. DICOM Study Reference in an HL7 V3 Act (CDA Act Entry)

Attribute | Data Type | Multiplicity | Value
--- | --- | --- | ---
classCode | CS | 1..1 | ACT
moodCode | CS | 1..1 | EVN
id | II | 1..1 | <Study Instance UID (0020,000D) as root property with no extension property >
code | CD | 1..1 | <113014 as code property, 1.2.840.10008.2.16.4 as codeSystem property, DCM as codeSystemName property, "DICOM Study" as displayName property>
text | ST | 0..1 | <Study Description (0008,1030) >
effectiveTime | TS | 0..1 | < Study Date (0008,0020) and Study Time (0008,0030) >

Table X.3-3. DICOM Series Reference in an HL7 V3 Act (CDA Act Entry)

Attribute | Data Type | Multiplicity | Value
--- | --- | --- | ---
classCode | CS | 1..1 | ACT
moodCode | CS | 1..1 | EVN
id | II | 1..1 | <Series Instance UID (0020,000E) as root property with no extension property >
code | CD | 0..1 | <113015 as code property, 1.2.840.10008.2.16.4 as codeSystem property, DCM as codeSystemName property, "DICOM Series" as displayName property, Modality as qualifier property (see text and Table X.3-4) >
text | ST | 0..1 | < Series Description (0008,103E) >
effectiveTime | TS | 0..1 | < Series Date (0008,0021) and Series Time (0008,0031) >

The code for the Act representing a Series uses a qualifier property to indicate the modality. The qualifier property is a list of coded name/value pairs. For this use, only a single list entry is used, as described in Table X.3-4.

Table X.3-4. Modality Qualifier for The Series Act.Code

Property | Data Type | Value
--- | --- | ---
name | CV | <121139 as code property, 1.2.840.10008.2.16.4 as codeSystem property, DCM as codeSystemName property, "Modality" as displayName property>
value | CD | < Modality (0008,0060) as code property, 1.2.840.10008.2.16.4 as codeSystem property, DCM as codeSystemName property, Modality code meaning (from PS3.16) as displayName property>

Table X.3-5. DICOM Composite Object Reference in an HL7 V3 Act (CDA Observation Entry)

Attribute | Data Type | Multiplicity | Value
--- | --- | --- | ---
classCode | CS | 1..1 | DGIMG
moodCode | CS | 1..1 | EVN
id | II | 1..1 | < SOP Instance UID (0008,0018) as root property with no extension property>
code | CD | 1..1 | < SOP Class UID (0008,0016) as code property, 1.2.840.10008.2.6.1 as codeSystem property, DCMUID as codeSystemName property, SOP Class UID Name (from PS3.6) as displayName property>
text | ED | 0..1 | <application/DICOM as mediaType property, WADO reference (see Table X.3-6) as reference property>
effectiveTime | TS | 0..1 | < Content Date (0008,0023) and Content Time (0008,0033) >

### Note

1. The DGIMG class is used to reference all DICOM Composite Instances, not just diagnostic images.

2. The Observation.Text reference property may alternatively use a DICOM protocol based URI, rather than WADO, should such a URI be defined.

Table X.3-6. WADO Reference in an HL7 DGIMG Observation.Text

WADO Component | Source
--- | ---
<scheme>:// <authority> / <path> | Configuration setting, used by the conversion process, identifying the WADO server
?requestType=WADO | Fixed
&studyUID =<uid> | Study Instance UID for referenced instance
&seriesUID= <uid> | Series Instance UID for referenced instance
&objectUID= <uid> | SOP Instance UID for referenced instance
&contentType=application/DICOM | Fixed

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