Hierarchies in sections Findings and Impression

[chgessner]

section:findings and section:impression both have entry slices for finding and keyImage.

section:impression has an entry slice for impression in addition.

I do not understand the way to express relations and possibly hierarchies between those (three) entry types. And should findings that relate to impressions be repeated in both sections then?

Maybe impressions could reference the findings (finding referernces, too be correct) as referenced in the findings section, instead of repeating them?

In my understanding, keyimages often serve as evidence to findings. How can this be expressed within the given (non-) hierarchy?

Can Observation.basedOn or Observation.partOf be used for that purpose?

[chgessner]

I found a large number of good examples or test cases in "IHE Radiology Technical Framework Supplement Imaging Diagnostic Report (IDR) Revision 1.0" https://www.ihe.net/uploadedFiles/Documents/Radiology/IHE_RAD_Suppl_IDR_Rev1-0_PC_2024-05-09.pdf

Partly reproduced in the corresponding FHIR IG work https://build.fhir.org/ig/IHE/RAD.IDR/index.html

[chgessner]

To the topic of hierarchies:

The FHIR Condition resource would allow for referencing back to Observations, DiagnosticReport etc. through evidence (or stage.assessment). But we have removed those elements in https://build.fhir.org/ig/hl7-eu/imaging/StructureDefinition-im-impression.html. How would we express such hierarchies then, e. g. between Conditions and Observation-as-evidence? Or to indicate what was used as the basis for staging/grading?

[bvdh]

stage.assessment is not removed, it is not labeled as must support. The use is still allowed although no requirement for them has been identified from the mapping process.

I think the best way to explore this issue is to map a report that has staging related conclusions and see what is required and whether we need to require more fields to be supported.