Imaging order

Imaging orders live on ServiceRequest with category=imaging. DSP's free-string modality/laterality/views need structured bindings via extensions for cross-system comparability.

DSP content_type

`order.imaging`

FHIR target

`ServiceRequest (category=imaging)`

Field-by-field

DSP	FHIR R4	Notes
`type: IMAGING_ORDER`	`ServiceRequest.category = imaging`	`http://snomed.info/sct\|363679005`.
`description`	`ServiceRequest.code.text`
`order_data.imaging_modality` (string "X-ray" / "MRI" / "CT")	Extension `imaging-modality` (coded)	Bind to DCM (`http://dicom.nema.org/resources/ontology/DCM`) — the DICOM controlled terminology FHIR code system.
`order_data.imaging_body_location`	`ServiceRequest.bodySite`	Prefer SNOMED body structure codes.
`order_data.imaging_location_laterality`	Extension `bodysite-laterality` on bodySite	right/left/bilateral (SNOMED).
`order_data.views`	Extension `imaging-views`
`order_data.contrast`	Extension `imaging-contrast`	with / without / with-and-without.
`order_data.imaging_instructions`	`ServiceRequest.note.text`
`order_data.patient_instructions`	`ServiceRequest.patientInstruction`

Side-by-side example

DSP

{
  "id": "f7d8e9a0b1c2d3e4f5g6h7i8j9k0l1m2",
  "type": "IMAGING_ORDER",
  "context": { "content_type": "order.imaging" },
  "description": "Chest X-ray to evaluate shortness of breath",
  "intent": "order",
  "order_data": {
    "imaging_modality": "X-ray",
    "imaging_body_location": "chest",
    "imaging_location_laterality": "bilateral",
    "views": "2 view",
    "contrast": "without contrast",
    "imaging_instructions": "Standard PA and lateral views",
    "patient_instructions": "No preparation required."
  },
  "confidence_score": 1.0
}

FHIR R4 (DSP-FHIR profile)

{
  "resourceType":"ServiceRequest",
  "status":"active","intent":"order",
  "category":[{"coding":[{"system":"http://snomed.info/sct","code":"363679005","display":"Imaging"}]}],
  "code":{"text":"Chest X-ray 2 view without contrast"},
  "bodySite":[{
    "coding":[{"system":"http://snomed.info/sct","code":"51185008","display":"Thoracic structure"}],
    "extension":[{"url":"https://dsp-fhir.org/StructureDefinition/bodysite-laterality","valueCode":"bilateral"}]
  }],
  "subject":{"reference":"Patient/pat-67890"},
  "encounter":{"reference":"Encounter/enc-12345"},
  "patientInstruction":"No preparation required.",
  "note":[{"text":"Standard PA and lateral views"}],
  "extension":[
    {"url":"https://dsp-fhir.org/StructureDefinition/imaging-modality",
     "valueCoding":{"system":"http://dicom.nema.org/resources/ontology/DCM","code":"CR","display":"Computed Radiography"}},
    {"url":"https://dsp-fhir.org/StructureDefinition/imaging-views","valueString":"2 view"},
    {"url":"https://dsp-fhir.org/StructureDefinition/imaging-contrast","valueCode":"without"},
    {"url":"https://dsp-fhir.org/StructureDefinition/confidence-score","valueDecimal":1.0}
  ]
}

DSP → FHIR mapping

Skeleton for DspImagingOrder → ServiceRequest(category=imaging).

map "https://dsp-fhir.org/StructureMap/DspImagingOrderToServiceRequest" = "DspImagingOrderToServiceRequest"

uses "https://dsp-fhir.org/StructureDefinition/DspOrderImagingResource" alias DspImgOrder as source
uses "http://hl7.org/fhir/StructureDefinition/ServiceRequest" alias ServiceRequest as target

group DspImagingOrderToServiceRequest(source src : DspImgOrder, target tgt : ServiceRequest) {
  src.id as id -> tgt.id = id;
  src -> tgt.status = 'active';
  src -> tgt.intent = 'order';
  src -> tgt.category as cat, cat.coding as co,
    co.system = 'http://snomed.info/sct', co.code = '363679005',
    co.display = 'Imaging' "category";

  src.payload as p then {
    p.modality as m -> tgt.extension as ext then {
      m -> ext.url = 'https://dsp-fhir.org/StructureDefinition/dsp-imaging-modality',
           ext.value = create('CodeableConcept') as cc, cc.text = m;
    } "modality";
    p.body_site as bs -> tgt.bodySite as bodyCc, bodyCc.text = bs "body-site";
    p.laterality as lat -> tgt.bodySite as bodyCc, bodyCc.extension as ext then {
      lat -> ext.url = 'https://dsp-fhir.org/StructureDefinition/dsp-bodysite-laterality',
             ext.value = create('code') as v, v.value = lat;
    } "laterality";
    p.contrast as c -> tgt.extension as ext then {
      c -> ext.url = 'https://dsp-fhir.org/StructureDefinition/dsp-imaging-contrast',
           ext.value = create('code') as v, v.value = c;
    } "contrast";
    p.views as v -> tgt.extension as ext,
      ext.url = 'https://dsp-fhir.org/StructureDefinition/dsp-imaging-views',
      ext.value = create('string') as vs, vs.value = v "view";
  };

  src.confidence as conf -> tgt.extension as ext then {
    conf -> ext.url = 'https://dsp-fhir.org/StructureDefinition/dsp-confidence-score',
            ext.value = create('decimal') as v, v.value = conf;
  } "confidence";
}

FHIR → DSP (canonical `$graphql` read)

Standard FHIR $graphql selects every native ServiceRequest field and DSP-namespaced extension. The imaging-specific extensions (dsp-imaging-modality, dsp-imaging-views, dsp-imaging-contrast, dsp-bodysite-laterality) carry the structured codings the DSP wording can't recover by itself.

Canonical query

query DspImagingOrder($id: ID!) {
  ServiceRequest(id: $id) {
    id status intent
    category { coding { system code display } }
    code { text coding { system code display } }
    bodySite {
      coding { system code display }
      text
      laterality: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-bodysite-laterality") {
        valueCode
      }
    }
    note { text }
    patientInstruction
    reasonCode { text }

    modality: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-imaging-modality") {
      valueCoding { system code display }
    }
    views: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-imaging-views") {
      valueString
    }
    contrast: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-imaging-contrast") {
      valueCode
    }
    confidence: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-confidence-score") {
      valueDecimal
    }
    turnRefs: extension(url: "https://dsp-fhir.org/StructureDefinition/dsp-transcript-turn-ref") {
      transcript: extension(url: "transcript") { valueReference { reference } }
      turn:       extension(url: "turn")       { valueInteger }
    }
  }
}

DSP reconstruction adapter

function toDspImagingOrder(s) {
  const body = s.bodySite?.[0];
  const turnRefs = s.turnRefs ?? [];
  return {
    id: s.id,
    type: 'IMAGING_ORDER',
    intent: s.intent,
    description: s.code?.text,
    order_data: {
      imaging_modality:            s.modality?.[0]?.valueCoding?.display,
      imaging_modality_code:       s.modality?.[0]?.valueCoding?.code,
      imaging_body_location:       body?.text ?? body?.coding?.[0]?.display,
      imaging_location_laterality: body?.laterality?.[0]?.valueCode,
      views:    s.views?.map(v => v.valueString).join(', '),
      contrast: s.contrast?.[0]?.valueCode,
      imaging_instructions: s.note?.map(n => n.text).join('\n'),
      patient_instructions: s.patientInstruction,
    },
    reason: s.reasonCode?.[0]?.text,
    confidence_score: s.confidence?.[0]?.valueDecimal,
    provenance:       turnRefs.map(t => t.turn?.valueInteger),
    transcript_ref:   turnRefs[0]?.transcript?.valueReference?.reference,
  };
}

No data loss. Modality, views, contrast and laterality are all preserved on structured dsp-imaging-* extensions — the original DSP free-text is recoverable.

SQL-on-FHIR v2 ViewDefinition that flattens every field above — including DSP extensions — into a tabular projection. Runnable as-is on any spec-conformant engine (Pathling, sof-exec, Aidbox SQL-on-FHIR, Databricks). See the SQL-on-FHIR v2 spec. These ViewDefinitions also ship as JSON in the IG zip.

`dsp_service_request_imaging` — DSP Imaging order (ServiceRequest)

Flattens DSP dsp imaging order (servicerequest) orders. Filtered by category=imaging.

{
  "resourceType": "ViewDefinition",
  "url": "https://dsp-fhir.org/ViewDefinition/dsp-service-request-imaging",
  "name": "dsp_service_request_imaging",
  "title": "DSP Imaging order (ServiceRequest)",
  "status": "draft",
  "description": "Flattens DSP dsp imaging order (servicerequest) orders. Filtered by category=imaging.",
  "resource": "ServiceRequest",
  "fhirVersion": [
    "4.0.1"
  ],
  "where": [
    {
      "path": "category.coding.where(code='imaging').exists()"
    }
  ],
  "select": [
    {
      "column": [
        {
          "name": "id",
          "path": "id",
          "type": "id",
          "description": "Server-assigned logical id."
        },
        {
          "name": "version_id",
          "path": "meta.versionId",
          "type": "id",
          "description": "FHIR version id (drives NEW/UPDATED classification)."
        },
        {
          "name": "last_updated",
          "path": "meta.lastUpdated",
          "type": "instant",
          "description": "Instant of last mutation."
        },
        {
          "name": "meta_source",
          "path": "meta.source",
          "type": "uri"
        },
        {
          "name": "payload_version",
          "path": "meta.tag.where(system='https://dsp-fhir.org/CodeSystem/payload-version').code.first()",
          "type": "code",
          "description": "DSP payload version this resource was last emitted under."
        },
        {
          "name": "confidence_score",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/confidence-score').value.ofType(decimal)",
          "type": "decimal",
          "description": "DSP confidence (0..1)."
        },
        {
          "name": "transcript_ref",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/transcript-turn-refs').extension('transcript').value.ofType(Reference).reference",
          "type": "string",
          "description": "DocumentReference/<id>/_history/<v> that pins the transcript version for turn indices."
        },
        {
          "name": "turn_indices",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/transcript-turn-refs').extension('turn').value.ofType(integer)",
          "type": "integer",
          "collection": true,
          "description": "Turn indices joined by $ground into transcript content."
        },
        {
          "name": "spoken_forms",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/spoken-forms').extension('form').value.ofType(string)",
          "type": "string",
          "collection": true
        },
        {
          "name": "search_terms",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/search-terms').extension('term').value.ofType(string)",
          "type": "string",
          "collection": true
        },
        {
          "name": "status",
          "path": "status",
          "type": "code"
        },
        {
          "name": "intent",
          "path": "intent",
          "type": "code"
        },
        {
          "name": "priority",
          "path": "priority",
          "type": "code"
        },
        {
          "name": "subject_patient_id",
          "path": "subject.reference.substring(8)",
          "type": "string"
        },
        {
          "name": "encounter_id",
          "path": "encounter.reference.substring(10)",
          "type": "string"
        },
        {
          "name": "authored_on",
          "path": "authoredOn",
          "type": "dateTime"
        },
        {
          "name": "requester_practitioner_id",
          "path": "requester.reference.where($this.startsWith('Practitioner/')).substring(13).first()",
          "type": "string"
        },
        {
          "name": "code_system",
          "path": "code.coding.system.first()",
          "type": "uri"
        },
        {
          "name": "code",
          "path": "code.coding.code.first()",
          "type": "code"
        },
        {
          "name": "code_display",
          "path": "code.coding.display.first()",
          "type": "string"
        },
        {
          "name": "code_text",
          "path": "code.text",
          "type": "string"
        },
        {
          "name": "reason_code_text",
          "path": "reasonCode.text.first()",
          "type": "string"
        },
        {
          "name": "reason_reference",
          "path": "reasonReference.reference.first()",
          "type": "string"
        },
        {
          "name": "body_site_code",
          "path": "bodySite.coding.code.first()",
          "type": "code"
        },
        {
          "name": "modality_code",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/dsp-imaging-modality').value.ofType(code)",
          "type": "code"
        },
        {
          "name": "contrast_used",
          "path": "extension('https://dsp-fhir.org/StructureDefinition/dsp-imaging-contrast').value.ofType(boolean)",
          "type": "boolean"
        },
        {
          "name": "laterality_code",
          "path": "bodySite.coding.where(system='http://snomed.info/sct').code.first()",
          "type": "code"
        }
      ]
    }
  ]
}

Imaging order

order.imaging

ServiceRequest (category=imaging)

Field-by-field

Side-by-side example

DSP

FHIR R4 (DSP-FHIR profile)

DSP → FHIR mapping

FHIR → DSP (canonical $graphql read)

Canonical query

DSP reconstruction adapter

dsp_service_request_imaging — DSP Imaging order (ServiceRequest)

`order.imaging`

`ServiceRequest (category=imaging)`

FHIR → DSP (canonical `$graphql` read)

`dsp_service_request_imaging` — DSP Imaging order (ServiceRequest)