Future versions of this document will likely include detailed requirements on what information has to be present in which section.

Sections and content

The document is subdivided in a set of required sections. Sections are required instead of optional to make it clear that when no data is present, why that is the case, which is expressed in composition.section.emptyReason.

Document structure

The Imaging Report holds the following sections:

Header

General information on the report. Most of the information elements in this part of the report overlap with other clinical reports. The document header includes information on the patient, source organization, author, attester and custodian of the report.

Imaging Study

Information on the studies that this report is reporting on. It includes such as the study identifiers, date and time the exam was done, the modalities used in the exam and the different series.

Order

The order section contains information on the orders that resulted in the studies and this report. It includes information such as the AccessionNumber, the identity of the referring physician or organization, the indication for examination, and, ideally, additional patient context and specific clinical questions provided by the referring physician. Clinical questions are sometimes of the form “Follow-up X”, where X is an existing known finding (perhaps from a previous exam), or “Rule out X”, where X is a condition for which imaging input is requested on whether or not it is present. Indications are also, hopefully, provided to provide important clinical context to the imaging clinician, and to support assessment of the appropriateness of the order and/or billing. If indications are not present, they are sometimes sought out by imaging staff.

Note: “Rule out X”, while somewhat helpful for the imaging clinician, can be problematic for billing since the symptoms that suggest the possible presence of the condition and establish the medical necessity of the imaging exam are implied, but not captured. Site practices increasingly deprecate such wording.

History

This section includes patient history and other prior clinical details deemed relevant to the imaging study by the imaging clinician. Some information may be provided by the referring physician in the order, and more is extracted from the medical record by imaging staff, automated tools, or by the radiologist themselves. This information provides background for the imaging clinician, context for the contents of the report, and is sometimes relevant to billing and clinical guidelines. Potential sources include impressions or summaries of the clinical notes from the encounter where the imaging order was placed.

Procedure

This section contains information such as the procedure type, the anatomy imaged, the date and time of the imaging examination, and the facility that performed it.

Also called Imaging technique, this section may describe the parameters that were used, details of any contrast media and/or radiopharmaceuticals administered, including concentration, volume, and route of administration, and any medications, and catheters or devices used.

The section can also describe preparation of the data produced by the procedure: Views, image sets, recons, reformats and post processing.

Radiation dose may also be described here; the text content and metrics may be constrained/formatted to meet local regulations.

The information in this section is typically more detailed than what is listed as the Order, and in fact may differ from the ordered exam based on the needs of the patient and the judgment of the imaging clinician.

Any deficiencies of the study may also be described here, such as whether the imaging was incomplete or if there were quality issues that prevented interpretation of some part of the study or otherwise compromise the sensitivity and specificity of the examination. In the event that a patient was unable to undergo imaging, for example due to claustrophobia or a seizure, a report might still be produced and this section would note that the exam was not performed and provide a reason.

While the actual instructions given to the patient are not typically listed in the report, some mention the fact that instructions were given, and perhaps that risks were discussed, and consent was obtained. Procedure notes from the technologist are typically captured elsewhere, but significant details such as adverse patient reactions, or things that may affect the quality of the study, may be included here.

Procedure details that may be required for billing are sometimes included here as well.

Comparison

This section is a list of other studies that were considered relevant by the imaging clinician. They are typically identified by type (modality, anatomy, exam type) and date. Findings from these studies and comparisons with the current study are typically woven into the next section (e.g. indicating no change, differentiating descriptions and/or measurements), although some of these studies may not be specifically mentioned in the findings. It is typically presumed that both the images and the report for each comparison study were available to the imaging clinician, however in some cases, such as for external priors, only the report or only the images were available, in which case that may be noted here.

Findings

This section provides a detailed description of the findings on the imaging examination. The findings should be described in a clear and concise manner, using standardized anatomic, pathologic, and radiologic terminology whenever possible.

When there are significant numbers of findings, the imaging clinician will typically organize them into groups, typically by anatomy. Reporting templates for particular procedure types (such as those at radreport.org) will also often organize the findings.

An important distinction between Findings and Impressions is that Findings capture what the imaging clinician saw in the image, while Impressions capture what they inferred/concluded. The findings might record a radiolucency, while the impression records a fracture. There are some cases where the two overlap, but generally imaging clinicians try to capture in the Findings what the significant image features are and strive in the Impressions to communicate to the referring physician what they think those represent in clinical terms.

Impression

Sometimes also called Conclusion or Diagnosis, provides the radiologist’s overall interpretation of the findings, a specific diagnosis and/or differential diagnosis (when possible), responses to any clinical questions posed by the referring physician, and any recommendations for further management and/or confirmation, as appropriate.

Recommendations most often cover subsequent diagnostic imaging or other diagnostic procedures such as biopsies or lab tests. They may also include suggestions to correlate the imaging result with other clinical information to improve the confidence of the diagnosis, referrals to specialists, or less commonly, therapeutic procedures. The recommendations may cite specific guidelines applied, particularly when the referring physician might be less familiar with the current guidelines for certain findings than the imaging clinician. The imaging clinician may take into account the expertise of the referring physician when composing recommendations; for an unusual cancer, a family physician might find follow-up recommendations more helpful than an oncology specialist would.

Since referring physicians may specifically focus their attention on this section, the imaging clinician may choose particularly important details such as key findings or any adverse events, to re-iterate and summarize here.

The order of items in the impression is often significant, in that imaging clinicians frequently put the most critical, most actionable, most significant items first in the impression section to minimize the chance of them being overlooked. In the case of differential diagnosis, the multiple possible diagnoses are typically presented in order from the most likely to the least likely. Impression items may also be numbered to facilitate verbal referencing or linking to communications.

Some items in the impression may be clinically significant but were not associated with the indications or reason for exam; for example, a lung nodule deemed to be suspicious on a chest exam for trauma. These are often referred to as “incidental findings”.

Some items in the impression may be critical, in that they represent the potential for severe negative clinical impact to the patient if appropriate action is not taken promptly. The presence of such items almost always results in a communication with care staff and/or the patient.

Recommendation

Some items in the impression may be considered actionable, in that some follow-up action or communication is advisable. The recommendations may or may not include a specific corresponding follow-up action. A corresponding communication to relevant persons may or may not have taken place during the reporting process and be noted in the report.

Communication

This is an optional section as it not anticipated that it is often required.

There is strong interest in tooling to facilitate communicating critical results clearly and rapidly with the appropriate people, confirming that follow-up of actionable findings takes place, and making sure that incidental findings do not “fall through the cracks”.

Communications are records in the report about attempted and/or successful communications of some content of the report to the referring physician, the patient, or other appropriate person. These communications are initiated during the generation of the DiagnosticReport by members of the organization fulfilling that order. E.g. direct communication of time critical results by the radiologist to the referring physician.

Communication is not listed as a separate section in the ACR guidance, but codes for a communication section do exist. It is common practice to present communication records at the bottom of the report, just below the impressions, since they are often driven by specific items in the impression and occur at the end of the report creation process. Such communication records support medico-legal usage and the review and improvement of conformance to best practices for patient safety and quality of care.

The communication entry typically records the date, time, and method of communication, the person/organization contacted, and may summarize the content communicated.

• Key Elements Table
• Differential Table
• Snapshot Table
• Statistics/References
• All

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	CompositionEu	Imaging Report composition
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
extension:versionNumber		0..*	string	Version-specific identifier for composition URL: http://hl7.org/fhir/StructureDefinition/composition-clinicaldocument-versionNumber
extension:basedOn		0..*	Reference(Resource)	Fulfills plan, proposal or order URL: http://hl7.org/fhir/StructureDefinition/event-basedOn
extension:informationRecipient		0..*	Reference(Practitioner | Device | Patient | RelatedPerson | PractitionerRole | Organization)	Composition: Information recipient URL: http://hl7.eu/fhir/StructureDefinition/information-recipient
extension:diagnosticreport-reference		1..1	Reference(Imaging Diagnostic Report)	Document DiagnosticReport Reference URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-composition-diagnosticReportReference
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
status	?!Σ	1..1	code	preliminary | final | amended | entered-in-error Binding: CompositionStatus (required): The workflow/clinical status of the composition.
type	Σ	1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: HL7 EU Imaging Report Types (extensible)
Slices for coding	Σ	1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:eu-template	Σ	1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r4/CodeSystem/Hl7EuDocumentTypes
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: imaging-report-v0-0-1
display		1..1	string	Representation defined by the system Fixed Value: Imaging Report V0.0.1
userSelected		0..1	boolean	If this coding was chosen directly by the user
Slices for category	Σ	1..*	CodeableConcept	Categorization of Composition Slice: Unordered, Open by value:$this Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level.
category:imaging	Σ	1..1	CodeableConcept	Categorization of Composition Binding: DocumentClassValueSet (example): High-level kind of a clinical document at a macro level. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
coding	Σ	1..1	Coding	Code defined by a terminology system
date	Σ	1..1	dateTime	Composition editing time
Slices for author	Σ	1..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the composition Slice: Unordered, Open by profile:$this
author:author	Σ	0..*	Reference(PractitionerRole (EU base))	Who and/or what authored the composition
author:authoringDevice	Σ	0..*	Reference(Device)	Who and/or what authored the composition
title	Σ	1..1	string	Human Readable name/title
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode
attester:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition.
attester:legalAuthenticator		0..*	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: legal
time		1..1	dateTime	When the composition was attested
party		0..1	Reference(PractitionerRole (EU base))	Who attested the composition
attester:resultValidator		0..*	BackboneElement	Attests to accuracy of composition
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
mode		1..1	code	personal | professional | legal | official Binding: CompositionAttestationMode (required): The way in which a person authenticated a composition. Required Pattern: professional
time		1..1	dateTime	When the composition was attested
party		0..1	Reference(PractitionerRole (EU base))	Who attested the composition
custodian	Σ	0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
Slices for event	Σ	2..*	BackboneElement	The clinical service(s) being documented Slice: Unordered, Open by value:detail.concept
event:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
event:imagingstudy	Σ	1..*	BackboneElement	Modality
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	Σ	1..*	Reference(Resource)	The event(s) being documented
Slices for extension				Content/Rules for all slices
extension:detailext		0..*	(Complex)	The event(s) being documented, as code(s), reference(s), or both URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail
Slices for extension				Content/Rules for all slices
extension:_datatype		0..1	(Complex)	Data type name for Composition.event.detail from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
extension:concept		0..1	Extension	Extension
extension		0..0
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html (extensible)
extension:reference		0..1	Extension	Extension
extension		0..0
url		1..1	uri	"reference"
value[x]		0..1	Reference(IM Imaging Study)	Reference to a resource (by instance)
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail"
event:procedure	Σ	1..*	BackboneElement	Study Type
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
detail	Σ	1..*	Reference(Resource)	The event(s) being documented
Slices for extension				Content/Rules for all slices
extension:detailext		0..*	(Complex)	The event(s) being documented, as code(s), reference(s), or both URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail
Slices for extension				Content/Rules for all slices
extension:_datatype		0..1	(Complex)	Data type name for Composition.event.detail from FHIR R5 URL: http://hl7.org/fhir/StructureDefinition/_datatype
url		1..1	uri	"http://hl7.org/fhir/StructureDefinition/_datatype"
value[x]		1..1	string	Value of extension Fixed Value: CodeableReference
extension:concept		0..1	Extension	Extension
extension		0..0
url		1..1	uri	"concept"
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: https://www.hl7.org/fhir/valueset-procedure-reason.html (extensible)
extension:reference		0..1	Extension	Extension
extension		0..0
url		1..1	uri	"reference"
value[x]		0..1	Reference(IM Imaging Procedure)	Reference to a resource (by instance)
url		1..1	uri	"http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail"
Slices for section	C	8..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code Constraints: cmp-1, cmp-2, eu-imaging-composition-1
section:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document.
emptyReason	C	0..1	CodeableConcept	Why the section is empty Binding: Reasons a section in an imaging report is empty. (preferred)
section:imagingstudy	C	1..1	BackboneElement	Imaging Study Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18726-0
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:imagingstudy	C	1..*	Reference(IM Imaging Study)	Imaging Study Reference
section:order	C	1..1	BackboneElement	Order Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55115-0
display		1..1	string	Representation defined by the system Fixed Value: Requested imaging studies information Document
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:order	C	0..*	Reference(IM Imaging Order)	Order reference
section:history	C	1..1	BackboneElement	History Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11329-0
display		1..1	string	Representation defined by the system Fixed Value: History general Narrative - Reported
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
section:procedure	C	1..1	BackboneElement	Procedure Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55111-9
display		1..1	string	Representation defined by the system Fixed Value: Current imaging procedure descriptions Document
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:procedure	C	0..*	Reference(IM Imaging Procedure)	A reference to data that supports this section
section:comparison	C	1..1	BackboneElement	History Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18834-2
display		1..1	string	Representation defined by the system Fixed Value: Radiology Comparison study (narrative)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:comparedstudy	C	0..*	Reference(IM Imaging Study | Imaging Selection profile for R4)	A reference to data that supports this section
section:findings	C	1..1	BackboneElement	Findings Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 59776-5
display		1..1	string	Representation defined by the system Fixed Value: Findings
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:finding	C	0..*	Reference(Finding)	A reference to data that supports this section
entry:keyimage	C	0..*	Reference(Imaging Key Image Document Reference | Key images represented as an ImagingSelection for R4)	A reference to data that supports this section
section:impression	C	1..1	BackboneElement	Impressions Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 19005-8
display		1..1	string	Representation defined by the system Fixed Value: Radiology Imaging study [Impression] (narrative)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:finding	C	0..*	Reference(Finding)	A reference to data that supports this section
entry:impression	C	0..*	Reference(EU Condition)	A reference to data that supports this section
entry:keyimage	C	0..*	Reference(Imaging Key Image Document Reference | Key images represented as an ImagingSelection for R4)	A reference to data that supports this section
section:recommendation	C	1..1	BackboneElement	Recommendations Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18783-1
display		1..1	string	Representation defined by the system Fixed Value: Radiology Study recommendation (narrative)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Slices for entry	C	0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:careplan	C	0..*	Reference(EU CarePlan)	A reference to data that supports this section
section:communication	C	0..1	BackboneElement	Communications Constraints: cmp-1, cmp-2
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
code		1..1	CodeableConcept	Classification of section (recommended) Binding: DocumentSectionCodes (example): Classification of a section of a composition/document. Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18783-1
display		1..1	string	Representation defined by the system Fixed Value: Radiology Study recommendation (narrative)
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Composition.status	required	CompositionStatus http://hl7.org/fhir/ValueSet/composition-status|4.0.1 From the FHIR Standard
Composition.type	extensible	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r4/ValueSet/ImImagingReportTypesEuVS From this IG
Composition.category	example	DocumentClassValueSet http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
Composition.category:imaging	example	Pattern Value: LOINC Code 18748-4("Diagnostic imaging study") http://hl7.org/fhir/ValueSet/document-classcodes From the FHIR Standard
Composition.attester.mode	required	CompositionAttestationMode http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.attester:legalAuthenticator.mode	required	Pattern Value: legal http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.attester:resultValidator.mode	required	Pattern Value: professional http://hl7.org/fhir/ValueSet/composition-attestation-mode|4.0.1 From the FHIR Standard
Composition.event:imagingstudy.detail.extension:detailext.extension:concept.value[x]	extensible	https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
Composition.event:procedure.detail.extension:detailext.extension:concept.value[x]	extensible	https://www.hl7.org/fhir/valueset-procedure-reason.html https://www.hl7.org/fhir/valueset-procedure-reason.html
Composition.section.code	example	DocumentSectionCodes http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section.emptyReason	preferred	ImSectionEmptyReason http://hl7.eu/fhir/imaging-r4/ValueSet/ImSectionEmptyReason From this IG
Composition.section:imagingstudy.code	example	Pattern Value: LOINC Code 18726-0 http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:order.code	example	Pattern Value: LOINC Code 55115-0("Requested imaging studies information Document") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:history.code	example	Pattern Value: LOINC Code 11329-0("History general Narrative - Reported") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:procedure.code	example	Pattern Value: LOINC Code 55111-9("Current imaging procedure descriptions Document") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:comparison.code	example	Pattern Value: LOINC Code 18834-2("Radiology Comparison study (narrative)") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:findings.code	example	Pattern Value: LOINC Code 59776-5("Findings") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:impression.code	example	Pattern Value: LOINC Code 19005-8("Radiology Imaging study [Impression] (narrative)") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:recommendation.code	example	Pattern Value: LOINC Code 18783-1("Radiology Study recommendation (narrative)") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard
Composition.section:communication.code	example	Pattern Value: LOINC Code 18783-1("Radiology Study recommendation (narrative)") http://hl7.org/fhir/ValueSet/doc-section-codes From the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
cmp-1	error	Composition.section, Composition.section:imagingstudy, Composition.section:order, Composition.section:history, Composition.section:procedure, Composition.section:comparison, Composition.section:findings, Composition.section:impression, Composition.section:recommendation, Composition.section:communication	A section must contain at least one of text, entries, or sub-sections : text.exists() or entry.exists() or section.exists()
cmp-2	error	Composition.section, Composition.section:imagingstudy, Composition.section:order, Composition.section:history, Composition.section:procedure, Composition.section:comparison, Composition.section:findings, Composition.section:impression, Composition.section:recommendation, Composition.section:communication	A section can only have an emptyReason if it is empty : emptyReason.empty() or entry.empty()
dom-2	error	Composition	If the resource is contained in another resource, it SHALL NOT contain nested Resources : contained.contained.empty()
dom-3	error	Composition	If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource : contained.where((('#'+id in (%resource.descendants().reference | %resource.descendants().as(canonical) | %resource.descendants().as(uri) | %resource.descendants().as(url))) or descendants().where(reference = '#').exists() or descendants().where(as(canonical) = '#').exists() or descendants().where(as(canonical) = '#').exists()).not()).trace('unmatched', id).empty()
dom-4	error	Composition	If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated : contained.meta.versionId.empty() and contained.meta.lastUpdated.empty()
dom-5	error	Composition	If a resource is contained in another resource, it SHALL NOT have a security label : contained.meta.security.empty()
dom-6	best practice	Composition	A resource should have narrative for robust management : text.`div`.exists()
ele-1	error	**ALL** elements	All FHIR elements must have a @value or children : hasValue() or (children().count() > id.count())
eu-imaging-composition-1	error	Composition.section	When a section is empty, the emptyReason extension SHALL be present. : entry.empty() and emptyReason.exists()
ext-1	error	**ALL** extensions	Must have either extensions or value[x], not both : extension.exists() != value.exists()

This structure is derived from CompositionEu

Name	Flags	Card.	Type	Description & Constraints    Filter: Bindings Constraints Obligations
Composition		0..*	CompositionEu	Imaging Report composition
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:diagnosticreport-reference		1..1	Reference(Imaging Diagnostic Report)	Document DiagnosticReport Reference URL: http://hl7.eu/fhir/imaging-r4/StructureDefinition/im-composition-diagnosticReportReference
identifier
extension		1..*	Extension	Extension
Slices for extension				Content/Rules for all slices
extension:identifier		1..*	base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta	Optional Extensions Element URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.identifier
type		1..1	CodeableConcept	Kind of composition (LOINC if possible) Binding: HL7 EU Imaging Report Types (extensible)
Slices for coding		1..*	Coding	Code defined by a terminology system Slice: Unordered, Open by value:$this
coding:eu-template		1..1	Coding	Code defined by a terminology system Required Pattern: At least the following
system		1..1	uri	Identity of the terminology system Fixed Value: http://hl7.eu/fhir/imaging-r4/CodeSystem/Hl7EuDocumentTypes
code		1..1	code	Symbol in syntax defined by the system Fixed Value: imaging-report-v0-0-1
display		1..1	string	Representation defined by the system Fixed Value: Imaging Report V0.0.1
Slices for category				Content/Rules for all slices
category:imaging		1..1	CodeableConcept	Categorization of Composition Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18748-4
display		1..1	string	Representation defined by the system Fixed Value: Diagnostic imaging study
coding		1..1	Coding	Code defined by a terminology system
Slices for author		1..*	Reference(Practitioner | PractitionerRole | Device | Patient | RelatedPerson | Organization)	Who and/or what authored the composition Slice: Unordered, Open by profile:$this
author:author		0..*	Reference(PractitionerRole (EU base))	Who and/or what authored the composition
author:authoringDevice		0..*	Reference(Device)	Who and/or what authored the composition
Slices for attester		0..*	BackboneElement	Attests to accuracy of composition Slice: Unordered, Open by value:mode
attester:legalAuthenticator		0..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal | professional | legal | official Required Pattern: legal
time		1..1	dateTime	When the composition was attested
party		0..1	Reference(PractitionerRole (EU base))	Who attested the composition
attester:resultValidator		0..*	BackboneElement	Attests to accuracy of composition
mode		1..1	code	personal | professional | legal | official Required Pattern: professional
time		1..1	dateTime	When the composition was attested
party		0..1	Reference(PractitionerRole (EU base))	Who attested the composition
custodian		0..1	Reference(Organization (EU base))	Organization that manages the Imaging Report
Slices for event		2..*	BackboneElement	The clinical service(s) being documented Slice: Unordered, Open by value:detail.concept
event:All Slices				Content/Rules for all slices
detail
Slices for extension				Content/Rules for all slices
extension:detailext		0..*	base64Binary, boolean, canonical(), code, date, dateTime, decimal, id, instant, integer, markdown, oid, positiveInt, string, time, unsignedInt, uri, url, uuid, Address, Age, Annotation, Attachment, CodeableConcept, Coding, ContactPoint, Count, Distance, Duration, HumanName, Identifier, Money, Period, Quantity, Range, Ratio, Reference(), SampledData, Signature, Timing, ContactDetail, Contributor, DataRequirement, Expression, ParameterDefinition, RelatedArtifact, TriggerDefinition, UsageContext, Dosage, Meta	The event(s) being documented, as code(s), reference(s), or both URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail
event:imagingstudy		1..*	BackboneElement	Modality
detail		1..*	Reference(Resource)	The event(s) being documented
Slices for extension				Content/Rules for all slices
extension:detailext		0..*	(Complex)	The event(s) being documented, as code(s), reference(s), or both URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail
Slices for extension				Content/Rules for all slices
extension:concept		0..1	Extension	Extension
extension		0..0
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html (extensible)
extension:reference		0..1	Extension	Extension
extension		0..0
value[x]		0..1	Reference(IM Imaging Study)	Reference to a resource (by instance)
value[x]		0..0
event:procedure		1..*	BackboneElement	Study Type
detail		1..*	Reference(Resource)	The event(s) being documented
Slices for extension				Content/Rules for all slices
extension:detailext		0..*	(Complex)	The event(s) being documented, as code(s), reference(s), or both URL: http://hl7.org/fhir/5.0/StructureDefinition/extension-Composition.event.detail
Slices for extension				Content/Rules for all slices
extension:concept		0..1	Extension	Extension
extension		0..0
value[x]		0..1	CodeableConcept	Reference to a concept (by class) Binding: https://www.hl7.org/fhir/valueset-procedure-reason.html (extensible)
extension:reference		0..1	Extension	Extension
extension		0..0
value[x]		0..1	Reference(IM Imaging Procedure)	Reference to a resource (by instance)
value[x]		0..0
Slices for section	C	8..*	BackboneElement	Composition is broken into sections Slice: Unordered, Open by value:code Constraints: eu-imaging-composition-1
section:All Slices				Content/Rules for all slices
code		1..1	CodeableConcept	Classification of section (recommended)
emptyReason		0..1	CodeableConcept	Why the section is empty Binding: Reasons a section in an imaging report is empty. (preferred)
section:imagingstudy		1..1	BackboneElement	Imaging Study
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18726-0
Slices for entry		1..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:imagingstudy		1..*	Reference(IM Imaging Study)	Imaging Study Reference
section:order		1..1	BackboneElement	Order
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55115-0
display		1..1	string	Representation defined by the system Fixed Value: Requested imaging studies information Document
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:order		0..*	Reference(IM Imaging Order)	Order reference
section:history		1..1	BackboneElement	History
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 11329-0
display		1..1	string	Representation defined by the system Fixed Value: History general Narrative - Reported
section:procedure		1..1	BackboneElement	Procedure
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 55111-9
display		1..1	string	Representation defined by the system Fixed Value: Current imaging procedure descriptions Document
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:procedure		0..*	Reference(IM Imaging Procedure)	A reference to data that supports this section
section:comparison		1..1	BackboneElement	History
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18834-2
display		1..1	string	Representation defined by the system Fixed Value: Radiology Comparison study (narrative)
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:comparedstudy		0..*	Reference(IM Imaging Study | Imaging Selection profile for R4)	A reference to data that supports this section
section:findings		1..1	BackboneElement	Findings
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 59776-5
display		1..1	string	Representation defined by the system Fixed Value: Findings
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:finding		0..*	Reference(Finding)	A reference to data that supports this section
entry:keyimage		0..*	Reference(Imaging Key Image Document Reference | Key images represented as an ImagingSelection for R4)	A reference to data that supports this section
section:impression		1..1	BackboneElement	Impressions
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 19005-8
display		1..1	string	Representation defined by the system Fixed Value: Radiology Imaging study [Impression] (narrative)
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:finding		0..*	Reference(Finding)	A reference to data that supports this section
entry:impression		0..*	Reference(EU Condition)	A reference to data that supports this section
entry:keyimage		0..*	Reference(Imaging Key Image Document Reference | Key images represented as an ImagingSelection for R4)	A reference to data that supports this section
section:recommendation		1..1	BackboneElement	Recommendations
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18783-1
display		1..1	string	Representation defined by the system Fixed Value: Radiology Study recommendation (narrative)
Slices for entry		0..*	Reference(Resource)	A reference to data that supports this section Slice: Unordered, Open by profile:$this
entry:careplan		0..*	Reference(EU CarePlan)	A reference to data that supports this section
section:communication		0..1	BackboneElement	Communications
Slices for extension		0..*	Extension	Extension Slice: Unordered, Open by value:url
extension:note		0..*	Annotation	Additional notes that apply to this resource or element. URL: http://hl7.org/fhir/StructureDefinition/note
code		1..1	CodeableConcept	Classification of section (recommended) Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://loinc.org
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 18783-1
display		1..1	string	Representation defined by the system Fixed Value: Radiology Study recommendation (narrative)
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Composition.type	extensible	ImImagingReportTypesEuVS http://hl7.eu/fhir/imaging-r4/ValueSet/ImImagingReportTypesEuVS From this IG
Composition.event:imagingstudy.detail.extension:detailext.extension:concept.value[x]	extensible	https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html https://dicom.nema.org/medical/dicom/current/output/chtml/part16/sect_CID_33.html
Composition.event:procedure.detail.extension:detailext.extension:concept.value[x]	extensible	https://www.hl7.org/fhir/valueset-procedure-reason.html https://www.hl7.org/fhir/valueset-procedure-reason.html
Composition.section.emptyReason	preferred	ImSectionEmptyReason http://hl7.eu/fhir/imaging-r4/ValueSet/ImSectionEmptyReason From this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
eu-imaging-composition-1	error	Composition.section	When a section is empty, the emptyReason extension SHALL be present. : entry.empty() and emptyReason.exists()