9.1. Inbound

9.1.1. Inbound Messages

9.1.1.1. ORU - Unsolicited Observation Result Message (Event R01)

Supported HL7 version: 2.3.1 (RAD-28), 2.5.1 (RAD-128)

9.1.1.1.1. Trigger Event

When DICOM Structured Reports are verified and finalized by the Report Manager, the Report Manager sends unsolicited ORU transactions to the Image Manager. Image Manager creates/updates the study with the referenced Structured Report in the HL7 message.

9.1.1.1.2. Supported Segments

The following segments are processed from an incoming ORU^R01^ORU_R01 message:

Table 9.1 Supported segments of ORU^R01^ORU_R01 (HL7 versions 2.3.1)

Segment	Meaning	HL7 Chapter
MSH - MSH - Message Header segment (HL7 v2.3.1)	Message Header	2
PID - PID - Patient Identification segment (HL7 v2.3.1)	Patient Identification	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.3.1)	Notes and Comments (for PID)	2
PV1 - Patient Visit segment (HL7 v2.3.1)	Patient Visit	3
OBR - OBR - Observation Request segment (HL7 v2.3.1)	Order Detail	4
OBX - OBX - Observation/Result segment (HL7 v2.3.1)	Observation Results	7

Table 9.2 Supported segments of ORU^R01^ORU_R01 (HL7 v2.5.1)

Segment	Meaning	Usage	Card.	HL7 chapter
MSH - MSH - Message Header segment (HL7 v2.5.1)	Message Header	R	[1..1]	2
PID - PID - Patient Identification segment (HL7 v2.5.1)	Patient Identification	R	[1..1]	3
NTE - NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)	Notes and Comments (for PID)	O	[0..1]	2
PV1 - Patient Visit segment (HL7 v2.5.1)	Patient Visit	O	[0..1]	3
OBR - OBR - Observation Request segment (HL7 v2.5.1)	Order Detail	R	[1..*]	4
OBX - OBX - Observation/Result segment (HL7 v2.5.1)	Order Detail	R	[1..*]	4

9.1.1.1.3. Performed Actions

Patient Demographic Information are extracted from the PID segment of the received message and mapped into corresponding DICOM attributes as defined in HL7 ADT mapping of PID segment to DICOM Patient Attributes. If a Patient record with the extracted primary Patient ID already exists in the database, that Patient record will get updated. If there is no such Patient record a new Patient record will be inserted into the database [1]. Based on the information received in the OBR and OBX segments, a SR / PDF / CDA object is stored to the study.

[1]

The creation of new Patient records will be suppressed for message types which are listed by configuration parameter HL7 No Patient Create Message Type(s) of dcm4che DICOM Archive 5.

9.1.2. Inbound Message Segments

9.1.2.1. MSH - Message Header segment

Same as specified in MSH - Message Header segment (HL7 v2.3.1) or MSH - Message Header segment (HL7 v2.5.1)

9.1.2.2. PID - Patient Identification segment

Same as specified in PID - Patient Identification segment (HL7 v2.3.1) or PID - Patient Identification segment (HL7 v2.5.1)

9.1.2.3. NTE - Notes and Comments segment (for PID)

Same as specified in NTE - Notes and Comments segment (for PID) (HL7 v2.3.1) or NTE - Notes and Comments segment (for PID) (HL7 v2.5.1)

9.1.2.4. PV1 - Patient Visit segment

Same as specified in Patient Visit segment (HL7 v2.3.1) or Patient Visit segment (HL7 v2.5.1)

9.1.2.5. OBR - Observation Request segment

Table 9.3 OBR - Observation Request segment (HL7 v2.3.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00237	SetID - OBR
2	75	EI	R		00216	Placer Order Number
3	75	EI	O		00217	Filler Order Number
4	200	CE	R		00238	Universal Service ID
5	2	ID	O		00239	Priority
6	26	TS	O		00240	Requested Date/Time
7	26	TS	O		00241	Observation Date/Time
8	26	TS	O		00242	Observation End Date/Time
9	20	CQ	O		00243	Collection Volume
10	60	XCN	O		00244	Collection Identifier
11	1	ID	O	0065	00245	Specimen Action Code
12	60	CE	R2		00246	Danger Code
13	300	ST	C		00247	Relevant Clinical Info
14	26	TS	O		00248	Specimen Received Date/Time
15	300	CM	C	0070	00249	Specimen Source
16	80	XCN	R		00226	Ordering Provider
17	40	XTN	O		00250	Order Callback Phone Number
18	60	ST	O		00251	Placer Field 1
19	60	ST	O		00252	Placer Field 2
20	60	ST	O		00253	Filler Field 1
21	60	ST	O		00254	Filler Field 2
22	26	TS	O		00255	Results Rpt/Status Chng - Date/Time
23	40	CM	O		00256	Charge to Practice
24	10	ID	O	0074	00257	Diagnostic Service Sect ID
25	1	ID	O	0123	00258	Result Status
26	400	CM	O		00259	Parent Result
27	200	TQ	R		00221	Quantity/Timing
28	150	XCN	O		00260	Result Copies To
29	150	CM	C		00261	Parent
30	20	ID	R2	0124	00262	Transportation Mode
31	300	CE	R2		00263	Reason For Study
32	200	CM	O		00264	Principal Result Interpreter
33	200	CM	O		00265	Assistant Result Interpreter
34	200	CM	O		00266	Technician
35	200	CM	O		00267	Transcriptionist
36	26	TS	O		00268	Scheduled Date/Time
37	4	NM	O		01028	Number of Sample Containers
38	60	CE	O		01029	Transport Logistics of Collected Sample
39	200	CE	O		01030	Collector’s Comment
40	60	CE	O		01031	Transport Arrangement Responsibility
41	30	ID	R2	0224	01032	Transport Arranged
42	1	ID	O	0225	01033	Escort Required
43	200	CE	O		01034	Planned Patient Transport Comment
44	80	CE	O	0088	00393	Procedure Code
45	80	CE	O	0340	01036	Procedure Code Modifier

Table 9.4 OBR - Observation Request segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00237	SetID - OBR
2	22	EI	R		00216	Placer Order Number
3	22	EI	O		00217	Filler Order Number
4	250	CE	R		00238	Universal Service ID
5	2	ID	O		00239	Priority
6	26	TS	O		00240	Requested Date/Time
7	26	TS	O		00241	Observation Date/Time
8	26	TS	O		00242	Observation End Date/Time
9	20	CQ	O		00243	Collection Volume
10	250	XCN	O		00244	Collection Identifier
11	1	ID	O	0065	00245	Specimen Action Code
12	250	CE	R2		00246	Danger Code
13	300	ST	C		00247	Relevant Clinical Info
14	26	TS	X		00248	Specimen Received Date/Time
15	300	SPS	X	0070	00249	Specimen Source
16	250	XCN	R		00226	Ordering Provider
17	250	XTN	O		00250	Order Callback Phone Number
18	60	ST	O		00251	Placer Field 1
19	60	ST	O		00252	Placer Field 2
20	60	ST	O		00253	Filler Field 1
21	60	ST	O		00254	Filler Field 2
22	26	TS	O		00255	Results Rpt/Status Chng - Date/Time
23	40	MOC	O		00256	Charge to Practice
24	10	ID	O	0074	00257	Diagnostic Service Sect ID
25	1	ID	O	0123	00258	Result Status
26	400	PRL	O		00259	Parent Result
27	200	TQ	X		00221	Quantity/Timing
28	250	XCN	O		00260	Result Copies To
29	200	EIP	C		00261	Parent
30	20	ID	R2	0124	00262	Transportation Mode
31	250	CE	R2		00263	Reason For Study
32	200	NDL	O		00264	Principal Result Interpreter
33	200	NDL	O		00265	Assistant Result Interpreter
34	200	NDL	O		00266	Technician
35	200	NDL	O		00267	Transcriptionist
36	26	TS	O		00268	Scheduled Date/Time
37	4	NM	O		01028	Number of Sample Containers
38	250	CE	O		01029	Transport Logistics of Collected Sample
39	250	CE	O		01030	Collector’s Comment
40	250	CE	O		01031	Transport Arrangement Responsibility
41	30	ID	R2	0224	01032	Transport Arranged
42	1	ID	O	0225	01033	Escort Required
43	250	CE	O		01034	Planned Patient Transport Comment
44	250	CE	O	0088	00393	Procedure Code
45	250	CE	O	0340	01036	Procedure Code Modifier
46	250	CE	R2	0411	01474	Placer Supplemental Service Information
47	250	CE	R2	0411	01475	Filler Supplemental Service Information
48	250	CWE	R2	0476	01646	Medically Necessary Duplicate Procedure Reason
49	2	IS	O	0507	01647	Result Handling
50	250	CWE	O		02286	Parent Universal Service Identifier

9.1.2.6. OBX - Observation Request segment

Table 9.5 OBX - Observation/Result segment (HL7 v2.3.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00569	SetID - OBX
2	3	ID	C	0125	00570	Value Type
3	80	CE	R		00571	Observation Identifier
4	20	ST	C		00572	Observation Sub-ID
5	65536³		C		00573	Observation Value
6	60	CE	O		00574	Units
7	60	ST	O		00575	References Range
8	5	ID	O	0078	00576	Abnormal Flags
9	5	NM	O		00577	Probability
10	2	ID	O	0080	00578	Nature of Abnormal Test
11	1	ID	R	0085	00579	Observation Result Status
12	26	TS	O		00580	Date Last Obs Normal Values
13	20	ST	O		00581	User Defined Access Checks
14	26	TS	O		00582	Date/Time of the Observation
15	60	CE	O		00583	Producer’s ID
16	80	XCN	O		00584	Responsible Observer
17	60	CE	O		00936	Observation Method

Table 9.6 OBX - Observation/Result segment (HL7 v2.5.1)

SEQ	LEN	DT	OPT	TBL#	ITEM #	Element Name
1	4	SI	O		00569	SetID - OBX
2	2	ID	C	0125	00570	Value Type
3	250	CE	R		00571	Observation Identifier
4	20	ST	C		00572	Observation Sub-ID
5	99999	Varies	C		00573	Observation Value
6	250	CE	O		00574	Units
7	60	ST	O		00575	References Range
8	5	IS	O	0078	00576	Abnormal Flags
9	5	NM	O		00577	Probability
10	2	ID	O	0080	00578	Nature of Abnormal Test
11	1	ID	R	0085	00579	Observation Result Status
12	26	TS	O		00580	Effective Date of Reference Range
13	20	ST	O		00581	User Defined Access Checks
14	26	TS	O		00582	Date/Time of the Observation
15	250	CE	O		00583	Producer’s ID
16	250	XCN	O		00584	Responsible Observer
17	250	CE	O		00936	Observation Method
18	22	EI	O		01479	Equipment Instance Identifier
19	26	TS	O		01480	Date/Time of Analysis
20	0	ST	X			Reserved for harmonization with V2.6
21	0	ST	X			Reserved for harmonization with V2.6
22	0	ST	X			Reserved for harmonization with V2.6
23	567	XON	O			Performing Organization Name
24	631	XAD	O			Performing Organization Address
25	3002	XCN	O			Performing Organization Medical Director

Element names in bold indicates that the field is used by dcm4che DICOM Archive 5.

9.1.3. HL7 ORU to DICOM Mapping

Mappings between HL7 and DICOM are illustrated in the following manner:

• Element Name (HL7 item_number.component.sub-component #/ DICOM (group, element))

• The component / sub-component value is not listed if the HL7 element does not contain multiple components / sub-components.

9.1.3.1. HL7 ORU Text Report to DICOM SR Mapping (RAD-28)

Inverse of the mapping specified by IHE Transaction Structured Report Export [RAD-28] has been used.

9.1.3.1.1. Mapping of HL7 ORU Text Report to DICOM SR Attributes

Table 9.7 HL7 ORU Text Report to DICOM Structured Report Attributes mapping

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Notes/Default values
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[10]
Patient Identification
Same as Patient Identification in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Demographic
Same as Patient Demographic in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Visit
Same as Visit Identification in HL7 order mapping to DICOM Modality Worklist Attributes for (HL7 v2.3.1 and v2.5.1)
Patient Medical
Pregnancy Status	(0010, 21C0)	Ambulatory Status	00145	PV1:15	[19]
Structured Report
Content Date	(0008, 0023)	Observation Date/Time	00241	OBR:7
Content Time	(0008, 0033)	Observation Date/Time	00241	OBR:7
Accession Number	(0008, 0050)	Placer field 1	00251	OBR:18
SOP Class UID	(0008, 0016)				1.2.840.10008.5.1.4.1.1.88.11
Request Attributes Sequence	(0040, 0275)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Modality	(0008, 0060)				SR
Institution Name	(0008, 0080)	Performing Organization Name or Sending Facility		OBX:23 or MSH:4	[17]
SOP Instance UID	(0008, 0018)			OBX[1]:5	[7]
Study Instance UID	(0020, 000D)			OBX[2]:5	[5]
Series Instance UID	(0020, 000E)			OBX[3]:5	[6]
Instance Number	(0020, 0013)				1
Value Type	(0040, A040)				CONTAINER
Continuity Of Content	(0040, A050)				SEPARATE
Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				11528-7
>>Code Scheme Designator	(0008, 0102)				LN
>>Code Meaning	(0008, 0104)				Radiology Report
Verifying Observer Sequence	(0040, A073)
>Verifying Organization	(0040, A027)				Default Value : Verifying Organization
>Verifying Observer Name	(0040, A075)	Principal Result Interpreter	00264	OBR:32.1	[9]
>Verification DateTime	(0040, A030)	Observation Date/Time	00241	OBR:7
Referenced Request Sequence	(0040, A370)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Completion Flag	(0040, A491)	Result Status	00258	OBR:25	[2]
Verification Flag	(0040, A493)	Result Status	00258	OBR:25	[3]
Content Sequence	(0040, A730)				[4]
Item 1
>Relationship Type	(0040, A010)				HAS CONCEPT MOD
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121049
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Language of Content Item and Descendants
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)				eng
>>Code Scheme Designator	(0008, 0102)				ISO639_2
>>Code Meaning	(0008, 0104)				English
Item 2
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				PNAME
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121008
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Person Observer Name
>Person Name	(0040, A123)	Principal Result Interpreter	00264	OBR:32.1
Item 3
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121023
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Procedure Code
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
Item 4
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121060
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				History
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT
>>Concept Name Code Sequence	(0040, A043)
>>>Code Value	(0008, 0100)				121060
>>>Code Scheme Designator	(0008, 0102)				DCM
>>>Code Meaning	(0008, 0104)				History
>>Text Value	(0040, A160)			OBX:3/component=’SR Text’
Item 5
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121070
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Findings
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT
>>Concept Name Code Sequence	(0040, A043)
>>>Code Value	(0008, 0100)				121071
>>>Code Scheme Designator	(0008, 0102)				DCM
>>>Code Meaning	(0008, 0104)				Finding
>>Text Value	(0040, A160)			OBX:3/component=’SR Text’
Item 6
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121076
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Conclusions
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT
>>Concept Name Code Sequence	(0040, A043)
>>>Code Value	(0008, 0100)				121077
>>>Code Scheme Designator	(0008, 0102)				DCM
>>>Code Meaning	(0008, 0104)				Conclusion
>>Text Value	(0040, A160)			OBX:3/component=’SR Text’

9.1.3.2. HL7 ORU Report to DICOM Mapping (RAD-128)

Inverse of the mapping specified by IHE Transaction Send Imaging Result [RAD-128] has been used.

9.1.3.2.1. Mapping of HL7 ORU Text Report to DICOM SR Attributes

Table 9.8 HL7 ORU Text Report to DICOM Structured Report Attributes mapping

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Notes/Default values
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[10]
Patient Identification
Same as Patient Identification in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Demographic
Same as Patient Demographic in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Visit
Same as Visit Identification in HL7 order mapping to DICOM Modality Worklist Attributes for (HL7 v2.3.1 and v2.5.1)
Patient Medical
Pregnancy Status	(0010, 21C0)	Ambulatory Status	00145	PV1:15	[19]
Structured Report
Content Date	(0008, 0023)	Observation Date/Time	00241	OBR:7
Content Time	(0008, 0033)	Observation Date/Time	00241	OBR:7
Accession Number	(0008, 0050)	Placer field 1	00251	OBR:18
SOP Class UID	(0008, 0016)				1.2.840.10008.5.1.4.1.1.88.11
Request Attributes Sequence	(0040, 0275)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Modality	(0008, 0060)				SR
Institution Name	(0008, 0080)	Performing Organization Name or Sending Facility		OBX:23 or MSH:4	[17]
Study Instance UID	(0020, 000D)			OBX[2]:5	[11]
Instance Number	(0020, 0013)				1
Value Type	(0040, A040)				CONTAINER
Continuity Of Content	(0040, A050)				SEPARATE
Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				11528-7
>>Code Scheme Designator	(0008, 0102)				LN
>>Code Meaning	(0008, 0104)				Radiology Report
Verifying Observer Sequence	(0040, A073)
>Verifying Organization	(0040, A027)				Default Value : Verifying Organization
>Verifying Observer Name	(0040, A075)	Principal Result Interpreter	00264	OBR:32.1	[9]
>Verification DateTime	(0040, A030)	Observation Date/Time	00241	OBR:7
Referenced Request Sequence	(0040, A370)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Completion Flag	(0040, A491)	Result Status	00258	OBR:25	[2]
Verification Flag	(0040, A493)	Result Status	00258	OBR:25	[3]
Content Sequence	(0040, A730)				[4]
Item 1
>Relationship Type	(0040, A010)				HAS CONCEPT MOD
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121049
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Language of Content Item and Descendants
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)				eng
>>Code Scheme Designator	(0008, 0102)				ISO639_2
>>Code Meaning	(0008, 0104)				English
Item 2
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				PNAME
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121008
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Person Observer Name
>Person Name	(0040, A123)	Principal Result Interpreter	00264	OBR:32.1
Item 3
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121023
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Procedure Code
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
Item 4
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT or CODE	[12]
>>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>>Text Value	(0040, A160)			OBX:5	[13]
>>Concept Code Sequence	(0040, A168)					[14]
>>>Code Value	(0008, 0100)				OBX:5.1
>>>Code Scheme Designator	(0008, 0102)				OBX:5.3
>>>Code Meaning	(0008, 0104)				OBX:5.2

9.1.3.2.2. Mapping of HL7 ORU containing CDA to Encapsulated CDA DICOM SR Attributes

Table 9.9 HL7 ORU containing CDA to Encapsulated CDA DICOM Structured Report Attributes mapping

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Notes/Default values
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[10]
Patient Identification
Same as Patient Identification in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Demographic
Same as Patient Demographic in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Visit
Same as Visit Identification in HL7 order mapping to DICOM Modality Worklist Attributes for (HL7 v2.3.1 and v2.5.1)
Patient Medical
Pregnancy Status	(0010, 21C0)	Ambulatory Status	00145	PV1:15	[19]
Structured Report
Content Date	(0008, 0023)	Observation Date/Time	00241	OBR:7
Content Time	(0008, 0033)	Observation Date/Time	00241	OBR:7
Accession Number	(0008, 0050)	Placer field 1	00251	OBR:18
SOP Class UID	(0008, 0016)				1.2.840.10008.5.1.4.1.1.104.2
Request Attributes Sequence	(0040, 0275)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Modality	(0008, 0060)				SR
Institution Name	(0008, 0080)	Performing Organization Name or Sending Facility		OBX:23 or MSH:4	[17]
Conversion Type	(0008, 0064)				WSD
Burned In Annotation	(0028, 0301)				NO
Encapsulated Document	(0042, 0011)				OBX:5.5	[15]
MIME Type of Encapsulated Document	(0042, 0012)				text/xml
Study Instance UID	(0020, 000D)			OBX[2]:5	[11]
Instance Number	(0020, 0013)				1
Value Type	(0040, A040)				CONTAINER
Continuity Of Content	(0040, A050)				SEPARATE
Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				11528-7
>>Code Scheme Designator	(0008, 0102)				LN
>>Code Meaning	(0008, 0104)				Radiology Report
Verifying Observer Sequence	(0040, A073)
>Verifying Organization	(0040, A027)				Default Value : Verifying Organization
>Verifying Observer Name	(0040, A075)	Principal Result Interpreter	00264	OBR:32.1	[9]
>Verification DateTime	(0040, A030)	Observation Date/Time	00241	OBR:7
Referenced Request Sequence	(0040, A370)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Completion Flag	(0040, A491)	Result Status	00258	OBR:25	[2]
Verification Flag	(0040, A493)	Result Status	00258	OBR:25	[3]
Content Sequence	(0040, A730)				[4]
Item 1
>Relationship Type	(0040, A010)				HAS CONCEPT MOD
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121049
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Language of Content Item and Descendants
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)				eng
>>Code Scheme Designator	(0008, 0102)				ISO639_2
>>Code Meaning	(0008, 0104)				English
Item 2
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				PNAME
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121008
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Person Observer Name
>Person Name	(0040, A123)	Principal Result Interpreter	00264	OBR:32.1
Item 3
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121023
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Procedure Code
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
Item 4
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT or CODE	[12]
>>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>>Text Value	(0040, A160)			OBX:5	[13]
>>Concept Code Sequence	(0040, A168)					[14]
>>>Code Value	(0008, 0100)				OBX:5.1
>>>Code Scheme Designator	(0008, 0102)				OBX:5.3
>>>Code Meaning	(0008, 0104)				OBX:5.2

9.1.3.2.3. Mapping of HL7 ORU containing PDF to Encapsulated PDF DICOM Attributes

Table 9.10 HL7 ORU containing PDF to Encapsulated PDF DICOM Attributes mapping

DICOM Attribute	DICOM Tag	HL7 Field	HL7 Item #	HL7 Segment	Notes/Default values
SOP Common
Specific Character Set	(0008, 0005)	Character Set	00692	MSH:18	[10]
Patient Identification
Same as Patient Identification in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Demographic
Same as Patient Demographic in HL7 ADT mapping of PID segment to DICOM Patient Attributes
Patient Visit
Same as Visit Identification in HL7 order mapping to DICOM Modality Worklist Attributes for (HL7 v2.3.1 and v2.5.1)
Patient Medical
Pregnancy Status	(0010, 21C0)	Ambulatory Status	00145	PV1:15	[19]
Structured Report
Content Date	(0008, 0023)	Observation Date/Time	00241	OBR:7
Content Time	(0008, 0033)	Observation Date/Time	00241	OBR:7
Accession Number	(0008, 0050)	Placer field 1	00251	OBR:18
SOP Class UID	(0008, 0016)				1.2.840.10008.5.1.4.1.1.104.1
Request Attributes Sequence	(0040, 0275)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Modality	(0008, 0060)				DOC
Institution Name	(0008, 0080)	Performing Organization Name or Sending Facility		OBX:23 or MSH:4	[17]
Conversion Type	(0008, 0064)				SD
Burned In Annotation	(0028, 0301)				NO
Encapsulated Document	(0042, 0011)				OBX:5.5	[16]
MIME Type of Encapsulated Document	(0042, 0012)				application/pdf
Study Instance UID	(0020, 000D)			OBX[2]:5	[11]
Instance Number	(0020, 0013)				1
Value Type	(0040, A040)				CONTAINER
Continuity Of Content	(0040, A050)				SEPARATE
Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				11528-7
>>Code Scheme Designator	(0008, 0102)				LN
>>Code Meaning	(0008, 0104)				Radiology Report
Verifying Observer Sequence	(0040, A073)
>Verifying Organization	(0040, A027)				Default Value : Verifying Organization
>Verifying Observer Name	(0040, A075)	Principal Result Interpreter	00264	OBR:32.1	[9]
>Verification DateTime	(0040, A030)	Observation Date/Time	00241	OBR:7
Referenced Request Sequence	(0040, A370)
>Study Instance UID	(0020, 000D)			OBX[1]:5	[5]
>Requesting Physician	(0032, 1032)	Ordering Provider	00226	OBR:16
>Accession Number	(0008, 0050)	Placer Field 1	00251	OBR:18
>Requested Procedure ID	(0040, 1001)	Placer Field 2	00252	OBR:19
>Requested Procedure Description	(0032, 1060)	Universal Service ID	00238	OBR:4.2
>Requested Procedure Code Sequence	(0032, 1064)	Universal Service ID
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
>Placer Order Number Imaging Service Request	(0040, 2016)	Placer Order Number	00216	OBR:2	[8]
>Filler Order Number Imaging Service Request	(0040, 2017)	Filler Order Number	00217	OBR:3	[8]
Completion Flag	(0040, A491)	Result Status	00258	OBR:25	[2]
Verification Flag	(0040, A493)	Result Status	00258	OBR:25	[3]
Content Sequence	(0040, A730)				[4]
Item 1
>Relationship Type	(0040, A010)				HAS CONCEPT MOD
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121049
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Language of Content Item and Descendants
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)				eng
>>Code Scheme Designator	(0008, 0102)				ISO639_2
>>Code Meaning	(0008, 0104)				English
Item 2
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				PNAME
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121008
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Person Observer Name
>Person Name	(0040, A123)	Principal Result Interpreter	00264	OBR:32.1
Item 3
>Relationship Type	(0040, A010)				HAS OBS CONTEXT
>Value Type	(0040, A040)				CODE
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				121023
>>Code Scheme Designator	(0008, 0102)				DCM
>>Code Meaning	(0008, 0104)				Procedure Code
>Concept Code Sequence	(0040, A168)
>>Code Value	(0008, 0100)		00238.1	OBR:4.1
>>Code Scheme Designator	(0008, 0102)		00238.3	OBR:4.3
>>Code Meaning	(0008, 0104)		00238.2	OBR:4.2
Item 4
>Relationship Type	(0040, A010)				CONTAINS
>Value Type	(0040, A040)				CONTAINER
>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>Continuity Of Content	(0040, A050)				SEPARATE
>Content Sequence	(0040, A730)
>>Relationship Type	(0040, A010)				CONTAINS
>>Value Type	(0040, A040)				TEXT or CODE	[12]
>>Concept Name Code Sequence	(0040, A043)
>>Code Value	(0008, 0100)				OBX:3.1
>>Code Scheme Designator	(0008, 0102)				OBX:3.3
>>Code Meaning	(0008, 0104)				OBX:3.2
>>Text Value	(0040, A160)			OBX:5	[13]
>>Concept Code Sequence	(0040, A168)					[14]
>>>Code Value	(0008, 0100)				OBX:5.1
>>>Code Scheme Designator	(0008, 0102)				OBX:5.3
>>>Code Meaning	(0008, 0104)				OBX:5.2

9.1.4. HL7 ORU - Error Mapping

Following table gives an overview of error codes and messages sent by dcm4che DICOM Archive 5 for incoming HL7 ADT messages triggering error conditions.

Table 9.11 Error Codes Mapping and Usage

Error Code	Error Code Meaning	Error Location	User Message	Notes
Error Common
Same as Error Codes Mapping and Usage in Error Codes Mapping and Usage
Patient Management specific
Same as Error Codes Mapping and Usage in Error Codes Mapping and Usage specific to PID segment.
Observation Reporting Management specific
101	Required Field Missing	OBX^1^5^1^2	Invalid encoding of encapsulated document in components 2 and/or 3 and/or 4 of field 5”	[18]
		OBX^1^5^1^5	Encapsulated document data missing	[18]
		OBX^1^5^1^1	Missing study instance uid
		OBR^1^18^1^1	Missing accession number
		PV1^1^19^1^1	Missing admission ID
206	Application Record Locked		No HL7 Message Listener configured	[4]

[2] (1,2,3,4)

If the value of this field is P, then CompletionFlag is set to PARTIAL. In all other cases it is set to COMPLETE

[3] (1,2,3,4)

If the value of this field is P or F, then VerificationFlag is set to VERIFIED. In all other cases it is set to UNVERIFIED

[4] (1,2,3,4,5)

This sequence is present only if Field 32 (i.e. Principal Result Interpreter) is present in OBR segment.

[5] (1,2,3,4,5,6,7,8,9)

If OBX field[3] component 1 is Study Instance UID, then value is taken from OBX:5; else value is system generated.

[6]

If OBX field[3] component 1 is Series Instance UID, then value is taken from OBX:5; else value is system generated.

[7]

If OBX field[3] component 1 is SR Instance UID, then value is taken from OBX:5; else value is system generated.

[8] (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16)

If the Placer and/or Filler order number are not provided by the Referenced Request Sequence, it is assumed that the Report Manager is able to obtain values.

[9] (1,2,3,4)

If absent “UNKNOWN” is used.

[10] (1,2,3,4)

HL7 DICOM Character Set if configured, is selected to specify Specific Character Set. Else, MSH-18 if present in the incoming HL7 message, Mapping of MSH-18-Character Set to (0008,0005) Specific Character Set is selected to specify Specific Character Set. If MSH-18 is absent, then HL7 Default Character Set is selected to specify Specific Character Set.

[11] (1,2,3)

If OBX field[3] component 1 is DICOM Study, then value is taken from OBX:5; else value is system generated.

[12] (1,2,3)

If OBX:2 is TX then the value is TEXT else if OBX:2 is CE then the value is CODE

[13] (1,2,3)

If OBX:2 is TX, only then Text Value (0040, A160) is set in this item with text value taken from OBX:5

[14] (1,2,3)

If OBX:2 is CE, only then Concept Code Sequence (0040, A168) is set in this item with code item taken from OBX:5

[15]

OBX:5.5 shall contain the CDA document which is then encapsulated into a DICOM object. Though the value for this attribute shall contain the Retrieve URL path to this bulkdata.

[16]

OBX:5.5 shall contain the base 64 encoded PDF document which is then encapsulated into a DICOM object. Though the value for this attribute shall contain the Retrieve URL path to this bulkdata.

[17] (1,2,3,4)

OBX:23 - Performing Organization Name : This field contains the name of the organization/service responsible for performing the service. When this field is null, the receiving system assumes that the observations were produced by the sending organization (MSH:4).

[18] (1,2)

Applicable only for HL7 ORU^O01 messages containing encapsulated documents

[19] (1,2,3,4)

“B6” must be mapped to DICOM. Enumerated value “3” (definitely pregnant)