Chapter 8: WIA-MEDICAL-IMAGING Standard

{
  "studyInstanceUID": "string (DICOM UID)",
  "accessionNumber": "string",
  "studyDate": "date (YYYYMMDD)",
  "studyTime": "time (HHMMSS)",
  "studyDescription": "string",
  "modality": ["string (CT|MR|US|CR|MG|PT|NM)"],
  "patient": {
    "patientId": "string",
    "patientName": "string (DICOM PN format)",
    "birthDate": "date",
    "sex": "enum (M|F|O)"
  },
  "referringPhysician": {
    "name": "string",
    "identifier": "string"
  },
  "numberOfSeries": "integer",
  "numberOfInstances": "integer",
  "procedureCodes": [{
    "code": "string",
    "scheme": "string",
    "meaning": "string"
  }],
  "availability": "enum (ONLINE|NEARLINE|OFFLINE)",
  "retrieveURL": "string (DICOMweb endpoint)"
}

{
  "seriesInstanceUID": "string (DICOM UID)",
  "studyInstanceUID": "string",
  "seriesNumber": "integer",
  "seriesDescription": "string",
  "modality": "string",
  "bodyPartExamined": "string",
  "seriesDate": "date",
  "seriesTime": "time",
  "numberOfInstances": "integer",
  "laterality": "enum (L|R|B)",
  "manufacturer": "string",
  "modelName": "string",
  "stationName": "string",
  "performedProcedure": {
    "code": "string",
    "description": "string"
  }
}

{
  "resultId": "string (UUID)",
  "studyInstanceUID": "string",
  "algorithmName": "string",
  "algorithmVersion": "string",
  "vendor": "string",
  "analysisType": "enum (detection|classification|segmentation|quantification)",
  "findings": [{
    "findingId": "string",
    "findingCode": { "code": "string", "scheme": "string", "meaning": "string" },
    "probability": "number (0-1)",
    "severity": "enum (normal|mild|moderate|severe)",
    "location": {
      "reference": "seriesInstanceUID:sopInstanceUID",
      "coordinates": { "x": "number", "y": "number", "z": "number" },
      "boundingBox": { "x1": "y1": "x2": "y2" }
    }
  }],
  "processingTime": "number (seconds)",
  "confidence": "number (0-1)",
  "timestamp": "datetime"
}

{
  "header": {
    "messageId": "string (UUID)",
    "messageType": "AI_ANALYSIS_REQUEST|AI_ANALYSIS_RESULT",
    "timestamp": "datetime (ISO 8601)",
    "source": { "systemId": "string", "name": "string" },
    "destination": { "systemId": "string", "name": "string" }
  },
  "payload": {
    "studyInstanceUID": "string",
    "algorithm": "string",
    "priority": "enum (STAT|ROUTINE)",
    "parameters": { /* algorithm-specific */ },
    "callbackURL": "string (webhook for results)"
  }
}

8.9 Simulator ENUM Tokens and Threshold Mapping

This section aligns Chapter 8 integrated-standard content with simulator panels 1-5 at the token level. The ENUMs DICOM_3_0, DICOMWEB, HL7_FHIR_IMAGING, IHE_RAD, NEMA_MITA, DICOM_SR, DICOM_PS3, and RADLEX appear throughout the book in UNDERSCORE notation and map 1:1 with WIA-MEDICAL-IMAGING's four-layer architecture: Data, API, Protocol, and Integration. ENUM tokens serve as common identifiers across NEMA, IHE, HL7, and national-regulator standards documentation.

8.9.1 Standard ENUM Mapping

8.9.2 PACS and Infrastructure ENUMs

WIA-MEDICAL-IMAGING provides integration standards for the following infrastructure ENUMs: PACS (Picture Archiving and Communication System), VNA (Vendor Neutral Archive), RIS (Radiology Information System), HIS (Hospital Information System), CIS (Clinical Information System), EMR (Electronic Medical Record), and EHR (Electronic Health Record), all connected by the WIA Integration Layer (IHE SWF, XDS-I, HL7, FHIR). DICOM_NODE and AE_TITLE identify DICOM network nodes. Certification ENUMs FDA_510K, CE_MDR, MFDS_CLASS_2, HIPAA, GDPR, and DICOM_CONFORMANCE ensure regional regulatory compliance when applying the integrated standard.

8.10 WIA-MEDICAL-IMAGING Integrated Standard Deep Dive

8.10.1 Four-Layer Architecture Alignment

WIA-MEDICAL-IMAGING comprises four layers: Data (DICOM-aligned ImagingStudy, ImagingSeries, AIResult), API (DICOMweb WADO-RS, STOW-RS, QIDO-RS plus REST), Protocol (DICOM DIMSE plus DICOMweb plus HL7 plus FHIR), and Integration (EHR, RIS, AI, analytics). Each layer aligns with the four-axis governance model for medical imaging information published by national health authorities, providing clear responsibility boundaries across data governance, interoperability, clinical application, and regulatory compliance. NEMA PS3 (Korean edition, published via the Korean Society of Radiology) translates DICOM PS3.1 through PS3.20 in full.

8.10.2 DICOMweb and RESTful Medical Imaging

DICOMweb (NEMA PS3.18) is the RESTful web services layer of DICOM. WADO_RS (Web Access to DICOM Objects RESTful Services) handles image retrieval, STOW_RS (Store Over the Web RESTful Services) handles storage, QIDO_RS (Query based on ID for DICOM Objects RESTful Services) handles queries, and WADO_URI supports single-object URI access. Modern medical imaging viewers (OHIF Viewer, Cornerstone3D) increasingly migrate to DICOMweb-based zero-footprint web viewers, replacing legacy desktop clients. National security guidelines mandate TLS 1.3, OAuth 2.0, and OpenID Connect for DICOMweb traffic.

8.10.3 HL7 FHIR ImagingStudy Integration

HL7 FHIR R4 ImagingStudy resources express patient, image series, DICOM UIDs, and acquisition information in EHR-friendly JSON. The WIA Integration Layer uses FHIR ImagingStudy to bidirectionally synchronize images with EHR systems (Epic, Cerner, OpenMRS, and similar platforms). DiagnosticReport represents radiology reports, while Observation resources express quantitative measurements such as RECIST, BMD, and ejection fraction. National EHR certification programs increasingly require EHR-DICOM integration verified through FHIR conformance.

8.10.4 IHE Radiology Integration Profiles

IHE Radiology Technical Framework provides standard integration profiles for imaging workflow. SWF (Scheduled Workflow) defines the standard RIS-modality-PACS-viewer workflow; XDS-I (Cross-Enterprise Document Sharing for Imaging) supports cross-institutional image sharing; PIR (Patient Information Reconciliation) reconciles patient information; ARI (Access to Radiology Information) enables external system access; MRRT (Management of Radiology Report Templates) governs reporting templates; and AIR (Artificial Intelligence Results) standardizes AI output. The ATNA (Audit Trail and Node Authentication) profile is the standard for security and audit logging.

8.10.5 RadLex and Imaging Vocabulary Standards

RadLex (RSNA Radiology Lexicon) defines over 50,000 radiology terms in a hierarchical structure. The WIA Data Layer applies RadLex codes to DICOM SR (Structured Report) reports, FHIR Observations, and RIS procedure codes, ensuring semantic interoperability. National radiology societies often translate RadLex into local languages and recommend its use in national medical imaging data standardization white papers. Mappings to SNOMED CT, LOINC, and ICD-10-CM are verified through NIST Health IT standards tools.

8.10.6 Security, Privacy, and Audit Trails

WIA-MEDICAL-IMAGING complies with HIPAA, GDPR, and equivalent national personal-information statutes governing sensitive medical data. Security consists of TLS 1.3, OAuth 2.0, OpenID Connect, multi-factor authentication (MFA), and end-to-end encryption (at-rest and in-transit). Audit trails record all image access, modification, deletion, and export events per the IHE ATNA (Audit Trail and Node Authentication) profile. Retention periods commonly span 10 years for imaging records and 5-10 years for clinical reports, depending on jurisdiction. The Office of the National Coordinator for Health IT (ONC) provides additional federation guidance for cross-jurisdictional health IT exchanges.

8.11 Extended Endnotes