Cross-Community Access - Images (XCA-I)

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1. Proposed Workitem:Cross Community Access - Images (XCA-I)

  • Proposal Editor: Chris Lindop'
  • Editor: Chris Lindop
  • Date: N/A (Wiki keeps history)
  • Version: N/A (Wiki keeps history)
  • Domain: Radiology

2. The Problem

There is no solution for exchanging images between facilities that are not in the same affinity domain.

XDS.b and XDS-I.b provide the framework and solution for cross-enterprise image exchange within an affinity domain. A registry, a set of repositories and a set of Image Document Source actors form the basis of the imaging exchange in a comunity.

For cross-community imaging exchange, XCA provides the frame work for exchanging the manifest, but not images.

This proposal is to extend the imaging exchange framework to include the exchange of images between communities.

3. Key Use Case

Use Case (how it should work)

  • An Imaging Document Consumer requests images for a particular patient from an XCA Initiating Gateway.
  • The Initiating Gateway communicates with it's known Responding Gateways with the request.
  • A Responding Gateway provides a registry entry for an Image Manifest in it's community to the Initiating Gateway.
  • The manifest entry is agreggated and forwarded on to the Imaging Document Consumer whom requested the information.
  • The Imaging Document Consumer requests the image manifest from the Initiating Gateway.
  • The Initiating Gateway communicates with the Responding Gateway to retrieve the manifest and route it back to the Imaging Document Consumer via the Initiating Gateway.
  • The Imaging Document Consumer would like to retrieve the images from the system. A request is made to an Initiating Image Gateway and forwarded on to the Responding Image Gateway which retrieves the images from the Imaging Document Source and forwards on to the Imaging Document Consumer via the Initiating Image Gateway.

There currently is no concept of an Image Gateway. The proposal is to create this Actor pair to resolve the gap.

4. Standards and Systems




Image Exchange Systems, PACS, EMRs, RISs

5. Discussion

IHE is the logical choice for developing a standards-based approach to cross-community Image Exchange. The alternative is proprietary methods or people figuring it out themselves.

The IHE Technical approach would be an extension or adaptation of the existing Cross-Community Access (XCA) protocol defined in ITI.



  • Has XCA been sufficiently widely adopted for us to leverage?
    • It is a new profile in ITI. There is global interest in leveraging XCA for linking communities. There is no competitor technology. Already we see some uptake in Europe. Canada is using this profile to link the regions. There may be some hold back in the USA due to a lack of National strategy.
  • Has XDS-I been sufficiently widely deployed for us to leverage?
    • Yes. It is the standard for imaging exchange throughout the world. It is being deployed Nationally in Canada, regionally in various location throughout Europe and USA.