Mobile access to Health Documents for Imaging - Brief Proposal

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1. Proposed Workitem: Mobile access to Health Documents for Imaging (MHD-I)

  • Proposal Editor: Brad Genereaux
  • Editor: Brad Genereaux
  • Domain: Radiology


XDS-I provides a method to share imaging documents across enterprises by a query and retrieve mechanism, but the technology is burdensome for lightweight web and mobile clients. This proposal calls for the creation of a profile to mimic the Mobile access to Health Documents (MHD) profile for Cross Document Sharing (XDS) for XDS-I, by defining a simple HTTP interface.

Unlike MHD, however, creation of Health Documents for Imaging via a mobile interface is intentionally not in scope.

2. The Problem

Participating as a client in XDS-I is straightforward in a controlled, robust, server or desktop configuration. Libraries exist that can make MTOM/XOP requests for manifests with DICOM KOS parsers for SOP instance retrieval.

However, in a resource or bandwidth constrained environment, the XDS mechanisms do not work effectively. There needs to be a lightweight mechanism to simply request, retrieve, and parse the manifest without putting undue pressure on the client. The client, in this case, is browser-based and capable of making HTTP requests and parsing web-friendly formats, like XML and JSON.

3. Key Use Case

A physician, away from the hospital, is asked to provide a preliminary review of a patient in crisis.

  • He launches the electronic health record (EHR) web site on his mobile device
  • He authenticates, and then opens the patient record
  • He reviews documents stored in his facility’s XDS repository using MHD, and notes that imaging data is available.
  • Using MHD-I, the EHR web page makes a query for studies available for the patient
  • A list of studies are returned with WADO-RS locations to retrieve the relevant instances
  • He selects a study
  • The EHR website retrieves and renders for the physician

4. Standards and Systems

Systems include XDS-I servers and clients, web and mobile clients

Standards include XDS-I, DICOM, WADO-RS, REST, JSON, XML, HTTP

5. Discussion

This is a logical extension of MHD.

New MHD-I Profile

  • Existing actors: Imaging Document Consumer
  • New actors: Imaging Document Responder
  • New transactions
    • Find Imaging Document Dossiers (standards used?)
    • Get Imaging Document Dossier (standards used?)

This would supplement XDS-I with a RESTful web friendly methodology

This would complement MHD with an imaging-centric retrieval methodology

Breakdown of Tasks:

  • Review MHD profile to ensure coverage of imaging paradigms
  • Account for possible changes with FHIR enhancements
  • Draft two new transactions and one new profile


  • confirm the need/business case does exist
  • Lack of Participation from vendors is a risk.
  • There is a possibility that the proposed DICOM JSON may change.
  • MHD is being reviewed and may be updated due to enhanced FHIR integration