How are images (like x-rays) stored and retrieved for FHIR servers



I am very new to FHIR schema, and I am working on a server that hosts FHIR data and an application that represent the data.

I was wondering how to represent images associated with FHIR data. For example, if I have x-ray images from an Observation, can I upload the images to the FHIR server and have them retrieved, or should they be uploaded to a different storage and only their urls are given to the FHIR data?

I would also like to know which resourceType to use with the images. I’ve found Media, ImagingStudy, and ImagingManifest on stu3, but it’s difficult for me understand them fully. Am I correct that images themselves need to be Media and ImagingStudy ties them to the Patient?

Thank you,


ImagingManifest is being removed in R4. Your real choice is between Media and ImagingStudy. Media is a simple wrapper around something jpg/png; it provides some simple metadata and links directly to patient. ImagingStudy is an alternative that, instead of containing the pixels in some format, refers to the images as available on a DICOM-WS server. The second option brings to bear to the awesome power of the DICOM stack, but also brings the price and complexity of that.

Which is a better choice is not one the FHIR standard can make for you; it just defines these 2 different paths so that you can choose. In terms of your question, I think it depends where and how you get the images.