Radiology Service — Data Model

Status: populated Owner: TBD Last updated: 2026-04-18 Companion: Service Template · 03 platform-services · 02 DDD

---

1. ID Prefix Convention

Entity	Prefix	Example
ImagingStudyRef	STU_	STU_01J...
RadiologyReport	RPT_	RPT_01J...
PacsEndpoint	PACS_	PACS_01J...
ViewerLaunchToken	VLT_	VLT_01J...

---

2. TypeScript Interfaces

export interface ImagingStudyRef {
  id: string;                      // STU_ prefixed ULID
  tenantId: string;
  patientId: string;
  encounterId?: string;
  orderId?: string;
  accessionNumber?: string;
  modality: string;
  startedAt?: Date;
  status: ImagingStudyStatus;
  pacsStudyUid: string;
  pacsEndpointId: string;
  seriesCount?: number;
  instanceCount?: number;
  fhirImagingStudyId?: string;
  payloadJson?: object;            // FHIR ImagingStudy resource
  version: number;
  createdAt: Date;
  updatedAt: Date;
}

export type ImagingStudyStatus =
  | 'registered' | 'available' | 'cancelled' | 'entered-in-error' | 'unknown';

export interface RadiologyReport {
  id: string;                      // RPT_ prefixed ULID
  tenantId: string;
  imagingStudyId: string;
  status: ReportStatus;
  authorId: string;
  authoredAt: Date;
  contentText: string;
  contentStructured?: object;      // SR JSON if structured
  criticalFindingFlag: boolean;
  priorReportId?: string;
  amendmentReason?: string;
  fhirDiagnosticReportId?: string;
  version: number;
  createdAt: Date;
  updatedAt: Date;
}

export type ReportStatus =
  | 'preliminary' | 'final' | 'amended' | 'superseded' | 'canceled';

export interface PacsEndpoint {
  id: string;                      // PACS_ prefixed ULID
  tenantId: string;
  nodeId?: string;
  name: string;
  qidoUrl: string;
  wadoUrl: string;
  stowUrl?: string;
  authMode: 'none' | 'bearer' | 'basic' | 'oauth2-client-credentials';
  authConfig?: object;             // Encrypted JSON
  facilityId?: string;
  active: boolean;
  createdAt: Date;
  updatedAt: Date;
}

---

3. PostgreSQL Schema

CREATE TABLE pacs_endpoints (
  id          TEXT PRIMARY KEY,
  tenant_id   TEXT NOT NULL,
  node_id     TEXT,
  name        TEXT NOT NULL,
  qido_url    TEXT NOT NULL,
  wado_url    TEXT NOT NULL,
  stow_url    TEXT,
  auth_mode   TEXT NOT NULL DEFAULT 'none',
  auth_config JSONB,              -- encrypted at application layer
  facility_id TEXT,
  active      BOOLEAN NOT NULL DEFAULT TRUE,
  created_at  TIMESTAMPTZ NOT NULL DEFAULT NOW(),
  updated_at  TIMESTAMPTZ NOT NULL DEFAULT NOW()
);

CREATE INDEX idx_pacs_tenant ON pacs_endpoints(tenant_id, active);
ALTER TABLE pacs_endpoints ENABLE ROW LEVEL SECURITY;
CREATE POLICY pacs_tenant ON pacs_endpoints
  USING (tenant_id = current_setting('app.current_tenant_id'));

---

CREATE TABLE imaging_studies (
  id                    TEXT PRIMARY KEY,
  tenant_id             TEXT NOT NULL,
  patient_id            TEXT NOT NULL,
  encounter_id          TEXT,
  order_id              TEXT,
  accession_number      TEXT,
  modality              TEXT NOT NULL,
  started_at            TIMESTAMPTZ,
  status                TEXT NOT NULL DEFAULT 'registered',
  pacs_study_uid        TEXT NOT NULL,
  pacs_endpoint_id      TEXT NOT NULL REFERENCES pacs_endpoints(id),
  series_count          INTEGER,
  instance_count        INTEGER,
  fhir_imaging_study_id TEXT,
  payload_json          JSONB,
  version               INTEGER NOT NULL DEFAULT 1,
  created_at            TIMESTAMPTZ NOT NULL DEFAULT NOW(),
  updated_at            TIMESTAMPTZ NOT NULL DEFAULT NOW(),
  UNIQUE (tenant_id, pacs_study_uid)
);

CREATE INDEX idx_studies_patient ON imaging_studies(tenant_id, patient_id, started_at DESC);
CREATE INDEX idx_studies_order ON imaging_studies(tenant_id, order_id);
CREATE INDEX idx_studies_modality ON imaging_studies(tenant_id, modality, started_at DESC);
ALTER TABLE imaging_studies ENABLE ROW LEVEL SECURITY;
CREATE POLICY studies_tenant ON imaging_studies
  USING (tenant_id = current_setting('app.current_tenant_id'));

---

CREATE TABLE radiology_reports (
  id                        TEXT PRIMARY KEY,
  tenant_id                 TEXT NOT NULL,
  imaging_study_id          TEXT NOT NULL REFERENCES imaging_studies(id),
  status                    TEXT NOT NULL DEFAULT 'preliminary',
  author_id                 TEXT NOT NULL,
  authored_at               TIMESTAMPTZ NOT NULL,
  content_text              TEXT NOT NULL,
  content_structured        JSONB,
  critical_finding_flag     BOOLEAN NOT NULL DEFAULT FALSE,
  prior_report_id           TEXT REFERENCES radiology_reports(id),
  amendment_reason          TEXT,
  fhir_diagnostic_report_id TEXT,
  version                   INTEGER NOT NULL DEFAULT 1,
  created_at                TIMESTAMPTZ NOT NULL DEFAULT NOW(),
  updated_at                TIMESTAMPTZ NOT NULL DEFAULT NOW()
);

CREATE INDEX idx_reports_study ON radiology_reports(tenant_id, imaging_study_id, authored_at DESC);
ALTER TABLE radiology_reports ENABLE ROW LEVEL SECURITY;
CREATE POLICY reports_tenant ON radiology_reports
  USING (tenant_id = current_setting('app.current_tenant_id'));

---

CREATE TABLE outbox_events (
  id          TEXT PRIMARY KEY,
  tenant_id   TEXT NOT NULL,
  subject     TEXT NOT NULL,
  event_type  TEXT NOT NULL,
  payload     JSONB NOT NULL,
  published   BOOLEAN NOT NULL DEFAULT FALSE,
  created_at  TIMESTAMPTZ NOT NULL DEFAULT NOW()
);

CREATE INDEX idx_rad_outbox_unpublished ON outbox_events(published, created_at)
  WHERE published = FALSE;