DICOM PS3.17 2024a - Explanatory Information

X.4.2 Document Cross-reference

Due to the inherent differences between DICOM SR and HL7 CDA, a transcoded document will have a different UID than the source document. However, the SR Document may reference the CDA Document as equivalent using the Equivalent CDA Document Sequence (0040,A090) Attribute, and the CDA Document may reference the SR Document with a relatedDocument act relationship.

Since the ParentDocument target of the relatedDocument relationship is constrained to be a simple DOCCLIN act, it is recommended that the reference to the DICOM SR be encoded per Table X.3-4, without explicit identification of the Study and Series Instance UIDs, and with classCode DOCCLIN (rather than DGIMG).


  1. The Study and Series Instance UIDs would be encoded in the WADO reference in the Act.Text ED data type.

  2. CDA Release 1 does not provide a standard for the relatedDocument relationship to another document.

DICOM PS3.17 2024a - Explanatory Information