Multi-country Working Group on Imaging Information Sharing

Coordinators: Charles Parisot, Claudio Saccavini

Overview presentation: Multi-Country Working Group (MCWG) on Image Information Sharing: An IHE-Europe Taskforce

MCWG Welcomes additional countries engaged in imaging information sharing at the national or regional levels

MCWG Scope and Objectives

Scope: Deployment of interoperability for Imaging Exchange	National & regional level world-wide. Complements Cross-Border focus of EU Commission (eHN, xt-EHR).
Goal: Deliver design analysis for specific extensions	Extensions to effectively deploy IHE Profiles, DICOM, FHIR and other standards within countries’ ehealth services.
Benefits: Pool expertise and resources	Direct engagement of members in active national deployment. Consensus analysis of specific issues to increase consistency.
Deliverables: Analysis results as MCWG recommendations.	Mature and complete (multi-country consensus) Offered for adoption and easily included into national frameworks.

MCWG Mode of Operation, Members & Recommendations

MCWG plenary every two weeks, 1-hour T-con	Members prioritize topics for recommendations. Each one is addressed by a dedicated Focus Group including 3-4 Members or designees, committed to complete the recommendation on the topic in less than two months All members review and comment on draft recommendations and approve final recommendations
Currently includes representatives from	Netherlands, Denmark, Spain, Belgium, Norway, Finland, France, Czechia, Canada, Austria Other countries are welcome
MCWG has produced 3 sets of recommendations in four months	Intended to be sufficiently mature, complete (multi-country consensus) and stable to be offered for adoption and included into national interoperability frameworks. Initially delivered in a PowerPoint Slide Format. Publicly available documents, MCWG members to ensure rapid feedback as they apply.

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MCWG Approved Recommendations on Imaging Information Sharing:

Profile and Standards Positioning (June 2025)
Positions the role of HL7 FHIR in the sharing of imaging information architectures, choice of profiles and standards such as MHD(FHIR), XDS-I. Coexistence with XCA and FHIR/MHD, integration of Web Access to DICOM Objects (WADO-RS) in XDS-I.
Imaging Metadata and linkages (December 2023)
Strategies or metadata definitions for filtering access in queries (key filtering elements) and linkages between orders, reports and imaging studies.
Extensions to Imaging Study Manifest (June 2025)
Context of use of imaging study manifests, explain the choice of DICOM KOS, refine the content of imaging study manifest in areas such as patient IDs, accession numbers, additional content in study/series descriptions.
Flagging Significant Images in shared Imaging Studies (December 2024)
Using the IHE KIN profile this recommendation adds minimal information to the imaging study manifest to allow the imaging consuming health professional to identify and access directly the significant images flagged by the imaging source health professional.
A quick user guide for clinicians. Why do you need metadata? Finding the right patient data fast! (February 2025)
This quick guide addresses, in clinical terms, the information elements (search metadata) Health Professionals need to understand, when searching in a patient record for relevant clinical documents (such as radiology reports, patient summaries, or laboratory reports) that are shared at the regional or national levels. It also provides guidance on ensuring simple and reliable creation of the metadata related to imaging studies and imaging reports.
Deployment tools including Image Sharing Gateaway (February 2025)
Provides a deployment strategy and associated guidance by identifying the real world systems that are involved in sharing imaging information. The concept of a common imaging gateway is introduced. This acts as a bridge to the legacy interfaces available on most PACS and RIS systems, so simplifying MCWG compliance to a national or regional imaging sharing infrastructure.

MCWG Relationship with MyHealth@EU, eHDSI cross-border and the eHealth Network Guidelines on Imaging

MCWG maintains a close relationship with the relevant EU Projects (Xt-EHR, MyHealth@EU, X-Share, etc.) and activities in which the EU Commission and the Member States are engaged.

MCWG has adopted the Use Case defined by the eHN guidelines on Medical imaging studies and reports sharing.
MCWG presented its work to the eHN Imaging Task Force March 15th and April 12th 2024.
MCWG shared its recommendations with the eHN SubGroups (Semantic and Interoperability) – April 11, 2024
MCWG provided input to the Xt-EHR 7.2 work package on the specification of the Imaging Study Manifest based on DICOM KOS.

Other interactions: HL7-EU Imaging and Industry X-net

As part of the current activities (March 2025 onwards), MCWG is providing specific recommendations on:

the linkage between imaging report and imaging study manifest
the transformation formats of the imaging study manifest from the pivot DICOM KOS representation
inclusion of the IHE XC-WADO profile for cross-community image retrieval

Several MCWG Members are also representing their country in the EU eHealth Network Imaging Task Force, the Xt-EHR Joint Action and the eHN SubGroups.

MCWG Current Activities March-September 2025

Following the publication of three additional three sets of recommendations in December 2024 and February 2025, two new Focus Groups have been established to better communicate with EHDS (Xt-EHR and MyHealth@EU) the rationale of several MCWG interoperability design choices:

Focus Group on specific issues on the content of the Imaging Report:
- Management of the URLs and retrieve location UID in the DICOM KOS imaging manifests used to reference imaging studies
- Respond to Ballot of the new IHE Radiology Profile XC-WADO, Cross-Community-Web Access to DICOM Objects. Ensure its publication as Trial Implementation in time for Xt-EHR and MyHealth@EU specifications to reference the XC-WADO profile.
Focus Group on the access to images and related addressing challenges:
- Use of server-side viewing links within the report associated to the content of the study(ies) being reported.
- The inclusion of Observation level image Links within the report.
- Rationale to ensure that imaging study manifest is a distinct document versus embedding manifest information in a report.
- The choice of the encoding format for the manifest as a distinct issue. Provide to EHDS, the rationale to prefer DICOM encoding for the cross-border, national and regional use case.
Adoption and Feedback Focus Group continues to track the adoption of the MCWG recommendations and ensure their maintenance.
- Two change Proposals clarifying specific points have been adopted.
- The MCWG recommendations adoption dashboard is being updated to facilitate tracking by the countries and MCWG.
- Invite non-European and European countries not yet participating to learn about MCWG and join. (England joined in November 2024).
MCWG Workshop at European IHE Connectathon to be held in Vienna (Monday June 23, 2025 at 15h00):
- Opportunity for Countries to learn about MCWG, its published recommendations and meet current members
- Understand MCWG contribution and alignment with EHDS
- Review the progress of ongoing work of Focus Groups
- Invite vendors and clinicians to join the second meeting of the MCWG on Imaging – Community of Doers.
MCWG on Imaging – Community of Doers was created following IHE-Europe agreement with EU XpanDH project
- Held kick-off teleconference on December 10th with about 10 first stakeholders.
- Support the current 6 MCWG recommendations (see above). Provided excellent suggestions for improvements.
- Second Meeting planned during the IHE-Europe Connecathon

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