Euridice Specification
Xt-EHR WP7.2 together with the IHE Radiology Technical Committee and the EURIDICE initiative (that brings together IHE-Europe and HL7-Europe) have produced an international version of the Manifest based Access to DICOM Objects (MADO) IHE Profile.
A first draft of the MADO Profile was issued along with the European Xt-EHR D7.2 Stakeholder Consultation (November 2025). It has been improved with a second version issued for IHE Public Comment (January 2026). The Trial Implementation versionhas been issued for implementation and deployment on March 16th.
This IHE MADO Trial Implementation version is targeted for inclusion by Xt-EHR in its updated D7.2 Medical imaging studies and reports: implementation guides on EEHRxF, functional and technical requirements and specifications for EHR systems.
The EURIDICE Initiative and the IHE MADO Profile
The European Health Data Space (EHDS) requires robust, interoperable, and testable technical specifications. To meet this need, HL7 Europe and IHE-Europe have partnered to create the EURIDICE Initiative. This collaboration leverages the strengths of both organizations: the agility and community of HL7 FHIR and the established methodology and testability of IHE. The goal of EURIDICE is to take proposals and turn them into trusted, technical artifacts that are endorsed by both communities and can be proposed as specifications for the EHDS.
The MADO Profile in the context of EHDS and EURIDICE
The need for the IHE MADO profile has been championed by the Xt-EHR Project that is tasked with the scoping and the development of the EHDS specifications for the Exchange of Imaging Studies and related Imaging Reports. The IHE Radiology domain has agreed to further the development of MADO as an internationally adopted profile over the past few months under the IHE PRISM, a new program that prioritizes interoperability for specific market imperatives.
The initial implementation and testing of the IHE MADO profile is planned for the Xt-EHR Projectathon to be held during the IHE Connectathon Week in Brussels March 22nd through 26th, 2026.
Scope of the Manifest-Based Access to DICOM Objects (MADO) Profile
The Manifest-Based Access to DICOM Objects (MADO) is a new IHE profile for accessing DICOM instances based on an imaging study manifest. The MADO profile is designed to support a common and effective way to retrieve medical imaging studies, whether through existing or emerging standards. It is intended to be used in national and regional exchanges, and when used in conjunction with the IHE XC-WADO Profile its operation are extended across communities (e.g. MyHealth@EU cross-border).
While a similar concept was introduced almost 20 years ago by a part of the XDS-I.b profile, the MADO profile aims to create a second-generation solution. It provides a more precise and flexible approach that can be combined with various document sharing infrastructures such as those based on the newer FHIR-based document sharing profiles, like MHD/MHDS, which are critical for meeting the requirements of the EHDS regulation, but also with XDS with a large number of deployments, in Europe and world-wide.
Two formats of imaging study manifest are offered by IHE MADO alongside with the mapping between them:
- The DICOM KOS-Based Manifest format
- The HL7 FHIR-Based Manifest format
Based on the information and addressing information recorded in either manifests, remotely stored DICOM Objects are accessed from an Imaging Document Source through a specifically profiled DICOM Web WADO-RS transaction thus allowing the user of the Imaging Document Consumer to benefit from the flexibility to access as needed by the user, the entire content of an imaging study, the content of a specific series, specific instances or only the imaging instances that may have been flagged as significant.