1. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Rad Reporting PACS XDS Registry XDS PIX Rad Reporting XDS Repository 1 2 3 4 5 1 6 7

2. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Radiologist Reporting PACS XDS Registry XDS PIX Family Doctor XDS Repository 1 2 3 4 5 1 6 7

3. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Radiologist Reporting PACS XDS Registry XDS PIX Family Doctor XDS Repository 1a 2a 3 4 5 1b 6 7 2b DICOM HL7 SOAP w/ Attach HTTP | SMIME SOAP/HTTP HTTP GET SOAP/HTTP HL7

4. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Radiologist Reporting PACS XDS Registry XDS Patient ID Source Family Doctor XDS Repository 0a 1a 2 3 4 0b 5 6 1b DICOM HL7 SOAP w/ Attach HTTP | SMIME SOAP/HTTP HTTP GET SOAP/HTTP HL7 LAB 7 HTTP GET (Browser)

5. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Radiologist Reporting PACS XDS Registry XDS Patient ID Source Family Doctor XDS Repository 0a 1a 2a 3 4 0b 5 6 1b DICOM HL7 SOAP w/ Attach HTTP | SMIME SOAP/HTTP HTTP GET SOAP HTTP HL7 LAB 7 HTTP GET (Browser) 2b DICOM Key: Original Transaction XUA modification Section HH.1.3.n n Internal Exported

6. XUA – Circle of Trust (e.g. XDS Affinity Domain) St. Johns North Clinic Auth Prov ID Prov Auth Prov ID Prov Radiologist Reporting PACS XDS Patient ID Source Family Doctor 0a 1a 2a 3 4 0b 5 6 1b Any DICOM Any HL7 XDS Provide & Register XDS Register XDS Retrieve XDS Query Any HL7 LAB 7 RID (Browser) 2b Any DICOM Key: Original Transaction XUA modification Use-Case number ‘n’ n Internal Exported XDS Repository User auth XDS Registry

7. Original Transaction Message (e.g. HL7, URI, DICOM, SOAP) SAML Assertion When needed TLS or XMLenc/sig Original Transaction Transport (e.g. TCP, HTTP, SMTP)

8. XUA – Authentication Domains South Clinic Auth Prov ID Prov Auth Prov ID Prov General Workstation General Workstation North Clinic General Workstation Auth Prov ID Prov General Workstation General Workstation

9. XUA – Authentication Domains Auth Prov ID Prov General Workstation General Workstation

10. XUA – Authentication Domains South Clinic Auth Prov ID Prov Auth Prov ID Prov General Workstation General Workstation North Clinic General Workstation Auth Prov ID Prov General Workstation General Workstation

11. XUA – Authentication Domains South Clinic Auth Prov ID Prov Auth Prov ID Prov General Workstation General Workstation North Clinic General Workstation Auth Prov ID Prov General Workstation General Workstation

12. XUA – Authentication Domains South Clinic Auth Prov ID Prov Auth Prov ID Prov General Workstation General Workstation North Clinic General Workstation Auth Prov ID Prov General Workstation General Workstation

13. EHR (ATNA Secure Node) Patient Data User ID user auth provider X-Identity Provider X-Service User XDS Consumer XDS Registry (ATNA Secure Node) Key: Original Transaction XUA Assertion TLS Protections