Remove the Must Support imagingStudy element from the profile and update examples   Change implementation note   _ Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. DiagnosticReport resource can link to both DICOM imaging studies and binary images directly by referencing  ImagingStudy  in  DocumentReference.imagingStudy , or  Media  in{{DocumentReference.media}}._ Although both are marked as must support, the server system is not required to support both, but  SHALL  support at least one of these elements._ the client application  SHALL  support both elements and target resources._      to ... Diagnostic imaging results in visual images requiring interpretation and clinical test results/reports may also reference images as part of the report. The DiagnosticReport resource links to both   Media  which represents a  specific kind of Observation whose value is image data and[ ImagingStudy|http://example.com] which represents the content in a DICOM imaging study. Only Media is marked as must support in this profile The imagingStudy element MAY be used by systems to reference ImagingStudy.  However, it is not supported by the majority of systems and its inclusion would be an unnecessary barrier to adoption.