hospital-management/radiology/models.py

"""
Radiology app models for hospital management system.
Provides imaging orders, DICOM management, and radiology workflows.
"""

import uuid
from django.db import models
from django.core.validators import MinValueValidator, MaxValueValidator
from django.core.exceptions import ValidationError
from django.utils import timezone
from django.conf import settings
from django.contrib.contenttypes.fields import GenericRelation
from datetime import timedelta, datetime, date
from decimal import Decimal
import json

from .constants import RadiologyChoices, RadiologyValidators, RadiologyBusinessRules
from .managers import (
    ImagingStudyManager, RadiologyReportManager, ImagingOrderManager,
    ImagingSeriesManager, DICOMImageManager, ReportTemplateManager
)


class ImagingStudy(models.Model):
    """
    Imaging study model for radiology studies and DICOM management.
    Improved with centralized constants, validation, and optimized structure.
    """
    # Tenant relationship
    tenant = models.ForeignKey(
        'core.Tenant',
        on_delete=models.CASCADE,
        related_name='imaging_studies',
        help_text='Organization tenant'
    )
    
    # Study Information
    study_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique study identifier'
    )
    study_instance_uid = models.CharField(
        max_length=64,
        unique=True,
        help_text='DICOM Study Instance UID'
    )
    accession_number = models.CharField(
        max_length=20,
        unique=True,
        help_text='Study accession number'
    )
    
    # Patient and Provider
    patient = models.ForeignKey(
        'patients.PatientProfile',
        on_delete=models.CASCADE,
        related_name='imaging_studies',
        help_text='Patient'
    )
    referring_physician = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.CASCADE,
        related_name='referred_studies',
        help_text='Referring physician'
    )
    radiologist = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='interpreted_studies',
        help_text='Interpreting radiologist'
    )
    
    # Study Details
    modality = models.CharField(
        max_length=10,
        choices=RadiologyChoices.Modality.choices,
        help_text='Study modality'
    )
    study_description = models.CharField(
        max_length=200,
        help_text='Study description'
    )
    body_part = models.CharField(
        max_length=100,
        choices=RadiologyChoices.BodyPart.choices,
        help_text='Body part examined'
    )
    
    # Study Scheduling and Workflow Timestamps
    scheduled_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time study was scheduled'
    )
    study_datetime = models.DateTimeField(
        help_text='Planned study date and time'
    )
    arrived_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time patient arrived for study'
    )
    started_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time study acquisition started'
    )
    completed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time study acquisition completed'
    )
    interpreted_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time study was interpreted'
    )
    finalized_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time study was finalized'
    )
    
    # Clinical Information
    clinical_indication = models.TextField(
        blank=True,
        null=True,
        help_text='Clinical indication for study'
    )
    clinical_history = models.TextField(
        blank=True,
        null=True,
        help_text='Clinical history'
    )
    diagnosis_code = models.CharField(
        max_length=20,
        blank=True,
        null=True,
        help_text='ICD-10 diagnosis code'
    )
    
    # Study Status
    status = models.CharField(
        max_length=20,
        choices=RadiologyChoices.StudyStatus.choices,
        default='SCHEDULED',
        help_text='Study status'
    )
    
    # Priority
    priority = models.CharField(
        max_length=20,
        choices=RadiologyChoices.Priority.choices,
        default='ROUTINE',
        help_text='Study priority'
    )
    
    # Technical Parameters
    kvp = models.FloatField(
        blank=True,
        null=True,
        help_text='Peak kilovoltage (kVp)'
    )
    mas = models.FloatField(
        blank=True,
        null=True,
        help_text='Milliampere-seconds (mAs)'
    )
    exposure_time = models.FloatField(
        blank=True,
        null=True,
        help_text='Exposure time in milliseconds'
    )
    slice_thickness = models.FloatField(
        blank=True,
        null=True,
        help_text='Slice thickness in mm'
    )
    
    # Equipment Information
    station_name = models.CharField(
        max_length=50,
        blank=True,
        null=True,
        help_text='Acquisition station name'
    )
    manufacturer = models.CharField(
        max_length=50,
        blank=True,
        null=True,
        help_text='Equipment manufacturer'
    )
    model_name = models.CharField(
        max_length=50,
        blank=True,
        null=True,
        help_text='Equipment model name'
    )
    
    # Study Metrics
    number_of_series = models.PositiveIntegerField(
        default=0,
        help_text='Number of series in study'
    )
    number_of_instances = models.PositiveIntegerField(
        default=0,
        help_text='Number of instances in study'
    )
    study_size = models.BigIntegerField(
        default=0,
        help_text='Study size in bytes'
    )
    
    # Quality and Completion
    image_quality = models.CharField(
        max_length=20,
        choices=RadiologyChoices.ImageQuality.choices,
        blank=True,
        null=True,
        help_text='Image quality assessment'
    )
    completion_status = models.CharField(
        max_length=20,
        choices=RadiologyChoices.CompletionStatus.choices,
        default='COMPLETE',
        help_text='Study completion status'
    )
    
    # Related Information
    encounter = models.ForeignKey(
        'emr.Encounter',
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='imaging_studies',
        help_text='Related encounter'
    )
    imaging_order = models.ForeignKey(
        'ImagingOrder',
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='studies',
        help_text='Related imaging order'
    )
    
    # PACS Information
    pacs_location = models.CharField(
        max_length=200,
        blank=True,
        null=True,
        help_text='PACS storage location'
    )
    archived = models.BooleanField(
        default=False,
        help_text='Study is archived'
    )
    archive_location = models.CharField(
        max_length=200,
        blank=True,
        null=True,
        help_text='Archive storage location'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    created_by = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='created_studies',
        help_text='User who created the study'
    )
    
    # Custom manager
    objects = ImagingStudyManager()
    
    class Meta:
        db_table = 'radiology_imaging_study'
        verbose_name = 'Imaging Study'
        verbose_name_plural = 'Imaging Studies'
        ordering = ['-study_datetime']
        indexes = [
            models.Index(fields=['tenant', 'status']),
            models.Index(fields=['patient', 'study_datetime']),
            models.Index(fields=['modality', 'study_datetime']),
            models.Index(fields=['accession_number']),
            models.Index(fields=['study_instance_uid']),
            models.Index(fields=['priority']),
            models.Index(fields=['radiologist']),
        ]
    
    def __str__(self):
        return f"{self.accession_number} - {self.study_description}"
    
    def save(self, *args, **kwargs):
        """
        Generate accession number if not provided.
        """
        if not self.accession_number:
            # Generate accession number (simple implementation)
            today = timezone.now().date()
            last_study = ImagingStudy.objects.filter(
                tenant=self.tenant,
                created_at__date=today
            ).order_by('-id').first()
            
            if last_study:
                last_number = int(last_study.accession_number.split('-')[-1])
                self.accession_number = f"RAD-{today.strftime('%Y%m%d')}-{last_number + 1:04d}"
            else:
                self.accession_number = f"RAD-{today.strftime('%Y%m%d')}-0001"
        
        # Set study_datetime from date and time
        # if self.study_datetime:
        #     self.study_datetime = timezone.make_aware(
        #         datetime.combine(self.study_date, self.study_time)
        #     )
        
        super().save(*args, **kwargs)
    
    @property
    def is_stat(self):
        """
        Check if study is STAT priority.
        """
        return self.priority in ['STAT', 'EMERGENCY']
    
    @property
    def is_complete(self):
        """
        Check if study is complete.
        """
        return self.status in ['COMPLETED', 'INTERPRETED', 'FINALIZED']
    
    @property
    def is_final(self):
        """
        Check if study is finalized.
        """
        return self.status == 'FINALIZED'
    
    @property
    def acquisition_duration(self):
        """
        Calculate acquisition duration in minutes.
        """
        if self.started_datetime and self.completed_datetime:
            delta = self.completed_datetime - self.started_datetime
            return int(delta.total_seconds() / 60)
        return None
    
    @property
    def total_turnaround_time(self):
        """
        Calculate total turnaround time from scheduled to finalized in minutes.
        """
        if self.scheduled_datetime and self.finalized_datetime:
            delta = self.finalized_datetime - self.scheduled_datetime
            return int(delta.total_seconds() / 60)
        return None
    
    @property
    def interpretation_turnaround_time(self):
        """
        Calculate interpretation turnaround time from completed to interpreted in minutes.
        """
        if self.completed_datetime and self.interpreted_datetime:
            delta = self.interpreted_datetime - self.completed_datetime
            return int(delta.total_seconds() / 60)
        return None
    
    @property
    def patient_wait_time(self):
        """
        Calculate patient wait time from arrival to study start in minutes.
        """
        if self.arrived_datetime and self.started_datetime:
            delta = self.started_datetime - self.arrived_datetime
            return int(delta.total_seconds() / 60)
        return None
    
    @property
    def is_overdue(self):
        """
        Check if study is overdue based on priority and business rules.
        """
        if not self.scheduled_datetime or self.is_complete:
            return False
        
        now = timezone.now()
        hours_since_scheduled = (now - self.scheduled_datetime).total_seconds() / 3600
        
        # Use business rules from constants
        max_hours = RadiologyBusinessRules.PRIORITY_ESCALATION_HOURS.get(self.priority, 24)
        return hours_since_scheduled > max_hours
    
    @property
    def workflow_stage(self):
        """
        Get current workflow stage with timestamp.
        """
        stages = [
            ('scheduled', self.scheduled_datetime),
            ('arrived', self.arrived_datetime),
            ('started', self.started_datetime),
            ('completed', self.completed_datetime),
            ('interpreted', self.interpreted_datetime),
            ('finalized', self.finalized_datetime),
        ]
        
        current_stage = 'scheduled'
        for stage, timestamp in stages:
            if timestamp:
                current_stage = stage
            else:
                break
        
        return current_stage
    
    def clean(self):
        """
        Validate study data and business rules.
        """
        super().clean()
        
        # Validate timestamp sequence
        timestamps = [
            ('scheduled_datetime', self.scheduled_datetime),
            ('arrived_datetime', self.arrived_datetime),
            ('started_datetime', self.started_datetime),
            ('completed_datetime', self.completed_datetime),
            ('interpreted_datetime', self.interpreted_datetime),
            ('finalized_datetime', self.finalized_datetime),
        ]
        
        previous_timestamp = None
        for field_name, timestamp in timestamps:
            if timestamp:
                if previous_timestamp and timestamp < previous_timestamp:
                    raise ValidationError(f'{field_name} cannot be before previous workflow step')
                previous_timestamp = timestamp
        
        # Validate status transitions
        if self.pk:  # Only for existing objects
            old_instance = ImagingStudy.objects.get(pk=self.pk)
            valid_transitions = RadiologyBusinessRules.VALID_STATUS_TRANSITIONS.get(old_instance.status, [])
            if self.status != old_instance.status and self.status not in valid_transitions:
                raise ValidationError(f'Invalid status transition from {old_instance.status} to {self.status}')
        
        # Validate required fields based on status
        if self.status == 'COMPLETED' and not self.completed_datetime:
            self.completed_datetime = timezone.now()
        
        if self.status == 'INTERPRETED' and not self.interpreted_datetime:
            self.interpreted_datetime = timezone.now()
        
        if self.status == 'FINALIZED' and not self.finalized_datetime:
            self.finalized_datetime = timezone.now()


class ImagingSeries(models.Model):
    """
    Imaging series model for DICOM series management.
    """
    
    # Study relationship
    study = models.ForeignKey(
        ImagingStudy,
        on_delete=models.CASCADE,
        related_name='series',
        help_text='Parent imaging study'
    )
    
    # Series Information
    series_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique series identifier'
    )
    series_instance_uid = models.CharField(
        max_length=64,
        unique=True,
        help_text='DICOM Series Instance UID'
    )
    series_number = models.PositiveIntegerField(
        help_text='Series number within study'
    )
    
    # Series Details
    modality = models.CharField(
        max_length=10,
        choices=RadiologyChoices.Modality.choices,
        help_text='Series modality'
    )
    series_description = models.CharField(
        max_length=200,
        blank=True,
        null=True,
        help_text='Series description'
    )
    protocol_name = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Protocol name'
    )
    
    # Series Workflow Timestamps
    series_datetime = models.DateTimeField(
        help_text='Series acquisition date and time'
    )
    started_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time series acquisition started'
    )
    completed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time series acquisition completed'
    )
    processed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time series was processed'
    )
    archived_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time series was archived'
    )
    
    # Technical Parameters
    slice_thickness = models.FloatField(
        blank=True,
        null=True,
        help_text='Slice thickness in mm'
    )
    spacing_between_slices = models.FloatField(
        blank=True,
        null=True,
        help_text='Spacing between slices in mm'
    )
    pixel_spacing = models.CharField(
        max_length=50,
        blank=True,
        null=True,
        help_text='Pixel spacing'
    )
    image_orientation = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Image orientation'
    )
    
    # Series Metrics
    number_of_instances = models.PositiveIntegerField(
        default=0,
        help_text='Number of instances in series'
    )
    series_size = models.BigIntegerField(
        default=0,
        help_text='Series size in bytes'
    )
    
    # Body Part and Position
    body_part = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Body part examined'
    )
    patient_position = models.CharField(
        max_length=20,
        choices=[
            ('HFP', 'Head First-Prone'),
            ('HFS', 'Head First-Supine'),
            ('HFDR', 'Head First-Decubitus Right'),
            ('HFDL', 'Head First-Decubitus Left'),
            ('FFP', 'Feet First-Prone'),
            ('FFS', 'Feet First-Supine'),
            ('FFDR', 'Feet First-Decubitus Right'),
            ('FFDL', 'Feet First-Decubitus Left'),
        ],
        blank=True,
        null=True,
        help_text='Patient position'
    )
    
    # Contrast Information
    contrast_agent = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Contrast agent used'
    )
    contrast_route = models.CharField(
        max_length=20,
        choices=[
            ('IV', 'Intravenous'),
            ('ORAL', 'Oral'),
            ('RECTAL', 'Rectal'),
            ('INTRATHECAL', 'Intrathecal'),
            ('INTRA_ARTICULAR', 'Intra-articular'),
            ('OTHER', 'Other'),
        ],
        blank=True,
        null=True,
        help_text='Contrast administration route'
    )
    
    # Quality
    image_quality = models.CharField(
        max_length=20,
        choices=[
            ('EXCELLENT', 'Excellent'),
            ('GOOD', 'Good'),
            ('ADEQUATE', 'Adequate'),
            ('POOR', 'Poor'),
            ('UNACCEPTABLE', 'Unacceptable'),
        ],
        blank=True,
        null=True,
        help_text='Image quality assessment'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    
    # Custom manager
    objects = ImagingSeriesManager()
    
    class Meta:
        db_table = 'radiology_imaging_series'
        verbose_name = 'Imaging Series'
        verbose_name_plural = 'Imaging Series'
        ordering = ['study', 'series_number']
        indexes = [
            models.Index(fields=['study', 'series_number']),
            models.Index(fields=['series_instance_uid']),
            models.Index(fields=['modality']),
            models.Index(fields=['series_datetime']),
        ]
        unique_together = ['study', 'series_number']
    
    def __str__(self):
        return f"Series {self.series_number}: {self.series_description or 'No description'}"
    
    def save(self, *args, **kwargs):
        """
        Set series_datetime if not provided.
        """
        if not self.series_datetime:
            self.series_datetime = timezone.now()
        
        super().save(*args, **kwargs)
    
    @property
    def patient(self):
        """
        Get patient from study.
        """
        return self.study.patient


class DICOMImage(models.Model):
    """
    DICOM image model for individual image instances.
    """
    
    # Series relationship
    series = models.ForeignKey(
        ImagingSeries,
        on_delete=models.CASCADE,
        related_name='images',
        help_text='Parent imaging series'
    )
    
    # Image Information
    image_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique image identifier'
    )
    sop_instance_uid = models.CharField(
        max_length=64,
        unique=True,
        help_text='DICOM SOP Instance UID'
    )
    instance_number = models.PositiveIntegerField(
        help_text='Instance number within series'
    )
    
    # Image Details
    image_type = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='DICOM image type'
    )
    sop_class_uid = models.CharField(
        max_length=64,
        help_text='DICOM SOP Class UID'
    )
    
    # Image Dimensions
    rows = models.PositiveIntegerField(
        help_text='Number of rows in image'
    )
    columns = models.PositiveIntegerField(
        help_text='Number of columns in image'
    )
    bits_allocated = models.PositiveIntegerField(
        help_text='Number of bits allocated for each pixel'
    )
    bits_stored = models.PositiveIntegerField(
        help_text='Number of bits stored for each pixel'
    )
    
    # Image Position and Orientation
    image_position = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Image position (patient)'
    )
    image_orientation = models.CharField(
        max_length=100,
        blank=True,
        null=True,
        help_text='Image orientation (patient)'
    )
    slice_location = models.FloatField(
        blank=True,
        null=True,
        help_text='Slice location'
    )
    
    # Window/Level Settings
    window_center = models.FloatField(
        blank=True,
        null=True,
        help_text='Window center'
    )
    window_width = models.FloatField(
        blank=True,
        null=True,
        help_text='Window width'
    )
    
    # File Information
    file_path = models.CharField(
        max_length=500,
        help_text='File path on storage system'
    )
    file_size = models.BigIntegerField(
        help_text='File size in bytes'
    )
    transfer_syntax_uid = models.CharField(
        max_length=64,
        blank=True,
        null=True,
        help_text='Transfer syntax UID'
    )
    
    # Content Information
    content_date = models.DateField(
        blank=True,
        null=True,
        help_text='Content date'
    )
    content_time = models.TimeField(
        blank=True,
        null=True,
        help_text='Content time'
    )
    acquisition_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Acquisition date and time'
    )
    
    # Processing Workflow Timestamps
    processed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time image was processed'
    )
    quality_checked_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time image quality was checked'
    )
    archived_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time image was archived'
    )
    
    # Quality and Status
    image_quality = models.CharField(
        max_length=20,
        choices=RadiologyChoices.ImageQuality.choices,
        blank=True,
        null=True,
        help_text='Image quality assessment'
    )
    
    # Processing Status
    processed = models.BooleanField(
        default=False,
        help_text='Image has been processed'
    )
    archived = models.BooleanField(
        default=False,
        help_text='Image is archived'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    
    # Custom manager
    objects = DICOMImageManager()
    
    class Meta:
        db_table = 'radiology_dicom_image'
        verbose_name = 'DICOM Image'
        verbose_name_plural = 'DICOM Images'
        ordering = ['series', 'instance_number']
        indexes = [
            models.Index(fields=['series', 'instance_number']),
            models.Index(fields=['sop_instance_uid']),
            models.Index(fields=['sop_class_uid']),
            models.Index(fields=['processed']),
            models.Index(fields=['archived']),
        ]
        unique_together = ['series', 'instance_number']
    
    def __str__(self):
        return f"Image {self.instance_number} ({self.sop_instance_uid})"
    
    @property
    def study(self):
        """
        Get study from series.
        """
        return self.series.study
    
    @property
    def patient(self):
        """
        Get patient from study.
        """
        return self.series.study.patient
    
    @property
    def file_size_mb(self):
        """
        Get file size in MB.
        """
        return round(self.file_size / (1024 * 1024), 2)
    
    def generate_dicom_file(self, pixel_data=None):
        """
        Generate DICOM file from this model instance.
        
        Args:
            pixel_data: Optional numpy array for pixel data
            
        Returns:
            str: Path to generated DICOM file
        """
        from .services import DICOMGenerator
        generator = DICOMGenerator()
        return generator.generate_dicom_from_model(self, pixel_data)
    
    def validate_for_dicom_generation(self):
        """
        Validate this instance for DICOM generation.
        
        Returns:
            dict: Validation results
        """
        from .services import DICOMValidator
        return DICOMValidator.validate_dicom_image_model(self)
    
    def has_dicom_file(self):
        """
        Check if DICOM file exists on disk.
        
        Returns:
            bool: True if file exists
        """
        import os
        return bool(self.file_path and os.path.exists(self.file_path))
    
    def get_dicom_metadata(self):
        """
        Extract metadata from DICOM file if it exists.
        
        Returns:
            dict: DICOM metadata or None if file doesn't exist
        """
        if not self.has_dicom_file():
            return None
        
        from .services import DICOMValidator
        return DICOMValidator.validate_dicom_file(self.file_path)


class RadiologyReport(models.Model):
    """
    Radiology report model for study interpretation and reporting.
    """
    
    # Study relationship
    study = models.OneToOneField(
        ImagingStudy,
        on_delete=models.CASCADE,
        related_name='report',
        help_text='Related imaging study'
    )
    
    # Report Information
    report_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique report identifier'
    )
    
    # Radiologist Information
    radiologist = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.CASCADE,
        related_name='radiology_reports',
        help_text='Interpreting radiologist'
    )
    dictated_by = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='dictated_reports',
        help_text='Radiologist who dictated the report'
    )
    transcribed_by = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='transcribed_reports',
        help_text='Person who transcribed the report'
    )
    
    # Report Content
    clinical_history = models.TextField(
        blank=True,
        null=True,
        help_text='Clinical history and indication'
    )
    technique = models.TextField(
        blank=True,
        null=True,
        help_text='Imaging technique and protocol'
    )
    findings = models.TextField(
        help_text='Imaging findings'
    )
    impression = models.TextField(
        help_text='Radiologist impression and conclusion'
    )
    recommendations = models.TextField(
        blank=True,
        null=True,
        help_text='Recommendations for follow-up'
    )
    
    # Report Status
    status = models.CharField(
        max_length=20,
        choices=[
            ('DRAFT', 'Draft'),
            ('PRELIMINARY', 'Preliminary'),
            ('FINAL', 'Final'),
            ('AMENDED', 'Amended'),
            ('CORRECTED', 'Corrected'),
        ],
        default='DRAFT',
        help_text='Report status'
    )
    
    # Critical Findings
    critical_finding = models.BooleanField(
        default=False,
        help_text='Report contains critical findings'
    )
    critical_communicated = models.BooleanField(
        default=False,
        help_text='Critical findings have been communicated'
    )
    critical_communicated_to = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        related_name='critical_communicated_reports',
        blank=True,
        null=True,
        help_text='Person critical findings were communicated to'
    )
    critical_communicated_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time critical findings were communicated'
    )
    
    # Report Dates
    dictated_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time report was dictated'
    )
    transcribed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time report was transcribed'
    )
    verified_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time report was verified'
    )
    finalized_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time report was finalized'
    )
    
    # Template and Structured Reporting
    template_used = models.ForeignKey(
        'ReportTemplate',
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='reports',
        help_text='Report template used'
    )
    structured_data = models.JSONField(
        default=dict,
        help_text='Structured reporting data'
    )
    
    # Quality and Metrics
    report_length = models.PositiveIntegerField(
        default=0,
        help_text='Report length in characters'
    )
    turnaround_time = models.PositiveIntegerField(
        blank=True,
        null=True,
        help_text='Turnaround time in minutes'
    )
    
    # Addenda
    addendum = models.TextField(
        blank=True,
        null=True,
        help_text='Report addendum'
    )
    addendum_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time addendum was added'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    
    # Custom manager
    objects = RadiologyReportManager()
    
    class Meta:
        db_table = 'radiology_radiology_report'
        verbose_name = 'Radiology Report'
        verbose_name_plural = 'Radiology Reports'
        ordering = ['-created_at']
        indexes = [
            models.Index(fields=['study']),
            models.Index(fields=['radiologist']),
            models.Index(fields=['status']),
            models.Index(fields=['critical_finding']),
            models.Index(fields=['finalized_datetime']),
        ]
    
    def __str__(self):
        return f"Report for {self.study.accession_number}"
    
    def save(self, *args, **kwargs):
        """
        Calculate report length and turnaround time.
        """
        # Calculate report length
        content = f"{self.findings} {self.impression}"
        self.report_length = len(content)
        
        # Calculate turnaround time
        if self.finalized_datetime and self.study.study_datetime:
            delta = self.finalized_datetime - self.study.study_datetime
            self.turnaround_time = int(delta.total_seconds() / 60)
        
        # Set finalized datetime if status is final
        if self.status == 'FINAL' and not self.finalized_datetime:
            self.finalized_datetime = timezone.now()
        
        super().save(*args, **kwargs)
    
    @property
    def patient(self):
        """
        Get patient from study.
        """
        return self.study.patient
    
    @property
    def is_final(self):
        """
        Check if report is final.
        """
        return self.status == 'FINAL'
    
    @property
    def is_critical(self):
        """
        Check if report has critical findings.
        """
        return self.critical_finding


class ReportTemplate(models.Model):
    """
    Report template model for standardized reporting.
    """
    
    # Tenant relationship
    tenant = models.ForeignKey(
        'core.Tenant',
        on_delete=models.CASCADE,
        related_name='report_templates',
        help_text='Organization tenant'
    )
    
    # Template Information
    template_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique template identifier'
    )
    name = models.CharField(
        max_length=100,
        help_text='Template name'
    )
    description = models.TextField(
        blank=True,
        null=True,
        help_text='Template description'
    )
    
    # Template Scope
    modality = models.CharField(
        max_length=10,
        choices=[
            ('ALL', 'All Modalities'),
            ('CR', 'Computed Radiography'),
            ('CT', 'Computed Tomography'),
            ('MR', 'Magnetic Resonance'),
            ('US', 'Ultrasound'),
            ('XA', 'X-Ray Angiography'),
            ('RF', 'Radiofluoroscopy'),
            ('DX', 'Digital Radiography'),
            ('MG', 'Mammography'),
            ('NM', 'Nuclear Medicine'),
            ('PT', 'Positron Emission Tomography'),
        ],
        default='ALL',
        help_text='Applicable modality'
    )
    body_part = models.CharField(
        max_length=100,
        choices=[
            ('ALL', 'All Body Parts'),
            ('HEAD', 'Head'),
            ('NECK', 'Neck'),
            ('CHEST', 'Chest'),
            ('ABDOMEN', 'Abdomen'),
            ('PELVIS', 'Pelvis'),
            ('SPINE', 'Spine'),
            ('EXTREMITY', 'Extremity'),
            ('BREAST', 'Breast'),
            ('HEART', 'Heart'),
            ('BRAIN', 'Brain'),
        ],
        default='ALL',
        help_text='Applicable body part'
    )
    
    # Template Content
    clinical_history_template = models.TextField(
        blank=True,
        null=True,
        help_text='Clinical history template'
    )
    technique_template = models.TextField(
        blank=True,
        null=True,
        help_text='Technique template'
    )
    findings_template = models.TextField(
        help_text='Findings template'
    )
    impression_template = models.TextField(
        help_text='Impression template'
    )
    recommendations_template = models.TextField(
        blank=True,
        null=True,
        help_text='Recommendations template'
    )
    
    # Structured Reporting
    structured_fields = models.JSONField(
        default=dict,
        help_text='Structured reporting field definitions'
    )
    
    # Template Status
    is_active = models.BooleanField(
        default=True,
        help_text='Template is active'
    )
    is_default = models.BooleanField(
        default=False,
        help_text='Default template for modality/body part'
    )
    
    # Usage Statistics
    usage_count = models.PositiveIntegerField(
        default=0,
        help_text='Number of times template has been used'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    created_by = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='created_report_templates',
        help_text='User who created the template'
    )
    
    # Custom manager
    objects = ReportTemplateManager()
    
    class Meta:
        db_table = 'radiology_report_template'
        verbose_name = 'Report Template'
        verbose_name_plural = 'Report Templates'
        ordering = ['modality', 'body_part', 'name']
        indexes = [
            models.Index(fields=['tenant', 'is_active']),
            models.Index(fields=['modality', 'body_part']),
            models.Index(fields=['is_default']),
        ]
        unique_together = ['tenant', 'name']
    
    def __str__(self):
        return f"{self.name} ({self.modality}/{self.body_part})"
    
    def save(self, *args, **kwargs):
        """
        Ensure only one default template per modality/body part.
        """
        if self.is_default:
            # Remove default flag from other templates
            ReportTemplate.objects.filter(
                tenant=self.tenant,
                modality=self.modality,
                body_part=self.body_part,
                is_default=True
            ).exclude(pk=self.pk).update(is_default=False)
        
        super().save(*args, **kwargs)


class ImagingOrder(models.Model):
    """
    Imaging order model for radiology order management.
    """
    MODALITY_CHOICES = [
        ('CR', 'Computed Radiography'),
        ('CT', 'Computed Tomography'),
        ('MR', 'Magnetic Resonance'),
        ('US', 'Ultrasound'),
        ('XA', 'X-Ray Angiography'),
        ('RF', 'Radiofluoroscopy'),
        ('DX', 'Digital Radiography'),
        ('MG', 'Mammography'),
        ('NM', 'Nuclear Medicine'),
        ('PT', 'Positron Emission Tomography'),
    ]
    PRIORITY_CHOICES = [
        ('ROUTINE', 'Routine'),
        ('URGENT', 'Urgent'),
        ('STAT', 'STAT'),
        ('EMERGENCY', 'Emergency'),
    ]
    BODY_PART_CHOICES = [
        ('HEAD', 'Head'),
        ('NECK', 'Neck'),
        ('CHEST', 'Chest'),
        ('ABDOMEN', 'Abdomen'),
        ('PELVIS', 'Pelvis'),
        ('SPINE', 'Spine'),
        ('EXTREMITY', 'Extremity'),
        ('BREAST', 'Breast'),
        ('HEART', 'Heart'),
        ('BRAIN', 'Brain'),
        ('WHOLE_BODY', 'Whole Body'),
        ('OTHER', 'Other'),
    ]
    CONTRAST_ROUTE_CHOICES = [
        ('IV', 'Intravenous'),
        ('ORAL', 'Oral'),
        ('RECTAL', 'Rectal'),
        ('INTRATHECAL', 'Intrathecal'),
        ('INTRA_ARTICULAR', 'Intra-articular'),
        ('OTHER', 'Other'),
    ]
    STATUS_CHOICES = [
        ('PENDING', 'Pending'),
        ('SCHEDULED', 'Scheduled'),
        ('IN_PROGRESS', 'In Progress'),
        ('COMPLETED', 'Completed'),
        ('CANCELLED', 'Cancelled'),
        ('ON_HOLD', 'On Hold'),
    ]
    # Tenant relationship
    tenant = models.ForeignKey(
        'core.Tenant',
        on_delete=models.CASCADE,
        related_name='imaging_orders',
        help_text='Organization tenant'
    )
    
    # Order Information
    order_id = models.UUIDField(
        default=uuid.uuid4,
        unique=True,
        editable=False,
        help_text='Unique order identifier'
    )
    order_number = models.CharField(
        max_length=20,
        unique=True,
        help_text='Imaging order number'
    )
    
    # Patient and Provider
    patient = models.ForeignKey(
        'patients.PatientProfile',
        on_delete=models.CASCADE,
        related_name='imaging_orders',
        help_text='Patient'
    )
    ordering_provider = models.ForeignKey(
        settings.AUTH_USER_MODEL,
        on_delete=models.CASCADE,
        related_name='ordered_imaging_studies',
        help_text='Ordering provider'
    )
    
    # Order Details
    order_datetime = models.DateTimeField(
        default=timezone.now,
        help_text='Date and time order was placed'
    )
    priority = models.CharField(
        max_length=20,
        choices=PRIORITY_CHOICES,
        default='ROUTINE',
        help_text='Order priority'
    )
    
    # Imaging Details
    modality = models.CharField(
        max_length=10,
        choices=MODALITY_CHOICES,
        help_text='Requested modality'
    )
    study_description = models.CharField(
        max_length=200,
        help_text='Study description'
    )
    body_part = models.CharField(
        max_length=100,
        choices=BODY_PART_CHOICES,
        help_text='Body part to be examined'
    )
    
    # Clinical Information
    clinical_indication = models.TextField(
        help_text='Clinical indication for imaging'
    )
    clinical_history = models.TextField(
        blank=True,
        null=True,
        help_text='Relevant clinical history'
    )
    diagnosis_code = models.CharField(
        max_length=20,
        blank=True,
        null=True,
        help_text='ICD-10 diagnosis code'
    )
    
    # Contrast Information
    contrast_required = models.BooleanField(
        default=False,
        help_text='Contrast agent required'
    )
    contrast_type = models.CharField(
        max_length=50,
        blank=True,
        null=True,
        help_text='Type of contrast agent'
    )
    contrast_route = models.CharField(
        max_length=20,
        choices=CONTRAST_ROUTE_CHOICES,
        blank=True,
        null=True,
        help_text='Contrast administration route'
    )
    
    # Order Workflow Timestamps
    requested_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Requested study date and time'
    )
    approved_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time order was approved'
    )
    scheduled_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Scheduled study date and time'
    )
    cancelled_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time order was cancelled'
    )
    completed_datetime = models.DateTimeField(
        blank=True,
        null=True,
        help_text='Date and time order was completed'
    )
    
    # Status
    status = models.CharField(
        max_length=20,
        choices=STATUS_CHOICES,
        default='PENDING',
        help_text='Order status'
    )
    
    # Related Information
    encounter = models.ForeignKey(
        'emr.Encounter',
        on_delete=models.SET_NULL,
        null=True,
        blank=True,
        related_name='imaging_orders',
        help_text='Related encounter'
    )
    
    # Special Instructions
    special_instructions = models.TextField(
        blank=True,
        null=True,
        help_text='Special instructions for imaging'
    )
    patient_preparation = models.TextField(
        blank=True,
        null=True,
        help_text='Patient preparation instructions'
    )
    
    # Insurance Approval Integration
    approval_requests = GenericRelation(
        'insurance_approvals.InsuranceApprovalRequest',
        content_type_field='content_type',
        object_id_field='object_id',
        related_query_name='imaging_order'
    )
    
    # Metadata
    created_at = models.DateTimeField(auto_now_add=True)
    updated_at = models.DateTimeField(auto_now=True)
    
    # Custom manager
    objects = ImagingOrderManager()
    
    class Meta:
        db_table = 'radiology_imaging_order'
        verbose_name = 'Imaging Order'
        verbose_name_plural = 'Imaging Orders'
        ordering = ['-order_datetime']
        indexes = [
            models.Index(fields=['tenant', 'status']),
            models.Index(fields=['patient', 'status']),
            models.Index(fields=['ordering_provider']),
            models.Index(fields=['order_datetime']),
            models.Index(fields=['order_number']),
            models.Index(fields=['priority']),
            models.Index(fields=['modality']),
        ]
    
    def __str__(self):
        return f"{self.order_number} - {self.study_description}"
    
    def save(self, *args, **kwargs):
        """
        Generate order number if not provided.
        """
        if not self.order_number:
            # Generate order number (simple implementation)
            last_order = ImagingOrder.objects.filter(tenant=self.tenant).order_by('-id').first()
            if last_order:
                last_number = int(last_order.order_number.split('-')[-1])
                self.order_number = f"IMG-{self.tenant.id}-{last_number + 1:06d}"
            else:
                self.order_number = f"IMG-{self.tenant.id}-000001"
        
        super().save(*args, **kwargs)
    
    @property
    def is_stat(self):
        """
        Check if order is STAT priority.
        """
        return self.priority in ['STAT', 'EMERGENCY']
    
    def has_valid_approval(self):
        """
        Check if order has a valid insurance approval.
        """
        from django.utils import timezone
        return self.approval_requests.filter(
            status__in=['APPROVED', 'PARTIALLY_APPROVED'],
            expiration_date__gte=timezone.now().date()
        ).exists()
    
    def get_active_approval(self):
        """
        Get the active insurance approval for this order.
        """
        from django.utils import timezone
        return self.approval_requests.filter(
            status__in=['APPROVED', 'PARTIALLY_APPROVED'],
            expiration_date__gte=timezone.now().date()
        ).first()
    
    def requires_approval(self):
        """
        Check if order requires insurance approval.
        Returns True if patient has insurance and no valid approval exists.
        """
        if not self.patient.insurance_info.exists():
            return False
        return not self.has_valid_approval()
    
    @property
    def approval_status(self):
        """
        Get current approval status for display.
        """
        if not self.patient.insurance_info.exists():
            return 'NO_INSURANCE'
        
        latest_approval = self.approval_requests.order_by('-created_at').first()
        if not latest_approval:
            return 'APPROVAL_REQUIRED'
        
        if self.has_valid_approval():
            return 'APPROVED'
        
        return latest_approval.status