CodeX Radiation Therapy, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 2.0.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/codex-radiation-therapy/ and changes regularly. See the Directory of published versions

Change Log

CodeX Radiation Therapy Continue Integration Build for STU2

These changes were added to the CI build, and have not been ballotted or published.

• Eliminated local code system for Adverse Event Stages or Grades, and used NCI Thesaurus terms instead. Impacts [AdverseEventSeverityOrGradeVS]
• Dependency Changes
  • Changed mCODE dependency to STU3
  • Changed USCore dependency to 5.0.1
• USCore Changes
  • ServiceRequest profiles are now based on USCoreServiceRequest.
• Extension Contexts
  • All extension contexts have been tightened.
• Rename of Disease Progression Qualifier Extension
  • DiseaseProgressionQualifier extension has been renamed [RadiotherapyDiseaseProgressionQualifier].
• Additions
  • Added Radiotherapy Treated Fraction and Radiotherapy Treatment Session profiles to model treatment sessions. (FHIR-42773)
  • Added extension Intrafraction Verification to all radiotherapy Procedures and ServiceRequests. This extension is used to annotate the procedure that is used to verify the position of the patient during treatment fractions.
  • Added a RadiobiologicMetric extension to capture a radiobiologic metric of effective dose, as defined by the TG-263. The extension has been added to all ServiceRequest and Procedure profiles, i.e. RadiotherapyCoursePrescription, RadiotherapyPhasePrescription, RadiotherapyPlanPrescription, RadiotherapyPlannedCourse, RadiotherapyPlannedPhase, RadiotherapyTreatmentPlan, RadiotherapyCourseSummary, RadiotherapyTreatedPhase, and RadiotherapyTreatedPlan.
• Narrative Changes
  • Extended the overview with exaplanations of the added Radiotherapy Treated Fraction and Radiotherapy Treatment Session profiles, including the newly added section Session and Fraction Numbering.
  • Changed references from outdated “Operational Ontology for Radiation Oncology (OORO)” to “Operational Ontology for Oncology (O3)” (FHIR-41682).
• Profile Changes
  • Procedure.category and ServiceRequest.category: mCODE STU2.1 RadiotherapyCourseSummary had a required Procedure.category value for RadiotherapyCourseSummary that used a SNOMEDCT code (108290001 Radiation oncology AND/OR radiotherapy (procedure)) that has become inactive. mCODE STU3 dropped the Procedure.category binding completely. CodeXRT STU1 required all ServiceRequest.category to include the same SNOMEDCT code. In CodeXRT STU2, a requirement for a category code has been added to all none of the Procedure and ServiceRequest profiles with a required binding to a valueset that includes the old code as well as a new SNOMEDCT code (1287742003 “Radiotherapy (procedure)”). An invariant warns if the old code is used.
  • Fixed typo (radiotheraphy) in extension url for Reason for Revision or Adaptation (FHIR-42893). Fixed the same typo in Radiotherapy Adverse Event Grade, and Adverse Event Severity or Grade Value Set.
  • In the RadiotherapyVolume, changed the cardinality of the identifier slice for display name from the 0..1 of mCODE to 1..1. In CodeX RT, the display name is mandatory. The identifier cardinality was already 2..* to reflect the two mandatory slices (FHIR-41885).
• Changed Binding Strengths
  • As discussed and changed in mCODE 3.0.0, some binding strengths were relaxed because required bindings were a barrier to broader implementation (CodeX RT finding FHIR-42775, corresponding mCODE change FHIR-41503). The binding strength was changed from required to extensible on the following elements.
    • bodySite in all Procedure and ServiceRequest (as in the mCODE STU3 RadiotherapyCourseSummary).
    • Reason for Revision or Adaptation
    • Free-Breathing Motion Management Technique
    • Image Guided Radiotherapy (IGRT)
• ValueSet Changes
  • Redefine [AdverseEventSeverityOrGradeVS] using NCI Thesaurus terms for the CTCAE grades of adverse effects instead of an unnecessary local code system. This eliminates a local code system Severity or Grade CodeSystem based on CTCAE .

CodeX Radiation Therapy STU1 Publication Version

These are the changes that were made during ballot reconciliation.

Narrative Changes

• Added description of relationship between the profiles
• Added description of revision or adaptation of prescriptions and plans
• Updated the data elements diagram to reflect changes in the profiles

Profile Additions

• Added Radiotherapy Adverse Event profile based on Vulcan and CTCAE, along with associated ValueSets (FHIR-40654)

Profile Changes

• The relationship between the profiles have been implemented with open, profile-based slicing of the basedOn and replaces fields of the profiles. (FHIR-38231)
• Treatment devices are represented as proper references to [RadiotherapyTreatmentDevice], rather than using an extension. (FHIR-38220 and FHIR-38114)
• Radioactive Seeds are represented with new references to [RadiotherapySeedDevice]
• Device references have been moved out of extensions into the built-in fields with the ServiceRequest and Procedure resources (FHIR-38220 and FHIR-38114)
• A new RadiotherapyDiseaseStatus profile was added based on mCODE’s CancerDiseaseStatus profile with an additional [qualifier][RadiotherapyDiseaseProgressionQualifier] for disease progression.(FHIR-37922)
• The mCODE [DoseDeliveredToVolume] extension has been extended with a boolean uniformFractionation flag when incorporated into the RadiotherapyCourseSummary profile. (FHIR-37976)
• The extensions [DosePlannedToVolume] and [DoseDeliveredToVolume] were extended in all profiles in which they were used, i.e. RadiotherapyPlannedCourse, RadiotherapyPlannedPhase, RadiotherapyTreatmentPlan, RadiotherapyCourseSummary, RadiotherapyTreatedPhase, and RadiotherapyTreatedPlan, with the following boolean flags.
  • Primary Plan Dose flag, which indicates whether the dose is the primary plan dose in a radiotherapy treatment plan.
  • Point Dose flag, which indicates whether the dose is determined at at a single point.
• An extension with a codeable concept for reason for revision and adaptation was added to all Plan and Phase profiles. (FHIR-38231)
• An extension with a Reference to DICOM SOP Instance was added to RadiotherapyTreatmentPlan and RadiotherapyTreatedPlan profiles.
• An extension with a boolean for course involves reirradiation was added to the 3 course-level profiles.
• An extension supporting Image Guided Radiotherapy (IGRT) was added everywhere Therapeutic Modality and Technique was present. This is supported by a ValueSet of IGRT modalities and energies.
• Extensions Respiratory Motion Management and Free-Breathing Motion Management Technique were added everywhere Therapeutic Modality and Technique was present. Those are supported by the ValueSets Motion Management and Free Breathing Motion Management Technique.

Valueset Changes

• The Brachytherapy Applicator Types ValueSet has been reworked using new codes requested from SNOMEDCT.
• New SNOMEDCT codes requested by the authors have replaced local codes as they have been issued.

Codesystem Changes

• New SNOMEDCT codes requested by the authors have replaced local codes as they have been issued.

Capability Statement Changes

• Added a server capabilty statement based on XRTS requirements. Included credits for rendering.

Added Data Dictionary

• Add a data dictionary with the same format as the mCODE data dictionary.