minimal Common Oncology Data Elements (mCODE) Implementation Guide
2.1.0 - Pre-STU 3 Development United States of America flag

minimal Common Oncology Data Elements (mCODE) Implementation Guide, published by HL7 International Clinical Interoperability Council. This is not an authorized publication; it is the continuous build for version 2.1.0). This version is based on the current content of https://github.com/HL7/fhir-mCODE-ig/ and changes regularly. See the Directory of published versions

Resource Profile: Radiotherapy Volume Profile

Official URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-volume Version: 2.1.0
Active as of 2023-01-13 Maturity Level: 3 Computable Name: RadiotherapyVolume

A volume of the body used in radiotherapy planning or treatment delivery.

Background

Radiotherapy is a directed treatment that targets a specific areas or volumes in or on the body. The RadiotherapyVolume profile describes these areas or volumes in terms of a BodyStructure resource. Using a standalone resource permits reuse of the same body volume in planning, executing, and reporting a radiotherapy treatment, as opposed to repeating the same elements in multiple places.

The code list of anatomic structures and location qualifiers applicable to RadiotherapyVolume follows the recommendations of the American Association of Physicists in Medicine (AAPM) Task Group 263 report on Standardizing Nomenclatures in Radiation Oncology. Volumes are further classified according to their type, including the following Burnet et al., 2004:

  • Gross tumour volume (GTV) - what can be seen, palpated or imaged
  • Clinical target volume (CTV) - the GTV plus a margin accounting for sub-clinical disease spread which therefore cannot be fully imaged
  • Planning target volume (PTV) - a geometric concept designed to ensure that the radiotherapy dose is actually delivered to the CTV
  • Organs at Risk (OR or OAR) - critical normal tissue structures that should be protected against excessive radiation

An additional volume types referenced by ICRU62 is the term Internal Target Volume (ITV), represents a volume encompassing the CTV with an internal margin compensating for patient movement. As defined by Ezhil et al the Internal Gross Tumor Volume (IGTV) represents the GTV with an internal margin to compensate for all movements.

Usage

The treatment location should be expressed using the anatomical concepts in the American Association of Physicists in Medicine (AAPM) Task Group 263 report on Standardizing Nomenclatures in Radiation Oncology, expressed using SNOMEDCT. The mapping from AAPM TG263 concepts to SNOMEDCT codes (RadiotherapyTreatmentLocationVS) and qualifiers (RadiotherapyTreatmentLocationQualifierVS) can be found in this spreadsheet. An excerpt of this spreadsheet is shown below. For example, if the treatment location was the Left Breast, with TG263 primary name Breast_L, the location would be expressed by using the SNOMEDCT 76752008 (Breast structure (body structure)) for location, and 7771000 (Left) for the locationQualifier.

Excerpt from TG263 to SNOMED mapping

Limitations

A known limitation of the RadiotherapyVolume is that it accepts only one coded location. This limitation stems from the base BodyStructure resource. As a result, a compound volume (such as prostate plus seminal vesicles) cannot be represented. If this presents a serious limitation in practice, an extension with additional pairs (location, location qualifiers) will be required.

Conformance

BodyStructure resources whose morphology has a code from the value set RadiotherapyVolumeTypeVS MUST conform to this profile. Beyond this requirement, a producer of resources SHOULD ensure that any resource instance associated with an in-scope patient that would reasonably be expected to conform to this profile SHOULD be published in this form. Any resource intended to conform to this profile SHOULD populate meta.profile accordingly.

Usage:

Formal Views of Profile Content

Description of Profiles, Differentials, Snapshots and how the different presentations work.

This structure is derived from BodyStructure

NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... Slices for identifier S0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName S0..1IdentifierBodystructure identifier
..... use 1..1codeusual | official | temp | secondary | old (If known)
Required Pattern: usual
..... value S1..1stringThe value that is unique
... morphology S0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location S0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... description S0..1stringVolume Description
... patient S1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

Constraints

IdGradePath(s)DetailsRequirements
mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
: description.exists() or identifier.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName SΣ0..1IdentifierBodystructure identifier
..... use ?!Σ1..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... value SΣ1..1stringThe value that is unique
Example General: 123456
... morphology SΣ0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location SΣ0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... locationQualifier S0..*CodeableConceptQualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
Binding: Radiotherapy Treatment Location Qualifier Value Set (required)
... description SΣ0..1stringVolume Description
... patient SΣ1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
BodyStructure.identifier:displayName.userequiredPattern: usual
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

Constraints

IdGradePath(s)DetailsRequirements
mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
: description.exists() or identifier.exists()
NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName SΣ0..1IdentifierBodystructure identifier
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ1..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!Σ0..1booleanWhether this record is in active use
... morphology SΣ0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location SΣ0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... locationQualifier S0..*CodeableConceptQualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
Binding: Radiotherapy Treatment Location Qualifier Value Set (required)
... description SΣ0..1stringVolume Description
... image 0..*AttachmentAttached images
... patient SΣ1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
BodyStructure.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
BodyStructure.identifier:displayName.userequiredPattern: usual
BodyStructure.identifier:displayName.typeextensibleIdentifier Type Codes
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

This structure is derived from BodyStructure

Summary

Mandatory: 0 element (2 nested mandatory elements)
Must-Support: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element BodyStructure.identifier is sliced based on the value of value:use

Maturity: 3

Differential View

This structure is derived from BodyStructure

NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... Slices for identifier S0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName S0..1IdentifierBodystructure identifier
..... use 1..1codeusual | official | temp | secondary | old (If known)
Required Pattern: usual
..... value S1..1stringThe value that is unique
... morphology S0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location S0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... description S0..1stringVolume Description
... patient S1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings (Differential)

PathConformanceValueSet
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

Constraints

IdGradePath(s)DetailsRequirements
mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
: description.exists() or identifier.exists()

Key Elements View

NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName SΣ0..1IdentifierBodystructure identifier
..... use ?!Σ1..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... value SΣ1..1stringThe value that is unique
Example General: 123456
... morphology SΣ0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location SΣ0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... locationQualifier S0..*CodeableConceptQualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
Binding: Radiotherapy Treatment Location Qualifier Value Set (required)
... description SΣ0..1stringVolume Description
... patient SΣ1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
BodyStructure.identifier:displayName.userequiredPattern: usual
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

Constraints

IdGradePath(s)DetailsRequirements
mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
: description.exists() or identifier.exists()

Snapshot View

NameFlagsCard.TypeDescription & Constraintsdoco
.. BodyStructure C0..*BodyStructureSpecific and identified anatomical structure
mcode-description-or-id-required: One of description or identifier MUST be present
... id Σ0..1idLogical id of this artifact
... meta Σ0..1MetaMetadata about the resource
... implicitRules ?!Σ0..1uriA set of rules under which this content was created
... text 0..1NarrativeText summary of the resource, for human interpretation
... contained 0..*ResourceContained, inline Resources
... extension 0..*ExtensionAdditional content defined by implementations
... modifierExtension ?!0..*ExtensionExtensions that cannot be ignored
... Slices for identifier SΣ0..*IdentifierVolume Identifier
Slice: Unordered, Open by value:use
.... identifier:displayName SΣ0..1IdentifierBodystructure identifier
..... id 0..1stringUnique id for inter-element referencing
..... extension 0..*ExtensionAdditional content defined by implementations
Slice: Unordered, Open by value:url
..... use ?!Σ1..1codeusual | official | temp | secondary | old (If known)
Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


Required Pattern: usual
..... type Σ0..1CodeableConceptDescription of identifier
Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

..... system Σ0..1uriThe namespace for the identifier value
Example General: http://www.acme.com/identifiers/patient
..... value SΣ1..1stringThe value that is unique
Example General: 123456
..... period Σ0..1PeriodTime period when id is/was valid for use
..... assigner Σ0..1Reference(Organization)Organization that issued id (may be just text)
... active ?!Σ0..1booleanWhether this record is in active use
... morphology SΣ0..1CodeableConceptType of Radiotherapy Volume
Binding: Radiotherapy Volume Type Value Set (extensible)
... location SΣ0..1CodeableConceptBody Location Code.
Binding: Radiotherapy Treatment Location Value Set (required)
... locationQualifier S0..*CodeableConceptQualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
Binding: Radiotherapy Treatment Location Qualifier Value Set (required)
... description SΣ0..1stringVolume Description
... image 0..*AttachmentAttached images
... patient SΣ1..1Reference(Cancer Patient Profile)Who this is about

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / Code
BodyStructure.languagepreferredCommonLanguages
Additional Bindings Purpose
AllLanguages Max Binding
BodyStructure.identifier:displayName.userequiredPattern: usual
BodyStructure.identifier:displayName.typeextensibleIdentifier Type Codes
BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
BodyStructure.locationrequiredRadiotherapyTreatmentLocationVS
BodyStructure.locationQualifierrequiredRadiotherapyTreatmentLocationQualifierVS

This structure is derived from BodyStructure

Summary

Mandatory: 0 element (2 nested mandatory elements)
Must-Support: 8 elements

Structures

This structure refers to these other structures:

Slices

This structure defines the following Slices:

  • The element BodyStructure.identifier is sliced based on the value of value:use

Maturity: 3

 

Other representations of profile: CSV, Excel, Schematron