Usage

This profile is used to capture a course of radiotherapy delivered to a patient. An overview of radiotherapy courses, phases, and treatment plans is shown here. A course of therapy systematically addresses a condition or set of related conditions. The course can include multiple sessions, can be divided into multiple phases, and can last for several months. A course of treatment has a distinct beginning and end. While the Radiotherapy Course Summary can be incrementally updated as the treatment progresses, the primary purpose is to summarize the entire course of treatment from beginning to end. The status element indicates whether the treatment is in progress or complete. The relationships between the various radiotherapy profiles are shown here.

Course and Phase definitions follow the recommendations of the American Association of Physicists in Medicine (AAPM) Operational Ontology for Oncology (O3).

Conformance

Procedure resources whose code is SNOMEDCT 1217123003 (Radiotherapy course of treatment (regime/therapy)) MUST conform to this profile. Any resource intended to conform to this profile SHOULD populate meta.profile accordingly.

• Differential Table
• Key Elements Table
• Snapshot Table
• Statistics/References
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This structure is derived from RadiotherapyCourseSummary

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
Slices for extension				Content/Rules for all slices
extension:modalityAndTechnique		0..*	RadiotherapyModalityAndTechnique	Radiotherapy Modality And Technique Extension
Slices for extension				Content/Rules for all slices
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
extension:doseDeliveredToVolume		0..*	RadiotherapyDoseDeliveredToVolume	Radiotherapy Dose Delivered To Volume Extension
extension		2..*	Extension	Extension
Slices for extension				Content/Rules for all slices
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
Slices for identifier	S	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use
identifier:displayName	S	1..1	Identifier	The name that is displayed to the user.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
identifier:official	S	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve()
basedOn:planned-course	S	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary.
basedOn:course-prescription	S	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary.
category		1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required)
performed[x]
start	S	0..1	dateTime	The date and time when the first therapeutic radiation was delivered.
end	S	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed'
Slices for performer	S	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve()
performer:organization	S	0..*	BackboneElement	The people who performed the procedure
actor		1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment.
location	S	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed.
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve()
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy.
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve()
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped mcode-reason-required: One of reasonCode or reasonReference SHALL be present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
terminationReason		0..1	CodeableConcept	Treatment Termination Reason Extension (deprecated) URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-treatment-termination-reason Binding: Treatment Termination Reason Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required) ele-1: All FHIR elements must have a @value or children
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required) ele-1: All FHIR elements must have a @value or children
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
actualNumberOfSessions	S	0..1	unsignedInt	Radiotherapy Number of Sessions Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-sessions ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
doseDeliveredToVolume	S	0..*	(Complex)	Radiotherapy Dose Delivered To Volume Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:volume	S	1..1	Extension	Volume in the body where radiation was delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"volume"
extension:totalDoseDelivered	S	0..1	Extension	Total Physical Radiation Dose Delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"totalDoseDelivered"
value[x]		0..1	Quantity	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractionsDelivered	S	0..1	Extension	Number of Fractions Delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"fractionsDelivered"
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume"
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use ele-1: All FHIR elements must have a @value or children
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user. ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: usual
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID. ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: official
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
Slices for basedOn	Σ	0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
basedOn:planned-course	SΣ	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary. ele-1: All FHIR elements must have a @value or children
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary. ele-1: All FHIR elements must have a @value or children
status	?!SΣC	1..1	code	(USCDI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required) ele-1: All FHIR elements must have a @value or children
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred) ele-1: All FHIR elements must have a @value or children
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	(USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
subject	SΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who the procedure was performed on ele-1: All FHIR elements must have a @value or children
performed[x]	SΣC	0..1	Period	(USCDI) When the procedure was performed ele-1: All FHIR elements must have a @value or children
start	SΣC	0..1	dateTime	The date and time when the first therapeutic radiation was delivered. ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed' ele-1: All FHIR elements must have a @value or children
Slices for performer	SΣ	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve() ele-1: All FHIR elements must have a @value or children
performer:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner ele-1: All FHIR elements must have a @value or children
performer:organization	SΣ	0..*	BackboneElement	The people who performed the procedure ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	Σ	1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment. ele-1: All FHIR elements must have a @value or children
location	SΣ	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed. ele-1: All FHIR elements must have a @value or children
reasonCode	SΣ	0..*	CodeableConcept	Coded reason procedure performed Binding: Cancer Disorder Value Set (extensible) ele-1: All FHIR elements must have a @value or children
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	The justification that the procedure was performed ele-1: All FHIR elements must have a @value or children
bodySite	SΣ	0..*	CodeableConcept	All body structure(s) treated Binding: Radiotherapy Treatment Location Value Set (extensible) ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve() ele-1: All FHIR elements must have a @value or children
focalDevice:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
manipulated		1..1	Reference(Device)	Device that was changed ele-1: All FHIR elements must have a @value or children
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy. ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed ele-1: All FHIR elements must have a @value or children
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy. ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Procedure.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
Procedure.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
Procedure.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status from the FHIR Standard
Procedure.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
Procedure.code	extensible	Pattern: SNOMED-CT Code 1217123003 http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
Procedure.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped mcode-reason-required: One of reasonCode or reasonReference SHALL be present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
terminationReason		0..1	CodeableConcept	Treatment Termination Reason Extension (deprecated) URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-treatment-termination-reason Binding: Treatment Termination Reason Value Set (extensible)
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
actualNumberOfSessions	S	0..1	unsignedInt	Radiotherapy Number of Sessions Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-sessions
doseDeliveredToVolume	S	0..*	(Complex)	Radiotherapy Dose Delivered To Volume Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume in the body where radiation was delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"volume"
value[x]		0..1	Reference(Radiotherapy Volume Profile)	Value of extension
extension:totalDoseDelivered	S	0..1	Extension	Total Physical Radiation Dose Delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"totalDoseDelivered"
value[x]		0..1	Quantity	Value of extension Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
value		0..1	decimal	Numerical value (with implicit precision)
comparator		0..1	code	< | <= | >= | > - how to understand the value
unit		0..1	string	Unit representation
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractionsDelivered	S	0..1	Extension	Number of Fractions Delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"fractionsDelivered"
value[x]		0..1	unsignedInt	Value of extension
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume"
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
type	Σ	0..1	CodeableConcept	Description 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	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description 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	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	Σ	0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve()
basedOn:planned-course	SΣ	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary.
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary.
partOf	Σ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣC	1..1	code	(USCDI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required)
code	SΣ	1..1	CodeableConcept	(USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who the procedure was performed on
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
performed[x]	SΣC	0..1	Period	(USCDI) When the procedure was performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	The date and time when the first therapeutic radiation was delivered.
end	SΣC	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed'
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
Slices for performer	SΣ	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve()
performer:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
performer:organization	SΣ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment.
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	SΣ	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed.
reasonCode	SΣ	0..*	CodeableConcept	Coded reason procedure performed Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	All body structure(s) treated Binding: Radiotherapy Treatment Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
outcome	Σ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note		0..*	Annotation	Additional information about the procedure
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve()
focalDevice:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve()
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy.
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Procedure.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Procedure.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
Procedure.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
Procedure.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:displayName.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:official.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status from the FHIR Standard
Procedure.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
Procedure.code	extensible	Pattern: SNOMED-CT Code 1217123003 http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.performer:organization.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
Procedure.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
Procedure.outcome	example	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Procedure.followUp	example	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.focalDevice:seedDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

Differential View

This structure is derived from RadiotherapyCourseSummary

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
Slices for extension				Content/Rules for all slices
extension:modalityAndTechnique		0..*	RadiotherapyModalityAndTechnique	Radiotherapy Modality And Technique Extension
Slices for extension				Content/Rules for all slices
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
extension:doseDeliveredToVolume		0..*	RadiotherapyDoseDeliveredToVolume	Radiotherapy Dose Delivered To Volume Extension
extension		2..*	Extension	Extension
Slices for extension				Content/Rules for all slices
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
Slices for identifier	S	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use
identifier:displayName	S	1..1	Identifier	The name that is displayed to the user.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: usual
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
identifier:official	S	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
use		1..1	code	usual | official | temp | secondary | old (If known) Required Pattern: official
system	S	1..1	uri	The namespace for the identifier value
value	S	1..1	string	The value that is unique
Slices for basedOn		0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve()
basedOn:planned-course	S	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary.
basedOn:course-prescription	S	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary.
category		1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required)
performed[x]
start	S	0..1	dateTime	The date and time when the first therapeutic radiation was delivered.
end	S	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed'
Slices for performer	S	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve()
performer:organization	S	0..*	BackboneElement	The people who performed the procedure
actor		1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment.
location	S	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed.
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve()
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy.
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve()
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy.
Documentation for this format

Terminology Bindings (Differential)

Path	Conformance	ValueSet	URI
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

Key Elements View

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient dom-2: If the resource is contained in another resource, it SHALL NOT contain nested Resources dom-3: If the resource is contained in another resource, it SHALL be referred to from elsewhere in the resource or SHALL refer to the containing resource dom-4: If a resource is contained in another resource, it SHALL NOT have a meta.versionId or a meta.lastUpdated dom-5: If a resource is contained in another resource, it SHALL NOT have a security label dom-6: A resource should have narrative for robust management us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped mcode-reason-required: One of reasonCode or reasonReference SHALL be present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created ele-1: All FHIR elements must have a @value or children
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
terminationReason		0..1	CodeableConcept	Treatment Termination Reason Extension (deprecated) URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-treatment-termination-reason Binding: Treatment Termination Reason Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required) ele-1: All FHIR elements must have a @value or children
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required) ele-1: All FHIR elements must have a @value or children
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
actualNumberOfSessions	S	0..1	unsignedInt	Radiotherapy Number of Sessions Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-sessions ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
doseDeliveredToVolume	S	0..*	(Complex)	Radiotherapy Dose Delivered To Volume Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension:volume	S	1..1	Extension	Volume in the body where radiation was delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"volume"
extension:totalDoseDelivered	S	0..1	Extension	Total Physical Radiation Dose Delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"totalDoseDelivered"
value[x]		0..1	Quantity	Value of extension ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractionsDelivered	S	0..1	Extension	Number of Fractions Delivered ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
extension		0..0
url		1..1	uri	"fractionsDelivered"
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume"
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for identifier	SΣ	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use ele-1: All FHIR elements must have a @value or children
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user. ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: usual
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID. ele-1: All FHIR elements must have a @value or children
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . ele-1: All FHIR elements must have a @value or children Required Pattern: official
system	SΣ	1..1	uri	The namespace for the identifier value ele-1: All FHIR elements must have a @value or children Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique ele-1: All FHIR elements must have a @value or children Example General: 123456
Slices for basedOn	Σ	0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
basedOn:planned-course	SΣ	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary. ele-1: All FHIR elements must have a @value or children
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary. ele-1: All FHIR elements must have a @value or children
status	?!SΣC	1..1	code	(USCDI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required) ele-1: All FHIR elements must have a @value or children
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred) ele-1: All FHIR elements must have a @value or children
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required) ele-1: All FHIR elements must have a @value or children
code	SΣ	1..1	CodeableConcept	(USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure ele-1: All FHIR elements must have a @value or children Required Pattern: At least the following
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
subject	SΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who the procedure was performed on ele-1: All FHIR elements must have a @value or children
performed[x]	SΣC	0..1	Period	(USCDI) When the procedure was performed ele-1: All FHIR elements must have a @value or children
start	SΣC	0..1	dateTime	The date and time when the first therapeutic radiation was delivered. ele-1: All FHIR elements must have a @value or children
end	SΣC	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed' ele-1: All FHIR elements must have a @value or children
Slices for performer	SΣ	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve() ele-1: All FHIR elements must have a @value or children
performer:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner ele-1: All FHIR elements must have a @value or children
performer:organization	SΣ	0..*	BackboneElement	The people who performed the procedure ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
actor	Σ	1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment. ele-1: All FHIR elements must have a @value or children
location	SΣ	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed. ele-1: All FHIR elements must have a @value or children
reasonCode	SΣ	0..*	CodeableConcept	Coded reason procedure performed Binding: Cancer Disorder Value Set (extensible) ele-1: All FHIR elements must have a @value or children
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	The justification that the procedure was performed ele-1: All FHIR elements must have a @value or children
bodySite	SΣ	0..*	CodeableConcept	All body structure(s) treated Binding: Radiotherapy Treatment Location Value Set (extensible) ele-1: All FHIR elements must have a @value or children
Slices for extension				Content/Rules for all slices
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required) ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve() ele-1: All FHIR elements must have a @value or children
focalDevice:All Slices				Content/Rules for all slices
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
manipulated		1..1	Reference(Device)	Device that was changed ele-1: All FHIR elements must have a @value or children
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy. ele-1: All FHIR elements must have a @value or children
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized ele-1: All FHIR elements must have a @value or children ext-1: Must have either extensions or value[x], not both
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed ele-1: All FHIR elements must have a @value or children
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve() ele-1: All FHIR elements must have a @value or children
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy. ele-1: All FHIR elements must have a @value or children
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Procedure.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
Procedure.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
Procedure.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status from the FHIR Standard
Procedure.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
Procedure.code	extensible	Pattern: SNOMED-CT Code 1217123003 http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
Procedure.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

Snapshot View

Name	Flags	Card.	Type	Description & Constraints
Procedure	C	0..*	RadiotherapyCourseSummary	An action that is being or was performed on a patient us-core-7: Performed SHALL be present if the status is 'completed' or 'in-progress' termination-reason-code-invariant: When status is stopped, only certain statusReason values are allowed termination-reason-invariant: Certain statusReason values are allowed only when status is stopped mcode-reason-required: One of reasonCode or reasonReference SHALL be present codexrt-motion-management-none: If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" codexrt-free-breathing-technique: The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" CategoryPreferred: This code 108290001 is inactive and should be used only for backward compatibility. codexrt-procedure-status: Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed
id	Σ	0..1	id	Logical id of this artifact
meta	Σ	0..1	Meta	Metadata about the resource
implicitRules	?!Σ	0..1	uri	A set of rules under which this content was created
language		0..1	code	Language of the resource content Binding: CommonLanguages (preferred): A human language. Additional Bindings Purpose AllLanguages Max Binding
text		0..1	Narrative	Text summary of the resource, for human interpretation
contained		0..*	Resource	Contained, inline Resources
Slices for extension	S	0..*	Extension	Extension Slice: Unordered, Open by value:url
treatmentIntent	S	0..1	CodeableConcept	Procedure Intent Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-procedure-intent Binding: Procedure Intent Value Set (extensible)
terminationReason		0..1	CodeableConcept	Treatment Termination Reason Extension (deprecated) URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-treatment-termination-reason Binding: Treatment Termination Reason Value Set (extensible)
modalityAndTechnique	SC	0..*	(Complex)	Radiotherapy Modality And Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique TechniquesForNeutronBeamModality: Allowed Techniques for Neutron Beam Modality TechniquesForPhotonBeamModality: Allowed Techniques for Photon Beam Modality TechniquesForElectronBeamModality: Allowed Techniques for Electron Beam Modality TechniquesForCarbonIonBeamModality: Allowed Techniques for Carbon Ion Beam Modality TechniquesForProtonBeamModality: Allowed Techniques for Proton Beam Modality TechniquesForInternalRadiotherapyPermanentSeeds: Allowed Techniques for Internal Radiotherapy - Permanent Seeds TechniquesForLowDoseRateUsingTempRadSource: Allowed Techniques for Low Dose Rate Using Temp Radiation Source TechniquesForPulsedDoseRate: Allowed Techniques for Pulsed Dose Rate TechniquesForHighDoseRate: Allowed Techniques for High Dose Rate TechniquesForHighDoseRateElectronic: Allowed Techniques for High Dose Rate Electronic TechniquesForRadioPharmaceutical: Allowed Techniques for Radiopharmaceutical ModalityTextRequiredForOther: Require a text literal for code other TechniqueTextRequiredForOther: Require a text literal for code other
id		0..1	string	Unique id for inter-element referencing
Slices for extension		1..*	Extension	Extension Slice: Unordered, Open by value:url
modality	S	1..1	(Complex)	Radiotherapy Modality Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Modality Value Set (required)
technique	S	0..*	(Complex)	Radiotherapy Technique Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-technique"
value[x]		1..1	CodeableConcept	Value of extension Binding: Radiotherapy Technique Value Set (required)
radiotherapyEnergyOrIsotope	S	0..*	SimpleQuantity	Radiotherapy Energy or Isotope URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope Binding: Radiotherapy Energy Unit Value Set (required)
radiotherapyTreatmentApplicatorType	S	0..*	CodeableConcept	Radiotherapy Treatment Applicator Type URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type Binding: Brachytherapy Applicator Type Value Set (extensible)
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-modality-and-technique"
actualNumberOfSessions	S	0..1	unsignedInt	Radiotherapy Number of Sessions Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-sessions
doseDeliveredToVolume	S	0..*	(Complex)	Radiotherapy Dose Delivered To Volume Extension URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume
id		0..1	string	Unique id for inter-element referencing
Slices for extension		2..*	Extension	Extension Slice: Unordered, Open by value:url
extension:volume	S	1..1	Extension	Volume in the body where radiation was delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"volume"
value[x]		0..1	Reference(Radiotherapy Volume Profile)	Value of extension
extension:totalDoseDelivered	S	0..1	Extension	Total Physical Radiation Dose Delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"totalDoseDelivered"
value[x]		0..1	Quantity	Value of extension Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
value		0..1	decimal	Numerical value (with implicit precision)
comparator		0..1	code	< | <= | >= | > - how to understand the value
unit		0..1	string	Unit representation
system		1..1	uri	System that defines coded unit form Fixed Value: http://unitsofmeasure.org
code		1..1	code	Coded form of the unit Fixed Value: cGy
extension:fractionsDelivered	S	0..1	Extension	Number of Fractions Delivered
id		0..1	string	Unique id for inter-element referencing
extension		0..0
url		1..1	uri	"fractionsDelivered"
value[x]		0..1	unsignedInt	Value of extension
pointDose	S	0..1	boolean	Point Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
primaryPlanDose	S	0..1	boolean	Primary Plan Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
radiobiologicMetric	S	0..*	Quantity	Radiotherapy Biologically Effective Dose URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
uniformFractionation	S	1..1	boolean	Uniform Fractionation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation
url		1..1	uri	"http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-dose-delivered-to-volume"
respiratoryMotionManagement	S	0..*	CodeableConcept	Respiratory Motion Management URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management Binding: Radiotherapy Respiratory Motion Management Value Set (required)
freeBreathingMotionManagementTechnique	S	0..*	CodeableConcept	Free-Breathing Motion Management Technique URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique Binding: Radiotherapy Free-Breathing Motion Management Technique Value Set (extensible)
intrafractionVerification	S	0..*	(Complex)	Intrafraction Verification URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
imageGuidedRadiotherapyModality	S	0..*	(Complex)	Image Guided Radiotherapy Modality URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
courseInvolvesReirradiation	S	0..1	boolean	Course Involves Reirradiation URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation
modifierExtension	?!	0..*	Extension	Extensions that cannot be ignored
Slices for identifier	SΣ	2..*	Identifier	External Identifiers for this procedure Slice: Unordered, Open by value:use
identifier:displayName	SΣ	1..1	Identifier	The name that is displayed to the user.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: usual
type	Σ	0..1	CodeableConcept	Description 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	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
identifier:official	SΣ	1..*	Identifier	A business identifier for the request or procedure, which is independent of its FHIR representation, such as a GUID or DICOM UID.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
use	?!Σ	1..1	code	usual | official | temp | secondary | old (If known) Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known . Required Pattern: official
type	Σ	0..1	CodeableConcept	Description 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	SΣ	1..1	uri	The namespace for the identifier value Example General: http://www.acme.com/identifiers/patient
value	SΣ	1..1	string	The value that is unique Example General: 123456
period	Σ	0..1	Period	Time period when id is/was valid for use
assigner	Σ	0..1	Reference(Organization)	Organization that issued id (may be just text)
instantiatesCanonical	Σ	0..*	canonical(PlanDefinition | ActivityDefinition | Measure | OperationDefinition | Questionnaire)	Instantiates FHIR protocol or definition
instantiatesUri	Σ	0..*	uri	Instantiates external protocol or definition
Slices for basedOn	Σ	0..*	Reference(US Core CarePlan Profile | US Core ServiceRequest Profile)	(USCDI) A request for this procedure Slice: Unordered, Open by profile:$this.resolve()
basedOn:planned-course	SΣ	0..1	Reference(Radiotherapy Planned Course)	Radiotherapy Planned Course that planned the treatment summarized in this Radiotherapy Course Summary.
basedOn:course-prescription	SΣ	0..1	Reference(Radiotherapy Course Prescription)	Radiotherapy Course Prescription that prescribed the treatment summarized in this Radiotherapy Course Summary.
partOf	Σ	0..*	Reference(Procedure | Observation | MedicationAdministration)	Part of referenced event
status	?!SΣC	1..1	code	(USCDI) preparation | in-progress | not-done | on-hold | stopped | completed | entered-in-error | unknown Binding: EventStatus (required)
statusReason	SΣ	0..1	CodeableConcept	Reason for current status Binding: Treatment Termination Reason Value Set (preferred)
category	Σ	1..1	CodeableConcept	Classification of the procedure Binding: Radiotherapy Category Code Max Value Set (required)
code	SΣ	1..1	CodeableConcept	(USCDI) Identification of the procedure Binding: US Core Procedure Codes (extensible): Codes describing the type of Procedure Required Pattern: At least the following
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
coding		1..*	Coding	Code defined by a terminology system Fixed Value: (complex)
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
system		1..1	uri	Identity of the terminology system Fixed Value: http://snomed.info/sct
version		0..1	string	Version of the system - if relevant
code		1..1	code	Symbol in syntax defined by the system Fixed Value: 1217123003
display		0..1	string	Representation defined by the system
userSelected		0..1	boolean	If this coding was chosen directly by the user
text		0..1	string	Plain text representation of the concept
subject	SΣ	1..1	Reference(Cancer Patient Profile)	(USCDI) Who the procedure was performed on
encounter	Σ	0..1	Reference(Encounter)	Encounter created as part of
performed[x]	SΣC	0..1	Period	(USCDI) When the procedure was performed
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
start	SΣC	0..1	dateTime	The date and time when the first therapeutic radiation was delivered.
end	SΣC	0..1	dateTime	An end date is expected if the status is 'stopped' or 'completed'
recorder	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Who recorded the procedure
asserter	Σ	0..1	Reference(Patient | RelatedPerson | Practitioner | PractitionerRole)	Person who asserts this procedure
Slices for performer	SΣ	0..*	BackboneElement	The people who performed the procedure Slice: Unordered, Open by profile:actor.resolve()
performer:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(Practitioner | PractitionerRole | Organization | Patient | RelatedPerson | Device)	The reference to the practitioner
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
performer:organization	SΣ	0..*	BackboneElement	The people who performed the procedure
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
function	Σ	0..1	CodeableConcept	Type of performance Binding: ProcedurePerformerRoleCodes (example): A code that identifies the role of a performer of the procedure.
actor	Σ	1..1	Reference(US Core Organization Profile)	Organization that provided the radiotherapy treatment.
onBehalfOf		0..1	Reference(Organization)	Organization the device or practitioner was acting for
location	SΣ	0..1	Reference(US Core Location Profile)	Location where the radiotherapy treatment was performed.
reasonCode	SΣ	0..*	CodeableConcept	Coded reason procedure performed Binding: Cancer Disorder Value Set (extensible)
reasonReference	SΣ	0..*	Reference(US Core Condition Problems and Health Concerns Profile)	The justification that the procedure was performed
bodySite	SΣ	0..*	CodeableConcept	All body structure(s) treated Binding: Radiotherapy Treatment Location Value Set (extensible)
id		0..1	string	Unique id for inter-element referencing
Slices for extension		0..*	Extension	Additional content defined by implementations Slice: Unordered, Open by value:url
locationQualifier		0..*	CodeableConcept	General location qualifier (excluding laterality) for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-body-location-qualifier Binding: Body Location Qualifier Value Set (required)
lateralityQualifier		0..1	CodeableConcept	Laterality qualifier for this bodySite URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-laterality-qualifier Binding: Laterality Qualifier Value Set (required)
coding	Σ	0..*	Coding	Code defined by a terminology system
text	Σ	0..1	string	Plain text representation of the concept
outcome	Σ	0..1	CodeableConcept	The result of procedure Binding: ProcedureOutcomeCodes(SNOMEDCT) (example): An outcome of a procedure - whether it was resolved or otherwise.
report		0..*	Reference(DiagnosticReport | DocumentReference | Composition)	Any report resulting from the procedure
complication		0..*	CodeableConcept	Complication following the procedure Binding: Condition/Problem/DiagnosisCodes (example): Codes describing complications that resulted from a procedure.
complicationDetail		0..*	Reference(Condition)	A condition that is a result of the procedure
followUp		0..*	CodeableConcept	Instructions for follow up Binding: ProcedureFollowUpCodes(SNOMEDCT) (example): Specific follow up required for a procedure e.g. removal of sutures.
note		0..*	Annotation	Additional information about the procedure
Slices for focalDevice		0..*	BackboneElement	Manipulated, implanted, or removed device Slice: Unordered, Open by profile:manipulated.resolve()
focalDevice:All Slices				Content/Rules for all slices
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Device)	Device that was changed
focalDevice:seedDevice	S	0..*	BackboneElement	Radiotherapy Seed Device used as part of therapy.
id		0..1	string	Unique id for inter-element referencing
extension		0..*	Extension	Additional content defined by implementations
modifierExtension	?!Σ	0..*	Extension	Extensions that cannot be ignored even if unrecognized
action		0..1	CodeableConcept	Kind of change to device Binding: ProcedureDeviceActionCodes (preferred): A kind of change that happened to the device during the procedure.
manipulated		1..1	Reference(Radiotherapy Seed Device)	Device that was changed
Slices for usedReference	S	0..*	Reference(Device | Medication | Substance)	Items used during procedure Slice: Unordered, Open by profile:$this.resolve()
usedReference:treatmentDevice	S	0..*	Reference(Radiotherapy Treatment Device)	Radiotherapy Treatment Device used as part of therapy.
usedCode		0..*	CodeableConcept	Coded items used during the procedure Binding: FHIRDeviceTypes (example): Codes describing items used during a procedure.
Documentation for this format

Terminology Bindings

Path	Conformance	ValueSet / Code	URI
Procedure.language	preferred	CommonLanguages http://hl7.org/fhir/ValueSet/languages from the FHIR Standard Additional Bindings Purpose AllLanguages Max Binding
Procedure.extension:modalityAndTechnique.extension:modality.value[x]	required	RadiotherapyModalityVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
Procedure.extension:modalityAndTechnique.extension:technique.value[x]	required	RadiotherapyTechniqueVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
Procedure.identifier:displayName.use	required	Pattern: usual http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:displayName.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.identifier:official.use	required	Pattern: official http://hl7.org/fhir/ValueSet/identifier-use|4.0.1 from the FHIR Standard
Procedure.identifier:official.type	extensible	Identifier Type Codes http://hl7.org/fhir/ValueSet/identifier-type from the FHIR Standard
Procedure.status	required	EventStatus http://hl7.org/fhir/ValueSet/event-status from the FHIR Standard
Procedure.statusReason	preferred	TreatmentTerminationReasonVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs
Procedure.category	required	RadiotherapyCategoryVS http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs from this IG
Procedure.code	extensible	Pattern: SNOMED-CT Code 1217123003 http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.performer.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.performer:organization.function	example	ProcedurePerformerRoleCodes http://hl7.org/fhir/ValueSet/performer-role from the FHIR Standard
Procedure.reasonCode	extensible	CancerDisorderVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
Procedure.bodySite	extensible	RadiotherapyTreatmentLocationVS http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
Procedure.outcome	example	ProcedureOutcomeCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-outcome from the FHIR Standard
Procedure.complication	example	Condition/Problem/DiagnosisCodes http://hl7.org/fhir/ValueSet/condition-code from the FHIR Standard
Procedure.followUp	example	ProcedureFollowUpCodes(SNOMEDCT) http://hl7.org/fhir/ValueSet/procedure-followup from the FHIR Standard
Procedure.focalDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.focalDevice:seedDevice.action	preferred	ProcedureDeviceActionCodes http://hl7.org/fhir/ValueSet/device-action from the FHIR Standard
Procedure.usedCode	example	FHIRDeviceTypes http://hl7.org/fhir/ValueSet/device-kind from the FHIR Standard

Constraints

Id	Grade	Path(s)	Details	Requirements
CategoryPreferred	warning	Procedure	This code 108290001 is inactive and should be used only for backward compatibility. : category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-technique	error	Procedure	The extension for the technique of free-breathing motion management is only allowed if motion management is free-breathing. SNOMEDCT code 721071000124104 is "External beam radiotherapy with free breathing (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique') implies extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721071000124104' and system = 'http://snomed.info/sct')))
codexrt-motion-management-none	error	Procedure	If the respiratory motion management is 'none', then no other respiratory motion management extensions are allowed. They would also be 'none' or contradict the 'none'. SNOMEDCT code 721031000124102 is "External beam radiotherapy without respiratory motion management (procedure)" : extension.exists(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management' and value.exists(coding.exists(code = '721031000124102' and system = 'http://snomed.info/sct'))) implies extension.where(url = 'http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management').count() = 1
codexrt-procedure-status	error	Procedure	Only the following status values are supported: in-progress | not-done | on-hold | stopped | completed : status = 'in-progress' or status = 'not-done' or status = 'on-hold' or status = 'stopped' or status = 'completed'

This structure is derived from RadiotherapyCourseSummary

Summary

Mandatory: 9 elements(1 nested mandatory element)
Must-Support: 28 elements

Structures

This structure refers to these other structures:

• Radiotherapy Planned Course (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-planned-course)
• Radiotherapy Course Prescription (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-prescription)
• US Core Organization Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-organization)
• US Core Location Profile (http://hl7.org/fhir/us/core/StructureDefinition/us-core-location)
• Radiotherapy Seed Device (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-seed-device)
• Radiotherapy Treatment Device (http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-device)

Extensions

This structure refers to these extensions:

• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-energy-or-isotope
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-treatment-applicator-type
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-point-dose
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-primary-plan-dose
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiobiologic-metric
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-uniform-fractionation
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-respiratory-motion-management
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-free-breathing-motion-mgmt-technique
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-intrafraction-verification
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-image-guided-radiotherapy-modality
• http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-involves-reirradiation

Slices

This structure defines the following Slices:

• The element 1 is sliced based on the value of Procedure.identifier
• The element 1 is sliced based on the value of Procedure.basedOn
• The element 1 is sliced based on the value of Procedure.performer
• The element 1 is sliced based on the value of Procedure.focalDevice
• The element 1 is sliced based on the value of Procedure.usedReference