CodeX Radiation Therapy
2.0.0 - STU2  flag

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

Resource Profile: Radiotherapy Course Summary

Official URL: http://hl7.org/fhir/us/codex-radiation-therapy/StructureDefinition/codexrt-radiotherapy-course-summary Version: 2.0.0
Active as of 2025-02-17 Computable Name: RadiotherapyCourseSummary
Other Identifiers: OID:2.16.840.1.113883.4.642.40.14.42.8

A summary of the treatment progress in a radiotherapy course. Whenever new contributions in the scope of the same course are delivered, this resource is updated (no new resource created).

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.

Usage:

Formal Views of Profile Content

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

NameFlagsCard.TypeDescription & Constraintsdoco
.. 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
.... 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

doco Documentation for this format

Terminology Bindings

PathConformanceValueSet / CodeURI
Procedure.extension:modalityAndTechnique.extension:modality.value[x]requiredRadiotherapyModalityVS
http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-modality-vs
Procedure.extension:modalityAndTechnique.extension:technique.value[x]requiredRadiotherapyTechniqueVS
http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-technique-vs
Procedure.identifier:displayName.userequiredPattern: usual
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Procedure.identifier:official.userequiredPattern: official
http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
from the FHIR Standard
Procedure.statusrequiredEventStatus
http://hl7.org/fhir/ValueSet/event-status
from the FHIR Standard
Procedure.statusReasonpreferredTreatmentTerminationReasonVS
http://hl7.org/fhir/us/mcode/ValueSet/mcode-treatment-termination-reason-vs
Procedure.categoryrequiredRadiotherapyCategoryVS
http://hl7.org/fhir/us/codex-radiation-therapy/ValueSet/codexrt-radiotherapy-category-vs
from this IG
Procedure.codeextensiblePattern: SNOMED-CT Code 1217123003
http://hl7.org/fhir/us/core/ValueSet/us-core-procedure-code
Procedure.reasonCodeextensibleCancerDisorderVS
http://hl7.org/fhir/us/mcode/ValueSet/mcode-cancer-disorder-vs
Procedure.bodySiteextensibleRadiotherapyTreatmentLocationVS
http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs

Constraints

IdGradePath(s)DetailsRequirements
CategoryPreferredwarningProcedureThis code 108290001 is inactive and should be used only for backward compatibility.
: category.exists() and category.coding.exists( code = '108290001' ).not()
codexrt-free-breathing-techniqueerrorProcedureThe 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-noneerrorProcedureIf 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-statuserrorProcedureOnly 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'

 

Other representations of profile: CSV, Excel, Schematron