{ "resourceType" : "Questionnaire", "id" : "questionnaire-mammogram-lt-breast", "language" : "en", "text" : { "status" : "generated", "div" : "

English

Generated Narrative: Questionnaire questionnaire-mammogram-lt-breast

Language: en

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" MammogramQuestionnaireLtBreastStructured data-capture form for mammogram reporting based on ADP Table 7.1.Questionnairehttps://hl7.lt/fhir/breast/Questionnaire/questionnaire-mammogram-lt-breast#0.0.1
\".\"\".\"\".\" grp-exam-contextExamination context0..1group
\".\"\".\"\".\"\".\" exam-dateDate of test0..1dateTime
\".\"\".\"\".\"\".\" radiation-doseRadiation dose (mGy)0..1quantity
\".\"\".\"\".\"\".\" technologist-nameRadiology technologist0..1string
\".\"\".\"\".\"\".\" equipment-nameEquipment name0..1string
\".\"\".\"\".\"\".\" facility-nameFacility name0..1string
\".\"\".\"\".\" grp-palpable-changesPalpable / visible changes0..1group
\".\"\".\"\".\"\".\" skin-formationsSkin formations0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" scarsScars0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" nipple-inversionNipple inversion0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" prior-breast-surgeryPrior breast surgery0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" breast-injuriesBreast injuries0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" breast-diseasesBreast diseases0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" other-informationOther information0..1text
\".\"\".\"\".\" grp-gland-densityGland density0..1group
\".\"\".\"\".\"\".\" acr-densityACR breast density category0..1codingOptions: 4 options
\".\"\".\"\".\" grp-findings-rightFindings – right breast0..1group
\".\"\".\"\".\"\".\" right-changes-presentChanges present0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" right-formationsFormations0..1codingOptions: 2 options
\".\"\".\"\".\"\".\"\".\" right-formations-quadrantQuadrant location0..1codingOptions: 4 options
\".\"\".\"\".\"\".\" right-calcificationsCalcifications0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" right-deformationDeformation0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" right-asymmetric-tissueAsymmetric tissue0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" right-dataset-sizeDataset size (mm)0..1quantity
\".\"\".\"\".\" grp-findings-leftFindings – left breast0..1group
\".\"\".\"\".\"\".\" left-changes-presentChanges present0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" left-formationsFormations0..1codingOptions: 2 options
\".\"\".\"\".\"\".\"\".\" left-formations-quadrantQuadrant location0..1codingOptions: 4 options
\".\"\".\"\".\"\".\" left-calcificationsCalcifications0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" left-deformationDeformation0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" left-asymmetric-tissueAsymmetric tissue0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" left-dataset-sizeDataset size (mm)0..1quantity
\".\"\".\"\".\" grp-dynamicsDynamic changes compared to previous examination0..1group
\".\"\".\"\".\"\".\" dynamicsDynamic changes0..1codingOptions: 2 options
Related changes0..1group
\".\"\".\"\".\"\".\" skin-changesSkin changes0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" nipple-changesNipple changes0..1codingOptions: 2 options
\".\"\".\"\".\"\".\" lymph-node-changesLymph node changes0..1codingOptions: 2 options
\".\"\".\"\".\" grp-conclusionConclusion0..1group
\".\"\".\"\".\"\".\" birads-conclusionBI-RADS conclusion0..1codingOptions: 6 options
\".\"\".\"\".\"\".\" recommendationsRecommendations0..*codingOptions: 6 options
\".\"\".\"\".\"\".\" conclusion-notesNotes0..1text

\"doco\" Documentation for this format

Options Sets

Answer options for skin-formations

Answer options for scars

Answer options for nipple-inversion

Answer options for prior-breast-surgery

Answer options for breast-injuries

Answer options for breast-diseases

Answer options for acr-density

Answer options for right-changes-present

Answer options for right-formations

Answer options for right-formations-quadrant

Answer options for right-calcifications

Answer options for right-deformation

Answer options for right-asymmetric-tissue

Answer options for left-changes-present

Answer options for left-formations

Answer options for left-formations-quadrant

Answer options for left-calcifications

Answer options for left-deformation

Answer options for left-asymmetric-tissue

Answer options for dynamics

Answer options for skin-changes

Answer options for nipple-changes

Answer options for lymph-node-changes

Answer options for birads-conclusion

Answer options for recommendations

" }, "url" : "https://hl7.lt/fhir/breast/Questionnaire/questionnaire-mammogram-lt-breast", "version" : "0.0.1", "name" : "MammogramQuestionnaireLtBreast", "title" : "Questionnaire: Mammogram ESPBI Form (LT Breast)", "status" : "active", "date" : "2026-03-29T12:06:43+00:00", "publisher" : "Lithuanian Medical Library", "contact" : [{ "name" : "Lithuanian Medical Library", "telecom" : [{ "system" : "url", "value" : "https://medicinosnk.lt" }, { "system" : "email", "value" : "info@medicinosnk.lt" }] }], "description" : "Structured data-capture form for mammogram reporting based on ADP Table 7.1.", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "LT" }] }], "item" : [{ "linkId" : "grp-exam-context", "text" : "Examination context", "type" : "group", "item" : [{ "linkId" : "exam-date", "text" : "Date of test", "type" : "dateTime" }, { "linkId" : "radiation-dose", "text" : "Radiation dose (mGy)", "type" : "quantity" }, { "linkId" : "technologist-name", "text" : "Radiology technologist", "type" : "string" }, { "linkId" : "equipment-name", "text" : "Equipment name", "type" : "string" }, { "linkId" : "facility-name", "text" : "Facility name", "type" : "string" }] }, { "linkId" : "grp-palpable-changes", "text" : "Palpable / visible changes", "type" : "group", "item" : [{ "linkId" : "skin-formations", "text" : "Skin formations", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "scars", "text" : "Scars", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "nipple-inversion", "text" : "Nipple inversion", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "prior-breast-surgery", "text" : "Prior breast surgery", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "breast-injuries", "text" : "Breast injuries", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "breast-diseases", "text" : "Breast diseases", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "other-information", "text" : "Other information", "type" : "text" }] }, { "linkId" : "grp-gland-density", "text" : "Gland density", "type" : "group", "item" : [{ "linkId" : "acr-density", "text" : "ACR breast density category", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "acr-a", "display" : "ACR A – Almost entirely fatty" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "acr-b", "display" : "ACR B – Scattered areas of fibroglandular density" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "acr-c", "display" : "ACR C – Heterogeneously dense" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "acr-d", "display" : "ACR D – Extremely dense" } }] }] }, { "linkId" : "grp-findings-right", "text" : "Findings – right breast", "type" : "group", "item" : [{ "linkId" : "right-changes-present", "text" : "Changes present", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "right-formations", "text" : "Formations", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }], "item" : [{ "linkId" : "right-formations-quadrant", "text" : "Quadrant location", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "uoq", "display" : "Upper outer quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "uiq", "display" : "Upper inner quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "loq", "display" : "Lower outer quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "liq", "display" : "Lower inner quadrant" } }] }] }, { "linkId" : "right-calcifications", "text" : "Calcifications", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "right-deformation", "text" : "Deformation", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "right-asymmetric-tissue", "text" : "Asymmetric tissue", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "right-dataset-size", "text" : "Dataset size (mm)", "type" : "quantity" }] }, { "linkId" : "grp-findings-left", "text" : "Findings – left breast", "type" : "group", "item" : [{ "linkId" : "left-changes-present", "text" : "Changes present", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "left-formations", "text" : "Formations", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }], "item" : [{ "linkId" : "left-formations-quadrant", "text" : "Quadrant location", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "uoq", "display" : "Upper outer quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "uiq", "display" : "Upper inner quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "loq", "display" : "Lower outer quadrant" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "liq", "display" : "Lower inner quadrant" } }] }] }, { "linkId" : "left-calcifications", "text" : "Calcifications", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "left-deformation", "text" : "Deformation", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "left-asymmetric-tissue", "text" : "Asymmetric tissue", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "left-dataset-size", "text" : "Dataset size (mm)", "type" : "quantity" }] }, { "linkId" : "grp-dynamics", "text" : "Dynamic changes compared to previous examination", "type" : "group", "item" : [{ "linkId" : "dynamics", "text" : "Dynamic changes", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "dynamics-none", "display" : "Image without negative dynamics" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "dynamics-negative", "display" : "Negative dynamics observed" } }] }] }, { "linkId" : "grp-related-changes", "text" : "Related changes", "type" : "group", "item" : [{ "linkId" : "skin-changes", "text" : "Skin changes", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "nipple-changes", "text" : "Nipple changes", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }, { "linkId" : "lymph-node-changes", "text" : "Lymph node changes", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "no", "display" : "No" } }] }] }, { "linkId" : "grp-conclusion", "text" : "Conclusion", "type" : "group", "item" : [{ "linkId" : "birads-conclusion", "text" : "BI-RADS conclusion", "type" : "coding", "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-0", "display" : "BI-RADS 0 – Incomplete examination" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-1", "display" : "BI-RADS 1 – No changes found" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-2", "display" : "BI-RADS 2 – Benign changes found" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-3", "display" : "BI-RADS 3 – Possibly benign changes" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-4", "display" : "BI-RADS 4 – Suspicious malignant finding" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "birads-5", "display" : "BI-RADS 5 – Highly probable malignant finding" } }] }, { "linkId" : "recommendations", "text" : "Recommendations", "type" : "coding", "repeats" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-mammographic-control", "display" : "Mammographic control" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-additional-mammography", "display" : "Additional mammography" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-ultrasound", "display" : "Ultrasound examination" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-mri", "display" : "MRI examination" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-biopsy", "display" : "Biopsy indicated" } }, { "valueCoding" : { "system" : "https://tx.hl7.lt/fhir/CodeSystem/breast-questionnaire-options", "code" : "rec-consultation", "display" : "Consultation with breast specialist" } }] }, { "linkId" : "conclusion-notes", "text" : "Notes", "type" : "text" }] }] }