Lithuanian Breast Diagnostics Implementation Guide
0.0.1 - ci-build
Lithuanian Breast Diagnostics Implementation Guide, published by Lithuanian Medical Library. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7LT/ig-lt-breast/ and changes regularly. See the Directory of published versions
Contents:
This page provides a list of the FHIR artifacts defined as part of this implementation guide.
These define forms used by systems conforming to this implementation guide to capture or expose data to end users.
| Questionnaire: Mammogram ESPBI Form (LT Breast) |
Structured data-capture form for mammogram reporting based on ADP Table 7.1. |
| Questionnaire: Tomosynthesis ESPBI Form (LT Breast) |
Structured data-capture form for breast tomosynthesis reporting based on ADP Table 7.2. |
These define constraints on FHIR resources for systems conforming to this implementation guide.
| BI-RADS Assessment |
Final radiological diagnostic conclusion according to BI-RADS classification. |
| Breast Biopsy Procedure (LT Breast) |
Breast biopsy procedure profile for the breast cancer prevention program, covering ultrasound-guided and X-ray-guided biopsy types. |
| Breast Body Structure |
BodyStructure profile representing breast structures including laterality and quadrants. |
| Breast Composition (LT Breast) |
Breast-specific imaging composition extending the base imaging composition with breast-specific constraints on findings, impression, and history sections. Designed for use in the Lithuanian breast cancer prevention programme. |
| Breast Diagnostic Report (LT Breast) |
Overall breast diagnostic report covering the entire breast cancer diagnostic pathway. Wraps a BreastCompositionLtBreast and aggregates structured results including BI-RADS assessments, mammographic findings, ultrasound findings, gland density, and nipple observations. |
| Breast Duct Condition (LT Breast) |
Breast duct condition observation as assessed by ultrasound, recorded per breast side. |
| Breast Examination Order |
A profile of ServiceRequest used to capture a clinical recommendation (e.g., follow-up ultrasound, surgical referral). |
| Breast Gland Density |
Breast gland density observation according to ACR BI-RADS classification. |
| Breast History Assessment |
Breast history assessment according to the patient saying. |
| Breast Nipple Inversion |
Observation representing nipple inversion assessment in a patient summary. |
| Breast Observation Finding |
Breast observation findings. |
| Breast Parenchyma Structure (LT Breast) |
Ultrasound breast parenchyma structure observation per breast side. |
| Breast Ultrasound Findings |
A radiology observation representing one specific ultrasound lesion with localization, dimensions, and characteristics. |
| Mammographic Examination Findings |
Observation representing mammographic breast changes using BodyStructure. |
| Mammography Diagnostic Report (LT Breast) |
A Diagnostic Report for Mammography imaging studies. Aggregates BI-RADS assessments, mammographic findings, ultrasound findings, and general breast observations. |
| Tomosynthesis Examination Finding (LT Breast) |
Observation representing tomosynthesis breast findings including finding type, size, cross-section localization in CC and MLO projections, and finding evolution. |
These define sets of codes used by systems conforming to this implementation guide.
| BI-RADS Category |
Categories of Breast Imaging Reporting and Data System. |
| Breast Assessment Services and Procedures |
This ValueSet includes all clinical services and procedures related to the assessment and diagnostic evaluation of the breast, such as imaging, biopsy, and specialist referrals. |
| Breast Biopsy Procedure Type |
Types of breast biopsy procedures used in the breast cancer prevention program. |
| Breast Body Site |
Entire breast and left/right breasts. |
| Breast Clock Position |
Clock positions (1-12 o'clock) for localizing breast findings. |
| Breast Duct Condition |
Breast duct condition as assessed by ultrasound examination. |
| Breast Finding |
SNOMED CT finding representing findings on the breast. |
| Breast Gland Density ACR |
ACR (BI-RADS) glandular density assessment. |
| Breast History Situations |
A value set of SNOMED CT situations representing various types of breast history. |
| Breast Nipple Appearance Finding |
SNOMED CT finding representing findings of the breast nipple appearance. |
| Breast Parenchyma Structure |
Ultrasound breast parenchyma structure classification. |
| Breast Quadrants |
Quadrants of the breast. |
| Finding Evolution |
Evolution of findings during the mammographic procedure. |
| Lymph Node Level |
Regional lymph node involvement level (N1, N2, N3) for breast diagnostics. |
| Mammographic Finding |
Findings during the mammographic procedure. |
| Ultrasound Lesion Finding |
Lesions findings identified during breast ultrasound. |
| WHO Breast Tumor Classification |
Breast tumor pathological diagnosis codes according to the WHO Classification of Tumours, 5th edition. Used for pathological histological examination conclusion/diagnosis in the breast cancer prevention program. |
These define new code systems used by systems conforming to this implementation guide.
| Breast questionnaire answer options (illustrative) |
Illustrative codes for Questionnaire answer options used in breast ESPBI-style forms. Register or replace with national coded values in production. |
| SNOMED Breast Extension |
Extension codes for breast diagnostics concepts not yet available in SNOMED CT. These codes are intended to be replaced by official SNOMED CT codes when they become available. |
These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.
| BodyStructure: Bilateral Upper Inner Quadrant (example) |
Bilateral upper inner quadrant body structure. |
| BodyStructure: Left Breast Upper Outer Quadrant (example) |
Left breast upper outer quadrant for mammographic localization. |
| BodyStructure: Left Breast – Upper Outer Quadrant (example) |
Left breast upper outer quadrant body structure for anatomical localization. |
| BodyStructure: Right Breast Lower Inner Quadrant (example) |
Right breast lower inner quadrant for mammographic localization. |
| BodyStructure: Right Breast – Upper Inner Quadrant (example) |
Right breast upper inner quadrant body structure. |
| CarePlan: Breast Follow-up (example) |
Follow-up care plan for breast screening with BI-RADS-based recommendations. |
| Composition: Breast Diagnostic Process (example) |
Imaging composition summarizing the breast cancer ADP diagnostic process with all required sections. |
| DiagnosticReport: Breast Diagnostic Report (example) |
Example of a complete breast diagnostic report aggregating imaging composition, BI-RADS assessment, gland density, and mammographic findings. |
| DiagnosticReport: Breast Imaging (example) |
Placeholder DiagnosticReport referenced by the breast imaging composition. |
| Encounter: Breast Imaging Acquisition Step 2 (example) | |
| Encounter: First Visit (example) |
First outpatient encounter for breast imaging screening. |
| Encounter: Palpation (example) |
The specific encounter where the breast history and palpation were performed. |
| ImagingStudy: Mammography (example) |
Mammography imaging study with bilateral breast series. |
| ImagingStudy: Previous Mammography (example) |
Prior mammography study used for comparison in the current evaluation. |
| Observation: Asymmetric Tissue – Bilateral UIQ (example) |
Focal asymmetric breast tissue finding increasing bilaterally in upper inner quadrants. |
| Observation: BI-RADS 1 – Negative (example) |
BI-RADS category 1 (Negative) assessment – no abnormality detected. |
| Observation: BI-RADS 4 – Suspicious Abnormality (example) |
BI-RADS category 4 (Suspicious Abnormality) – biopsy should be considered. |
| Observation: Breast Density – Fatty (example) |
Mammography shows predominantly fatty breast density. |
| Observation: Breast Injury History (example) | |
| Observation: Breast Lesion – Right Cyst (example) |
Ultrasound finding of a cyst in the right breast at 10 o'clock. |
| Observation: Breast Nipple Inversion (example) |
An example instance of a breast nipple inversion observation. |
| Observation: Breast Scar (example) |
An example instance of a breast scar observation. |
| Observation: Breast Skin Formation (example) |
Observation of a skin mass on the breast surface. |
| Observation: Breast Surgery History (example) | |
| Observation: Lesion – Left Fibroadenoma (example) |
Ultrasound finding of a fibroadenoma in the left breast at 3 o'clock. |
| Observation: Lesion – Right Malignant Tumor (example) |
Ultrasound finding of a malignant tumor in the right breast at 6 o'clock. |
| Observation: Mammographic Calcification – Right LIQ (example) |
Mammographic calcification finding in the right lower inner quadrant, unchanged. |
| Observation: Mammographic Mass – Left UOQ (12 mm) (example) |
Mammographic finding of a new 12 mm mass in the left upper outer quadrant. |
| Observation: No Breast Disease History (example) | |
| Observation: No Mammographic Architectural Distortion (example) |
Negative mammographic finding – no architectural distortion detected. |
| Observation: Radiation Dose (example) |
Radiation dose of 2.5 mGy recorded during the mammography procedure. |
| Organization: Breast Clinic (example) |
Example healthcare organization providing breast diagnostic services. |
| Patient: Janette Petrauskaite (example) |
An example Patient conforming to the Lithuanian Base Profile. |
| Practitioner: Diagnostic Radiologist (example) |
Diagnostic radiologist evaluating mammography studies. |
| Practitioner: Triage Nurse (example) |
Triage nurse practitioner involved in breast screening workflow. |
| PractitionerRole: Radiologist (example) |
Radiologist role linked to the breast diagnostics organization. |
| Procedure: Breast Palpation (example) |
Clinical breast palpation performed during the initial outpatient visit. |
| Procedure: Mammography (example) |
Bilateral digital mammography procedure during imaging acquisition. |
| Procedure: Palpation – Mass Finding (example) |
Breast palpation procedure revealing a palpable mass. |
| Questionnaire: Biopsy ESPBI Form (LT Breast) |
ESPBI-style form for breast biopsy data capture, based on ADP Table 7.4. |
| Questionnaire: Pathological Histological Examination ESPBI Form (LT Breast) |
ADP Table 7.5 — Pathological histological examination questionnaire for Lithuanian breast diagnostics ESPBI-style forms. |
| Questionnaire: Ultrasound Examination ESPBI Form (LT Breast) |
ESPBI-style form for breast ultrasound examination data capture, based on ADP Table 7.3. |
| QuestionnaireResponse: Biopsy – Right Breast Mass (example) |
Completed biopsy ESPBI form: US-guided core biopsy of a 15 mm mass in the right breast at 10 o'clock, BI-RADS 4, 2 sample containers. |
| QuestionnaireResponse: Mammogram ESPBI (example) |
Screening mammogram example – ACR B density, no findings, BI-RADS 1. |
| QuestionnaireResponse: Pathological Histological Examination (example) |
Example response for pathological histological examination — invasive ductal carcinoma, core needle biopsy, ER+/PR+/HER2 borderline. |
| QuestionnaireResponse: Tomosynthesis ESPBI (example) |
Tomosynthesis follow-up for BI-RADS 0 – mass found in right breast UOQ, BI-RADS 4. |
| QuestionnaireResponse: Ultrasound – Cyst Left Breast (example) |
Completed ultrasound ESPBI form: targeted examination revealing a simple cyst in the left breast at 2 o'clock, 8 x 6 mm, BI-RADS 2. |
| ServiceRequest: BI-RADS Category 4 Referral (example) |
A ServiceRequest instance recommending a referral to a breast surgeon due to a Category 4 (suspicious) BI-RADS finding. |
| ServiceRequest: Breast Screening (example) |
An example of a ServiceRequest for breast cancer screening. |