IDEA4RC FHIR Implementation Guide
0.1.0 - CI Build 150

IDEA4RC FHIR Implementation Guide, published by IDEA4RC Project. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/hl7-eu/idea4rc/ and changes regularly. See the Directory of published versions

Logical Model: RadiotherapyI4RC - Detailed Descriptions

Draft as of 2025-01-13

Definitions for the Radiotherapy logical model.

Guidance on how to interpret the contents of this table can be found here

0. Radiotherapy
Definition

Radiotherapy Maturity Level: 0 Draft

ShortRadiotherapy
Control0..*
Is Modifierfalse
Logical ModelInstances of this logical model are not marked to be the target of a Reference
2. Radiotherapy.diagnosisReference
Definition

Diagnosis reference in case the treatment was done for baseline

ShortDiagnosis reference (M)
Control1..*
Typehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/Diagnosis
Obligations
    ObligationsActor
    SHALL:handleHead and Neck
    SHALL:handleSarcoma
    4. Radiotherapy.episodeEvent
    Definition

    EpisodeEvent element containing the data regarding the patient's cancer

    ShortEpisode Event reference (M)
    Control1..*
    Typehttp://hl7.eu/fhir/ig/idea4rc/StructureDefinition/EpisodeEvent
    Obligations
      ObligationsActor
      SHALL:handleHead and Neck
      SHALL:handleSarcoma
      6. Radiotherapy.radiotherapyHospital
      Definition

      Whether it was performed at the registering hospital or another hospital.

      ShortRadiotherapy Hospital (M)
      Control1..*
      Typestring
      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
      Obligations
        ObligationsActor
        SHALL:handleHead and Neck
        SHALL:handleSarcoma
        8. Radiotherapy.intent
        Definition

        Radiotherapy intent refers to whether the intention of treatment is to cure the patient or to treat symptoms and palliate

        ShortIntent (M)
        Comments

        Palliative - 4179711 Curative procedure intent - 4162591

        Control1..*
        TypeCodeableConcept
        Obligations
          ObligationsActor
          SHALL:handleHead and Neck
          SHALL:handleSarcoma
          10. Radiotherapy.setting
          Definition

          Whether radiotherapy is delivered as the main treatment modality (definitive) or if it is delivered before or after another treatment such as surgery THIS INFO CAN BE DERIVED AT QUERY TIME (OMOP)

          Preoperative: Refers to radiotherapy given before surgery. Preoperative Concomitant to Systemic Treatment: Radiotherapy administered before surgery, alongside systemic treatments (like chemotherapy). Postoperative: Radiotherapy given after surgery. Postoperative Concomitant to Systemic Treatment: Radiotherapy given after surgery along with systemic treatments. Definitive: Radiotherapy used as the primary treatment without planned surgery. Definitive Concomitant to Systemic Treatment: Radiotherapy used as the main treatment alongside systemic therapy with curative intent.

          We need to check it also at query time. So we are deriving the information at query time and we will also perform quality checks. Additionally, do them at normalized table in possible cases.

          ShortSetting (M (only if Intent is Curative OR Unknown))
          Comments

          Preoperative - 4059384 Preoperative radiotherapy concomitant to systemic treatment - 2000100031 Postoperative - 4058775 Postoperative concomitant to systemic treatment - 2000100032 Definitive radiotherapy - 2000100033 Definitive radiotherapy concomitant to systemic treatment - 2000100034

          Control0..*
          TypeCodeableConcept
          Obligations
            ObligationsActor
            SHALL:handleHead and Neck
            SHALL:handleSarcoma
            12. Radiotherapy.beamQuality
            Definition

            Describes the type of radiation therapy given. If external beam, please specify if delivered with Photons (most common), electrons, carbon, or protons. 'External beam RT Photons - 607996 External beam RT Electrons - 4165039 External beam radiation therapy using carbon ions - 607995 External Beam RT Protons - 4024005 Brachytherapy interstitial endocavitary contact - 4012485 Radionuclide therapy - 4161415 Boron neutron capture Therapy - 4058601 other - 4077953' '2D - 603132 Three dimensional external beam radiation therapy - 37156151 IMRT CONVENTIONAL - 40480519 VMAT - 603135 Tomotherapy - 3662120 SBRT - 4215577 Ultra high dose rate radiotherapy - 37156211 PASSIVE SCATTERING - SINGLE BEAM OPTIMIZATION - CUSTOM CODE Intensity Modulated Proton Therapy (IMPT) - CUSTOM CODE Other - 4077990'

            ShortBeam quality (M)
            Comments

            External beam RT Photons - 607996 External beam RT Electrons - 4165039 External beam radiation therapy using carbon ions - 607995 External Beam RT Protons - 4024005 Brachytherapy interstitial endocavitary contact - 4012485 Radionuclide therapy - 4161415 Boron neutron capture Therapy - 4058601 other - 4077953

            Control1..*
            TypeCodeableConcept
            Obligations
              ObligationsActor
              SHALL:handleHead and Neck
              14. Radiotherapy.other
              Definition

              Other; specify (O)

              ShortOther; specify (O)
              Control0..*
              Typestring
              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
              Obligations
                ObligationsActor
                SHALL:handleHead and Neck
                16. Radiotherapy.treatmentTechnique
                Definition

                Refers to the type of radiotherapy treatment delivered 'External beam RT Photons - 607996 External beam RT Electrons - 4165039 External beam radiation therapy using carbon ions - 607995 External Beam RT Protons - 4024005 Brachytherapy interstitial endocavitary contact - 4012485 Radionuclide therapy - 4161415 Boron neutron capture Therapy - 4058601 other - 4077953' '2D - 603132 Three dimensional external beam radiation therapy - 37156151 IMRT CONVENTIONAL - 40480519 VMAT - 603135 Tomotherapy - 3662120 SBRT - 4215577 Ultra high dose rate radiotherapy - 37156211 PASSIVE SCATTERING - SINGLE BEAM OPTIMIZATION - CUSTOM CODE Intensity Modulated Proton Therapy (IMPT) - CUSTOM CODE Other - 4077990'

                ShortTreatment technique (M)
                Comments

                Two dimensional (2D) radiotherapy - 2000100035 Three dimensional (3D) radiotherapy - 2000100036 Intensity modulated radiation therapy (IMRT) - 2000100037 Volumetric modulated arc therapy (VMAT) - 2000100038 Tomotherapy - 2000100039 Stereotactic radiotherapy (SBRT) - 2000100040 Ultra high dose rate radiotherapy (Flash therapy) - 2000100041 Passive scattering - 2000100042 Single beam optimization - 2000100043 Intensity modulated proton therapy (IMPT) - 2000100044

                Control1..*
                TypeCodeableConcept
                Obligations
                  ObligationsActor
                  SHALL:handleHead and Neck
                  18. Radiotherapy.totalDoseGy
                  Definition

                  Refers to the total dose delivered to the patient in Gy

                  ShortTotal Dose (TD) Gy (M)
                  Control1..*
                  TypeQuantity
                  Obligations
                    ObligationsActor
                    SHALL:handleHead and Neck
                    SHALL:handleSarcoma
                    20. Radiotherapy.totalHighDose
                    Definition

                    Refers to the highest dose delivered to the patient. In a SIB boost and SEQ (only with a single beam) this varibale contains the same value of theTotal Dose. Value only expected for progression, recurrence...

                    ShortTotal High Dose (Gy) (R)
                    Comments

                    High dose - 4129296

                    Control0..*
                    TypeQuantity
                    Obligations
                      ObligationsActor
                      SHALL:handleHead and Neck
                      22. Radiotherapy.numberOfFractions
                      Definition

                      Refers to the total number of fractions delivered to the patient

                      ShortNumber of fractions (M)
                      Control1..*
                      TypeQuantity
                      Obligations
                        ObligationsActor
                        SHALL:handleHead and Neck
                        SHALL:handleSarcoma
                        24. Radiotherapy.adaptiveRt
                        Definition

                        Refers to whether treatment planning was changed or adapted after the initial radiation plan was developed. This could be due to a change in the patient’s anatomy or if the tumor changed in size.

                        ShortAdaptive RT (O)
                        Comments

                        Adaptive radiotherapy - 2000100045

                        Control0..*
                        Typeboolean
                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                        Obligations
                          ObligationsActor
                          SHALL:handleHead and Neck
                          26. Radiotherapy.igrt
                          Definition

                          Refers to whether image guided radiotherapy was used for delivery of radiotherapy and to check the patient set up. This includes MV, KV, or Cone Beam CT imaging.

                          ShortIGRT (image guide radiotherapy) (O)
                          Comments

                          Image guided radiotherapy (IGRT) - 2000100046

                          Control0..*
                          Typeboolean
                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                          Obligations
                            ObligationsActor
                            SHALL:handleHead and Neck
                            28. Radiotherapy.reirradiation
                            Definition

                            Whether the patient was re-irradiated loco-regionally. Value only expected for progression, recurrence...

                            ShortReirradiation (local or regional) (O)
                            Comments

                            NOT to be recorded in OMOP, it should be derived from second radiotherapy in same site.

                            Control0..*
                            Typeboolean
                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                            Obligations
                              ObligationsActor
                              SHALL:handleHead and Neck
                              30. Radiotherapy.fieldOfReirradiation
                              Definition

                              Specifes the reason for loco-regional re-irradiation. Value only expected for progression, recurrence...

                              ShortField of Re-irradiation (O)
                              Comments

                              Re-irradiation in field of first radiation - 2000100047 Re-irradiation out of field of first radiation - 2000100048 Re-irradiation marginal field of first radiation - 2000100049

                              Control0..*
                              TypeCodeableConcept
                              Obligations
                                ObligationsActor
                                SHALL:handleHead and Neck
                                32. Radiotherapy.startDate
                                Definition

                                Date when the first radiation treatment was delivered

                                ShortStart date (M)
                                Control1..*
                                Typedate
                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                Obligations
                                  ObligationsActor
                                  SHALL:handleHead and Neck
                                  SHALL:handleSarcoma
                                  34. Radiotherapy.endDate
                                  Definition

                                  Date when the last radiation treatment ended

                                  ShortEnd date (M)
                                  Control1..*
                                  Typedate
                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                  Obligations
                                    ObligationsActor
                                    SHALL:handleHead and Neck
                                    SHALL:handleSarcoma
                                    36. Radiotherapy.treatmentSitePrimaryOnly
                                    Definition

                                    Treatment site primary only (M (suggest to modify the label into Primary only))

                                    ShortTreatment site primary only (M (suggest to modify the label into Primary only))
                                    Control0..*
                                    Typeboolean
                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                    Obligations
                                      ObligationsActor
                                      SHALL:handleHead and Neck
                                      38. Radiotherapy.treatmentSiteNeckOnly
                                      Definition

                                      Treatment site neck only (M (suggest to modify the label into Neck only))

                                      ShortTreatment site neck only (M (suggest to modify the label into Neck only))
                                      Control0..*
                                      Typeboolean
                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                      Obligations
                                        ObligationsActor
                                        SHALL:handleHead and Neck
                                        40. Radiotherapy.treatmentSitePrimaryAndIpsilateralNeck
                                        Definition

                                        Refers to the areas that the radiation is targeting. This could include the primary tumor , the neck lymph nodes, the ipsilateral neck and the primary, the bilateral neck and the primary, or a distant metastatic lesion

                                        ShortTreatment site primary and ipsilateral neck (M)
                                        Control1..*
                                        Typeboolean
                                        Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                        Obligations
                                          ObligationsActor
                                          SHALL:handleHead and Neck
                                          42. Radiotherapy.treatmentSitePrimaryAndBilateralNeck
                                          Definition

                                          Refers to the areas that the radiation is targeting. This could include the primary tumor , the neck lymph nodes, the ipsilateral neck and the primary, the bilateral neck and the primary, or a distant metastatic lesion

                                          ShortTreatment site primary and bilateral neck (M)
                                          Control1..*
                                          Typeboolean
                                          Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                          Obligations
                                            ObligationsActor
                                            SHALL:handleHead and Neck
                                            44. Radiotherapy.treatmentSiteDistantMetastasis
                                            Definition

                                            Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                            ShortTreatment site distant metastasis (M)
                                            Comments

                                            Metastasis - 36769180

                                            NO SPECIFIC CODE (DEPRECATED)

                                            Control1..*
                                            Typeboolean
                                            Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                            Obligations
                                              ObligationsActor
                                              SHALL:handleHead and Neck
                                              46. Radiotherapy.metastaticTreatmentSiteLung
                                              Definition

                                              Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                              ShortMetastatic treatment site lung (R)
                                              Comments

                                              Metastasis to lung - 36770283

                                              Control0..*
                                              Typeboolean
                                              Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                              Obligations
                                                ObligationsActor
                                                SHALL:handleHead and Neck
                                                SHALL:handleSarcoma
                                                48. Radiotherapy.metastaticTreatmentSiteMediastinum
                                                Definition

                                                Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                                ShortMetastatic treatment site mediastinum (R)
                                                Comments

                                                Metastasis to mediastinum - 35225542

                                                Control0..*
                                                Typeboolean
                                                Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                Obligations
                                                  ObligationsActor
                                                  SHALL:handleHead and Neck
                                                  SHALL:handleSarcoma
                                                  50. Radiotherapy.metastaticTreatmentSiteBone
                                                  Definition

                                                  Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                                  ShortMetastatic treatment site bone (R)
                                                  Comments

                                                  Metastasis to bone - 36769301

                                                  Control0..*
                                                  Typeboolean
                                                  Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                  Obligations
                                                    ObligationsActor
                                                    SHALL:handleHead and Neck
                                                    SHALL:handleSarcoma
                                                    52. Radiotherapy.metastaticTreatmentSiteSoftTissue
                                                    Definition

                                                    Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                                    ShortMetastatic treatment site soft tissue (R)
                                                    Comments

                                                    Metastasis to soft tissues - 35225724

                                                    Control0..*
                                                    Typeboolean
                                                    Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                    Obligations
                                                      ObligationsActor
                                                      SHALL:handleHead and Neck
                                                      SHALL:handleSarcoma
                                                      54. Radiotherapy.metastaticTreatmentSiteLiver
                                                      Definition

                                                      Designates which treatment sites were irradiated. Lung Vs Mediastinum Vs Bone Vs soft tissue vs liver Vs other.

                                                      ShortMetastatic treatment site liver (R)
                                                      Comments

                                                      Metastasis to liver - 36770544

                                                      Control0..*
                                                      Typeboolean
                                                      Primitive ValueThis primitive element may be present, or absent, or replaced by an extension
                                                      Obligations
                                                        ObligationsActor
                                                        SHALL:handleHead and Neck
                                                        SHALL:handleSarcoma
                                                        56. Radiotherapy.rtTreatmentCompletedAsPlanned
                                                        Definition

                                                        Refers to whether patient completed all treatment as planned or if it had to be interrupted due to several reasons including toxicity, a co-morbidity preventing the delivery of radiation (pulmonary embolism, failure to thrive during RT), death due to progression of the cancer or patient decision Check CODES

                                                        ShortRT Treatment Completed as Planned? (M)
                                                        Comments

                                                        Completed successfully - 44788181 Radiotherapy course change due to acute radiotherapy toxicity - 4161588 Treatment ended due to comorbidity - CUSTOM CODE Intolerance - 4105297 Procedure discontinued by patient - 37017062 Death - 4306655

                                                        Control1..*
                                                        TypeCodeableConcept
                                                        Obligations
                                                          ObligationsActor
                                                          SHALL:handleHead and Neck
                                                          SHALL:handleSarcoma
                                                          58. Radiotherapy.regionalDeepHyperthemia
                                                          Definition

                                                          Whether Regional Deep Hyperthemia was applied with the RT (information for Regional Deep Hyperthemia can be found in the specific entity) Redundant

                                                          ShortRegional deep hyperthemia (M)
                                                          Control1..*
                                                          TypeCodeableConcept
                                                          Obligations
                                                            ObligationsActor
                                                            SHALL:handleSarcoma
                                                            60. Radiotherapy.treatmentResponse
                                                            Definition

                                                            Clinical treatment response for the radiotherapy OLD

                                                            Complete response - 4163135 Partial response - 4161302 Stable disease - 32948 Progression - 4168352 Unknown - 4129922

                                                            'A treatment response is a record of the EPISODE table; episode_start_date is end date of regimen; episode_object_concept_id is the overarching sarcoma'

                                                            ShortTreatment response (R)
                                                            Comments

                                                            Complete Remission - 32946 Partial Remission - 32947 Stable Disease - 32948 Progression - 32949 Not applicable - 4294169 (Not usable in OMOP)

                                                            Control0..*
                                                            TypeCodeableConcept
                                                            Obligations
                                                              ObligationsActor
                                                              SHALL:handleSarcoma