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  1. FHIR Specification Feedback
  2. FHIR-32881

Is Coding target volumes with codes practical, or do you expect use of description? (Christodouleas)

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    • Type: Question
    • Status: Triaged (View Workflow)
    • Priority: Medium
    • Resolution: Considered - Question answered
    • Specification:
      US Minimal Common Oncology Data Elements (mCODE) (FHIR)
    • Work Group:
      Clinical Interoperability Council
    • Related Artifact(s):
      Radiotherapy Course Summary Profile
    • Resolution Description:
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      "It is feasible to use the BodyStructure.description element in the way he provided, which in part could make it more practical for use.

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      "It is feasible to use the BodyStructure.description element in the way he provided, which in part could make it more practical for use.

      Description

      Received via e-mail from John.Christodouleas@elekta.com

      The biggest challenge I see is that it would be hard for clinics to use ONLY target volume codes from the available value sets. For example, I tried to code Use Case 4 from our paper (locally advanced oropharynx with 3 neck levels treated with SIB-screen shot below) using only the available target volume codes and ended up with this:

       

      Radiation Treatment Summary:

      1. Oropharnynx (GTV); 7000 cGy; 35
      2. Level 3 neck,  (right, GTV); 7000 cGy; 35
      3. Soft palate; 5950; 35
      4. Neck structure; 5950; 35
      5. Levels 2A (right, CTV); 5950; 35
      6. Levels 2B (right, CTV); 5950; 35
      7. Levels 3A (right, CTV); 5950; 35
      8. Levels 3B (right, CTV); 5950; 35
      9. Levels 4 (right, CTV); 5950; 35
      10. Levels 1B (right, CTV); 5600; 35
      11. Levels 5A (right, CTV); 5600; 35
      12. Levels 5B (right, CTV); 5600; 35
      13. Levels 2A (left, CTV); 5600; 35
      14. Levels 2B (left, CTV); 5600; 35
      15. Levels 3A (left, CTV); 5600; 35
      16. Levels 3B (left, CTV); 5600; 35
      17. Levels 4 (left, CTV); 5600; 35

       

       

      Because this would be so labor intensive, I don’t think clinics would implement this.  I note however that the profile includes a string field “BodyStructure.description” which I understand to be a “free text field”.  Is this correct?  If so then, I think centers would end up adopting something like the following: 

       

      Radiation Treatment Summary:

      1. Neck Structure (GTV); 7000 cGy; 35
      2. BodyStructure.description: “Oropharynx, level 3 gross node”
      1. Neck structure (CTV); 5950; 35
      2. BodyStructure.description: “soft palate, adjacent parapharyngeal space, leves II-IV left neck”
      1. Neck structure (CT; 5600; 35
      2. BodyStructure.description: “Levels IB-VB right neck, levels II-IV left neck”

       

      I think this would be acceptable both from a workflow perspective and from a communication perspective.  Is this your expectation how the BodyStructure.description field could and will be used? 

       

      If I am understanding the above correctly, then I think your proposal is very promising!

       

      Thanks again for this enormous contribution,

       

      John

       

       

      Use Case 4

       

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            Reporter:
            saul_kravitz Saul Kravitz
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