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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)



    • 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:

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

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


      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,





      Use Case 4





            Unassigned Unassigned
            saul_kravitz Saul Kravitz
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