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