Details
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Question
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Resolution: Considered - Question answered
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Medium
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US Minimal Common Oncology Data Elements (mCODE) (FHIR)
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Clinical Interoperability Council
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Radiotherapy Course Summary Profile
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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:
- Oropharnynx (GTV); 7000 cGy; 35
- Level 3 neck, (right, GTV); 7000 cGy; 35
- Soft palate; 5950; 35
- Neck structure; 5950; 35
- Levels 2A (right, CTV); 5950; 35
- Levels 2B (right, CTV); 5950; 35
- Levels 3A (right, CTV); 5950; 35
- Levels 3B (right, CTV); 5950; 35
- Levels 4 (right, CTV); 5950; 35
- Levels 1B (right, CTV); 5600; 35
- Levels 5A (right, CTV); 5600; 35
- Levels 5B (right, CTV); 5600; 35
- Levels 2A (left, CTV); 5600; 35
- Levels 2B (left, CTV); 5600; 35
- Levels 3A (left, CTV); 5600; 35
- Levels 3B (left, CTV); 5600; 35
- 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:
- Neck Structure (GTV); 7000 cGy; 35
- BodyStructure.description: “Oropharynx, level 3 gross node”
- Neck structure (CTV); 5950; 35
- BodyStructure.description: “soft palate, adjacent parapharyngeal space, leves II-IV left neck”
- Neck structure (CT; 5600; 35
- 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