Imaging Example (Bone Density DXA)

@prefix fhir: <http://hl7.org/fhir/> .
@prefix loinc: <https://loinc.org/rdf/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix sct: <http://snomed.info/id/> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

[a fhir:DiagnosticReport ;
  fhir:nodeRole fhir:treeRoot ;
  fhir:id [ fhir:v "102"] ; # 
  fhir:text [
     fhir:status [ fhir:v "generated" ] ;
     fhir:div "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n			<h2>DXA BONE DENSITOMETRY</h2>\n			<table>\n				<tr>\n					<td>NAME</td>\n					<td>XXXXXXX</td>\n				</tr>\n				<tr>\n					<td>DOB</td>\n					<td>10/02/1974</td>\n				</tr>\n				<tr>\n					<td>REFERRING DR</td>\n					<td>Smith, Jane</td>\n				</tr>\n				<tr>\n					<td>INDICATIONS</td>\n					<td>Early menopause on estrogen levels. No period  for 18 months</td>\n				</tr>\n				<tr>\n					<td>PROCEDURE</td>\n					<td>Dual energy x-ray absorptiometry (DEXA)</td>\n				</tr>\n			</table>\n			<h3>Bone Mineral Density</h3>\n			<table>\n				<tr>\n					<td>Scan Type</td>\n					<td>Region</td>\n					<td>Measured</td>\n					<td>Age</td>\n					<td>BMD</td>\n					<td>T-Score</td>\n					<td>Z-Score</td>\n					<td>?BMD(g/cm2)</td>\n					<td>?BMD(%)</td>\n				</tr>\n				<tr>\n					<td>AP Spine</td>\n					<td>L1-L4</td>\n					<td>17/06/2008</td>\n					<td>34.4</td>\n					<td>1.148 g/cm²</td>\n					<td>-0.4</td>\n					<td>-0.5</td>\n					<td>-</td>\n					<td>-</td>\n				</tr>\n				<tr>\n					<td>Left Femur</td>\n					<td>Neck</td>\n					<td>17/06/2008</td>\n					<td>34.4</td>\n					<td>0.891 g/cm²</td>\n					<td>-1.0</td>\n					<td>-0.9</td>\n					<td>-</td>\n					<td>-</td>\n				</tr>\n				<tr>\n					<td>Left Femur</td>\n					<td>Total</td>\n					<td>17/06/2008</td>\n					<td>34.4</td>\n					<td>0.887 g/cm²</td>\n					<td>-1.2</td>\n					<td>-1.3</td>\n					<td>-</td>\n					<td>-</td>\n				</tr>\n				<tr>\n					<td>Right Femur</td>\n					<td>Neck</td>\n					<td>17/06/2008</td>\n					<td>34.4</td>\n					<td>0.885 g/cm²</td>\n					<td>-1.0</td>\n					<td>-1.0</td>\n					<td>-</td>\n					<td>-</td>\n				</tr>\n				<tr>\n					<td>Right Femur</td>\n					<td>Total</td>\n					<td>17/06/2008</td>\n					<td>34.4</td>\n					<td>0.867 g/cm²</td>\n					<td>-1.4</td>\n					<td>-1.4</td>\n					<td>-</td>\n					<td>-</td>\n				</tr>\n			</table>\n			<p>Assessment:</p>\n			<ul>\n				<li>The Spine L1-L4 BMD is normal.</li>\n				<li>The Left Femur Neck BMD is in the osteopenic range. Relative fracture risk is about 2.</li>\n				<li>The Left Femur Total BMD is in the osteopenic range. Relative fracture risk is about 2.</li>\n				<li>The Right Femur Neck BMD is in the osteopenic range. Relative fracture risk is about 2.</li>\n				<li>The Right Femur Total BMD is in the osteopenic range. Relative fracture risk is about 2.</li>\n			</ul>\n			<p>\n				<b>COMMENT</b>\n			</p>\n			<p>Osteopenia on measured BMD. The estimated 10-year probability of fracture based on present age, gender and measured BMD is less than 10%. This absolute fracture risk remains low. A follow-up assessment may be considered in 2 to 3 years to monitor the trend in BMD.</p>\n			<p>Thank you for your referral.  Dr Henry Seven  17/06/2008</p>\n			<pre>\nNote:\nWHO classification of osteoporosis (WHO Technical Report Series 1994: 843)\n- Normal: T-score equal to -1.0 s.d. or higher\n- Osteopenia: T-score  between -1.0 and -2.5 s.d.\n- Osteoporosis: T-score equal to -2.5 s.d. or lower\n- Severe/Established osteoporosis: Osteoporosis with one or more fragility fracture.\nT-score: The number of s.d. from the mean BMD for a gender-matched young adult population.\nZ-score: The number of s.d. from the mean BMD for an age-, weight- and gender-matched population.\nReference for 10-year probability of fracture risk: Kanis JA, Johnell O, Oden A, Dawson A,  De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos.Int. 2001;12(12):989-995.\nGE LUNAR PRODIGY DENSITOMETER\n</pre>\n		</div>"
  ] ; # 
  fhir:status [ fhir:v "final"] ; # 
  fhir:code [
     fhir:coding ( [
       a loinc:38269-7 ;
       fhir:system [ fhir:v "http://loinc.org"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "38269-7" ]
     ] ) ;
     fhir:text [ fhir:v "DXA BONE DENSITOMETRY" ]
  ] ; #        femur, laterality = left       ,        first, various administrative/context stuff       
  fhir:subject [
     fhir:reference [ fhir:v "Patient/pat2" ]
  ] ; # 
  fhir:effective [ fhir:v "2008-06-17"^^xsd:date] ; # 
  fhir:issued [ fhir:v "2008-06-18T09:23:00+10:00"^^xsd:dateTime] ; #        all this report is final       
  fhir:performer ( [
     fhir:reference [ fhir:v "Practitioner/3ad0687e-f477-468c-afd5-fcc2bf897809" ] ;
     fhir:display [ fhir:v "Dr Henry Seven" ]
  ] ) ; #        well, actually. this isn't the patient, but it'll do for now       
  fhir:result ( [
     fhir:reference [ fhir:v "Observation/bmd" ]
  ] ) ; #  	 but just one for now,  but for this example there should be more as listed here 
#<reference value="Observation/bmd1"/>      (LEFT  24701-5  Femur DXA Bone densityO g/cm2) 
#<reference value="Observation/bmd2>      (LEFT 8263-0  Femur DXA [T-score] Bone densityO {T-score})
#
#<reference value="Observation/bmd3"/>      (RIGHT 24701-5  Femur DXA Bone densityO g/cm2)
#<reference value="Observation/bmd4"/>      (RIGHT 38263-0  Femur DXA [T-score] Bone densityO {T-score})
#
#<reference value="Observation/bmd5"/>      (24966-4  Lumbar spine DXA Bone densityO g/cm2)
#<reference value="Observation/bmd6"/>     (38267-1  Lumbar spine DXA [T-score] Bone densityO {T-score})
# 
  fhir:conclusionCode ( [
     fhir:coding ( [
       a sct:391040000 ;
       fhir:system [ fhir:v "http://snomed.info/sct"^^xsd:anyURI ] ;
       fhir:code [ fhir:v "391040000" ] ;
       fhir:display [ fhir:v "At risk of osteoporotic fracture" ]
     ] )
  ] )] . #        the imaging service marks this to help find categories of patient       

# -------------------------------------------------------------------------------------