minimal Common Oncology Data Elements (mCODE) Implementation Guide
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This page is part of the HL7 FHIR Implementation Guide: minimal Common Oncology Data Elements (mCODE) Release 1 - US Realm | STU1 (v4.0.0-ballot: STU4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

Resource Profile: Radiotherapy Volume Profile

Official URL: http://hl7.org/fhir/us/mcode/StructureDefinition/mcode-radiotherapy-volume Version: 4.0.0-ballot
Active as of 2024-04-10 Maturity Level: 3 Computable Name: RadiotherapyVolume
Other Identifiers: OID:2.16.840.1.113883.4.642.40.15.42.49

A volume of the body used in radiotherapy planning or treatment delivery.

Background

Radiotherapy is a directed treatment that targets a specific areas or volumes in or on the body. The RadiotherapyVolume profile describes these areas or volumes in terms of a BodyStructure resource. Using a standalone resource permits reuse of the same body volume in planning, executing, and reporting a radiotherapy treatment, as opposed to repeating the same elements in multiple places.

The code list of anatomic structures and location qualifiers applicable to RadiotherapyVolume follows the recommendations of the American Association of Physicists in Medicine (AAPM) Task Group 263 report on Standardizing Nomenclatures in Radiation Oncology. Volumes are further classified according to their type, including the following Burnet et al., 2004:

  • Gross tumour volume (GTV) - what can be seen, palpated or imaged
  • Clinical target volume (CTV) - the GTV plus a margin accounting for sub-clinical disease spread which therefore cannot be fully imaged
  • Planning target volume (PTV) - a geometric concept designed to ensure that the radiotherapy dose is actually delivered to the CTV
  • Organs at Risk (OR or OAR) - critical normal tissue structures that should be protected against excessive radiation

An additional volume types referenced by ICRU62 is the term Internal Target Volume (ITV), represents a volume encompassing the CTV with an internal margin compensating for patient movement. As defined by Ezhil et al the Internal Gross Tumor Volume (IGTV) represents the GTV with an internal margin to compensate for all movements.

Usage

The treatment location should be expressed using the anatomical concepts in the American Association of Physicists in Medicine (AAPM) Task Group 263 report on Standardizing Nomenclatures in Radiation Oncology, expressed using SNOMED CT. The mapping from AAPM TG263 concepts to SNOMEDCT codes (RadiotherapyTreatmentLocationVS) and qualifiers (RadiotherapyTreatmentLocationQualifierVS) can be found in this spreadsheet. An excerpt of this spreadsheet is shown below. For example, if the treatment location was the Left Breast, with TG263 primary name Breast_L, the location would be expressed by using the SNOMEDCT 76752008 (Breast structure (body structure)) for location, and 7771000 (Left) for the locationQualifier.

Excerpt from TG263 to SNOMED mapping

Limitations

A known limitation of the RadiotherapyVolume is that it accepts only one coded location. This limitation stems from the base BodyStructure resource. As a result, a compound volume (such as prostate plus seminal vesicles) cannot be represented. If this presents a serious limitation in practice, an extension with additional pairs (location, location qualifiers) will be required.

Conformance

BodyStructure resources whose morphology has a code from the value set RadiotherapyVolumeTypeVS SHALL conform to this profile. Beyond this requirement, a producer of resources SHOULD ensure that any resource instance associated with an in-scope patient that would reasonably be expected to conform to this profile SHOULD be published in this form. Any resource intended to conform to this profile SHOULD populate meta.profile accordingly.

Usage:

Changes since version true:

  • No changes

    • Formal Views of Profile Content

    Description of Profiles, Differentials, Snapshots and how the different presentations work.

    This structure is derived from BodyStructure

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... Slices for identifier S 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName S 0..1 Identifier Bodystructure identifier
    ..... use 1..1 code usual | official | temp | secondary | old (If known)
    Required Pattern: usual
    ..... value S 1..1 string The value that is unique
    ... morphology S 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location S 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... description S 0..1 string Volume Description
    ... patient S 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier SΣ 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName SΣ 0..1 Identifier Bodystructure identifier
    ..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


    Required Pattern: usual
    ..... value SΣ 1..1 string The value that is unique
    Example General: 123456
    ... morphology SΣ 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location SΣ 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... locationQualifier S 0..* CodeableConcept Qualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
    Binding: Radiotherapy Treatment Location Qualifier Value Set (extensible)
    ... description SΣ 0..1 string Volume Description
    ... patient SΣ 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    BodyStructure.identifier:displayName.userequiredPattern: usual
    http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    from the FHIR Standard
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()
    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier SΣ 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName SΣ 0..1 Identifier Bodystructure identifier
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


    Required Pattern: usual
    ..... type Σ 0..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

    ..... system Σ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value SΣ 1..1 string The value that is unique
    Example General: 123456
    ..... period Σ 0..1 Period Time period when id is/was valid for use
    ..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
    ... active ?!Σ 0..1 boolean Whether this record is in active use
    ... morphology SΣ 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location SΣ 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... locationQualifier S 0..* CodeableConcept Qualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
    Binding: Radiotherapy Treatment Location Qualifier Value Set (extensible)
    ... description SΣ 0..1 string Volume Description
    ... image 0..* Attachment Attached images
    ... patient SΣ 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    BodyStructure.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    BodyStructure.identifier:displayName.userequiredPattern: usual
    http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    from the FHIR Standard
    BodyStructure.identifier:displayName.typeextensibleIdentifier Type Codes
    http://hl7.org/fhir/ValueSet/identifier-type
    from the FHIR Standard
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()

    This structure is derived from BodyStructure

    Summary

    Mandatory: 0 element(2 nested mandatory elements)
    Must-Support: 8 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of BodyStructure.identifier

    Maturity: 3

    Differential View

    This structure is derived from BodyStructure

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... Slices for identifier S 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName S 0..1 Identifier Bodystructure identifier
    ..... use 1..1 code usual | official | temp | secondary | old (If known)
    Required Pattern: usual
    ..... value S 1..1 string The value that is unique
    ... morphology S 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location S 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... description S 0..1 string Volume Description
    ... patient S 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings (Differential)

    PathConformanceValueSetURI
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()

    Key Elements View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier SΣ 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName SΣ 0..1 Identifier Bodystructure identifier
    ..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


    Required Pattern: usual
    ..... value SΣ 1..1 string The value that is unique
    Example General: 123456
    ... morphology SΣ 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location SΣ 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... locationQualifier S 0..* CodeableConcept Qualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
    Binding: Radiotherapy Treatment Location Qualifier Value Set (extensible)
    ... description SΣ 0..1 string Volume Description
    ... patient SΣ 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    BodyStructure.identifier:displayName.userequiredPattern: usual
    http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    from the FHIR Standard
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()

    Snapshot View

    NameFlagsCard.TypeDescription & Constraintsdoco
    .. BodyStructure C 0..* BodyStructure Specific and identified anatomical structure
    mcode-description-or-id-required: One of description or identifier MUST be present
    ... id Σ 0..1 id Logical id of this artifact
    ... meta Σ 0..1 Meta Metadata about the resource
    ... implicitRules ?!Σ 0..1 uri A set of rules under which this content was created
    ... text 0..1 Narrative Text summary of the resource, for human interpretation
    ... contained 0..* Resource Contained, inline Resources
    ... extension 0..* Extension Additional content defined by implementations
    ... modifierExtension ?! 0..* Extension Extensions that cannot be ignored
    ... Slices for identifier SΣ 0..* Identifier Volume Identifier
    Slice: Unordered, Open by value:use
    .... identifier:displayName SΣ 0..1 Identifier Bodystructure identifier
    ..... id 0..1 string Unique id for inter-element referencing
    ..... extension 0..* Extension Additional content defined by implementations
    Slice: Unordered, Open by value:url
    ..... use ?!Σ 1..1 code usual | official | temp | secondary | old (If known)
    Binding: IdentifierUse (required): Identifies the purpose for this identifier, if known .


    Required Pattern: usual
    ..... type Σ 0..1 CodeableConcept Description of identifier
    Binding: Identifier Type Codes (extensible): A coded type for an identifier that can be used to determine which identifier to use for a specific purpose.

    ..... system Σ 0..1 uri The namespace for the identifier value
    Example General: http://www.acme.com/identifiers/patient
    ..... value SΣ 1..1 string The value that is unique
    Example General: 123456
    ..... period Σ 0..1 Period Time period when id is/was valid for use
    ..... assigner Σ 0..1 Reference(Organization) Organization that issued id (may be just text)
    ... active ?!Σ 0..1 boolean Whether this record is in active use
    ... morphology SΣ 0..1 CodeableConcept Type of Radiotherapy Volume
    Binding: Radiotherapy Volume Type Value Set (extensible)
    ... location SΣ 0..1 CodeableConcept Body Location Code.
    Binding: Radiotherapy Treatment Location Value Set (extensible)
    ... locationQualifier S 0..* CodeableConcept Qualifiers on location used to specify a TG263 body structure comprising the irradiated volume.
    Binding: Radiotherapy Treatment Location Qualifier Value Set (extensible)
    ... description SΣ 0..1 string Volume Description
    ... image 0..* Attachment Attached images
    ... patient SΣ 1..1 Reference(Cancer Patient Profile) Who this is about

    doco Documentation for this format

    Terminology Bindings

    PathConformanceValueSet / CodeURI
    BodyStructure.languagepreferredCommonLanguages
    Additional Bindings Purpose
    AllLanguages Max Binding
    http://hl7.org/fhir/ValueSet/languages
    from the FHIR Standard
    BodyStructure.identifier:displayName.userequiredPattern: usual
    http://hl7.org/fhir/ValueSet/identifier-use|4.0.1
    from the FHIR Standard
    BodyStructure.identifier:displayName.typeextensibleIdentifier Type Codes
    http://hl7.org/fhir/ValueSet/identifier-type
    from the FHIR Standard
    BodyStructure.morphologyextensibleRadiotherapyVolumeTypeVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-volume-type-vs
    from this IG
    BodyStructure.locationextensibleRadiotherapyTreatmentLocationVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-vs
    from this IG
    BodyStructure.locationQualifierextensibleRadiotherapyTreatmentLocationQualifierVS
    http://hl7.org/fhir/us/mcode/ValueSet/mcode-radiotherapy-treatment-location-qualifier-vs
    from this IG

    Constraints

    IdGradePath(s)DetailsRequirements
    mcode-description-or-id-requirederrorBodyStructureOne of description or identifier MUST be present
    : description.exists() or identifier.exists()

    This structure is derived from BodyStructure

    Summary

    Mandatory: 0 element(2 nested mandatory elements)
    Must-Support: 8 elements

    Structures

    This structure refers to these other structures:

    Slices

    This structure defines the following Slices:

    • The element 1 is sliced based on the value of BodyStructure.identifier

    Maturity: 3

     

    Other representations of profile: CSV, Excel, Schematron