A Radiotherapy Course Prescription is a high-level request for a complete course of radiotherapy, which may be fulfilled by one or more phases.

A summary of the treatment progress in a radiotherapy course. Whenever new contributions in the scope of the same course are delivered, this resource is updated (no new resource created).

A Radiotherapy Planned Course covers all radiotherapy plans to deliver a complete course.

A Radiotherapy Phase Prescription is a request for one series of fractionated treatments using radiotherapy. It can define treatment parameters such as modality or technique, and prescribe dose to multiple targets.

A Radiotherapy Planned Phase is the summary over all radiotherapy plans to deliver a single phase of radiotherapy treatment.

A summary of a phase of radiotherapy treatment that has been delivered. A phase consists of a set of identical fractions. In this context, identical means that each fraction uses the same modality, technique, dose per fraction, and is applied to the same treatment volume or volumes. Because of their spatial relationship or the technique used, all treatment volumes do not necessarily receive the same total dose during a phase.

A Radiotherapy Plan Prescription is a request for radiotherapy treatment with a single treatment plan.

A summary of radiotherapy treatment delivered with a single treatment plan.

A Radiotherapy Treatment Plan resource describes the radiotherapy treatment that is planned to be delivered with a single treatment plan.

A device that represents implanted seeds for brachytherapy. The device is specified by the type of radioactive seed (at a minimum).

The device used to deliver radiotherapy. For example, a LINAC (external beam) or an afterloader (brachytherapy). The device is specified by at least its manufacturer and model name.

A volume of the body used in radiotherapy planning or treatment delivery. This corresponds to the Conceptual Volume in DICOM.

CodeX RT Server CapabilityStatement

A Radiotherapy Adverse Event is an adverse event resulting from radiation toxicity. This profile is based on the work of the Vulcan project. Future versions of this IG should reference adverse event profiles from Vulcan, once they are published. The current profile is inspired by the work of Vulcan and Common Terminology Criteria (CTC) Adverse Event (CTCAE).

Disease Status Reported by Radiation Oncologist

This flag is true if the radiotherapy course of treatment involves reirradiation of targets or organs at risk that were already irradiated in previous courses.

Extension providing a qualifier for a disease progression

Dose parameters planned for one radiotherapy volume.

Dose parameters prescribed for one radiotherapy volume.

The radiation energy used for radiotherapy. The energy spectrum is characterized by the maximum energy, the maximum accelaration voltage, or the used isotope.

Technique to manage respiratory motion with free-breathing.

The modality and associated energy used for imaging in Image Guided Radiotherapy (IGRT)

The total number of fractions (treatment divisions) actually delivered for this volume.

The number of planned fractions in this scope. This extension SHALL only be present if the treatment is structured as countable fractions, for example in a Radiotherapy Planned Phase or in a Radiotherapy Treatment Plan.

The number of prescribed fractions in this scope. This extension SHALL only be present if the treatment is structured as countable fractions, for example in a Radiotherapy Phase Prescription.

This flag is true if the dose is determined at a single point. Point doses are often used to check dose at a specific point in a calculated 3D dose distribution. Since point doses mostly have a technical role, high-level summaries may decide to exclude them from displays.

This flag is true if the dose is the primary plan dose in a radiotherapy treatment plan. For a single treatment plan, the primary plan dose serves as the main dose value for tracking delivered dose vs. planned dose. In summaries over multiple treatment plans, the flag indicates that the dose is a primary plan dose in any of the summarized plans.

The grade associated with the severity of an adverse event, using CTCAE criteria. The code ‘0’ representing no adverse event may be used to provide positive confirmation that the clinician assessed or considered this particular AE, although the absence of an adverse event is generally not reportable. See https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm

Extension providing a reference to a RadiotherapyVolume

The reason a planned or prescribed radiotherapy treatment was revised, superceded, or adapted.

A reference to a DICOM SOP Instance.

Method applied to manage respiratory motion.

Radiotherapy Treatment Applicator Type.

This flag is true if the fractionation was uniform (i.e., treated with same modality and dose per fraction) and false if the fractionation was mixed. Treatment technique may vary in uniform fractionation. If the fractionation was uniform, then the correspondence between the physical and biologically effective dose can be determined at the course level. If the fractionation was not uniform, then the correspondence between the physical and biologically effective dose has to be determined per the phase level. The flag was introduced to support determination of whether fractionation was uniform when viewing the Radiotherapy Course Summary (without first checking the details of each treatment phase). This is important in registry use cases to efficiently assess whether checking phase level information is needed.

CTCAE Grades 0 through 5. The grade of the adverse event, determined by CTCAE criteria, where 0 represents confirmation that the given adverse event did NOT occur, and 5 represents death. Note that grade 0 events are generally not reportable, but may be created to give positive confirmation that the clinician assessed or considered a particular AE.

The NCI Common Terminology Criteria for Adverse Events (CTCAE) is utilized for Adverse Event (AE) reporting. The codes are drawn from the NCI Thesaurus. Each CTCAE term is a MedDRA LLT (Lowest Level Term) with corresponding codes that can be used in place of the NCI code. The value set is CTCAE 5.0 and corresponds to MedDRA version 20.1. See https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_5.0/NCIt_CTCAE_5.0.xlsx.

Use of ‘Other, specify’: In the event a suitable CTCAE term cannot be found, the appropriate verbatim term SHALL be captured via the ‘Other, specify’ mechanism. In this case, the verbatim term is populated into the event.text field, the NCIT code for the body system into the event.coding.code field, and the display string corresponding to the code into the event.coding.display field. For example, if reporting the unusual adverse event ‘Vulcan-green blood’ it will be reported as: event.text of ‘Vulcan-green blood’, event.coding.display of ‘Blood and lymphatic system disorders - Other, specify’, and event.coding.code of NCIT code C143323.

Applicator type used in brachytherapy

The type of radioactive seed used in brachytherapy

Qualifier that describes disease progression and/or disease recurrence

Unit to characterize the energy spectrum used for imaging in Image Guided Radiotherapy (IGRT). For photons, the maximum acceleration voltage is given in MV or kV, although those are not units of energy.

Modality used for imaging in Image Guided Radiotherapy (IGRT)

Unit to characterize the energy spectrum used in radiotherapy. For electrons, the maximum energy is given in MeV. For photons, the maximum acceleration voltage is given in MV or kV, although those are not units of energy.

Technique to manage respiratory motion with free-breathing.

Isotope used in radiotherapy

The reason a planned or prescribed radiotherapy treatment was revised, superceded, or adapted.

Method applied to manage respiratory motion.

Codes requested from SNOMED by CodeX RT, to be issued at a later date. Where numeric codes are given, these correspond to the expected SNOMED-CT codes. Terms beginning with ‘USCRS-‘ (for United States Content Request Service) represent requests in April 2023 with no SNOMED code yet approved or assigned.

Common terminology criteria (CTC) grades associated with the severity of an adverse event, expressed as integers, 0 through 5, with 0 representing no adverse event, and 5 representing death.

Extended example: example showing disease status (patient’s condition regression)

Adverse Event, Nausea following course of treatment.

An example diagnosis for a breast case.

An example diagnosis for a breast case for Patient-101.

An example diagnosis for a prostate case.

An example female patient to relate radiotherapy resources to.

An example female patient to relate radiotherapy resources to.

An example male patient to relate radiotherapy resources to.

An example practitioner to relate radiotherapy resources to.

An example patient, test case XRTS-01.

An example patient, test case XRTS-02.

An example patient, test case XRTS-03.

An example patient, test case XRTS-04.

An example patient, test case XRTS-05.

An example patient, test case XRTS-06.

An example patient, test case XRTS-07.

Radiotherapy CoursePrescription with elements of IHE-RO XRTS profile for a prostate example.

Radiotherapy Course Prescription example from Codex RTTD collection.

Treatment Summary over Radiotherapy Course with all elements expected in XRTS.

Radiotherapy Course Summary example from Codex RTTD collection, ‘Bilateral Breast’.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-01 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-01 after 1 fraction.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-02 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-02 after 1 fraction.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-03 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-03 after 1 fraction.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-04 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-04 after 1 fraction.

Radiotherapy Course Summary example, test case XRTS-05, Course 1 completely treated.

Radiotherapy Course Summary example, test case XRTS-05, Course 1 after 1 fraction.

Radiotherapy Course Summary example, test case XRTS-05, Course 2 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-06 completely treated.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-06 after 1 fraction.

Radiotherapy Course Summary example from Codex XRTS collection, test case XRTS-07 after 1 fraction.

Radiotherapy Phase Prescription to cover IHE-RO XRTS profile for a Prostate example, phase 1.

Radiotherapy Phase Prescription to cover IHE-RO XRTS profile for a Prostate example, phase 2.

Radiotherapy Phase Prescription example from Codex RTTD collection.

Radiotherapy Phase Prescription example from Codex RTTD collection.

Radiotherapy Phase Prescription example from Codex RTTD collection.

Radiotherapy Planned Course example.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-01.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-02.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-03.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-04.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-05, Course 1.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-05, Course 2.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-06.

Radiotherapy Planned Course example from Codex XRTS collection, test case XRTS-07.

Radiotherapy Planned Phase, Prostate example, phase 1.

Radiotherapy Planned Phase, Prostate example, phase 2.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-01, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-02, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-02, Phase 2.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-03, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-04, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-04, Phase 2.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-04, Phase 3.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-05, Course 1, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-05, Course 2, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-06, Phase 1.

Radiotherapy Planned Phase example from Codex XRTS collection, test case XRTS-07, Phase 1.

Radiotherapy Plan Prescription to cover IHE-RO XRTS profile for a Prostate example, phase 1, plan 1.

Radiotherapy Plan Prescription to cover IHE-RO XRTS profile for a Prostate example, phase 2, plan 1.

Mesh of brachytherapy seeds.

Treatment Summary for first phase

Radiotherapy Treated Phase example from Codex RTTD collection.

Radiotherapy Treated Phase example from Codex RTTD collection.

Radiotherapy Treated Phase example from Codex RTTDcollection.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-01, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-01, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-02, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-02, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-02, Phase 2 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-03, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-03, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-04, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-04, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-04, Phase 2 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-04, Phase 3 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-05, Course 1, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-05, Course 1, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-05, Course 2, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-06, Phase 1 completely treated.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-06, Phase 1 after 1 fraction.

Radiotherapy Treated Phase example from Codex XRTS collection, test case XRTS-07, Phase 1 after 1 fraction.

Treatment Summary for treamtment plan in the first phase

ACMETurbo3000 Afterloader Device

Radiotherapy Treatment Plan to cover IHE-RO XRTS profile for a Prostate example, phase 1, plan 1.

Radiotherapy Treatment Plan, Prostate example, phase 2, plan 1.

Example target volume ‘PTV50’.

Example target volume ‘PTV64’.

Example target volume ‘Prostate’.

Example target volume ‘Pelvic Nodes’.

Example target volume ‘Seminal Vesicles’.

Example target volume ‘Left Breast’.

Example target volume ‘Left Breast Boost’.

Example target volume ‘Right Breast’.

Example target volume XRTS-01 ‘Prostate’.

Example target volume XRTS-02 ‘Prostate’.

Example target volume XRTS-03 ‘Prostate’.

Example target volume XRTS-03 ‘Pelvic Lymph Nodes’.

Example target volume XRTS-03 ‘Seminal Vesicles’.

Example target volume XRTS-04 ‘Left Breast’.

Example target volume XRTS-04 ‘Left Breast Boost’.

Example target volume XRTS-04 ‘Right Breast’.

Example target volume XRTS-05 ‘Brain Mets’ Course 1.

Example target volume XRTS-05 ‘Brain Mets’ Course 2. Same label as Brain Mets in first course, but conceptually a different volume. Dose is not added up.

Example target volume XRTS-06 ‘Cervix Uteri’.

Example target volume XRTS-07 ‘Cervix Uteri’.

This SearchParameter enables query of conditions by code with the in modifier.

This SearchParameter enables query of patients by _id with mutlipleOr enabled.

An example treatment location.