DBIR Implementation Guide

FirstImplantSurgery

FHIR Profile

The FirstImplantSurgery extension defines whether a whether the breast implant surgery is the first implant surgery of this breast.

This extension is used for FHIR Profile Breast Implant Surgery, accessible via BreastImplantSurgery.

This profile is based on the FHIR version R4 specifications for extensions, see also Extensibility.

FirstImplantSurgery (Extension)	I		Extension	There are no (further) constraints on this element Element id Extension Short description Optional Extensions Element Definition Optional Extension Element - found in all resources. Data type Extension Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a rim: N/A
id		0..1	string	There are no (further) constraints on this element Element id Extension.id Short description Unique id for inter-element referencing Definition Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces. Data type string Mappings rim: n/a
extension	I	0..*	Extension	There are no (further) constraints on this element Element id Extension.extension Short description Additional content defined by implementations Alternate names extensions, user content Definition May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Comments There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. Data type Extension Sliced: Unordered, Open, by url(Value) Extensions are always sliced by (at least) url Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` ext-1: Must have either extensions or value[x], not both `extension.exists() != value.exists()` Mappings rim: n/a
url		1..1	uriFixed Value	Element id Extension.url Short description identifies the meaning of the extension Definition Source of the definition for the extension code - a logical name or a URL. Comments The definition may point directly to a computable or human-readable definition of the extensibility codes, or it may be a logical URI as declared in some other specification. The definition SHALL be a URI for the Structure Definition defining the extension. Data type uri Fixed value http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/FirstImplantSurgery Mappings rim: N/A
value[x]		0..1		There are no (further) constraints on this element Element id Extension.value[x] Short description Value of extension Definition Value of extension - must be one of a constrained set of the data types (see Extensibility for a list). Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
valueCode			code	Data type code
valueCodeableConcept			CodeableConcept	Data type CodeableConcept

Mapping

Here is a list of the exact mapping for this FHIR Profile. The mapping includes the DICA variable and corresponding FHIR data element. In case of a DICA option set, the relation between the DICA options and available values within the FHIR data element are defined.

DICA variable	FHIR Data Element	DICA OptionSet	Value DICA OptionSet	FHIR ValueSet/Code/System
first	performed.extension.First	101	1-yes	1331000119107
first	performed.extension.First	101	1-yes	427894009
first	performed.extension.First	101	1-yes	1507100011910
first	performed.extension.First	101	1-yes	16088491000119105
first	performed.extension.First	101	1-yes	16088571000119108

The extension is defined as a valueCodeableConcept. The element has a generic structure, as shown below

   "extension":[
            {
               "url":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/FirstImplantSurgery",
               "valueCodeableConcept":{
                  "coding":[
                     {
                        "system":"http://snomed.info/sct",
                        "code":"16088491000119105"
                     }
                  ]
               }
            }
         ]

Constraints

Constraints can refer to the cardinality of an element, required value or type of value.

The following constraints apply:

The extension element must use url "http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/FirstImplantSurgery"
The coding element should abide by the mapping codes listed above
The code.system value is "http://snomed.info/sct"

Example Breast Implant Surgery which is the first surgery of this breast

{
   "resourceType":"Procedure",
   "id":"example-first-breast-implant-surgery",
   "meta":{
      "profile":[
         "http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/BreastImplantSurgery"
      ]
   },
   "status":"completed",
   "code":{
      "coding":[
         {
            "system":"http://snomed.info/sct",
            "code":"442128000"
         }
      ],
      "coding":[
         {
            "system":"http://snomed.info/sct",
            "code":"303445008"
         }
      ]
   },
   "subject":{
      "reference":"Patient/21244"
   },
   "encounter":{
      "reference":"Encounter/43456"
   },
   "performedDateTime":"2025-01-07",
   "_performedDateTime":{
      "extension":[
         {
            "url":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/FirstImplantSurgery",
            "valueCodeableConcept":{
               "coding":[
                  {
                     "system":"http://snomed.info/sct",
                     "code":"16088491000119105"
                  }
               ]
            }
         }
      ]
   },
   "performer":[
      {
         "actor":{
            "reference":"Practitioner/2234"
         },
         "onBehalfOf":{
            "reference":"Organization/452323"
         }
      }
   ],
   "reasonCode":{
      "coding":[
         {
            "system":" http://mrdm.nl/profiles/fhir/R4/dbir/CodeSystem/code-system",
            "code":"11",
            "display":"Cosmetic augmentation"
         }
      ]
   },
   "extension":[
      {
         "url":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/SurgeryComponents",
         "valueCodeableConcept":{
            "coding":[
               {
                  "system":"http://snomed.info/sct",
                  "code":"56593003",
                  "display":"Mastectomy scar nipple-sparing "
               }
            ],
            "coding":[
               {
                  "system":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/Plane",
                  "code":"3",
                  "display":"Subfascial"
               }
            ],
            "coding":[
               {
                  "system":"http://snomed.info/sct",
                  "code":"80280009",
                  "display":"Immediate"
               }
            ],
            "coding":[
               {
                  "system":"http://snomed.info/sct",
                  "code":"74451000146105",
                  "display":"Replacement of tissue expander for breast prosthesis"
               }
            ]
         }
      }
   ],
   "bodySite":[
      {
         "coding":[
            {
               "system":"http://snomed.info/sct",
               "code":"7771000",
               "display":"Left"
            }
         ]
      }
   ],
   "usedReference":[
      {
         "reference":"Device/example-implant"
      }
   ]
}