DBIR Implementation Guide

SurgeryComponents

FHIR Profile

The SurgeryComponents extension covers several componenents that are possibly included in breast implant surgery.

The extension includes the following components:

IncisionSite
Plane
TimingReconstruction
Replacement of TE with permanent implant
Planned replacement of TE for autologous reconstruction

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.

SurgeryComponents (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/SurgeryComponents Mappings rim: N/A
value[x]		0..1		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). Sliced: Unordered, Open, by $this(Value), $this(Type) Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
IncisionSite		0..1	CodeableConcept	Element id Extension.value[x]:IncisionSite 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). Data type CodeableConcept Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
Plane		0..1	code	Element id Extension.value[x]:Plane 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). Data type code Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
TimingReconstruction		0..1	date	Element id Extension.value[x]:TimingReconstruction 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). Data type date Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A
PlannedReplacement		0..1	integer	Element id Extension.value[x]:PlannedReplacement 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). Data type integer Constraints ele-1: All FHIR elements must have a @value or children `hasValue() or (children().count() > id.count())` Mappings rim: N/A

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
incissite	extension.SurgeryComponents	109	1-Inframammary	56593003
incissite	extension.SurgeryComponents	109	2-Mastectomy scar non nipple-sparing	245850007
incissite	extension.SurgeryComponents	109	4-Periareolar	UNKNOWN
incissite	extension.SurgeryComponents	109	6-Mastectomy scar nipple-sparing	70183006
incissite	extension.SurgeryComponents	109	6-Mastectomy scar nipple-sparing	14693006
incissite	extension.SurgeryComponents	109	7-Other	UNKNOWN
plane	extension.SurgeryComponents	110	1-Subglandular	Plane
plane	extension.SurgeryComponents	110	3-Subfascial	Plane
plane	extension.SurgeryComponents	110	4-Sub flap	Plane
plane	extension.SurgeryComponents	110	5-Subcutaneous	Plane
plane	extension.SurgeryComponents	110	6-Complete cover with P.M.	Plane
plane	extension.SurgeryComponents	110	7-Partial cover with P.M.	Plane
timingrec	extension.SurgeryComponents	122	1-Immediate	80280009
timingrec	extension.SurgeryComponents	122	2-Delayed	86864004
te-to-implant	extension.SurgeryComponents	101	1-yes	74451000146105
te-to-autologous	extension.SurgeryComponents	101	1-yes	UNKNOWN

Each slice consists of an valueCodeableConcept. The element has a generic structure, as shown below

      "valueCodeableConcept": {
        "coding": [
          {
            "system": "URL",
            "code": "code",
            "display": "display value"
          }
        ]
      }

Each coding element represent a component of a breast surgery. The system URL within the coding elements are set with the following base URL: http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/SurgeryComponents.

Codes for the variable Plane is mapped using the following ValueSet: {http://mrdm.nl/profiles/fhir/r4/dbir/ValueSet/Plane}

An example of a SurgeryComponent element with a given value for incissite. The display value is optional, the code value is required.


   "extension":[
      {
         "url":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/SurgeryComponents",
         "valueCodeableConcept":{
            "coding":[
               {
                  "system":"http://snomed.info/sct",
                  "code":"56593003",
                  "display":"Inframammary"
               }
            ]
      }
   ],

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/SurgeryComponents".
Each coding element should adhere to the above-mentioned URL listed
Each coding element should abide by the code available in the mapping above-mentioned

Example Breast Implant Surgery where:

the implant is inserted
the procedure is carried out for the purpose of symmetrizing augmentation
the procedure concerns the right breast
the procedure contains:
- An inframammary incision
- An replacement of tissue expander for breast prosthesis
- A plane that is subcutaneous

{
   "resourceType":"Procedure",
   "id":"example-breast-implant-surgery",
   "meta":{
      "profile":[
         "http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/BreastImplantSurgery"
      ]
   },
   "status":"completed",
   "code":{
      "coding":[
         {
            "system":"http://snomed.info/sct",
            "code":"302343007"
         }
      ]
   },
   "subject":{
      "reference":"Patient/21244"
   },
   "encounter":{
      "reference":"Encounter/43456"
   },
   "performedDateTime":"2024-11-08",
   "performer":[
      {
         "actor":{
            "reference":"Practitioner/3434"
         },
         "onBehalfOf":{
            "reference":"Organization/32325"
         }
      }
   ],
   "reasonCode":{
      "coding":[
         {
            "system":" http://mrdm.nl/profiles/fhir/R4/dbir/CodeSystem/code-system",
            "code":"10",
            "display":"Symmetrizing augmentation"
         }
      ]
   },
   "extension":[
      {
         "url":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/SurgeryComponents",
         "valueCodeableConcept":{
            "coding":[
               {
                  "system":"http://snomed.info/sct",
                  "code":"56593003",
                  "display":"Inframammary"
               }
            ],
            "coding":[
               {
                  "system":"http://mrdm.nl/profiles/fhir/r4/dbir/StructureDefinition/Plane",
                  "code":"5",
                  "display":"Subcutaneous"
               }
            ]
         }
      }
   ],
   "bodySite":[
      {
         "coding":[
            {
               "system":"http://snomed.info/sct",
               "code":"24028007",
               "display":"Right"
            }
         ]
      }
   ],
   "usedReference":[
      {
         "reference":"Device/example-implant"
      }
   ]
}