Lesion

Description

This structure describes the properties of the lesions found and obserserved during a colonoscopy. These findings are part of the diagnostic report. These observations are built out of multiple parts each describes in a Observation.component. Some examples are: Morpholology, Size, and whether the lesion is suspect of Malignancy. Each lesion is numbered using an identifier described in Observation.identifier:LesionNumber

Structure

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
id0..1string
extensionI0..*Extension
useΣ ?!0..1codeBinding
typeΣ0..1CodeableConceptBinding
systemΣ1..1uriFixed Value
valueΣ1..1string
periodΣ I0..1Period
assignerΣ I0..1Reference(Organization)
basedOnΣ I0..0Reference(CarePlan | DeviceRequest | ImmunizationRecommendation | MedicationRequest | NutritionOrder | ServiceRequest)
partOfΣ I0..0Reference(MedicationAdministration | MedicationDispense | MedicationStatement | Procedure | Immunization | ImagingStudy)
statusΣ ?!1..1codeBinding
category0..0CodeableConceptBinding
id0..1string
extensionI0..*Extension
SNOMED-CTΣ1..1CodingPattern
textΣ0..1string
subjectΣ I0..1Reference(Patient | Group | Device | Location)
focusΣ I0..0Reference(Resource)
encounterΣ I0..0Reference(Encounter)
issuedΣ0..0instant
performerΣ I0..0Reference(Practitioner | PractitionerRole | Organization | CareTeam | Patient | RelatedPerson)
dataAbsentReasonI0..0CodeableConceptBinding
interpretation0..0CodeableConceptBinding
note0..0Annotation
bodySiteS0..1CodeableConceptBinding
method0..0CodeableConcept
specimenI0..0Reference(Specimen)
deviceI0..0Reference(Device | DeviceMetric)
hasMemberΣ I0..0Reference(Observation | QuestionnaireResponse | MolecularSequence)
derivedFromΣ I0..0Reference(DocumentReference | ImagingStudy | Media | QuestionnaireResponse | Observation | MolecularSequence)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
codeΣ1..1CodeableConcept
valueQuantityQuantity
valueCodeableConceptCodeableConcept
valueStringstring
valueBooleanboolean
valueIntegerinteger
valueRangeRange
valueRatioRatio
valueSampledDataSampledData
valueTimetime
valueDateTimedateTime
valuePeriodPeriod
dataAbsentReasonI0..0CodeableConceptBinding
interpretation0..0CodeableConceptBinding
referenceRange0..0see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
SNOMED-CTΣ1..1CodingPattern
textΣ0..1string
valueCodeableConceptCodeableConcept
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
Model-specificΣ1..1CodingPattern
textΣ0..1string
valueCodeableConceptCodeableConcept
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
SNOMED-CTΣ1..1CodingPattern
textΣ0..1string
valueCodeableConceptCodeableConcept
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
SNOMED-CTΣ1..1CodingPattern
textΣ0..1string
valueBooleanboolean
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
SNOMED-CTS Σ1..1CodingPattern
textΣ0..1string
valueQuantityQuantity
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
id0..1string
extensionI0..*Extension
SNOMED-CTS Σ1..1CodingPattern
textΣ0..1string
valueBooleanboolean
dataAbsentReasonI0..1CodeableConceptBinding
interpretation0..*CodeableConceptBinding
referenceRange0..*see (referenceRange)

Terminology

Path Binding
Observation.bodySite No-colonoscopy-segment-lesion
Observation.component:Morphology.value[x] No-colonoscopy-paris-polyp-classification
Observation.component:TissueRemovingMethod.value[x] No-colonoscopy-method-tissue-removal-biopsy
Observation.component:EndoscopicalRemoved.value[x] No-colonoscopy-lesion-completely-removed

Example