Radiotherapy (procedure) - 1.0

The template had a slot here:  [[~1..1]]  260686004 |Method (attribute)|  = [[+id ( 129445006 |Administration - action (qualifier value)| ]],   but you can't have a slot if there's no choice to be made, so in this case we just "hard code" the method value to be administration.

Hi Victor Medina  I am trying to simplify this template. The role groups could be reduced by only having two separate role groups for the administration action and other actions in the second role group. Then the fourth and fifth role groups could be merged into the first role group with the updated cardiality. 29 imaging-guided readiotherapies could be covered by the generic template for imaging guidance. The following is an alternative representation of your template:

Domain: <<  1287742003 |Radiotherapy (procedure)|  MINUS (<<  1287742003 |Radiotherapy (procedure)| :  363703001 |Has intent (attribute)|  = <<  429892002 |Guidance intent (qualifier value)|)

Template:

71388002 |Procedure (procedure)| :
[[~0..1]]
{[[~0..1]] 363702006 |Has focus (attribute)| = [[+id(<< 404684003 |Clinical finding (finding)| )]] },
[[~1..*]]
{[[~1..1]] 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)|, 
[[~0..1]] [[+id(< 363704007 |Procedure site (attribute)|)]] = [[+id(<< 442083009 |Anatomical or acquired body structure (body structure)| )]],
[[~1..1]] 424244007 |Using energy (attribute)| = [[+id(<< 125576007 |Ionizing radiation (physical force)| )]], 
[[~0..1]] 424226004 |Using device (attribute)| = [[+id(<< 466194000 |External beam radiation therapy radionuclide system (physical object)| )]], 
[[~0..1]] 363701004 |Direct substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)| or << 410942007 |Drug or medicament (substance)|)]],
[[~0..1]] 424361007 |Using substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)| )]], 
[[~0..1]] 260507000 |Access (attribute)| = [[+id(< 309795001 |Surgical access values (qualifier value)| )]], 
[[~0..1]] 410675002 |Route of administration (attribute)| = [[+id(< 284009009 |Route of administration value (qualifier value)| )]], 
[[~0..1]] 363700003 |Direct morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)| )]],
 [[~0..1]]  363703001 |Has intent (attribute)|  = [[+id(< 363675004 |Intents (nature of procedure values) (qualifier value)|)]] },
[[~0..1]]
{ [[~1..1]] 260686004 |Method (attribute)| = [[+id( << 129425003 |Application - action (qualifier value)| OR << 129336009 |Implantation - action (qualifier value)| OR << 257867005 |Insertion - action (qualifier value)| )]], 
[[~1..1]] 363699004 |Direct device (attribute)| = [[+id(<< 371792008 |Brachytherapy device (physical object)| )]], 
[[~0..1]] [[+id(< 363704007 |Procedure site (attribute)|)]] = [[+id(<< 91723000 |Anatomical structure (body structure)| )]], 
[[~0..1]] 363709002 |Indirect morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)| )]] }

I would like to propose moving 363701004 |Direct substance (attribute)| under 424361007 |Using substance (attribute)|. Then, the model of 399315003 |Radionuclide therapy (procedure)| and its subconcepts could be simplified by using a single role group instead of two. I demonstrated the changes in a task and assigned it to you and Jim Case  at https://authoring.ihtsdotools.org/#/tasks/task/ANCRJAN22/ANCRJAN22-649/edit

I also produced a model pattern report for radiotherapy at https://drive.google.com/drive/folders/1xLT-QoZ_ykcSr-rKh3XCMJ4s8h9YSkkL?usp=sharing

Hi Victor Medina  There are 13 role group changes in the model pattern report. I have highlighted the issues for two concepts related to multiple using energy attributes in the inferred model. They need to be fixed. The others in the list needs to be reviewed. Please let me know if you need any further information. 

Hi Victor Medina  Please review and fix the misaligned concepts in the report https://docs.google.com/spreadsheets/d/1iSHN1zllvrxfNpp4uZol1b8P7flfYnSzMoRmCBfz4GU/edit?gid=0#gid=0 Some concepts could be modeled by a single role group. Some have an unexpected additional role group that is also identified in the model pattern report.

Hi Victor Medina  I am trying to break down the template by its types in the UML diagram of radiotherapy procedures   The scope for the radiotherapy and external beam radiation therapy:

'Pure' radiotherapy excluding radionuclide, brachytherapy and chemotherapy
<  1287742003 |Radiotherapy (procedure)| MINUS (<< 399315003 |Radionuclide therapy (procedure)| OR << 152198000 |Brachytherapy (procedure)| OR << 367336001 |Chemotherapy (procedure)|  OR (<  1287742003 |Radiotherapy (procedure)| : 260686004 |Method (attribute)| != << 129445006 |Administration - action (qualifier value)|))

Template:

71388002 |Procedure (procedure)|:
[[~0..1]] { [[~0..1]] 363702006 |Has focus (attribute)| = [[+id(<< 404684003 |Clinical finding (finding)|) ]] }
[[~1..1]] {
[[~1..1]] 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)|,
[[~0..1]] [[+id(< 363704007 |Procedure site (attribute)| ) @null]] = [[+id(<< 442083009 |Anatomical or acquired body structure (body structure)|)]],
[[~1..1]] 424244007 |Using energy (attribute)| = [[+id(<< 125576007 |Ionizing radiation (physical force)|) ]],
[[~0..1]] 424226004 |Using device (attribute)| = [[+id(<< 466194000 |External beam radiation therapy radionuclide system (physical object)| OR << 706285003 |Accelerator system (physical object)| )]],
[[~0..1]] 424361007 |Using substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)|or << 285322002 |Subatomic particle (substance)| or << 2141009 ) ]],
[[~0..1]] 363700003 |Direct morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)|) ]],
[[~0..1]] 363703001 |Has intent (attribute)| = [[+id(< 363675004 |Intents (nature of procedure values) (qualifier value)| )]] }

This has identified a handful of misalignments. https://docs.google.com/spreadsheets/d/1EBARbJ4Gk42Z1eUS7puK2sgl8OZvjrTvXb_yHH8gb5Q/edit?gid=0#gid=0

The range for using substance in radiotherapy needs to be reviewed. We may need to extend the range to include those that are not radioactive isotopes. For example, A Betatron is a type of particle accelerator used to accelerate electrons. Once the electrons are accelerated to high energies, they can be directed to hit a target, which then produces X-rays through bremsstrahlung radiation. Photon therapy, which is a form of radiotherapy, uses high-energy photons (X-rays or gamma rays) to target and destroy cancer cells.

Hi Yongsheng Gao 

Th issue with those concepts are: In these cases, the concepts were modeled originally with the Destruction Role group, I left those RG untouched to avoid losing the supertypes. But if we are going to be consistent... a single Relationship group including the Direct morphology attribute would be more helpful to gain consistency. But we would need to change the FSNs where the term "destruction" is stated...

Hi Victor Medina  Please review the concepts in the alignment report for concepts under << 399315003 |Radionuclide therapy (procedure)|

    71388002 |Procedure (procedure)|: 
    [[~0..1]] { [[~0..1]] 363702006 |Has focus (attribute)| = [[+id(<< 404684003 |Clinical finding (finding)|) ]] } 
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)|, 
    [[~0..1]] [[+id(< 363704007 |Procedure site (attribute)| ) @null]] = [[+id(<< 442083009 |Anatomical or acquired body structure (body structure)|)]], 
    [[~1..1]] 424244007 |Using energy (attribute)| = [[+id(<< 125576007 |Ionizing radiation (physical force)|) ]], 
    [[~0..1]] 424226004 |Using device (attribute)| = [[+id(<< 466194000 |External beam radiation therapy radionuclide system (physical object)| OR << 706285003 |Accelerator system (physical object)| )]], [[~0..1]] 424361007 |Using substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)|or << 285322002 |Subatomic particle (substance)| or << 2141009 ) ]], 
    [[~0..1]] 363700003 |Direct morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)|) ]], 
    [[~0..1]] 363703001 |Has intent (attribute)| = [[+id(< 363675004 |Intents (nature of procedure values) (qualifier value)| )]] },
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| = [[+id(<< 129445006 |Administration - action (qualifier value)|) ]], 
    [[~1..1]]  363701004 |Direct substance (attribute)|  = [[+id(<<  89457008 |Radioactive isotope (substance)| )]],
    [[~0..1]]  405814001 |Procedure site - Indirect (attribute)|  = [[+id(<<  91723000 |Anatomical structure (body structure)| )]],
    [[~0..1]]  363709002 |Indirect morphology (attribute)|  = [[+id(<<  49755003 |Morphologically abnormal structure (morphologic abnormality)| )]],
    [[~0..1]]  410675002 |Route of administration (attribute)|  = [[+id(<  284009009 |Route of administration value (qualifier value)| )]] }

The alignment report at:

https://docs.google.com/spreadsheets/d/1i2ek5nUnVCBlvxzPyaDnw9zXZLeXcUN3PLCOElqc9ms/edit?gid=0#gid=0

For concepts in scope : (<< 152198000 |Brachytherapy (procedure)| MINUS << 228660009 |Contact therapy (procedure)|) MINUS (<< 152198000 |Brachytherapy (procedure)| : 363703001 |Has intent (attribute)|  = <<  429892002 |Guidance intent (qualifier value)| )

    71388002 |Procedure (procedure)|: 
    [[~0..1]] { [[~0..1]] 363702006 |Has focus (attribute)| = [[+id(<< 404684003 |Clinical finding (finding)|) ]] } 
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)|, 
    [[~0..1]] [[+id(< 363704007 |Procedure site (attribute)| ) @null]] = [[+id(<< 442083009 |Anatomical or acquired body structure (body structure)|)]], 
    [[~1..1]] 424244007 |Using energy (attribute)| = [[+id(<< 125576007 |Ionizing radiation (physical force)|) ]], 
    [[~0..1]] 424226004 |Using device (attribute)| = [[+id(<< 466194000 |External beam radiation therapy radionuclide system (physical object)| OR << 706285003 |Accelerator system (physical object)| )]], [[~0..1]] 424361007 |Using substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)|or << 285322002 |Subatomic particle (substance)| or << 2141009 ) ]], 
    [[~0..1]] 363700003 |Direct morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)|) ]], 
    [[~0..1]] 363703001 |Has intent (attribute)| = [[+id(< 363675004 |Intents (nature of procedure values) (qualifier value)| )]] },
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| =  [[+id( << 129336009 |Implantation - action (qualifier value)|  OR  << 257867005 |Insertion - action (qualifier value)| )]], 
    [[~1..1]]  363699004 |Direct device (attribute)|  = [[+id(<<  371792008 |Brachytherapy device (physical object)| )]],
    [[~0..1]]  405814001 |Procedure site - Indirect (attribute)|  = [[+id(<<  91723000 |Anatomical structure (body structure)| )]],
    [[~0..1]]  260507000 |Access (attribute)|  = [[+id(<  309795001 |Surgical access values (qualifier value)| )]] }

The alignment report at:

https://docs.google.com/spreadsheets/d/1kxLIehpEjVrAT4Ge4s8SzN1iIODkYeQwK1qVfOnYYr4/edit?gid=0#gid=0

For concepts under << 228660009 |Contact therapy (procedure)|

     71388002 |Procedure (procedure)|: 
    [[~0..1]] { [[~0..1]] 363702006 |Has focus (attribute)| = [[+id(<< 404684003 |Clinical finding (finding)|) ]] } 
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| = 129445006 |Administration - action (qualifier value)|, 
    [[~0..1]] [[+id(< 363704007 |Procedure site (attribute)| ) @null]] = [[+id(<< 442083009 |Anatomical or acquired body structure (body structure)|)]], 
    [[~1..1]] 424244007 |Using energy (attribute)| = [[+id(<< 125576007 |Ionizing radiation (physical force)|) ]], 
    [[~0..1]] 424226004 |Using device (attribute)| = [[+id(<< 466194000 |External beam radiation therapy radionuclide system (physical object)| OR << 706285003 |Accelerator system (physical object)| )]], [[~0..1]] 424361007 |Using substance (attribute)| = [[+id(<< 89457008 |Radioactive isotope (substance)|or << 285322002 |Subatomic particle (substance)| or << 2141009 ) ]], 
    [[~0..1]] 363700003 |Direct morphology (attribute)| = [[+id(<< 49755003 |Morphologically abnormal structure (morphologic abnormality)|) ]], 
    [[~0..1]] 363703001 |Has intent (attribute)| = [[+id(< 363675004 |Intents (nature of procedure values) (qualifier value)| )]] },
    [[~1..1]] { [[~1..1]] 260686004 |Method (attribute)| =  [[+id( << 129425003 |Application - action (qualifier value)| )]], 
    [[~1..1]]  363699004 |Direct device (attribute)|  = [[+id(<<  1255212006 |Brachytherapy surface applicator (physical object)| )]],
    [[~0..1]]  405813007 |Procedure site - Direct (attribute)|  = [[+id(<<  442083009 |Anatomical or acquired body structure (body structure)| )]],
    [[~0..1]]  260507000 |Access (attribute)|  = [[+id(<  309795001 |Surgical access values (qualifier value)| )]] }

The alignment report at:

https://docs.google.com/spreadsheets/d/1r2iVHjLszja2ocmxhnVHZggU4wg0YQbxVUUwriy3AQM/edit?gid=0#gid=0

Victor Medina  I added three extra templates to cover brachytherapy, contact therapy and radionuclide therapy because they have different model patterns in the UML.