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Supp_155_Example_Message.xml
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Supp_155_Example_Message.xml
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<?xml version="1.0"?>
<!-- ?xml-stylesheet type="text/xsl" href="CDA.xsl"? -->
<!-- DICOM Supplement 155 Example Clinical Document. -->
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ps3-20="urn:dicom-org:ps3-20" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
<!--
********************************************************
CDA Header
********************************************************
-->
<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
<!-- templateID for the Synoptic Template used, i.e. clinical sub-specialty requirements. Fictional OID assigned under the CCO branch.-->
<templateId root="2.16.840.1.113883.3.239.23.12.x" extension="2012-09-04"/>
<!-- templateID for the Imaging Report document-->
<templateId root="1.2.840.10008.20.x1.x1"/>
<!-- templateID for the General Header Elements-->
<templateId root="1.2.840.10008.20.x4.x1"/>
<!-- templateID for the Imaging Header Elements-->
<templateId root="1.2.840.10008.20.x4.x2"/>
<id root="2.16.840.1.113883.19" extension="1234567890"/>
<code code="18748-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Diagnostic Imaging Report"/>
<title>MRI Report for Rectal Cancer</title>
<effectiveTime value="20140730120000-0400"/>
<confidentialityCode code="N" codeSystem="2.16.840.1.113883.1.11.16926"/>
<languageCode code="en-CA"/>
<setId root="2.16.840.1.113883.19" extension="54321"/>
<versionNumber value="1"/>
<recordTarget>
<patientRole>
<!-- Example ID using fake OID -->
<id root="2.16.840.1.113743.19" extension="12345"/>
<addr>
<streetAddressLine>123 Main St.</streetAddressLine>
<city>Ottawa</city>
<state>ON</state>
<postalCode>K1A 0K9</postalCode>
<country>CA</country>
</addr>
<telecom value="tel:(613)867-5309" use="HP"/>
<patient>
<name>
<given>Bobo</given>
<family>Clown</family>
<suffix>the 1st</suffix>
</name>
<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1" displayName="Male"/>
<birthTime value="19601231"/>
</patient>
<providerOrganization>
<id root="2.16.840.1.113883.19"/>
<name>The Ottawa Hospital</name>
<telecom value="tel:(613)798-5555" use="WP"/>
<addr>
<streetAddressLine>501 Smyth Rd.</streetAddressLine>
<city>Ottawa</city>
<state>ON</state>
<postalCode>K1H 8L6</postalCode>
<country>CA</country>
</addr>
</providerOrganization>
</patientRole>
</recordTarget>
<author>
<time value="20140730120000-0400"/>
<assignedAuthor>
<id root="2.16.840.1.113883.4.347" extension="12345"/>
<!-- Fictitious CPSO# and OID for CPSO (Ontario College of Physicians and Surgeons) -->
<id root="2.16.840.1.113883.19.5" extension="TOH1234"/>
<!-- Ottawa Hospital Physician ID -->
<addr>
<streetAddressLine>333 Laurier Avenue West</streetAddressLine>
<city>Ottawa</city>
<state>ON</state>
<postalCode>K1A 0L9</postalCode>
<country>CA</country>
</addr>
<telecom use="WP" value="tel:(613)555-1234"/>
<assignedPerson>
<name>
<given>Slim</given>
<family>Pickens</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedAuthor>
</author>
<custodian>
<assignedCustodian>
<representedCustodianOrganization>
<id root="2.16.840.1.113883.19.5"/>
<name>The Ottawa Hospital</name>
<telecom value="tel:(613)798-5555" use="WP"/>
<addr>
<streetAddressLine>501 Smyth Rd.</streetAddressLine>
<city>Ottawa</city>
<state>ON</state>
<postalCode>K1H 8L6</postalCode>
<country>CA</country>
</addr>
</representedCustodianOrganization>
</assignedCustodian>
</custodian>
<legalAuthenticator>
<time value="20140730120000-0400"/>
<signatureCode code="S"/>
<assignedEntity>
<id root="2.16.840.1.113883.4.347" extension="12345"/>
<!-- Fictitious CPSO# and OID for CPSO (Ontario College of Physicians and Surgeons) -->
<id root="2.16.840.1.113883.19.5" extension="TOH1234"/>
<!-- Ottawa Hospital Physician ID -->
<addr>
<streetAddressLine>333 Laurier Avenue West</streetAddressLine>
<city>Ottawa</city>
<state>ON</state>
<postalCode>K1A 0L9</postalCode>
<country>CA</country>
</addr>
<telecom use="WP" value="tel:(613)555-1234"/>
<assignedPerson>
<name>
<given>Slim</given>
<family>Pickens</family>
<suffix>MD</suffix>
</name>
</assignedPerson>
</assignedEntity>
</legalAuthenticator>
<!-- participant is 1..1 SHALL - in this case a referring physician -->
<participant typeCode="REF">
<associatedEntity classCode="PROV">
<id nullFlavor="NI"/>
<addr nullFlavor="NI"/>
<telecom nullFlavor="NI"/>
<associatedPerson>
<name>
<given>Ty</given>
<family>Cobb</family>
<suffix>MD</suffix>
</name>
</associatedPerson>
</associatedEntity>
</participant>
<!--
********************************************************
Imaging Header Elements
********************************************************
-->
<inFulfillmentOf>
<order>
<!-- extension = Placer Order Number/Imaging Service Request (0040,2016) root = Order Placer Identifier Sequence (0040,0026) and Universal Entity ID (0040,0032) or from HL7 order message -->
<id root="2.16.840.1.113883.19.4.33" extension="089-927851"/>
<!-- {extension}= Accession Number (0008,0050) {root}= Issuer of Accession Number Sequence (0008,0051) > Universal Entity ID (0040,0032) -->
<ps3-20:accessionNumber extension="10523475" root="2.16.840.1.113883.19.4.27"/>
<!-- The Requested Procedure Code would go here if it were present(0032, 1064) or from HL7 order -->
</order>
</inFulfillmentOf>
<documentationOf>
<serviceEvent classCode="ACT">
<!-- study instance UID -->
<id root="1.2.840.113619.2.62.994044785528.114289542805"/>
<!-- DICOM (Performed) Procedure Code (0008,1032) -->
<code code="RPID629" displayName="MR PELVIS RECTUM" codeSystem="2.16.840.1.113883.6.256" codeSystemName="RadLex">
<!-- translation code is Modality (0008,0060) -->
<translation code="MR" displayName="Magnetic Resonance" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM"/>
<translation code="12921003" displayName="Pelvis" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT"/>
</code>
<effectiveTime>
<low value="20140730120000-0400"/>
</effectiveTime>
</serviceEvent>
</documentationOf>
<componentOf>
<encompassingEncounter>
<id root="1.3.6.4.1.4.1.2835.12" extension="1234567890"/>
<effectiveTime value="20140730120000-0400"/>
</encompassingEncounter>
</componentOf>
<!--
********************************************************
CDA Body
********************************************************
-->
<component>
<structuredBody>
<!--
********************************************************
Clinical Information Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.2.840.10008.20.x2.x1"/>
<id root="1.2.840.10213.2.62.994044785528.114289542805"/>
<code code="55752-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Clinical Information"/>
<title>Clinical Information</title>
<text>The patient was referred for rectal cancer staging following preoperative chemoradiation for Stage III primary rectal cancer.</text>
<!--
********************************************************
Request Sub Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.2.840.10008.20.x2.x6"/>
<id root="1.2.840.10213.2.62.7906994785528.114289506"/>
<code code="55115-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Request"/>
<title>Request</title>
<text>For staging of Rectal Cancer.
<content ID="CDS001">Procedure ordered by Ty Cobb, MD. Classified APPROPRIATE by RadCDS based on ACR Select criteria at 2015-07-21 10:52:31 CDT</content>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<id root="1.2.840.90012.1097.9961.100" extension="20150721-16554"/>
<code code="99SUP155-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Appropriate to Indication"/>
<text>
<reference value="#CDS001"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20150721105231-0400"/>
<value xsi:type="CD" code="LA33-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Yes"/>
<methodCode code="CDS-003" codeSystem="2.16.840.1.113883.19.166" codeSystemName="US DHHS CDS" displayName="ACR Select"/>
<author>
<time value="20150721105231-0400" />
<assignedAuthor>
<id root="2.16.840.1.113883.19.169" extension="900104"/>
<assignedAuthoringDevice>
<softwareName>RadCDS</softwareName>
</assignedAuthoringDevice>
</assignedAuthor>
</author>
<participant typeCode="REF">
<participantRole>
<id root="2.16.840.1.113883.4.6" extension="8740944987"/>
<playingEntity classCode="PSN">
<name>Pat Smith, MD</name>
</playingEntity>
</participantRole>
</participant>
</observation>
</entry>
</section>
</component>
<!--
********************************************************
Procedure Indications Sub Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.2.840.10008.20.x2.x12"/>
<id root="1.2.840.10213.2.62.044785528.1142895426"/>
<code code="59768-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Indications"/>
<title>Procedure Indications</title>
<text>The procedure is performed as a follow-up for an abnormal screening result.</text>
</section>
</component>
</section>
</component>
<!--
********************************************************
Imaging Procedure Description Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.2.840.10008.20.x2.x2"/>
<!-- Fictitious DCE UUID string, used in sections, labelled sub-sections and entries. -->
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="55111-9" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Current imaging procedure descriptions"/>
<title>Imaging Procedure Description</title>
<text>
<list>
<item>
<content ID="id01a">A MR study of the rectum was performed with Axial large FOV TSE T2, high resolution 3D T2 SPACE, and...</content>
</item>
<item>
<content ID="id01b">Overall Image Quality: Adequate</content>
</item>
</list>
</text>
<!--
***********************************************************
Procedure Technique Entry
***********************************************************
-->
<entry>
<procedure moodCode="EVN" classCode="PROC">
<templateId root="1.2.840.10008.20.x3.x2"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="RPID629" displayName="MR Pelvis Rectum" codeSystem="2.16.840.1.113883.6.256" codeSystemName="RadLex"/>
<text>
<reference value="#id01a"/>
</text>
<effectiveTime value="20140730120000-0400"/>
<methodCode code="MR" displayName="Magnetic Resonance" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM"/>
</procedure>
</entry>
<!--
********************************************************
Image Quality Entry
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="1.2.840.10008.20.x3.x4"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="111050" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Image Quality Assessment"/>
<text>
<reference value="#id01b"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="RID12" codeSystem="2.16.840.1.113883.6.256" codeSystemName="RadLex" displayName="Diagnostic quality"/>
</observation>
</entry>
<!--
***********************************************************
DICOM Object Catalog Sub Section
***********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.1.1"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="121181" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="DICOM Object Catalog"/>
<entry>
<!-- **** Study Act **** -->
<act classCode="ACT" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.6"/>
<id root="1.2.840.113619.2.62.994044785528.114289542805"/>
<code code="113014" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Study"/>
<!-- **** Series Act****-->
<entryRelationship typeCode="COMP">
<act classCode="ACT" moodCode="EVN">
<id root="1.2.840.113619.2.62.994044785528.20060823223142485051"/>
<code code="113015" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Series"> ... </code>
<!-- **** SOP Instance UID *** -->
<!-- 2 References -->
<entryRelationship typeCode="COMP">
<observation classCode="DGIMG" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.x3.x7"/>
<id root="1.2.840.113619.2.62.994044785528.20060823.200608232232322.3"/>
<!-- MR Enhanced Storage SOP Class -->
<code code="1.2.840.10008.5.1.4.1.1.4.1" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="MR Enhanced"/>
</code>
</observation>
</entryRelationship>
<entryRelationship typeCode="COMP">
<observation classCode="DGIMG" moodCode="EVN"><templateId root="2.16.840.1.113883.10.20.6.2.8"/> ... </observation>
</entryRelationship>
</act>
</entryRelationship>
</act>
</entry>
</section>
</component>
</section>
</component>
<!--
********************************************************
Comparison Study Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.2.840.10008.20.x2.x3"/>
<id root="1.2.840.10213.2.62.994056444785528.1142893564536542805"/>
<code code="18834-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Radiology Comparison Study"/>
<title>Comparison Study</title>
<text>
<content ID="id01c">A prior MRI Pelvis Rectum performed on Jan 1, 2014 showed that the patient has Stage III primary rectal cancer.</content>
</text>
<!--
***********************************************************
Procedure Technique Entry
***********************************************************
-->
<entry>
<procedure moodCode="EVN" classCode="PROC">
<templateId root="1.2.840.10008.20.x3.x2"/>
<id root="29a9be6a-ec21-447b-af5c-4f4e5196b08f"/>
<code code="RPID629" displayName="MR Pelvis Rectum" codeSystem="2.16.840.1.113883.6.256" codeSystemName="RadLex"/>
<text>
<reference value="#id01c"/>
</text>
<effectiveTime value="20140101120000-0400"/>
<methodCode code="MR" displayName="Magnetic Resonance" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM"/>
</procedure>
</entry>
</section>
</component>
<!--
********************************************************
Findings Section
********************************************************
-->
<component>
<section>
<templateId root="2.16.840.1.113883.10.20.6.1.2"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="59776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Procedure Findings"/>
<title>Findings</title>
<!--
********************************************************
Tumour Location Subsection (i.e. Labelled Subsection)
********************************************************
-->
<component>
<section ID="TumourLocation">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Tumour Location</title>
<text>
<list>
<item>
<content ID="id02">Tumour Location (from anal verge): Low (0-5.0 cm)</content>
</item>
<item>
<content ID="id03">Distance of the Lowest Extent of Tumour from Anal Verge: 3 cm</content>
</item>
<item>
<content ID="id04">Distance of the Lowest Extent of Tumour from Top of Anal Sphincter: -1 cm</content>
</item>
<item>
<content ID="id05">Relationship to Anterior Peritoneal Reflection: Below</content>
</item>
</list>
</text>
<!--
********************************************************
Coded Observation - single select
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q2" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Tumour Location from Anal Verge"/>
<text>
<reference value="#id02"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q2a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Low (0-5.0 cm)"/>
</observation>
</entry>
<!--
********************************************************
Quantity Measurement
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q3" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Distance of Lowest Extent of Tumour from Anal Verge"/>
<text>
<reference value="#id03"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="cm" value="3"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q4" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Distance of Lowest Extent of Tumor from Top of Anal Sphincter"/>
<text>
<reference value="#id04"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="cm" value="-1"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q5" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Relationship to Anterior Peritoneal Reflection"/>
<text>
<reference value="#id05"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q5c" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Below"/>
</observation>
</entry>
</section>
</component>
<component>
<section ID="TumourCharacteristics">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Tumour Characteristics</title>
<text>
<list>
<item>
<content ID="id06a">Circumferential Extent/Location from: 9 o'clock</content>
</item>
<item>
<content ID="id06b">Circumferential Extent/Location to: 3 o'clock</content>
</item>
<item>
<content ID="id07">Craniocaudad Extent: 5 cm</content>
</item>
<item>
<content ID="id08">The tumour is not mucinous.</content>
</item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q6a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Circumferential Extent/Location from"/>
<text>
<reference value="#id06a"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="260343005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="9 o'clock position"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q6a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Circumferential Extent/Location to"/>
<text>
<reference value="#id06b"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="260330005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="3 o'clock position"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q7" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Craniocaudad Extent"/>
<text>
<reference value="#id07"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="cm" value="5"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q8" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Mucinous"/>
<text>
<reference value="#id08"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q8a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="No"/>
</observation>
</entry>
</section>
</component>
<component>
<section ID="T-Category">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>T-Category</title>
<text>
<list>
<item>
<content ID="id09" styleCode="Bold">T-Category: T4 [HIGH - ACR Cat3]</content>
</item>
<item>
<content ID="id10a">Structures with Possible Invasion: Prostate</content>
</item>
<item>
<content ID="id10b">Structures with Possible Invasion: Pubococcygeus</content>
</item>
<item>
<content ID="id11">The lower extent of the tumour is at or below the top border of the puborectalis</content>
</item>
<item>
<content ID="id12">The most penetrating component of the tumour below the top border of the puborectalis is through the external sphincter. There is definite involvement of adjacent organs. (T4)</content>
</item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q9" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="T-category"/>
<text>
<reference value="#id09"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q9e" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="T4"/>
<!--Actionable Finding-->
<interpretationCode code="HH" codeSystem="2.16.840.1.113883.5.83" codeSystemName="ObservationInterpretation" displayName="High Alert">
<translation code="RID49482" codeSystem="2.16.840.1.113883.6.256" codeSystemName="RADLEX" displayName="ACR Category 3 Actionable Finding"/>
</interpretationCode>
</observation>
</entry>
<!--
********************************************************
Coded Observation - multi-select
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q10" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Structures with Possible Invasion"/>
<text>
<reference value="#id10a"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="41216001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="prostatic structure"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q10" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Structures with Possible Invasion"/>
<text>
<reference value="#id10b"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="22355009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="structure of pubococcygeus muscle"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q11" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Lower extent of tumour at or below top border of puborectalis"/>
<text>
<reference value="#id09"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q11b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Yes"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q12" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Most penetrating component of tumour below top border of puborectalis is"/>
<text>
<reference value="#id12"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q12f" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Through external sphincter and definite involvement of adjacent organs (i.e., prostate, vagina) (T4)"/>
</observation>
</entry>
</section>
</component>
<component>
<section ID="DistanceToTheMesorectalFasciaAndExtramuralDepthOfInvasion">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Distance to the Mesorectal Fascia (MRF) and Extramural Depth of Invasion (EMD)</title>
<text>
<list>
<item>
<content ID="id13a">Minimum Distance of Primary Tumour to the Mesorectal Fascia: 0 mm</content>
</item>
<!-- Second answer provided below to demonstrate how nullFlavor code is utilized. See corresponding entry below. -->
<item>
<content ID="id13b">Minimum Distance of Primary Tumour to the Mesorectal Fascia: N/A</content>
</item>
<item>
<content ID="id15">Extramural Depth of Invasion (EMD) at this level: 10 mm</content>
</item>
<item>
<content ID="id16">There are no tumour spiculations closer to the MRF.</content>
</item>
<item>
<content ID="id19">There are no other components of the tumour (any T2-3) closer to the MRF.</content>
</item>
</list>
</text>
<!--
********************************************************
When answer is a PQ
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q13a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Minimum Distance of Primary Tumour to Mesorectal Fascia"/>
<text>
<reference value="#id13a"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="mm" value="0"/>
</observation>
</entry>
<!--
********************************************************
When answer is coded (not used in this report instance but included to demonstrate how nullFlavor code is utilized)
********************************************************
-->
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q13b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Minimum Distance of Primary Tumour to Mesorectal Fascia"/>
<text>
<reference value="#id13b"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" nullFlavor="NA"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q15" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Extramural Depth of Invasion (EMD) at this level"/>
<text>
<reference value="#id15"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="mm" value="10"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q16" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Tumour Spiculations Closer to the MRF"/>
<text>
<reference value="#id16"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q16a" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="No"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q16" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Other Component of Tumour (any T2-3) closer to the MRF"/>
<text>
<reference value="#id19"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q19b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="No"/>
</observation>
</entry>
</section>
</component>
<component>
<section ID="ExtramuralVascularInvasion">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Extramural Vascular Invasion (EMVI)</title>
<text>
<list>
<item>
<content ID="id22">EMVI is present.</content>
</item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q22" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="EMVI"/>
<text>
<reference value="#id22"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q22c" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Present"/>
</observation>
</entry>
</section>
</component>
<component>
<section ID="MesorectalLymphNodesAndTumourDeposits">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Mesorectal Lymph Nodes and Tumour Deposits</title>
<text>
<list>
<item>
<content ID="id23">There are suspicious mesorectal lymph nodes and/or tumour deposits.</content>
</item>
<item>
<content ID="id24">Shortest distance of any suspicious mesorectal lymph node/tumour deposit: 7 mm</content>
</item>
<item>
<content ID="id25">Location of lymph node / deposit closest to MRF: Above tumour</content>
</item>
<item>
<content ID="id26">Clock location of lymph node / deposit closest to MRF: 10 o'clock</content>
</item>
</list>
</text>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q23" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Suspicious mesorectal lymph nodes and/or tumour deposits"/>
<text>
<reference value="#id23"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q23b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Yes"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.14"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q24" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Shortest distance of any suspicious mesorectal lymph node/tumour deposit"/>
<text>
<reference value="#id24"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="PQ" unit="mm" value="7"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q25" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Location of lymph node / deposit closest to MRF"/>
<text>
<reference value="#id25"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q25b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Above tumour"/>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.6.2.13"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q26" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Clock location of lymph node / deposit closest to MRF"/>
<text>
<reference value="#id26"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="260322009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="10 o'clock position"/>
</observation>
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<component>
<section ID="ExtramesorectalLymphNodes">
<templateId root="1.2.840.10008.20.x2.x9"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<title>Extramesorectal Lymph Nodes</title>
<text>
<list>
<item>
<content ID="id28">There are extramesorectal lymph node(s) with suspicious morphology.</content>
</item>
<item>
<content ID="id29">Location(s) of extramesorectal lymph nodes with suspicious morphology or signal: right internal iliac; right common iliac</content>
</item>
</list>
</text>
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<observation classCode="OBS" moodCode="EVN">
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<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="Q28" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Extramesorectal lymph node(s) with suspicious morphology"/>
<text>
<reference value="#id28"/>
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<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" code="Q28b" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Yes"/>
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<code code="Q29" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Location(s) of extramesorectal lymph nodes with suspicious morphology or signal"/>
<text>
<reference value="#id29"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" nullFlavor="NA"/>
</observation>
</entry>
</section>
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</section>
</component>
<!--
********************************************************
Impressions Section
********************************************************
-->
<component>
<section>
<templateId root="1.2.840.10008.20.x2.x4"/>
<id root="f81d4fae-7dec-11d0-a765-00a0c91e6bf6"/>
<code code="19005-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Impressions"/>
<title>Impression</title>
<text>
<content ID="id30">Circumferential tumour stage T4 rectal mass approximately 3 cm from the anal verge over a length of approximately 5cm. There are suspicious mesorectal lymph nodes and/or tumour deposits.</content>
</text>
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<observation classCode="OBS" moodCode="EVN">
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<code code="Q30" codeSystem="2.16.840.1.113883.3.239.23.12.x" codeSystemName="CCO MRI Rectal Tumour Checklist" displayName="Additional Comments"/>
<text>
<reference value="#id30"/>
</text>
<statusCode code="completed"/>
<effectiveTime value="20140730120000-0400"/>
<value xsi:type="CD" nullFlavor="NA"/>
</observation>
</entry>
<!--
********************************************************
Communication of Actionable Findings Sub Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
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<id root="1.2.840.10213.2.62.7044794679.114296787"/>
<code code="73568-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Communication of Critical Results"/>
<title>Communication of Actionable Results</title>
<text>
<content ID="CR1">Dr. Cobb was phoned at 613-555-1234 at 3:14pm on Wednesday, June 4, 2015, and the T4 classification was discussed directly with Dr. Cobb to explain the follow-up recommendation of...</content>
<!--T4 staging classification from <reference value="#id09"/> above in Findings -->
</text>
<entry>
<act classCode="ACT" moodCode="EVN">
<code code="99SUP155-5" codeSystem="1.2.840.10008.2.16.4" codeSystemName="DCM" displayName="Results Communicated"/>
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<reference value="#CR1"/>
</text>
<effectiveTime value="20140604221400-0400"/>
<performer>
<assignedEntity>
<id root="1.2.840.10213.2.62.7044794679.114298686"/>
<assignedPerson>
<name>Jane Doctor</name>
</assignedPerson>
</assignedEntity>
</performer>
<participant typeCode="NOT">
<participantRole>
<telecom value="tel:262-966-0120"/>
<playingEntity>
<name>Dr. Smith</name>
</playingEntity>
</participantRole>
</participant>
</act>
</entry>
</section>
</component>
<!--
********************************************************
Key Images Sub Section
********************************************************
-->
<component>
<section classCode="DOCSECT" moodCode="EVN">
<templateId root="1.3.6.1.4.1.19376.1.4.1.2.14"/>
<id root="1.2.840.10213.2.62.704478559484.11428372623"/>
<code code="55113-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Key Images"/>
<title>Key Images</title>
<text>Maximum extent of tumor is shown in
<linkHtml href="http://www.example.org/wado?requestType=WADO&...">image 1</linkHtml>
<renderMultiMedia referencedObject="refimag1"/>
</text>
<entry>