Belgian Cancer Registry on FHIR
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Artifacts Summary

Contents:

This page provides a list of the FHIR artifacts defined as part of this implementation guide.

Structures: Logical Models

These define data models that represent the domain covered by this implementation guide in more business-friendly terms than the underlying FHIR resources.

BCR Breast Tumour Supplement — Bijlage 55 vervolg 1 (Logical Model)

Logical model of the breast-tumour-specific supplement to the standard cancer registration form (Bijlage 55, vervolg 1). Contains menopausal status, molecular markers (with separate values for tumour 1 and, when multifocal, tumour 2), and surgical / lymph node data.

Source: Bijlage 55 (vervolg 1) of the RIZIV Verordening of 28 July 2003, amended 15 December 2025.
BCR CHP Breast Sample (Logical Model)

Logical model of one breast cyto-histopathology sample registered in the Belgian Cancer Registry CHP register. Covers all breast samples treated and delivered by Belgian pathological anatomy laboratories under the breast cancer screening programme.

Source: BCR — Cyto-histopathology register breast - metadata.
BCR CHP Cervix Sample (Logical Model)

Logical model of one cervical cyto-histopathology sample registered in the Belgian Cancer Registry CHP register. Covers all cervical samples treated and delivered by Belgian pathological anatomy laboratories under the cervical cancer screening programme.

Source: BCR — Cyto-histopathology register cervix - metadata.
BCR CHP Colorectal Sample (Logical Model)

Logical model of one colorectal cyto-histopathology sample registered in the Belgian Cancer Registry CHP register. Covers all colorectal samples treated and delivered by Belgian pathological anatomy laboratories under the colorectal cancer screening programme.

Source: BCR — Cyto-histopathology register colorectal - metadata.
BCR CHP Sample (Abstract Base Logical Model)

Abstract base for the Belgian Cancer Registry cyto-histopathology (CHP) screening supplements. One row per laboratory sample (not per patient or per cancer case).
BCR Cancer Case (Logical Model)

Logical model of a single cancer case as published in the Belgian Cancer Registry (BCR) research dataset ("Cancer in Belgium").

This is the exported, derived dataset — patient demographics are pseudonymised, several fields are derived (numeric ICD-10, age categories, region, vital-status dates), and tumour-sequence variables are computed registry-wide.

For the submission form that hospitals fill in for every new diagnosis, see BCRCancerRegistrationForm (Bijlage 55), which is the upstream source of most of the variables here.

Source: BCR — Cancer in Belgium - metadata, version 2, 2025-05-05.
BCR Cancer Registration Form — Bijlage 55 (Logical Model)

Logical model of the Belgian standard cancer registration form (Kankerregistratieformulier voor een nieuwe diagnose). This is what hospitals submit to the Belgian Cancer Registry through WBCR or via batch extraction for every new cancer diagnosis.

Distinct from BCRCancerCase, which models the published research dataset derived from these submissions plus registry follow-up.

Source (canonical): Bijlage 55 to the RIZIV Verordening of 28 July 2003, as amended by the Verordening of 15 December 2025 (Belgisch Staatsblad 23-12-2025, p. 96356).
BCR Follow-Up Form — Bijlage 55 vervolg 3 (Logical Model)

Logical model of the cancer registration follow-up form. Submitted to BCR at each follow-up MOC or disease event after the initial registration. Captures the primary tumour reference, recurrence information, the planned treatment for the current problem, and the reason for the follow-up MOC.

Source: Bijlage 55 (vervolg 3) of the RIZIV Verordening of 28 July 2003, amended 15 December 2025.
BCR MOC Form — Bijlage 55 vervolg 2 (Logical Model)

Logical model of the Multidisciplinair Oncologisch Consult (MOC) attestation attached to a Belgian cancer registration. Captures the reason for convening the MOC, the coordinator, and the participants. Per RIZIV nomenclature 350276-350280 / 350291-350302 / 350372-350383, the coordinator confirms that both the MOC report and the registration form have been completed.

Source: Bijlage 55 (vervolg 2) of the RIZIV Verordening of 28 July 2003, amended 15 December 2025.

Structures: Resource Profiles

These define constraints on FHIR resources for systems conforming to this implementation guide.

BCR Registration Task

The hospital's obligation to register a new cancer case with the Belgian Cancer Registry, tracked across the whole lifecycle of submission and (re)validation. The national service creates this Task when the hospital posts the Condition that opens the case; focus points back at that Condition.

status is forward-only: ready → in-progress → completed, or cancelled/failed as terminal exits.

  • ready → in-progress is a side effect of the first QuestionnaireResponse submission (the first BCRValidationTask).
  • in-progress → completed may be performed by either the registry or the hospital once they consider the oncology case complete — but only after a submission with final intent (see BCRValidationTask) has validated successfully.

All of the back-and-forth of repeated validation attempts lives in the history of BCRValidationTasks (one per attempt, linked via Task.partOf), not on this Task — the current situation (awaiting data, under validation, correction required, partially or fully accepted) is derived from the most recent attempt's status, submission-intent and output. A correction after completion (a new BCRValidationTask arriving while this Task is already completed) does not rewind status.

Draft — confirm with BCR.
BCR Validation Outcome

The result of asynchronous validation of a cancer-registration submission, referenced from BCRValidationTask.output. Each issue SHOULD use expression (a FHIRPath into the submitted QuestionnaireResponse) so the submitting system can point the user at the exact field to correct. Draft — confirm with BCR.
BCR Validation Task

A single submission of a completed cancer-registration QuestionnaireResponse to the national validation service. Its status reflects the validation lifecycle of this attempt only:

requested → in-progress → completed | failed

The client POSTs the Task as requested; on receipt the server moves it straight to in-progress and validates in the background.

  • completed — validation passed; output carries the validation OperationOutcome and (on success) the registry registration-id.
  • failed — validation found blocking errors; statusReason gives the coded reason and output references the OperationOutcome listing the issues.

Every attempt declares a submission intent (partial or final) as a typed input. The parent BCRRegistrationTask can only be closed after an attempt with final intent validates successfully; a successful partial attempt leaves the registration open (status stays in-progress).

Attempts are linked to their parent BCRRegistrationTask via Task.partOf and ordered by authoredOn; a corrected resubmission is simply a new BCRValidationTask. Draft — confirm with BCR.

Terminology: Value Sets

These define sets of codes used by systems conforming to this implementation guide.

BCR Basis of Diagnosis

All codes from BCRBasisOfDiagnosis.
BCR Belgian Region

All codes from BCRRegion. Draft — confirm with BCR.
BCR Breast Tumour Sequence

All codes from BCRBreastTumourSequence. Draft — confirm with BCR.
BCR CHP Data Confidence Level

All codes from BCRDataConfidenceLevel. Draft — confirm with BCR.
BCR CHP Sample Category

All codes from BCRSampleCategory. Draft — confirm with BCR.
BCR Clinical Trial Indicator

All codes from BCRClinicalTrialIndicator.
BCR Differentiation Grade

All codes from BCRDifferentiationGrade.
BCR ER / PR Result

Result codes valid for the ER and PR markers (Bijlage 55 vervolg 1, footnote 10).
BCR Follow-Up MOC Reason

All codes from BCRFollowUpMOCReason.
BCR Gene Mutation Result

Result codes valid for the BRCA1/2, CHEK2, PALB2, ATM, and PIK3CA markers (Bijlage 55 vervolg 1, footnote 13).
BCR HER2 Combined (IHC + ISH) Result

Result codes valid for HER2 status based on combined IHC + ISH (Bijlage 55 vervolg 1, footnote 12).
BCR HER2 IHC Score Result

Result codes valid for the HER2 IHC score (Bijlage 55 vervolg 1, footnote 11).
BCR HPV Genotype

All codes from BCRHPVType. Draft — confirm with BCR.
BCR HPV Test Result

All codes from BCRHPVTestResult. Draft — confirm with BCR.
BCR ICD-10

ICD-10 codes used to express cancer histology codes derived by BCR (icd10 on the research dataset).
BCR ICD-O-3 Behaviour (digit only)

All codes from BCRBehaviour.
BCR ICD-O-3 Morphology

ICD-O-3 morphology codes (without behaviour suffix). Conformant data SHOULD use only the four-digit morphology portion (e.g. 8500); the behaviour digit is captured separately on histologyBehaviour (bound to BCRBehaviourVS).
BCR ICD-O-3 Topography

ICD-O-3 codes used to express the primary tumour location (fld_tp in the research dataset, primaryTumourLocation on Bijlage 55). Note: ICD-O-3 has no published topography-only subset in FHIR; this ValueSet includes the full system. Conformant data SHOULD use only ICD-O-3 topography codes (C00–C80) for this binding.
BCR Intended Treatment Code

Intent-to-treat codes accepted on Bijlage 55 vervolg 3 (§II).
BCR Ki-67 Result

Result codes valid for Ki-67 (Bijlage 55 vervolg 1, footnote 14). The percentage value is captured separately on molecularMarker.resultPercentage; this ValueSet only enumerates the categorical not tested sentinel.
BCR Laterality

All codes from BCRLaterality.
BCR Lymph Node Location

All codes from BCRLymphNodeLocation.
BCR MOC Reason

All codes from BCRMOCReason.
BCR Menopausal Status

All codes from BCRMenopausalStatus.
BCR Molecular Marker

All codes from BCRMolecularMarker.
BCR Molecular Marker Result (union)

Union of all per-marker result codes. Bound on BCRBreastTumourSupplement.molecularMarker.result. Per-marker constraints are documented in the marker-specific ValueSets.
BCR Other Stage Classification

All codes from BCROtherClassification.
BCR Recurrence Type

All codes from BCRRecurrenceType.
BCR Sex at Birth

Administrative gender codes used for the BCR sex / sexAtBirth fields.
BCR Specimen Quality

All codes from BCRSpecimenQuality. Draft — confirm with BCR.
BCR Submission Intent

All codes from BCRSubmissionIntent. Draft — confirm with BCR.
BCR Task Code

All codes from BCRTaskCode. Draft — confirm with BCR.
BCR Task Input/Output Type

All codes from BCRTaskIO. Draft — confirm with BCR.
BCR Task Status Reason

All codes from BCRTaskStatusReason. Draft — confirm with BCR.
BCR Treatment Chronology Code

Treatment chronology codes accepted on the main Bijlage 55 form (footnote 8). Excludes code 15 (bone marrow transplant), which is only used on Bijlage 55 vervolg 3.
BCR Vital Status

All codes from BCRVitalStatus. Draft — confirm with BCR.
BCR WHO Performance Score

All codes from BCRWHOPerformanceScore.

Terminology: Code Systems

These define new code systems used by systems conforming to this implementation guide.

BCR Basis of Diagnosis

Most reliable method by which a cancer diagnosis was established. Bijlage 55, footnote 2.
BCR Belgian Region

Region of official residence (research dataset region) or laboratory location (CHP supplements region_source). The metadata does not enumerate codes; the three Belgian regions plus an explicit unknown placeholder are used here. Draft — confirm with BCR.
BCR Breast Tumour Sequence

Indicates whether a breast tumour is the patient's first primary breast tumour or a subsequent breast tumour (variable borsttelling). Draft — confirm with BCR.
BCR CHP Data Confidence Level

Level of confidence in the registered data or result (fld_ge in the breast and colorectal CHP supplements). The metadata does not enumerate codes. Draft — confirm with BCR.
BCR CHP Sample Category

Grouping of cyto-histopathology samples into BCR-defined categories (fld_ca in the breast and colorectal CHP supplements). The metadata does not enumerate codes; common screening-pathway categories are listed here. Draft — confirm with BCR.
BCR Clinical Trial Indicator

Whether the cancer treatment is part of a clinical study. Bijlage 55, §10 A.
BCR Diagnosis / Treatment Code

Diagnosis and treatment chronology codes used on Bijlage 55 (main form footnote 8) and on Bijlage 55 vervolg 3.
BCR Differentiation Grade

Degree of resemblance of tumour cells to the original tissue. Bijlage 55, footnote 5.
BCR Follow-Up MOC Reason

Reason for a follow-up MOC. Bijlage 55 vervolg 3, §III.
BCR HPV Genotype

HPV genotypes detected when the HPV test is positive (fld_ht in the CHP cervix supplement). Multiple genotypes may be reported per sample. The metadata does not enumerate codes; the WHO/IARC high- and low-risk HPV genotypes are listed here. Draft — confirm with BCR.
BCR HPV Test Result

Result of the HPV test (fld_hr in the CHP cervix supplement). The metadata does not enumerate codes; conventional HPV-test outcome codes are listed here. Draft — confirm with BCR.
BCR ICD-O-3 Behaviour

Single-digit ICD-O-3 behaviour code (the value after the slash on a morphology code such as 8500/3).
BCR Laterality

Laterality of the primary tumour. Bijlage 55, footnote 4.
BCR Lymph Node Location

Lymph node groups assessed in the breast tumour surgical block. Bijlage 55 vervolg 1, §3b.
BCR MOC Reason

Reason for the multidisciplinary oncology consultation (MOC). Bijlage 55 vervolg 2.
BCR Menopausal Status

Menopausal status at diagnosis. Bijlage 55 vervolg 1, footnote 9.
BCR Molecular Marker

Molecular markers listed on Bijlage 55 vervolg 1. The form spells PIK3CA as 'PIKCA3'; the canonical gene symbol is preserved here.
BCR Molecular Marker Result

Result codes used across the molecular-marker table on Bijlage 55 vervolg 1. Footnotes 10–13.
BCR Other Stage Classification

Alternative staging classification used when applicable. Bijlage 55, footnote 6.
BCR Recurrence Type

Type(s) of recurrence at follow-up. Bijlage 55 vervolg 3, §I.
BCR Specimen Quality

Assessment of the specimen's quality / adequacy for diagnosis (fld_qs in the CHP cervix supplement). The metadata does not enumerate codes; common adequacy categories are listed here. Draft — confirm with BCR.
BCR Submission Intent

The submitting hospital's intent for a single BCRValidationTask: whether the submitted QuestionnaireResponse is an interim (partial) submission or the final submission for the cancer case. A BCRRegistrationTask may only be closed (status = completed) after a final submission validates successfully. Draft — confirm with BCR.
BCR Task Code

Distinguishes the two Tasks used in the asynchronous submission channel: the long-lived registration obligation and the short-lived, per-attempt validation Task. Draft — confirm with BCR.
BCR Task Input/Output Type

Types for the Task.input and Task.output slices used by the submission workflow. Draft — confirm with BCR.
BCR Task Status Reason

Coded reason explaining why a BCRValidationTask failed (R4 Task.statusReason is a CodeableConcept, so the human-readable detail lives in the linked OperationOutcome referenced from Task.output). Draft — confirm with BCR.
BCR Vital Status

Vital-status flag from the published research dataset (variable fld_vs). The metadata describes three states; codes below are reconstructions — confirm with BCR before production use.
BCR WHO Performance Score

Patient performance score at incidence date. Bijlage 55, footnote 3.
Tiro Item Control

Tiro-specific Questionnaire item-control layout hints read by the Tiro form renderer.

Example: Example Instances

These are example instances that show what data produced and consumed by systems conforming with this implementation guide might look like.

BCR Cancer Registration Form Questionnaire

Example Questionnaire mirroring the BCR Cancer Registration Form (Bijlage 55). Item definitions point at the corresponding elements of the BCRCancerRegistrationForm logical model.
BCR FHIR Validation Service

The national server endpoint that performs asynchronous validation.
Belgian Cancer Registry (example)

The registry that imposes the registration obligation and runs validation.
Example BCR Cancer Case

Illustrative cancer case record. Codes are placeholders pending the publication of the official BCR value sets.
Example BCR Patient

Illustrative patient for the async-validation worked example.
Example Cancer Case (Condition)

The malignant breast neoplasm whose registration this workflow tracks. The hospital posts this Condition to the national service, which creates the BCRRegistrationTask from it.
Example Oncology Hospital

The submitting hospital, legally obliged to register cancer cases.
Example Registration Task

The hospital's obligation to register the case. Status moves forward only (here in-progress, mid-flow); that attempt 1 failed and a correction is expected is derived from the linked BCRValidationTasks, not stored on this Task.
Example Submitted Cancer Registration (QuestionnaireResponse)

An attempt-1 BCR cancer-registration form submitted for validation. Status is in-progress: it is an incomplete submission (topography and other required items are still missing) which is exactly why validation fails.
Example Validation Outcome — accepted

Successful validation result for attempt 2.
Example Validation Outcome — failed

Blocking validation errors returned for attempt 1.
Example Validation Result Subscription

Hospital X is notified by rest-hook whenever a validation attempt for this registration reaches a terminal state.
Example Validation Task — attempt 1 (failed)

First submission attempt; validation found a blocking error.
Example Validation Task — attempt 2 (completed)

Corrected resubmission; validation passed and a registration id was issued.