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The results for TUTEST = Tumor Identification, are typically TUORRES = Target and Non-target. However results for this test can also be: BONE LESION, measurable/non-measurable, benign/malignant, new, etc. I think the purpose of this test is to identify the “role” of a tumor, such as tumor type, malignancy status, measurability, etc. However, TU domain definition also states that TU is used to identify the location of the tumor. There is no specific TUTEST associated with the tumor location identification process - tumor locations are treated as a known fact and are mapped to TULOC directly for the Tumor Identification TUTEST. It isn't clear whether TUTEST = Tumor Identification, is also intended to be used to identify the location of the tumor.

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•  If all I need to do is to identify an object, it’s location, and then evaluate its severity, no disease response to treatment data, in other words I have TU and CC data, but no TR and RS, can I use TU?
•  How do we modeling Result Location, when the result itself is the location? Should this be modeled in variables (RESLOC), or should we create tests for result location findings?
•  For tumor findings, it is recommended that "The TR domain does not include anatomical location information of each measurement record, this information can be found in the TU domain." - This works for tumor, but it is a bit odd for non-tumor lesions, show example, case 1 tr.xpt.

CT Questions - The Non-Tumor Lesion Side

•  On the tumor side, because you are only dealing with one type of lesion, you can get away with TUTEST = Tumor Identification. Use "tumor" as the beginning for all the identification tests. For non-tumor lesions, this convention is a bit odd. In the published CT I found: TUTEST = Cardiovascular Lesion Indicator, so is the expectation then to put the "type" of CV lesion in TULNKID? For example, TULNKID = Thoracic Aortic Aneurysm 1, where TUTEST = Cardiovascular Lesion Indicator? Alternative approach would be to pre-coordinate the suspected object into TUTEST, i.e. TUTEST = Aneurysm Lesion Indicator; TUTEST = Calcified Cardiac Annuls Indicator, etc.
  

Recommendations

1. STOP combining domains. Oftentimes domains are created by different groups under different circumstances. The premises based on which a domain is built varies greatly for essentially, the same type of data (Tumor vs Non-tumor lesions). Because domains are governed by different teams (i.e. oncology and QRS SDS/CT teams), there are also different CT business rules developed for different domains.
   
2. Add May consider adding an assumption to better define "lesion" for TU: A localized pathological or traumatic structural change, damage, deformity, or discontinuity of tissue, organ, or body part (C3824). Anything that causes fundamental architectural changes to the structure is considered as a lesion. Jordan Li : ask Al and Nick to draft a better definition for lesion.

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