{
  "resourceType" : "PlanDefinition",
  "id" : "atrius-imaging-appropriateness",
  "meta" : {
    "profile" : ["http://hl7.org/fhir/StructureDefinition/cdshooksserviceplandefinition|4.0.1"]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p>See <code>Library/AtriusImagingAppropriateness</code> for gating expressions and ValueSets.</p></div>"
  },
  "extension" : [{
    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-cdsHooksEndpoint",
    "valueUri" : "https://cds.atrius.in/cds-services/atrius-imaging-appropriateness"
  }],
  "url" : "https://atrius.in/fhir/r4/atrius-in/PlanDefinition/atrius-imaging-appropriateness",
  "identifier" : [{
    "use" : "official",
    "value" : "atrius-imaging-appropriateness"
  },
  {
    "system" : "urn:ietf:rfc:3986",
    "value" : "urn:oid:1.3.6.1.4.1.66219.1.34.3"
  }],
  "version" : "0.1.0",
  "name" : "AtriusImagingAppropriateness",
  "title" : "Imaging Appropriateness (Lumbar MRI)",
  "type" : {
    "coding" : [{
      "system" : "http://terminology.hl7.org/CodeSystem/plan-definition-type",
      "code" : "eca-rule"
    }]
  },
  "status" : "draft",
  "experimental" : true,
  "date" : "2026-09-21T19:22:21+05:30",
  "publisher" : "Atrius",
  "contact" : [{
    "name" : "Atrius",
    "telecom" : [{
      "system" : "url",
      "value" : "https://atrius.in"
    }]
  }],
  "description" : "When a lumbar spine MRI is selected for a patient whose low back pain began within 6 weeks and who has no red-flag condition (cauda equina, malignancy), advise conservative therapy first and propose a plain lumbar radiograph when imaging is required.",
  "relatedArtifact" : [{
    "type" : "documentation",
    "display" : "ACR Appropriateness Criteria — Low Back Pain",
    "url" : "https://acsearch.acr.org/docs/69483/Narrative/",
    "document" : {
      "url" : "https://acsearch.acr.org/docs/69483/Narrative/"
    }
  }],
  "library" : ["https://atrius.in/fhir/r4/atrius-in/Library/AtriusImagingAppropriateness|0.1.0"],
  "action" : [{
    "id" : "atrius-imaging-appropriateness-root",
    "title" : "Imaging Appropriateness (Lumbar MRI)",
    "description" : "Early lumbar MRI selected without red flags.",
    "trigger" : [{
      "type" : "named-event",
      "name" : "order-select"
    }],
    "condition" : [{
      "kind" : "applicability",
      "expression" : {
        "language" : "text/cql",
        "expression" : "Early Lumbar MRI Without Red Flags"
      }
    }],
    "input" : [{
      "type" : "Patient",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-patient|0.1.0"]
    },
    {
      "type" : "Condition",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-encounter-diagnosis|0.1.0",
      "https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-condition-problems-health-concerns|0.1.0"]
    },
    {
      "type" : "ServiceRequest",
      "profile" : ["https://atrius.in/fhir/r4/atrius-in/StructureDefinition/atrius-in-servicerequest|0.1.0"]
    }],
    "groupingBehavior" : "logical-group",
    "action" : [{
      "id" : "lumbar-mri-early",
      "title" : "Early lumbar MRI: imaging likely not indicated yet",
      "description" : "Low back pain of less than 6 weeks without red flags: imaging does not improve outcomes. Prefer conservative therapy (activity modification, analgesia, physiotherapy) and reassess; if imaging is clinically required, start with plain radiographs.",
      "priority" : "urgent",
      "documentation" : [{
        "type" : "documentation",
        "display" : "ACR Appropriateness Criteria — Low Back Pain",
        "url" : "https://acsearch.acr.org/docs/69483/Narrative/",
        "document" : {
          "url" : "https://acsearch.acr.org/docs/69483/Narrative/"
        }
      }],
      "condition" : [{
        "kind" : "applicability",
        "expression" : {
          "language" : "text/cql",
          "expression" : "Early Lumbar MRI Without Red Flags"
        }
      }],
      "groupingBehavior" : "logical-group",
      "selectionBehavior" : "at-most-one",
      "action" : [{
        "id" : "lumbar-xr-instead",
        "title" : "Order plain lumbar spine X-ray instead",
        "priority" : "urgent",
        "definitionCanonical" : "https://atrius.in/fhir/r4/atrius-in/ActivityDefinition/atrius-ad-rad-xr-lumbar-spine|0.1.0"
      }]
    }]
  }]
}