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ID

10574

Beschrijving

RADIOTHERAPY SUBMISSION FORM - LUNG NCT00020709 S0023: Combination Chemo Plus RT With or Without Gefitinib in Treating Patients With Unresectable Stage III NSCLC Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-501A-361C-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9CA62D43-501A-361C-E034-080020C9C0E0

Trefwoorden

  1. 19-09-12 19-09-12 -
  2. 28-05-15 28-05-15 -
  3. 03-06-15 03-06-15 -
Geüploaded op

3 juni 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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    RADIOTHERAPY SUBMISSION FORM - LUNG NCT00020709

    No Instruction available.

    1. StudyEvent: RADIOTHERAPY SUBMISSION FORM - LUNG
      1. No Instruction available.
    SWOG clinical trial administrative data
    Beschrijving

    SWOG clinical trial administrative data

    SWOG Study No.
    Beschrijving

    SWOGStudyNo.

    Datatype

    text

    Registration Step
    Beschrijving

    RegistrationStep

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337 (undefined)
    UMLS 2011AA ValueDomain
    C0237753 (Numbers)
    SNOMED
    260299005
    LOINC
    LP6841-3
    NCI Thesaurus ValueDomain-2
    C16154 (undefined)
    UMLS 2011AA ValueDomain-2
    C1704379 (Treatment Step)
    SWOG Patient ID
    Beschrijving

    SWOGPatientID

    Datatype

    text

    Patient Initials (L, F M)
    Beschrijving

    PatientInitials

    Datatype

    text

    Institution / Affiliate
    Beschrijving

    Institution/Affiliate

    Datatype

    text

    Investigator
    Beschrijving

    Investigator

    Datatype

    text

    RADIOTHERAPY documentation
    Beschrijving

    RADIOTHERAPY documentation

    RT Facility
    Beschrijving

    RTFacility

    Datatype

    text

    RT Physician
    Beschrijving

    RTPhysician

    Datatype

    text

    Radiation Therapy End Date (month, day, year )
    Beschrijving

    RTEndDate

    Datatype

    date

    Required Materials (if not enclosed, explain in Notes)
    Beschrijving

    RequiredMaterials

    Datatype

    text

    Dose Volume Histogram
    Beschrijving

    DoseVolumeHistogram

    Datatype

    text

    Enclosed
    Beschrijving

    Enclosed

    Datatype

    boolean

    Notes
    Beschrijving

    Notes

    Datatype

    text

    Notes
    Beschrijving

    Notes

    Similar models

    No Instruction available.

    1. StudyEvent: RADIOTHERAPY SUBMISSION FORM - LUNG
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    Alias
    Item Group
    SWOG clinical trial administrative data
    SWOGStudyNo.
    Item
    SWOG Study No.
    text
    RegistrationStep
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16154 (NCI Thesaurus ValueDomain-2)
    C1704379 (UMLS 2011AA ValueDomain-2)
    SWOGPatientID
    Item
    SWOG Patient ID
    text
    PatientInitials
    Item
    Patient Initials (L, F M)
    text
    Institution/Affiliate
    Item
    Institution / Affiliate
    text
    Investigator
    Item
    Investigator
    text
    Item Group
    RADIOTHERAPY documentation
    RTFacility
    Item
    RT Facility
    text
    RTPhysician
    Item
    RT Physician
    text
    RTEndDate
    Item
    Radiation Therapy End Date (month, day, year )
    date
    Item
    Required Materials (if not enclosed, explain in Notes)
    text
    Code List
    Required Materials (if not enclosed, explain in Notes)
    CL Item
    Treatment Prescription Sheet (Treatment Prescription Sheet)
    CL Item
    Simulator Films or digital reconstruction rendering (Simulator Films or digital reconstruction rendering)
    CL Item
    CT Scan (CT Scan)
    CL Item
    Polaroid of Treatment Set-Up (Polaroid of Treatment Set-Up)
    CL Item
    Lung Carcinoma Radiation Therapy Form (Lung Carcinoma Radiation Therapy Form)
    Item
    Dose Volume Histogram
    text
    Code List
    Dose Volume Histogram
    CL Item
    Tumor (Tumor)
    CL Item
    Left Lung (Left Lung)
    CL Item
    Right Lung (Right Lung)
    CL Item
    Right + Left Lung (Right + Left Lung)
    Enclosed
    Item
    Enclosed
    boolean
    Notes
    Item
    Notes
    text
    Item Group
    Notes

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