ID

11662

Descrição

On-Study - North Central Cancer Treatment Group On-Study Form - 2467371v1.0 Stereotactic Radiation Therapy With or Without Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=104D18F2-219E-2AE1-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=104D18F2-219E-2AE1-E044-0003BA3F9857

Palavras-chave

Versões (3)
  1. 26/08/2012 26/08/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
  3. 25/07/2015 25/07/2015 - Martin Dugas
Transferido a

25 de julho de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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On-Study Form Brain Metastases NCT00377156

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: North Central Cancer Treatment Group On-Study Form
    1. No Instruction available.
Header
Descrição

Header

NCCTG Protocol Number
Descrição

Protocol ID NCCTG

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1518419
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25581
NCCTG Patient ID
Descrição

PatientNorthCentralCancerTreatmentGroupIdentifierNumber

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property-2
C25581
UMLS 2011AA Property-2
C1518419
Patient Initials (L F M)
Descrição

Patient Initials

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Institution
Descrição

Institution Name

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
NCI Thesaurus ValueDomain-2
C21541
NCI Thesaurus Property
C25364
Institution Number
Descrição

Institution Number

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass
C21541
UMLS CUI-2
C0805701
NCI Thesaurus Property
C25364
Are data amended (If yes, highlight amended areas)
Descrição

Data amended

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Description Of Primary Disease
Descrição

Description Of Primary Disease

MedDRA Code (primary tumor site: Metastases to brain parenchyma)
Descrição

MedDRACode

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25162
NCI Thesaurus Property
C25364
NCI Metathesaurus ObjectClass
CL104089
UMLS CUI-1
C1140263
Disease/history
Descrição

Disease/history

Primary Site (check one)
Descrição

BrainTumorPrimarySite

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Other, specify
Descrição

BrainTumorPrimaryLocationSpecify

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C12439
UMLS 2011AA ObjectClass-2
C0006104
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25251
UMLS 2011AA Property-2
C0205225
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Neurologic Examination
Descrição

Neurologic Examination

Cranial nerves (check one)
Descrição

PatientCranialNerveNeurologicFunctionAssessmentStatus

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25262
UMLS 2011AA Property-2
C0205494
NCI Thesaurus Property-3
C25518
UMLS 2011AA Property-3
C0542341
NCI Thesaurus Property-4
C12700
UMLS 2011AA Property-4
C0010268
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Sensation (check one)
Descrição

PatientSensoryNeurologicFunctionAssessmentStatus

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25262
UMLS 2011AA Property-2
C0205494
NCI Thesaurus Property-3
C25518
UMLS 2011AA Property-3
C0542341
NCI Thesaurus Property-4
C28259
UMLS 2011AA Property-4
C0445254
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Motor (check one)
Descrição

PatientMotorNeurologicFunctionAssessmentStatus

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25262
UMLS 2011AA Property-2
C0205494
NCI Thesaurus Property-3
C25518
UMLS 2011AA Property-3
C0542341
NCI Thesaurus Property-4
C28367
UMLS 2011AA Property-4
C1513492
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Cerebellar (check one)
Descrição

PatientCerebellumNeurologicFunctionAssessmentStatus

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C25262
UMLS 2011AA Property-2
C0205494
NCI Thesaurus Property-3
C25518
UMLS 2011AA Property-3
C0542341
NCI Thesaurus Property-4
C12445
UMLS 2011AA Property-4
C0007765
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Height
Descrição

Height

Height
Descrição

Height

Tipo de dados

float

Unidades de medida
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25347
UMLS CUI-1
C0005890
cm
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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: North Central Cancer Treatment Group On-Study Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header
Protocol ID NCCTG
Item
NCCTG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1518419 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25581 (NCI Thesaurus Property-2)
PatientNorthCentralCancerTreatmentGroupIdentifierNumber
Item
NCCTG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25581 (NCI Thesaurus Property-2)
C1518419 (UMLS 2011AA Property-2)
Patient Initials
Item
Patient Initials (L F M)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Institution Name
Item
Institution
text
C25191 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C21541 (NCI Thesaurus ValueDomain-2)
C25364 (NCI Thesaurus Property)
Institution Number
Item
Institution Number
text
C25337 (NCI Thesaurus ValueDomain)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (If yes, highlight amended areas)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Description Of Primary Disease
MedDRA
Item
MedDRA Code (primary tumor site: Metastases to brain parenchyma)
text
C25162 (NCI Thesaurus ValueDomain)
C25364 (NCI Thesaurus Property)
CL104089 (NCI Metathesaurus ObjectClass)
C1140263 (UMLS CUI-1)
Item Group
Disease/history
Item
Primary Site (check one)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.2
Code List
Primary Site (check one)
CL Item
Breast (breast)
C12971 (NCI Thesaurus)
C0006141 (UMLS 2011AA)
CL Item
Colorectal (Colorectal)
C13363 (NCI Thesaurus)
C0555952 (UMLS 2011AA)
CL Item
Lung (lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
CL Item
Skin/melanoma (skin/melanoma)
CL Item
Prostate Gland (Prostate)
C12410 (NCI Thesaurus)
C0033572 (UMLS 2011AA)
CL Item
Bladder (Bladder)
C12414 (NCI Thesaurus)
C0005682 (UMLS 2011AA)
CL Item
Kidney (Kidney)
C12415 (NCI Thesaurus)
C0022646 (UMLS 2011AA)
CL Item
Sarcoma (Sarcoma)
C9118 (NCI Thesaurus)
C1261473 (UMLS 2011AA)
CL Item
Gynecologic (Gynecologic)
C28016 (NCI Thesaurus)
C0205480 (UMLS 2011AA)
CL Item
Other Specify (other)
BrainTumorPrimaryLocationSpecify
Item
Other, specify
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12439 (NCI Thesaurus ObjectClass-2)
C0006104 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25251 (NCI Thesaurus Property-2)
C0205225 (UMLS 2011AA Property-2)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Neurologic Examination
Item
Cranial nerves (check one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25262 (NCI Thesaurus Property-2)
C0205494 (UMLS 2011AA Property-2)
C25518 (NCI Thesaurus Property-3)
C0542341 (UMLS 2011AA Property-3)
C12700 (NCI Thesaurus Property-4)
C0010268 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Cranial nerves (check one)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Sensation (check one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25262 (NCI Thesaurus Property-2)
C0205494 (UMLS 2011AA Property-2)
C25518 (NCI Thesaurus Property-3)
C0542341 (UMLS 2011AA Property-3)
C28259 (NCI Thesaurus Property-4)
C0445254 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.4
Code List
Sensation (check one)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Motor (check one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25262 (NCI Thesaurus Property-2)
C0205494 (UMLS 2011AA Property-2)
C25518 (NCI Thesaurus Property-3)
C0542341 (UMLS 2011AA Property-3)
C28367 (NCI Thesaurus Property-4)
C1513492 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.5
Code List
Motor (check one)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item
Cerebellar (check one)
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25262 (NCI Thesaurus Property-2)
C0205494 (UMLS 2011AA Property-2)
C25518 (NCI Thesaurus Property-3)
C0542341 (UMLS 2011AA Property-3)
C12445 (NCI Thesaurus Property-4)
C0007765 (UMLS 2011AA Property-4)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.6
Code List
Cerebellar (check one)
CL Item
Abnormal (Abnormal)
C25401 (NCI Thesaurus)
C0205161 (UMLS 2011AA)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
Item Group
Height
Height
Item
Height
float
C25209 (NCI Thesaurus ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C25347 (NCI Thesaurus Property)
C0005890 (UMLS CUI-1)
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