ID

10105

Description

CALGB: Imaging Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=46848A6F-07AE-238A-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=46848A6F-07AE-238A-E044-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 3/30/15 3/30/15 - Martin Dugas
Uploaded on

March 30, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Imaging Form CALGB

English

Instructions: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice...

1 forms  
Header
Description

Header

Alias
UMLS CUI-1
C1320722
CALGB Form
Description

Form ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3262252
NCI Thesaurus ObjectClass
C19464
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus ObjectClass-2
C25442
CALGB Study No
Description

Protocol ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
CALGB Patient ID
Description

Trial subject ID CALGB

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1516238
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25442
Date of CT Scan
Description

DiagnosticComputedTomographyPerformedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass-2
C25482
UMLS 2011AA ObjectClass-2
C0348026
Are data amended
Description

Data amended

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Patient Initials (Last, First Middle)
Description

Patient Initials

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Hospital No.
Description

Medical Record Number

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1301894
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25261
NCI Thesaurus Property-2
C25198
Institution/Affiliate
Description

Institution Name

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Participating Group
Description

Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2347449
NCI Thesaurus ObjectClass
C25608
NCI Thesaurus ObjectClass-2
C17005
NCI Thesaurus Property
C25364
Participating Group Study No.
Description

Study Number Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Description

Trial subject ID Participating Group

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Hospital Name (or imaging center performing chest CT)
Description

TreatingHospitalName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
Completed by (Last name, First name)
Description

Person Completing Form

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Date Form Originally Completed
Description

Form Completion Date

Data type

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Technique Factors
Description

Technique Factors

KVp
Description

ChestComputedTomographyKilovoltPeakMeasurement

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Thesaurus Property
C48432
UMLS 2011AA Property
C1708610
Pitch
Description

ChestComputedTomographyPitchMeasurement

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Thesaurus Property
C48442
UMLS 2011AA Property
C1704634
mA
Description

ChestComputedTomographyAmpereMeasurement

Data type

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Metathesaurus Property
C0457243
Scan Length (craniocaudal extent)
Description

ChestComputedTomographyScanLengthMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Thesaurus Property
C17999
UMLS 2011AA Property
C0441633
NCI Thesaurus Property-2
C25334
UMLS 2011AA Property-2
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Rotation Time
Description

ChestComputedTomographyRevolutionTimeMeasurement

Data type

float

Measurement units
  • seconds
Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Thesaurus Property
C25207
UMLS 2011AA Property
C0040223
NCI Thesaurus Property-2
C48439
UMLS 2011AA Property-2
C0035868
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
seconds
Tumor Features
Description

Tumor Features

Alias
UMLS CUI-1
C3273022
Tumor Location Area (Mark one)
Description

TumorLungAreaType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C12468
UMLS 2011AA Property
C0024109
NCI Thesaurus Property-2
C25244
UMLS 2011AA Property-2
C0205146
Table position of the most superior section in which aerated lung is visible (For the lung that contains the tumor provide:)
Description

MostSuperiorComputedTomographyCoordinateAeratedLungPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C17204
NCI Thesaurus ObjectClass-2
C44465
NCI Thesaurus ObjectClass-3
C25235
NCI Thesaurus ObjectClass-4
C25258
NCI Thesaurus Property
C12468
NCI Thesaurus Property-2
C38000
NCI Thesaurus ValueDomain
C25704
Table position of the most superior section that shows the dome of the hemidiaphragm
Description

MostSuperiorComputedTomographyCoordinateDiaphragmPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C17204
NCI Thesaurus ObjectClass-2
C44465
NCI Thesaurus ObjectClass-3
C25235
NCI Thesaurus ObjectClass-4
C25258
NCI Thesaurus Property
C12702
NCI Thesaurus Property-2
C38000
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0040405
UMLS CUI-2
C1707511
UMLS CUI-3
C1282910
UMLS CUI-4
C0205393
UMLS CUI-5
C0011980
UMLS CUI-6
C0884358
UMLS CUI-7
C1527021
Table position of the section that best demonstrated the center of the tumor
Description

BestComputedTomographyCoordinateNeoplasmCenterPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25432
UMLS 2011AA ObjectClass-2
C1522427
NCI Thesaurus ObjectClass-3
C44465
UMLS 2011AA ObjectClass-3
C1707511
NCI Thesaurus Property
C3262
UMLS 2011AA Property
C0027651
NCI Thesaurus Property-2
C38000
UMLS 2011AA Property-2
C0884358
NCI Thesaurus Property-3
C25445
UMLS 2011AA Property-3
C0205099
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Distance from midline to center of tumor
Description

BestComputedTomographyCoordinateMidlineCenterLengthMeasurement

Data type

text

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25432
UMLS 2011AA ObjectClass-2
C1522427
NCI Thesaurus ObjectClass-3
C44465
UMLS 2011AA ObjectClass-3
C1707511
NCI Metathesaurus Property
C0549183
NCI Thesaurus Property
C25445
UMLS 2011AA Property
C0205099
NCI Thesaurus Property-2
C25334
UMLS 2011AA Property-2
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Maximum anteroposterior extent of aerated lung (same side as tumor)
Description

ComputedTomographyCoordinateAeratedLungAnteriorPosteriorLengthMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
NCI Thesaurus ObjectClass-2
C44465
NCI Thesaurus Property
C12468
NCI Thesaurus Property-2
C25231
NCI Thesaurus Property-3
C25622
NCI Thesaurus Property-4
C25334
NCI Thesaurus ValueDomain
C25209
cm
Distance from the most posterior extent of aerated lung to center of tumor
Description

ComputedTomographyCoordinateAeratedLungPosteriorCenterLengthMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
NCI Thesaurus ObjectClass-2
C44465
NCI Thesaurus Property
C12468
NCI Thesaurus Property-2
C25622
NCI Thesaurus Property-3
C25445
NCI Thesaurus Property-4
C25334
NCI Thesaurus ValueDomain
C25209
cm
Maximum diameter of tumor using lung window settings
Description

ChestComputedTomographyNeoplasmMaximumDiameterLengthMeasurement

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C17204
NCI Thesaurus ObjectClass-3
C25389
NCI Thesaurus Property
C25285
NCI Thesaurus Property-2
C25564
NCI Thesaurus Property-3
C25334
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C3272927
UMLS CUI-2
C0806909
cm
Maximum diameter of tumor, using soft tissue (chest/abdomen) window settings
Description

ChestAbdominalCavityComputedTomographyNeoplasmMaximumDiameterLengthMeasurement

Data type

text

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C17204
NCI Thesaurus ObjectClass-3
C25389
NCI Thesaurus ObjectClass-4
C12664
NCI Thesaurus Property
C25285
NCI Thesaurus Property-2
C25564
NCI Thesaurus Property-3
C25334
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C3272927
UMLS CUI-2
C0806909
cm
Is a previous CT scan available for comparison
Description

PatientPriorChestComputedTomographyInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Metathesaurus Property
C0202823
Has the tumor changed
Description

TumorChangeType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25446
UMLS 2011AA Property
C0392747
Indicate previous maximum diameter (on lung window images - cm)
Description

TumorPriorMaximumDiameterMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus Property-3
C25564
UMLS 2011AA Property-3
C0806909
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Date of previous scan
Description

PriorChestComputedTomographyPerformedDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass-2
C25389
UMLS 2011AA ObjectClass-2
C0817096
NCI Thesaurus ObjectClass-3
C25629
UMLS 2011AA ObjectClass-3
C0332152
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Tumor Appearance
Description

Tumor Appearance

Margin and shape based on lung window settings (Mark all that apply with an X.)
Description

TumorMarginType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25563
UMLS 2011AA Property
C0205284
Tumor appearance on lung window settings (Mark all that apply with an X.)
Description

TumorAppearanceType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25377
UMLS 2011AA Property
C0700364
If the scan includes non-contrast enhanced images of the tumor, are any of the following present (Tumor appearance on soft tissue chest/abdomen window settings)
Description

ChestAbdomenCavityComputedTomographyNeoplasmAppearanceType

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass-2
C17204
UMLS 2011AA ObjectClass-2
C0040405
NCI Thesaurus ObjectClass-3
C25389
UMLS 2011AA ObjectClass-3
C0817096
NCI Thesaurus ObjectClass-4
C12664
UMLS 2011AA ObjectClass-4
C0230168
NCI Thesaurus Property
C25377
UMLS 2011AA Property
C0700364
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
If the scan includes contrast-enhanced images of the tumor, are any of the following present within the tumor (Tumor appearance on soft tissue chest/abdomen window settings)
Description

ChestAbdominalCavityComputedTomographyNeoplasmContrastAppearanceType

Data type

text

Alias
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus ObjectClass-2
C17204
NCI Thesaurus ObjectClass-3
C25389
NCI Thesaurus ObjectClass-4
C12664
NCI Thesaurus Property
C25377
NCI Thesaurus Property-2
C43290
NCI Thesaurus ValueDomain
C25284
Lymph Nodes
Description

Lymph Nodes

Alias
UMLS CUI-1
C0024204
Indicate stations of all enlarged lymph nodes
Description

LungLymphNodeSwellingAssessmentSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus ObjectClass-2
C12745
UMLS 2011AA ObjectClass-2
C0024204
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C3399
UMLS 2011AA Property-2
C0038999
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Was a pre-operative PET scan performed
Description

PriorTreatmentPositronEmissionTomographyInterpretationAvailableInd-2

Data type

boolean

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus ObjectClass-3
C15368
NCI Thesaurus Property
C25429
UMLS 2011AA Property
C0470187
NCI Thesaurus Property-2
C41255
UMLS 2011AA Property-2
C0459471
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Date of PET scan (If yes,)
Description

PatientPre-studyChestPositronEmissionTomographyEligibilityDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C17007
UMLS 2011AA Property
C0032743
NCI Thesaurus Property-2
C25389
UMLS 2011AA Property-2
C0817096
NCI Thesaurus Property-3
C25171
UMLS 2011AA Property-3
C0013893
NCI Thesaurus Property-4
C38010
UMLS 2011AA Property-4
C1527048
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Pet Scan Results
Description

Pet Scan Results

Alias
UMLS CUI-1
C0032743
Site of lesion
Description

PositronEmissionTomographyMedicalImagingLungNeoplasmAssessmentAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C16831
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3200
NCI Thesaurus ValueDomain
C13717
UMLS CUI-1
C0449695
Nodal lesion, specify
Description

PositronEmissionTomographyMedicalImagingLungNeoplasmAssessmentSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C16831
NCI Thesaurus Property
C20989
NCI Thesaurus Property-2
C3200
NCI Thesaurus ValueDomain
C25685
SUV Max
Description

StandardUptakeValuePositronEmissionTomographyAssessmentMaximumMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C44275
NCI Metathesaurus ObjectClass
C0243144
NCI Thesaurus ObjectClass-3
C25712
NCI Thesaurus Property
C20989
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ValueDomain-2
C25564
SUV Mean
Description

StandardUptakeValuePositronEmissionTomographyAssessmentMeanMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C44275
NCI Metathesaurus ObjectClass
C0243144
NCI Thesaurus ObjectClass-3
C25712
NCI Thesaurus Property
C20989
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ValueDomain-2
C53319
UMLS CUI-1
C3272866
What tests were performed to rule out possible distant metastases present on PET scan?
Description

DiagnosticProcedureLungDistantMetastasisPresentPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C18020
NCI Thesaurus Property
C25626
NCI Thesaurus Property-2
C12468
NCI Thesaurus Property-3
C18206
NCI Thesaurus Property-4
C38000
NCI Thesaurus ValueDomain
C25704
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Similar models

Instructions: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice...

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Form ID CALGB
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
Protocol ID CALGB
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
Trial subject ID CALGB
Item
CALGB Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus Property-2)
DiagnosticComputedTomographyPerformedDate
Item
Date of CT Scan
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25482 (NCI Thesaurus ObjectClass-2)
C0348026 (UMLS 2011AA ObjectClass-2)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Medical Record Number
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Participating Group
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C2347449 (UMLS CUI-1)
C25608 (NCI Thesaurus ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
TreatingHospitalName
Item
Hospital Name (or imaging center performing chest CT)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
Person Completing Form
Item
Completed by (Last name, First name)
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Form Completion Date
Item
Date Form Originally Completed
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Item Group
Technique Factors
ChestComputedTomographyKilovoltPeakMeasurement
Item
KVp
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C48432 (NCI Thesaurus Property)
C1708610 (UMLS 2011AA Property)
ChestComputedTomographyPitchMeasurement
Item
Pitch
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C48442 (NCI Thesaurus Property)
C1704634 (UMLS 2011AA Property)
ChestComputedTomographyAmpereMeasurement
Item
mA
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C0457243 (NCI Metathesaurus Property)
ChestComputedTomographyScanLengthMeasurement
Item
Scan Length (craniocaudal extent)
float
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C17999 (NCI Thesaurus Property)
C0441633 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property-2)
C1444754 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ChestComputedTomographyRevolutionTimeMeasurement
Item
Rotation Time
float
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C48439 (NCI Thesaurus Property-2)
C0035868 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item Group
Tumor Features
C3273022 (UMLS CUI-1)
Item
Tumor Location Area (Mark one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C25244 (NCI Thesaurus Property-2)
C0205146 (UMLS 2011AA Property-2)
CL.2
Code List
Tumor Location Area (Mark one)
CL Item
Upper Lobe (right) (Upper Lobe (right))
CL Item
Middle Lobe (right) (Middle Lobe (right))
CL Item
Lower Lobe (right) (Lower Lobe (right))
CL Item
Upper Lobe (left) (Upper Lobe (left))
CL Item
Lower Lobe (left) (Lower Lobe (left))
CL Item
Lingula (Lingula)
most superior section in which aerated lung is visible
Item
Table position of the most superior section in which aerated lung is visible (For the lung that contains the tumor provide:)
text
C17204 (NCI Thesaurus ObjectClass)
C44465 (NCI Thesaurus ObjectClass-2)
C25235 (NCI Thesaurus ObjectClass-3)
C25258 (NCI Thesaurus ObjectClass-4)
C12468 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)
most superior section with dome of hemidiaphragm
Item
Table position of the most superior section that shows the dome of the hemidiaphragm
text
C17204 (NCI Thesaurus ObjectClass)
C44465 (NCI Thesaurus ObjectClass-2)
C25235 (NCI Thesaurus ObjectClass-3)
C25258 (NCI Thesaurus ObjectClass-4)
C12702 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)
C0040405 (UMLS CUI-1)
C1707511 (UMLS CUI-2)
C1282910 (UMLS CUI-3)
C0205393 (UMLS CUI-4)
C0011980 (UMLS CUI-5)
C0884358 (UMLS CUI-6)
C1527021 (UMLS CUI-7)
BestComputedTomographyCoordinateNeoplasmCenterPerformedText
Item
Table position of the section that best demonstrated the center of the tumor
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25432 (NCI Thesaurus ObjectClass-2)
C1522427 (UMLS 2011AA ObjectClass-2)
C44465 (NCI Thesaurus ObjectClass-3)
C1707511 (UMLS 2011AA ObjectClass-3)
C3262 (NCI Thesaurus Property)
C0027651 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25445 (NCI Thesaurus Property-3)
C0205099 (UMLS 2011AA Property-3)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
BestComputedTomographyCoordinateMidlineCenterLengthMeasurement
Item
Distance from midline to center of tumor
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25432 (NCI Thesaurus ObjectClass-2)
C1522427 (UMLS 2011AA ObjectClass-2)
C44465 (NCI Thesaurus ObjectClass-3)
C1707511 (UMLS 2011AA ObjectClass-3)
C0549183 (NCI Metathesaurus Property)
C25445 (NCI Thesaurus Property)
C0205099 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property-2)
C1444754 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Maximum anteroposterior extent of aerated lung
Item
Maximum anteroposterior extent of aerated lung (same side as tumor)
float
C17204 (NCI Thesaurus ObjectClass)
C44465 (NCI Thesaurus ObjectClass-2)
C12468 (NCI Thesaurus Property)
C25231 (NCI Thesaurus Property-2)
C25622 (NCI Thesaurus Property-3)
C25334 (NCI Thesaurus Property-4)
C25209 (NCI Thesaurus ValueDomain)
Distance from the most posterior extent of aerated lung to center of tumor
Item
Distance from the most posterior extent of aerated lung to center of tumor
float
C17204 (NCI Thesaurus ObjectClass)
C44465 (NCI Thesaurus ObjectClass-2)
C12468 (NCI Thesaurus Property)
C25622 (NCI Thesaurus Property-2)
C25445 (NCI Thesaurus Property-3)
C25334 (NCI Thesaurus Property-4)
C25209 (NCI Thesaurus ValueDomain)
Maximum diameter of tumor
Item
Maximum diameter of tumor using lung window settings
float
C3262 (NCI Thesaurus ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C25389 (NCI Thesaurus ObjectClass-3)
C25285 (NCI Thesaurus Property)
C25564 (NCI Thesaurus Property-2)
C25334 (NCI Thesaurus Property-3)
C25209 (NCI Thesaurus ValueDomain)
C3272927 (UMLS CUI-1)
C0806909 (UMLS CUI-2)
Diameter of tumor, maximum
Item
Maximum diameter of tumor, using soft tissue (chest/abdomen) window settings
text
C3262 (NCI Thesaurus ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C25389 (NCI Thesaurus ObjectClass-3)
C12664 (NCI Thesaurus ObjectClass-4)
C25285 (NCI Thesaurus Property)
C25564 (NCI Thesaurus Property-2)
C25334 (NCI Thesaurus Property-3)
C25209 (NCI Thesaurus ValueDomain)
C3272927 (UMLS CUI-1)
C0806909 (UMLS CUI-2)
PatientPriorChestComputedTomographyInd-2
Item
Is a previous CT scan available for comparison
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C0202823 (NCI Metathesaurus Property)
Item
Has the tumor changed
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25446 (NCI Thesaurus Property)
C0392747 (UMLS 2011AA Property)
CL.4
Code List
Has the tumor changed
CL Item
New Finding (New finding)
CL Item
Tumor Size Increased (Tumor size increased)
CL Item
Tumor Size Decreased (Tumor size decreased)
TumorPriorMaximumDiameterMeasurement
Item
Indicate previous maximum diameter (on lung window images - cm)
float
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25564 (NCI Thesaurus Property-3)
C0806909 (UMLS 2011AA Property-3)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
PriorChestComputedTomographyPerformedDate
Item
Date of previous scan
date
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass-2)
C0817096 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus ObjectClass-3)
C0332152 (UMLS 2011AA ObjectClass-3)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Tumor Appearance
Item
Margin and shape based on lung window settings (Mark all that apply with an X.)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25563 (NCI Thesaurus Property)
C0205284 (UMLS 2011AA Property)
CL.5
Code List
Margin and shape based on lung window settings (Mark all that apply with an X.)
CL Item
Well Defined (Well-defined)
C0442825 (NCI Metathesaurus)
CL Item
Ill-defined (Ill-defined)
CL Item
Lobulated (Lobulated)
CL Item
Spiculated (Spiculated)
CL Item
Round (Round)
C48348 (NCI Thesaurus)
C0332490 (UMLS 2011AA)
Item
Tumor appearance on lung window settings (Mark all that apply with an X.)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus Property)
C0700364 (UMLS 2011AA Property)
CL.6
Code List
Tumor appearance on lung window settings (Mark all that apply with an X.)
CL Item
Solid: C45300 (Solid)
C45300 (NCI Thesaurus)
C0205208 (UMLS 2011AA)
CL Item
Part Solid/mixed (Part-Solid)
Item
If the scan includes non-contrast enhanced images of the tumor, are any of the following present (Tumor appearance on soft tissue chest/abdomen window settings)
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C0040405 (UMLS 2011AA ObjectClass-2)
C25389 (NCI Thesaurus ObjectClass-3)
C0817096 (UMLS 2011AA ObjectClass-3)
C12664 (NCI Thesaurus ObjectClass-4)
C0230168 (UMLS 2011AA ObjectClass-4)
C25377 (NCI Thesaurus Property)
C0700364 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.7
Code List
If the scan includes non-contrast enhanced images of the tumor, are any of the following present (Tumor appearance on soft tissue chest/abdomen window settings)
CL Item
High- Attenuation Foci (e.g., Calcification) (High- attenuation foci (e.g., calcification))
CL Item
Water- Attenuation Foci (e.g., Necrosis) (Water- attenuation foci (e.g., necrosis))
CL Item
Gas- Attenuation Foci (Gas- attenuation foci)
Item
If the scan includes contrast-enhanced images of the tumor, are any of the following present within the tumor (Tumor appearance on soft tissue chest/abdomen window settings)
text
C3262 (NCI Thesaurus ObjectClass)
C17204 (NCI Thesaurus ObjectClass-2)
C25389 (NCI Thesaurus ObjectClass-3)
C12664 (NCI Thesaurus ObjectClass-4)
C25377 (NCI Thesaurus Property)
C43290 (NCI Thesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
CL.8
Code List
If the scan includes contrast-enhanced images of the tumor, are any of the following present within the tumor (Tumor appearance on soft tissue chest/abdomen window settings)
CL Item
High- Attenuation Foci (e.g., Calcification) (High- attenuation foci (e.g., calcification))
CL Item
Water- Attenuation Foci (e.g., Necrosis) (Water- attenuation foci (e.g., necrosis))
CL Item
Gas- Attenuation Foci (Gas- attenuation foci)
Item Group
Lymph Nodes
C0024204 (UMLS CUI-1)
Item
Indicate stations of all enlarged lymph nodes
text
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass-2)
C0024204 (UMLS 2011AA ObjectClass-2)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property-2)
C0038999 (UMLS 2011AA Property-2)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.9
Code List
Indicate stations of all enlarged lymph nodes
CL Item
Left Hilar Node (Left hilar (10L))
CL Item
Left Lower Paratracheal Node (Left lower paratracheal (4L))
CL Item
Left Pulmonary Ligament (9l) (Left pulmonary ligament (9L))
CL Item
Left Upper Paratracheal Node (Left upper paratracheal (2L))
CL Item
Para-aortic Node (Para-aortic (6))
CL Item
Paraesophageal (Paraesophageal (8))
C25344 (NCI Thesaurus)
C0475302 (UMLS 2011AA)
CL Item
Pre-vascular (3a) (Pre-vascular (3A))
CL Item
Retrotracheal (3p) (Retrotracheal (3P))
CL Item
Right Hilar Node (Right hilar (10R))
CL Item
Right Lower Paratracheal Node (Right lower paratracheal (4R))
CL Item
Right Pulmonary Ligament (9r) (Right pulmonary ligament (9R))
CL Item
Right Upper Paratracheal Node (Right upper paratracheal (2R))
CL Item
Subaortic Node (Subaortic (5))
CL Item
Subcarinal Node (Subcarinal (7))
PriorTreatmentPositronEmissionTomographyInterpretationAvailableInd-2
Item
Was a pre-operative PET scan performed
boolean
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15368 (NCI Thesaurus ObjectClass-3)
C25429 (NCI Thesaurus Property)
C0470187 (UMLS 2011AA Property)
C41255 (NCI Thesaurus Property-2)
C0459471 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PatientPre-studyChestPositronEmissionTomographyEligibilityDate
Item
Date of PET scan (If yes,)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C17007 (NCI Thesaurus Property)
C0032743 (UMLS 2011AA Property)
C25389 (NCI Thesaurus Property-2)
C0817096 (UMLS 2011AA Property-2)
C25171 (NCI Thesaurus Property-3)
C0013893 (UMLS 2011AA Property-3)
C38010 (NCI Thesaurus Property-4)
C1527048 (UMLS 2011AA Property-4)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Pet Scan Results
C0032743 (UMLS CUI-1)
Item
Site of lesion
text
C17007 (NCI Thesaurus ObjectClass)
C16831 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C3200 (NCI Thesaurus Property-2)
C13717 (NCI Thesaurus ValueDomain)
C0449695 (UMLS CUI-1)
CL.11
Code List
Site of lesion
CL Item
Lymph Node (Nodal lesion)
C12745 (NCI Thesaurus)
C0024204 (UMLS 2011AA)
CL Item
Other (Other lesion)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Lung (Primary Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
Nodal lesion
Item
Nodal lesion, specify
text
C17007 (NCI Thesaurus ObjectClass)
C16831 (NCI Thesaurus ObjectClass-2)
C20989 (NCI Thesaurus Property)
C3200 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
SUV max
Item
SUV Max
float
C17007 (NCI Thesaurus ObjectClass)
C44275 (NCI Thesaurus ObjectClass-2)
C0243144 (NCI Metathesaurus ObjectClass)
C25712 (NCI Thesaurus ObjectClass-3)
C20989 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C25564 (NCI Thesaurus ValueDomain-2)
SUV Mean
Item
SUV Mean
float
C17007 (NCI Thesaurus ObjectClass)
C44275 (NCI Thesaurus ObjectClass-2)
C0243144 (NCI Metathesaurus ObjectClass)
C25712 (NCI Thesaurus ObjectClass-3)
C20989 (NCI Thesaurus Property)
C25209 (NCI Thesaurus ValueDomain)
C53319 (NCI Thesaurus ValueDomain-2)
C3272866 (UMLS CUI-1)
Tests to rule out metastases
Item
What tests were performed to rule out possible distant metastases present on PET scan?
text
C18020 (NCI Thesaurus ObjectClass)
C25626 (NCI Thesaurus Property)
C12468 (NCI Thesaurus Property-2)
C18206 (NCI Thesaurus Property-3)
C38000 (NCI Thesaurus Property-4)
C25704 (NCI Thesaurus ValueDomain)
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