ID

3119

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

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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On-Study - CALGB: Imaging Form - 2730039v1.0

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  
Unnamed1
Description

Unnamed1

CALGB Form
Description

CALGBFormIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25442
UMLS 2011AA ObjectClass
C1516238
CALGB Study No
Description

ProtocolCALGBIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C25442
UMLS 2011AA Property
C1516238
CALGB Patient ID
Description

PatientCALGBIdentifierNumber

Data type

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
C25442
UMLS 2011AA Property
C1516238
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
C25482
UMLS 2011AA ObjectClass
C0348026
Are data amended
Description

DataAmendedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Unnamed2
Description

Unnamed2

Patient Initials (Last, First Middle)
Description

PatientInitialsName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25536
UMLS 2011AA Property
C1555582
Patient Hospital No.
Description

PatientMedicalRecordNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25261
UMLS 2011AA Property
C0205476
NCI Thesaurus Property
C25198
UMLS 2011AA Property
C0034869
Institution/Affiliate
Description

CombinedInstitutionName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS 2011AA ObjectClass
C0205195
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain
C21541
UMLS 2011AA ValueDomain
C0018704
Participating Group
Description

ParticipatingGroupName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Study No.
Description

ProtocolParticipatingIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C25320
UMLS 2011AA ObjectClass
C1507394
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Patient ID
Description

PatientParticipatingIdentifierNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25608
UMLS 2011AA Property
C0679823
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Unnamed3
Description

Unnamed3

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
C25705
UMLS 2011AA ObjectClass
C1522326
Technique Factors
Description

Technique Factors

KVp
Description

ChestComputedTomographyKilovoltPeakMeasurement

Data type

double

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

ChestComputedTomographyPitchMeasurement

Data type

double

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

ChestComputedTomographyAmpereMeasurement

Data type

double

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

ChestComputedTomographyScanLengthMeasurement

Data type

double

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

ChestComputedTomographyRevolutionTimeMeasurement

Data type

double

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

Tumor Features

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
C25244
UMLS 2011AA Property
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
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Thesaurus ObjectClass
C25235
UMLS 2011AA ObjectClass
C1282910
NCI Thesaurus ObjectClass
C25258
UMLS 2011AA ObjectClass
C0205393
NCI Thesaurus Property
C12468
UMLS 2011AA Property
C0024109
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Table position of the most superior section that shows the dome of the hemidiaphragm
Description

MostSuperiorComputedTomographyCoordinateDiaphragmPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Thesaurus ObjectClass
C25235
UMLS 2011AA ObjectClass
C1282910
NCI Thesaurus ObjectClass
C25258
UMLS 2011AA ObjectClass
C0205393
NCI Thesaurus Property
C12702
UMLS 2011AA Property
C0011980
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
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
C25432
UMLS 2011AA ObjectClass
C1522427
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Thesaurus Property
C3262
UMLS 2011AA Property
C0027651
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C25445
UMLS 2011AA Property
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
C25432
UMLS 2011AA ObjectClass
C1522427
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Metathesaurus Property
C0549183
NCI Thesaurus Property
C25445
UMLS 2011AA Property
C0205099
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Maximum anteroposterior extent of aerated lung (same side as tumor)
Description

ComputedTomographyCoordinateAeratedLungAnteriorPosteriorLengthMeasurement

Data type

text

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Thesaurus Property
C12468
UMLS 2011AA Property
C0024109
NCI Thesaurus Property
C25231
UMLS 2011AA Property
C0205094
NCI Thesaurus Property
C25622
UMLS 2011AA Property
C0205095
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Distance from the most posterior extent of aerated lung to center of tumor
Description

ComputedTomographyCoordinateAeratedLungPosteriorCenterLengthMeasurement

Data type

text

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C44465
UMLS 2011AA ObjectClass
C1707511
NCI Thesaurus Property
C12468
UMLS 2011AA Property
C0024109
NCI Thesaurus Property
C25622
UMLS 2011AA Property
C0205095
NCI Thesaurus Property
C25445
UMLS 2011AA Property
C0205099
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Maximum diameter of tumor using lung window settings
Description

ChestComputedTomographyNeoplasmMaximumDiameterLengthMeasurement

Data type

text

Measurement units
  • cm
Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C25389
UMLS 2011AA ObjectClass
C0817096
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus Property
C25564
UMLS 2011AA Property
C0806909
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
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
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C25389
UMLS 2011AA ObjectClass
C0817096
NCI Thesaurus ObjectClass
C12664
UMLS 2011AA ObjectClass
C0230168
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus Property
C25564
UMLS 2011AA Property
C0806909
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
cm
Tumor Features (cont)
Description

Tumor Features (cont)

Is a previous CT scan available for comparison
Description

PatientPriorChestComputedTomographyInd-2

Data type

text

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

double

Alias
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property
C25564
UMLS 2011AA Property
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
C25389
UMLS 2011AA ObjectClass
C0817096
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
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
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C25389
UMLS 2011AA ObjectClass
C0817096
NCI Thesaurus ObjectClass
C12664
UMLS 2011AA ObjectClass
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
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus ObjectClass
C17204
UMLS 2011AA ObjectClass
C0040405
NCI Thesaurus ObjectClass
C25389
UMLS 2011AA ObjectClass
C0817096
NCI Thesaurus ObjectClass
C12664
UMLS 2011AA ObjectClass
C0230168
NCI Thesaurus Property
C25377
UMLS 2011AA Property
C0700364
NCI Thesaurus Property
C43290
UMLS 2011AA Property
C1711375
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Lymph Nodes
Description

Lymph Nodes

Indicate stations of all enlarged lymph nodes
Description

LungLymphNodeSwellingAssessmentSite

Data type

text

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

PriorTreatmentPositronEmissionTomographyInterpretationAvailableInd-2

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25429
UMLS 2011AA Property
C0470187
NCI Thesaurus Property
C41255
UMLS 2011AA Property
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
C25389
UMLS 2011AA Property
C0817096
NCI Thesaurus Property
C25171
UMLS 2011AA Property
C0013893
NCI Thesaurus Property
C38010
UMLS 2011AA Property
C1527048
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Pet Scan Results
Description

Pet Scan Results

Site of lesion
Description

PositronEmissionTomographyMedicalImagingLungNeoplasmAssessmentAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C16831
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C3200
UMLS 2011AA Property
C0020445
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Nodal lesion, specify
Description

PositronEmissionTomographyMedicalImagingLungNeoplasmAssessmentSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C16831
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property
C3200
UMLS 2011AA Property
C0020445
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
SUV Max
Description

StandardUptakeValuePositronEmissionTomographyAssessmentMaximumMeasurement

Data type

double

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C44275
UMLS 2011AA ObjectClass
C1442989
NCI Metathesaurus ObjectClass
C0243144
NCI Thesaurus ObjectClass
C25712
UMLS 2011AA ObjectClass
C1522609
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C25564
UMLS 2011AA ValueDomain
C0806909
SUV Mean
Description

StandardUptakeValuePositronEmissionTomographyAssessmentMeanMeasurement

Data type

double

Alias
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C44275
UMLS 2011AA ObjectClass
C1442989
NCI Metathesaurus ObjectClass
C0243144
NCI Thesaurus ObjectClass
C25712
UMLS 2011AA ObjectClass
C1522609
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ValueDomain
C53319
UMLS 2011AA ValueDomain
C0444504
What tests were performed to rule out possible distant metastases present on PET scan?
Description

DiagnosticProcedureLungDistantMetastasisPresentPerformedText

Data type

text

Alias
NCI Thesaurus ObjectClass
C18020
UMLS 2011AA ObjectClass
C0430022
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C12468
UMLS 2011AA Property
C0024109
NCI Thesaurus Property
C18206
UMLS 2011AA Property
C1269798
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Footer
Description

Footer

Completed by (Last name, First name)
Description

ResponsiblePersonName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25657
UMLS 2011AA ObjectClass
C1273518
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Date Form Originally Completed
Description

FormOriginalCompleteDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus Property
C25250
UMLS 2011AA Property
C0205197
NCI Thesaurus Property
C25604
UMLS 2011AA Property
C0205313
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
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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
Unnamed1
CALGBFormIdentifierNumber
Item
CALGB Form
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus ObjectClass)
C1516238 (UMLS 2011AA ObjectClass)
ProtocolCALGBIdentifierNumber
Item
CALGB Study No
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
PatientCALGBIdentifierNumber
Item
CALGB 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)
C25442 (NCI Thesaurus Property)
C1516238 (UMLS 2011AA Property)
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)
C0348026 (UMLS 2011AA ObjectClass)
Item
Are data amended
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Are data amended
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item Group
Unnamed2
PatientInitialsName
Item
Patient Initials (Last, First Middle)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
PatientMedicalRecordNumber
Item
Patient Hospital No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25261 (NCI Thesaurus Property)
C0205476 (UMLS 2011AA Property)
C25198 (NCI Thesaurus Property)
C0034869 (UMLS 2011AA Property)
CombinedInstitutionName
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C0205195 (UMLS 2011AA ObjectClass)
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
ParticipatingGroupName
Item
Participating Group
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
ProtocolParticipatingIdentifierNumber
Item
Participating Group Study No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25320 (NCI Thesaurus ObjectClass)
C1507394 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientParticipatingIdentifierNumber
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25608 (NCI Thesaurus Property)
C0679823 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item Group
Unnamed3
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)
C1522326 (UMLS 2011AA ObjectClass)
Item Group
Technique Factors
ChestComputedTomographyKilovoltPeakMeasurement
Item
KVp
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C48432 (NCI Thesaurus Property)
C1708610 (UMLS 2011AA Property)
ChestComputedTomographyPitchMeasurement
Item
Pitch
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C48442 (NCI Thesaurus Property)
C1704634 (UMLS 2011AA Property)
ChestComputedTomographyAmpereMeasurement
Item
mA
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C0457243 (NCI Metathesaurus Property)
ChestComputedTomographyScanLengthMeasurement
Item
Scan Length (craniocaudal extent)
double
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C17999 (NCI Thesaurus Property)
C0441633 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ChestComputedTomographyRevolutionTimeMeasurement
Item
Rotation Time
double
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C25207 (NCI Thesaurus Property)
C0040223 (UMLS 2011AA Property)
C48439 (NCI Thesaurus Property)
C0035868 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item Group
Tumor Features
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)
C0205146 (UMLS 2011AA Property)
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)
MostSuperiorComputedTomographyCoordinateAeratedLungPerformedText
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)
C0040405 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C25235 (NCI Thesaurus ObjectClass)
C1282910 (UMLS 2011AA ObjectClass)
C25258 (NCI Thesaurus ObjectClass)
C0205393 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
MostSuperiorComputedTomographyCoordinateDiaphragmPerformedText
Item
Table position of the most superior section that shows the dome of the hemidiaphragm
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C25235 (NCI Thesaurus ObjectClass)
C1282910 (UMLS 2011AA ObjectClass)
C25258 (NCI Thesaurus ObjectClass)
C0205393 (UMLS 2011AA ObjectClass)
C12702 (NCI Thesaurus Property)
C0011980 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
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)
C1522427 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C3262 (NCI Thesaurus Property)
C0027651 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25445 (NCI Thesaurus Property)
C0205099 (UMLS 2011AA Property)
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)
C1522427 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C0549183 (NCI Metathesaurus Property)
C25445 (NCI Thesaurus Property)
C0205099 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ComputedTomographyCoordinateAeratedLungAnteriorPosteriorLengthMeasurement
Item
Maximum anteroposterior extent of aerated lung (same side as tumor)
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C25231 (NCI Thesaurus Property)
C0205094 (UMLS 2011AA Property)
C25622 (NCI Thesaurus Property)
C0205095 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ComputedTomographyCoordinateAeratedLungPosteriorCenterLengthMeasurement
Item
Distance from the most posterior extent of aerated lung to center of tumor
text
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C44465 (NCI Thesaurus ObjectClass)
C1707511 (UMLS 2011AA ObjectClass)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C25622 (NCI Thesaurus Property)
C0205095 (UMLS 2011AA Property)
C25445 (NCI Thesaurus Property)
C0205099 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ChestComputedTomographyNeoplasmMaximumDiameterLengthMeasurement
Item
Maximum diameter of tumor using lung window settings
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25564 (NCI Thesaurus Property)
C0806909 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
ChestAbdominalCavityComputedTomographyNeoplasmMaximumDiameterLengthMeasurement
Item
Maximum diameter of tumor, using soft tissue (chest/abdomen) window settings
text
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C12664 (NCI Thesaurus ObjectClass)
C0230168 (UMLS 2011AA ObjectClass)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25564 (NCI Thesaurus Property)
C0806909 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Item Group
Tumor Features (cont)
Item
Is a previous CT scan available for comparison
text
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)
CL.3
Code List
Is a previous CT scan available for comparison
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
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)
double
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25564 (NCI Thesaurus Property)
C0806909 (UMLS 2011AA Property)
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)
C0817096 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
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)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C12664 (NCI Thesaurus ObjectClass)
C0230168 (UMLS 2011AA ObjectClass)
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)
C0027651 (UMLS 2011AA ObjectClass)
C17204 (NCI Thesaurus ObjectClass)
C0040405 (UMLS 2011AA ObjectClass)
C25389 (NCI Thesaurus ObjectClass)
C0817096 (UMLS 2011AA ObjectClass)
C12664 (NCI Thesaurus ObjectClass)
C0230168 (UMLS 2011AA ObjectClass)
C25377 (NCI Thesaurus Property)
C0700364 (UMLS 2011AA Property)
C43290 (NCI Thesaurus Property)
C1711375 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA 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
Item
Indicate stations of all enlarged lymph nodes
text
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3399 (NCI Thesaurus Property)
C0038999 (UMLS 2011AA Property)
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))
Item
Was a pre-operative PET scan performed
text
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass)
C25429 (NCI Thesaurus Property)
C0470187 (UMLS 2011AA Property)
C41255 (NCI Thesaurus Property)
C0459471 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.10
Code List
Was a pre-operative PET scan performed
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
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)
C0817096 (UMLS 2011AA Property)
C25171 (NCI Thesaurus Property)
C0013893 (UMLS 2011AA Property)
C38010 (NCI Thesaurus Property)
C1527048 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Pet Scan Results
Item
Site of lesion
text
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C16831 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3200 (NCI Thesaurus Property)
C0020445 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
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)
PositronEmissionTomographyMedicalImagingLungNeoplasmAssessmentSpecify
Item
Nodal lesion, specify
text
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C16831 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C3200 (NCI Thesaurus Property)
C0020445 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
StandardUptakeValuePositronEmissionTomographyAssessmentMaximumMeasurement
Item
SUV Max
double
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C44275 (NCI Thesaurus ObjectClass)
C1442989 (UMLS 2011AA ObjectClass)
C0243144 (NCI Metathesaurus ObjectClass)
C25712 (NCI Thesaurus ObjectClass)
C1522609 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25564 (NCI Thesaurus ValueDomain)
C0806909 (UMLS 2011AA ValueDomain)
StandardUptakeValuePositronEmissionTomographyAssessmentMeanMeasurement
Item
SUV Mean
double
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C44275 (NCI Thesaurus ObjectClass)
C1442989 (UMLS 2011AA ObjectClass)
C0243144 (NCI Metathesaurus ObjectClass)
C25712 (NCI Thesaurus ObjectClass)
C1522609 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C53319 (NCI Thesaurus ValueDomain)
C0444504 (UMLS 2011AA ValueDomain)
DiagnosticProcedureLungDistantMetastasisPresentPerformedText
Item
What tests were performed to rule out possible distant metastases present on PET scan?
text
C18020 (NCI Thesaurus ObjectClass)
C0430022 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12468 (NCI Thesaurus Property)
C0024109 (UMLS 2011AA Property)
C18206 (NCI Thesaurus Property)
C1269798 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item Group
Footer
ResponsiblePersonName
Item
Completed by (Last name, First name)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25657 (NCI Thesaurus ObjectClass)
C1273518 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
FormOriginalCompleteDate
Item
Date Form Originally Completed
date
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25250 (NCI Thesaurus Property)
C0205197 (UMLS 2011AA Property)
C25604 (NCI Thesaurus Property)
C0205313 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
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