ID

3194

Beschrijving

T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E2767E-4BDF-2632-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E2767E-4BDF-2632-E034-080020C9C0E0

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 01-06-15 01-06-15 -
  3. 03-06-15 03-06-15 -
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19 september 2012

DOI

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Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer NCT00023829 Treatment - T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form - 2039507v3.0

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
    1. No Instruction available.
Unnamed1
Beschrijving

Unnamed1

RTOG Study
Beschrijving

RTOGStudy

Datatype

text

Case #
Beschrijving

Case#

Datatype

text

Unnamed2
Beschrijving

Unnamed2

Institution
Beschrijving

Institution

Datatype

text

Institution No.
Beschrijving

InstitutionNo.

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient's Name
Beschrijving

Patient'sName

Datatype

text

Patient's I.D. No.
Beschrijving

Patient'sI.D.No.

Datatype

text

Option #
Beschrijving

Option#

Datatype

text

Description
Beschrijving

DESCRIPTION

Datatype

text

Date RT starts
Beschrijving

DateRTstarts

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Surgical Stage: T
Beschrijving

SurgicalStage:T

Datatype

text

Surgical Stage: N
Beschrijving

SurgicalStage:N

Datatype

text

Surgical Stage: M (or)
Beschrijving

SurgicalStage:M

Datatype

text

system
Beschrijving

BodySystem

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C13041
UMLS 2011AA ObjectClass
C1268086
NCI Thesaurus Property
C25700
UMLS 2011AA Property
C0449913
NCI Metathesaurus ValueDomain
C0332307
Primary Site
Beschrijving

PrimarySite

Datatype

text

ENERGY (Check all that apply)
Beschrijving

ENERGY

Datatype

text

BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
Beschrijving

BRACHYTHERAPYIMPLANT/INSERTION/APPLICATION

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
specify source (brachytherapy)
Beschrijving

specifysource(brachytherapy)

Datatype

text

PLANNED IMPLANT DOSE
Beschrijving

PLANNEDIMPLANTDOSE

Datatype

double

FIELDS (Check all that apply)
Beschrijving

FIELDS

Datatype

text

Other, specify (fields)
Beschrijving

Other,specify(fields)

Datatype

text

ELECTRONS
Beschrijving

ELECTRONS

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
SITE OF ELECTRON RT
Beschrijving

SITEOFELECTRONRT

Datatype

text

ALL FIELDS TREATED EACH SESSION
Beschrijving

ALLFIELDSTREATEDEACHSESSION

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
FRACTIONATION (CHECK ALL THAT APPLY)
Beschrijving

FRACTIONATION

Datatype

text

Other, specify (fractionation) (FOR FRACTIONATION SCHEDULES OTHER THAN ONCE PER DAY)
Beschrijving

Other,specify(fractionation)

Datatype

text

SPECIFY TIME INTERVAL BETWEEN FRACTIONS
Beschrijving

SPECIFYTIMEINTERVALBETWEENFRACTIONS

Datatype

text

POINT OF PRIMARY TREATMENT PRESCRIPTION
Beschrijving

POINTOFPRIMARYTREATMENTPRESCRIPTION

Datatype

text

Other, specify (points of primary treatment prescription)
Beschrijving

Other,specify(pointsofprimarytreatmentprescription)

Datatype

text

# OF INSERTIONS
Beschrijving

#OFINSERTIONS

Datatype

text

Unnamed3
Beschrijving

Unnamed3

SITE OF PROTOCOL TREATMENT
Beschrijving

SITEOFPROTOCOLTREATMENT

Datatype

text

NODES
Beschrijving

NODES

Datatype

text

DAILY DOSE
Beschrijving

DAILYDOSE

Datatype

double

TOTAL FX
Beschrijving

TOTALFX

Datatype

double

TOTAL DOSE
Beschrijving

TotalDoseValue

Datatype

text

PLANNED TOTAL DOSE, TOTAL FX
Beschrijving

PLANNEDTOTALDOSE,TOTALFX

Datatype

text

PLANNED TOTAL DOSE, TOTAL DOSE
Beschrijving

PLANNEDTOTALDOSE,TOTALDOSE

Datatype

text

Unnamed4
Beschrijving

Unnamed4

CRITICAL STRUCTURES
Beschrijving

RadiationTherapyCriticalAnatomicSite

Datatype

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus Property
C25467
UMLS 2011AA Property
C1511545
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
MAXIMUM DOSE (GY)
Beschrijving

MAXIMUMDOSE

Datatype

double

SPECIFY METHOD USED TO RESTRICT DOSE
Beschrijving

SPECIFYMETHODUSEDTORESTRICTDOSE

Datatype

text

Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
Beschrijving

Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form

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Similar models

No Instruction available.

1 Formulieren
  1. StudyEvent: T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Unnamed1
RTOGStudy
Item
RTOG Study
text
Case#
Item
Case #
text
Item Group
Unnamed2
Institution
Item
Institution
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
Patient'sI.D.No.
Item
Patient's I.D. No.
text
Option#
Item
Option #
text
DESCRIPTION
Item
Description
text
DateRTstarts
Item
Date RT starts
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
SurgicalStage:T
Item
Surgical Stage: T
text
SurgicalStage:N
Item
Surgical Stage: N
text
SurgicalStage:M
Item
Surgical Stage: M (or)
text
BodySystem
Item
system
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C13041 (NCI Thesaurus ObjectClass)
C1268086 (UMLS 2011AA ObjectClass)
C25700 (NCI Thesaurus Property)
C0449913 (UMLS 2011AA Property)
C0332307 (NCI Metathesaurus ValueDomain)
PrimarySite
Item
Primary Site
text
Item
ENERGY (Check all that apply)
text
CL.1
Code List
ENERGY (Check all that apply)
CL Item
2-4 Mv (2-4 Mv)
CL Item
6-8 Mv (6-8 Mv)
CL Item
> 10 Mv (> 10 Mv)
CL Item
Particle (Particle)
C63850 (NCI Thesaurus)
C0597177 (UMLS 2011AA)
Item
BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.2
Code List
BRACHYTHERAPY IMPLANT/INSERTION/APPLICATION
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
specifysource(brachytherapy)
Item
specify source (brachytherapy)
text
PLANNEDIMPLANTDOSE
Item
PLANNED IMPLANT DOSE
double
Item
FIELDS (Check all that apply)
text
CL.3
Code List
FIELDS (Check all that apply)
CL Item
The Angle Or Type Of Radiation Used Was Ap (AP)
CL Item
The Angle Or Type Of Radiation Used Was Pa (PA)
CL Item
The Angle Or Type Of Radiation Used Was Left Lateral (Left lateral)
CL Item
The Angle Or Type Of Radiation Used Was Right Lateral (Right lateral)
CL Item
The Angle Or Type Of Radiation Used Was Left Oblique (Left oblique)
CL Item
The Angle Or Type Of Radiation Used Was Right Oblique (Right oblique)
CL Item
The Angle Or Type Of Radiation Used Was Left Arc (Left arc)
CL Item
The Angle Or Type Of Radiation Used Was Right Arc (Right arc)
CL Item
The Angle Or Type Of Radiation Used Was 360 Rotation (360 degree rotation)
CL Item
Specify Other Angle Or Type Of Radiation Used (Other, specify)
Other,specify(fields)
Item
Other, specify (fields)
text
Item
ELECTRONS
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.4
Code List
ELECTRONS
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
SITEOFELECTRONRT
Item
SITE OF ELECTRON RT
text
Item
ALL FIELDS TREATED EACH SESSION
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
CL.5
Code List
ALL FIELDS TREATED EACH SESSION
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
FRACTIONATION (CHECK ALL THAT APPLY)
text
CL.6
Code List
FRACTIONATION (CHECK ALL THAT APPLY)
CL Item
5 Fx/week; Once Per Day (5 FX/Week; once per day)
CL Item
10 Fx/week; Twice Per Day (10 FX/Week; twice per day)
CL Item
Other, Specify (Other, specify)
Other,specify(fractionation)
Item
Other, specify (fractionation) (FOR FRACTIONATION SCHEDULES OTHER THAN ONCE PER DAY)
text
SPECIFYTIMEINTERVALBETWEENFRACTIONS
Item
SPECIFY TIME INTERVAL BETWEEN FRACTIONS
text
Item
POINT OF PRIMARY TREATMENT PRESCRIPTION
text
CL.7
Code List
POINT OF PRIMARY TREATMENT PRESCRIPTION
CL Item
Midplane Depth (Midplane depth)
CL Item
Intersection Of Multiple Fields (Intersection of multiple fields)
CL Item
Isocenter/center Of Rotation (Isocenter/center of rotation)
CL Item
Other, Specify (Other, specify)
Other,specify(pointsofprimarytreatmentprescription)
Item
Other, specify (points of primary treatment prescription)
text
#OFINSERTIONS
Item
# OF INSERTIONS
text
Item Group
Unnamed3
Item
SITE OF PROTOCOL TREATMENT
text
CL.8
Code List
SITE OF PROTOCOL TREATMENT
CL Item
Initial Field (INITIAL FIELD)
CL Item
Boost Field #1 (BOOST FIELD #1)
CL Item
Boost Field #2 (BOOST FIELD #2)
CL Item
Additional Site (ADDITIONAL SITE)
CL Item
Nodes (NODES)
Item
NODES
text
CL.9
Code List
NODES
CL Item
Head & Neck, Ant To Cord (HEAD & NECK, Ant to cord)
CL Item
Head & Neck, Post To Cord (HEAD & NECK, Post to cord)
CL Item
Head & Neck, S'clav (HEAD & NECK, S'clav)
CL Item
Lung (upper/mid Lobes), Ipsil Hilar/subcar (LUNG (UPPER/MID LOBES), Ipsil hilar/subcar)
CL Item
Lung (upper/mid Lobes), Contra Hilar (LUNG (UPPER/MID LOBES), Contra hilar)
CL Item
Lung (upper/mid Lobes), S'clav (LUNG (UPPER/MID LOBES), S'clav)
CL Item
Lung (lower Lobes), Ipsil Hilar/subcar (LUNG (LOWER LOBES), Ipsil hilar/subcar)
CL Item
Lung (lower Lobes), Contra Hilar (LUNG (LOWER LOBES), Contra hilar)
CL Item
Lung (lower Lobes), Inf Mediastinal (LUNG (LOWER LOBES), Inf mediastinal)
CL Item
Esophagus, Mediastinal (ESOPHAGUS, Mediastinal)
CL Item
Esophagus, S'clav (ESOPHAGUS, S'clav)
CL Item
Pelvic Primaries, Int/ext Iliac (PELVIC PRIMARIES, Int/ext iliac)
CL Item
Pelvic Primaries, Common Iliac (PELVIC PRIMARIES, Common iliac)
CL Item
Pelvic Primaries, Para-aortic (PELVIC PRIMARIES, Para-aortic)
CL Item
Breast, Int Mammary (BREAST, Int mammary)
CL Item
Breast, Axillary (BREAST, Axillary)
CL Item
Breast, S'clav (BREAST, S'clav)
CL Item
Abdomen, Mesenteric (ABDOMEN, Mesenteric)
DAILYDOSE
Item
DAILY DOSE
double
TOTALFX
Item
TOTAL FX
double
TotalDoseValue
Item
TOTAL DOSE
text
PLANNEDTOTALDOSE,TOTALFX
Item
PLANNED TOTAL DOSE, TOTAL FX
text
PLANNEDTOTALDOSE,TOTALDOSE
Item
PLANNED TOTAL DOSE, TOTAL DOSE
text
Item Group
Unnamed4
Item
CRITICAL STRUCTURES
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C25467 (NCI Thesaurus Property)
C1511545 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
CL.10
Code List
CRITICAL STRUCTURES
CL Item
HEAD & NECK, Spinal cord (HEAD & NECK, Spinal cord)
CL Item
LUNG (UPPER / MID LOBES), Spinal cord (LUNG (UPPER / MID LOBES), Spinal cord)
CL Item
LUNG (UPPER / MID LOBES), Heart (LUNG (UPPER / MID LOBES), Heart)
CL Item
LUNG (UPPER / MID LOBES), Contra lung (LUNG (UPPER / MID LOBES), Contra lung)
CL Item
LUNG (LOWER LOBES), Spinal cord (LUNG (LOWER LOBES), Spinal cord)
CL Item
LUNG (LOWER LOBES), Heart (LUNG (LOWER LOBES), Heart)
CL Item
LUNG (LOWER LOBES), Contra lung (LUNG (LOWER LOBES), Contra lung)
CL Item
ESOPHAGUS, Spinal cord (ESOPHAGUS, Spinal cord)
CL Item
ESOPHAGUS, Heart (ESOPHAGUS, Heart)
CL Item
ESOPHAGUS, Lung (ESOPHAGUS, Lung)
CL Item
PELVIC PRIMARIES, Bladder (PELVIC PRIMARIES, Bladder)
CL Item
PELVIC PRIMARIES, Rectum (PELVIC PRIMARIES, Rectum)
CL Item
PELVIC PRIMARIES, Small bowel (PELVIC PRIMARIES, Small bowel)
CL Item
BRAIN, Lens (right) (BRAIN, Lens (right))
CL Item
BRAIN, Lens (left) (BRAIN, Lens (left))
CL Item
BRAIN, Spinal cord (BRAIN, Spinal cord)
CL Item
ABDOMEN, Kidney (ABDOMEN, Kidney)
CL Item
ABDOMEN, Liver (ABDOMEN, Liver)
CL Item
ABDOMEN, Spinal cord (ABDOMEN, Spinal cord)
CL Item
ABDOMEN, Small intestine (ABDOMEN, Small intestine)
MAXIMUMDOSE
Item
MAXIMUM DOSE (GY)
double
SPECIFYMETHODUSEDTORESTRICTDOSE
Item
SPECIFY METHOD USED TO RESTRICT DOSE
text
Item Group
Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form
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