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Toxicity during radiotherapy

1 forms  
Show identification of patient
Description

Show identification of patient

Dummy
Description

Dummy

Data type

text

Toxicity hematology
Description

Toxicity hematology

Hemoglobin
Description

Grade Hemoglobin

Data type

integer

WBC
Description

Grade WBC

Data type

integer

Neutrophils
Description

Grade neutrophils

Data type

integer

Platelets
Description

Grade platelets

Data type

integer

Hemorrhage
Description

Grade hemorrhage

Data type

integer

Toxicity neurological
Description

Toxicity neurological

Headache
Description

Grade headache

Data type

integer

Seizures
Description

Grade peripheral neurotoxicity

Data type

integer

Central neurotoxicity
Description

Grade central neurotoxicity

Data type

integer

Peripheral neurotoxicity
Description

Grade peripheral neurotoxicity

Data type

integer

Epilepsy
Description

Grade epilepsy

Data type

integer

Toxicity infection
Description

Toxicity infection

Infection
Description

Grade infection

Data type

integer

Fever
Description

Grade fever

Data type

integer

Toxicity gastrointestinal
Description

Toxicity gastrointestinal

Nausea
Description

Grade nausea

Data type

integer

Vomiting
Description

Grade vomiting

Data type

integer

Mucosa (CTC version 2)
Description

Mucosa (CTC version 2)

Data type

integer

Toxicity skin
Description

Toxicity skin

Alopecia
Description

Grade alopecia

Data type

integer

Changes in the skin
Description

Grade changes in the skin

Data type

integer

Erythema multiforme
Description

Grade erythema multiforme

Data type

integer

Ear/skin
Description

Ear/skin

Data type

integer

Toxicity other
Description

Toxicity other

Other toxicity occurred
Description

Other toxicity occurred

Data type

integer

Grade of other toxicity
Description

Other toxicity grade

Data type

integer

Other toxicity specified
Description

Other toxicity specified

Data type

text

Further data on radiotherapy toxicity
Description

Further data on radiotherapy toxicity

Hospitalisation during radiotherapy
Description

Hospitalisation during radiotherapy

Data type

integer

Remarks about hospitalisation
Description

Remarks about hospitalisation

Data type

text

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Similar models

Toxicity during radiotherapy

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Dummy
Item
Dummy
text
Item
Hemoglobin
integer
Toxicity grade
Code List
Hemoglobin
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
WBC
integer
Toxicity grade
Code List
WBC
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Neutrophils
integer
Toxicity grade
Code List
Neutrophils
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Platelets
integer
Toxicity grade
Code List
Platelets
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Hemorrhage
integer
Toxicity grade
Code List
Hemorrhage
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Headache
integer
Toxicity grade
Code List
Headache
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Seizures
integer
Toxicity grade
Code List
Seizures
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Central neurotoxicity
integer
Toxicity grade
Code List
Central neurotoxicity
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Peripheral neurotoxicity
integer
Toxicity grade
Code List
Peripheral neurotoxicity
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Epilepsy
integer
Toxicity grade
Code List
Epilepsy
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Infection
integer
Toxicity grade
Code List
Infection
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Fever
integer
Toxicity grade
Code List
Fever
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Nausea
integer
Toxicity grade
Code List
Nausea
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Vomiting
integer
Toxicity grade
Code List
Vomiting
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Mucosa (CTC version 2)
integer
Toxicity grade
Code List
Mucosa (CTC version 2)
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item Group
Item
Alopecia
integer
Toxicity grade
Code List
Alopecia
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Changes in the skin
integer
Toxicity grade
Code List
Changes in the skin
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Erythema multiforme
integer
Toxicity grade
Code List
Erythema multiforme
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item
Ear/skin
integer
Toxicity grade
Code List
Ear/skin
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Item Group
Item
Other toxicity occurred
integer
NoYes
Code List
Other toxicity occurred
CL Item
No (1)
CL Item
Yes (2)
Item
Grade of other toxicity
integer
Toxicity grade
Code List
Grade of other toxicity
CL Item
Grade 0 (0)
CL Item
Grade 1 (1)
CL Item
Grade 2 (2)
CL Item
Grade 3 (3)
CL Item
Grade 4 (4)
Other toxicity specified
Item
Other toxicity specified
text
Item
Hospitalisation during radiotherapy
integer
NoYes
Code List
Hospitalisation during radiotherapy
CL Item
No (1)
CL Item
Yes (2)
Remarks about hospitalisation
Item
Remarks about hospitalisation
text
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