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ID
6350
Description
T4 Radiation Therapy Oncology Group Protocol Calculation 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=A4E27DE7-685D-26F8-E034-080020C9C0E0
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Versions (2)
- 12/18/14 12/18/14 - Martin Dugas
- 5/20/15 5/20/15 - Martin Dugas
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December 18, 2014
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Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer NCT00023829 RT Submission - T4 Radiation Therapy Oncology Group Protocol Calculation Form - 2039344v3.0
INSTRUCTIONS: Submit this form with initial dosimetry data. If additional boost fields are given, complete form again to include all additional data and send with final dosimetry data.
- StudyEvent: T4 Radiation Therapy Oncology Group Protocol Calculation Form
Similar models
INSTRUCTIONS: Submit this form with initial dosimetry data. If additional boost fields are given, complete form again to include all additional data and send with final dosimetry data.
- StudyEvent: T4 Radiation Therapy Oncology Group Protocol Calculation Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
RTOGStudy
Item
RTOG Study
text
Case#
Item
Case #
text
Institution
Item
Institution
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
Patient'sName
Item
Patient's Name
text
Patient'sI.D.No.
Item
Patient's I.D. No.
text
AnatomicalTreatmentArea
Item
Anatomical Treatment Area (DAILY DOSE CALCULATIONS)
text
Fieldprojection
Item
Field projection (ant, lat, oblique, etc.)
text
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
CL Item
Rt Field (I)
CL Item
Rt Field (II)
CL Item
Rt Field (III)
CL Item
Rt Field (IV)
CL Item
Rt Field (V)
CL Item
Rt Field (VI)
Manufacturernameandunitenergy
Item
Manufacturer name and unit energy
text
Monitorunits/minutes
Item
Monitor units/minutes
text
Tumordoseperfieldforeachfield@pointofprotocolprescription
Item
Tumor dose per field for each field @ point of protocol prescription
text
CL Item
SSD (SSD)
CL Item
SAD (SAD)
CL Item
SSD (SSD)
CL Item
SAD (SAD)
Treatmentdepth
Item
Treatment depth (cm)
text
Collimatorsetting
Item
Collimator setting (Field size in cm at isocenter)
text
EquivalentsquareatSSD/SAD
Item
Equivalent square at SSD/SAD
text
CGY/MU(Linac)
Item
CGY/MU (Linac)
text
CGY/MIN(cobalt)
Item
CGY/MIN (cobalt)
text
Wedge
Item
Wedge
text
Tray
Item
Tray
text
Comp
Item
Comp
text
Other,specify(transmissionfactors)
Item
Other, specify (transmission factors)
text
Other,specify(transmissionfactors)
Item
Other, specify (transmission factors)
text
%DD,TAR,TMR,TPR,TOR
Item
% DD, TAR, TMR, TPR, TOR
text
CL Item
% DD (% DD)
CL Item
TAR (TAR)
CL Item
TMR (TMR)
CL Item
TPR (TPR)
CL Item
TOR (TOR)
Formcompletedby
Item
Form completed by
text
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Ccrr Module For T4 Radiation Therapy Oncology Group Protocol Calculation Form