ID

7635

Description

ACOSOG-Z4099 Pretreatment RECIST Measurement Form (Arm 2) Surgery With or Without Internal Radiation Therapy Compared With Stereotactic Body Radiation Therapy in Treating Patients With High-Risk Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=986988FF-3289-FDB7-E040-BB89AD4317E3

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=986988FF-3289-FDB7-E040-BB89AD4317E3

Keywords

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

January 9, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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    Lung Cancer NCT01336894 Response - ACOSOG-Z4099 Pretreatment RECIST Measurement Form (Arm 2) - 3178401v1.0

    English

    INSTRUCTIONS: 1. Record the target lesions (Per Section 7 of the protocol). 2. Measure non-nodal target lesion in cm. using longest diameter (one dimension only). 3. Record measurement at pretreatment. 4. Maintain same type of assessment throughout study

    1 forms  
    Header Module
    Description

    Header Module

    Protocol Number
    Description

    Protocol ID ACOSOG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1515944
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C19712
    Patient ID
    Description

    Patient Study ID

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Patient Initials (L F M)
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution Number
    Description

    Institution Number

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    UMLS CUI-2
    C0805701
    NCI Thesaurus Property
    C25364
    Institution
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Are data amended (check one if data amended, please circle in red when using paper forms)
    Description

    Data amended

    Data type

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Visit
    Description

    Visit

    Visit
    Description

    AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C25616
    UMLS 2011AA Property
    C1948053
    NCI Thesaurus ObjectClass
    C19712
    UMLS 2011AA ObjectClass
    C1515944
    NCI Thesaurus ObjectClass-2
    C25716
    UMLS 2011AA ObjectClass-2
    C0545082
    Overall Response Status
    Description

    Overall Response Status

    Assessment date (dd MMM yyyy assessment date is the date reflecting type of assessment, not the physician interpretation date)
    Description

    Assessment Date

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985720
    NCI Thesaurus ObjectClass
    C25367
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C38000
    Non-nodal target lesion site(s) (Primary Tumor)
    Description

    NonNodalTargetLesionPresentSite

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus ObjectClass-2
    C25594
    UMLS 2011AA ObjectClass-2
    C1518422
    NCI Thesaurus ObjectClass-3
    C25323
    UMLS 2011AA ObjectClass-3
    C0443268
    NCI Thesaurus ObjectClass-4
    C25702
    UMLS 2011AA ObjectClass-4
    C1521840
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    Method of Evaluation
    Description

    Evaluation method

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2911685
    NCI Thesaurus ObjectClass
    C20989
    NCI Thesaurus Property
    C16847
    Non-Nodal Longest Diameter of Lesion(s) (Primary Tumor cm)
    Description

    NegationNodalTargetLesionLongestDiameterMeasurement

    Data type

    float

    Measurement units
    • cm
    Alias
    NCI Thesaurus ObjectClass
    C3824
    UMLS 2011AA ObjectClass
    C0221198
    NCI Thesaurus ObjectClass-2
    C25594
    UMLS 2011AA ObjectClass-2
    C1518422
    NCI Thesaurus ObjectClass-3
    C25323
    UMLS 2011AA ObjectClass-3
    C0443268
    NCI Thesaurus ObjectClass-4
    C25702
    UMLS 2011AA ObjectClass-4
    C1521840
    NCI Thesaurus Property
    C25285
    UMLS 2011AA Property
    C1301886
    NCI Thesaurus Property-2
    C25558
    UMLS 2011AA Property-2
    C1522425
    NCI Thesaurus ValueDomain
    C25209
    UMLS 2011AA ValueDomain
    C0242485
    NCI Thesaurus ValueDomain-2
    C25285
    UMLS 2011AA ValueDomain-2
    C1301886
    cm
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    Similar models

    INSTRUCTIONS: 1. Record the target lesions (Per Section 7 of the protocol). 2. Measure non-nodal target lesion in cm. using longest diameter (one dimension only). 3. Record measurement at pretreatment. 4. Maintain same type of assessment throughout study

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header Module
    Protocol ID ACOSOG
    Item
    Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1515944 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C19712 (NCI Thesaurus Property-2)
    Patient Study ID
    Item
    Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Patient Initials
    Item
    Patient Initials (L F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Number
    Item
    Institution Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Data amended
    Item
    Are data amended (check one if data amended, please circle in red when using paper forms)
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Item Group
    Visit
    Item
    Visit
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25616 (NCI Thesaurus Property)
    C1948053 (UMLS 2011AA Property)
    C19712 (NCI Thesaurus ObjectClass)
    C1515944 (UMLS 2011AA ObjectClass)
    C25716 (NCI Thesaurus ObjectClass-2)
    C0545082 (UMLS 2011AA ObjectClass-2)
    CL.2
    Code List
    Visit
    CL Item
    Registration (Registration)
    C25646 (NCI Thesaurus)
    C1514821 (UMLS 2011AA)
    Item Group
    Overall Response Status
    Assessment Date
    Item
    Assessment date (dd MMM yyyy assessment date is the date reflecting type of assessment, not the physician interpretation date)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985720 (UMLS CUI-1)
    C25367 (NCI Thesaurus ObjectClass)
    C25367 (NCI Thesaurus ValueDomain-2)
    C38000 (NCI Thesaurus Property)
    NonNodalTargetLesionPresentSite
    Item
    Non-nodal target lesion site(s) (Primary Tumor)
    text
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus ObjectClass-2)
    C1518422 (UMLS 2011AA ObjectClass-2)
    C25323 (NCI Thesaurus ObjectClass-3)
    C0443268 (UMLS 2011AA ObjectClass-3)
    C25702 (NCI Thesaurus ObjectClass-4)
    C1521840 (UMLS 2011AA ObjectClass-4)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    Item
    Method of Evaluation
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2911685 (UMLS CUI-1)
    C20989 (NCI Thesaurus ObjectClass)
    C16847 (NCI Thesaurus Property)
    CL.3
    Code List
    Method of Evaluation
    CL Item
    Ct Scan (CT scan)
    CL Item
    Pet/ct Scan (PET/CT scan)
    NegationNodalTargetLesionLongestDiameterMeasurement
    Item
    Non-Nodal Longest Diameter of Lesion(s) (Primary Tumor cm)
    float
    C3824 (NCI Thesaurus ObjectClass)
    C0221198 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus ObjectClass-2)
    C1518422 (UMLS 2011AA ObjectClass-2)
    C25323 (NCI Thesaurus ObjectClass-3)
    C0443268 (UMLS 2011AA ObjectClass-3)
    C25702 (NCI Thesaurus ObjectClass-4)
    C1521840 (UMLS 2011AA ObjectClass-4)
    C25285 (NCI Thesaurus Property)
    C1301886 (UMLS 2011AA Property)
    C25558 (NCI Thesaurus Property-2)
    C1522425 (UMLS 2011AA Property-2)
    C25209 (NCI Thesaurus ValueDomain)
    C0242485 (UMLS 2011AA ValueDomain)
    C25285 (NCI Thesaurus ValueDomain-2)
    C1301886 (UMLS 2011AA ValueDomain-2)
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