ID

7635

Beschrijving

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

Trefwoorden

Versies (2)
  1. 19-09-12 19-09-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Licentie

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

Engels

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 Formulieren  
Header Module
Beschrijving

Header Module

Protocol Number
Beschrijving

Protocol ID ACOSOG

Datatype

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
Beschrijving

Patient Study ID

Datatype

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)
Beschrijving

Patient Initials

Datatype

text

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

Institution Number

Datatype

text

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

Institution Name

Datatype

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)
Beschrijving

Data amended

Datatype

boolean

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

Visit

Visit
Beschrijving

AmericanCollegeofSurgeonsOncologyGroupVisitPeriodAmericanCollegeofSurgeonsOncologyGroupVisitPeriodType

Datatype

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
Beschrijving

Overall Response Status

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

Assessment Date

Datatype

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)
Beschrijving

NonNodalTargetLesionPresentSite

Datatype

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
Beschrijving

Evaluation method

Datatype

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)
Beschrijving

NegationNodalTargetLesionLongestDiameterMeasurement

Datatype

float

Maateenheden
  • 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 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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