ID

8326

Descrição

LDR Intracavitary Radiation Oncology Form, Form LDR, GOG-0219 Cisplatin and Radiation Therapy With or Without Tirapazamine in Treating Patients With Cervical Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF8A4419-CCDF-0767-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF8A4419-CCDF-0767-E034-0003BA3F9857

Palavras-chave

Versões (2)
  1. 27/08/2012 27/08/2012 -
  2. 09/01/2015 09/01/2015 - Martin Dugas
Transferido a

9 de janeiro de 2015

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0 Legacy
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Cervical Cancer NCT00262821 Treatment - LDR Intracavitary Radiation Oncology Form, Form LDR, GOG-0219 - 2301943v3.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: LDR Intracavitary Radiation Oncology Form, Form LDR, GOG-0219
    1. No Instruction available.
Header Module
Descrição

Header Module

Date form originally completed (m d y)
Descrição

Form Completion Date

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C1549507
NCI Thesaurus Property
C25250
NCI Thesaurus Property-2
C25604
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Date form amended (m d y)
Descrição

Amendment date

Tipo de dados

date

Alias
NCI Thesaurus ObjectClass
C19464
UMLS CUI-1
C0680532
NCI Thesaurus Property
C25250
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C25416
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
Person amending form, last name
Descrição

Person Amending Form

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25190
UMLS CUI-2
C1547383
NCI Thesaurus Property
C25364
Patient Initials (First, Middle, Last)
Descrição

Patient Initials

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Patient Study ID
Descrição

Patient Study ID

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Person Completing Form, Last Name
Descrição

Person Completing Form Last Name

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass-2
C25657
UMLS CUI-2
C1301584
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25551
NCI Thesaurus ValueDomain
C25191
Radiation
Descrição

Radiation

Application
Descrição

BrachtherapyApplicationInterval

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25397
UMLS 2011AA Property
C0185125
NCI Thesaurus ValueDomain
C25543
UMLS 2011AA ValueDomain
C1272706
Physicist's name
Descrição

PhysicsPhysicianName

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C16989
UMLS 2011AA ObjectClass-2
C0031837
Radiation Oncologist's name
Descrição

RadiationOncologyPhysicianName

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C25741
UMLS 2011AA ObjectClass
C0031831
NCI Thesaurus ObjectClass-2
C17833
UMLS 2011AA ObjectClass-2
C1514693
Form Completed by
Descrição

Person Completing Form

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Brachytherapy facility
Descrição

BrachtherapyInstitutionName

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C21541
UMLS 2011AA ObjectClass
C0018704
NCI Metathesaurus ObjectClass
CL054378
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C21541
UMLS 2011AA ValueDomain-2
C0018704
Isotope
Descrição

RTIsotopeText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Metathesaurus Property
C0022262
Applicator type
Descrição

BrachtherapyApplicationText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25397
UMLS 2011AA Property
C0185125
Date (m d y)
Descrição

BrachtherapyApplicationDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25397
UMLS 2011AA Property
C0185125
Total hours
Descrição

BrachtherapyApplicationTotalDuration

Tipo de dados

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25397
UMLS 2011AA Property
C0185125
NCI Thesaurus ValueDomain-2
C25330
UMLS 2011AA ValueDomain-2
C0449238
Dose to point A - Rt (Gy)
Descrição

RightBrachytherapyFirstReferencePointDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25228
UMLS 2011AA ObjectClass
C0205090
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Dose to point A - Lt (Gy)
Descrição

LeftBrachytherapyFirstReferencePointDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25229
UMLS 2011AA ObjectClass
C0205091
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Dose to point B - Rt (Gy)
Descrição

RightBrachytherapySecondReferencePointDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25228
UMLS 2011AA ObjectClass
C0205090
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Dose to point B - Lt (Gy)
Descrição

LeftBrachytherapySecondReferencePointDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25229
UMLS 2011AA ObjectClass
C0205091
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Bladder dose (Gy)
Descrição

BrachytherapyBladderDose

Tipo de dados

float

Alias
NCI Thesaurus Property
C12414
UMLS 2011AA Property
C0005682
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
ICRU Bladder dose (Gy)
Descrição

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsBladderAdministeredDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C12414
UMLS 2011AA Property
C0005682
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C43966
UMLS 2011AA Property-3
C1708542
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Rectal dose (Gy)
Descrição

BrachytherapyRectumDose

Tipo de dados

float

Alias
NCI Thesaurus Property
C12390
UMLS 2011AA Property
C0034896
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
ICRU Rectal dose (Gy)
Descrição

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsRectumAdministeredDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C12390
UMLS 2011AA Property
C0034896
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C43966
UMLS 2011AA Property-3
C1708542
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Total Dose to point A - Rt (Gy)
Descrição

RightBrachytherapyFirstReferencePointDoseTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25228
UMLS 2011AA ObjectClass
C0205090
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total Dose to point A - Lt (Gy)
Descrição

LeftBrachytherapyFirstReferencePointDoseTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25229
UMLS 2011AA ObjectClass
C0205091
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total Dose to point B - Rt (Gy)
Descrição

RightBrachytherapySecondReferencePointDoseTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25228
UMLS 2011AA ObjectClass
C0205090
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total Dose to point B - Lt (Gy)
Descrição

LeftBrachytherapySecondReferencePointDoseTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C25229
UMLS 2011AA ObjectClass
C0205091
NCI Thesaurus ObjectClass-2
C15195
UMLS 2011AA ObjectClass-2
C0006098
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Metathesaurus Property
CL220834
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total Bladder dose (Gy)
Descrição

RTBladderAdministeredTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C12414
UMLS 2011AA Property
C0005682
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total ICRU Bladder dose (Gy)
Descrição

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsBladderAdministeredTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C12414
UMLS 2011AA Property
C0005682
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C43966
UMLS 2011AA Property-3
C1708542
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total Rectal dose (Gy)
Descrição

RTRectumAdministeredTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus Property
C12390
UMLS 2011AA Property
C0034896
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Total ICRU Rectal dose (Gy)
Descrição

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsRectumAdministeredTotalDose

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C12390
UMLS 2011AA Property
C0034896
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C43966
UMLS 2011AA Property-3
C1708542
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
Magnification
Descrição

Magnification

Application
Descrição

BrachtherapyApplicationInterval

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25397
UMLS 2011AA Property
C0185125
NCI Thesaurus ValueDomain
C25543
UMLS 2011AA ValueDomain
C1272706
AP
Descrição

BrachytherapyAnteroposteriorPlaneRadiographicMagnificationText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Metathesaurus Property
C0034568
NCI Metathesaurus Property-2
C0458349
Lateral
Descrição

BrachytherapyLateralRadiographicMagnificationText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C25230
UMLS 2011AA Property
C0205093
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Metathesaurus Property
C0034568
Diagram
Descrição

Diagram

Source
Descrição

BrachytherapySourceType

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
Source Strength #1
Descrição

FirstBrachytherapyStrengthSourceValue

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C25509
UMLS 2011AA ObjectClass-2
C1279901
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Metathesaurus Property
C0808080
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Source Strength #2
Descrição

SecondBrachytherapyStrengthSourceValue

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C25666
UMLS 2011AA ObjectClass-2
C0205436
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Metathesaurus Property
C0808080
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Total Source Strength #1
Descrição

FirstBrachytherapyStrengthSourceTotalValue

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C25509
UMLS 2011AA ObjectClass-2
C1279901
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Metathesaurus Property
C0808080
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
Total Source Strength #2
Descrição

SecondBrachytherapyStrengthSourceTotalValue

Tipo de dados

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C25666
UMLS 2011AA ObjectClass-2
C0205436
NCI Thesaurus Property
C25683
UMLS 2011AA Property
C0449416
NCI Metathesaurus Property
C0808080
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
Comments
Descrição

Comments

COMMENTS
Descrição

Research Comments

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Footer Module
Descrição

Footer Module

Participating Group Code
Descrição

ParticipatingGroupIdentifierCode

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass-2
C17005
UMLS 2011AA ObjectClass-2
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Participating Group Protocol Number
Descrição

Study Number Participating Group

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Patient ID
Descrição

Trial subject ID Participating Group

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
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1 Formulários
  1. StudyEvent: LDR Intracavitary Radiation Oncology Form, Form LDR, GOG-0219
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Header Module
Form Completion Date
Item
Date form originally completed (m d y)
date
C19464 (NCI Thesaurus ObjectClass)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Amendment date
Item
Date form amended (m d y)
date
C19464 (NCI Thesaurus ObjectClass)
C0680532 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
Person Amending Form
Item
Person amending form, last name
text
C25191 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1547383 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
Patient Initials
Item
Patient Initials (First, Middle, Last)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Person Completing Form Last Name
Item
Person Completing Form, Last Name
text
C25190 (NCI Thesaurus ObjectClass)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
Item Group
Radiation
Item
Application
text
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25397 (NCI Thesaurus Property)
C0185125 (UMLS 2011AA Property)
C25543 (NCI Thesaurus ValueDomain)
C1272706 (UMLS 2011AA ValueDomain)
CL.2
Code List
Application
CL Item
Application #1 (Application #1)
CL Item
Application #2 (Application #2)
PhysicsPhysicianName
Item
Physicist's name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C16989 (NCI Thesaurus ObjectClass-2)
C0031837 (UMLS 2011AA ObjectClass-2)
RadiationOncologyPhysicianName
Item
Radiation Oncologist's name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25678 (NCI Thesaurus Property)
C1519316 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C17833 (NCI Thesaurus ObjectClass-2)
C1514693 (UMLS 2011AA ObjectClass-2)
Person Completing Form
Item
Form Completed by
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
BrachtherapyInstitutionName
Item
Brachytherapy facility
text
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
CL054378 (NCI Metathesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0018704 (UMLS 2011AA ValueDomain-2)
RTIsotopeText
Item
Isotope
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C0022262 (NCI Metathesaurus Property)
BrachtherapyApplicationText
Item
Applicator type
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25397 (NCI Thesaurus Property)
C0185125 (UMLS 2011AA Property)
BrachtherapyApplicationDate
Item
Date (m d y)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25397 (NCI Thesaurus Property)
C0185125 (UMLS 2011AA Property)
BrachtherapyApplicationTotalDuration
Item
Total hours
float
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25397 (NCI Thesaurus Property)
C0185125 (UMLS 2011AA Property)
C25330 (NCI Thesaurus ValueDomain-2)
C0449238 (UMLS 2011AA ValueDomain-2)
RightBrachytherapyFirstReferencePointDose
Item
Dose to point A - Rt (Gy)
float
C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
LeftBrachytherapyFirstReferencePointDose
Item
Dose to point A - Lt (Gy)
float
C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
RightBrachytherapySecondReferencePointDose
Item
Dose to point B - Rt (Gy)
float
C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
LeftBrachytherapySecondReferencePointDose
Item
Dose to point B - Lt (Gy)
float
C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
BrachytherapyBladderDose
Item
Bladder dose (Gy)
float
C12414 (NCI Thesaurus Property)
C0005682 (UMLS 2011AA Property)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsBladderAdministeredDose
Item
ICRU Bladder dose (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus Property)
C0005682 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C43966 (NCI Thesaurus Property-3)
C1708542 (UMLS 2011AA Property-3)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
BrachytherapyRectumDose
Item
Rectal dose (Gy)
float
C12390 (NCI Thesaurus Property)
C0034896 (UMLS 2011AA Property)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsRectumAdministeredDose
Item
ICRU Rectal dose (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C12390 (NCI Thesaurus Property)
C0034896 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C43966 (NCI Thesaurus Property-3)
C1708542 (UMLS 2011AA Property-3)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
RightBrachytherapyFirstReferencePointDoseTotalDose
Item
Total Dose to point A - Rt (Gy)
float
C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
LeftBrachytherapyFirstReferencePointDoseTotalDose
Item
Total Dose to point A - Lt (Gy)
float
C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
RightBrachytherapySecondReferencePointDoseTotalDose
Item
Total Dose to point B - Rt (Gy)
float
C25228 (NCI Thesaurus ObjectClass)
C0205090 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
LeftBrachytherapySecondReferencePointDoseTotalDose
Item
Total Dose to point B - Lt (Gy)
float
C25229 (NCI Thesaurus ObjectClass)
C0205091 (UMLS 2011AA ObjectClass)
C15195 (NCI Thesaurus ObjectClass-2)
C0006098 (UMLS 2011AA ObjectClass-2)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
CL220834 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
RTBladderAdministeredTotalDose
Item
Total Bladder dose (Gy)
float
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus Property)
C0005682 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsBladderAdministeredTotalDose
Item
Total ICRU Bladder dose (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C12414 (NCI Thesaurus Property)
C0005682 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C43966 (NCI Thesaurus Property-3)
C1708542 (UMLS 2011AA Property-3)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
RTRectumAdministeredTotalDose
Item
Total Rectal dose (Gy)
float
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C12390 (NCI Thesaurus Property)
C0034896 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsRectumAdministeredTotalDose
Item
Total ICRU Rectal dose (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C12390 (NCI Thesaurus Property)
C0034896 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C43966 (NCI Thesaurus Property-3)
C1708542 (UMLS 2011AA Property-3)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
Item Group
Magnification
Item
Application
text
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25397 (NCI Thesaurus Property)
C0185125 (UMLS 2011AA Property)
C25543 (NCI Thesaurus ValueDomain)
C1272706 (UMLS 2011AA ValueDomain)
CL.2
Code List
Application
CL Item
Application #1 (Application #1)
CL Item
Application #2 (Application #2)
BrachytherapyAnteroposteriorPlaneRadiographicMagnificationText
Item
AP
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C0034568 (NCI Metathesaurus Property)
C0458349 (NCI Metathesaurus Property-2)
BrachytherapyLateralRadiographicMagnificationText
Item
Lateral
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25230 (NCI Thesaurus Property)
C0205093 (UMLS 2011AA Property)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C0034568 (NCI Metathesaurus Property)
Item Group
Diagram
Item
Source
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
CL.3
Code List
Source
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
Total (Total)
C25304 (NCI Thesaurus)
C0439810 (UMLS 2011AA)
FirstBrachytherapyStrengthSourceValue
Item
Source Strength #1
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus ObjectClass-2)
C1279901 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C0808080 (NCI Metathesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
SecondBrachytherapyStrengthSourceValue
Item
Source Strength #2
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus ObjectClass-2)
C0205436 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C0808080 (NCI Metathesaurus Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
FirstBrachytherapyStrengthSourceTotalValue
Item
Total Source Strength #1
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus ObjectClass-2)
C1279901 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C0808080 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
SecondBrachytherapyStrengthSourceTotalValue
Item
Total Source Strength #2
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus ObjectClass-2)
C0205436 (UMLS 2011AA ObjectClass-2)
C25683 (NCI Thesaurus Property)
C0449416 (UMLS 2011AA Property)
C0808080 (NCI Metathesaurus Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
Item Group
Comments
Research Comments
Item
COMMENTS
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item Group
Footer Module
ParticipatingGroupIdentifierCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Study Number Participating Group
Item
Participating Group Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Trial subject ID Participating Group
Item
Participating Group Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
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