ID

9369

Description

GOG-0249 Vaginal HDR Intracavitary Radiation Oncology Form Pelvic Radiation Therapy or Vaginal Implant Radiation Therapy, Paclitaxel, and Carboplatin in Treating Patients With High-Risk Stage I or Stage II Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4FB4E3CF-D77D-4890-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4FB4E3CF-D77D-4890-E044-0003BA3F9857

Keywords

Versions (2)
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
Uploaded on

January 9, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Endometrial Cancer NCT00807768 Treatment - GOG-0249 Vaginal HDR Intracavitary Radiation Oncology Form - 2759637v1.0

English

The following materials are required for submission: Films for all insertions Dose distributions for all insertions Activity, dwell times and dwell positions for all insertions

1 forms  
Header Module
Description

Header Module

Date form originally completed (m d y)
Description

Form Completion Date

Data type

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)
Description

Amendment date

Data type

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
Description

Person Amending Form

Data type

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)
Description

Patient Initials

Data type

text

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

Patient ID GOG

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512288
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25521
Person Completing Form, Last Name
Description

Person Completing Form Last Name

Data type

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 Description
Description

Radiation Description

Total Number of Brachytherapy Applications (high dose rate intracavitary applications delivered to patient)
Description

BrachytherapyImplantTotalCount

Data type

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ValueDomain-2
C25463
UMLS 2011AA ValueDomain-2
C0750480
NCI Thesaurus Property
C17948
UMLS 2011AA Property
C0013183
Reason treatment ended (intracavitary )
Description

TreatmentCurrentCycleDiscontinuedSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25471
UMLS 2011AA Property
C0521116
NCI Thesaurus Property-2
C25472
UMLS 2011AA Property-2
C1511572
NCI Thesaurus Property-3
C25484
UMLS 2011AA Property-3
C1444662
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Radiation
Description

Radiation

Application
Description

BrachtherapyApplicationInterval

Data type

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
Brachytherapy Start Date (m d y)
Description

BrachytherapyBeginDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ValueDomain-2
C25431
UMLS 2011AA ValueDomain-2
C0439659
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Isotope Type
Description

RTIsotopeText

Data type

text

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

BrachtherapyApplicationText

Data type

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
Diameter of ovoid/cylinder (cm)
Description

CylinderBrachytherapyImplantDiameterMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C63806
UMLS 2011AA ObjectClass-2
C0946010
NCI Thesaurus Property
C25285
UMLS 2011AA Property
C1301886
NCI Thesaurus Property-2
C41075
UMLS 2011AA Property-2
C0021102
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Activity of isotope (Ci)
Description

BrachytherapySeedImplantationSutureMaterialTotalAdministrationDose

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C16219
UMLS 2011AA ObjectClass-2
C1519225
NCI Thesaurus Property
C42858
UMLS 2011AA Property
C0038969
NCI Thesaurus ValueDomain
C25304
UMLS 2011AA ValueDomain
C0439810
NCI Thesaurus ValueDomain-2
C25488
UMLS 2011AA ValueDomain-2
C0178602
NCI Thesaurus ValueDomain-3
C25409
UMLS 2011AA ValueDomain-3
C1533734
Number of active dwell positions
Description

VaginalBrachytherapyIntracavitaryAdministeredCount

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C13309
UMLS 2011AA ObjectClass-2
C0042232
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property-2
C38231
UMLS 2011AA Property-2
C1521952
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Total dwell time (sec)
Description

VaginalBrachytherapyIntracavitaryAdministeredDuration

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C13309
UMLS 2011AA ObjectClass-2
C0042232
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property-2
C38231
UMLS 2011AA Property-2
C1521952
NCI Thesaurus ValueDomain
C25330
UMLS 2011AA ValueDomain
C0449238
Vaginal surface dose at apex (Gy)
Description

VaginalBrachytherapyIntracavitaryTopLocationAdministeredDose

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C13309
UMLS 2011AA ObjectClass-2
C0042232
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C38231
UMLS 2011AA Property-3
C1521952
NCI Thesaurus Property-4
C62637
UMLS 2011AA Property-4
C1704458
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Vaginal dose at 0.5 cm (Gy)
Description

VaginalBrachytherapyIntracavitaryPerpendicularAxisMiddleAdministeredDose

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C13309
UMLS 2011AA ObjectClass-2
C0042232
NCI Thesaurus Property
C25569
UMLS 2011AA Property
C0444598
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus Property-3
C38231
UMLS 2011AA Property-3
C1521952
NCI Thesaurus Property-4
C54649
UMLS 2011AA Property-4
C1295725
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
Isodose length along axis of vagina (Gy)
Description

VaginalBrachytherapyIsodoseLengthAdministeredMeasurement

Data type

float

Alias
NCI Thesaurus ObjectClass
C15195
UMLS 2011AA ObjectClass
C0006098
NCI Thesaurus ObjectClass-2
C13309
UMLS 2011AA ObjectClass-2
C0042232
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Thesaurus Property-2
C25334
UMLS 2011AA Property-2
C1444754
NCI Thesaurus Property-3
C54654
UMLS 2011AA Property-3
C1881277
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
ICRU Bladder dose (Gy)
Description

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsBladderAdministeredDose

Data type

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
ICRU Rectal dose (Gy)
Description

BrachytherapyInternationalCommissiononRadiationUnitsandMeasurementsRectumAdministeredDose

Data type

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
RT Total Dose
Description

Radiation Therapy Total Dose

Data type

float

Alias
NCI Thesaurus ValueDomain
C25304
UMLS CUI-1
C2169193
NCI Thesaurus ObjectClass
C15313
NCI Thesaurus ValueDomain-2
C25488
NCI Thesaurus Property
C25382
Magnification Factor
Description

Magnification Factor

AP
Description

BrachytherapyAnteroposteriorPlaneRadiographicMagnificationText

Data type

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
Description

BrachytherapyLateralRadiographicMagnificationText

Data type

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
Totals
Description

Totals

Physicist's name
Description

PhysicsPhysicianName

Data type

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
Physicist's E-mail address
Description

PhysicistPersonE-mailAddressText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C53446
UMLS 2011AA ObjectClass-2
C0221456
NCI Thesaurus Property
C42775
UMLS 2011AA Property
C1705961
Radiation Oncologist's name
Description

RadiationOncologyPhysicianName

Data type

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
Radiation Oncologist's E-mail address
Description

RadiationOncologistPersonE-mailAddressText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass-2
C17833
UMLS 2011AA ObjectClass-2
C1514693
NCI Thesaurus Property
C42775
UMLS 2011AA Property
C1705961
Radiation Oncologist's phone number
Description

TreatingRadiationOncologistPhoneNumber

Data type

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C17833
UMLS 2011AA ObjectClass
C1514693
NCI Thesaurus Property
C25395
UMLS 2011AA Property
C0039457
NCI Thesaurus ObjectClass-2
C25705
UMLS 2011AA ObjectClass-2
C1522326
RT Facility Code
Description

RadiologyLabIdentifierNumber

Data type

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ObjectClass
C17059
UMLS 2011AA ObjectClass
C0034599
NCI Thesaurus ObjectClass-2
C37984
UMLS 2011AA ObjectClass-2
C0022877
Completed by
Description

Person Completing Form

Data type

text

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

BrachtherapyInstitutionName

Data type

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
Comments
Description

Comments

COMMENTS
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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Similar models

The following materials are required for submission: Films for all insertions Dose distributions for all insertions Activity, dwell times and dwell positions for all insertions

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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 ID GOG
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512288 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25521 (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 Description
BrachytherapyImplantTotalCount
Item
Total Number of Brachytherapy Applications (high dose rate intracavitary applications delivered to patient)
float
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain-2)
C0750480 (UMLS 2011AA ValueDomain-2)
C17948 (NCI Thesaurus Property)
C0013183 (UMLS 2011AA Property)
TreatmentCurrentCycleDiscontinuedSpecify
Item
Reason treatment ended (intracavitary )
text
C15368 (NCI Thesaurus ObjectClass)
C25471 (NCI Thesaurus Property)
C0521116 (UMLS 2011AA Property)
C25472 (NCI Thesaurus Property-2)
C1511572 (UMLS 2011AA Property-2)
C25484 (NCI Thesaurus Property-3)
C1444662 (UMLS 2011AA Property-3)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA 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.1
Code List
Application
CL Item
Application #1 (Application #1)
CL Item
Application #2 (Application #2)
CL Item
Application #3 (Application #3)
BrachytherapyBeginDate
Item
Brachytherapy Start Date (m d y)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
RTIsotopeText
Item
Isotope Type
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)
CylinderBrachytherapyImplantDiameterMeasurement
Item
Diameter of ovoid/cylinder (cm)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C63806 (NCI Thesaurus ObjectClass-2)
C0946010 (UMLS 2011AA ObjectClass-2)
C25285 (NCI Thesaurus Property)
C1301886 (UMLS 2011AA Property)
C41075 (NCI Thesaurus Property-2)
C0021102 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
BrachytherapySeedImplantationSutureMaterialTotalAdministrationDose
Item
Activity of isotope (Ci)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C16219 (NCI Thesaurus ObjectClass-2)
C1519225 (UMLS 2011AA ObjectClass-2)
C42858 (NCI Thesaurus Property)
C0038969 (UMLS 2011AA Property)
C25304 (NCI Thesaurus ValueDomain)
C0439810 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
C25409 (NCI Thesaurus ValueDomain-3)
C1533734 (UMLS 2011AA ValueDomain-3)
VaginalBrachytherapyIntracavitaryAdministeredCount
Item
Number of active dwell positions
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C13309 (NCI Thesaurus ObjectClass-2)
C0042232 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38231 (NCI Thesaurus Property-2)
C1521952 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
VaginalBrachytherapyIntracavitaryAdministeredDuration
Item
Total dwell time (sec)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C13309 (NCI Thesaurus ObjectClass-2)
C0042232 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C38231 (NCI Thesaurus Property-2)
C1521952 (UMLS 2011AA Property-2)
C25330 (NCI Thesaurus ValueDomain)
C0449238 (UMLS 2011AA ValueDomain)
VaginalBrachytherapyIntracavitaryTopLocationAdministeredDose
Item
Vaginal surface dose at apex (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C13309 (NCI Thesaurus ObjectClass-2)
C0042232 (UMLS 2011AA ObjectClass-2)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38231 (NCI Thesaurus Property-3)
C1521952 (UMLS 2011AA Property-3)
C62637 (NCI Thesaurus Property-4)
C1704458 (UMLS 2011AA Property-4)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
VaginalBrachytherapyIntracavitaryPerpendicularAxisMiddleAdministeredDose
Item
Vaginal dose at 0.5 cm (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C13309 (NCI Thesaurus ObjectClass-2)
C0042232 (UMLS 2011AA ObjectClass-2)
C25569 (NCI Thesaurus Property)
C0444598 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38231 (NCI Thesaurus Property-3)
C1521952 (UMLS 2011AA Property-3)
C54649 (NCI Thesaurus Property-4)
C1295725 (UMLS 2011AA Property-4)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
VaginalBrachytherapyIsodoseLengthAdministeredMeasurement
Item
Isodose length along axis of vagina (Gy)
float
C15195 (NCI Thesaurus ObjectClass)
C0006098 (UMLS 2011AA ObjectClass)
C13309 (NCI Thesaurus ObjectClass-2)
C0042232 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property-2)
C1444754 (UMLS 2011AA Property-2)
C54654 (NCI Thesaurus Property-3)
C1881277 (UMLS 2011AA Property-3)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (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)
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)
Radiation Therapy Total Dose
Item
RT Total Dose
float
C25304 (NCI Thesaurus ValueDomain)
C2169193 (UMLS CUI-1)
C15313 (NCI Thesaurus ObjectClass)
C25488 (NCI Thesaurus ValueDomain-2)
C25382 (NCI Thesaurus Property)
Item Group
Magnification Factor
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
Totals
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)
PhysicistPersonE-mailAddressText
Item
Physicist's E-mail address
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C53446 (NCI Thesaurus ObjectClass-2)
C0221456 (UMLS 2011AA ObjectClass-2)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
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)
RadiationOncologistPersonE-mailAddressText
Item
Radiation Oncologist's E-mail address
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C17833 (NCI Thesaurus ObjectClass-2)
C1514693 (UMLS 2011AA ObjectClass-2)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
TreatingRadiationOncologistPhoneNumber
Item
Radiation Oncologist's phone number
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C17833 (NCI Thesaurus ObjectClass)
C1514693 (UMLS 2011AA ObjectClass)
C25395 (NCI Thesaurus Property)
C0039457 (UMLS 2011AA Property)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
RadiologyLabIdentifierNumber
Item
RT Facility Code
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C17059 (NCI Thesaurus ObjectClass)
C0034599 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus ObjectClass-2)
C0022877 (UMLS 2011AA ObjectClass-2)
Person Completing Form
Item
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)
Item Group
Comments
Research Comments
Item
COMMENTS
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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