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1 forms
  1. StudyEvent: North Central Cancer Treatment Group Radiosurgery (SRS) Reporting Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
Protocol ID NCCTG
Item
NCCTG Protocol Number
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1518419 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25581 (NCI Thesaurus Property-2)
PatientNorthCentralCancerTreatmentGroupIdentifierNumber
Item
NCCTG Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25581 (NCI Thesaurus Property-2)
C1518419 (UMLS 2011AA 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 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)
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)
Data amended
Item
Are data amended (If yes, highlight amended areas)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Header
TreatingInstitutionStereotacticRadiosurgeryAdministeredName
Item
Radiosurgery Treating Institution
text
C21541 (NCI Thesaurus ObjectClass)
C0018704 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
C15358 (NCI Thesaurus Property)
C0085203 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0018704 (UMLS 2011AA ValueDomain-2)
Item
Target Lesion Site (as entered on the Pretreatment Measurement Form: check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25702 (NCI Thesaurus Property-2)
C1521840 (UMLS 2011AA Property-2)
CL.2
Code List
Target Lesion Site (as entered on the Pretreatment Measurement Form: check one)
CL Item
Site 1 (Site 1)
CL Item
Site 2 (Site 2)
CL Item
Site 3 (Site 3)
RadiationSurgeryAdministeredBeginDate
Item
Date of Radiosurgery Procedure (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
Item Group
Treatment Unit
Item
Treatment Unit (check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C50329 (NCI Thesaurus Property)
C1509845 (UMLS 2011AA Property)
CL.3
Code List
Treatment Unit (check one)
CL Item
Linear Accelerator (Linear Accelerator)
C28169 (NCI Thesaurus)
C0023730 (UMLS 2011AA)
CL Item
Gamma Knife (Gamma Knife)
C15382 (NCI Thesaurus)
C0086330 (UMLS 2011AA)
MedicalDeviceManufacturerName
Item
Manufacturer Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16830 (NCI Thesaurus ObjectClass)
C0025080 (UMLS 2011AA ObjectClass)
C25392 (NCI Thesaurus Property)
C0947322 (UMLS 2011AA Property)
MedicalDeviceManufacturerNumber
Item
Model Number
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16830 (NCI Thesaurus ObjectClass)
C0025080 (UMLS 2011AA ObjectClass)
C25392 (NCI Thesaurus Property)
C0947322 (UMLS 2011AA Property)
RadiationSurgeryLinearAcceleratorEnergyDeviceUnitValue
Item
Energy (Linear Accelerator - MV)
float
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C28169 (NCI Thesaurus Property)
C0023730 (UMLS 2011AA Property)
C48058 (NCI Thesaurus Property-2)
C0542479 (UMLS 2011AA Property-2)
C50329 (NCI Thesaurus Property-3)
C1509845 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item Group
Technique
Item
Technique (check one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
CL.4
Code List
Technique (check one)
CL Item
Isocenters Or Beam-center Positions (Isocenters or beam-center positions)
CL Item
Stationary Beams (Stationary beams)
RadiationSurgeryIsocenterMethodCount
Item
Number of isocenters or beam-center positions
float
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C54651 (NCI Thesaurus Property-2)
C1881275 (UMLS 2011AA Property-2)
RadiationSurgeryStationaryBeamRadiationTherapyMethodCount
Item
Number of stationary beams
float
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C60646 (NCI Thesaurus Property-2)
C1883168 (UMLS 2011AA Property-2)
RadiationSurgeryRadiationArcMethodCount
Item
Number of arcs
float
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C54652 (NCI Thesaurus Property-2)
C1882534 (UMLS 2011AA Property-2)
RadiationSurgerySumRadiationArcMethodCount
Item
Sum of degrees per arc for all arcs (If applicable,)
float
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25697 (NCI Thesaurus Property)
C1515051 (UMLS 2011AA Property)
C16847 (NCI Thesaurus Property-2)
C0449851 (UMLS 2011AA Property-2)
C54652 (NCI Thesaurus Property-3)
C1882534 (UMLS 2011AA Property-3)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
CollimatorRadiationTherapyIsocenterLengthDiameterMeasurement
Item
Collimator diameter(s): isocenter (#2)
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25216 (NCI Thesaurus ObjectClass-2)
C0454169 (UMLS 2011AA ObjectClass-2)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C54651 (NCI Thesaurus Property-2)
C1881275 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
CollimatorRadiationTherapyIsocenterLengthDiameterMeasurement
Item
Collimator diameter(s): isocenter (#2)
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25216 (NCI Thesaurus ObjectClass-2)
C0454169 (UMLS 2011AA ObjectClass-2)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C54651 (NCI Thesaurus Property-2)
C1881275 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25285 (NCI Thesaurus ValueDomain-2)
C1301886 (UMLS 2011AA ValueDomain-2)
Item Group
Target Volume
RadiationSurgeryTargetLengthLargestMeasurement
Item
Largest measure in any direction (mm)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25702 (NCI Thesaurus Property)
C1521840 (UMLS 2011AA Property)
C25334 (NCI Thesaurus Property-2)
C1444754 (UMLS 2011AA Property-2)
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C25550 (NCI Thesaurus ValueDomain-2)
C0443228 (UMLS 2011AA ValueDomain-2)
RadiationSurgeryLeftRightTargetLengthValue
Item
Left-right measure (mm)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25229 (NCI Thesaurus Property)
C0205091 (UMLS 2011AA Property)
C25228 (NCI Thesaurus Property-2)
C0205090 (UMLS 2011AA Property-2)
C25702 (NCI Thesaurus Property-3)
C1521840 (UMLS 2011AA Property-3)
C25334 (NCI Thesaurus Property-4)
C1444754 (UMLS 2011AA Property-4)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
RadiationSurgeryAnteriorPosteriorTargetLengthValue
Item
Anterior-posterior measure (mm)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25231 (NCI Thesaurus Property)
C0205094 (UMLS 2011AA Property)
C25622 (NCI Thesaurus Property-2)
C0205095 (UMLS 2011AA Property-2)
C25702 (NCI Thesaurus Property-3)
C1521840 (UMLS 2011AA Property-3)
C25334 (NCI Thesaurus Property-4)
C1444754 (UMLS 2011AA Property-4)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
RadiationSurgeryCephaladCaudalTargetLengthValue
Item
Cephalad-caudad measure (mm)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C60642 (NCI Thesaurus Property-2)
C0205097 (UMLS 2011AA Property-2)
C60645 (NCI Thesaurus Property-3)
C0205096 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
RadiationSurgeryTargetVolumeMeasurement
Item
Target volume (cm^3)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25702 (NCI Thesaurus Property)
C1521840 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25335 (NCI Thesaurus Property-2)
C0449468 (UMLS 2011AA Property-2)
Item Group
Prescription Dose
RadiationSurgeryQuantityAdministeredDose
Item
Prescription Dose (Gy)
text
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
RadiationSurgeryIsodoseAdministeredPercentageDose
Item
% isodose contour
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54654 (NCI Thesaurus Property-2)
C1881277 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25488 (NCI Thesaurus ValueDomain-2)
C0178602 (UMLS 2011AA ValueDomain-2)
RadiationSurgeryTargetMinimumAdministeredDose
Item
Minimum within target volume (Gy)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25570 (NCI Thesaurus Property)
C1524031 (UMLS 2011AA Property)
C25702 (NCI Thesaurus Property-2)
C1521840 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
RadiationSurgeryTargetMaximumAdministeredDose
Item
Maximum within target volume (Gy)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25564 (NCI Thesaurus Property)
C0806909 (UMLS 2011AA Property)
C25702 (NCI Thesaurus Property-2)
C1521840 (UMLS 2011AA Property-2)
C25382 (NCI Thesaurus Property-3)
C1521801 (UMLS 2011AA Property-3)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
RadiationSurgeryIsodoseVolumeAdministeredValue
Item
Volume inside prescription isodose surface (cm^3)
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C54654 (NCI Thesaurus Property-2)
C1881277 (UMLS 2011AA Property-2)
C43320 (NCI Thesaurus Property-3)
C1705102 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
RadiationSurgeryIsodoseTargetAdministeredVolumeRatioValue
Item
Ratio of Prescription Isodose Volume/Target Volume
text
C15696 (NCI Thesaurus ObjectClass)
C0085203 (UMLS 2011AA ObjectClass)
C25702 (NCI Thesaurus Property)
C1521840 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C54654 (NCI Thesaurus Property-3)
C1881277 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C44256 (NCI Thesaurus ValueDomain-2)
C0456603 (UMLS 2011AA ValueDomain-2)
C43320 (NCI Thesaurus ValueDomain-3)
C1705102 (UMLS 2011AA ValueDomain-3)
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