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Long NamePET Patient Prep NCI Standard Template
DefinitionThe collection of CDEs used in the PET patient prep modules.
ContextcaBIG
Protocol Long NameNCI Standard Template Forms
WorkflowRELEASED
TypeCRF
Public ID3476327
Version1.0
Module Long NameModule InstructionsQuestionCDECDE Public IDCDE VersionValue Domain Data TypeValue Domain Unit of MeasureDisplay FormatValid ValueForm Value Meaning TextForm Value Meaning Desc.
Conditional PET Patient Prep QuestionThere are business rules to indicate situations under which these elements should be used on a case report form.
Duration of patient fasting pre-PET imagingPrior To PET Fasting Hour Duration27148901.0NUMBER
PET Blood GlucosePET Blood Glucose Prior To Injection Value27148921.0NUMBER999.9
Time blood sample was obtained for glucose measurementPET Blood Glucose Measurement Military Time31623831.0TIMETIME (HR(24):MN)
Was Foley catheter in place for scan?PET Foley Catheter Placed Ind-327176502.0CHARACTER
NoNoThe non-affirmative response to a question.
UnknownUnknownNot known, not observed, not recorded, or refused.
YesYesThe affirmative response to a question or activity.
Patient voided immediately pre-imaging?PET Urination Prior Imaging Agent Ind-327165202.0CHARACTER
NoNoThe non-affirmative response to a question.
UnknownUnknownNot known, not observed, not recorded, or refused.
YesYesThe affirmative response to a question or activity.
Confirmation of fasting requirementsPerson Imaging Agent Fasting Drink Exercise Required Complete Yes No Unknown Indicator38360181.0CHARACTER
NoNoThe non-affirmative response to a question.
UnknownUnknownNot known, not observed, not recorded, or refused.
YesYesThe affirmative response to a question or activity.
Conditional PET Patient Prep Question There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.
Patient voided immediately post-imaging?PET Urination Post Imaging Agent Ind-327176522.0CHARACTER
NoNoThe non-affirmative response to a question.
UnknownUnknownNot known, not observed, not recorded, or refused.
YesYesThe affirmative response to a question or activity.