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Xformpusher


OrderTypeCDASHIG VariableQuestion TextPromptCRF Completion InstructionsSDTMIG TargetSDTMIG Variable MappingControlled Terminology Codelist NameImplementation NotesPermissible ValuesPre-populated ValueQuery DisplayList StyleHidden
1textTUDATCollection Date
Collection DateTUDTC
N/A


Prompt


2textTULOCWhat was the anatomical region shown by the imaging procedure?Image Location
TULOC

This is the general anatomical part or region made available for assessment by the imaging procedure. If this location is not known, leave TULOC blank.
CORONARY VESSEL SYSTEM

Y
3textTUTESTWhat was the
lesion
identification test
name?
Lesion
Identification
Test Name
Record the name of the TU
test, if not printed on the CRF.
If collected on the CRF, the
sponsor may provide additional
instructions to ensure the data
is entered as intended.
TUTEST
(TUTEST)Required to identify to which test the result relates. It is
recommended that test names be preprinted on the CRF rather than collected in a field that requires the site to enter text. If the form is laid out as a grid, then words such as Test can be included as the column header.

Lesion Location Identification

Y
4textTUORRES
Result
TUORRES
N/A

IDENTIFIED

Y
5textTURESLOCWhat was the
location of
the lesion based on the assessment of the image?
Result Anatomical LocationIf this location is a graft, enter the name of the native tissue, organ or blood vessel.TURESLOC when TUTEST = Lesion Location Identification
(LOC)






7textTURESLATIf applicable, indicate the laterality of the location of the lesion.Result Location Laterality
TURESLAT when TUTEST = Lesion Location Identification
(LAT)






8textTURESLDLIf applicable, provide more detail of the location of the lesion.Result Location directionality
TURESLDL when TUTEST = Lesion Location Identification
N/A






9textTULNKIDWhat was the
Lesion ID?
Lesion IDSponsor-specifiedTULNKID, TRLNKID, RSLNKID
N/AThis variable is used to provide a unique code for each identified lesion in order to link records across related domains (TU, TR, RS).





10textRSCATRecord the clinical classification used for the assessment of Coronary lesion severity.Coronary Lesion Severity Clinical Classification
RSCAT



ACC/AHA CLASSIFICATION OF CORONARY LESIONS

Y
11textRSTESTWhat was the severity of the coronary lesion?Coronary Lesion Severity
RSTEST when RSTEST = ACCAHA01-ACC/AHA Classification of Coronary Lesions Type

If the instrument is considered as a clinical classification (i.e. validated, peer-reviewed public domain or copyrighted instrument), use the combined RS/CC domain and follow CC controlled terminology business rules.Type A; Type B; Type C

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12textRSCATRecord the clinical classification used for the assessment of coronary arterial perfusion.Coronary Arterial Perfusion Clinical Classification
RSCAT



TIMIFLOW

Y
13textRSTESTHow severely was perfusion impacted as a result of the coronary lesion?Coronary Arterial Perfusion Perfusion Grade
RSTEST when RSTEST = TIMI01-TIMI Flow Grade

If the instrument is considered as a clinical classification (i.e. validated, peer-reviewed public domain or copyrighted instrument), use the combined RS/CC domain and follow CC controlled terminology business rules.Grade I; Grade II; Grade III; Grade IIII

radio





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