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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?Anatomical Part or Region Shown by the Image
TULOC

This is the general anatomical part or region made available for assessment by the imaging procedure.
CORONARY ARTERY 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 Indicator

Y
4textTUORRESWas there a lesion present based on the assessment of the image?Presence of Lesion
TUORRES
(Y/N)
Yes;No
redio

5textTUTESTWhat 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.

Examination for Abnormality

Y
6textTUORRESWhat was the type of lesion observed based on the assessment of the image?Lesion TypeRecord the type of lesion observed, e.g. aneurysm, calcified annulus, valvular stenosis, etc.TUORRES when TUTEST = ABNEXAM




Prompt

7textTURESLOCWhat was the
location of
the lesion based on the assessment of the image?
Result Anatomical LocationIf this location is a graft (or transplant), enter the name of the native tissue, organ or blood vessel on which the graft is built (or in which the transplant is implanted).TURESLOC when TUTEST = ABNEXAM
(LOC)





8textTURLGFFLIndicate whether the located lesion is in a graft or transplant.Graft Result Location FlagCheck "Yes" for this question if the lesion is located in a graft (or transplant) tissue, organ or blood vessel.NSTU.TURLGFFL


Yes

checkbox



9textTURESLATIf applicable, indicate the laterality of the location of the lesion.Result Location Laterality
TURESLAT when TUTEST = ABNEXAM
(LAT)





10textTURESLDLIf applicable, provide more detail of the location of the lesion.Result Location directionality
TURLODTL when TUTEST = ABNEXAM
N/A





11textTULNKIDWhat 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).




1210textRSCATRecord the clinical classification used for the assessment of Coronary lesion severity.Coronary Lesion Severity Clinical Classification
RSCAT



ACC/AHA CLASSIFICATION OF CORONARY LESIONS

Y
1311textRSTESTWhat was the severity of the coronary lesion?Coronary Lesion Severity
RSTEST when RSTEST = ACCAHA01-ACC/AHA Classification of Coronary Lesions Type ACAH0101

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

radio





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