Form Structure: Imaging PET
This form structure is an organized set of data definitions for a form that has not been copyrighted
Resource:
FITBIR
Title:
Imaging PET
Short Name:
ImagingPET
Description:
Positron Emission Tomography imaging information
Disease:
General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Imaging
Publication Date:
2015-04-29
Version:
1.1
Date Created:
2015-04-29
Owner:
Number of Data Elements:
109
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | GUID | Global Unique ID which uniquely identifies a subject | GUID | Required | CDE |
| 2 | Subject identifier number | An identification number assigned to the participant/subject within a given protocol or a study. | SubjectIDNum | Optional | CDE |
| 3 | Age in years | Value for participant's subject age recorded in years. | AgeYrs | Recommended | CDE |
| 4 | Visit date | Actual interview or visit date | VisitDate | Recommended | CDE |
| 5 | Site name | The name of the site for the study | SiteName | Recommended | CDE |
| 6 | Days since baseline | The number of days since baseline | DaysSinceBaseline | Optional | CDE |
| 7 | Case control indicator | Indicator of whether subject is in the case or control arm of the study. | CaseContrlInd | Optional | CDE |
| 8 | General notes text | General notes | GeneralNotesTxt | Optional | CDE |
Additional Element Groups
Listed below are your additional element groups.
Image Information (Appears At Least 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Imaging study date and time | Date (and time, if applicable and known) the radiologic study was obtained. | ImgStdyDateTime | Recommended | CDE |
| 2 | Imaging file | Image data file | ImgFile | Required | CDE |
| 3 | Imaging file format type | Format of the imaging file | ImgFileFormatTyp | Required | CDE |
| 4 | Imaging file format type other text | Format of the imaging file other text | ImgFileFormatTypOTH | Optional | CDE |
| 5 | Imaging modality type | Type of radiologic study performed on the participant/subject | ImgModltyTyp | Required | CDE |
| 6 | Imaging modality other text | The free-text field related to 'Imaging modality type' specifying other text. Type of radiologic study performed on the participant/subject | ImgModltyOTH | Optional | CDE |
| 7 | Imaging preview file | Imaging preview file | ImgPreviewFile | Recommended | CDE |
| 8 | Imaging file hash code | Hash code of the imaging file (SHA256). SHA256 produces hashes that are 256 bits long. | ImgFileHashCode | Optional | CDE |
| 9 | Imaging acquisition duration | The duration of the imaging acquisition, in minutes | ImgAcquisitionDur | Recommended | CDE |
| 10 | Imaging anatomic site | Type of body part or anatomy scanned in the imaging study | ImgAntmicSite | Recommended | CDE |
| 11 | Imaging anatomic site other text | The free-text field related to 'Imaging anatomic site' specifying other text. Type of body part or anatomy scanned in the imaging study | ImgAntmicSitOTH | Optional | CDE |
| 12 | Imaging head position text | Text describing head position relative to AC-PC coordinates, the line from the outer corner of the subjects eye to the ear tragus | ImgHeadPostnTxt | Recommended | CDE |
| 13 | Sedation used indicator | Whether the participant/subject was administered any sedation | SedationUsedInd | Optional | CDE |
| 14 | Imaging pre-scan procedure type | Type(s) of pre-scan action(s) administered to the participant/subject | ImgPrescnProcdrTyp | Optional | CDE |
| 15 | Imaging pre-scan procedure other text | The free-text field related to 'Imaging pre-scan procedure type' specifying other text. Type(s) of pre-scan procedures administered to the participant/subject | ImgPrescnProcdrOTH | Optional | CDE |
| 16 | Imaging scanner manufacturer name | Imaging scanner manufacturer name | ImgScannerManufName | Recommended | CDE |
| 17 | Imaging scanner manufacturer other text | The free-text field related to 'Imaging scanner manufacturer name' specifying other text. Name of manufacturer of imaging scanner | ImgScannerManufOTH | Optional | CDE |
| 18 | Imaging scanner model name | Name of model of imaging scanner | ImgScannerModelName | Recommended | CDE |
| 19 | Imaging scanner model other text | The free-text field related to 'Imaging scanner model name' specifying other text. Name of model of imaging scanner | ImgScannerModelOTH | Optional | CDE |
| 20 | Imaging scanner software name | Name of the scanner software that runs the imaging camera | ImgScannerSftwrName | Optional | CDE |
| 21 | Imaging scanner software version number | Version number of the imaging scanner software | ImgScannerSftwrVrsnNum | Recommended | CDE |
| 22 | Imaging provenance text | Imaging provenance | ImgProvenanceTxt | Optional | CDE |
| 23 | Imaging analysis software name | Name of the software used for data processing or analysis of the imaging study. | ImgAnlysisSftwrName | Optional | CDE |
| 24 | Imaging analysis software other text | The free-text field related to 'Imaging analysis software name' specifying other text. Name of the software used for data processing or analysis of the imaging study. | ImgAnlysisSftwrOTH | Optional | CDE |
| 25 | Imaging analysis software version number | The version number of the software used for quantitative analysis of the imaging study | ImgAnlysisSftwrVrsnNum | Optional | CDE |
| 26 | Imaging notes text | General imaging notes | ImgNotesTxt | Recommended | CDE |
| 27 | Imaging skull stripping performed indicator | Skull stripping performed for anatomical and functional images | ImgSklStrpPerfInd | Optional | CDE |
Image pixel information and dimensions (Appears At Least 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Imaging dimension type | Type of imaging dimension used | ImgDimensionTyp | Required | CDE |
| 2 | Imaging dimension other text | The free-text field related to 'Imaging dimension type' specifying other text. Type of imaging dimension used | ImgDimensionOTH | Optional | CDE |
| 3 | Imaging 1st dimension extent value | Image extent in first dimension (X) | ImgDim1ExtentVal | Required | CDE |
| 4 | Imaging 1st dimension resolution value | Resolution in first dimension (X) | ImgDim1ResolVal | Required | CDE |
| 5 | Imaging 1st dimension unit of measure value | Units of measure for image extent in first dimension (X) | ImgDim1UoMVal | Recommended | CDE |
| 6 | Imaging 1st dimension unit of measure value other text | Units of measure for image extent in first dimension (X) other text | ImgDim1UoMValOTH | Optional | CDE |
| 7 | Imaging 2nd dimension extent value | Image extent in second dimension (Y) | ImgDim2ExtentVal | Required | CDE |
| 8 | Imaging 2nd dimension resolution value | Resolution in second dimension (Y) | ImgDim2ResolVal | Required | CDE |
| 9 | Imaging 2nd dimension unit of measure value | Units of measure for image extent in second dimension (Y) | ImgDim2UoMVal | Recommended | CDE |
| 10 | Imaging 2nd dimension unit of measure value other text | Units of measure for image extent in second dimension (Y) other text | ImgDim2UoMValOTH | Optional | CDE |
| 11 | Imaging 3rd dimension extent value | Image extent in third dimension (Z) | ImgDim3ExtentVal | Recommended | CDE |
| 12 | Imaging 3rd dimension resolution value | Resolution in third dimension (Z) | ImgDim3ResolVal | Recommended | CDE |
| 13 | Imaging 3rd dimension unit of measure value | Units of measure for image extent in third dimension (Z) | ImgDim3UoMVal | Optional | CDE |
| 14 | Imaging 3rd dimension unit of measure value other text | Units of measure for image extent in third dimension (Z) other text | ImgDim3UoMValOTH | Optional | CDE |
| 15 | Imaging 4th dimension extent value | Image extent in forth dimension | ImgDim4ExtentVal | Optional | CDE |
| 16 | Imaging 4th dimension extent type | Description of image extent in forth dimension | ImgDim4ExtentTyp | Optional | CDE |
| 17 | Imaging 4th dimension extent type other text | Description of image extent in forth dimension other text | ImgDim4ExtentTypOTH | Optional | CDE |
| 18 | Imaging 4th dimension resolution value | Resolution in forth dimension | ImgDim4ResolVal | Optional | CDE |
| 19 | Imaging 4th dimension unit of measure value | Units of measure for image extent in forth dimension | ImgDim4UoMVal | Optional | CDE |
| 20 | Imaging 4th dimension unit of measure value other text | Units of measure for image extent in forth dimension other text | ImgDim4UoMValOTH | Optional | CDE |
| 21 | Imaging 5th dimension extent value | Image extent in fifth dimension | ImgDim5ExtentVal | Optional | CDE |
| 22 | Imaging 5th dimension extent type | Description of image extent in fifth dimension | ImgDim5ExtentTyp | Optional | CDE |
| 23 | Imaging 5th dimension extent type other text | Description of image extent in fifth dimension other text | ImgDim5ExtentTypOTH | Optional | CDE |
| 24 | Imaging 5th dimension resolution value | Resolution in fifth dimension | ImgDim5ResolVal | Optional | CDE |
| 25 | Imaging 5th dimension unit of measure value | Units of measure for image extent in fifth dimension | ImgDim5UoMVal | Optional | CDE |
| 26 | Imaging 5th dimension unit of measure value other text | Units of measure for image extent in fifth dimension other text | ImgDim5UoMValOTH | Optional | CDE |
| 27 | Imaging field of view measurement description text | The general description of field of view (FOV) or anatomical positioning | ImgFOVMeasrDescTxt | Recommended | CDE |
| 28 | Imaging bandwidth value | Value, in Hertz per pixel, of bandwidth used in imaging acquisition. | ImgBandwidthVal | Optional | CDE |
| 29 | Imaging slice orientation type | The slice orientation used in imaging acquisition | ImgSliceOrientTyp | Recommended | CDE |
| 30 | Imaging slice orientation other text | The free-text field related to 'Imaging slice orientation type' specifying other text. The slice orientation used in imaging acquisition | ImgSliceOrientOTH | Optional | CDE |
| 31 | Imaging slice over sampling value | Value of the slice over sampling (as a percentage) used in imaging acquisition | ImgSliceOverSampVal | Recommended | CDE |
| 32 | Imaging slice thickness value | Value of the thickness of the optical slice measured in millimeters (mm) | ImgSliceThicknessVal | Recommended | CDE |
| 33 | Imaging gap between slices measurement | Measurement of the gap between slices used in imaging acquisition | ImgGapBetwnSlicesMeasr | Optional | CDE |
| 34 | Imaging registration technique used indicator | Indicator of whether a registration technique used to calculate the transformation to a standard average brain space | ImgRegistTechUsedInd | Recommended | CDE |
| 35 | Imaging registration technique type | Type of registration technique used | ImgRegistTechTyp | Optional | CDE |
| 36 | Imaging registration technique other text | The free-text field related to 'Imaging registration technique type' specifying other text. Type of registration technique used | ImgRegistTechOTH | Optional | CDE |
PET specific information (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Imaging radioligand type | Isotope-labeled bioactive compound (generic or common name) used in the imaging scan | ImgRadiolgndTyp | Recommended | CDE |
| 2 | Imaging radioligand other text | The free-text field related to 'Imaging radioligand type' specifying other text. Isotope-labeled bioactive compound (generic or common name) used in the imaging scan | ImgRadiolgndOTH | Recommended | CDE |
| 3 | Imaging radioligand dose value | Dose of injected radioligand for the imaging scan | ImgRadiolgndDosVal | Recommended | CDE |
| 4 | Imaging radioligand dose other text | The free-text field related to 'Imaging radioligand dose unit of measure' specifying other text. Unit of measure for the dose of injected radioligand for the imaging scan | ImgRadiolgndDoseOTH | Recommended | CDE |
| 5 | Imaging radioligand dose unit of measure | Unit of measure for the dose of injected radioligand for the imaging scan | ImgRadiolgndDoseUoM | Recommended | CDE |
| 6 | Imaging radioligand dose unit of measure other text | Other unit of measure for the dose of injected radioligand for the imaging scan | ImgRadiolgndDoseUoMOTH | Recommended | CDE |
| 7 | Imaging radioligand specific activity value indicator | Whether the specific activity value is known | ImgRadiolgndSpcfcActValInd | Recommended | CDE |
| 8 | Imaging radioligand specific activity value | Value of the specific activity of the Radioligand in Bq/Kg | ImgRadiolgndActVal | Recommended | CDE |
| 9 | Imaging raw data reconstruction method type | The type of method used for reconstruction of raw data from the imaging scan | ImgRawDataReconstructMthdTyp | Recommended | CDE |
| 10 | Imaging raw data reconstruction method other text | The free-text field related to 'Imaging raw data reconstruction method type' specifying other text. The type of method used for reconstruction of raw data from the imaging scan | ImgRawDataReconstructMthdOTH | Recommended | CDE |
| 11 | Brain landmark side indicator | Whether the Positron Emission Tomography (PET) scan was on the left or right side of the brain | BrainLndmrkSideInd | Recommended | CDE |
| 12 | Imaging PET localization processing type | Type of processing performed on image produced by positron emission tomography (PET) localization. | ImgPETLoclProcTyp | Recommended | CDE |
| 13 | Imaging positron emission tomography ictal localization study type | Type of imaging study of the brain during a seizure using Ictal positron emission tomography (PET) | ImgPETIctalLocalizStudyTyp | Recommended | CDE |
| 14 | PET localization cortical anatomic site | The cortical location of tracer binding/uptake based on Ictal positron emission tomography (PET) | PETLocalCortclAntmicSite | Recommended | CDE |
| 15 | PET localization distribution pattern type | General pattern of tracer binding/uptake based on the Positron Emission Tomography (PET) scan | PETLocalDistrPatrnTyp | Recommended | CDE |
| 16 | PET localization rating type | Localization rating indicator of imaging using positron emission tomography (PET). | PETLocalRatTyp | Recommended | CDE |
| 17 | Imaging anatomical scan date | Date of the cooresponding anatomical scan acquisition. | ImgAntmicalScanDate | Optional | CDE |
| 18 | Imaging anatomical scan file hash code | Hash code of the corresponding anatomical scan file (SHA256). SHA256 produces hashes that are 256 bits long. | ImgAntmicalScanFileHashCode | Optional | CDE |
| 19 | Imaging anatomical scan modality type | Modality of the corresponding anatomical scan. | ImgAntmicalScanModltyTyp | Optional | CDE |
| 20 | Imaging anatomical scan modality type other text | The free-text field related to 'Imaging anatomical scan modality type' specifying other text. Type of radiologic study performed on the participant/subject | ImgAntmicalScanModltyTypOTH | Optional | CDE |
Image QA & QC (Appears At Least 1 Time)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Imaging QA/QC performed indicator | Was image-based QA/QC performed? | ImgQAQCPerfInd | Required | CDE |
| 2 | Imaging QA/QC result | Results of image-based QA/QC | ImgQAQCReslt | Optional | CDE |
| 3 | Imaging quality assurance/quality control (QA/QC) implemented techniques text | Free text field to describe the quality assurance techniques implemented. | ImgQAQCImplentTxt | Optional | CDE |
| 4 | Imaging scan aborted reason | Reason the imaging was aborted | ImgAbortRsn | Optional | CDE |
| 5 | Imaging artifacts indicator | Indicator of any obvious artifacts in the image | ImgArtifactInd | Optional | CDE |
| 6 | Imaging artifact type | The artifacts present on the scan | ImgArtifactTyp | Optional | CDE |
| 7 | Imaging artifact other text | The free-text field related to 'Imaging artifact type' specifying other text. The artifacts present on the scan | ImgArtifactOTH | Optional | CDE |
| 8 | Imaging acquisition entire brain coverage indicator | Indicator of whether the imaging acquisition covered the entire brain | ImgAcqEntireBrnCoverageInd | Recommended | CDE |
| 9 | Imaging visual analysis blinded indicator | Indicator of whether the visual analysis was performed blinded to clinical data | ImgVisAnlysisBlindInd | Optional | CDE |
| 10 | Imaging visual analysis location performed type | Location where visual analysis of the imaging data are performed | ImgVisAnlysisLocPerfTyp | Optional | CDE |
| 11 | Imaging visual analysis location performed other text | The free-text field related to 'Imaging visual analysis location performed type' specifying other text. Location where visual analysis of the imaging data are performed | ImgVisAnlysisLocPerfOTH | Optional | CDE |
| 12 | Imaging visual analysis status | Status of findings from subjective review of image data | ImgVisAnlysisStatus | Optional | CDE |
| 13 | Imaging visual analysis other text | The free-text field related to 'Imaging visual analysis status' specifying other text. Status of findings from subjective review of image data | ImgVisAnlysisOTH | Optional | CDE |
| 14 | Imaging quality of images technically satisfactory indicator | Indicator of whether the quality of the images were technically satisfactory. | ImgQualImgTechnSatisInd | Optional | CDE |
Medication Pre-treatment (Repeat Infinitely)
| # | Title | Short Description | Variable Name | Required? | Type |
|---|---|---|---|---|---|
| 1 | Imaging medication pre-treatment status | Status of the medication(s) taken by the participant/subject pre-treatment for the imaging scan | ImgMedctnPretrtmntStatus | Optional | CDE |
| 2 | Imaging medication pre-treatment withheld duration | Duration of time medication(s) were withheld from the participant/subject pre-treatment for the imaging scan | ImgMedctnPretrtmntWithldDur | Optional | CDE |
| 3 | Imaging medication pre-treatment withheld duration unit of measure | Unit of measure (UOM) used to specify the length of time medication(s) were withheld from the participant/subject pre-treatment for the imaging scan | ImgMedctnPrtrtmntWithhldDurUOM | Optional | CDE |
| 4 | Imaging medication pre-treatment withheld name | Medication pre-treatment withheld name | ImgMedctnPrtrtmntWithhldName | Optional | CDE |
Keywords
