PrCa New Bone Lesions - Pre-specified Locations


This example shows a CRF used to collect information on the total number of new bone lesions identified by pre-specified locations.



"New Bone Lesions (Pre-Specified Locations) [PrCa_New Bone Lesions (Pre-Specified Locations)]" Form Preview
New Bone Lesions (Pre-Specified Locations)
New Lesions (Pre-Specified Locations)
Response Criteria
Tumor/Lesion Type
Were any new bone lesions identified? Yes  No  
Date of Procedure
 01 Jan 2000
Evaluator Investigator  Independent Assessor  
Evaluator Identifier Radiologist 1  Radiologist 2  Oncologist  
Method of Evaluation Scintigraphy  CT Scan  Other  
If Other, Specify Method of Evaluation
What assessment will be used as a reference to evaluate this scan? Baseline  Flare Assessment  Last Scan  
What was the number of new bone lesions identified in the skull since reference scan?
Skull Bone Lesion ID
What was the number of new bone lesions identified in the thorax since reference scan?
Thorax Bone Lesion ID
What was the number of new bone lesions identified in the pelvic bone since reference scan?
Pelvic Bone Lesion ID
What was the number of new bone lesions identified in the limb extremities since reference scan?
Limb Bone Lesion ID
Are there two or more persisting new bone lesions since the last scan? Yes  No  
Are there 2 or more new bone lesions since the reference scan? Yes  No  
* Mandatory field