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Clinical Trials Unit

Bristol CT/MRI Reporting Form 1: Diagnostic Staging

This form is for the use of the Bristol medical centre. It is to be filled in after the reading of the CT/MRI scan

Procedure to be Used Upon Receipt of CT-MRI Scans - SOP to be used by the Bristol Royal Infirmary centre when receiving scans to be read from other centres

Scan Type (required)
Nodal Sites Involved (Recorded by centre/site). Please tick all that apply (required)
Distant Metastases detected (Recorded by centre/site) (required)
If ‘Yes’, Indicate type of Distant Metastases detected (required)
Information pertaining to the CT and MRI reports of the local (originating) site.
Is the recorded Primary Site correct? (required)
Is the recorded T Stage correct? (required)
Is the recorded N Stage correct? (required)
Are the recorded Distant Metastases correct? (required)
Privacy notice
The data provided will be used solely for the PET-Neck trial

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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