Paul Strickland PET-CT Response Form
This form is for use by Paul Strickland Scanner Centre to submit the results of the 2nd reading.
Procedure to be Used Upon Receipt of PET-CT Scans - SOP to be used by the Paul Strickland Scanner Centre when receiving scans to be read from other centres
{"elements":[{"isDiscrete":false,"hidden":false,"name":"Patient_Trial_Number (3-digit)","readOnly":false,"id":69409562,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Patient_Initials (If known)","readOnly":false,"id":69409563,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"4-digit_Dicom_Form_Code","readOnly":false,"id":69409564,"type":"textFieldElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Aberdeen","value":"0-aberdeen"},{"text":"Basildon","value":"1-basildon"},{"text":"Bath","value":"2-bath"},{"text":"Belfast","value":"3-belfast"},{"text":"Birmingham PET Centre (QE)","value":"4-birminghampetcentreqe"},{"text":"Bradford","value":"5-bradford"},{"text":"Bristol","value":"6-bristol"},{"text":"Cardiff Medical Physics Department","value":"7-cardiffmedicalphysicsdepartment"},{"text":"Christie","value":"8-christie"},{"text":"Clatterbridge Oncology Centre","value":"9-clatterbridgeoncologycentre"},{"text":"Broadgreen Hospital Liverpool","value":"10-broadgreenhospitalliverpool"},{"text":"Edinburgh","value":"11-edinburgh"},{"text":"Hull Royal Infirmary","value":"12-hullroyalinfirmary"},{"text":"James Cook","value":"13-jamescook"},{"text":"Kent","value":"14-kent"},{"text":"Linton house, Cheltenham","value":"15-lintonhousecheltenham"},{"text":"Newcastle PET Centre","value":"16-newcastlepetcentre"},{"text":"Nottingham City","value":"17-nottinghamcity"},{"text":"Paul Strickland Scanner Centre","value":"18-paulstricklandscannercentre"},{"text":"Plymouth Academy","value":"19-plymouthacademy"},{"text":"Poole","value":"20-poole"},{"text":"Preston","value":"21-preston"},{"text":"Royal Marsden","value":"22-royalmarsden"},{"text":"Royal Surrey","value":"23-royalsurrey"},{"text":"Seacroft","value":"24-seacroft"},{"text":"Sheffield PET Centre","value":"25-sheffieldpetcentre"},{"text":"St Thomas\u0092","value":"26-stthomas"},{"text":"UCL","value":"27-ucl"},{"text":"UHCW","value":"28-uhcw"},{"text":"West of Scotland PET-CT Centre","value":"29-westofscotlandpetctcentre"}],"name":"Scanning_Centre","readOnly":false,"id":69409565,"type":"listElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Aberdeen Royal Infirmary","value":"0-aberdeenroyalinfirmary"},{"text":"Basildon University Hospital","value":"1-basildonuniversityhospital"},{"text":"Beatson West of Scotland Cancer care Centre","value":"2-beatsonwestofscotlandcancercarecentre"},{"text":"Belfast City Hospital","value":"3-belfastcityhospital"},{"text":"Blackpool Victoria Hospital","value":"4-blackpoolvictoriahospital"},{"text":"Bradford Royal infirmary","value":"5-bradfordroyalinfirmary"},{"text":"Bristol Haematology and Oncology Centre","value":"6-bristolhaematologyandoncologycentre"},{"text":"Burnley General Hospital","value":"7-burnleygeneralhospital"},{"text":"Castle Hill Hospital","value":"8-castlehillhospital"},{"text":"Cheltenham General Hospital","value":"9-cheltenhamgeneralhospital"},{"text":"Chesterfield Royal Hospital","value":"10-chesterfieldroyalhospital"},{"text":"Christie Hospital","value":"11-christiehospital"},{"text":"Derriford Hospital","value":"12-derrifordhospital"},{"text":"Dumfries & Galloway","value":"13-dumfriesgalloway"},{"text":"Gloucester Royal Hospital","value":"14-gloucesterroyalhospital"},{"text":"Guy\u0092s Hospital","value":"15-guyshospital"},{"text":"Heartlands Hospital","value":"16-heartlandshospital"},{"text":"James Cook University hospital","value":"17-jamescookuniversityhospital"},{"text":"Kent & Canterbury Hospital","value":"18-kentcanterburyhospital"},{"text":"Luton and Dunstable","value":"19-lutonanddunstable"},{"text":"Manchester Royal Infirmary","value":"20-manchesterroyalinfirmary"},{"text":"Mount Vernon Hospital","value":"21-mountvernonhospital"},{"text":"New Cross Hospital","value":"22-newcrosshospital"},{"text":"North Manchester General Hospital","value":"23-northmanchestergeneralhospital"},{"text":"Nottingham university Hospitals","value":"24-nottinghamuniversityhospitals"},{"text":"Poole Hospital","value":"25-poolehospital"},{"text":"Queen Elizabeth Hospital Birmingham","value":"26-queenelizabethhospitalbirmingham"},{"text":"Queen Elizabeth Queen Mother Hospital Belfast","value":"27-queenelizabethqueenmotherhospitalbelfast"},{"text":"Royal Blackburn Hospital","value":"28-royalblackburnhospital"},{"text":"Royal Derby Hospital","value":"29-royalderbyhospital"},{"text":"Royal Devon & Exeter Hospital","value":"30-royaldevonexeterhospital"},{"text":"Royal Marsden Hospital","value":"31-royalmarsdenhospital"},{"text":"Royal Preston Hospital","value":"32-royalprestonhospital"},{"text":"Royal Surrey County Hospital","value":"33-royalsurreycountyhospital"},{"text":"Royal United Hospital","value":"34-royalunitedhospital"},{"text":"Royal Victoria Hospital","value":"35-royalvictoriahospital"},{"text":"Russells Hall Hospital","value":"36-russellshallhospital"},{"text":"Singleton Hospital","value":"37-singletonhospital"},{"text":"Sir Bobby Robson Cancer Trials Research Centre","value":"38-sirbobbyrobsoncancertrialsresearchcentre"},{"text":"Southend University Hospital","value":"39-southenduniversityhospital"},{"text":"Southmead Hospital","value":"40-southmeadhospital"},{"text":"St James\u0092 University Hospital","value":"41-stjamesuniversityhospital"},{"text":"Sunderland Royal hospital","value":"42-sunderlandroyalhospital"},{"text":"Torbay Hospital","value":"43-torbayhospital"},{"text":"University College London Hospital","value":"44-universitycollegelondonhospital"},{"text":"University Hospital Aintree","value":"45-universityhospitalaintree"},{"text":"University Hospitals Coventry and Warwickshire","value":"46-universityhospitalscoventryandwarwickshire"},{"text":"Velindre Cancer Centre","value":"47-velindrecancercentre"},{"text":"Walsall Manor Hospital","value":"48-walsallmanorhospital"},{"text":"Western General Hospital","value":"49-westerngeneralhospital"},{"text":"Weston Park Hospital","value":"50-westonparkhospital"},{"text":"William Harvey Hospital","value":"51-williamharveyhospital"}],"name":"Referring Hospital","readOnly":false,"id":69409566,"type":"listElement"},{"isDiscrete":false,"hidden":false,"name":"Scan_Date","readOnly":false,"id":69409567,"type":"dateTimeElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Complete response","value":"0-completeresponse"},{"text":"Partial response","value":"1-partialresponse"},{"text":"Stable disease","value":"2-stabledisease"},{"text":"Progressive disease","value":"3-progressivedisease"}],"name":"Response_in_Primary_Tumour","readOnly":false,"id":69409568,"type":"checkboxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Complete response","value":"0-completeresponse"},{"text":"Partial response","value":"1-partialresponse"},{"text":"Stable disease","value":"2-stabledisease"},{"text":"Progressive disease","value":"3-progressivedisease"}],"name":"Response_in_Nodes","readOnly":false,"id":69409569,"type":"checkboxElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"},{"text":"No","value":"1-no"},{"text":"Indeterminate","value":"2-indeterminate"},{"text":"Incidental","value":"3-incidental"},{"text":"Not assessed","value":"4-notassessed"},{"text":"Not known","value":"5-notknown"}],"name":"Distant_Metastases_Detected","readOnly":false,"id":69409570,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"If Not_Known_Indicate_Type_of_Metastases_(If applicable)","readOnly":false,"id":94838028,"type":"textFieldElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Lung","value":"0-lung"},{"text":"Bone","value":"1-bone"},{"text":"Liver","value":"2-liver"},{"text":"Other (please specify below)","value":"3-otherpleasespecifybelow"}],"name":"Metastases_Type_(If applicable)","readOnly":false,"id":69409571,"type":"checkboxElement"},{"isDiscrete":false,"hidden":false,"name":"If Other_Indicate_Type_of_Metastases_(If applicable)","readOnly":false,"id":69409572,"type":"textFieldElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Yes","value":"0-yes"},{"text":"No","value":"1-no"}],"name":"Concordance_between_readings_of_Core_Lab_and_Local_Report","readOnly":false,"id":69409573,"type":"radioElement"},{"isDiscrete":true,"hidden":false,"values":[{"text":"Core Lab Report Accepted","value":"0-corelabreportaccepted"},{"text":"Local Centre Report Accepted","value":"1-localcentrereportaccepted"}],"name":"If_No_Which_report_has_been_accepted","readOnly":false,"id":69409574,"type":"radioElement"},{"isDiscrete":false,"hidden":false,"name":"Comments","readOnly":false,"id":69409575,"type":"textBoxElement"},{"isDiscrete":false,"hidden":false,"name":"Form_Completed_By_(Name)","readOnly":false,"id":69409576,"type":"textFieldElement"},{"isDiscrete":false,"hidden":false,"name":"Form_Completion_Date","readOnly":false,"id":69409577,"type":"dateTimeElement"}]}
