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CTC Exam Form

After you submit the registration form, a link to the CTC CTC Data Collection Menu - ExamExam Form appears. You can also access the exam form by clicking Exam under Data Collection in the CTC Registry menu. 

Complete the form by selecting from among the options presented on the form and filling in the blank fields. Fields marked with an asterisk (*) must be entered or the form cannot be submitted. Specific instructions for each field are as follows below.

Note: View the video on completing the Case Registration and Exam forms

Select the appropriate response. 

Field Name


Facility ID Number

Registry Case Number

Patient First Name

Patient Last Name

Exam Date

These fields are filled in automatically from the case registration form.

A. General Information

*Type of Study

Select the appropriate response.

*Interpreting Physician

The physician’s name must be selected from the drop-down list. For a physician to be listed as the interpreting physician, he or she must be listed as a CTC participant in the physician dictionary. Refer to Manage Physicians and Add Physicians to an Individual Registry for instructions on listing a physician as a CTC participant.

Did technique meet ACR guidelines?

Select the appropriate response. Click the Question mark Help Icon.png icon for details.

Referred from incomplete colonoscopy

Select the appropriate response.


Enter the CTDIvol in mGy as displayed on the console. Range: 0.01 – 999.99.

*Supine image acquisition

*Prone image acquisition

*Decubitus image acquisition

Select the appropriate response.

B. Post Examination and Adverse Events

*At least one polyp >= 10 mm

Select the appropriate response. 

*Colonic perforation

If Yes is selected then etiology, location, and whether patient was symptomatic from perforation must be indicated.

C Score    

Select the appropriate response.

E Score    

Select the appropriate response.

Click the Submit button when the form is complete. You must correct any errors or the form will not be accepted by the registry. If no errors are detected a confirmation message appears and the case moves to Completed status. 


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