Section A 'General Information' contains data from a baseline or annual screening exam. If your data are for a follow-up exam, e.g. any additional imaging, biopsy, or surgery which occurred within 12 months of a screening exam, then proceed to Section B 'Follow-Up Within 1-Year.'
Complete the General Information section by selecting from the options presented on the form and filling in the blank fields.
The exam form cannot be submitted to the registry, using the Submit button, unless all fields marked with an asterisk (*) are filled. However, the form’s data can be retained and completed later using the Save button. You should enter data for all fields, as required by the NRDR Participation Agreement, to help provide a robust data set for all LCSR participants.
Field Name | Description |
*Smoking Status | Current smoker: An adult who has smoked 100 cigarettes in his or her lifetime and who currently smokes cigarettes. Includes daily smokers and non-daily smokers (also known as occasional smokers).Former smoker: A person who was not smoking at the time of the interview but has smoked at least 100 cigarettes in his or her life.Never smoker: A person who was not smoking at the time of the interview and has smoked fewer than 100 cigarettes in his or her life.Smoker, Current Status Unknown: A person who is known to have smoked but whose current smoking status is unknown.Unknown If Ever Smoked: Indicates that a person's smoking status is unknown.For current or former smokers, estimate the number of pack-years, defined as(number of packs per day x total years smoked)For example, 10 pack-years is the equivalent of smoking one pack of cigarettes per day for ten years, or two packs of cigarettes per day for five years. |
Did physician provide smoking cessation guidance to patient? | Indicate Yes if guidance was provided by either the imaging or ordering physician. |
Is there documentation of shared decision making? | Select the appropriate response. |
*Patient’s Height*Patient's Weight | Enter patient’s height in inches and weight in pounds.Note: If you do not know the patient’s height or weight, please enter the number 0 in the data field(s). However, moving forward, we expect you to provide the correct data. The expectation of complete and correct data is specified in the participation agreement signed by all participating facilities. |
Other comorbidities listed on patient record that limit life expectancy | Select all that apply. |
*Radiologist (reading) | Select the reading radiologist’s name from the drop-down list.Note: In order for a physician to be listed as the reading radiologist, he or she must be listed in the Physician database and then added to the LCSR. See Manage Physicians for how to add physicians. The Physician NPI is filled in automatically from the Physician database. |
Ordering Practitioner | Enter the first and last name and NPI of the ordering practitioner. |
*Indication for Exam | Select the appropriate response. Baseline screen indicates the patient has had no prior lung cancer screening CTs. Annual screen indicates the patient has had at least one prior screening exam. |
*Modality | Select the appropriate modality. |
*CT Scanner | Enter the manufacturer and model of the CT scanner used to perform the exam. If the scanner has already been entered on a previous record, you can use the drop down box to select the scanner. |
Screening CT Radiation Exposure | Enter the exam parameters. Tube current-time, tube voltage, scanning time, scanning volume and pitch are optional. |
*CT Exam Results by Lung-RADS Category | Select the appropriate response. |
*Other clinically significant or potentially significant abnormalities – CT exam result modifier S | Select the appropriate response. |
Prior history of lung cancer – CT exam result modifier C | Select the appropriate response. |
Years since prior diagnosis of lung cancer | Enter number of years as a whole number. |
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