Updated December 2020

Insured and Registry PreScan

Entity	Data Element	Definition	Format	Valid Values	Purpose and Use	Changes
Request-Specific Information
Insured and Registry PreScan	Disease Category	Category of the disease.	CHAR 50	Oncology (adult), Oncology (paediatric).	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Indication	List of Insured & Registry Indications	CHAR 50	See Appendix 13.13 for the list of active Insured and Registry indications.	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	Indication Other (specify)	Indication if "Other Connective/other soft tissue" or "Other Primary Brain" is chosen in the pre-defined list of Indication	CHAR 100	Alphanumeric with special characters	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Province PET Centre	Province code where PET Centre of Choice is located	CHAR 2	Use official 2-letter abbreviation as per CIHI for Canadian provinces. See abbreviation for Canadian provinces in the Appendix B.	Required in order to see the list of available PET Centres within that province	New in 2017-18
Insured and Registry PreScan	PET Centre	The PET Centre of choice chosen by the referring physician.	CHAR 100	For the list of available PET centres see Appendix 13.11.	Required for scheduling scans.
Indication-Specific Information
Insured and Registry PreScan	Purpose	The field is available for colorectal cancer, esophageal cancer, germ cell tumour, lymphoma, melanoma, metastatic squamous cell carcinoma, nasopharyngeal cancer, non-small cell lung cancer, pancreatic cancer, small cell lung cancer, solitary pulmonary nodule and thyroid cancer. Indicates the purpose for the PET scan.	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	MRN	This field is available for all indications under "Disease Category: Oncology (paediatric)"	CHAR 100	Alphanumeric with special characters	Provision of information to PET Steering and/or Ministry and/or POGO	Updated in 2017-18
Insured and Registry PreScan	Section 1 - Cancer Type: Has this cancer diagnosis been pathologically proven?	This field is available for all indications under "Disease Category: Oncology (paediatric)"	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 2 - Reason for PET:	This field is available for all indications under "Disease Category: Oncology (paediatric)"	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 3 - Working Staging: Working Staging Before the PET Scan	This field is available for all indications under "Disease Category: Oncology (paediatric)"	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 3 - Working Staging: Please select reason for working staging	This field is available for all indications under "Disease Category: Oncology (paediatric)"	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 3 - Working Staging: Is your assessment based on imaging obtained prior to PET/CT?	This field is available for all indications under "Disease Category: Oncology (paediatric)"; but ONLY if in Section 2 the following options are chosen: Initial Staging; Rule out progression prior to further therapy; Suspected recurrence/relapse	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 4 - Treatment Plan: If PET were not available, your treatment plan would be:	This field is available for all indications under "Disease Category: Oncology (paediatric)"; but ONLY if in Section 2 the following option is chosen: Initial Staging	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 4 - Treatment Plan: Registered on or treated according to a clinical trial protocol or documented Institutional Standard of Care (SOC)	This field is available for all indications under "Disease Category: Oncology (paediatric)"; but ONLY if in Section 2 the following option is chosen: Initial Staging	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Section 4 - Treatment Plan: Protocol or documented SOC Name or Number	This field is available for all indications under "Disease Category: Oncology (paediatric)"; but ONLY if in Section 2 the following option is chosen: Initial Staging and if in Section 4 "Yes" is chosen for the following field "Registered on or treated according to a clinical trial protocol or documented Institutional Standard of Care (SOC)"	CHAR 100	Refer to Appendix 13.14 for the list of valid values	Provision of information to PET Steering and/or Ministry and/or POGO
Insured and Registry PreScan	Diagnosis	The field is available for colorectal cancer, esophageal cancer, germ cell tumour,lymphoma, melanoma, metastatic squamous cell carcinoma, nasopharyngeal cancer, non-small cell lung cancer, pancreatic cancer, small cell lung cancer, solitary pulmonary nodule and thyroid cancer. Indicates the patients diagnosis.	char100	See Appendix 13.14	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	Eligibility	The field is available for colorectal cancer, esophageal cancer, germ cell tumour, lymphoma, melanoma, metastatic squamous cell carcinoma, nasopharyngeal cancer, non-small cell lung cancer, pancreatic cancer, small cell lung cancer, solitary pulmonary nodule and thyroid cancer. Indicates eligibility of patient with a particular diagnosis for a PET scan.	CHAR 100	See Appendix 13.14	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	Indication Specific Data Primary	Available for colorectal cancer, esophageal cancer, lymphoma, melanoma, metastatic squamous cell carcinoma, nasopharyngeal cancer, non-small cell lung cancer, pancreatic cancer, small cell lung cancer, solitary pulmonary nodule. List of questions the referring physician must answer to demonstrate patient eligibility.	char1000	See Appendix 13.14	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	Indication Specific Data Secondary	Available for colorectal cancer, esophageal cancer, lymphoma, melanoma, metastatic squamous cell carcinoma, nasopharyngeal cancer, non-small cell lung cancer, pancreatic cancer, small cell lung cancer. List of questions the referring physician must answer to demonstrate patient eligibility. Secondary questions are dependent on primary questions.	char1000	See Appendix 13.14	Provision of information to PET Steering and/or Ministry.
Insured and Registry PreScan	Indication Specific Data Tertiary	Available for lymphoma. List of questions the referring physician must answer to demonstrate patient eligibility. Tertiary questions are dependent on secondary questions.	char1000	See Appendix 13.14	Provision of information to PET Steering and/or Ministry.
Relevant Imaging Studies
Insured and Registry PreScan	Prior Imaging Study	The type of imaging study.	char50	Type of imaging study that supports the PET request. See Appendix 13.7 for the pre-defined list of the imaging studies.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Prior Imaging Study - Other	Text free field "Other" that will be available when "Other" is selected in the prior imaging study field.	char100	Length: 0 - 100. Free text field.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Body Region	Body region of the imaging study.	char50	Body region of the provided imaging study. See Appendix 13.8 for pre-defined list of Body Region field.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Body Region - Other	Text free field "Other" that will be available when "Other" is selected in the Body region field.	char50	Length: 0 - 50. Free text field.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Date of Prior Imaging Study	The date imaging study was performed.	YYYYMMDD	Valid Date Value between 19000101 and current date. Default to today's date.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Imaging Study To Be:	How the imaging study will be made available, either faxed or attached via the eTool.	char50	Pre-defined options: Faxed Uploaded in Attached Files section	Provision of information to radiologist, PET Steering and/or Ministry.
Uploaded Files
Insured and Registry PreScan	File Type	Pre-defined list of supporting documents file types to be uploaded.	char500	Type of supporting documents for PET request. See Appendix 13.10 for the pre-defined list of the supporting document types.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	Select a File	Uploaded supporting document.	char100	Supporting file types: PDF, DOC, DOCX, XLS, XLSX, PPT, PPTX, TXT.	Provision of information to radiologist, PET Steering and/or Ministry.
Insured and Registry PreScan	File Type - Other	Text free field to provide the type of the supporting document. that will be available when "Other" is selected in the File Type field.	char100	Length: 0 - 100.Free text field.	Provision of information to radiologist, PET Steering and/or Ministry.
General Comments
Insured and Registry PreScan	General Comments	Free-form text field for user to provide comments related to PET request.	char500	Alphanumeric including special characters.	Provision of information to radiologist, PET Steering and/or Ministry.