|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
|
|
interview_age |
Integer |
|
Required |
Age in months at the time of the interview/test/sampling/imaging. |
0::1440
|
Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
|
|
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
test_date_fmri_prescreen |
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
gender |
Query
|
hight_met |
Float |
|
Recommended |
Hight metric |
|
|
height |
Query
|
weight_met |
Float |
|
Recommended |
Weight - Metric Unit |
|
999 = Missing; -999 = No Data
|
weight |
Query
|
q01_surgery |
Integer |
|
Recommended |
Have you had prior surgery or an operation of any kind? |
0;1
|
0 = No; 1 = Yes
|
previous_surgery |
Query
|
q02_surgery_date_type |
String |
150
|
Recommended |
If yes, please indicate date and type of surgery |
|
|
explain_surgery |
Query
|
q03_eye_injury |
Integer |
|
Recommended |
Have you had an injury to the eyes involving a metallic object (e.g.,metallic slivers, foreign body)? |
0;1
|
0 = No; 1 = Yes
|
|
|
q04_eye_injury_describe |
String |
150
|
Recommended |
If yes, please describe |
|
|
|
Query
|
q05_metallic_injury |
Integer |
|
Recommended |
Have you ever been injured by a metallic object or foreign body (e.g., BB, bullet, shrapnel, etc)? |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q06_metallic_injury_describe |
String |
150
|
Recommended |
If yes, please describe |
|
|
|
Query
|
q07_pregnant |
Integer |
|
Recommended |
If you are female, are you pregnant or suspect that you are pregnant? |
0;1
|
0 = No; 1 = Yes
|
pregnancy, pregnant |
Query
|
q08_claust_panic_attacks |
Integer |
|
Recommended |
Are you prone to claustrophobia or panic attacks? |
0;1
|
0 = No; 1 = Yes
|
q08_claustrophobia_panic_attacks |
Query
|
q09_aneurism_clip |
Integer |
|
Recommended |
Presence of: Aneurism Clip |
0;1
|
0 = No; 1 = Yes
|
aneurism_clip |
Query
|
q10_cardiac_pacemaker |
Integer |
|
Recommended |
Presence of: Cardiac Pacemaker |
0;1
|
0 = No; 1 = Yes
|
cardiac_pacemaker |
Query
|
q11_icd |
Integer |
|
Recommended |
Presence of: ICD |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q12_electronic_implant |
Integer |
|
Recommended |
Presence of: Electronic implant or device |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q13_magnetic_implant |
Integer |
|
Recommended |
Presence of: Magnetically-Activated Implant |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q14_neurostimulation_system |
Integer |
|
Recommended |
Presence of: Neurostimulation System |
0;1
|
0 = No; 1 = Yes
|
neurostimulator |
Query
|
q15_cochlear_implant |
Integer |
|
Recommended |
Presence of: Cochlear implant or implanted hearing aid |
0;1
|
0 = No; 1 = Yes
|
cochlear_implants |
Query
|
q16_insulin_infusion_pump |
Integer |
|
Recommended |
Presence of: Insulin or Infusion Pump |
0;1
|
0 = No; 1 = Yes
|
implanted_pumps |
Query
|
q17_dental_implant |
Integer |
|
Recommended |
Presence of: Dental implants; retainer; dentures |
0;1
|
0 = No; 1 = Yes
|
metal_hearingaid_dental |
Query
|
q18_artificial_link |
Integer |
|
Recommended |
Presence of: Artificial or Prosthetic Limb |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q19_braces_retainer |
Integer |
|
Recommended |
Presence of: Braces or Retainer |
0;1
|
0 = No; 1 = Yes
|
braces |
Query
|
q20_metallic_object |
Integer |
|
Recommended |
Presence of: Any external or internal metallic object |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q21_hearing_aid |
Integer |
|
Recommended |
Presence of: Hearing Aid |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q22_tattoos_piercings |
Integer |
|
Recommended |
Presence of: Tattoos/Piercings |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q23_tattoos_piercings_where |
String |
150
|
Recommended |
Where? |
|
|
explain_tatto |
Query
|
q24_medication_patchtes |
Integer |
|
Required |
Presence of: Medication Patches |
0;1;999
|
0 = No; 1 = Yes
|
|
Query
|
q25_intrauterine_device |
Integer |
|
Recommended |
Presence of: Intrauterine Device |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q26_intrauterine_device_type |
String |
150
|
Recommended |
What Kind? |
|
|
|
Query
|
q27_visit_1_signature |
Integer |
|
Recommended |
First Visit Participant Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q28_visit_1_reviewer_signature |
Integer |
|
Recommended |
Reviewer Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q29_visit_1_reviewer_role |
Integer |
|
Recommended |
Reviewer Role |
1;2;3
|
1 = MRI Technologist;2 = Olin Center Ph.D.;3 = Research Assistant
|
|
Query
|
q30_visit_2_signature |
Integer |
|
Recommended |
Second Visit Participant Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q31_visit_2_reviewer_signature |
Integer |
|
Recommended |
Reviewer Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q32_visit_2_reviewer_role |
Integer |
|
Recommended |
Reviewer Role |
1;2;3
|
1 = MRI Technologist;2 = Olin Center Ph.D.;3 = Research Assistant
|
|
Query
|
q33_visit_3_signature |
Integer |
|
Recommended |
Third Visit Participant Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q34_visit_3_reviewer_signature |
Integer |
|
Recommended |
Reviewer Signature and Date |
0;1
|
0 = No; 1 = Yes
|
|
Query
|
q35_visit_3_reviewer_role |
Integer |
|
Recommended |
Reviewer Role |
1;2;3
|
1 = MRI Technologist;2 = Olin Center Ph.D.;3 = Research Assistant
|
|
Query
|
surgical |
Integer |
|
Recommended |
Surgical implants (including IUD birth control devices) |
0;1
|
0=No; 1=Yes
|
iud |
|
surgical_s |
String |
50
|
Recommended |
Brief explanation of surgical implant |
|
|
explain_iud |
Query
|
piercing |
Integer |
|
Recommended |
Irremovable piercings |
0;1
|
0=No; 1=Yes
|
|
Query
|
eyelid |
Integer |
|
Recommended |
Eyelid springs/wires |
0;1
|
0=No; 1=Yes
|
|
Query
|
tattoo_head |
Integer |
|
Recommended |
Tattoos anywhere on the head |
0;1
|
0=No; 1=Yes
|
|
Query
|
tattoo_body |
Integer |
|
Recommended |
Massive or full body tattoos |
0;1
|
0=No; 1=Yes
|
|
Query
|
medication_current |
String |
50
|
Recommended |
Currently taking medication? |
|
|
takemed |
|
medication_name |
String |
255
|
Recommended |
Name of medication |
|
|
list_meds, medname |
Query
|
rhanded |
Integer |
|
Recommended |
Are you right handed? |
0;1
|
0=No; 1=Yes
|
|
Query
|
laying |
Integer |
|
Recommended |
Are you able to handle laying in an enclosed space for an hour? |
0;1
|
0=No; 1=Yes
|
|
Query
|
iec001b |
Integer |
|
Recommended |
Inclusion: Negative Urine Toxicology |
0;1;-9
|
0=No; 1=Yes; -9=Unknown
|
urinalysis |
Query
|
scanscheduled |
Integer |
|
Recommended |
Scan scheduled? |
0;1
|
0=No; 1=Yes
|
|
|
scan1_date |
Date |
|
Recommended |
Scan 1: Date of scan |
|
|
|
|
scan1_time |
String |
10
|
Recommended |
Scan 1: Time of scan |
|
|
|
|
scan2_date |
Date |
|
Recommended |
Scan 2: Date of scan |
|
|
|
|
scan2_time |
String |
10
|
Recommended |
Scan 2: Time of scan |
|
|
|
|
scan3_date |
Date |
|
Recommended |
Scan 3: Date of scan |
|
|
|
|
scan3_time |
String |
10
|
Recommended |
Scan 3: Time of scan |
|
|
|
|
scan4_date |
Date |
|
Recommended |
Scan 4: Date of scan |
|
|
|
|
scan4_time |
String |
10
|
Recommended |
Scan 4: Time of scan |
|
|
|
Query
|
scan_rason |
Integer |
|
Recommended |
If scan not scheduled, please specify reason |
1::3
|
1=Not interested; 2=Screen failure; 3=Other
|
|
|
scan_othersp |
String |
30
|
Recommended |
Scan no scheduled, if other please specify |
|
|
other_s |
Query
|
mri_mock |
Integer |
|
Recommended |
MRI MOCK-Pass? |
0;1
|
0=No; 1=Yes
|
|
Query
|
visit |
String |
60
|
Recommended |
Visit name |
|
|
|
|
comments_misc |
String |
4,000
|
Recommended |
Miscellaneous comments on study, interview, methodology relevant to this form data |
|
|
|
Query
|
mri_problem |
Integer |
|
Recommended |
Have you experienced any problem related to a previous MRI examination or MR procedure |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_medication |
Integer |
|
Recommended |
Are you currently taking or have you recently taken any medication or drug? |
0;1
|
0=No; 1=Yes
|
medications |
Query
|
mri_diabetes |
Integer |
|
Recommended |
Do you have diabetes? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_carhyp |
Integer |
|
Recommended |
Do you have cardiac hypertension? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_beta |
Integer |
|
Recommended |
Do you take beta blockers? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_sed |
Integer |
|
Recommended |
Are you taking sedatives? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_diur |
Integer |
|
Recommended |
Do you take diuretics? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_fev |
Integer |
|
Recommended |
Do you have a fever? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_preg |
Integer |
|
Recommended |
Are you pregnant or experiencing a late menstrual period? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_fert |
Integer |
|
Recommended |
Are you taking any type of fertility medication or having fertility treatments? |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_spcs |
Integer |
|
Recommended |
Presence of: spinal cord stimulator |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_elec |
Integer |
|
Recommended |
Presence of: Internal electrodes or wires |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_bone |
Integer |
|
Recommended |
Presence of: Bone growth/ bone fusion stimulator |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_dental |
Integer |
|
Recommended |
Presence of: dental implants; retainer; dentures |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_hvp |
Integer |
|
Recommended |
Presence of: heart valve prosthesis |
0;1
|
0=No; 1=Yes
|
prosthetic_heart_valve |
Query
|
mri_eyespr |
Integer |
|
Recommended |
Presence of: eyelid spring or wire |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_stent |
Integer |
|
Recommended |
Presence of: metallic stent, filter, or coil |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_shunt |
Integer |
|
Recommended |
Presence of: shunt |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_vascp |
Integer |
|
Recommended |
Presence of: vascular access port and/ or catheter |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_radsd |
Integer |
|
Recommended |
Presence of: radiation seeds or implants |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_swgnx |
Integer |
|
Recommended |
Presence of: Swan-Ganx or thermodilution catheter |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_medp |
Integer |
|
Recommended |
Presence of: Medication patch (Nicotine, Nitroglycerine) |
0;1
|
0=No; 1=Yes
|
metal_patch |
Query
|
mri_metfr |
Integer |
|
Recommended |
Presence of: Any metallic fragment or foreign body |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_wirmsh |
Integer |
|
Recommended |
Presence of: Wire mesh implant |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_tssexp |
Integer |
|
Recommended |
Presence of: Tissue expander |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_surgstpl |
Integer |
|
Recommended |
Presence of: Surgical staples, clips, or metallic sutures |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_jrepl |
Integer |
|
Recommended |
Presence of: Joint replacement |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_bnpn |
Integer |
|
Recommended |
Presence of: Bone/ joint pin, screw, nail, wire, plate, etc. |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_dntrs |
Integer |
|
Recommended |
Presence of: Dentures or partial plates |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_tttoo |
Integer |
|
Recommended |
Presence of: Tattoo or permanent makeup |
0;1
|
0=No; 1=Yes
|
tattoos |
Query
|
mri_pierce |
Integer |
|
Recommended |
Presence of: Body piercing jewelry |
0;1
|
0=No; 1=Yes
|
piercings |
Query
|
mri_hrad |
Integer |
|
Recommended |
Presence of: Hearing aid |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_other |
Integer |
|
Recommended |
MRI results - Other |
0;1
|
0=No;1=Yes
|
|
Query
|
mri_brpr |
Integer |
|
Recommended |
Presence of: Breathing problem or motion disorder |
0;1
|
0=No; 1=Yes
|
|
Query
|
mri_clstrph |
Integer |
|
Recommended |
Presence of: Claustrophobia |
0;1
|
0=No; 1=Yes
|
|
|
ct_4 |
Float |
|
Recommended |
Magnetization Transfer |
|
|
|
|
ct5 |
Float |
|
Recommended |
Stim intensity: 1.2 x MT |
|
|
|
|
mriyn |
Integer |
|
Recommended |
Was the MRI completed? |
0;1
|
0= No; 1= Yes
|
|
|
demo_26 |
Integer |
|
Recommended |
Do you CURRENTLY use tobacco or nicotine products (cigarettes, e-cigarettes, pipes, cigars, smokeless tobacco chew, dipping, pinching)? |
0;1
|
1 = Yes ; 0 = No
|
|
|
mrin2 |
Date |
|
Recommended |
Date of most recent nicotine use: |
|
|
|
|
mrin3 |
String |
20
|
Recommended |
Time of most recent nicotine use: |
|
|
|
|
aescode |
Integer |
|
Recommended |
Staff code number of person completing this form |
|
999= Missing Data
|
|
|
meas0 |
Date |
|
Recommended |
Date of patient measurements |
|
|
|
|
ct1 |
Float |
|
Recommended |
Measure of nasium to bottom edge of cap (in centimeters) |
|
|
|
|
depression |
Integer |
|
Recommended |
Depression |
0;1;-9
|
0=Not Selected; 1=Selected; -9=Missing (Question not answered)
|
history_of_depression |
|
medreason1 |
String |
250
|
Recommended |
Reason for taking medication 1 |
|
|
reason_for_taking_medicait |
|
explain_clips |
String |
150
|
Recommended |
Do you have or have you had: Aneurism Clip - If yes, please explain |
|
|
|
|
explain_pacemaker |
String |
150
|
Recommended |
Do you have or have you had: Cardiac Pacemaker - If yes, please explain |
|
|
|
|
explain_heartvalve |
String |
150
|
Recommended |
Do you have or have you had: Prosthetic heart valve - If yes, please explain |
|
|
|
|
explain_neurostimulator |
String |
150
|
Recommended |
Do you have or have you had: Neurostimulator - If yes, please explain |
|
|
|
|
explain_pumps |
String |
150
|
Recommended |
Do you have or have you had: Insulin or Infusion Pump - If yes, please explain |
|
|
|
|
explain_cochlear |
String |
150
|
Recommended |
Do you have or have you had: Cochlear implant or implanted hearing aid - If yes, please explain |
|
|
|
|
explain_metal_rodplatescrew |
String |
150
|
Recommended |
Presence of: Metal rods, plates, screws, etc. - If yes, please explain |
|
|
|
|
explain_metal |
String |
150
|
Recommended |
Do you have or have you had: Hearing Aid, dentures, retainer, braces - If yes, please explain |
|
|
|
|
injury_to_eye |
Integer |
|
Recommended |
Do you have or have you had: Any injury to the eyes |
0;1
|
0 = No; 1 = Yes
|
|
|
explain_eyeinjury |
String |
150
|
Recommended |
Do you have or have you had: Any injury to the eyes - If yes, please explain |
|
|
|
|
explain_pregnant |
String |
150
|
Recommended |
If you are female, are you pregnant or suspect that you are pregnant? - If yes, please explain |
|
|
|
|
explain_breast_feed |
String |
150
|
Recommended |
Are you currently breast feeding? - If yes, please explain |
|
|
|
|
explain_menieres |
String |
150
|
Recommended |
Do you have or have you had: Menieres disease - If yes, please explain |
|
|
|
|
explain_metal_patch |
String |
150
|
Recommended |
Presence of: Nicotine Patches - If yes, please explain |
|
|
|
|
mental_illnesses |
Integer |
|
Recommended |
Do you have or have you had: Mental illness |
0;1
|
0 = No; 1 = Yes
|
|
|
explain_mental_ill |
String |
150
|
Recommended |
Do you have or have you had: Mental illness - If yes, please explain |
|
|
|
|
explain_depression |
String |
150
|
Recommended |
Do you have or have you had: Depression - If yes, please explain |
|
|
|
|
neurological_illness |
Integer |
|
Recommended |
Do you have or have you had: Neurological illness |
0;1
|
0 = No; 1 = Yes
|
|
|
explain_neurological |
String |
150
|
Recommended |
Do you have or have you had: Neurological illness - If yes, please explain |
|
|
|
|
explain_piercing |
String |
150
|
Recommended |
Do you have or have you had: Body piercing jewelry - If yes, please explain |
|
|
|
|
hair_extensions |
Integer |
|
Recommended |
Do you have or have you had: Wig or hair extentions |
0;1
|
0 = No; 1 = Yes
|
|
|
explain_hair |
String |
150
|
Recommended |
Do you have or have you had: Wig or hair extentions - If yes, please explain |
|
|
|
|
contacts_glasses |
Integer |
|
Recommended |
Do you wear: Contacts |
0;1
|
0 = No; 1 = Yes
|
|
|
contacts_colored |
Integer |
|
Recommended |
Do you wear: Contacts - If you wear contacts, are they colored? |
0;1
|
0 = No; 1 = Yes
|
|
|
q20_1a |
Float |
|
Recommended |
Weight lbs |
|
Weight change greater than 30 percent from baseline will be flagged as an adverse event. Field should not be left blank. If missing, please use -7,-8, -9.
|
weight |
|
hist_trauma |
String |
10
|
Recommended |
History of head trauma |
Yes; No; NK; NS
|
NK= Not known; NS = Not sure
|
head_trauma |
|
headtraumaspecify |
String |
200
|
Recommended |
History of head trauma if yes specify |
|
|
explain_headtrauma |
|
feed4 |
Integer |
|
Recommended |
Are you currently breastfeeding or feeding pumped milk to your baby? |
0;1
|
0= No; 1= Yes
|
currently_breast_feeding |
|
meniere |
Integer |
|
Recommended |
Menieres Disease |
0 :: 1; -9
|
0=Not Selected; 1=Selected; -9=Missing (Question not answered)
|
meniere_s_disease |