Loading...

National Institute of Mental Health Data Archive (NDA) Sign In
NDA

Enter the email address associated with your existing NDA Account and click Continue Linking Process.

If you do not have an existing NDA account, click Go Back.

Warning Notice This is a U.S. Government computer system, which may be accessed and used only for authorized Government business by authorized personnel. Unauthorized access or use of this computer system may subject violators to criminal, civil, and/or administrative action. All information on this computer system may be intercepted, recorded, read, copied, and disclosed by and to authorized personnel for official purposes, including criminal investigations. Such information includes sensitive data encrypted to comply with confidentiality and privacy requirements. Access or use of this computer system by any person, whether authorized or unauthorized, constitutes consent to these terms. There is no right of privacy in this system.
National Institute of Mental Health Data Archive (NDA) Sign In
NDA

Success! An email is on its way!

Please check your email to complete the linking process. The link you receive is only valid for 30 minutes.

Check your spam or junk folder if you do not receive the email in the next few minutes.

Warning Notice This is a U.S. Government computer system, which may be accessed and used only for authorized Government business by authorized personnel. Unauthorized access or use of this computer system may subject violators to criminal, civil, and/or administrative action. All information on this computer system may be intercepted, recorded, read, copied, and disclosed by and to authorized personnel for official purposes, including criminal investigations. Such information includes sensitive data encrypted to comply with confidentiality and privacy requirements. Access or use of this computer system by any person, whether authorized or unauthorized, constitutes consent to these terms. There is no right of privacy in this system.
Create or Link an Existing NDA Account

Warning Notice

This is a U.S. Government computer system, which may be accessed and used only for authorized Government business by authorized personnel. Unauthorized access or use of this computer system may subject violators to criminal, civil, and/or administrative action. All information on this computer system may be intercepted, recorded, read, copied, and disclosed by and to authorized personnel for official purposes, including criminal investigations. Such information includes sensitive data encrypted to comply with confidentiality and privacy requirements. Access or use of this computer system by any person, whether authorized or unauthorized, constitutes consent to these terms. There is no right of privacy in this system.

NIMH Data Archive (NDA) Sign In or Create An Account
Update Password

You have logged in with a temporary password. Please update your password. Passwords must contain 8 or more characters and must contain at least 3 of the following types of characters:

  • Uppercase
  • Lowercase
  • Numbers
  • Special Characters limited to: %,_,!,@,#,$,-,%,&,+,=,),(,*,^,:,;
Update Password

Subscribe to our mailing list

Mailing List(s)
Email Format

You are now leaving the NIMH Data Archive (NDA) web site to go to:

Click on the address above if the page does not change within 10 seconds.

Disclaimer

NDA is not responsible for the content of this external site and does not monitor other web sites for accuracy.

Accept Terms
Data Access Terms - Decline Terms

Are you sure you want to cancel? This will decline terms and you will not be authorized for access.

NIMH Data Archive
NDA ABCD CCF OAI NIAAADA AMP SCZ HEAL

MRI Screening Form

224 Shared Subjects

Olin Research Center MRI Screening Form for Research Subjects and Patients
Clinical Assessments
Questionnaire
01/06/2014
mri_screening01
02/04/2021
View Change History
01
Definition
Submission Template
Query Element Name Data Type Size Required Description Value Range Notes Aliases
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?
Yes;No
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
Data Structure

This page displays the data structure defined for the measure identified in the title and structure short name. The table below displays a list of data elements in this structure (also called variables) and the following information:

  • Element Name: This is the standard element name
  • Data Type: Which type of data this element is, e.g. String, Float, File location.
  • Size: If applicable, the character limit of this element
  • Required: This column displays whether the element is Required for valid submissions, Recommended for valid submissions, Conditional on other elements, or Optional
  • Description: A basic description
  • Value Range: Which values can appear validly in this element (case sensitive for strings)
  • Notes: Expanded description or notes on coding of values
  • Aliases: A list of currently supported Aliases (alternate element names)
  • For valid elements with shared data, on the far left is a Filter button you can use to view a summary of shared data for that element and apply a query filter to your Cart based on selected value ranges

At the top of this page you can also:

  • Use the search bar to filter the elements displayed. This will not filter on the Size of Required columns
  • Download a copy of this definition in CSV format
  • Download a blank CSV submission template prepopulated with the correct structure header rows ready to fill with subject records and upload

Please email the The NDA Help Desk with any questions.

Additional Information
Training Privacy Policy Disclaimer Contact Us
External Resources
Accessibility FOIA OIG HHS Vulnerability Disclosure
NIH Logo HHS Logo USA Gov Logo
c725efb98f608e6bc0136950f08b0c3af2bde994