Radiation therapy
Institution
text
InstitutionNo.
text
Patient'sName
text
Patient'sI.D.No.
text
Option#
text
DESCRIPTION
text
DateRTstarts
date
SurgicalStage:T
text
SurgicalStage:N
text
SurgicalStage:M
text
BodySystem
text
PrimarySite
text
ENERGY
text
BRACHYTHERAPYIMPLANT/INSERTION/APPLICATION
text
specifysource(brachytherapy)
text
PLANNEDIMPLANTDOSE
double
FIELDS
text
Other,specify(fields)
text
ELECTRONS
text
SITEOFELECTRONRT
text
ALLFIELDSTREATEDEACHSESSION
text
FRACTIONATION
text
Other,specify(fractionation)
text
SPECIFYTIMEINTERVALBETWEENFRACTIONS
text
POINTOFPRIMARYTREATMENTPRESCRIPTION
text
Other,specify(pointsofprimarytreatmentprescription)
text
#OFINSERTIONS
text
Site of treatment
SITEOFPROTOCOLTREATMENT
text
NODES
text
DAILYDOSE
double
TOTALFX
double
TotalDoseValue
text
PLANNEDTOTALDOSE,TOTALFX
text
PLANNEDTOTALDOSE,TOTALDOSE
text
Critical structures
RadiationTherapyCriticalAnatomicSite
text
MAXIMUMDOSE
double
SPECIFYMETHODUSEDTORESTRICTDOSE
text
Ccrr Module For T2 Radiation Therapy Oncology Group Initial Protocol Treatment Form