To be completed by the radiophysicist group
EBMT Centre Identification Code (CIC) of radiophysicist unit (if CIC exists
integer
Hospital
text
Unit
text
Patient phone number
text
Fax
text
TARGET VOLUME defined as WHOLE BODY (including the skin)
NORMAL TISSUE LUNG, ORGAN MOST AT RISK
TRANSVERSE -
float
LONGITUDINAL +
float
LONGITUDINAL -
float
IF VARYING FROM T.B.I. DOSE BY 10% OR MORE
float
IF VARYING FROM T.B.I. DOSE BY 10% OR MORE
float
IF VARYING FROM T.B.I. DOSE BY 10% OR MORE
float
NORMAL TISSUE LUNG, ORGAN MOST AT RISK
mean of total at reference points of both lungs
float
estimated
integer
number of days, including the first day
integer
STARTING DATE
date
MIN.TIME GAP
integer
lung dose per fraction over irradiation time
float
instantaneous lung dose rate
float
NORMAL TISSUE OTHER ORGANS AT RISK
with respect to 100%, if varying from T.B.I. by 10% or more
float
with respect to 100%, if varying from T.B.I. by 10% or more
float
with respect to 100%, if varying from T.B.I. by 10% or more
float
with respect to 100%, if varying from T.B.I. by 10% or more
float
COMMENTS