vs 1.0 - May 2011
Instructions: This form should be completed by the physicist together with submission of DDSI form
Name:
Email address :
EORTC site number : (4 digits max)
Site Name:
Patient SeqID :
RT protocol used
1.Technique used
other, specify
2.Relocation accuracy (mm)
3. Number of fractions
4. Fraction size (Gy)
5. Overall treatment time (days)
6. Treatment verification
7. Portal imaging dose taken into account
Comments
