1/22/2025 7:40:29 AM
RTOG 1304 Dosimetry Summary Form
Patient’s ID/ Benchmark
Institution’s Name
RTF #
Arm
Primary Prescription
PTV nodal Prescription
Boost Prescription
Technique(3D or/and IMRT)
Modality (photon or/and electron)
1 A
2 A
2 B
Comments:
Contact Information: