Beam Direction RAO LAO. Pt supine. LL Treatment couch LPO RPO. WHA Consulting. Wilson Apollo

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1 Beam Direction AP RAO LAO Pt supine RL LL Treatment couch RPO LPO PA Wilson Apollo

2 DELIVERY TECHNOLOGY & CODING Based on FORDS Manual Equipment Dose Delivery Method Modality Code Comments Zeiss Intrabeam 50 kvp Linac Orthovoltage 21 Isotope-free. No radioactive source XOFT Axxent 50 kvp Linac Orthovoltage 21 Isotope-free. No radioactive source LIAC 10 by Sordina Electron Accelerator Electron 28 Max energy is 10 MeV LIAC 12 by Sordina Electron Accelerator Electron 28 Max energy is 12 MeV NOVAC by Sordina Electron Accelerator Electron 28 Mobetron Electron Accelerator Electron 28 Electron energies of 6 MeV, 9 MeV, 12 MeV Strut Assisted Volume Implant (SAVI) Ir-192 source HDR 52 Most applications are HDR, Mammosite Ir-192 source HDR 52 Most applications are HDR, Contura MLB Ir-192 source HDR 52 Most applications are HDR, Prepared by Wilson Apollo

3 Delivery Technology & Coding Based on STORE 2018 Manual Equipment Dose Delivery RT Modality Planning Comments Method Code Zeiss Intrabeam 50 kvp Linac 12, Brachytherapy, electronic 02 Isotope-free. No radioactive source XOFT Axxent 50 kvp Linac 12, Brachytherapy, electronic 02 Isotope-free. No radioactive source LIAC 10 by Sordina Electron Accelerator 04, Electron 01 Max energy is 10 MeV LIAC 12 by Sordina NOVAC 11 by Sordina Electron Accelerator 04, Electron 01 Max energy is 12 MeV Electron Accelerator 04, Electron 01 4 MeV to 10 MeV Mobetron Electron Accelerator 04, Electron 01 Electron energies of 6 MeV, 9 MeV, 12 MeV Strut Assisted Volume Implant (SAVI) Ir-192 source 09, Brachytherapy,, HDR Mammosite Ir-192 source 09, Brachytherapy,, HDR Contura MLB Ir-192 source 09, Brachytherapy,, HDR Prepared by Wilson Apollo

4 Report Date Name Date of Birth Sequence Number Medical Record Number Date of Diagnosis Phase I Primary Treatment Volume Phase I to Draining Lymph Nodes Phase I Treatment Modality Phase I External Beam Planning Technique Phase I Dose Per Fraction (cgy) Phase I Number of Fractions Phase I Total Dose (cgy) Phase II Primary Treatment Volume Phase II to Draining Lymph Nodes Phase II Treatment Modality Phase II External Beam Planning Technique Phase II Dose Per Fraction (cgy) Phase II Number of Fractions Phase II Total Dose (cgy) Total Dose in Radiation Course (cgy) Date Radiation Started Date Radiation Ended Number of Phases Radiation Treatment Discontinued Early? Radiation/Surgery Sequence Rad Onc Patient and Disease Information Phase I Radiation Phase II Radiation Course Summary

5 Abbreviations AP BED BID CAX cgy CTV Dmax DMLC DVH Dx EBRT EFRT ENLs EPID Fx GTV Gy IFD IFRT IGRT INRT ISRT ITV LAO LL LPO MLC MP MU OAR OBI ODI PA PSA PTV R&V RAO RBE RL RPO Rx SAD SART SBPT SDD SSD STD TBI TID TSEB USEFUL ABBREVIATIONS Term Anterior-Posterior Biologica Equivalent Dose Twice a day Central Axis Centigray, 1/100th of a Gy Clinical Tumor Volume Depth of Maximum Dose Dynamic Multileaf Collimator Dose-Volume Histogram Diagnosis External Beam Radiation Therapy Extended Field Radiation Therapy Extranodal Lymphomas Electronic Portal Imaging Device Fraction Gross Tumor Volum Gray, unit of absorbed dose Intra-field Distance (separation) Involved Field Radiation Therapy Image-guided Radiation Therapy Involved Nodal Radiation Therapy Intraoperative Radiation Therapy Involved Site RadiationTherapy Irradiated Tumor Volume Left Anterior Oblique Left Lateral Left Posterior Oblique Multileaf Collimator Midplane Monitor Unit Organs at Risk On-Board Imaging Optical Distance Indicator Posterior-Anterior Patient Support Assembly (treatment couch) Planning Tumor Volume Record and Verify Right Anterior Oblique Relative Biological Effect Right Lateral Right Posterior Oblique Prescription Source-to-Axis Distance Stereotactic Ablative Radiation Therapy Stereotactic Body Proton Therapy Source-to-Diaphragm Distance Source-to-Skin Distance Source-to-Target Distance Total Body Irradiation Three times a day Total Skin Electron Boost