877 / 1726
w = 7.5 cm
h = 4.7 cm
t = 4.8 cm
w
X
Dose of EBT
Gy
IIIA
Vagina:
7
cm
7.5cm
2cm
from urethra
4cm
from urethra
5cm
dd/mm/yy
/ /
Signature
At Diagnosis
At Brachytherapy
or
Cervix
Vagina
Parametria
Rectum or Bladder
Infiltration
Exophytic
Legend: Option 2