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Table 2 Gathering major pitfalls of two cases among 94 treatment plans from the 47 institutions through the dummy-run test

From: Dummy-run for standardizing plan quality of intensity-modulated radiotherapy for postoperative uterine cervical cancer: Japan Clinical Oncology Group study (JCOG1402)

ItemNo. of deviationsContents (N = 94)
Nodal CTV
 27Caudal margin of the obturator lymph node area is the superior part of the obturator foramen.
 14Caudal margin of the presacral lymph node area is the lower level of S2 or cranial section of the piriform muscle.
 13Adipose connective tissue between lateral surface of vertebral body and psoas muscle is included in the CTV.
 13Caudal margin of the external iliac lymph node area is the superior aspect of the femoral head.
 5Cranial margin of the common iliac lymph node area is aortic bifurcation.
 2Bone or muscle is excluded from the CTV.
 9Others
CTV vaginal cuff
 19Anterior margin of the CTV vaginal cuff is the posterior border of the bladder or retropubic pad of fat.
 16Posterior margin of the CTV vaginal cuff is the anterior part of the mesorectal fascia or anterior wall of the rectum.
 13Cranial margin of the CTV vaginal cuff is 1–1.5 cm cranial from the most cranial vaginal marker/gauze.
 11Lateral margin of the CTV vaginal cuff is the medial edge of the internal obturator, piriformis, coccygeus, iliococcygeus, or puborectalis muscle; the ishiorectal fossa should be excluded from the CTV vaginal cuff.
 4Caudal margin of the CTV vaginal cuff is 3–4 cm caudal from the most cranial vaginal marker/gauze or at lowest level of the obturator foramen, whichever is lower.
Bowel bag
 9Cranial margin in the protocol was not adhered to, leading to inaccuracy of dosimetric evaluation.
 7A part of the rectum was included.
 7Caudal margin was inadequate, and it should be the lowest part of the bowel.
 3Bladder should be excluded from the bowel
 17Others
f) Pelvic bone
 13Delineation region in the protocol was not adhered to, leading to inaccuracy of dosimetric evaluation.
 10Bone marrow and intervertebral disc were not partially included, leading to inaccuracy of dosimetric evaluation for hematotoxicity.
 16Others
g) Dose distribution
 10Insufficient 95% dose coverage.
 6Insufficient 105% dose coverage.
 10Insufficient dose sparing of 40 Gy.