Deviations between simulation and first check films were quantitatively assessed for 95 unselected head and neck cancer patients. All measured deviations--calculated on the basis of a total of 190 simulation and 380 verification films--were normally distributed, with mean values of 0-3 mm and standard deviations of 3-5 mm. Of the absolute deviations, 50% and 95% were within 3 mm and 9 mm, respectively. These results should be considered in clinical practice when prescribing safety margins and adequate cut off doses for sparing critical organs in head and neck cancer.