RTOG-放疗中胸部危及器官勾画-Organsat Risk OARs in Thoracic.ppt

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1、AtlasesforOrgansatRisk(OARs)inThoracicRadiationTherapy放疗中胸部危机器官勾画Feng-Ming(Spring)KongMDPhDLeslieQuintMDMitchellMachtayMDJeffreyBradleyMDOutlineofContentAtlasforlung,esophagus,andspinalcord肺、食管、脊髓的勾画Atlasforbrachialplexus臂丛神经的勾画Atlasforproximalbronchialtree近端支气管树的勾画Atlasf

2、orchestwall胸壁的勾画Atlasforpericardium,heartandgreatvessels(includingnormalpericardialrecesses)心包、心脏、大血管（包括正常心包凹陷）的勾画RTOG1106RequiredOARsStructureDescriptionStructuredefinitionandcontouringinstructionsLungLungs–PreGTV(compositeofCT1GTVandPETMTV)Bothlungsshouldbecontouredusin

3、gpulmonarywindows.Therightandleftlungscanbecontouredseparately,buttheyshouldbeconsideredasonestructureforlungdosimetry.Allinflatedandcollapsed,fibroticandemphysematiclungsshouldbecontoured,smallvesselsextendingbeyondthehilarregionsshouldbeincluded;however,preGTV,hilarsand

4、trachea/mainbronchusshouldnotbeincludedinthisstructure.HeartHeart&PericardiumTheheartwillbecontouredalongwiththepericardialsac.Thesuperioraspect(orbase)willbeginattheleveloftheinferioraspectofthepulmonaryarterypassingthemidlineandextendinferiorlytotheapexoftheheart.Esopha

5、gusEsophagusTheesophagusshouldbecontouredfromthebeginningattheleveljustbelowthecricoidtoitsentrancetothestomachatGEjunction.Theesophaguswillbecontouredusingmediastinalwindow/levelonCTtocorrespondtothemucosal,submucosa,andallmuscularlayersouttothefattyadventitia.Spinalcord

6、SpinalCanalThespinalcordwillbecontouredbasedonthebonylimitsofthespinalcanal.Thespinalcordshouldbecontouredstartingattheleveljustbelowcricoid(baseofskullforapextumors)andcontinuingoneveryCTslicetothebottomofL2.Neuroformaninesshouldnotbeincluded.BrachialplexBrachialPlexusTh

7、isisonlyrequiredforpatientswithtumorsofupperlobes.Onlytheipsilateralbrachialplexisrequired.ThiswillincludethespinalnervesexitingtheneuroforaminefromtopofC5totopofT2.IncontrasttopriorRTOGlungstudiesofcontouringthemajortrunksofthebrachialplexuswithinclusionofsubclavianandax

8、illaryvessels,thistrialrequestscontouringthenervesaccordingtotheCTanatomyoneveryotherCTslice.The