1、 1 Atlases for Organs at Risk(OARs)in Atlases for Organs at Risk(OARs)in Thoracic Radiation TherapyThoracic Radiation Therapy 放疗中胸部危机器官勾画放疗中胸部危机器官勾画 Feng-Ming(Spring)Kong MD PhD Leslie Quint MD Mitchell Machtay MD Jeffrey Bradley MD 2 Outline of ContentOutline of Content Atlas for lung,esophagus,and
2、 spinal cord 肺、食管、脊髓的勾画 Atlas for brachial plexus 臂丛神经的勾画 Atlas for proximal bronchial tree 近端支气管树的勾画 Atlas for chest wall 胸壁的勾画 Atlas for pericardium,heart and great vessels(including normal pericardial recesses)心包、心脏、大血管（包括正常心包凹陷）的勾画 3 RTOG 1106 Required OARsRTOG 1106 Required OARs Structure Descr
3、iption Structure definition and contouring instructions Lung Lungs PreGTV(composite of CT1GTV and PETMTV)Both lungs should be contoured using pulmonary windows.The right and left lungs can be contoured separately,but they should be considered as one structure for lung dosimetry.All inflated and coll
4、apsed,fibrotic and emphysematic lungs should be contoured,small vessels extending beyond the hilar regions should be included;however,pre GTV,hilars and trachea/main bronchus should not be included in this structure.Heart Heart&Pericardium The heart will be contoured along with the pericardial sac.T
5、he superior aspect(or base)will begin at the level of the inferior aspect of the pulmonary artery passing the midline and extend inferiorly to the apex of the heart.Esophagus Esophagus The esophagus should be contoured from the beginning at the level just below the cricoid to its entrance to the sto
6、mach at GE junction.The esophagus will be contoured using mediastinal window/level on CT to correspond to the mucosal,submucosa,and all muscular layers out to the fatty adventitia.Spinalcord Spinal Canal The spinal cord will be contoured based on the bony limits of the spinal canal.The spinal cord s
7、hould be contoured starting at the level just below cricoid(base of skull for apex tumors)and continuing on every CT slice to the bottom of L2.Neuroformanines should not be included.Brachialplex Brachial Plexus This is only required for patients with tumors of upper lobes.Only the ipsilateral brachi
8、alplex is required.This will include the spinal nerves exiting the neuroforamine from top of C5 to top of T2.In contrast to prior RTOG lung studies of contouring the major trunks of the brachial plexus with inclusion of subclavian and axillary vessels,this trial requests contouring the nerves accord
9、ing to the CT anatomy on every other CT slice.The structure should extend at least 3 cm above the PTV.4 RTOG 1106 Optional OARsRTOG 1106 Optional OARs Structure Description Structure definition and contouring instructions Pericard Pericardium The structure of pericardium includes pericardial fatty t
10、issue,part of great vessels,normal recesses,pericardial effusion (if applicable)and heart chambers.Pericardium starts at one slice above the top of aortic arch,ends at the last slice of heart apex at diaphragm.Pericardium includes the heart.Greatves Aorta SVC IVC PV PA Great vessels Aorta Superior v
11、ena cava Inferior vena cava pulmonary vein pulmonary artery The great vessels should be contoured separately from the heart,using mediastinal windowing to correspond to the vascular wall and all muscular layers out to the fatty adventitia(5 mm from the contrast enhanced vascular wall).The great vess
12、el should be contoured starting at least 3 cm above the superior extent of the PTV and continuing on every CT slice to at least 3 cm below the inferior extent of the PTV.For right sided tumors,SVC will be contoured,and for left sided tumors,the aorta will be contoured.The ipsilateral PA will be deli
13、neated for tumor of either side.Pbtree Proximal Bronchial Tree This structure includes the distal 2 cm of the trachea,the carina,the right and left mainstem bronchi,the right and left upper lobe bronchi,the intermedius bronchus,the right middle lobe bronchus,the lingular bronchus,and the right and l
14、eft lower lobe bronchi.CW2cm Chest wall 2 cm outside of lung Chest wall can be autosegmented from the ipsilateral lung with a 2-cm expansion in the lateral,anterior,and posterior directions.Anteriorly and medially,it ends at the edge of the sternum.Posteriorly and medially,it stops at the edge of th
15、e vertebral body with inclusion of the spinal nerve root exit site.CW2cm which include intercostal muscles,nerves exclude vertebrate bodies,sternum and skin.This can be accomplished through auto-expansion of the ipsilateral lung(within 3 cm range of PTV).5 结结构构 描述 结构定义和勾画说明 肺肺 双肺 PreGTV (composite o
16、f CT1GTV and PETMTV)双肺勾画需要在肺窗勾画.左右肺分开勾画但作为一个器官来评价计量学。所有膨胀的、萎陷的纤维化的气肿的均应勾画，肺门区的小血管应包括在内。然而，preGTV该结构不应包括肺门、气管/大的支气管。心心脏脏 心脏&心包 心脏的勾画紧贴心包.上方即心底从肺静脉的下缘开始越过中线延伸到心尖底部.heart.食食管管 食管 食管的勾画从环状软骨下缘开始到进入腹腔处的食管胃连接处.在CT纵膈窗勾画食管,以区别粘膜/粘膜下层肌层和外膜的脂肪组织。脊脊髓髓 椎管 脊髓的勾画基于椎管的骨性限制。脊髓的勾画从环状软骨下缘开始（肺尖肿瘤从颅底）依次勾画每一张层面直至L2。椎间孔不应包括在内。臂臂丛丛 臂丛 臂丛的勾画仅仅在上叶肿瘤时勾画。仅仅同侧臂丛神经需要勾画。范围包括C5上缘到T2上缘从椎间孔穿出的脊神经。不同于先前的勾画包括锁骨下和腋血管在内的臂丛主干的RTOG肺癌研究，该研究要求在CT每一层面上依据解剖来勾画。臂丛至少勾画至PTV上3cm。6 结构 描述 结构定义与勾画说明 心包 心包 心包包括心包脂肪组织、部分大血管、正常凹陷、心包积液（如果有的话）和心室腔。心
