1、Atlases for Organs at Risk(OARs)in Thoracic Radiation Therapy放疗中胸部危机器官勾画,Feng-Ming(Spring)Kong MD PhDLeslie Quint MDMitchell Machtay MDJeffrey Bradley MD,第一页，共一百零九页。,Outline of Content,Atlas for lung,esophagus,and 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
2、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,第二页，共一百零九页。,RTOG 1106 Required OARs,第三页，共一百零九页。,RTOG 1106 Optional OARs,第四页，共一百零九页。,第五页，共一百零九页。,第六页，共一百零九页。,Atlas of lung,esophagus,and spinal cord 肺、食管、脊髓勾画,In
3、t J Radiat Oncol Biol Phys.2022 81(5):1442-57,第七页，共一百零九页。,第八页，共一百零九页。,Esophagus starts at the level of cricoidLung is visible now of the left apex食管从环状软骨开始，此时左侧肺尖可见,Spinal cord should also start at this level just below the cricord or from the base of skull C1 if scan is available,particularly when
4、the tumors involve neck or apex.脊髓亦应从环状软骨下一层开始，或从颅底C1脊髓可见时开始，尤其是当肿瘤侵犯颈部和肺尖时。,Lung,第九页，共一百零九页。,The structure of spinal cord should include the entire spinal canal to decrease contouring variations.脊髓应该包括整个椎管，且向下勾画的轮廓在变化,Esophagus and lung continue食管和肺继续向下勾画,Spinal cord,第十页，共一百零九页。,Esophagus,lung and
5、cord continue,Great vessels delineation is recommended,but not mandated.大血管、近端支气管推荐勾画但不强求,SVC=superior vena cava,Proximal bronchial tree delineation is recommended,but not mandated.,Proximal Bronchial Tree,第十一页，共一百零九页。,Esophagus,lung and cord continue,SVC=superior vena cava,great vessels start from
6、the level of aortic arch大血管从主动脉弓层面开始,Proximal bronchial tree starts at 2 cm above carina近端支气管树从隆突上2cm开始,第十二页，共一百零九页。,Esophagus,lung and cord continue,and great vessels,proximal bronchial tree,AA=ascending aorta升主动脉,PA=pulmonary artery肺动脉,DA=descending aorta降主动脉,SVC=superior vena cava上腔静脉,第十三页，共一百零九页
7、。,Esophagus,lung,cord,great vessels and proximal bronchial tree,AA=ascending aorta,PA=pulmonary artery,DA=descending aorta,SVC=superior vena cava,第十四页，共一百零九页。,Esophagus,lung,cord,great vessels and proximal bronchial tree,AA=ascending aorta,PA=pulmonary artery,DA=descending aorta,SVC=superior vena ca
8、va,第十五页，共一百零九页。,Esophagus,lung,cord,great vessels and proximal bronchial tree continue,AA=ascending aorta,PA=pulmonary artery,DA=descending aorta,SVC=superior vena cava,第十六页，共一百零九页。,AA=ascending aorta,PA=pulmonary artery,DA=descending aorta,SVC=superior vena cava,Esophagus,lung,cord,great vessels an
9、d proximal bronchial tree,第十七页，共一百零九页。,Esophagus,lung,cord continue,DA=descending aorta,第十八页，共一百零九页。,Esophagus ends at gastric-esophageal junction,Lung and cord continue,IVC=inferior vena cava下腔静脉,DA=descending aorta,第十九页，共一百零九页。,Lung ends,cord continues until the bottom of L2 Vertebral body肺结束，脊髓继续
10、直到L2椎体,IVC=inferior vena cava,DA=descending aorta,第二十页，共一百零九页。,Atlas for Brachial Plexus臂丛勾画,第二十一页，共一百零九页。,Locating the Brachial Plexus定位臂丛,Vein,artery,and nerve(VAN,anterior to posterior)will go over the 1st rib and under the clavicle静脉、动脉、神经VAN，后前位从第1肋和锁骨间经过Using coronal images,find the plane wher
11、e vascular/nerve structures(tubes and wires)pass between the 1st rib and clavicle用冠状位图像，找到血管神经穿过第1肋和锁骨处的层面Roughly contour these neuro-vascular tissues in this coronal plane(as shown in yellow)在冠状位上粗步勾画这些神经血管组织You will use these rough contours in the next step下一步要用到粗步勾画的轮廓,1st rib,clavicle,Timmermans
12、 Trick-1,第二十二页，共一百零九页。,Locating the Brachial Plexus,Project coronal contours onto axial images(yellow points shown on axial image)将冠状位勾画的轮廓投影到轴位In the region between the projected points,identify the VAN on either side.Contour the“N as the root(s)of the brachial plexus将所投影的点之间的区域内在每一层内找到血管神经，勾画出神经作为
13、臂丛的神经根Note:Finding the brachial plexus on the uninvolved side will help in finding it on the involved side找到不涉及臂丛的层面有助于找到臂丛Note:IV contrast greatly facilitates this task(see contrast in artery)静脉用比照剂用利于勾画,Timmermans Trick-1,第二十三页，共一百零九页。,Brachial plexus starts between C4 C5臂丛从C4C5开始,第二十四页，共一百零九页。,第二
14、十五页，共一百零九页。,第二十六页，共一百零九页。,第二十七页，共一百零九页。,第二十八页，共一百零九页。,第二十九页，共一百零九页。,第三十页，共一百零九页。,第三十一页，共一百零九页。,Vein,Artery,Nerve,第三十二页，共一百零九页。,Brachial plexus not visible any more,第三十三页，共一百零九页。,PBT should include the distal 2 cm of the trachea,the carina,the right and left mainstem bronchi,the right and left upper
15、lobe bronchi,the intermedius bronchus,the right middle lobe bronchus,the lingular bronchus,and the right and left lower lobe bronchi(a,b,c,d,e,f,g in the figure)PBT应该包括器官远端2cm、隆突、左右主支气管、左右上叶支气管、中间支气管、右中叶支气管、舌叶支气管、和左右下叶支气管。,Proximal Bronchial Tree(PBT)近端支气管树,PBT can be contoured by autosegmenting the
16、 airspace of the central airway with 3 mm expansion(2 mm for lobar bronchus,3 mm for main bronchus,4 mm for trachea),第三十四页，共一百零九页。,Proximal Bronchial Tree,The proximal bronchial tree can be contoured using mediastinal windows on the CT scan to correspond to the mucosal,submucosa,and cartilage rings and airway channels associated with these structures.It can be contoured as one structure,including the most inferior 2 cm of distal trachea and the proximal airways of both sides.Contouring the lobar