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Mayur Mayank
25.05.2015
 ICRU 50
 Organs at Risk : These are normal tissues whose radiation sensitivity may
significantly influence the treatmen...
 Brainstem
 Temporal lobe
 Eyes and lens
 Optic Nerves and Optic Chiasm
 Pituitary
 Temporomandibular Joint
 Inner ...
 Good Planning CT
 Good Immobilization setup
 Contrast imaging
 3mm slice thickness or smaller
 MRI fusion if require...
 RTOG Contouring guidelines
 Cranial Nerves IX-XII
 Brachial Plexus
 William H. Hall et al. ; International Journal of...
 Identify and contour C5, T1, and T2.
 Identify and contour the subclavian and axillary neurovascular bundle.
 Identify...
 Parotid Gland
 Lateral : Hypodense area corresponding to subcutaneous fat and more caudally
by the platysma.
 Medial :...
Radiotherapy and Oncology Vol 110, March 2014
 Submandibular Gland
 Cranial : Medial pterygoid muscle and the mylohyoid muscle
 Caudal : Fatty tissue
 Anterior : La...
Radiotherapy and Oncology Vol 110, March 2014
IJROBP Vol 75, Oct 2009
IJROBP Vol 75, Oct 2009
 Should be contoured on the Brain window
 The lateral boundary of the temporal lobe should be delineated on the soft
tis...
 Middle ear : The tympanic cavity and bony part of the Eustachian Tube (ET)
should be contoured individually
 The tympan...
1: Cochlea (basal turn)
2: Tensor tympani
muscle
3: Manubrium of
malleus
4: Facial nerve canal
5: Stapedius muscle
6: Roun...
Radiotherapy and Oncology Vol 110, March 2014
 RTOG Contouring atlas
 Cranial Nerves IX-XII :
http://www.rtog.org/CoreLab/ContouringAtlases/HNAtlases.aspx
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
Radiotherapy and Oncology Vol 110, March 2014
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
OAR Delineation in Head and Neck Cancers
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OAR Delineation in Head and Neck Cancers

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Atlas of Organs at Risk in Head and Neck Cancer Radiotherapy with Organ specific contouring guidelines

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OAR Delineation in Head and Neck Cancers

  1. 1. Mayur Mayank 25.05.2015
  2. 2.  ICRU 50  Organs at Risk : These are normal tissues whose radiation sensitivity may significantly influence the treatment planning and/or prescribed dose.  Divided into 3 classes : 1. Class I : Radiation lesions are fatal or result in severe morbidity. 2. Class II : Radiation lesions result in mild to moderate morbidity. 3. Class III : Radiation lesions are mild, transient, and reversible, or result in no significant morbidity.
  3. 3.  Brainstem  Temporal lobe  Eyes and lens  Optic Nerves and Optic Chiasm  Pituitary  Temporomandibular Joint  Inner Ear  Middle Ear  Mandible  Parotids  Submandibular glands  Spinal cord  Pharyngeal Constrictors  Brachial Plexus  Cranial Nerves IX-XII  Oesophagus  Thyroid
  4. 4.  Good Planning CT  Good Immobilization setup  Contrast imaging  3mm slice thickness or smaller  MRI fusion if required  Optimal CT window settings [Centre (HU) and width (HU) values] used to delineate the OARs  Brain: C35, W100  Bone: C450, W1,600  H&N: C35, W350  Parotid: C840 , W370
  5. 5.  RTOG Contouring guidelines  Cranial Nerves IX-XII  Brachial Plexus  William H. Hall et al. ; International Journal of Radiation Oncology*Biology*Physics, Volume 72, Issue 5, 1 December 2008, Pages 1362-1367  Salivary Glands  Van de Water et al. ; Radiotherapy and Oncology, Volume 93, Issue 3, December 2009, Pages 545- 552  Swallowing Apparatus  Piet Dirix et al. ; International Journal of Radiation Oncology*Biology*Physics, Volume 75, Issue 2, October 2009, Pages 385-392  Optic Nerves and Chiasm  Charles Mayo et al. ; International Journal of Radiation Oncology*Biology*Physics, Volume 76, Issue 3, Supplement, 1 March 2010, Pages S28-S35  Temporal lobe and Ear  Ying Sun et al. ; Radiotherapy and Oncology, Volume 110, Issue 3, March 2014, Pages 390-397
  6. 6.  Identify and contour C5, T1, and T2.  Identify and contour the subclavian and axillary neurovascular bundle.  Identify and contour anterior and middle scalene muscles from C5 to insertion onto the first rib.  To contour the brachial plexus OAR use a 5-mm diameter paint tool.  Start at the neural foramina from C5 to T1; this should extend from the lateral aspect of the spinal canal to the small space between the anterior and middle scalene muscles.  For CT slices, where no neural foramen is present, contour only the space between the anterior and middle scalene muscles.  Continue to contour the space between the anterior and middle scalene muscles; eventually the middle scalene will end in the region of the subclavian neurovascular bundle.  Contour the brachial plexus as the posterior aspect of the neurovascular bundle inferiorly and laterally to one to two CT slices below the clavicular head.  The first and second ribs serve as the medial limit of the OAR contour. IJROBP Vol 72, Dec 2008
  7. 7.  Parotid Gland  Lateral : Hypodense area corresponding to subcutaneous fat and more caudally by the platysma.  Medial : Posterior belly of the digastric muscle, the styloid process and the parapharyngeal space.  Cranial : Related to the external auditory canal and mastoid process.  Caudal : Protrudes into the posterior submandibular space inferior to the mandibular angle.  Anterior : Masseter muscle, the posterior border of the mandibular bone and the medial and lateral part of the pterygoid muscle.  Posterior : Anterior belly of the sternocleidomastoid muscle and the lateral side of the posterior belly of the digastric muscle.  The external carotid artery, the retromandibular vein and the extracranial facial nerve are prescribed to be enclosed in the parotid gland Radiotherapy and Oncology Vol 93, Dec 2009
  8. 8. Radiotherapy and Oncology Vol 110, March 2014
  9. 9.  Submandibular Gland  Cranial : Medial pterygoid muscle and the mylohyoid muscle  Caudal : Fatty tissue  Anterior : Lateral surface of the mylohyoid muscle and the hyoglossus muscle  Posterior : Parapharyngeal space and the sternocleidomastoid muscle  Lateral : Medial surface of the medial pterygoid muscle, the medial surface of the mandibular bone and the platysma.  Medial : Lateral surface of the mylohydoid muscle, the hyoglossus muscle, the superior and middle pharyngeal constrictor muscle and the anterior belly of the digastric muscle. Radiotherapy and Oncology Vol 93, Dec 2009
  10. 10. Radiotherapy and Oncology Vol 110, March 2014
  11. 11. IJROBP Vol 75, Oct 2009
  12. 12. IJROBP Vol 75, Oct 2009
  13. 13.  Should be contoured on the Brain window  The lateral boundary of the temporal lobe should be delineated on the soft tissue window  Should include the hippocampus, parahippocampal gyrus and uncus  The basal ganglia and insula are located anteriorly and superiorly to the hippocampus and parahippocampal gyrus and should be excluded  Delineation is better when fused with MRI Radiotherapy and Oncology Vol 110, March 2014
  14. 14.  Middle ear : The tympanic cavity and bony part of the Eustachian Tube (ET) should be contoured individually  The tympanic cavity is delineated  Laterally by the tympanic membrane, defined by the ligature between the two bony structures with an increased density along the anterior and posterior walls of the most medial aspect of the outer air canal  The sharp narrow region connected anteriorly to the ET, and the interface between the temporal bone and air at all other walls  Inner ear : Delineation of the cochlea and Internal Auditory Canal (IAC) should be done individually  The cochlea is located anteriorly to the IAC Radiotherapy and Oncology Vol 110, March 2014
  15. 15. 1: Cochlea (basal turn) 2: Tensor tympani muscle 3: Manubrium of malleus 4: Facial nerve canal 5: Stapedius muscle 6: Round window
  16. 16. Radiotherapy and Oncology Vol 110, March 2014
  17. 17.  RTOG Contouring atlas  Cranial Nerves IX-XII : http://www.rtog.org/CoreLab/ContouringAtlases/HNAtlases.aspx
  18. 18. Radiotherapy and Oncology Vol 110, March 2014
  19. 19. Radiotherapy and Oncology Vol 110, March 2014
  20. 20. Radiotherapy and Oncology Vol 110, March 2014
  21. 21. Radiotherapy and Oncology Vol 110, March 2014
  22. 22. Radiotherapy and Oncology Vol 110, March 2014
  23. 23. Radiotherapy and Oncology Vol 110, March 2014
  24. 24. Radiotherapy and Oncology Vol 110, March 2014
  25. 25. Radiotherapy and Oncology Vol 110, March 2014

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