1AtlasesforOrgansatRisk(OARs)inThoracicRadiationTherapy放疗中胸部危机器官勾画Feng-Ming(Spring)KongMDPhDLeslieQuintMDMitchellMachtayMDJeffreyBradleyMD2OutlineofContent•Atlasforlung,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•Atlasforchestwall•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3RTOG1106RequiredOARsStructureDescriptionStructuredefinitionandcontouringinstructionsLungLungs–PreGTV(compositeofCT1GTVandPETMTV)Bothlungsshouldbecontouredusingpulmonarywindows.Therightandleftlungscanbecontouredseparately,buttheyshouldbeconsideredasonestructureforlungdosimetry.Allinflatedandcollapsed,fibroticandemphysematiclungsshouldbecontoured,smallvesselsextendingbeyondthehilarregionsshouldbeincluded;however,preGTV,hilarsandtrachea/mainbronchusshouldnotbeincludedinthisstructure.HeartHeart&PericardiumTheheartwillbecontouredalongwiththepericardialsac.Thesuperioraspect(orbase)willbeginattheleveloftheinferioraspectofthepulmonaryarterypassingthemidlineandextendinferiorlytotheapexoftheheart.EsophagusEsophagusTheesophagusshouldbecontouredfromthebeginningattheleveljustbelowthecricoidtoitsentrancetothestomachatGEjunction.Theesophaguswillbecontouredusingmediastinalwindow/levelonCTtocorrespondtothemucosal,submucosa,andallmuscularlayersouttothefattyadventitia.SpinalcordSpinalCanalThespinalcordwillbecontouredbasedonthebonylimitsofthespinalcanal.Thespinalcordshouldbecontouredstartingattheleveljustbelowcricoid(baseofskullforapextumors)andcontinuingoneveryCTslicetothebottomofL2.Neuroformaninesshouldnotbeincluded.BrachialplexBrachialPlexusThisisonlyrequiredforpatientswithtumorsofupperlobes.Onlytheipsilateralbrachialplexisrequired.ThiswillincludethespinalnervesexitingtheneuroforaminefromtopofC5totopofT2.IncontrasttopriorRTOGlungstudiesofcontouringthemajortrunksofthebrachialplexuswithinclusionofsubclavianandaxillaryvessels,thistrialrequestscontouringthenervesaccordingtotheCTanatomyoneveryotherCTslice.Thestructureshouldextendatleast3cmabovethePTV.4RTOG1106OptionalOARsStructureDescriptionStructuredefinitionandcontouringinstructionsPericardPericardiumThestructureofpericardiumincludespericardialfattytissue,partofgreatvessels,normalrecesses,pericardialeffusion(ifapplicable)andheartchambers.Pericardiumstartsatonesliceabovethetopofaorticarch,endsatthelastsliceofheartapexatdiaphragm.Pericardiumincludestheheart.GreatvesAortaSVCIVCPVPAGreatvesselsAortaSuperiorvenacavaInferiorvenacavapulmonaryveinpulmonaryarteryThegreatvesselsshouldbecontouredseparatelyfromtheheart,usingmediastinalwindowingtocorrespondtothevascularwallandallmuscularlayersouttothefattyadventitia(5mmfromthecontrastenhancedvascularwall).Thegreatvesselshouldbecontouredstartingatleast3cmabovethesuperiorextentofthePTVandcontinuingoneveryCTslicetoatleast3cmbelowtheinferiorextentofthePTV.Forrightsidedtumors,SVCwillbecontoured,andforleftsidedtumors,theaortawillbecontoured.TheipsilateralPAwillbedelineatedfortumorofeitherside.PbtreeProximalBronchialTreeThisstructureincludesthedistal2cmofthetrachea,thecarina,therightandleftmainstembronchi,therightandleftupperlobebronchi,theintermediusbronchus,therightmiddlelobebronchus,thelingularbronchus,andtherightandleftlowerlobebronchi.CW2c...
