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Bladder Bladder PTV Bladder PTV Rectum Case 1 PTV Rectum Rectum • Bladder Bladder PTV PTV Sem Ves Bladder Sem Ves Sem Ves Rectum 1.0 cm • PTV Rectum Rectum • Bladder PTV Prostate Rectum Bladder Bladder PTV Prostate Rectum Prostate Rectum The proximal seminal vesicles (first 1.0 cm) should be included as part of the clinical target volume. The PTV encompasses the CTV (prostate and proximal seminal vesicles) with a 5 to 10 mm margin. The rectum extends superiorly to the level of the sacroiliac joints. PTV • Note: In these examples, not all slices are shown Prostate Prostate PTV Rectum PTV Rectum Prostate Case 1 PTV Rectum • Prostate PTV Rectum Penile bulb Rectum PTV Rectum Penile bulb Rectum • Penile bulb Rectum The penile bulb is the part of the bulbous spongiosum that starts inferior to the urogenital diaphragm. Rectum ends no more inferior than the ischial tuberosities. Bladder Bladder Bladder PTV Rectum Sem Ves Rectum Case 2 PTV Rectum • Bladder Sem Ves Bladder Prostate Prostate PTV Rectum Bladder Prostate Bladder PTV Rectum PTV Rectum • PTV Rectum Bladder Prostate PTV Rectum Prostate PTV Rectum In this case the seminal vesicles cannot be distinguished from prostate on the most superior slice. The seminal vesicles should be contoured above the gland, not to exceed 1.0 cm total length Prostate Prostate PTV Rectum Prostate PTV Rectum Prostate Case 2 PTV Rectum • • Prostate Prostate PTV Rectum PTV Penile bulb Rectum Penile bulb Rectum • Penile bulb Rectum Penile bulb Rectum Rectum In some cases the distance from the penile bulb and the PTV will be short, or even overlapping. Penile bulb, defined for this protocol, ends as the penile urethra moves anterior. Note: In these examples, not all slices are shown Sagittal and lateral DRR demonstrating anatomical relationships Rectum Bladder Rectum 1.0 cm PTV Bladder Penile Bulb Penile Bulb • Avoid over distension of bladder or rectum at simulation. – This may contribute to systematic errors during therapy – Relative DVHs may be deceptively good.
