Download Standard Contour Nomenclature V1.4

Standardised Anatomical
Nomenclature
for Radiotherapy Planning
This mapping of anatomical names is based on the Foundational Model of Anatomy1. The
reason for this is that the FMA is a formal ontology which means that it embodies the
relationships that exist between other anatomic structures. Relationships such as
is_inferior_to and is_drained_by are catered for and can be manipulated by computers.
Although developed independently, this nomenclature also uses patterns proposed by the
ATC 2 but extends it to achieve oncologist-specific aims.
The following pattern of naming is determined as a logical sequence to permit
standardisation across multiple departments. When DICOM-RT files are finally shared and
collated, the use of standardised names will permit meaningful comparison of plans. The
document address volumes and contours to reduce confusion.
For external sites who may wish to use a different but logical schema, this schema can be
used as a template. If the local schema relates back to the FMA number, translation between
schemas is enabled. This schema is the Illawarra schema and it means that the hard work
has been done already if implemented. The list should be updated as required and
redistributed when changed. To this end, the current document will be uploaded online.3
References
1. Structural Informatics Group at the University of Washington. Foundational Model of Anatomy. at
<http://sig.biostr.washington.edu/projects/fm/AboutFM.html>
2. Santanam, L. et al. Standardizing Naming Conventions in Radiation Oncology. International journal of radiation oncology, biology,
physics 83, 1344–1349 (2012).
3. Miller, A. A. Standardised Nomenclature for Radiation Oncology Planning | Andrew Miller - Academia.edu. at
<https://www.academia.edu/5273434/Standardised_Nomenclature_for_Radiation_Oncology_Planning>
4. Ng, M. et al. Australasian Gastrointestinal Trials Group (AGITG) Contouring Atlas and Planning Guidelines for Intensity-Modulated
Radiotherapy in Anal Cancer. International Journal of Radiation Oncology*Biology*Physics 83, 1455–1462 (2012).
5. Myerson, R. J. et al. Elective Clinical Target Volumes for Conformal Therapy in Anorectal Cancer: A Radiation Therapy Oncology Group
Consensus Panel Contouring Atlas. International Journal of Radiation Oncology*Biology*Physics 74, 824–830 (2009).
6. Grégoire, V. et al. Delineation of the neck node levels for head and neck tumors: A 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC
CTG, NCRI, RTOG, TROG consensus guidelines. Radiotherapy and Oncology doi:10.1016/j.radonc.2013.10.010
Professor A. Andrew Miller
B.Med, B.Sc, Grad.Dip.Ed, M.Inf.CommTech(Res), FRANZCR, FACHI
Senior Staff Specialist, Radiation Oncology
Illawarra Cancer Care Centre
D:\DROPBOX\DOCUMENTSARTICLES\STANDARDISEDNOMENCLATURE\STANDARD CONTOUR NOMENCLATURE V1.4.DOCX
14/04/2014 9:37 PM
Contents
1.
2.
3.
4.
5.
6.
7.
8.
9.
Names for Contours of Anatomy
Planning Risk Volumes
Names for Volumes of Risk
The list of Anatomical Names Standardised against the FMA
Pelvic & intra-abdominal lymph chains
Head & Neck Lymphatic Chains
APPENDIX 1 : Use of the Document
APPENDIX 2 : Suggestions for scripting
APPENDIX 3 : Cheat Sheet
1. Names for Contours of Anatomy
All OAR names are in capitals. Some OAR names may be truncated as there is a
restriction on the length of names in the DICOM format. The names are specified so
that the identifier is unique. Where a unique name can used to represent a single
entity, a single word is preferred and substituted (e.g., the hyoid bone becomes
'HYOID'). Likewise, there are standardised additions for laterality (_R/L) and
description.
The usefulness of this approach derives from the ability of a site to undertake DVH
analysis of OARs by using a single report on the DICOM-RT file, and then being able to
use that report anywhere without alteration when the OAR names are identical.
If the definition of the anatomical structure is in question, please consult the FMA
Explorer on the website1 to adjudicate.
For the sake of interoperability later, the important part of this table is the FMAID and
the definition of this FMA-described organ. The joining of several organ parts (e.g.,
upper femur) likewise can specify the FMAIDs used.
Should you substitute different words for the OAR names here then do three things:
i. record the alternate name
ii. use the same name for all oncologists within the same unit
iii. use the same name all the time within the same unit
Where organ contours are being produced, the use of auto-contouring based on CT
numbers will result in a reproducible result, more so than free hand drawing. In the
coming age of adaptive radiotherapy, this contouring technique is even more
meaningful in trying to achieve reproducibility in contouring.
2. Planning Risk Volumes
The PRV is a construct which indicates how an organ at risk should be avoided
during plan construction. The PRV is always constructed from a contoured
organ. The organ is deemed to be ‘at risk’, and predicted to have an impact on
plan appearance. Organs at Risk (OAR) can be sub-classified:
i. Critical structures which have a maximum dose allowable that may be
achieved at the expense of PTV coverage.
The normal examples are the SPINALCORD and BRAINSTEM. These
organs will have their dose limited to a maximum, usually determined
by documents such as those derived from QUANTEC.
ii. Expendable structures which have a desired dose but not at the
expense of PTV coverage.
The normal examples are PAROTID, LENS, KIDNEYS and OESOPHAGUS.
These organs may be entirely expendable (e.g., LENS), or partially
expendable (KIDNEYS).
The PRVs for each are manufactured in different ways
iii. CRITICAL STRUCTURE_PRV
1. STRUCTURE_PRV = STRUCTURE + [MOTION EXPANSION]
This will mean that the STRUCTURE_PRV may overlap the PTV
indicating that the STRUCTURE_PRV should be spared in
preference to PTV coverage.
iv. EXPENDABLE STRUCTURE_PRV
1. STRUCTURE _PRV = STRUCTURE +[MOTION EXPANSION] – PTV
This will mean that the STRUCTURE_PRV will not overlap the
PTV, indicating that PTV coverage is preferred. The DVH should
be assessed to ensure that the STRUCTURE doses are not
excessive (e.g., KIDNEY_TOTAL V18Gy>80%, LUNG_TOTAL
V20Gy>60%)
2. Names for Volumes of Risk
There are three volumes that require specification. The logical naming of these volumes
requires an understanding of definitions of the volumes.
a. GTV
Each gross tumour volume exists in one of three varieties – primary or Tumour,
draining nodes or Nodes, and finally Metastases. The proposal is that these suffixes be
added without spacer to the GTV, with numbers used to indicate individual masses if
desired.
a. GTVp
the primary as visualised on the planning imaging scans
b. GTVn
an involved node (single) or multiple involved nodes where no differentiation
is required
i. GTVn5
the fifth involved node volumed , if you wish to distinguish it from the
first four
c. GTVm
a single metastasis or multiple metastases where no differentiation is required
i. GTVm2
the second metastasis volumed
b. CTV
Each GTV will have an associated CTV which related to a risk-estimated expansion
trimmed to unbreached anatomical boundaries where the risk estimates approach
zero. The use of CTV1, CTV2, etc is to be avoided on the basis that it does not define
the reason for the CTV, nor its attendant risk.
a. CTVp
this volume is not a 0.5, 1 or 2 cm expansion of the GTVp, it should be drawn to
match the anatomical boundaries distant to the GTVp boundary where the
probability of tumour breach falls to zero.
b. CTVn
this volume is an expansion which is clipped at anatomical boundaries, since
the extent of extracapsular extension in in situ nodes is unknown unless there
is obvious change in fat density, at present expansions of less than 0.5cm
cannot be justified, but whether it is 0,5, 1 or 2cm is a matter of personal risk
estimation. It is difficult to see how more than 2cm could be justified if
intervening fat is normal on imaging. The volumes should be produced in the
same way as CTVp above (i.e., to produce CTVn1, CTVn2, etc.) with one
addition.
i. CTVn0
this is, the ‘node negative’ neck, which is an anatomical volume in the
neck volume which is devoid of any involved nodes and outside the risk
assessed expansion on involved nodes. This volume should be drawn
around and exclude the CTVn. Modern software allows for overinclusive volumes to be automatically trimmed.
It is understood that some oncologists wish to define two CTVn0 areas
of moderate and low risk and deliver different doses. In the case of
three dose levels define the CTVp/CTVn (high dose), CTVn0a (medium
dose) and CTVn0b (low dose). CTVn0a/b will relate to different
contours (contour the nodal areas at risk separately).
c. CTVm
this volume is not a 0.5, 1 or 2 cm expansion of the GTVm, it should be drawn
to match the anatomical boundaries distant to the GTVp boundary where the
probability of tumour breach falls to zero.
c. PTV
The definition of the PTV is a geometric expansion of the CTVs which can be grouped
automatically in current software with isotropic or anisotropic expansions to form
PTVs which are to receive a particular dose. For this reason, the PTV is annotated by a
number representing the number of centiGray (cGy) desired in the prescription. The
reason for using centiGray revolves around the possible ambiguity of the decimal
point in the IT world.
a. PTV7000
this is a volume including all CTVs to which the radiation oncologist required a
total dose of 70Gy.
b. PTV7000_3
this is the same volume where an isotropic expansion margin of 3mm has been
used. In the case of an anisotropic volume, no suffix should be used.
d. TBV
Tumour Bed Volume is optional and a thing volume where the sides of the operative
bed have joined or are separated by fluid collection.
Notes:
1.
** Under no circumstances is the PTV ever drawn or manipulated by hand.
2.
It should be possible to specify PTV construction based on the specified CTVs
present in the plan. For example,
PTV6000 = CTVp + CTVn1 + CTVn2 +CTVn0 + 3mm
PTV7000 = CTVp + CTVn1 +CTVn2 + 3mm
It is worth noting that this process will overlap PTV7000 on PTV6000. This has
no implications for planning as success in covering the 7000 will also
successfully cover the PTV6000. If separate, non-overlapping PTVs are
preferred, it is easier to define the highest dose first and then use that PTV as an
exclusion volume:
#1
#2
PTV7000 = CTVp + CTVn1 +CTVn2 + 3mm
PTV6000 = CTVn0 + 3mm – (PTV7000)
Change Log
V1.4
added mediastinal lymph node groups – LN_MED_1234567810_R/L
altered H&N lymph node groups from LN_1a2a345_R/L to LN_HN_1a2a345_R/L
V1.3
added hippocampus
added TBV
The List of Anatomical names standardised against the FMA
Standard Nomenclature
Root Name
OAR Name
FMA number
(FMAID)
Right Pectoral axillary lymphatic
chain
Right Central axillary lymphatic chain
Right Apical axillary lymphatic chain
Right Axillary lymphatic chain
Left Pectoral axillary lymphatic chain
Left Central axillary lymphatic chain
Left Apical axillary lymphatic chain
Left Axillary lymphatic chain
Breast
LNAx1_R
LN_AX1_R
73252
Lymphatic
Primary
Region
Chest
LNAx2_R
LNAx3_R
LNAx_R
LNAx1_L
LNAx2_L
LNAx3_L
LNAx_L
BREAST
73262
73264
73249
73253
73263
73265
73250
Lymphatic
Lymphatic
Chest
Chest
Chest
BRONCHUS
Respiratory
Chest
Carina of trachea
Diaphragm
Heart
Anterior interventricular branch of
left coronary artery
Lung - lower lobe of left
Lung - upper lobe of left
Lung - lower lobe of right
Lung - middle lobe of right
Lung - upper lobe of right
Lung
CARINA
DIAPHRAGM
HEART
LAD
73124
73125
26661
26662
7465
13295
7088
Endocrine
Bronchial tree
LN_AX2_R
LN_AX3_R
LN_AX_R
LN_AX1_L
LN_AX2_L
LN_AX3_L
LN_AX_L
BREAST_R
BREAST_L
BRONCHUS_R
BRONCHUS_L
CARINA
DIAPHRAGM
HEART
A_LAD
Respiratory
Muscular
Vascular
Vascular
Chest
Chest
Chest
Chest
Respiratory
Respiratory
Respiratory
Respiratory
Respiratory
Respiratory
Chest
Chest
Chest
Chest
Chest
Chest
Intestinal
Vascular
Vascular
Skeleton
Chest
Chest
Chest
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
LUNG_LLL
LUNG_LUL
LUNG_RLL
LUNG_RML
LUNG_RUL
LUNG
Esophagus
Pulmonary artery
Pulmonary vein
First Rib
OESOPHAGUS
PULMONARY ARTERY
PULMONARY VEIN
RIB1
Tenth rib
RIB10
Eleventh rib
RIB11
Twelfth rib
RIB12
Second rib
RIB2
LUNG_LLL
LUNG_LUL
LUNG_RLL
LUNG_RML
LUNG_RUL
LUNG_TOTAL
LUNG_R
LUNG_L
OESOPHAGUS
A_PULM
V_PULM
RIB1_R
RIB1_L
RIB10_R
RIB10_L
RIB11_R
RIB11_L
RIB12_R
RIB12_L
RIB2_R
3862
7371
7370
7337
7383
7333
68877
7309
7310
7131
66326
66643
7857
7987
8445
8472
8531
8532
8533
8534
7882
Type
Secondary
Region
UpperAbdo
Third rib
RIB3
Fourth rib
RIB4
Fifth rib
RIB5
Sixth rib
RIB6
Seventh rib
RIB7
Eighth rib
RIB8
Ninth rib
RIB9
Scapula
SCAPULA
Superior vena cava
Trachea
Brain
Brainstem
Cerebellum
Cerebrum
Optic chiasm
Abducens nerve
SVC
TRACHEA
BRAIN
BRAINSTEM
CEREBELLUM
CEREBRUM
CHIASM
CNVI
Spinal accessory nerve
CNXI
Eyeball
EYE
Optic nerve
OPTICN
Orbit
ORBIT
Pineal body
Pituitary gland
Pons
Spinal cord
Hippocampus
PINEAL
PITUITARY
PONS
SPINALCORD
HIPPOCAMPUS
Femur
FEMUR BASE
RIB2_L
RIB3_R
RIB3_L
RIB4_R
RIB4_L
RIB5_R
RIB5_L
RIB6_R
RIB6_L
RIB7_R
RIB7_L
RIB8_R
RIB8_L
RIB9_R
RIB9_L
SCAPULA_R
SCAPULA_L
SVC
TRACHEA
BRAIN
BRAINSTEM
CEREBELLUM
CEREBRUM
CHIASM
CNVI
CNVI_R
CNVI_L
CNXI_R
CNXI_L
EYE_R
EYE_L
OPTICN_R
OPTICN_L
ORBIT_R
ORBIT_L
PINEAL
PITUITARY
PONS
SPINALCORD
HIPPOCAMPUS
HIPPOCAMPUS_R
HIPPOCAMPUS_L
BOF_R
BOF_L
8012
7909
8039
7957
8148
8066
8093
8175
8202
8229
8256
8283
8310
8364
8391
13395
13396
4720
7394
50801
79876
67944
62000
62045
50867
50886
50887
50897
50899
12514
12515
50875
50878
53082
53083
62033
13889
67943
7647
275020
275022
275024
32845
32846
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Skeleton
Chest
Vascular
Respiratory
Neural
Neural
Neural
Neural
Neural
Neural
Chest
Chest
CNS
CNS
CNS
CNS
CNS
CNS
Neural
CNS
Neural
CNS
H&N
Neural
CNS
H&N
Neural
CNS
H&N
Neural
Neural
Neural
Neural
Neural
CNS
CNS
CNS
CNS
CNS
Skeleton
Extremities
H&N
H&N
H&N
H&N
H&N
Femur
FEMUR WHOLE
Fibula
FIBULA
Femur
FEMUR NECK
Humerus
HUMERUS
Radius
RADIUS
Femur
FEMUR SHAFT
Arytenoid cartilage
ARYTENOID
Atlas
Axis
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Clavicle
C1
C2
C3
C4
C5
C6
C7
C8
CLAVICLE
Oculomotor nerve
CNIII
Glossopharyngeal nerve
CNIX
Facial nerve
CNVII
Hypoglossal nerve
CNXII
Cochlea
COCHLEA
Cricoid cartilage
Digastric muscle
CRICOID
DIGASTRIC
Hyoid bone
Lacrimal gland
HYOID
LACRIMAL
FEMUR_R
FEMUR_L
FIBULA
FIBULA_R
FIBULA_L
HOF_R
HOF_L
HUMERUS_R
HUMERUS_L
RADIUS_R
RADIUS_L
SOF_R
SOF_L
ARYTENOIDs
ARYTENOID_R
ARYTENOID_L
24474
24475
24479
24480
24481
32842
32843
23130
23131
23464
23465
32848
32849
Skeleton
Extremities
Skeleton
Extremities
Skeleton
Extremities
Skeleton
Extremities
Skeleton
Extremities
Skeleton
Extremities
55109
55113
55114
Skeleton
H&N
VB_C1
VB_C2
VB_C3
VB_C4
VB_C5
VB_C6
VB_C7
VB_C8
CLAVICLE_R
CLAVICLE_L
CNIII_R
CNIII_L
CNIX
CNIX_R
CNIX_L
CNVII_R
CNVII_L
CNXII_R
CNXII_L
COCHLEA_R
COCHLEA_L
CRICOID
DIGASTRIC_R
DIGASTRIC_L
HYOID
LACRIMAL_R
LACRIMAL_L
12519
12520
12521
12522
12523
12524
12525
23892
13322
13323
50879
50880
50870
50892
50894
50888
50889
50901
50903
60202
60203
9615
46292
46293
52749
59102
59103
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
H&N
H&N
H&N
H&N
H&N
H&N
H&N
H&N
H&N
Chest
Neural
H&N
CNS
Neural
H&N
CNS
Neural
H&N
CNS
Neural
H&N
CNS
Neural
H&N
CNS
Skeleton
Muscular
H&N
H&N
Skeleton
Endocrine
H&N
H&N
CNS
Larynx
Lens
LARYNX
LENS
Mandible
Masseter
MANDIBLE
MASSETER
Parotid gland
PAROTID
Platysma
PLATYSMA
Pterygoid muscles
Lateral pterygoid
Pterygoid muscles
Medial pterygoid
Sternocleidomastoid
SCM
Submandibular gland
SUBMAND
Brachial Plexus
Thyroid
Thyroid cartilage
Anal canal
Urinary Bladder
Large intestine
Common iliac artery
BRACHIALP
THYROID
THYROIDCART
ANUS
BLADDER
COLON
ILIAC_CA
Common iliac vein
ILIAC_CV
External iliac artery
ILIAC_EA
External iliac vein
ILIAC_EV
Internal iliac artery
ILIAC_IC
Internal iliac vein
ILIAC_IV
Ilium
ILIUM
Ischium
ISCHIUM
Lumbar Vertebra
Lumbar Vertebra
Lumbar Vertebra
Lumbar Vertebra
L1
L2
L3
L4
LARYNX
LENS_R
LENS_L
MANDIBLE
MASSETER_R
MASSETER_L
PAROTID_R
PAROTID_L
PLATYSMA_R
PLATYSMA_L
PTERYGOIDL_R
PTERYGOIDL_L
PTERYGOIDM _R
PTERYGOIDM _L
SCM_R
SCM_L
SUBMAND_R
SUBMAND_L
BRACHIALP
THYROID
THYROID_C
ANUS
BLADDER
COLON
A_ILIAC_C_R
A_ILIAC_C_L
V_ILIAC_C_R
V_ILIAC_C_L
A_ILIAC_E_R
A_ILIAC_E_L
V_ILIAC_E_R
V_ILIAC_E_L
A_ILIAC_I_R
A_ILIAC_I_L
V_ILIAC_I_R
V_ILIAC_I_L
ILIUM_R
ILIUM_L
ISCHIUM_R
ISCHIUM_L
VB_L1
VB_L2
VB_L3
VB_L4
55097
58242
58243
52748
48997
48998
59797
59798
45739
45740
49016
49017
49012
49013
13408
13409
59802
59803
5906
9603
55099
15703
15900
7201
14765
14766
21387
21388
18806
18807
18885
18886
18809
18810
18887
18888
16590
16591
16593
16594
13072
13073
13074
13075
H&N
Neural
H&N
H&N
Skeleton
Muscular
H&N
H&N
H&N
H&N
H&N
H&N
H&N
H&N
H&N
H&N
Muscular
H&N
H&N
H&N
H&N
Endocrine
H&N
Intestinal
Urinary
Intestinal
Vascular
H&N
H&N
H&N
Pelvis
Pelvis
Pelvis
Pelvis
Vascular
Pelvis
Vascular
Pelvis
Vascular
Pelvis
Vascular
Pelvis
Vascular
Pelvis
Skeleton
Pelvis
Skeleton
Pelvis
Skeleton
Skeleton
Skeleton
Skeleton
Pelvis
Pelvis
Pelvis
Pelvis
CNS
UpperAbdo
Lumbar Vertebra
Parametrium
Vagina
Cervix of uterus
Uterus
Ovary
L5
PARAMETRIUM
VAGINA
CERVIX
UTERUS
OVARY
Bony pelvis
PELVIS
Peritoneal sac
Prostate
Penis
PERITONEUM
PROSTATE
PENIS
CORPUS CAVERNOSUM
CORPUS SPONGIOSUM
Pubic bone
PUBIS
Rectum
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacrum
Seminal vesicle
Adrenal glands
RECTUM
S1
S2
S3
S4
S5
SACRUM
SV
ADRENAL
Aorta
Small intestine
Duodenum
Gall bladder
Inferior vena cava
Kidney
AORTA
BOWEL
DUODENUM
GALLB
IVC
KIDNEY
Renal pelvis
KPELVIS
Liver
Pancreas
Stomach
Ureter
LIVER
PANCREAS
STOMACH
URETER
Testis
TESTIS
VB_L5
PARAMETRIUM
VAGINA
CERVIX
UTERUS
OVARY_R
OVARY_L
PELVIS
PELVIS_R
PELVIS_L
PERITONEUM
PROSTATE
PENIS
CAVERNOSUM
SPONGIOSUM
13076
77061
19949
17740
17558
7213
7214
16586
20226
20227
9908
9600
9707
75189
19617
Skeleton
Gynae
Gynae
Gynae
Gynae
Gynae
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Skeleton
Pelvis
Intestinal
Urinary
Urinary
Pelvis
Pelvis
Pelvis
PUBIS_R
PUBIS_L
RECTUM
VB_S1
VB_S2
VB_S3
VB_S4
VB_S5
SACRUM
SV
ADRENAL_R
ADRENAL_L
AORTA
BOWEL
DUODENUM
GALLB
IVC
KIDNEY_R
KIDNEY_L
KIDNEY_TOTAL
KPELVIS_R
KPELVIS_L
LIVER
PANCREAS
STOMACH
URETER_R
URETER_L
TESTIS_R
16596
16597
14544
13077
13078
13079
13080
13081
16202
19387
15630
15629
3734
7200
7206
7202
10951
7204
7205
Skeleton
Pelvis
Intestinal
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Skeleton
Urinary
Endocrine
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
UpperAbdo
Vascular
Intestinal
Intestinal
Intestinal
Vascular
Renal
UpperAbdo
UpperAbdo
UpperAbdo
UpperAbdo
UpperAbdo
UpperAbdo
Urinary
UpperAbdo
Intestinal
Intestinal
Intestinal
Urinary
UpperAbdo
UpperAbdo
UpperAbdo
UpperAbdo
UpperAbdo
Chest
264815
15578
15579
7197
7198
7148
17887
17888
7211
Urinary
Pelvis
Pelvis
Scrotum (skin & cremasteric fascia)
Vulva (includes mons pubis)
Thoracic Duct
Lymph nodes – para-aortic (upper T
level – lower L level)
Lymph nodes – common iliac
Lymph nodes – presacral
Lymph nodes – external iliac
Lymph nodes – internal iliac
Lymph nodes – obturator
Parametrium
SCROTUM
VULVA
THORACIC DUCT
LN_PARAAORTIC_TxLx
TESTIS_L
SCROTUM
VULVA
THORACICDUCT
LN_PARAAORTIC_TxLx
7212
18252
20462
5031
223899
LN_ILIAC_COM
LN_PRESACRAL
LN_ILIAC_EXT
LN_ILIAC_INT
LN_OBT
PARAMETRIUM
LN_ILIAC_COM
LN_PRESACRAL
LN_ILIAC_EXT
LN_ILIAC_INT
LN_OBT
PARAMETRIUM
224269
234280
229177
224275
16676
77061
Urinary
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvis
Pelvic & intra-abdominal lymph chains
Individual chains with radiological demarcation.
Lymphatic Chain
FMAID
Thoracic duct
[5031]
THORACICDUCT
Lateral aortic lymphatic chains
PARAMETRIUM
Bottom: common iliac bifurcation (level of CIA ‘carina’)
Lateral: medial edge of psoas muscle
Posterior: pelvic bones (do not enter nerve canals)
Top:
common iliac bifurcation (level of CIA ‘carina’)
Medial: continuous volume
Anterior: peritoneum (thin, <10mm thick)
Bottom:
Lateral:
S1-2 junction
common iliac LC
Posterior: sacral bones
[224275]
[16676]
LN_OBT
Parametrium
Top:
aortic bifurcation (level of aortic ‘carina’)
Medial: no medial border (extend across contralaterally)
Anterior: peritoneum (do not include bowel)
Top:
common iliac bifurcation (level of CIA ‘carina’)
Bottom: superior level of mesorectum
Medial: peritoneum
Lateral: pelvic muscle/bone
Anterior: anterior border of artery/vein complex, cease at ‘pelvic brim’ (line connecting anterior pelvic bones)
Posterior: mid-distance to internal iliac artery [this is arbitrary], obturator LC
LN_ILIAC_INT
Obturator lymphatic chain
Bottom: aortic bifurcation (level of aortic ‘carina’)
Left:
lateral edge of psoas muscle
Posterior: vertebra
[229177]
LN_ILIAC_EXT
Internal iliac lymphatic chains
Top:
second lumbar vertebra
Right:
lateral edge of psoas muscle
Anterior: peritoneum
[234280]
LN_PRESACRAL
External iliac lymphatic chains
Bottom: second lumbar vertebra
Left:
aorta
Posterior: body of the second lumbar vertebra
[224269]
LN_ILIAC_COM
Sacral lymphatic chain
Top:
root of the neck
Right:
right crus of the diaphragm
Anterior: aorta
[223899]
LN_PARAAORTIC
Common iliac lymphatic chains
Anatomy
[none of these entities enter the peritoneal space, mesorectum, muscles or bones]
[77061]
Top:
common iliac bifurcation (level of CIA ‘carina’)
Bottom: superior level of mesorectum
Medial: peritoneum
Lateral: pelvic muscle/bone
Anterior: mid-distance to external iliac artery, obturator LC Posterior: anterior aspect of piriformis muscle
[between internal & external iliac LC inferiorly]
Top:
level near superior level of mesorectum posterior to the bladder where vessels start to move medially
Bottom: base of seminal vesicles, cervix {will be in the span of the femoral head)
Lateral: pelvic side wall muscle/bone
Medial: seminal vesicles
Anterior: vascular tissue
Posterior: mesorectum
[very thin posterior to bladder, encompasses vascular tissue]
Top:
level near superior level of mesorectum posterior to the bladder where vessels start to move medially
Bottom: base of seminal vesicles, cervix {will be in the span of the femoral head)
Medial: posterior bladder with large vessels
Lateral: obturator LC
Anterior: posterior bladder wall
Posterior: mesorectum
1. LN_PARAAORTIC_TxLx
fill in the levels – upper level (“Tx”) and lower level (“Lx”)
para-aortic nodes superior:
crura of the diaphragms
inferior:
bifurcation of the aorta (1st slice with common iliac vessels)
Since the pelvic nodes are in continuity rather than discrete, multiple areas may be contoured, but still need to be identified. The
proposal for naming of combined pelvic lymph nodes is to reduce to 2 groups:
1. PELVIC NODES
a. All nodes
b. One sided nodes
LN_PELVIS_F_EI_ CI_II_O_PS
This contour includes ALL the nodes in the pelvis and down to the femoral nodes. This should
only be used when the nodes volumed are bilaterally identical.
The nodes are centred on the vessels, but do not extend into the muscle, bones or across the
peritoneum into the peritoneal cavity which containing bowel (meaning that this contour
should not contain any bowel loops).
femoral
Inferior:
starts at ischial tuberosities4 (no definite anatomic level)
superior:
1st slice to see acetabulum
external iliac
inferior:
last slice above the acetabulum (midpoint inguinal ligament)
superior:
1st slice to see external iliac vessels
common iliac
superior:
1st slice to see iliac vessels
inferior:
the slice ABOVE the 1st slice to see internal iliac vessels
internal iliac
superior:
1st slice to see internal iliac vessels
inferior:
lack of space between o. internus m and midline organs
obturator
superior:
EI & II vessels
inferior:
exit of obturator artery outside the pelvis
presacral space
superior:
CI vessels
inferior:
mesorectum or S3/4 junction
LN_PELVIS_ F_EI_ CI_II_O_PS_R/L
This contour names the lateralised nodes in the pelvis. Similar to the neck nodes, the regions NOT
included should be deleted from the name, e.g., LN_ CI_II_O _R includes the common, internal iliac
and obturator nodes on the right.
The nodes are centred on the vessels, but do not extend into the muscle, bones or across the
peritoneum into the peritoneal cavity which containing bowel (meaning that this contour
should not contain any bowel loops).
2. MESORECTUM
superior:
Inferior:
lateral:
anorectal junction with surrounding retroperitoneal fat
pelvic floor (where fat around rectum is no longer visible)4
outer border of the pelvic floor muscles (the inner margin of ischiorectal
fossa)5
In all cases, areas that are NOT volumed have their name removed. The easiest and most sensible way to do this is to decide which nodal areas will
be contoured before drawing anything and to adjust names to reflect the decision making. Then do the drawing.
The treatment of the external iliac & femoral nodal areas is only likely to occur with perineal malignancy (anus, vulva, lower vagina). Treatment of
the mesorectum (MESORECTUM) is only likely to occur with rectal cancer and extensive anal cancers.
Head & Neck Lymphatic Chains
This naming procedure is adopted to indicate the nodal areas that are being targeted for radiotherapy.
Lymphatic Chain
Level I
SUPERFICIAL
Gregoire6
Submental (IA)
1
Submandibular (IB)
2
Facial (IX)
11
Buccal (IX)
11
Level IIa
3
Level IIb
3
Retropharyngeal (VIIa)
Parotid (VIII)
Mastoid (Xa)
9
10
12
Level II
DEEP
SUPERFICIAL
SUPERFICIAL
4
Level III
SUPERFICIAL
Level IV
Occipital (Xb)
Anatomy
Divided by the anterior belly of the digastric muscle
Top:
MANDIBLE (symphysis menti)
Medial: Anterior: DIGASTRIC (Medial)
Top:
MANDIBLE
Medial: STYLOHYOID, GENIOGLOSSUS
Anterior: MANDIBLE
Bottom: superior THYROID_C
Lateral: DIGASTRIC (Medial)
Posterior: muscle anterior to HYOID
Bottom: lowest extent of SUBMAND
Lateral: DEEP FASCIA
Posterior: posterior SUBMAND, STYLOHYOID_M
Top:
Bottom: SUBMAND
Medial: DEEP FASCIA
Lateral: MANDIBLE
Anterior: FACIAL_A
Posterior: anterior SCM
Top:
level of zygoma
Bottom: bottom of MANDIBLE
Medial: oral cavity
Lateral: fascial plane under the subcutaneous fat (SMAS)
Anterior:
Posterior: anterior MASSETER
a.k.a “upper deep cervical nodes”
Top:
skull base
Bottom: inferior border of the hyoid
Medial: lateral neck muscles
Lateral: medial SCM
Anterior: posterior SUBMAND
Posterior: posterior SCM
Top:
skull base
Bottom: inferior border of the hyoid
Medial: lateral neck muscles
Lateral: medial SCM
Anterior: anterior SCM
Posterior: posterior SCM
retropharyngeal space between pharynx & vertebral bodies, drains nasopharynx and posterior pharynx
predominately around the superficial lobe, draining lateral face, lateral eyelids, anterior/lateral scalp
posterior to mastoid process and ear, drains lateral scalp, drains to superficial & deep cervical nodes
Top:
inferior border of the hyoid
Medial: medial vessels
Anterior: medial SCM
Bottom: inferior border of the cricoid
Lateral: neck muscles
Posterior: posterior SCM
Top:
inferior border of the cricoid
Medial: medial vessels
Anterior: medial SCM
Bottom: brachiocephalic vein
Lateral: neck muscles
Posterior: posterior SCM
Top:
mastoid
Medial: neck muscles
Anterior: posterior SCM
Top:
inferior border of the cricoid
Medial: neck muscles
Anterior: posterior SCM
Lateral supraclavicular fossa
Bottom: inferior cricoid cartilage
Lateral: neck fascia
Posterior: anterior trapezius
Bottom: level of sternoclavicular joint
Lateral: neck fascia
Posterior: anterior trapezius
Top:
inferior border of the hyoid
Medial: Anterior: fascia
Bottom: sternal notch
Lateral: medial vessels
Posterior: aerodigestive tube
12
5
Level V
Level VI
Va
6
Vb
6
Vc
7
8
The proposal for naming of the H&N lymph nodes is to start with the name – LN_HN_1a1b2a2b3456_rp_fb_p_o_R/L - and for the RO to then
remove from the name those parts that will NOT be volumed. This follows the normal pattern of oncological thought in defining at risk areas, where
the at-risk volume is decided BEFORE voluming commences. This is therefore the time to adjust names immediately. If these areas are defined
initially (before Volumes), then the nodal contour can be used to define the at-risk boundaries for clipping of CTVs to these boundaries.
So “LN_ HN_2a2b34_R” would represent a right ipsilateral neck node volume that does not include LN stations 1a, 1b, 5, 6, retropharyngeal, facial
parotid or occipital nodes. The anatomical boundaries of the volume should be consistent with the descriptive code provided.
If the oncologist desires to use 3 dose levels then during the contouring phase the oncologist would produce two contours with non-overlapping
numbers, e.g., LN_ HN_1a1b2a2b3_R and LN_45_R, The first should be used in the definition of CTVn0a and the second used to define CTVn0b. The
equations to produce the PTVs would be :
PTV7000 = CTVp + CTVn1 +CTVn2 + 3mm
PTV6000 = CTVp + CTVn1 + CTVn2 +CTVn0a + 3mm
PTV5400 = CTVn0b + 3mm – PTV6000
Mediastinal Lymph Node Chains
The delineation of nodal stations in the mediastinum is not, to my knowledge, a commonly undertaken task. Accurate delineation of the nodal
regions requires a contrast scan as the appearance of pulmonary vasculature can be deceiving on a plain scan.
The thoracic nodal volumes are arranged in three columns – front, middle and back (these divisions are not necessarily reflective of the normal
anatomical divisions of the mediastinum so I hesitate to use the proper anatomical terms like anterior). The naming confusingly is top down, i.e.,
the first nodal group – the hilar nodes – are level 10/11. The uppermost and presumably last involved node behind the upper sternum is level 1.
The front column is a sheet wrapped around the anterior mediastinum in front of the vasculature, the middle and back columns form a central core
divided along the line of the posterior trachea, and finally the middle column divides under the shadow of the carina.
The back column of nodes includes the oesophagus over its entire length, and is split into three levels at the level of the carina with level 8 (below
the carina inferiorly to the level of the R middle lobe bronchus and behind the line of the posterior bronchial walls), level 7 (below the carina
inferiorly to the level of the R middle lobe bronchus and behind the line of the anterior & posterior bronchial walls) and level 3P (up from the
carina to the suprasternal notch where it sits behind the posterior trachea).
The middle column of nodes contains the trachea and the tissue around and in front, and is split at the level of the arch of the aorta into level
4_R/L (below the arch of the aorta inferiorly to the R pulmonary artery where mediastinal fat disappears, and in front of the posterior wall of the
trachea) and level 1/2 (up from the arch of the aorta to the suprasternal notch superiorly where it contains the brachiocephalic vein moving from
behind the left sternoclavicular joint to the R second interspace [angle of Louis], and in behind of the arterial vascular arcade arising from the aortic
arch).
The front column of nodes has two levels split at the level of the level of the carina into level 6 (from the first slice showing the carina inferiorly to
lowest image containing the R pulmonary artery but only around to the midpoint of the aortic ellipse where it junctions with level 5 which
occupies the posterior L lateral portion of the aortic ellipse around to the descending aorta and then L pulmonary artery & vein at the hilum)
and level 3A (from first slice above the carina to suprasternal notch and anterior to the aortic vascular arcade arising from the aortic arch but
not extending laterally past the L subclavian artery). On the left lateral side, level 3A junctions with level 6 on the exposed anterolateral aortic
wall behind the L subclavian artery which extends around to the mid-aortic wall, and moves around posteriorly to level 5 (starts under the aortic
arch and extends between the aortic limbs, the left pleura and the closest point between the aortic limbs inferiorly to lowest image containing the
R pulmonary artery).
LEVEL 3A
FMAID 5944
Brachiocephalic LN
lat - pleurae, not past left subclavian
(L6)
ant - posterior sternum
post - in front of arterial vascular
structures & SVC
includes L brachiocephalic vein
Carina (first slice with separation)
LEVEL 6
Inferior aortic arch
LEVEL 5
Superior aortic arch (first slice with aortic wall)
LEVEL 4R/L
lateral R – R pleura & SVC
FMAID 5959
anterior - behind arterial vascular
Superior tracheobronchial LN
arcade, aorta & SVC
FMAID 5960
lateral L – line between vascular
R Superior tracheobronchial LN
structures, junctions LEVEL 5
FMAID 5961
anterior - posterior trachea
L Superior tracheobronchial LN
R pulmonary artery where mediastinal fat disappears
Posterior line of trachea/bronchi
Middle Column
Suprasternal notch (last slice down before sternal bone)
LEVEL 1 / 2
lateral - R pleura to L pleura
FMAID 276933
anterior - behind arterial vascular
Upper paratracheal LN
arcade & SVC
posterior - post tracheal wall
Midpoint connecting line of arterial vascular arcade, aorta & pulmonary
artery
Front Column
Back Column
LEVEL 3P
FMAID 276905
superior
posterior
mediastinum
LEVEL 7
FMAID 5962
Inferior
tracheobronchial
LN
“SUBCARINAL”
Contains the oesophagus
lateral – R & L pleura
anterior – line of posterior trachea
posterior - anterior vertebral body, aortic arch & descending aorta
Carina (first slice with separation)
sup - carina
LEVEL 8
inf - R ML bronchus
FMAID 12784
ant - anterior
Esophageal LN
bronchial walls
post - posterior
bronchial walls
lat - medial bronchial
walls
Contains the
oesophagus
lateral – R & L pleura;
aortic arch &
descending aorta
ant –posterior
trachea/bronchi
post - anterior vertebral
body,
level of R middle lobe bronchus
A suggested Contouring Method in discrete steps
1. Outline the soft tissue component in the following manner:
a. Draw a line starting from the junction of the R ANTERIOR VERTEBRAL BODY and the R PLEURA,
i. contour the PARIETAL PLEURA to the level of the POSTERIOR WALL OF THE TRACHEA,
ii. turn left and contour across the POSTERIOR TRACHEA until the L PLEURA is reached,
iii. turn inferiorly and contour the PARIETAL PLEURA or RIGHT VASCULAR WALL to reach the junction of the L ANTERIOR
VERTEBRAL WALL and the L PLEURA
iv. draw across the bony margin of the ANTERIOR VERTEBRAL BODY to complete the volume
b. Apply this procedure
i. to produce LEVEL 3P from SSN down to CARINA
ii. from the CARINA inferiorly
1. produce LEVEL 8 from CARINA down to LEVEL OF R MIDDLE LOBE BRONCHUS using the same method
2. produce LEVEL 7 by returning to the CARINA; contour the subcarinal area by drawing a line
a. From the medial wall of the RIGHT MAIN BRONCHUS anteriorly to reach the line joining the ANTERIOR
WALLS OF THE R&L MAIN BRONCHI
b. turn left to trace this imaginary line to reach the wall of the LEFT MAIN BRONCHUS
c. turn posteriorly and outline the MEDIAL WALL of the L MAIN BRONCHUS
d. turn right to trace the imaginary line connecting the POSTERIOR WALLS OF THE R&L MAIN BRONCHI to
reach the wall of the RIGHT MAIN BRONCHUS
e. turn anterior to outline the remaining MEDIAL WALL of the R MAIN BRONCHUS
f. repeat this contour from CARINA down to LEVEL OF R MIDDLE LOBE BRONCHUS
2. Returning to the SUPRASTERNAL NOTCH, outline the soft tissue component below:
a. Draw a line from the MID-POSTERIOR STERNUM to the right to meet the PLEURA or SVC
b. Draw a line down and across the anterior SVC wall to the midpoint of the vascular arcade (anterior SVC > aortic arch vessels > aortic
arch > descending aorta > pulmonary trunk > left pulmonary vessels
c. Draw a connected line following the L pleura up to the POSTERIOR STERNUM and back to meet the point of origin
d. Divide this volume into 3 LEVELS:
i. Tissue medial to the most lateral vessel seen on the vascular arcade ( starts with L SUBCLAVIAN ARTERY) is LEVEL 3A (this
contains the entire L BRACHIOCEPHALIC VEIN)
ii. Tissue lying lateral on the AORTIC ARCH above the INFERIOR AORTIC ARCH is LEVEL 6 (usually this lies anterior to the
MIDPLANE of the AORTA)
iii. At the level of the INFERIOR AORTIC ARCH, all inferior tissue is LEVEL 5 (this is lying posterior to the MIDPLANE of the
AORTA and anterior to the DESCENDING AORTA (also lateral to the midpoints of these vessels)
APPENDIX 1 : Use of the Document
Departmental
The departmental group responsible for introduction of protocols
should review the document and approve it. A governance radiation
oncologist should be nominated to manage the present status of the
document, or accept that the default document will be the default.
All scripting of names in the TPS should be reviewed and updated to
the standard and verified by the Governance RO.
Personal
The most logical way to produce contours and volumes is to follow
this pattern. Note that initially ROIs are freehanded, and then once
the CTVp is complete, the rest are geometric manipulations:
1. Produce all of the contours first, including nodal groups
For the nodal areas required, generate contours of nodal
areas with anatomical names by freehand or segmentation. If
3 dose levels will be used, contour two nodal areas with nonoverlapping names.
2. Produce the volumes in the order
a. Produce the GTVp &GTVn
Usually achieved by freehand drawing on sim CT
b. Produce CTVp
i. Transform GTVp into CTVp
1. Expand with NO margin to create the
CTVp, and then,
2. Freehand modification of the CTVp to
match appropriate radial anatomical
planes (bone, air, lung, fascia, muscle)
c. Produce CTVn
i. Expand GTVn to CTVn
1. With margin (0.3-0.5?)
2. excluding external to LN contours
3. excluding internal of CTVp
d. Produce CTVn0
i. Expand LN contour into CTVn0a/b
1. With NO margin
2. Excluding internal of CTVp
3. Excluding internal of CTVn
e. Produce PTV_highdose
i. Expand CTVp + CTVn
1. With margin (0.3mm)
2. Rename to PTVxxxx
f.
Produce PTV_middose
i. Expand CTVp + CTVn + CTVn0a
1. With margin (0.3mm)
2. Rename to PTVyyyy
g. Produce PTV lowdose
i. Expand CTVn0b
1. With margin (0.3mm)
2. Exclude PTVyyyy (middose)
APPENDIX 2 : Suggestions for scripting
Brain
All names
H&N
Neuroaxis
Base of
Brain
All names
Upper H&N
Lower H&N
Chest
H&N bones
H&N glands
H&N
muscles
All names
Breast
Lung
Oesophagus
Chest bones
UpperAbdo
All names
Major names BRAIN, BRAINSTEM, CEREBELLUM, CHIASM, EYE_R, EYE_L, OPTICN_R, OPTICN_L, ORBIT_R, ORBIT_L,
SPINALCORD,
Minor names CEREBRUM, CNVI, CNVI_R, CNVI_L, CNXI_R , CNXI_L, PINEAL, PITUITARY, PONS,
BRAIN, BRAINSTEM, CEREBELLUM, CEREBRUM, PINEAL, PONS, SPINALCORD, HIPPOCAMPUS
CHIASM, CNVI, CNVI_R, CNVI_L, CNXI_R , CNXI_L, EYE_R, EYE_L, OPTICN_R, OPTICN_L, ORBIT_R, ORBIT_L, PITUITARY
Major names COCHLEA_R, COCHLEA_L, LACRIMAL_R, LACRIMAL_L, LARYNX, LENS_R, LENS_L, MANDIBLE, PAROTID_R,
PAROTID_L, SUBMAND_R, SUBMAND_L, THYROID, LN_HN_1a1b2a2b3456_rp_fb_p_o_R/L
Minor names ARYTENOID, ARYTENOID_R, ARYTENOID_L, C1, C2, C3, C4, C5, C6, C7, C8, CLAVICLE_R, CLAVICLE_L, CNIII_R, CNIII_L,
CNIX_R , CNIX_L, CNVII_R, CNVII_L, CNXII_R , CNXII_L, CRICOID, DIGASTRIC_R, DIGASTRIC_L, HYOID, MASSETER_R, MASSETER_L,
PLATYSMA_R, PLATYSMA_L, PTERYGOIDL_R, PTERYGOIDL_L, PTERYGOIDM _R, PTERYGOIDM _L, SCM_R, SCM_L, THYROID_C
C1, C2, C3, C4, C5, C6, C7, C8, CNIII_R, CNIII_L, CNIX_R , CNIX_L, CNVII_R, CNVII_L, CNXII_R , CNXII_L, COCHLEA_R, COCHLEA_L,
DIGASTRIC_R, DIGASTRIC_L, HYOID, LACRIMAL_R, LACRIMAL_L, LENS_R, LENS_L, MANDIBLE, MASSETER_R, MASSETER_L,
PAROTID_R, PAROTID_L, PTERYGOIDL_R, PTERYGOIDL_L, PTERYGOIDM _R, PTERYGOIDM _L, SUBMAND_R, SUBMAND_L
ARYTENOID, ARYTENOID_R, ARYTENOID_L, C1, C2, C3, C4, C5, C6, C7, C8, CRICOID, HYOID, LARYNX, MANDIBLE, PAROTID_R,
PAROTID_L, SCM_R, SCM_L, SUBMAND_R, SUBMAND_L, THYROID, THYROID_C
VB_C1, VB_C2, VB_C3, VB_C4, VB_C5, VB_C6, VB_C7, VB_C8, CLAVICLE_R, CLAVICLE_L, HYOID, MANDIBLE
LACRIMAL_R, LACRIMAL_L, PAROTID_R, PAROTID_L, SUBMAND_R, SUBMAND_L, THYROID
DIGASTRIC_R, DIGASTRIC_L, MASSETER_R, MASSETER_L, PLATYSMA_R, PLATYSMA_L, PTERYGOIDL_R, PTERYGOIDL_L,
PTERYGOIDM _R, PTERYGOIDM _L, SCM_R, SCM_L
Major names LN_AX_R, LN_AX_L, BREAST_R, BREAST_L, HEART, LUNG_TOTAL, LUNG_R, LUNG_L, OESOPHAGUS,
Minor names BRONCHUS_R, BRONCHUS_L, CARINA, DIAPHRAGM, LUNG_LLL, LUNG_LUL, LUNG_RLL, LUNG_RML, LUNG_RUL,
PULM_A, PULM_V, RIB1_R, RIB1_L, RIB10_R, RIB10_L, RIB11_R, RIB11_L, RIB12_R, RIB12_L, RIB2_R, RIB2_L, RIB3_R, RIB3_L, RIB4_R,
RIB4_L, RIB5_R, RIB5_L, RIB6_R, RIB6_L, RIB7_R, RIB7_L, RIB8_R, RIB8_L, RIB9_R, RIB9_L, SCAPULA_R , SCAPULA_L, SVC, TRACHEA,
A_LAD
LN_AX1_R, LN_AX2_R, LN_AX3_R, LN_AX1_L, LN_AX2_L, LN_AX3_L, BREAST_R, BREAST_L, HEART, A_LAD, LUNG_TOTAL, LUNG_R,
LUNG_L, OESOPHAGUS
BRONCHUS_R, BRONCHUS_L, CARINA, DIAPHRAGM, HEART, LUNG_LLL, LUNG_LUL, LUNG_RLL, LUNG_RML, LUNG_RUL,
LUNG_TOTAL, LUNG_R, LUNG_L, OESOPHAGUS, PULM_A, PULM_V, SVC, TRACHEA
HEART, LUNG_TOTAL, LUNG_R, LUNG_L, OESOPHAGUS
RIB1_R, RIB1_L, RIB10_R, RIB10_L, RIB11_R, RIB11_L, RIB12_R, RIB12_L, RIB2_R, RIB2_L, RIB3_R, RIB3_L, RIB4_R, RIB4_L,
RIB5_R, RIB5_L, RIB6_R, RIB6_L, RIB7_R, RIB7_L, RIB8_R, RIB8_L, RIB9_R, RIB9_L, SCAPULA_R , SCAPULA_L
Major names BOWEL, KIDNEY_R, KIDNEY_L, LIVER, LN_PARAAORTIC_TxLx
Minor names ADRENAL_R, ADRENAL_L, AORTA, DUODENUM, GALLB, IVC, KPELVIS_R, KPELVIS_L, PANCREAS, STOMACH,
URETER_R, URETER_L
Pelvis
All names
Anus
Bladder
Gynae
Prostate
Rectum
Pelvic
bones
Extremities
Major names ANUS, BLADDER, COLON, PARAMETRIUM, PERITONEUM, PROSTATE, RECTUM, SV,
LN_PARAAORTIC_TxLx, LN_ F_EI_ CI_II_O_PS_R/L, MESORECTUM
Minor names A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, ILIUM_R, ILIUM_L, ISCHIUM_R, ISCHIUM_L, L1, L2, L3, L4, L5, VAGINA, CERVIX,
UTERUS, PELVIS, PELVIS_R , PELVIS_L, CAVERNOSUM, SPONGIOSUM, PUBIS_R, PUBIS_L, S1, S2, S3, S4, S5, SACRUM, SV_R , SV_L
ANUS, BLADDER A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, PERITONEUM, RECTUM
BLADDER, A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, PERITONEUM, RECTUM
BLADDER, A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, PARAMETRIUM, VAGINA, CERVIX, UTERUS, PERITONEUM
BLADDER, A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, PERITONEUM, PROSTATE, CAVERNOSUM, SPONGIOSUM, RECTUM, SV_R ,
SV_L
BLADDER, COLON A_ILIAC_C_R, A_ILIAC_C_L,V_ ILIAC_C_R, C_ILIAC_C_L, A_ILIAC_E_R, A_ILIAC_E_L, V_ILIAC_E_R, V_ ILIAC_E_L,
A_ILIAC_I_R, A_ILIAC_I_L, V_ILIAC_I_R, V_ILIAC_I_L, PERITONEUM, RECTUM
ILIUM_R, ILIUM_L, ISCHIUM_R, ISCHIUM_L, L1, L2, L3, L4, L5, PELVIS, PELVIS_R, PELVIS_L, PUBIS_R, PUBIS_L, S1, S2, S3, S4, S5,
SACRUM
BOF_R, BOF_L, FEMUR_R, FEMUR_L, FIBULA , FIBULA_R, FIBULA_L, HOF_R, HOF_L, HUMERUS_R , HUMERUS_L, RADIUS_R , RADIUS_L,
SOF_R, SOF_L
APPENDIX 3 : Cheat Sheet
VOLUMES
GTV
GTVpx, GTVnx
versions permitted (x=1,2,3)
CTV
CTVpx, CTVnx, CTVn0
versions permitted (x=1,2,3)
PTV
Dose levels PTVxxxx_m (x = cGy, m = mm)
CONTOURS
Standard Nomenclature OAR Name
BONES
First Rib
Tenth rib
Eleventh rib
Twelfth rib
Second rib
Third rib
Fourth rib
Fifth rib
Sixth rib
Seventh rib
Eighth rib
Ninth rib
Scapula
Femur (entire)
Femur (head)
Femur (shaft)
Femur (base/distal)
Fibula
RIB1_R, RIB1_L
RIB10_R, RIB10_L
RIB11_R, RIB11_L
RIB12_R, RIB12_L
RIB2_R, RIB2_L
RIB3_R, RIB3_L
RIB4_R, RIB4_L
RIB5_R, RIB5_L
RIB6_R, RIB6_L
RIB7_R, RIB7_L
RIB8_R, RIB8_L
RIB9_R, RIB9_L
SCAPULA_R, SCAPULA_L
FEMUR_R, FEMUR_L
HOF_R, HOF_L
SOF_R, SOF_L
BOF_R, BOF_L
FIBULA_R, FIBULA_L
Humerus
Radius
Atlas
Axis
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Cervical Vertebra
Clavicle
Pubic bone
Rectum
Mandible
Ilium
Ischium
Lumbar Vertebra
Lumbar Vertebra
Lumbar Vertebra
Lumbar Vertebra
Lumbar Vertebra
Bony pelvis
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacral Vertebra
Sacrum
HUMERUS_R, HUMERUS_L
RADIUS_R, RADIUS_L
VB_C1
VB_C2
VB_C3
VB_C4
VB_C5
VB_C6
VB_C7
VB_C8
CLAVICLE_R, CLAVICLE_L
PUBIS_R, PUBIS_L
RECTUM
MANDIBLE
ILIUM_R, ILIUM_L
ISCHIUM_R, ISCHIUM_L
VB_L1
VB_L2
VB_L3
VB_L4
VB_L5
PELVIS, PELVIS_R , PELVIS_L
VB_S1
VB_S2
VB_S3
VB_S4
VB_S5
SACRUM
NEURAL
Brain
Brainstem
Cerebellum
Cerebrum
Optic chiasm
Abducens nerve
Spinal accessory nerve
BRAIN
BRAINSTEM
CEREBELLUM
CEREBRUM
CHIASM
CNVI, CNVI_R, CNVI_L
CNXI_R , CNXI_L
Eyeball
Optic nerve
Orbit
Pineal body
Pituitary gland
Pons
Spinal cord
Oculomotor nerve
Glossopharyngeal nerve
Facial nerve
Hypoglossal nerve
Cochlea
Brachial Plexus
EYE_R, EYE_L
OPTICN_R, OPTICN_L
ORBIT_R, ORBIT_L
PINEAL
PITUITARY
PONS
SPINALCORD
CNIII_R, CNIII_L
CNIX, CNIX_R , CNIX_L
CNVII_R, CNVII_L
CNXII_R , CNXII_L
COCHLEA_R, COCHLEA_L
BRACHIALP
LYMPHATICS
Pectoral axillary lymphatic chain
LN_AX1_R, LN_AX1_L
Central axillary lymphatic chain
LN_AX2_R, LN_AX2_L
Apical axillary lymphatic chain
LN_AX3_R, LN_AX3_L
Axillary lymphatic chain
LN_AX_R, LN_AX_L
Cervical lymphatic chain
LN_HN_1a1b2a2b3456_rp_f_p_o
(add _R/L at end)
Mesorectal lymphatics
MESORECTUM
Pelvic lymphatics
LN_PELVIS_EI_F_ CI_II_O_PS
(add _R/L at end)
Para-aortic lymphatics
LN_PARAAORTIC_TxLx
Mediastinal lymphatics
LN_MED_1234567810_R/L
Thoracic Duct
THORACICDUCT
Common iliac lymphatics LN_ILIAC_COM
Presacral lymphatics
LN_PRESACRAL
External iliac lymphatics
LN_ILIAC_EXT
Internal iliac lymphatics
LN_ILIAC_INT
Obturator lymphatics
LN_OBT
Parametrium
PARAMETRIUM
VASCULAR
Pulmonary artery
Pulmonary vein
Superior vena cava
Common iliac artery
Common iliac vein
External iliac artery
External iliac vein
Internal iliac artery
Internal iliac vein
Aorta
Inferior vena cava
THORAX
Breast
Bronchial tree
Carina of trachea
Diaphragm
Heart
Lung - lower lobe of left
Lung - upper lobe of left
Lung - lower lobe of right
Lung - middle lobe of right
Lung - upper lobe of right
Lung
Esophagus
Trachea
HEAD &NECK
Arytenoid cartilage
Cricoid cartilage
Digastric muscle
Hyoid bone
Lacrimal gland
Larynx
Lens
Masseter
Mucosa
Parotid gland
A_PULM
V_PULM
SVC
A_ILIAC_C_R, A_ILIAC_C_L
V_ILIAC_C_R, V_ILIAC_C_L
A_ILIAC_E_R, A_ILIAC_E_L
V_ILIAC_E_R, V_ILIAC_E_L
A_ILIAC_I_R, A_ILIAC_I_L
V_ILIAC_I_R, V_ILIAC_I_L
AORTA
IVC
BREAST_R, BREAST_L
BRONCHUS_R, BRONCHUS_L
CARINA
DIAPHRAGM
HEART
LUNG_LL_L
LUNG_UL_L
LUNG_LL_R
LUNG_ML_R
LUNG_UL_R
LUNG_TOTAL, LUNGs
LUNG_R, LUNG_L
OESOPHAGUS
TRACHEA
ARYTENOID,
ARYTENOID_R, ARYTENOID_L
CRICOID
DIGASTRIC_R. DIGASTRIC_L
HYOID
LACRIMAL_R, LACRIMAL_L
LARYNX
LENS_R, LENS_L
MASSETER_R, MASSETER_L
MUCOSA
PAROTID_R, PAROTID_L
Platysma
Pterygoid muscles
(Lateral)
Pterygoid muscles
(medial)
Sternocleidomastoid
Submandibular gland
Thyroid
Thyroid cartilage
ABDOMEN
Peritoneal sac
Adrenal glands
Small intestine
Duodenum
Gall bladder
Kidney
Renal pelvis
Liver
Pancreas
Stomach
PELVIS
Anal canal
Urinary Bladder
Large intestine
Parametrium
Vagina
Cervix of uterus
Uterus
Ovary
Prostate
Penis
Seminal vesicle
Ureter
Testis
Scrotum
PLATYSMA_R, PLATYSMA_L
PTERYGOIDL_R
PTERYGOIDL_L
PTERYGOIDM _R
PTERYGOIDM _L
SCM_R, SCM_L
SUBMAND_R, SUBMAND_L
THYROID
THYROID_C
PERITONEUM
ADRENAL_R, ADRENAL_L
BOWEL
DUODENUM
GALLB
KIDNEY_R, KIDNEY_L
KIDNEY_TOTAL
KPELVIS_R, KPELVIS_L
LIVER
PANCREAS
STOMACH
ANUS
BLADDER
COLON
PARAMETRIUM
VAGINA
CERVIX
UTERUS
OVARY_R, OVARY_L
PROSTATE
PENIS, CAVERNOSUM,
SPONGIOSUM,
SPONGIOSUM_R,
SPONGIOSUM_L
SV_R , SV_L
URETER_R , URETER_L
TESTIS_R, TESTIS_L
SCROTUM
Vulva
VULVA