1、 1Atlases for Organs at Risk (OARs) in Atlases for Organs at Risk (OARs) in Thoracic Radiation TherapyThoracic Radiation Therapy放療中胸部危機(jī)放療中胸部危機(jī)(wij)(wij)器官勾畫(huà)器官勾畫(huà)Feng-Ming (Spring) Kong MD PhDLeslie Quint MDMitchell Machtay MDJeffrey Bradley MD第一頁(yè)，共一百零九頁(yè)。 2Outline of ContentOutline of ContentAtlas for

2、 lung, esophagus, and spinal cord肺、食管、脊髓(j su)的勾畫(huà)Atlas for brachial plexus臂叢神經(jīng)的勾畫(huà)Atlas for proximal bronchial tree近端支氣管樹(shù)的勾畫(huà)Atlas for chest wall 胸壁的勾畫(huà)Atlas for pericardium, heart and great vessels (including normal pericardial recesses)心包、心臟、大血管（包括正常心包凹陷）的勾畫(huà)第二頁(yè)，共一百零九頁(yè)。 3RTOG 1106 Required OARsRTOG 11

3、06 Required OARsStructureDescriptionStructure definition and contouring instructionsLungLungs PreGTV(composite of CT1GTV and PETMTV)Both lungs should be contoured using pulmonary windows. The right and left lungs can be contoured separately, but they should be considered as one structure for lung do

4、simetry. All inflated and collapsed, fibrotic and emphysematic lungs should be contoured, small vessels extending beyond the hilar regions should be included; however, pre GTV, hilars and trachea/main bronchus should not be included in this structure.HeartHeart & PericardiumThe heart will be con

5、toured along with the pericardial sac. The superior aspect (or base) will begin at the level of the inferior aspect of the pulmonary artery passing the midline and extend inferiorly to the apex of the heart.EsophagusEsophagusThe esophagus should be contoured from the beginning at the level just belo

6、w the cricoid to its entrance to the stomach at GE junction. The esophagus will be contoured using mediastinal window/level on CT to correspond to the mucosal, submucosa, and all muscular layers out to the fatty adventitia.SpinalcordSpinal CanalThe spinal cord will be contoured based on the bony lim

7、its of the spinal canal. The spinal cord should be contoured starting at the level just below cricoid (base of skull for apex tumors) and continuing on every CT slice to the bottom of L2. Neuroformanines should not be included. BrachialplexBrachial PlexusThis is only required for patients with tumor

8、s of upper lobes. Only the ipsilateral brachialplex is required. This will include the spinal nerves exiting the neuroforamine from top of C5 to top of T2. In contrast to prior RTOG lung studies of contouring the major trunks of the brachial plexus with inclusion of subclavian and axillary vessels,

9、this trial requests contouring the nerves according to the CT anatomy on every other CT slice. The structure should extend at least 3 cm above the PTV. 第三頁(yè)，共一百零九頁(yè)。 4RTOG 1106 Optional OARsRTOG 1106 Optional OARsStructure DescriptionStructure definition and contouring instructionsPericardPericardiumT

10、he structure of pericardium includes pericardial fatty tissue, part of great vessels, normal recesses, pericardial effusion (if applicable) and heart chambers. Pericardium starts at one slice above the top of aortic arch, ends at the last slice of heart apex at diaphragm. Pericardium includes the he

11、art. GreatvesAortaSVCIVCPVPAGreat vesselsAortaSuperior vena cavaInferior vena cavapulmonary veinpulmonary artery The great vessels should be contoured separately from the heart, using mediastinal windowing to correspond to the vascular wall and all muscular layers out to the fatty adventitia (5 mm f

12、rom the contrast enhanced vascular wall). The great vessel should be contoured starting at least 3 cm above the superior extent of the PTV and continuing on every CT slice to at least 3 cm below the inferior extent of the PTV. For right sided tumors, SVC will be contoured, and for left sided tumors,

13、 the aorta will be contoured. The ipsilateral PA will be delineated for tumor of either side. PbtreeProximal Bronchial TreeThis structure includes the distal 2 cm of the trachea, the carina, the right and left mainstem bronchi, the right and left upper lobe bronchi, the intermedius bronchus, the rig

14、ht middle lobe bronchus, the lingular bronchus, and the right and left lower lobe bronchi. CW2cmChest wall 2 cm outside of lungChest wall can be autosegmented from the ipsilateral lung with a 2-cm expansion in the lateral, anterior, and posterior directions. Anteriorly and medially, it ends at the e

15、dge of the sternum. Posteriorly and medially, it stops at the edge of the vertebral body with inclusion of the spinal nerve root exit site. CW2cm which include intercostal muscles, nerves exclude vertebrate bodies, sternum and skin. This can be accomplished through auto-expansion of the ipsilateral

16、lung (within 3 cm range of PTV).第四頁(yè)，共一百零九頁(yè)。 5結(jié)結(jié)構(gòu)構(gòu) 描述結(jié)構(gòu)定義和勾畫(huà)說(shuō)明肺肺雙肺 PreGTV (composite of CT1GTV and PETMTV) 雙肺勾畫(huà)需要在肺窗勾畫(huà).左右肺分開(kāi)勾畫(huà)但作為一個(gè)器官來(lái)評(píng)價(jià)計(jì)量學(xué)。所有膨脹的、萎陷的纖維化的氣腫的均應(yīng)勾畫(huà)，肺門區(qū)的小血管應(yīng)包括在內(nèi)。然而，preGTV該結(jié)構(gòu)不應(yīng)包括肺門、氣管/大的支氣管。心心臟臟心臟 & 心包 心臟的勾畫(huà)緊貼心包.上方即心底從肺靜脈的下緣開(kāi)始越過(guò)中線延伸到心尖底部.heart. 食食管管 食管食管的勾畫(huà)從環(huán)狀軟骨下緣開(kāi)始到進(jìn)入腹腔處的食管胃連接處.在CT縱膈

17、窗勾畫(huà)食管,以區(qū)別粘膜/粘膜下層肌層和外膜的脂肪組織。脊脊髓髓 椎管 脊髓的勾畫(huà)基于椎管的骨性限制。脊髓的勾畫(huà)從環(huán)狀軟骨下緣開(kāi)始（肺尖腫瘤從顱底）依次勾畫(huà)每一張層面直至L2。椎間孔不應(yīng)包括在內(nèi)。臂臂叢叢 臂叢 臂叢的勾畫(huà)僅僅在上葉腫瘤時(shí)勾畫(huà)。僅僅同側(cè)臂叢神經(jīng)需要勾畫(huà)。范圍包括C5上緣到T2上緣從椎間孔穿出的脊神經(jīng)。不同于先前的勾畫(huà)包括鎖骨下和腋血管在內(nèi)的臂叢主干的RTOG肺癌研究，該研究要求在CT每一層面上依據(jù)解剖來(lái)勾畫(huà)。臂叢至少勾畫(huà)至PTV上3cm。第五頁(yè)，共一百零九頁(yè)。 6結(jié)構(gòu)描述結(jié)構(gòu)定義與勾畫(huà)說(shuō)明心包心包心包包括心包脂肪組織、部分大血管、正常凹陷、心包積液（如果有的話）和心室腔。心包從主

18、動(dòng)脈弓上緣開(kāi)始到膈上心尖的最后一層結(jié)束。心包包括心臟。 大血管（主動(dòng)脈上腔靜脈下腔靜脈肺靜脈肺動(dòng)脈）大血管（主動(dòng)脈、上腔靜脈、下腔靜脈、肺靜脈、肺動(dòng)脈）大血管應(yīng)與心臟分開(kāi)勾畫(huà)在，在縱隔窗將血管壁和肌層與外膜脂肪組織（對(duì)比劑增強(qiáng)后的血管壁外5mm）區(qū)別。大血管勾畫(huà)至少?gòu)腜TV上3cm開(kāi)始，依次勾畫(huà)直至PTV下3cm。對(duì)于右側(cè)的腫瘤上腔靜脈需要勾畫(huà)，左側(cè)腫瘤主動(dòng)脈需要勾畫(huà)，任意一側(cè)的腫瘤，肺動(dòng)脈均需勾畫(huà)。 近端支氣管樹(shù)近端支氣管樹(shù)該結(jié)構(gòu)包括氣管遠(yuǎn)端2cm、隆突、雙側(cè)主支氣管、左右上葉支氣管、中間葉支氣管、右中葉支氣管、舌葉支氣管、左右下葉支氣管。 胸壁2cm 肺外胸壁2cm 胸壁可以自動(dòng)從同側(cè)肺向

19、外、前、后擴(kuò)2cm來(lái)勾畫(huà)。前內(nèi)界為胸骨邊緣。后內(nèi)界為椎體邊緣包括脊神經(jīng)根穿出處。 2cm的胸壁包括肋間肌肉、神經(jīng)，不包括椎體、胸骨、皮膚。可以通過(guò)同側(cè)肺自動(dòng)外擴(kuò)來(lái)完成（PTV3cm范圍內(nèi)）第六頁(yè)，共一百零九頁(yè)。 7Atlas of lung, esophagus, and spinal cord 肺、食管肺、食管(shgun)、脊髓勾畫(huà)、脊髓勾畫(huà) Int J Radiat Oncol Biol Phys. 2011 81(5):1442-57第七頁(yè)，共一百零九頁(yè)。 8第八頁(yè)，共一百零九頁(yè)。 9Esophagus starts at the level of cricoidLung is vis

20、ible now of the left apex食管食管(shgun)從環(huán)狀軟骨開(kāi)始，此時(shí)左側(cè)肺尖可見(jiàn)從環(huán)狀軟骨開(kāi)始，此時(shí)左側(cè)肺尖可見(jiàn)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 the tumors involve neck or apex.脊髓亦應(yīng)從環(huán)狀軟骨下一層開(kāi)始，或脊髓亦應(yīng)從環(huán)狀軟骨下一層開(kāi)始，或從顱底從顱底C1脊髓可見(jiàn)時(shí)開(kāi)始，尤其是當(dāng)腫瘤侵犯脊髓可見(jiàn)時(shí)開(kāi)始，

21、尤其是當(dāng)腫瘤侵犯(qnfn)頸部和肺尖時(shí)。頸部和肺尖時(shí)。Lung第九頁(yè)，共一百零九頁(yè)。 10The structure of spinal cord should include the entire spinal canal to decrease contouring variations .脊髓脊髓(j su)應(yīng)該包括整個(gè)椎管，且向下勾畫(huà)的輪廓在變化應(yīng)該包括整個(gè)椎管，且向下勾畫(huà)的輪廓在變化Esophagus and lung continue食管食管(shgun)和肺繼續(xù)向下勾畫(huà)和肺繼續(xù)向下勾畫(huà)Spinal cord 第十頁(yè)，共一百零九頁(yè)。 11Esophagus, lung and c

22、ord continueGreat vessels delineation is recommended, but not mandated.大血管、近端支氣管推薦勾畫(huà)大血管、近端支氣管推薦勾畫(huà)(guhu)但不強(qiáng)求但不強(qiáng)求SVC=superior vena cavaProximal bronchial tree delineation is recommended, but not mandated.Proximal Bronchial Tree第十一頁(yè)，共一百零九頁(yè)。 12Esophagus, lung and cord continueSVC=superior vena cavagreat

23、 vessels start from the level of aortic arch大血管從主動(dòng)脈弓大血管從主動(dòng)脈弓(zhdngmigng)層面開(kāi)始層面開(kāi)始Proximal bronchial tree starts at 2 cm above carina近端支氣管樹(shù)從隆突上近端支氣管樹(shù)從隆突上2cm開(kāi)始開(kāi)始(kish) 第十二頁(yè)，共一百零九頁(yè)。 13Esophagus, lung and cord continueand great vessels, proximal bronchial treeAA=ascending aorta升主動(dòng)脈, PA=pulmonary artery肺動(dòng)

24、脈, DA=descending aorta降主動(dòng)脈, SVC=superior vena cava上腔靜脈(jngmi)第十三頁(yè)，共一百零九頁(yè)。 14Esophagus, lung, cord, great vessels and proximal bronchial treeAA=ascending aorta, PA=pulmonary artery, DA=descending aorta, SVC=superior vena cava第十四頁(yè)，共一百零九頁(yè)。 15Esophagus, lung, cord, great vessels and proximal bronchial t

25、reeAA=ascending aorta, PA=pulmonary artery, DA=descending aorta, SVC=superior vena cava第十五頁(yè)，共一百零九頁(yè)。 16Esophagus, lung, cord, great vessels and proximal bronchial tree continueAA=ascending aorta, PA=pulmonary artery, DA=descending aorta, SVC=superior vena cava第十六頁(yè)，共一百零九頁(yè)。 17AA=ascending aorta, PA=pul

26、monary artery, DA=descending aorta, SVC=superior vena cavaEsophagus, lung, cord, great vessels and proximal bronchial tree 第十七頁(yè)，共一百零九頁(yè)。 18Esophagus, lung, cord continueDA=descending aorta第十八頁(yè)，共一百零九頁(yè)。 19Esophagus ends at gastric-esophageal junction,Lung and cord continue IVC=inferior vena cava下腔靜脈下腔靜

27、脈(jngmi), DA=descending aorta第十九頁(yè)，共一百零九頁(yè)。 20Lung ends, cord continues until the bottom of L2 Vertebral body肺結(jié)束，脊髓肺結(jié)束，脊髓(j su)繼續(xù)直到繼續(xù)直到L2椎體椎體IVC=inferior vena cava, DA=descending aorta第二十頁(yè)，共一百零九頁(yè)。 21Atlas for Brachial PlexusAtlas for Brachial Plexus臂叢勾畫(huà)臂叢勾畫(huà)(guhu)(guhu)第二十一頁(yè)，共一百零九頁(yè)。 22Locating the Brac

28、hial PlexusLocating the Brachial Plexus定位定位(dngwi)(dngwi)臂叢臂叢Vein, artery, and nerve (VAN, anterior to posterior) will go over the 1st rib and under the clavicle靜脈、動(dòng)脈、神經(jīng)（VAN，后前位）從第1肋和鎖骨間經(jīng)過(guò)Using coronal images, find the plane where vascular/nerve structures (tubes and wires) pass between the 1st rib

29、and clavicle用冠狀位圖像，找到血管神經(jīng)穿過(guò)第1肋和鎖骨處的層面Roughly contour these neuro-vascular tissues in this coronal plane (as shown in yellow)在冠狀位上粗步勾畫(huà)這些(zhxi)神經(jīng)血管組織You will use these rough contours in the next step下一步要用到粗步勾畫(huà)的輪廓1st ribclavicleTimmermans Trick-1第二十二頁(yè)，共一百零九頁(yè)。 23Locating the Brachial Plexus Locating the

30、 Brachial Plexus Project coronal contours onto axial images (yellow points shown on axial image)將冠狀位勾畫(huà)的輪廓投影到軸位In the region between the projected points, identify the VAN on either side. Contour the “N” as the root(s) of the brachial plexus將所投影的點(diǎn)之間的區(qū)域內(nèi)在每一層內(nèi)找到血管神經(jīng)，勾畫(huà)出神經(jīng)作為臂叢的神經(jīng)根Note: Finding the brach

31、ial plexus on the uninvolved side will help in finding it on the involved side找到不涉及臂叢的層面有助于找到臂叢Note: IV contrast greatly facilitates this task (see contrast in artery)靜脈(jngmi)用對(duì)比劑用利于勾畫(huà)Timmermans Trick-1第二十三頁(yè)，共一百零九頁(yè)。 24Brachial plexus starts between C4 C5臂叢從臂叢從C4C5開(kāi)始開(kāi)始(kish)第二十四頁(yè)，共一百零九頁(yè)。 25第二十五頁(yè)，共一百

32、零九頁(yè)。 26第二十六頁(yè)，共一百零九頁(yè)。 27第二十七頁(yè)，共一百零九頁(yè)。 28第二十八頁(yè)，共一百零九頁(yè)。 29第二十九頁(yè)，共一百零九頁(yè)。 30第三十頁(yè)，共一百零九頁(yè)。 31第三十一頁(yè)，共一百零九頁(yè)。 32VeinArteryNerve第三十二頁(yè)，共一百零九頁(yè)。 33Brachial plexus not visible any more第三十三頁(yè)，共一百零九頁(yè)。 34PBT should include the distal 2 cm of the trachea, the carina, the right and left mainstem bronchi, the right and l

33、eft upper 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應(yīng)該(ynggi)包括器官遠(yuǎn)端2cm、隆突、左右主支氣管、左右上葉支氣管、中間支氣管、右中葉支氣管、舌葉支氣管、和左右下葉支氣管。Proximal Bronchial Tree (PBT)近端支氣管近端支氣管樹(shù)樹(shù)PBT can

34、be contoured by autosegmenting the airspace of the central airway with 3 mm expansion (2 mm for lobar bronchus, 3 mm for main bronchus, 4 mm for trachea) 第三十四頁(yè)，共一百零九頁(yè)。 35Proximal Bronchial TreeProximal Bronchial TreeThe proximal bronchial tree can be contoured using mediastinal windows on the CT sca

35、n 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 bronchi should end immediately at

36、 the level of a segmental bifurcation.PBT用CT掃描的縱隔窗勾畫(huà)，可以顯示(xinsh)粘膜、粘膜下、軟骨環(huán)、氣道及相關(guān)結(jié)構(gòu)。作為一個(gè)結(jié)構(gòu)來(lái)勾畫(huà)，包括氣管最遠(yuǎn)端2層cm和雙側(cè)臨近氣道。葉支氣管的勾畫(huà)應(yīng)該在段支氣管分叉處結(jié)束。Recommendation based on Timmerman et al for RTOG 0236 and RTOG 0618, Bezjak et al for RTOG 0813 第三十五頁(yè)，共一百零九頁(yè)。 36PBT starts at 2 cm above carinaPBT starts at 2 cm above

37、carinaPBTPBT從隆突上從隆突上2cm2cm開(kāi)始開(kāi)始(kish(kish) )第三十六頁(yè)，共一百零九頁(yè)。 37Proximal Bronchus Tree continues第三十七頁(yè)，共一百零九頁(yè)。 38 Proximal Bronchus Tree continues第三十八頁(yè)，共一百零九頁(yè)。 39Proximal Bronchus Tree Continues第三十九頁(yè)，共一百零九頁(yè)。 40Proximal Bronchus Tree continues第四十頁(yè)，共一百零九頁(yè)。 41第四十一頁(yè)，共一百零九頁(yè)。 42第四十二頁(yè)，共一百零九頁(yè)。 43第四十三頁(yè)，共一百零九頁(yè)。 44第

38、四十四頁(yè)，共一百零九頁(yè)。 45第四十五頁(yè)，共一百零九頁(yè)。 46第四十六頁(yè)，共一百零九頁(yè)。 47第四十七頁(yè)，共一百零九頁(yè)。 48第四十八頁(yè)，共一百零九頁(yè)。 49第四十九頁(yè)，共一百零九頁(yè)。 50第五十頁(yè)，共一百零九頁(yè)。 51第五十一頁(yè)，共一百零九頁(yè)。 52Proximal Bronchus Tree Ends at the level of lobar bronchus bifurcatinginto segmental bronchus第五十二頁(yè)，共一百零九頁(yè)。 53Chest Wall ContoursChest Wall Contours Chest wall can be autosegm

39、ented from the ipsilateral lung with a 2-cm expansion in the lateral, anterior, and posterior directions. Anteriorly and medially, it ends at the edge of the sternum. Posteriorly and medially, it stops at the edge of the vertebral body with inclusion of the spinal nerve root exit site.胸壁可以自動(dòng)從同側(cè)肺向外、前

40、、后擴(kuò)2cm來(lái)勾畫(huà)(guhu)。前內(nèi)界為胸骨邊緣。后內(nèi)界為椎體邊緣包括脊神經(jīng)根穿出處。This recommendation was: based on Kong et al, Int J Radiat Oncol Biol Phys. 2010 Oct 7. Epub ahead of printSupported by “CW2cm consistently enabled better prediction of CW toxicity than CW3cm” in Mutter et al, Int J Radiat Oncol Biol Phys. 2011 Aug 23. Epub

41、 ahead of print第五十三頁(yè)，共一百零九頁(yè)。 54Chest Wall (CW)Chest Wall (CW)Chest wallCW contouring starts at 3 cm above the PTV胸壁從PTV上3cm開(kāi)始(kish)勾畫(huà)CW refers to CW2cm which include intercostal muscles, nerves exclude vertebral bodies, sternum and skin. This can be accomplished through auto-expansion of the ipsilat

42、eral lung (within 3 cm range of PTV).2cm的胸壁包括肋間肌肉、神經(jīng)，不包括椎體、胸骨、皮膚。可以(ky)通過(guò)同側(cè)肺自動(dòng)外擴(kuò)來(lái)完成。第五十四頁(yè)，共一百零九頁(yè)。 55Chest Wall Chest Wall The superior end of PTVPTVCW refers to CW2cm which include intercostal muscles, nerves exclude vertebral bodies, sternum and skin. 第五十五頁(yè)，共一百零九頁(yè)。 56Chest WallChest WallThe superio

43、r end of GTVGTVPTVCW refers to CW2cm which include intercostal muscles, nerves exclude vertebral bodies, sternum and skin. 第五十六頁(yè)，共一百零九頁(yè)。 57Chest WallChest WallCW refers to CW2cm which include intercostal muscles, nerves exclude vertebral bodies, sternum and skin. Chest wall contours around GTV.第五十七頁(yè)

44、，共一百零九頁(yè)。 58Chest WallChest WallThe inferior end of PTV3 cm below PTV CW refers to CW2cm which include intercostal muscles, nerves exclude vertebral bodies, sternum and skin. CW ends at 3cm from the inferior edge of PTV.胸壁在PTV下3cm結(jié)束(jish)。第五十八頁(yè)，共一百零九頁(yè)。 59Pericardium/Heart, Great Vessels, Heart Chambe

45、rs, and Normal Pericardial Recesses心包(xnbo)/心臟、大血管、心腔、正常心包凹陷 Feng-Ming (Spring) Kong (RTOG), Leslie Quint (ACRIN), Jeffrey Bradley (RTOG), Suresh Senan (EORTC), Ritsuko Komaki (RTOG), Laurie Gaspar (SWOG), Luying Xu (UM), Chengbo Han (UM), Jun Liu (UM), Weili Wang (UM), Robin Marsh (UM), Randall Ten

46、 Haken (UM), Charles Thomas (SWOG), Jeffrey Bogart (CALGB), Mitchell Machtay (RTOG)第五十九頁(yè)，共一百零九頁(yè)。 60Pericardium, normal recesses and heart chambers心包(xnbo)、正常凹陷和心腔The structure of pericardium includes pericardial fatty tissue, part of great vessels, normal recesses, pericardial effusion (if applicabl

47、e) and heart chambers. 心包的結(jié)構(gòu)(jigu)包括心包脂肪組織、部分大血管 、正常凹陷、心包積液和心腔。第六十頁(yè)，共一百零九頁(yè)。 61Anatomy of PericardiumAnatomy of PericardiumPericardial sac and normal recesses第六十一頁(yè)，共一百零九頁(yè)。 62Pericardial Normal Recesses Pericardial Normal Recesses Groell et al, Radiology, 1999Vesely et al, 1986第六十二頁(yè)，共一百零九頁(yè)。 63AAAA=asc

48、ending aorta, SVC=superior vena cavaSVC第六十三頁(yè)，共一百零九頁(yè)。 64AAPosterior superior anterior recesses (pSAR)AA=ascending aorta, V=superior vena cavaSVC第六十四頁(yè)，共一百零九頁(yè)。 65SVCAADAAA=ascending aorta, DA=descending aorta, SVC=superior vena cava第六十五頁(yè)，共一百零九頁(yè)。 66AAVDAAnterior superior aorta recess (aSAR) AA=ascending

49、 aorta, DA=descending aorta, SVC=superior vena cavaPosterior superior aorta recess (pSAR) Pericardium第六十六頁(yè)，共一百零九頁(yè)。 67AADAAASVCPAAA=ascending aorta, DA=descending aorta, SVC=superior vena cava, PA= pulmonary arteryPericardiumAnterior superior aorta recess (aSAR) Posterior superior aorta recess (pSAR)

50、 第六十七頁(yè)，共一百零九頁(yè)。 68MPADAAAAA=ascending aorta, DA=descending aorta, MPA=main pulmonary arteryPericardiumPericardiumPericardium第六十八頁(yè)，共一百零九頁(yè)。 69DAAASVCPALALeft pulmonic recess (LPR)Right superior aortic recess (rSAR)AA=ascending aorta, DA=descending aorta, V=superior vena cava, PA=main pulmonary artery,

51、PA=right pulmonary artery, LA=left atriumPericardiumPericardium第六十九頁(yè)，共一百零九頁(yè)。 70DAAASVCLARAMPAEPericardiumPosterior Pericardial recess (PPR)PericardiumPericardiumRight pulmonic recess (RPR)RA=right atrium心房(xnfng), AA=aortic arch, LV=left ventricle, LA=Left atrium, MPA=main pulmonary artery, DA=desce

52、nding aorta, E=esophagus第七十頁(yè)，共一百零九頁(yè)。 71DAAALARARVELVPericardiumPericardiumPericardiumOblique sinus (OS)RA=right atrium, RV=right ventricle心室(xnsh), LV=left ventricle, LA=Left atrium, AA=aortic arch, DA=descending aorta, E=esophagus第七十一頁(yè)，共一百零九頁(yè)。 72PericardiumPericardiumRVLVLARA=right atrium, RV=right

53、 ventricle, LV=left ventricle, LA=Left atrium, AA=Ascending AortaRAAA第七十二頁(yè)，共一百零九頁(yè)。 73PericardiumPericardiumPericardium effusion (PEFF)RVLVDALARARA=right atrium, RV=right ventricle, LV=left ventricle, LA=Left atrium, AA=aortic arch第七十三頁(yè)，共一百零九頁(yè)。 74DALARARVELVPericardiumPericardiumPericardiumPericardia

54、l effusion (PEFF)RA=right atrium, RV=right ventricle, LV=left ventricle, LA=Left atrium第七十四頁(yè)，共一百零九頁(yè)。 75LIVERPericardial effusion (PEFF)PericardiumPericardiumLV第七十五頁(yè)，共一百零九頁(yè)。 76Atlas for Heart and Pericardium心臟(xnzng)心包圖解Pericardium: based on anatomyPericardium: based on anatomyHeart: based on consens

55、us Heart: based on consensus contours of most RTOG contours of most RTOG centers/previous trials, centers/previous trials, actually including part of actually including part of pericardium pericardium 第七十六頁(yè)，共一百零九頁(yè)。 77Pericardium startsPericardium startsPericardiumAPericardium starts at 1-2 slices (5

56、-6 mm) above the superior end of the aortic arch心包的勾畫(huà)從主動(dòng)脈弓(zhdngmigng)上表面上1-2層（5-6mm）開(kāi)始。PericardiumBrachiocephalic veinLeft carotid arteryInnominate arterySubclavian artery第七十七頁(yè)，共一百零九頁(yè)。 78Pericardium continuesPericardium continuesPericardiumPericardiumAortic ArchAortic ArchSVCSVCSVC=superior vena ca

57、va第七十八頁(yè)，共一百零九頁(yè)。 79Pericardium continuesPericardium continuesPericardiumPericardiumSVCSVCAortic ArchAortic ArchSVC=superior vena cava第七十九頁(yè)，共一百零九頁(yè)。 80Pericardium continuesPericardium continuesPericardiumAAPericardiumDASVCSVCAortic ArchSVC=superior vena cava第八十頁(yè)，共一百零九頁(yè)。 81Pericardium continuesPericardi

58、um continuesPericardiumAADAPericardiumAADASVCSVCSVC=superior vena cavaAA=Ascending aortaDA=Descending aorta第八十一頁(yè)，共一百零九頁(yè)。 82Pericardium continuesPericardium continuesPericardiumAADAPAPericardiumAADAPASVCSVCSVC=superior vena cavaPA=Pulmonary arteryAA=Ascending aortaDA=Descending aorta第八十二頁(yè)，共一百零九頁(yè)。 83P

59、ericardiumAADAPAPericardiumAADAPASVCSVCSVC=Superior vena cavaPA=Pulmonary arteryAA=Ascending aortaDA=Descending aorta第八十三頁(yè)，共一百零九頁(yè)。 84Pericardium ContinuesPericardium ContinuesPericardiumAADAPAPericardiumAADAPASVCSVCSVC=Superior vena cavaPA=Pulmonary arteryAA=Ascending aortaDA=Descending aorta第八十四頁(yè)，共

60、一百零九頁(yè)。 85Pericardium ContinuesPericardium ContinuesPericardiumAADAPAPericardiumAADAPASVCPAPASVCSVC=superior vena cavaPA=Pulmonary arteryAA=Ascending aortaDA=Descending aortaCT-GTV第八十五頁(yè)，共一百零九頁(yè)。 86Pericardium ContinuesPericardium ContinuesPericardiumAADAPAPericardiumAADAPASVCPAPASVCSVC=Superior vena cavaPA=Pu