co-registration and fusion of planning ct with t2/ flair ......co-registration and fusion of...
TRANSCRIPT
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Co-registration and fusion of Planning CT with T2/ FLAIR images
and T1 contrast-enhanced images of post-operative MRI.
GTV1 = T2/ FLAIR abnormality
Include all enhancement on postoperative MRI and the surgical
cavity.
TIP: Draw GTV2 (described below) and create a summation
contour which should be labeled back as GTV1. This will ensure
all enhancement and surgical cavity is part of GTV1.
GTV2 = T1 Contrast-enhanced abnormality, Include the complete
surgical cavity
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CTV1 = GTV1 + 2 cm margin
The CTV1 margin may be reduced to 0.5 cm around natural barriers
to tumor growth such as the skull, ventricles, falx, etc, and to allow
sparing OAR, if necessary.
PTV1 = CTV1 + 3 to 5 mm margin, depending upon localization
method and reproducibility at each center.
If no surrounding edema is present, then PTV1 = GTV2 + 2.5-cm
margin.
CTV2 = GTV2 + 2 cm margin not extending beyond CTV1
PTV2 = CTV2 + 3 to 5 mm margin
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PTV1 to be planned to receive a dose of 46 Gy in 23 fractions.
PTV2 to be planned to receive an additional 14 Gy in 7 fractions.
The inhomogeneity within the target volume shall be kept to ± 10%
of the prescribed dose.
The minimum dose to the target volume should be kept within 10%
of the dose at the center of the volume.
Doses are specified such that at least 95% of the PTV shall
receive 100% of the prescribed dose
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OAR must be defined , along with a planning risk volume (PRV) for
each OAR.
PRV = OAR + 3 mm.
In the event that an OAR is in immediate proximity to a PTV such
that dose to the OAR cannot be constrained within protocol limits,
a second PTV (PTVoverlap) is generated.
PTVoverlap = The overlap between the PTV2 and the particular
PRV of concern (i.e. the overlap is the intersection between the
PTV1 and the PRV).
Dose to the PTVoverlap must be as close as permissible to 14 Gy
while not exceeding the OAR dose limit.
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GTV1 = T2/ FLAIR abnormality
Co-registration and fusion of Planning CT with T2/ FLAIR images
of post-operative MRI.
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GTV1 = T2/ FLAIR abnormality
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GTV1 = T2/ FLAIR abnormality
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GTV1 = Include all enhancement on postoperative MRI and the
surgical cavity.
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TIP: Draw GTV2 (described next) and create a summation contour which should be labeled back as GTV1. This will ensure all enhancement and surgical cavity is part of GTV1.
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Co-registration and fusion of Planning CT with T1 Contrast-
enhanced images of post-operative MRI.
GTV2 = T1 Contrast-enhanced abnormality
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GTV2 = T1 Contrast-enhanced abnormality
GTV1
GTV2
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GTV2 = Include the complete surgical cavity
GTV1
GTV2
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GTV2 = Include the complete surgical cavity
GTV1
GTV2
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CTV1 = GTV1 + 2 cm margin Reference 2cm expansion reduced to 0.5 cm around natural barriers to
tumor growth such as the skull, ventricles, falx, etc to create CTV1
GTV1 CTV1
Reference 2cm expansion
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GTV1 CTV1
Reference 2cm expansion
CTV1 = GTV1 + 2 cm margin Reference 2cm expansion reduced to 0.5 cm around natural barriers to
tumor growth such as the skull, ventricles, falx, etc to create CTV1
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CTV1 margin may be reduced to allow sparing of optic nerve/
chiasm, brain stem if necessary.
GTV1 CTV1
Reference 2cm expansion
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PTV1 = CTV1 + 3-5 mm based on institutional localization method
and reproducibility at each center.
GTV1 CTV1
PTV1
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If no surrounding edema is present, then PTV1 = contrast-
enhancing lesion/ surgical cavity plus 2.5 cm margin.
GTV1 CTV1
PTV1
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PTV1 margins alterations to reduce organ at risk dose is not
permissible
GTV1
GTV2
CTV1
PTV1
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CTV2 = GTV2 + 2cm margin not extending beyond CTV1
GTV1
GTV2
CTV1
CTV2
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CTV2 margin may be reduced to 0.5 cm around natural barriers to
tumor growth such as the skull, ventricles, falx, etc.
GTV1
GTV2
CTV1
CTV2
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CTV2 margin may be reduced to allow sparing of optic nerve/
chiasm, brain stem if necessary.
GTV1
GTV2
CTV1
CTV2
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PTV2 = CTV2 + 3-5 mm based on institutional localization method
and reproducibility at each center.
GTV1
PTV2
PTV1
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GTV1
PTV2
PTV1
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GTV2
GTV1
PTV2
PTV1
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GTV2
GTV1
PTV2
PTV1