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Upper Abdominal Normal Organ Contouring Guidelines: RTOG Consensus Panel 2013
Upper Abdominal Normal Organ Contouring Guidelines: RTOG Consensus Panel 2013
1. Department of Radiation Oncology, The Cancer Institute of New Jersey, University of Medicine and Dentistry of
New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ
2. Department of Radiation Oncology, Princess Margaret Hospital/University of Toronto, Toronto, Ontario, Canada
3. present address: Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
4. Washington University School of Medicine, St. Louis, MO
5. Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital,
University of Toronto, Toronto, Ontario, Canada
6. 21st Century Oncology Translational Research Consortium Scottsdale, AZ
7. Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI
8. Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA
9. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
10. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY
11. Department of Radiation Oncology, Mayo Clinic, Rochester, MN
12. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
13. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
14. Department of Radiation Oncology, Boston University Medical Center, Boston, Massachusetts
15. Department of Radiation Oncology, Dana Farber Cancer Institute, Boston, Massachusetts; Brigham and Women's
Hospital, Boston, MA
16. Department of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
Abbreviations
• Roman numerals refer to liver segments
• L_: left
• R_: right
Heart
Esophagus
Heart
VIII
Esophagus
IVa
Heart
VIII
Esophagus
VII
IVa
Heart
VIII
Esophagus
VII
Lung_R Lung_L
IVa
Heart
VIII
Esophagus
VII
Lung_R Lung_L
IVa
Heart
VIII
Esophagus
VII Spleen
Lung_R Lung_L
IVa
Heart
VIII
Esophagus
Stomach S95
VII Spleen
Lung_R Lung_L
IVa
Heart
VIII
MHV Esophagus
Stomach S95
RHV
VII Spleen
Lung_R Lung_L
IVa
Heart
VIII
MHV Esophagus
Stomach S95
RHV
VII Spleen
Lung_R Lung_L
III
IVa
Heart
VIII GEJ
MHV Esophagus
I Stomach S95
RHV
VII Spleen
Lung_R Lung_L
III
IVa
VIII GEJ
MHV Esophagus
I Stomach S95
RHV
VII Spleen
Lung_R Lung_L
III
IVa
LPV
VIII GEJ
MHV Esophagus
I Stomach S95
RHV
VII Spleen
Lung_R Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV
VII Spleen
Adrenal R
Lung_R Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV
VII Spleen
Adrenal R
Lung_R Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV
VII Spleen
Adrenal R
Lung_R Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV SplinicHilum
RPPV
VII Spleen
Adrenal R
Lung_R Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV SplinicHilum
RPPV
VII Spleen
Adrenal R
Lung_L
III
IVa
LargeBowel
LPV
RTAPV
VIII
MHV
I Stomach S95
RHV SV
RPPV
VII Spleen
Adrenal R
Lung_L
III
IVa
LargeBowel
LPV SmallBowel
RTAPV
VIII
MHV
I Stomach S95
RHV SV
RPPV
VII Spleen
Adrenal R
Adrenal_L
Lung_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
VIII
MHV
I Stomach S95
RHV SV
RPPV
VII Spleen
Adrenal R
Adrenal_L
Lung_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
VIII
MHV CA
I Stomach S95
RHV SV
RPPV Pancreas
VII Spleen
Adrenal R
Adrenal_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
VIII
CA
RHV SV
RPPV Pancreas
VII Spleen
Adrenal R
Adrenal_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
VIII
CA
RHV SV
RPPV Pancreas
VII Spleen
Adrenal R
Adrenal_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
V SV
PV CA
RHV
RPPV
VI Spleen
Adrenal_L
III
IVb
LargeBowel
LPV SmallBowel
RTAPV Pancreas
V SV
PV CA
I SMA
RHV
RPPV
VI Spleen
Adrenal_L
III
IVb
LPV SmallBowel
RTAPV Pancreas
V SV
PV SA
I SMA
RHV
RPPV
VI
Adrenal_L
III
IVb
SmallBowel
CommonBileD Pancreas
V SV
PV SA
I SMA
RHV
RPPV Pancreas
VI
Adrenal_L
III
IVb
SmallBowel
CommonBileD Pancreas
V SV
PV
I SMA
RHV
RPPV Pancreas
VI LargeBowel
Adrenal_L
III
IVb
SmallBowel
CommonBileD Pancreas
V SV
PV
I SMA
RHV
RPPV
VI LargeBowel
Adrenal_L
III
IVb
GallBladder SmallBowel
CommonBileD Pancreas
V SV
PV
SMA
RHV
RPPV
VI LargeBowel
III
IVb
GallBladder SmallBowel
CommonBileD Pancreas
V SV
PV IMV
SMA
RPPV
VI LargeBowel
III
IVb
GallBladder SmallBowel
CommonBileD Pancreas
V SV
PV IMV
SMA
RPPV
VI LargeBowel
III
IVb
GallBladder SmallBowel
CommonBileD Pancreas
RPPV
VI LargeBowel
GallBladder SmallBowel
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
4th portion
SMV IMV
SMA
RPPV
VI LargeBowel
IVb
GallBladder SmallBowel
V Duodenum
4th portion
SMV IMV
SMA
RPPV
VI LargeBowel
IVb
GallBladder SmallBowel
V Duodenum
4th portion
SMV IMV
SMA
RPPV
VI LargeBowel
IVb
GallBladder SmallBowel
V Duodenum
4th portion
SMV IMV
SMA
RPPV
VI LargeBowel
IVb
GallBladder SmallBowel
V Duodenum
3rd portion
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
3rd portion
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
3rd portion
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
3rd portion
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
3rd portion
SMV IMV
SMA
RPPV
VI LargeBowel
GallBladder SmallBowel
V Duodenum
3rd portion
SMV
SMA
RPPV
VI LargeBowel
SmallBowel
V Duodenum
3rd portion
SMV
SMA
VI LargeBowel
SmallBowel
V Duodenum
3rd portion
SMV
SMA
VI LargeBowel
SmallBowel
Pancreas Uncinate
V Duodenum
3rd portion
SMV
SMA
VI LargeBowel
SmallBowel
Pancreas Uncinate
V Duodenum
3rd portion
SMV
SMA
VI LargeBowel
Duodenum
3rd portion
SMV
SMA
VI LargeBowel
a b
c
d h j
e f
g
Liver
• The porta hepatis is the site of entry of the portal vein,
hepatic artery, hepatic ducts, in addition to the hepatic
nerve plexus and lymphatic vessels.
• The right and left lobe are separated by a plane extending vertically through
the gallbladder fossa and middle hepatic vein.
• The right anterior and posterior segments are divided by a vertical plane
through the right hepatic vein (V & VIII anteriorly from VI & VII posteriorly).
• The falciform ligament separates the left lateral and medial segments (II &
III from IV).
• A plane of the main right and left portal vein demarcates superior from
inferior segments (VII & VIII from V & VI).
For liver contouring (light blue contour below),
• Gallbladder should be excluded
• IVC should be excluded when it is discrete from the liver
• The portal vein (PV) should be included in the liver contour
when Segment (Seg) I (caudate lobe) is seen to the left of PV.
e.g. Seg I is primarily posterior to PV, e.g. Seg I is left of PV, so the liver
so liver contour should exclude PV contour should include PV
Portal Vein (PV)
• PV is formed behind the pancreatic neck by the
intersection of the SMV and SV