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Target delineation in Pelvic malignancies

ICRU definitions. Gross Tumor Volume: GTVClinical Target Volume: CTVInternal Target Volume: ITVPlanning Target Volume: PTVOrgan at Risk: OARPlanning Organ at Risk Volume: PRV. ICRU 50

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Target delineation in Pelvic malignancies

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    1. Target delineation in Pelvic malignancies Thastro March 20-22nd Pierre Scalliet MD, PhD, HFRCR

    2. ICRU definitions

    3. GTV Demonstrable macroscopic tumour (CT scan, MRI, PET-CT,other…). Does not apply to postoperative RT. Does not apply in situations where the tumour is not easy to see: prostate and rectum cancer. Long learning curve, need for training or “retraining” in modern imaging

    4. Lymphatic CTV in the pelvis

    5. Lymphatic CTV in the pelvis

    6. Cervix cancer imaging with MRI (GTV)

    7. Cervix cancer imaging with MRI (GTV)

    8. Cervix cancer imaging with MRI (GTV)

    9. 3D imaging of brachytherapy

    10. Inter-observer variation in delineation for cervix cancer

    11. Poor organ definition with CT Organ definition sometimes difficult with CT due to lack of contrast. MRI offers much better contrast for soft tissue. Combination of CT with MRI offers a good solution for anatomy definition.

    12. CTV for cervix cancer

    13. Volumes in rectum cancer

    14. Characterisation of rectal cancer: standard is MRI

    15. Characterisation of rectal cancer: standard is MRI

    16. Rectum cancer: before and after chemoradiation

    17. Rectum cancer: before and after chemoradiation

    18. Rectum cancer: before and after chemoradiation

    19. Prostate cancer

    20. Prostate cancer CTV

    21. PTV? Systematic deviations Random deviations

    22. PTV?

    23. Calculating the PTV

    24. Calculating the PTV

    25. Repeated (3/w) portal imaging in 30 patients treated for various tumors scatter plot reporting the discrepancies in the beam axis of portal images relative to simulation films in Centre A and Centre B

    26. ITV? Respiratory movements

    27. ITV? Respiratory movements (16/min) Cardiac beats (80/min) Random movements (bowel, bladder, etc…)

    28. ITV?

    29. ITV?

    30. Question without answer…

    31. Towards multidimensional conformal radiotherapy?

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