Pelvic normal tissue contouring guidelines for radiation therapy: A radiation therapy oncology group consensus panel atlas

Hiram A. Gay, H. Joseph Barthold, Elizabeth O'Meara, Walter R. Bosch, Issam El Naqa, Rawan Al-Lozi, Seth A. Rosenthal, Colleen Lawton, W. Robert Lee, Howard Sandler, Anthony Zietman, Robert Myerson, Laura A. Dawson, Christopher Willett, Lisa A. Kachnic, Anuja Jhingran, Lorraine Portelance, Janice Ryu, William Small, David GaffneyAkila N. Viswanathan, Jeff M. Michalski

Research output: Contribution to journalArticlepeer-review

404 Scopus citations


Purpose: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. Results: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa-R, Adnexa-L, Prostate, SeminalVesc, PenileBulb, Femur-R, and Femur-L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. Conclusions: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

Original languageEnglish
Pages (from-to)e353-e362
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number3
StatePublished - Jul 1 2012


  • Female pelvis
  • Male pelvis
  • Normal tissue volumes
  • Pelvic contouring atlas
  • Radiation therapy atlas


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