Michelle Rocque

March 2015
Conformal Terminology
Organs at Risk (OR)
Organs at risk are critical structures that have dose limitations due to the risk of radiation
induced toxicity. Damage to ORs may leave the patient with an inferior quality of life or can
even lead to death.1 The sensitivity and proximity of the OR to the CTV can influence the way
the dosimetrist sets the beam or table angles. It can also influence the dose the physician
prescribes. ORs are identified based on the site of treatment. For example, if treating the whole
brain, the lens or brainstem would be considered an organ at risk but the liver would not.
Dose to an OR must be followed as closely as your intended treatment volumes. This is
done by carefully contouring each critical normal structure. If an IMRT or RapidArc plan is
done, these structures can have constraints placed on them to attempt to keep the dose to an
acceptable level. With a 3D plan, beam angles are used to avoid the ORs as much as possible.
When the plan is evaluated, a dose volume histogram (DVH), shows proof of the efforts in
maintaining dose limits to the ORs. The dosimetrist will evaluate each OR against planning
objectives approved by the physician and if they are met the plan can go on for approval. If they
are not, decisions are made to make changes in the plan or discuss compromises if the planning
organ at risk volume is in close proximity to the PTV.2
I found great information regarding OR delineation for the H&N region. The slideshow
names organs at risk and include contours of each. It can be found at
http://www.slideshare.net/RajeshBalakrishnan1/atlas-of-organs-at-risk-delineation-head-andneck-region
Listed below are common ORs for the Head and Neck, Chest, Abdomen, and Pelvis.
Depending on your facility or physician, there may be additional ORs that I have not listed. Ive
only included the most common.

Head & Neck: (Figure 1) Temporal Lobes, Right/Lt eye and lens, Right/Left Optic nerve, Optic
chiasm, Pituitary, Cochlea, Brainstem, Spine, Right/Left Parotid glands, Submandibular gland,
Mandible, Pharyngeal constrictors, Trachea, Brachial plexus

Figure 1 Rt/Lt Lens, Rt/Lt eye, Rt/Lt Optic Nerve, Rt/Lt Temporal Lobe

Chest & Abdomen: (Figure 2) Right/Left Lungs, Esophagus, Heart, Right/Left Kidneys, Spinal
cord, Stomach, Small bowel, Large bowel, Liver

Figure 2 Rt/Lt Lungs

Pelvis: (Figure 3) Rectum, Bladder, Femoral Heads, Penile bulb

Figure 3 Rectum, Bladder, Rt/Lt Femoral Heads

References
1. Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 3rd ed. St.
Louis, MO: Mosby-Elsevier; 2010.
2. McDermott P, Orton C. The Physics & Technology of Radiation Therapy. Madison, WI:
Medical Physics Publishing; 2010