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Abstract：
The objective of this project was to define consensus guidelines for delineating brainstem substructures (dorsal vagal complex, including the area postrema) involved in radiation-induced nausea and vomiting (RINV). The three parts of the brainstem are rarely delineated, so this study was also an opportunity to find a consensus on this subject.
The dorsal vagal complex (DVC) was identified on autopsy sections and endoscopic descriptions. Anatomic landmarks and boundaries were used to establish radio-anatomic correlations on CT and Magnetic Resonance Imaging (MRI). Additionally, delineation of RINV structures was performed on MRI images and reported on CT scans. Next, guidelines were provided to eight radiation oncologists for delineation guidance of these RINV-related structures on DICOM-RT images of two patients being treated for a nasopharyngeal carcinoma. Interobserver variability was computed.
The DVC and the three parts of the brainstem were defined with a concise description of their main anatomic boundaries. The interobserver analysis showed that the DVC, the midbrain, the pons, and the medulla oblongata delineations were reproducible with KI = 0.72, 0.84, 0.94 and 0.89, respectively. The Supplemental Material section provides an atlas of the consensus guidelines projected on 1-mm MR axial slices.
This RINV-atlas was feasible and reproducible for the delineation of RINV structures on planning CT using fused MRI. It may be used to prospectively assess dose-volume relationship for RINV structures and occurrence of nausea vomiting during intracranial or head and neck irradiation.
The dorsal vagal complex (DVC) was identified on autopsy sections and endoscopic descriptions. Anatomic landmarks and boundaries were used to establish radio-anatomic correlations on CT and Magnetic Resonance Imaging (MRI). Additionally, delineation of RINV structures was performed on MRI images and reported on CT scans. Next, guidelines were provided to eight radiation oncologists for delineation guidance of these RINV-related structures on DICOM-RT images of two patients being treated for a nasopharyngeal carcinoma. Interobserver variability was computed.
The DVC and the three parts of the brainstem were defined with a concise description of their main anatomic boundaries. The interobserver analysis showed that the DVC, the midbrain, the pons, and the medulla oblongata delineations were reproducible with KI = 0.72, 0.84, 0.94 and 0.89, respectively. The Supplemental Material section provides an atlas of the consensus guidelines projected on 1-mm MR axial slices.
This RINV-atlas was feasible and reproducible for the delineation of RINV structures on planning CT using fused MRI. It may be used to prospectively assess dose-volume relationship for RINV structures and occurrence of nausea vomiting during intracranial or head and neck irradiation.
摘要：
该项目的目的是定义描绘脑干亚结构（背侧迷走神经复合体，包括后区域）涉及辐射引起的恶心和呕吐（RINV）。脑干的三个部分很少被划定，因此，这项研究也是一个在这个问题上达成共识的机会。
在尸检切片和内窥镜描述中确定了背侧迷走神经复合体（DVC）。使用解剖标志和边界在CT和磁共振成像（MRI）上建立放射解剖相关性。此外,RINV结构的勾画在MRI图像上进行,并在CT扫描中报告.接下来,我们向8名放射肿瘤学家提供了指南,以指导在2名鼻咽癌患者的DICOM-RT图像上这些RINV相关结构的勾画.计算了观察者间的变异性。
定义了DVC和脑干的三个部分，并简要描述了它们的主要解剖边界。观察者间的分析表明，DVC，中脑，Pons,延髓的轮廓可重现性分别为KI=0.72、0.84、0.94和0.89。补充材料部分提供了在1毫米MR轴向切片上投影的共识指南的图集。
此RINV图集对于使用融合MRI在计划CT上描绘RINV结构是可行和可再现的。它可用于前瞻性评估RINV结构的剂量-体积关系以及颅内或头颈部照射期间恶心呕吐的发生。
在尸检切片和内窥镜描述中确定了背侧迷走神经复合体（DVC）。使用解剖标志和边界在CT和磁共振成像（MRI）上建立放射解剖相关性。此外,RINV结构的勾画在MRI图像上进行,并在CT扫描中报告.接下来,我们向8名放射肿瘤学家提供了指南,以指导在2名鼻咽癌患者的DICOM-RT图像上这些RINV相关结构的勾画.计算了观察者间的变异性。
定义了DVC和脑干的三个部分，并简要描述了它们的主要解剖边界。观察者间的分析表明，DVC，中脑，Pons,延髓的轮廓可重现性分别为KI=0.72、0.84、0.94和0.89。补充材料部分提供了在1毫米MR轴向切片上投影的共识指南的图集。
此RINV图集对于使用融合MRI在计划CT上描绘RINV结构是可行和可再现的。它可用于前瞻性评估RINV结构的剂量-体积关系以及颅内或头颈部照射期间恶心呕吐的发生。
