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The GTV should be described in standard topographical or anatomical terms, e.g. Since the description of a GTV on scans for radiation treatment planning usually is made subjectively, an interobserver variation can be expected.
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The image format should make it possible to fuse information from different imaging equipments, using, e.g.
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The problem has been highlighted recently. The radiation oncologists should therefore indicate in each case which methods have been used for evaluation and for the definition of the GTV. palpation or mammography for breast tumours, and CT or MRI for some brain tumours). The GTV (primary tumour (GTV-T), metastatic lymphadenopathy (GTV-N), other metastases (GTV-M)), may be different in size and shape, sometimes significantly, depending on what examination technique is used for evaluation (e.g.
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The methods used to determine the GTV should meet the requirements for staging the tumour according to the clinical TNM and American Joint Committee on Cancer (AJCC) systems, and the definition of the GTV is then in full agreement with the criteria used for the TNM classification. X-ray, computed tomography (CT), digital radiography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide methods). inspection, palpation, endoscopy), and various imaging techniques (e.g. The shape, size, and location of a GTV may be determined by different methods such as clinical examination (e.g. No GTV can be defined if the tumour has been completely removed, e.g. Due to the high density of the cancer cells in the GTV, an adequate dose must be delivered to the whole GTV to obtain local tumour control in radical treatments. The GTV corresponds almost always to those parts of the malignant growth where the tumour cell density is the highest. The GTV may consist of primary tumour (GTV-T), metastatic lymphadenopathy (GTV-N), or other metastases (GTV-M). The gross tumour volume (GTV) is the gross palpable or visible/demonstrable extent and location of the malignant growth. Only GTV, CTV, and OR represent tissues, whereas the others are geometric concepts and do not strictly represent tissue or organ volumes. Irradiated volume is the tissue volume which receives a dose that is considered significant in relation to normal tissue tolerance (other than those specifically defined as organs at risk) (reproduced by kind permission from the ICRU).
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The concept is useful for the evaluation of loco-regional relapses. Treated volume is the volume that receives a dose that is considered important for local cure or palliation. Note that in the example shown, the magnitude of foreseen movements of the CTV is different in different directions. The PTV is thus a geometrical concept used to ensure that the CTV receives the prescribed dose, and it is defined in relation to a fixed coordinate system. Planning target volume (PTV) consists of the CTV(s) and a margin to account for variations in size, shape, and position relative to the treatment beam(s). The CTV is thus a purely anatomical clinical concept. a margin around the GTV and regional lymph nodes not invaded clinically). Clinical target volume (CTV) denotes the demonstrated tumour (when present) and also volumes with suspected (subclinical) tumour considered to need treatment (e.g. Gross tumour volume (GTV) denotes the demonstrated tumour. Schematic illustration of the different volumes as defined in ICRU Report 50 (1993).