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Contouring in the Brain—Barriers to Tumor Spread, Avoidance Structures and Future Directions

Course Details

CEUs: 1.0

Available Until: 10/31/2019

Non-Member Price: $35.00

Member Price: $20.00

Member PLUS Price: $20.00

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Presented by Timothy Kruser, MD
Radiation Oncologist
Northwestern Memorial Hospital

Recorded 9/17/18

Current protocols for target delineation in the brain utilize T2-FLAIR and post-resection cavity enhancement to guide treatment volumes. Anatomic barriers to spread such as the falx, tentorium, and ventricles are utilized to customize target volumes and therefore intricate knowledge of white matter tracts in the brain are important to understand appropriate customization of target volumes. This session will review these structures and pathways, as well as common mistakes in glioma contouring. In addition, avoidance structures and future directions in brain tumor contouring will be discussed. Preliminary data from four postoperative glioblastoma (GBM) cases in varying locations in the brain that were contoured by ten academic radiation oncologists specializing in brain tumor treatment will be utilized to highlight common mistakes in contouring for glioma radiotherapy. The presentation will focus on practical contouring concerns in the context of current brain tumor protocols. Current literature and protocols will serve the basis for discussions of avoidance organ delineation. 

Learner Outcomes:  

  1. Understand white matter tracts in the brain and how they impact radiation planning.
  2. Recognize barriers to spread of brain tumors and how these can be common errors in contour delineation
  3. Describe normal structure contouring in the brain including novel areas such as the hippocampus


Dr. Kruser is a radiation oncologist at Northwestern Memorial Hospital. He trained at the University of Wisconsin, and now lives in Chicago where he specializes in radiation for lung and brain malignancies.