1 2

Volume Max Max Point Endpoint

Serial Tissue Volume Serial Tissue
(Gy) Dose (Gy)** (≥Grade 3)

Optic Optic
<0.2 cc 8 Gy 10 Gy neuritis
Pathway Pathway

Cochlea 9 Gy hearing loss Cochlea

Brainstem cranial Brainstem

<0.5 cc 10 Gy 15 Gy
(not medulla) neuropathy (not medulla)

Spinal Cord Spinal Cord

<0.35 cc 10 Gy 14 Gy myelitis
and medulla and medulla

Cauda Equina <5 cc 14 Gy 16 Gy neuritis Cauda Equina

Sacral Plexus <5 cc 14.4 Gy 16 Gy neuropathy Sacral Plexus

Esophagus* <5 cc 20 Gy 24 Gy esophagitis Esophagus*

Brachial Brachial
<3 cc 13.6 Gy 16.4 Gy neuropathy
Plexus Plexus

Heart/ Heart/
<15 cc 16 Gy 22 Gy pericarditis
Pericardium Pericardium

Great vessels <10 cc 31 Gy 37 Gy aneurysm Great vessels

Trachea and impairment of Trachea and
Large <4 cc 27.5 Gy 30 Gy pulmonary Large
Bronchus* toilet Bronchus*

Bronchus- Bronchus-
stenosis with
smaller <0.5 cc 17.4 Gy 20.2 Gy smaller
atelectasis
airways airways

Pain or
Rib <5 cc 28 Gy 33 Gy Rib
fracture
Skin <10 cc 25.5 Gy 27.5 Gy ulceration Skin

ulceration/
Stomach <5 cc 17.4 Gy 22 Gy Stomach
fistula
Bile duct 30 Gy stenosis Bile duct

Duodenum* <5 cc 17.4 Gy 22 Gy ulceration Duodenum*

Jejunum/ enteritis/ Jejunum/
<30 cc 17.6 Gy 20 Gy
Ileum* obstruction Ileum*

Colon* <20 cc 20.5 Gy 31 Gy colitis/fistula Colon*

<3.5 cc 30 Gy

proctitis/
Rectum* 33.7 Gy Rectum*
fistula

<20 cc 23 Gy

Ureter 35 Gy stenosis Ureter

Bladder wall <15 cc 12 Gy 25 Gy cystitis/fistula Bladder wall

Penile bulb <3 cc 16 Gy impotence Penile bulb

Femoral Femoral
<10 cc 15 Gy necrosis
Heads Heads

Renal Renal
malignant
hilum/vascula 15 cc 14 Gy hilum/vascula
hypertension
r trunk r trunk

Critical
Parallel Critical Endpoint Parallel
Volume Dose
Tissue Volume (cc) (≥Grade 3) Tissue
Max (Gy)
1500 cc for
Lung (Right males and Basic Lung Lung (Right
7.2 Gy
& Left) 950cc for Function & Left)
females***

Lung (Right Radiation Lung (Right

V-8Gy <37%
& Left) Pneumonitis & Left)

Basic Liver
Liver 700 cc*** 11.6 Gy Liver
Function
Renal cortex Renal cortex
Basic renal
(Right & 200 cc*** 9.5 Gy (Right &
function
Left) Left)
 3
Volume Max Max Point Endpoint Volume Max
Volume Serial Tissue Volume
(Gy) Dose (Gy)** (≥Grade 3) (Gy)

Optic
<0.2 cc 11.7 Gy 13.7 Gy neuritis <0.2 cc 15.3 Gy
Pathway

11.7 Gy hearing loss Cochlea

cranial Brainstem
<0.5 cc 13 Gy 19.1 Gy <0.5 cc 15.9 Gy
neuropathy (not medulla)

Spinal Cord
<0.35 cc 13 Gy 18.3 Gy myelitis <0.35 cc 15.9 Gy
and medulla

<5 cc 18 Gy 20.8 Gy neuritis Cauda Equina <5 cc 21.9 Gy

<5 cc 18.5 Gy 20.8 Gy neuropathy Sacral Plexus <5 cc 22.5 Gy

<5 cc 24.3 Gy 28.3 Gy esophagitis Esophagus* <5 cc 27.9 Gy

Brachial
<3 cc 17.8 Gy 21.2 Gy neuropathy <3 cc 22 Gy
Plexus

Heart/
<15 cc 20 Gy 26 Gy pericarditis <15 cc 24 Gy
Pericardium

<10 cc 35 Gy 41 Gy aneurysm Great vessels <10 cc 39 Gy

 impairment of Trachea and
<4 cc 34.5 Gy 38 Gy pulmonary Large <5 cc 39 Gy
toilet Bronchus*

Bronchus-
stenosis with
<0.5 cc 21.6 Gy 25.1 Gy smaller <0.5 cc 25.8 Gy
atelectasis
airways

Pain or
<5 cc 34 Gy 41.5 Gy Rib <5 cc 40 Gy
fracture
<10 cc 28.3 Gy 30.3 Gy ulceration Skin <10 cc 31 Gy

ulceration/
<5 cc 20 Gy 26 Gy Stomach <5 cc 22.5 Gy
fistula
 33 Gy stenosis Bile duct

<5 cc 20 Gy 26 Gy ulceration Duodenum* <5 cc 22.5 Gy

 enteritis/ Jejunum/
<30 cc 19.2 Gy 24 Gy <30 cc 20.7 Gy
obstruction Ileum*

<20 cc 25.8 Gy 39 Gy colitis/fistula Colon* <20 cc 28.8 Gy

<3.5 cc 38 Gy <3.5 cc 43 Gy

proctitis/
41.3 Gy Rectum*
fistula

<20 cc 26.7 Gy <20 cc 30.3 Gy

37.5 Gy stenosis Ureter

<15 cc 14.5 Gy 29 Gy cystitis/fistula Bladder wall <15 cc 17 Gy

<3 cc 20.5 Gy impotence Penile bulb <3 cc 25 Gy

Femoral
<10 cc 19.5 Gy necrosis <10 cc 24 Gy
Heads

Renal
malignant
15 cc 16.8 Gy hilum/vascula 15 cc 19.5 Gy
hypertension
r trunk

Critical Critical
Critical Endpoint Parallel Critical
Volume Dose Volume Dose
Volume (cc) (≥Grade 3) Tissue Volume (cc)
Max (Gy) Max (Gy)
1500 cc for 1500 cc for
males and Basic Lung Lung (Right males and
9.4 Gy 10.8 Gy
950cc for Function & Left) 950cc for
females*** females***

V-10Gy Radiation Lung (Right

<37% Pneumonitis & Left)

Basic Liver
700 cc*** 15.1 Gy Liver 700 cc*** 17.7 Gy
Function
 Renal cortex
Basic renal
200 cc*** 12.5 Gy (Right & 200 cc*** 14.7 Gy
function
Left)
 4
Max Point Endpoint Volume Max Max Point Endpoint
Serial Tissue Volume
Dose (Gy)** (≥Grade 3) (Gy) Dose (Gy)** (≥Grade 3)

Optic
17.4 Gy neuritis <0.2 cc 19.2 Gy 21.2 Gy neuritis
Pathway

14.4 Gy hearing loss Cochlea 18 Gy hearing loss

cranial Brainstem cranial

23.1 Gy <0.5 cc 20.8 Gy 27.2 Gy
neuropathy (not medulla) neuropathy

Spinal Cord
22.5 Gy myelitis <0.35 cc 18 Gy 25.6 Gy myelitis
and medulla

25.5 Gy neuritis Cauda Equina <5 cc 26 Gy 28.8 Gy neuritis

25.5 Gy neuropathy Sacral Plexus <5 cc 26 Gy 28.8 Gy neuropathy

32.4 Gy esophagitis Esophagus* <5 cc 30.4 Gy 35.6 Gy esophagitis

Brachial
26 Gy neuropathy <3 cc 24.8 Gy 29.6 Gy neuropathy
Plexus

Heart/
30 Gy pericarditis <15 cc 28 Gy 34 Gy pericarditis
Pericardium

45 Gy aneurysm Great vessels <10 cc 43 Gy 49 Gy aneurysm

 impairment of Trachea and impairment of
43 Gy pulmonary Large <5 cc 42.4 Gy 47 Gy pulmonary
toilet Bronchus* toilet

Bronchus-
stenosis with stenosis with
30 Gy smaller <0.5 cc 28.8 Gy 34.8 Gy
atelectasis atelectasis
airways

Pain or Pain or
50 Gy Rib <5 cc 43 Gy 54 Gy
fracture fracture
33 Gy ulceration Skin <10 cc 33.6 Gy 36 Gy ulceration

ulceration/ ulceration/
30 Gy Stomach <5 cc 25 Gy 33.2 Gy
fistula fistula
36 Gy stenosis Bile duct 38.4 Gy stenosis

30 Gy ulceration Duodenum* <5 cc 25 Gy 33.2 Gy ulceration

 enteritis/ Jejunum/ enteritis/
28.5 Gy <30 cc 22.4 Gy 31.6 Gy
obstruction Ileum* obstruction

45 Gy colitis/fistula Colon* <20 cc 30.8 Gy 48.5 Gy colitis/fistula

<3.5 cc 47.2 Gy

proctitis/ proctitis/
47 Gy Rectum* 51.6 Gy
fistula fistula

<20 cc 34 Gy

40 Gy stenosis Ureter 43 Gy stenosis

33 Gy cystitis/fistula Bladder wall <15 cc 18.5 Gy 35.6 Gy cystitis/fistula

impotence Penile Bulb <3 cc 27 Gy impotence

Femoral
necrosis <10 cc 27 Gy necrosis
Heads

Renal
malignant malignant
hilum/vascula 15 cc 21.5 Gy
hypertension hypertension
r trunk

Critical
Endpoint Parallel Critical Endpoint
Volume Dose
(≥Grade 3) Tissue Volume (cc) (≥Grade 3)
Max (Gy)
1500 cc for
Basic Lung Lung (Right males and Basic Lung
12 Gy
Function & Left) 950cc for Function
females***

V- Lung (Right V-
Pneumonitis Pneumonitis
11.4Gy<37% & Left) 12.8Gy<37%

Basic Liver Basic Liver

Liver 700 cc*** 19.6 Gy
Function Function
 Renal cortex
Basic renal Basic renal
(Right & 200 cc*** 16 Gy
function function
Left)
 5 8
Volume Max Max Point Endpoint
Serial Tissue Volume Serial Tissue
(Gy) Dose (Gy)** (≥Grade 3)

Optic Optic
<0.2 cc 23 Gy 25 Gy neuritis
Pathway Pathway

Cochlea 22 Gy hearing loss Cochlea

Brainstem cranial Brainstem

<0.5 cc 23 Gy 31 Gy
(not medulla) neuropathy (not medulla)

Spinal Cord Spinal Cord

<0.35 cc 22 Gy 28 Gy myelitis
and medulla and medulla

Cauda Equina <5 cc 30 Gy 31.5 Gy neuritis

Cauda Equina
Sacral Plexus <5 cc 30 Gy 32 Gy neuropathy

Esophagus* <5 cc 32.5 Gy 38 Gy esophagitis

Sacral Plexus

Brachial
<3 cc 27 Gy 32.5 Gy neuropathy
Plexus

Heart/
<15 cc 32 Gy 38 Gy pericarditis Esophagus*
Pericardium
Brachial
Great vessels <10 cc 47 Gy 53 Gy aneurysm
Plexus
Trachea and impairment of
Heart/
Large <5 cc 45 Gy 50 Gy pulmonary
Pericardium
Bronchus* toilet

Bronchus-
stenosis with
smaller <0.5 cc 32 Gy 40 Gy Great vessels
atelectasis
airways

Trachea and
Pain or
Rib <5 cc 45 Gy 57 Gy Large
fracture
Bronchus*
 Bronchus-
Skin <10 cc 36.5 Gy 38.5 Gy ulceration smaller
airways

ulceration/
Stomach <5cc 26.5 Gy 35 Gy Rib
fistula
Bile duct 41 Gy stenosis Skin

Duodenum* <5 cc 26.5 Gy 35 Gy ulceration Stomach

Jejunum/ enteritis/
<30 cc 24 Gy 34.5 Gy Bile duct
Ileum* obstruction

Colon* <20 cc 32.5 Gy 52.5 Gy colitis/fistula Duodenum*

Jejunum/
<3.5 cc 50 Gy
Ileum*

proctitis/
Rectum* 55 Gy
fistula

<20 cc 37.5 Gy Colon*

Ureter 45 Gy stenosis

Rectum*
 Rectum*

Bladder wall <15 cc 20 Gy 38 Gy cystitis/fistula

Penile Bulb <3 cc 30 Gy impotence Ureter

Femoral
<10 cc 30 Gy necrosis Bladder wall
Heads

Renal
malignant
hilum/vascula 15 cc 23 Gy Penile Bulb
hypertension
r trunk
Femoral
Heads
Critical Renal
Parallel Critical Endpoint
Volume Dose hilum/vascula
Tissue Volume (cc) (≥Grade 3)
Max (Gy) r trunk
1500 cc for
Lung (Right males and Basic Lung
12.5 Gy
& Left) 950cc for Function
females***

Lung (Right V- Parallel

Pneumonitis
& Left) 13.5Gy<37% Tissue

Basic Liver Lung (Right

Liver 700 cc*** 21.5 Gy
Function & Left)
Renal cortex
Basic renal Lung (Right
(Right & 200 cc*** 17.5 Gy
function & Left)
Left)

Liver

Renal cortex
(Right &
Left)
 10
Volume Max Max Point Endpoint Contouring
Volume Serial Tissue Volume
(Gy) Dose (Gy)** (≥Grade 3) Instructions

One structure
both sides
from
posterior
Optic globe,
<0.2 cc 27.2 Gy 29.6 Gy neuritis <0.5 cc
Pathway including
chiasm, to
proximal
optic
radiations

Each side
26.4 Gy hearing loss Eye (retina) separately, Mean dose
entire globe
cranial Each side
<0.5 cc 27.2 Gy 37.6 Gy Lens
neuropathy separately
Each side
Eyelid –
separately,
Meibomian
<0.35 cc 26.4 Gy 33.6 Gy myelitis upper and
glands (one
lower lid as
side)
one structure
Lacrimal
Each side
gland (one <1 cc
separately
side)

<5 cc 34 Gy 38.4 Gy neuritis Each side

separately,
Cochlea include at <0.5 cc
least 3 CT
slices

Superiorly
from incisura,
Brainstem
midbrain and <5 cc
(not medulla)
pons only,
one structure

<5 cc 34 Gy 38.4 Gy neuropathy entire bony

canal
including at
Spinal Cord least 10 cm <5 cc
superior and
inferior to
PTV

<5 cc 36.8 Gy 43.2 Gy esophagitis Salivary Each parotid <7 cc

gland (one gland
<3 cc 32.8 Gy 39.2 Gy neuropathy side) separately Mean dose
 Starting 1 cm
above first
appearance of
true vocal
cord include
entire cord,
arytenoid
muscles,
corniculate
and arytenoid
cartilages and
<15 cc 34.4 Gy 40 Gy pericarditis Larynx <3 cc
portions of
thyroid
cartilage
abutting these
structures
ending at the
first
appearance of
the
cricothyroid
ligament.

Each side
separately
starting at the
superior
articular
surface near
the zygoma
<10 cc 55.2 Gy 62 Gy aneurysm TM joint <1cc
bone and
ending at the
notch at the
superior part
of the ramus
of the
mandible.

Based on the
bony limits of
the spinal
canal starting
superiorly at
the bottom of
impairment of the spinal
<5 cc 50 Gy 56 Gy pulmonary Cauda Equina cord <5 cc
toilet (typically
around L2)
and ending at
the inferior
extent of the
thecal sac
(typically S3)
 Outlining the
space defined
medially by
the sacral
foramina
from S1-S3
including
contouring
within the
sacral
foramina,
posteriorly
stenosis with
<0.5 cc 38.4 Gy 48.8 Gy Sacral Plexus along the <5 cc
atelectasis
limits of the
true pelvis,
laterally to 2-
3 cm lateral
to the sacral
foramina, and
anteriorly
about 3-5 mm
from the
posterior
limits of the
countour

Include the
mucosal,
submucosa,
and all
muscular
Pain or layers out to
<5 cc 50 Gy 63 Gy Esophagus <5 cc
fracture the fatty
adventitia at
least 10 cm
superior and
inferior to
PTV
 spinal nerves
exiting the
neuroforamin
a from around
C5 to T2 to
include only
the major tr
Vunks of the
brachial
plexus using
the
subclavian
and axillary
vessels as a
surrogate for
identifying its
location
extending
Brachial proximally at
<10 cc 43.2 Gy 45.6 Gy ulceration <3 cc
Plexus the
bifurcation of
the
brachiocephal
ic trunk into
the
jugular/subcla
vian veins (or
carotid/subcla
vian arteries)
and following
along the
route of the
subclavian
vein to the
axillary vein
ending after
the
neurovascular

Contoured
along with the
pericardial
sac. The
superior
aspect (or
base) for
purposes of
contouring
will begin at
ulceration/ Heart/
<5 cc 31.2 Gy 42 Gy the level of <15 cc
fistula Pericardium
the inferior
aspect of the
aortic arch
(aorto-
pulmonary
window) and
extend
inferiorly to
the apex of
the heart.
 The wall and
lumen of the
named vessel
48 Gy stenosis Great vessels at least 10 cm <10 cc
superior and
inferior to
PTV

Contour the
trachea and
cartilage rings
starting 10 cm
superior to
the PTV
Trachea and extending
<5 cc 31.2 Gy 42 Gy ulceration Large inferiorly to <5 cc
Bronchus the bronchi
ending at the
first
bifurcation of
the named
lobar
bronchus.

The outer 0.5

cm of the
body surface
enteritis/
<30 cc 28.8 Gy 40 Gy Skin anywhere <10 cc
obstruction
within the
whole body
contour.

The entire
stomach wall
and the
gastric
contents
<20 cc 35.2 Gy 57.5 Gy colitis/fistula Stomach included from <50 cc
the GE
junction to
the proximal
duodenum at
the pyloris.

The entire
duodenal wall
and lumen
<3.5 cc 56 Gy Duodenum from the <5 cc
pyloris to the
duodenojejun
al flexure.
proctitis/
61.5 Gy
fistula
 proctitis/
61.5 Gy
fistula
Any and all
loops of small
bowel as one
Jejunum/
<20 cc 45 Gy structure <120 cc
Ileum
within 10 cm
of the PTV in
any direction.

Each side
separately
including
major
Renal
calyces, renal
53 Gy stenosis hilum/vascula 15 cc
pelvis, and
r trunk
proximal
renal artery
medially to
the aorta

One structure
including
wall and
contents of
lumen
<15 cc 22.4 Gy 44.8 Gy cystitis/fistula Colon <20 cc
starting 10 cm
superior to
PTV and
ending 10 cm
below PTV.

<3 cc 35 impotence One structure <10 cc

including
wall of
<10 cc 35 Gy necrosis rectum and all <20 cc
contents in
Rectum
lumen. Start
malignant (including
15 cc 28 Gy contouring 10 <30 cc
hypertension stool)
cm superior
to PTV then
inferior to
anal <40 cc
sphincter.

Critical Contour the

Critical Endpoint
Volume Dose bladder wall <90 cc
Volume (cc) (≥Grade 3)
Max (Gy) and all urine
Bladder (with
1500 cc for ending
urine)
males and Basic Lung inferiorly at
14.4 Gy the base of <125 cc
950cc for Function
females*** the prostate.
 Contour the
anterior
inferior wall
resting above
and around
the superior
Bladder
V- aspect of the
Pneumonitis (suprapubic <5 cc
15.2Gy<37% pubic bone
wall)
starting at the
prostate
inferiorly and
extending 2-3
cm superiorly
from there.

Contour
starting
superiorly at
the inferior
aspect of the
pelvic
Basic Liver
700 cc*** 24.8 Gy Penile bulb diaphragm <3 cc
Function
(urethral
sphincter) and
extending
inferiorly and
anteriorly up
to 3 cm

Contour both
Basic renal Femoral
200 cc*** 20 Gy right and left <10 cc
function Heads
separately.

Parallel Critical
Tissue Volume (cc)

Contour right
and left lung
as one
structure
including all
1500 cc for
Lung (Right parenchymal
males and
& Left) minus lung tissue
950cc for
GTV but exluding
females***
the GTV and
major airways
(trachea and
main/lobar
bronchi)
 Contour right
and left lung
as one
structure
including all
Lung (Right parenchymal
& Left) minus lung tissue
GTV but exluding
the GTV and
major airways
(trachea and
main/lobar
bronchi)

Contour right
and left lobes
as one
structure
including all
parenchymal
liver tissue
Liver minus but exluding
700 cc***
GTV the GTV and
major
draining
ducts,
extrahepatic
portal vein,
and gall
bladder.

Contour right
and left
kidney as one
structure
including all
Renal cortex parenchymal
(Right & capsular 200 cc***
Left) tissue but
exluding the
renal
hilum/vascula
r trunk (see
above)
 15
Volume Max Max Point Endpoint Contouring Volume Max
Serial Tissue Volume
(Gy) Dose (Gy) (≥Grade 3) Instructions (Gy)

One structure
both sides
from
posterior
Optic globe,
30.6 Gy 33.1 Gy neuritis <0.5 cc 39 Gy
Pathway including
chiasm, to
proximal
optic
radiations

Each side
<26 Gy 30 Gy retinitis Eye (retina) separately, Mean dose <33 Gy
entire globe
Each side
7 Gy cataract Lens
separately
Each side
Eyelid –
separately,
dry eye Meibomian
21.3 Gy upper and
syndrome glands (one
lower lid as
side)
one structure
Lacrimal
Each side
14.1 Gy 23.6 Gy lack of tears gland (one <1 cc 18 Gy
separately
side)
Each side
separately,
25 Gy 27 Gy hearing loss Cochlea include at <0.5 cc 30 Gy
least 3 CT
slices

Superiorly
from incisura,
cranial Brainstem
32 Gy 38 Gy midbrain and <5 cc 40 Gy
neuropathy (not medulla)
pons only,
one structure

entire bony
canal
including at
31 Gy 36 Gy myelitis Spinal Cord least 10 cm <5 cc 39 Gy
superior and
inferior to
PTV

14.1 Gy Salivary Each parotid <7 cc 18 Gy

21.3 Gy xerostomia gland (one gland
<17.7 Gy side) separately Mean dose <22.5 Gy
 Starting 1 cm
above first
appearance of
true vocal
cord include
entire cord,
arytenoid
muscles,
corniculate
and arytenoid
necrosis/ cartilages and
30 Gy 45 Gy Larynx <3 cc 34.5 Gy
edema portions of
thyroid
cartilage
abutting these
structures
ending at the
first
appearance of
the
cricothyroid
ligament.

Each side
separately
starting at the
superior
articular
surface near
the zygoma
37.7 Gy 41.4 Gy inflammation TM joint <1cc 48 Gy
bone and
ending at the
notch at the
superior part
of the ramus
of the
mandible.

Based on the
bony limits of
the spinal
canal starting
superiorly at
the bottom of
the spinal
35 Gy 41 Gy neuritis Cauda Equina cord <5 cc 40.5 Gy
(typically
around L2)
and ending at
the inferior
extent of the
thecal sac
(typically S3)
 Outlining the
space defined
medially by
the sacral
foramina
from S1-S3
including
contouring
within the
sacral
foramina,
posteriorly
35 Gy 41 Gy neuropathy Sacral Plexus along the <5 cc 40.5 Gy
limits of the
true pelvis,
laterally to 2-
3 cm lateral
to the sacral
foramina, and
anteriorly
about 3-5 mm
from the
posterior
limits of the
countour

Include the
mucosal,
submucosa,
and all
muscular
layers out to
40 Gy 48 Gy esophagitis Esophagus <5 cc 45 Gy
the fatty
adventitia at
least 10 cm
superior and
inferior to
PTV
 spinal nerves
exiting the
neuroforamin
a from around
C5 to T2 to
include only
the major
trunks of the
brachial
plexus using
the
subclavian
and axillary
vessels as a
surrogate for
identifying its
location
extending
Brachial proximally at
37 Gy 43 Gy neuropathy <3 cc 48 Gy
Plexus the
bifurcation of
the
brachiocephal
ic trunk into
the
jugular/subcla
vian veins (or
carotid/subcla
vian arteries)
and following
along the
route of the
subclavian
vein to the
axillary vein
ending after
the
neurovascular

Contoured
along with the
pericardial
sac. The
superior
aspect (or
base) for
purposes of
contouring
will begin at
Heart/
36.6 Gy 42.5 Gy pericarditis the level of <15 cc 42 Gy
Pericardium
the inferior
aspect of the
aortic arch
(aorto-
pulmonary
window) and
extend
inferiorly to
the apex of
the heart.
 The wall and
lumen of the
named vessel
55.7 Gy 62.9 Gy aneurysm Great vessels at least 10 cm <10 cc 57 Gy
superior and
inferior to
PTV

Contour the
trachea and
cartilage rings
starting 10 cm
superior to
the PTV
impairment of Trachea and extending
52 Gy 59 Gy pulmonary Large inferiorly to <5 cc 55.5 Gy
toilet Bronchus the bronchi
ending at the
first
bifurcation of
the named
lobar
bronchus.

The outer 0.5

cm of the
body surface
46.3 Gy 48.9 Gy ulceration Skin anywhere <10 cc 54 Gy
within the
whole body
contour.

The entire
stomach wall
and the
gastric
contents
ulceration/
33.9 Gy 45 Gy Stomach included from <50 cc 39 Gy
fistula
the GE
junction to
the proximal
duodenum at
the pyloris.

The entire
duodenal wall
and lumen
33.9 Gy 45 Gy ulceration Duodenum from the <5 cc 39 Gy
pyloris to the
duodenojejun
al flexure.
 Any and all
loops of small
bowel as one
enteritis/ Jejunum/
33.9 Gy 41 Gy structure <120 cc 39 Gy
obstruction Ileum
within 10 cm
of the PTV in
any direction.

Each side
separately
including
major
Renal
malignant calyces, renal
30.7 Gy hilum/vascula 15 cc 37.5 Gy
hypertension pelvis, and
r trunk
proximal
renal artery
medially to
the aorta

One structure
including
wall and
contents of
lumen
47 Gy 60 Gy colitis/fistula Colon <20 cc 47 Gy
starting 10 cm
superior to
PTV and
ending 10 cm
below PTV.

52 Gy One structure <10 cc 60 Gy

including
wall of
49 Gy rectum and all <20 cc 57 Gy
contents in
Rectum
proctitis/ lumen. Start
65 Gy (including
46 Gy fistula contouring 10 <30 cc 52.5 Gy
stool)
cm superior
to PTV then
inferior to
43 Gy anal <40 cc 49.5 Gy
sphincter.

Contour the
48 Gy bladder wall <90 cc 55.5 Gy
and all urine
Bladder (with
53 Gy cystitis/fistula ending
urine)
inferiorly at
45 Gy the base of <125 cc 52.5 Gy
the prostate.
 Contour the
anterior
inferior wall
resting above
and around
the superior
Bladder
aspect of the
23 Gy 42 Gy dysuria (suprapubic <5 cc 26 Gy
pubic bone
wall)
starting at the
prostate
inferiorly and
extending 2-3
cm superiorly
from there.

Contour
starting
superiorly at
the inferior
aspect of the
pelvic
38 Gy 44 Gy impotence Penile bulb diaphragm <3 cc 42 Gy
(urethral
sphincter) and
extending
inferiorly and
anteriorly up
to 3 cm

Contour both
Femoral
38 Gy 43.5 Gy necrosis right and left <10 cc 40 Gy
Heads
separately.

Critical Critical
Other Endpoint Parallel Critical
Volume Dose Volume Dose
Constraints (≥Grade 3) Tissue Volume (cc)
Max (Gy) Max (Gy)

Contour right
and left lung
as one
structure
including all
1500 cc for
Lung (Right parenchymal
Basic Lung males and
15 Gy & Left) minus lung tissue 16.5 Gy
Function 950cc for
GTV but exluding
females***
the GTV and
major airways
(trachea and
main/lobar
bronchi)
 Contour right
and left lung
as one
structure
including all
Lung (Right parenchymal
V-16Gy
Pneumonitis & Left) minus lung tissue
<37%
GTV but exluding
the GTV and
major airways
(trachea and
main/lobar
bronchi)

Contour right
and left lobes
as one
structure
including all
parenchymal
liver tissue
Basic Liver Liver minus but exluding
27 Gy 700 cc*** 30 Gy
Function GTV the GTV and
major
draining
ducts,
extrahepatic
portal vein,
and gall
bladder.

Contour right
and left
kidney as one
structure
including all
Renal cortex parenchymal
Basic renal
21 Gy (Right & capsular 200 cc*** 24 Gy
function
Left) tissue but
exluding the
renal
hilum/vascula
r trunk (see
above)
 20
Max Point Endpoint Contouring Volume Max Max Point
Serial Tissue Volume
Dose (Gy) (≥Grade 3) Instructions (Gy) Dose (Gy)

One structure
both sides
from
posterior
Optic globe,
42 Gy neuritis <0.5 cc 42 Gy 48 Gy
Pathway including
chiasm, to
proximal
optic
radiations

Each side
37.5 Gy retinitis Eye (retina) separately, Mean dose <36 Gy 42 Gy
entire globe
Each side
9 Gy cataract Lens 10 Gy
separately
Each side
Eyelid –
separately,
dry eye Meibomian
27 Gy upper and 30 Gy
syndrome glands (one
lower lid as
side)
one structure
Lacrimal
Each side
30 Gy lack of tears gland (one <1 cc 18 Gy 32 Gy
separately
side)
Each side
separately,
33 Gy hearing loss Cochlea include at <0.5 cc 32 Gy 36 Gy
least 3 CT
slices

Superiorly
from incisura,
cranial Brainstem
44 Gy midbrain and <5 cc 44 Gy 50 Gy
neuropathy (not medulla)
pons only,
one structure

For medulla:
starting at
inferior pons
to foramen
magnum. For
Spinal Cord cord: entire
42.0 Gy myelitis <5 cc 42 Gy 46 Gy
and medulla bony canal
including at
least 10 cm
superior and
inferior to
PTV

Salivary Each parotid <7 cc 18 Gy

27 Gy xerostomia gland (one gland 30 Gy
side) separately Mean dose <24 Gy
 Starting 1 cm
above first
appearance of
true vocal
cord include
entire cord,
arytenoid
muscles,
corniculate
and arytenoid
necrosis/ cartilages and
52.5 Gy Larynx <3 cc 36 Gy 58 Gy
edema portions of
thyroid
cartilage
abutting these
structures
ending at the
first
appearance of
the
cricothyroid
ligament.

Each side
separately
starting at the
superior
articular
surface near
the zygoma
52.5 Gy inflammation TM joint <1cc 52 Gy 58 Gy
bone and
ending at the
notch at the
superior part
of the ramus
of the
mandible.

Based on the
bony limits of
the spinal
canal starting
superiorly at
the bottom of
the spinal
48 Gy neuritis Cauda Equina cord <5 cc 44 Gy 52 Gy
(typically
around L2)
and ending at
the inferior
extent of the
thecal sac
(typically S3)
 Outlining the
space defined
medially by
the sacral
foramina
from S1-S3
including
contouring
within the
sacral
foramina,
posteriorly
48 Gy neuropathy Sacral Plexus along the <5 cc 44 Gy 52 Gy
limits of the
true pelvis,
laterally to 2-
3 cm lateral
to the sacral
foramina, and
anteriorly
about 3-5 mm
from the
posterior
limits of the
countour

Include the
mucosal,
submucosa,
and all
muscular
layers out to
54 Gy esophagitis Esophagus <5 cc 48 Gy 58 Gy
the fatty
adventitia at
least 10 cm
superior and
inferior to
PTV
 spinal nerves
exiting the
neuroforamin
a from around
C5 to T2 to
include only
the major
trunks of the
brachial
plexus using
the
subclavian
and axillary
vessels as a
surrogate for
identifying its
location
extending
Brachial proximally at
52.5 Gy neuropathy <3 cc 54 Gy 58 Gy
Plexus the
bifurcation of
the
brachiocephal
ic trunk into
the
jugular/subcla
vian veins (or
carotid/subcla
vian arteries)
and following
along the
route of the
subclavian
vein to the
axillary vein
ending after
the
neurovascular

Contoured
along with the
pericardial
sac. The
superior
aspect (or
base) for
purposes of
contouring
will begin at
Heart/
48.9 Gy pericarditis the level of <15 cc 46 Gy 52 Gy
Pericardium
the inferior
aspect of the
aortic arch
(aorto-
pulmonary
window) and
extend
inferiorly to
the apex of
the heart.
 The wall and
lumen of the
named vessel
65 Gy aneurysm Great vessels at least 10 cm <10 cc 60 Gy 70 Gy
superior and
inferior to
PTV

Contour the
trachea and
cartilage rings
starting 10 cm
superior to
the PTV
impairment of Trachea and extending
63 Gy pulmonary Large inferiorly to <5 cc 58 Gy 66 Gy
toilet Bronchus the bronchi
ending at the
first
bifurcation of
the named
lobar
bronchus.

The outer 0.5

cm of the
body surface
57 Gy ulceration Skin anywhere <10 cc 60 Gy 64 Gy
within the
whole body
contour.

The entire
stomach wall
and the
gastric
contents
ulceration/
51 Gy Stomach included from <50 cc 42 Gy 54 Gy
fistula
the GE
junction to
the proximal
duodenum at
the pyloris.

The entire
duodenal wall
and lumen
51 Gy ulceration Duodenum from the <5 cc 42 Gy 54 Gy
pyloris to the
duodenojejun
al flexure.
 Any and all
loops of small
bowel as one
enteritis/ Jejunum/
46.5 Gy structure <120 cc 42 Gy 50 Gy
obstruction Ileum
within 10 cm
of the PTV in
any direction.

Each side
separately
including
major
Renal
malignant calyces, renal
hilum/vascula 15 cc 40 Gy
hypertension pelvis, and
r trunk
proximal
renal artery
medially to
the aorta

One structure
including
wall and
contents of
lumen
64.5 Gy colitis/fistula Colon <20 cc 50 Gy 66 Gy
starting 10 cm
superior to
PTV and
ending 10 cm
below PTV.

One structure <10 cc 66 Gy

including
wall of
rectum and all <20 cc 62 Gy
contents in
Rectum
proctitis/ lumen. Start
70.5 Gy (including 74 Gy
fistula contouring 10 <30 cc 58 Gy
stool)
cm superior
to PTV then
inferior to
anal <40 cc 54 Gy
sphincter.

Contour the
bladder wall <90 cc 60 Gy
and all urine
Bladder (with
61.5 Gy cystitis/fistula ending 66 Gy
urine)
inferiorly at
the base of <125 cc 56 Gy
the prostate.
 Contour the
anterior
inferior wall
resting above
and around
the superior
Bladder
aspect of the
48 Gy dysuria (suprapubic <5 cc 28 Gy 52 Gy
pubic bone
wall)
starting at the
prostate
inferiorly and
extending 2-3
cm superiorly
from there.

Contour
starting
superiorly at
the inferior
aspect of the
pelvic
48 Gy impotence Penile bulb diaphragm <3 cc 44 Gy 52 Gy
(urethral
sphincter) and
extending
inferiorly and
anteriorly up
to 3 cm

Contour both
Femoral
46.5 Gy necrosis right and left <10 cc 44 Gy 50 Gy
Heads
separately.

Critical
Other Endpoint Parallel Critical Other
Volume Dose
Constraints (≥Grade 3) Tissue Volume (cc) Constraints
Max (Gy)

Contour right
and left lung
as one
structure
including all
1500 cc for
Lung (Right parenchymal
Basic Lung males and
& Left) minus lung tissue 18 Gy
Function 950cc for
GTV but exluding
females***
the GTV and
major airways
(trachea and
main/lobar
bronchi)
 Contour right
and left lung
as one
structure
including all
Lung (Right parenchymal
V-18Gy V-19Gy
Pneumonitis & Left) minus lung tissue
<37% <37%
GTV but exluding
the GTV and
major airways
(trachea and
main/lobar
bronchi)

Contour right
and left lobes
as one
structure
including all
parenchymal
liver tissue
Basic Liver Liver minus but exluding
700 cc*** 32 Gy
Function GTV the GTV and
major
draining
ducts,
extrahepatic
portal vein,
and gall
bladder.

Contour right
and left
kidney as one
structure
including all
Renal cortex parenchymal
Basic renal
(Right & capsular 200 cc*** 26 Gy
function
Left) tissue but
exluding the
renal
hilum/vascula
r trunk (see
above)
 30
Endpoint Contouring Volume Max Max Point Endpoint
Serial Tissue Volume
(≥Grade 3) Instructions (Gy) Dose (Gy) (≥Grade 3)

One structure
both sides
from
posterior
Optic globe,
neuritis <0.5 cc 44 Gy 52 Gy neuritis
Pathway including
chiasm, to
proximal
optic
radiations

Each side
retinitis Eye (retina) separately, Mean dose <38 Gy 45 Gy retinitis
entire globe
Each side
cataract Lens 10 Gy cataract
separately
Each side
Eyelid –
separately,
dry eye Meibomian dry eye
upper and 32 Gy
syndrome glands (one syndrome
lower lid as
side)
one structure
Lacrimal
Each side
lack of tears gland (one <1 cc 20 Gy 36 Gy lack of tears
separately
side)
Each side
separately,
hearing loss Cochlea include at <0.5 cc 36 Gy 40 Gy hearing loss
least 3 CT
slices

Superiorly
from incisura,
cranial Brainstem cranial
midbrain and <5 cc 52 Gy 60 Gy
neuropathy (not medulla) neuropathy
pons only,
one structure

For medulla:
starting at
inferior pons
to foramen
magnum. For
Spinal Cord cord: entire
myelitis <5 cc 47.4 Gy 52.8 Gy myelitis
and medulla bony canal
including at
least 10 cm
superior and
inferior to
PTV

Salivary Each parotid <7 cc 20 Gy

xerostomia gland (one gland 32 Gy xerostomia
side) separately Mean dose <26 Gy
 Starting 1 cm
above first
appearance of
true vocal
cord include
entire cord,
arytenoid
muscles,
corniculate
and arytenoid
necrosis/ cartilages and necrosis/
Larynx <3 cc 39 Gy 63 Gy
edema portions of edema
thyroid
cartilage
abutting these
structures
ending at the
first
appearance of
the
cricothyroid
ligament.

Each side
separately
starting at the
superior
articular
surface near
the zygoma
inflammation TM joint <1cc 60 Gy 65 Gy inflammation
bone and
ending at the
notch at the
superior part
of the ramus
of the
mandible.

Based on the
bony limits of
the spinal
canal starting
superiorly at
the bottom of
the spinal
neuritis Cauda Equina cord <5 cc 50 Gy 60 Gy neuritis
(typically
around L2)
and ending at
the inferior
extent of the
thecal sac
(typically S3)
 Outlining the
space defined
medially by
the sacral
foramina
from S1-S3
including
contouring
within the
sacral
foramina,
posteriorly
neuropathy Sacral Plexus along the <5 cc 50 Gy 60 Gy neuropathy
limits of the
true pelvis,
laterally to 2-
3 cm lateral
to the sacral
foramina, and
anteriorly
about 3-5 mm
from the
posterior
limits of the
countour

Include the
mucosal,
submucosa,
and all
muscular
layers out to
esophagitis Esophagus <5 cc 51 Gy 60 Gy esophagitis
the fatty
adventitia at
least 10 cm
superior and
inferior to
PTV
 spinal nerves
exiting the
neuroforamin
a from around
C5 to T2 to
include only
the major
trunks of the
brachial
plexus using
the
subclavian
and axillary
vessels as a
surrogate for
identifying its
location
extending
Brachial proximally at
neuropathy <3 cc 62 Gy 66 Gy neuropathy
Plexus the
bifurcation of
the
brachiocephal
ic trunk into
the
jugular/subcla
vian veins (or
carotid/subcla
vian arteries)
and following
along the
route of the
subclavian
vein to the
axillary vein
ending after
the
neurovascular

Contoured
along with the
pericardial
sac. The
superior
aspect (or
base) for
purposes of
contouring
will begin at
Heart/
pericarditis the level of <15 cc 60 Gy 60 Gy pericarditis
Pericardium
the inferior
aspect of the
aortic arch
(aorto-
pulmonary
window) and
extend
inferiorly to
the apex of
the heart.
 The wall and
lumen of the
named vessel
aneurysm Great vessels at least 10 cm <10 cc 60 Gy 76 Gy aneurysm
superior and
inferior to
PTV

Contour the
trachea and
cartilage rings
starting 10 cm
superior to
the PTV
impairment of Trachea and extending impairment of
pulmonary Large inferiorly to <5 cc 60 Gy 69 Gy pulmonary
toilet Bronchus the bronchi toilet
ending at the
first
bifurcation of
the named
lobar
bronchus.

The outer 0.5

cm of the
body surface
ulceration Skin anywhere <10 cc 70 Gy 76 Gy ulceration
within the
whole body
contour.

The entire
stomach wall
and the
gastric
contents
ulceration/ ulceration/
Stomach included from <50 cc 45 Gy 60 Gy
fistula fistula
the GE
junction to
the proximal
duodenum at
the pyloris.

The entire
duodenal wall
and lumen
ulceration Duodenum from the <5 cc 45 Gy 60 Gy ulceration
pyloris to the
duodenojejun
al flexure.
 Any and all
loops of small
bowel as one
enteritis/ Jejunum/ enteritis/
structure <120 cc 45 Gy 54 Gy
obstruction Ileum obstruction
within 10 cm
of the PTV in
any direction.

Each side
separately
including
major
Renal
malignant calyces, renal malignant
hilum/vascula 15 cc 42 Gy
hypertension pelvis, and hypertension
r trunk
proximal
renal artery
medially to
the aorta

One structure
including
wall and
contents of
lumen
colitis/fistula Colon <20 cc 54 Gy 70 Gy colitis/fistula
starting 10 cm
superior to
PTV and
ending 10 cm
below PTV.

One structure <10 cc 75 Gy

including
wall of
rectum and all <20 cc 70 Gy
contents in
Rectum
proctitis/ lumen. Start proctitis/
(including 79 Gy
fistula contouring 10 <30 cc 65 Gy fistula
stool)
cm superior
to PTV then
inferior to
anal <40 cc 60 Gy
sphincter.

Contour the
bladder wall <90 cc 70 Gy
and all urine
Bladder (with
cystitis/fistula ending 79 Gy cystitis/fistula
urine)
inferiorly at
the base of <150 cc 65 Gy
the prostate.
 Contour the
anterior
inferior wall
resting above
and around
the superior
Bladder
aspect of the
dysuria (suprapubic <5 cc 30 Gy 60 Gy dysuria
pubic bone
wall)
starting at the
prostate
inferiorly and
extending 2-3
cm superiorly
from there.

Contour
starting
superiorly at
the inferior
aspect of the
pelvic
impotence Penile bulb diaphragm <3 cc 48 Gy 56 Gy impotence
(urethral
sphincter) and
extending
inferiorly and
anteriorly up
to 3 cm

Contour both
Femoral
necrosis right and left <10 cc 48 Gy 56 Gy necrosis
Heads
separately.
4-6 Gy (5%
Growth Plate Contour a risk)
(in pediatric single plate growth arrest
Endpoint patient) irradiated 12 Gy (100%
(≥Grade 3) risk)

Basic Lung
Function
 Critical
Parallel Critical Other Endpoint
Pneumonitis Volume Dose
Tissue Volume (cc) Constraints (≥Grade 3)
Max (Gy)

Contour right
and left lung
as one
structure
including all
1500 cc for
Lung (Right parenchymal
Basic Liver males and Basic Lung
& Left) minus lung tissue 18 Gy
Function 950cc for Function
GTV but exluding
females***
the GTV and
major airways
(trachea and
main/lobar
bronchi)

Contour right
and left lung
as one
structure
including all
Lung (Right parenchymal
Basic renal V-20Gy
& Left) minus lung tissue Pneumonitis
function <37%
GTV but exluding
the GTV and
major airways
(trachea and
main/lobar
bronchi)
 Contour right
and left lobes
as one
structure
including all
parenchymal
liver tissue
Liver minus but exluding Basic Liver
700 cc*** 36 Gy
GTV the GTV and Function
major
draining
ducts,
extrahepatic
portal vein,
and gall
bladder.

Contour right
and left
kidney as one
structure
including all
Renal cortex parenchymal
Basic renal
(Right & capsular 200 cc*** 27 Gy
function
Left) tissue but
exluding the
renal
hilum/vascula
r trunk (see
above)