PURPOSE: To create a digital, online atlas for organs at risk (OAR) delineation in neuro-oncology based on high-quality computed tomography (CT) and magnetic resonance (MR) imaging. METHODS: CT and 3 Tesla (3T) MR images (slice thickness 1 mm with intravenous contrast agent) were obtained from the same patient and subsequently fused. In addition, a 7T MR without intravenous contrast agent was obtained from a healthy volunteer. Based on discussion between experienced radiation oncologists, the clinically relevant organs at risk (OARs) to be included in the atlas for neuro-oncology were determined, excluding typical head and neck OARs previously published. The draft atlas was delineated by a senior radiation oncologist, 2 residents in radiation oncology, and a senior neuro-radiologist incorporating relevant available literature. The proposed atlas was then critically reviewed and discussed by European radiation oncologists until consensus was reached. RESULTS: The online atlas includes one CT-scan at two different window settings and one MR scan (3T) showing the OARs in axial, coronal and sagittal view. This manuscript presents the three-dimensional descriptions of the fifteen consensus OARs for neuro-oncology. Among these is a new OAR relevant for neuro-cognition, the posterior cerebellum (illustrated on 7T MR images). CONCLUSION: In order to decrease inter- and intra-observer variability in delineating OARs relevant for neuro-oncology and thus derive consistent dosimetric data, we propose this atlas to be used in photon and particle therapy. The atlas is available online at www.cancerdata.org and will be updated whenever required.

Clinic for Particle Therapy University Hospital Essen West German Cancer Center partnersite Essen Essen Germany

Danish Center for Particle Therapy Aarhus Denmark

Department of Radiation Oncology Eberhard Carls Universität Tübingen Germany

Department of Radiation Oncology GROW School for Oncology and Developmental Biology Maastricht University Medical Centre The Netherlands

Department of Radiation Oncology GROW School for Oncology and Developmental Biology Maastricht University Medical Centre The Netherlands; Department of Radiotherapy Oncology Leuven Kanker Instituut UZ Gasthuisberg Belgium

Department of Radiation Oncology GROW School for Oncology and Developmental Biology Maastricht University Medical Centre The Netherlands; The D Lab Decision Support for Precision Medicine GROW School for Oncology and Developmental Biology Maastricht University Medical Centre The Netherlands

Department of Radiation Oncology Maastricht The Netherlands

Department of Radiation Oncology Medical Faculty and University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany; Institute of Radiooncology OncoRay Helmholtz Zentrum Dresden Rossendorf Dresden Germany; OncoRay National Center for Radiation Research in Oncology Dresden Germany; German Cancer Consortium partnersite Dresden Dresden Germany

Department of Radiation Oncology University Medical Center Groningen University of Groningen The Netherlands

Department of Radiology and Nuclear Medicine MUMC Maastricht The Netherlands

Department of Radiotherapy Oncology Leuven Kanker Instituut UZ Gasthuisberg Belgium

EBG MedAustron GmbH Wiener Neustadt Austria

Holland Proton Therapy Centre Delft The Netherlands; Erasmus Medical Centre Rotterdam The Netherlands

Holland Proton Therapy Centre Delft The Netherlands; Haaglanden Medisch Centrum Department of Radiotherapy Leidschendam The Netherlands

Institut Curie Radiation Oncology Department Paris and Proton Center Orsay France

Institute Curie Paris France; Institute Curie Centre de Protonthérapie d'Orsay Orsay France

Leiden University Medical Centre Department of Radiotherapy The Netherlands; Holland Proton Therapy Centre Delft The Netherlands

Paul Scherrer Institut med Center for Proton Therapy Switzerland

Proton Therapy Center Czech Prague Czech Republic

Service de Radiothérapie Oncologique Cliniques universitaires St Luc Brussels Belgium

The Skandion Clinic Uppsala Sweden; Department of Immunology Genetics and Pathology Uppsala University Sweden

The University of Manchester Manchester Academic Health Science Centre The Christie NHS Foundation Trust United Kingdom; The Children's Brain Tumour Research Network University of Manchester Royal Manchester Children's Hospital United Kingdom

University of Cambridge Department of Oncology Addenbrooke's Hospital United Kingdom

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