BACKGROUND AND PURPOSE: To update the digital online atlas for organs at risk (OARs) delineation in neuro-oncology based on high-quality computed tomography (CT) and magnetic resonance (MR) imaging with new OARs. MATERIALS AND METHODS: In this planned update of the neurological contouring atlas published in 2018, ten new clinically relevant OARs were included, after thorough discussion between experienced neuro-radiation oncologists (RTOs) representing 30 European radiotherapy-oncology institutes. Inclusion was based on daily practice and research requirements. Consensus was reached for the delineation after critical review. Contouring was performed on registered CT with intravenous (IV) contrast (soft tissue & bone window setting) and 3 Tesla (T) MRI (T1 with gadolinium & T2 FLAIR) images of one patient (1 mm slices). For illustration purposes, delineation on a 7 T MRI without IV contrast from a healthy volunteer was added. OARs were delineated by three experienced RTOs and a neuroradiologist based on the relevant literature. RESULTS: The presented update of the neurological contouring atlas was reviewed and approved by 28 experts in the field. The atlas is available online and includes in total 25 OARs relevant to neuro-oncology, contoured on CT and MRI T1 and FLAIR (3 T & 7 T). Three-dimensional (3D) rendered films are also available online. CONCLUSION: In order to further decrease inter- and intra-observer OAR delineation variability in the field of neuro-oncology, we propose the use of this contouring atlas in photon and particle therapy, in clinical practice and in the research setting. The updated atlas is freely available on www.cancerdata.org.

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

Clinical Department Radiotherapy Unit National Center for Oncological Hadrontherapy Pavia Italy

Danish Centre for Particle Therapy Aarhus Denmark

Department of Medical Psychology MUMC Maastricht The Netherlands

Department of Oncology Cambridge University Hospitals NHS Foundation Trust United Kingdom

Department of Oncology Sahlgrenska University Hospital Gothenburg Sweden

Department of Radiation Oncology Cliniques universitaires Saint Luc Brussels Belgium

Department of Radiation Oncology Eberhard Karls Universität Tübingen Germany

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

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

Department of Radiotherapy Heidelberg Germany

Department of Radiotherapy Oncology Leuven Kanker Instituut UZ Gasthuisberg Belgium

HollandPTC Delft The Netherlands; Department of Radiotherapy Erasmus MC Cancer Institute Erasmus University Medical Centre Rotterdam The Netherlands

HollandPTC 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 Leiden The Netherlands; HollandPTC Delft The Netherlands

Leiden University Medical Centre Department of Radiotherapy Leiden The Netherlands; HollandPTC Delft The Netherlands; Department of Radiotherapy Erasmus MC Cancer Institute Erasmus University Medical Centre Rotterdam The Netherlands

Paul Scherrer Institut Center for Proton Therapy Villigen PSI Switzerland

Proton Therapy Center Czech Prague Czech Republic

The Christie NHS Foundation Trust Manchester United Kingdom

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

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