Functional Swallowing Units (FSUs) as organs-at-risk for radiotherapy. PART 2: Advanced delineation guidelines for FSUs

Agata Gawryszuk*, Hendrik P Bijl, Monique Holwerda, Gyorgy B Halmos, Jan Wedman, Max J H Witjes, Anton M van der Vliet, Bart Dorgelo, Johannes A Langendijk

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

6 Citaten (Scopus)
263 Downloads (Pure)


Background and purpose: In a separate article (PART 1), a rationale and explanation of the physiology-and-anatomy-based concept of Functional Swallowing Units (FSUs) was presented. FSUs are swallowing muscles not included in the set of commonly defined swallowing organs at risk (SWOARs). They are involved in three crucial swallowing components: hyolaryngeal elevation (HLE), tongue base retraction (TBR) and tongue motion. This paper is a continuation of PART 1 and it provides detailed computed tomography (CT)-based delineation guidelines for FSUs, which presumably are also at risk of radiationinduced dysphagia.

Material and methods: Following analysis of swallowing physiology and human anatomy, presented in PART 1, CT-based delineation guidelines for defined FSUs were created. Delineation was performed by the first author and revised by a panel of experts.

Results and conclusions: Detailed delineation guidelines are presented for seven FSUs involved in HLE, TBR and tongue motion. The guidelines are supplemented by CT and MRI-based exemplary illustrations and complete CT/MRI-based delineation atlases (available online). This paper provides information essential to the implementation of the FSU concept in radiation practice, and supports uniform contouring, data collection and further improvement of swallowing sparing radiation-based strategies. (C) 2018 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (

Originele taal-2English
Pagina's (van-tot)68-74
Aantal pagina's7
TijdschriftRadiotherapy and Oncology
Vroegere onlinedatum11-dec.-2018
StatusPublished - jan.-2019

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