DOI: 10.21276/aimdr.2017.3.2.RT3 Original Article ISSN (O):2395-2822; ISSN (P):2395-2814 Annals of International Medical and Dental Research, Vol (3), Issue (2) Page 5 Section: Radiotherapy Evaluation of Level of Aortic Bifurcation in Patients of Carcinoma Cervix. Himanshu Mishra 1 , Rahat Hadi 2 , Kamal Sahni 3 , Ritusha Mishra 4 , Mohammad Ali 5 1,5 Assistant Senior Resident, Department of Radiation Oncology, DR RMLIMS, Lucknow. 2 Associate Professor, Department of Radiation Oncology, DR RMLIMS, Lucknow. 3 Professor, Department of Radiation Oncology, DR RML IMS, Lucknow. 4 Junior Resident, Department of Radiation Oncology, DR RMLIMS, Lucknow. Received: January 2017 Accepted: January 2017 Copyright: © the author(s), publisher. Annals of International Medical and Dental Research (AIMDR) is an Official Publication of “Society for Health Care & Research Development”. It is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Concurrent Chemotherapy and Radiotherapy (RT) is considered as standard of care in advanced carcinoma cervix. The superior border of radiation portal is kept at L4-L5 junction to cover common iliac group of lymph nodes which lie along common iliac vessels. Methods: Level of aortic bifurcation in to two common iliacs was retrospectively evaluated in 90 patients of carcinoma cervix to reconsider the level of superior border of radiation portal while RT planning. Evaluation was done on contrast enhanced computed tomography (CT) simulation images of the patients who were previously treated with radical intent. Results: We found that aortic bifurcation occured mostly at mid vertebral level of L4 and it was above L4-L5 junction in 74.4% of the cases. Conclusion: With conventional simulator based RT planning the superior border of radiation Portal should be kept above mid-vertebral level of L4 while with CT- simulator based planning, it should be placed considering individual patient anatomy. Keywords: Aorta, Cervix, Radiotherapy. INTRODUCTION Carcinoma Cervix is the 2nd most common cancer in Indian female and accounts for about 12% of all newly diagnosed cases of cancer annually. Concurrent Chemotherapy and Radiotherapy (RT) is considered as standard of care in carcinoma cervix (FIGO Stage IIB –IV A) patients. External beam radiotherapy (RT) and brachytherapy are two essential components of RT. The EBRT treatment volume includes the primary tumour and the regional draining lymph nodes i.e. obturator nodes, internal iliac, external iliac, common iliac and pre-sacral. [1] EBRT planning typically involves two- field or four- field box technique depending upon the antero- posterior separation of the patient and during the planning, usually the superior border of Radiation portal is kept at L4-L5 junction. The common iliac nodes lie in relation with bilateral common iliac vessels. The common iliac vessels begin as right and left divisions of abdominal aorta. [2] Name & Address of Corresponding Author Dr. Himanshu Mishra, Senior Resident, Department of Radiation Oncology, DR RMLIMS, Lucknow. There are a significant number of patients who are being treated by conventional X-Ray based planning using bony landmarks in many centers in our country and the traditional upper border of the radiation portal is kept at the level of L4-L5 intervertebral space in order to cover common iliac lymph nodes. However level of division of abdominal aorta in to two common iliacs may vary from individual to individual. Aim The aim of the study was to evaluate the level of aortic bifurcation (in to two common iliacs) in denovo carcinoma cervix patients to reconsider the level of superior border of Radiation portal while RT planning. MATERIAL AND METHODS This is a retrospective observational study which included 90 patients. Newly diagnosed, histo- pathologically proven cases of carcinoma cervix treated with concurrent chemoradiotherapy or RT alone with radical intent were included in the study. Post-operative cases were excluded. For EBRT either non-contrast or contrast enhanced computed tomography (CT) simulation was done. Planning was done using system XIO (Version 5.0). Some patients were treated with 2-D while others with 3-D technique using 6-15 MV photon. Images of only Contrast Enhanced CT Simulation were