Radiation Oncology/Anatomy
|
See also: Contouring
This page is for Anatomy Pearls useful for radiation oncology. Suitable examples include radiographic landmarks, location of lymph node groups, and lymph drainage patterns.
Anatomy atlases edit
- HeadNeckBrainSpine Neuroradiology
- Gray's Anatomy @ Bartleby.com
- Basic Anatomy @ Dartmouth
- Wesley Norman Anatomists
- AnatomyAtlases.org
- Radiology Assistant
- Cross-sectional nodal atlas, 1999 (Ohio State) - PMID 10352611 Full text — "Cross-sectional nodal atlas: a tool for the definition of clinical target volumes in three-dimensional radiation therapy planning." Martinez-Monge R et al. Radiology. 1999 Jun;211(3):815-28.
- Atlas of everything (H&N, lung, GI, GU, Gyn) on CT images with nodal regions shaded.
- Wayne State University link
- Brain: MRI (Sagittal, Coronal, Axial)
- Upper Abdomen: CT
- Thorax: CT
- Pelvis + Upper Thigh: CT
Dissections edit
Vertebral Levels edit
D means disc below level
Categorized:
- Vocal Cord —> C5
- Cricoid —> C6
- Start of trachea —> C6-C7
- Thyroid gland —> C7
- Lung apex —> T1
- Origin SVC —> T3
- AO arch —> T4/DT3
- Carina —> T5
- 25 cm from the incisors
- Liver
- Upper level: T7-8
- Suprasternal Notch —> T3
- Manubrium —> T4
- Angle of louis —> T5
- Xiphoid Process —> T10
- Ant costodiaphragm —> T10
- Post costodiaphragm —> L3
- GEJ —> T10/T11 ( 2-3cm to left of midline )
- 40cm from incisors
- Spleen —> T10-T11 ( 5cm left to midline )
- Pancreas body —> L1
- Cysterna chili —> L1-L2
- Umbilicus —> L4
- If standing and in infants —> lower
- Gallbladder —> at 9th rib; right lat border of rectus abdomens ( transpyloric plane )
- Start of large bowel ( Cecum ) —> L4
- Ascending Colon : 15cm
- Descending Colon : 25cm
- Rectum —>
- Starts : S3
- Ends : 4cm from anus
- R Kidney hilum —> L2
- L Kidney hilum —> L1
- Para-AO nodes —> T12-L4
- Common Iliac nodes —> L4 ( Bifurcation of AO )
- Bifurcation of common iliac —> L5-S1
Uncategorized:
- Hyoid Bone C4
- Right Lung T1-T11
- Left Lung T1-DT10
- Suprasternal Notch T3
- Aortic arch DT3
- Origin SVC T3
- Bifurcation of Trachea T5
- SVC Heart junction T7
- IVC Heart T9
- Apex of Heart T10
- Fundus stomach T10
- Spleen T10-L1
- GE Junction T11
- Xiphoid Apex DT11
- Left Kidney DT11-L3
- Right Adrenal T11-L1
- Left Adrenal T12-L1
- Superior duodenum DT12
- Colon splenic Flexure T12
- Pancreas Body T12
- Right lobe of Liver T9-DL3
- Right Kidney T12-L3
- Duodenal Jejeunal Flexure L1
- Stomach pylorus L1
- Colon hepatic flexure L2
- Bottom of gallbladder L2
- Aortic bifurcation L4
- Iliac Crest L4
- Umbilicus L4
- Ileo Cecal Valve L5
- Base of Appendix L5
- IVC origin L5
- Lower border of Cecum DS2
Clinical Syndromes with CN Palsy edit
- Please see the Clinical Syndromes with CN Palsy page
Head & Neck edit
- Please see the H&N anatomy page
Regional breast lymph nodes edit
- Please see the axilla RT technique section
Supraclavicular edit
Brachial plexus:
- Please see the Brachial plexus section
- Also see the section on this page Radiation_Oncology/Anatomy#Thorax
Thorax edit
- See also: Radiation Oncology/Thorax/Anatomy (Lung lymph node stations)
Abdomen edit
Vessels edit
In order, superior to inferior:
- Celiac artery
- At T12 (75%) or L1 (25%)
- SMA
- Renal arteries/veins
- Ovarian/testicular vein - Right side, drains into IVC 1 cm below R renal vein. Left side, drains into L renal vein lateral to the aorta.
- Ovarian/testicular arteries - 5 to 6 cm above aortic bifurcation
- IMA - 3 to 4 cm above aortic bifurcation
Lymphatics edit
- Pancreaticoduodenal nodes - lie in C-loop of duodenum
- Paraaortic lymph nodes (may also be called para-aortic, periaortic, or peri-aortic) - located adjacent to aorta, anterior to lumbar spine, extending bilaterally to the medial margins of the psoas major muscles, up to diaphragmatic crura.
- For a paraaortic lymph node dissection, the surgeon usually dissects from aortic bifurcation up to SMA or renal veins.
CT Atlas edit
- Baylor; 2007 PMID 17959923 -- "Learning the nodal stations in the abdomen." (Moron FE, Br J Radiol. 2007 Oct;80(958):841-8.)
Pelvic lymph nodes edit
- Beth Israel, 2010 - PMID 20032141 -- "Lymphatic metastases from pelvic tumors: anatomic classification, characterization, and staging." (McMahon CJ, Radiology. 2010 Jan;254(1):31-46.)
- Comment: shows subdivisions of lymph node groups. Normal node size cutoffs.
- Park (MDACC), 1994 - PMID 7855343 — "Pathways of nodal metastasis from pelvic tumors: CT demonstration." (Park JM, Radiographics. 1994 Nov;14(6):1309-21.)
Prostate edit
- Please see Radiation_Oncology/Prostate/Anatomy
Skin LN drainage edit
- Auckland; 2007 (New Zealand) PMID 17643351 -- "Three-dimensional visualisation of lymphatic drainage patterns in patients with cutaneous melanoma." (Reynolds HM, Lancet Oncol. 2007 Sep;8(9):806-12.)
- Heat maps based on 5239 SLN analyses of cutaneous melanoma patients
- Conclusion: Sappey's lines not effective
Pterygopalatine ganglion edit
- Suspended from V2 branch of trigeminal (CNV) nerve
- Parasympathetic input from superior salivary nucleus in brain stem travel via facial nerve (CNVII) to greater superficial petrosal nerve
- Sympathetic fibers from carotid plexus travel via deep petrosal nerve
- The deep petrosal nerve and greater superficial petrosal nerves join to form the vidian nerve, which passes through (sympathetic fibers)/into (parasympathetic fibers) the pterygopalatine nucleus
- Postganglionic parasympathetic fibers and passing-through sympathetic fibers travel through trigeminal nerve to lacrimal gland and nasal/oral mucosa