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Radiation Oncology/Anatomy

< Radiation Oncology
The latest reviewed version was checked on 16 November 2020. There is 1 pending change awaiting review.

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

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Dissections

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Vertebral Levels

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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

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Head & Neck

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Regional breast lymph nodes

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Supraclavicular

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Brachial plexus:

Thorax

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See also: Radiation Oncology/Thorax/Anatomy (Lung lymph node stations)

Abdomen

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Vessels

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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

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  • 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

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  • 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

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  • 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

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Skin LN drainage

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  • 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

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  • 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

External Resources

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