Radiation Oncology/Anatomy
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This page is for Anatomy Pearls useful for radiation oncology. Suitable examples include radiographic landmarks, location of lymph node groups, and lymph drainage patterns.
Contents |
[edit] Anatomy atlases
- Gray's Anatomy @ Bartleby.com
- Basic Anatomy @ Dartmouth
- Wesley Norman Anatomists
- AnatomyAtlases.org
- 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.
[edit] Dissections
[edit] Vertebral Levels
D means disc below level
- 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
[edit] CNS
Hippocampus
- Florida; 2009 PMID 19194118 -- "A radiation oncologist's guide to contouring the hippocampus." (Chera BS, Am J Clin Oncol. 2009 Feb;32(1):20-2.)
- Step-by-step guide to contouring the hippocampus on axial magnetic resonance images for radiation therapy treatment planning
[edit] Head & Neck
- Please see the H&N anatomy page
[edit] Regional breast lymph nodes
- Please see the axilla RT technique section
[edit] Supraclavicular
Brachial plexus:
- Please see the Brachial plexus section
[edit] Abdomen
[edit] Vessels
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
[edit] Lymphatics
- 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.
[edit] CT Atlas
- Baylor; 2007 PMID 17959923 -- "Learning the nodal stations in the abdomen." (Moron FE, Br J Radiol. 2007 Oct;80(958):841-8.)
[edit] Groin
Inguinal lymph nodes:
- For RT field design, see Radiation_Oncology/Vulva#Radiation_treatment_volumes (from PMID 8641909)
[edit] Pelvic lymph nodes
- RTOG; 2008 PMID 18037584 -- "Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer." (Small W Jr, Int J Radiat Oncol Biol Phys. 2008 Jun 1;71(2):428-34. Epub 2007 Nov 26.)
- Consensus atlas of CTV for post-op RT of endometrial and cervical centers for IMRT
- St. Bartholomew (UK)
- 2007 PMID 17624745 -- "An atlas of the pelvic lymph node regions to aid radiotherapy target volume definition." (Taylor A, Clin Oncol (R Coll Radiol). 2007 Sep;19(7):542-50. Epub 2007 Jul 10.)
- Development of a CT atlas
- 2005 PMID 16198509 — "Mapping pelvic lymph nodes: guidelines for delineation in intensity-modulated radiotherapy." Taylor A et al. Int J Radiat Oncol Biol Phys. 2005 Dec 1;63(5):1604-12.
- Gynecologic malignancies. Used MRI with iron oxide particles to visualize lymph nodes. Determined the size of margins around vessels in order to include lymph nodes.
- Gives common iliac, external iliac, internal iliac, obturator, and presacral.
- Gives guidelines for pelvic nodal CTV delineation
- 2007 PMID 17624745 -- "An atlas of the pelvic lymph node regions to aid radiotherapy target volume definition." (Taylor A, Clin Oncol (R Coll Radiol). 2007 Sep;19(7):542-50. Epub 2007 Jul 10.)
- Portaluri (Italy), 2005 - PMID 15913911 — "A three-dimensional definition of nodal spaces on the basis of CT images showing enlarged nodes for pelvic radiotherapy." Portaluri M et al. Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1101-7.
- Defines anatomic boundaries for enlarged pelvic lymph nodes. Boundaries presented in table form. CT contours for each nodal group.
- Gives common iliac, external iliac, internal iliac, obturator, pudendal, deep inguinal, superficial inguinal, and presacral.
- Chao (Washington U.), 2002 - PMID 12419442 — "Lymphangiogram-assisted lymph node target delineation for patients with gynecologic malignancies." Chao KS et al. Int J Radiat Oncol Biol Phys. 2002 Nov 15;54(4):1147-52.
- Gynecologic malignancies. CT and lymphangiogram. Determined greatest distance from lymph node to the vessels.
- Did not include internal iliac (not usually visible on LAG)
- Conclusion: vessel expansion alone was not sufficient to cover the nodal areas fully and reasonably exclude normal tissue.
- Park (MDACC), 1994 - PMID 7855343 — "Pathways of nodal metastasis from pelvic tumors: CT demonstration." (Park JM, Radiographics. 1994 Nov;14(6):1309-21.)
[edit] Prostate
- Please see Radiation_Oncology/Prostate/Anatomy
[edit] Skin LN drainage
- 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
[edit] Pterygopalatine ganglion
- 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