Radiation Oncology/Anatomy

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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]


Vertebral Levels[edit]

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

Head & Neck[edit]

Regional breast lymph nodes[edit]


Brachial plexus:


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



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


  • 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.)


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