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

[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

[edit] Regional breast lymph nodes

[edit] Supraclavicular

Brachial plexus:

[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:


[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
  • 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

[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
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