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 HeadNeckBrainSpine Neuroradiology Gray's Anatomy @ Bartleby.com Basic Anatomy @ Dartmouth Wesley Norman Anatomists AnatomyAtlases.org Radiology Assistant Cross-sectional nodal atlas, 1999 (Ohio State) - 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 SUNY Downstate Vertebral Levels 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 Please see the Clinical Syndromes with CN Palsy page Head & Neck Please see the H&N anatomy page Regional breast lymph nodes Please see the axilla RT technique section Supraclavicular Brachial plexus: Please see the Brachial plexus section Also see the section on this page Radiation_Oncology/Anatomy#Thorax Thorax See also: Radiation Oncology/Thorax/Anatomy (Lung lymph node stations) Abdomen 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 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. CT Atlas Baylor; 2007 17959923 -- "Learning the nodal stations in the abdomen." (Moron FE, Br J Radiol. 2007 Oct;80(958):841-8.) Pelvic lymph nodes Beth Israel, 2010 - 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 - 7855343 — "Pathways of nodal metastasis from pelvic tumors: CT demonstration." (Park JM, Radiographics. 1994 Nov;14(6):1309-21.) Prostate Please see Radiation_Oncology/Prostate/Anatomy Skin LN drainage Auckland; 2007 (New Zealand) 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 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 Diagnostic Radiology Nuclear Medicine