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) - PMID 10352611 Full text &mdash; "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: Uncategorized:
 * 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
 * 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

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

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 PMID 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 - 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 &mdash; "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) 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

 * 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