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标题: A Guide for Delineation of Lymph Nodal Clinical Target ebook代购 [打印本页]

作者: uulc4eGygx    时间: 2015-12-16 10:48     标题: A Guide for Delineation of Lymph Nodal Clinical Target ebook代购

Contents
Section I
General Considerations .. . . . . . . . . . . . . . . . . . . 1
1 Anatomy .. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.1 Head and Neck Region .. . . . . . . . . . . . . . 3
1.1.1 Occipital Lymph Nodes .. . . . . . . . . . . . . 3
1.1.2 Mastoid or Retroauricular
Lymph Nodes .. . . . . . . . . . . . . . . . . . . . . . 3
1.1.3 Parotid Lymph Nodes .. . . . . . . . . . . . . . . 4
1.1.4 Submandibular Lymph Nodes .. . . . . . . 4
1.1.5 Submental Lymph Nodes .. . . . . . . . . . . . 4
1.1.6 Facial Lymph Nodes .. . . . . . . . . . . . . . . . 5
1.1.7 Sublingual Lymph Nodes .. . . . . . . . . . . . 5
1.1.8 Retropharyngeal Lymph Nodes .. . . . . . 5
1.1.9 Anterior Cervical Lymph Nodes .. . . . . 5
1.1.10 Lateral Cervical Lymph Nodes .. . . . . . . 5
1.2 Thoracic Region .. . . . . . . . . . . . . . . . . . . . 6
1.2.1 Parietal Lymph Nodes .. . . . . . . . . . . . . . . 6
1.2.2 Visceral Lymph Nodes .. . . . . . . . . . . . . . 7
1.3 Upper Abdominal Region .. . . . . . . . . . . 7
1.3.1 Abdominal Visceral Lymph Nodes .. . . 8
1.3.2 Lumboaortic Lymph Nodes . . . . . . . . . . 8
1.4 Pelvic Region .. . . . . . . . . . . . . . . . . . . . . . . 8
1.4.1 Group of the Common Iliac Lymph
Nodes .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4.2 Group of the Internal Iliac Lymph
Nodes (or Hypogastric) .. . . . . . . . . . . . . 9
1.4.3 Group of the External Iliac Lymph
Nodes .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.4.4 Sacral or Presacral Lymph Nodes . . . . 10
1.4.5 Inguinal Lymph Nodes .. . . . . . . . . . . . . 10
2 Lymph Node Classification .. . . . . . . . . 11
2.1 Head and Neck Region .. . . . . . . . . . . . . 11
2.2 Mediastinal Region .. . . . . . . . . . . . . . . . 13
2.3 Upper Abdominal Region .. . . . . . . . . . 20
2.4 Pelvic Region .. . . . . . . . . . . . . . . . . . . . . . 26
3 Anatomicoradiological
Boundaries . . . . . . . . . . . . . . . . . . . . . . . . 29
3.1 Head and Neck Region .. . . . . . . . . . . . . 29
3.2 Mediastinal Region .. . . . . . . . . . . . . . . . 30
3.3 Upper Abdominal Region .. . . . . . . . . . 34
3.4 Pelvic Region .. . . . . . . . . . . . . . . . . . . . . . 34
4 Planing CT: Technical Notes . . . . . . . . 39
Section II
Target Volume Delineation
in Modern Radiation Therapy .. . . . . . . . . . . . 43
5 Critical Importance of Target
Definition, Including Lymph Nodes,
in Image-Guided Radiation Therapy . 45
5.1 Target Volume and Critical Structure
Delineation .. . . . . . . . . . . . . . . . . . . . . . . 47
5.2 Delineation of Lymph Node Volumes . 53
A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy
X
7 Mediastinal Lymph Nodes . . . . . . . . . 97
8 Upper Abdominal Region
Lymph Nodes .. . . . . . . . . . . . . . . . . . . . 113
9 Pelvic Lymph Nodes .. . . . . . . . . . . . . . 137
10 Digitally Reconstructed
Radiographs (DRRs) .. . . . . . . . . . . . . . 161
References .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
5.3 Implications of Target Definition
for Innovative Technology in
Contemporary Radiation Therapy .. . . 56
5.4 Quality Assurance .. . . . . . . . . . . . . . . . . 56
5.5 Cost Benefit and Utility .. . . . . . . . . . . . 57
5.6 Conclusions .. . . . . . . . . . . . . . . . . . . . . . . 59
Section III
Axial CT Radiological Anatomy .. . . . . . . . . 61
6 Head and Neck Lymph Nodes .. . . . . 63
Contributors
Antonietta Augurio, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
Nicola Filippo Basilico, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
Raffaella Basilico, MD
Department of Radiology
University Hospital
Chieti
Italy
Marco D’Alessandro, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
Angelo Di Pilla, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
Antonella Filippone, MD
Department of Radiology
University Hospital
Chieti
Italy
James A. Purdy, PhD
Department of Radiation Oncology
University of California, Davis Medical Center
Sacramento, CA
USA
Pietro Sanpaolo, MD
Department of Radiation Oncology
Regional Oncological Hospital, CROB
Rionero in Vulture
Italy
Maria Luigia Storto, MD
Director of Radiology Department
“G. d’Annunzio” University School of Medicine
Chieti
Italy
Maria Taraborrelli, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy
XII
Lucia Anna Ursini, MD
Department of Radiation Oncology
University Hospital
Chieti
Italy
Armando Tartaro
Professor of Radiology
“G. d’Annunzio” University School of Medicine
Chieti
Italy
Section I
General Considerations
1
3
Anatomy
1.1 Head and Neck Region
The head and neck region [1, 2] has a dense lymphatic
network which, through the jugular, spinal
accessory, and transverse cervical nodes under the
jugular-subclavian axis, drains lymph from the skull
base to the thoracic duct.
Lymph drainage of the anatomical structures
belonging to this region is ipsilateral, apart from
tonsil, soft palate, basal tongue, posterior pharyngeal
wall, and, especially, nasopharynx, all of which
drain bilaterally. Vocal folds, paranasal sinuses, and
middle ear do not have lymph vessels, or have them
in limited number.
According to Rouvière, head and neck lymph
nodes are clustered in groups or form chains that
are satellites of the main blood vessels (Fig. 1.1).
These nodal groups are listed below:
?? The pericervical ring, which includes six nodal
groups surrounding the upper neck:
–– Occipital nodes
–– Mastoid or retroauricular nodes
–– Parotid nodes
–– Submandibular nodes
–– Submental nodes
Facial nodes – –
?? Sublingual and retropharyngeal lymph nodes,
located medial to the pericervical nodal ring
?? Anterior and lateral cervical lymph nodes of
the neck, located anterior and lateral to the neck,
respectively
1.1.1 Occipital Lymph Nodes
They are adjacent to the occipital artery. Rouvière
distinguishes them into superficial, subfascial, and
submuscular.
The superficial nodes are located at the level of
the insertion of the sternocleidomastoid and the
trapezius muscles; the subfascial nodes are situated
above the splenius muscle; and the submuscular
nodes are located below the splenius muscle.
They receive lymphatics from the occipital area
of the scalp and from the skin and deep regions of
the upper nape.
1.1.2 Mastoid or Retroauricular
Lymph Nodes
They are located on the superficial aspect of the anterior
and superior insertions of the sternocleidomastoid
muscle.
They receive lymphatics from the skin of the medial
aspect of the ear, the back of the temporal region,
and the parietal area of the skull.
A Guide for Delineation of Lymph Nodal Clinical Target Volume in Radiation Therapy
4
1.1.4 Submandibular Lymph Nodes
These are deep nodes, anatomically located in the
submandibular cavity, adjacent to the salivary gland
and the anterior facial vein. Rouvière divided them
into five groups: periglandular, perivascular, retrovascular,




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