Antoine Micheau - MD , Denis Hoa - MD
Tuesday 10 December 2019
Thorax, Abdomen, Pelvis
This human anatomy module is about the lymph nodes, ganglionic areas and organs involved in oncological disease spread assessments. It was created from a scanner (computed tomography) with iodine injection of a healthy subject, covering the face, neck, thorax, abdomen and pelvis.
We selected a cross-sectional imaging approach usually used in oncological disease spread assessment: a cervico-thoraco-abdomino-pelvic CT scan of a male subject.
The DICOM images were exported in JPEG format then cropped and resized using Adobe Photoshop. The images were then integrated into a module using Adobe Animate.
We have integrated on the left a vector skeleton diagram in order to locate navigation buttons and cross-references.
We first used the interactive labels to identify anatomical structures commonly used in oncologic imaging, particularly to determinate the local and regional expansion and remote pre-treatment (TNM) or acting as limit for the classification of ganglionic areas:
• Bone: hyoid bone, collarbone, spine, vertebrae, sternum, ribs, hip bone, sacrum...
• Respiratory system: nose, nasal cavities, larynx, cricoid cartilage, trachea and lungs.
• Digestive system: oral cavity, tongue, pharynx, oesophagus, stomach, small intestine, colon and rectum.
• Urinary system: kidneys, adrenal glands, ureters, bladder, urethra and prostate.
• Arteries: the thoracic and abdominal aorta and its major branches.
• Veins: jugular veins, subclavian veins, brachiocephalic veins, superior and inferior vena cava, azygos vein, iliac veins and femoral veins and the portal system (portal vein, splenic vein, inferior and superior mesenteric veins).
• NB: Some structures were included in groups to which they do not belong in theory, to facilitate the browsing. For example, the spleen in the digestive system and the thyroid gland in the respiratory system.
We represented lymph nodes by colored bullets to have a better view of their placement. These are purely hypothetical anatomical placements; most nodes in this module are not visible in this healthy subject.
The nomenclature of lymph nodes varies enormously according to the authors; therefore, we are limited to the nomenclature of Terminologia Anatomica. You will notice that the placement and the name of the lymph nodes vary significantly from the nomenclature used for the designation of the ganglionic areas.
We outlined the cervical and thoracic lymph nodes. These areas are those used for imaging in oncological disease spread assessment, and those used for irradiation in radiotherapy.
For a shortcut, you will find the infraclavicular and supraclavicular fossa in the ganglionic areas; although this is not strictly about the ganglionic areas, but rather the anatomical regions.
The ganglionic areas in the neck are numbered from I to VI including the retropharyngeal area.
This classification is based on Robin's classification.
The thoracic ganglionic areas are numbered from I to XII and associated with their common names based on the Mountain and Dressler classifications. Some unspecified limits in this classification were derived from the article by Chapet O. et al.
We outlined the various hepatic segments by partitioning the segment IV into IVa and IVb. We defined the segments using the sub-hepatic veins.
Human Anatomy: display of anatomical labels.
To use this module, you must click on the "anatomical structures" tab. You can then choose between the different structures available.
Some structures such as ganglionic areas are shown by delimited areas and interactive labels.
Others, such as the lymph nodes of the thorax, abdomen and pelvis, are shown only by labels.
Finally, the segmentation of the liver is displayed by zones of demarcation designed on a graphics tablet.
The "Viewzone" feature delimits an area that can be moved and resized using the mouse. The labels displayed will be those selected in this rectangular area. However, it does not show an isolated anatomical area.
The "Full screen" mode is available for Premium IMAIOS members only.
The "Quick access" provides a faster access to the neck, chest, abdomen or pelvis.
On the main menu, the "Language" option allows to switch the labels in the different languages available: Latin (Terminologia Anatomica), English, French, Spanish, Portuguese, Polish, Russian, German, Italian, Korean, Chinese and Japanese.
This module is intended for medical students, including those specializing in e.g. radiology, oncology, oncology, radiotherapy, nuclear medicine and all medical specialties in which the preoperative treatment of cancer is primordial.
This atlas of human anatomy will be helpful as an aide-memoire for oncologists, radiotherapists, radiologists, practitioners of nuclear medicine and oncologists disease spread assessment of malignancies, including the study of lymph nodes relating to the TNM classification, but also through ability to recall the segmentation of the liver.