Antoine Micheau - MD , Denis Hoa - MD
Friday 22 December 2017Thorax, Abdomen, Pelvis
This human anatomy module is devoted to the lymph nodes, ganglionic areas and organs involved in oncological disease spread assessments. It has been produced 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 redimensioned using Adobe Photoshop. The images were then integrated into a module using Flash.
We have integrated on the left a vector skeleton diagram in order to locate navigation buttons and cross-references.
We first used the interactive captions to identify anatomical structures commonly used in oncologic imaging, particularly to determine 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 in order to facilitate navigation. For example, the spleen in the digestive system and the thyroid gland in the respiratory system.
We have represented lymph nodes by coloured bullets in order to better visualise their position. These are purely hypothetical anatomical locations; 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 location and the name of the lymph nodes vary significantly from the nomenclature used for the designation of the ganglionic areas.
We have 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 speaking 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 legends
To use this module, you must click on the "anatomical structures" tab.
There you can choose between the different structures for display.
Some structures such as ganglionic areas are shown by delimited areas and interactive legends.
Others, such as the lymph nodes of the thorax, abdomen and pelvis, are shown only by legends.
Finally, the segmentation of the liver is displayed by zones of demarcation designed on a graphics tablet…
The "captioning limited to an area" function permits all the legends in a square that the user imposes on the image to be displayed. On the other hand, it does not permit the display of isolated anatomical areas.
The "full screen" function allows the large-scale display of images from the specific module, but is reserved for Premium IMAIOS members.
The "Regions" tab provides more rapid access to the neck, chest, abdomen or pelvis.
The language menu allows the display of captions in different languages: Latin (Terminologia Anatomica), English, French, Spanish, Portuguese, Czech, Chinese, Japanese...
This module is intended for medical students, including those specialising in e.g. radiology, oncology, oncology, radiotherapy, nuclear medicine and all medical specialties where the preoperative treatment of cancer is paramount.
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.