Pelvic lymph node contouring guidelines

1. What are the contouring guidelines for inguinal lymph nodes?
2. What is the normal size of a pelvic lymph node?
3. How do you perform a pelvic lymphadenectomy?
4. What are the organs at risk to be contoured in pelvic cases?
5. How much margin is needed around the vessels when contouring inguinal and femoral nodes?
6. What size inguinal lymph node is abnormal?
7. What size lymph node is suspicious?
8. At what size are lymph nodes concerning?
9. Is a 2.5 cm lymph node big?
10. What landmarks are involved in pelvic lymphadenectomy?
11. What are the borders for pelvic lymph node dissection?
12. How many lymph nodes are in the pelvis?
13. What are the 5 major organs of the female pelvic cavity?
14. What can be found by Xraying and scanning the pelvis?
15. What is the most radiosensitive pelvic organ?
16. How do you measure lymphatic drainage?
17. Are inguinal lymph nodes superficial or deep?
18. How many miles of lymphatic vessels are in the body?
19. What is contouring in radiation oncology?
20. When should an inguinal lymph node be biopsied?
21. Are inguinal lymph nodes normally palpable?
22. Are groin lymph nodes normally palpable?
23. Where are pelvic lymph nodes?
24. Do lymph nodes need surgery?
25. What kind of doctor specializes in lymph nodes?
26. Are lymph nodes in the groin serious?
27. What are the 5 Rules of contour lines?
28. What are the 3 types of contour lines?

What are the contouring guidelines for inguinal lymph nodes?

The majority of inguinal lymph nodes lay anteromedial to the femoral vessels. A uniform margin of 0.7-0.8 cm around the vessels is insufficient to include most of the nodes. In order to cover 90% of nodes, a margin of 3.37 cm anteriorly, 2.77 cm medially, and 4.06 cm laterally from the vessels should be applied.

What is the normal size of a pelvic lymph node?

CONCLUSION: Almost all normal pelvic nodes are less than 10 mm MSAD, depending on the site. The low sensitivity of CT in depicting metastases to the pelvic lymph nodes might be improved by adopting upper limits of normal that reflect this size.

How do you perform a pelvic lymphadenectomy?

Surgical technique

In order to achieve a successful pelvic lymphadenectomy, first, a good anatomic exposure should be maintained to visualize the entire surgical field (Figure 1), secondly, lymph nodes over the external and internal iliac vessels are dissected and then the obturator lymph nodes are removed.

What are the organs at risk to be contoured in pelvic cases?

External Beam Pelvic Irradiation

The main organs at risk for complications are the rectosigmoid, small bowel, and bladder.

How much margin is needed around the vessels when contouring inguinal and femoral nodes?

To ensure adequate coverage of ≥90% of the positive nodes in the inguino- femoral region, the necessary margin around the nearest femoral vessel was anteromedial ≥35 mm, anterior ≥23 mm, anterolateral ≥25 mm, medial ≥22 mm, posterior ≥9 mm, and ≥32 mm lateral.

What size inguinal lymph node is abnormal?

How big are inguinal lymph nodes? A normal inguinal lymph node is about 1/4 inch in width. The length of an inguinal lymph node should be at least two times its width. When the width of an inguinal lymph node is more than 1/2 inch, it's considered abnormal.

What size lymph node is suspicious?

In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal. Supraclavicular nodes are the most worrisome for malignancy. A three- to four-week period of observation is prudent in patients with localized nodes and a benign clinical picture.

At what size are lymph nodes concerning?

But the normal size of an average lymph node is under 1.5 centimeters, or about ¾ of an inch or smaller. So, if something is larger than that or growing continuously, it needs to be checked out.

Is a 2.5 cm lymph node big?

Call Your Doctor If:

Node gets 1 inch (2.5 cm) or larger in size. Big node lasts more than 1 month. You think your child needs to be seen. Your child becomes worse.

What landmarks are involved in pelvic lymphadenectomy?

The boundaries for a systematic pelvic lymphadenectomy are the following: (1) proximally—the common iliac artery; (2) distally—the circumflex iliac vein; (3) laterally—the pelvic side wall and the mid–psoas muscle; (4) medially—to the hypogastric artery and the obliterated umbilical artery (terminal branch); and (5) ...

What are the borders for pelvic lymph node dissection?

Selective PLND—Anatomical Landmarks and Techniques

Anatomic boundaries of the common PLND are: ventral—common iliac artery bifurcations, dorsal—abdominal aorta bifurcation, lateral—psoas major muscle, medial—right-medial aspect of common iliac vessels, left-mesoureter [5].

How many lymph nodes are in the pelvis?

The number of pelvic lymph nodes

Canessa et al. cleared pelvic lymph nodes below the bifurcation of iliac vessels in 16 cadavers and obtained a mean of 28.6 (16–46) nodes [12].

What are the 5 major organs of the female pelvic cavity?

The space below contains the bladder, rectum, and part of the descending colon. In females, the pelvis also houses the uterus, fallopian tubes, and ovaries.

What can be found by Xraying and scanning the pelvis?

A pelvis X-ray can help doctors find the cause of pain, swelling, or deformity in the pelvic, hip, or upper leg areas. It also can show broken bones after an injury. An X-ray can help doctors plan surgery, when needed, and check the results after it.

What is the most radiosensitive pelvic organ?

The bladder is the most radiosensitive organ of the urinary system. The bladder wall becomes edematous and symmetrically thickened.

How do you measure lymphatic drainage?

By repeated imaging of a lymph node over time, lymphatic drainage can be assessed by the increase in signal intensity over time. However, the poor resolution of this technique does not allow clear identification of vessel or lymph node location. 3D imaging is also possible with scintigraphy.

Are inguinal lymph nodes superficial or deep?

The inguinal lymph nodes are in the groin area and classify as superficial and deep. The superficial inguinal lymph nodes reside below the inguinal ligament and subdivide into the inferior, superolateral, and superomedial nodes.

How many miles of lymphatic vessels are in the body?

Blood vessels of a typical adult human compose 8% of body mass, and end to end would go around the earth 2.5 times, a distance of 60,000 miles.

What is contouring in radiation oncology?

Contour delineation is a crucial treatment planning process that involves outlining target(s) and organs at risk (OARs) to guide radiation therapy plans that optimize tumor control and reduce radiation toxicity.

When should an inguinal lymph node be biopsied?

If your lymph nodes remain swollen or grow even larger, your doctor may order a lymph node biopsy. This test will help your doctor look for signs of a chronic infection, an immune disorder, or cancer.

Are inguinal lymph nodes normally palpable?

The body has approximately 600 lymph nodes, but only those in the submandibular, axillary or inguinal regions may normally be palpable in healthy people.

Are groin lymph nodes normally palpable?

The groin contains one or two deep inguinal lymph nodes, and about 11 (range 3-18) superficial inguinal lymph nodes, as per imaging studies. Inguinal lymph nodes are often palpable in healthy people. 2 Their largest dimension ranges from 2.1 mm to 13.6 mm.

Where are pelvic lymph nodes?

The lymph nodes in the pelvis lie along the internal, external and common iliac arteries (the main blood vessels that supply blood to the lower abdomen and trunk of the body).

Do lymph nodes need surgery?

Lymph nodes can often become swollen due to infection, as well as autoimmune diseases, and more rarely, cancer. Having swollen lymph nodes doesn't mean that you'll necessarily need your lymph nodes removed. Swollen lymph nodes often get better on their own. But if they don't after a few weeks, contact your GP.

What kind of doctor specializes in lymph nodes?

Lymphologists are doctors who are specially trained in the diagnosis of and therapy for diseases of the lymphatic system.

Are lymph nodes in the groin serious?

You have 10 lymph nodes in each groin area. They are part of your body's natural defense against disease. Swollen lymph nodes are typically a sign of an infection. But it's important to see your healthcare provider to know for sure.

What are the 5 Rules of contour lines?

General Rules for contour lines Page 2 Page 3 A contour line connects points of equal elevation. A contour line never branches or splits Page 5 Steep slopes are shown by closely spaced contour lines. Contour lines never cross, but they may touch. Hills are represented by a concentric series of closed contour lines.

What are the 3 types of contour lines?

There are 3 kinds of contour lines you'll see on a map: intermediate, index, and supplementary. Index lines are the thickest contour lines and are usually labeled with a number at one point along the line. This tells you the elevation above sea level.