Sectional Anatomy for Imaging Professionals

777 Pages·2012·346.34 MB·English

by  Lorrie L. Kelley

Lorrie L. Kelley, MS, RT(R)(MR)(CT)
Associate Professor, CT/MRI Program Director
Boise State University
Boise, Idaho
Connie M. Petersen, MS, RT(R)(CT)
Adjunct Instructor, Radiologic Sciences Program
Boise State University
Boise, Idaho
3251 Riverport Lane
St. Louis, Missouri 63043
SECTIONAL ANATOMY FOR IMAGING PROFESSIONALS, ISBN: 978-0-323-08260-0
THIRD EDITION
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
Copyright © 2007, 1997 by Mosby, Inc., an affiliate of Elsevier Inc.
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To James,
Min beste venn og evig ledsager, jeg smil hver dag på grunn av deg.
Your strength sustains me during the dark moments, your unconditional
patience and love elevates me, and your faith inspires me.
And to Kristina, Matt, Jennifer, John, Michael, Natalie, Angela, James,
Daniel, Dean, Maren, Evelyn, McKenzie, and Jakob, et al, my
greatest treasures, who bless me with their laughter and enthusiasm for
life. Thanks for reminding me to dream and never stop learning.
And to my parents,
Bill and Darhl Buchanan, for teaching me the value of hard work and sharing
their wisdom and encouragement in ways that strengthen and inspire me.
LLK
Thank you to my family and friends whose guidance, love, and support
carried me through my most trying times.
I dedicate this book to:
My greatest blessings, Brady and Trinity, for the countless joys you have
graced my life with. May you never lose sight of the incredible good and
strengths within you as you reach for greatness. Always know that you
are loved and how truly honored I am to be your mom.
Carl and Ellen Collins, my parents, for the wonderful gifts of life
and love. Thank you for your ever-present understanding, wisdom, and
encouragement. I love you both dearly.
Grant, my amazing gift from God, for loving me and being there
when I needed you most.
CMP
A C K N O W L E D G M E N T S
Many provided encouragement and direction as the • Chris Hayden for his tremendous patience, knowl-
compilation of this text commenced. Amy Whittier had edge, and time invested in helping us find and create
the tiresome duty of encouraging us to meet deadlines, all of the new CT images for the third edition. And
which she did with grace and humor. Jennifer Geistler St. Alphonsus Regional Medical Center for providing
had the daunting task of strategically pulling it all to- the CT images.
gether. We are indebted to them for their editorial assis- • Mary Pullin from Philips Medical Systems for providing
tance in seeing this project through completion. some beautiful MR images.
We wish to extend our gratitude to everyone who • Dave Arnold and St. Luke’s Regional Medical Center,
thought the first and second editions had value and to as well as Kevin Bean and Intermountain Medical
those who took the time to provide constructive criti- Imaging, for providing the majority of the MR
cism and suggestions for further improvements and in- images.
creased accuracy. And to the many students who were
not shy in providing feedback so that we could see the We owe a debt of gratitude to Jeanne Robertson, who
text from many different perspectives. provided numerous new illustrations and revised many
The following individuals and institutions deserve old drawings in record time. Because of her efforts and
special acknowledgment: talent, there is more consistency in the visual presentation
of the artwork throughout the text.
• The faculty at Boise State University for their sup-
port and patience as we faced fast-approaching Lorrie L. Kelley
deadlines. Connie M. Petersen
iv
R E V I E W E R S
Becky Britt, MSRS, RT(R)(M) Kathleen Kienstra, MAT, RT(R)(T) Kenneth Roszel, MS, RT(R)
Assistant Professor Program Director Program Director
Northwestern State University Radiation Therapy Program Geisenger Medical Center
Shreveport, Louisiana Saint Louis University Danville, Pennsylvania
St. Louis, Missouri
Gail Faig, BS, RT(R)(CV)(CT) Rebecca Silva, MEd, MPH, RT(R)
Clinical Coordinator Bob McGee, MEd, RT(R), CCI Department Chair
Shore Medical Center Assistant Professor/Clinical South Texas College
School of Radiologic Technology Coordinator McAllen, Texas
Somers Point, New Jersey South College/Asheville
Asheville, North Carolina Karen Tillelli, RT, CT(R)
Lisa Fanning, MEd, RT(R)(CT) Program Instructor
Radiography Program Director Marcia Moore BS, RT(R)(CT) University of Utah Hospital/Clinics
Massachusetts College of Pharmacy Instructor Salt Lake City, Utah
and Health Sciences St. Luke’s College
Boston, Massachusetts Sioux City, Iowa Diana Werderman, MSEd, RT(R)
Assistant Professor
Kelli Haynes, MSRS, RT(R) Roger Preston, MSRS, RT(R)(CT) Trinity College of Nursing and
Director of Undergraduate Studies/ Program Director Health Sciences
Associate Professor/Graduate School of Radiologic Technology Rock Island, Illinois
Faculty Richmond, Indiana
Radiologic Sciences Department
Northwestern State University of Theresa Roberts, MHS, RT(R)(MR)
Louisiana Program Director
Shreveport, Louisiana Radiologic Technology
Keiser University
Marelene Johnson, MEd, RT(R) Melbourne, Florida
Education Director
University of Utah
Salt Lake City, Utah
v
P R E F A C E
This text was written to address the needs of today’s
CONTENT AND ORGANIZATION
practicing health professional. As technology in diagnos-
tic imaging advances, so does the need to competently The images include identification of vital anatomic struc-
recognize and identify cross-sectional anatomy. Our goal tures to assist the health professional in locating and
was to create a clear, concise text that would demon- identifying the desired anatomy during actual clinical
strate in an easy-to-use yet comprehensive format the examinations. The narrative accompanying these images
anatomy the health professional is required to under- clearly and concisely describes the location and function
stand to optimize patient care. The text was purposely of the anatomy in a format easily understood by health
designed to be used both as a clinical reference manual professionals. The text is divided into chapters by
and as an instructional text, either in a formal classroom anatomic regions. Each chapter of the text contains an
environment or as a self-instructional volume. outline that provides an overview of the chapter’s con-
Included are close to 1000 high-quality MR and CT tents, pathology boxes that briefly describe common
images for every feasible plane of anatomy most com- pathologies related to the anatomy being presented,
monly imaged. An additional 350 anatomic maps and tables designed to organize and summarize the anatomy
line drawings related to the MR and CT images add to contained in the chapter, and reference illustrations that
the learner’s understanding of the anatomy being stud- provide the correct orientation for scanning the anatomy
ied. In addition, pathology boxes describe common of interest.
pathologies related to the anatomy presented, assisting
the reader in making connections between the images in
ANCILLARIES
the text and common pathologies that will be encoun-
tered in clinical practice. Tables that summarize muscle A Workbook and an Evolve site complement the text.
group information include points of origin and insertion, When used together, these additional tools create a vir-
as well as functions, for the muscle structures pertinent tual learning system/reference resource.
to the images the reader is studying. Workbook: The Workbook provides practice oppor-
tunities for the user to identify specific anatomy. The
Workbook includes learning objectives that focus on the
NEW TO THIS EDITION
key elements of each chapter, a variety of practice items
• Nearly 150 new MR and CT images and 30 new line to test the reader’s knowledge of key concepts, labeling
drawings provide more 3D and vascular images to bet- exercises to test the reader’s knowledge of the anatomy,
ter demonstrate anatomy seen with current technology. and answers to exercises.
• Chapter Objectives will help readers prepare for the Instructor Resources on Evolve: These resources in-
material they will learn in each chapter. clude a test bank with approximately 500 questions and
• Addition of full labels to scans will improve usability an image collection with approximately 1000 images.
of the images and allow readers to quickly and effi-
ciently see the anatomy displayed on the scan. Lorrie L. Kelley
• Addition of Test Bank to Evolve Instructor Resources Connie M. Petersen
will provide readers with the tools for an enhanced
learning experience.
vi
C O N T E N T S
1  Introduction to Sectional Anatomy, 1 Mediastinum, 322
Lymphatic System, 326
Anatomic Positions and Planes, 2
Heart and Vasculature, 331
Terminology and Landmarks, 2
Great Vessels, 349
Body Cavities, 6
Coronary Circulation, 368
Abdominal and Pelvic Divisions, 6
Off-Axis Cardiac Imaging, 377
Image Display, 8
Azygos Venous System, 386
Multiplanar Reformation and 3D Imaging, 9
Muscles, 389
2  Cranium and Facial Bones, 15
Breast, 395
Cranium, 16
7  Abdomen, 397
Facial Bones, 51
Abdominal Cavity, 398
Temporomandibular Joint, 62
Liver, 412
Paranasal Sinuses, 68
Gallbladder and Biliary System, 431
Orbit, 75
Pancreas, 437
3  Brain, 89
Spleen, 441
Meninges, 90
Adrenal Glands, 442
Ventricular System, 93
Urinary System, 446
Cerebrum, 102
Stomach, 453
Diencephalon, 113
Intestines, 458
Limbic System, 117
Abdominal Aorta and Branches, 468
Brainstem, 120
Inferior Vena Cava and Tributaries, 485
Cerebellum, 128
Lymph Nodes, 488
Cerebral Vascular System, 131
Muscles of the Abdominal Wall, 490
Cranial Nerves, 157
8  Pelvis, 494
4  Spine, 172
Bony Pelvis, 495
Vertebral Column, 173
Muscles, 505
Ligaments, 193
Viscera, 517
Muscles, 201
Vasculature, 550
Spinal Cord, 210
Lymph Nodes, 561
Plexuses, 226
9  Upper Extremity, 563
Vasculature, 241
Shoulder, 564
5  Neck, 250
Elbow, 601
Organs, 251
Wrist and Hand, 621
Muscles, 291
Neurovasculature, 646
Vascular Structures, 300
10  Lower Extremity, 654
6  Thorax, 307
Hip, 655
Bony Thorax, 308
Knee and Lower Leg, 682
Pleural Cavities, 312
Ankle and Foot, 714
Lungs, 313
Neurovasculature, 746
Bronchi, 318
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C H A P T E R
1
Introduction to Sectional
Anatomy
Acetabulum Femoral head Sectional anatomy has had a long history. Beginning as
early as the sixteenth century, the great anatomist and art-
ist, Leonardo da Vinci, was among the first to represent the
body in anatomic sections. In the following centuries,
numerous anatomists continued to provide illustrations of
various body structures in sectional planes to gain greater
understanding of the topographical relationships of the
organs. The ability to see inside the body for medical pur-
poses has been around since 1895, when Wilhelm Conrad
Roentgen discovered x-rays. Since that time, medical imag-
ing has evolved from the static 2-dimensional (2D) image
of the first x-ray to the 2D cross-section image of com-
puted tomography (CT), and finally to the 3-dimensional
(3D) imaging techniques used today. These changes war-
rant the need for medical professionals to understand and
R L
Coccygeus muscle identify human anatomy in both 2D and 3D images.
Sectional anatomy emphasizes the physical relationship
Rectum Coccyx Gluteus maximus
muscle between internal structures. Prior knowledge of anatomy
FIGURE 1.1 Axial CT of hips. from drawings or radiographs may assist in understanding
the location of specific structures on a sectional image. For
example, it may be difficult to recognize all the internal
anatomy of the pelvis in cross-section, but by identifying
the femoral head on the image, it will be easier to recog-
nize soft tissue structures adjacent to the hip in the general
location of the slice (Figure 1.1).
O B J E C T I V E S
• Define the four anatomic planes. • Describe the dorsal and ventral cavities of the body.
• Describe the relative position of specific structures within • List the four abdominal quadrants.
the body using directional and regional terminology. • List the nine regions of the abdomen.
• Identify commonly used external landmarks. • Describe the gray scale used in CT and MR imaging.
• Identify the location of commonly used internal • Describe MPR, CPR, SSD, MIP and VR.
landmarks.
O U T L I N E
Anatomic Positions and Planes, 2 Image Display, 8 3D Imaging, 9
Terminology and Landmarks, 2 Multiplanar Reformation Shaded Surface Display
External Landmarks, 2 and 3D Imaging, 9 (SSD), 12
Internal Landmarks, 2 Multiplanar Reformation Maximum Intensity
Body Cavities, 6 (Reformat) (MPR), 9 Projection (MIP), 12
Abdominal and Pelvic Divisions, 6 Curved Planar Reformation Volume Rendering (VR), 12
Quadrants, 7 (Reformat) (CPR), 9
Regions, 7
Copyright © 2013, Elsevier Inc. 1