title: Adequate irradiation of the internal jugular lymph node chain: technical considerations.
abstract: OBJECTIVE
  This research aimed to study the anatomic relationship between the internal jugular vein with the surrounding internal jugular lymph node chain and the underlying bony anatomical structures which are commonly used as landmarks for radiation therapy planning.
  
  
  METHODS
  Twelve patients with carcinoma of the head and neck region were studied prospectively. Using our three-dimensional planning system, a beam's-eye view of the internal jugular vein was projected onto a lateral and anterior simulation film. Quantitative measurements were made in every case of the anatomic relationship between the internal jugular vein and the posterior border of the cervical vertebrae and sagittal midline.
  
  
  RESULTS
  The distance between the posterior border of the internal jugular vein and the posterior border of the cervical vertebrae ranged between 0 and 2.5 cm. The distances between the sagittal midline and the medial border of the internal jugular veins ranged between 2 and 4 cm.
  
  
  CONCLUSIONS
  To ensure adequate irradiation of the internal jugular lymph nodes, the posterior border of the lateral radiation therapy upper-neck fields should be placed at least 1 cm posterior to the posterior aspect of the cervical vertebrae. The midline block used in the lower neck anterior field should not exceed 2 cm in width.
authors.affiliation: Department of Radiation Oncology, Wayne State University, Karmanos Cancer Institute, Detroit, MI 48201-2097, USA.
authors.forename: A
authors.initials: A
authors.lastname: Aref
authors.forename: M
authors.initials: M
authors.lastname: Gross
authors.forename: J
authors.initials: J
authors.lastname: Fontanesi
authors.forename: S
authors.initials: S
authors.lastname: Devi
authors.forename: C
authors.initials: C
authors.lastname: Kopel
authors.forename: D
authors.initials: D
authors.lastname: Thornton
mesh_terms: D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D007601:Jugular Veins / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*