Netter’s Concise Radiologic Anatomy (Netter Basic Science) Saunders – 1st Edition 2008 PDF

Netter's Concise Radiologic Anatomy



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Preface

Netter’s Concise Radiologic Anatomy, Diagnostic medical images are now an integral component of contemporary courses in Medical Gross Anatomy. This primarily reflects the steadily increasing teaching of clinical correlations within such courses. Accordingly, radiologic images now are included in all gross anatomy atlases and textbooks. These images are typically plain radiographs, axial CT/MRI (computed tomography/magnetic resonance image) scans, and angiograms of various portions of the vascular system.
Although such images reflect the capabilities of diagnostic imaging technology perhaps 15 years ago, they do not reflect the full integration of computer graphics capabilities into radiology. This integration has resulted in a tremendous expansion in the ability of radiology to represent human anatomy. The active process of reformatting imaging data into optimal planes and types of image reconstruction that best illustrate anatomic/pathologic features is not limited to academic centers. To the contrary, the graphics workstation is now a common tool used in the practice of diagnostic radiology. Special views and image reconstructions are currently part of the diagnostic process and are usually made available to all those participating in the care of a patient, along with an interpretation by the radiologist that describes the pathology and relevant anatomy.
This situation led us to the realization that any student of anatomy would benefit from early exposure to the manner of appearance of key anatomic structures in diagnostic images, especially advanced CTs and MRIs. Thus, we (a radiologist and two anatomists) chose to develop a handbook that illustrates how modern radiology portrays human anatomy. To accomplish this task, we decided to match modern diagnostic images with a subset of the anatomic drawings from the Atlas of Human Anatomy by Dr. Frank H. Netter. Netter’s atlas has become the “gold standard” of human anatomy atlases. Its images are quite familiar to the vast majority of students who complete a course in human gross anatomy. By providing a bridge from the manner in which anatomic features appear in Netter’s atlas to their appearance in radiologic images, this book will enable the acquisition of comfortable familiarity with how human anatomy is typically viewed in clinical practice.
In selecting and creating images for this atlas, we frequently had to choose between diagnostic images that are in very common use (axial, coronal, and sagittal slices) or images that result from more advanced reconstruction techniques—images that more clearly depict anatomic structures and relationships. When a “routine” image was found that matched a Netter plate well and illustrated key anatomic points, it was selected. However, we decided to include many advanced image reconstructions such as maximum intensity projections and volume rendered displays because these will be the routine images of the near future.
Although the idealized anatomy depicted in the Netter plates is wonderful for teaching anatomic relationships, they can sometimes lead to confusion pertaining to recognizing structures “in real life.” A perfect example is the suprarenal (adrenal) gland. When a radiologist looks at a Netter plate showing the adrenal gland, he or she will likely think, “This is not how the gland appears radiologically.” We felt it important to select some images that highlight the differences in the manner that some structures appear radiologically versus anatomically.
The physician must understand that anatomic structures often appear quite differently from the Netter drawings when shown on a cross-sectional image. Curved structures may enter and leave a thin imaging plane so that the structure appears as two or more “structures” on a cross-sectional image. Similarly, only part of a structure may appear on an image because of such curvatures. For example, the normal kyphotic and lordotic curvatures of the spine may be anterior or posterior to a particular coronal section. Furthermore, when the plane of a thin imaging “slice” is oblique to an anatomic structure, the appearance of that structure may be distorted. A common example is that blood vessels may appear ovoid instead of round if a cross-sectional image is oblique to the axis of that vessel. We selected some images in which these “distortions” were apparent and noted this in the associated text.
Images in this Atlas that are not credited to an outside source all originated at The Imaging Center, Fort Wayne, Indiana. They were obtained from routine clinical scanning at this small, independent practice of diagnostic radiology. Because of concern about radiation exposure, no standard CT scan protocols were ever modified for the sake of producing an image. CT image data for the book were processed after patients had undergone routine scanning appropriate to the medical reasons for which the scans were requested, and after all patient identifiers had been removed. None of these images originated in a university or corporate imaging laboratory. The Imaging Center MRI scanner is an Infinion scanner from Philips Corporation. The CT scanner used is a Brilliance 40, and the graphics workstation is the Extended Brilliance Workspace. Both of these are also manufactured by Philips.
We understand that learning to interpret radiologic images requires reference to normal anatomy. Accordingly, we believe our atlas will facilitate this process by the closing of a common mental gap between how an anatomic feature looks in an anatomic atlas versus its appearance in clinical imaging.


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