The inauguration of President Donald Trump revealed that the USA has more in common with the Czech Republic than anyone (presumably, Americans least of all) had hoped for.

President Trumps inauguration ceremony was a flop, at least within the parameters of the universe most of us live in. A universe, it turns out, not shared by Trump and his Press Secretary Sean Spicer. America is getting its first glimpse into the wonderful world of alternative facts, coming from the highest level and it honestly seems a bit shocked. But worry not dear, poor America: you are not the first nor the last. We have been there. We can share survival tips.

The Antichrists Lesson

For starters, there are historical precedents. When the then-President of the Czech Republic Vclav Klaus decided to employ known conspiracy theorist Petr Hjek, most famous for denying evolution, claiming that 9/11 was an inside job, and accusing the late Havel of having been a servant of Satan, he left more than a few heads scratching. Hjek, however, possessed a very useful ability: should it ever become necessary to draw the medias attention, he could always give an interview and bleat something about the Antichrist among us. And then shock and awe would follow.

It was not that what he claimed was particularly interesting or original; the trick was doing it from a position of authority.

This man worked directly for the president and because of that, when he spouted his drivel, the media listened because they simply could not afford to ignore him, especially with the appeal of pure, unadulterated bullshit being so high to audiences. Remove the authority, however, and you get just another conspiracy nut job with a blog. Which, coincidentally, is exactly what became of Hjek.

Now, it seems President Trump possesses a pet lunatic of his own in the person of his Director of Social Media, Dan Scavino. Hoaxes, conspiracy theories, smear campaigns, he has shared it all. The biggest challenge he has faced was to defend his lord and master after Trump retweeted an image from a white supremacist message board. Trumps campaign placed heavy emphasis on social media and there was no indication this would stop once he came in power so it will be quite a surprise if we do not hear more of the talented Mr. Scavino in the near future, and quite possibly in a newfound capacity as a sacrificial lamb. The thing about crackpots is that there are always more where they came from.

There is a lesson and a warning in this comparison: people in power always like having an idiot around and being near that power entitles said idiot to inflict his views on the country. So, dear America, you should prepare for a new onslaught of flashy nonsense.

Going Professional

The most obvious analogy, however, is that between the current presidents of the Czech Republic and the United States. Both President Zeman and President Trump are populists who declare strong pro-Russian views, both love the use of fear mongering and xenophobia to garner popularity and both possess a relationship with facts that can be described as tenuous at best. They also both employ PR specialists whose job descriptions include publicly ignoring realty.

In spite of rather overwhelming photographic evidence to the contrary, Sean Spicer claims President Trumps inauguration gathered the biggest crowd ever. It is a public, shameless lie delivered from a position of authority. It is, also, something that the Czech Republic happens to have experience with, especially given the results of last Novembers presidential vote gathering tour (above: the official version; below: police camera at the other end of the square). And it is an extremely efficient means of dealing with the pesky media.

Lenin is said to have coined the term useful idiot and a tame conspiracy theorist works very well in that role. Presidents Trump and Zeman, however, took this a step further.

What we have in Spicer and Ovek is a logical evolution: the professional idiot.

Here is how it works: the president either slips up or unabashedly tells a lie about, say, a historical article that totally exists or the oh-so-huge Chinese investments in the Czech Republic. The Media points it out and in steps Ovek, either insisting on the lie, producing an alternative and even more outrageous statement or attacking the media in extremely petty ways. Standard PR practice where the truth does not enter the process at any point, right? But there is a difference: professional idiocy results in the unprecedented presence of Zeman in the media the Czech Republic is not a presidential system, the man is there literally just to ruin our reputation abroad. Yet his every (mis)step is religiously followed by the media and he uses it to the maximum to voice populist views quite likely to help him in the next election after all, terror is coming!

Jester to Speaker

The professional idiot strategy works simultaneously as an attention grab and misdirection. Consider President Trumps inauguration mess. Almost immediately afterward, Trump followed it up with a lie about the popular election presumably the same invisible crowd present at his inauguration that happened to have voted invisibly by casting invisible ballots into invisible boxes. Americas stealth plane technology has apparently entered the public domain.

Meanwhile, Spicer proves that he is a real pro in the idiot biz by attacking the media and pitching another shovelful of bullshit towards the pile by stating that the inauguration had the largest audience ever, and by the way, why are we still talking about this and can we get to running that pipeline over Sioux sacred grounds again already?

A professional idiot possesses no qualms about ethics or taste and will most certainly not let something as trivial as facts slow him down on his way towards attention. An analogy to the time-honored institution of the court jester comes to mind, although with a rather crucial difference: while in ages past it was the jesters prerogative to talk smack in the presence of the monarch and to the monarch, it seems a supremely stupid suggestion to have the jester speak for the monarch.

To Wage War on Reality

There is another, altogether more sinister turn to this. A professional idiots job (which, at least in some cases, appears to be a hobby as well) is a symptom of society. Post-truth is the buzzword that immediately comes to mind, but there is more. A systematic denial of reality is also a tool of totalitarian propaganda: recall that the crowning achievement of indoctrination is doublethink. This is something professional idiots seem to radiate effortlessly, especially when flocking around politicians with dictatorial tendencies.

It is entirely possible that Spicer cheered along with the invisible crowd at the inauguration, that Zeman and Ovek read the article on the bottom left of the page and that Trump has evidence that the popular vote was tampered with by millions of illegal voters. We all do this to some extent mentally editing experiences and memories to fit our own world-view. It only becomes problematic once the person in question is unaware of the factand in possession of power.

And so we get alternative facts instead of lies, different recollections instead of mistakes and quickly evolving opinions instead of contradictions. It is a sign of the times. Perfectly natural. Nothing wrong about this sign of the times, we got the best times in the world.

Do not worry, America. You will be alternatively fine.

Go here to read the rest:
Professional Idiot: an Anatomy - PoliticalCritique.org

AHMEDABAD: The city reports six deaths per week on the road. Victims vary from senior citizens crossing a road to youths high on liquor behind wheels. Out of over 3,000 road accidents reported with EMRI 108 ambulances, majority take place in the city periphery on roads such as SG Road and SP Ring Road. Why do these accidents take place, and how to reduce fatalities?

A report by JP Research India, titled 'Ahmedabad and Gandhinagar Road Accident Study' analyzes 211 accidents that took place between February 2004 and February 2015 on the 31-km stretch of SG Road, 27 km of SP Ring Road, 13.5 km of NH8 and 27 km of state highways passing near or through Ahmedabad and Gandhinagar.

The study is part of a national scientific database called "Road Accident Sampling System - India" (RASSI). It is submitted to the state transport commissioner by the agency. According to the research, cars and two-wheelers posed highest risk of accidents among road users. Both segments were found involved in 56% (28% each) of total road accidents. Moreover, two-wheelers were most affected - having been involved in 53% of fatal accidents and 47% of serious accidents. The study mentions that only 22% of the total road accidents get reported to police. Moreover, out of 211 accidents, 34% were serious accidents, 8% fatal and 48% minor. In 8% cases, there were no injuries whereas in 2% cases there is unknown outcome.

See original here:
Anatomy of Ahmedabad's road accidents - Times of India

Updated February 07, 2017 10:02:49

What makes a song a hit, and why do some songs stay with us years later?

Musician turned academic Andrew West has written hundreds of songs, and he designed the world's first Masters degree in songwriting. He explains the secrets behind three classic hits.

Pretty Woman shows terrific attention to detail.

First of all, there's the tempo. They would have figured that out in the studio: not too slow, not too fast. And the final version of the song moves at a certain pace that feels exactly right.

The song also uses a dynamic build, the way that the musicians are playing. That memorable riff gets louder and louder until it seems absolutely necessary for Orbison's voice to come in.

It's also important to note the way Orbison uses harmonies on his voice, but only for certain sections of the song.

A lot of critical thought has gone into the way the song is arranged.

Sometimes having the chords match the musical expression, or the expression of the words, can work against the songwriter because it becomes too obvious.

Changing that gives the listener subtext, a backstory, so that you're thinking that maybe the person who sounds downhearted is actually feeling quite optimistic, so the listener becomes more interested in the story.

Highway Patrolman is a consummate example of a song that's written as a story, and one that doesn't work in consecutive time.

Springsteen moves the listener back and forth and by the time you've gotten four or five minutes into the song, you really feel that these people are real. You feel like you've got a sense of their past, their present and their future.

You'd be hard-pressed to equal the way he phrases it, the timing. It's like a great comedian: the spaces he leaves between the lines are the ones where you figure out what's just happened.

Because Springsteen paid so much attention to the way the lyrics are shaped, and the imagery in the lyrics, he put the music as far into the background as he could.

Springsteen actually recorded this entire album with the E Street Band, but those recordings weren't used.

He doesn't want the audience to be listening to the music or the music performances. He wants your attention on his words.

Winehouse's success draws first and foremost on her lyrics being fearlessly autobiographical.

When you put that voice, which is so obviously honest, within the musical influence of the old Stax and Motown records, then it's an irresistible combination.

In songs like Rehab and Back to Black, Winehouse makes use of very familiar song structures or chord sequences.

But Love is a Losing Game uses an A-A-A structure (or three verses), which is very unusual in popular music.

Across an album you need to mix songs that seem familiar, that you enjoy for their predictability, with songs that are completely unpredictable and you enjoy because you can't figure out what's coming next.

Topics: music, arts-and-entertainment, australia

First posted February 07, 2017 09:58:35

See more here:
From Bruce Springsteen to Amy Winehouse: The anatomy of a hit song - ABC Online

Ambitious doesn't quite fully describe Tide's gameplan for Super Bowl LI.

Marketing executives for the Procter & Gamble brand made it clear they would rather not run a big game ad if the creative wasn't worthy of Tide's Super Bowl heritage.

This year, live commercials are dominating the pre-game buzz but Tide, in partnership with Saatchi and Saatchi, Traktor and The Mill went a completely different and costly route.

Instead of simply advertising in the game, Tide became part of the broadcast, with a little help from Fox Sports announcers Curt Menefee and Terry Bradshaw -- and a bottle of barbeque sauce.

In part one of Anatomy of an Ad: The Stain below, we look at the idea behind Tide's big gambit in the big game. The goal: to trick an audience of over 100 million into believing Mr. Bradshaw's stain is happening in real time, that his anxiety is genuine and that Tide is there to clean up the mess.

The idea is one thing. The execution is quite another. Just three weeks before the game, P&G and its army of producers, gaffers and grips descended on El Camino Community College in Torrance, Calif. to turn it into a replica of NRG Stadium in Houston, Texas, complete with Fox Sport's Super Bowl broadcast booth and the tunnel leading to the field.

They didn't count on the rain.

In Episode 2 of Anatomy of an Ad: The Stain, we look at how the Tide team overcame the deluge during filming and put the finishing touches on an unprecedented three-part campaign the brand hopes will make Super Bowl history.

Tomorrow, we will post the third installment of Anatomy of An Ad: The Stain. Our videographers Nate Skid and David Hall follow the Tide team during the Super Bowl as it monitors the ad's social impact in real time.

See the original post here:
Anatomy of an Ad: Tide's Super Bowl Stain - AdAge.com

I recently conducted an informal survey of some cloud integration companies and found something deeply troubling. Aside from cookie-cutter or formulaic quick-start projects, more than 70 percent of cloud consulting engagements involving new customers resulted in either a 10 percent cost overrun or a change-order. The bigger the project, the more likely the overrun.

You can blame it on stupid consultants or bad estimation or nutty customers or sunspot activity, but blame does no good. Something is going wrong here, and its causing a lot of heartburn for customers and vendors alike.

In an earlier article on trends making the cloud consulting market treacherous, I mentioned that a root cause of any cloud overrun is mis-set expectations: customers believing that meeting their requirements will be simpler than it is and that it should cost less than it will. However significant that observation may be, its not particularly actionable. So lets take the next step to understand the driving specifics, and what steps we can take.

[ How to compare cloud costs between Amazon, Microsoft and Google ]

In most cloud projects, several areas are nicely contained and are unlikely to cause significant cost surprises. If setting up a function is merely a matter of system configuration, there cant be that many hours of mouse-driving involved.

We should be so lucky!

Here are the project areas where we see cost surprises on a regular basis:

This twin-headed beast can involve some very serious surprises, as its impossible to detect many of the issues until youre in the middle of draining the swamp. The cost issues scale both with the amount of data and the number of data sources.

Even if the data looks superficially clean, there may be non-printing characters, format problems, improper values, overloaded semantics and object-model ambiguities that make for a messy migration or integration. If an ongoing integration is needed, you may not realize early on that the point-to-point adaptor you originally bid needs to be replaced with a full-blown middleware system.

Solution strategy: Do a real cost-benefit analysis of the amount of data to be migrated and the number of sources to be integrated, and develop a cost model that reflects reality. Start on the migration/integration/validation tasks at the outset of the project, so the surprises come early. Expect that migration and integration can represent the single largest part of your project.

Clients often stipulate no code, out of the box functionality only as part of their project definition, and on day two of the project discover requirements that cannot be satisfied any other way. Unfortunately, too many consultants are code-happy, so they willingly nudge the client toward custom-code land. And the rich coding environment of the Salesforce.com (SFDC) platform makes it tempting for both user interface and business logic.

The problem, of course, will be developer productivity and code maintenance costs. Expect custom coding a feature to be at least an order of magnitude more expensive than configuring the standard functionality.

[ Essential CRM software features: A savvy buyer's guide ]

Solution strategy: To the degree possible, use standard system features and off-the-shelf plug-in products to meet requirements. Bend requirements to fit whats available. Push coding out of the initial delivery if possible, so coders are working on a stable platform. For items that must be built, push to streamline processes and business rules that can cause combinatorial explosions (e.g., the security model, order configurations, distribution/partner networks).

The original SFDC reporting engine strikes a nice balance between power and ease of use, but it gives spreadsheet-quality output. If you want really clever and beautiful reports, it wont take long before you run into a wall.

SFDCs Wave reporting system is both more powerful and prettier, but really leveraging its power means writing query code. For even fancier stuff with nice formatting, multi-page layouts, and automatic office-document generation third-party add-ons are needed.

But as I noted in a previous article on design work in CRM projects, if its got to be pretty, its going to be pretty expensive both to set up in the first place, and to evolve over time with your needs.

Solution strategy: Thoroughly understand and specify every variant including formats and user-specific tweaks of every single report you will need prior to putting the system out to bid. Its best to discover that you actually require 100+ reports, not the ten you thought. If you have a working report (e.g., from Access or Crystal) that you need the system to emulate, provide the vendor with a sample set of input data and the reports output, with annotations regarding format and exception conditions.

This means you, project leaders and executive champions! Things you do will contribute directly to overruns. As I discussed in an article on agile project management, distance and delay are the enemies of efficient and economical projects.

But I need to add some new Ds that are even more deadly: dithering and (unending) discovery. The first of these, dithering (a.k.a. indecisiveness) is bad enough, as it causes delay and erratic direction, which leads directly to rework. But the second, whose hallmarks are discovering that (1) the requirements werent really known up front, (2) your assumptions about how things need to work were wrong, and (3) your assumptions about how the new system features will work were wrong, is the root cause of scope creep. I cant tell you how many large projects discovered more than half of the costly requirements after formal discovery was completed.

Solution strategy: Make the discovery phase longer, and when its complete have a signoff sheet for a strict feature and data freeze. Make the project team as small and tight as it can be, and do not hire more than one consulting company (to reduce finger-pointing). Work to constantly improve trust among the team members. Kick people off the team who blame. Keep executives and bean counters as far away from the project as you can, and limit big review meetings. Focus everyones attention on business value rather than abstract or arbitrary metrics and project dashboards.

Im currently reading the book Being Wrong Adventures in the Margin of Error after having finished Wrong! Why Experts Keep Failing Us. So maybe Im a little jaded, but it sure looks to me like cost overruns are the result of bad assumptions, fragmentary information, incomplete requirements and low trust.

Interestingly, overruns are much less common for follow-on projects, where both sides have put the time in to develop good assumptions, a solid understanding of the real requirements and a trust relationship. So for initial projects, we clients and consultants have to stop the pretend-certainty about our projects.

The truth is we dont really know, and were not willing to spend the time and money to get sufficiently knowledgeable about, all the niggling details of a new project. We run off and get a budget without knowing what the project will really entail. And then we discover too many plot complications after weve reached the halfway mark in the project. For those hoping that hybrid agile techniques will solve the problem, I havent seen much help there.

In contrast, the real agile approach admits we dont know, and simply scopes the project deliverables dynamically to fit within the budget and schedule. The team discovers as they go, prioritizes as they go and focuses on maximizing business value instead of fixed (and possibly random) criteria. When done right, agile makes the bean counters happy (they can claim on time, on budget) and gets the most important stuff out to the users as soon as its done.

>> Agile project management: A beginner's guide <<

See the article here:
Anatomy of a cloud project cost overrun - CIO

Entering Super Bowl 51, it seemed the Patriots bestand maybe onlychance was to keep Atlantas electrifying offense off the field. Sure enough, the Falcons finished with 46 snaps in Super Bowl 51, 18 fewer than the NFL average in 2016.

But the games biggest factor wasnt that Atlantas offense was off the field. It was that Atlantas defense was on it. A lot. For 93 snaps, to be exact. Naturally, fatigue set in. And thats the biggest reason why the Falcons suffered the greatest collapse in Super Bowl history.

Its worth examining exactly how those 93 snaps exhausted the Falcons. For starters, 93 snaps equates to playing a game and a half. Then factor in the adrenaline of that game being on the Super Bowl stage, and what happens to a players energy as that adrenaline wears off. Then add in the halftime, which is twice as long as usual. Yes, that gives your body more time to rest. But it also means your body must operate on an unfamiliar internal clock. Over your previous 18 games, your body had grown accustom to its halftime routine. Oh, and speaking of 18 games, that, too, is a lot. Its cumulative effect magnifies the toll of those 93 snaps.

* * *

* * *

More importantly, however, was the style of snaps the Falcons were playing. As expected, they defended the Patriots primarily with man coverage. When a defender plays man-to-man, hes chasing an offensive player all over the field. Thats considerably more taxing than sitting back in zone. Furthermore, Falcons defenders often matched to specific receivers in man. With the Patriots limitless supply of formations, those defenders were often crossing the field back and forth before the snap. Because chances were, if a defenders man aligned in, say, the left slot on one play, he very well could be aligned near the right sideline on the next. The 35- to 40-yard jogs that a defender takes to follow this add up. In fact, many NFL coaches who play man coverage will implement extra snaps of zone or limit their specific man-matchup calls in order to mitigate fatigue.

Mind you, this is all just with the secondary. There are also defensive linemen, who wear down faster than any position. Theyre constantly firing off the ball and wrestling with 300-pound blockers. Thats why Dan Quinn, like the rest of the NFL, employs a deep rotation up front. But on 93 snaps, even rotating defensive linemen succumb to exhaustion.

With the D-line tiring, the pressure that had been hounding Brady (he endured five sacks and about three times as many hits) dried up. Dwight Freeney stopped eating left tackle Nate Solders lunch. Grady Jarrett, who was sensational, flashed less. Vic Beasley no longer made noise. And thats when the greatest quarterback of all time rediscovered the precision accuracy that had evaded him for the first three quarters. With Brady in a clean pocket and throwing in rhythm, the Patriots had no trouble moving the ball.

This is where people want to assign blame. Quinn played too much man coverage! Matt Ryan and Kyle Shanahan blew it in crunch time, forcing Atlantas defense back on the field! No.

THE GREATEST COMEBACK EVER:Tom Bradys season started with a four-game suspension and ended, in dramatic fashion, with his fifth championship after the Patriots overcame the largest deficit in Super Bowl history.

The man coverage had been workingthats why Quinn kept playing it. The Falcons specifically had success in man-lurk coverage, keeping a free defender (safety Keanu Neal or linebacker DeVondre Campbell) in the shallow middle. That lurker took away New Englands crossing patterns and allowed the Falcons to switch coverage assignments on the flyBrady failed to recognize one of those switches when he threw the pick-six to Robert Alford.

As for Atlantas offense, to say that Ryan and Shanahan blew it is absurd. If the Falcons had given their best performance, would they have registered more than 46 snaps? Absolutely. But understand: the game didnt flow that way, plus Ryan and Shanahan stayed aggressive late in the fourth. After Danny Amendolas touchdown made it 28-20 with just under 6:00, the Falcons called a first-down play-action deep shot. Ryan checked it down to Devonta Freeman for 39 yards. Two plays later Ryan rifled a gutsy ball into double coverage to create an incredible sideline catch by Julio Jones. But after that, unfortunately, the Patriots broke down Atlantas protection, with Trey Flowers getting inside for a late-in-the-down sack (maybe Ryan wrongly held the ball, maybe he didnt; we cant know without seeing the all-22 film) and with Chris Long drawing a hold against left tackle Jake Matthews. On previous Falcons drives, there had been protection mistakes, both physical and mental, leading to sacks and a turnover. Those arent quarterbacking or offensive coordinating issues.

FOR THE BRADY FAMILY, REDEMPTION: Tom Brady Sr. on why this victory meant so much more

The reality is Atlantas defense was simply on the field too long. It wore down. If youre a unit built almost solely on speed, thats a problem big enough to cost you a Super Bowl.

Question or comment? Email us at talkback@themmqb.com.

More:
Anatomy of an All-Time Super Bowl Collapse - Monday Morning Quarterback

Last weeks episode may have thrown us for a very unexpected loop, as we didnt really get all the information we wanted about Alexs legal issues thanks to a not-so-fun prison field trip. But nowMaggie and Meredith are hard at work, scouring the internet for details on Alexs case not that theyre having much luck. When they find his case number, the only detail they manage to come across is that he could possibly be facing 30 years to life in prison. JK, thats not Alexs case Maggie mistyped a digit when searching through the database and, as it turns out, Alexs trial has actually been indefinitely postponed, leading Meredith to believe that the Evil Spawn followed through with his threat to turn himself in and take that plea deal. To sum things up, Alex is likely in jail. And Jo doesnt seem to be taking it very well.

In fact, Jo has a bit of an attitude today because shes pretty sure its her fault that Alex is locked up. Ben is feeling a little sorry for her, and he tries apologize to her in the locker room, but she isnt in the mood to hear it. She also isnt in the mood to deal with her patient, a hockey player whose teammate is currently living through your worst nightmare: The left side of his face was sliced open by someones skate. (Umm, ouch.) After listening to Jo yell at him in the emergency room, Ben tries to console her again toward the end of the hour, but she is still having NONE of it.

Speaking of people who are having none of it, its Eliza first day at Grey Sloan. While she gears up to prove to the rest of the attendings that shes the HBIC, Webber and gang Jackson, April, Maggie, and Arizona are getting ready for war. They create an elaborate scheme to make Elizas first day a living hell by plotting to keep her out of all the O.R.s and sassing her like nobodys business. But the plan turns out to be a (poorly executed) bust when Eliza catches on to whats happening and sort of snitches on everyone. Baileys solution is to call an emergency staff meeting with everyone except Dr. Webber, but her request is ignored by everyone except Dr. Webber, who shows up to basically reiterate to Bailey that hes still pissed about being replaced.

NEXT: Owen worries about Amelia

Read more:
'Grey's Anatomy' recap: 'Jukebox Hero' - EW.com

Camilla Luddington and fellow "Grey's Anatomy" stars Ellen Pompeo and Debbie Allen got in formation on Friday for an adorable tribute to Beyonc.

Luddington is pregnant (and her "Grey's" character Jo Wilson may or may not be pregnant as well), and we all know that Queen Bey is pregnant right now, too. So Pompeo (Meredith Grey) pressured the reluctant Luddington to recreate Bey's now iconic pose in a video directed by Allen (Catherine Avery).

The stars all captioned versions of the shoot on Instagram:

Someday, that baby is going to be able to look back on this and laugh ... or be so embarrassed about her crazy mom.

We know that's a "her" in there, since the 33-year-old "Grey's" actress also just revealed that she and her boyfriend Matthew Alan are expecting a girl. Here's what she wrote on Instagram just before the Bey photo and video:

"I am so excited to announce today that I am having a... girl! ?? I want her to grow up knowing how strong women are ??. To be a little warrior who is not afraid to use her voice and stand up for what she believes is right. To navigate through life with courage and kindness, and to be one of the girls who says "you CAN sit with us..". Special shoutout to #crystaldynamics for sending me her first #tombraider onesie."

Congrats! "Grey's Anatomy" fans are still trying to sort through what's happening with Jo and Alex, but after the midseason premiere, many fans suspect Jo is carring Alex's baby. We'll see if that's the case as Season 13 continues Thursdays at 8 p.m. on ABC.

Want more stuff like this? Like us on Facebook.

Read more from the original source:
Pregnant 'Grey's Anatomy' Star Spoofs Beyonc in Hilarious Video - Moviefone

Watch Grey's Anatomy Online: Season 13 Episode 10

On Grey's Anatomy Season 13 Episode 10, the doctors tried to find a way to save a pregnant teenager. Watch the full episode online right here via TV Fanatic.

On Grey's Anatomy Season 13 Episode 10, Arizona, Bailey and Jo take on a challenging case at a women's correctional facility. Read on for a lot more!

Scandal, How to Get Away with Murder and Grey's Anatomy are returning later than planned, but just how later are they returning? We have the details you need.

What do Grey's Anatomy and Happy Days have in common? They debuted at midseason. What other shows hit the midseason jackpot? Check out our list!

We have tallied the results and your votes have been counted...the winners may shock and astound you, but it's your voice that set the victors free!

Quantico will need to put up a huge fight for renewal when it moves to a new night on ABC. Is Designated Survivor a cause for concern? We have the figures.

Sometimes you just want to enjoy your shows without annoyance. You don't want to roll your eyes at every decision made. These characters don't help.

Taste is subjective. As a matter of fact, the case could be made that these popular shows are garbage. Are these the best shows on TV or the worst? You decide.

Some are sexy, others relaxing, while still others tip into the terrible... but these 13 top TV bathtub scenes are the ones we'll never forget.

It's always nice to join our favorite television families as they celebrate a holiday together! Check out some of the most memorable Thanksgiving dinners!

On Grey's Anatomy Season 13 Episode 9, Alex faced an uncertain future as he made a decision. Watch the full episode online now to get caught up!

On Grey's Anatomy Season 13 Episode 9, Alex finally learned Jo's secret. Is he now about to make the biggest mistake of his life? Read on to find out!

Grey's Anatomy debuted as a mid-season replacement for Boston Legal in 2005, and became a bona fide success after just nine episodes. The combination of medical drama, likable but flawed characters coming of age, and one hot doc known as McDreamy catapulted the show to smash hit status the following season.

Critically, Seasons Three and Four failed to live up to the lofty standards of the first two but the series remains one of the top ten highest rated on TV.

Grey's Anatomy is created by Shonda Rhimes. Its diverse and talented cast stars Ellen Pompeo, Patrick Dempsey, Sandra Oh, Chandra Wilson, Katherine Heigl, T.R. Knight, Justin Chambers, James Pickens, Jr., Brooke Smith, Eric Dane, Sara Ramirez and Chyler Leigh.

Former stars include Isaiah Washington (fired) and Kate Walsh (left for spin-off Private Practice).

Here is the original post:
Grey's Anatomy - TV Fanatic

Development this abbreviated, important sectionprecedsdiscussion of adult anatomy. A more complete discussion is found in the dedicated section of neurovascular embryology.

The basicarrangementof the spinal system consists of ametameric grid of trasversely oriented segmental vessels, connected by various longitudinal channels. This simple bit of knowledge goes a long way in understanding spinal anatomy. Millions of years of speciation have taken place upon a basic building block of the organism the metameric segment. Just like the fly and the worm, the human body consists of metameric segments, with ecto-, meso-, and endodermal elements. Each vertebral body, its ribs, muscle, nerves, and dermatome, correspond to one level or segment. It is perhaps easiest to appreciate this concept at the thoracic level, where each rib, vertebral body, and other elements constitute the prototyical segment. In the early human embryo, the neural tube is first supplied by simple diffusion. When its limits are reached (200 micrometers perhaps), a primitive vascular system consisting of paired dorsal and ventral aortae (longitudinal vessels) and transversely oriented segmental arteries come into play to vascularize the developing tissue of the embryo.

As the tissue of spinal cord continues to enlarge, new longitudinal connections form between the transverse segmental arteries, most likely to facilitate distribution of blood within the vascular system. This pattern is seen throughout the body, but is somewhat easier to recognize in the vertebrospinal arterial system, where it gives rise to adult anterior spinal artery and numerous extradural longitudinal segmental connections which will be discussed below.

Gradual establishment of dominant longitudinal vessels leads to regression of most transverse segmental arteries, except at some levels where such vessels persist in supplying the longitudinal artery.

This process, in terms of the spinal cord, gives rise to the familiar adult appearanec of the anterior spinal artery and its remaining radiculomedullary feeders, while most segmental arteriespreviouslyconnected to it in early fetal life are limited to supply of the nerve root and adjacent tissues in the adult.

The same pattern of development takes place in the extra-axial, paravertebral space, where longitudinal connections between segmental arteries form a multitude of adult vessels, such as the vertebral, pre-vertebral, pre-transverse, deep cervical, lateral spinal, and other arteries, as will be illustrated below.

Adult Vertebrospinal Arterial Anatomy

The basic arterial vertebrospinal vascular unit consists of two segmental vessels, left and right, arising from the dorsal surface of the aorta. The vessel curves posterolaterally in front of the vertebral body, and sends small branches into its marrow. In front of the transverse process, the segmental artery bifurcates into a dorsal branch and an intrercostal branch. The intercostal segment supplies the rib and adjacent muscle and other tissues. The dorsal branch feeds the posterior elements and, via the neural foramen, sends branches to supply the local epidural and dural elements, as well as a radicular artery to nourish the nerve root. At some levels, the radicular artery is enlarged because, instead of supplying local neural elements, it maintained its embryonic access to the anterior spinal artery. At this level, the artery is called radiculomedullary because it also supplies a large segment of the spinal cord. Various other arrangements are seen, for example when radicular artery supplies portions of the dorsal spinal cord, a discontinuous network which is often misrepresented in venerable anatomical texts as a continuous system of two posterior spinal arteries. This is the basic arrangement of spinal supply.

The system varies in the cervical, upper thoracic, and sacral segments (i.e. exceptions are greater than the rule) but the basic principle of segmental dural and radicular vessels supplying neural tube elements is a very useful guide. Variation comes chiefly in form of segmental vessel origin whereas descending aorta serves this puprose for most thoracic and lumbar segments, the vertebral artery, subclavian branches (costocervical trunk for example), supreme intercostal artery, and median sacral artery (effectively a diminuitive continuation of the aorta below the iliac bifurcation) play this role at the appropriate segments. These vessels of origin are part of the gridline of longitudinal channels which form to connect embryonic segmental vessels. For example, the vertebral artery represents a confluence of discontinuous embryonic channels termed the longitudinal neural system into a single trunk. This, in part, explains multiple variations and duplications encountered in the vertebral territory.

Figure 1: Somatotopic organization of the vertebrospinal arterial vasculature, highlighting segmental vascular organization of the vertebrospinal axis and homologous longitudinal anastomoses along its entire length.

As you can see, numerous longitudinal vessels exist throughout the vertebrospinal axis, often with the same vessel going by several different names, for historical reasons. For example, see above for homology between the lateral spinal, pre-transverse, and deep cervical arteries. The segmental arrangement is particularly modified in the cervical region, where longitudinal vessels are dominant most obviously the vertebral arteries. It is important however to recognize the existence of segmental vessels connecting the three dominant cervical longitudinal arteries (ascending cervical, vertebral, and deep cervical) in terms of their anastomotic potential and its implications for both collateral revascularization and inadvertent embolization during interventional procedures.

The following diagrams provide a basic view of relevant arterial anatomy of the spinal elements, serving as a guide for interpretation of subsequent catheter angiography illustrations.

A aorta; B segmental artery; Ba intersegmental arterial anastomosis; C prevertebral anastomotic network; D direct vertebral body feeding arteries; E dorsal spinal artery; F intercostal/muscular artery; G pretransverse anastomotic network; H dorsal division of the dorsal spinal artery; I post-transverse anastomotic network; J muscular branches of the post-transverse anastomotic network; K ventral division of the dorsal spinal artery; Ka radicular artery; La ventral epidural arcade; Lb dorsal epidural arcade; M nerve root sleeve dural branch of the ventral division dorsal spinal artery; N dural branch of the ventral division dorsal spinal artery; O radiculopial artery; P radiculomedullary artery; Q anterior spinal artery; R mesh-like pial arterial network; S, T posterior spinal artery; U, V pial arterial network (a.k.a. vasocorona) anastomoses between anterior and posterior spinal arterial systems, W sulco-commissural artery, X rami perforantes of the peripheral (centripetal) system, Y central (centrifugal) system of sulcal arteries, originating from pial network of the cord; altogether, the pial network and rami perforantes (R+Y) are called the vasocorona or corona vasorum; Z rami cruciantes (a.k.a. crux vasculosa, a.k.a. rami anastomotici arcuati)

In the following examples, nomenclature using the above letters will be used for correlation.

Aorta and segmental vessels. Many spinal angiogramsstart with imaging the biggest vessel in the body. Some are surprised to discover that these segmental lumbar and intercostal arteries (red)are actually not that small (between 1 and 2 mm diameter typically) most can be easily engaged (and occluded) with a 5F catheter. The aortic injection gives a roadmap, may identify a particularly large fistula, and show which levels may have missing segmental arteries, thereby obviating a frustrating search. In this angiogram of a patient with a dural fistula, a congested spinal cord vein (light blue) can be seen in the venous phase (dark blue). Celiac trunk (orange) and renal arteries (yellow) are also labeled.

Typical Lumbar artery (segmental artery) injection. During spinal angiography, the segmental artery is selected with an appropriate 4F or 5F catheter (RDC, SAS). Injection rates are 1-2 cc/sec for as long as you think you need it, typically 2-4 seconds. Frame rates vary from 1-3 per second, and should not exceed 3 unless particularly necessary (to visualize microanatomy of a high flow fistula, for example). When dural or other fistula is suspected, multiple levels may need to be interrogated. One can easily go through 300 ml or more of contrast, so be aware. For metastatic disease, the search may be more focused. It is helpful to view the angiogram in both subtracted and native views to appreciate both fine vascular detail and bony landmarks.

The lumbar artery (purple, B)is relatively selectively injected, with trace opacification of hte contralateral left L3 lumbar artery due to proximity of the left and right orifices to each other. Since there is no rib, the artery does not have a prominent intercostal component. The arteries of the dorsal branch (red, H, J) supply the lamina and adjacent tissues, with anastomosis to the spinal process arterial arcade (yellow, I). You can see continuation of this arcade inferiorly, NOT to be mistaken for the anterior spinal artery or other spinal artery. The anterior spinal artery is straighter and has a characteristic radiculomedullary hairpin turn (see below). A large paravertebral anastomotic branch (green, G) is present, which opacifes ipsilateral L4 level dorsal branches (blue, H, J). No radiculomedullary artery is seen at this level.

Common lumbar trunk: Especially in the lower spine, single left and right lumbar artery origins are common. Absent levels are also common, usually supplied via paravertebral and prevertebral anasomoses.

Paravertebral anastomotic network typically, this is the dominant longitudinal anastomotic connection between adjacent segmental arteries.It is particularly well visualized in young, normotensive patients. Technical considerations are also important having the catheter well-wedged into the ostium of the segmental artery, as well as longer, higher volume injections (within reason, of course), are key to opacifying all kinds of collaterals.The paravertebral network is located along the lateral aspect of the vertebral body, adjacent to the sympathetic chain, for example. A well developedparavertebral network (blue, G) is present. The catheter (red) is engaged in a lumbar artery (brown, B) and via this network opacifies thelumbar atery of the level immediately above (purple) and immediately below (pink). Notice the spinous process arcade again (black, I). This network ensures virtual impunity for atherosclerotic or iatrogenic occlusion ofa proximal segmental artery. More care should be excersized at radiculomedullary artery levels.

Multiple longtitudinal anastomotic networks prevertebral, paravertebral, spinous process

In this patient, all three networks are demonstrated stereoscopy is very helpful to decide which is which. Also notice prevertebral transverse and retrocorporeal networks at same level.

C prevertebral anastomotic network; G paravertebral anastomotic network (can opacify adjacent levels with strong injection, or supply adjacent level in case of intercostal artery hypoplasia/aquired stenosis);I spinous process branch and associated anastomotic network connecting spinous processes; Blue precorporeal anastomotic network (not shown in diagram); blue retrocorporeal anastomotic network (pink color vessels in diagram, and see section below); light blue left L1 segmental artery; brown left T12 segmental artery; dark green right T12 segmental artery; pink radiculopial artery.

Another demonstration of multiple longitudinal anastomoses:

Lumbar segmental artery injection, demonstrating a well-developed post-transverse anastomotic network (I) visualized through the ventral division (H) of the segmental artery (B), with its muscular branches (J), as well as the pre-transverse anastomosis (G), both contributing to collateral visualization of the adjacent cranial segmental artery (B). F muscular artery, homolog of the intercostal artery.

Retrocorporeal arterial network

This characteristic diamond-shaped network behind the vertebral body (in the epidural space dorsal to the posterior vertebral body cortex, also known as anterior [with respect to the spinal cord] epidural space) marked with L on the diagrams above, constitutes the primary anastomotic connection between left and right segmental arteries of the same level. Like everything, else it is variable in prominence based on developmental and other considerations. A good injection can usually opacify parts of the network, but it becomes quite obvious once the diamond-shaped configuration corresponding to left and right superior and inferior contributors to the diamond are revealed. One way to improve visualization of the network is via an injection adjacent to a dissected segmental artery.

More retrocorporeal arcade images, demonstrated to great advantage in a young patient

T12 segmental artery injection of a young, normotensive slender patient, providing exquisite visualization of the various trans-segmental anastomoses, demonstrating a hexagon-shaped multilevel anterior epidural arcade (La), and prevertebral anastomoses (G). Notice developmental hypoplasia of the right T11 segmental artery (single white arrow, one level above the catheter), with a corresponding small intercostal artery caudal to its normal position (double white arrow). Both radiculomedullary (P) and radiculopial (O) arteries are present, the former demonstrating its characteristic midline course.

Another injection, which happens to preferentially opacify the retrocorporeal network

The median sacral artery continuation of the aorta, the median sacral artery usually comes off the carotid bifurcation, and can be most easily engaged via some kind of recurved catheter (It is the artery to the tail of countless species which happen to have one). As a homolog of the aorta, it gives origin to segmental vessels of the sacrum. Thus median sacral artery injection is in fact a sacral aortogram opacifying multiple segmental sacral branches. It is a must see artery when looking for a fistula. Here, the median sacral artery (red) originates from the left L4 branch (blue and yellow). Lumbar segmental vessels seen on the aortogram are shown in green.

Median Sacral Artery andLateral Sacral Arteries -- the lateral sacral arteries are longitudinal vessels wich are homologous to the paravertebral (pre-transverse) anastomoses in the thoracolumbar segments and to the vertebral artery in the cervical spine. They arise from proximal internal iliac arteries, and can be seen from either internal iliac or median sacral injections, as well-demonstrated below:

Inferior lumbar and sacral anatomy. A stereo pair, B native image, C legends: Selective catheterization of a common L5 segmental trunk (white arrow), also giving rise to the median sacral artery (normally arising from the region of aortoiliac bifurcation). The injection opacifies bilateral L5 and sacral segmental arteries (B), and the prevertebral anastomotic network (G), which is homologous with lateral sacral arteries. A stereo pair; B native image; C Labels.

Here is an injection of the lateral sacral artery (center) with adjacent images of bilateral internal iliac injections, demonstrating existence of extensive collateralization between the internal iliac and median sacral systems by opacifying the same arteries which are labeled with the same color arrows. The purple and red arrows point to the lateral spinal artery seen from both median sacral and internal iliac injections. Green arrows outline the remainder of the lateral sacral system, best seen from medial sacral in this case.

Median sacral artery (purple) giving rise to multiple sacral segmental arteries (red) and to a lumbar artery (yellow)

In this example, median sacral artery arises from a common L5 trunk.

Below the aortic bifurcation, segmental arteries can be visualized by injection of the median sacral artery (above) and internal iliac arteries, via the lateral sacral artery (see figure 1 above) The importance of iliac artery investigation cannot be overstated. The patient whose images are shown below underwent two spinal angiograms for investigation of suspected dural fistula, based on classic MRI appearance of cord congestion and serpiginous vessels in setting of progressive neurologic decline. Only on third time around was the left internal iliac artery interrogated, easily disclosing a dural fistula, supplied by a segmental artery (purple) and collateral probably dural artery (orange) with fistula point (red) and draining into a radicular vein (light blue) connected to the spinal venous network (above, not shown).

ANTERIOR SPINAL ARTERY (ASA): Cervical, thoracic, lumbar, and conus regions.

Overview: the anterior spinal artery (Q) develops as a longitudinal vessels connecting transversely oriented segmental arteries, as discussed at length above. It is located on the ventral surface of the cord, adjacent to the ventral median fissure of the spinal cord. It varies in size, more or less based on the amount of gray matter at the given segment. As such, its size is substantially larger in the cervical and lumbar segments (might be500-750 micrometersin diameter), as compared with slender mid-thoracic size. As such, one end of the ASA has limited to no capacity to support the other should its dominant radiculomedullary supply fail. The arterial supply to the ASA consists of radiculomedullary arteries (P), which represent persistence of embyronic segmental connections between the aorta and the developing ASA. Their number varies, perhaps being 6-10 in the human. Some are quite small and, as such, below resolution of in vivo spinal angiography. The larger cervical and lumbar ASA segments are associated with larger radiculomedullary arteries to supply them the famous artery of lumbar enlargement (Adamkiewicz), and the less well known (radiculomedullary) artery of the cervical enlargement, known to some neurovacular anatomists as the artery of Lazorthes. The Lazorthes most commonly arises from lower cervical vertebral artery, though not infrequently from deep cervical or supreme intercostal vessels also. The Adamkiewicz comes off between T9 and T12 in 75% of cases,more commonlyon the left (which means, to me, that 1/4 of the time, its somewhere else). Not infrequently, there are two relatively smaller radiculomedullary arteries at the lower thoracic spine, instead of one big Adamkiewicz. At the bottom of the cord, the anterior spinal atery is typically connected to posterior spinal arteries (T) via what paired arteries (Z) which go by many names (such as rami cruciantes), forming a kind ofarterial basket (see above diagram, and below for angio images). Visualization of this basket is critical if you wish to call a spinal angiogram complete.

Cervical ASA:

Bilateral vertebral artery study in anterior spinal artery supply. Sometimes, in intracranial work, it becomes important to know the location of the anterior spinal artery with respect to the cervical spine. For example, vertebral artery dissection may be treated differently depending on whether it involves ASA origin. Vertebral artery sacrifice should not be undertaken until the location of the ASA has been considered. For example, closing a vert immediately distal to radiculomedullary ASA contribution, without other runoff branches, risks possibility of the vert stump thrombosing back and closing this ASA segment. Collaterals are often insufficient to maintain cord viability.

Just seeing one radiculomedullary ASA contributor may not be enough in some cases to truly define full anatomy one must opacify the entire ASA system. If a given radiculomedullary artery only shows the ASA inferior to its level, then one must keep looking for additional rostral sourses. For example, if one sees an ASA from C5 down in a case where ascending or deep cervical embolization is required, it would be advisable to find the source of superior cervical supply before concluding that ASA territory is safe. In this case, the upper cervical cord segment is supplied from the left C5/6 level, while the inferior cervical cord from the right C4/5 segment.

Left vertebral (top) and right vertebral (bottom) set of images from the same patient, demonstrating full length of cervical anterior cerebral artery supply from the vertebral system. The lower portion of the cervical ASA (red, Q) is fed via the left C5/6 radiculomedullary contributor (yellow, P), which also happens to supply the posterior spinal artery network (purple, S, T). The upper ASA segment is fed by the right C4/5 radiculomedullary artery (yellow, P) seen on the image below. The radicular portion is labeled in yellow. ASA=red; Posterior spinal arteries = purple

Another view of cervical radiculomedullary artery (of Lazorthes) arising from inferior vertebral (C6 segment). This kind of dominant supply is seen less frequently for the cervical spinal cord than it is for the thoracolumbar enlargement in case of the artery of Adamkiewicz.

A, B Frontal and C lateral stereo pair projection digital subtraction and native angiographic views of right vertebral artery injection, visualizing a dominant cervical radiculomedullary artery (P, artery of Lazores) and the anterior spinal artery (Q), anastomosing with its basilar homolog (long white arrowhead). Very faint posterior spinal artery (T) is best seen in stereo, as well as the lateral spinal artery (short white arrow).

Another view of the cervical cord, this one also displaying the posterior spinal (brown) axis and the pial vessels (yellow) which connect the anterior and posterior axes on the pial surface of the cord. Visualizaton of the pial network of the thoracolumbar cord is limited by the body habitus of the patient, which works against resolving small vessels even under conditions of perfect paralysis and apnea. The situation is much better in the cervical spine. Notice the discontiguous nature of the posterior spinal network, in contrast to the straight anterior spinal artery.

Although balanced supply to the cervical cord is more common, and most of the time it comes from the cervical vert, occasionally the typically small distal intracranial vertebral artery supply is dominant, as in this case. It is important to pay attention to this when flow diversion methods are used in the distal vertebral artery.

Lateral view of the same, in stereo

Deep Cervical origin of the radiculomedullary artery second most common after the vert. At our institution, all cases of posterior fossa subarachnoid hemorrhage with no intracranial cause REQUIRE indentification of the anterior spinal artery, as in ~10% of cases (in-house experience) the pathology turns out to be in the cervical spine.

Anterior spinal artery (Q) origin from deep cervical artery, P= radiculomedullary artery; notice collateral opacification of the vertebral artery (long white arrow) via the C2 segmental artery (short white arrow).

Another deep cervical origin any longitudinal system can give origin to the radiculomedullary artery in this case the radiculomedullar artery (orange) originates from the deep cervical branch (red). Notice also injection of supreme intercostal artery (pink, lower two images)with extensive deep servical artery anastomoses (yellow) through which the anterior spinal artery can be inadvertently embolized. The catheter, barely engaged in the supreme intercostal,is labeled in blue.

Same patient, contralateral side, demonstrating tumor blush (hemangiopericytoma) from the right subclavian injection supplied by costocervical (purple) and thyrocervical (orange) branches. An ipsilateral supreme interconstal (red) injection demonstrates extensive additional tumor, which is not apparent from the subclavian injection. The vert is labeled in light blue.

Supreme Intercostal Origin of Cervical Spinal Artery occasionally seen as well, and important to know. The supreme intercostal and upper thoracic arteries can be difficult to catheterize sometimes, especially in patients with capacious dilated atherosclerotic aortas. We use a 4F or 5F RDC (which can be too small for the upper thoracic spine); if that does not work, one can try an appropriately-sized Cobra, or perhaps a Simmons 1. Sometimes, hand-shaping an RDC to produce a bigger curve (so as to push against the contralateral aortic wall) is more helpful than another catheter. In this case, the supereme intercostal was visualized via the T4 segmenal injection through a prominent paraspinal anastomosis (I)

stereo pair, supreme intercostal arteyr origin ofthe anterior spinal artery (same legends as above), visualized via T4 injection through a prominent post-transverse anastomosis (I). Notice transient contrast reflux into a cervical radiculomedullary branch (P); another longitudinal anastomosis (white arrow) between adjacent T3, T4, and T5 segmental arteries

Supreme intercostal artery (redP origin from the vertebral artery another example of homology between various longitudinal anastomoses. Notice multiple intercostal arteries (yellow)

Stereo pairs, demonstrating posterior course of the supreme intercostal artery at the level of dorsal ribs

Thoracic region: The artery of thoracic enlargement (Adamkiewicz) usually comes of T9 throughT12 region. There is often a region of thoracic cord (mid-lower, depending on the Adamkiewitz origin, which is rather small in caliber, relative to the more well-developed cervical region vessel. A watershed of sorts (yellow) therefore exists which occasionally may correspond to cord infarction in states of hypotension. This double catheter injection (done for evaluation of cord infarction in the region of the basket, below the watershed) demonstrates the slender size of mid-to-lower thoracic ASA. Red=ASA; Purple=radiculomedullary arteries

The artery of Adamkiewicz. Typical appearance. Another patient, with stereo views of the radiculomedullary artery.The radiculomedullary artery (pink) often demonstrates a small segment of narrowing at the point where itpierces the dura(white arrow). The intradural segment (blue) opacifies the anterior spinal artery (red). RDC (catheter) is labeled in green.

Radiculomedullopial artery. By definition, the radiculomedullary artery is a radicular artery which supplies the ASA (red). A radiculopial artery is one which supplies the pial (posterior spinal) system (yellow). When one does both (orange), it is called radiculomedullopial. So there

Figure 9 A-D: A early arterial, B late arterial, C native, and D venous phase images. The artery of Adamkiewicz (Ka), originating at left L1 level, opacifies the anterior spinal artery (Q). The force of contrast injection transiently reverses flow in a smaller radiculomedullary contributor (Ka) sephalad of the Adamkiewicz. A faint radiculopial artery (O) from contralateral right L1 level is visualized through the anterior epidural arcade (La). Notice subtle caliber change where the radiculopial artery pierces the dura (short black arrow). D- venous phase image demonstrating expected visualization of spinal vein (e, either anterior or posterior), and the Great Radicular Vein (j), the venous homolog of the Adamkiewicz.

The main contributor to the anterior spinal axis (Adamkiewicz, ) arises from the left T11 level. The tumor can still be embolized from the right T8 level as long as the Adamkiewicz can adequately reconstitute the anterior spinal axis at the level supplied by the right T8 segment. This can be determined by Balloon Test Occlusion of the right T8 radiculomedullary artery while injecting the level of the Adamkiewicz. The decision is made on angiographic basis as the patient is asleep and, in my opinion, the exam is too unreliable in the time span of the BTO. If the patient passes BTO, the right T8 radiculomedullary artery is closed (very tightly) with coils, and the tumor can then be embolized (particles). So, below is an injection of the left T11 Adamkiewicz (pink) with balloon inflated in the right T8 ventral division (black). Notice amazing visualization of the anterior spinal axis (white), with contrast reflux into the radiculomedullary arteries at the right T8 level (light blue) and left T10 levels (dark blue). Also extremely well seen are long contiguous segments of the posterior spinal artery on the right and somewhat shorter but still quite extensive for the posterior spinal system segment on the left (purple arrows), The PSAs are opacified via the well-seen vasocorona (pial) networks (green), retrogradely visualizing radiculopial contributing vessels (orange). The left T10 level supplies both anterior and posterior spinal arteries, and therefore would be technically radiculomedullopial.

This kind of anatomy is best seen in stereo:

Variant high origin of thoracic ASA. The Adamkiewicz can occasionally (25% of the time) come off unusually high or low. In these cases, there is often variation in terms of posterior cerebral artery anatomy as well. In this patient, a large Left T5 level radiculomedullary artery supplies the ASA (white) of entire thoracic spine. Patients like these are at a somewhat higher risk of cord infarction, having little in the way of collateral radiculomedullary ASA supply. An unusually prominent posterior spinal artery (red) is present also.

See the rest here:
Spinal Arterial Anatomy | neuroangio.org