Procedures Test 2-Spine Flashcards

AP
Terms Definitions
Place exams in order: APs, laterals, cross-table lateral
Cross-table lateral, APs, laterals
EAM
external acoustic meatus
HNP
herniated nucleus pulposus
IOML
infraorbitomeatal line
OML
orbitomeatal line
Spine forms ______ _____ of skeleton
central axis
Functions of spine
-Encloses and protects spinal cord-Acts as a support for trunk-Supports skull superiorly-Provides for attachment for deep muscles of back and ribs laterally
Upper limbs are supported indirectly via ____, which articulate with _____, which articulates with ______ girdle
ribs, sternum, shoulder
Where does the spine articulate with each hipbone?
sacroiliac joints
What supports the vertebral column and transmits the weight of the trunk through the hip joints and to the lower limbs?
SI joints
What acts as cushions between vertebrae?
Intervertebral disks (disks of fibrocartilage)
The vertebral column is made of ______ and is held together by _________.
vertebrae; ligaments
Why is the spine jointed and curved?
For flexibility and resilience
In early life, the spine consists of (#)__ irregularly shaped bones divided into (#)__ groups
33; 5
How many cervical vertebrae are there?
7
How many thoracic vertebrae are there?
12
How many lumbar vertebrae are there?
5
In what region are lumbar vertebrae found?
loin region
In what region are sacral vertebrae and coccygeal vertebrae found?
pelvic region
How many sacral vertebrae are there?
5
How many coccygeal vertebrae are there?
3-5
The 1st (#)__ vertebral segments remain distinct throughout life
24
The 3 upper regions of vertebrae (1st 24) are called ___ or _____ vertebrae
true; movable
The pelvic segments of vertebrae are known as ______ or _______ vertebrae
false; fixed
When do the sacral vertebrae fuse into 1 bone and coccygeal vertebrae fuse into 1 bone?
In adulthood
About __% of the population have 6 lumbar vertebrae. About __% of the population have 5 lumbar vertebrae with no ribs on T12.
2; 7
From the spine, how many curves does the spine have?
4
What are the 4 curves of the spine?
-Cervical-Thoracic-Lumbar-Pelvic
The spinal curves are viewed in anatomical position and referred to as concave or convex _______
anteriorly
What spinal curves are convex anteriorly?
Cervical and lumbar
Which are the lordotic curves?
Cervical and lumbar curves
Which spinal curves are concave anteriorly?
Thoracic and pelvic
Which are the kyphotic curves?
Thoracic and pelvic curves
We describe the spinal curves as if the patient is in ________ position, but most doctors prefer to evaluate the spine from the _______ aspect so their use of terms may mean the exact opposite.
anatomic; posterior
The lumbar curve can be described as ________ anteriorly or _______ posteriorly.
convex; concave
Which spinal curvatures are primary, and why?
Thoracic and pelvic, because they are present at birth
Which spinal curvatures are called secondary, and why?
Cervical and lumbar, because they develop after birth
Which spinal curvatures are called compensatory, and why?
Cervical and lumbar, because they develop after birth
Which spinal curve is the least pronounced, and when does it develop?
Cervical curve. 3-4 months (when child begins to hold head up) and 8-9 months (when child begins to sit)
When does lumbar curve develop?
1-1.5 years of age (when child begins to walk)
The lumbosacral angle is an ______ angle that varies between patients.
obtuse
Do females or males have a more acute lumbosacral angle?
Females
Vertebrae normally increase in width from ____ to ______, then decrease sharply
C2; superior part of sacrum
A slight lateral curvature is sometimes present in the upper _________ region due to muscle action.
thoracic
A vertebra is composed of 2 main parts: ________________
Body and vertebral arch
What is the anterior mass of bone in a vertebra?
Body
What is the solid anterior part of a vertebra?
Body
What is the posterior ringlike part of a vertebra?
Vertebral arch
What do the vertebral body and arch enclose?
vertebral foramen
What encloses the vertebral foramen?
vertebral body and arch
What do the vertebral foramina form?
vertebral canal
What forms the vertebral canal?
vertebral foramina
What is the body of a vertebra made of?
cancellous bony tissue covered by a layer of compact tissue
What covers the flattened superior and inferior surfaces of a vertebral body?
articular cartilage
What separates the vertebral bodies in the spine?
intervertebral disks
IV disks make up __ the length of the vertebral column
1/4
Each intervertebral disk has a central mass of soft, pulpy, semigelatinous material called _________, which is surrounded by a fibrocartilaginous disk called ____________
nucleus pulposus; annulus fibrosis
The vertebral arch is formed by 2 _______ and 2 ______ that support 4 _______ processes, 2 _________ processes, and 1 _______ process
pedicles; laminae; articular; transverse; spinous
What are short, thick, and project posteriorly from the superior and lateral parts of the posterior surface of the vertebral body?
Pedicles
What are the concave superior and inferior surfaces of the pedicles, or roots?
Vertebral notches
By articulation with vertebra above or below, the vertebral notches form _________
intervertebral foramina
What allows for transmission of spinal nerves and blood vessels in the spine?
Intervertebral foramina
What are broad, flat, and project posteriorly and medially from the pedicles?
Laminae
What are the articular processes also known as?
Zygapophyses
How many articular processes does 1 vertebra have?
4 (2 superior and 2 inferior)
What arise from the junction of the laminae and pedicles to articulate with vertebrae above and below?
Articular processes
The articulating surfaces of articular processes are called _____ and are covered with __________.
facets; fibrocartilage
Facets of superior and inferior articular processes join and make up the _________ (_________ ______) joints
zygapophyseal; interarticular facet
What connects the transverse process with the spinous process?
Lamina
What projects laterally and slightly posteriorly from the junction of the pedicle and lamina?
Transverse process
What projects posteriorly and inferiorly from the junction of the laminae in the posterior midline?
Spinous process
The 1st 2 cervical vertebrae are atypical in that...
they are structurally modified to join the skull
The 7th cervical vertebra is atypical and slightly modified to...
join the T-spine
C1
atlas
C2
axis
Which cervical vertebra is ringlike with no body and a short spinous process?
C1
Which cervical vertebra has an anterior arch, posterior arch, 2 lateral masses, and 2 transverse processes?
C1
The ring formed by the anterior and posterior arches of C1 is divided into an anterior and posterior portion by the...
transverse atlantal ligament
Which of the cervical vertebrae has the longest transverse processes?
C1
Each lateral mass of C1 has a _______ and ________ _______ process
superior; inferior articular
The superior processes of C1 are large, concave, and receive...
the occipital condyles
The dens (odontoid process) arises from...
the body of C2
Dens is received into anterior part of atlantal ring to act as _____ or _____ for atlas
pivot; body
Articulation between C1 and C2
atlantoaxial joint
Vertebra prominens
C7
Which cervical vertebra has a long, prominent spinous process that projects almost horizontally to the posterior and is easily palpable at the posterior base of the neck?
C7
The transverse processes of ______ vertebrae have ________ _______ for passage of vertebral artery and vein
cervical; transverse foramina
Transverse foramina allow passage of...
vertebral artery and vein
How many foramina does a cervical vertebra have?
3 (2 transverse foramina and 1 vertebral foramen)
Which vertebrae have bifid (double-pointed) spinous processes?
cervical
The superior and inferior articular processes of a cervical vertebra are located posterior to transverse processes, forming a thick pillar of bone called the...
articular pillars
With reference to MSP, how do zygapophyseal joints open in cervical vertebrae?
90 degrees laterally (right angle)
What projection shows cervical zygapophyseal joints?
Lateral
With reference to MSP, how do intervertebral foramina open in cervical vertebrae?
45 degrees anteriorly (also, 15 degrees inferior to the horizontal)
The body of the typical thoracic vertebra is ________ in shape
triangular
Which type of vertebrae have demifacets?
thoracic
Which structures articulate with vertebral demifacets?
Heads of ribs
How many thoracic vertebrae have a facet for articulation with a rib tubercle?
10 (all but T11 and T12)
The transverse processes of T1-T10 have a facet for articulation with _________ to form _________ joints
rib tubercles; costotransverse
With reference to MSP, how do zygapophyseal joints open in thoracic vertebrae?
70-75 degrees anteriorly
To demonstrate thoracic Z-joints, you rotate patient ___ degrees from lateral position OR ___ degrees from anatomic position
15-20; 70-75
With reference to MSP, how do intervertebral foramina open in thoracic vertebrae?
90 degrees laterally (perp)
What projection demonstrates thoracic intervertebral foramina?
Lateral
Ribs elevate upon _______ and when arms are ______, removing ribs from overlying intervertebral foramina
inspiration; raised
Which have smaller transverse processes, thoracic or lumbar vertebrae?
Lumbar
What is a smoothly rounded projection on the back of each superior articular process of a lumbar vertebrae?
mammillary process
What is located at the back of the root of the transverse process of a lumbar vertebrae?
accessory process
The body of L5 is deeper in _____ than _____, giving it a _____ shape
front; behind; wedge
Part of lamina between superior and inferior articular processes of lumbar vertebrae
pars interarticularis
With reference to MSP, how do zygapophyseal joints open in lumbar vertebrae?
30-60 degrees posteriorly
With reference to MSP, how do intervertebral foramina of L1-L4 open?
90 degrees (right angle)f
What projection shows the intervertebral foramina of L1-L4?
Lateral
The 5th intervertebral foramina (L5) turns slightly ______
anteriorly
Neck of Scottie dog is...
pars interarticularis
Is the male or female sacrum longer, narrower, more evenly curved, and more vertical?
Male
Is the male or female sacrum more acutely curved and more oblique, with a sharper angle at the junction of the lumbar and pelvic curves?
Female
With reference to MSP, how do SI joints open?
25-30 degrees anteriorly
What is the superior surface of the sacrum?
base
What part of sacrum forms lumbosacral junction with L5?
Base
Where is the last pair of intervertebral foramina?
Between concavities on pedicles of L5 and S1
Where is the last pair of zygapophyseal joints?
Between the inferior articular processes of L5 and the superior articular processes of S1
Ridge at superior anterior margin of base of sacrum
sacral promontory
What is located behind bodies of sacral segments and contained within the bone?
Sacral canal
What is a continuation of the vertebral canal and transmits sacral nerves into sacral foramina?
Sacral canal
What serve as passage for sacral nerves and blood vessels?
Sacral foramina
How many pairs of sacral foramina are there?
4
What is the large winglike mass on each side of the sacral base?
ala
What is the superoanterior part of lateral surface of ala?
auricular surface
What part of sacrum articulates with iliac bones of pelvis?
auricular surface
What transmits sacral nerves?
Sacral canal
The inferior surface of apex of sacrum has an oval facet for articulation with _______ and _______ _______
coccyx; sacral cornua
What are 2 processes that project inferiorly from posterolateral aspect of last sacral segment to join coccygeal cornua?
Sacral cornua
What is the average number of coccygeal vertebrae?
4 (can be 3-5)
Coccyx curves _______ and _______ from its articulation with sacrum
anteriorly; inferiorly
What project superiorly from the posterolateral aspect of the 1st coccygeal segment to join sacral cornua?
Coccygeal cornua
Coccyx may have slight deviation from...
midline
Degrees of rotation needed to show intervertebral foramina of C-spine
45 (AP side up, PA side down)
Degrees of rotation needed to show zygapophyseal joints of C-spine
Lateral
Degrees of rotation needed to show intervertebral foramina of T-spine
Lateral
Degrees of rotation needed to show zygapophyseal joints of T-spine
70 degrees (AP side up, PA side down)
Degrees of rotation needed to show intervertebral foramina of L-spine
Lateral
Degrees of rotation needed to show zygapophyseal joints of L-spine
30-60 (AP side down, PA side up)
Vertebral articulations consist of 2 types of joints:
Intervertebral joints and zygapophyseal joints
What type of joints are between 2 vertebral bodies?
Intervertebral joints
What type of joint are intervertebral joints?
cartilaginous symphysis (slight movement)
What joints are between the articulation processes of the vertebral arches?
Zygapophyseal joints
What type of joint are zygapophyseal joints?
Synovial gliding (freely movable)
What movements can the vertebral column make?
Flexion, extension, lateral flexion, and rotation
What type of joint are atlanto-occipital joints?
Synovial ellipsoidal
What are the articulations between atlas and occipital bone?
Atlanto-occipital joints
What joint is formed by the anterior arch of the atlas rotating around the dens?
Atlantoaxial joint
What type of joint is the atlantoaxial joint?
Synovial gliding and synovial pivot
What joint is formed by head of rib and body of vertebra?
Costovertebral joint
What type of joint are costovertebral joints?
Synovial gliding
What joint is formed by tubercle of rib and transverse process of vertebra?
Costotransverse joint
What type of joint are costotransverse joints?
Synovial gliding
What is the SID for most of spinework?
48"
What projection is used to demonstrate dens when its upper half is not clearly shown in open-mouth position?
AP dens (Fuchs method)
Preferred position for AP dens
Supine
Head positioning for AP Fuchs
Extend chin until tip of chin and tip of mastoid processes are vertical
IR for AP dens
8x10 CW
IR for AP dens (Fuchs method)
8x10 CW
For AP dens (Fuchs method), IR is centered to...
tips of mastoid processes
Breathing for AP dens (Fuchs method)
Suspend
What projection shows entire dens within foramen magnum?
AP dens (Fuchs method)
SID for AP atlas and axis (open-mouth)
30" to increase field of view in odontoid area
Preferred position for AP atlas and axis (open-mouth)
Supine
Head positioning for AP atlas and axis (open-mouth)
Open mouth as wide as possible. Adjust head so a line from lower edge of upper incisors to tip of mastoid processes (occlusal plane) is perp to IR and so base of occipital bones is perp to IR
IR for AP atlas and axis (open-mouth)
8x10 CW
For AP atlas and axis, IR is centered at...
level of axis (C2)
CR for AP atlas and axis (open-mouth)
Perp to MSP, entering midpoint of open mouth
Breathing for AP atlas and axis (open-mouth)
Phonate "ah" during exposure
What projection shows dens, atlas, axis, and articulations between C1 and C2 (including lateral masses)
AP atlas and axis (open-mouth)
In AP atlas and axis (open-mouth), what should appear superimposed?
Occlusal plane of upper central incisors and base of skull
What position is preferred for AP axial C-spine?
Supine (upright is also possible)
Head positioning for AP axial C-spine
Extend chin so occlusal plane is perp to IR (prevents superimposition of mandible and midcervical vertebrae)
IR for AP axial C-spine
8x10 LW
For AP axial C-spine, IR is centered at...
level of C4 (at or slightly inferior to most prominent point of thyroid cartilage)
CR for AP axial C-spine
Angled 15-20 degrees cephalad, entering MSP and directed through C4
Breathing for AP axial C-spine
Suspend
AP axial C-spine shows area from _____ to ___
superior part of C3; T2 (C1 and C2 are usually not shown)
For AP axial C-spine, intervertebral disk spaces are...
open
For AP axial C-spine, spinous processes are equidistant to...
pedicles and aligned with midline of cervical bodies
For AP axial C-spine, mandibular angles and mastoid processes are equidistant to...
vertebrae
Which projection demonstrates the absence or presence of cervical ribs?
AP axial C-spine
The lateral projection of the C-spine is called the ______ method
Grandy
What projection is usually done first in a C-spine exam?
Lateral
What SID is recommended for lateral C-spine?
60-72" (to compensate for increased OID and help demonstrate C7)
Position for lateral C-spine
Either seated or standing in true lateral position
For lateral C-spine, a coronal plane passing through ________ is centered to midline of IR
mastoid tips
For lateral C-spine, rotate shoulders ________ OR, if round-shouldered, rotate shoulders _________
posteriorly; anteriorly
For lateral C-spine, make sure shoulders are in same plane, __________, and _________ by attaching 1 small sandbag of equal weight to each _____
depressed; immobilized; wrist
Head positioning for lateral C-spine
Elevate chin slightly, or have patient protrude mandible (to prevent superimposition of mandibular rami and spine)
IR for lateral C-spine
8x10 LW
For lateral C-spine, IR is centered at...
level of C4; top of IR 1" above EAM
CR for lateral C-spine
Horizontal and perp to MCP at level of C4
The CR direction and centering for a _______ projection of the C-spine is the same as hyperextension/hyperflexion studies of C-spine
lateral
Breathing for lateral C-spine
Suspend at end of full expiration (for maximum shoulder depression)
For lateral C-spine, what indicates no rotation or tilt of spine?
Superimposed open zygapophyseal joints and intervertebral disk spaces
Spinous processes should be demonstrated in profile in what projection of the C-spine?
Lateral
For lateral C-spine, magnified outline of shoulder farthest from IR is projected...
below lower cervical vertebrae
AP axial obliques of the C-spine best demonstrate _______ and __________
pedicles; intervertebral foramina
What SID is recommended for AP axial oblique C-spine?
60-72"
Recommended position for AP axial oblique C-spine
Upright (due to patient comfort and ease of positioning. May also be done supine)
Degree of body obliquity for oblique C-spine
45
IR for AP axial oblique C-spine
8x10 LW
For AP axial oblique C-spine, IR is centered to...
C3 (1" superior to most prominent point of thyroid cartilage)
CR for AP axial oblique C-spine
Angled 15-20 degrees cephalad, directed to C4
Breathing for AP axial oblique C-spine
Suspend
For AP axial oblique C-spine, intervertebral foramina _____ to IR will be open
farthest
What vertebrae are shown in AP axial oblique C-spine?
C1-C7 and T1
What SID is recommended for PA axial oblique C-spine?
60-72"
Recommended position for PA axial oblique C-spine
Upright (for patient comfort and accurate positioning. May also be done prone)
IR for PA axial oblique C-spine
8x10 LW
For PA axial oblique C-spine, IR is centered at...
level of C5 (1" caudal to most prominent point of thyroid cartilage)
CR for PA axial oblique C-spine
Angled 15-20 degrees caudad, directed to C4
Breathing for PA axial oblique C-spine
Suspend
For PA axial oblique C-spine, intervertebral foramina ________ to IR are open
closest
What vertebrae are demonstrated for PA axial oblique C-spine?
C1-C7 and T1
IR for lateral cervicothoracic region
10x12 LW
For lateral cervicothoracic region, IR should be centered at...
level of C7-T1 interspace (2" above jugular notch)
CR for lateral cervicothoracic region
Directed to C7-T1 interspace, entering MCP-Perp if shoulder away from IR is well depressed-Angled 3-5 degrees caudad if shoulder is not well depressed-Monda: Angled 5-15 degrees cephalad to better demonstrate intervertebral disk spaces when spine is tilted because of broad shoulders or a nonelevated lower spine
Breathing for lateral cervicothoracic region
Suspend OR a breathing technique (to blur lung anatomy)
What vertebrae are demonstrated in a lateral cervicothoracic region radiograph?
~C5-T4
To maintain an even density for AP T-spine, what should you do?
Use a compensating filter
Recommended position for AP T-spine
Supine (Peters says upright is just for scoliosis demonstration)
What do you do to reduce thoracic kyphosis for an AP T-spine?
Let head rest on table or thin pillow, and flex hips and knees to place thighs in vertical position
IR for AP T-spine
35x43 or 18x43 LW; top of IR 1.5-2" above shoulders
What vertebra appears near the center of an AP T-spine radiograph?
T7
CR for AP T-spine
Perp, entering MSP halfway between jugular notch and xiphoid process (slightly below sternal angle)
What projection of the spine would you most likely use the anode heel effect for, and which way would cathode be directed?
AP T-spine. Cathode toward feet
Sometimes a full 14x17 IR is used for AP T-spine (and chest), especially for...
trauma patients
Breathing for AP T-spine
Suspend at end of full expiration OR shallow breathing (to blur lungs)
What vertebrae should be shown for AP T-spine?
C7-L1
What do you do if thoracic vertebrae are not demonstrated with uniform density for AP T-spine?
Take 2 radiographs (1 for upper and 1 for lower T-spine)
If a full 14x17 IR is used for AP T-spine, what should be included besides spine?
Ribs, shoulders, lungs, diaphragm
For what projections should a sheet of leaded rubber be placed behind the patient?
Lateral T-spine, lateral L-spine, lateral L5-S1 lumbosacral junction, lateral sacrum and coccyx
Why should a sheet of leaded rubber be placed behind the patient?
To absorb scatter (which, when using AEC, can prematurely terminate exposure) and improve image quality
What projection best demonstrates kyphosis?
Lateral T-spine
Position for lateral T-spine
Lateral recumbent or upright (left lateral is recommended to place heart closer to IR and minimize overlapping of vertebrae by heart)
Where should arms be for a lateral T-spine?
At right angles to long axis of body to elevate ribs enough to clear intervertebral foramina
IR for lateral T-spine
35x43 or 18x43 LW
Top of IR for lateral T-spine should be ____ above relaxed shoulders
1.5-2"
Breathing for lateral T-spine
End of expiration OR breathing normally (to blur vascular markings and ribs)
What projection shows vertebrae through rib and lung shadows?
Lateral T-spine
What projection best demonstrates thoracic intervertebral foramina?
Lateral T-spine
Latitude of exposure for lateral T-spine should be...
wide
Is it easier to show upper thoracic bodies on a younger or older patient?
Younger
Prep for exams of L-spine, sacrum, and coccyx
Clear gas and fecal material from intestinal tract. Empty urinary bladder just before exam to eliminate superimposition caused by secondary radiation generated by filled bladder.
For exams of L-spine, why should elastic waistband be removed?
It can cause an artifact shadow or soft tissue folds in image
For lumbosacral vertebrae, AP projection is generally used for _______ exams
recumbent
The extended limb position accentuates the ______ curve, resulting in distortion of bodies and poor delineation of intervertebral disk spaces
lordotic
What SID is recommended for lumbosacral exams?
48" (to reduce distortion, open intervertebral disk spaces, and improve overall quality of exam)
Recommended position for AP L-spine
Supine-If patient has severe back pain, stand patient on footboard, turn table upright, position patient, turn table to horizontal position for exposure, and then return table to upright position-Upright for scoliosis series
Upper and lower extremity positioning for AP L-spine
Flex elbows and place hands on upper chest. Flex hips and knees to reduce lordotic curve and place back in contact with table (to place vertebra closer to IR)
IR for AP L-spine OR AP L-spine and sacrum
11x14 LW (L-spine) OR 14x17 LW (L-spine and sacrum)-May include full 14x17 IR (esp. for trauma) to show liver, kidney, spleen, psoas muscles, and air or gas patterns
CR for AP lumbosacral exam
Perp, entering MSP at level of iliac crests (L4)
CR for AP lumbar exam
Perp, entering MSP at level of 1.5" above iliac crests (L3)
Breathing for AP L-spine
Suspend at end of expiration
What area of spine should be shown for AP L-spine?
Area from lower thoracic vertebrae to sacrum
What should be the edge of your collimation for an AP L-spine?
Lateral margin of psoas muscles
What projection best demonstrates lordosis?
Lateral L-spine
Recommended position for lateral L-spine
Recumbent, on affected side-Upright may be used for scoliosis series
What is the preferred method for making the long axis of the spine horizontal for a lateral L-spine?
Place a radiolucent support under lower thorax
Where should supports be placed for a lateral L-spine?
Under head, under lower thorax, and between knees
What positioning aids do you need to perform a lateral projection of the L-spine, sacrum, or coccyx?
Sandbag, radiolucent supports/sponges, lead strip
IR for lateral L-spine
14x17 LW
CARD ABOVE IS WRONG. IR for lateral L-spine and sacrum
14x17 LW
Breathing for lateral L-spine exam
Suspend at end of expiration
What area of the spine should be demonstrated for a lateral lumbar exam?
Area from lower thoracic vertebrae to sacrum
What area of the spine should be demonstrated for a lateral lumbosacral exam?
Area from lower thoracic vertebrae to coccyx
What projection best demonstrates L-spine intervertebral foramina?
Lateral
When x-ray beam is not angled for lateral L-spine, iliac crests should appear...
nearly superimposed
Lateral L-spine shows a profile image of _____ intervertebral foramina, but not __ intervertebral foramina (because of their oblique direction; oblique projections are used for THESE foramina)
L1-L4; L5
Recommended position for lateral L5-S1 lumbosacral junction
Lateral recumbent
Upper and lower extremity positioning for lateral L5-S1 lumbosacral junction
Flex elbow and adjust dependent arm at right angles to body. Fully extend hips if possible. Place a support between superimposed knees
What is the preferred method for making the long axis of the spine horizontal for lateral L5-S1 lumbosacral junction?
Place a support under lower thorax
IR for lateral L5-S1 lumbosacral junction
8x10 LW
CR for lateral L5-S1 lumbosacral junction
Perp, entering 2" posterior to ASIS and 1.5" inferior to iliac crest-If spine is not horizontal, angle CR 5 degrees caudad for males or 8 degrees caudad for females; OR adjust CR angulation to be parallel with interiliac line
Breathing for lateral L5-S1 lubmosacral junction
Suspend
What projection best demonstrates an open lumbosacral intervertebral joint?
Lateral L5-S1 lumbosacral junction
What part of spine should be seen in lateral L5-S1 lumbosacral junction?
All of L5 and upper sacrum (should include lower one or two lumbar vertebrae and upper sacrum)
What projection best demonstrates zygapophyseal joints of L-spine?
Obliques
AP oblique L-spine demonstrates __________ and _________
articular processes; zygapophyseal joints
Properly obliqued lumbar vertebrae look like...
Scottie dogs
Appearance of "Scottie dog" indicates ______ and ________ are demonstrated
articular processes; zygapophyseal joints
Eye in Scottie dog is...
pedicle closest to IR
Degree of body obliquity for AP oblique L-spine
45 degrees toward affected side-Up to 60 degrees may be needed to demonstrate L5-S1 zygapophyseal joint and articular processes
In oblique position, L-spine lies in a longitudinal plane that passes __" _______ to elevated ASIS
2" medial
IR for AP oblique L-spine
14x17 or 11x14 LW-8x10 for last zygapophyseal joint
CR for AP oblique L-spine
Perp, entering 2" medial to elevated ASIS and 1.5" above iliac crest (L3)-For 5th zygapophyseal joint, entering 2" medial to elevated ASIS and then up to a point midway between iliac crest and ASIS
Breathing for AP oblique L-spine
Suspend at end of expiration
What area of spine should be demonstrated for AP oblique L-spine?
From lower thoracic vertebrae to sacrum
For AP oblique L-spine, zygapophyseal joints ______ to IR should be open
closest
When Z-joint is not well demonstrated and pedicle is anterior on vertebral body for AP oblique L-spine, patient is...
not rotated enough
When Z-joint is not well demonstrated and pedicle is posterior on vertebral body for AP oblique L-spine, patient is...
rotated too much
RPO position shows ______ SI joint
left
IR for AP axial sacrum
10x12 LW
Recommended position and obliquity for AP oblique SI joints
Supine. Elevate side being examined about 25-30 degrees
LPO position shows _____ SI joint
right
IR for AP oblique SI joints
8x10 or 10x12 LW
For AP oblique SI joints, IR is centered at...
level of ASIS
CR for AP oblique SI joints
Perp, entering 1" medial to elevated ASIS at level of ASIS
Breathing for AP oblique SI joints
Suspend
AP oblique projection of SI joints shows SI joint _______ from IR
farthest
Recommended position for AP axial sacrum and coccyx
Supine (so bones are close as possible to IR)
IR for AP axial coccyx
8x10 LW
CR for AP axial sacrum
Angled 15 degrees cephalad, entering MSP 2" above pubic symphysis
CR for PA axial sacrum
Angled 15 degrees caudad, entering MSP and centered to clearly visible sacral curve
CR for AP axial coccyx
Angled 10 degrees caudad, entering MSP 2" above pubic symphysis
CR for PA axial coccyx
Angled 10 degrees cephalad, entering MSP, centered to palpable coccyx
Breathing for AP axial sacrum/coccyx
Suspend
Exams of sacrum should have _____-scale contrast
short
Recommended position for lateral sacrum and coccyx
Lateral recumbent
What is the reference point for centering sacrum, coccyx, and L5-S1 spot?
ASIS
IR for lateral sacrum
10x12 LW
IR for lateral coccyx
8x10 LW
CR for lateral sacrum
Perp, directed to level of ASIS and 3.5" posterior
CR for lateral coccyx
Perp, directed to level of 2" inferior to ASIS and 3.5" posterior
Breathing for lateral sacrum/coccyx
Suspend
Recommended body position for scoliosis series
Upright if possible
Scoliosis series includes...
AP and lateral of T and L spines
What projection is done in trauma situations for clearance to remove a neck brace?
Cross-table lateral C-spine
What SID is used for cross-table lateral C-spine?
48"
Why are flexion and extension views performed?
To show how joint spaces move in spine when patient moves backward and forward
Flexion and extension views may be done for lateral projections of _______ and _________ spine in hyper-movement
cervical; lumbar
What projection best demonstrates scoliosis?
PA T-spine
Hyperflexion and hyperextension views of lateral C-spine must not be attempted until...
C-spine pathology or fracture has been ruled out
Spinous processes are elevated and widely separated in...
hyperflexion
Spinous processes are depressed and in close approximation in...
hyperextension
What SID is recommended for hyperflexion and hyperextension views of C-spine?
60-72"
Recommended body position for hyperextension and hyperflexion views of lateral C-spine
Standing or seated upright
Is hyperflexion or hyperextension performed 1st?
Hyperflexion, then hyperextension
Drop head forward and draw chin as close to chest as possible for...
hyperflexion
Elevate chin as much as possible for...
hyperextension
IR for hyperflexion and hyperextension views of lateral C-spine
10x12 LW
For hyperflexion and hyperextension views of C-spine, IR is centered at...
level of C4 (top of IR 2" above EAM)
CR for hyperflexion and hyperextension views of lateral C-spine
Perp to C4
Breathing for hyperextension and hyperflexion views of lateral C-spine
Suspend
Which view of C-spine shows body of mandible almost vertical?
Hyperflexion
Which view of C-spine shows body of mandible almost horizontal?
Hyperextension
What vertebrae are shown in hyperflexion/hyperextension views of C-spine?
All 7 cervical vertebrae
What shows motility of C-spine?
Hyperflexion and hyperextension views
What is "wagging jaw" method called?
Ottonello method
Ottonello method blurs mandible by...
patient doing an even chewing motion during exposure (long exposure time; minimum of 1 sec)
Position for AP C-spine (Ottonello method)
Supine
Head positioning for AP C-spine (Ottonello method)
Elevate chin enough to place occlusal surface of upper incisors and mastoid tips in same vertical plane. Immobilize head
IR for AP C-spine (Ottonello method)
8x10 LW
For AP C-spine (Ottonello method), IR is centered at...
level of C4
CR for AP C-spine (Ottonello method)
Perp to C4, entering MSP at most prominent point of thyroid cartilage
Breathing for AP C-spine (Ottonello method)
Suspend
What area of spine is shown for AP C-spine (Ottonello method)?
All 7 cervical vertebrae (blurred mandible allows visualization of underlying atlas and axis)
AP oblique T-spine demonstrates Z-joints ______ from IR
farthest
PA oblique T-spine demonstrates Z-joints ________ to IR
closest
IR for AP or PA oblique T-spine
14x17 LW
For AP or PA oblique T-spine, IR is centered...
to T7 (top of IR 1.5-2" above shoulder)
Position and obliquity for AP or PA oblique T-spine
Lateral upright or lateral recumbent. Rotate body 20 degrees anterior or posterior so coronal plane forms 70-degree angle from IR
CR for AP or PA oblique T-spine
Perp to level of T7
Breathing for AP or PA oblique T-spine
Suspend at end of expiration
Is semisupine (AP obl) or semiprone (PA obl) position preferred for oblique L-spine?
Semiprone (due to ease of positioning and ease of duplication). However, increased OID can affect resolution
Recommended position and obliquity for PA oblique L-spine
Recumbent (upright can also be used). 45 degrees obliquity (up to 60 degrees to demonstrate last zygapophyseal joint and articular processes)
PA oblique L-spine demonstrates zygapophyseal joints ______ from IR
farthest
IR for PA oblique L-spine
14x17 or 11x14 LW-8x10 for last zygapophyseal joint
CR for PA oblique L-spine
Perp, entering elevated side 2" lateral to palpable spinous process at L3 (1-1.5" above iliac crest) OR at L5 (for lumbosacral joint)
Breathing for PA oblique L-spine
Suspend at end of expiration
What is the method called for AP or PA axial lumbosacral junction and SI joints?
Ferguson method
Position for AP axial lumbosacral junction and sacroiliac joints
Supine. Do NOT flex knees. Extend lower limbs or abduct thighs and adjust in vertical position
Position for PA axial lumbosacral junction and sacroiliac joints
Prone (PA axial may be used to help demonstrate SI joints because their obliquity places them in a position more nearly parallel with beam divergence)
CR for PA axial lumbosacral junction
Angled 35 degrees caudad through lumbosacral joint, entering spinous process of L4
CR for AP axial lumbosacral junction and SI joints
Angled 30-35 degrees cephalad through lumbosacral joint, entering MSP about 1.5" above pubic symphysis (30 for males; 35 for females)
CR for PA axial SI joints
Perp, centered at level of ASISs, entering MSP 2" distal to spinous processes of L5
Breathing for AP or PA axial lumbosacral junction and SI joints
Suspend
Position and obliquity for PA oblique SI joints
Semiprone. 25-30 degree angle
IR for AP or PA axial lumbosacral junction and SI joints
8x10 or 10x12 LW
PA oblique SI joints shows SI joint _______ to IR
closest
IR for PA oblique SI joints
8x10 or 10x12 LW
For PA oblique SI joints, center IR at...
level of ASIS
CR for PA oblique SI joints
Perp, entering 1" medial to ASIS closest to IR
Breathing for PA oblique SI joints
Suspend
Bending views are generally ordered to demonstrate...
mobility of intervertebral joints (most commonly of L-spine) OR to localize involved joint in patients with disk protrusion as shown by limitation of motion at site of lesion
Position for bending views
Standing. 1 radiograph bending to right and 1 bending to left
Is AP or PA projection preferred for bending views?
PA (recommended because divergent rays are more nearly parallel with intervertebral disk spaces, and because gonadal dose is reduced)
IR for PA lumbar intervertebral disks (bending views)
14x17 LW
For PA lumbar intervertebral disks (bending views), IR is centered at...
level of L3
CR for PA lumbar intervertebral disks (bending views)
Perp to L3, entering MSP at an angle of 15-20 degrees caudad OR projected through L4-L5 or L5-S1 interspaces
Breathing for PA lumbar intervertebral disks
Suspend
Position for AP lumbar spine (spinal fusion; bending views)
Supine. 1st radiograph with maximum right bending. 2nd radiograph with maximum left bending. Use compression band to prevent movement after patient is in place
IR for AP lumbar spine (spinal fusion; bending views)
10x12 or 14x17 LW
CR for AP lumbar spine (spinal fusion; bending views)
Perp, entering MSP at level of L3 (1-1.5" above iliac crest)
Breathing for AP lumbar spine (spinal fusion; bending views)
Suspend
Position for lateral lumbar spine (spinal fusion; hyperflexion and hyperextension)
Lateral recumbent. 1st radiograph in hyperflexion. 2nd radiograph in hyperextension. Use a compression band to prevent movement
IR for lateral lumbar spine (spinal fusion; hyperflexion and hyperextension)
14x17 LW
For lateral lumbar spine (spinal fusion; hyperflexion and hyperextension), center IR at...
level of spinal fusion
CR for lateral lumbar spine (spinal fusion; hyperflexion and hyperextension)
Perp to spinal fusion area
Breathing for lateral lumbar spine (spinal fusion; hyperflexion and hyperextension)
Suspend
Diagnosis and monitoring of scoliosis requires a series of radiographs that may include...
upright, supine, and bending studies
Typical scoliosis study may include:
-PA/AP upright-PA/AP upright with lateral bending-Lateral upright (with or without bending)-PA/AP prone or supine
Ideally, for scoliosis studies, a ____ IR is used to demonstrate entire spine with one exposure
14x36"
What SID is recommended for scoliosis studies?
Minimum of 60" for a 36" long IR
What should be used to even out density for scoliosis studies?
Compensating filter
Is AP or PA projection preferred for scoliosis studies?
PA (reduced dose to radiosensitive organs)
What method is used for PA projection of thoracolumbar spine for scoliosis?
Ferguson method
Position for PA projection of thoracolumbar spine for scoliosis
Seated or standing upright
IR for PA projection of thoracolumbar spine for scoliosis
14x36 or 14x17 LW (adjust IR to include 1" of iliac crests)
Ferguson series requires __ radiographs
2
For 1st radiograph for PA projection of thoracolumbar spine for scoliosis, patient in what position?
Normal standing/seated position to check spinal curvature
For PA projection of thoracolumbar spine for scoliosis, can a compression band be used?
No
For PA projection of thoracolumbar spine for scoliosis, what position is patient in for 2nd radiograph?
Standing or seated, with hip or foot on convex side of primary curve elevated 3-4"
The 2 radiographs in the Ferguson series are used for comparison to distinguish the ______ or _______ curve from the ________ curve in patients with scoliosis
deforming; primary; compensatory
IR for PA projection of thoracolumbar spine for scoliosis (Ferguson method)
14x17 or 14x36 LW
CR for PA projection of thoracolumbar spine for scoliosis
Perp to IR
Breathing for PA projection of thoracolumbar spine for scoliosis
Suspend
What area is included for PA projection of thoracolumbar spine for scoliosis?
Thoracic and lumbar vertebrae to include about 1" of iliac crests
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