Procedures Test 2-Spine
Terms
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- 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