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Positioning Test 3


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copy deck
no body
C2- Axis-has
a dens or odontoid process
Each cervical vertebrae has a
lateral mass or pillar which is the anatomy with the superior articulating process and the inferior articulating process on bottom
All cervical vertebrae have
transverse foramen which house the vertebral arteries and veins from the posterior circulation of the cerebrum
All spinous processes of the typical cervical vertebrae also have
bifid tips
⬢ This view does not demonstrate the C1/ C2 joint space
Positioning for Judd
prone with hands positioned at level of face; extend head so OML so it forms a 37 degree angle with tabletop

o perp. entering MSP just distal to the level of the mastoid tips

⬢ a good addition to AP and Lateral views when pt. Is unable to open their mouth at all for the odontoid
Positioning for Kasabach
⬢ Postioning
o supine; 45 degrees right or left and adjust IOML perp. to table

CR for Kasabach
⬢ CR
o 10-15 degrees caudal entering at a midpt. Between EAM and outer canthus

⬢ done to show AP of the entire cervical spine C1 through C7
Evaluation for Kasabach
all Cspine demonstrated C1- C7 with mandible blurred out or obliterated

AP axial Pillars
although lateral masses are dem. Other structures are seen including C 3 through T4 thoracic vertebrae, the laminae, and spinous processes
Postioning for AP axial pillars
o Supine and hyperextend as much as possible without causing discomfort to pt. If too much do oblique position it is recommended
CR for AP axial pillars
o 20 to 30 degrees caudal entering thyroid cartilage and MSP

Eval for AP axial Pillars
⬢ Evaluation
o Verterbral arches with articular pillars in profile and open joint spaces between articulating processes

⬢ Positioning-
o Supine, rotate head 45 degrees away from side of intrest; if lower cervical and upper thoracic of interest rotate 60 to 70 degrees instead

⬢ CR-
o Position IR so top edge is at the level of the mastoid tip; 30 to 40degrees caudal to center of IR ensuring that C spine is directed longitudinally to exposure area

⬢ Evaluation
o Verterbral arches with articular pillars in profile; open joint spaces between articular processes

⬢ Positioning-
o No movement; place IR under pt. Or backboard centered to C4 transversely and mastoid tip longitudinally

⬢ CR-
o Direct a double tube angle 45 degrees medially and 15-20 degrees cephalic centering at the IR; CR in most cases will enter a point between MSP and MCP at level of thyroid cartilage

⬢ Evalution-
o Open intervertebral foramina at the side farthest from the tube

weight bearing method showing intervertebral joints
lumbar intervertebral disks
why is lumbar intervertebral disk a PA projection
divergence of beam causes rays to be almost parallel to disk spaces also will limit radiation to breast and gonadal area
Positioning for Lumbar intervertebral Disk?
Erect; PA; align MSP with vertical grid; transversely L3; both sides are done for comparison
central ray for lumbar intervertebral disk?
15 to 20 caudal
spinal fusion is done to demonstrate?
mobility of intervertebral disk space at site of spinal fusion at least 6 months following surgery
spinal fusion can also be done to show what?
HNP and early evaluation early signs of scoliosis
Positioning for spinal fusion?
supine with MSP on table
Central Ray for Spinal Fusion
at the level of L3 perp.
Kovacs is used to demonstrate what?
used to show L5 intervertebral foramina in profile
Positioning for Kovac?
Lateral recumbent position; center plane 1.5 posterior to MCP to midline of table ; rotate pt. Anterior 30 degrees while keeping thorax in lateral position; flex knee on side up to maintain obliquity
Central Ray for Kovacs
15-30 caudal
Lumbar vertebrae have
large bodies
Extending laterally from pedicles are
transverse processes
The superior and inferior articulating processes are
part of the lamina
With the bony area b/w the articular processes being the
pars interarticularis
Lamina- unite posteriorly to form
spinous processes
o Center of disk is called; it is a mass of gelatinous pulp which acts as a shock absorber
nucleous pulpous
The outer portion of disk is the which is made of fibers that are would about in rings

annulus fibrous

When subject to pressure (standing) the disks spread out, sudden severe pressure can cause
the disk to rupture with the nucleus pulpous pertruding through the annulus fibrosis which causes pressure on the spinal cord known as HNP or herniated pulpous or slipped disk
are 4 irregular shaped cavities filled with CSF which lubricates and protects brain and Spinal cord
______one in each hemisphere
2 lateral ventricles
Contains choroid plexus-

Can be divided into:

network of tiny blood vessels that produce CSF

anterior, posterior, and inferior horns and a body

foramen of Monroe) is a narrow opening lateral ventricles indirectly to each other and directly to the third ventricle
interventricular foramen
CSF passes through 3rd ventricle into 4th through cerebral aqueduct which is also known
aqueduct of sylvius
From fourth ventricle CSF blows into subaracnoid space via
the foramen of Magendie also know as the median aperature

⬢ Consists of outside layer of white matter and inner layer of grey matter

spinal cord
spinal cords extends from
aprox. Foramen magnum to L2
Spinal Cord is enclosed by
3 meningeal layers
what are the 3 layers that encloses the spinal cord
1. pia mater
2. arachnoid
3. dura mater

between pia mater and arachnoid space and is continuous with ventricle s of brain
subarachnoid space
Distal end of spinal cord is ______ with its tip at level of L2
conus medularis
Conus Medullaris and spinal nerves extending past the level of L2 together form an area called
cauda aquina know as horses tail
Dura mater -> _____->arachnoid layer-> ______-> pia mater
subdural space; subarachnoid space;
fingerlike projections that extend into the dura mater to return CSF into bloodstream
subarachnoid villi
⬢ Radiologic examiniation of CNS structures within spinal canal after introduction of contrast into the subarachnoid space
what type of contrast is used for myelography
⬢ A water soluable iondinated contrast or gaseous contrast maybe used
Myelograms require an ____technique
Depending of radiologist insertion of needle may be done
prone or lateral
Usually a ____ spinal needle is placed ____ into subarachnoid space at level of _____ with use of fluoroscopy
20-22 guage; intrathecally ;L2 – L3 or L3 –L4
⬢ During exam, the patients head should remain extended to prevent contrast flow past the
foramen magnum
Once Myelograpy is complete, patient supine with head elevated
30-45 degrees
A ______ maybe done after the exam
post myelogram CT
Recovery time for myelography is
4- 8 hours
Headaches are common if patient sits up more than 45 degrees and caused by
air passing through subarachnoid space into ventricles of brain
⬢ Aka spinal tap
spinal puncture
CT of head usually done prior to show evidence of ______ ; if there is pressure a spinal tap could cause severe complications
intracranial pressure;
⬢ Done to withdraw CSF from subarachnoid space
spinal puncture
They are not recommended if pt has had a myelogram in the previous ____; why?
2 weeks; there might be contrast in spinal column so could be withdrawn with CSF and could result in false lab results
Positioning for spinal puncture?
Depending on doctor maybe in left lateral postion or prone
Injection site for spinal puncture?
o Spinal needle is inserted at L3 L4 level
⬢ Radiological exam of the intervertebral disk by introduction of a water soluable ionated contrast media into disk by way of a double needle entry
Under fluoro, a large outer needle is used to perform the spinal puncture and reach the ____ of the disk; once the outer needle is in place a smaller needle is advanced into the ____
annulous fibrosus; nucleus pulposus
⬢ This can be done separate in combination with myelography
⬢ Done as intradisk therapy by way of injection of chymopapain into the nucleus pulpous of the injured disk
o enzyme extracted from the papaya tree which reduces intradisk pressure when injected into the nucleus pulposus
Chemonucleolysis is an alternative to the ____
⬢ Surgical chipping away of the bony arches of one or more vertebrae in order to relieve compression of the spinal cord caused by bone displacement or herniated disks

If more than one vertebrae’s _____ is removed the vertebrae may be fused together for added support of the spine

Done in place of chemonucleolysis or laminectomy
⬢ First perform a diskogram, needle is removed and replaced with a ___
_____ is sharp pointed surgical instrument contained in a cannula; used for aspiration purposes ; connected to a double lumen suction tube through which nitrogen and saline are introduced
used to shave away the HNP; while the resulting fragments are suctioned out
_____ is much safer than a laminectomy and requires a much shorter recovery time
what are the two positions for viewing the dens?
Kasabach and Judd
which view is used in conjunction with the AP and lateral projections of the C-spine?
What vertebrae is demonstrated when you rotate the head 45-50 degrees for the AP axial oblique (pillars)
C2-C7 and T1
What vertebrae are demonstrated when you rotate the head 60-70 degrees for the AP axial oblique pillars?
C6 and T1-T4

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