Cervical and Thoracic Spine

Situation: A radiograph of an AP open-mouth projection reveals that the base of the skull is superimposed over the dens. What positioning error led to this radiographic outcome? A. Excessive flexion of the skull C. Excessive CR angulation B. Excessive extension of the skull D. Rotation of the skull

b

Situation: A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed. The lower vertebrae have acceptable density and contrast. Which one of the following modifications will improve the visibility of the upper thoracic spine? A. Place the upper spine under the cathode side of the tube. C. Increase the kV to decrease the contrast of the upper spine. B. Use a compensating (wedge) filter. D. Use a breathing technique.

b

Which of the following curves is classified as being compensatory? A. Thoracic C. Sacral B. Cervical D. None of the above

b

Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine? A. LPO C. RAO B. RPO D. Lateral

b

How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)? A. 20 C. 50 to 60 B. 45 D. 70

d

Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine? A. RAO C. Lateral B. LPO D. LAO

d

Which position and/or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2? A. AP axial C. 45 obliques B. Lateral D. AP open mouth

d

An inflammation of the vertebrae, more common in men ages 20 to 40 years, causing calcification and forming bony ridges between vertebrae, resulting in stiffness and lack of spinal column mobility

Ankylosing spondylitis

Which of the following factors does not apply to a lateral projection of the cervical spine? A. Use a 72-inch (183 cm) SID. C. Perform horizontal-beam lateral projection if trauma is suspected. B. Suspend respiration upon full inspiration. D. Center CR to thyroid cartilage.

b

Which of the following thoracic vertebra(e) possess no facets for costotransverse joints? A. T9-10 C. T1 B. T11-12 D. None of the above

b

Why are the anterior oblique projections (RAO/LAO) preferred over the posterior oblique projections of the cervical spine? A. More comfortable for the patient C. Prevent overlap of the mandible over the spine B. Less thyroid and breast dose D. Place the zygapophyseal joints closer to the image receptor

b

For an average-size adult, which of the following would receive the highest skin dose? A. AP "wagging jaw" cervical spine, 3-second exposure time C. Lateral cervical spine at 72-inch (183 cm) SID B. AP thoracic spine D. Lateral thoracic spine

d

Fracture through pedicles of C2, usually resulting in anterior subluxation of C2 on C3

Hangman's fracture

Herniation of intervertebral disk into the spinal canal

Herniated nucleus pulposus

Comminuted fracture of the anterior and posterior arches of C1 caused by an "on-end" impact trauma demonstrated by the offset or spreading of lateral masses:

Jefferson fracture

Abnormal convex thoracic curvature

Kyphosis

T2-3 intervertebral disk space is found at the level of the: A. jugular notch. C. xiphoid process. B. sternal angle. D. 2 inches (5 cm) below the jugular notch.

a

A fracture of the vertebral body in which the anterior margin collapses, frequently associated with osteoporosis

Compression fracture

Normal or abnormal concave lumbar curvature

Lordosis

A disease more common in teenage boys than girls, resulting in spinal curvature

Scheuermann disease

Inflammation of the vertebrae

Spondylitis

Comminuted fragments from anteroinferior and posterior vertebral borders displaced into the spinal canal, frequently resulting in quadriplegia neurologic damage

Teardrop burst fracture

Along with the upper incisors, what other bony landmark must be aligned for the AP open-mouth projection? A. Base of skull C. Inferior margin of lower incisors B. Tip of mandible D. Thyroid cartilage

a

Situation: A patient enters the ER because of a motor vehicle accident. The patient is on a back board and wearing a cervical collar. The technologist is concerned about the artifacts that the collar will project on the spine during the horizontal beam lateral projection. What should the technologist do in this situation? A. Leave the collar on during the exposure. C. Ask the patient to remove the collar herself (for liability reasons). B. Remove the cervical collar but be careful not to move the patient's head. D. Ask the ER physician to remove the collar and to hold the patient's head while the technologist is initiating the exposure.

a

Situation: A radiograph of a lateral projection of the cervical spine reveals that the ramus of the mandible is superimposed over the spine. What could the technologist have done to prevent this? A. Increase the extension of the skull. C. Angle the CR 3 to 5 caudad. B. Increase the flexion of the skull. D. Have the patient hold 5 to 10 lb in each hand.

a

The bony structures connected directly to the vertebral body are the: A. pedicles. C. laminae. B. articular processes. D. transverse processes.

a

The breast dose for a posterior oblique thoracic spine is more than four times the dose of an anterior oblique. A. True B. False

a

The joints between articular processes of vertebra are termed: A. zygapophyseal joints. C. intervertebral joints. B. fibrous joints. D. synarthrodial joints.

a

The most prominent aspect of the thyroid cartilage corresponds to the vertebral level of: A. C5. C. C6-7. B. C1-2. D. C7-T1.

a

What type of CR angle is required for posterior oblique (LPO/RPO) positions of the cervical spine? A. 15 cephalad C. 5 to 10 cephalad B. 15 caudad D. None. CR is perpendicular to IR.

a

Where is the articular pillar located on a cervical vertebra? A. Between the superior and inferior articular processes C. Between the spinous process and the lamina B. Between the pedicle and the body D. Are not present on cervical vertebrae

a

Which aspect of the intervertebral disk is composed of semigelatinous material? A. Nucleus pulposus C. Conus medullaris B. Annulus fibrosus D. Cauda equina

a

Which of the following pathologic conditions will require a decrease in manual technical factors? A. Advanced osteoporosis C. Moderate lordosis B. Severe scoliosis D. Scheuermann disease

a

Which of the following statements is true for a typical adult vertebra? A. The transverse processes extend laterally from the junction of the pedicles and laminae. C. The spinous process extends posteriorly from the body of the vertebra. B. The transverse processes are present only on thoracic vertebrae containing rib connections. D. All of the above

a

Along with increasing the SID, what other factor will improve detail for lateral and oblique projections of the cervical spine? A. Increasing OID C. Using higher kV, lower mAs B. Using a small focal spot D. Using a breathing technique

b

An RPO position of the cervical spine requires a 45 oblique of the body with a 15 caudad CR angle. A. True B. False

b

The AP axial-vertebral arch projection may be performed to better demonstrate the: A. lateral masses of C1 and C1-2 zygapophyseal joint space. C. open intervertebral disk spaces of C3-T1. B. articular pillars of C4-7. D. dens within the foramen magnum.

b

The PA projection (Judd method) is intended to demonstrate the zygapophyseal joint between C1 and C2. A. True B. False

b

The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints. A. True B. False

b

The most posterior aspect of a typical vertebra is the: A. pedicle. C. lamina. B. spinous process. D. body.

b

The posterior cervical oblique projections demonstrate the intervertebral foramina and pedicles on the side closest to the image receptor. A. True B. False

b

The xiphoid process corresponds to the vertebral level of: A. T8. C. T7. B. T10. D. T12.

b

What type of CR angle must be used when performing the AP axial C spine projection erect? A. 15 cephalad C. 15 caudad B. 20 cephalad D. 25 cephalad

b

Which of the following projections will project the dens within the shadow of the foramen magnum? A. AP open mouth C. Twining method B. AP projection (Fuchs method) D. None of the above

b

Which of the following statements is true? A. All adult vertebrae are separated by intervertebral disks. C. The intervertebral disks are tightly bound to the vertebral bodies to prevent movement within the vertebral column. B. All thoracic vertebrae have at least one facet for rib articulation. D. All of the above

b

Which one of the following projections will best demonstrate a compression fracture of the thoracic spine? A. AP projection C. Posterior oblique positions B. Lateral projection D. Anterior oblique positions

b

How many bones make up the adult vertebral column? A. 33 C. 26 B. 28 D. 31

c

How much CR angulation is required for the AP axial projection for the cervical spine? A. CR is perpendicular to the image receptor C. 15 to 20 cephalad B. 5 to 10 cephalad D. 15 to 20 caudad

c

Scoliosis is defined as an abnormal or exaggerated: A. concave curvature. C. lateral curvature. B. convex curvature. D. "swayback" lumbar curvature.

c

Situation: A digital (CR) radiograph taken of a lateral thoracic spine projection demonstrates poor visibility of the spine. The image was taken on a full 14 17-inch (35 43 cm) IR. The following factors were used during the exposure: 80 kV, 80 mAs, 40-inch (102 cm) SID, and collimation to the size of the IR. Which one of the following modifications will result in a more diagnostic image? A. Decrease kV C. Collimate to spine B. Decrease mAs D. Increase SID

c

Situation: A patient comes to radiology for a follow-up study for a clay shoveler's fracture. Which of the following projections will best demonstrate this fracture? A. AP cervical spine C. Lateral cervical spine B. Lateral thoracic spine D. AP axial-vertebral arch projection

c

Situation: A patient comes to the radiology department for a cervical spine routine. The study is ordered for nontraumatic reasons. The AP open-mouth projection reveals that the base of the skull and upper incisors are superimposed, but they are obscuring the upper portion of the dens. On the repeat exposure, what should the technologist do to demonstrate the entire dens? A. Increase the flexion of the skull. C. Perform the Fuchs or Judd method. B. Increase the extension of the skull. D. Perform the AP chewing projection.

c

Situation: A patient enters the ER with a cervical spine injury as a result of a fall. The initial horizontal beam lateral projection reveals no subluxation or fracture. The ER physician is concerned about a whiplash injury. Which of the following routines would be most helpful in diagnosing this type of injury? A. Patient in the swimmer's lateral position C. Patient in hyperflexion and hyperextension lateral positions B. Oblique projections of the cervical spine D. AP Ottonello method

c

Situation: A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric. No fracture or subluxation are present. Which one of the following positioning errors most likely lead to this radiographic outcome? A. Excessive CR angulation C. Rotation of the spine B. Insufficient CR angulation D. Excessive flexion of the head

c

Situation: A radiograph of an RAO of the cervical spine reveals that the lower intervertebral foramina are not open. The upper vertebral foramina are well visualized. Which positioning error most likely lead to this radiographic outcome? A. Excessive CR angulation C. Insufficient rotation of the upper body B. Insufficient CR angulation D. Incorrect CR placement

c

The gonion corresponds to the vertebral level of: A. C1. C. C3. B. C4-5. D. C7.

c

The spinal cord tapers off to a point distally at the level of: A. lower L5. C. L1-L2. B. L2-3 intervertebral space. D. L4-5 intervertebral space.

c

The thyroid dose for a posterior cervical oblique is ____ greater than that of the anterior oblique. A. two times C. more than 10 times B. one fourth D. None of the above; there is no significant difference with proper collimation.

c

The zygapophyseal joints for the thoracic spine lie at an angle of ____ in relation to the midsagittal plane. A. 45 C. 70 to 75 B. 60 D. 90

c

Which factor is most important to open up the intervertebral joint spaces for a lateral thoracic spine projection? A. Use sufficiently high kV C. Keep vertebral column parallel to tabletop B. Collimate the spine region to reduce scatter D. Angle the CR 5 to 10 caudad

c

Which imaging modality will best demonstrate HNP in the cervical spine? A. CT C. MRI B. Hyperflexion and hyperextension lateral projections D. Nuclear medicine

c

Which of the following factors will enhance the visibility of the vertebral bodies during a lateral projection of the thoracic spine? A. Use a high kV C. Use a breathing technique B. Increase SID D. Flex the spine

c

Which of the following pathologic conditions is defined as "a condition of the spine characterized by rigidity of a vertebral joint"? A. Spondylitis C. Spondylosis B. Ankylosing spondylitis D. Scheuermann disease

c

Which of the following positions will best demonstrate the zygapophyseal joints of the cervical spine? A. AP axial C. Lateral B. Posterior obliques D. Anterior obliques

c

Kyphosis is defined as a(n): A. normal or abnormal lumbar swayback curvature. C. normal compensatory curve of thoracic spine. B. normal or abnormal convex sacral curvature. D. abnormal thoracic curvature with increased convexity.

d

Situation: A lateral projection of the thoracic spine reveals that the upper aspect, which is a primary area of interest on this patient, is obscured by the patient's shoulders. Which of the following changes will best demonstrate this region of the spine? A. Use a compensating (wedge) filter and repeat the exposure with increased kV. C. Perform the projection with the patient erect and holding weights in hand during exposure. B. Angle the CR 10 to 15 cephalad. D. Perform a cervicothoracic (swimmer's) lateral position.

d

Situation: A patient comes to radiology for a thoracic spine routine. The patient has a history of arthritis of the spine. The radiologist requests that additional projections be taken to demonstrate the zygapophyseal joints. What positions and/or projections would be ideal to demonstrate these structures? A. Pillar view projection of interest region C. Spot AP and lateral projections of interest region B. Swimmer's lateral projection D. 70 oblique projections

d

Situation: A patient enters the ER due to a MVA. He is on a back board and in a cervical collar. The initial lateral cervical spine projection demonstrates C1 to C6. The patient has broad and thick shoulders. Because the hospital is in a rural setting, no CT scanner is available. Which of the following modifications would best demonstrate the lower cervical spine? A. Repeat the exposure and increase kV. C. Repeat the exposure but have a student pull down on the arms during the exposure. B. Repeat the exposure but ask the patient to stand up and do the lateral projection erect. D. Perform the horizontal beam cervicothoracic (swimmer's) lateral position.

d

Situation: A radiograph of a lateral thoracic spine reveals that there is excessive density along the posterior aspect of the spine. Even with good collimation, the scatter radiation reaching the image receptor obscures the spinous processes. What can the technologist do to improve the visibility of the posterior elements of the spine? A. Use higher-speed screens and film. C. Use a higher-ratio grid. B. Increase the kV, lower the mAs. D. Place a lead mat on the tabletop just posterior to the patient.

d

Situation: A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following factors were used for this projection: 5 cephalad angle, 40-inch (100 cm) SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage. Which of the following modifications should be made during the repeat exposure? A. Keep the CR perpendicular to the image receptor. C. Center the CR to the gonion. B. Increase the SID to 72 inches (183 cm). D. Increase the CR angulation.

d

Situation: Patient comes to radiology for a follow-up study of the cervical spine. The patient had spinal fusion between C5-6 performed 6 months earlier. His physician wants to assess the cervical spine for anteroposterior mobility. Which of the following projections would provide this assessment? A. Cervicothoracic projection C. Judd or Fuchs projection B. AP axial-vertebral arch projection D. Hyperflexion and hyperextension projections

d

The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ in relation to the midsagittal plane. A. 45 C. 70 to 75 B. 60 D. 90

d

Which of the following features makes the cervical vertebra unique as compared with other vertebrae of the spine? A. Transverse foramina and double (bifid) tips on spinous processes C. Presence of zygapophyseal joints B. Overlapping vertebral bodies D. All of the above

d

Which of the following is not a correct criterion for the AP axial C spine projection? A. C3 to T2 or T3 vertebral bodies should be visible. C. Center of the collimation field is at C4. B. Spinous processes are seen to be equal distances from the vertebra body lateral borders. D. All of the above are correct criteria.

d

Which term best defines or describes the vertebral body of C1? A. The smallest of all vertebral bodies C. A large bony mass B. A column of bone supported by an intervertebral disk D. There is no vertebral body at C1.

d

Why is the chin extended for a lateral projection of the cervical spine? A. To open up the C1-2 joint space C. To open up the intervertebral joint space B. To demonstrate the articular pillars D. To prevent superimposition of the mandible upon the spine

d