Chapter 8 C-Spine & L-Spine
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Vertebra prominens = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
A. C7
What type of CR angle is required for posterior oblique (left posterior oblique [LPO]/right posterior oblique [RPO]) positions of the cervical spine? A) 15° cephalad B) 15° caudad C) 5° to 10° cephalad D) None; the CR is perpendicular to the image receptor (IR)
B. 15º cephalad pg. 312: Anterior obliques = 15º to 20º caudad Posterior obliques = 15º to 20º cephalad
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. B) Increase SID. C) Use a breathing technique. D) Flex the spine.
C. Use a breathing technique pg. 312: use orthostatic breathing technique to blur unwanted rib and lung markings.
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 B) Excessive extension of the skull C) Excessive CR angulation D) Rotation of the skull
Excessive extension of the skull
T/F: An RPO position of the cervical spine requires a 45 degree oblique of the body with a 15 degree caudad CR angle.
False
T/F: The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints.
False
T/F: The PA projection (Judd method) is intended to demonstrate the atlantoaxial joints between C1 and C2.
False pg. 317: pathology involving the dens and surrounding bony structures of the C1 ring.
Which aspect of the intervertebral disk is composed of semigelatinous material? a. nucluel pulposus b. annulus fibrosis c. conus medullaris d. cauda equina
Nucleus pulposus pg. 295: each disk consists of an outer fibrous portion termed the annulus fibrosus and a soft, semi-gelatinous termed nucleus pulposus.
T/F: Another term for a breathing technique during exposure is the orthostatic technique.
True
On average, how many separate bones make up the adult vertebral column? a. 33 b. 28 c. 26 d. 31
b. 26 pg. 292: there are 33 separate bones in the vertebral column of a young child. The adult vertebral column has 26 separate bones.
T2-T3 intervertebral disk space is found at the level of the: a. jugular notch b. sternal angle c. xiphoid process d. 2 inches (5 cm) below the jugular notch
a. jugular notch pg. 304: the jugular notch is at the level of T2 and T3.
The xiphoid process corresponds to the vertebral level of: a. T8 b. T9-10 c. T7 d. T12
b. T9-T10 pg. 304: the most inferior end of the sternum is called the xiphoid process, xiphoid tip, or ensiform process. The xiphoid tip is at the level of T9-T10.
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Dens = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
B. C2
Which position or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2? A) Anteroposterior (AP) axial B) Lateral C) 45° posterior or anterior oblique D) AP open mouth
D. AP open mouth pg. 296: In contrast to the other cervical zygapophyseal joints, those between C1 and C2 (atlantoaxial joints) are visualized only through AP open mouth projections.
Where is the articular pillar located on a cervical vertebra? a. between the superior and inferior articular processes b. between the pedicle and the body c. between the spinous process and the lamina d. nowhere
a. Between the superior and inferior articular processes pg. 297: the articular pillars = the segments of bone between the superior and inferior articular processes (they are called lateral masses for C1)
The most prominent aspect of the thyroid cartilage corresponds to the vertebral level of: a. C5 b. C1-2 c. C6-7 d. C7-T1
a. C5 pg. 304: the most prominent part of the thyroid cartilage (Adam's apple) is at the approximate level of C5. This thyroid cartilage landmark varies between the levels of C4 and C6.
The spinal cord tapers off to a point distally at the vertebral level of: a. lower L5 b. L2-L3 intervertebral space c. L1 - L2 d. L4 - 5 intervertebral space
c. L1-L2 pg. 292: the spinal cord continues down to the lower border of the first lumbar vertebrae (tapers off at the conus medullaris). In some persons the conus medullaris may extend as low as the body of L2.
Which of the following clinical conditions will require a decrease in manual technical factors? A) Advanced osteoporosis B) Severe scoliosis C) Moderate lordosis D) Scheuermann disease
A. Advanced osteoporosis Pg. 309: decrease in severe cases
Along with the upper incisors, what other bony landmark must be aligned for the AP open-mouth projection? A) Base of skull B) Tip of mandible C) Inferior margin of lower incisors D) Thyroid cartilage
A. Base of skull pg. 310: adjust the head so that a line from the lower margin of upper incisors to the base of the skull (mastoid tips —> correspond to the level of C1) is perpendicular to the table/IR
Fig. 8.17 C1 and C2 posterior oblique view
A. Transverse process B. Right superior articular surface of C2 C. Lamina of C2 D. Body of C2 E. Inferior articular surface of C1 F. Left atlantoaxial joint G. Superior facet (part of atlantooccipital joint) H. Anterior arch of the Atlas I. Odontoid process
What type of CR angle is recommended when performing the AP axial C spine projection erect? A) 15° cephalad B) 20° cephalad C) 15° caudad D) 25° cephalad
B. 20º degrees cephalad pg. 311: angle CR 15º to 20º cephalad - angle the CR 20º when the patient is erect, or when more lordotic curvature is evident.
Which of the following projections will project the dens within the shadow of the foramen magnum? A) AP open mouth B) AP projection (Fuchs method) C) Twining method D) None of the above
B. AP projection (Fuchs method) pg. 317
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Axis = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
B. C2
Which of the following projections will best demonstrate a compression fracture of the thoracic spine A) AP projection B) Lateral projection C) Posterior oblique positions D) Anterior oblique positions
B. Lateral projection
Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine? A) LPO B) RPO C) RAO D) Lateral
B. RPO pg. 303: the zygapophyseal joints form an angle of 70º to 75º from the midsagittal plane. Therefore, to demonstrate them a 70º to 75º oblique position with a perpendicular CR is required. Posterior Oblique T-spine = upside visualized. - LPO = right foramina - RPO = left foramina Anterior Oblique T-spine = downside visualized - LAO = left foramina - RAO = right foramina
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Anterior arch = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
C. C1
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Lateral masses = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
C. C1
A digital (CR) image taken of a lateral thoracic spine projection demonstrates poor visibility of the spine.The image was taken on a full 14 x 17-inch (35 x 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. B) Decrease mAs. C) Collimate to spine. D) Increase SID.
C. Collimate to spine
Which factor is most important to open up the intervertebral joint spaces for a lateral thoracic spine projection? A) Use sufficiently high kV. B) Collimate the spine region to reduce scatter. C) Keep vertebral column parallel to tabletop. D) Angle the central ray (CR) 5° to 10° caudad.
C. Keep vertebral column parallel to tabletop. pg. 321: support waist so entire spine is near parallel to table - lower vertebrae should be the same distance from the table as the upper vertebrae. A patient with broad shoulders may require a 10º to 15º cephalad CR angle if the waist is not supported.
Which of the following projections will best demonstrate the zygapophyseal joints of the cervical spine? A) AP axial B) Posterior oblique C) Lateral D) Anterior oblique
C. Lateral pg. 296: the zygapophyseal joints of C2 - C7 are located 90º to the midsagittal plane and thus are visualized only in a true lateral position.
A patient comes to radiology for a follow-up study for a clay shoveler's fracture. Which of the following projections will best demonstrate the extent of this fracture? A) AP cervical spine B) Lateral thoracic spine C) Lateral cervical spine D) AP axial-vertebral arch projection
C. Lateral cervical spine
Which imaging modality will best demonstrate herniated nucleus pulposus in the cervical spine A) Computed tomography (CT) B) Hyperflexion and hyperextension lateral projections C) Magnetic resonance imaging (MRI) D) Nuclear medicine
C. Magnetic resonance imaging (MRI)
The chin is extended for a lateral projection of the cervical spine to: A) open up the C1-2 joint space. B) demonstrate the articular pillars. C) open up the intervertebral joint space. D) prevent superimposition of the mandible upon the spine.
D. prevent superimposition of the mandible upon the spine. pg. 313: elevate the chin to place acanthiomeatal line (AML) parallel with the floor. Protract chin to prevent superimposition of the mandible on upper vertebrae).
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 B) AP thoracic spine C) Lateral cervical spine at 72-inch (183 cm) SID D) Lateral thoracic spine
Lateral thoracic spine
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. B) Use a compensating (wedge) filter. C) Increase the kV to decrease the contrast of the upper spine. D) Use a breathing technique.
Use a compensating (wedge) filter.
The zygapophyseal joints for the thoracic spine lie at an angle of ____ in relation to the midsagittal plane. a. 45° b. 60° c. 70° to 75° d. 90°
c. 70° to 75° pg. 299: in the thoracic vertebrae, the zygapophyseal joints form an angle of 70° to 75° from the midsagittal plane. To demonstrate them radiographically a 70° to 75° oblique position with a perpendicular CR is required.
The gonion corresponds to the vertebral level of: a. C1 b. C4-5 c. C3 d. C7
c. C3 pg. 304: with the head in a neutral position, the angel of the jaw, or gonion, is at the same level as C3.
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 B) Swimmer's lateral projection C) Spot AP and lateral projections of interest region D) 70° oblique projections
70 degree oblique projections
Which of the following factors does not apply to a lateral projection of the cervical spine? A) Use a 72-inch (183 cm) SID. B) Suspend respiration upon full inspiration. C) Perform horizontal-beam lateral projection if trauma is suspected. D) Center CR to thyroid cartilage.
B. Suspend respiration upon full inspiration pg. 313: you suspend on full expiration for maximum shoulder depression
Why are the anterior oblique projections (right anterior oblique [RAO]/left anterior oblique [LAO]) preferred over the posterior oblique projections of the cervical spine? A) To make the patient more comfortable B) To reduce the thyroid dose C) To prevent overlap of the mandible over the spine D) To place the zygapophyseal joints closer to the image receptor
B. To reduce the thyroid dose pg. 312: anterior oblique positions - RAO and LAO are preferred because f the reduced thyroid dose.
The AP axial-vertebral arch projection may be performed to better demonstrate the: A) C1 and C1-2 atlantoaxial joint spaces. B) articular pillars of C4-7. C) open intervertebral disk spaces of C3-T1. D) dens within the foramen magnum.
B. articular pillars of C4-7 pg. 319: pathology or trauma involving the posterior vertebral arch (particularly the pillars) of C4 to C7 and spinous processes of cervicothoracic vertebrae with whiplash injuries.
How much CR angulation is required for the AP axial projection for the cervical spine? A) CR is perpendicular to the image receptor. B) 5° to 10° cephalad C) 15° to 20° cephalad D) 15° to 20° caudad
C. 15º to 20º cephalad pg. Angle CR 15º to 20º cephalad —> cephalad angulation directs the beam between the overlapping cervical vertebral bodies to demonstrate the intervertebral joint spaces.
How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)? A) 20° B) 45° C) 50° to 60° D) 70°
D. 70º pg. 303: the zygapophyseal joints form an angle of 70º to 75º from the midsagittal plane. Therefore, to demonstrate them a 70º to 75º oblique position with a perpendicular CR is required
Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.) Typical cervical vertebra = ? a. C7 b. C2 c. C1 d. C4 e. T1 f. T7
D. C4
A 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 B) AP axial-vertebral arch projection C) Judd or Fuchs projection D) Hyperflexion and hyperextension projections
D. Hyperflexion and hyperextension projections
Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine? A) RAO B) Left posterior oblique (LPO) C) Lateral D) LAO
D. LAO pg. 296: the intervertebral foramina are situated at a 45º angle to the midsagittal plane. They also are directed at a 15º inferior angle — therefore to open up and demonstrate them a 45º oblique position combined with a 15º cephalad angle of the CR is required. pg. 302: Posterior Oblique C-spine = upside visualized. - LPO = right foramina - RPO = left foramina Anterior Oblique C-spine = downside visualized - LAO = left foramina - RAO = right foramina
A patient enters the ED due to an MVA. He is on a backboard 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. B) Repeat the exposure but ask the patient to stand up and do the lateral projection erect. C) Repeat the exposure but have a student pull down on the arms during the exposure. D) Perform the horizontal beam cervicothoracic (swimmer's) lateral position.
D. Perform the horizontal beam cervicothoracic (swimmer's) lateral position
T/F: The posterior cervical oblique projections demonstrate the intervertebral foramina and pedicles on the side closest to the image receptor
False pg. 312: anterior oblique demonstrates the intervertebral foramina and pedicles on the side closest to the image receptor. Posterior obliques demonstrate intervertebral foramina and pedicles on the side farthest from the image receptor.
A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following analog factors were used for this projection: 5 degree 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. B) Increase the SID to 72 inches (183 cm). C) Center the CR to the gonion. D) Increase the CR angulation.
Increase the CR angulation.
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 B) Increase the flexion of the skull. C) Angle the CR 3° to 5° caudad. D) Have the patient hold 5 to 10 lb in each hand.
Increase the extension of the skull
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 B) Insufficient CR angulation C) Insufficient rotation of the upper body D) Incorrect CR placement
Insufficient rotation of the upper body
A patient enters the emergency department (ED) because of a motor vehicle accident (MVA). The patient is on a backboardand 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. B) Remove the cervical collar but be careful not to move the patient's head. C) Ask the patient to remove the collar herself (for liability reasons). D) Ask the ED physician to remove the collar and to hold the patient's head while the technologist is initiating the exposure.
Leave the collar on during the exposure
A patient enters the ED with a cervical spine injury as a result of a fall. The initial horizontal beam lateral projection reveals no subluxation or fracture. The ED 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 B) Oblique projections of the cervical spine C) Patient in hyperflexion and hyperextension lateral positions D) AP Ottonello method
Patient in hyperflexion and hyperextension lateral positions
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. B) Angle the CR 10° to 15° cephalad. C) Perform the projection with the patient erect and holding weights in hand during exposure. D) Perform a cervicothoracic (swimmer's) lateral position.
Perform a cervicothoracic (swimmer's) lateral position
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. B) Increase the extension of the skull. C) Perform the Fuchs or Judd method. D) Perform the AP chewing projection.
Perform the Fuchs or Judd method
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. B) Increase the kV, lower the mAs. C) Use a higher-ratio grid. D) Place a lead mat on the tabletop just posterior to the patient.
Place a lead mat on the tabletop just posterior to the patient.
A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric. No fracture or subluxation is present. Which one of the following positioning errors most likely led to this radiographic outcome? A) Excessive CR angulation B) Insufficient CR angulation C) Rotation of the spine D) Excessive flexion of the head
Rotation of the spine
Spondylitis is defined as a(n): a. inflammation of the vertebrae. b. normal lumbar curvature. c. abnormal exaggerated lateral curvature of the spine. d. abnormal thoracic curvature with increased convexity.
a. inflammation of the vertebrae pg. 308: spondylitis - this condition is inflammation of the vertebrae
The bony structures connected directly to the vertebral body are the: a. pedicles b. articular processes c laminae d. transverse process
a. pedicles pg. 294: extending posteriorly, directly from the vertebral body on each side are the pedicles.
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. b. The transverse processes are present only on thoracic vertebrae containing rib connections. c. The spinous process extends posteriorly from the body of the vertebra. d. All of the above are true statements.
a. the transverse processes extend laterally from the junction of the pedicles and laminae. pg. 294: extending laterally from approximately the junction of each pedicle and lamina is a projection termed the transverse process.
The joints between articular processes of vertebra are termed _____ joints. a. zygopophyseal b. fibrous c. intervertebral d. synarthrodial
a. zygapophyseal pg. 295: four articular processes (2 inferior & 2 superior) project from the area of the junction of the pedicles (superiorly) and laminae (inferiorly). These processes articulate to form the zygapophyseal joints.
Which of the following is the first compensatory spinal curvature to develop in the young child? a. thoracic b. cervical c. sacral d. lumbar
b. Cervical pg. 293: As children begin to raise their heads and sit up, the first compensatory concave curve forms in the cervical region.
Which of the following thoracic vertebra(e) possess no facets for costotransverse joints? a. T9-10 b. T11-12 c. T1 d. None of the above
b. T11-T12 pg. 298: Costotransverse joints = articulation between the transverse process of the thoracic vertebrae and the tubercles of the ribs. Only the first 10 thoracic vertebrae have facets for costotransverse joints.
Along with increasing the source image receptor distance (SID), what other factor(s) will improve spatial resolution for lateral and oblique projections of the cervical spine? a. increasing object image receptor distance (OID) b. using a small focal spot c. using higher kV, lower mAs d. using a breathing technique
b. Using a small focal spot pg. 305 use of a small focal spot can improve spatial resolution. An increased SID of 60" to 72" should be used for lateral, cervicothoracic, and oblique projections to compensate for the increased OID of this positions.
The most posterior aspect of a typical vertebra is the: a. pedicle b. spinous process c. lamina d body
b. spinous process. pg. 294: the spinous process extends posteriorly at the midline junction of the two laminae. Te spinous process, the most posterior extension of the vertebrae, often can be palpated along the posterior surface of the neck and back.
Which of the following pathologic conditions causes neck stiffness dues to arthritic changes that may affect the zygapophyseal joints and intervertebral formina? a. spondylitis b. ankylosing spondylitis c. spondylosis d. scheuermann disease
c. Spondylosis
The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ in relation to the midsagittal plane. a. 45° b. 60° c. 70° to 75° d. 90°
d. 90° pg. 296: the zygapophyseal joints of the 2nd through 7th cervical vertebrae are located at right angles (90°) to the midsagittal plane, and thus are visualized in only a true lateral position.
Which of the following features makes the cervical vertebra unique as compared with other vertebrae of the spine? a. Transverse foramina b. Overlapping vertebral bodies c. Double (bifid) tips on spinous processes d. All of the above
d. All of the above pg. 296: Cervical vertebra have unique characteristics such as transverse foramina, bifid spinous process tips, and overlapping vertebral bodies
Which of the following is NOT a correct evaluation criterion for the AP axial C-spine projection? a. C3 to T2 vertebral bodies should be visualized. b. Spinous processes are seen to be equal distances from the vertebra body lateral borders. c. Center of the collimation field is at C4. d. All of the above are correct criteria.
d. All of the above are correct criteria. Pg. 311
Kyphosis is defined as: a. normal lumbar curvature b. normal convex sacral curvature c. normal compensatory curve of thoracic spine d. abnormal thoracic curvature with increased convexity
d. abnormal thoracic curvature with increased convexity. pg. 293: an abnormal condition characterized by increased convexity of the thoracic curvature ("humpback").
Which of the following statements is true? a. all adult vertebra are separated by intervertebral disks b. all thoracic vertebrae have at least one facet for rib articulation c. the intervertebral disks are tightly bound to their vertebral bodies to prevent movement with the vertebral column d. all of the above are true statements
d. all of the above are true statements pg. 292: tough fibrocartilaginous disks (intervertebral disks) separate typical adult vertebrae. pg. 298: all 12 thoracic vertebrae have facets for articulation with ribs = costovertebral joints. Costovertebral joints = articulation between the head of the rib and thoracic vertebrae. Costotransverse joints = articulation between the transverse process of the thoracic vertebrae and the tubercles of the ribs. Only the first 10 thoracic vertebrae have facets for costotransverse joints. pg. 292: these cushion like disks (intervertebral disks) are tightly bound to the vertebrae for spinal stability
Which term best defines or describes the vertebral body of C1? a. the smallest of all vertebral bodies b. a column of bone supported by intervertebral disk c. a large bony mass d. there is no vertebral body at C1
d. there is no vertebral body at C1. pg. 297: anteriorly there is no body but simply a thick arch of one called the anterior arch.
Scoliosis is defined as an abnormal or exaggerated _____ curvature a. concave b. convex c. lateral d. "swayback" lumbar
lateral pg. 293: an abnormal or exaggerated lateral curve of the spin is called scoliosis.
The thyroid dose for a posterior cervical oblique is ____ greater than that of the anterior oblique. A) two times B) one fourth C) more than 10 times D) None of these; there is no significant difference with proper collimation.
more than 10 times
