Lecture Test 3 (Fall Semester)

What type of CR angle is required for the posterior oblique (LPO/RPO) positions of the cervical spine?

15 degree cephalad

For the central ray to pass through and "open" the intervertebral spaces on a 45-degree posterior oblique projection of the cervical vertebrae, what central ray angle (if any) is required?

15 degrees cephalad

What central ray angulation (amount and direction) must be used with a posterior oblique projection of the cervical spine?

15-20 degrees cephalad

How many bones are found in the coccyx?

1

How many bones are found in the sacrum?

1

What are the functions for the spinal column?

1. encloses & protects the spinal cord 2. acts like a support 3. supports the skull 4. provides attachment to the deep muscles of the back and ribs

How much is the CR angled for the AP axial coccyx projection?

10 degrees caudad

How many bones are found in the thoracic vertebra?

12

Where is the central ray centered for an AP projection of the coccyx?

2 inches superior to the symphysis pubis

How many bones total makes up the adult vertebral column?

26

For the Ferguson method, the elevated foot must be raised a minimum of __________ inches.

3-4

How much rotation is required to visualize the zygapophyseal joints properly at the L5-S1 level?

30 degrees

How much would you angle the tube on a male patient when performing a L5-S1 position?

30 degrees

what CR angulation should be used an AP axial projection of the L5-S1 Joint space on a male patient?

30 degrees cephalad

How much would you angle the tube on a female patient when performing a L5-S1 position?

35 degrees

What is the recommended SID for the cervicothoracic position of the cervical spine?

40, 60-72 inches

The average degree of rotation required to demonstrate the L3-L4 zygapophyseal joints is:

45 degrees

How many bones are found in the lumbar vertebra?

5

A patient with a wide pelvis and a narrow thorax may require a central ray angle of ______ Degrees __________ for a lateral position of the lumbar spine

5, caudad

How many bones are found in the cervical vertebra?

7

Situation: a young female patient comes to radiology for a scoliosis study. The patient has had the series perform frequently. How much would the breast dose be decreased if a PA rather than an AP projection is taken?

90%

A radiograph of a lateral L5-S1 projection shows that the joint space is not open. The technologist did support the middle aspect of the spine with a sponge. What else can a technologist due to open up the joint space during the repeat exposure

Angle tube 5-8 degrees

What is an inflammatory condition that is most common in males in their 30's?

Ankylosing spondylitis

Before inserting contrast through a diabetics veins, what should you ask the patient?

Ask them if they are on glucophage

List alternative names for the following cervical vertebrae: C1, C2, and C7.

Atlas, axis, vertebra prominens

For an AP axial of the cervical spine, a plane through the tip of the mandible and the __________ should be parallel to the angled central ray.

Base of skull

The center portion of the sternum is called __________.

Body

The two main parts of a typical vertebra are the __________ and the __________.

Body; vertebral arch

Which modality best demonstrates osteoporosis?

Bone densitometry

What is the most common type of needle?

Butterfly needle

The mastoid tip is at the level of __________.

C1

Where would you find the dens/odontoid?

C2

The gonion is at the level of __________.

C3

The thyroid cartilage is at the level of __________.

C4-C6

The vertebra prominens is at the level of __________.

C7-T1

What is a fracture of the vertebral body cause by hyper flexion force called?

Chance fracture

What is the formal term for the "tailbone"?

Coccyx

Situation: a patient comes in with a possible compression fracture of L3. What positioning routines would best demonstrate the body of L3 and the intervertebral joint spaces above and below it?

Collimated AP and lateral projections

What is a type of fracture that rarely causes neurologic deficits?

Compression fracture

Which modality best demonstrates compression fractures of the lumbar spine?

Computed tomography (CT)

A radiograph of an AP projection of the lumbar spine on average sized patient reveals that the psoas muscles and transverse processes are not visible. The following factors were use for this projection: AEC with center ionization chamber, 95 kV, 40in SID, grid, and 14 x 17 image receptor. What modification will be most effective in demonstrating the structures?

Decrease the kV

The modified body of C2 is called the __________ or __________.

Dens or odontoid process

Which positioning error has been committed if the pedicles are too far posterior with a 45 degree oblique position of the lumbar spine?

Excessive rotation

The lateral projection of the cervical spine should be taken during __________ (inspiration, expiration, or suspended respiration). Why?

Expiration; for maximum shoulder depression

True/False: An RPO position of the cervical spine requires a 45 degree oblique of the body with a 15-20 degree caudad angle

False

True/False: The anterior oblique (RAO and LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the IR

False

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

False

True/False: The use of higher kV and lower mA seconds (mAs) for lumbar spine radiography improves radiographic contrast but increases patient dose.

False

True/Fasle: the "nose" of the Scotty dog represents the spinous process of a lumbar vertebra

False

True/false: The lead blocker mat and close collimation must not be used when performing digital imaging of the lumbar spine.

False

True/false: the second projection for the Ferguson method of the scoliosis series requires that the concave side of the curve be built up 3 to 4 inches by placing blocks beneath the patients foot

False

True/False: Gonadal shielding should always be used for male and female patients for studies of the lumbar spine, sacrum, and coccyx.

False (not used for females if the shield would obscure essential anatomy)

True/False: The knees and hips should be extended for an AP projection of the lumbar spine.

False (should be flexed)

True/False The tip of the odontoid process does not have to be demonstrated on the AP "open mouth" projection, because it is best seen on the lateral projection.

False; the entire dens or odontoid process must be demonstrated. If trauma or injury is ruled out, the technologist could perform the AP or PA projection for the odontoid process to demonstrate the tip.

Situation: Patient comes to radiology for a follow-up study of the cervical spine. The patient had spinal fusion between C5-C6 performed 6 months earlier. His physician wants to assess the cervical spine for anteroposterior mobility. Which of the following projections would provide this assessment?

Flexion and extension projections

What are needles described by?

Gauge

The condition involving a "slipped disk" is correctly referred to as __________.

Herniated nucleus pulposus (HNP)

What is most common at L4-L5 level and may result in sciatica?

Herniated nucleus pulposus (HNP)

When should the Judd or Fuchs method be performed?

If unable to demonstrate the upper portion of the odontoid process (dens) with the AP "open mouth" projection

With a 14x17 IR, the central ray is at the level of the __________ for AP and lateral lumbar spine projections.

Iliac crest

Two small notches on the superior and inferior aspects of the pedicles create the __________ foramina.

Intervertebral

The superior and inferior vertebral notches join together to form the __________.

Intervertebral foramina

An advantage of a PA projection of the lumbar spine compared with the AP projection is:

It opens the intervertebral disk space more and it reduces female ovarian dose by 25% to 30%

The superior margin of the upper section of the manibrium (landmark) is called __________.

Jugular (suprasternal) notch

which factor is most important to open up the intervertebral joint spaces for a lateral thoracic spine projection?

Keep vertebral column parallel to tabletop

An abnormal or exaggerated thoracic hump back curvature of the spine is called?

Kyphosis

The spine cord tapers off to a point at the level of:

L1-L2

The lower costal margin is located at the level of __________.

L2-L3

The iliac crest is located at the level of __________.

L4-L5

The __________ are two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline.

Lamina

On a cervical spine, the intervertebral disk/joint space is best seen on what position?

Lateral

What position will best demonstrate the zygapophyseal joints of the cervical spine?

Lateral

Which position or projection of the lumbar spine series best demonstrates a possible compression fracture?

Lateral

When x-raying the vertebral column, what is the most important x-ray?

Lateral C-spine

To rule out whiplash, what positions would you do?

Lateral Flexion and Extension

Situation: a patient comes to radiology for a follow up study of the lumbar spine. The patient recently had a spinal fusion performed at the L3-L4 level. What would best demonstrate the degree of movement at the fusion site?

Lateral hyperextension and hyperflexion projections

On a Cervical spine, what position would best demonstrate a collapse vertebral body?

Lateral position

On a Lumbar spine, what position would demonstrate the intervertebral foramina?

Lateral position

Which radiographic position best demonstrates the intervertebral foramina?

Lateral position

Which specific projection must be taken first if trauma to the cervical spine is suspected and the patient is in a supine position on a backboard?

Lateral; horizontal beam projection

Situation: A patient enters the ED due to 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 for the first cervical spine projection?

Leave the collar on during the exposure

Which foramina are demonstrated with a left anterior oblique (LAO) position of the cervical spine?

Left intervertebral foramina (upside)

A bent inward or an abnormal increased swayback curvature of the lumbar spine is called?

Lordosis

An abnormal, or exaggerated, "sway back" lumbar curvature is called __________.

Lordosis

Which two landmarks must be aligned for an AP "open mouth" projection?

Lower margin of upper incisors (teeth) and base of skull

Which modality best demonstrates soft tissues of the lumbar spine?

Magnetic resonance imaging (MRI)

Which modality best demonstrates structures within the subarachnoid space?

Magnetic resonance imaging (MRI) and myelography

The upper portion of the sternum is called __________.

Manubrium

The spinal cord begins with the __________ of the brain and extends down to the __________ vertebra, where it tapers and ends. The tapered ending is called the __________.

Medulla oblongata, lower border of L1, conus medullaris

Which imaging modality is ideal for detecting early signs of osteomyelitis?

Nuclear medicine

Which modality best demonstrates inflammatory conditions such as Paget's disease?

Nuclear medicine

When doing a thoracic spine, what position do you perform to demonstrate the z-joints?

Oblique

On a Lumbar spine, what position would demonstrate the z-joints?

Oblique position

If a patient cannot lie on his back for the AP sacrum because it is too painful, what alternate projection can be taken to achieve a similar view of the sacrum?

PA (prone) with 15 degrees caudad central ray angle

A portion of the lamina located between the superior and inferior articular processes is called the __________.

Pars interarticularis

The area between the superior and inferior articulating processes is called?

Pars interarticularis

The small section of bone found between the superior and inferior processes of the lumbar spine is termed:

Pars interarticularis

The ___________, which is the eye of "Scottie dog" should be near the center of the vertebral body on a correctly oblique lumbar spine position

Pedicle

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 the region of the spine?

Perform a swimmer's lateral projection

Situation: A patient enters the ED 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. If a CT scanner is not available what should the technologist do next?

Perform horizontal beam swimmer's lateral projection

The symphysis pubis is located at the level of the __________.

Prominence of the greater trochanter

A radiograph of an AP open-mouth projections of the cervical spine reveals that the zygapophyseal joints are not symmetrical. What positioning error can lead to this radiographic outcome?

Rotation of the spine

Which specific set of zygapophyseal joints is demonstrated with and LAO position?

Right (upside)

Which foramina are demonstrated with a left posterior oblique (LPO) position of the cervical spine?

Right intervertebral foramina (upside)

In addition to extending the chin, which additional positioning technique can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for oblique projections?

Rotate the skull into a near lateral position

A radiograph of the in AP projection of the lumbar spine shows at the spinous processes are not midline to the vertebral column and distortion of the vertebral bodies is present. Which specific positioning error is present on this radiograph?

Rotation issue

The ASIS is located at the level of __________.

S1-S2

Which two structures can be evaluated to determine whether rotation is present on a radiograph of an AP projection of the lumbar spine?

Sacroiliac (SI) joints are equidistant from the spine; spinous process should be midline to the vertebral column (transverse processes are equal length)

An abnormal lateral curvature of the spine is called?

Scoliosis

An abnormal lateral curvature seen in the thoracolumbar spine is called __________.

Scoliosis

What is the lateral curvature of the vertebral column called?

Scoliosis

What is the congenital defect in which the posterior elements of the vertebrae fail to unite called?

Spina bifida

Which structures pass through the intervertebral foramina?

Spinal nerves and blood vessels

What is the forward displacement of one vertebra onto another vertebra?

Spondylolisthesis

What is dissolution and separation of the pars interarticularis called?

Spondylolysis

The joint between top and center portions of the manibrium (landmark) is called __________.

Sternal angle

The jugular notch is at the level of __________.

T2-T3

The sternal angle is at the level of _________.

T4-T5

3-4 inches below the jugular notch is at the level of __________.

T7

The xiphoid process (tip) is at the level of __________.

T9-T10

The xiphoid process is located at the level of __________.

T9-T10

What term best defines or describes the vertebral body of C1?

There is no vertebral body at C1

True/False: Performing the cervicothoracic projection is often required to demonstrate the C7/T1 region for the obese patient.

True

True/False: Placing a lead blocker mat behind the patient for lateral lumbar spine positions improves image quality.

True

True/False: When positioning the obese patient, the iliac crest is typically at the level of the inferior margin of the flexed elbow.

True

True/false: Radiation is crucial when performing a scoliosis series

True

True/false: Standing is easier when performing a scoliosis series

True

True/false: bone densitometry is approximately 30 times more accurate for detecting bone loss compared with conventional radiography

True

True/false: the pelvis must remain stationary for the AP right and left bending projections of the scoliosis series

True

What is the Swimmer's position also known as?

Twining method

What is the purpose of the 15-20 degree cephalad angle for the AP axial projection of the cervical spine?

To open up the intervertebral disk spaces

Why should the hips and knees be flexed for an AP projection of the lumbar spine?

To reduce the lumbar curvature

List three features that make the cervical vertebrae unique.

Transverse foramina, bifid spinous process, and overlapping vertebral bodies

True/False: If the patient has scoliosis, the convexity of the spine should be down toward the IR for the lateral spine projection.

True

True/False: Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than erect.

True

True/False: MRI is superior to CT for evaluation of spinal cord and intervertebral disks

True

A radiograph of a lateral thoracic spine shows that long markings and ribs make it difficult to visualize the vertebral bodies. The following factors were used: recumbent position, 40 inch SID, Short exposure time, and exposure made during full expiration. Which of these factors must be modified to produce a more diagnostic image during the repeat exposure?

Use a breathing technique

What factors will enhance the visibility of the vertebral bodies during a lateral projections of the thoracic spine?

Use a breathing technique

A radiograph of an AP projection of the thoracic spine shows that the upper thoracic spine is greatly overexpose but the lower vertebrae are well visualized. The head of the patient was placed at the anode end of the table. What can be used during the repeat exposure to produce a more diagnostic image?

Use a compensation filter

For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail. This can be done by __________.

Using a small focal spot and increasing the SID

The opening, or passageway, for the spinal cord is the __________.

Vertebral (spinal) canal

What is extravasation?

When you are ejecting contrast and it is not going into the vein

How should the spine of a patient with scoliosis be positioned for a lateral position of the lumbar spine?

With the sag or convexity of the spine closest to the IR

The most inferior aspect of the sternum (landmark) is called __________.

Xiphoid process

Which of the following is found between the superior and inferior articular processes?

Zygapophyseal joints

Kyphosis is defined as:

abnormal thoracic curvature with increased convexity

An anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called:

compression fracture

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?

excessive extension of the skull

What is the older term for z-joints?

facets

What is a rupture of disks?

herniated disks

What projection is considered a "functional study" of the cervical spine?

hyperextension and hyperflexion lateral postions

What position demonstrates mobility on a scoliosis series?

hyperflexion and hyperextension

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 degree cephalad angle, 40 inch SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage. What alteration should be made for the repeat exposure?

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?

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. What positioning error may have lead to this radiographic outcome?

insufficient rotation of the upper body

What is between the bodies of the vertebras and acts like a shock absorber?

intervertebral disks

To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections, it is important to __________.

keep the vertebral column parallel to the IR

What projection will best demonstrate a compression fracture of the thoracic spine?

lateral projection

What are the two important benefits of using a SID 60 to 72 inches for the lateral cervical spine projection?

less magnification and better visualize C7

The common name of the method for the cervicothoracic lateral position is the:

level of T1

What is the purpose of bending when performing a scoliosis series?

mobility/range of motion

What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space?

mylogram

How should a needle be inserted into a patients arm?

parallel to vein and at a 15-30 angle

Situation: A patient enters the ED with a cervical spine injury due to a fall. The initial horizontal beam lateral position reveals no subluxation or fracture. The ED physician is concerned about a whiplash injury. What routine would be most helpful in diagnosing this type of injury?

patient in flexion and extension lateral positions

When performing a scoliosis series, what needs to against the IR on a lateral position?

the convex

Situation: A patient come 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?

perform the Fuchs or Judd method

A radiograph of a lateral thoracic spine reveals that there is less visibility along the posterior aspect of the spine. Even with good collimation, the scatter radiation reaching the image receptor obscures the spinous processes. What can be the technologist do to improve the visibility of the posterior elements of the spine?

place a lead blocker on the tabletop posterior to the patient

What is "concave"?

rounded, inward, or depressed surface (goes inward) also know as lordotic

What is "convex"?

rounded, outward, or elevated surface (goes outward) also know as kyphotic

The most posterior aspect of a typical vertebra is the:

spinous process

What statement is true for a typical adult vertebra?

the transverse processes extend laterally from the junction of the pedicles and laminae

In addition to the gonads, which other radiosensitive organs are of greatest concern during cervical and thoracic spine radiography?

thyroid and breast

What is the purpose of venipuncture?

to insert contrast media through the veins for urographic procedures

Why do you flex the knees on a Thoracic and Lumbar spine?

to reduce the OID

A radiograph of an AP "open-mouth" projection of the cervical spine shows that the base of the skull is superimposed over the upper odontoid process. What specific positioning error is present on this radiograph?

too much extension

A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed when compared to the lower thoracic spine. What modifications will improve the visibility of the upper thoracic spine?

use a compensating (wedge) filter

What do you want to see on a lateral and "open mouth" cervical spine?

zygapophyseal joints