Rad Review Spine

Which of the following projections can be used to supplement the traditional "open-mouth" projection when the upper portion of the odontoid process cannot be well demonstrated? A AP or PA through the foramen magnum B AP oblique with right and left head rotation C Horizontal beam lateral D AP axial

The Correct Answer is: A A diagnostic image of C1-2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed. Accurate adjustment of these structures usually will allow good visualization of the odontoid process and the atlantoaxial articulation. Should patient anatomy occasionally prevent the usual visualization, the odontoid process can be visualized through the foramen magnum, either AP or PA. In the AP position (Fuchs method) or the PA position (Judd method), the patient's chin is extended to be in line vertically with the mastoid tip (similar to a Waters' or reverse Waters' position). The CR is directed to the midline and perpendicularly at the level of the mastoid tip. The resulting image demonstrates the odontoid process through the foramen magnum. These positions should not be attempted if the patient has a suspected, new, or healing fracture or destructive disease. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 392-394)

The pedicle is represented by what part of the "scotty dog" seen in a correctly positioned oblique lumbar spine? A Eye B Front foot C Body D Neck

The Correct Answer is: A The 45° oblique position of the lumbar spine is generally performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "scotty dog" images are demonstrated. The scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process (Fig. A). (Saia, p 131)

In the anterior oblique position of the cervical spine, the structures best seen are the A intervertebral foramina nearest the IR B intervertebral foramina furthest from the IR C interarticular joints D intervertebral joints

The Correct Answer is: A The cervical intervertebral foramina lie 45 degrees to the MSP and 15 to 20 degrees to a transverse plane. When the anterior oblique position (LAO or RAO) is used, the cervical intervertebral foramina demonstrated are those closer to the IR. In the posterior oblique position (LPO or RPO), the foramina disclosed are those farther from the IR. There is, therefore, some magnification of the foramina in the posterior oblique positions. The interarticular (apophyseal) joints and intervertebral joints are best visualized in the lateral projection. (Frank, Long, and Smith, 11th ed., vol. 1, p. 405)

The right anterior oblique of the cervical spine requires which of the following combinations of tube angle and direction? A 15° to 20° caudad B 15° to 20° cephalad C 25° to 30° caudad D 25° to 30° cephalad

The Correct Answer is: A The cervical intervertebral foramina lie 45° to the midsagittal plane (MSP) and 15° to 20° to a transverse plane. When the posterior oblique position (LPO, RPO) is used, the central ray is directed 15° to 20° cephalad and the cervical intervertebral foramina demonstrated are those farther from the image recorder. There is therefore some magnification of the foramina (because of the OID). In the anterior oblique position (LAO, RAO), the central ray is directed 15° to 20° caudad, and the foramina disclosed are those closer to the image recorder. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)

Which of the following positions will provide an AP projection of the L5-S1 interspace? A Patient AP with 30- to 35-degree angle cephalad B Patient AP with 30- to 35-degree angle caudad C Patient AP with 0-degree angle D Patient lateral, coned to L5

The Correct Answer is: A The routine AP projection of the lumbar spine demonstrates the intervertebral disk spaces between the first four lumbar vertebrae. The space between L5 and S1, however, is angled with respect to the other disk spaces. Therefore, the CR must be directed 30 to 35 degrees cephalad to parallel the disk space and thus project it open onto the IR. (Frank, Long, and Smith, 11th ed., vol. 1, p. 436)

Which of the following is demonstrated in a 25-degree RPO position with the CR entering 1 inch medial to the elevated ASIS? A Left sacroiliac joint B Right sacroiliac joint C Left ilium D Right ilium

The Correct Answer is: A The sacroiliac joints angle posteriorly and medially 25 degrees to the MSP. Therefore, to demonstrate the sacroiliac joints with the patient in the AP position, the affected side must be elevated 25 degrees. This places the joint space perpendicular to the IR and parallel to the CR. Therefore, the RPO position will demonstrate the left sacroiliac joint, and the LPO position will demonstrate the right sacroiliac joint. When the examination is performed with the patient in the PA position, the unaffected side will be elevated 25 degrees. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 438-441)

With the patient supine, the left side of the pelvis elevated 25 degrees, and the CR entering 1 in. medial to the left anterosuperior iliac spine (ASIS), which of the following is demonstrated? A Left sacroiliac joint B Left ilium C Right sacroiliac joint D Right ilium

The Correct Answer is: A The sacroiliac joints angle posteriorly and medially 25 degrees to the MSP. Therefore, to demonstrate them with an AP oblique projection, the affected side must be elevated 25 degrees. This places the joint space perpendicular to the IR and parallel to the CR. When the PA oblique projection is used, the unaffected side will be elevated 25 degrees. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 438-441)

Which of the following radiographic procedures requires an intrathecal injection? A IV pyelogram B Myelogram C Lymphangiogram D Computed tomography (CT)

The Correct Answer is: B A myelogram, or radiographic examination of the spinal canal, requires an intrathecal (intraspinal) injection. Intrathecal administration of contrast medium is usually at the level of L2/3 or L3/4. An intravenous pyelogram is performed with an injection of contrast medium into the venous system. A lymphangiogram requires that contrast medium be delivered into the lymphatic vessels. A CT scan may or may not require the use of an IV injection. (Torres et al, p 369)

The articular facets of L5-S1 are best demonstrated in a(n) A AP projection B 30-degree oblique C 75-degree oblique D AP axial

The Correct Answer is: B Lumbar articular facets, forming the apophyseal joints, are demonstrated in the oblique position. L1 through L4 are best demonstrated in a 45-degree oblique, while L5-S1 are best seen in the 30-degree oblique (up to 60° oblique could be required). The AP axial projection is used to demonstrate an AP projection of L5-S1. (Bontrager and Lampignano, 7th ed., p. 334)

The lumbar transverse process is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine? A Eye B Nose C Body D Ear

The Correct Answer is: B The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated (Figures 2-53 and 2-54 ). The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process. (Bontrager and Lampignano, 6th ed., p. 334)

The AP projection of the coccyx requires that the CR be directed 15 degrees cephalad 2 inches superior to the pubic symphysis to a level midway between the ASIS and pubic symphysis A 1 only B 2 only C 1 and 2 only D 1 and 3 only

The Correct Answer is: B The AP projection of the coccyx requires the CR to be directed 10 degrees caudally and centered 2 inches superior to the pubic symphysis. The AP projection of the sacrum requires a 15-degree cephalad angle centered at a point midway between the pubic symphysis and the ASIS. (Bontrager and Lampignano, 6th ed., p. 344)

The RPO position of the cervical spine requires which of the following combinations of tube angle and direction? A 15 to 20 degrees caudad B 15 to 20 degrees cephalad C 25 to 30 degrees caudad D 25 to 30 degrees cephalad

The Correct Answer is: B The cervical intervertebral foramina lie 45 degrees to the midsagittal plane (MSP) and 15 to 20 degrees to the transverse plane. When the posterior oblique position (i.e., LPO or RPO) is used, the CR is directed 15 to 20 degrees cephalad, and the cervical intervertebral foramina demonstrated are those farther from the IR. There is, therefore, some magnification of the foramina (because of the OID). In the anterior oblique position (i.e., LAO or RAO), the CR is directed 15 to 20 degrees caudad, and the foramina disclosed are those closer to the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)

The laryngeal prominence is formed by the A thyroid gland B thyroid cartilage C vocal cords D pharynx

The Correct Answer is: B The laryngeal prominence, or "Adam's apple," is formed by the thyroid cartilage—the principal cartilage of the larynx. The thyroid gland, one of the endocrine glands, is lateral and inferior to the thyroid cartilage. The vocal cords are within the laryngeal cavity. Portions of the pharynx serve as passages for both air and food. (Frank, Long, and Smith, 11th ed., vol. 2, p. 76)

A kyphotic curve is formed by which of the following? Sacral vertebrae Thoracic vertebrae Lumbar vertebrae A 1 only B 1 and 2 only C 3 only D 1 and 3 only

The Correct Answer is: B The lordotic curves are secondary curves; that is, they develop sometime after birth. The cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit the primary kyphotic curves, those that are present at birth. (Frank, Long, and Smith, 11th ed., vol. 1, p. 375)

Structures comprising the neural, or vertebral, arch include pedicles laminae body A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The Correct Answer is: B The typical vertebra has a body and a neural/vertebral arch surrounding the vertebral foramen (Figure 2-58). The neural arch is composed of two pedicles and two laminae that support four articular processes, two transverse processes, and one spinous process. The pedicles are short, thick processes extending back from the posterior aspect of the vertebral body, each one sustaining a lamina. The laminae extend posteriorly to the midline and join to form the spinous process. Each pedicle has notches superiorly and inferiorly (superior and inferior vertebral notches) that—with adjacent vertebrae—form the intervertebral foramina, through which the spinal nerves pass. The neural arch also has lateral transverse processes for muscle attachment and superior and inferior articular processes for the formation of apophyseal joints (classified as diarthrotic). The vertebral column permits flexion, extension, and lateral and rotary motions through its various articulations. (Frank, Long, and Smith, 11th ed., vol. 1, p. 376)

Which of the following structures is located at the level of the interspace between the second and third thoracic vertebrae? A Manubrium B Jugular notch C Sternal angle D Xiphoid process

The Correct Answer is: B There are several surface landmarks and localization points that can help the radiographer in positioning various body structures. The jugular notch, located at the superior aspect of the manubrium, is approximately opposite the T2-3 interspace. The sternal angle is located opposite the T4-5 interspace. The xiphoid (or ensiform) process is located opposite T10. (Frank, Long, and Smith, 11th ed., vol. 1, p. 63)

A radiolucent sponge can be placed under the patient's waist for a lateral projection of the lumbosacral spine to make the vertebral column parallel with the IR place the intervertebral disk spaces perpendicular to the IR decrease the amount of SR reaching the IR A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The Correct Answer is: B When placed in the recumbent lateral position, the average adult's lumbar spine will not be parallel to the x-ray tabletop. Because the shoulders and hips generally are wider than the waist, the vertebral column slopes downward in the central areas—making the lower thoracic and upper lumbar spine closer to the tabletop than the upper thoracic and lower lumbar spine. One solution is to place a radiolucent sponge under the patient's waist. This will elevate the sagging spinal area and make the vertebral column parallel to the x-ray tabletop and IR. It will also open the intervertebral disks better, placing more of them parallel to the path of the x-ray photons and perpendicular to the IR. This position also places the intervertebral foramina parallel with the path of the CR. The radiolucent sponge is strictly a positioning aid and has no impact on the amount of SR reaching the IR. (Bontrager and Lampignano, 6th ed., p. 335)

A lateral projection of the larynx is occasionally required to rule out foreign body, polyps, or tumor. The CR should be directed A just below the EAM B to the level of the mandibular angles C to the level of the laryngeal prominence D to the level of C7

The Correct Answer is: C AP and lateral projections of the airway and larynx are required occasionally to rule out foreign body, polyps, tumors, or any other condition suspected of causing some airway obstruction. The AP projection is positioned as for an AP cervical spine projection with the CR perpendicular to the laryngeal prominence. The lateral projection is positioned as for a lateral cervical spine projection and is centered to the coronal plane passing through the trachea (anterior to the cervical spine) at the level of the laryngeal prominence. Centering just below the EAM would demonstrate the nasopharynx. Centering at the mandibular angles would demonstrate the oropharynx. Exposures are made on slow inspiration to visualize air-filled structures. (Frank, Long, and Smith, 11th ed., vol. 2, p. 88)

The AP projection of the sacrum requires the central ray to be directed A perpendicular to the midline midway between the anterior superior iliac spine (ASIS) and the pubis. B to the midline approximately 2 inches superior to the pubis. C 15° cephalad to a point approximately 2 inches superior to the pubis. D 15° caudad to a point approximately 2 inches superior to the pubis.

The Correct Answer is: C For the AP projection of the sacrum, the patient is AP supine with the MSP perpendicular to the x-ray tabletop. The central ray is directed 15° cephalad to a point 2 inches superior to the pubis (approximately midway between the ASIS and the pubic symphysis). In this projection, the central ray angulation parallels the sacral curve and provides less distorted visualization of the sacrum and its foramina. (Saia, p 133)

Myelography is a diagnostic examination used to demonstrate internal disk lesions. posttraumatic swelling of the spinal cord. posterior disk herniation. A 1 only B 2 only C 2 and 3 only D 1, 2, and 3

The Correct Answer is: C Myelography is used to demonstrate encroachment on and compression of the spinal cord as a result of disk herniation, tumor growth, or posttraumatic swelling of the cord. This is accomplished by placing positive or negative contrast medium into the subarachnoid space. Myelography will demonstrate posterior protrusion of herniated intervertebral disks or spinal cord tumors. Anterior protrusion of a herniated intervertebral disk does not impinge on the spinal cord and is not demonstrated in myelography. Internal disk lesions can be demonstrated only by injecting contrast medium into the individual disks (diskography). (Bontrager and Lampignano, 6th ed., p. 762)

Which of the following statements regarding myelography is (are) correct? Spinal puncture may be performed in the prone or flexed lateral position. Contrast medium distribution is regulated through x-ray tube angulation. The patient's neck must be in extension during Trendelenburg positions. A 1 only B 1 and 2 only C 1 and 3 only D 1, 2, and 3

The Correct Answer is: C Myelography is radiologic examination of the structures within the spinal canal. Opaque contrast medium is usually used. Following injection, the contrast medium is distributed to the vertebral region of interest by gravity; the table is angled Trendelenburg for visualization of the cervical region and in the Fowler position for visualization of the thoracic and lumbar regions. Although the table is Trendelenburg, care must be taken that the patient's neck is kept in acute extension to compress the cisterna magna and keep contrast medium from traveling into the ventricles of the brain. (Bontrager and Lampignano, 6th ed., p. 763)

To visualize or "open" the right sacroiliac joint, the patient is positioned A 30 to 40 degrees LPO B 30 to 40 degrees RPO C 25 to 30 degrees LPO D 25 to 30 degrees RPO.

The Correct Answer is: C Sacroiliac joints lie obliquely within the pelvis and open anteriorly at an angle of 25 to 30 degrees to the midsagittal plane. A 25- to 30-degree oblique position places the joints perpendicular to the IR. The right sacroiliac joint may be demonstrated in the LPO and RAO positions with little magnification variation. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 438-441)

The lumbar lamina is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine view? A Eye B Nose C Body D Neck

The Correct Answer is: C The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process (Figure 2-56). (Bontrager and Lampignano, 6th ed., p. 334)

Which of the following is a functional study used to demonstrate the degree of AP motion present in the cervical spine? A Moving mandible position B AP open-mouth projection C Flexion and extension laterals D AP right and left bending

The Correct Answer is: C The degree of anterior and posterior motion is occasionally diminished with a whiplash-type injury. Anterior (forward, flexion) and posterior (backward, extension) motion is evaluated in the lateral position with the patient assuming flexion and extension as best as he or she can. Left and right bending images of the thoracic and lumbar vertebrae are obtained frequently when evaluating scoliosis. The AP open-mouth projection is used to evaluate the first two cervical vertebrae. The moving mandible AP projection is used to demonstrate the entire cervical spine while blurring out the superimposed mandible. (Frank, Long, and Smith, 11th ed., vol. 1, p. 402)

The long, flat structures that project posteromedially from the pedicles are the A transverse processes B vertebral arches C laminae D pedicles

The Correct Answer is: C The typical vertebra has two parts—the body and the vertebral arch. The body is the dense, anterior bony mass. Posteriorly attached is the vertebral arch, a ring-like structure. The vertebral arch is formed by two pedicles (short, thick processes projecting posteriorly from the body) and two laminae (broad, flat processes projecting posteriorly and medially from the pedicles). (Bontrager and Lampignano, 6th ed., p. 290)

What is the name of the condition that results in the forward slipping of one vertebra on the one below it? A Spondylitis B Spondylolysis C Spondylolisthesis D Spondylosis

The Correct Answer is: C The forward slipping of one vertebra on the one below it is called spondylolisthesis. Spondylolysis is the breakdown of the pars interarticularis; it may be unilateral or bilateral and results in forward slipping of the involved vertebra—the condition of spondylolisthesis. Inflammation of one or more vertebrae is called spondylitis. Spondylosis refers to degenerative changes occurring in the vertebra. (Frank, Long, and Smith, 11th ed., vol. 1, p. 388)

Which of the following should be performed to rule out subluxation or fracture of the cervical spine? A Oblique cervical spine, seated B AP cervical spine, recumbent C Horizontal beam lateral D Laterals in flexion and extension

The Correct Answer is: C When a cervical spine radiograph is requested to rule out subluxation or fracture, the patient will arrive in the radiology area on a stretcher. The patient should not be moved before a subluxation is ruled out. Any movement of the head and neck could cause serious damage to the spinal cord. A horizontal beam lateral projection is performed and evaluated. The physician then will decide what further images are required. Flexion and extension laterals are generally performed in cases of whiplash, to demonstrate degree of anterior/posterior motion. (Frank, Long, and Smith, 11th ed., vol. 2, p. 35)

Which of the following is (are) appropriate technique(s) for imaging a patient with a possible traumatic spine injury? Instruct the patient to turn slowly and stop if anything hurts. Maneuver the x-ray tube instead of moving the patient. Call for help and use the log-rolling method to turn the patient. A 1 and 2 only B 1 and 3 only C 2 and 3 only D 1, 2, and 3

The Correct Answer is: C When imaging a patient with a possible traumatic spine injury, it is appropriate to either maneuver the x-ray tube head or, if the patient must be moved, to use the log-rolling method. This cannot be done by one person; the radiographer must summon assistance. If the patient is on a backboard and in a neck collar, as most patients with suspected spine injury are, it is never appropriate to ask the patient to turn, scoot, or slide over. The only movement that should be permitted is movement of the entire spine, body, and head together, as in log-rolling. Any twisting could cause severe and permanent damage to the spinal cord, resulting in paralysis or even death. (Torres et al., pp. 77-79)

In myelography, the contrast medium generally is injected into the A cisterna magna B individual intervertebral disks C subarachnoid space between the first and second lumbar vertebrae D subarachnoid space between the third and fourth lumbar vertebrae

The Correct Answer is: D Generally, contrast medium is injected into the subarachnoid space between the third and fourth lumbar vertebrae (Figure 2-62). Because the spinal cord ends at the level of the first or second lumbar vertebra, this is considered to be a relatively safe injection site. The cisterna magna can be used, but the risk of contrast medium entering the ventricles and causing side effects increases. Diskography requires injection of contrast medium into the individual intervertebral disks. (Tortora and Derrickson, 11th ed., p. 440)

In myelography, the contrast medium generally is injected into the A cisterna magna. B individual intervertebral disks. C subarachnoid space between the first and second vertebrae. D subarachnoid space between the third and fourth lumbar vertebrae.

The Correct Answer is: D Generally, contrast medium is injected into the subarachnoid space between the third and fourth lumbar vertebrae. Because the spinal cord ends at the level of the first or second lumbar vertebra, this is considered to be a relatively safe injection site. The cisterna magna can be used, but the risk of contrast medium entering the ventricles and causing side effects increases. Diskography requires injection of contrast medium into the individual intervertebral disks. (Frank, Long, and Smith, 11th ed., vol. 3, p. 6)

Which of the following will best demonstrate the lumbosacral junction in the AP position? A CR perpendicular to L3 B CR perpendicular to L5-S1 C CR caudad 30-35 degrees D CR cephalad 30-35 degrees

The Correct Answer is: D In the AP projection of the lumbar spine, the disk spaces of L1 to L4 are perpendicular to the IR and well visualized, but the L5 to S1 disk space is angled 30 to 35 degrees cephalad to the perpendicular. If the CR is directed 30 to 35 degrees cephalad midway between the ASIS and the publis symphysis, the L5 to S1 interspace will be well demonstrated. (Bontrger and Lampignano, 6th ed., p. 337)

An accurately positioned oblique projection of the first through fourth lumbar vertebrae will demonstrate the classic "Scotty dog." What bony structure does the Scotty dog's neck represent? A Superior articular process B Pedicle C Transverse process D Pars interarticularis

The Correct Answer is: D The 45-degree oblique position of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process. (Frank, Long, and Smith, 11th ed., vol. 1, p. 432)

In the anterior oblique position of the cervical spine, the CR should be directed A parallel to C4 B perpendicular to C4 C 15 degrees cephalad to C4 D 15 degrees caudad to C4.

The Correct Answer is: D The anterior oblique positions (LAO and RAO) of the cervical spine require a 15-degree caudal angulation and demonstrate the intervertebral foramina closest to the IR. The posterior oblique positions (LPO and RPO) require that the CR be directed cephalad 15 degrees to C4. The posterior oblique positions demonstrate the intervertebral foramina farther away from the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)

To demonstrate the first two cervical vertebrae in the AP recumbent projection, the patient is positioned so that A the glabellomeatal line is vertical. B the acanthiomeatal line is vertical. C a line between the mentum and the mastoid tip is vertical. D a line between the maxillary occlusal plane and the mastoid tip is vertical.

The Correct Answer is: D To clearly demonstrate the atlas and axis without superimposition of the teeth or the base of the skull, a line between the maxillary occlusal plane (edge of upper teeth) and mastoid tip must be vertical (in the recumbent AP position). If the head is flexed too much, the teeth will be superimposed. If the head is extended too much, the cranial base will be superimposed on the area of interest. A line between the mentum and the mastoid tip is used to demonstrate the odontoid process only through the foramen magnum (Fuchs method). (Frank, Long, and Smith, 11th ed., vol. 1, p. 393)

The lateral coccyx image shown in the figure below was made using AEC but is overexposed. This is most likely a result of

The Correct Answer is: D incorrect centering of the part The lateral projection of the coccyx seen in the figure is markedly overexposed. Although a small focal spot would not be a practical selection for a lateral coccyx, focal spot size is unrelated to receptor exposure. If insufficient backup time had been selected, the image would be underexposed. The center photocell is the appropriate photocell to select because the part of interest, the coccyx, should be in the center of the image. Because the coccyx was not centered to the IR (but rather the thicker hip portion of the body was centered), the AEC correctly exposed the thicker portion—thus overexposing the less dense coccyx area. Accurate positioning/centering is particularly important when using AEC. (Shephard, p. 281)

Which of the following are demonstrated in the oblique position of the cervical spine? 1. Intervertebral foramina 2. Zygapophyseal joints 3. Intervertebral joints A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The correct answer is (A). Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zygapophyseal joints) are 90° to the midsagittal plane and are therefore well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45° to the midsagittal plane (and 15° to 20° to a transverse plane) and are therefore demonstrated in the oblique position.

Which of the following is (are) well demonstrated in the oblique position of the cervical vertebrae? Intervertebral foramina Disk spaces Zygapophyseal joints A 1 only B 1 and 2 only C 1 and 3 only D 1, 2, and 3

The correct answer is (A). The cervical intervertebral foramina form a 45-degree angle with the MSP and, therefore, are well visualized in a 45-degree oblique position. Zygapophyseal joints are formed by articulating surfaces of the inferior articular facet of one vertebra with the superior articular facet of the vertebra below; they are well demonstrated in the lateral position of the cervical spine. The intervertebral disk spaces are best demonstrated in the lateral position.

Which of the following positions would best demonstrate the left zygapophyseal articulations of the lumbar vertebrae? A LPO B RPO C Left lateral D PA

The correct answer is (A). The posterior oblique positions (LPO, RPO) of the lumbar vertebrae demonstrate the zygapophyseal articulations closer to the image receptor. The left zygapophyseal articulations are demonstrated in the LPO position, while the right zygapophyseal articulations are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. (Saia, p 131)

Which of the following is (are) demonstrated in the AP projection of the thoracic spine? 1. Intervertebral spaces 2. Zygapophyseal joints 3. Intervertebral foramina A 1 only B 2 only C 1 and 3 D 1, 2, and 3

The correct answer is (A). The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral. The thoracic zygapophyseal joints are 70° to the MSP and are demonstrated in a steep (70°) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90° to the MSP. They are therefore well demonstrated in the lateral position.

Which of the positions illustrated in the figure below will best demonstrate the lumbar zygapophyseal joints closest to the IR?

The correct answer is (A). RPO Four positions for the lumbar spine are illustrated. Number 1 is an RPO, and number 2 an LAO. The posterior oblique positions (LPO and RPO) demonstrate the zygapophyseal joints closer to the IR, while the anterior oblique positions (LAO and RAO) demonstrate the zygapophyseal joints further from the IR (Fig. B). Number 3 is the AP projection, which demonstrates the lumbar bodies and disk spaces and the transverse and spinous processes. Number 4 is the lateral position, which provides the best demonstration of the lumbar bodies, intervertebral disk spaces, spinous processes, pedicles, and intervertebral foramina.

Which of the following is (are) demonstrated in the lateral projection of the cervical spine? Intervertebral joints Zygapophyseal joints Intervertebral foramina A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The correct answer is (B). Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zygapophyseal joints) are 90 degrees to the MSP and, therefore, are well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45 degrees to the MSP (and 15-20 degrees to a transverse plane) and, therefore, are demonstrated in the oblique position.

Which of the following is (are) demonstrated in a lateral projection of the cervical spine? Intervertebral foramina Zygapophyseal joints Intervertebral joints A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The correct answer is (C). Intervertebral joints (occupied by the intervertebral disks) are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming zygapophyseal/interarticular joints) are 90 degrees to the midsagittal plane and, therefore, are well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45 degree to the midsagittal plane (and 15-20 degrees to a transverse plane) and, therefore, are demonstrated in the oblique position.

Which of the following positions will demonstrate the lumbosacral zygapophyseal articulation? A AP B Lateral C 30-degree RPO D 45-degree LPO

The correct answer is (C). The articular facets (zygapophyseal joints) of the L5-S1 articulation form a 30-degree angle with the MSP; they are, therefore, well demonstrated in a 30-degree oblique position. The 45-degree oblique position demonstrates the zygapophyseal joints of L1-4.

Which of the following positions will best demonstrate the right zygapophyseal articulations of the lumbar vertebrae? A PA B Left lateral C RPO D LPO

The correct answer is (C). The posterior oblique positions (LPO and RPO) of the lumbar vertebrae demonstrate the zygapophyseal joints closer to the IR. The left zygapophyseal joints are demonstrated in the LPO position, whereas the right zygapophyseal joints are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes.

Which of the following is (are) demonstrated in the lateral projection of the thoracic spine? Intervertebral spaces Zygapophyseal joints Intervertebral foramina A 1 only B 2 only C 1 and 3 only D 1, 2, and 3

The correct answer is (C). The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral projection. The thoracic zygapophyseal joints are 70 degrees to the MSP and are demonstrated in a steep (70-degree) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90 degrees to the MSP. They are, therefore, well demonstrated in the lateral position.

Which of the following positions would demonstrate the right lumbar zygapophyseal articulations closest to the IR? A LAO B RAO C LPO D RPO

The correct answer is (D). The posterior oblique positions (i.e., LPO and RPO) of the lumbar vertebrae demonstrate the zygapophyseal joints closer to the IR. The left zygapophyseal joints are demonstrated in the LPO position, whereas the right zygapophyseal joints are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes.

The thoracic zygapophyseal joints are demonstrated with the A coronal plane 90 degrees to the IR B midsagittal plane 90 degrees to the IR C coronal plane 20 degrees to the IR D midsagittal plane 20 degrees to the IR.

The correct answer is (D). The thoracic zygapophyseal joints are demonstrated in an oblique position with the coronal plane 70 degrees to the IR (MSP 20 degrees to the IR). This may be accomplished by first placing the patient lateral and then obliquing the patient 20 degrees "off lateral." The zygapophyseal joints closest to the IR are demonstrated in the PA oblique projection and those remote from the IR in the AP oblique projection. Comparable resolution is obtained using either method because the OID is about the same. The thoracic intervertebral foramina are demonstrated in the lateral projection. This places the MSP of the patient parallel to the IR, and the coronal plane perpendicular to the IR.

Which of the positions illustrated below would best demonstrate the cervical pedicles?

The correct answer is: (C) LPO Three positions of the cervical spine are illustrated. Figure B shows the left lateral position. Lateral projections of the cervical spine are done to demonstrate the intervertebral disk spaces, apophyseal joints, and spinous processes. Apophyseal joints are formed by adjacent superior and inferior articular processes and their facets. Spinous processes are formed by the union of the laminae. Figure A is an RAO with caudal angulation; Figure C is an LPO with cephalad angulation. Anterior oblique positions (LAO, RAO) of the cervical spine demonstrate the intervertebral foramina closer to the IR, while posterior oblique positions (LPO, RPO) demonstrate the intervertebral foramina farther from the IR. Intervertebral foramina are formed by the vertebral notches of the pedicles. (Ballinger & Frank, pp 400-403)

Which of the following is (are) effective in reducing exposure to sensitive tissues for frontal views during scoliosis examinations? Use of PA position Use of breast shields Use of compensating filtration A 1 only B 1 and 2 only C 2 and 3 only D 1, 2, and 3

The correct answer is: (D) Spinal column studies often are required for evaluation of adolescent scoliosis, thus presenting a twofold problem—radiation exposure to youthful gonadal and breast tissues and significantly differing tissue densities/thicknesses. Exposure-dose concerns also addressed with the use of a compensating filter (for uniform density) that incorporates lead shielding for the breasts and gonads (Figure 2-63). (Bontrager and Lampignano, 6th ed., p. 338)

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