Chapter 8 Positioning

Situation: A lateral cervical spine radiograph demonstrates that the zygapophyseal joint spaces are not superimposed. Which type of positioning error(s) may lead to this radiographic outcome?

A tilt or rotation of the spine

Which two things can be done to minimize the effects of scatter radiation on lateral projections of the thoracic and lumbar spine?

Close side collimation and place lead/mask on table top behind the patient

What is the correct term for the condition involving a "slipped disk"?

Herniated Nucleus Pulposus (HNP)

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

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

Which of the following imaging modalities is recommended for a "teardrop burst" fracture? a. CT b. MRI c. Nuclear Medicine d. Sonography

a. CT

A comminuted fracture of the anterior and posterior arches of C1 is termed: a. Hangman's fracture b. Clay shoveler's fracture c. Jefferson fracture d. Teardrop burst fracture

c. Jefferson fracture

How much and in which direction (caudad or cephalad) should the central ray be angled for each of the following projections? A. An AP axial projection of the cervical spine B. An anterior oblique projection of the cervical spine C. A posterior oblique projection of the cervical spine

A. An AP axial projection of the cervical spine >> 15°-20° Cephalad B. An anterior oblique projection of the cervical spine >> 15° Caudal C. A posterior oblique projection of the cervical spine >> 15° Cephalad

The bony structures connected directly to the vertebral body are the: a. Pedicles b. Articular processes c. Laminae d. Transverse processes

A. Pedicles

List two positions or projections that will project the dens in the center of the foramen magnum.

AP Projection (Fuchs method) and PA Projection (Judd method)

Situation: A patient comes to the radiology department for a follow-up study for a Clay shoveler's fracture. Which spine projections will best demonstrate this type of fracture?

AP and lateral C-spine projections

Situation: A patient a possible Jefferson fracture enters the ER. which specific radiographic position best demonstrates this type of fracture?

AP open-mouth C-spine

Which position or projection best demonstrates the zygapophyseal joints between C1 and C2?

AP open-mouth projection

The large joint space between C1 and C2 is called the

Atlantoaxial Joint

What type of CR angle is required on an RAO projection of the cervical spine? a. 20° caudad b. 20° cephalad c. 15° cephalad d. 15° caudad

d. 15° caudad

What type of CR angle is required with the AP axial-vertebral arch projection? a. None; CR I perpendicular b. 5° or 10° cephalad c. 15° caudad d. 20° to 30° caudad

d. 20° to 30° caudad

The soft, semigelatinous inner part of the intervertebral disk is termed: a. Nuclear core b. Annulus fibrous c. Fovea centralis d. Nucleus pulposis

d. Nucleus pulposis

True or False: The lumbar possesses a concave posterior spinal curvature.

true

Two partial facets found on the thoracic vertebrae are called

Demifacets

Situation: A radiograph of an AP open-mouth projection of the cervical spine demonstrates the upper incisors superimposed over the top of the dens. What specific positioning error is present on this radiograph?

Excessive flexion of the head

True or False: For a lateral projection of the cervical spine, the exposure is initiated during full inspiration of the lungs

False

True or False: The carotid artery and certain nerves pass through the cervical transverse foramina.

False

True or False: The thoracic spine processes facets for ribs articulations and bifid spinous processes.

False

An abnormal or exaggerated thoracic spinal curvature with increased convexity is called

Kyphosis

Which position or projection of the cervical spine best demonstrates the zygapophyseal joints (between C3 to C7)?

Lateral Position

Which position of the thoracic spine best demonstrates the intervertebral foramina?

Lateral position

What is the one feature of all thoracic vertebrae that makes them different from all other vertebrae?

The presence of facets which allows articulation with the ribs

What are three distinctive features of all cervical vertebrae that make them different from any other vertebrae?

They all have 3 transverse vertebral foramina, Bifid spinous process tips, and Overlapping vertebral bodies

Which ligament holds the dens against the anterior arch of C1?

Transverse Atlantal Ligament

True or False: The thoracic spinal curvature is classified as a primary curve.

True

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. 20° cephalad

What type of CR angulation is required for an AP axial projection of the cervical spine? a. None. CR is perpendicular to the IR b. 5° to 10° cephalad c. 15° to 20° cephalad d. 15° to 20° caudad

c. 15° to 20° cephalad

On average, how many separate bones make up the adult vertebral column? a. 33 b. 28 c. 26 d. 31

c. 26

What is the total number of bones in the child's vertebral column? a. 26 b. 28 c. 33 d. 36

c. 33

What is the recommended kV range for thoracic spine projections when using digital systems? a. 70 to 80 kV b. 60 to 70 kV c. 75 to 85 kV d. 110 to 120 kV

c. 75 to 85 kV

The articulations between C1 and the occipital condyles of the skull are termed: a. Occipital joints b. Occipital facets c. Occipitoatlantal joints d. Articular joints

c. Occipitoatlantal joints

Match each of the following topographic landmarks to the correct vertebral level (using each choice only one) 1. Vertebra Prominens 2. Jugular Notch 3. 3 to 4 inches (8 to 10 cm) below jugular notch 4. Gonion 5. Sternal Angle 6 Thyroid Cartilage A. T2-T3 B. C7-T1 C. T7 D. C3 E. C4-C6 F. T4-T5

1. Vertebra Prominens >> B. C7-T1 2. Jugular Notch >> A. T2-T3 3. 3 to 4 inches (8 to 10 cm) below jugular notch >> C. T7 4. Gonion >> D. C3 5. Sternal Angle >> F. T4-T5 6 Thyroid Cartilage >> E. C4-C6

The intervertebral foramina for the cervical spine lie at a __________ angle to the midsagittal plane.

45°

How many segments make up the sacrum in the neonate?

5

Situation: A radiograph of a lateral thoracic spine projection shows that the intervertebral foramina and intervertebral joint spaces are not clearly demonstrated. Which type of problems can lead to this radiographic outcome?

By not keeping the spine (parallel) aligned with the IR, and/or not ensuring CR is perpendicular to the spine

Which position or projection demonstrates the lower cervical and upper thoracic spine (C4 to T3) in a lateral perspective (fraxture/subluxation has been ruled-out)

Cervicothoracic lateral or "Swimmers" projection

True or False: HNP most frequently develops at the L2-3 vertebral level.

False, develops at L4-L5

Situation: A patient comes into the radiology department for a follow-up study 6 months after leaving spinal fusion surgery of the lower cervical spine (C5-6). The surgeon wants to check for anteroposterior mobility of the fused spine. Beyond the basic cervical spine projections, what additional projections can be taken to assess mobility of the spine?

Flexion (hyperflexion) and extension (hyperextension) mobility

The superior and inferior vertebral notches create which foramina?

Intervertebral Foramina

Which specific joint spaces are visualized with a left anterior oblique (LAO) projection of the thoracic spine?

Left Zygapophyseal Joint

At which vertebral level does the solid spinal cord terminate?

Lower border of L1

An abnormal exaggerated lateral spinal curvature is called

Scoliosis

In addition to using a long SID, list two positioning maneuvers you can use to lower the shoulders enough to visualize C7-T1 for a lateral projection of the cervical spine.

Suspend respirations on full expiration and have patient hold 5-10 lb in hand

Which of the following imaging modalities is not normally performed to rule out a Herniated Nucleus Pulposus (HNP)? a. CT b. Myelography c. MRI d. Nuclear Medicine

d. Nuclear Medicine

Situation: A patient who was involved in a motor vehicle accident (MVA) 3 days ago is experiencing severe neck pain and comes to the radiology department for a cervical spine series. The patient is not wearing a cervical collar. Should the tech take a horizontal beam lateral projection and have it cleared before proceeding with the study? Explain.

Yes, we must assume that the fracture/c-spine injury is present. The radiologist/physician must clear the patient for further exams.

Which joints are found between the superior and inferior articular processes?

Zygapophyseal Joints

The intervertebral joints are classified as: a. Amphiarthrodial b. Diathrodial c. Synarthrodial d. Myothrodial

a. Amphiarthrodial

What additional measure can be taken if the patient cannot depress the shoulders adequately for the cervicothoracic (swimmer's) lateral projection? a. Angle the CR 3° to 5° caudad b. Have a technologist pull down on the arm c. Increase kV to penetrate through the shoulders d. Perform the AP axial-vertebral arch projection instead

a. Angle the CR 3° to 5° caudad

T2-3 intervertebral disk space is found: a. At the level of the jugular notch b. At the level of the sternal angle c. At the level of the xiphoid process d. 2 inches (5 cm) below the jugular notch

a. At the level of the jugular notch

Scheuermann disease is a form of: a. Scoliosis and/or Kyphosis b. Subluxation c. Arthritis d. Fracture

a. Scoliosis and/or Kyphosis

Which of the following divisions of the spine is described as possessing a primary curve? (There may be more than one correct answer) a. Thoracic b. Cervical c. Lumbar d. Sacral

a. Thoracic and d. Sacral

A lumbar rib is an example of a/an: a. Transitional vertebra b. Spondylitis c. Ankylosing spondylitis d. Scheuermann's disease

a. Transitional vertebra

The joints between articular process of vertebra are termed _______ joints. a. Zygapophyseal b. Fibrous c. Intervertebral d. Synarthrodial

a. Zygapophyseal

An avulsion fracture of the spinous processes of C6 through T1 is called a: a. Hangman's fracture b. Clay shoveler's fracture c. Jefferson fracture d. Teardrop burst fracture

b. Clay shoveler's 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? a. Excessive flexion of the skull b. Excessive extension of the skull c. Excessive CR angulation d. Rotation of the skull

b. Excessive extension of the skull

Which of the following projections of the cervical spine demonstrates the left intervertebral foramen? a. LPO b. LAO c. Lateral projection d. RAO

b. LAO

Which of the following 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

An abnormally increased "sway-back_ spinal curvature is termed: a. Kyphosis b. Lordosis c. Scoliosis d. Thorosis

b. Lordosis

Which of the following structures makes up the inner aspect of the intervertebral disk? a. Annulus Fibrosus b. Nucleus Pulposis c. Annulus Pulposis d. Nucleus Fibrosus

b. Nucleus Pulposis

The most posterior aspect of a typical vertebra is the: a. Pedicle b. Spinous process c. Lamina d. Body

b. Spinous process

The xiphoid process corresponds to the vertebral level of: a. T8 b. T9-10 c. T7 d. T12

b. T9-10

Which of the following thoracic vertebrae does not possess a facet for the costotransverse joint? a. T1 b. T7 c. T11 d. T12

c. T11 and d. T12

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°

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

Kyphosis is defined as a(n): a. Normal lumbar curvature b. Normal convex sacral curvature c. Normal compensatory curve of the thoracic spine d. Abnormal thoracic curvature with increased convexity

d. Abnormal thoracic curvature with increased convexity

Which of the following features makes the cervical vertebra unique as compared with other vertebrae of the spine? a. Transverse foramina and double (bífid) tips on spinous processes b. Overlapping vertebral bodies c. Presence of zygapophyseal joints d. All of the above

d. All of the above

Which of the following technical factors is most important in producing a high-quality CR image? a. Decrease SID whenever possible b. Minimize the use of grids c. Decrease kV as much as possible d. Collimate as close as possible

d. Collimate as close as possible

The tapered end of the solid spinal cord is termed: a. Medulla oblongata b. Filum terminale c. Spinalis terminalis d. Conus medullaris

d. Conus medullaris

Which two bony landmarks must be superimposed for an AP open-mouth projection? a. Front incisors and tip of mentum b. Base of skull and tip of mentum c. Front incisors and inion d. Front incisors and base of skull

d. Front incisors and base of skull

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

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

Which of the following best defines or describes the vertebral body of C1? a. The smallest of all vertebral bodies b. A column of bone supported by an intervertebral disk c. A large bony mass d. There is no vertebral body at C1

d. There is no vertebral body at C1

The costotransverse joint is formed between the: a. Head of the rib and thoracic vertebral body b. Head of the rib and transverse process of the vertebra c. Tubercle of the rib and spinous process of the vertebra d. Tubercle of the rib and transverse process of the vertebra

d. Tubercle of the rib and transverse process of the vertebra