Chapter 9 Lumbar Spine, Sacrum, and Coccyx

This person is more likely to suffer from a fracture of the coccyx due to a backward fall.

Female

This method of a scoliosis series requires the use of a block

Ferguson

Conventional radiography does not detect loss of bone density until bone mass has been reduced ___%

90

The centering point for the posterior oblique projection of the SI joints is 1" medial to the upside of the ______.

ASIS

This fracture occurs through the vertebral body and posterior elements, often caused by lap seat belts.

Chance fracture

How many degrees from the midsagittal plane are the z jt of the UPPer lumbar vertebra located?

50 degrees

The patient hips and knees should be flexed for this projection of the lumbar spine

AP

41. A radiograph of an AP axial sacrum reveals that it is foreshortened and hte sacral foramina are not clearly seen. The patient was in an AP supine position and the technologist angled the CR 10 cephalad. What specific positioning error is present on this radiograph? a. excessive CR angle b. Rotation of the sacrum c. Insufficient CR angle d. Wrong direction of the CR angle

C

This condition is most likely to occur at the level of L4/5

HNP

These joints of the lumbar spine are cartilaginous/amphiarthrodial

Intervertebral

The part of the scotty dog that represents the transverse process of a lumbar vertebra

Nose

The CR is centered 2" superior to this structure for the AP axial projection of the sacrum.

Pubic Symphysis

This condition is indicated by the forward displacement of one vertebra into another.

Spondylolisthesis

22. If the waist is supported properly, and average-size patient does not require any CR angulation for the lateral lumbar spine projection. a. true b. false

a. true

45. Young female patient comes to radiology for a scoliosis study. The patient has had this series performed frequently. How much will the breast dose be decreased if a PA rather than a AP proj taken? a. 15% b. 90% c. 35% d. No difference

b

46. Patient comes in with a possible compression fracture of L3. Which one of the following positioning routines would best demonstrate the body of L3 and the intervertebral jt space above and below it? a. collimate R and L P.O and AP proj b. Collimate Pa and Lateral proj c. Erect AP and lateral d. Collimated LPO and RPO

b

Patient comes to radiology for a study of the lumbar spine. The initial radiographs demonstrate potential pathology involving the L5/S1 z jt. Which of the following position and or proj would best demonstrate this jt space? A. Lateral L5/S1 position b. Rt and Lf 30 oblique c. Rt and Lf 50 oblique d. closely collimated and lateral position of L5/S1 region

b

48. Female patient is brought to Er bc of a MVA. Her chief complaint is pain in the lower lumbar region. The er dr. orders a lumbar series. Upon questioning the tech learns that the patient is pregnant. ER dr knows of pregnancy but still wants the lumbar spine series performed. What can the tech do to minimize dose to the fetus and mother? a. Use high kV reduce mAs b. Increase the SID c. Collimate as much as feasible d. All above

d

44. Patient comes to radiology for a follow up study of the lumbar spine. The patient had a spinal fusion performed at the L3/4 level 4 months earlier. Which of thet following would best demonstrate the degree of movement at the fusion site? a. Lateral flex/exten b. ferguson c. AP and lateral erect d. Rt and Lf 45 oblique

A

A radiograph of an LPO proj of the lumbar spine reveals that downside pedicle is proj too far posterior on the vertebral body. What specific positioning error is present on this radiograph? A. Excessive rotation of the spine B. Insufficient rotation of the spine C. Tilt of the spine D. Incorrect CR placement

A

A radiograph of the AP proj of the lumbar spine on an average size patient reveals that the psoas major muscles and transverse process are not visible. The following factors were used for the projections: 95 kV, 40 SID grid, and 14x17 image receptor. Which of the following mod will be most effective in demonstrating these structures? A. decrease the kV b. Activate all ionization chambers c. Decrease the mAs d. Increase kV

A

A radiograph of an AP axial coccyx reveals that the symphysis pubis is superimposed over the distal end of the coccyx. Which of hte following modifications will correct this problem during the repeat exposure? a. Decrease the CR angle b. Increase the CR angle c. Slightly oblique the patient d. Ask the patient to empty her bladder

B

54. Radiograph of obliques proj of SI jt dont clearly demonstrate the inferior/distal aspect of jt. What can the tech do to better demonstrate this region? a. Increase rotation of pelvis b. Initiate exposure upon expiration c. angle CR 15 to 20 cephalad d. perform position erect

C

42. A radiograph of an AP axial L5/S1 projection reveals that the jt space is not open. The following factors were used on this female patient: 80 kV, 40 SID, grid, 35 caudal, and CR centered to ASIS. Which of the following factor needs to be mod to produce a more diagnostic image? a. Increase the CR angle b. Decrease the CR angle c. Change the direction of the CR angle d. Center the CR higher to place it parallel to the jt space

C

Scatter radiation is minimized when using this important step.

Collimation

A radiograph of a lateral proj of the lumbar spine reveals that the mid- to lower intervertebral jt spaces are not open. The pt waist was supported. Which of the following modifications will help open these jt spaces during the repeat exposure? a. Increase the SID for less divergence of hte x-ray beam b. Decrease waist support and/or angle the CR 5 to 8 cephalic c. Have the patient hold her breath on a deeper inspiration to expand the thorax and straighten the spine d. Increase waist support and/or angle CR 5 to 8 caudal

D

Bone ________ produces very little skin does to the patient.

Densitometry

The breathing instruction recommended for most lumbar and sacral projections.

Expiration

This position is performed to demonstrate the right SI joint open

LPO

This curvature is decreased by flexing the knees for an AP lumbar projection

Lordotic

This modality best demonstrates the spinal cord and intervertebral disks

MRI

This type of metastases is indicated radiographically as a destruction lesion with irregular margins and increased density

Osteoblastic

The vertebral structure represents by the eye of the scotty dog.

Pedicle

What type of joint movement occurs with the z jt.?

Plane

The right lumbar z jt are demonstrated with this position.

RPO

25 to 30 degrees obliquity is required for this projections

Sacroiliac

This should be supported when performing the lateral lumbar and L5/S1 spot

Waist

47. Geriatric patient comes to radiology for a lumbar spine series. She has severe kyphosis of the thoracolumbar spine. Which one of the following mod should be applied to this patient? A. perform all positions erect b. perform all positions recumbent, include flex and ext c. include entire spine regardless whats ordered d. Use high 90 kV for all proj

a

This structure corresponds with the level of T9/10

Xiphoid Process

55. Where is the CR centered for posterior oblique projections of the SI joints? a. 1 inch (2.5 cm) medial upside ASIS b. 2 inches ( 5 cm) medial to upside ASIS c. Centered at upside ASIS d. 1 inch (2.5 cm) medial and inferior to upside ASIS

a. 1 inch (2.5 cm) medial upside ASIS

34. What type of CR angulation is required for an AP axial projection of the coccyx? a. 10 degrees caudad b. 15 degrees cephalad c. 10 degrees cephalad d. perpendicular to the cassette

a. 10 degrees caudad

20. Where is the CR centered for an AP projection of the lumbar spine with a 14 x 17-inch (35-x43-cm) IR? a. At the iliac crest b. At the ASIS c. 1 to 1.5 inches (2.5 to 3 cm) above the iliac crest d. At the lower costal margin

a. At the iliac crest

8. What is the best term for the superior aspect of the coccyx? a. Base b. Apex c. superior margin d. sacrococcygeal junction

a. Base

23. Which of the following statements is not true about the lateral L5-S1 projection? a. If the waist is not supported, the CR must be angled 5-8 degrees caudad. b. A lead mat should be placed on the tabletop behind the patient, and there should be close collimation to improve image quality. c. A 14 x 17-inch (35- x 43-cm) IR should be used. d. The CR is centered 1.5 inches (3-4 cm) inferior to the iliac crest and 2 inches (5 cm) posterior to the ASIS.

a. If the waist is not supported, the CR must be angled 5-8 degrees caudad.

7. Which one of the following structures of the sacrum is considered to be the most posterior? a. median sacral crest b. promontory c. Superior articular processes d. spinous processes

a. Median Sacral Crest

4. The anterior projecting bony process of the sacrum that forms part of the inlet of the true pelvis is the: a. Promontory of the sacrum b. body of the S1 c. apex of coccyx d. sacral foramina

a. Promontory of the sacrum

10. Which one of the following structures is located at the level of the ASIS? a. S1-2 b. Tip of coccyx c. Promontory of sacrum d. L4-5

a. S1-2

32. A key advantage of a PA projection taken suring a pediatric scoliosis study as compared with the AP projection is: a. it reduces breast and thyroid dose by 90% b. it reduces female ovarian dose by 25% to 30% c. it reduces breast dose by 15% to 30% d. it reduces breast and thyroid dose by 150%

a. it reduces breast and thyroid dose by 90%

30. The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine. a. true b. false

a. true

31. The second projection for the Ferguson methos of the scoliosis series requires that the concave side of the curve be built up 3 to 4 inches (8 to 10 cm) by placing blocks beneath the patient's foot. a. true b. false

a. true

52. The LPO position for sacroiliac joints will best demonstrate the right joint. a. true b. false

a. true

28. What CR angulation should be used for an AP axial projection of the L5-S1 joint space on a male patient? a. 20 degree cephalad b. 30 degree cephalad c. 35 degree caudad d. 40-45 degree cephalad

b. 30 degree cephalad

17. The average degree of rotation required to demonstrate the L3-4 zygapophyseal joints is: a. 50 degrees b. 30 degrees c. 20-25 degrees d. 45 degrees

b. 30 degrees

3. The zygapophyseal joints of the upper lumbar vertebrae are ___ in relationship to the midsagittal plane. a. 30 degrees b. 50 degrees c. 45 degrees d. 90 degrees

b. 50 degrees

36. Which of the following is a condition of unknown cause in which calcification of bony ridges between vertebrae occurs, creating a lack of mobility with a "bamboo" appearance? a. Scheuermann disease b. Ankylosing spondylitis c. Spondylolisthesis d. Osteoblastic type of metastases

b. Ankylosing spondylitis

19. Which of the following should be done to reduce scatter radiation from reaching the image receptor for the lateral lumbar, sacrum, and coccyx projections? a. use a lower kV b. Place a lead mat on the tabletop behind the patient c. Increase the SID to 44 inches (110 cm) d. use a smaller image receptor

b. Place a lead mat on the tabletop behind the patient

53. A radiograph of the left SI joints demonstrates it open and clearly seen. Which of the following positions was performed? a. LPO b. RPO c. RAO d. AP

b. RPO

15. The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine. a. true b. false

b. false

16. The anterior oblique (RAO/LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor. a. true b. false

b. false

29. Carefully placed gonadal shielding must always be used on female patients for the AP lumbar spine projection. a. true b. false

b. false

49. The "nose" of the Scottie dog represents the spinous process of a lumbar vertebrae. a. true b. false

b. false

38. Sciatic type of pain resulting from a "slipped disk" indicates: a. Spondylolisthesis b. herniated nucleus pulposus c. Ankylosing spondylitis d. spina bifida

b. herniated nucleus pulposus

43. A patient comes to radiology for a study of the lumbar spine. He has a clinical history of spondylolisthesis of L5. Which of hte following proj will best demonstrate severity of this condition? a. 30 oblique b. 50 oblique c. Lateral L5/S1 d. AP axial L5/S1

c

6. Which aspect of the sacrum articulates with the ilium to form the sacroiliac joint? a. Promontory b. cornu c. Auricular surface d. Inferior articular processes

c. Auricular surface

40. What CR angle should be used for a lateral sacrum/coccyx projection? a. 15 degree cephalad b. 30 degree cephalad c. None. CR is perpendicular to the image receptor. d. 10 degrees cephalad

c. None. CR is perpendicular to the image receptor.

37. The anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called: a. a teardrop burst fracture b. a chance fracture c. a compression fracture d. spondylolysis

c. a compression fracture

5. Another term for the sacral horns is the: a. base of the sacrum b. promontory of the sacrum c. cornu of the sacrum d. median sacral crest

c. cornu of the sacrum

50. For a lateral L5-S1 projection, the CR must be parallel to the ____. a. midsaggital plane b. midcoronal plane c. interiliac line d. transverse plane

c. interiliac line

33. Where is the CR centered for an AP axial projection of the sacrum? a. At the level of the ASIS b. At the level of the symphysis pubis c. 1 to 1 1/2 inches (3-4 cm) below the iliac crest d. 2 inches (5 cm) above symphysis pubis

d. 2 inches (5 cm) above symphysis pubis

51. How much obliquity of the body is required for posterior oblique positions for the sacroiliac joints? a. 45 degrees b. 10-15 degrees c. 60-70 degrees d. 25-30 degrees

d. 25-30 degrees

21. An average of ___segment(s) make up the adult coccyx. a. 1 b. 4 c. 5 d. 3

d. 3

1. The intervertebral formaina of the Lumbar spine are located at an angle of ___ in relation to the midsagittal plane. a. 45 degrees b. 30-35 degrees c. 70-75 degrees d. 90 degrees

d. 90

35. The radiographic appreance on an oblique lumbar spine in which the neck of the Scottie dog appears broken suggest the presence of ___. a. spondylolisthesis b. spina bifida c. compression fracture d. spondyloysis

d. Spondylolysis

18. Why should the hips and knees be flexed for an AP projection of the lumbar spine? a. for patient comfort b. to reduce the lumbar curvature c. to demonstrate and possible spondylolisthesis d. both answers A and B

d. both answers A and B

9. Which one of the following topographical landmarks corresponds with the L4-5 vertebral level? a. Xiphoid process b. Lower costal margin c. ASIS d. Iliac crest

d. iliac crest

2. The small section of the bone found between the superior and inferior articular processes of the lumbar spine is termed: a. pillar b. transverse processes c. articular facets d. par interarticularis

d. pars interarticularis

39. An abnormal lateral curvature of the spine is a congenital condition termed: a. spina bifida b. Spondylolisthesis c. lordorsis d. scoliosis

d. scoliosis

This pathologic condition is one cause of a compression fracture

osteoporosis