Bontrager Ch 8 Cervical and Thoracic Spine Workbook

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

LORDOSIS

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

15 degrees cephalad

Which region of the spine must be demonstrated with a cervicothoracic lateral position

C5 to T3

Match the following topographic landmarks to the correct vertebral level- Vertebra prominens

C7-T1

List three features that make the cervical vertebrae unique.

A. Transverse foramina B. Bifid spinous process C. Overlapping vertebral bodies

List the number of bones found in each division in the adult vertebral column Thoracic

12 (lunch)

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

The zygapophyseal joints for the second through seventh cervical vertebrae are at a ___________degree angle to the midsagittal plane; the thoracic vertebrae are at a __________ degree angle to the midsagittal plane.

90 ;70-75

Indicate which two portions of the vertebral column are classified as secondary or compensatory curves.

A. Cervical B. Lumbar

List the outer and inner aspects of the intervertebral disk.

A. Outer aspect Annulus fibrosus B. Inner aspect Nucleus pulposus

Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection

AP "wagging jaw" projection (Ottonello method)

A short column of bone found between the superior and articular processes in a typical cervical vertebra is called

Articular pillar

Which of the following structures is best demonstrated with an AP axial vertebral arch projection

Articular pillars (lateral masses) of the cervical spine

What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull

Atlanto-occipital articulation

alternative names for C1 cervical vertebrae.

Atlas

alternative names for C2 cervical vertebrae.

Axis

Name the following parts of the sternum or associated topographic landmarks. Center portion of sternum:

BODY

The two main parts of a typical vertebra are the

BODY and the VERTEBRAL ARCH

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

Match the following topographic landmarks to the correct vertebral level- Mastoid tip

C1

Match the following topographic landmarks to the correct vertebral level- Gonion

C3

Which two things can be done to produce equal density along the entire thoracic spine for an AP projection (especially for a patient with a thick chest)

Correct use of anode-heel effect and use of compensating (wedge) filter

The modified body of C2 is called the

Dens or odontoid process

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

EXPIRATION; MAXIMUM SHOULDER DEPRESSION

True/False: Only T11 and T12 have full facets for articulation with ribs. (T1, T10 to T-12 have full facets)

False

True/False: The zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position.

False

True/False: If close collimation is used during conventional (analog) radiography of the spine, the use of lead masking (blockers) is generally not required.

False (Lead masking should be used even if close collimation is used.)

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.

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

Herniated nucleus pulposus (HNP)

Situation: A patient with a possible cervical spine injury enters the emergency room. The patient is on a backboard. Which projection of the cervical spine should be taken first

Horizontal beam lateral projection

Situation: A patient who has been in a motor vehicle accident (MVA) enters the emergency room. The basic projections of the cervical spine show no subluxation (partial dislocation) or fracture. The physician wants the spine evaluated for whiplash injury. Which additional projections would best demonstrate this type of injury

Hyperextension and hyperflexion lateral positions

Which of the following projections is considered a "functional study" of the cervical spine

Hyperextension and hyperflexion lateral positions

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

INTERVERTEBRAL foramina.

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

A radiograph of an AP axial projection of the cervical spine shows that the intervertebral disk spaces are not open. The following positioning factors were used: extension of the skull, central ray angled 10-degree cephalad, central ray centered to the thyroid cartilage, and no rotation or tilt of the spine. Which of these factors must be modified to produce a more diagnostic image

Increase central ray angulation to 15 degrees cephalad.

A radiograph on a lateral projection of the cervical spine shows that C7 is not clearly demonstrated. The following factors were used: erect position, 44-inch (112-cm) SID, arms down by the patient's side, and exposure made during inspiration. Which two of these factors should be changed to produce a more diagnostic image during the repeat exposure

Initiate exposure during suspended expiration and increase SID to 72 inches (183 cm).

Name the following parts of the sternum or associated topographic landmarks. Superior margin of this upper section (landmark):

JUGULAR (SUPRASTERNAL) NOTCH

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

LAMINA

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

LT Intervertebral foramina(DOWNSIDE)

The spinal cord begins with the (A) __________ of the brain and extends down to the (B) _______, where it tapers and ends. This tapered ending is called the (C) __________

MEDULLA OBLONGATA;LOWER BORDER OF L1 vertebra;CONUS MEDULLARIS

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

MYELOGRAPHY

What is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae

Presence of facets for articulation with ribs

Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine

Right

Which zygapophyseal joints are demonstrated in a right anterior oblique (RAO) projection of the thoracic spine

Right (downside)

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

Right intervertebral foramina (upside)

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

Swimmer's method

Match the correct aspect(s) of the Convex curve (with respect to posterior) (with respect to posterior) with the following characteristics. (There may be more than one correct answer.)

Thoracic spine & Sacrum

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: Many geriatric patients have a fear of falling off the radiographic table.

True

True/False: Nuclear medicine is often performed to diagnose bone tumors of the spine.

True

A radiograph of a lateral thoracic spine shows that lung markings and ribs make it difficult to visualize the vertebral bodies. The following factors were used: recumbent position, 40-inch (102-cm) 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 of an orthostatic (breathing) technique to blur lung markings and ribs more effectively.

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

VERTEBRAL (SPINAL) CORD

Name the following parts of the sternum or associated topographic landmarks. Most inferior aspect of sternum (landmark):

XIPHOID PROCESS

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

Zygapophyseal joints

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 lack of symmetry of the zygapophyseal joints between C1 and C2 may be caused by injury or may be associated with

Rotation of the skull

An abnormal lateral curvature seen in the thoracolumbar spine is called

SCOILIOSIS

Which structures pass through the intervertebral foramina

SPINAL NERVES & BLOOD VESSELS

Name the following parts of the sternum or associated topographic landmarks. Joint between top and center portions (landmark):

STERNAL ANGLE

Situation: A patient comes to the radiology department with a clinical history of Scheuermann disease. Which radiographic procedure is often performed for this condition

Scoliosis series

What are the major differences between spondylosis and spondylitis

Spondylitis is an inflammatory process of the vertebrae characterized by bony bridges between vertebrae (advanced stages). Spondylosis is a condition of the spine characterized by decreased vertebral joint space and arthritic changes of the zygapophyseal joints.

Situation: A patient comes to the radiology department for a cervical spine series. An AP "open mouth" radiograph indicates that the base of the skull and the lower edge of the front incisors are superimposed, but the top of the dens is not clearly demonstrated. What should the technologist do to demonstrate the upper portion of the dens

(A horizontal beam lateral projection has ruled out a C-spine fracture or subluxation.) Perform either the (AP) Fuchs or (PA) Judd method.

List the number of bones found in each division in the adult vertebral column Coccyx

1

List the number of bones found in each division in the adult vertebral column Sacrum

1

How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position

20 degrees from lateral position (70 degrees from plane of table or wall bucky)

What central-ray angle must be used with the AP axial-vertebral arch (Pillars) projection

20- to 30-degree caudad

List the number of bones found in each division in the adult vertebral column Lumbar

5 (dinner)

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

60 to 72 inches (152 to 183 cm)

List the number of bones found in each division in the adult vertebral column Cervical

7 (breakfast)

What are two important benefits of using an SID 60 to 72 inches (152 to 183 cm) for the lateral cervical spine projection

A. Compensates for increased object image receptor distance (OID); reduces magnification B. Less divergence of x-ray beam to reduce shoulder superimposition of C7

List the two advantages of using higher kV exposure factors with high-latitude analog (film-screen) systems imaging for spine radiography, especially on an anteroposterior (AP) thoracic spine radiograph.

A. Increase in exposure latitude (wider range of densities) B. Decrease in patient dose

List the two primary or posterior convex curves seen in the vertebral column

A. Thoracic B. Sacral

Situation: A patient enters the ER with a possible cervical spine fracture, but the initial projections do not demonstrate any gross fracture or subluxation. After reviewing the initial radiographs, the ER physician suspects either a congenital defect or a fracture of the articular pillars of C4. He wants an additional projection taken to see better this aspect of the vertebrae. What additional projection can be taken to demonstrate the articular pillars of C4

AP axial—vertebral arch (pillar) projection

Situation: A patient comes to the ER with a possible Jefferson fracture. Other than a lateral projection or a CT scan, what specific radiographic projection will best demonstrate this type of fracture

AP open mouth projection. The patient's mouth must be carefully opened without any movement of the cervical spine.

A radiograph of a cervicothoracic lateral position demonstrates superimposition of the humeral heads over the upper thoracic spine. Because of an arthritic condition, the patient is unable to rotate the shoulders any farther apart. What can the technologist do to separate the shoulders further during the repeat exposure

Angle CR 3 to 5 degrees caudad.

Match the following topographic landmarks to the correct vertebral level- Thyroid cartilage

C4-C6

Match the correct aspect(s) of Develops as child learns to hold head erect (with respect to posterior) with the following characteristics. (There may be more than one correct answer.)

Cervical spine

Match the correct aspect(s) of the Concave curve (with respect to posterior) (with respect to posterior) with the following characteristics. (There may be more than one correct answer.)

Cervical spine & Lumbar spine

Match the correct aspect(s) of the Secondary curve (with respect to posterior) with the following characteristics. (There may be more than one correct answer.)

Cervical spine & Lumbar spine

Situation: A broad shouldered patient comes to the radiology department for a routine cervical spine series. The lateral projection demonstrates only the C1 to C5 region. The radiologist wants to see C6-T1. What additional projection can be taken to demonstrate this region of the spine

Cervicothoracic (swimmer's) lateral position

Which of the following projections delivers the greatest skin dose to the patient

Cervicothoracic lateral position

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. Which specific positioning error is present on this radiograph

Excessive extension of the skull

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 image receptor (IR)

What is the term for the same structure, identified in the previous question, for the C1 vertebra

Lateral mass

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

What ancillary device should be placed behind the patient on the tabletop for a recumbent lateral projection of the thoracic spine

Lead mat or masking

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

Lower margin of upper incisors and base of skull

Name the following parts of the sternum or associated topographic landmarks. Upper portion of sternum:

MANUBRIUM

Which skull positioning line is aligned perpendicular to the IR for a PA (Judd) projection for the odontoid process

Mentomeatal line (MML)

Which imaging modality is ideal for detecting early signs of osteomyelitis

NUC MED

A radiograph of an AP "wagging jaw" (Ottonello method) projection taken at 75 kV, 10 mAs, and 0.5 second (analog technique) demonstrates that part of the image of the mandible is still visible and is obscuring the upper cervical spine. Which modification needs to be made to produce a more diagnostic image during the repeat exposure

Reduce mAs and increase exposure time to produce more blurring of the mandible.

Match the following topographic landmarks to the correct vertebral level- Jugular notch

T2-T3

Match the following topographic landmarks to the correct vertebral level- Sternal angle

T4-T5

Which specific thoracic vertebrae are classified as typical thoracic vertebrae (i.e., they least resemble cervical or lumbar vertebrae)

T5 to T8

Match the following topographic landmarks to the correct vertebral level- 3 to 4 inches (8 to 10 cm) below jugular notch

T7

Match the following topographic landmarks to the correct vertebral level- Xiphoid process (tip)

T9-T10

Match the correct aspect(s) of the Primary curve (with respect to posterior) with the following characteristics. (There may be more than one correct answer.)

Thoracic spine & Sacrum

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

Thyroid, parathyroid glands, and breasts

Where should the central ray be placed for a cervicothoracic lateral position

To T1; 1 inch (2.5 cm) above the jugular notch anteriorly and level of vertebra prominens posteriorly

What is the purpose of using an orthostatic (breathing) technique for a lateral projection of the thoracic spine

To blur out rib and lung markings that obscure detail of thoracic vertebrae

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

To open up the intervertebral disk spaces

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

True

True/False: The thyroid dose delivered during a posterior oblique cervical spine (LPO or RPO) projection is greater than the thyroid dose for an anterior oblique (RAO or LAO) projection of the cervical spine.

True

True/False: To a certain degree, magnetic resonance imaging (MRI) and computed tomography (CT) are replacing myelography as the imaging modalities of choice for the diagnosis of a ruptured intervertebral disk.

True

True/False: When using digital imaging for spine radiography, it is important to use close collimation, grids, and lead masking.

True

A radiograph of an AP projection of the thoracic spine shows that the upper thoracic spine is greatly overexposed 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 compensating (wedge) filter with thicker part of filter placed over the upper thoracic spine to equalize the density along the thoracic spine.

For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail. This can be done by (more than one answer may be used):

Using a small focal spot Increasing the source image receptor distance (SID)

alternative names for C7 cervical vertebrae.

Vertebra prominens

A radiograph of a right posterior oblique (RPO) cervical spine projection shows that the lower intervertebral foramina are not open. The upper intervertebral foramina are well visualized. What positioning error most likely led to this radiographic outcome

When the lower intervertebral foramina are narrowed while the upper foramina are well demonstrated, the positioning error most often is under-rotation of the upper body (shoulders). The upper body must be rotated 45 degrees.