Bontrager's Chapter 8 Cervical and Thoracic Spine

Match the vertebra with the corresponding terms and/or structures. (You may use an answer more than once.): a. C7 1. Dens b. C2 2. Vertebra prominens c. C1 3. Axis d. C4 4. Anterior arch e. T1 5. Typical cervical vertebra f. T7 6. Lateral masses

1. B 2. A 3. B 4. C 5. D 6. C

Which best demonstrate a compression fracture of the thoracic spine

Lateral projection

The xiphoid process corresponds to the vertebral level of

T9-10

How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)?

70°

A patient comes to radiology for a thoracic spine routine. The patient has a history of arthritis of the spine. The radiologist requests that additional projections be taken to demonstrate the zygapophyseal joints. What position(s) and/or projection(s) would be ideal to demonstrate these structures?

70° oblique projections

The zygapophyseal joints for the thoracic spine lie at an angle of ____ in relation to the midsagittal plane.

70° to 75°

What is the recommended kV range for thoracic spine projections when using digital systems?

75 to 85 kV

The body of C2 is labeled _____.

D

A patient comes to radiology for a follow-up study of the cervical spine. The patient had spinal fusion between C5 and 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?

Hyperflexion and hyperextension projections

Stress from a severe whiplash type of injury may cause a fracture of the structure labeled

I

(T/F) Another term for a breathing technique during exposure is the orthostatic technique

True

All thoracic vertebrae have at least one facet for rib articulation.

True

A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed. The lower vertebrae have acceptable density and contrast. Which one of the following modifications will improve the visibility of the upper thoracic spine?

Use a compensating (wedge) filter

Which of the following is NOT a correct evaluation criterion for the AP axial C-spine projection?

a. C3-T2 vertebral bodies should be visualized. b. Spinous processes are seen to be equal distances from the vertebral body lateral borders. c. CR is at the lower margin of the thyroid cartilage.

The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ in relation to the midsagittal plane.

90°

The structure transverse process is labeled _____.

A

Which position or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2?

AP open mouth

This radiographic image which projection represents?

AP open-mouth projection

Which of the following clinical conditions will require a decrease in analog manual technical factors?

Advanced osteoporosis

The AP axial-vertebral arch projection may be performed to better demonstrate the:

vertebral arch (articular pillars) of C4-7

The joints between articular processes of vertebra are termed _____ joints.

zygapophyseal

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

(T/F) An RPO position of the cervical spine requires a 45° oblique of the body with a 15° caudad CR angle.

False

(T/F) The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints.

False

(T/F) The posterior cervical oblique projections demonstrate the intervertebral foramina and pedicles on the side closest to the image receptor.

False

(T/F)The PA projection (Judd method) is intended to demonstrate the atlantoaxial joints between C1 and C2.

False

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

Keep the vertebral column parallel to the tabletop

The structure pedicle is labeled _____.

L

The spinal cord tapers off to a point distally at the vertebral level of:

L1-2.

Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine?

LAO

Which of the following projections will best demonstrate the C4-5 zygapophyseal joints of the cervical spine?

Lateral

A patient comes to radiology for a follow-up study for a clay shoveler's fracture. Which of the following projections will best demonstrate the extent of this fracture?

Lateral cervical spine

For an average-size adult, which of the following would receive the highest skin dose?

Lateral thoracic spine

At the level of the jugular notch.

T2-3 intervertebral disk space is found

Which of the following best defines or describes the vertebral body of C1?

There is no vertebral body at C1.

Why are the anterior oblique projections (right anterior oblique [RAO]/left anterior oblique [LAO]) preferred over the posterior oblique projections of the cervical spine?

To reduce the thyroid dose

For a typical adult vertebra, the transverse processes extend laterally from the junction of the pedicles and laminae

True

Which of the following factors will enhance the visibility of the vertebral bodies during a lateral projection of the thoracic spine?

Use an orthostatic (breathing) technique.

Along with increasing the source image receptor distance (SID), what other factor(s) will improve spatial resolution for lateral and oblique projections of the cervical spine?

Using a small focal spot

Which thoracic vertebra(e) possess(es) no facets for costotransverse joints?

T11-12

The most posterior aspect of a typical vertebra is the:

spinous process.

Which projection will project the dens within the shadow of the foramen magnum?

AP projection (Fuchs method)

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

15° cephalad

What type of CR angulation is required for the AP axial projection for the cervical spine?

15° to 20° cephalad.

What type of CR angle is recommended when performing the AP axial C-spine projection erect?

20° cephalad

On average, how many separate bones make up the adult vertebral column?

26

Along with the upper incisors, what other bony landmark must be aligned for the AP open-mouth projection?

Base of skull

Where is the articular pillar located on a cervical vertebra?

Between the superior and inferior articular processes

The gonion corresponds to the vertebral level of

C3

The most prominent aspect of the thyroid cartilage corresponds to the vertebral level of:

C5

Which of the following is the first compensatory spinal curvature to develop in the young child?

Cervical

A digital image taken of a lateral thoracic spine projection demonstrates poor visibility of the spine. The image was taken on a full 14- 17-inch (35- 43-cm) IR. The following factors were used during the exposure: 80 kV, 80 mAs, 40-inch (102-cm) SID, and collimation to the size of the IR. Which one of the following modifications will result in a more diagnostic image?

Collimate to spine

A critique of the image demonstrates which repeatable error? a. Excessive flexion of the skull b. Excessive extension of the skull c. Mouth not open far enough d. None of the above are repeatable errors.

D. None of the above are repeatable errors.

. The superior articular facet is labeled _____.

G

The structure anterior arch of the atlas is labeled _____.

H

A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following analog factors were used for this projection: 5° cephalad angle, 40-inch (100-cm) SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage. Which of the following modifications should be made during the repeat exposure?

Increase the CR angulation.

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. Which positioning error most likely lead to this radiographic outcome?

Insufficient rotation of the upper body

A patient enters the emergency department (ED) because of a motor vehicle accident (MVA). The patient is on a backboard 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?

Leave the collar on during the exposure

The structure lamina is labeled _____.

M

Which aspect of the intervertebral disk is composed of semigelatinous material?

Nucleus pulposus

The part vertebral foramen is labeled _____.

O

A patient enters the ED with a cervical spine injury as a result of a fall. The initial horizontal beam lateral projection reveals no subluxation or fracture. The ED physician is concerned about a whiplash injury. Which of the following routines would be most helpful in diagnosing this type of injury?

Patient in hyperflexion and hyperextension lateral positions

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 broad shoulders. Which of the following options will best demonstrate this region of the spine?

Perform a cervicothoracic (swimmer's) lateral position.

A patient comes 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 upper portion of the dens?

Perform the Fuchs or Judd method

A patient enters the ED due to an MVA. He is on a backboard and in a cervical collar. The initial lateral cervical spine projection demonstrates C1-6. The patient has broad and thick shoulders. Because the hospital is in a rural setting, no CT scanner is available. Which of the following modifications would best demonstrate the lower cervical spine safely?

Perform the horizontal beam cervicothoracic (swimmer's) lateral position.

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

Place a lead mat on the tabletop just posterior to the patient

The structure transverse foramen is labeled _____.

Q

Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine?

RPO

A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric. No fracture or subluxation is present. Which one of the following positioning errors most likely led to this radiographic outcome?

Rotation of the spine

Which of the following pathologic conditions is defined as "a condition of the spine characterized by rigidity of a vertebral joint"?

Spondylosis

Which of the following factors does not apply to a lateral projection of the cervical spine?

Suspend respiration upon full inspiration prior to exposure.

Which features makes the cervical vertebra unique as compared with other vertebrae of the spine?

a. Transverse foramina and double (bifid) tips on spinous processes b. Overlapping vertebral bodies c. Presence of zygapophyseal joints

Kyphosis is defined as a(n):

abnormal thoracic curvature with increased convexity.

Scoliosis is defined as an abnormal or exaggerated _____ curvature.

lateral

The structure labeled A, which should be well demonstrated on this projection, is the:

odontoid process.

The bony structures connected directly to the vertebral body are the:

pedicles.

The chin is extended for a lateral projection of the cervical spine to:

prevent superimposition of the mandible upon the spine