Combo with "Chapter 8 Cervical & Thoracic Spine" and 5 others
outer aspects of the intervertebral disks
annulus fibrosus
what is the name for the superior broad aspect of the coccyx
base
The spinous processes of C2-C6 are short and end in double-pointed or ______?
bifid tips
The occipitoatlantal joint between skull and C1 is ________classification type, _______ mobility type, _______ movement type?
synocial, diarthrodial, ellipsoid
The superior cross-sectional perspective of typical rib articulations show that articulations are closely spaced and are enclosed in______?
synovial capsules
The synovial joints are classified as______ and allow slight ______ movement?
synovial joints, gliding movements
Option 1 for Odontoid if cant perform:
•Fuchs Method (AP)
Both of the inferior curves, the lumbar and the sacral (or pelvic), are usually more pronounced in men or in women?
•In women
3.Which of the following curves is classified as being compensatory? a. Thoracic b. Cervical c. Sacral d. None of the above
?
Herniated Nucleus Pulposus (HNP)
A slipped disk
what topographic landmark corresponds to S1-S2
ASIS
# of bones: Cervical
7
32. The posterior cervical oblique projections demonstrate the intervertebral foremina and pedicles on the side closest to the image receptor. a. true b. false
?
45. An RPO position of the cervical spine requires a 45 degree oblique of the body with a 15 degree caudad CR angle. a. true b. false
?
46. The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints. a. true b. false
?
Clinical Indication: Ankylosing Spondylitis
A form of rheumatoid arthritis
Scheuermann's Disease
A relatively common disease of unknown origin that generally begins during adolescence. Results in abnormal spinal curvature of kyphosis and scoliosis.
Transitional Vertebra
An incidental finding that occurs when the vertebra takes on a characteristic of the adjacent region of the spine.
A radiograph of the cervicothoracic lateral position demonstrates superimposition of the humeral heads over the upper t-spine. Because of an arthritic condition, the patient is unable to rotate the shoulders any farther apart. What can the tech do to further separate the shoulders during the repeat exposure?
Angle CR 3* to 5* caudad
Disease that affects men ages 20-40 years old results in pain and stiffness and inflammation of the sacroiliac, intervertebral and costovertebral joints?
Ankylosing Spondylitis
A short column of bone found between the superior and articular processes in a typical cervical vertebra called _________ ______.
Articular pillar
Which structure is best demonstrated with an AP axial vertebral arch projection?
Articular pillars (lateral masses of c-spine)
Clinical Indication: Clay Shoveler's Fracture
Avulsion fracture of the spinous process of C7
Clinical Indication: Teardrop burst Fracture
Comminuted fracture of the vertebral body with posterior fragments displaced into the spinal column
When a baby begins to learn how to hold their head up, the ______ concave curve forms in the cervical region?
First compensatory
Clinical Indication: Hangman's Fracture
Fracture through the pedicles and anterior arch of C2 with forward displacement upon C3
Compression Fracture
Frequently associated with osteoporosis, involves collapsing of the vertebrae.
Fracture extends through the pedicles of C2 with or without subluxation of C2 on C3, from hyperextension?
Hangman's fracture
The soft inner part of the intervertebral disk protrudes through fibrous cartilage outer layer into the spinal canal, it can press on nerves and spinal cord?
Herniated nucleus pulposus
The condition involving a "slipped disk" is correctly referred to as _________ _______ ________.
Herniated nucleus pulposus (HNP)
Situation: A patient with a possible c-spine injury enters the ER. The patient is on a backboard. Which projection of the c-spine should be taken first?
Horizontal beam lateral postions
A radiograph of an AP axial projection of the c-spine reveals that the intervertebral disk spaces are not open. The following positioning factors were used: extension of the skull, CR angled 10* cephalad, CR centered to the thyroid cartilage, & no rotation or tilt of the spine. Which of these factors must be modified to produce a more diagnostic image?
Increase CR angle to 15* cephalad
Spondylitis
Inflammation of the vertebrae
A radiograph on a lateral projection of the c-spine reveals that C7 is not clearly demonstrated. The following factors were used: erect position, 44" SID, arms down by the patient's side, and exposure made during inspiration. Which 2 of these factors should be changed to produce a more diagnostic image during that repeat exposure?
Initiate exposure during suspended expiration and increase SID to 72"
The ______________ foramina are created by 2 small notches on the superior and inferior aspects of the pedicles.
Intervertebral
Type of fracture splintered or crushed at site of impact occurs as a result of axial loading, such as landing on ones head abruptly?
Jefferson fracture
Name of the superior portion of this upper section of the sternum (topographic landmark)
Jugular notch
Abnormal or exaggerated convex curvature of the thoracic spine that results in stopped posture and reduced height?
Kyphosis
An abnormal condition characterized by increased convexity of the thoracic spine curvature?
Kyphosis
Intervertebral Foramina CR 15 to head-visualize.... CR 15 to feet-visualize....
LPO-Right Foramina; RPO-Left Foramina (upside) LAO-Left Foramina; RAO-Right Foramina (downside)
The ______ are 2 bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline.
Lamina
What is the most posterior portion of the vertebrae?
Laminae
What position best demonstrates the zygapophyseal joints?
Lateral
What is the term for the articular pillar, for the C1 vertebra?
Lateral mass
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 foramina are demonstrated with a LAO position of the cervical spine?
Left intervertebral foramina (upside)
An abnormal, or exaggerated, "sway back" lumbar curvature is called ________.
Lordosis
Refers to an abnormal anterior concavity of the lumbar spine is termed?
Lordosis
Movement type: Intervertebral
No movement
Which imaging modality is ideal for detecting early signs of osteomyelitis?
Nuclear Medicine
What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull?
Occipitoatlantal articulation
Clay Shoveler's Fracture
Occurs with hyperflexion of the neck, results in avulsion fractures of the spinous processes of C6 through T1.
The odontoid fracture involves the dens and can extend into the lateral masses or arches of C1?
Odontoid fracture
What is the outer and inner aspects of the intervertebral disk
Outer: Annulus fibrosus Inner: Nucleus pulposus
if a patient cannot lie on his back for the AP sacrum because it is to painful, what alternate projection can be taken to achieve a similar view of the sacrum
PA (prone) with 15 degree caudad CR angle
What is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae?
Presence of facets for articulation with ribs
Clinical Indication: Unilateral Subluxation
Produces the "bow tie" sign
A radiograph of an AP "wagging jaw" projection taken at 75kV, 20mAs, and 0.5 sec demonstrates that part of the image of the mandible is still visible and 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
Common disease of unknown orgin that generally begins during adolescences. Results in abnormal spinal curvature of hyphosis and scolisosis?
Scheuermann's disease
An abnormal lateral curvature seen in the thoracolumbar spine is called _________.
Scoliosis
Slight lateral curvature of the thoracic spine?
Scoliosis
Situation: A patient comes to the radiology dept with a clinical history of Scheuermann disease. Which radiographic procedure is often performed for this condition?
Scoliosis Series
Which structures pass through the intervertebral foramina?
Spinal nerves & blood vessels
Classification: All Joints except C2-T12 (Intervertebral)
Synovial
The jugular notch is at what thoracic vertebra?
T2 and T3
The jugular notch is approximately at the level of...
T2-3
Correct vertebral level: Jugular notch
T2-T3
topographic landmarks: jugular notch
T2-T3
Correct vertebral level: Sternal angle
T4-T5
topographic landmarks: sternal angle
T4-T5
Which vertebra of the thoracic spine are smaller and share features of the cervical vertebrae?
T5, T6, T7, T8
Out of the 12 thoracic vertebrae, which ones are considered typical vertebrae and why?
T5-8 because they do not resemble the cervical or lumbar vertebrae.
Which specific thoracic vertebrae are classified as typical vertebrae? (Ex: they least resemble cervical or lumbar vertebrae)
T5-T8
which vertebrae are classified as typical thoracic vertebrae
T5-T8
The spinous process of the last vertebra, C7 vertebra prominens is at the same level as the body of _____ vertebra?
T7
Begins at the base of the skull and extends distally to the sacrum it contains cerebrospinal fluid?
The spinal canal
A transitional vertebra is an incidental finding occurs when the vertebra takes on a characteristics of adjacent region of the spine?
Transitional vertebra
A radiograph of a lateral t-spine reveals that lung markings and ribs make it difficult to visualize the vertebral bodies. The following factors were used: recumbent position, 40" SID, short exposure time, and exposure made during full inspiration. 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
VERTEBRAL COLUMN
VERTEBRAL COLUMN
The opening, or passageway, for the spinal cord is the _________ ______.
Vertebral (spinal) column
A radiograph of a RPO c-spine projection reveals 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. The upper body must be rotated 45*.
Name of the most inferior aspect of the sternum (topographic landmark)
Xiphoid process
What is found between the superior and inferior articular processes?
Zygapophyseal joints
Facets-Unilateral Subluxation and Bilateral Locks
Zygapophyseal joints in the cervical region can be disrupted during trauma.
C1 has no body but does have a thick arch of bone called the ______?
anterior arch
The anterior arch of C1 includes a small______?
anterior tubercle
In a lateral perspective between the superior and inferior articular processes is short column of bone that is more supportive than the similar area in the rest of the spinal column. This column of bone is called______, and sometimes called_____ when referring to C1?
articular pillar, lateral mass
The segments of bone between the superior and inferior articular processes of C1 are called?
articular pillars
a short column of bone found between the superior and articular processes in a typical cervical vertebra is called
articular pillars
imaging modality for osteoporosis
bone densitometry
In between every 2 vertebra are 2_____, one on each side through which important spinal nerves and blood vessels pass?
intervertebral foramen
When vertebra are stacked the superior and inferior notches line up, these half moon shaped areas form a single opening called?
intervertebral foramen
On each side, between any thoracic vertebrae are __________ which are defined on the superior and inferior margins by the pedicles?
intervertebral foramina
Allow for flexibility and movement of the vertebral column located tightly bound between adjacent vertebral bodies for spinal stability?
intervertebral joint
To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections, it is important to..
keep the vertebral column parallel to image receptor
the two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline
lamina
On each side of the of the transverse process when looking at a lateral view you can find the _____?
laminae
The posterior part of the vertebral arch is formed by two some what flat layers of bone called____?
laminae
compared with the spinous processes of the cervical and thoracic spine, the lumbar spinous processes are
larger and more blunt
The thoracic intervertebral foramina are best demonstrated on a ______ position?
lateral
The zygapophyseal joints of the cervical spine are best visualized in a ______ position?
lateral
which position or projection of the lumbar spine series best demonstrates a possible compression fracture
lateral
where is the central ray centered for an AP axial projection for L5-S1
level of ASIS at midline of body
what is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae
presence of facets for articulation with the ribs
Thoracic and sacral curves begin to develop after birth these curves are called the ______ curves?
primary curves
A LPO position opens up the foramina on the _____side and a ______ angle is needed?
right, 15 degree cephalad (A posterior oblique of the cervical the upside is the side on which in the intervertebral foramina are opened well)
The zygopophyseal joints of the 2nd-7th cervical vertebrae are located at _____ angles or _____ degrees to the midsagittal plane and thus are visualized only in a true lateral position?
right, 90
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
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
which two structures can be evaluated to determine whether rotation is present on a radiograph of an AP projection of the lumbar spine
sacroiliac joints & spinous process (should be midline to the vertebral column)
The manubrium and the body connect at a slight easily located angle termed?
sternal angle
Depending on the patient body habitus the shoulders may _____ the last cervical vertebra on a lateral position?
superimpose
Seen on a lateral view the right and left ______ and the lower pair of the right and left ________ are superimposed?
superior articular processes, inferior articular processes
Each of the left and right C1 superior articular processes presents a large depressed surface called a _____for articulation with the respective left and right occipital condyles of the skull?
superior facet
Along the upper surface of the pedicle is a half moon shaped area called?
superior vertebral notch
The costovertebral joints between T1-T12 are classified as _______ type, ______mobility type, and _______ movement type?
synovial, diarthrodial, plane (gliding)
opening or passageway for the spinal cord
vertebral (spinal) canal
How many thoracic vertebrae are there?
•12
Which vertebrae are the largest and how many of them are there?
•5 lumbar
How many sacral and coccyx bones does a newborn have?
•5 sacral segments •3 to 5 coccygeal segments
Which thoracic spines are performed at 40 inches?
•AP •Lateral
Thoracic Spine Positions: (2)
•AP •Lateral (All 14 x 17)
Cervical spine positions: (5)
•AP Axial •AP Open mouth (C1-C2) •Lateral •Oblique (Anterior or Posterior) •Swimmer's Lateral (Twining Method) (All 10 x 12)
Which cervical spines are performed at 40 inches?
•AP Axial •Odontoid
(AP) Posterior Oblique C-Spine
•AP w/CR 15⁰ cephalad •Body at a 45⁰ angle, head may be lateral depending on protocol •Extend chin slightly •Ray to pass through C4 (upper margin of thyroid cartilage and center of oblique plane) •SID 40-72"
How many articular processes do each typical vertebra have
•Four processes, two superior articular processes and two inferior articular processes
Alternatives to Odontoid Open Mouth?
•Fuchs Method (AP) •(Judd Method (PA)
Where does the spinal canal begin and end?
•It begins at the base of the skull and extends distally into the sacrum
What does the vertebral column provide?
•It provides a flexible supporting column for the trunk and head and also transmits the weight of the trunk and upper body to the lower limbs.
The posterior part of the vertebral arch is formed by these two somewhat flat layers of bone called what?
•Laminae
Which cervical spines are performed at 60-72 inches?
•Lateral •Oblique •Swimmer's
Lateral Thoracic Spine
•Left lateral recumbent •Support under waist •Flex knees, support between knees •*Place lead behind patient to absorb scatter* •*Breathing technique* •CR perp to T7 and slightly posterior to MCP •IR about 2" above shoulders on average patient •Patients with very broad shoulders may require 3-5 degree cephalic angle •Collimate (7 x 17)
What are three common descriptions of vertebral curvature's when they become exaggerated or abnormal?
•Lordosis, kyphosis and scoliosis
Advantage of the Judd Method over the Fuchs Method:
•Lower radiation dose to thyroid gland
(PA) Anterior Oblique C-Spine
•PA w/CR 15⁰ caudad •Body at a 45⁰ angle, head may be lateral depending on protocol •Extend chin slightly •Ray to pass through C4 (upper margin of thyroid cartilage and center of oblique plane) •*Preferred due to less radiation to thyroid gland) •SID 40-72"
Fuchs Method pathology
•Pathology involving dens and surrounding bony structures of the C1 ring
Lateral C Spine X-ray pathology
•Pathology of C-Spine & soft tissues •Spondylosis •Osteoarthritis
Lateral C Spine position & pathology *Horizontal beam/trauma*
•Pathology of cervical spine, particularly fractures
AP Axial Pathology
•Pathology of mid to lower cervical spine (C3-C7) •Clay shoveler's fracture, compression fractures, and herniated disks
AP Thoracic Spine pathology
•Pathology of thoracic spine, fractures, subluxation, kyphosis
AP Open Mouth pathology
•Pathology/fractures •C1-C2 and adjacent soft tissue structures •Odontoid and Jefferson fractures
These structures extend posteriorly from either side of the vertebral body and for most of the sides of the vertebral arch.
•Pedicles
From where does the spinous process extend, and in which direction does it extend?
•Posteriorly, from the midline junction of the two laminae
AP Thoracic Spine position
•Recumbent •No rotation, use wedge filter if possible or use anode heel effect •Flex knees/sponge •Be sure T10-12 are included •Expose on expiration •CR perp to T7 and MSP •Top of cassette should be about 1-1 1/2 inches above the level of the shoulder •Collimate (7x17) •SID 40"
An exaggerated lateral curvature of the spine is called what?
•Scoliosis
Cervical Spine AP Axial Positioning
•Supine or erect •Occlusal plane & mastoid tip parallel to IR
AP Axial Position
•Supine or erect •Occlusal plane/mastoid tip are perpendicular to the IR •CR 15⁰-20⁰ cephalad @ C4 (Lower margin of thyroid cartilage) •SID 40"
Cervical Spine Odontoid (Open Mouth) Positioning
•Supine or erect •Upper incisors in line with mastoid tips •Drop lower jaw, mouth open wide, no tilt or rotation
AP Open Mouth position
•Supine or erect •Upper incisors line up with base of skull (mastoid tips) •Mouth wide during exposure •CR Perpendicular to open mouth •SID 40'
What are the two main parts of each vertebra?
•The body and the vertebral arch
What type of spinal curves begin to develop soon after birth?
•The convex primary curves of the thoracic and sacral regions
A slight curvature of the vertebral column is normal and is typically associated with what?
•The dominant extremity. •A right-handed person might have a convexity to the right whereas a left-handed person might have a convexity to the left
What develops as a child begins to raise its head and sit up?
•The first compensatory concave curve of the cervical region
What is the most common spot for a lumbar puncture and why?
•The level of L3 to L4 to avoid striking the conus medullaris at L2
Why are the lumbar vertebrae the strongest in the vertebral column?
•The lumbar vertebrae carry the load of body weight which increases toward the inferior end of the column. •For this reason the cartilaginous disks between the inferior lumbar vertebrae are common sites of injury and pathology.
Where is the vertebral column located?
•The mid sagittal plane posteriorly, forming the posterior dorsal aspect of the bony trunk of the body
What does the vertebral foreman contain?
•The spinal cord
What does the spinal canal contain?
•The spinal cord and the cerebrospinal fluid
Where does the spinal cord begin?
•The spinal cord, which is enclosed and protected by the spinal canal, begins with the medulla oblongata of the brain. It passes through the foramen magnum of the skull, and continues through the first cervical vertebra all the way down to the lower border of the first lumbar vertebrae where it tapers off to a point called the conus medullaris.
What extends laterally from approximately the junction of each pedicle and lamina?
•The transverse processes
When several vertebrae are stacked, as they are in the normal articulated vertebral column, the succession of vertebral foramena forms a tube-like opening called what?
•Vertebral canal •It encloses and protects the spinal cord
What is the name of the opening formed by the surface of the vertebral body and the arch?
•Vertebral foramen
When does the second compensatory concave curve develop and where is it located?
•When the child learns to walk •Located at the lumbar curvature
Lateral C Spine position & pathology *Hyperflexion & Hyperextension*
•Whiplash injuries •Pre or post surgery
The gonion corresponds to the level of...
C3
What projection is considered a "functional study" of the cervical spine?
Hyperextension and hyperflexion lateral positions
When should the Judd or Fuchs method be performed?
If unable to demonstrate the upper portion of the dens with the AP "open mouth" projection
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
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 the oblique projections?
Rotate the skull into a near lateral position
The second primary curve is...
Sacral Curvature (convex)
Oblique
Similar to lateral, only 20 degrees posterior from lateral. •Shows zygapophyseal joints •CR 40"
Name of the joint between top and center portion of the sternum (topographic landmark)
Sternal angle
Another way to localize the level of C1 is to go about 1 inch below the level of the ______?
EAM- external acoustic meatus
Movement type: Occipitoatlantal(Skull-C1)
Ellipsoid (condyloid)
Zygapophyseal joints in the cervical region can be disrupted during trauma. Zygapophyseal joint may be out of alignment with unilateral subluxation?
Facets, unilateral subluxation and bilateral locks
The intervertebral foramen are formed by...
the superior and inferior vertebral notches
Which 2 things can be done to produce equal density along the entire thoracic spine for the AP projection (especially for a patient with a thick chest)?
Correct use of anode heel effect; use of compensating (wedge) filter
C1 is also referred to as the _____?
atlas
alternate name for C2
axis
35. Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine? a. LPO b. RPO c. RAO d. Lateral
b. RPO
Vetebral arteries and veins and certain nerves pass through the _______?
transverse foramen
what are the three features that make the cervical vertebra uniquie
transverse foramina, bifid spinous process and overlapping vertebral bodies
nose of scott dog
transverse process
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
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
True/ False: The zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position.
False
Rather than two laminae and spinous process found in typical vertebrae, C1 has a _______ that generally bears a small _____ at midline?
posterior arch, posterior tubercle
unilateral subluxation
produces the "bow tie" sign
The anterior/superior ridge of the upper sacrum is called
promontory
the anterior and superior aspect of the sacrum that forms the posterior wall of the pelvic inlet is called the
promontory
what topographic landmark corresponds to the tip of the coccyx
pubis symphysis
In addition to the gonads, which other radiosensitive organs are of greatest concern during cervical and thoracic spine radiography?
Thyroid, parathyroid glands, and breasts
Jefferson Fracture
A comminuted fracture that occurs as a result of axial loading, such as landing on one's head or abruptly on one's feet.
Situation: A patient who has been in a MVA enters the ER. The basic projections of the c-spine reveal no subluxation 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
The first compensatory curve is also known as...
the cervical curvature (concave) (Lordotic)
Ribs 11 and 12 only articulate at...
the costovertebral joints.
The mastoid tip corresponds to...
the level of C1
Which 4 vertebra of the thoracic spine are larger and share characteristics of the lumbar vertebrae?
the lower 4 thoracic vertebra
The mechanism of injury is compression with hyperfelxion in the cervical region?
Teardrop burst fracture
Where should the CR be placed for the cervicothoracic (swimmer's) position?
To T1; 1" above the jugular notch anteriorly, or 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* angle for the AP axial projection of the cervical spine?
To open up the intervertebral disk spaces
True/ False: The thyroid dose used during a posterior oblique cervical spine projection is more than 10 times greater than the dose used for an anterior oblique projection of the c-spine.
True
True/ False: To a certain degree, MRI and CT are replacing myelography as the imaging modalities of choice for the diagnosis of a ruptured intervertebral disk.
True
What is the proper name of the method for performing the cervicothoracic (swimmer's) position?
Twinning method
1. The number of bones that make up the adult vertebral column? a. 33 b. 28 c. 26 d. 31
c. 26
34. Which of the following factors will enhance the visibility of the vertebral bodies during a lateral projection of the thoracic spine? a. Using a high kV b. Increase SID c. Using a Breathing Technique d. Flex the spine
c. Using a Breathing Technique
the intervertebral foramina of the lumbar spine are classified as, mobility type and movement type
cartilaginous, amphiarthrodial (slightly movable), n/a
The intervertebral joints between C2-T12 are classified as ______type, _______ mobility type, and _______ movement type?
cartilaginous, amphiarthrodial, N/A
Anterior oblique of the intervetbral foramina of the cervical spine with the closest to the IR (downside) would be opened and a 15 degree_____ angle is required?
caudad
indicate which two portions of the vertebral column are classified as secondary or compensatory curves
cervical and lumbar
what two things can be done to reduce high amounts of scatter reaching the IR during a lateral projection of the sacrum and coccyx
close collimation and lead mat on the table behind the patient
what is the formal term for the "tail bone"
coccyx
teardrop burst fracture
comminuted fracture of the vertebral body with posterior fragments displaced into the spinal canal
what device produces a more uniform density along the vertebral column for an AP/PA scoliosis projection
compensating filter
another term for sacral horn
cornua
Articulations of the ribs to the thoracic vertebra consists of joints called?
costal joints
All of the first 10 thoracic vertebrae also have facets that articulates with the tubercles of ribs 1-10, these articulations are called______?
costotransverse joints
Each facet or combination of two demifacets accepts the head of a rib to form a ________?
costovertebral joint
Ribs 11 and 12 articulate only the _______?
costovertebral joint
T2-T8 have ______ on their upper and lower margins?
demifacets
why should a single lateral projection of the sacrum and coccyx be performed rather than separate laterals of the sacrum and coccyx
dosage
The anterior oblique of the thoracic spine would demonstrate the _____ joints?
downside
chance fracture
fracture of the vertebral body caused by hyperflexion force
hangmans fracture
fracture through the pedicles and anterior arch of C2 with forward displacement upon C3
T10-T12 have ____facets?
full
Each thoracic has a ____ facet or ____ ____ facets called ____.
full, two partial, demifacets
With the head in neutral position, the angle of the jaw or _____ is at the same level as C3?
gonion
When the soft inner part of the disk referred to as the nucleus pulposus protrudes through the outer fibrous layer, it presses on the spinal cord and causes pain and numbness this is called?
herniated nucleus pulposus
the condition involving "slipped disks" is correctly referred to as
herniated nucleus pulposus (HNP)
The lateral position of the thoracic spine best shows the _______?
intervertebral foramina
created by two small notches on the superior and inferior aspects of the pedicles
intervertebral foramina
the superior and inferior vertebral notches join together to form the
intervertebral foramina
scoliosis
lateral curvature of the vertebral column
which sacroiliac joint is visualized with an RPO position
left
scheuermann disease
mild form of scoliosis and kyphosis developing during adolesence
Cervical Spine AP Axial Centering
•CR 15⁰-20⁰ •C4 (enters at lower margin of thyroid cartilage) •MSP •40" SID
Cervical Spine Odontoid (Open Mouth) Centering
•CR Perpendicular to open mouth •MSP •40" SID
What are the five sections of the vertebral column?
•Cervical •Thoracic •Lumbar •Sacral •Coccygeal
Ring like or arch of the bone that extends posteriorly for the vertebral body. The posterior surface of the body and arch from a circular opening is called_____?
vertebral foramen
The _____ contains the spinal cord?
vertebral foramen
how should the spine of a patient with scoliosis be positioned for a lateral position of the lumbar spine
with the sag or convexity of the spine closest to the IR
what topographic landmark corresponds to T9-T10
xiphoid process
the ear and the front leg of the scottie dog make up the _______ joint, best seen in the oblique position
zygapophyseal
In a lateral oblique perspective of the thoracic spine the superior articular processes and the inferior articular processes are shown to connect the successive thoracic vertebrae to form the _______ joint?
zygapophyseal joint
what is found between the superior and inferior articular processes
zygapophyseal joints
# of bones: Coccyx
1
How many inches superior to the jugular notch is the T1?
1.5 inches
how many thoracic vertebrae are there
12
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 is required
15 degree cephalad
where is the central ray centered for an AP projection of the coccyx
2 inches superior to the symphysis pubis
The typical vertebra consists of _____ pedicles, _____ laminae, _____transverse processes, ____spinous process, and ______ articular processes?
2, 2,2,1,4
how much rotation of the body is required for oblique positions of the SI joints
25 to 30 degrees
# of total bones in the vertebral column
26
How many total vertebrae are there in an adult?
26
43. Patient enters the ER because of motor vehicle accident. The patient is on a back board and wearing a cervical collar. The technologist is concerned about the aritfacts that the collar will project on the spine during the horizontal beam lateral projection. What should the technologist do in this situation? A. Leave on during exposure B. Remove collar but be careful not to move head C. Ask patient to remove the collar herself D. Ask ER physician to remove and hold pt head
A. Leave on during exposure
41. Situation: Radiograph of AP open mouth reveals that the base of the skull is superimposed over the dens. What positioning error led to this radiographic outcome? A. Excess flexion B. Excess extension C. Excess CR angle D. Rotation of skull
B. Excess extension
The first 7 vertebrae are known as?
Cervical vertebrae
Mobility Type: All Joints except C2-T12 (Intervertebral)
Diarthrodial
Which joint (s) have a movement type of plane or gliding?
R and L lateral atlantoaxial; zygapophyseal; costovertebral; and costotransverse
When several vertebrae are stacked the succession of vertebral foramina form a tube like opening the _____?
vertebral canal
Swimmer's C Spine pathology
•C7-T1pathologies and fractures when not visualized •C5-T3 *Twining Method*
Hangman's Fracture
This fracture extends through the pedicles of C2, with or without subluxation of C2 on C3.
Lordosis is the...
normal compensatory concave curvature of the cervical and lumbar spine.
imaging modality for inflammatory conditions such as pagets disease
nuclear medicine
Exaggerated lateral curvature of the spine is referred to as?
scoliosis
What are the vertebral foramen formed by?
The lamina, pedicles, and body.
# of bones: Sacrum
1
where is the central ray centered for a lateral L5-S1 projection of the lumbar spine
1 1/2 inches inferior to the iliac crest and 2 inches posterior to the ASIS
where is the central ray for an AP projection of the sacrum
1 in. superior to the ASIS
where is the CR centered for an oblique projection of the SI joints
1 inch medial from the upside ASIS
where is the central ray centered for an AP projection of the lumbar spine with a 30X35cm (11X14in) IR
1-1 1/2in above the iliac crest (approximate level of the lower costal margin)
What are 2 important benefits of an SID longer than 40"-44" for the lateral cervical spine projection?
1. Compensates for increased OID; reduces magnification 2. Less divergence of x-ray beam to reduce shoulder superimposition of C7
# of bones: Thoracic
12
For the central ray to pass through and "open" the intervertebral spaces on a 45* posterior oblique projection of the cervical vertebrae, what central ray angle (if any) is required?
15* cephalad
the degree of obliquity required for an oblique projection at the T12-L1 level is approximately ______ degrees, where as the L5-S1 level spine requires ______ degrees oblique
50, 30
What is the recommended SID for a lateral projection of the cervical spine?
60" to 72"
how many cervical vertebrae are there
7
What does the Atlas (C1) have instead of a body?
A thick arch of bone called the anterior arch.
The cervical zygopophyseal joints of C1 and C2 are visualized only on an _____ projection?
AP open mouth
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 c-spine
Situation:A patient comes to the radiology dept for a routine c-spine series. The lateral projection demonstrates only the C1 to C6 region. The radiologist wants to see C7-T1. What additional projection can be taken to demonstrate this region of the spine?
Cervicothoracic (swimmer's) lateral projection
Which projection delivers the greatest skin dose to the patient?
Cervicothoracic position
Ankylosing Spondylitis
Illness of unknown origin involves the spine and larger joints. Results in pain and stiffness that result from inflammation of the sacroiliac joints.
Clinical Indication: Jefferson Fracture
Impact fracture from axial loading of the anterior and posterior arch of C1
Clinical Indication: Spondylitis
Inflammation of the vertebrae
POSITIONING
POSITIONING
The spinal cord begins with the _______ _________ of the brain and extends down to the _____ ______ __ __ vertebra, where it tapers and ends. The tapered ending is called the _____ __________.
Medulla oblongata; Lower border of L1; Conus medullaris
Which skull positioning line in aligned perpendicular to the IR for a PA (Judd) projection for the odontoid process?
Mentomeatal line (MML)
Clinical Indication: Scheuermann Disease
Mild form of scoliosis and kyphosis developing during adolescence
What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space?
Myelography
Extend posteriorly from either side of the vertebral body form most of the sides of the vertebral arch is _____?
Pedicles
Situation: A patient comes to the radiology dept for a c-spine series. An AP "open mouth" radiograph indicates that the base of the skull and lower edge of the front incisors are superimposed, but the top of the dens is not clearly demonstrated. What should the tech do to demonstrate the upper portion of the dens?
Perform either the (AP) Fuchs or (PA) Judd method
Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine?
Right
Which zygapophyseal joints are demonstrated in a RAO projection of the thoracic spine?
Right (downside)
Which foramina are demonstrated with a LPO position of the cervical spine?
Right intervertebral foramina (downside)
What are the major differences between spondylosis and spondylitis?
Spondylitis is an inflammatory process of the vertebrae. Spondylosis is a condition of the spine characterized by rigidity of a vertebral joint
The xiphoid tip is approximately at the level of...
T9-10
Correct vertebral level: Xiphoid process (tip)
T9-T10
The xiphoid tip is at the level of _____ thoracic vertebrae?
T9-T10
Which two parts of the vertebral column is considered concaved?
The cervical and the lumbar vertebra
Spondylosis
The characteristic of this condition is neck stiffness that occurs when age-related degeneration of the intervertebral disks.
Where does the spinal canal end?
The conus medullaris or L1
Which of the cervical vertebra has no body?
The first one
What are articular pillars also known as?
The lateral mass
Teardrop Burst Fracture
The mechanism of injury is compression with hyperflexion in the cervical region.
Where does the spinal canal begin?
The medulla oblongata of the brain.
The intervertebral disk contains two parts. What are they and where are they located?
The nucleus pulposus is located in the center and the annulus fibrosus is located on the outer rim.
The first primary curve is...
The thoracic curvature (convex)
What are the transverse foramen formed by?
The transverse processes and the pedicles.
Which two parts of the vertebral column is considered convex?
Thoracic and sacral
Movement type: Medial Atlantoaxial
Trochoid (Pivot)
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
True/ False: Only T1, T11, and T12 have full facets for articulation with ribs.
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 t-spine reveals 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 modified to produce a more diagnostic image during the repeat exposure?
Use a compensating (wedge) filter with a thicker part of filter placed over the upper thoracic spine to equalize the density along the t-spine
33. What type of CR angle for posterior oblique (LPO/RPO) positions of the cervical spine? a. 15 degree cephalad b. 15 degree caudad c. 5-10 degree cephalad d. none CR is perpendicular to the IR
a. 15 degree cephalad
22. Which of the following pathologic conditions will require a decrease in manual technical factors? a. Advanced Osteoporosis b. Serve scoliosis c. Moderate Lordosis d. Scheuermann disease
a. Advanced Osteoporosis
When trying to get a radiographic image of C1 and C2 what are the 2 things that need to be perfectly symmetric or the can imitate injury?
atlantoaxial joints and the relationship of the dens to C1
alternate name for C1
atlas
clay shovelers fracture
avulsion fracture of the spinous process of C7
C2 is also referred to as the _____?
axis
28. Which of the following positions will demonstrate the zygapophyseal joints of the cervical spine? a. AP axial b. Posterior Obliques c. lateral dAnterior Obliques
c. lateral
4. Scoliosis is defined as an abnormal or exaggerated: a. concave curvature b. convex curvature c. lateral curvature d. "swayback" lumbar curvature
c. lateral curvature
which projections are designed to measure mobility of the vertebral column at the site of a spinal fusion
hypertension and hyperflexion
which projection should be taken to evaluate flexibility following spinal fusion surgery
hypertension and hyperflexion projections
what topographic landmark corresponds to L4-L5
iliac crest
with a 35X43cm (14X17in) IR, the central ray is centered at the level of the ________ for AP and lateral lumbar positions
iliac crest
jeffersons fracture
impact fracture from axial loading of the anterior and posterior arch of C1
What purpose does the curves of the vertebral column serve?
increases strength of the vertebral column and helps maintain balance along the center line of gravity in the upright position
What lies inferior to the lamina that articulates with C3 on C2 vertebra?
inferior articular process
leg of scottie dog
inferior articular process
Along the lower surface of each pedicle is another half moon shaped area called?
inferior vertebral notch
sponylitis
inflammation of the vertebrae
ankylosing spindylitis
inflammatory condition that is most common in males in their 30s and a form of rheumatoid arthritis
for the lateral L5-S1 projection, the CR is parallel to the ______ plane
interiliac
inner aspects of the intervertebral disks
nucleus pulposus
what is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull
occipitoatlantal articulation
The articulations between C1 and the occipital condyles of the skull are called?
occipitoatlantal joints
The thyroid cartilage is approximately at the level....
of C4-6
T9 has only ____demifacet on its upper margin?
one
Type of arthritis characterized by degenertation of one or many joints?
osteoarthritis
Condition characterized by loss of bone mass. Bone loss that increases with age?
osteoporosis
Injury to C1 and C2 can cause what?
paralysis or death
neck of scottie dog
pars interarticularis
what is the abnormal lateral curvature seen in the thoracolumbar spine
scoliosis
The _______ concave curve, the lumbar curvature develops when children learn to walk?
second compensatory
what condition is often diagnosed by prenatal ultrasound
spina bifida
what structures pass through the intervertebral foramina
spinal nerves and blood vessels
Extends posteriorly at the midline junction of the two laminae, can often be palpated along the posterior surface of the neck and back is called?
spinous process
The blunt_____ with its bifid tip extends posteriorly on the C2 vertebra?
spinous process
The first thoracic vertebra can be located by palpating the posteriorly at the base of the neck for the ________ prominens?
spinous process of C7 vertebra
Inflammation of the vertebrae?
spondylitis
Condition is neck stiffness due to age related degeneration of intervertebral disks?
spondylosis
ear of scottie dog
superior articular process
The right and left lateral atlantoaxial joints between C1 and C2 are classified as ______ type of joint with a _____mobility type and a________ movement type?
synovial, diarthrodial, plane (gliding)
The zygapophyseal joints between C2-T12 are classified as ______ type, _______ mobility type, and ______ movement type?
synovial, diarthrodial, plane (gliding)
the costotransverse joint between T1-T10 are classified as ______ type, ______ mobility type, and ________movement type?
synovial, diarthrodial, plane (gliding)
the zygapophyseal joints of the lumbar spine are classified as, mobility type and movement type
synovial, diarthrodial, plane or gliding
The medial atlantoaxial joint between C1 and C2 is classified as ______type, _______mobility type, and _________ movement type?
synovial, diarthrodial, trochoid
The tubercles of ribs 1 through 10 articulate with the facets where...
the costotransverse joints.
what set of zygopophyseal joints of the lumbar spine is seen on a posterior oblique
the downside (RPO-right & LPO-left)
Swimmer's C Spine position
•Arm closest to IR is up, closest to tube is back •Head of humerus should be slightly anterior to the vertebrae •CR perp to MCP and T1 (approximately 1 1/2 inches above the jugular notch, anteriorly, at the level of C7 prominens. •If the arms can't be separated, angle beam 3-5 degrees caudad. •SID 72"
This part of the vertebra is the thick weight-bearing anterior part of the vertebra. Its superior and inferior surfaces are flat and rough for attachment of what?
•Body •Intervertebral disks
What are the first seven vertebrae called?
•Cervical vertebrae
what set of zygapophyseal joints of the lumar spine is seen on an anterior oblique
the upside (LAO-right & RAO- right)
The cervical and lumbar regions of the spine have what type of curvature, and how are they described?
•Concave and lordotic
The thoracic and sacral regions have what type of curvatures?
•Convex
Lateral C Spine position
•Erect if possible •Depress shoulders as much as possible and rotate forward •Extend chin forward •*Expose on full expiration* •CR perp to C4 and MCP •*Top of cassette about 1" above EAM* •SID 60-72"
The vertebral column is divided into how many sections?
•Five sections
the two primary or posterior convex curves seen in the vertebral column
thoracic and sacral
convex curve (with respect to posterior)
thoracic spine and sacrum
primary curve
thoracic spine and sacrum
The ______ or the adams apple is at the approximate level of C5?
thyroid cartliage
why should the knees and legs be flexed for an AP projection of the lumbar spine
to level out lumbar curvature which opens intervertebral disk space
The dens or the odontoid process is held in place by the ______?
transverse atlantal ligament
In a superior view of the vertebra of C3-C6 the transverse processes are small and arise from both the pedicle and the body, rather than from the pedicle lamina junction. The hole in each of the transverse process is called?
transverse foramen
Extending laterally from approximately the junction of each pedicle and lamina is a projection termed?
transverse process
The posterior oblique of the thoracic spine on the right shows the zygapophyseal joint on the ______ ?
upside
For lateral and oblique projections of the cervical spine, it is important to minimize magnification and minimize detail by:
using a small focal spot & increasing SID
The last or seventh cervical vertebra is called the______?
vertebra prominence
Option 2 for Odontoid if cant perform:
•Judd Method (PA)
Compare the number of vertebral segments in a child compared to an adult?
•There are an average of 33 separate bones in the vertebral column of a young child. After fusion into a single sacrum and a single coccyx, the adult vertebral column is composed of an average of 26 separate bones
What do intravertebral disks provide?
•These cushion-like disks are tightly bound to the vertebrae for spinal stability but allow for flexibility and movement of the vertebral column
From where do the lamina extend and where do they unite?
•They extend posteriorly from each pedicle to unite in the midline.
These primary and compensatory curvatures are normal and serve what important function?
•They increase the strength of the vertebral column and help maintain balance along a centerline of gravity in the upright position
The effect of scoliosis is more obvious if it occurs in the lower vertebral column where it may create what?
•Tilting of the pelvis with a resultant effect on the lower limbs, producing a limp or an uneven walk.
What separates the typical adult vertebrae from one another?
•Tough fibrocartilaginous disks called intervertebral disks
What is the second part of a typical vertebra consisting of a ring or arch of bone that extends posteriorly from the vertebral body?
•Vertebral arch
Vertebral column curvatures
•Vertebral column curvatures
7-8 inches below the jugular notch is what thoracic vertebrae?
T7
Correct vertebral level: 3"-4" below jugular notch
T7
Odontoid Fracture
Involves the dens and can extend into the lateral masses or arches of C1.
List 2 advantages of using higher kV exposure factors (analog imaging) for spine radiography, especially on an AP thoracic spine radiograph.
1. Increase in exposure latitude 2. Decrease in patient dose
List 3 features that make the cervical vertebrae unique.
1. Transverse foramina 2. Bifid spinous process 3. Overlapping vertebral bodies
Which 2 landmarks must be aligned or an AP "open mouth" projection?
Lower margin of upper incisors and base of skull
Cervicothoracic (Swimmers) Lateral C-Spine
72 inch or 180 cm (erect); 40 inch or 100 cm (recumbent); 10 x 12 LW; stripe to head; 80-95 kV; CR to T1 which is approximately 1 inch superior to jugular notch; lateral collimation only; breathe in, out, hold out.
how much central ray angulation is required for an AP projection of the sacrum for a typical male
15 degrees cephalad
What CR angle must be used with a posterior oblique projection of the cervical spine?
15* cephalad
The intervertebral foramina are also directed at a _____ degree _____ angle because of shape and overlapping of the cervical vertebrae?
15, inferior
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position?
20* from lateral position
What CR angle must be used with the AP axial vertebral arch projection?
20* to 30* caudad
the sacroiliac joints lie at an oblique angle of _____ degrees to the coronal plane
30 degrees
After fusion of the sacral bones in adult life how many bones is the vertebral column composed of?
26 separate bones
each sacroiliac joint opens obliquely _____ degrees posteriorly
30
what amount and direction of central ray angulation is required for an AP axial L5-S1 projection on a male patient
30 degree cephalad
how much rotation is required to properly visualize the zygapophyseal joints at the L5-S1 level
30 degrees
How many total vertebrae are there in a child?
33
Before fusion of sacral coccyx bones how many bones does a young child have in a vertebral column?
33 separate bones
what type of cr angle is recommended for the AP axial projection of the SI joints on a female patient
35 degrees cephalad
AP T-Spine
40 inch or 100 cm; 14 x 17 LW; stripe to head; 85-95 kV; knees flexed with feet flat on table; CR to T7 and Midsagittal; collimate to 7 x 17; breathe in, out, hold out
Lateral T-Spine
40 inch or 100 cm; 14 x 17 LW; stripe to head; 85-95 kV; must use sponge under waist and lead mat behind back; CR to T7 and 1-2 inches posterior to Midcoronal; collimate 7 x 17; 2 second breathing technique
AP "Open Mouth"-Odontoid
40 inch or 100 cm; 8 x 10 LW, Stripe to right; 75-85 kV; CR to center of open mouth; align lower margin of upper incisors with the base of the skull; 4 x 4 collimation; don't move, breathe, or swallow
AP Axial C-Spine
40 inch or 100 cm; 8 x 10 LW; stripe to right; 75-85 kV; CR 15 degrees to the head; CR to C4 (upper margin) and Midsagittal; lateral collimation only; suspend respiration
The second compensatory curve is...
Lumbar curvature (Concave) (Lordotic)
The intervertebral foramina are situated at a ___ angle to the midsagittal plane?
45 degree
the angle of the mid lumbar spine zygapophyseal joints in relation to the midsagittal plane is
45 degrees
To open up and demonstrate the cervical intervertebral foramina radiographically, a _____degree oblique position combined with a ______ angle of the x-ray tube is required?
45, 15 degree cephalad
In order to open up and demonstrate the thoracic zygapophyseal joints radiographically, a _______ position with a perpendicular ray is needed?
70-75 degrees oblique
# of bones: Lumbar
5
how many lumbar vertebrae are there
5
what type of central ray angulation should be used for the lateral L5-S1 projection if the waist is not supported
5 to 8 degree caudad
a patient with a wide pelvis and narrow thorax may require a central ray angle of ______ for a lateral position of the lumbar spine
5-8 degree caudad
How many and of what parts make up the vertebral column?
7 Cervical; 12 Thoracic; 5 Lumbar; 5 Sacrum (in a child) and 1 sacrum (in an adult); 4 Coccyx (in a child) and 1 coccyx (in an adult)
A ______ oblique position is necessary to open up the zygapophyseal joints in the thoracic spine?
70 degree
In thoracic vertebrae, the zygapophyseal joints form an angle of _____ from midagittal plane?
70-75 degrees
Lateral C-Spine (Also hyperextension and hyperflexion)
72 inch or 180 cm; 10 x 12 LW; stripe to head; 75-85 kV; must use weights to depress shoulders; CR to level of C4 (upper margin); breathe in, out, hold out.
Anterior and Posterior Oblique C-Spine
72 inch or 180 cm; 8 x 10 LW; stripe to right; 75-85 kV; CR 15 to feet for AO (change to PA on monitor); CR 15 to head for PO; CR to level of C4 (upper margin); suspend respiration
The openings of the intervertebral foramina on the thoracic vertebra are located at right angles or _________?
90 degree to the midsagittal plane
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 _____ angle to the midsagittal plane
90, 70-75
The zygapophyseal joints for the 2nd through 7th vertebrae are at a __* angle to the midsagittal plane; the thoracic vertebrae are at a __* to __* angle to the midsagittal plane.
90; 70 to 75
10. Which of the following statements are true? a. All adult vertebrae are separated by intervertebral disks. b. All thoracic vertebrae have atleast one facet for rib articulation. c. The intervertebral disks are tightly bound to the vertebral bodies to prevent movement within the vertebral column. d. All of the above
?
11. Which of the following makes the cervical vertebra unique as compared with other vertebrae of the spine? a. Transverse formina and double (bifid) tips on spinous process b. Overlapping vertebral bodies c. Presence of zygapophyseal joints d. All of the above
?
29. Which of the following is not correct criterion for the AP axial C spine projection? a. C3 to T2 vertebral bodies should be visible b. Spinous processes are seen to be equal distances from the vertebral body lateral borders c. Center of the collimation field is at C4 d. All of the above are correct criteria
?
Which AP projection of the C-spine demonstrates the entire upper cervical spine with one single projection?
AP "wagging jaw" projection (Ottonello method)
Situation:A patient enters the ER with a possible c-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 fracture of the articular pillars of C4. He wants an additional projection taken to better see this aspect of the vertebrae. What additional projection can be taken to demonstrate the articular pillar of C4.
AP axial- vertebral arch projection
patients should be asked to empty their bladder before performing which projection of the vertebral column
AP of sacrum and coccyx
Clinical Indication: Scoliosis
Abnormal lateral curvature of the spine
Clinical Indication: Kyphosis
Abnormal or exaggerated convex curvature of the thoracic spine
For an AP axial of the cervical spine, a plane through the tip of the mandible and ____ __ _____ should be parallel to the angled central ray.
Base of skull
The path of the spinal cord from the most superior down?
Begins with the medulla oblangata, then passes through the foramen magnum of the skull, continues through the 1st cervical vertebra all the way down to the lower border of the first lumbar vertebra all the way down to the lower body of the first lumbar vertebra where it tapers off at a point called conus medullaris
What are the short and double-pointed tips?
Bifid Tips
Name of the center portion of the sternum
Body
The 2 main parts of a typical vertebra are the ____ and the _________ ____.
Body; vertebral arch
38. Situation: A radiograph of an AP open mouth projection for the cervical spine reveals that the zygopophyseal joints are not symmetric. No fracture or subluxation are present. Which of the following positioning errors most likely lead to this radiographic outcome? A. Excessive CR angle B. Insufficient CR angle C. Rotation of spine D. Excessive flexion of head
C. Rotation of the spine
42. Situation: Pt comes to the radiology department for a c/s 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, what should tech do to demonstrate the entire dens? A. Increase flexion B. Increase extension C. perform Fuch or Judd D. Perform AP chewing projection
C. perform Fuch or Judd
Correct vertebral level: Mastoid tip
C1
topographic landmarks: mastoid tip
C1
What are other names for the C1 and C2 vertebrae?
C1 is the Atlas and C2 is the Axis
Rotation of head primarily occurs between_____ with the ____ acting as a pivot?
C1-C2, dens
List the alternative names for the following cerival vertebrae: C1, C2, & C7
C1: Atlas C2: Axis C7: Vertebra Prominens
Correct vertebral level: Gonion
C3
topographic landmarks: gonion
C3
The thyroid cartilage landmark varies between the levels of ____ and ____ of the cervical spine?
C4, C6
Correct vertebral level: Thyroid cartilage
C4-C6
topographic landmarks: thyroid cartilage
C4-C6
Which region of the spine must be demonstrated with the cervicothoracic (swimmer's) position?
C5- T3
Correct vertebral level: Vertebra prominens
C7-T1
Fracture which results from hyperflexion of the neck?
Clay shovelers fracture
A rounded outward or elevated surface curve of the vertebral column is?
Convex
50. Pt comes to radiology for a follow-up study of the c/s. The patient had spinal fusion btwn C5/6 performed 7 months earlier. His physician wants to assess the c/s for anteroposterior mobility. Which of the following projections would provide this assessment? A. Cervicothoracic B. AP axial vertebral arch C. Judd or Fuch D. Flexion, Extension
D. Flexion, Extension
52. Pt enter ER due to MVA. He is on a back board and in a cervical collar. The initial lateral c/s projection demonstrates C1 to C6. The patient has broad and thick shoulders. BC of the hospital is in rural setting, no CT scanner available. Which of the following mod would best demonstrate lower c/s? A. increase kV B. Ask patient to stand and do lateral C. Have student pull down the arm during exposure D. Horizontal beam swimmers
D. Horizontal beam swimmers
39. Situtation: A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following factors were used for this projection: 5 degree cephalad angle, 40 inch (100 cm) SID, grid, slight extension of the skull, and CR centered to the thyroid cartilage. WHich of the following modifications should be made during the repeat exposure? A. CR perpendicular B. Increase SID C. Center CR to gonion D. Increase CR angle
D. Increase CR angulation
40. Situation: A radiograph of lateral t/s 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 tech do to improve the visibility of the posterior elements of the spine? A. Use higher-speed screens and film B. Increase the kV, lower the mAs C. use higher-ratio grid D. Place lead mat on table behind patient
D. Place lead mat on table behind patient
44. Lateral projection of the thoracic spine reveals that the upper aspect which is the primary area of interest is obscured by pt shoulders. Which of the following changes will best demonstrate this region of the spine? A. Use compensating wedge filter B. Angle CR 10 to 15 cephalad C. Have pt erect and hold weight in hand D. perform a cervicothoracic (swimmer's) lateral position
D. perform a cervicothoracic (swimmer's) lateral position
The _____ or ______ is part of the second cervical vertebra but a superior perspective of C1?
Dens odontoid process
The conical process that projects up from the superior surface of the body of C2 is called?
Dens or odontoid process
The modified body of C2 is called the ____ or ________ _______.
Dens or odontoid process
A radiograph of an AP "open mouth" projection of the cervical spine reveals 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
The lateral projection of the cervical spine should be taken during __________. Why?
Expiration; for maximum shoulder depression
Name of the upper portion of sternum
Manubrium
compression fracture
a type of fracture that rarely causes neurologic deficits
The 12 vertebrae following the 7 cervical where each connect to a pair of ribs is the____?
Thoracic vertebrae
What is the area called on the atlas that the axis rests on?
The inferior articular surface of C1. The superior articular surface is on C2.
24. 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
16. The most prominent aspect of the thyroid cartilage corresponds to this vertebral level. a. C4-5 b. C1-2 c. C6-7 d. C7-T1
a. C4-5
18. T2-3 intervertebral disk space is found at the level of the: a. jugular notch b. sternal angle c. xiphoid process d. 2 inches (5cm) below the jugular notch
a. Jugular Notch
9. Aspect of the intervertebral disk that is composed of semigelatinous materal? a. Nucleus Pulposus b. Annulus Fibrosus c. Conus medullaris d. cauda equina
a. Nucleus Pulposus
12. Where is the articular pillars located on a cervical vertebra? a. between the superior and inferior articular processes. b. Between the pedicle and the body c. Between the spinous process and the lamina d. Are not present in the cervical vertebrae
a. between the superior and inferior articular processes.
6. The bony structure connected directly to the vertebral body are the: a. pedicles b. articular process c. laminae d. transverse process
a. pedicles
8. The joints between articular processes of vertebra are termed: a. zygapophyseal joints b. fibrous joints c. intervertebral joints d. synarthrodial joints
a. zygapophyseal joints
Kyphosis is the....
abnormal exaggerated thoracic curvature with increased convexity
Scoliosis is the...
abnormal lateral curvature of the spine.
lordosis
abnormal or exaggerated "swayback" lumbar curvature
What type of joint is the intervertebral joint?
amphiarthrodial
Each disk consists of an outer fibrous portion called the _____ and soft inner part called ______?
annulus fibrosus, nucleus pulposus
37. Which of the following projections will project the dens within the shadow of the foramen magnum? a. AP Open Mouth b. AP projection (Fuchs method) c. Twining method d. None of the above
b. AP projection (Fuchs method)
51. Which on of the following projections 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
26. Whay re the anterior oblique projections (RAO/LAO) perferred over the posterior oblique projections of the cervical spine? a. More comfortable for the patient b. Less thyroid and breast dose c. Prevent overlap of the madible over the spine d. Place the zygapophseal joints closer to the image receptor
b. Less thyroid and breast dose
20.The xiphoid process corresponds to the vertebral level of: a. T8 b. T10 c. T7 d. T12
b. T10
14. Which of the following thoracic vertebra(e) possesess no facets for costotransverse joints? a. T9-10 b. T11-12 c. T1 d. None of the above
b. T11-12
7. The most posterior aspect of a typical vertebra is the: a. pedicle b. spinous process c. lamina d. transverse process
b. spinous process
30. Which of the following factors does not apply to a lateral projection of the cervical spine? a. Use a 72 inch SID b. suspend respiration upon full inspiration c. perform horizontal-beam lateral projection if trauma is suspected d. Center CR to thyroid cartilage
b. suspend respiration upon full inspiration
where is the pars interarticularis found
between the superior and inferior articular processes
The ______ is thick, weight bearing anterior part of the vertebra and the superior surfaces are flat and rough for attachment of the intervertebral disc?
body
The central portion of the sternum is called the ____?
body
A vertebra consist of two main parts _____ and _____?
body and vertebral arch
the two main parts of a typical vertabrae are the _____ and the ______
body and vertebral arch
25. How much CR angulation is require for the AP axial projection for the cervical spine? a. CR is perpendicular to the image receptor b. 5-10 degrees cephalad c. 15-20 degrees cephalad d. 15-20 degrees caudad
c. 15-20 degrees cephalad
17. The zygapophyseal joints for the thoracic spine lie at an angle of ____ degrees in relation to the midsagittal plane. a. 45 degrees b. 60 degrees c. 70-75 degrees d. 90 degrees
c. 70-75 degrees
19. The gonion corresponds to the vertebral level of: a. C1 b. C4-5 c. C3 d. C7
c. C3
2. The spinal cord tapers off to a point distally at the level of: a. lower L-5 b. L2-3 intervertebral space c. L1-L2 d. L4-5 intervertebral space
c. L1-L2
21. Which of the following pathologic conditions is defined as "a condition of the spine characterized by rigidity of a vertebral joint." a. Spondylitis b. Ankylosing Spondylitis c. Spondylosis d. Scheuermann disease
c. Spondylosis
Advantage of the Fuchs Method over the Judd Method:
•More comfortable for the patient
develops as child learns to hold head erect
cervical spine
concave curve (in respect to posterior)
cervical spine and lumbar spine
secondary curve
cervical spine and lumbar spine
Frequently associated with osteoporosis, often involves collapse of the vertebral body?
compression fracture
anterior wedging and loss of vertebral body height are characteristics of
compression fracture
imaging modality for compression fractures of the lumbar spine
computed tomography
A rounded inward or depressed surface is termed what kind of curve of the vertebral column?
concave
spina bifida
congenital defect in which the posterior elements of the vertebrae fail to unite
36. How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)? a. 20 degrees b. 45 degrees c. 50 to 60 degrees d. 70 degrees
d. 70 degrees
15. The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ degrees in relation to the midsagittal plane. a. 45 degrees b. 60 degrees c. 70 to 75 degrees d. 90 degrees
d. 90 degrees
23. Which position and/or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2? a. AP Axial b. Lateral c. 45 degree obliquie d. AP Open Mouth
d. AP Open Mouth
27. Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine? a. RAO b. LPO c. Lateral d. LAO
d. LAO
13. What term 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 mass d. There is no vertebral body at C1
d. There is no vertebral body at C1
31. Why is the chin extended for a lateral projection of the cervical spine? a. To open up the C1-2 joint space b. to demonstrate the articular pillars c. to open up the intervertebral joint space d. To prevent superimposition of the mandible upon the spine
d. To prevent superimposition of the mandible upon the spine
5. Kyphosis is defined as a(n): a. normal or abnormal lumbar swayback curvature b. normal or abnormal convex sacral curvature c. normal compensatory curve of thoracic spine d. abnormal thoracic cuve with increased convexity
d. abnormal thoracic cuve with increased convexity
Each thoracic vertebra has a full facet or two partial facets called_____?
demifacets
Severe stress or hyperextension "whiplash" type of injury may cause fracture of the ____?
dens
the modified body of C2 is called the _____ or ____
dens or odontoid process
spondylolysis
dissolution and separation of the pars interarticularis
what topographic landmark corresponds to L2-L3
lower costal margins
Each 12 thoracic vertebra have ______ with one pair of ribs?
facets for articulation
which projection or method is designed to demonstrate the degree of scoliosis deformity between the primary and compensatory curves as part of a scoliosis study
ferguson
All cervical vertebra have 3 ______ that run vertically, the right and left transverse foramina and the single large vertebral foramen?
foramina
spondylolisthesis
forward displacement of one vertebra onto another vertebrae
imaging modality for structures within subarachoid space
magnetic resonance imagaing
imaging modality for soft tissues of the lumbar spine
magnetic resonance imaging
The ______ is the anatomy that corresponds to the level of C1?
mastoid process (tip)
herniated nucleus pulposus (HNP)
most common at the L4-L5 level and may result in sciatica
a portion of the lamina located between the superior and inferior articular processes is called the
pars interarticularis
eye of scottie dog
pedicle
the small foramina found in the sacrum are called
pelvic sacral foramina
during the ap/pa right and left bending projection of the lumbar spine, the _____ must remain stationary during positioning
pelvis
alternate name for C7
vertebra prominens
