Image Eval Unit 3 Spine

Rotation ERROR: same as sacrum

** Most COMMON error: Anterior rotation. •Look at femoral heads: right side (magnified) anterior to left = Anterior rotation

ERROR: Tilting AWAY from IR

- Cranial cortices not superimposed - Posterior arch of C1 appears in profile (foramen 'closed') - Mandibular rami: not aligned - Supero-inferior separation between right and left articular pillars: closing off zygapophyseal joint spaces Correction: Tilt body / head toward IR until interpupillary line is perpendicular to IR

ERROR: Posterior Rotation Lumbar lateral

1. Posterior portion of bodies show rotation 2. Magnified RIGHT 12th rib (since this is a Left Lateral) appears more posterior than the left rib = Posterior Rotation!

Opened disk spaces lumbar lateral

ALWAYS place sponge just superior to iliac crest to avoid Latera Lumbar flexion or "sagging".....or ANGLE caudally 5-8 degrees

Error: RPO rotation

ANALYSIS: Spinous process shifted to LEFT Head not tilted back sufficiently: lower jaw not elevated = superimposed over vertebrae CORRECTION: •Rotate pt. toward left until SHOULDERS are equal distance to IR. Elevate jaw until level with back of skull (occiput) (disk spaces look closed-think Angle of CR)

Axial Oblique Cervical Vertebrae: Name the position? Which pedicles are of interest in this projection?

AP projection = RPO PA projection = LAO Side of interest: Left side (pedicles and intervertebral foramina)

Detecting Rotation (lateral grandy)

Analysis •Articular pillars not aligned: one side appears more anterior than the other •Zygapophyseal joints not opened Correct: rotate patient until mid-coronal plane is perpendicular to IR ** Often hard to tell whether anterior or posterior rotation. Some magnification 'may' provide some clues ........

Major ERROR

Analysis: Disc spaces ALL closed ELONGATED ribs Angled the WRONG WAY! Makes the head 'appear' tilted'

(LT) posterior rotation

Analysis: •12th rib furthest from IR (magnified) appears MORE posterior than opposing side (more than ½ inch) •Correction: rotate pt. anterior until shoulders, posterior ribs, and pelvic wings are superimposed

Error: Excessive cephalic beam angulation

Analysis: •Closed intervertebral disk spaces •Spinous process demonstrated within inferior adjoining vertebral body •Uncinate processes elongated CORRECTION: •Decrease beam angulation to 15-20 degrees

T-spine Sagging

Analysis: •Closed intervertebral disk spaces: Most evident in lower T-spine e.g. WIDE hips with small waist •Distorted vertebral bodies Correction: place sponge under curvature of waist ..... or ..... or angle CR 10-15 degrees cephalic

Error: LPO rotation

Analysis: •Spinous process shifted to RIGHT •Head rolled slightly to the Left •Jaw superimposed over vertebrae CORRECTION: •Rotate pt. toward right until SHOULDERS and mandibular angles are equal distance to IR. Elevate jaw until level with occiput (also HAIR BRAIDS)

LPO Rotation

Analysis: •Spinous processes shifted toward RIGHT i.e. right side of body is positioned further from table •Right pedicle and spinous processes have LESS distance: they appear closer to each other •Left clavicle separated from spine CORRECTION: rotate pt. toward right until SHOULDERS and ASIS's are equal distance to table.

Open mouth odontoid

Atlas: symmetrical over axis Atlas lateral masses: equal distances from dens spinous processes of axis aligned with midline of axis body. mandibular rami: at equal distances from lateral masses upper incisors and base of skull: superior to dens Atlanto-axial joint (zygopophyseal joint of C1-C2): Open axis' spinous process: at midline and slightly inferior to the dens Dens (odontoid process): centered to exposure field. Base of skull, C1-C2, atlas' lateral masses and transverse processes; and axis' dens and body: ALL in light field

AP Axial C-Spine

CR @ C4 spinous process aligned down midline of cervical bodies. pedicles symmetrical and lateral to cervical bodies. intervertebral disk spaces: open 2-7 & surrounding tissue ALL included in collimated field. chin and back of skull superimposed

Detecting Lateral L-SPine Rotation

Clues: 1. Posterior vertebral bodies will tell you if there's rotation 2. Then look at 11th - 12th posterior ribs for direction: •If magnified 11th - 12th rib appears more posterior than opposing side = POSTERIOR ROTATION •If magnified 11th - 12th rib appears more anterior than opposing side = ANTERIOR ROTATION Rib that is farthest away from IR= magnified AND appears longer

Lateral Sacrum: Detecting Rotation

Clues: look at femoral heads! 1. Most magnified femoral head is the one that is farthest from IR. - Posterior rotation: femoral head farthest from IR will appear Posterior - Anterior rotation: femoral head farthest from IR will appear Anterior. ** Most common is ANTERIOR rotation error!! •Correction: rotate pelvis (anterior or posterior, according to error) until pelvic wings are superimposed

RPO Rotation ERROR AP coccyx

Coccyx rotated toward patient's left, i.e. left side is furthest from IR Ischial spine visible on right

Error: head tilted too far UP (base skull superimposes dens)

Correction: tilt head DOWN until incisors and occipital base are perp. to IR (plus hed is rotated also)

Error: AP C-spine Insufficient Cephalic Beam Angle

ERROR: Spinous processes appear within middle of vertebral bodies -Check CR angle Correct angle would show spinous processes: -at lower border of its body or -at level of its inferior disk space.

What are uncinate processes?

Elevated superolateral margins of the vertebral bodies. Found in the cervical vertebrae

Detecting Rotation (AP T)

Evaluate: •Spinous processes: shifted to the side? •Pedicle and spinous processes: equal distance? •Vertebral Column and clavicle: equal separation? Scoliosis: •Look for lateral deviation ** Scoliosis rotation would appear in mid vertebrae only while upper and lower stay intact.

ERROR: L5-S1 lateral posterior rotation

Inferiorly and more magnification = is one situated farthest from IR ! ! Since we do LEFT laterals, the side that is more magnified is the RIGHT side. Right side more posterior than left = POSTERIOR ROTATION

Detecting Rotation (L5-S1 lateral spot)

Look at the femoral heads: Femoral head projected more inferiorly with greatest MAGNIFICATION is the one situated farthest from IR ! ! * Posterior Rotation: femoral head furthest from IR will appear MORE Posterior(AND LOWER) than opposing side * Anterior Rotation: femoral head furthest from IR will appear MORE Anterior (AND LOWER) than opposing side •Most common is ANTERIOR rotation

Know which part of the Scotty Dog is missing here?

Pars Interarticularis- pt has Spina Bifida

Lateral Grandy anatomy

R/L articular pillars= superimposed Z-joints= superimposed IV disk spaces: open •Cranial cortices: superimposed •Posterior arch of C1 + spinous process of C2 in profile without posterior occiput superimposition •Mandibular rami: superimposed and anterior to vertebral column •Sella turcica; C1 thru 7, T-1, and surrounding soft tissue are included within the collimated field.

Posterior rotation L5-S1

Remember: •Most Inferior & Magnified = one farthest from IR •Demonstrates more posteriorly •Correction: rotate side farthest from IR anteriorly until pelvic wings are superimposed Look at the size of the joint space: one is larger than the other!

ERROR: Under rotated Oblique Lumbar (RPO)

Too shallow rotation of body Spines pointing to the left of patient; Dogs pointing to the right = RPO Correction: have patient rotate more until 45 degrees is achieved

ERROR: Insufficient (Not Enough) Angle (less than 15 degree tube angle)

•Foreshortened sacrum •Sacral foramina not opened •ALL of coccyx visible

Error: head tilted DOWN (upper incisors superimposed over dens)

correction: tilt head UP until incisors and occipital base are perp to IR

HEAD tilted AWAY from IR

inferior cranial cortices not superimposed vertebral foramen of C1 appears closed superior and inferior borders (surfaces) of pillars are separated mandibular rami not superimposed

ERROR: hips-legs NOT FLEXED

intervertebral disk spaces of T12-L3 closed

OPEN (lumbar) intervertebral disk spaces

knees and hips flexed until lower back rests firmly against table; reduces natural lordotic curvature of the spine

to detect rotation

look at Dens vs Lateral mass space Dens shifts to opposite side of rotation i.e. dens at Right + left side mass space widened= LPO rotation dens at LEFT + right side mass space is widened= RPO rotation (also can look at the location of the teeth vs the dens also)

Head not tilted enough

mandible superimposed with upper c-spine

Head tilted too far back

occipital bone (base of skull) superimposed with upper c-spine

Open intervertebral disk spaces

supine: 15 degrees cephalic angle upright: 20 degrees cephalic angle. spinous processes at lower border of body or at level of inferior intervertebral disk space

ERROR: Insufficient or beam was not angled (perpendicular beam) AP Axial coccyx

symphysis pubis superimposed over coccyx correct: add 10 degree caudal angle

AP Open Mouth Odontoid (Atlas & Axis)

upper incisors and mastoid tips aligned perp. to IR. Drop lower jaw wide (AML perp.) 5 degrees cephalic angle may be used to avoid magnified teeth on dens.

What is wrong with this Swimmer's view

wrong arm elevated

C-7-T1 i.e. patients with thick shoulders

•5-10 lbs weights on wrists •Depress shoulders •Clasp hands to back and straighten elbows to pull shoulders back and downward If this does not work = SWIMMERS!

Opened Disk Spaces for L5-S1

•ALWAYS Place sponge just superior to iliac crest to avoid LATERAL Lumbar flexion or "sagging" •or ANGLE caudally 5-8 degrees

Lateral c-spine "Grandy Method"

•AML (Acanthomeatal line) parallel to FLOOR •Protrude - jut jaw out slightly (away from anterior cervical vertebrae) •Cervical vertebral column PARALLEL with IR •Interpupillary line perpendicular to IR •Mid-sagittal plane of head is parallel to IR •CR: at C-4 •Anterior and posterior aspects of right and left articular pillars = superimposed •Superior and inferior aspects of the articular pillars = superimposed •R / L zygapophyseal jts = superimposed •Spinous processes: in profile •Intervertebral disk spaces: open •Long axis of cervical column: aligned with long axis of exposure field

Trauma Patients

•Always obtain image of patient "as is" •NEVER, NEVER, NEVER, EVER remove collar ! ! ! •Direct horizontal beam (x-table lateral)

"Posterior Rotation" (swimmer's)

•Body is rotated = posterior ribs separated •Articular pillars are distorted •Dependent (elevated) humerus is anterior to opposing humerus Correction: rotate patient anteriorly until shoulders and ribs are perpendicular to IR

Detecting Posterior Rotation (T-spine Lateral)

•CLUE 1: Posterior borders of the bodies will NOT be superimposed. CLUE 2: 12th posterior rib = greatest magnification or longest will be side furthest from IR

AP Lumbar criteria

•CR at L4 •Equal distance: pedicles to spinous processes •Spinous processes: aligned with midline of vertebral bodies •Sacrum & coccyx: centered within inlet pelvis & aligned with symphysis pubis •Intervertebral disk spaces: open •Vertebral bodies: without distortion •Long axis of lumbar column: aligned with long axis of exposure field T12 vertebra, ALL Lumbar vertebrae, SI Joints, sacrum, coccyx and psoas muscles: ALL within collimated field

Anteroposterior Oblique L-spine Criteria

•CR at L4 •Patient obliqued 45 degrees •T12 vertebra, 1st through 5th lumbar vertebrae, 1st and 2nd sacral segments, and SI Joints within field.

Lateral L5-S1 lumbosacral joint criteria

•CR: L5-S1 •Intervertebral Foramina: demonstrated properly •Right and Left pedicles: superimposed and in profile •L5-S1 intervertebral disk space opened •Greater sciatic notches and pelvic wings: nearly superimposed. •Pelvic alae: superimposed •L5; 1st & 2nd sacral segments: ALL within collimated field.

AP Axial Sacrum Criteria

•CR: S3; 15o Cephalic angle •Legs fully extended!! •Sacral foramina: equal spacing •Ischial spines: equally and aligned with pelvic brim •Median sacral crest and coccyx: aligned with symphysis pubis. •1st - 5th sacral segments: without foreshortening

Axial Oblique C-spine analysis criteria

•Can be performed AP or PA Oblique From C-2 to C-7: - Intervertebral Foramina open - Pedicles of interest: shown in profile - Opposite pedicles: aligned with anterior vertebral bodies - Intervertebral disk spaces: open - Cervical bodies: seen as individual structures + uniform in shape

ERROR: sagging L5-S1

•Closed intervertebral disk spaces •Distorted bodies by being able to view the inferior and superior surfaces of the vertebral bodies •Correction: place sponge or angle until entire lumbar spine is parallel with imaging table

ERROR: Sagging Lumbar

•Closed intervertebral disk spaces •Distorted bodies: look at the inferior and superior surfaces of the vertebral bodies •Plus .... POSterior rotation (look at posterior bodies and ribs) •Correction: place sponge or angle until entire lumbar spine is parallel with imaging table. Roll patient posteriorly until MCP is perpendicular to table.

error: AP C-Spine Insufficient Cephalic Beam Angle

•Closed intervertebral disk spaces •Spinous processes within their own vertebral body •Uncinate appears FLATTENED Note: without angulation, patient's head will "appear" tilted (i.e. jaw higher than occiput) Correction: Angle beam 15-20 degrees cephalic

CR angled wrong way (APA C-Oblique)

•Closed intervertebral disk spaces •Vertebral bodies do NOT appear as individual structures •EXCESSIVE distortion •Correction: Angle CR 15-20 degrees caudally for PA and cephalically for AP

ERROR: UNDER Rotated Oblique Lumbar

•Closed zygapophyseal joint. •Pedicles: closer to ANTERIOR aspect of vertebral body •More lamina is demonstrated •Oblique is TOO shallow ** Which oblique this is? •Spines pointing to the RIGHT of patient; •Dogs pointing to the LEFT = LPO

ERROR: OVER Rotated Oblique Lumbar

•Closed zygapophyseal joints •Less lamina demonstrated •Superior & inferior articular processes not in profile •Pedicles are demonstrated closer to midline or posterior aspect of vertebral body; i.e. patient was rotated more than 45 degrees (too steep). Correction: •Decrease degree of rotation until MCP is at a 45-degree angle with IR.

AP Axial Coccyx Criteria

•Coccyx aligned with symphysis pubis & equal distance from lateral walls of inlet pelvis. •1st to 3rd coccygeal vertebrae: seen without foreshortening and without symphysis pubis superimposition •Coccyx: centered in exposure field. •CR: 10 degrees caudal •5th sacral segment, 3 coccygeal vertebrae, symphysis pubis, and pelvic brim: ALL within collimated field.

LPO Rotation ERROR AP coccyx

•Coccyx rotated toward patient's right, i.e. right side is furthest from IR. •Ischial spine demonstrated on left

ERROR: LPO Rotation

•Dens shifted to right •TEETH shifted to left •Space between dens and lateral mass is widened on left side = LPO rotation Correction: rotate head toward RIGHT until mandibular angles are equal distances to IR

Lateral Cervico-Thoracic Vertebrae (Twining / Swimmers Method) Criteria

•Dependent Humerus (elevated): rolled slightly anteriorly without rotating body. •Independent Humerus (depressed): by patient's side with shoulder depressed and rolled slightly posteriorly (without body being obliqued) CR: at C7 - T1 joint •3 - 5 degrees caudal angle only when appropriate (if shoulders are not separated out of way) •C-5 through C-7: ALL within collimated field •Right and Left zygapophyseal joints: superimposed •Articular pillars: superimposed •Intervertebral disk spaces: open •Vertebral bodies: without distortion Intervertebral Disk Spaces: OPENED

ERROR: AP Sacrum Over-angulation (over 15 degrees)

•Excessive cephalic CR angulation: cut off apex of sacrum PLUS: Off center: top of sacrum not included

ERROR: (APA C-Oblique) Excessive Rotation

•I.F. appears opened but with extremely visible spinous processes •Zygapophyseal joint spaces in profile? Should not be seen in oblique!! •Pedicles of interest: foreshortened •Opposite pedicles: aligned to midline (middle) of vertebral body (should be at anterior side of bodies) •Intervertebral Foramina CLOSED Correction: decrease pt obliquity until MC plane is 45 degrees to IR

ERROR: Chin NOT elevated + Jaw not jutted out

•If head not adjusted correctly: atlas and axis will be superimposed with mandible Correction: Adjust head until AML is parallel to floor & jut chin out slightly

ERROR: Tilting TOward IR

•Inferior cranial cortices not superimposed •Mandibular rami not superimposed •Supero-inferior separation between right and left articular pillars •Vertebral foramen of C-1 is "opened" (i.e. well demonstrated) Correction: Tilt body / head away from IR until IP line (interpupillary line) is perpendicular to IR

Lateral L-Spine Criteria

•Intervertebral foramina demonstrated •Spinous processes: in profile •Right and Left pedicles: superimposed •Posterior surfaces of vertebral bodies: superimposed •Vertebral bodies: without distortion •CR at L4 and iliac crest •Intervertebral disk spaces: open •Vertebral column: in neutral position, without anteroposterior flexion or extension •Long axis of column is aligned with long axis of the exposure field.

ERROR: Lateral L5-S1 "Sagging"

•L5-S1 intervertebral disk space is closed. •L5 vertebral body is distorted. •Lumbar vertebral column was sagging toward the table. Correction: place radiolucent sponge between patient's lateral body surface and table surface to align the vertebral column parallel with the table, or angle CR 5-8 degrees caudally.

ERROR: AP Sacrum w/ LPO Rotation

•Left ischial spine demonstrated •Sacrum / coccyx rotated toward right = LPO rotation •Correction: rotate patient toward right until ASIS's are equal distance to imaging table

Head NOT elevated enough; Jaw not jutted forward

•Mandibular Ramus superimposed with upper C-spine •Rami not in same plane (rotation of head) Correction: •elevate head until AML is parallel to FLOOR •Jut / protrude jaw forward slightly •Make sure head is not rotated: MS plane should be parallel to IR and inter-pupillary line perpendicular to IR

Lateral Sacrum Criteria

•Median sacral crest: in profile •Greater sciatic notches almost superimposed •L5-S1 disk space: open •Sacrum without foreshortening. •Femoral heads superimposed •CR: 3rd Sacral segment level •L-5, 1st through 5th sacral segments, promontory, and 1st coccygeal vertebra within collimated field.

Lateral Coccyx Criteria

•Median sacral crest: in profile •Greater sciatic notches: superimposed •Coccyx: not foreshortening and centered in exposure field •S 5, 1st through 3rd coccygeal vertebrae, and inferior median sacral crest: ALL within collimated field.

Anterior Rotation L5-S1

•Most inferior and magnified head is the furthest one from IR. •Demonstrates more anteriorly •Correction: rotate side farthest from IR posteriorly until pelvic wings are superimposed

ERROR (APA C- Oblique): Insufficient rotation

•Narrowed intervertebral foramen •Foreshortened pedicles on side of interest •Insufficient rotation Correction: increase patient's obliquity until MC plane is 45 degrees to IR Head to the right = LAO / RPO Looking for LEFT pedicles LEFT IF

ERROR: AP Sacrum with RPO Rotation AND OVER-angulation of beam (over 15 degrees)

•Patient rotated toward right side, i.e. Sacrum pointing to patient's left = RPO rotation. •Excessive cephalic CR angulation: symphysis superimposed over apex end of sacrum Correction: Rotate patient toward left side until MCP is parallel with IR. Decrease cephalic CR angulation to 15 degrees.

RAO/LPO AP Axial Oblique (head to left) (evaluates right side)

•Posterior arch of atlas: demonstrating the vertebral foramen. •Upper cervical vertebrae will show posterior occipital and mandibular superimposition •Inferior outline of the outer cranial cortices and mandibular rami: without superimposition •C-4: center of exposure field •C-1 to C-4; T-2; and surrounding soft tissue: ALL within collimated field Midcoronal plane 45 degrees to IR 15-20 degrees CR angulation Adjust head 45 degrees WITH the body

ERROR: Posterior Rotation Lateral Lumbar.

•Posterior bodies not superimposed •Magnified 12th rib furthest from IR appears MORE Posterior than opposing side •Correction: rotate side furthest from IR anteriorly until ribs & pelvic wings are superimposed, i.e. roll patient forward ! !

ERROR: Anterior Rotation (lumbar lateral)

•Posterior bodies show rotation •Right 12th rib furthest from IR appears MORE Anterior than opposing side (Hint: the more MAGNIFIED one) •Adjust: rotate side furthest from IR posteriorly until ribs & pelvic wings are superimposed

ERROR: Lateral T-spine

•Posterior ribs demonstrate more than 1" of space between them. •Magnified ribs located posterior to dependent side; i.e. Right thorax was rotated posteriorly = POSTERIOR ROTATION Correction •Rotate the right thorax anteriorly until MCP is perpendicular with IR.

"Anterior Rotation" (swimmer's)

•Posterior ribs rotated •Articular pillars are distorted •Dependent humerus is posterior to opposing (independent) humerus Correction: rotate patient posteriorly until shoulders and ribs are perpendicular to IR

(Lateral T-spine) Anterior Rotation

•Posterior ribs will "appear" superimposed. •BUT ... posterior surfaces of body = NOT superimposed!! Correction: rotate pt. posterior until shoulders, post ribs, and pelvic wings are superimposed

Lateral T-spine criteria2

•Posterior surfaces of vertebral bodies: superimposed •Intervertebral disk spaces opened •Vertebral bodies demonstrated without distortion. C-7 through L-1 vertebra: ALL included within collimated field.

Open disk spaces (Lateral T)

•Radiolucent sponge placed just superior to iliac crest to avoid lateral Thoracic flexion or "sagging" ... or ... angle 10-15 degrees cephalic

ERROR: RPO Rotation AP sacrum

•Right ischial spine seen •Sacrum / coccyx rotated toward the Left •Correction: rotate patient toward left until ASIS's equal distance to imaging table What else is in error? Coccyx extremely elevated away from pubis, Sacral foramina closed = think angulation

ERROR: (AP L-spine) LPO Rotation

•Sacrum-coccyx rotated to RIGHT •Spinous processes rotated to RIGHT i.e. less distance from spinous processes to pedicles on RIGHT side of spine = RIGHT side of body is farther away from table •Correction: rotate pt. toward RIGHT until SHOULDERS and ASIS's are equal distance to table

ERROR: RPO Rotation (L-spine)

•Sacrum-coccyx rotated toward LEFT •Spinous process rotated toward LEFT i.e. less distance from spinous processes to pedicles on LEFT side of spine = LEFT side of body is farther away from table •Correction: rotate pt. toward LEFT side until SHOULDERS and ASIS's are equal distance to table

Scoliosis vs. Rotation

•Scoliotic vertebral column demonstrates LATERAL DEVIATION •Middle lumbar vertebrae may demonstrate rotation without corresponding to upper or lower vertebral rotation.

Scoliosis

•Scoliotic vertebral column demonstrates lateral deviation •Middle thoracic vertebrae may demonstrate rotation without corresponding upper or lower vertebral rotation

ERROR: RPO Rotation

•Space between dens and lateral mass is widened on right side •Dens shifted to left of patient •TEETH shifted to the right = RPO rotation correction: rotate head toward LEFT until mandibular angles are equal distances to IR

Error Analysis

•Space between dens and lateral mass is widened on right side •Dens shifted to left of patient •TEETH shifted to the right = RPO rotation •Plus .... Head tilted too far back

RPO Rotation (AP T)

•Spinous process shifted toward LEFT i.e. left side of body is positioned further from table •Left pedicle and spinous process have LESS distance: they appear closer to each other •Right clavicle separated from spine CORRECTION: rotate pt. toward left until SHOULDERS and ASIS's are equal distance to table

AP T-Spine Criteria

•Spinous processes aligned with midline of vertebral bodies •Distances from vertebral column to sternal clavicular ends = equal on both sides •Pedicles to spinous processes = equal on both sides •Intervertebral disk spaces: open •Vertebral bodies: without foreshortening. •CR: at T-7 •C-7 through L-1 within collimated field, as well as 2.5" lateral to vertebral column on both sides.

ERRORs: AP Axial C-Spine

•Spinous processes not aligned with midline of cervical bodies = more toward left side; i.e. patient in slight RPO. •Mandible superimposing C-3: chin was tucked too far downward. •Spinous processed demonstrated within its own vertebral body; not in lower half of body = Insufficient Cephalic Angulation Correction •Increase CR angulation •Elevate chin until lower surface of upper incisors and mastoid tip is aligned perpendicular with IR. Rotate patient toward LEFT until MCP is parallel with IR

ERROR: Too Much Angle (more than 15 degrees tube angle) ap sacrum

•Symphysis pubis superimposed with inferior sacral segments plus rotated LPO

AP Axial sacrum ID

•Symphysis pubis: not superimposed over any portion of sacrum •L5, 1st to 5th sacral segments, first coccygeal vertebra, symphysis pubis, and SI Joints ALL within collimated field.

Lateral T-spine Criteria

•T-7 at center •Thoracic vertebrae: seen through overlying lung and rib structures. •Intervertebral foramina: clearly shown •Pedicles: in profile •No more than ½ inch of space is demonstrated between posterior ribs.