Spine Worksheet
Which of the following are demonstrated in the oblique position of the cervical spine? 1. Intervertebral foramina 2. Apophyseal joints 3. Intervertebral joints a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
a. 1 only Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming apophyseal joints) are 90° to the midsagittal plane and are therefore well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45° to the midsagittal plane (and 15° to 20° to a transverse plane) and are therefore demonstrated in the oblique position. (Bontrager and Lampignano, 6th ed., p. 292)
Which of the following is (are) well demonstrated in the oblique position of the cervical vertebrae? 1. Intervertebral foramina 2. Disk spaces 3. Apophyseal joints a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3
a. 1 only The cervical intervertebral foramina form a 45-degree angle with the MSP and, therefore, are well visualized in a 45-degree oblique position. Apophyseal joints are formed by articulating surfaces of the inferior articular facet of one vertebra with the superior articular facet of the vertebra below; they are well demonstrated in the lateral position of the cervical spine. The intervertebral disk spaces are best demonstrated in the lateral position. (Bontrager and Lampignano, 6th ed., p. 298)
Which of the following is (are) demonstrated in the AP projection of the thoracic spine? 1. Intervertebral spaces 2. Apophyseal joints 3. Intervertebral foramina a. 1 only b. 2 only c. 1 and 3 only d. 1, 2, and 3
a. 1 only The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral. The thoracic apophyseal joints are 70° to the MSP and are demonstrated in a steep (70°) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90° to the MSP. They are therefore well demonstrated in the lateral position. (Bontrager, p 283)
Which of the following statements is (are) correct with respect to the images shown in Figure 2-23? 1. Image A was made with cephalad angulation. 2. Image B was made with cephalad angulation. 3. Images A and B were made with CR directed 15 degrees cephalad. a. 1 only b. 2 only c. 2 and 3 only d. 1, 2, and 3
a. 1 only There are five fused sacral vertebrae; the fused transverse processes form the alae. The anterior and posterior sacral foramina transmit spinal nerves. The sacrum articulates superiorly with the fifth lumbar vertebra, forming the L5-S1 articulation, and inferiorly with the coccyx, forming the sacrococcygeal joint. The sacrum curves posteriorly and inferiorly, whereas the coccyx curves anteriorly; thus, they require different tuble angles to "open them up." Image A demonstrates an AP axial projection of the sacrum with CR angulation of 15 degrees cephalad. Image B is an AP axial projection of the coccyx using the required 10-degree caudal CR angle. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 444-445)
Where is the top of the IR on an AP T-Spine? a. 1.5 to 2" inches above relaxed shoulder b. 1" above shoulder c. Even with top of shoulders d. 1/2 inch above shoulders
a. 1.5 to 2" inches above relaxed shoulder
What is the degree and direction of the CR for an AP cervical spine? a. 15-20 degrees; cephalic b. 15-20 degrees; Caudal c. 25-30 degrees; caudal d. 25-30 degrees; cephalic
a. 15-20 degrees; cephalic
The right anterior oblique of the cervical spine requires which of the following combinations of tube angle and direction? a. 15° to 20° caudad b. 15° to 20° cephalad c. 25° to 30° caudad d. 25° to 30° cephalad
a. 15° to 20° caudad The cervical intervertebral foramina lie 45° to the midsagittal plane (MSP) and 15° to 20° to a transverse plane. When the posterior oblique position (LPO, RPO) is used, the central ray is directed 15° to 20° cephalad and the cervical intervertebral foramina demonstrated are those farther from the image recorder. There is therefore some magnification of the foramina (because of the OID). In the anterior oblique position (LAO, RAO), the central ray is directed 15° to 20° caudad, and the foramina disclosed are those closer to the image recorder. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)
What is the distance for lateral C-spine and obliques? a. 60"-72" b. 72" c. 40" d. 60
a. 60"-72"
Which of the following projections can be used to supplement the traditional "open-mouth" projection, when the upper portion of the odontoid process cannot be well demonstrated? a. AP or PA through the foramen magnum b. AP oblique with R and L head rotation c. horizontal beam lateral d. AP axial
a. AP or PA through the foramen magnum A diagnostic image of C1-2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed. Accurate adjustment of these structures usually will allow good visualization of the odontoid process and the atlantoaxial articulation. Should patient anatomy occasionally prevent the usual visualization, the odontoid process can be visualized through the foramen magnum, either AP or PA. In the AP position (Fuchs method) or the PA position (Judd method), the patient's chin is extended to be in line vertically with the mastoid tip (similar to a Waters' or reverse Waters' position). The CR is directed to the midline and perpendicularly at the level of the mastoid tip. The resulting image demonstrates the odontoid process through the foramen magnum. These positions should not be attempted if the patient has a suspected, new, or healing fracture or destructive disease. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 392-394)A diagnostic image of C1-2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed. Accurate adjustment of these structures usually will allow good visualization of the odontoid process and the atlantoaxial articulation. Should patient anatomy occasionally prevent the usual visualization, the odontoid process can be visualized through the foramen magnum, either AP or PA. In the AP position (Fuchs method) or the PA position (Judd method), the patient's chin is extended to be in line vertically with the mastoid tip (similar to a Waters' or reverse Waters' position). The CR is directed to the midline and perpendicularly at the level of the mastoid tip. The resulting image demonstrates the odontoid process through the foramen magnum. These positions should not be attempted if the patient has a suspected, new, or healing fracture or destructive disease. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 392-394)
For the PA oblique projection, when the patient is in the RAO position, are the opened intervertebral formina CLOSEST or FARTHEST from the IR? In other words, which ones are parallel to IR? a. CLOSEST b. FARTHEST
a. CLOSEST
The pedicle is represented by what part of the "scotty dog" seen in a correctly positioned oblique lumbar spine? a. Eye b. Front foot c. Body d. Neck
a. Eye The 45° oblique position of the lumbar spine is generally performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "scotty dog" images are demonstrated. The scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process (Fig. A). (Saia, p 131)
Which of the following positions would best demonstrate the left apophyseal articulations of the lumbar vertebrae? a. LPO b. RPO c. Left lateral d. PA
a. LPO The posterior oblique positions (LPO, RPO) of the lumbar vertebrae demonstrate the apophyseal articulations closer to the image receptor. The left apophyseal articulations are demonstrated in the LPO position, while the right apophyseal articulations are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. (Saia, p 131)
With the patient supine, the left side of the pelvis elevated 25 degrees, and the CR entering 1 in. medial to the left anterosuperior iliac spine (ASIS), which of the following is demonstrated? a. Left sacroiliac joint b. Left ilium c. Right sacroiliac joint d. Right ilium
a. Left sacroiliac joint
Which of the following is demonstrated in a 25° RPO position with the central ray entering 1 inch medial to the elevated ASIS? a. Left sacroiliac joint b. Right sacroiliac joint c. Left ilium d. Right ilium
a. Left sacroiliac joint The sacroiliac joints angle posteriorly and medially 25 degrees to the MSP. Therefore, to demonstrate the sacroiliac joints with the patient in the AP position, the affected side must be elevated 25 degrees. This places the joint space perpendicular to the IR and parallel to the CR. Therefore, the RPO position will demonstrate the left sacroiliac joint, and the LPO position will demonstrate the right sacroiliac joint. When the examination is performed with the patient in the PA position, the unaffected side will be elevated 25 degrees. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 438-441)
Which of the positions illustrated in Figure A will best demonstrate the lumbar apophyseal joints closest to the IR? a. Number 1 b. Number 2 c. Number 3 d. Number 4
a. Number 1 Four positions for the lumbar spine are illustrated. Number 1 is an RPO, and number 2 an LAO. The posterior oblique positions (LPO and RPO) demonstrate the apophyseal joints closer to the IR, while the anterior oblique positions (LAO and RAO) demonstrate the apophyseal joints further from the IR (Fig. B). Number 3 is the AP projection, which demonstrates the lumbar bodies and disk spaces and the transverse and spinous processes. Number 4 is the lateral position, which provides the best demonstration of the lumbar bodies, intervertebral disk spaces, spinous processes, pedicles, and intervertebral foramina. (Bontrager & Frank, vol 1, pp 431, 434-435)
Which of the following positions will provide an AP projection of the L5-S1 interspace? a. Patient AP with 30° to 35° angle cephalad b. Patient AP with 30° to 35° angle caudad c. Patient AP with 0° angle d. Patient lateral, coned to L5
a. Patient AP with 30° to 35° angle cephalad The routine AP projection of the lumbar spine demonstrates the intervertebral disk spaces between the first four lumbar vertebrae. The space between L5 and S1, however, is angled with respect to the other disk spaces. Therefore, the CR must be directed 30 to 35 degrees cephalad to parallel the disk space and thus project it open onto the IR. (Frank, Long, and Smith, 11th ed., vol. 1, p. 436)
What is the anatomic structure indicated by number 1 in the radiograph shown in Figure 6-21? a. Superior articular process b. Inferior articular process c. Transverse process d. Lamina
a. Superior articular process An LPO projection of the lumbar spine is shown. The patient is positioned so that the lumbar spine forms a 45-degree angle with the IR. The apophyseal joints (those closest to the IR) are well demonstrated in this position. The typical "Scotty dog" image is depicted. The "ear" of the Scotty is the superior articular process (number 1), and the front foot is the inferior articular process (number 4). The Scotty's eye is the pedicle, its body is the lamina (number 3), and its nose is the transverse process (number 2). (Bontrager and Lampignano, 6th ed., p. 326)
In the anterior oblique position of the cervical spine, the structures best seen are the a. intervertebral foramina nearest the IR b. intervertebral foramina furthest from the IR c. interarticular joints d. intervertebral joints
a. intervertebral foramina nearest the IR The cervical intervertebral foramina lie 45 degrees to the MSP and 15 to 20 degrees to a transverse plane. When the anterior oblique position (LAO or RAO) is used, the cervical intervertebral foramina demonstrated are those closer to the IR. In the posterior oblique position (LPO or RPO), the foramina disclosed are those farther from the IR. There is, therefore, some magnification of the foramina in the posterior oblique positions. The interarticular (apophyseal) joints and intervertebral joints are best visualized in the lateral projection. (Frank, Long, and Smith, 11th ed., vol. 1, p. 405)
What is the name of the line between the inferior edge of upper incisors and the mastoid tip called? a. occlusal plane b. Baseline c. Oral plane d. Occular plane
a. occlusal plane
What does employing a breathing technique on a lateral Thoracic spine do? a. uses controlled motion to blur and obscure ribs b. causes artifacts c. Shows C-7 d. increases exposure
a. uses controlled motion to blur and obscure ribs
Which of the following is (are) demonstrated in the lateral projection of the cervical spine? 1. Intervertebral joints 2. Apophyseal joints 3. Intervertebral foramina a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
b. 1 and 2 only Intervertebral joints are well visualized in the lateral projection of all the vertebral groups. Cervical articular facets (forming apophyseal joints) are 90 degrees to the MSP and, therefore, are well demonstrated in the lateral projection. The cervical intervertebral foramina lie 45 degrees to the MSP (and 15-20 degrees to a transverse plane) and, therefore, are demonstrated in the oblique position. (Bontrager and Lampignano, 6th ed., p. 296)
Which of the following is (are) demonstrated in the AP projection of the cervical spine? 1. Intervertebral disk spaces 2. C3-7 cervical bodies 3. Apophyseal joints a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
b. 1 and 2 only The AP projection of the cervical spine demonstrates the bodies and intervertebral spaces of the last five vertebrae (C3-7). The cervical apophyseal joints are 90 degrees to the MSP and, therefore, are demonstrated in the lateral projection. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 398-399)
The lumbar transverse process is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine? a. Eye b. Nose c. Body d. Ear
b. Nose The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated (Figures 2-53 and 2-54). The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process. (Bontrager and Lampignano, 6th ed., p. 334)
The right posterior oblique (RPO) position of the left acetabulum will demonstrate the 1. posterior rim of the left acetabulum. 2. left anterior iliopubic column. 3. left iliac wing. a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
b. 1 and 2 only The posterior oblique projection of the acetabulum (Judet method) requires a 45-degree obliquity of the entire midsagittal plane (MSP). In the RPO position, the down side (the right side in this case) will demonstrate the anterior rim of the right acetabulum, the right posterior ilioischial column, and the right iliac wing. When centered to the up side (the left side in this case), the structures demonstrated are the posterior rim of the left acetabulum, the left anterior iliopubic column, and the left obturator foramen. The right iliac wing will be demonstrated in this position. (Bontrager and Lampignano, 6th ed., p. 279)
Which of the following is (are) accurate criticism(s) of the open-mouth projection of C1-2 seen in Figure A? 1. The MSP is not centered and perpendicular to the midline of the table. 2. The neck should be flexed more. 3. The neck should be extended more. a. 1 only b. 1 and 2 only c. 3 only d. 1 and 3 only
b. 1 and 2 only The radiograph illustrated shows the odontoid process superimposed on the base of the skull. The maxillary teeth can be seen significantly superior to the base of the skull. A diagnostic image of C1-2 depends on adjusting the flexion of the neck so that the maxillary occlusal plane and the base of the skull are superimposed (see the dotted lines in Fig. B). Accurate adjustment of these structures will usually allow good visualization of the odontoid process and the atlantoaxial articulation. Too much flexion superimposes the teeth on the odontoid process; too much extension superimposes the base of the skull on the odontoid process. (Ballinger & Frank, vol 1, pp 388-389)
A kyphotic curve is formed by which of the following? 1. Sacral vertebrae 2. Thoracic vertebrae 3. Lumbar vertebrae a. 1 only b. 1 and 2 only c. 3 only d. 1 and 3 only
b. 1 and 2 only The lordotic curves are secondary curves; that is, they develop sometime after birth. The cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit the primary kyphotic curves, those that are present at birth. (Frank, Long, and Smith, 11th ed., vol. 1, p. 375)
A radiolucent sponge can be placed under the patient's waist for a lateral projection of the lumbosacral spine to 1. make the vertebral column parallel with the IR 2. place the intervertebral disk spaces perpendicular to the IR 3. decrease the amount of SR reaching the IR a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
b. 1 and 2 only When placed in the recumbent lateral position, the average adult's lumbar spine will not be parallel to the x-ray tabletop. Because the shoulders and hips generally are wider than the waist, the vertebral column slopes downward in the central areas—making the lower thoracic and upper lumbar spine closer to the tabletop than the upper thoracic and lower lumbar spine. One solution is to place a radiolucent sponge under the patient's waist. This will elevate the sagging spinal area and make the vertebral column parallel to the x-ray tabletop and IR. It will also open the intervertebral disks better, placing more of them parallel to the path of the x-ray photons and perpendicular to the IR. This position also places the intervertebral foramina parallel with the path of the CR. The radiolucent sponge is strictly a positioning aid and has no impact on the amount of SR reaching the IR. (Bontrager and Lampignano, 6th ed., p. 335)
The RPO position of the cervical spine requires which of the following combinations of tube angle and direction? a. 15 to 20 degrees caudad b. 15 to 20 degrees cephalad c. 25 to 30 degrees caudad d. 25 to 30 degrees cephalad
b. 15 to 20 degrees cephalad The cervical intervertebral foramina lie 45 degrees to the midsagittal plane (MSP) and 15 to 20 degrees to the transverse plane. When the posterior oblique position (i.e., LPO or RPO) is used, the CR is directed 15 to 20 degrees cephalad, and the cervical intervertebral foramina demonstrated are those farther from the IR. There is, therefore, some magnification of the foramina (because of the OID). In the anterior oblique position (i.e., LAO or RAO), the CR is directed 15 to 20 degrees caudad, and the foramina disclosed are those closer to the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)
The AP projection of the coccyx requires that the CR be directed 1. 15 degrees cephalad 2. 2 inches superior to the pubic symphysis 3. to a level midway between the ASIS and pubic symphysis a. 1 only b. 2 only c. 1 and 2 only d. 1 and 3 only
b. 2 only The AP projection of the coccyx requires the CR to be directed 10 degrees caudally and centered 2 inches superior to the pubic symphysis. The AP projection of the sacrum requires a 15-degree cephalad angle centered at a point midway between the pubic symphysis and the ASIS. (Bontrager and Lampignano, 6th ed., p. 344)
The left sacroiliac joint is positioned perpendicular to the IR when the patient is positioned in a a. left lateral position. b. 25° to 30° LAO position. c. 25° to 30° LPO position. d. 30° to 40° LPO position.
b. 25° to 30° LAO position. Sacroiliac joints lie obliquely within the pelvis and open anteriorly at an angle of 25° to 30° to the midsagittal plane. A 25° to 30° oblique position places the joints perpendicular to the IR. The left sacroiliac joint may be demonstrated in the LAO and RPO positions with little magnification variation. (Ballinger & Frank, vol 1, p 327)
The articular facets of L5-S1 are best demonstrated in a(n) a. AP projection b. 30 degree oblique c. 45 degree oblique d. AP axial
b. 30 degree oblique Lumbar articular facets, forming the apophyseal joints, are demonstrated in the oblique position. L1 through L4 are best demonstrated in a 45-degree oblique, while L5-S1 are best seen in the 30-degree oblique (up to 60° oblique could be required). The AP axial projection is used to demonstrate an AP projection of L5-S1. (Bontrager and Lampignano, 7th ed., p. 334)
Place the following vertebral sections into order (A-D) from inferior to superior A. Sacrococcygeal B. Thoracic C. Cervical D. Lumbar a. D:A:B:C b. A:D:B:C c. C:B:D:A d. B:D:A:C
b. A:D:B:C
Where is the central ray for an AP Cervical spine ? a. C-2 b. C-4 c. C-5 d. C-6
b. C-4
Which of the following structures is located at the level of the interspace between the second and third thoracic vertebrae? a. Manubrium b. Jugular notch c. Sternal angle d. Xiphoid process
b. Jugular notch There are several surface landmarks and localization points that can help the radiographer in positioning various body structures. The jugular notch, located at the superior aspect of the manubrium, is approximately opposite the T2-3 interspace. The sternal angle is located opposite the T4-5 interspace. The xiphoid (or ensiform) process is located opposite T10. (Frank, Long, and Smith, 11th ed., vol. 1, p. 63)
Which of the following positions would best demonstrate the right apophyseal articulations of the lumbar vertebrae? a. LPO b. RPO c. Left lateral d. PA
b. RPO The posterior oblique positions (LPO and RPO) of the lumbar vertebrae demonstrate the apophyseal joints closer to the IR. The left apophyseal joints are demonstrated in the LPO position, whereas the right apophyseal joints are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. (Frank, Long, and Smith, 11th ed., vol. 1, p. 458)
Where should the CR of an AP T-spine be? a. T-4 b. T-7 c. T-8 d. T-10
b. T-7
Which of the following is (are) well demonstrated in the lumbar spine shown in Figure 2-35? 1.Apophyseal articulations 2.Intervertebral foramina 3.Inferior articular processes a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3
c. 1 and 3 only An oblique projection of the lumbar spine is shown. This is a 45-degree LPO projection demonstrating the apophyseal joints closest to the IR. The apophyseal joints are formed by the articulation of the inferior articular facets of one vertebra with the superior articular facets of the vertebra below. Note the "Scotty dog" images that appear in the oblique lumbar spine. Intervertebral foramina are best visualized in the lateral lumbar position. (Bontrager and Lampignano, 6th ed., p. 334)
Which of the following is (are) demonstrated in the lateral projection of the thoracic spine? 1. Intervertebral spaces 2. Apophyseal joints 3. Intervertebral foramina a. 1 only b. 2 only c. 1 and 3 only d. 1, 2, and 3
c. 1 and 3 only The thoracic intervertebral (disk) spaces are demonstrated in the AP and lateral projections, although they are probably best demonstrated in the lateral projection. The thoracic apophyseal joints are 70 degrees to the MSP and are demonstrated in a steep (70-degree) oblique position. The thoracic intervertebral foramina, formed by the vertebral notches of the pedicles, are 90 degrees to the MSP. They are, therefore, well demonstrated in the lateral position. (Bontrager and Lampignano, 6th ed., p. 316)
Which of the positions illustrated below would best demonstrate the cervical pedicles? 1. A. 2. B. 3. C. a. 1 only b. 2 only c. 1 and 3 only d. 2 and 3 only
c. 1 and 3 only Three positions of the cervical spine are illustrated. Figure B shows the left lateral position. Lateral projections of the cervical spine are done to demonstrate the intervertebral disk spaces, apophyseal joints, and spinous processes. Apophyseal joints are formed by adjacent superior and inferior articular processes and their facets. Spinous processes are formed by the union of the laminae. Figure A is an RAO with caudal angulation; Figure C is an LPO with cephalad angulation. Anterior oblique positions (LAO, RAO) of the cervical spine demonstrate the intervertebral foramina closer to the IR, while posterior oblique positions (LPO, RPO) demonstrate the intervertebral foramina farther from the IR. Intervertebral foramina are formed by the vertebral notches of the pedicles. (Ballinger & Frank, pp 400-403)
Which of the following statements is (are) true regarding the lateral projection of the lumbar spine? 1.The MSP is parallel to the tabletop. 2.The vertebral foramina are well visualized. 3.The pedicles are well visualized. a. 1 only b. 1 and 2 only c. 1 and 3 only d. 1, 2, and 3
c. 1 and 3 only With the patient in the lateral position, the MSP is parallel to the x-ray tabletop. Because the intervertebral foramina, which are formed by the pedicles, are 90 degrees to the MSP, they are well demonstrated in the lateral projection. The intervertebral joints (i.e., disk spaces) are also well demonstrated. The spinal cord passes through the vertebral foramina, which would not be visualized in conventional radiograph
The AP projection of the sacrum requires the central ray to be directed a. perpendicular to the midline midway between the anterior superior iliac spine (ASIS) and the pubis. b. to the midline approximately 2 inches superior to the pubis. c. 15° cephalad to a point approximately 2 inches superior to the pubis. d. 15° caudad to a point approximately 2 inches superior to the pubis.
c. 15° cephalad to a point approximately 2 inches superior to the pubis. For the AP projection of the sacrum, the patient is AP supine with the MSP perpendicular to the x-ray tabletop. The central ray is directed 15° cephalad to a point 2 inches superior to the pubis (approximately midway between the ASIS and the pubic symphysis). In this projection, the central ray angulation parallels the sacral curve and provides less distorted visualization of the sacrum and its foramina. (Saia, p 133)
Which of the following is (are) well demonstrated in the lumbar spine pictured in Figure 2-8? 1. Apophyseal articulations 2. Intervertebral foramina 3. Pedicles a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
c. 2 and 3 only A lateral projection of the lumbar spine is illustrated. The intervertebral articulations (disk spaces) are well demonstrated. Because the intervertebral foramina, which are formed by the pedicles, are 90 degrees to the MSP, they are also well demonstrated in the lateral projection. The articular facets, forming the apophyseal joints, lie 30 to 50 degrees to the MSP and are visualized in the oblique position. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 428-429)
The axiolateral, or horizontal beam, projection of the hip requires the IR to be placed 1. parallel to the central ray (CR) 2. parallel to the long axis of the femoral neck 3. in contact with the lateral surface of the body a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
c. 2 and 3 only The cassette for a cross-table (axiolateral or horizontal beam) lateral projection of the hip is placed in a vertical position. The top edge of the cassette should be placed directly above the iliac crest and adjacent to the lateral surface of the affected hip. The cassette is positioned parallel to the femoral neck; the CR is perpendicular to the femoral neck and cassette. (Frank, Long, and Smith, 11th ed., vol. 1, p. 358)
Which of the following is (are) appropriate technique(s) for imaging a patient with a possible traumatic spine injury? 1. Instruct the patient to turn slowly and stop if anything hurts. 2. Maneuver the x-ray tube instead of moving the patient. 3. Call for help and use the log-rolling method to turn the patient. a. 1 and 2 only b. 1 and 3 only c. 2 and 3 only d. 1, 2, and 3
c. 2 and 3 only When imaging a patient with a possible traumatic spine injury, it is appropriate to either maneuver the x-ray tube head or, if the patient must be moved, to use the log-rolling method. This cannot be done by one person; the radiographer must summon assistance. If the patient is on a backboard and in a neck collar, as most patients with suspected spine injury are, it is never appropriate to ask the patient to turn, scoot, or slide over. The only movement that should be permitted is movement of the entire spine, body, and head together, as in log-rolling. Any twisting could cause severe and permanent damage to the spinal cord, resulting in paralysis or even death. (Torres et al., pp. 77-79)
To visualize or "open" the right sacroiliac joint, the patient is positioned a. 30 to 40 degrees LPO b. 30 to 40 degrees RPO c. 25 to 30 degrees LPO d. 25 to 30 degrees RPO
c. 25 to 30 degrees LPO Sacroiliac joints lie obliquely within the pelvis and open anteriorly at an angle of 25 to 30 degrees to the midsagittal plane. A 25- to 30-degree oblique position places the joints perpendicular to the IR. The right sacroiliac joint may be demonstrated in the LPO and RAO positions with little magnification variation. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 438-441)
What vertebrae can or should you be able to see on a lateral Thoracic spine? a. All 12 b. 3-10 c. 3-12 d. 1-10
c. 3-12
Which of the following positions will demonstrate the lumbosacral apophyseal articulation? a. AP b. Lateral c. 30° RPO d. 45° LPO
c. 30° RPO The articular facets (apophyseal joints) of the L5-S1 articulation form a 30-degree angle with the MSP; they are, therefore, well demonstrated in a 30-degree oblique position. The 45-degree oblique position demonstrates the apophyseal joints of L1-4. (Frank, Long, and Smith, 11th ed., vol. 1, p. 432)
What is the SID for a lateral cervical spine? a. 40" b. 60" c. 72" d. 80"
c. 72"
What is to be projected in the open mouth view of the C-spine exam? a. Atlas b. Axis c. Atlas and Axis and joint space d. Vertebrae Prominens
c. Atlas and Axis and joint space
The lumbar lamina is represented by what part of the "Scotty dog" seen in a correctly positioned oblique lumbar spine view? a. Eye b. Nose c. Body d. Neck
c. Body The 45-degree oblique projection of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process (Figure 2-56). (Bontrager and Lampignano, 6th ed., p. 334)
Which of the following is a functional study used to demonstrate the degree of AP motion present in the cervical spine? a. Moving mandible position b. AP open-mouth projection c. Flexion and extension laterals d. AP right and left bending
c. Flexion and extension laterals The degree of anterior and posterior motion is occasionally diminished with a whiplash-type injury. Anterior (forward, flexion) and posterior (backward, extension) motion is evaluated in the lateral position with the patient assuming flexion and extension as best as he or she can. Left and right bending images of the thoracic and lumbar vertebrae are obtained frequently when evaluating scoliosis. The AP open-mouth projection is used to evaluate the first two cervical vertebrae. The moving mandible AP projection is used to demonstrate the entire cervical spine while blurring out the superimposed mandible. (Frank, Long, and Smith, 11th ed., vol. 1, p. 402)
Which of the following should be performed to rule out subluxation or fracture of the cervical spine? a. Oblique cervical spine, seated b. AP cervical spine, recumbent c. Horizontal beam lateral d. Laterals in flexion and extension
c. Horizontal beam lateral When a cervical spine radiograph is requested to rule out subluxation or fracture, the patient will arrive in the radiology area on a stretcher. The patient should not be moved before a subluxation is ruled out. Any movement of the head and neck could cause serious damage to the spinal cord. A horizontal beam lateral projection is performed and evaluated. The physician then will decide what further images are required. (Frank, Long, and Smith, 11th ed., vol. 2, p. 35)
The number 2 in Figure 2-40 represents which of the following structures? a. Body b. Pedicle c. Inferior articular process d. Superior articular process
c. Inferior articular process The typical vertebra, shown in Figure 2-65, is divided into two portions—the body (anteriorly) and the vertebral arch (posteriorly). The vertebral arch supports seven processes—two transverse, one spinous (number 3), two superior articular (number 4), and two inferior articular (number 2). The superior articular processes and the superjacent inferior articular processes join to form apophyseal joints. Pedicles (number 5) project posteriorly from the vertebral body (number 6). Their upper and lower surfaces form vertebral notches. Superjacent vertebral notches form intervertebral foramina. The lamina is represented by number 1. The transverse and spinous processes serve as attachments for muscles or articulations for ribs in the thoracic region. The superior and inferior surfaces of the vertebral body are covered with articular cartilage, and between the vertebral bodies lie the intervertebral disks. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 380-381)
Which of the following positions would best demonstrate the lumbar intervertebral disk spaces and foramina? a. LPO b. RPO c. Lateral d. PA
c. Lateral The lateral lumbar position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. The posterior oblique positions (i.e., LPO and RPO) of the lumbar vertebrae demonstrate the apophyseal articulations closer to the IR. The left apophyseal articulations are demonstrated in the LPO position, whereas the right apophyseal articulations are demonstrated in the RPO position. (Bontrager and Lampignano, 6th ed., pp. 334-335)
What is the AAAHHH sound you ask your patient to do when you do an Odontoid exam called? a. Noisy b. Pronounciation c. Phonation d. Oration
c. Phonation
Which of the following anatomic structures is indicated by the number 1 in Figure 2-24? a. Body of L3 b. Body of L4 c. Spinous process d. Transverse process
c. Spinous process The radiograph shown illustrates an AP projection of the lumbar spine. The intervertebral disk spaces (number 2) are well visualized because the patient's knees were flexed with feet flat on the table. Number 1 points out the spinous process; number 3 is the transverse process. Number 4 points out the body of the fourth lumbar vertebra, and number 5 is the medial border of the iliac crest. The prominent border of the psoas muscle is well demonstrated. (Bontrager and Lampignano, 6th ed., p. 333)
What is the name of the condition that results in the forward slipping of one vertebra on the one below it? a. Spondylitis b. Spondylolysis c. Spondylolisthesis d. Spondylosis
c. Spondylolisthesis The forward slipping of one vertebra on the one below it is called spondylolisthesis. Spondylolysis is the breakdown of the pars interarticularis; it may be unilateral or bilateral and results in forward slipping of the involved vertebra—the condition of spondylolisthesis. Inflammation of one or more vertebrae is called spondylitis. Spondylosis refers to degenerative changes occurring in the vertebra. (Frank, Long, and Smith, 11th ed., vol. 1, p. 388)
At what level is the top of the IR for a lateral cervical spine? a. EAM b. Mastoid tip c. TEA Top of Ear Attachment d. Outer corner of eye
c. TEA Top of Ear
The radiograph in Figure 6-12 could be improved in which of the following ways? a. The MSP should be 45 degrees to the plane of the IR. b. The MSP should be 90 degrees to the plane of the cassette. c. The chin should be elevated slightly. d. The head should be flexed slightly.
c. The chin should be elevated slightly. An oblique projection of the cervical spine is shown. The first two cervical vertebrae are poorly visualized because of superimposition with the mandible; the chin should be elevated to correct this problem. Otherwise, the positioning is satisfactory, with good demonstration of the remainder of the cervical intervertebral foramina. The patient has been accurately rotated 45 degrees, and a 15- to 20-degree tube angle was used. (Bontrager and Lampignano, 6th ed., p. 308)
Why do you lift the chin on oblique Cervical Spine projections? a. To elongate the spine b. To open foramina c. To remove superimposition of the mandible d. To open the intervertebral disk spaces
c. To remove superimposition of the mandible
The apophyseal articulations of the thoracic spine are demonstrated with the a. coronal plane 45° to the IR. b. midsagittal plane 45° to the IR. c. coronal plane 70° to the IR. d. midsagittal plane 70° to the IR.
c. coronal plane 70° to the IR. The thoracic apophyseal joints are demonstrated by placing the patient in an oblique position with the coronal plane 70° to the IR (MSP 20° to the IR). This may be accomplished by first placing the patient lateral, then obliquing the patient 20° "off lateral." The apophyseal joints closest to the IR are demonstrated in the PA oblique, and those remote from the IR in the AP oblique. Comparable detail is obtained using either method, because the OID is about the same. (Ballinger & Frank, vol 1, p 327)
The long, flat structures that project posteromedially from the pedicles are the a. transverse processes b. vertebral arches c. laminae d. pedicles
c. laminae The typical vertebra has two parts—the body and the vertebral arch. The body is the dense, anterior bony mass. Posteriorly attached is the vertebral arch, a ring-like structure. The vertebral arch is formed by two pedicles (short, thick processes projecting posteriorly from the body) and two laminae (broad, flat processes projecting posteriorly and medially from the pedicles). (Bontrager and Lampignano, 6th ed., p. 290)
The structure labeled 4 in Figure 2-32 is the a. body of C1 b. body of C2 c. odontoid process d. anterior arch of C1
c. odontoid process The radiograph shown is a lateral projection of the cervical spine taken in flexion. Flexion and extension views are useful in certain cervical injuries, such as whiplash, to indicate the degree of anterior and posterior motion. The structure labeled number 1 is an apophyseal joint; because apophyseal joints are positioned 90 degrees to the MSP, they are well visualized in the lateral projection. The structure labeled number 2 is a vertebral body. Numbers 3 through 6 are various components of C1 (atlas) and C2 (axis). The large body of C2 (number 6) is has a process superiorly, the odontoid process/dens (number 4). The odontoid process fits into, and articulates with. C1. The superimposed posterior arch of C1 is indicated by number 3. The dens is articulated with the anterior arch of C1 (number 5). (Frank, Long, and Smith, 11th ed., vol. 1, p. 397)
AP erect left and right bending images of the thoracic and lumbar vertebrae, to include 1 inch of the iliac crest, are performed to demonstrate a. spondylolisthesis. b. subluxation. c. scoliosis. d. arthritis.
c. scoliosis. Scoliosis is a lateral curvature of the spine and is typically noted in early adolescence. These young patients usually return for follow-up studies, and it is imperative to limit their radiation dose as much as possible. Examining the patient in the PA position is frequently advisable, because the gonadal dose is significantly reduced and there is usually no appreciable loss of detail. Thyroid and breast shields are also a valuable protection, especially for the patient who requires follow-up examinations. Bending images would not be performed on a patient with suspected subluxation or spondylolisthesis, as further serious injury could result. (Ballinger & Frank, vol 1, p 396)
Which of the following vertebral groups form(s) lordotic curve(s)? 1.Cervical 2.Thoracic 3.Lumbar a. 1 only b. 2 only c. 1 and 2 only d. 1 and 3 only
d. 1 and 3 only The lordotic curves are secondary curves; that is, they develop sometime after birth. The cervical and lumbar vertebrae form lordotic curves. The thoracic and sacral vertebrae exhibit the primary kyphotic curves, those that are present at birth. (Saia, p 123)
What are the routine positions for a cervical spine exam? 1. AP 2. Lateral 3. Obliques (AP or PA) 4. Odontoid a. 1,2 & 3 b. 1 & 2 c. 1, 3, & 4 d. 1, 2, 3, &4
d. 1, 2, 3, &4
Which of the following is (are) effective in reducing exposure to sensitive tissues for frontal views during scoliosis examinations? 1. Use of PA position 2. Use of breast shields 3. Use of compensating filtration a. 1 only b. 1 and 2 only c. 2 and 3 only d. 1, 2, and 3
d. 1, 2, and 3 Spinal column studies often are required for evaluation of adolescent scoliosis, thus presenting a twofold problem—radiation exposure to youthful gonadal and breast tissues and significantly differing tissue densities/thicknesses. The use of a high-speed-film-screen combination helps to reduce the exposure required for the examination. Exposure-dose concerns also can be resolved with the use of a compensating filter (for uniform density) that incorporates lead shielding for the breasts and gonads (Figure 2-63). (Bontrager and Lampignano, 6th ed., p. 338)
In the anterior oblique position of the cervical spine, the CR should be directed a. parallel to C4 b. perpendicular to C4 c. 15 degrees cephalad to C4 d. 15 degrees caudad to C4
d. 15 degrees caudad to C4 The anterior oblique positions (LAO and RAO) of the cervical spine require a 15-degree caudal angulation and demonstrate the intervertebral foramina closest to the IR. The posterior oblique positions (LPO and RPO) require that the CR be directed cephalad 15 degrees to C4. The posterior oblique positions demonstrate the intervertebral foramina farther away from the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 404-406)
What is the degree of rotation/obliquity for the cervical spine obliques? a. 15 b. 20 c. 35 d. 45
d. 45
What is a Swimmer's view used for? a. To see C-7/T-1 junction in lateral projection b. To remove superimposition of shoulders c. To offset the shoulders from one another d. All of the above
d. All of the above
Which of the following will best demonstrate the lumbosacral junction in the AP position? a. CR perpendicular to L3 b. CR perpendicular to L5-S1 c. CR caudad 30° to 35° d. CR cephalad 30° to 35°
d. CR cephalad 30° to 35° In the AP projection of the lumbar spine, the disk spaces of L1 to L4 are perpendicular to the IR and well visualized, but the L5 to S1 disk space is angled 30 to 35 degrees cephalad to the perpendicular. If the CR is directed 30 to 35 degrees cephalad midway between the ASIS and the publis symphysis, the L5 to S1 interspace will be well demonstrated. (Bontrger and Lampignano, 6th ed., p. 337)
In Figure 2-27, the structure indicated as number 7 is which of the following? a. Neck of rib b. Tubercle of rib c. Transverse process d. Head of rib
d. Head of rib The typical vertebra is divided into two portions—the (anterior) body (number 11) and the (posterior) vertebral arch. The vertebral arch supports seven processes: two transverse (number 8), one spinous (number 1), two superior articular processes, and two inferior articular processes. A thoracic vertebra is shown. The thoracic vertebrae are unique in that they have downward-angling spinous processes and articulations for ribs. Numbers 5 and 10 illustrate the facets where the heads of ribs (number 7) articulate to form the costovertebral articulations (number 6). Number 2 illustrates the ribs' tubercle—it articulates with the transverse process facet (number 9) to form the costotransverse articulation (number 3). (Frank, Long, and Smith, 11th ed., vol. 1, pp. 380-381)
All of the following are seen on the lateral cervical spine except: a. Intervertebral Disk Spaces b. Spinous processes c. Zygapophyseal joints d. Intervertebral foramina
d. Intervertebral foramina
What is the anatomic structure indicated by number 3 in the radiography in Figure 6-21? a. Superior articular process b. Inferior articular process c. Pedicle d. Lamina
d. Lamina An LPO projection of the lumbar spine is shown. The patient is positioned so that the lumbar spine forms a 45-degree angle with the IR. The apophyseal joints (those closest to the IR) are well demonstrated in this position. The typical "Scotty dog" image is depicted. The "ear" of the Scotty is the superior articular process (number 1), and the front foot is the inferior articular process (number 4). The Scotty's eye is the pedicle (number 2), its body is the lamina (number 3), its nose is the transverse process (number 5), and it's "neck" is the pars interarticularis (number 6). (Frank, Long, and Smith, 11th ed. Vol I, p. 432)
Which of the positions illustrated in Figure A will best demonstrate the lumbar intervertebral foramina? a. Number 1 b. Number 2 c. Number 3 d. Number 4
d. Number 4 Four positions for the lumbar spine are illustrated. Number 1 is an RPO, and number 2 an LAO. The posterior oblique positions (LPO and RPO) demonstrate the apophyseal joints closer to the IR, while the anterior oblique positions (LAO and RAO) demonstrate the apophyseal joints further from the IR (Fig. B). Number 3 is the AP projection, which demonstrates the lumbar bodies and disk spaces and the transverse and spinous processes. Number 4 is the lateral position, which provides the best demonstration of the lumbar bodies, intervertebral disk spaces, spinous processes, pedicles, and intervertebral foramina. (Bontrager & Frank, vol 1, pp 431, 434-435)
An accurately positioned oblique projection of the first through fourth lumbar vertebrae will demonstrate the classic "scotty dog." What bony structure does the scotty dog's neck represent? a. Superior articular process b. Pedicle c. Transverse process d. Pars interarticularis
d. Pars interarticularis The 45-degree oblique position of the lumbar spine generally is performed for demonstration of the apophyseal joints. In a correctly positioned oblique lumbar spine, "Scotty dog" images are demonstrated. The Scotty's ear corresponds to the superior articular process, his nose to the transverse process, his eye to the pedicle, his neck to the pars interarticularis, his body to the lamina, and his front foot to the inferior articular process. (Frank, Long, and Smith, 11th ed., vol. 1, p. 432)
Which of the following positions would demonstrate the right lumbar apophyseal articulations closest to the IR? a. LAO b. RAO c. LPO d. RPO
d. RPO The posterior oblique positions (i.e., LPO and RPO) of the lumbar vertebrae demonstrate the apophyseal joints closer to the IR. The left apophyseal joints are demonstrated in the LPO position, whereas the right apophyseal joints are demonstrated in the RPO position. The lateral position is useful to demonstrate the intervertebral disk spaces, intervertebral foramina, and spinous processes. (Bontrager and Lampignano, 6th ed., pp. 334-335)
Critique the lateral cervical spine seen in Figure 2-1 and select the most correct statement below. a. The chin has been depressed too much. b. The chin needs to be extended more. c. The head is tilted. d. The shoulders are not depressed enough.
d. The shoulders are not depressed enough. The lateral projection of the cervical spine requires that the MSP be parallel to the IR and the MCP be perpendicular to the IR. The chin must be elevated enough so as not to superimpose the mandibular angles on cervical structures—yet not so much that the base of the skull obscures cervical structures. The degree of flexion/extension is appropriate in this image; no cervical structures are obscured. The vertebrae are symmetrical—no rotation is present. However, C7 is not clearly delineated, and its all-important articulation with T1 is not visible. This indicates that the shoulders are not sufficiently depressed. (Frank, Long, and Smith, 11th ed., vol. 1, p. 401)
To demonstrate the first two cervical vertebrae in the AP projection, the patient is positioned so that a. the glabellomeatal line is vertical. b. the acanthiomeatal line is vertical. c. a line between the mentum and the mastoid tip is vertical. d. a line between the maxillary occlusal plane and the mastoid tip is vertical.
d. a line between the maxillary occlusal plane and the mastoid tip is vertical. To clearly demonstrate the atlas and axis without superimposition of the teeth or the base of the skull, a line between the maxillary occlusal plane (edge of upper teeth) and mastoid tip must be vertical. If the head is flexed too much, the teeth will be superimposed. If the head is extended too much, the cranial base will be superimposed on the area of interest. A line between the mentum and the mastoid tip is used to demonstrate the odontoid process only through the foramen magnum (Fuchs method). (Frank, Long, and Smith, 11th ed., vol. 1, p. 393)
The structure labeled 5 in Figure 2-32 is the a. body of C1 b. body of C2 c. odontoid process d. anterior arch of C1
d. anterior arch of C1 The radiograph shown is a lateral projection of the cervical spine taken in flexion. Flexion and extension views are useful in certain cervical injuries, such as whiplash, to indicate the degree of anterior and posterior motion. The structure labeled number 1 is an apophyseal joint; because apophyseal joints are positioned 90 degrees to the MSP, they are well visualized in the lateral projection. The structure labeled number 2 is a vertebral body. Numbers 3 through 6 are various components of C1 (atlas) and C2 (axis). The large body of C2 (number 6) is has a process superiorly, the odontoid process/dens (number 4). The odontoid process fits into, and articulates with. C1. The superimposed posterior arch of C1 is indicated by number 3. The dens is articulated with the anterior arch of C1 (number 5). (Frank, Long, and Smith, 11th ed., vol. 1, p. 397)
The thoracic apophyseal joints are demonstrated with the a. coronal plane 90 degrees to the IR b. midsagittal plane 90 degrees to the IR c. coronal plane 20 degrees to the IR d. midsagittal plane 20 degrees to the IR.
d. midsagittal plane 20 degrees to the IR. The thoracic apophyseal joints are demonstrated in an oblique position with the coronal plane 70 degrees to the IR (MSP 20 degrees to the IR). This may be accomplished by first placing the patient lateral and then obliquing the patient 20 degrees "off lateral." The apophyseal joints closest to the IR are demonstrated in the PA oblique projection and those remote from the IR in the AP oblique projection. Comparable detail is obtained using either method because the OID is about the same. The thoracic intervertebral foramina are demonstrated in the lateral projection. This places the MSP of the patient parallel to the IR, and the coronal plane perpendicular to the IR. (Frank, Long, and Smith, 11th ed., vol. 1, pp. 421-423)
The short, thick processes that project posteriorly from the vertebral body are the a. transverse processes. b. vertebral arches. c. laminae. d. pedicles.
d. pedicles. The typical vertebra has two parts, the body and the vertebral arch. The body is the dense, anterior bony mass. Posteriorly attached is the vertebral arch, a ringlike structure. The vertebral arch is formed by two pedicles (short, thick processes projecting posteriorly from the body) and two laminae (broad, flat processes projecting posteriorly and medially from the pedicles). (Saia, p 123)
