Chapter 8 Workbook-Cervical & Thoracic Spine
true
Nuclear medicine is often performed to diagnose bone tumors of the spine
T7
3-4"(8-10 cm) below jugular notch
cervicothoracic(Swimmer's) lateral position
A broad shouldered patient comes to the radiology department for a routine c-spine series. The lateral projections demonstrates only the C1-C5 region. The radiologist wants to see C6-T1. What additional projection can be taken to demonstrate this region of the spine?
herniated nucleus pulposus
A condition involving a "slipped disk" is correctly referred to as _.
AP open mouth projection. The patient's mouth must be carefully open without any movement of the c-spine.
A patient comes to the ER with a possible Jefferson fracture. Other than a lateral projection or a CT scan, what specific radiograph projection will best demonstrate this type of fracture?
Perform either the (AP) Fuchs or (PA) Judd method
A patient comes to the radiology department for a c-spine series. An AP "open mouth" radiograph indicates that the base of the skull and the lower edge of the front incisors are superimposed, but the top of the dens is not clearly demonstrated. What should the technologist do to demonstrate the upper portion of the dens?(A horizontal beam lateral projection has ruled out a C-spine fracture or subluxation).
scoliosis series
A patient comes to the radiology department with a clinical history of Scheurmann disease. Which radiographic procedure is often performed for this condition?
AP axial-vertebral arch(pillar) projection
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 see better this aspect of the vertebrae. What additional projection can be taken to demonstrate the articular pillars of C4?
hyperextension and hyperflexion lateral positions
A patient who has been in a motor vehicle accident(MVA) enters the ER. The basic projection of the c-spine show no subluxation(partial dislocation) or fracture. The physician wants the spine evaluated for whiplash injury. Which additional projections would best demonstrate this type of injury?
horizontal beam lateral projection
A patient with a possible cervical spine injury enters the ER. The patient is on a backboard. Which projection of the c-spine should be taken first?
angle CR 3-5 degrees ciudad
A radiograph of a cervicothoracic lateral position demonstrates superimposition of the humeral heads over the upper thoracic spine. Because of an arthritic condition, the patient is unable to rotate the shoulders any farther apart. What can the technologist do to separate the shoulders further during the repeat exposure?
use of an orthostatic(breathing) technique to blur lung markings and ribs more effectively
A radiograph of a lateral thoracic spine shows that lung markings and ribs make it difficult to visualize the vertebral bodies. The following factors were used: recumbent position, 40 inch(102 cm) SID, short exposure time, and exposure made during full expiration. Which of these factors must be modified to produce a more diagnostic image during the repeat exposure?
when the lower intervertebral foramina are narrowed while the upper foramina are well demonstrated, the positioning error most often is under rotation of the upper body(shoulders). The upper body must be rotated 45 degrees.
A radiograph of a right posterior oblique(RPO) cervical spine projection shows that the lower intervertebral foramina are not open. The upper intervertebral foramina are well visualized. What positioning error most likely led to this radiographic outcome?
excessive extension of the skull
A radiograph of an AP "open mouth" projection of the cervical spine reveals that the base of the skill is superimposed over the upper odontoid process. Which specific positioning error is present on the radiograph?
Reduce mAs and increase exposure time to produce more blurring of the mandible.
A radiograph of an AP "wagging jaw"(Ottonello method) projection taken at 75 kV, 10 mAs, and 0.5 second(analog technique) demonstrates that part of the image of the mandible is still visible and is obscuring the upper cervical spine. Which modification needs to be made to produce a more diagnostic image during the repeat exposure?
use a compensating(wedge) filter with thicker part of filter placed over the upper thoracic spine to equalize the density along the t-spine
A radiograph of an AP projection of the thoracic spine is greatly overexposed but the lower vertebrae are well visualized. The head of the patient was placed at the anode end of the table. What can be used during the repeat exposure to produce a more diagnostic image?
increase CR angulation to 15 degrees cephalad
A radiograph of an Ap axial projection of the cervical spine shows that the intervertebral disk spaces are not open. The following positioning factors were used: extension of the skull, central ray angled 10-degrees cephalad, central ray centered to the thyroid cartilage, and no rotation or title of the spine. Which of these factors must be modified to produce a more diagnostic image?
initiate exposure during suspended expiration and increase SID to 72 inches(183 cm)
A radiograph on a lateral projection of the cervical spine shows that C7 is not clearly demonstrated. The following factors were used; erect position, 44 inch(112 cm) SID, arms down by the patient's side, and exposure made during inspiration. Which two of these factors should be changed to produce a more diagnostic image during the repeat exposure?
articular pillar
A short column of bone found between the superior and inferior articular processes in a typical cervical vertebra is called:
kyphosis
Abnormal or exaggerated convex curvature of the thoracic spine
scoliosis
An abnormal lateral curvature seen in the thoracolumbar spine is called _.
lordosis
An abnormal, or exaggerated, "sway back" lumbar curvature is called _.
clay shoveler's fracture
Avulsion fracture of the spinous process of C7
teardrop burst fracture
Comminuted fracture of the vertebral body with posterior fragments displaced into the spinal canal
c
For an AP axial of the cervical spine, a plane through the tip of the mandible and the __ should be parallel to the angled CR. a) mastoid process b) gonion c) base of skull d) external auditory meatus(EAM)
e
For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail. This can be done by: a) keeping the vertebral column parallel to the IR b) use a small focal spot c) increasing the SID d) use a breathing technique e) b and c
15 degrees cephalad
For the CR to pass through and "open" the intervertebral spaces on a 45-degree posterior oblique projection of the cervical vertebrae, what CR angle (if any) is required?
false
If close collimation is used during conventional(analog) radiography of the spine, the use of lead masking(blockers) is generally not required.
20 degrees from lateral position(70 degrees from plane of table or wall bucky)
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position?
jefferson's fracture
Impact fracture from axial loading of the anterior and posterior arch of C1
Rotate the skull into a near lateral position
In addition to extending the chin, which additional positioning technique can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for oblique projections?
thyroid, parathyroids glands and breast
In addition to the gonads, which other radiosensitive organs are of greatest concern during cervical and thoracic spine radiography?
cervical & lumbar
Indicate which two portions of the vertebral column are classified as secondary or compensatory curves.
true
Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than erect
a) C1: Atlas b) C2: Axis c) C7: Vertebra Prominens
List the alternative names for the following cervical vertebra.
ap and lateral of affected spine
List the conventional radiographic examination and/or projections performed for the following clinical indications: Herniated nucleus pulposes(HNP)
scoliosis series
List the conventional radiographic examination and/or projections performed for the following clinical indications: Scheuermann disease
erect (ap/pa) and lateral spine including bending laterals
List the conventional radiographic examination and/or projections performed for the following clinical indications: Scoliosis
lateral cervical
List the conventional radiographic examination and/or projections performed for the following clinical indications: Teardrop burst fracture
lateral c-spine
List the conventional radiographic examination and/or projections performed for the following clinical indications: Unilateral subluxation of cervical spine
ap open mouth C1-C2
List the conventional radiographic examination and/or projections performed for the following clinical indications: jefferson fracture
7
List the number of bones found in each division in the adult vertebral column: cervical
1
List the number of bones found in each division in the adult vertebral column: coccyx
5
List the number of bones found in each division in the adult vertebral column: lumbar
1
List the number of bones found in each division in the adult vertebral column: sacrum
12
List the number of bones found in each division in the adult vertebral column: thoracic
a) annulus b) fibrosus
List the outer and inner aspects of the intervertebral disk. a) outer aspect b) inner aspect
thoracic & sacral
List the two primary or posterior convex curves seen in the vertebral column.
a) transverse foramina b) bifid spinous process c) overlapping vertebral bodies
List three features that make the cervical vertebrae unique:
a) increase in exposure latitude(wider range of densities) b) decrease in patient dose
List two advantages of using higher kVp exposure factors with high-latitude analog(film-screen) systems imaging for spine radiography, especially on an anteroposterior(AP) thoracic spine radiograph.
done
Look over workbook page 190 #29
true
Many geriatric patients have a fear of falling off the radiographic table.
C1
Mastoid tip
a & c
Match the correct aspect(s) of the vertebral column with the following characteristics. (There may be more than one correct answer): A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum Concave curve(with respect to posterior)
b & d
Match the correct aspect(s) of the vertebral column with the following characteristics. (There may be more than one correct answer): A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum Convex curve(with respect to posterior)
a
Match the correct aspect(s) of the vertebral column with the following characteristics. (There may be more than one correct answer): A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum Develops as child learns to hold head erect
b & d
Match the correct aspect(s) of the vertebral column with the following characteristics. (There may be more than one correct answer): A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum Primary curve
a & c
Match the correct aspect(s) of the vertebral column with the following characteristics. (There may be more than one correct answer): A. Cervical spine B. Thoracic spine C. Lumbar spine D. Sacrum Secondary curve
scheuermann disease
Mild form of scoliosis and kyphosis developing during adolescence
false
Only T11 and T12 have full facets for articulation with ribs.
true
Performing the cervicothoracic projection is often required to demonstrate the C7/T1 region for the obese patient.
Unilateral subluxation
Produces the "bow tie" sign
lamina
The _ are two bony aspects of the vertebral arch that extend posteriorly from each pedicle to join at the midline.
swimmer's method
The common name of the method for the cervicothoracic lateral position is the
rotation of the skull
The lack of symmetry of the zygapophyseal joints between C1 and C2 may be caused by injury or may be associated with _.
expiration; for maximum shoulder deression
The lateral projection of the cervical spine should be taken during _(inspiration, expiration, or suspended respiration). Why?
dens or odontoid process
The modified body of C2 is called the _ or _.
vertebral(spinal) canal
The opening, or passageway, for the spinal cord is the _.
medulla oblongata; lower border of L1; conus medullaris
The spinal cord begins with the _ of the brain and extends down to the _ vertebra, where it tapers and ends. This tapered ending is called the _.
true
The thyroid dose delivered during a posterior oblique cervical spine(LPO or RPO) projection is greater than the thyroid dose for an anterior oblique(RAO or LAO) projection of the cervical spine.
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.
body; vertebral arch
The two main parts of a typical vertebra are the _ and the _.
90; 70 to 75
The zygapopyseal joints for the 2nd-7th cervical vertebrae are at a _ degree angle tot he midsagittal plane; the thoracic vertebrae are at a _ degree angle to the midsagittal plane.
false
The zygapopyseal joints of all cervical vertebra are visualized only in a true lateral position.
true
To a certain degree, MRI and CT are replacing myelography as the imaging modalities of choice for the diagnosis of a ruptured intervertebral disk.
a
To ensure that the intervertebral joint space are open for lateral thoracic spine projections, it is important to: a) keep the vertebral column parallel to the IR b) use a small focal spot c) use a breathing technique d) angle the CR caudad
intervertebral
Two small notches on the superior and inferior aspects of the pedicles create the _ foramina.
c
What CR angle must be used with the AP axial-vertebral arch(PIllars) projection?
15 degrees cephalad
What CR angulation(amount and direction) must be used with a posterior oblique projection of the cervical spine?
Lead mat or Masking
What ancillary device should be placed behind the patient on the table top for a recumbent lateral projection of the thoracic spine?
spondylitis is an inflammatory process of the vertebrae characterized by bony bridges between vertebrae(advanced stages). Spondylosis a condition of the spine characterized by decrease vertebral joint space and arthritic changes of the zygopopyseal joint
What are the two major differences spondylitis and spondylosis.
a) compensate for increased OID; reduces magnification b) less divergence of x-ray beam to reduce shoulder superimposition of C7
What are two important benefits of using an SOD 60-72 inches(152 to 183 cm) for the lateral cervical spine projection?
Atlantoocipital articulation
What is the name of the joint found between the superior articular processes of C1 and the occipital condyles of the skull?
myelography
What is the name of the radiographic procedures that requires the injection of contrast media into the subarachnoid space?
to open up the intervertebral disk space
What is the purpose of the 15-20 degree cephalad angle for the AP axial projection of the cervical spine?
to blur out rib and lung markings that obscure detail of thoracic vertebrae
What is the purpose of using an orthostatic(breathing) technique for a lateral projection of the thoracic spine?
60-72 inches(152-183cm)
What is the recommended SID for the cervicothoracic position of the cervical spine?
lateral mass
What is the term for the same structure, identified in the previous question, for C1 vertebra?
presence of facets for articulations with ribs
What is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae?
If unable to demonstrate the upper portion of the odontoid process(dens) with the AP "open mouth" projection
When should the Judd or Fuchs method be performed?
true
When using digital imaging for spine radiography, it is important to use close collimations, grids, and lead masking.
to T1; 1 inch(2.5 cm) above the jugular notch anteriorly and level of vertebrae prominens posteriorly
Where should the CR be placed for a cervicothoracic lateral position?
AP "Wagging Jaw" (Ottonello Method)
Which AP projection of the cervical spine demonstrates the entire upper upper cervical spine with one single projection?
Left Intervertebral Foramina ( Downside)
Which foramina are demonstrated with a left anterior oblique (LAO) position of the cervical spine?
Right intervertebral Foramina ( upside)
Which foramina are demonstrated with a left posterior oblique(LPO) position of the cervical spine?
nuclear medicine
Which imaging modality is ideal for detecting early signs of esteomyelitis?
c
Which of the following is found between the superior and inferior articular processes? a) intervertebral joints b) articular joints c) zygapopyseal joints d) intervertebral facets
c
Which of the following projections delivers the greatest skin dose to the patient? a) AP thoracic spine projection b) Lateral cervical spine projection c) Cerviocothoracic lateral position d) Fuchs or Judd method
d
Which of the following projections is considered a "functional study" of the cervical spine? a) AP "wagging jaw" projection b) AP "open mouth" position c) Fuchs or Judd method d) Hyperextension and hyperflexion lateral positions
b
Which of the following structures is best demonstrated with an AP axial vertebral arch projection? a) Spinous processes of the lumbar spine b) Articular pillars(lateral masses) of the cervical spine c) Zygapophyseal joints of the thoracic spine d) Cervicothoracic spine region
C5-T3
Which region of the spine must be demonstrated with a cervicothoracic lateral (swimmer's ) position?
Mentomeatal Line (MML)
Which skull positioning line is aligned perpendicular to the IR for a PA(Judd) projection for the odontoid process?
lateral, horizontal, beam 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?
T5-T8
Which specific thoracic vertebrae are classified as "typical" thoracic vertebrae?
spinal nerves & blood vessels
Which structures pass through the intervertebral foramina?
lower margin of upper incisors and base of skull
Which two landmarks must be aligned for an AP "open mouth" projection?
correct use of anode-heel effect and use of compensating(wedge) filter
Which two things can be done to produce equal density along the entire thoracic spine for an AP projection(especially for a patient with a thick chest)?
right(downside)
Which zygapophyseal joints are demonstrated in a a RAO projection of the thoracic spine?
right
Which zygopophyseal joints are best demonstrated with the LPO position of the thoracic spine?
done
Workbook Pg. 188
ankylosing spondylitis
a form of rheumatoid arthritis
scoliosis
abnormal lateral curvature of the spine
body
center portion of the sternum
hangman's fracture
fracture through the pedicles and anterior arch of C2 with forward displacement upon C3
C3
gonion
spondylitis
inflammation of the vertebrae
sternal angle
joint between top and center portions(landmark)
T2-T3
jugular notch
xiphoid process
most inferior portion of the sternum(landmark)
T4-T5
sternal angle
Jugular(suprasternal) notch
superior margin of this upper section(landmark)
C4-C6
thyroid cartilage
manubrium
upper portion of the sternum
C7-T1
vertebra prominens
T9-T10
xiphoid process(tip)