Exam 1
SCOLIOSIS SERIES: To determine degree and severity
-PA projection recommended for reduction in dose to patient. -90% reduction to sensitive breast tissue. -Use of shielding is imperative.
LATERAL (Non-trauma) GRANDY METHOD
-Relax and drop shoulders -Use sandbags if indicated -CR - ┴ to C4 -PoR - Expiration to drop the shoulders
CERVICAL SPINE RADIOGRAPHY: PROCEDURAL CONSIDERATIONS
-Remove earrings, necklaces, hearing aids, oral appliances, gum/candy, hair accessories (wigs), glasses and clothing with zippers, buttons, hooks and clasps above the axilla. -Secure all patient possessions in designated manner and location.
THORACIC CHARACTERISTICS
-Rib articulations (facets & demifacets) -Caudally pointed spinous processes
SACRUM, COCCYX, SI JTS & AIRWAY IMAGINGPROCEDURAL CONSIDERATIONS
-Changing Instructions -Empty bladder before beginning exam -Shielding for males; unable for females
Lumbar PROCEDURAL CONSIDERATIONS
-Changing Instructions: remove clothing below the assist. Undergarments may stay on provided no snaps, etc. -LMP/Pregnancy -Shielding
AP AXIAL COCCYX
-Coccyx free of superimposition -Free of gas and fecal content -No rotation
Thoracic vertebra joints
-Costotransverse joint (tubercle of rib) -Costovertebral joint (head of rib)
Alternative for c1-c2/dens
-Fuchs Method (AP) -Judd Method (PA)
Lumbar LEFT LATERAL best demonstrates
-Intervertebral Foramina -Vertebral Bodies -Intervertebral joint space -Spinous Processes
CERVICAL SPINE ROUTINE Essential projections
-Lateral -Both obliques -AP- -AP "open mouth" -Swimmer's lateral (if needed)
SUMMARY OF PATIENT respiratory INSTRUCTIONS
-Lateral technique: Suspension after full expiration to depress shoulders -AP Axial/AP "open mouth": Suspend -Swimmer's: Expiration
Erect Lateral Position: Scoliosis Series
-Routine PA (AP) Erect lateral -True lateral as possible -Lower IR border 1-2 inches (3-5 cm) below iliac crest
PA (AP) Projection: Scoliosis Series
-Routine PA (AP) -Lower IR border 1-2 inches (3-5 cm) below iliac crest
AP AXIAL SACRUM EVALUATION CRITERIA
-Sacrum not foreshortened -Sacral foramina visualized
The Zygapophyseal joints of all cervical vertebrae are visualized only in a true lateral position True/False
False (between C1 and C2 visualized on a frontal or AP projection)
Whats the name of the joint found between the superior articular process of C1 and the occipital condyles of the skull?
Atlanto-occipital articulation
Situation: A patient comes to the radiology department with a clinical history of HNP. Which of the following imaging modalities provide the most diagnostic study for this condition? A. Sonography B. MRI C. Nuclear medicine D. Radiography
B. MRI
Which of the following structures makes up inner aspect of the intervertebral disks? A. Annulus fibrous B. Nucleus pulposus C. Annulus pulposus D. Nucleus fibrosus
B. Nucleus pulposus
For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail by: A. Keeping the vertebral column parallel to the image receptor B. Using a small focal spot C. Increasing the source image receptor distance (SID) D> Using a breathing technique
B. Using a small focal spot
What is another term for the sacral horns?
Comua
Kyphotic curves
Convex (curve outward) Thoracic and sacral regions
If close collimation is used during conventional (analog) radiography of the spine, the use of lead masking (blockers) is generally not required
False
True/False: The lead blocker mat and close collimation must not be used when performing digital imaging of the lumbar spine.
False
True/False: The use of higher kV and lower mA seconds (mAs) for lumbar spine radiography improves radiographic contrast but increases patient dose.
False
5. True/False: The anteroposterior (AP) proiection of the lumbar spine opens the intervertebral joint spaces better than the posteroanterior (PA) projection.
False- (PA would open intervertebral joint spaces better.)
True/False The tip of the odontoid process does not have to be demonstrated on the AP "open mouth" projection because it is best seen on the lateral projection.
False: the entire dens or odontoid process must be demonstrated.
OBLIQUES: BEST DEMONSTRATED
AP OBLIQUES (RPO/LPO) Intervertebral foramina (IVF's) and pedicles FARTHEST from the IR PA OBLIQUES (LAO/RAO) Intervertebral foramina (IVF's) and pedicles CLOSEST to IR
A patient enters the ER with a possible cervical spine fracture, but the initial projections do not demonstrate any gross fracture or subluxation. After the initial radiographs, the ER physician suspects either a congenital defect or a fracture of 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?
AP axial- vertebral arch (pillar) projection
Patients should be asked to empty the urinary bladder before performing which projection(s) of the vertebral column?
AP of sacrum and coccy
sacrum anatomy
Articulating surface: L shaped running from s1-s3 that is essentially concave and covered with hyaline cartiliage; change in orientation occurs bw s1/s2 and s3
Which projections should be taken to evaluate flexibility following spinal fusion surgery?
Hyperextension and hyperflexion lateral projections
What projection is considered a "functional study" of the cervical spine?
Hyperextension and hyper flexion lateral positions
Situation: A patient comes to the radiology department for a lumbar spine study following spinal fusion surgery. Her surgeon wants a study to assess mobility of the spine at the fusion site. Which radiographic positions provide this information?
Hyperflexion and hyperextension lateral positions
"OPEN MOUTH"
If the occipital bone overlaps the dens, the chin must be tilted down more. If the teeth superimpose the dens, the chin must be elevated more.
A radiograph of an LPO projection of the lumbar spine shows that the downside pedicles and zygapophyseal joints are projected over the anterior portion of the vertebral bodies. Which specific positioning error is present on this radiograph?
Insufficient rotation of the spine (pedicle "eye'" should be to midvertebral bodies)
26. For the lateral L5-S1 projection, the CR is parallel to the ___________ plane A. Oblique B. Midcoronal C. Midsagittal D. Interiliac
Interiliac plane
HARRINGTON RODS
Interlocking plates w/ hooks and rods that correct or align spine
Name H
Intervertebral foramen, C4-C5
What is the term for the same structure, identified in the previous question, for the C1 vertebra?
Lateral mass
Which radiographic position best demonstrates the structure identified in the previous question?
Lateral position
Which specific projection must be taken first if trauma to cervical spine is suspended and the patient is in supine position on backboard?
Lateral, horizontal beam projection
Which sacroiliac (SI) joint is visualized with an RPO position?
Left
Which specific joint spaces are visualized with a left anterior oblique (LAO) projection of the thoracic spine?
Left Zygopaphyseal joint
27. Where is the central ray centered for an AP axial projection for L5-S1?
Level of ASIS at the midline of the body.
Which two landmarks must be aligned for an AP "open mouth" projection?
Lower margin of upper incisors and base of skull
36. A radiograph of an LPO projection of the lumbar spine shows that the downside pedicles are projected toward the posterior aspect of the vertebral bodies. What must be done to correct this error during the repeat exposure?
Rotation of the spine
A radiograph of an AP projection of the lumbar spine shows that the spinous processes are not midline to the vertebral column and distortion of the vertebral bodies is present. Which specific positioning error is present on this radiograph?
Rotation of the spine
Scoliosis Series
Routine PA/AP erect Erect lateral Special AP (Ferguson method) AP—right and left bending
Situation: A patient comes to the radiology department for a lumbar spine series. She has a clinical history of severe kyphosis. How should the lumbar spine series be modified for this patient?
Routine lumbar spine projections should be performed erect
In addition to the gonads, which other radiosensitive organs are greatest concern during cervical and thoracic spine radiography?
Thyroid, parathyroid glands and breasts
What is the purpose of using an orthostatic breathing technique for a lateral projection of the thoracic spine?
To blur out the ribs and lung markings that obscure detail of thoracic vertebrae
True/False: A PA or an AP projection for a scoliosis series frequently includes one erect and one recumbent position for comparison.
True
True/False: An increased source image receptor distance (SID) of 44 to 46 inches (112 to 117 cm) reduces magnification of the spine anatomy.
True
True/False: The thyroid dose delivered during a posterior obligue cervical spine (LPO or RPO) projection is greater than the thyroid dose for an anterior oblique (RAO or LAO) projection of the cervical spine.
True:
The large joint space between C1 and C2 is called the
atlantoaxial joint.
cervical vertebrae C2
axis
18. Anterior wedging and loss of vertebral body height are characteristic of: A. Chance fracture B. Spina bifida C. Compression fracture D. Spondylolysis
b. Compression fracture
For an AP axial of the cervical spine, a plane through the tip of the mandible and the __________________ should be parallel to the angled central ray
base of skull
vertebral foramen
canal through which spinal cord passes
INTERVERTEBRAL DISK
cartilaginous pad found between the vertebrae in the spine
9. The zygapophyseal joints of the lumbar spine are classified as ________________ as joints with _______________ type of joint movement.
cartilaginous/amphiarthrodial
NORMAL SPINAL CURVATURES
cervical - lordotic thoracic - kyphotic lumbar - lordotic sacral & coccygeal - kyphotic
Lordotic Curves
cervical and lumbar
two joint classifications
facet and intervertebral
kyphosis
hunchback
30. Which projections are designed to measure mobility of the vertebral column at the site of a spinal fusion?
hyperextension/hyperflexion lateral
31. Where is the central ray centered for an AP projection of the sacrum?
iliac crests
37. An AP projection of the sacrum shows that the sacrum is foreshortened and the foramina are not open. What positioning error may have led to this radiographic outcome?
insufficient cephalad CR angulation or CR angled in the wrong direction
The superior and inferior vertebral notches create which foramina?
intervertebral
Scheuermann's Disease
juvenile kyphosis
32 What two things can be done to reduce the high amounts of scatter reaching the IR during a lateral projection of the sacrum and coccyx? A. B.
lead mat behind patient, close collimation
What ancillary device should be placed behind the patient on the tabletop for a recumbent lateral projection of the thoracic spine?
lead mat or masking
Which foramina are demonstrated with a LAO position of the cervical spine?
left intervertebral foramina
40. Situation: A study of the sacroiliac joints demonstrates that the joints are not open and the upper iliac wings are nearly superimposing the joints. The technologist performed 35-degree RPO and LPO positions with a perpendicular CR. What can be done during the repeat exposure to open the joints?
reduce obliquity to 25-30 degrees
Which zygapophyscal joints are demonstrated in a right anterior obligue (RAO) projection of the thoracic spine?
right down side
Which foramina are demonstrated with a left posterior oblique (LPO) position of the cervical spine?
right intervertebral foramina
Most inferior aspect of sternum (landmark)
xiploid process
11. The ear and front leg of the "Scottie dog" make up the _____________ joint, best seen in the oblique position.
zygapophyseal
Which joints are found between the superior and inferior articular processes?
zygapophyseal or apophyseal joint, is a synovial joint
C3-C6- 3 Unique characteristics
➢Bifid tips ➢Articular pillar ➢3 foramina
Facet Joints
Diarthrotic, synovial joints
PRIMARY AND SECONDARY CURVES
Primary: thoracic, sacral Secondary: cervical, lumbar
ASIS
(S1-2)
AP AXIAL SACRO-ILIAC JOINTS
-2" below ASIS -30 degrees cephalic - MALES -35 degrees cephalic - FEMALES
Lateral Upper Airway
-72" SID to reduce magnification -CR at C6-7 -Slow, deep inspiration
Where is the central ray centered for a lateral L5-SI projection of the lumbar spine?
1 1/2 inches (4 cm) inferior to iliac crest and 2 inches (5 cm) posterior to ASIS
Where is the CR centered for an oblique projection of the SI joints?
1 inch (2.5 cm) medial from upside ASIS
How much is the CR angled for the AP axial coccyx projection?
10 degrees caudad
What central ray angulation must be used with a posterior oblique projection of the cervical spine?
15 degree cephalic
How much central ray angulation is required for an AP projection of the sacrum fora typical male patient?
15 degrees cephalad
Where is the CR centered for an AP axial projection of the sacrum?
2 inches (5 cm) superior to pubic symphysis
Where is the central ray centered for an AP projection of the coccyx?
2 inches (5 cm) superior to the symphysis pubis
How much rotation of the body is required for oblique positions of the SI joints?
25 to 30 degrees
For the Ferguson method, the elevated foot must be raised a minimum of __________ inches/cm
3 to 4 inches/8 to 10 cm
Each sacroiliac joint opens obliquely ______ degrees posteriorly A .20 B. 30 C. 45 D. 50
30
How much rotation is required to visualize the zygapophyseal joints properly at the L5-SI level?
30 degrees
The sacroiliac joints lie at an oblique angle of_____________degrees to the coronal plane.
30 degrees
What amount and direction of central ray angulation is required for an AP axial L5-S1 projection on a male patient?
30 degrees cephalad
How many segments make up the sacrum in the neonate?
5
Sacrum
5 fused vertebrae
A patient with a wide pelvis and narrow thorax may require a central ray angle of _______________ degrees _______(caudad or cephalad) for a lateral position of the lumbar spine.
5 to 8 degrees, caudad
25. What type of central ray angulation should be used for the lateral L5-S1 projection if the waist is not supported? A. Central ray perpendicular to IR B. 5 to 8 degrees caudad C. 10 to 15 degrees cephalad D. 3 to 5 degrees cephalad
5-8 degrees caudad
Would the degree of angle to demonstrate the structures identified in F in the previous question be greater or less for the lower lumbar vertebrae as compared with the upper?
50 degrees for upper and 30 degrees for lower vertebrae to the midsagittal plane
What is the recommended SID for the cervicothoracic position of the cervical spine?
60 to 72 inches
The zygapophyseal joint for the second through seventh cervical vertebrae are at? ______- degree angle to the midsagittal plane; the thoracic vertebrae are at a _____- degree angle to the midsagittal plane
90; 70-75
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?
A greater central ray angle is required. Female patients require a central ray angle of 30 to 45 degrees.
Situation: A patient with a clinical history of spondvlolisthesis at the L5-SI level comes to the radiology department. Which specific lumbar spine position is most diagnostic in demonstrating the extent of this condition?
A lateral L5-SI position would demonstrate the degree of forward displacement of L5 onto S1
AP "OPEN MOUTH" PROJECTION
A line formed by the bottom of the to teeth (incisors) and the mastoid process will be perpendicular to the IR. Requires the correct angulation of the head. Collimated field - Include from upper incisors to tip of chin C1 & C2 in center of field
Describe the body build that might require central ray angulation to open the intervertebral joint spaces with a lateral projection of the lumbar spine, even if the patient has some support under the waist.
A patient with a wide pelvis and narrow thorax(angle CR 5-8° caudal)
How much and in which direction should the central ray be angled for A. AP axial projection of the cervical spine B. Anterior oblique projection of the cervical spine C. posterior oblique projection of the cervical spine
A. AP axial projection of the cervical spine B. Anterior oblique projection of the cervical spine C. posterior oblique projection of the cervical spine
List the outer and inner aspects of the intervertebral disk A. Outer aspect ____________________ B. Inner aspect ______________________
A. Annulus fibrosus B. Nucleus pulpsus
Identify the following structures labeled on the radiographs of the lumbar spine (Figs. 9.2 and 9.3). A B. C. B G D. E F.____________ joint G. H. K.
A. Intervertebral disk space, LI-L2 B. Spinous process, L2 C. Transverse process, L3. D. Region of lamina (body) L4 E. Left ala of sacrum F. Left sacroiliacjoint G. Body of L1 H. Pedicles of L2 I. Intervertebral foramina, L3-LA J. Intervertebral disk space, L5-S1 K. Sacrum
To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections, it is import: A. Keep the vertebral column parallel to the image B. Use a small focal spot C. Use a breathing technique D. Angle the central ray caudal
A. Keep the vertebral column parallel to the image
Which two structures can be evaluated to determine whether rotation is present on a radiograph of an AP projection of the lumbar spine? A B.
A. Sacroiliac (SI) joints are equidistant from the spine. B. Spinous process should be midline to the vertebral column (transverse processes are equal length)
List the structure classification and movement classification and type for the following joints of the vertebrae Zygapophyseal- Mobility type___________ Movement type ____________ Intervertebral- Mobility type___________ Movement type ____________
A. Synovial, diarthrodial. plane, or gliding B. Cartilaginous, amphiarthrodial (slightly movable), none
Which of the following divisions of the spine is described as possessing a primary curve?
A. Thoracic D. Sacral
List three features that make the cervical vertebrae unique A. B. C.
A. Transverse Foramina B. Bifid spinous process C. Overlapping vertebral bodies
Situation: A patient comes to the radiology department fora follow-up study for a compression fracture of L3. The radiologist requests that collimated projections be taken of L3. Which specific projections and centering would provide a quality study of L3 and the intervertebral joint spaces?
AP or PA and collimated lateral projections would provide the best view of the L3 region. The central ray should be about 2 inches (5 cm) above the iliac Crest
Intervertebral Joints
Amphiarthrotic, cartilaginous joints
Scoliosis: An abnormal or exaggerated LATERAL curvature of the spine
An abnormal or exaggerated LATERAL curvature of the spine
A radiograph of an AP axial projection of the coccyx shows that the distal tip is superimposed over the symphysis pubis. What must the technologist do to eliminate this problem during the repeat exposure?
An increase in central ray angle is required to separate the coccyx from the symphysis pubis.
Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection?
Anode heel effect and wedge filter
The lateral projection of the cervical spine should be taken during ______ (inspiration, expiration, or suspended respiration) Why?
Expiration; for maximum shoulder depression
The superior and inferior vertebral notches join together to form the: A. Vertebral foramen B. Intervertebral foramina C.Pedicle D. Lamina
B. Intervertebral foramina
12. Which of the following topographic landmarks corresponds to the L2-L3 level? A. Xiphoid process B. Lower costal margin C. Iliac crest D ASIS
B) Lower costal margin
What is the name of the superior broad aspect of the coccyx?
Base
Center portion of sternum
Body
Which of the following projections delivers the greatest skin dose to the patient? A. AP thoracic spine projection C. Cervicothoracic lateral position B. Lateral cervical spine projection D. Fuchs or Judd method
C. Cervicothoracic lateral position
What central-ray angle must be used with the AP axial-vertebral arch (Pillars) projection? A. 15- to 20-degree cephalad C. 20- to 30-degree caudad B. B. 5- to 10-degree cephalad D. None (central ray is perpendicular to IR)
C. 20- to 30-degree caudad
Name the corresponding vertebra(e): Mastoid tip
C1
cervical atlas
C1
CERVICAL VERTEBRAE
C1-C7
LATERAL (Non-trauma) GRANDY METHOD: BEST DEMONSTRATED
C1-C7* (If C7 not demonstrated, as "swimmers" is required. -Zygapophyseal/facet joints -Vertebral bodies -Intervertebral joint/disk/disc spaces -Spinous processes
Name the corresponding vertebra(e): Gonion
C3
typical cervical vertebrae
C3-C6
Name the corresponding vertebra(e): Thyroid cartilage
C4-C6
Which region of the spine must be demonstrated with a cervicothoracic lateral position?
C5-T3
largest cervical vertebrae
C7
Name the corresponding vertebra(e) vertebra prominens
C7-T1
AP AXIAL SACRUM
CR 15 degrees CEPHALIC Enters 2 inches above pubic symphysis PoR: Suspend (to limit pt. motion)
AP Upper Airway
CR at T1-2 = (1" above jugular notch) AML perpendicular to IR BD: Larynx & trachea from C3-T4 filled with air.
LATERAL SACRUM/COCCYX- If coccyx is of interest ONLY:
CR is perpendicular to enter 3-4 posterior and 2 inches distal from ASIS If imaging separately, coccyx requires a lower kvp and a decreased mas.
21. Where is the central ray centered for an AP projection of the lumbar spine with a 30- >x 35-cm (11- x 14-inch) IR?
CR perpendicular to the level of iliac crests
"SWIMMERS" Best Demostrates
Cervicothoracic region C5-T3
A broad shouldered patient comes to the radiology department for a routine cervical spine
Cerviocothoracic (swimmers) lateral
An avulsion fracture of the spinous processes of C6 through T1 is called a: A. Hangmans fracture B. Clay shovelers fracture C. Jefferson fracture D. Teardrop burst fracture
Clay shoveler's fracture.
What is the recommended kV range for lateral-byperflexion and hyperextension positions of the spine for a digital imaging system? A. 70 to 75 B. 80 to 85 C. 85 to 95 D. 95 to 100
D. 95 to 100
What type of CR angle is recommended for the AP axial projection of the SI joints on a female patient? A. 20 degrees cephalad B. 30 degrees cephalad C. 30 degrees caudad D. 35 degrees cephalad
D. 35 degrees cephalad
TRAUMA PROTOCOL
DO NOT REMOVE neck braces, sandbags, etc. Do not move or transfer the patient Lateral with horizontal beam (Cross-Table Lateral) Check with physician for clearance to remove collar
A radiograph of an oblique position of the lumbar spine shows that the downside pedicle and zygapophyseal joint are posterior in relation to the vertebral body. What modification of the position must be made during the repeat exposure to produce a more diagnostic image
Decrease rotation of the body and spine.
FLEXION AND EXTENSION LATERALS: breathing
Expiration
AP AXIAL
General Survey of C3-C7 -Vertebral bodies -Vertebral joint spaces -Spinous processes
Whats the correct term for the condition involving a "slipped disk"?
Herniated Nucleus Pulposus
The condition involving a "slipped disk" is correctly referred to as?
Herniated nucleus pulpous (HNP)
MENTOMEATAL LINE (MML)
It is formed by connecting a line from the mental point and EAM.
RPO/LPO OBLIQUES Joints of interest
Joint of interest is AWAY/FARTHEST/ELEVATED from the IR RPO = left SI joint LPO = right SI joint BOTH sides are examined for comparison.
Superior margin of this upper section (landmark)
Jugular notch
ldentify parts of the "Scottie dog" image, which should be visible on an obligue lumbar spine image (Figs. 9,4 and 9.5) L. M.__________joint N O P Q
L. Inferior articular process, L3 (leg) M. Zygapophyseal joint, L4LS N. Pars interarticularis, L3 (neck) O. Pedicle, L3 (eye) P. Transverse process, L3 (nose) Q. Superior articular process, L3 (ear)
At which vertebral level does the soil spinal cord terminate?
L1
Lower costal margin
L2-L3
iliac crest
L4-5
Compared with the spinous processes of the cervical and thoracic spine, the lumbar spinous processes are: A. Smaller B. Pointed downward more C. Larger and more blunt D. Absent
Larger and more blunt
Upper portion of sternum
Manubrium
15. Why should the knees and hips be flexed for an AP projection of the lumbar spine?
Opens the intervertebral disk space by reducing the normal lumbar curvature of the spine.
The _____________ which is the eye of the "Scottie dog," should be near the center of the vertebral body on a correctly oblique lumbar spine position.
Pedicle
Name G
Pedicle, C4
The small foramina found in the sacrum are called?
Pelvic sacral foramina
During the AP (PA) right and left bending projections of the lumbar spine, the ___________ serves as a fulcrum during positioning.
Pelvis
Situation: A patient with an injury to the coccyx enters the emergency room. When attempting the AP projection, the patient complains that it is too uncomfortable to lie on his back. He is unable to stand. What other options are available to complete the study?
Perform a PA rather than an AP projection and reverse the direction of the central ray from caudad to cephalad.
Name C
Posterior arch and tubercle, C1
SACRO-ILIAC JOINTS
ROUTINE AP Axial OBLIQUES: RPO & LPO Why not a lateral?
Why should the knees and hips be flexed for an AP lumbar spine projection?
Reduces lumbar curvature, which opens the intervertebral disk space
A radiograph of a right posterior oblique (RPO) cervical spine projection shows that the lower intervertebral foramina are not open. are well visualized. I upper intervertebral foramina are well visualized. What positioning error most likely led to this radiographic outcome?
Repeat the exposure and only abduct the femur 20 to 30 degrees from vertical. (It will less distortion of the femoral.)
Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine?
Right
An abnormal or exaggerated lateral spinal curvature is called
SCOLIOSIS
CERVICAL SPINE RADIOGRAPHY: TECHNICAL CONSIDERATIONS
SID: 40 inches. 72 inches is recommended for projections with an increased OID: 72" will reduce magnification. Grid Usage: May or not be used due to AIR GAP theory. Markers: RIGHT or LEFT must be used on each image. Radiation Protection: Shield pediatric and patients of reproductive age. Other Radiation Protection Measures - Close collimation and optimal technical factors
ANATOMIC REFERENCE
Shows Mid Coronal plane of body = Note that the thoracic vertebra are found in the posterior ½ of the thorax.
Ferguson Method: Scoliosis Series
Special AP (Ferguson method) 2 IRs used Elevate convex side
COMPENSATING FILTER
Special filters added to the primary beam to alter its intensity. These types of filters are used to image anatomic areas that are nonuniform in makeup and assist in producing more consistent exposure to the image receptor.
The common name for the cervicothoracic lateral position is?
Swimmers position
Name the corresponding vertebra(e): Jugular notch
T2-T3
Name the corresponding vertebra(e): Sternal angle
T4-T5
Which thoracic vertebrae are classified as typical thoracic vertebrae?
T5 to T8
Name the corresponding vertebra(e) 3-4 inches below jugular notch
T7
ZYGAPOPHYSEAL JOINTS
The joints between articular processes of vertebra are termed:
LUMBAR SPINE
The lower part of the back, formed by the lowest five nonfused vertebrae; also called the dorsal spine.
Evaluation Criteria: Erect PA or AP
Thoracolumbar spine demonstrated Use of compensating filter recommended 1-2 inch (2.5-5 cm) iliac crest demonstrated Optimal exposure factors
Evaluation Criteria: Ferguson Method
Thoracolumbar spine demonstrated Vertebral column centered 1 inch (2.5 cm) iliac crest demonstrated Optimal exposure factors
What are there three distinctive features of all cervical vertebrae that make them different from any other vertebrae?
Triangular vertebral foramen. Bifid spinous process. Transverse foramina
17. True/False: The efficiency of CT and MRI of the spine is reducing the number of myelograms being performed.
True
TRAUMA LATERAL
Used to R/O subluxation*, fracture or cervical instability. *SUBLUXATION: Incomplete or partial dislocation
AP PROJECTION General survey
Vertebral bodies Intervertebral joint spaces Spinous processes Transverse processes
A radiograph of an AP projection of the thoracic spine shows that the upper thoracic spine Is greatly overexposed but the lower vertebrae are well visualized. The head of the patient was placed at the anode end of the table. What can be used during the repeat exposure to produce a more diagnostic image?
When using automatic exposure control (AEC) for an AP pelvis projection, the left and right ionization chambers must be activated. The center chamber is over the less dense pelvic cavity, which may lead to an underexposed image
Situation: A patient with a possible cervical spine injury enters the emergency room. The patient is on a backboard. Which projection of the cervical spine should be taken first?
Yes. Any orthopedic appliance or prosthesis must be seen in its entirety in both projections.
Which of the following is found between the superior and inferior articular processes? A. Intervertebral joints B. Articular joints C. Zygapophyseal joints D. Intervertebral facets
Zygapophyseal joints
_______________ _____________ are shown on a 70 degree oblique, which is not an essential projection for thoracic spine radiography.
Zygapophyseal joints
Name D
Zygapopyseal joint, C5-C6
symphysis pubis
a cartilaginous joint that is the point of fusion for two pubic bones
23. How much rotation of the spine is required to demonstrate the zygapophyseal joint space between LI-L2?
d. 50* from plane of table
INTERVERTEBRAL FORAMINA
openings providing for exit of spinal nerves
The anterior/superior ridge of the upper sacrum is called the: A. Median sacral crest B. Cornua C. Promontory D. Sacral horns
promontory
vertebral arch
protects the spinal cord
herniated nucleus pulposus (HNP)
protrusion of intervertebral disk between two vertebrae, which puts pressure on spinal nerves; also called herniated disk or ruptured disk; may require surgery
35. A radiograph of an AP projection of the lumbar spine shows that the sacroiliac (SI) joints are not equidistant from the spine. The right ala of the sacrum appears wider, and the left SI joint is more open than the left. Which specific positioning error is evident on this radiograph?
reduce RPO rotation, rotate a bit back to the left
Joint between top and center portions (landmark)
seternal angle
Which set of zygapophyseal joints of the lumbar spine is best demonstrated with an LAO position?
side farthest from IR, upside
19. Which of the following conditions is often diagnosed by prenatal ultrasound? A. Scoliosis B. Spina bifida C. Spondylolisthesis D. Ankylosing spondylitis
spina bifida.
What is the one feature of all thoracic vertebrae that makes them different from all other vertebrae?
thoracic vertebrae are unique among the bones of the spine in that they are the only vertebrae that support ribs and have overlapping spinous processes.
Why should a single lateral projection of the sacrum and coccyx be performed rather than separate laterals of sacrum and coccyx?
to decrease gonadal dose
What is the purpose of the 15 to 20 degree cephalic angle for the AP axial projection of the cervical spine?
to open up the intervertebral disk spaces
Vertebral body
transfers weight along the spine
Which ligament holds the dens against the anterior arch of c1
transverse ligament
28. True/False: A kV range of 90 to 100 kV can be used for a lateral L5-S1 projection when using a digital imaging system.
true
34. True/False: The pelvis must remain as stationary as possible for the positioning for the hyperextension and hyperflexion projections.
true
FLEXION & EXTENSION LATERALS (Spinal Fusion Series)
-Bottom of IR 1-2 inches below crest -PoR:Expiration
LATERAL SACRUM & COCCYX
-CR perpendicular to enter -3-4 inches POSTERIOR from the ASIS -Close collimation required -Lead blocker to reduce scatter
LATERAL L5-S1: "Spot film"
-CR: 1.5" below crest & 2"posterior from ASIS -Lead rubber -5 degrees caudally for males 8 degrees caudally for females -If waist is not supported, resulting in sagging of the spine, the CR must be angled 5-8 degrees caudally to be parallel to the interiliac line.
AP AXIAL SACRO-ILIAC JOINTS- RPO/LPO OBLIQUES
- 25 - 30 degree - PoR: Suspend
What are two important benefits of using a SID 60 to 72 inches for the lateral cervical spine projection?
- Compensates for increased object receptor distance; reduces magnification - Less divergence of x ray beam to reduce shoulder superimposition of c7
sacrum and coccyx RECAP
-AP SACRUM: 15 degrees cephalic -AP COCCYX: 10 degrees caudal -Laterals: Generally are imaged together
Lateral Upper Airway- Evaluation Criteria
-Air-filled trachea and larynx -Shoulders not superimposed over trachea -Collimation evident -Exposure factors
TECHNIQUES TO PROVIDE A MORE EVEN DENSITY
-Anode heel effect -compensating filter (wedge filter)
AIR GAP THEORY
-The quantity of scattered radiation in an x-ray beam can be reduced by separating the body and IR. This is separation is known as an air gap. -This technique acts like a grid.
LATERAL SACRUM AND COCCYX
-The sacrum and coccyx are imaged together to include both. -This is recommended to reduce gonadal doses.
LATERAL CERVICOTHORACIC"SWIMMERS"
-This position may be used for CERVICAL as well as THORACIC SPINE exams. -Used when C7 is not well demonstrated on lateral c-spine images. -Used when T1-T2-3 are not well demonstrated on a lateral thoracic image.
AP General Survey:
-Vertebral bodies -Intervertebral joint spaces -Transverse processes -Costovertebral articulations
Match each of the following topographic landmarks to the correct vertebral level. (Use each choice only once.) 1. ASIS 2. Xiphoid process 3. Lower costal margin 4. Iliac crest 5. Symphysis pubis A. L2-L3, B. L4-L5, C. SI-S2, D. Prominence of greater trochanter, E. T9-T10
1. ASIS- C 2. Xiphoid process- E 3. Lower costal margin- A 4. Iliac crest- B 5. Symphysis pubis- D
Select the imaging modality that best demonstrates each of the following pathologic features or conditions. (Answers may be used more than once.) 1. Magnetic resonance imaging (MRI) 2. Computed tomography (CT) 3. Myelography 4. Bone densitometry 5. Nuclear medicine A. Osteoporosis, B. Soft tissues of lumbar spine, C. Structures within subarachnoid space, D. Inflammatory conditions such as Paget's disease, E. Compression fractures of the lumbar spine
1. Magnetic resonance imaging (MRI)- B, C 2. Computed tomography (CT)- E 3. Myelography- C 4. Bone densitometry- A 5. Nuclear medicine- D
For the central ray to pass through and "open" the intervertebral spaces on 45 degree posterior oblique projection of the cervical vertebrae, what central-ray angle (if any) is required?
15 degrees cephalic
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position?
20 degrees from lateral position
The angle of the midlumbar spine zygapophyseal joints in relation to the midsagittal plane is?
45
The degree of obliquity required for an oblique projection at the T12-LI level is approximately ___________, whereas the L5-S1 spine level requires a(n) ____________________ oblique is performed for the general lumbar spine.
50 degrees, 30 degrees , 45 degrees
7. Identify the labeled parts on these radiographs of individual vertebrae (Figs. 9.8 and 9.9). A B C D E F G H I J
A B C D E F G H I J
6 ldentify the labeled parts of the sacrum and coccvx in the following drawings A B C D E F G H. I J K L
A B C D E F G H. I J K L
If a patient cannot lie on his back for the AP sacrum because it is too painful, what alternate projection can be taken to achieve a similar view of the sacrum?
A PA (prone) with 15 degrees caudad central ray angle
Epiglottitis
A disease in which the epiglottis becomes inflamed and enlarged and may cause an upper airway obstruction.
List the alternative names for the following cervical vertebrae A. C1: B. C2: C. C7:
A. C1: Atlas B. C2: Axis C. C7: Vertebra prominens
Name the corresponding vertebra(e): xiphoid process
T9-T10
List the specific joints or foramina that are demonstrated with the following lumbar spine positions. A. Left posterior oblique (LPO): B. Right anterior oblique (RAO): C. Lateral: D. Right posterior oblique (RPO): E. Left anterior oblique (LAO):
A. Left posterior oblique (LPO): A. Left zygapophyseal joints B. Right anterior oblique (RAO): Left zygapophyseal joints C. Lateral: Intervertebral foramina D. Right posterior oblique (RPO): Right zygapophyseal joints E. Left anterior oblique (LAO): Right zygapophyseal joints
4. Identify the parts of a typical lumbar vertebra as labeled in Fig. 9.1. A. B. C. D. E. F. The central ray projection, labeled F in this drawing, best demonstrates the __________________ __________________ G. The central ray projection, labeledG, best demonstrates the __________________ __________________
A. Pedicle B. Transverse process C. Superior articular process and facet D. Lamina E. Spinous process F. Zygapophyseal joints G. Intervertebral foramina
Xiphoid tip
T9-T10
Situation: A young female patient comes to the radiology department for a scoliosis series, She has had repeated radiation. What three exposure throughout a period of time and is understandably concerned about the radiation. What things can the technologist do to minimize the dose delivered to the patient's breasts: A B C
A. Use high kV technique. B. Perform a PA rather than an AP projection. C. Use breast shields.
List the two advantages of using kV exposure factors with high-latitude analog (film-screen) systems imaging for spine radiography, especially on an anteroposterior (AP) thoracic spine radiograph A._______________ B.______________
A. greater exposure B. Lower patient dose
10. List the correct terms of the lumbar vertebra that correspond to the following labeled parts of the "Scottie dog as seen on an oblique radiograph of the lumbar spine (Fig. 9.10). A B C D B D A E F ___________joint
A. superior articular process "ear" B. transverse process "nose" C. pedicle "eye" D. inferior articular process "leg" E. pars interarticularis "neck" F. zygapophyseal joint *Fig. 9.10 Oblique lumbar spine.
Situation: A patient who has been in a motor vehicle accident (MVA) enters the emergency room. The basic projections of the cervical 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?
AP pelvis and axiolateral (inferosuperior) left hip. The AP pelvis radiograph should be taken initially without leg rotation; the radiograph must be reviewed by the physician and checked for fractures or dislocations before attempting an internal rotation of the left for the axiolateral (inferosuperior) projection
39. Situation: A patient with a clinical history of spondylolisthesis of the L5-S1 region comes to the radiology department. What basic (i.e., routine) and special (i.e., optional) projections should be included in this study? (Hint: If the oblique positions are included, how much spine rotation should be used?)
AP, lateral, L5-S1 spot lateral and right and left 30° oblique positions
Situation: A patient comes to the radiology department for a lumbar spine series. He has a clinical history of advanced spondylolysis, Which specific projection(s) of the lumbar spine series will best demonstrate this condition
Although AP and lateral projections of the lumbar spine are helpful, posterior or anterior oblique positions best demonstrate advanced signs of spondylolysis.
A short column of bone found between the superior and articular processes in a typical cervical vertebra is called?
Articular pillar
Which of the following structures is best demonstrated with an AP axial vertebral arch projection? A. Spinous processes of the lumbar spine C. Zygapophyseal joints of the thoracic spine B. Articular pillars (lateral masses) of the cervical spine D. Cervicothoracic spine region
B. Articular pillars (lateral masses) of the cervical spine
Name A
Body, C4
PA/AP BENDING: Assesses range of motion May be used in evaluation of scoliosis
Bottom of IR 1-2 inches Below crest
AP Thoracic
CR: Perpendicular to T7; 3-4 inches below jugular notch Collimate: Crosswise PoR: Expiration because it reduces air volume in the thorax for more Uniform brightness and density.
AP AXIAL COCCYX
CR: 10 degree CAUDAL angle Enters 2 inches above pubic symphysis
LEFT LATERAL Thoracic
CR: Perpendicular to T7 and bisect from MCP and posterior aspect of thorax PoR: Breathing technique*
What is the formal term for the "tailbone"?
Coceyx
Which of the following techniques or devices produces a more uniform density along the vertebral column for an AP/PA scoliosis projection? A. Use of a 35- x 90-cm (14- x 36-inch) image receptor B. Lower kV C. Higher mÂs D. Compensating filter
D. Compensating filter
AP open mouth Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker:
AP Thoracic spine Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
AP axial projection Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
AP open mouth Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Two partial facets found on the thoracic vertebrae are called
Demifacets
VARIATIONS:FLEXION & EXTENSION LATERALS: Best Demonstrates
Demonstrates vertebral mobility ; "whiplash" type of injury Used also for post-op imaging
Name B
Dens (odontoid), C2
The modified body of C2 is called the _________ or ________
Dens or odontoid process
F. AP for odontoid Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
G. AP thoracic spine Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Horizontal beam lateral Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Right posterior oblique Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
Description of possible error: Anatomy demonstrated: Part Positioning: Collimation and central ray: Exposure: Anatomic side marker: Repeatable errors:
ANODE HEEL EFFECT
Due to the geometry of the angled anode target, the radiation intensity is greater on the cathode side. The 'intensity" of radiation is greater at the CATHODE end of tube. Place the CATHODE over the THICKEST part of the anatomy.
13. True/False: It is possible to shield females for an AP projection of the sacrum or coccyx if the gonadal shields are correctly placed.
False
8. 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?
Ensure that the central ray is centered to near the midline of the grid cassette and the face of the image receptor is perpendicular to the central ray.
Which positioning error has been committed if the structures described in the previous question are projected too far posterior with a 45-degree oblique position of the lumbar spine?
Excessive rotation
WHERE DOES FLEXION AND EXTENSION OF THE CERVICAL REGION TAKE PLACE?
FLEXION AND EXTENSION takes place between C1 and the occipital bone.
True/False: The AP projections of the sacrum and coccyx can be taken as one single projection to decrease gonadal dose.
False (need different central ray angles for AP projections; can ombine lateral but not AP projectior
TrueFalse: The knces and hips should be extended for an AP projection of the lumbar spine
False (should be flexed)
True/False: The lower margin of the cassette must include the symphysis pubis for a scoliosis series.
False [lower margin 1 to 2 inches (3 to 5 cm) below iliac crest]
True/False: Gonadal shielding should always be used for male and female patients for studies of the lumbar spine, sacrum, and coccyx
False- (not used for females if obscure the shield would essential anatomy)
16. True/False: A lead mat or masking for lateral positions of the lumbar spine should not be used with digital imaging.
False. The lead mat should be used with digital imaging to prevent secondary scatter from reaching the sensitive image receptor. Scatter radiation produces greater "noise" in the processed image.
True/False: The thoracic spine possesses facets for rib articulations and bifid spinous processes.
False; T-spine has no bifid spinous processes
True/False: The carotid artery and certain nerves pass through the cervical transverse foramina
False; vertebral arteries and veins
14. True/False: The female gonadal dose is approximately equal for either AP or PA projections of the lumbar spine.
False;AP results in 30% more dose than PA
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 (12-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?
If possible, elevate the patient at least 2 inches (or 5 cm) by placing sheets or blankets beneath the pelvis
A radiograph of a lateral projection of a female lumbar spine shows that the mid- to lower intervertebral joint spaces are not open. The technologist supported the midsection of the spine with sponges to straighten the spine. What else can be done to open the joint spaces during the repeat exposure?
If the patient has a wide pelvis, the central ray can be angled 5 to 8 degrees caudad.
When should the Judd or Fuchs method be performed?
If unable to demonstrate the upper portion of the dens with the AP "open mouth" projection
With a 35- x 43-cm (14- x 17-inch) IR, the central ray is centered at the level of the ___________________for AP and lateral lumbar spine projections.
Iliac crest
38. Situation: A patient with a possible compression fracture of L3 enters the emergency room. Which projection(s) of the lumbar spine best demonstrate(s) the extent of this injury?
Lateral
Which position or projection of the cervical spine best demonstrates the zygapophyseal joints (between C3 and C7)?
Lateral
Which position or projection of the lumbar spine series best demonstrates a possible compression fracture?
Lateral
Which position of the thoracic spine best demonstrate the intervertebral foramina?
Lateral Projection
Which skull positioning line is aligned perpendicular to the IR for a PA (Judd) projection for the odontoid process?
Mentomestal line
Which of the following imaging modalities is not normally performed to rule out a herniated nucleus pulposus (HNP)? A. Computer tomography (CT) B. Myelography C. Magnetic resonance imaging (MRI) D. Nuclear medicine
Nuclear Medicine
29. Which projection or method is designed to demonstrate the degree of scoliosis deformity between the primary and compensatory curves as part of a scoliosis study?
PA, Ferguson method
1. A portion of the lamina located between the superior and inferior articular processes is called the?
Pars interarticularis
AIRWAY IMAGING- INDICATIONS
Pathology of larynx/pharynx R/O foreign bodies (FB) Epiglottitis Common in children 2-5 yrs of age. Life threatening condition that can develop rapidly STS and/or edema
A radiograph of a lateral L5-SI projection shows that the joint space is not open. The technologist did support the middle aspect of the spine with a sponge. What else can the technologist do to open up the joint space during the repeat exposure?
Place additional support beneath the spine, or use a 5- to 8-degree caudad angle.
In addition to good collimation, what should be done to minimize overall "fogging" on a lateral lumbar spine or lateral sacrum and coccyx radiograph?
Place lead blocker on tabletop patient. behind
Name F
Posterior arch and tubercle, C1
What is the unique feature of all thoracic vertebrae that distinguishes them form other vertebrae?
Presence of facets for articulation with ribs
The anterior and superior aspect of the sacrum that forms the posterior wall of the pelvic inlet is called the?
Promontory
Which specific set of zygapophyseal joints is demonstrated with an LAO position?
Right (upside)
In addition to extending the chin, which additional positioning technique can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for the oblique projections?
Rotate skull into a near lateral position
A radiograph of an AP "open mouth" projection of the cervical spine shows that the base of the skull is Superimposed over the upper odontoid process. Which specific positioning error is present on this radiograph?
Rotate the lower limbs 15 to 20 degrees internally to place the proximal femurs in a true AP position. (With general chronic pain, the lower limbs usually can be rotated safley
The lack of symmetry of the zygapophyseal joints between C1 and C2 may be caused by injury or may be associated with . . . . . .
Rotation of the skull
Name E
Spinous process (vertebra prominent), C7
11. Situation: A positioning series for sacroiliac (SD joints is performed on a patient. The resultant radiographs do not demonstrate the inferior portion of the joints. What can be done during the repeat exposure to demonstrate this aspect of the SI joints?
The CR should be angled 15 to 20 degrees cephalad.
6. 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?
The PA axial oblique or posterior oblique can be taken to demonstrate aspects of the acetabulum more completely
TRAUMA: CROSS TABLE LATERAL
The cervical region of the spine is the least stable area of the vertebral column. Account for 1/3 of all spinal injuries. The most common injured vertebra are: -C2: Odontoid fractures -C6-C7: Most frequently affected levels in the spine A neurological injury occurs in about 15% of spine trauma patients.
Evaluation Criteria: Erect Lateral- With breast shield
Thoracolumbar spine demonstrated Use of compensating filter recommended 1-2 inch (2.5-5 cm) iliac crest demonstrated Optimal exposure factors
Which side of the spine should be elevated for the second exposure for the AP/PA projection (Ferguson method) scoliosis series (by having the patient stand on a block with one foot)?
The convex side of the spine
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-degree cephalad, central ray centered to the thyroid cartilage, no rotation or tilt of the spine. Which of these factors must be modified to produce a more diagnostic image?
The patient is rotated toward the left- left posterior oblique (LPO)
True/False: A PA projection fora scoliosis series produces only about 1/10 the dose to the breasts as compared with the AP projection, even if proper collimation is used.
True
True/False: Performing the cervicothoracic projection is often required to demonstrate the C7/T1 region for the obese patient
True
True/False: Placing a lead blocker mat behind the patient for lateral lumbar spine positions improves image quality.
True
True/False: The female ovarian dose used for a PA lumbar spine projection is approximately 25° to 30% less than the dose for an AP projection.
True
True/False: The lumbar possesses a concave posterior spinal curve
True
True/False: When positioning the obese patient, the iliac crest is typicaly at the level the inferior margin of the flexed elbow.
True
True/False: When using digital imaging for spine radiography, its important to use collimation, grids, and lead masking
True
Only T11 and T12 have full facets for articulation with ribs- T or F
True (T1, T10 to T12 have full facets)
How should the spine of a patient with scoliosis be positioned for a lateral position of the lumbar spine?
With the sag or convexity of the spine closest to the IR
Lumbar AP OBLIQUES: BEST DEMONSTRATES
Zygapophyseal/facet joints closest to the IR RPO = RT. APOPHYSEAL/FACET JOINTS LPO = LT. APOPHYSEAL/FACET JOINTS
20. True/False. Ankylosing spondylitis usually requires an increase in manual exposure factors.
false
The intervertebral foramina for the cervical spine lie at a ________ degree angle to the midsagittal plane
forty-five
COCCYX
four vertebrae fused together to form the tailbone
An abnormal or exaggerated thoracic spinal curvature with increased convexity is called
kyphosis
What are the characteristics of the vertebra in Fig. 9.9 that identify it as a lumbar vertebra rather than as a thoracic?
larger vertebral bodies, smaller transverse process, bulky spinous process, no facets for ribs
Thoracic spine intervertebral foramina are demonstrated on a _________ projection.
lateral
Vertebrae lamina
left or right dorsal half of the vertebrae arch
At which vertebral level does the spinal cord terminate?
level of L1, L2 intervertebral disc
True/ False: Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than erect.
true
vertebrae transverse process
two lateral projections from the vertebral arch
