Pos III vertebral column Lumbar, Sacrum, Coccyx
PA/AP scoliosis series, place lower margin of IR a minimum of
1-2" below iliac crest
erect lateral scoliosis series, lower margin of IR should bea minimum of
1-2" below iliac crest
spinal fusion, lateral hyperflexion and hyperextension, views thoracic and lumbar including
1-2" of iliac crest
AP axial coccyx, central ray
10 caudad to 2" superior to pubic symphysis
AP axial coccyx, this projection may be performed prone with CR angle
10 cephalad
AP axial coccyx, with a greater anterior curvature of the coccyx if apparent CR angle will be changed to
15 caudad
AP axial sacrum, may also be performed prone with cR
15 caudad
AP axial sacrum, central ray
15 cephalad, 2" superior to pubic symphysis
AP oblique of SI joints, to demonstrate the inferior or distal part of the joint more clearly the cR may be angled
15-20 cephalad
PA/AP scoliosis series, how many projections are taken
2 PA, one recumbent, one erect
AP axial sacrum, pt with greater posterior curvature or tilt of sacrum and pelvis CR angle must be
20 cephalad
lumbar, what is percentage decrease of ovarian dose from AP to PA
25-30
for ferguson method, what height is the block used for the second image to elevate foot on convex side
3-4"
coccyx is composed of BLANK rudimentary vertebra that have a tendency to fuse into one bone into adult hood
3-5 (usually 4)
45 oblique is for the general lumbar region, if the interest is specifically L5-S1 area then oblique
30
each SI joint opens obliquely posteriorly at angle of
30
oblique proj of lumbar, how many degrees do we oblique for L5-S1
30
zygapophyseal joints for lower lumbar form an angle of BLANK from MSP
30
AP axial L5-S1, central ray for male pts
30 cephalad
AP axial proj of SI joints, central ray angle for men
30 cephalad
AP axial proj of SI joints, alternative PA axial projection central ray angle
30-35 caudad to L4
AP axial L5-S1, central ray
30-35 cephalad at ASIS
AP axial proj of SI joints, central ray
30-35 cephalad to 2" below ASIS
lumbar, Zygapophyseal joints form an angle (open posteriorly) from BLANK from the MSP
30-50
AP or PA proj of lumbar, tighter collimation IR size
30x35
AP axial L5-S1, central ray for female pts
35 cephalad
AP axial proj of SI joints, central ray angle for women
35 cephalad
AP or PA proj of lumbar, open collimation IR size
35x43
AP axial coccyx, SID
40"
AP axial sacrum, SID
40"
AP or PA proj of lumbar, SID
40"
lateral proj of lumbar, SID
40"
oblique proj of lumbar, SID
40"
spinal fusion, lateral hyperflexion and hyperextension, SID
40"
PA/AP scoliosis series, SID
40-60"
erect lateral scoliosis series, SID
40-60"
ferguson method, SID
40-60"
lumbar, what projection views the zygapophyseal joints the best
45 oblique
lateral L5-S1, central ray angle with no support
5-8 caudad
lateral proj of lumbar, pts with a wider pelvis and a narrow thorax may require a CR angle
5-8 caudad (even w/t support)
A 45º oblique is for the general lumbar region, If the interest is specifically in L1 or L2, then oblique
50
oblique proj of lumbar, how many degrees do we oblique for L1-2
50
zygapophyseal joints for upper lumbar form an angle of BLANK from MSP
50
PA projection for a scoli series results in a BLANK percent reduction in dosage to breast
90
lumbar region, The pedicles are situated BLANK relative to MSP
90
lumbar spine 4 routine projections
AP (or PA), obliques, lateral, lateral L5-S1
lumbar spine 1 special projection
AP axial L5-S1
sacrum and coccyx 3 routine projections
AP axial sacrum, AP axial coccyx, lateral
SI joints 2 routine projections
AP axial, AP oblique
spinal fusion series and scoliosis series has the same 1 projection
AP or PA R and L bending (same positioning)
spinal fusion series 2 routine projections
AP or PA R and L bending, lateral hyperflexion and hyperextension
sacrum because of its posterior angle, what projection should be used
AP proj with cephalad angle
lateral proj of lumbar, the average male does not need
CR angle
lower costal margin
L2-3
iliac crest
L4-5
spondylolysis fx occurs most commonly on what specific vertebrae
L4-5
lateral L5-S1, anatomy demonstrated
L5 vertebral body, first and second sacral segment, L5-S1 joint space
spondylolisthesis most common at what vertebrae
L5-S1
AP axial L5-S1, anatomy demonstrated
L5-S1 joint space, SI joints
the right SI joint is open with an BLANK position
LPO
lumbar, 1 disadvantage to PA projection is increased
OID
PA/AP scoliosis series, which projection is preferred
PA
scoliosis series 2 special projections
PA or AP ferguson method, AP or PA R and L bending
scoliosis series 2 routine projections
PA or AP, erect lateral
AP axial L5-S1, clinical indications
Pathology of L5-S1, SI joints
lumbar spine, what positions are used to view left zygapophyseal joints
RAO, LPO
the left SI joint is open with an BLANK position
RPO
lumbar spine, what positions are used to view right zygapophyseal joints
RPO, LAO
oblique proj of lumbar, what positions
RPO, LPO, RAO, LAO
ASIS
S1-2
AP oblique of SI joints, anatomy demonstrated
SI joint farthest from IR
sacrums auricular surface articulates with auricular surface of ilium to form the
SI joints
AP axial proj of SI joints, anatomy demonstrated
SI joints, L5-S1 intervertebral joint space
AP or PA proj of lumbar, 35x43 collimation shows what vertebrae
T11 to distal sacrum
AP or PA proj of lumbar, 30x35 collimation shows what vertebrae
T12-S1
xiphoid tip
T9-10
another term for wings of the sacrum
ala
sacrum, "wings", large masses of bone lateral to 1st sacral segment
alae
sacrum BLANK surface is concave
anterior
Normally the coccyx curves
anteriorly and apex points to pubic symphysis
sacrum, points inferiorly and anteriorly
apex
the distal point tip of the coccyx is the
apex
sacrum, large articular process for articulation with similarly shaped process on the iliac bones of the pelvis.
auricular surface
superior margin of sacrum
base
the broader superior portion of coccyx is the
base
coccyx lateral projection, lead mat is used
behind pt
for females, the coccyx projects into the
birth canal (can impede birth process)
sacrum and coccyx lateral projection, what filter is used
boomerang (if coccyx is included)
which lumbar obliques are needed
both R and L
erect lateral scoliosis series, shielding
breast shielding
the most distal portion of the vertebral column is the
coccyx
what 2 things can you do to reduce scatter for thoracic-lumbar projections
collimation, lead matt
erect lateral scoliosis series, which side is against IR
convex side of curve is against IR
oblique proj of lumbar, clinical indication
defect of pars interarticularis, spondylolysis
PA or AP furguson method scoliosis, this method assists in differentiating
deforming curve from compensatory curve
PA/AP scoliosis series, clinical indications
determine severity of scoliosis
coccyx most common injury
direct blow to lower vertebrae (while sitting)
lateral proj of lumbar, if pt has lateral scoliosis place sag or convexity
down (on IR)
oblique proj of lumbar, RPO and LPO show BLANK zygapophyseal joints
downside
PA or AP with R and L bending, scoliosis series, these studies are used in pts with
early scoliosis
AP axial sacrum and coccyx, what should be done before this exam is performed
empty bladder, lower colon free of gas and fecal
erect lateral scoliosis series, pt position
erect, lateral position, arms elevated,
AP axial sacrum, respiration
expiration
AP or PA proj of lumbar, respiration
expiration
PA/AP scoliosis series, respiration
expiration
coccyx lateral projection, respiration
expiration
erect lateral scoliosis series, respiration
expiration
lateral proj of lumbar, respiration
expiration
oblique proj of lumbar, respiration
expiration
spinal fusion, lateral hyperflexion and hyperextension, respiration
expiration
which gender is most likely to fx coccyx
females
spondylolysis
fx of pars interarticularis
AP or PA of lumbar, clinical indications
fx, scoliosis, spina bifida
AP axial coccyx, for CR centering can be localized by using what structure
greater trochanter
spinal fusion, lateral hyperflexion and hyperextension, can localize a
herniated disk
occulta means
hidden
common sites for pathological processes are disks between BLANK region
inferior lumbar
lateral L5-S1, if waist is not supported efficiently CR must be angled 5-8 caudad so spine is parallel to the
interiliac plane
lumbar vertebrae, Palpable lower tip of each spinous process lies at level of
intervertebral disk space inferior to each vertebral body
PA projection of lumbar, in prone position puts the BLANK more parallel with CR
intervertebral disks
When vertebrae are stacked the superior and inferior vertebral notches create the
intervertebral foramina
lateral proj of lumbar, anatomy demonstrated
intervertebral foramina L1-4, vertebral bodies, intervertebral joints
lumbar vertebral bodies are BLANK than cervical and thoracic
larger
lumbar spine, what projection is used to view intervertebral foramina
lateral
which of the following lumbar spine projections will best demonstrated the extent of a compression fx?
lateral
spinal fusion, lateral hyperflexion and hyperextension, is two images
lateral in hyperflexion, lateral in hyperextension
lumbar region, intervertebral foramina are demonstrated best on what projection
lateral proj
sacrum and coccyx lateral projection, pt position
lateral recumbent, flex hips and knees
PA or AP with R and L bending, scoliosis series, with pelvis acting as a fulcrum, pt is asked to bend
laterally as possible to either side
lumbar, AP oblique proj with LPO pos view what zygapophyseal joints
left
lumbar, PA oblique proj with RAO pos view what zygapophyseal joints
left
AP projections of lumbar spine are taken with knees flexed to reduce
lordosis of lumbar
scottie dog is seen on
lumbar oblique proj
AP or PA proj of lumbar, anatomy demonstrated
lumbar vertebral body, intervertebral joints, spinous process, transverse process, SI joints, sacrum
PA/AP scoliosis series, anatomy demonstrated
lumbar, thoracic, 1-2" below iliac crest
coccyx curve is more pronounced in what gender
males
lumbar-sacrum-coccyx, gonadal shielding should always be used for
males
formed by the fused spinous processes of the sacral vertebra
median sacral crest
lateral proj of lumbar, on most pts, the long axis of the bodies of the of the lumbar spine is situated in the
midcoronal plane
spinal fusion, lateral hyperflexion and hyperextension, used to assess
mobility at spinal fusion site
spondylolysis is the fx on what part of the scottie dog
neck
lumbar, The pars interarticularis is demonstrated radiographically on what projection
oblique proj
PA or AP furguson method scoliosis, two images are obtained
one standard, one with foot of convex side elevated
AP axial coccyx, coccygeal segments appear
open
lumbar region, Portion of each lamina between the superior and inferior articular processes is the
pars interarticularis
neck of scottie dog is the
pars interarticularis
oblique proj of lumbar, underrotation is indicated by
pedicle anterior to vertebral body
oblique proj of lumbar, overroation is indicated by
pedicle posterior to vertebral body
sacrum, 4 sets similar to intervertebral foramina, transmit nerves and blood vessels
pelvic sacral foramina
PA/AP scoliosis series, central ray
perpendicular
sacrum and coccyx lateral projection, interiliac line should be BLANK to IR
perpendicular
AP oblique of SI joints, Central ray
perpendicular to 1" medial to upside ASIS
lateral L5-S1, central ray if spine is parallel to IR w/t sufficient waist support
perpendicular to 1.5" inferior to iliac crest and 2" posterior to ASIS
coccyx lateral projection, central ray
perpendicular to 3-4" posterior and 2" distal to ASIS
sacrum and coccyx lateral projection, Central ray
perpendicular to 3-4" posterior to ASIS
oblique proj of lumbar, central ray
perpendicular to L3 (at lower costal margin), 1-2" above iliac crest, 2" medial to upside ASIS
lateral proj of lumbar, central ray for tighter collimation
perpendicular to L3 (lower costal margin)
AP or PA proj of lumbar, Central ray for tighter collimation
perpendicular to L3, 1.5" above iliac (will only include lumbar vertebrae)
lateral proj of lumbar, central ray for open collimation
perpendicular to iliac crest
AP or PA proj of lumbar, Central ray for open collimation
perpendicular to iliac crest (to include lumbar vertebrae, sacrum, coccyx)
spinal fusion, lateral hyperflexion and hyperextension, central ray
perpendicular to site of fusion
spinal fusion, lateral hyperextension, using pelvis as fulcrum, ask pt to move torso legs
posterior
long axis of sacrum is angled
posteriorly
AP axial L5-S1, may also be performed
prone with caudal angle (it increases OID)
mid coccyx is about at the level of BLANK or BLANK
pubic symphysis, greater trochanter
PA or AP with R and L bending, scoliosis series, assessment of the
range of motion of vertebrae
why is PA preferred over AP for scoliosis series
reduce dose (to breast and thyroid)
scoliosis requires BLANK exams over several years
repeat
lumbar, AP oblique proj with RPO pos view what zygapophyseal joints
right
lumbar, PA oblique projection with LAO pos view what zygapophyseal joints
right
lumbar, AP oblique with RPO position demonstrates
right zygapophyseal joints
oblique proj of lumbar, pt position
rotate 45, equal rotation of hips and shoulders w/t sponge
continuation of vertebral canal in sacrum, contains sacral nerves
sacral canal
small tubercles that represent inferior articular processes and project inferiorly
sacral cornu
prominent ridge on base of sacrum
sacral promontory
Located inferior to lumbar vertebrae, is shovel-shaped or triangular-shaped
sacrum
AP axial sacrum, anatomy demonstrated
sacrum, SI joints, L5-S1 intervertebral joint space
sacrum and coccyx lateral projection, anatomy demonstrated
sacrum, coccyx, L5-S1 joint
AP axial sacrum, pathology of
sacrum, fx
lead matt placed posteriorly from pt for
scatter
lumbar transverse processes are BLANK than thoracic
smaller
a congenital condition in which the posterior aspects of the vertebrae fail to develop is termed
spina bifida
congenital malformation, consisting of a defect in the closure of the vertebral arch. It is the mildest form of spina bifida, and usually asymptomatic
spina bifida occulta
lumbar vertebrae, large, thick, and blunt, have an almost horizontal projection posteriorly
spinous processes
involves forward movement of one vertebrae in relation to another, commonly due to defects in pars interarticularis or may result from spondylolysis, severe cases require a spinal fusion
spondylolisthesis
lateral proj of lumbar, clinical indications
spondylolisthesis
lateral L5-S1, clinical indications
spondylolisthesis involving L4-5 or L5-S1
erect lateral scoliosis series, clinical indications
spondylolisthesis, degree of kyphosis, lordosis
lateral proj of lumbar, no rotation by
superimposed greater sciatic notches
AP axial coccyx, coccyx projected BLANK to pubic symphysis
superior
sacrum, Form zygapophyseal joints with inferior articular processes of 5th lumbar vertebrae
superior articular process
AP axial sacrum, Pt position
supine with legs extended, support under knees
AP oblique of SI joints, pt position
supine, 25-30 oblique, side of interest elevated
AP axial proj of SI joints, pt position
supine, legs extended with support under knees
AP axial L5-S1, pt position
supine, legs extended, support under knees
AP axial L5-S1, respiration
suspend
AP axial proj of SI joints, respiration
suspend
AP oblique of SI joints, respiration
suspend
sacrum and coccyx lateral projection, respiration
suspend
coccyx lateral projection, support
under waist, between knees
oblique proj of lumbar, RAO and LAO show BLANK zygapophyseal joints
upside
2 advantages of PA projections of lumbar
visualization of intervertebral disks, low ovarian dose
oblique proj of lumbar, anatomy demonstrated
zygapophyseal joints
