C-Spine and T-Spine

Question 1

AP C-Spine (Dens); Fuchs Method

Answer 1

• Pt supine or upright
• IR centered to tips of mastoid processes
• raise chin until it and mastoid process tips are vertical
• adjust head until MSP is perpendicular
• Image should show dens lying within foramen magnum

Question 2

AP C-Spine (Dens) Open-Mouth

Answer 2

• Pt supine or upright
• 30” SID (increase FOV for odontoid)
• IR centered to axis
• open mouth wide; line between base of skull and tip of upper incisors is perp. with IR
• Image should show dens without superimposition of skull or teeth
• Mandibular rami equidistant

Question 3

AP Axial C-Spine

Answer 3

• Pt supine or upright; extend chin until occlusal plane is perp. to IR
• MSP perp. to IR
• IR centered at C4
• 15-20 degrees cephalad angle
• Image should demonstrate C3-T2 and open disk spaces
• no rotation seen by spinous processes equidistant and midline

Question 4

Lateral C-Spine

Answer 4

• Pt upright or seated with MCP perp. to IR
• 60-72” SID
• center IR to C4
• expose on full EXpiration to fully depress shoulders
• can affix weights to wrists to depress further
• image should show C1-T1
• mandibular rami not superimposing vertebral bodies

Question 5

How is the patient positioned for hyperextension? Hyperflexion? Why are these done?

Answer 5

• hyperextension: tilt chin up
• hyperflexion: tilt chin down
• these are done to check for relationship between vertebral bodies

Question 6

AP Oblique C-Spine

Answer 6

• Pt upright or recumbent; facing x-ray tube
• 60-72” SID (to compensate for long OID)
• oblique whole body (including head) to 45 degrees
• angle 15-20 degrees cephalad
• center IR at C4
• **shows intervertebral foramina FARTHEST from IR

Question 7

PA Oblique C-Spine

Answer 7

• Pt upright or recumbent; facing IR
• 60-72” SID
• oblique whole body 45 degrees
• angle 15-20 degrees caudad
• center at C4
• **shows interverbetral foramina CLOSEST to IR

Question 8

Lateral Cervicothoracic (C7-T1 Junction)
Swimmer's Technique

Answer 8

• Pt in true lateral position
• raise arm closest to IR above head; relax and depress the opposite shoulder
• IR centered at C7-T1 disk space
• angle 3-5 degrees caudad if shoulder is immobile OR
• angle 5-15 degrees caudad if spine is tilted

Question 9

AP Thoracic

Answer 9

• If pt is supine, flex and draw up knees to reduce kyphosis
• superior edge of IR should be 1.5-2” above shoulder
• CR should be halfway between xiphoid process and jugular notch (at T7)
• expose in inspiration
• image should show no rotation
• all 12 thoracic vertebrae shown
• vertebral bodies at midline of image

Question 10

Lateral T-Spine (positioning)

Answer 10

• Pt in true lateral position
• arms above head and out of FOV
• center IR at T7; superior border 1.5-2” above shoulders
• can be done on expiration OR during breathing technique
• if pt is recumbent, angle 10 (females) or 15 (males) cephalad to compensate for shoulder width

Question 11

Lateral T-Spine (image eval)

Answer 11

• true lateral position
• all 12 vertebrae
• minimal overlap of ribs and visceral pleura
• free of superimposition of arms