C7/T1 Junction

Question 1

why do we need to see the c7/t1 junction?

Answer 1

it is prone to injuries and instability so early and accurate diagnosis is vital

Question 2

why can initial clinical assessment be v difficult? - 3 points

Answer 2

density of shoulders
length of neck
pt’s BMI
^ all vary within pt’s

Question 3

what is used for support whilst assessing the damage to the spine?

Answer 3

blocks

Question 4

what is the canadian c-spine rule?

Answer 4

decides whether a pt is low risk or high risk

^ used and followed universally

Question 5

what is done in primary imaging?

why is primary imaging done?

Answer 5

3 views - lateral/AP/peg
inexpensive and therefore the first imaging
gives a lower dose of 0.07mSv compared to 2.2mSv

Question 6

which primary view is most informative?

what happens if a good image is failed to be obtained?

Answer 6

lateral
Alternative views such as the Swimmer’s View can be carried out however this is contraindicated with trauma pt’s as it can cause further injuries
therefore taken to CT
Supine Oblique -

Question 7

what is another alternative view that could be carried out and why? - 3 points
what is a disadvantage of this alternative view?

Answer 7

Supine Oblique
much lower risk of causing further injury
lower dose than Swimmer’s with 1.6mGy to 7.2mGy
more successful in imaging the posterior aspect of the spine
doctors and radiographers are less familiar with this view

Question 8

What are the advantages to using CT? - 5 points

Answer 8

can be performed simultaneously in whole body screening in trauma pt’s - saves time
rarely requires repeats - saves time
multidetector CT increases visualisation of #s and dislocations - accurate & quick
seen to detect all injuries - subsequent images don’t provide any further info
excellent in demonstrating bony abnormalities & vertebral alignment

Question 9

what is a disadvantage to using CT?

Answer 9

poor at detecting ligament injury - MRI

Question 10

define sensitivity

Answer 10

ability to say an abnormality is present on an image

Question 11

define specificity

Answer 11

ability to say an abnormality is not present on an image

Question 12

what is the % of false negative rates in primary imaging?

Answer 12

up to 48%

Question 13

why is radiation dose important for c spine imaging?

Answer 13

thyroid gland

Question 14

why do we continue to use CT which gives a much higher dose?

Answer 14

advantages of CT outweigh the small radiation risk

Question 15

what is adaptive statistical iterative reconstruction?

Answer 15

an algorithm helping to reduce image dose and image noise

Question 16

what was overall most cost effective according to NICE guidelines

Answer 16

CT due to possibilities of being sued if misdiagnosed/sent away from primary imaging with an injury

Question 17

when is primary imaging sufficient?

Answer 17

in low risk pt’s