Cervical and Thoracic Spine Flashcards
Indications for imaging C spine
- neck pain and/or stiffness
- arthritis
- DDD - degenerative disk disease
- Whiplash - ligament damage
- primary or metastatic tumour
- non-specific shoulder and arm pain
- trauma
Routine patient prep
Remove - patient appliances, jewelry, hairpins or clips or elastics, thick hair braids, and glasses
Patient changed - bra straps, buttons and zippers
Lateral projection c-spine
light superior to EAM
lift chin
Shoulders down - with weights and exhalation
SID - 180
CR - perpendicular - C4 in coronal plane of mastoid tip
- equal light anterior and posterior of neck
- turn collimator if needed
what structures are shown in a lateral c-spine
must see at least 1/3 of T1
lateral cervical bodies
cervical disc spaces
zygopophyseal joints
evaluation criteria of lateral c-spine
neck extended
no rotation - superimposed articular pillars
Routine Swimmers C-spine
Done only when C7/T1 disc space is not shown on the routine lateral
Erect - Left lateral position
- Dependant arm- bend elbow and gently pull the shoulder anteriorly
- Remote arm - place hand on hip, roll shoulder posteriorly; do not push this shoulder down
SID - 180cm
CR - perpendicular
CP - level of C7-T1 - include C2 so you can count
Wedge filter places on the upper half of the image
expiration
Routine Swimmer’s - Textbook
Dependant arm - raised above the head and forearm placed on head - humeral head can be rotated anteriorly
Remote arm - placed along patients side; push the shoulder down as much as possible; humeral head can be rotated posteriorly
may require a 3-5 caudad angle if remote shoulder cannot be depressed enough
Oblique C-spine Rule
UP, UP, UP, UP OR DOWN, DOWN, DOWN, DOWN
Ap Axial Oblique (UP UP UP UP)
CR 15-20 CEPHALAD - (asses from lateral image)
SID - 180
Erect
marker FACE UP
RPO/LPO
rotate 45
elevate chin and turn head toward IR - move mandible off spine
Keep spine parallel to IR
CP - C4 - level of thyroid cartilage
rotate the collimator if needed
Demonstrates intervertebral foramina of RAISED SIDE (furthest from IR)
PA Axial Oblique (DOWN DOWN DOWN DOWN)
SID - 180
Rotate patient 45
RAO/LAO
Elevate chin and turn head away from IR - keep spine parallel
CR - 15-20 Caudad - angle determined from lateral
CP - level of C4 - thyroid cartilage
markers FACE DOWN
intervertebral foramina CLOSEST demonstrated
protects thyroid
must do seated - patient too tall with caudad angle
AP Axial Projection
SID - 102
Chin slightly elevated; A line from the occlusal plane can be perpendicular to IR/Bucky
CR - parallel with tip of chin to base of skull
CR - 15-20 cephalad - determine angle from the lateral
CP - thyroid cartilage (C5)
Demonstrates C3-T2
AP Axial Projection evaluation criteria
visualization of C3 to T2
open intervertebral spaces due to CR angle
spinous processes equidistant to pedicles
Ottonello Method - Wagging Jaw
Only on Written Exam
SID - 102
CR perpendicular to IR
CP - C4
ask patient to open and close mouth continuously during exposure without moving their head
need small mA and long time
Demonstrates C1-7
AP Projection - open mouth
SID - 102
supine or erect
line up lower edge of teeth and mastoid tip - perpendicular to IR
CR - midline, perpendicular
CP - corners of open mouth - C2
open mouth WIDE
collimate tightly - marker on
demonstrates atlas and axis
Evaluation criteria of AP Open Mouth
atlas and Axis and their articulations
must see lateral edges of both atlas and axis
entire dens through open-mouth
superimposed upper occlusal plane/base of skull
