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
AP projection - FUCHS Method
Done following a properly positioned open mouth odontoid image that still has the dens obscurred
SID - 102
supine or Errect
MSP - perpendicular
MML perpendicular to bucky - mental meatal line - tip of chin to EAM
CP just inferior to mental point
collimate tightly
Evaluation criteria of FUCHS method
dens within the foramen magnum
symmetric image
no rotation
contraindications
lateral hyperflexion
assess flexability or instability
SID - 180
stick chin out, then tuck towards chest
turn the collimator to match the spine
body of mandible nearly vertical
relax their shoulders
CP-C4
markers indicate position - often arrows
suspend on expiration
Lateral hyperextension
assess flexibility or instability
SID - 180
elevate chin as much as possible
body of the mandible almost horizontal (past horizontal)
CP-C4
markers indicate position - often arrows
suspend on expiration
Patient Prep thoracic
all jewelry and body piercings in the area to be exposed should be removed
remove everything from the waist up and tie the gown at the back
AP thoracic spine
SID - 102
tight collimation side to side
wedge filter on top half
supine with arms by side
CR- perpendicular
CP - T7 half way between jugular and xiphoid OR TOP OF LIGHT TO C7
suspend on expiration
collimate to width of neck side to side
AP thoracic spine criteria
C7 to L1 demonstrated
no rotation - spinous processes and trachea in midline of spine - SC joints ar symmetrical
Vertebral bodies well penetrated
Tight collimation to thoracic spine
Lateral Thoracic Spine
SID - 102
left lateral
knees bent, arms flexed at right angles
CR - perpendicular to spine - use eyes to see angle; 10 cephalad for females; 15 cephalad for males
CP - T& midway between MCP and posterior aspect of thorax
breathing technique preferred
bring forearms together anteriorly
place lead strip on table to help clean up scatter
Thoracic spine lateral criteria
T1-L1 demonstrated
Intervertebral disc space open
No rotation
optimal exposure factors
Lateral cervico-thoracic swimmers
needed because you will not see the upper thoracic vertebrae on a normal lateral T-spine
SID - 102
dependant arm - bend elbow and gently pull the shoulder anteriorly
remote arm - place hand on hip, roll shoulder posteriorly
head elevated on pillow and use a wedge filter
identical to erect swimmers for c-spine
Trauma c-spine
always treat as fracture
on # board, collar on - DO NOT MOVE PATIENTS HEAD
Trauma X-tl horizontal ray lateral
dorsal decubitus position
SID - 180
depress shoulders
expose on expiration
C4
wedge filter
Swimmers if C7-T1 not visible on lateral
Trauma Swimmer’s
raise dependant arm above head (if not contraindicated)
Depress remote arm as much as possible
use a wedge filter for vertebrae above remote shoulder
May use a 3-5 caudad angle in unable to depress remote arm
SID - 180
