Ch 9 - Thoracic Spine Flashcards
What is the size variation of thoracic vertebrae bodies from the first to the twelfth?
Bodies increase in size from the first to the twelfth vertebrae.
How do the superior thoracic bodies compare to cervical bodies?
Superior thoracic bodies resemble the cervical bodies.
How do the inferior thoracic bodies compare to lumbar bodies?
Inferior bodies resemble the lumbar bodies.
What shape are the bodies of the typical thoracic vertebrae (3-9)?
Triangular in form.
What are the unique features of the thoracic vertebrae?
- Costal facets on posterior, lateral sides of bodies for articulation with head of ribs
- Facets on transverse processes for articulation with tubercle of ribs (except for T11 and T12)
Which thoracic vertebra has facets to articulate with both the first and second ribs?
The first thoracic vertebra.
What do the bodies of the second through eighth thoracic vertebrae contain?
Demi facets superiorly and inferiorly.
What unique feature does the body of the ninth thoracic vertebra have?
Only has a Demi face superiorly.
What is the articulation feature of the eleventh and twelfth thoracic vertebrae?
A single facet at the superior margin to articulate with the eleventh and twelfth rib.
Which thoracic vertebrae are classified as typical?
T5-T8
Which cervical position demonstrated the intervertebral foramina?
45 degree oblique (RPO/LPO)
Which cervical position demonstrates the Z-joints?
Lateral position
Which thoracic position demonstrates the intervertebral foramina?
Lateral
Which thoracic position demonstrates the Z-joints?
70 degree oblique
What are the trauma cervical spine positions done when patients come to the ED?
Cross table lateral C-spine and Swimmers
What is the tube placement for Cross Table lateral?
Horizontal
What is the patient position for a cross table lateral?
Supine with the IR placed on the side of the neck crosswise
Where is the central ray pointed in a cross table lateral?
Horizontal at C4
What structures should be captured in a cross table lateral C-spine?
C1-C7 with shoulders depressed for C7
When should a Swimmer’s (Cerviocothoracic lateral) Projection be used?
Only used if you’re unable to get C7/T1 in a cross table lateral C and if the physician approves
What is the patient position for a swimmer’s lateral?
Patient in lateral recumbent or erect lateral with arm closest to the IR raised above the head and MCP centered to the midline of the grid
Where is the central ray positioned for a Swimmer’s lateral?
Perpendicular to the C7-T1 disk space
What are the structures demonstrated in a Swimmer’s lateral?
The cervicothoracic vertebrae between the shoulders
What are the evaluation criteria for Swimmer’s lateral?
- Adequate x-ray penetration through the shoulder region demonstrating the lower cervical and upper thoracic vertebrae not captured in a cross table lateral
- Humeral head minimally superimposed on the vertebral column
What are the essential projections of T-spine?
AP and Lateral
What is the recommended SID for thoracic vertebrae imaging?
40 inches.
What is the patient position for AP T-spine
Supine or upright position, with MSP centered to the midline of the grid and shoulders in the same plane and IR placed 1.5-2” above the shoulder
Where is the central ray positioned for AP T-spine?
Perpendicular to C7 (1/2 way between jugular notch and xiphoid process)
What are the breathing instructions for AP T-spine?
Suspended on expiration
What are the structures demonstrated in AP T-Spine?
Thoracic bodies, intervertebral disk spaces, transverse processes, costovertebral articulations and surrounding structures
What are the evaluation criteria for AP T-spine?
- All 12 thoracic vertebrae (C7-L1)
- No rotation - Demonstrated by spinous processes at the midline of the vertebral bodies
- Vertebral column aligned to the midline of the image
What is the patient position for Lateral T-spine
Lateral recumbent position or upright with left shoulder touching the IR. MCP centered to the midline of the grid and IR placed 1.5-2” above the shoulder
What is the central ray positioning for the lateral projection?
Perpendicular to the IR at the level of T7.
What structures are demonstrated in the lateral projection?
Thoracic bodies, intervertebral disk spaces, intervertebral foramina.
What is the evaluation criteria for the lateral projection?
- Vertebrae clearly seen through rib and lung shadows
- Twelve thoracic vertebra centered on the IR (C7-L1)
- Ribs superimposed posterior lay to indicate the patient wasn’t rotated
- Open intervertebral disk spaces
What specifically should be seen in a Lateral T-spine?
Intervertebral foramina well demonstrated
Why is the left lateral position preferred for a Lateral T-spine?
Left lateral minimizes heart magnification and overlapping of heart on spine
What are the special projections of the T-spine?
AP and PA Oblique - RPO and LAO
What is the patient position for AP Oblique - RPO
Patient in the right lateral position upright or recumbent, with the body rotated posteriorly 20 degrees toward the table/IR. Vertebral column centered to the grid and IR placed 1.5-2” above the shoulder
What is the patient position for PA Oblique - LAO
Patient in the left lateral position with the body rotated anteriorly 20 degrees toward the table/IR. Vertebral column centered to the grid and IR placed 1.5-2” above the shoulder
What is the position of the centray ray for AP/PA Oblique T-spine?
Perpendicular and entering/exiting the level of T7
What are the breathing instructions for PA/AP Oblique T-spine?
Suspended upon expiration
What are the structures demonstrated for AP/PA Oblique T-spine?
The thoracic zygapophyseal joints
What are the evaluation criteria for AP/PA Oblique T-spine?
- All 12 thoracic vertebrae
▪ Zygapophyseal joints closest to the IR on PA obli
