Diagnostic Imaging

Question 1

Vertebral bodies - ossification

Answer 1

ossified at birth

Lumbar bodies are round at birth

Question 2

Development

Answer 2

Sacrum is not fused at birth
age 5 = neural arches fuse (3)
age 6 = posterior elements fuse to vertebral body
age 8 = they fuse to bodies
age 10 = arches fuse to each other posteriorly
2 degree ossification appear at puberty and ossification is complete around age of 25

Question 3

Lumbar radiographs

Answer 3

5 views in most routine lumbar radiographic exams:
AP
Lateral
Lateral L5-S1
2 oblique projections (right and left)

Question 4

AP view

Answer 4

Lumbar vertebral bodies (larger as descend)
Spinous processes should be aligned
Intervertebral disc space
Transverse processes
Pedicles - 2 on each side equidistant from spinous processes
Sup and Inf articulating processes
Sacrum

Question 5

AP Lumbar

Answer 5

Spinous process in a line
Equidistant from vertebral border - intervals are relatively the same
Pedicles narrower L1 than L5
Pedicles equidistant from spinous processes

Question 6

Other things to look at

Answer 6

height of each vertebral body
intervertebral space heights
look at bone density

Question 7

Lumbar Lateral - central ray

Answer 7

Central ray is focused on L3-4 as it is in the AP proj

Question 8

Lumbar lateral - primarily used

Answer 8

Primarily used to evaluate alignment and condition of vertebral bodies

Question 9

Lumbar Lateral - three line reference

Answer 9

Ant line = ant vert bodies
Middle line = post vert bodies
Post line = spinolaminar line (where lamina and spinous processes meet)
If you have more than one column distrupted = unstable fracture

Question 10

Three line reference - osteophyte

Answer 10

Osteophytes do not count towards alignment problems

They are indicitvie of degenerative changes though

Question 11

Lateral Projection can be taken

Answer 11

in standing or side-lying

Lordotic curve is more prominent in standing

Question 12

Lumbar lateral - look for

Answer 12

osteophytes that will indicate degenerative changes

Look at intervertebral foramina

Question 13

Lumbar Oblique

Answer 13

Facet joint articulations (inf and sup processes)
Pars Interarticularis
Pedicles

Question 14

Naming a lumbar oblique projection

Answer 14

Right and left identifies the structures that are being viewed
Right = you are looking at right side strcutures

Question 15

Lateral L5-S1

Answer 15

Central ray through L5-S1
Lines continue to be used to evaluate alignemnt
Observe disc spaces
Sacrum alignment - need to pay attn to it

Question 16

Sacroiliac joint standard projection

Answer 16

AP but can also see oblique (lateral would just give you white)
Right and left oblique are named for the side that you are looking at more closely