Evaluation And Cervical Flashcards
5 keys to reading films
1) Normal v. Abnormal
2) Localize abnormality
3) Describe abnormality
4) Pertinent +/-
5) Cinical significance
Radio graphic evaluation
1) systematic approach
2) read all the information on the film
3) read to the edges of the film
Evaluation method
ABCs
1) alignment
2) bone
3) cartilage
4) soft tissues
Alignment - 4
1) spatial relationship
2) offset articular margins
3) proper position
4) measurements
Bone - 6
1) shape
2) size
3) Cortical integrity
4) trabeculation
5) radiographic density
6) specific structures
Cartilage - 3
1) joint shape
2) joint size
3) radiographic density
Soft tissues - 4
1) shape
2) size
3) position
4) radiographic density
5 steps in evaluation
1) identify study
2) identify the informational markers
3) collimation, shielding, artifacts
4) technical quality of the film
5) ABCs search pattern
Identify the study - 4
1) anatomy visualized
2) number of films
3) projections
4) use of contrast media
Informational markers - 3
1) name blocker
2) qualification of study
3) timing of certain studies
Name blocker
1) age
2) gender
3) date of study
Qualification
1) patient of study
2) type of study
Technical quality of the film - 3
1) diagnostic quality
2) proper positioning
3) entire area visualized
Normal v abnormal
1) anatomical variations
2) pathology
Cervical MDS
Standard Cx Series
1) neutral lateral
2) AP Lower cervical
3) AP Open Mouth
Lateral Cervical
1) upright
2) shoulder to film
3) coronal plane perpendicular to film
4) beam perpendicular to film
5) Co - C7
6) head and neck in neutral position
7) good superposition of R and L articular pillars
Lateral Cervical ABCs of Bone
1) cortical margins
2) trabecular patterns
3) shape of bones
4) size of bones
5) density of bones
7) specific structures
Lateral Cervical ABCs - C
1) IVDs
2) zygaphophyseal joints
3) uncovertebral joint spaces
4) temporomandibular joint spaces
Lateral Cervical ABCs - A
1) neutral position
2) specific relationships
3) measurements
Neutral position
1) use hard palate for reference
2) should be parallel to floor
Assess for rotation
1) posterior body margin
2) angle of the mandible
3) superimposed facets
5 cervical lines
1) prevertebral tissue
2) anterior body line
3) posterior body line
4) spinolaminar junction line
5) spinous process interspacing
Prevertebral soft tissue line
1) retropharangeal (Co -C2)
2) retrolaryngeal (C3 - C5)
3) retrotracheal (below C6)
Rule of 2s and 6s
C2 < 6mm
C6 < 22mm
Anterior vertebral bodies
1) smooth curve
2) no interruptions
3) not as sensitive for vertebral displacement as PVBL
Posterior vertebral body line
1) George’s line
2) smooth curve
3) uninterrupted line
4) evaluates vertebral body displacement
5) *superior and inferior body corners
Spinolaminar junction line
1) posterior cervical line
2) evaluates for displacement
Spinous process interspaces
1) check for equal spacing between spinous processes
Atlanto-dental interspace
1) posterior aspect of C1 anterior tubercle and anterior aspect of e dens
2) adults < 3mm
3) children < 5mm
Dens to foremen magnum
1) McGregor’s line
2) tip of the dens < 10mm above line
Lateral Cervical ABCs - S
1) pharyngeal Air Shadow
2) laryngeal air shadow
3) tracheal air shadow
4) calcification of cartilages
5) posterior cervical soft tissues
AP Lower Cx (structures visualized)
1) C3-C7 vertebral bodies
2) posterior elements
3) uncinate processes and uncovertebral joint spaces
4) soft tissues of neck
AP Cervical Alignment
1) centered at C4
2) postural/bilateral symmetry
3) tracheal air shadow
4) spinous processes
5) lateral body margins
6) head position
7) vertebral end plates
8) clavicles
9) posterior ribs
Tracheal air shadow
1) should be midline
2) constant diameter
3) laryngeal construction, narrow when patient hold breath, opens when patient is breathing
Spinous process AP Cervical alignment
1) should form vertical midline
Pedicles AP Cervical alignment
1) little circles form vertical line equidistant from midline
2) cancers can cause them to be missing
Lateral body margins AP cervical alignment
1) vertical lines equidistant from midline
Articular pillars AP cervical alignment
1) lateral margins
2) smooth sinusoidal lines
3) vertical orientation
4) equidistant from midline
Head position AP cervical alignment
1) level horizontally
2) assess for rotation and lateral flexion
Mandible AP cervical alignment
1) level horizontally
2) not rotated
Vertebral endplates AP cervical alignment
1) level horizontally
2) assess for lateral flexion
3) uncinate processes continuous with superior body margin
4) anterior body margins have inferior lipping
Clavicles AP cervical alignment
1) equidistant from midline
2) similar horizontal orientation
3) magnification and distortion
Posterior Rib AP cervical alignment
1) horizontal
2) assess bilaterally
3) symmetrical in spacing and orientation
4) rib 1 = T1
AP Cervical ABCs - Bone
1) cortical margins
2) internal matrix and trabecular patterns
3) size, shape, position of all bones
4) bilateral structural comparison
5) compare structures to layers above and below
6) evaluate all osseous structures
Cortical margins AP cervical bone
1) cortical integrity
2) cortical thickness
3) smooth, even, and uninterrupted
internal matrix and trabeculae AP cervical bone
1) density
2) definition of trabecular pattern
Structures seen on cervical obliques
1) vertebral bodies
2) pedicles, lamina
3) articular pillars
4) SPs behind spine
5) TPs: IVF side on end
McGregor’s Line
1) lateral skull/cervical
2) posterior hard palate to most inferior occipital bone
3) dens projection
males < 8mm
Females < 10mm
Chamberlain’s Line
1) lateral skull/cervical
2) posterior hard palate to posterior foremen magnum
3) dens projection
Males - 3mm
Females - 7mm
Macrae’s Line
1) lateral, without flexion
2) anterior to posterior borders of foremen magnum
Atlantodental interval
1) lateral cervical spine
2) posterior margin of anterior tubercle of C1 to nearest point on the anterior margin of the dens
3) child <3mm
George’s Line
1) posterior body margin line
2) lateral spine
3) line drawn along the posterior aspect of the vertical bodies
4) listhesis
5) instability if >4mm
Spinolaminar junction line
1) posterior cervical line
2) lateral spine
3) most anterior point of the spinolaminar junction at each level
4) listhesis
Sagittal dimension of the cervical spinal canal
1) C1 = 16mm
2) C2 = 14mm
3) C3 = 13mm
4) C4-C7 = 12mm
Atlantoaxial alignment
1) AP open mouth
2) lateral mass of atlas should not overhang lateral margin of axis superior facet (1mm)
Coronal dimensions of the cervical spine interpediculate distance
1) shortest distance between the inner cortical margins of the pedicles at any given segment
2) stenosis
Cervical gravity line
1) lateral cervical
2) apex of the dens through the 7th cervical vertebral body
Angle of Cervical curve
1) lateral cervical
2) two lines drawn
3) one through and parallel to inferior endplates if the 7th cervical body
4) other through the midpoints of the anterior and posterior tubercles of the atlas.
Prevertebral soft tissue
1) lateral cervical
2) space between vertebral bodies and the air shadow of the pharynx, larynx, and trachea
3) 10mm C1
6mm C2
20mm C6
Powers index
1) line from anterior foramen magnum to the spinolaminar junction of C1
2) line from posterior foramen magnum to the posterior margin of the anterior tubercle of C1
3) line 1 should be smaller than line 2
