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MRTY2105 > Lecture 3 - SACRUM, COCCYX, LUMBAR SPINE > Flashcards

Lecture 3 - SACRUM, COCCYX, LUMBAR SPINE Flashcards

1
Q

AP AXIAL SI JOINT

A

sig:

  • to see SI joint spaces
  • sacroilitis, osteitis condensans, degenertaion, articulation

tech:

  • in bucky
  • 18x24 lanscape
  • susped on respiration
  • exp:

pos:

  • supine is preffered
  • AP position
  • pillow or head

beam:

  • cephalad angulation 30deg in males and 35 in females
  • 5cm below level of ASIS

collim:

  • SI joints
  • medial aspects of ilium
  • collim to SI joints
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2
Q

POSTERIOR OBLIQUE SI joints

A

sig:
- to visualise individual joint space

tech:

  • 18x24 portrait
  • in bucky
  • exp:

pos:

  • elevate affected hip 25-40 deg
  • ask pt to keep affected sides leg flexed only a little ut the other leg can be flexed to provide stability
  • sponges if necessary

beam:
- 2.5cm medial to raised ASIS

collim:

  • SI joint of int open
  • ALA of ilium not overlapping sacrum (then that’s over rotation)
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3
Q

Name the projections done to see the sacrum

A

AP

LATERAL

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4
Q

Name the projections done to see the lumbar spine

A

AP
LATERAL
OBLIQUE

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5
Q

Name the projections done to see the coccyx

A

AP

LATERAL

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6
Q

AP AXIAL SACRUM

A

sig:
- degeneration, fractures, tumours, infection

tech:

  • 24x30 landscape
  • yes grid
  • in bucky
  • suspend on respiration
  • exp: 70 kVp, 20-30 mAs, 110

pos:
- supine
- legs extended with support under knee or elevate knee slightly
- midsag plane to CR

rotation? symmetrical iliac crests and SI joints

beam:
- cephalad 15 deg
- between symphysis (GT level) and ASIS level

collim:
- tight collim to region

FOV:

  • SACRUM, SI joints and L5/S1 junction
  • no foreshortening of sacrum
  • sacral foramina
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7
Q

AP AXIAL COCCYX

A

sig:
- is there real necessity for this projection?

tech:

  • in bucky
  • 24x30 portrait
  • yes grid
  • exp: 80 kVp, 15 mAs, 110 cm
  • suspend on respiration

pos:
- supine
- legs extended with knee support or flex knee slightly
- midsag plane to midline of table
- no rotation of pelvis
rotation? lateral margin of coccyx is equidistant from pelvic brim

beam:

  • caudad 10deg
  • 5cm sup to symphysis (GT level)

collim:
- tight collim

FOV:

  • coccyx free of superimposition from pubic rami
  • free of gas and feces (empty bladder and colon before)
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8
Q

LATERAL SACRUM AND COCCYX

A

sig:
- usually lateral sacrum and coccyx imaged together (cuz coccyx imaging doesn’t alter the pre-determined treatment)

tech:

  • 24x30 portrait
  • in bucky
  • suspend on respiration
  • exp: 80 kVp, 30-40mAs, 110

pos:

  • lateral recumbent
  • can be left or right (pt pref)
  • flex knees add sponge if needed
  • long axis of sacrum and coccyx to midline of table
  • rotation? greater sciatic notch and femoral heads should be superimposed

beam:
- 3-4” post ASIS

FOV:

  • L5/S1
  • distal coccyx
  • ant and post margin shown
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9
Q

Name the ligs of the lumbar spine?

A
  • Anterior longitudinal lig
  • posterior longitudinal lig
  • interspinous lig (between spinous process of 2 verts)
  • supraspinous lig (lines the length of spinous pocesses)
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10
Q

Explain the neurological and vascular supply of the lumbar spine

A
  • spinal cord ends at L1-2 in adults and forms the conus medullaris then he caudia equina (bundles of spinal erves and nerve rootlets)
  • vascular: blood supply to tissues and bones
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11
Q

why is imaging of the spine considered unnecessary?

A

cuz it does not improve pt outcomes.

Best used when pt has severe or progressive neurologic deficits or in situations of trauma

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12
Q

What is a trauma protocol for the lumbar spine?

A
  • probs go straight to CT
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13
Q

Why is gonadal shielding quite confusing for lumbar spine projections?

A

because shielding might block out necessary anatomy

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14
Q

Discuss AP vs PA lumbar spine projections

A

ask pt pres: supine or prone

AP

  • lumbar spine closer to IR
  • reduce OID
  • dose to gonad increased

PA

  • reduce dose to gonad.
    reason: tissue displacement , where abdominal soft tissue and contents compress.
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15
Q

AP LUMBAR SPINE

A

sig:

  • to see fractures, scoliosis, tumours
  • T11 all the way to distal sacrum

tech:

  • 35x43 portrait
  • suspend on expiration or use breathing tech
  • exp: 70-80 kVp, 40-60 mAs , 110 (BT: 75kVp, 35 mAs, 1.6 s)
  • yes grid

pos:

  • supine
  • knees and hips flexed to flatten natural curvature of lumbar spine and open IV disc space
  • hands NOT by sides (above head is better)
    rotation:
  • central spinous process and symmetrical appearance of SI and iliac wings
  • check pt from bottom to top and line according the midsaggital plane

beam:
- LCM in small pts or centre to iliac crests in bigger pts

collim:
- 5 cm laterally

FOV:

  • T12-Sacral region
  • TP shown (might be obscurred by bowel gas)
  • iV JOINTS
  • SI joints
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16
Q

Explain how the anode heel effect can be used to reduce dose for lumbar projections

A
  • head placed towards cathode side of xray tube will lead to a lower dose
17
Q

LATERAL LUMBAR

A

sig:

  • see T12-sacral region
  • frac, degeneration (osteoporosis), vert bodies
  • displacement, subluxation
  • bone lesions
  • spondylolisthesis
  • L5/S1 junction

tech:

  • 35x43 portrait
  • suspend on expiration
  • in bucky
  • exp: 70-80 kVp, 60-80 mAs, 110cm
  • use grid

pos:
- lateral recumbent or erect
- knees flexed and sponge under
- arms drawn into chest (HBL= arms corssed over chest)
- get lumabr spine straight and horizontal by placing sponges a waist
True Lateral?
- superimposition of greater sciatic notches
- superimposition of superior articulating facets
- superimposition of inferior endplates

beam:
- L3: LCM in small pt, iliac crest level big pts

collim:
- skin surface

FOV;

  • T12-SACRUM
  • IV foramina L1-L4 open
  • IV disc spaces open
  • facet joints
  • SP
  • L5/S1
18
Q

Is the left or right view of the lumbar spine better?

A
  • 38% reduced dose with left lat positioning
  • this is due to liver being uppermost when positioned left and so can help absorb the dose.
  • THIS ISN’T STANDARD TO LIE ON LEFT
19
Q

Distinguish between trauma and non-trauma reasons for imaging the lumbar spine

A

Trauma

  • fractures
  • dislocations

Non-trauma

  • scoliosis
  • osteoporosis
  • spondylolisthesis/spondylolysis
  • ankylosing spondylitis
  • degenerative joint disease
  • spina bifida (occulta)
20
Q

How do you asses a pt with spinal trauma?

A
  • Type of injury (mechanism)
  • asses 3 columns and notice pathology
  • stable or unstable?
  • look for more than 1 fracture
  • check for spinal canal compression
21
Q

where in the lumbar region is the most common for a fracture?

A

T12-L2

  • transition region from rigid to flexible
  • 75% = compression/wedge fracture
  • 20% = fracture/dislocations (involving post elements and vert body)

Don’t only do an AP spine, do a lateral and other projections to notice pathology

22
Q

Explain what a transverse process fracture is

A
  • avulsion fracture: abnoral tension in paraspinous muscles or direct trauma
  • check for psoas muscle bulging (haematoma)
  • if fracture in upper lumbar = possible renal damage due to close kidney proximity
23
Q

explain what are compression fractures of the lumbar spine

A
  • caused by anterior column not being able to withstand the axial force and becomes compressed
  • results in educed ant and post vert height and also anterior wedging
  • lateral projection is best
  • on AP u no longer can see cupid’s bow, and that’s indicative
24
Q

What’s the cupid bow radiographic component of the AP lumbar spine?

A
  • inferior borders of L3-5

- loss of it is indicative of compression fracture on an AP

25
Q

What’re schmorl’s nodes?

A
  • common in thoracic and lumbar spine
  • nucleus pulposus in the IV disc herniates into weakened end plate of vert (superior and/or inferior endplates)
  • looks like a wedge fracture
26
Q

Explain what’re burst fractures

A
  • axial loading combine with flexion
  • common in TL junction
  • post displacement of post vert margin
  • CT is better
  • can lead to cord compression

AP:

  • vertical split in body/lamina
  • paraspinal haematoma
  • increased interpendicular distance

Lateral:

  • comminution and displacement
  • loss of posterior vert height
27
Q

Discuss how a burst fracture can be stable or unstable?

A

stable:
- no post lig disruption

unstable:

  • middle and anterior columns disrupted or >50% vert body height is lost
  • instability increases with rotational force
  • this can cause posterior fragments to impinge on thecal sac and lodge into spinal canal
28
Q

explain what’re distraction fractures

A
  • “seatbelt” frac, or chance frac
  • very severe compression of vert (more than wedge)
  • distraction of post body and/or ligs (common at TL junction)
  • all 3 col fkd = unstable
    1. horizontal split of vert with no lig damage
  • rupture of ligs and IV disc
    1. frac of post col with rupture of ligs and IV disc
  • frac of post and mid col with rup

Lateral (best view)
- Horizontal fracture extending, transversely through the vertebral body, pedicles and posterior elements
+ Can have ligament damage and intervertebral disc rupture

  • Compex: disc injury, dislocation or subluxation
  • Possibly Paired with transverse process fracture
    Consider renal problems and GI injuries
29
Q

Explain what’s osteoporosis

A

Metabolic disease causing generalised or regional deminerlisation
(rate of bone resorption >bone formation)

begins in 5th decade

females>males

due tp:

  • genetic makeup
  • size of skeleton
  • level of activity/exercise
  • nutrition (low Ca)
  • gonadal hormones (estrogen)
30
Q

What are the radiographic indicators of osteoporosis

A
  • generalised osteopenia
  • thinning of secondary bony trabeculae
  • occasional stretching of primary (cortical) bony trabeculae from distribution of stress
  • noticeable striped trabecular pattrn on vert
31
Q

What is spina bifida?

A

posterior vert components unfused and so exposes spinal cord

congenital

can be accompanied by:

  • mengiolcele: herniated meninges
  • herniated spinal cords or nerve roots
  • spina bifida (occulta): unfused post arch of L5/S1 without protrusion of spinal cord or meminges
32
Q

How do you know when the lumbar region starts?

A

identify last rib and that will be the T12 and he one below is L1

33
Q

Is breathing technqiues used for lumabr spine projection?

A

Yes, it’s used to blur abdominal ribs in lateral lumbar views but most commonly used in lateral thoracic spine to blur thoracic ribs.

also used in AP lumbar to move the florid bowel gas (pts may have)

lumbar obl: minimise superimposing of the diaphragm over upper lumbar

technique: breathe in and out and hold (suspend on expiration)

MRTY2105 (8 decks)

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