Lecture 5-Spine Flashcards
What spaces/joint spaces should be open in a Lateral C-Spine?
-Open zygapophyseal joints
-Open intervertebral disk spaces
What radiographic sign ensures that the Zygopophyseal joints are open?
Superimposed articular pillars
What breathing technique ensures that C7/T1 is visualized in a lateral C spine?
Suspended deep exipiration (pulls the shoulders down)
What errors have been made in this image of the lateral C spine?
Rotation and tilt
Will not ask us which way we are tilted or rotated just tell that there is rotation and tilt present
What errors have been made in this image of the lateral C spine?
Tilt present
Congenital fusion of C6/7
What errors have been made in this image of the lateral C spine? What correction would have to be made?
-Cutting off C7
-Rotation and tilt present
-Would need a swimmers view
T/F
The intervertebral foramina should be closed in an Oblique C-Spine
False; The intervertebral foramina should be ope in an Oblique C-Spine
What projection is this?
Oblique C-Spine
RPO
Where should the opposite pedicles be in an oblique C spine?
Opposite pedicles are near the anterior vertebral body
What joint spaces should be open in an oblique C spine?
- Zygapophyseal joints
- Open intervertebral disc spaces
- intervertebral foramina (2nd – 7th)
What does an RPO oblique C spine demonstrate?
Demonstrates the z-joints, the left IV foramina and left pedicle
What does an LPO oblique C spine demonstrate?
LPO demonstrates the right IV foramina and pedicles
In an AP oblique C spine, what things should be “up?”
face up, angle up, demonstrated side up, marker face up
What projection is this?
RPO oblique C spine
What errors have been made in this image?
Too much/steep of an oblique, angle good
As you get closer to a lateral from an oblique, which way do the opposite pedicles move?
The opposite pedicles move more posterior
What is this projection and what is this demonstrating? What errors have been made in this image?
-LPO Oblique C spine demonstrating the right z joints,pedicles and IV foramina
-Patient under rotated
If the patient is under rotated in an oblique C spine, where will the opposite pedicles appear?
Will see the pedicles anterior
If the patient is under rotated in an oblique C spine, what two radiographic signs will appear?
-Opposite pedicles too anterior
-Perched appearance
If the joint space is closed in an oblique C spine, what angle was likely used?
Likely no angle was used at all
What projection is this? What errors have been made?
LPO C spine oblique
-Head not turned to lateral position
-Good oblique
What projection is this? What errors have been made?
LPO
-Under rotated, looks perched
-Mandible not turned to a true lateral
What is the posture for an oblique C spine?
Rotate body and head 45º - RPO and LPO
Slightly extend chin-
Ok to turn head toward IR if there is no trauma
Bi lateral views
What angle is used for an oblique C spine?
15º-20º cephalad
Assess the CR angle required from the lateral image
What is the centering point for a C-spine Oblique? What should the collimation include?
Centering point: C4 –Upper part of thyroid cartilage
Collimation: C1-7
What projection is shown here? What errors have been made?
RPO C spine oblique
-Slight mandible over top
-Nearly perfect image
What projection is shown here? What errors have been made?
LPO C spine oblique
No angle was used
-Obliquity good
What projection is this?
AP Axial C-Spine
What joint spaces need to be open in an AP Axial C-Spine?
Open intervertebral joint spaces
What is the posture for an AP Axial C spine?
Extend chin - Occlusal plane is to IR
OR- line from tip of mandible to base of skull should be parallel to angled CR
What angle is used for an AP axial C spine?
15º - supine or pt. with less Lordotic curvature
20º- erect or pt. with more Lordotic curvature
(acess from lateral)
What is the centering point for an AP axial C spine?
C5 - Thyroid cartilage
What should the collimation include for an AP axial C spine?
C3-7
But collimate to include C1-C7 even though it won’t be seen
How do you obtain the Cobbs angle for the c spine?
Draw line on top of C4 or C5
What projection is this? What errors were made?
AP Axial C-Spine
-Chin not lifted enough/extending your neck
-Good angle used
What projection is this? What errors were made?
-AP axial C spine
-Lifted the chin way too much, need to bring the chin down
-Slight LPO
joint space is open :)
What projection is this? What errors ahave been made?
AP axial C spine
-Slight RPO
-No angle used (joint space closed)
-Chin not extended enough
How would you correct this image?
-Use an angle
-Lift up the chin if the chin is already not lifted
In an AP Axial C spine, how do we acess for open joint spaces?
Look at C4 and C5 joint spaces
How do you position for an open mouth odontoid?
Upper incisors/occlusal plane (bottom of the top teeth) aligned with base of skull
How can you tell that the open mouth odontoid is not rotated?
Equal distance between dens and lateral masses
Why must we see the lateral edges of C1 and C2 in an open mouth odontoid?
To acess for a Jefferson’s fracture
What errors have been made in this image of the open mouth odontoid? How can this be corrected?
-Neck extended too much and RPO
-Tuck the chin down (flex the C spine) and rotate the nose to the left to correct the RPO
What projection is this? How would you correct the errors in this image?
Open mouth odontoid
-Need to raise the chin
-Rotate the nose to the left-ramus to look at
What corrections need to be made to this image of the open mouth odontoid?
Need to raise the chin/extend the neck
-Rotate the nose to the left
What corrections need to be made to this image of the open mouth odontoid?
-Need to flex the neck/lower the chin
-Rotate the nose to the left
What corrections need to be made to this image of the open mouth odontoid?
-Rotate the nose to the right
-Lower the chin/flex the neck
What corrections need to be made to this image of the open mouth odontoid?
None-perfect image
What corrections need to be made to this image of the open mouth odontoid?
Lower the chin/flex the neck
Rotate the nose to the left
What corrections need to be made to this image?
FUCHS needed
(image of what the patient looks like)-differnt type of anatomy
What method is shown here?
FUCHS method
What projection is this?
AP Wagging jaw method
What joint spaces should be open in an AP Lumbar Spine?
Open intervertebral disc spaces
What should the collimation for the AP lumbar spine include?
T10/11 to the ASIS/SI joints
In a supine AP lumbar spine, what positioning technique helps to open up the joint space?
Bend the knees to flatten the back to get the disk space open
What is better for getting through the lumbar spine; AP or PA positioning?
PA positioning
(even though OID present)
T/F
If the spinous process is closer to the pedicles on the left-hand side, they are in an LPO
False; RPO
What errors have been made in this image of the AP lumbar spine?
Joint spaces not open in this image
What errors have been made in this image of the AP lumbar spine?
Slight RPO
Marker at the bottom-need to be at the top
What errors have been made in this image of the AP lumbar spine?
LPO
spinous process are closer to the right pedicles
What errors have been made in this image of the AP lumbar spine?
-LPO Looking
-Closed joint space (did not flex the knees well)
What error has been made in this image of the AP lumbar spine? What side would be imaged for the lateral?
-Collimation too long
-Would do a right lateral
Why does image B look better
Breathing technique was used
What is the purpose of the Lateral Lumbar Spine position?
To see the disc spaces and intervertebral foramina
(L and T spine laterals show this)
T/F
Always direct the CR into the convex side if a curve is present
False; Always direct the CR into the concave side if a curve is present
How should the pedicles appear in a lateral L spine?
Superimposed pedicles
What is the angle for the lateral lumbar spine?
May require a 5º for men or 8º caudad angle for female patients with wider pelvis
MEASURE TO THE PATIENT’S SPINE
What errors have been made in this image of the lateral lumbar spine? What structure is circled?
-None;perfect image
-Pedicles are circled
Where should the marker be placed in a lateral lumbar spine?
Marker superiorly
What error has been made in this image lateral lumbar spine?
Film image-cannot see the spinous processes
If double lines of the structures are visible anterior to posterior in a lateral lumbar spine; what positioning error does this indicate?
Patient rotated
If double lines at the top and the bottom of vertebra in a lateral lumbar spine; what positioning error does this indicate?
Did not angle the CR perpendicular to the spine
How could this image of the lateral lumbar spine be corrected?
-Rotate the right side posteriorly and increase the caudad angle that was used
What is the best view to look for compression fractures in the lumbar spine?
The lateral lumbar spine
Why does the spine look fused in the second image?
Should have done a right lateral
What joint spaces should be open in an Oblique Lumbar Spine?
Open intervertebral disc spaces
Open zygapophyseal joints
Where should the z-joints be in an Oblique Lumbar Spine?
Zygapophyseal joints in the middle of the vertebral body
Where should the pedicles be seen in an oblique lumbar spine?
Pedicles are seen halfway between the midpoint of the vertebral bodies and the anterior border of the vertebral bodies
What positioning error has been made in the oblique lumbar spine if the pedicles are midline?
Patient is over rotated
What oblique is this? Why?
45 degree RPO (why not LAO?=because we did not get through the joint space, indicating this is taken AP)
What error has been made in this image of the oblique lumbar spine?
-Over rotated
If the z joints are anterior to the midline, what positioning error has been made?
Patient Under rotated
What error has been made in this image of the oblique lumbar spine?
Under rotated
What projection is this? What errors have been made in this oblique lumbar spine?
-LPO
-Over rotated
What oblique is this? What errors have been made?
RPO-Good at top, under rotated at the bottom
What oblique is this? What errors have been made?
LPO-Over rotated
What oblique is this? What errors have been made?
RPO
Slightly over rotated
What is demonstrated in an RPO position of the lumbar spine?
The right Z joints and the right pars inter articularis
What is demonstrated in an LAO position of the lumbar spine?
The right pars interarticularis and the right z joints
What is demonstrated in an RAO position of the lumbar spine?
The left pars interarticularis and the left z joints
What oblique is this? What errors have been made?
LAO
-Under rotated at the very bottom
What oblique is this? What error has been made?
LPO
Over rotated (pedicles midline)
T/F
Pelvis needs more rotation that the upper part in an oblique lumbar spine
True
