Normal Radiographic Anatomy Flashcards
What should be the limits of visualization of Lateral Cervical view?
Skull to T1
How can we visualise C7 on Lateral Cervical?
- depress shoulders (weights)
- spot view
- swimmers lateral of cervicothoracic junction
Which is the best view of IVDs?
Lateral Cervical
How can you tell there is lateral flexion or rotation in Lateral Cervical view?
Lateral flexion:
• double facet joint lines
Rotation:
• double spinolaminar junction lines
What are the alignment and measurements of the Lateral Cervical view?
- 4 lines
- Cervical lordosis
- Atlantodental interspace
- McGregor’s line
- Sella turcica
- soft tissue interspaces
- flexion-extension views
What are the Lines of alignment of the Lateral Cervical view?
- Anterior vertebral line
- Posterior vertebral line (George’s)
- Spinolaminar junction line
- Spinous process line
What are the possible views for Cervical spine? Which are routine?
- Ap
- APOM
- Lateral
- Oblique (not routine)
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint
Why do a transthoracic lateral view?
- true lateral view of humerus
- trauma (pt cant rotate arm safely)
- just looking for major defects or trauma
List the elbow epiphyses in order of appearance
- Capitulum (1 yr)
- Radial head (5 yrs)
- medial epicondyle (7yrs)
- Trochlea (10 yrs)
- Olecranon (10 yrs)
- lateral epicondyle (11 yrs)
(CRITOE)
What is the Fat pad sign?
- fat pad is lucent
- normally so close to bone its not visible
- indicates intra-articular swelling, probably fracture
List the alignments on lateral elbow view
- radiocapitellar line
- humerocapitellar line
Which wrist-view has a view of lateral thumb?
PA wrist and hand
List the alignments to observe in wrist and hand views
- Radioulnar alignment
- carpal arcs
- metacarpals and phalanges
Which view is best for observing the base of the thumb?
oblique wrist and hand
List the alignments to observe in an AP hip
- Shentons line (under)
- Iliofemoral line (over)
(Of femoral neck)
- anterior acetabular wall
- posterior acetabular wall
- acetabular roof
- iliopectineal line
- ilioischial line
- kohler’s tear drop
- Klein’s line
- hip femoral angle
- fempral neck margin
- teardrop distnce
What is coxa vara? Vs coxa valga?
Vara: femoral angle <120 degrees
Valga: femoral angle >135 degrees
What is Teardrop distance? What’s its normal value?
Distance btw inner femoral head and Kohler’s teardrop
Normal 6-11mm and <2mm difference bilaterally
What is the Ilioischial line?
- Kohler’s line
- line taken tangentially btw outer pelvic inlet and outer obturator foramen
- acetabular floor and femoral head should not cross this line
What is Coxa Profunda?
- acetabular floor crosses ilioischilal line
- possible femoroacetabular impingement
What is Protrusio acetabuli?
- femoral head crosses ilioischial line
- possible femoroacetabular impingement (minor displacement)
- Paget’s, osteomalacia, rheumatoid arthritis, trauma, dysplasias
What is the patella position measurement?
- length of patella from posterior superior corner to inferior anterior corner
- should be equal to length of patella tendon from inferior patella to tibial tuberosity
- patella alta
What is patella alta?
• patella tendon longer than patella
- chondromalacia patela
- swelling
List the views of the knee?
- AP
- Lateral
- Sunrise/skyline
- Intercondylar (tunnel)
Which knee view is best to see loose bodies?
Intercondylar (tunnel) view
What is Boehler’s angle? What are normal values?
- on lateral ankle view
- angle of intersection btw lines connecting the 3 highest points on the calcaneus
- 25-40 degrees
- calcaneus fracture if < 25 degrees
Which ankle view is best to view the tib-fib interspace?
Medial oblique ankle
What is the bet view to observe the lateral aspect of the metatarsals?
Medial oblique foot
What are the possible Alignments and Measurements of Lateral Cervical view?
- General skeletal architecture
- Lines (4)
- Lordosis
- Atlantodental interspace
- McG
What are the norma values of cervical lordosis angle?
35-45 degrees
What are the normal values for atlantodental interspace?
Adults: under 3mm
Kids: under 5mm
What is George’s line?
Posterior vertebral line
What is McGregor’s line?
- line from post.sup. hard palate to inf. surface of occiput
* checks odontoid protrusion into foramen magnum
What are the normal values of McGregor’s line?
Odontoid cannot project over 4.5mm above the line
What is the normal size of the Sella Turcica? And what is an abnormal size?
Normal: 5-16mm long and 4-12mm high
Small is nbd
Larger is problem
Why do a Flexion-Extension view?
- assess intersegmental motion and ligamentous stability
- only do if suspecting instability
- look at changes in ADI
List the prevertebral spaces in a lateral cervical view
- Retropharyngeal interspace
* Retrotracheal interspace
What are the normal values of Retropharyngeal interspace and Retrotracheal interspace? What is an abnormal value?
Pharyngeal: under 7mm
Tracheal: under 21mm
Increased is athological
What are the borders on the AP Cervical view?
C3 to T2-3
On an AP Cervical, how can you tell the difference btw T1 and C7?
- ribs
- TVPs of T1 point superior
- TVPs of C7 point inferior
What are the borders in APOM Cervical?
C1 and C2
What is the mach effect?
Relative lucency between 2 overlapping structures may simulate a fracture
What is the difference between normal and abnormal atlantoaxial alignment on APOM Cervical view?
Abnormal: overhang of lateral mas along with over 5 degrees lateral tilt indicate possibility of odontoid fracture
Normal: kids 4 yr old have normal overhang of atlas
Which Cervical view is best for observing IVFs?
Oblique cervical
What Oblique positions are the same to each other?
LAO = RPO RAO = LPO
Is there an Oblique thoracic view?
Nope
Just AP and lateral
What are the borders of AP thoracic?
C7 to L1
What is Cobb angle?
Angle that measures curve of a spine
Trace 2 lines on the vertebral body that would cross each other eventually
How do we assess vertebra rotation?
Look at pedicles NOT spinous processes
Distance from the midline
What are the borders of a Lateral Thoracic view?
C7 to L1
How can we best visualize T1-3?
Swimmers lateral
What are the guidelines for counting vertebrae on a Lateral Thoracic?
- use landmarks from AP view
- DONT use diaphragm
- see if last vertebra has a rib, if so we assume it is T12
What is the normal thoracic kyphosis curve value?
20-40 degree
What are the borders of an AP Lumbar view?
T12 to upper sacrum, including SIJs
What is the pars interarticularis and where do we find them in the spine?
- Only in lumbar spine
- not an anatomical structure
- named and identified because common area of fracture
What are the borders of Lateral Lumbar view?
-T12 to upper sacrum
Which is the best view for visualizing IVD spaces in lumbar spine?
Lateral lumbar
What is the best view for seeing the IVFs of lumbar spine?
Lateral lumbar
List the alignments and measurements of the lateral lumbar spine
1) Georgés line
2) Lordosis
3) Sacral base angle
4) Lumbosacral base angle
5) IVD angle
6) Lumbar gravity line
7) Eisenstein’s measurement
What is George’s line?
Line tracing posterior vertebral bodies and then into the sacral canal
What is a normal value of Lumbar lordosis?
50-60 degrees
What is the sacral base angle?
- 1 line tracing top of sacral body
- 1 line horizontal to ground
- angle btw them
What is a normal Sacral base angle? And what is abnormal?
- 26 to 57 degrees
- average of 41 degrees
- increased means increase anterior pelvic tilt
What is the Lumbosacral disc angle? And what happens when it’s abnormal?
10-15 degrees
Increased =facet impaction = LBP
Is lumbosacral disc angle related to spondylolisthesis?
No
What is the IVDs angles?
Lines following top and bottom of vertebral bodies
Can be done at all levels
What are normal values of IVDs angles?
L1 : 8 degrees
L4 : 14 degrees
What is the lumbar gravity line?
-Line from centre of L3 vertebral body toward straight vertical gravity
What are abnormal measures of lumbar gravity line?
- anterior to sacrum by over 1cm
- posterior shift
What is Eisensteins method measurement on lumbar lateral view?
Measures width of sacral canal
What are abnormal Eisensteins measures?
Under 15mm
When do we do an Oblique Lumbar view?
Suspect a pars fracture
How do we orient ourselves in oblique lumbar?
Draw line behind all vertebral bodies
All to the left is left and so on
Which lumbar is the best view for observing the facet joints?
Oblique
What are the borders for AP LUMBOPELVIC.
T12 to proximal femur including ilium
What is a Phlebolith?
Small rounded calcification of a vein
What alignments do we see on AP lumbopelvic?
- Scoliosis
- Pelvic obliquity
- Pelvic rotation
- Femoral head height
- Hip alignment
What are the Coccyx anomalies?
• 1: curved slightly
anteriorly
• 2: curved more anteriorly, coccyx pointing straight forward
• 3: angulated sharply anterior
• 4: subluxated at sacrococcygeal/intercoccygeal joints
List the alignments on AP shoulder with their normal values
- GH joint space (4-5mm)
- Acromiohumeral space (7-11mm)
- AC joint space (2-4mm)
- Coracoclavicular space (11-13mm)
List the shoulders views
- AP external rotation shoulder
- AP internal rotation shoulder
- AP neutral rotation shoulder
- Scapular Y
- Transthoracic lateral
- Axial
What is the goal of a Scapular Y view?
Lateral view of the scapula
-NOT to assess GH or AC joint