Positioning Of T Spine

Question 1

Routine thoracic spine protocol

Answer 1

• AP
• Lateral
• swimmers (twining method)

Question 2

T-spine techniques

Answer 2

AP projection: 90 Kv @ 20 mAs

Lateral projection: 90 Kv @ 40 mAs

Question 3

AP T spine (supine)

Answer 3

• 110 SID
• 18 X 43 lightfield
• make sure detector is all the way at head end
• go to head of table to make sure they are straight, palpate ASIS to make sure
• top of light 2 fingers above jug notch
• bottom of light should pass through costophenic angle (bottom ribs)
• center straight down the body, center at T7 (bottom of scapula or nipple line)
• side to side collimation 12-14 cm (width of hand)
• check for diverging rays
• make sure pillow isn’t under shoulders
• make sure tube and detector are lined up
• marker tucked under shoulder
• double check pt is straight, can move hips or shoulders
• shield legs
• suspend respiration at end of exhalation

Question 4

(Left) lateral T spine

Answer 4

• 110 SID
• 18 X 43 lightfield
• top of light at T3 (jug notch)
• bottom of light T12 (lower costal margin)
• center @ T7 (nipple line or inferior edge of scapula)
• bend arms into 90 degrees (like praying) and knees into 90 degrees
• want spine nice and straight and not to sag,put sponge under waist
• make sure shoulder and hips are stacked and palpate back spine to make sure it is straight
• lengthwise crosshair centered in posterior half (middle of armpit should be the very start of lightfield)
• need very very small amount of light on posterior
• suspend respiration at end of exhalation
• marker at center crosshair slightly anterior

Question 5

(Left) swimmers lateral aka Twinings

Answer 5

• 110 SID
• angle tube 5 degrees caudad
• 19 X 23 light field
• should have light on shoulder
• rotate collimator to run with direction of neck
• top of light at C5 laryngeal prominence (adams apple)
• bottom of light just below jug notch
• center at vertebral prominens (bump at bottom back of neck)
• marker in top anterior
• no pillow, pt should be lying head on top of left arm
• crosshair should be in line with EAM
• make sure pt is nice and straight
• super tight collimation
• left arm straight up and other arm reaching towards toes
• make sure tube and detector are in line
• suspend respiration at end of exhalation

Question 6

Evaluation criteria of AP T spine

Answer 6

• C7-L1
• open intervertebral joint spaces
• no rotation: spinous processes centered in vertebral bodies and SC joints equidistant from spine
• transverse processes
• costovertebral joints

Question 7

Evaluation criteria for lateral T spine

Answer 7

• T3-T12
• open intervertebral joint spaces (no tilt)
• open intervertebral foramina
• superimposition of posterior aspect of vertebral bodies
• less than 1.25 cm space between right and left posterior ribs (no rotation)
• you need to see L1 to prove you have T12

Question 8

Evaluation criteria for T spine swimmers (twinings)

Answer 8

• lateral view of C5 to T3 for non-trauma
• superimposed zygapophyseal joints (no rotation)
• separated numeral heads
• penetrated shoulder area
• (skull base to T4)