Positioning Test #3 Spines Flashcards
1
Q
What is the patient position for the AP axial projection for c-spine?
A
- Pt supine or upright
- Extend patients chin slightly to avoid superimposition mandible and cervical vertebrae
2
Q
Central ray for AP axial c-spine?
A
15-20 degrees cephalic entering c4 (Adams apple) midsagittal plane
3
Q
Structures shown for AP axial c-spine
A
- Lower 5 cervical vertebrae
- Area from c3-T2
- Open intervertebral disk spaces
- Mandible superimposed over atlas
- Spinous process aligned with midline of cervical bodies
4
Q
Why do we typically do the AP axial projection for c-spine at 40 inches?
A
To reduce dose of thyroid
5
Q
Patient position for AP c-spine
A
- Patient open moth as wide as they can
- Head drawn down enough where there is a line drawn from the lower edge of upper incisors to tip of the mastoid process to be perpendicular
6
Q
Where is the IR for the AP projection of c-spine?
A
Level of C2
7
Q
What is the central ray for the AP projection of c-spine?
A
Perpendicular to midpoint of the mouth
8
Q
What is another name for the AP projection of the c-spine?
A
(Open mouth) (adontoid or dens)
9
Q
What are structures shown for the AP (atlas and axis) projection for c-spine?
A
Dens
- atlas and axis projected through the open mouth
- C1-C2 articulation (checks for lateral displacement)
10
Q
What is the C1 articulation for the AP projection of c-spine?
A
Atlas
11
Q
What does C1 articulation do in terms of the purpose?
A
Holds up the head
12
Q
What is C2 articulation in the AP projection for c-spine?
A
Axis
13
Q
What is the purpose of seeing C2 on the AP projection of the c-Spine?
A
Rotation occurs here
14
Q
What is the patient position for the lateral right and left (grandy method)?
A
Patient in true lateral with the effected shoulder rested on IR with shoulders depressed
15
Q
Where should the top of the light of the IR be for the lateral (grandy method) projection for c-spine?
A
1 in above the EAM(external auditory meatus) (top of ear)
16
Q
What is the breathing technique for the lateral (grandy method) projection for c-spine?
A
Suspend respiration on full exhalation
17
Q
What is the central ray for the lateral (grandy) projection of the c-spine?
A
Horizontal and perpendicular to C4 (right behind ear)
18
Q
Structures shown for the lateral (grandy) projection of the c-spine?
A
- All C7 cervical vertebrae with spinous process in profile
- mandible not superimposed over C1-C2
- open intervertebral disk spaces
- zygophyseal joint spaces
19
Q
What does the lateral (grandy) projection of the C-spine good for demonstrating specifically?
A
The zygopophyseal joints with 2 vertebrae :
1) inferior articulate facet
2) superior articulate facet
20
Q
What is the patients position for the hyperflexion for the lateral c-spine?
A
Draw chin close to the chest as possible
21
Q
What is the patients position for the hyperextension position for the lateral c-spine?
A
Elevate the chin as much as possible and extend the head back
22
Q
What is the reason we do the lateral (hyperflexion/hyperextension) for the c-spine?
A
Demonstrates the mobility and lordotic curvature
23
Q
What is the central ray for the lateral (hyperflexion/hyperextension) c-spine projection?
A
Horizontal and perpendicular to c-4
24
Q
What are structures shown for the lateral (hyperflexion) for c-spine?
A
Spinous processes separates and elevated
25
What are the structures shown for the lateral (hyperextension) c-spine projection?
Spinous processes depressed (narrow/close together)
26
What are the structures shown for the lateral (hyperflexion/hyperextension) c-spine projection?
- Demonstrated normal movement of an absence of movement from trauma of diseases
- demos all C-7
27
What is the patient position for the AP axial oblique (RPO/LPO) projection of the c-spine?
- Body roared 45 degrees in RPO or LPO
| - patient look straight ahead and elevate the chin
28
Where is the central ray for the AP axial (RPO/LPO) projection for c-spine?
15-20 degrees cephalic entering C4
29
What is the breathing technique for the AP axial (RPO/LPO) c-spine?
Suspend respiration
30
What are the structures shown for the AP axial (RPO/LPO) c-spine?
- open intervertebral foramina farthest from film
- open intervertebral disk spaces
- all C7
31
Where are the intervertebral foramina locates when viewing the AP axial (RPO/LPO) c-spine?
On the side farthest from the IR
32
Where are the vertebral foramina demonstrates when viewing the PA axial (RAO/LAO) c-spine?
On the side closest to IR
33
What is the patient position for the PA axial (RAO/LAO) c-spine?
- Prone, recumbent, or supine
- Patient rotated 45 degrees into RAO or LAO
- chin elevated slightly and protrude the mandible
34
What is the central ray for the PA axial (LAO/RAO) for the c-spine?
15-20 degeees caudad entering C4
35
What are the structures shown for the PA axial (LAO/RAO) c-spine?
- open intervertebral foramina closest to IR
- open intervertebral disk spaces
- all C1-C7 to T1
36
Which oblique for the PA axial (RAO/LAO) demonstrates the right intervertebral foramina?
RAO
37
Which oblique in the PA axial (RAO/LAO) of c-spine demonstrates the left intervertebral foramina?
LAO
38
What view of the c-spine cannot be done if there is a suspected cervical fracture or if the patient has a trauma collar on?
AP (Fuchs method) (dens)
39
What is the patient position for the AP (Fuchs) (dens) c-spine projection?
Extend chin so the chin and mastoid process are perpendicular
40
What is the central ray for the AP (Fuchs method) (dens) c-spine projection?
Perpendicular entering distal to the top of chin
41
What are the structures shown for the AP (Fuchs method) (dens) is the c-spine?
- dens within the foramen magnum
- demos thought foramen magnum (where the spinal cord goes through)
- used to get the full adontaoid in view
42
What view for c-spines do we always do 1st on patients when there is a trauma for a severe injury where there may be cervical collars on patient?
Cross table lateral
43
How many vertebrae are there?
12
44
In the AP projection for the T-spine, what is the patient position?
-flex knees, feet flat on table, patient upright or supine
45
What is the central ray for the AP projection of the T-spine?
Perpendicular half way vwteeen the jugular notch and Xiphoid process
46
Where is the IR for the AP projection of this T-spine?
To T7, (3-4 in distal to jugular notch) or 1 1/2 -2in abode shoulders for top of IR
47
What is the breathing technique for the AP projection of T-spine?
After full exhalation
48
Why do we do the AP projection of the T-spine of full exhalation?
Gets the lungs in view
49
What is the structures shown for the AP projection of the T-spine?
- all 12 thoracic vertebrae
- T7 in the center
- spinous process centered
- transverse process
- intervertebral disk spaces
50
What do flexing the knees do for the AP projection of the T-spine?
Reduces some curvature in spine
51
For a more uniform density for the t-spine projections, what can be used in place?
The anode heel affect
52
What is the patient position for the lateral projection of the T-spine?
Patient in true lateral with either right or left arm up with head rested on shoulder to the long axis of the vertebral column
53
What is the central ray ray for the lateral projection of T-spine?
Perpendicular to T7 and posterior half of thorax(at shoulder blade) and top of IR 1 1/2-2in above relaxed shoulders
54
What is the breathing technique for the lateral projection of T-spine?
On full exhalation or using a technique of low ma and high seconds
55
What are the structures shown for thnkaterak projection of T-spine?
- all 12 thoracic vertebrae (T3-T12)
- shoulders may be obscured over vertebrae
- spinous processes
- no superimposition of ribs
- intervertebral foramina
- open intervertebral disk spaces
56
What can be used for the lateral projection of the T-spine to improve quality and attenuate scatter radiation?
A lead blocker/strip
57
Which lateral (R or L) Of the T-spine will minimize the heart magnification and overlapping of heart on spine?
Left lateral
58
What joint will be shown in the oblique projections of T-sounds?
Zygoapophyseal joint
59
What must be done if the patient measures over 100 in the lateral projection of the T-spine?
Use the 25% rule ( reduce by 15% (.85) and double mAs)
60
What is the function of the L-spine?
Supports most of the body weight
61
What is the patient position for the AP projection of the L-spine?
Supine with hips and knees flexed with soles of feet on the table
62
What does flexing the knees and hips do to help in the AP projection of the L-spine?
Reduces the lordotic curvature of the lumbar region
63
What is the central ray for the AP projection of the L-spine?
1) for a 14x17 lumbar and sacrum only: Perpendicular to level of the iliac crest (L4)
2) for an 11x14 lumbar only: perpendicular 1/2in above the crests(L3)
64
What are the structures shown for the AP projection of the L-spine?
- all 5 lumbar vertebrae
- open intervertebral disk spaces
- transverse process
- spinous processes centered
65
What does the PA projection of the L-spine specifically do that the AP projection doesn’t?
Significantly recuses gonadal dose
66
What is the breathing technique for the AP projection of the L-spine?
End of expiration
67
What is the patient position for the lateral projection of the L-spine?
Patient in true lateral with knees and hips flexed
68
What is the central ray for the lateral projection of the L-spine?
Center IR to midcoronal plane, level iliac crests for 14x17
For lumbar spine only... perpendicular to midcoronal plane , 1 1/2in above crests(L3) for an 11x14
69
What can be done to the central ray if the spine for the L-spine isn’t horizontal?
Angle the tube 5-10 degrees caudad
70
What can be used for the lateral projection of the L-spine to help reduce scatter?
Less strip
71
What are the structures shown for the lateral projection of the L-spine?
- all 5 lumbar vertebrae
- open intervertebral disk spaces
- spinous processes in profile
- open intervertebral foramina
72
What is the patient position for the L5-S1 (lumboscaral juncrion) (cone down) lateral projection of the L-spine?
Patient in true lateral (usually left) with knees and hips extended
73
Where is the central ray for the L5-S1 (lumbosacral junction) (cone down) lateral projection of the L-spine?
Perpendicular sling coronal plane, 2in posterior to ASIS and 1 1/2in inferior to iliac crests (if horizontal)
74
What is the tube angle for the L5-S1 (lumboscaral junction) (cone down) lateral projection of the L-spine for males if their not horizontal?
5 degrees Caudad
75
What is the tube angle for the L5-S1 (lumbosacral junction) (cone down) lateral projection of the L-spine for a male if they aren’t horizontal?
8 degrees caudad
76
What is the breathing technique for the L5-S1 (lumbosacral junction) (cone down) lateral projection of the L-spine?
On respiration
77
What are the structures shown for the L5-S1 ( lumbosacral junction) (cone down) lateral projection of the L-spine?
- all lumbosacral joint (L5-S1)
- all L5 and upper sacrum
- marker
- open intervertebral join spaces
78
What is spondylothesis?
Slipping of the vertebrae (usually L5-S1)
79
How do you help spondylothesis?
Will move forward over time, or can place a hardware to stabilize
80
What is the patient position for the AP oblique (RPO/LPO) position for L-spine?
Pt supine rotated 45 degrees into an RPO or LPO position
81
Where do you center the spine for an AP oblique (RPO/LPO) position for the L-spine?
Center spine to IR 2in medial to elevated ASIS
82
Where is the central ray for the AP oblique (RPO/LPO) position of L-spine?
Perpendicular, 1 1/2in above crests at level of L3 and 2in medial to elevated ASIS
83
What are the structures shown for the AP oblique (RPO/LPO) position of L-spine?
- the 2 zygapophyseal joints (right and left) closest to IR (Scottie dogs)
- both sides for comparison
84
In the PA oblique (RAO/LAO) position for the L-spine, where are the zygapophyseal joints?
Farthest away from the IR are demonstrated
85
Which oblique of the AP L-spine demonstrates the right side closest to the IR?
RPO
86
Which oblique for the AP oblique of the L-spine demonstrates the left side?
LPO
87
Which oblique of the L-spine will demonstrate the body part closest to the IR?
AP LPO and RPO
88
In the PA oblique of the L-spine, which demonstrates the right side of the body?
LAO
89
In the PA oblique of the L-spine, which demonstrates the the left side?
RAO
90
What is the patient position for the lateral (weight bearing method) (flexion/extension) if that the patient is hyperflexion?
Patient standing, arms are outside of area of interest, patient bend forward as far as possible
91
For the lateral (weight bearing method) (flexion/extension) of the L-spine, If thag patient is in hyperextension, what is their position?
Standing with arms out of the way of area of interest, bending backwards as far as possible
92
What is the breathing technique for the lateral (weight bearing method) (flexion/extension) projection of the L-alone?
Suspend respiration
93
What are the structures shown for the lateral (weight bearing method) (flexion/extension) projection of the L-spine?
All lower thoracic to sacrum (L5)
| Mobility of intervertebral joints
94
What projections of the L-spine are used for patients with early scoliosis and can determine the presence of any structural change when bending?
AP right and AP left bending positions
95
What projections of the L-spine demonstrate the mobility of the intervertebral joints?
AP right and left (bending)
96
What is Spina bifida?
When the spine doesn’t fuse in the back
97
What is Spina bifida caused by?
By incomplete formation of neutral tube, vertebral column is not closed resulting in protrusions (bone doesn’t encase spinal cord)
98
Why do we typically do SI joint projections?
When patients come due to arthritis, pain in legs, back, and any dislocations due to higher trauma.
99
What is the patienntposition for the AP axial (Ferguson method) for SI joints?
Patient supine with legs extended
100
What is the breathing technique for the AP axial (Ferguson method) projection of SI joints?
Respiration
101
What is the central ray for the AP axial (Ferguson method) projection of SI joints for males?
30 degrees cephalic, entering midsagittal plane, 1 1/2in superior to pubis symphysis
102
What is the central ray for the AP axial (Ferguson method) projection of the SI joints for females?
35 degrees cephalic, entering midsagittal plane, 1 1/2in superior to pubic symphysis
103
What are the structures shown for the AP axial (Ferguson method) projection of SI joints?
- Lumbosacral joint
- L5 junction and sacrum
- open L5-S1 intervertebral space
- symmetrical image of sacroiliac joints free of superimposition
104
What is the patient position for the AP oblique (RPO/LPO) projection of SI joints?
Supine, elevated side examined 25-30 degrees
105
What is the central ray for the AP oblique (RPO/LPO) projection of the SI joints?
Perpendicular entering 1in medial go elevated side ASIS
106
What is the breathing technique for the AP oblique (RPO/LPO) projection of the SI joints?
Respiration
107
What are the structures shown for the AP oblique (RPO/LPO) projection of the SI joints?
- open SI joint FARTHEST from IR
- both sides examines to compare
- entire joint space
108
Which oblique of the SI joint will demonstrate the SI joints CLOSEST to the IR?
PA oblique (RAO/LAO)
109
Which oblique of the SI joints will demonstrate the left side joint farthest from the Ir?
AP RPO
110
Which oblique of the SI joint will demonstrate the joint right side farthest from the Ir?
AP LPO
111
List four functions of the vertebral column
1. And closes and protects the spinal cord
2. Supports skull
3. Provides attachments of ribs
4. Acts as a support for trunk
112
As viewed from the lateral aspect name the )superior to inferior) the four vertebral curvatures
1. Cervical
2. Thoracic
3. Lumbar
4. Pelvic
113
State how vertebral curvatures are classified as either primary or secondary curvatures
1. Primary curve formed before birth
| 2. Secondary curve forms after birth
114
Need to vertebral curvatures that are classified as primary curvatures
1. Thoracic
| 2. Pelvic
115
Name the two vertebral curvatures that are classified as secondary curvatures
1. Cervical
| 2. Lumbar
116
What is the name of the opening formed by the vertebral artery in the body of a vertebra?
Vertebral foramen
117
What other name refers to C1?
Atlas
118
What other name refers to C2?
Axis
119
What other name refers to C7?
Vertebral prominens
120
What’s your typical vertebral parts are missing from the first cervical vertebra?
Body and spinous process
121
How are the transverse processes of cervical vertebrae significantly different from those of other typical vertebrae?
Transverse processes are performed with transfers foramen
122
What cervical vertebra has the dens?
Axis (C2)
123
What other name refers to the dens?
Adontoid process
124
How many cervical vertebrae are there in the vertebral column?
7
125
With reference to the mid sagittal plane how do Zygapophyseal articulations of the cervical vertebrae open?
90 degrees
126
With reference to the midsagittal plane, how do cervical intervertebral foramina open?
45 degrees anteriorly
127
Which section of the vertebral column has costovertebral joints?
Thoracic
128
Which section of the vertebral column has facets and Demi facets?
Thoracic
129
Which bones articulate with the thoracic facets and Demi facets?
Ribs
130
With reference to the midsagittal plane how do zygapophyseal articulations of the thoracic vertebrae open?
70 degrees anteriorly
131
With reference to the midsagittal plane how do thoracic intervertebral foramina open?
90 degrees
132
With reference to the midsagittal plane how do the zygapophyseal articulations of the lumbar vertebrae open?
30-50 degrees posteriorly
133
With reference to the midsagittal plane how do lumbar intervertebral foramina open?
90 degrees
134
What structure of the vertebral column articulates with both Ilia?
Sacrum
135
With reference to the midsagittal plane how many degrees and in what direction do SI joints open?
25-30 degrees anteriorly
136
What is this abbreviation?
EAM
External acoustic meatus
137
What is this abbreviation?
| HNP
Herniated nucleus pulposus
138
What is this abbreviation?
OML
Orbitimeautal line
139
For the swimmers technique for the C-spine it is performed when?
Shoulder superimposition of obscures C7 and lateral cervical spine or the lateral projection for the upper thoracic vertebrae is needed
140
Which body plane should be centered To the midline of the grid for a C-spine?
Midcoronal
141
With reference to the patient where should the IR centered for a C-spine?
C7-T1
142
Describe the patients Arms and should be positioned for a swimmers review for the C-spine
1. Elevated arm closer to IR
2. Flex elbow
3. Rest forearm on pt head
4. Other arm extended along side of pt to depress shoulders
143
Describe how the patients shoulders should be positioned in the Summers view for the C-spine
1. Shoulder closest to IR rostered posteriorly
| 2. Other shoulder depressed and rotated anteriorly
144
Listen the 2 ways that the patients respiration can be controlled for the swimmers view for the C-spine
1. Stop breathing
| 2. Take shallow breaths
145
Which two ways can the central ray be directed for the swimmers technique of the C-spine?
1. Perpendicular
| 2. 3-5 degrees caudad
146
When the patient is positioned recumbent where should the body be supported to maintain the long axis of the cervical thoracic vertebrae horizontal?
Lower thorax
147
With reference to the patient to what specific location should the central ray be directed for a C-spine
Disk space of C7 and T1
148
How many degrees in which direction should the central ray be directed for the Summersville for the C-alone?
5-15 degrees cephalic
149
If the patient is supine what should be done to reduce the normal thoracic kyphosis of the patient and in an AP T-spine
Flex the patients hips and knees
150
Which vertebra should be in the center of the collimator/IR for the AP T- spine
T7
151
Where exactly on the anterior side of the patient’s chest should the central ray before the AP T- spine
Midway between jugular birch and Xiphoid process
152
With reference to the patient where should the upper edge of the IR field be placed for the AP T-spine
1 1/2-2in above shoulders
153
List two options for the patients respiration for the AP T-spine and explain why
1. Breath normal= blurs our lungs and ribs
| 2. Suspend on exhalation= avoid motion
154
Which part of the x-ray tube the anode or cathode should be positioned over the patient’s head for the AP T-spine?
Anode- greatest % radiation projected at thickest region
155
For the supine patient of the T spine why should the patient’s head rest directly on the table?
To avoid accentuating kyphosis
156
What should the radiographer do to ensure uniform brightness and contrast when performing a single image AP projection of the thoracic spine?
He’s compensating filter or the anode heel affect
157
Why is it preferable to place a patient in the left lateral position instead of a right lateral position for the thoracic vertebrae?
Places the heart closer to the IR and minimizes overlapping of vertebrae and heart
158
For the lateral recumbent position for the T spine what is the purpose of placing a firm pillow under the patient’s head?
Keeps the long axis of vertebral column horizontal
159
To what level of the patient should the superior border of the IR be placed for the lateral T-spine projection?
1 1/2-2in above shoulders
160
Which posterior body landmark coincides with T7 for centering IR for the lateral T-spine?
Inferior angle of scapula
161
What is the purpose of placing a radioLucent support under the lower thoracic region when the patient is in the lateral recumbent position for the T spine?
Keeps long axis of vertebral column horizontal with the plane of IR
162
How many degrees in which direction should the central ray be directed if the thoracis vertebrae are not parallel with the table when a female patient is in the lateral recumbent position for the T spine?
Male patient?
Females- 10 degrees cephalad
| Males- 15 degrees cephalad
163
If an angled central ray is used why should it be angled more for Men then women for the Lateral T-spine
Men usually have a larger shoulders
164
With reference to the patient’s breathing when should the exposure be made for the lateral T spine projection?
Suspend expiration
165
Why should’ve sheet of the lead Rubber be placed on the table posterior to the patient when the IR is exposed and the patient is in a lateral recumbent position of the T spine?
To prevent scatter radiation which means gives us a better image
166
How can you be determined by looking at the ribs in the image that the patient was rotated in the Lateral T-spine projection?
The ribs are superimposed posteriorly
167
What additional projection may be performed if the upper thoracic vertebrae are not well demonstrated with a routine lateral projection of the T spine?
Lateral swimmers
168
How should the central ray be directed when the thoracic vertebrae are parallel with the plane of the IR for the T spine?
Perpendicular
169
True/false :
I lead apron should be placed over the patient’s pelvis and a lateral projection of the T spine
True
170
True/false:
The central ray should be directed to enter the posterior half of the thorax at the level of T7 of the lateral projection of the T-spine
True
171
True/false:
Normal breathing by the patient reduces the amount of scatter radiation that reaches the I R and a lateral projection of the T spine
False ( technique serves to blur lungs)
172
True/false:
Scattered radiation maybe cause the automatic exposure control system to terminate the exposure prematurely
True
173
True/false: T-spines
If the exposure is terminated prematurely the vertebral bodies will appear to light in the image
True
174
True/false:
The upper thoracic vertebrae specifically T1 and T2 are not usually demonstrated in the fall lateral view of the T spine
True
