Radiologic T/S Eval Flashcards
List general indications for radiography of the T-spine and ribs
- Trauma
- pain radiating around the chest wall
- ROM limitations
- Pre-op/post-op
- Malignancies
- Osteoporosis/compression fracture
- Arthropathy
- Health conditions associated with spinal abnormality
- Evaluation of scoliosis and kyphosis
- Suspected congenital abnormality
- Monitoring known abnormality
- suspected instability
list views available with a radiologic evaluation of the T-spine
- AP
- Lateral
- Other possibilities:
- Swimmer’s lateral view of the upper thoracic region
- Oblique views → z-joints
- Thoracolumbar/coned views
list radiologic views for the sternum
- RAO for sternum (posterior oblique projection)
- RAO and LAO for SC joints
- Lateral views
list radiologic views for the ribs
- Rib sections → AP, PA, oblique
- anterior, posterior, axillary
- R/L
- Upper (1-9)/ Lower (8-12)
- Chest x-rays
what can be seen in a lateral view of the T-spine?
- should be able to compare anterior, posterior bodies, spinolaminar lines, and articular pillars → should be smooth lines
- disc heights
- pedicles superimposed pairs
- open lateral foramina
- partial viewing of some z-joints
- bodies box-like
what is best seen with a posterior oblique (RAO position) radiograph of the T-spine?
- anterior and posterior ribs
- lungs
- manubrium and sternal body
- sternal angle
- sternal body/xiphoid process junction
- sternocostal joints
list general indications for CT of the T-spine
- Acute trauma (Adults)
- degenerative conditions
- post-op assessment
- infection
- image-guided intervention procedures
- neoplasm
- inflammatory lesions
- congenital/developmental conditions
- Cord Syrinxes/masses (with MRI contraindicated)
list general indications for MRI of the T-spine
- Acute trauma with suspected cord encroachment
- DDD
- neoplasms
- dx and intervention f/u
- intrinsic spinal cord pathology
- congenital/developmental conditions
- cord masses
- pre and post-op assessments
- soft tissues
- vertebroplasty/kyphoplasty
- meningeal abnormalities
- infection (disc space infections, epidural abscess, etc.)
List the ACR appropriateness criteria for imaging in the thoracic region
- suspected spine trauma
- suspected spine trauma - child
- rib fractures
- imaging in the diagnosis of TOS
- Back pain - child
- Scoliosis - child
- Management of vertebral compression fractures
if a patient has a new symptomatic compression fracture that was identified on radiographs or CT with no known malignancy, what follow up procedure(s) is most appropriate?
- Most appropriate
- medical management
- MRI spine area of interest
- CT spine area of interest
- May be appropriate:
- percutaneous vertebral augmentation
- surgical consultation
- bone scan whole body
- SPECT or SPECT/CT spine area of interest
what procedure(s) are most appropriate for a patient with an osteoporotic compression fracture (with or without edema on MRI, spinal deformity, worsening symptoms, or pulmonary dysfunction)?
medical management and percutaneous vertebral augmentation
what follow up procedure(s) is most appropriate for a patient with a painful osteoporotic compression fracture with edema on MRI and surgery or vertebral augmentation is contraindicated?
medial management
(surgical consultation may also be appropriate)
what procedure(s) are appropriate for a pt with a known malignancy and new back? Radiographs or CT having been already performed and identified a compression fracture.
- Usually appropriate:
- MRI spine area of interest
- Image guided biopsy
- May be appropriate
- FDG-PET/CT skull base to mid-thigh
- MRI
- Bone scan whole body
- SPECT or SPECT/CT spine area of interest
what procedure(s) are appropriate in a pt with an asymptomatic pathologic spiral fracture with or without edema on MRI?
- Usually appropriate:
- radiation oncology consultation
- medical management
- May be appropriate:
- percutaneous vertebral augmentation
- percutaneous thermal ablation
- surgical consultation
what procedure(s) are appropriate for a pt with a pathologic spiral fracture with severe and worsening pain?
- Usually appropriate:
- radiation oncology consultation
- percutaneous thermal ablation
- percutaneous vertebral augmentation
- surgical consultation
- May be appropriate:
- medical management
- systemic radionuclide therapy