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MEDIMAGE 301 > Spine > Flashcards

Spine Flashcards

1
Q

What are the projections included in the Trauma C-Spine Series?

A

AP, Odontoid Peg, Lateral, Swimmer’s

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2
Q

What are the projections included in the Pathology C-Spine Series?

A

AP, Odontoid Peg, AP/PA Obliques, Lateral, Swimmer’s (if C7-T1 junction not demonstrated)

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3
Q

What is a cervical rib, and how is it demonstrated radiographically?

A

A rare anomaly occurring in 1% of the population. Ribs arise from the 7th cervical vertebra (CV). Usually bilateral and more common in females. Most cases are asymptomatic. Demonstrated on an AP cervical spine radiograph with an increased field to include the first and second ribs.

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4
Q

What is the purpose of the Swimmer’s Lateral view?

A

Used to demonstrate the lower cervical and upper thoracic vertebrae. Assesses alignment of the cervico-thoracic junction.

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5
Q

How is the patient positioned for a Swimmer’s Lateral view?

A

Seated or standing with the lateral aspect against the IR. MSP parallel to the IR. Patient raises the arm nearest to the bucky and places the forearm above the head. Arm farthest from the bucky is relaxed downward.

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6
Q

What is the centering point for a Swimmer’s Lateral view?

A

HCR for erect patients. CP at the level of C7 posteriorly (above the jugular notch).

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7
Q

What are the image criteria for a Swimmer’s Lateral view?

A

Cervico-thoracic vertebrae seen in a lateral position.
Humerus elevated and aligned with the vertebral column.
Left and right zygapophyseal joints and articular pillars are superimposed.
Intervertebral disk spaces are open, and vertebral bodies are demonstrated without distortion.
Region of interest (ROI) is centered within the collimated field.

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8
Q

What does the AP (Posterior Oblique) C-Spine projection show?

A

Intervertebral foramina furthest from the IR.
MSP 45° to the IR, chin extended.
CR 15° cranial, centered at thyroid cartilage.
More magnification due to increased OID.
SID: 150 cm.

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9
Q

What does the PA (Anterior Oblique) C-Spine projection show? What is the patient positioning

A

Intervertebral foramina closest to the IR.
MSP 45° to the IR, chin extended.
CR 15° caudal, centered at thyroid cartilage.
Less magnification (preferred for better detail).
SID: 150 cm.

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10
Q

What does an AP (posterior oblique) C-spine view demonstrate?

A

Shows intervertebral foramina furthest from the detector.

Uses 15° cranial angulation. More magnification.

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11
Q

What does a PA (anterior oblique) C-spine view demonstrate?

A

Shows intervertebral foramina closest to the detector.

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12
Q

What is the key indicator of adequate flexion in a lateral C-spine view?

A

Spinous processes should be well separated.

Uses 15° caudal angulation. Less magnification and lower thyroid dose.

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13
Q

What is the key indicator of adequate extension in a lateral C-spine view?

A

Spinous processes should be close together.

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14
Q

Why are lateral flexion and extension C-spine views taken?

A

To check for ligament instability & vertebral mobility.

Used for RA patients before GA.

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15
Q

What is the position of the arm furthest from the bucky in a Swimmer’s Lateral X-ray?

A

The arm furthest from the bucky is relaxed downwards.

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16
Q

What is the CR (central ray) for a Swimmer’s Lateral X-ray?

A

Horizontal CR.

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17
Q

Where is the CP (central point) located for a Swimmer’s Lateral X-ray?

A

At the level of the vertebra prominens (C7) posteriorly.

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18
Q

What is the SID (source-to-image distance) for a Swimmer’s Lateral X-ray?

A

110 cm (erect) - 150 cm (supine).

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19
Q

What are the exposure factors for a Swimmer’s Lateral X-ray?

A

81-85 kVp, 30-60 mAs.

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20
Q

What is the patient positioning for a Swimmer’s Lateral X-ray?

A

Erect/Supine as close to the IR as possible; MSP parallel to the IR; raise the arm nearest the bucky and place the forearm above the head; arm furthest from the bucky is relaxed downwards.

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21
Q

What anatomical structure is well demonstrated in a Swimmer’s Lateral X-ray?

A

The apophyseal joints of C7/T1.

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22
Q

What is an indication of a well-positioned Swimmer’s Lateral X-ray?

A

The posterior ribs and apophyseal joints are seen without superimposition on each other, and the three contour lines can be drawn through the cervicothoracic junction.

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23
Q

What is the aim of using Halo Traction (brace)?

A

To keep the patient’s head still and prevent movement back and forth and side to side.

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24
Q

What does Halo Traction (brace) support?

A

It supports the muscles around the patient’s neck.

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25
What is the patient position for a Lateral Thoracic Spine X-ray?
Supine; move the stretcher so the spine is parallel to the IR; remove arms from the ROI.
26
Where is the HCR (horizontal central ray) located for a Lateral Thoracic Spine X-ray?
At the level of T7 (inferior border of the scapula).
27
Where is the CP (central point) for a Lateral Thoracic Spine X-ray?
Over the spine, generally the posterior third of the thorax.
28
What is the patient position for a Lateral Lumbar Spine X-ray?
Supine; move the stretcher so the spine is parallel to the IR; remove arms from the ROI.
29
Where is the HCR (horizontal central ray) located for a Lateral Lumbar Spine X-ray?
At the level of the iliac crest.
30
Where is the CP (central point) for a Lateral Lumbar Spine X-ray?
Over the spine.
31
What should be demonstrated in a Lateral Lumbar Spine X-ray?
The entire lumbar spine should be demonstrated without rotation, with no distortion of vertebral bodies or foreshortening of spinous processes.
32
What intervertebral spaces should be visualized in a Lateral Lumbar Spine X-ray?
The intervertebral foramina of L1-L4 should be visualized.
33
What should be open in a Lateral Lumbar Spine X-ray?
The lumbar disc spaces should be open.
34
Where is the center for the Horizontal Ray L5-S1 in a Lateral Lumbar Spine X-ray?
Midway between the uppermost ASIS and PSIS with a vertical ray perpendicular to the table center.
35
What is the exposure for a Lateral Lumbar Spine X-ray?
85-90 kVp, 60-80 mAs, 100-110 cm SID, Exposure class 400.
36
Where is the CP (central point) for the Lateral Lumbar Spine X-ray?
4 cm inferior to the iliac crest, midway between the ASIS and PSIS.
37
What are the technical considerations for a Lateral Lumbar Spine X-ray?
Bucky/Free Detector; Exposure Factors: 85 kVp, 80-120 mAs, 110-150 cm SID.
38
What should be demonstrated in a L5-S1 X-ray?
The lumbar-sacral junction should be demonstrated without rotation, with posterior vertebral bodies superimposed and superimposition of the greater sciatic notches.
39
What should be clearly demonstrated in a L5-S1 X-ray?
The intervertebral foramina.
40
What should be open in a L5-S1 X-ray?
The L5/S1 joint space.
41
What indicates no motion in a L5-S1 X-ray?
Clear bony margins and trabecular pattern.
42
How should collimation be adjusted in a L5-S1 X-ray?
Collimation should be to the region of interest (ROI).
43
What projections are used for scoliosis views?
AP T/L spine and Lateral T/L spine.
44
What is the general patient positioning for scoliosis views?
The patient is generally positioned erect.
45
What is the purpose of flexion and extension projections in lumbar vertebrae X-rays?
To demonstrate the degree of motion for the lumbar vertebrae.
46
What is the role of the pelvis in the flexion and extension positions?
The pelvis acts as an anchor and must remain stationary.
47
How is the patient positioned for the flexion position?
The patient is asked to draw their shoulders, hips, and thighs close together while flexing their back.
48
How is the patient positioned for the extension position?
The patient is asked to arch their back.
49
Where is centering done for the flexion and extension positions?
Centering is as for the lateral lumbar spine.
50
What is the patient position for the AP (Posterior Obliques) view?
From supine, the patient is rotated 45° each side in turn and supported.
51
Where is the CR (central ray) for the AP (Posterior Obliques) view?
Vertical Central Ray (VCR).
52
Where is the CP (central point) for the AP (Posterior Obliques) view?
At the level of the LCM (if the entire lumbar spine is to be included) in the mid-clavicular line, or 5 cm laterally from the patient's midline on the elevated side.
53
What anatomical structures does the AP (Posterior Obliques) view demonstrate?
The pars interarticularis and apophyseal joints on the side closest to the IR.
54
What is the patient position for the PA (Anterior Obliques) view?
From prone, the patient is rotated 45° each side in turn and supported.
55
Where is the CR (central ray) for the PA (Anterior Obliques) view?
Vertical Central Ray (VCR).
56
Where is the CP (central point) for the PA (Anterior Obliques) view?
At the level of the LCM, 5 cm lateral to the MSP on the elevated side.
57
What do the apophyseal joints appear as when the correct obliquity is used?
The apophyseal joints appear as a 'Scotty Dog'.
58
What happens if the patient is not obliqued enough in an oblique lumbar spine projection?
The pedicle of the Scotty dog will appear anterior on the vertebral body.
59
What happens if the patient is obliqued too much in an oblique lumbar spine projection?
The pedicle will appear posterior on the vertebral body.
60
What are AP sacroiliac joints (SIJ) used to assess?
Sacroiliitis, ankylosing spondylitis, and dislocation or subluxation of the joint.
61
How is the patient positioned for an AP sacroiliac joint (SIJ) X-ray?
The patient is positioned as for an AP lumbar spine with legs extended. If the SIJ is missed, a PA erect or prone position is preferred for a more specific examination of the SIJ.
62
What is the CR (central ray) angle for an AP SIJ X-ray?
30° cranially for males and 35° cranially for females.
63
What is the CR (central ray) angle for a PA SIJ X-ray?
30° caudally for males and 35° caudally for females.
64
Where is the CP (central point) for an AP SIJ X-ray?
In the midline, 3-5 cm inferior to the level of the ASISs.
65
Where is the CP (central point) for a PA SIJ X-ray?
In the midline, at the level of the iliac crests.
66
What is the image criterion for SIJ X-rays?
The SIJ should be equidistant from the spine, indicating no pelvic rotation. The L5-S1 joint space should be open, and both SIJs should be well visualized.
67
What are the clinical indications for an AP sacrum X-ray?
Ankylosing spondylitis, degenerative joint disease, sacral lesions/cysts, malignancy, and trauma.
68
What is the patient position for an AP sacrum X-ray?
The patient is supine with ASISs equidistant from the table, MSP perpendicular to the table, and knees slightly flexed and supported.
69
What is the CR (central ray) angle for an AP sacrum X-ray?
The CR is angled approximately 10-15° cranially.
70
Where is the CP (central point) for an AP sacrum X-ray?
In the midline, halfway between the ASIS and the symphysis pubis.
71
What should be demonstrated in the image for an AP sacrum X-ray?
Sacral foramina should demonstrate equal spacing. The sacrum should not appear foreshortened. The symphysis pubis should not superimpose the sacrum. Ischial spines should be equally demonstrated, indicating the patient is not rotated.
72
What is the patient position for the Lateral Sacrum and Coccyx X-ray?
The patient is turned onto their side, hands raised and placed on a pillow with elbows resting on each other, knees flexed with a pad placed between them. An imaginary line through the scapulae and pelvis should be perpendicular to the table.
73
Where is the CR (central ray) for a Lateral Sacrum and Coccyx X-ray?
The CR is vertical.
74
Where is the CP (central point) for a Lateral Sacrum and Coccyx X-ray?
Palpate the sacrum and center 5 cm anterior to the posterior sacral surface at the level of the ASIS.
75
What are the image criteria for a Lateral Sacrum and Coccyx X-ray?
The sacrum should be demonstrated in the lateral position without foreshortening. The median sacral crest should be in profile. The greater sciatic notches and pelvic wings should be superimposed. The 5th lumbar vertebra, 1-5 sacral segments, sacral promontory, and first coccygeal segments should be included in the field of view.
76
What is the patient position for an AP Coccyx X-ray?
The patient is supine, with ASIS equidistant from the table, MSP perpendicular to the table, and knees slightly flexed and supported.
77
What is the CR (central ray) angle for an AP Coccyx X-ray?
The CR is angled approximately 10° caudal.
78
Where is the CP (central point) for an AP Coccyx X-ray?
In the midline, approximately 4 cm above the symphysis pubis.
79
What are the key evaluation criteria for an anterior oblique cervical spine X-ray?
Intervertebral foramina should appear almost circular. Intervertebral disc spaces should be open. Base of the skull should not overlie C1. Mandibular rami should not overlie C1.

MEDIMAGE 301 (11 decks)

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