spine (l-spine, sacrum, coccyx) Flashcards
where does xiphoid tip correlate?
T9-10
where does lower costal margin correlate to?
L2-3
where does the Iliac crest correlate?
L4-5
where does the ASIS correlate?
S1-2
AP lumbar SID
40 inches
positioning for AP lumbar spine; why?
supine, flex knees and hips; to reduce lordotic curve
CR entrance for AP lumbar spine with a 14x17 field
L4-5 (iliac crests)
CR entrance for AP lumbar spine with a 11x14 field
L3 (lower costal margins)
CR angle for AP lumbar spine
perpendicular to IR
Eval criteria for AP lumbar spine
-__ through __
-Spinous processes equal distance from the _________
-(Open/closed) intervertebral joint spaces
-Lateral margins of the ______________
T12 through S1, pedicles, open, psoas muscle
AP/PA Obliques lumbar spine SID
40 inches
rotation for oblique lumbar spine
45 degrees
positioning for AP Oblique lumbar spine
rotate 45 degrees, bend knees, bring arm further from IR across the chest
CR entrance for AP oblique lumbar spine
L3 (lower costal margin), 1-2 inches above iliac crest and 2 inches medial to ASIS
CR angle for AP oblique lumbar spine
perpendicular
___________ are best visualized with an AP/PA oblique lumbar spine image
zygapophyseal joints
Scotty dog: what is the ear?
superior articular process
Scotty dog: what is the nose?
transverse process
Scotty dog: what is the eye?
pedicle
Scotty dog: what is the neck?
pars interarticularis
Scotty dog: what is the leg?
inferior articular process
Scotty dog: what is the “line behind the ear”?
zygapophyseal joints
Eval criteria for Oblique l spine
-___ to ___
-Zygapophyseal joints closest to the IR _______
-Appearance of the __________
-Posterior edge of the pedicle situated in the ________________
T12 to S1, open, Scotty Dog, center of the vertebral body
Lateral l-spine SID
40 inches
positioning for lateral l-spine
lateral recumbent, flex knees, support between knees/ankles; may place radiolucent support under waist to keep parallel
CR entrance for lateral l-spine on 14x17
L4-5 (iliac crests)
CR entrance for lateral l-spine on 11x14
L-3 (1.5 inches above the iliac crest)
CR angle for lateral l-spine
perpendicular
Eval criteria for lateral l-spine
-___ to __
-Posterior-lateral aspect of vertebral bodies __________
-Open __________________ and _______
T12 to S1, superimposed, intervertebral foramen and disk spaces
SID for lumbar flex/extension
40 inches
positioning for lumbar flex/ext.
prefer standing, but can be done recumbent
CR entrance for lumbar flex/ext. 14x17 field
to fusion site if known; level of iliac crest (L4-5)
CR angle for lumbar flex/ext.
perpendicular
respiration for lumbar spine flex/ext
full expiration
respiration for lateral l-spine
full expiration
respiration for oblique l-spine
full expiration
respiration for AP l-spine
full expiration*
keep the _____________ during lumbar flex/ext. studies
pelvis stationary
SID L5/S1 Spot l-spine
40 inches
CR entrance for L5/S1 Spot l-spine
1.5 inferior to iliac crest and 2 inches posterior to ASIS
CR angle for L5/S1 Spot l-spine
perpendicular; 5-8 caudad if a “hippy” patient
Eval criteria for L5/S1 Spot l-spine
-L-5 vertebral body, first two sacral segments, and an opened L5-S1 joint space
-No rotation indicated by ____________________ and _____________
superimposed posterior vertebral bodies and greater sciatic notches
Eval criteria for L5/S1 Spot l-spine
-__________________, _________________________, and an ______________________–
-No rotation indicated by superimposed posterior vertebral bodies and greater sciatic notches
L-5 vertebral body, first two sacral segments, and an opened L5-S1 joint space
SID for AP axial sacrum
40 inches
CR angle for AP axial sacrum
15 degrees cephalic
CR entrance for AP axial sacrum
at MSP 2 inches above pubic symphysis
Eval criteria AP axial sacrum
-Entire Sacrum
-SI joints
-______ intervertebral joint space
-No rotation indicated by mid sagittal crest in alignment with the coccyx and symphysis pubis / No motion
-______________________ are not superimposed
L5-S1, sacral foramen and pubis
SID for AP axial coccyx
40 inches
CR angle for AP axial coccyx
10 degrees caudal
CR entrance for AP axial coccyx
at MSP 2 inches above pubic symphysis
Eval criteria for AP axial coccyx (1 of 2)
-Entire Coccyx
-No rotation / No motion
-Coccyx free of superimposition and projected (inferior/superior) to pubis
-Coccyx should appear equidistant ___________________
-Segments of the coccyx should appear open. If not, either they could be fused, or the CR angle can be increased due to greater curvature of the coccyx
superior, to the walls of the pelvic opening,
Eval criteria for AP axial coccyx (2 of 2)
-Segments of the coccyx should appear (open/closed). If not, either they could be ______, or the CR angle can be ______________________
open, fused, increased due to greater curvature of the coccyx
how do you prep patient for sacrum/coccyx if you can?
have patient urinate to create uniform background
lateral sacrum/coccyx visualizes ____________
sacrum, L5-S1 joint space, and coccyx
CR angle for lateral sacrum/coccyx
perpendicular
CR entrance for lateral sacrum/coccyx
3-4 inches posterior to ASIS
Eval criteria for lateral sacrum/coccyx
-Sacrum, _____ joint, and coccyx visualized
-No rotation indicated by _____________
-No motion
L5-S1, greater sciatic notches and femoral heads
scoliosis curvature: up to 10 degrees
normal variation
scoliosis curvature: 20 degrees of less
mild curve
scoliosis curvature: 25-40 degrees
moderate curve
scoliosis curvature: 50 degrees or greater
severe curve
AP scoliosis series SID
40-60 inches
lower margin of IR for AP scoliosis series
1-2 inches below iliac crest
CR angle for AP scoliosis series
perpendicular
CR entrance for AP Scoliosis series
at MSP
Eval Criteria for AP Scoliosis
-Thoracic and lumbar vertebrae including ____________
-No rotation indicated by_____________ aligned with the vertebral midline and symmetry of the _________ and _____
-Collimate to ROI
1-2 inches below the iliac crest; spinous processes, iliac wings (ala) and upper sacrum
lateral scoliosis series SID
40-60 inches
place the ________ side of the curve against the IR; why?
convex side “outward side”, beam divergence
for lateral scoliosis series, set lower margin of the IR _______________________
1-2 inches below the iliac crest
CR angle for lateral scoliosis
perpendicular
respiration for lateral scoliosis
expiration
respiration for AP scoliosis
expiration
respiration for AP axial sacrum
suspend respiration
respiration for AP axial coccyx
suspend respiration
respiration for lateral sacrum/coccyx
suspend respiration
how do you determine if you use a perpendicular vs 5-8 degree caudal angle on a L5-S1 spot?
interiliac line