Thoracic Spine

Question 1

How do you take thoracic images?

Answer 1

to patient tolerance (standing or seated)

MUST be recumbent if ruling out a fracture

Question 2

Why is filtration needed for thoracic imaging?

Answer 2

create consistent radiographic density for anatomy shown

Question 3

What is the main differences between thoracic and cervical imaging

Answer 3

align film to part, THEN CR to IR

Question 4

where should you place filtration? Why?

Answer 4

over the thinnest portion of the anatomy to maintain consistent density on the final radiographic image

Question 5

set up flow for thoracic films

Answer 5

1. measure for all set-uups in the series
2. set control panel
3. set SID
4. set collimation and apply side marker
5. apply lead shielding to patient
6. position patient at bukcy
7. align cassette to patient
8. align CR to center of cassette

Question 6

if patient is over 50 and their main complaint is in the thoracics, what thoracic films do you take?

Answer 6

AP
lateral
PA chest

Question 7

if patient is over 60, what thoracic films do you take

Answer 7

PA and lateral chest

Question 8

AP thoracic spine measurements and positioning

Answer 8

measure over shoulder, spine to lower 1/3 of sternum
14x17 cassette vertical
collimate 7x17
top of cassette 1 1/2” above VP
CR to mid-film
filter UPPER VERTERAE DOWN TO CROSS HAIRS
breathe in and hold

Question 9

where should the ID blocker be in the AP thoracic spine?

Answer 9

down

Question 10

image criteria for AP thoracic spine

Answer 10

spine in center of image, including T1-T12
spinouses align with midline of vertebral bodies
distance betweeen vertebral column to ends of clavicle equal
distance from pedicles to spinous processes are equal on both sides
uniform film density from top to bottom of thoracics

Question 11

lateral thoracic spine measurement and positioning

Answer 11

arms in “prayer” position, measure R to L axilla
14x17 cassette vertical
top of cassette 1 1/2” above VP
align film to part and horizontal CR to film same as AP
vervical CR posterior to humeral head
collimate 10x17
filter lower vertebra (up to cross hairs of CR)
place side markder and raise arms
select breathing technique or breathe in and hold

Question 12

breathing technique

Answer 12

patient breathes during exposrue to blur ribs
need minimum 2 seconds exposure
compensate by decreasing MA

Question 13

image criteria for lateral thoracic

Answer 13

include T1-12
IVFs and disc spaces open
pedicles in profile
posterior borders of bodies and ribs superimposed
uniform density

Question 14

special considerations for cervical and thoracic spine

Answer 14

seated if possible (weight bearing, may be able to do in wheelchair)
stabilizing accessories utilized- including leaded assistant
adapt equipment to accommodate exaggerated curvatures

Question 15

if weight bearing is untolerable, how do you take thoracic and cervical films?

Answer 15

recumbent

Question 16

swimmer’s positioning

Answer 16

10x12 cassette vertical
patient lateral with arm closest to bucky in full extension
horizontal CR to T1
drop independent shoulder
vertical CR to spine
collimat\e to film size
breathe out and hold

Question 17

if someone’s ribs hurt in the back, what kind of film do you need to take?

Answer 17

AP ribs

Question 18

Why would you take posterior oblique ribs?

Answer 18

to look into rib cage

see between ribs

Question 19

if the rib hurting is below the diaphragm, what are the breathing instructions?

Answer 19

exhale and hold

Question 20

if the rib hurting is above the diaphragm, what are the breathing instructions?

Answer 20

inhale and hold

Question 21

how should you orientate the patient for a rib film?

Answer 21

injured part closest to bucky

Question 22

where should the cassette be if the hurting rib is above the diaphragm?

Answer 22

top of cassette 1 1/2” above VP

Question 23

where should the cassette be if the hurting rib is below the diaphragm?

Answer 23

bottom of the cassette at the iliac crests

Question 24

where should the CR be for a rib film?

Answer 24

mid-film

Question 25

describe bilateral AP or PA rib films

Answer 25

14x17 transverse

injured part closest to bucky

Question 26

where should the film be if the bilateral rib pain is above the diaphragm?

Answer 26

top of cassette 1 1/2” above shoulders

Question 27

where should the film be if the bilateral rib pain is below the diaphragm?

Answer 27

bottom of the cassette at crest

Question 28

describe posterior oblique rib films

Answer 28

14x17 cassette vertical
rotate UNAFFECTED side 45 degrees AWAY from bucky
above diaphragm: top of cassette 1 1/2” above VP
below diaphragm: bottom of cassette at crest

Question 29

for thoracic films, what is considered weight bearing?

Answer 29

standing or seated

Question 30

what should you use as a double check for correct cassette placement?

Answer 30

sternal notch

Question 31

how are ribs performed in the Palmer clinics?

Answer 31

recumbent