Thoracic Spine And Scoliosis Flashcards
Thoracic Spine Anatomy
-12 thoracic vertebrae
-Bodies increase in size from T1- T12
-T3-T9 are wedge shaped to allow for natural kyphotic curvature
-Spinous processes project sharply inferiorly
-Zygopophyseal joints angled at 70 degrees to MSP
-Intervertebral foramina are perpendicular to MSP
Thoracic Spine Anatomy Continued
The thoracic spine has a natural _________ curvature
Kyphotic (concaves anteriorly)
The thoracic vertebrae lie in the _________ half of the thorax in relation to the MCP
Posterior
Intervertebral joints are __________ __________ joints
cartilaginous symphysis
Zygapophyseal joints are _________ __________ joints
synovial gliding
Movements of the vertebral column include:
-Flexion
-Extension
-Lateral flexion
-Rotation
Zygapophyseal joints are formed by the _________ and_________ articular processes.
superior, inferior
Zygapophyseal joints at ___ angle to MSP
70 degree
The 12 thoracic vertebrae have ___ corresponding pairs of ribs.
12
The articulation of the rib and vertebral body is called ____________ and they are __________ ________ joints
costovertebral, synovial gliding joints
Vertebra have ______ ________ for articulation with the head of the ribs
costal facets
T1 has a whole facet on the _________ border and a demi-facet on the _________ border
Superior, Inferior
T2-T8 have _____________ superiorly and inferiorly
demi-facets
T9 has only one _________ demi-facet
Superior
T10-T12 have single whole _________ at the superior margins
Facets
Vertebral bodies and transverse processes have costal facets for articulation with the ____
Ribs
T1-T10 have articulating facets on each _________ __________
transverse process
T1-T10 Articulate with the tubercles of the ribs forming the _____________ joints
COSTOTRANSVERSE
COSTOTRANSVERSE joints are what kind of joints
Synovial gliding joints
The rays towards the cathode side of the tube are more
Intense
anode heel effect
-a variation in intensity of the x-ray beam from the anode to the cathode end
-The thorax is thinner at the superior than the inferior end, which means we use the anode heel effect to attain uniform density on the image
AP Throacic Spine Positioning
-14 X 17 Cassette LW in bucky
-SID: 40 inches
-Patient supine or upright
-If patient supine, rest their head on the table and flex their knees
-Superior border of IR should be 1 ½” to 2 inches above shoulders
-CR perpendicular to the MSP at T7
-Collimate closely to the spine
-Shield gonads
-Respiration may be shallow breathing OR full expiration
AP THORACIC SPINE EVALUATION CRITERIA
-All 12 thoracic vertebrae
-Thoracic bodies, intervertebral disc spaces, transverse processes, costovertebral articulations
-Vertebral column in the middle of the image
-No tilt or rotation:
-Spinous processes in the midline of the vertebral bodies
Lateral Thoracic Spine Positioning
-14 x 17 Cassette LW in bucky
-40” SID (May use 48”)
-Patient in lateral recumbent or upright in lateral , preferably left side down
-Long axis of vertebral column horizontal or in true lateral if upright
-Flex hips and knees and arms at right angles if recumbent
-Superior border of IR 1 1/2 to 2 inches above shoulder
-CR perpendicular to T7 just posterior to the MCP
-Lead strip placed behind the patient to reduce scatter
-Collimate
-Respiration may be shallow breathing OR full expiration
Lateral Thoracic Spine Evaluation Criteria
-Lateral projection of thoracic bodies, disk spaces, intervertebral foramina, and lower spinous processes and clearly seen through the rib and lung shadows
-12 Thoracis vertebrae centered on IR (upper T spine not well visualized due to shoulder)
-Superimposition of the shoulders on upper vertebrae (T1-T3)
-No Rotation:
-Ribs Superimposed posteriorly
-Open intervertebral disk spaces
PA Oblique Thoracic Spine Positioning
-14 X 17 Cassette LW in the bucky
-SID: 40-48 inches
-Patient standing in a lateral position
-Rotate patient 20 degrees (anteriorly) so that the coronal plane form an angle of 70 degrees to the IR
-Rest adjacent shoulder on the IR
-Superior border of IR should be 1 1/2 to 2 inches above shoulder
-CR: Perpendicular entering level of T7
-Shoulders in same horizontal plane
-Collimate to spine
-Shield gonads
-Suspend respiration at full expiration
AP Oblique Upright, AP Recumbent Oblique, and PA Recumbent Oblique
AP Oblique Upright
-Patient in a lateral position
-Rotate patient 20 degrees (posteriorly) so that the coronal plane form an angle of 70 degrees to the IR
-All else the same (meaning the same as PA Oblique View)
AP Recumbent Oblique
-Patient in a lateral recumbent position
-Rotate patient 20 degrees (posteriorly) so that the coronal plane form an angle of 70 degrees to the IR
-Place lower arm at right angle to the body
-Rest the patients head
-All else the same
PA Recumbent Oblique
-Patient in a lateral recumbent position
-Rotate patient 20 degrees (anteriorly) so that the coronal plane form an angle of 70 degrees to the IR
-Position down arm behind the body & use upper arm to support the patient
-All else the same
OBLIQUES THORACIC SPINE EVALUATION CRITERIA
-Thoracic zygapophyseal joints are best visualized in this position
-For AP obliques, the side farthest from the IR is seen
-For PA obliques, the side closest to the IR is seen
SWIMMER’S METHOD Thoracic Spine Positioning
-SID: 30 inches in book (40 inches in lab)
-10 X 12 Cassette LW in the bucky
-Patient in left lateral recumbent position for the PAWLOW method
-Patient in left lateral upright position for the TWINING method
-Extend the arm closest to the IR over the head and move humeral head slightly anteriorly or posteriorly
-MCP centered, MSP parallel to the IR
-Position other arm down the patient’s side, depress shoulder a much as possible, and move humeral head in opposite direction (anterior/posterior) as other arm
-CR ⟂or angled 3 to 5 degrees caudal to the level of the C7-T1 disk space (use angle for lab)
-Center to 2 inches above jugular notch
-Respiration: Suspend or use a breathing technique
SWIMMER’S METHOD Thoracic Spine Evaluation Criteria
-Lateral projection of the cervicothoracic vertebrae between the shoulders
-Adequate x-ray penetration through the shoulder region demonstrating the lower cervical and upper thoracic vertebra, not rotated from lateral position
-Humeral heads minimally superimposed
KYPHOSIS
-Most common in older women
-Bones may become weak due to calcium and density loss(osteoporosis)
-Osteoporosis may cause compression fractures of the thoracic spine
SCOLIOSIS
-Lateral deviation of the spine, with possible vertebral rotation
-Often develops during the pre-teen or teen years, more often in females
-Its unknown etiology is referred to by the term “idiopathic” scoliosis
SCOLIOSIS SERIES FRANKET METHOD Positioning
-Position: Upright
-PA:
-Center MSP, arms down by side
-ASIS equidistant from IR
-Lateral:
-MSP is parallel, MCP is ⟂ to IR
-Arms extended
-CR: ⟂ to center of IR
-Collimation: to anatomy
-Shield gonads and breasts, use ruler if needed
-Respiration: Suspend
SCOLIOSIS SERIES: EOS IMAGING SYSTEM
-Biplane body scan in less than 20 seconds produces AP and Lateral images (+3D model)
-Low dose technology (micro dose)
-Available at pediatric hospitals and spine centers
The Zygapophyseal joints of the the T spine lie at a ___ degree angle to the MSP
70
