Thoracic Spine And Scoliosis

Question 1

Thoracic Spine Anatomy

Answer 1

-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

Question 2

Thoracic Spine Anatomy Continued

Answer 2

Question 3

The thoracic spine has a natural _________ curvature

Answer 3

Kyphotic (concaves anteriorly)

Question 4

The thoracic vertebrae lie in the _________ half of the thorax in relation to the MCP

Answer 4

Posterior

Question 5

Intervertebral joints are __________ __________ joints

Answer 5

cartilaginous symphysis

Question 6

Zygapophyseal joints are _________ __________ joints

Answer 6

synovial gliding

Question 7

Movements of the vertebral column include:

Answer 7

-Flexion
-Extension
-Lateral flexion
-Rotation

Question 8

Zygapophyseal joints are formed by the _________ and_________ articular processes.

Answer 8

superior, inferior

Question 9

Zygapophyseal joints at ___ angle to MSP

Answer 9

70 degree

Question 10

The 12 thoracic vertebrae have ___ corresponding pairs of ribs.

Answer 10

12

Question 11

The articulation of the rib and vertebral body is called ____________ and they are __________ ________ joints

Answer 11

costovertebral, synovial gliding joints

Question 12

Vertebra have ______ ________ for articulation with the head of the ribs

Answer 12

costal facets

Question 13

T1 has a whole facet on the _________ border and a demi-facet on the _________ border

Answer 13

Superior, Inferior

Question 14

T2-T8 have _____________ superiorly and inferiorly

Answer 14

demi-facets

Question 15

T9 has only one _________ demi-facet

Answer 15

Superior

Question 16

T10-T12 have single whole _________ at the superior margins

Answer 16

Facets

Question 17

Vertebral bodies and transverse processes have costal facets for articulation with the ____

Answer 17

Ribs

Question 18

T1-T10 have articulating facets on each _________ __________

Answer 18

transverse process

Question 19

T1-T10 Articulate with the tubercles of the ribs forming the _____________ joints

Answer 19

COSTOTRANSVERSE

Question 20

COSTOTRANSVERSE joints are what kind of joints

Answer 20

Synovial gliding joints

Question 21

The rays towards the cathode side of the tube are more

Answer 21

Intense

Question 22

anode heel effect

Answer 22

-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

Question 23

AP Throacic Spine Positioning

Answer 23

-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 halfway between jugular notch and xiphoid process
-Collimate closely to the spine
-Shield gonads
-Respiration: full expiration

Question 24

AP THORACIC SPINE EVALUATION CRITERIA

Answer 24

-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

Question 25

Lateral Thoracic Spine Positioning

Answer 25

-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 normal breathing (breathing technique) with long exposure OR full expiration

Question 26

Lateral Thoracic Spine Evaluation Criteria

Answer 26

-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

Question 27

PA Oblique Thoracic Spine Positioning

Answer 27

-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

Question 28

AP Oblique Upright, AP Recumbent Oblique, and PA Recumbent Oblique

Answer 28

**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

Question 29

OBLIQUES THORACIC SPINE EVALUATION CRITERIA

Answer 29

**-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

Question 30

SWIMMER’S METHOD Thoracic Spine Positioning

Answer 30

-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

Question 31

SWIMMER’S METHOD Thoracic Spine Evaluation Criteria

Answer 31

-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

Question 32

KYPHOSIS

Answer 32

-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

Question 33

SCOLIOSIS

Answer 33

-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

Question 34

SCOLIOSIS SERIES FRANKET METHOD Positioning

Answer 34

-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

Question 35

SCOLIOSIS SERIES: EOS IMAGING SYSTEM

Answer 35

-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

Question 36

The Zygapophyseal joints of the the T spine lie at a ___ degree angle to the MSP

Answer 36

70