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MRAD2260 > Vertebral Column > Flashcards

Vertebral Column Flashcards

Radiographic Procedure and Image Critique

1
Q

What SID should be set for the lateral projection of the cervical spine?

A

72 inch/ 180 cm

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2
Q

Where should the CR enter for the lateral projection of the cervical spine?

A

Perpendicular to C4 - halfway between EAM and jugular notch

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3
Q

What breathing instructions should be given to the patient for the lateral projection of the cervical spine?

A

Suspend on full expiration to depress the shoulders

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4
Q

How should the patient be positioned for the lateral cervicothoracic swimmer’s projection

A

Elevate arm closest to IR; opposite arm depressed against patient’s side
Center IR to level of C7-T1 interspace
Midcoronal plane perpendicular to IR
Midsagittal plane parallel to IR

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5
Q

What plane should be aligned perpendicular to the IR for the AP open mouth and AP axial projections of the cervical spine?

A

Occlusal plane - edge of upper incisors to base of skull

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6
Q

How should the CR be directed for the AP axial projection of the cervical spine?

A

15-20 degrees cephalad, entering C4

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7
Q

How should the patient be positioned for an AP projection of the thoracic spine?

A

AP supine
Midcoronal plane parallel with IR
Flexed knees/hips
Center IR to MSP and halfway between jugular notch and xiphoid process (T7)
Top of IR 1 1/2 to 2 inches above shoulders

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8
Q

How should the patient be positioned for a lateral projection of the thoracic spine?

A

LEFT lateral recumbent (to avoid magnification of the heart and its superimposition on the spine)
Align thoracic vertebral column parallel to IR
Midcoronal plane perpendicular to IR
Center to posterior half of thorax, at level of T7
Upper border of IR 1 1/2 to 2 inches above shoulders

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9
Q

What breathing technique can be used for the lateral thoracic spine?

A

Suspend on expiration
OR
Breathing technique - use long exposure time (3-4 seconds and decrease mA)

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10
Q

What breathing instructions should be given to the patient for both the thoracic and lumbar spines?

A

Suspend on full expiration

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11
Q

What is the CR for the AP lumbar spine?

A

Perpendicular to the IR at 1-1.5 inch (2.5-4 cm) above iliac crests (L3)

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12
Q

What can be done if the spine is not horizontal/parallel to the IR for the lateral projection of the lumbar spine?

A

Place a radiolucent sponge under lower thorax

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13
Q

What is the CR for the lateral projection of the lumbar spine?

A

1.5 inches (4 cm) above iliac crest (L3); halfway between elevated ASIS and posterior aspect of pelvic ala

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14
Q

What is the CR for the lateral L5-S1 projection of the lumbar spine?

A

On the coronal plane, 2 inches (5cm) posterior to ASIS + 1.5 inches (4 cm) inferior to iliac crests

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15
Q

What can be done if spine is not horizontal for the lateral L5-S1 projection of the lumbar spine?

A

Angle CR caudad: 5 degrees (males); 8 degrees (females) on average
OR
Align CR parallel to interiliac plane

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16
Q

What should be part of the preparation of the patient when imaging the sacrum and coccyx?

A

Ask them to use the rest room before the procedure to empty their bowels and bladder if possible

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17
Q

What is the CR for the AP axial projection of the sacrum?

A

15 degrees cephalad to enter 2 inches (5 cm) superior to the pubic symphysis

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18
Q

What is the CR for the AP axial projection of the coccyx?

A

10 degrees caudad to enter 2 inches (5 cm) superior to the pubic symphysis

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19
Q

Where should the IR/CR be centered for the lateral projection of the sacrum?

A

3-4 inches (7.5-10 cm) posterior to the elevated ASIS

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20
Q

Where should the IR/CR be centered for the lateral projection of the coccyx?

A

3.5 inches (9cm) posterior and 2 inches (5 cm) inferior to the elevated ASIS

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21
Q

What artifacts must be removed when imaging the cervical spine?

A

All jewelry from the neck up
Bra and shirts with metal artifacts
Dental appliances

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22
Q

What image analysis guideline of the cervical spine indicates the lateral projection was positioned with no rotation?

A

Superimposed anterior and posterior aspects of the R and L zygapophyseal joints/articular pillars

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23
Q

What image analysis guideline of the cervical spine indicates the lateral projection was positioned with no tilt toward or away from the IR?

A

Superimposed superior and inferior aspects of the L and R zygapophyseal joints/articular pillars
Open intervertebral disk spaces

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24
Q

What positioning error occurred on a lateral projection of the cervical spine if C1 and C2 are superimposed by the mandibular rami?

A

AML was not parallel to the floor; chin was not elevated enough

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25
Q

What anatomy should be included on a lateral projection of the cervical spine?

A

Sella turcica + clivus
C1-C7
Superior half of T1
Surrounding soft tissues

26
Q

What anatomy should be centered to the exposure field on a lateral cervicothoracic swimmer’s projection?

A

T1

27
Q

What anatomy should be included on a lateral cervicothoracic swimmer’s projection?

A

C5-C7
T1-3

28
Q

What positioning error occurred on an AP open mouth projection of the cervical spine if there unequal spaces between the lateral masses and the dens; with a larger space on the right side of the patient?

A

Patient is rotated; looking to the right (RPO)

29
Q

What positioning error occurred on an AP open mouth projection of the cervical spine if the upper incisors are superimposing the dens?

A

Patient’s occlusal plane is not perpendicular to the IR
Their chin is tilted down (neck is flexed)

30
Q

What corrective action should be taken on an AP open mouth projection of the cervical spine if the occipital bone is superimposing the dens

A

Align occlusal plane perpendicular to the IR
Tilt their chin down (flex neck)

31
Q

What image analysis guidelines of the AP axial cervical spine indicate the patient was positioned without rotation?

A

Spinous process aligned to the midline of cervical bodies
Mandibular angles and mastoid tips equal distances from cervical vertebrae
Distances from vertebral column to medial ends of the clavicle are equal on both sides

32
Q

What image analysis guideline of the AP axial cervical spine indicates that the correct CR angle was used?

A

Open intervertebral disk spaces
Vertebral bodies without distortion
Spinous processes visualized at level of inferior intervertebral disk space

33
Q

What anatomy must be included within the exposure field for an AP axial projection of the cervical spine?

A

C2-C7
Surrounding soft tissues

34
Q

What should the technologist do if C7-T1 is not visualized well on a lateral projection of the cervical spine?

A

Perform a Swimmer’s projection

35
Q

What positioning error occurred on a lateral projection of the cervical spine if the zygapophyseal joints are misaligned inferiorly/superiorly and the vertebral foramen of C1 is demonstrated?

A

Head is tilted toward the IR

36
Q

What corrective action should be taken on an AP axial projection of the cervical spine if the intervertebral disk spaces are closed, and uncinate processes are elongated?

A

Decrease cephalic CR angulation

37
Q

What image analysis guideline of the thoracic and lumbar spines indicate that the patient was positioned without rotation?

A

Spinous process aligned to the midline of vertebral bodies

38
Q

What image analysis guideline of the thoracic and lumbar spines indicates that the patient’s knees and hips were flexed, placing the spine parallel to the IR?

A

Open intervertebral disk spaces

39
Q

What image analysis guideline of the thoracic spine indicates that the image was taken on full expiration?

A

No more than 9 posterior ribs demonstrated above the diaphragm

40
Q

What positioning error occurred on a lateral projection of the thoracic spine if the posterior ribs are not superimposed?

A

Patient is rotated

41
Q

What positioning error occurred on a lateral projection of the lumbar spine if the intervertebral disk spaces are closed?

A

Patient’s spine was not parallel/horizontal to the IR (tilt present)

42
Q

What positioning error occurred on an AP projection of the lumbar spine if the spinous process have shifted to the left of the midsagittal plane (not centered on the vertebral bodies)?

A

Rotation; patient is looking to the right (RPO)

43
Q

What anatomy should be at the center of the exposure field for the AP and lateral projections of the lumbar spine?

A

L3

44
Q

What anatomy must be included on an AP projection of the lumbar spine?

A

T12
L1-5
SI joints and psoas muslces

45
Q

What should a technologist do if the L5-S1 joint space is closed on a lateral projection of the lumbar spine?

A

Perform a lateral L5-S1

46
Q

What positioning error occurred on a lateral L5-S1 projection of the lumbar spine if the L5-S1 intervertebral joint space is closed, and the greater sciatic notches are misaligned superiorly/inferiorly?

A

Tilt - patient’s spine is not parallel/horizontal to the IR

47
Q

What image analysis guideline of the AP axial sacrum and AP axial coccyx indicates the patient was positioned without rotation?

A

Ischial spines equally demonstrated and aligned with pelvic brim
Sacrum and coccyx aligned with pubic symphysis

48
Q

What image analysis guideline of the AP axial sacrum indicates that the proper CR angle was used?

A

S1-5 demonstrated without foreshortening
Sacral foramina demonstrate equal spacing
Pubic symphysis not overlapping sacrum

49
Q

What positioning error occurred on an AP axial sacrum if the pubic symphysis is not aligned with the sacrum, and the sacrum has shifted to the right of the patient?

A

Patient is rotated LPO (looking to the left)

50
Q

What positioning error has occurred on an AP axial sacrum if the sacrum is elongated and the pubic symphysis is superimposing inferior sacral segments?

A

Excessive cephalic CR angulation

51
Q

What image analysis guideline of the lateral sacrum indicates the patient was in a true lateral position?

A

L5-S1 intervertebral foramen is open
Median sacral crest in profile
Greater sciatic notches superimposed (anterior/posteriorly)
Femoral heads aligned

52
Q

What positioning error occurred on an AP axial coccyx if the pubic symphysis is superimposing the coccyx?

A

Insufficient caudal CR angulation

53
Q

What structures are best demonstrated on an AP and PA axial projection of the cervical spine?

A

AP axial - Intervertebral foramina of the side furthest from the IR
(ex: if patient is LPO, we see the right intervertebral foramina)

PA axial - intervertebral foramina of the side closest to IR (ex: if patient is RAO, we see the right intervertebral foramina)

54
Q

What SID should be used for the AP and PA axial oblique projections of the cervical spine?

A

180 cm

55
Q

What is the central ray for the AP and PA axial projections of the cervical spine?

A

AP axial - directed at C4, 15-20 degrees cephalad

PA axial - directed at C4, 15-20 degrees cauda

56
Q

How should the patient be positioned for an AP oblique projection of the lumbar spine?

A

AP supine, RPO and LPO
45 degrees obliquity (but 60 degree obliquity to show L5-S1)

57
Q

What is the CR for the AP and PA oblique projections of the lumbar spine?

A

AP - enter 2 inches medial to elevated ASIS and 1-1.5 inches above iliac crest

PA - enter elevated side, 2 inches lateral to spinous processes and 1-1.5 inches above iliac crest

58
Q

What structures are best demonstrated on an AP and PA oblique projection of the lumbar spine?

A

Zygopophyseal joints and pars interarticularis
AP - side closest to IR (ex: LPO shows left zygopophyseal joints)
PA - side furthest from IR (ex: RAO shows left zygopophyseal joints)

59
Q

What positioning error occurred on an AP oblique projection of the lumbar spine if the pedicle is positioned anterior to the vertebral body?

A

Insufficient obliquity

60
Q

How should the patient be positioned for an AP oblique projection of the SI joint?
Which position demonstrates which SI joint best?

A

25-30 degree obliquity; side of interest furthest from IR
LPO shows right SI joint
RPO shows left SI joint

61
Q

What is the CR for the AP axial projection of the SI joint?

A

30 degrees (males) or 35 degrees (females) cephalad entering the lumbosacral joint (entering MSP 1.5 inches superior to pubic symphysis)

MRAD2260 (3 decks)

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