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application of imaging 1 > whole spine > Flashcards

whole spine Flashcards

1
Q

spinal stability?

A

The junctions of the
curves create natural
areas of weakness

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2
Q

what % of fractures occur in the T-spine region?

A

Approximately 20% spinal fractures happen in the T-spine region

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3
Q

what % of fractures occure between T11 and L4?

A

90 % fractures are
seen between T11 and L4

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4
Q

stable?

A

1 Column

Often managed conservatively
A weight bearing fracture in some cases
Does not usually involve spinal cord injury
Can become multi-column if managed incorrectly

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5
Q

unstable?

A

Multi column

Requires correction/surgery
Integrity of spinal cord at risk
Possible instantaneous paralysis
Not a weight bearing injury

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6
Q

common clinical indications for the spine?

A

Blunt trauma
Axial loading
Hyper-extension, hyper-flexion
Degenerative change
OA/RA
Congenital cause

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7
Q

spicfic clinical indications for lumbar spine?

A

Trauma
Pain (sudden onset or longstanding & increasing)
?osteoporotic collapse
? Bone primary/hot spot
? Osteomyelitis
SI joint lesion

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8
Q

L-spine AP patient position?

A

Patient supine on x-ray table
M-S plane in midline at right angles to the cassette
Patient’s head on pillow, arms by side
ASIS equidistant from table top
Shoulders equidistant from table top
Hips and knees flexed

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9
Q

L-spine AP centering point?

A

Central ray vertical to the image receptor
Midline at level of lower costal margin
Expose on arrested expiration

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10
Q

L-spine AP imaging criteria?

A

Bony cortex and trabeculae seen - kVp
Intervertebral disk spaces demonstrated.
T12-Sacroiliac joints demonstrated.
Sacroiliac joints are equidistant from the spine.

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11
Q

L-spine lateral patient position?

A

SUPINE: Lay patient on table in the lateral position
M-S plane parallel and middle of axilla coincident with midline of table.
Arms raised and folded over head
Vertebral column parallel to cassette
ASIS superimposed
Shoulders superimposed
Can be done standing/erect too

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12
Q

L-spine lateral centering point?

A

Central ray vertical to the image receptor
8-10cm anterior to spinous processes at level of lower costal margin (L3)
Expose on arrested expiration

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13
Q

L-spine imaging criteria?

A

Bony cortex and trabeculae seen.
Intervertebral disk spaces demonstrated.
Bodies of T12-L5/S1 demonstrated.
Vertebral endplates superimposed.
Cortices at the posterior and anterior margins of the vertebral body should also be superimposed. (No double edges)
The imaging factors selected must produce an image density sufficient for diagnosis from T12 to L5/S1, including the spinous processes.

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14
Q

additional lumbar spine views?

A

posterior/anterior obliques
horizontal beam lateral
lateral flexion and lateral extension
erect spine
side bending APs
AP L5/S1 projection

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15
Q

L5/S1 lateral patient position?

A

Same as lateral L-spine

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16
Q

L5/S1 lateral centering point?

A

Central ray vertical to the image receptor
8cm anterior L5 spinous process
PSIS

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17
Q

sacrum PA patient position and centering point?

A

Patient is prone
Central ray perpendicular to IR then angled caudally 10° -25°
Midway between PSIS
Ensures x-ray beam is 90° to sacrum

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18
Q

sacro-iliac joints?

A

To position patient in order to bring the SI joint 90° to the imaging plate and enable the diverging x-ray beam to pass through the joint rather than across the joint (PA not AP).

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19
Q

sacrum lateral?

A

Centred over the sacrum, this view is usually performed under specialist request and helps tovisualise pathology of the sacrumand coccyxNot performed very often

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20
Q

left and right posterior oblique L-spine?

A

To demonstrate the pars interarticularis. Side closest to the IR is demonstrated.

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21
Q

horizontal beam lateral lumbar spine?

A

To avoid moving the trauma patient and avoid exacerbating their injury and causing potential paralysis

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22
Q

lateral flexion and extension lumbar?

A

To assess the degree of movement/flexibility in the spine with the patient flexed forwards and extended backwards – Specialist orthopaedic request

23
Q

erect PA (whole spine)?

A

To assess the affect of gravity on the scoliosis spine
To measure Cobb angle - measurement to assess the degree of curvature

24
Q

side bending APs?

A

To assess the degree of flexibility in the scoliosis spine with the patient bending to the L and R, and give an indication of the level of spinal fusion.
Performed with horizontal beam
Tend to image Lumbar and Thoracic spine separately as apposed to one whole image.

25
Q

spicfic clinical indications thoracic spine?

A

Trauma
Pain ?osteoporotic collapse
? Bone primary/hot spot
? Osteomyelitis
? Arthropathy
Orthopaedic follow up

26
Q

T-spine AP projection patient position?

A

Patient supine with legs straight
M-S plane in midline at right angles to the cassette
Upper edge of IR at level just below prominence of thyroid cartilage
Patient’s head on pillow, arms by side
Shoulders equidistant from IR
ASIS equidistant from tabletop

27
Q

T-spine AP projection centering point?

A

Central ray vertical to the image receptor
Midline at level 5cm below sternal notch (T7)/ midway between xiphisternum and sternal notch
Ensure tube locked/aligned with bucky

28
Q

T-spine AP projection image criteria?

A

Bony cortex and trabeculae visualised - kVp
C7 – L1 demonstrated
Intervertebral disk spaces demonstrated
Spinous process should be central within vertebral bodies (no rotation).

29
Q

T-spine lateral patient position?

A

Lay patient on table in the lateral position
M-S plane parallel and middle of axilla coincident with midline of table or vertical IR
Arms raised and folded over head
Vertebral column parallel to cassette
Shoulders superimposed
ASIS superimposed

30
Q

T-spine lateral centering point?

A

Central ray vertical to the image receptor
3 – 4” below suprasternal notch (T7)
Perpendicular to mid-axillary line
Expose on arrested inspiration, in practice this is the armpit

31
Q

T-spine lateral image criteria?

A

Bony cortex and trabeculae seen - kVp
Intervertebral disk spaces demonstrated.
Intervertebral foramina superimposed
Bodies of T3-T12 demonstrated.

32
Q

thoracic spine considerations?

A

Different range of densities overlying TSP = different attenuations of the XR beam
Upper TSP superimposed by air filled trachea
Lower TSP superimposed by denser heart + liver
Thinner AP at top, thicker at bottom
Ribs superimpose TSP lateral
Difficult to demonstrate whole AP TSP in one projection

33
Q

thoracic spine solutions?

A

High KVp – demonstrates TSpine in useful density range
Filters to even out densities (not often used these days)
Anode heel effect – anode cranially ensures higher intensity of XR beam directed at the larger/denser lower end of the T-Spine
Gentle breathing blurs out ribs (not often used due to longer exposure time/increased dose and risk of unsharpness of spine).

34
Q

C-spine injury prevalence?

A

The most common mechanism of injury is accidental falls
Followed by motor vehicle/transport injuries.
A common site of injury is the atlantoaxial region
the most commonly injured levels in the subaxial cervical spine are C6 and C7.
1/3 of injuries identified are considered clinically insignificant.
Despite surprising number of clinically minor injuries, 55% of spinal cord injuries occur in the cervical spine region.

35
Q

cervical spine specific clinical indications?

A

Trauma
Unconscious patient (Unsure of injury if fallen)
? Ankylosing spondylitis
? Bone primary/hot spot
? Osteomyelitis
? RA
Pain and radiculopathy

36
Q

C-spine AP patient position?

A

Patient erect/supine with posterior aspect of head and shoulders against IR
M-S plane in midline at right angles to the IR
Depress/relax the shoulders
Elevate patient’s chin so that symphysis menti and occiput are superimposed

37
Q

C spine AP centering point?

A

Centre vertical central ray to sternal notch – then angle central ray
Cranially to the thyroid cartilage (5-15º)

38
Q

essential image characteristics?

A

The image must demonstrate the third cervical vertebra down to the cervical-thoracic junction.
Lateral collimation to soft tissue margins.
The chin should be superimposed over the occipital bone

39
Q

C-spine lateral patient position?

A

Patient stands with the affected side against the erect chest stand. Feet slightly apart.
M-S plane parallel to the IR
Chin slightly raised preventing the angle of the mandible from being superimposed over bodies of the upper cervical vertebrae
Ask patient to depress shoulders

40
Q

C-spine lateral centering point?

A

Central ray horizontal to the image receptor (SID = 180)
Centre at level of C4 (2.5cm behind, 5cm below angle of mandible)

41
Q

C spine lateral image characteristics?

A

Entire cervical spine and upper part of T1 should be included (C7-T1 joint space).
Mandible or occipital bone should not obscure any part of the upper vertebra.
Angles of the mandible and the lateral portions of the floor of the posterior cranial fossa should be superimposed.
Soft tissues of the neck should be included.

42
Q

air gap technique?

A

Gap between C-spine & IR
Reduces amount of scatter reaching the IR – improving image quality without need for a grid.
Removing need for a grid means exposure factors and therefore dose can be reduced.
Increased SID with air-gap can counteract magnification
Increased SID can prevent geometric unsharpness.

43
Q

c spine peg view (AP C1-C2) patient position?

A

Patient erect/supine with posterior aspect of head and shoulders against IR
M-S plane in midline at right angles to the IR
Neck extended so that the inferior border of the upper incisors are superimposed on the occiput (an imaginary line joining the tip of the mastoid and the inferior border of the upper incisors is at right angles to the IR)
Immediately prior to exposure ask patient to open mouth as wide as possible.

44
Q

c spine peg view (AP C1-C2) centering point?

A

Central ray vertical to the image receptor
Level of lower border of incisors (through open mouth)

45
Q

c spine peg view (AP C1-C2) collimation?

A

SUP: Upper C1
INF: Body C3
LAT: Transverse process
Note: Difficult examinations may require adapted technique…

46
Q

c spine peg view (AP C1-C2) image criteria?

A

Upper teeth and occiput superimposed
Odontoid peg and articulation demonstrated through open mouth
NO ROTATION (can mimic misalignment of lateral masses) Ensure symmetry of lateral masses

47
Q

C spine anatomical projections?

A

Anterior/posterior obliques
Horizontal Beam Lateral
Lateral extension
Lateral flexion
Lateral C7/T1 (Swimmers View)

48
Q

lateral flexion and lateral extension?

A

To assess range of movement for cervical spondylosis
To assess stability of spine
To assess atlanto-axial joint for RA patients prior to intubation for anaesthetic.

49
Q

spondylitis?

A

Inflammation of the vertebrae

Ankylosing Spondylitis:
a painful, progressive, rheumatic disease
mainly affects the spine
can also affect other joints, tendons and ligaments.
Bamboo spine

50
Q

spondylosis?

A

General term for degenerative changes due to OA (Osteoarthritis)

Can affect cervical, thoracic and lumbar regions

Bony spurs

51
Q

spondylolysis?

A

Defect of the pars interarticularis

Stress injury common in young athletes

52
Q

spondylolisthesis?

A

Anterior displacement of vertebra or vertebral column
Most common in L4/L5 and L5/S1
Graded 1-4
Retrolisthesis is displacement posteriorly in the opposite direction

53
Q

spinal variations?

A

kyphosis
lordosis
scoliosis

application of imaging 1 (8 decks)

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