Cervical and Thoracic Spine

How many bones make up the adult vertebral column?

26

The spinal cord tapers off to a point distally at the level of:

L1-L2.

Which of the following curves is classified as being compensatory?

Cervical

Scoliosis is defined as an abnormal or exaggerated:

lateral curvature.

Kyphosis is defined as a(n):

abnormal thoracic curvature with increased convexity.

The bony structures connected directly to the vertebral body are the:

pedicles

The most posterior aspect of a typical vertebra is the:

spinous process

The joints between articular processes of vertebra are termed:

Zygapophyseal joints

Which aspect of the intervertebral disk is composed of semigelatinous material?

Nucleus pulposus

Which of the following statements is true?

All thoracic vertebrae have at least one facet for rib articulation

Which of the following statements is true for a typical adult vertebra?

The transverse processes extend laterally from the junction of the pedicles and laminae

Which of the following features makes the cervical vertebra unique as compared with other vertebrae of the spine?

All of the above A. Transverse foramina and double (bifid) tips on spinous processes C. Presence of zygapophyseal joints

B. Overlapping vertebral bodies

Where is the articular pillar located on a cervical vertebra?

Between the superior and inferior articular processes

Which term best defines or describes the vertebral body of C1?

There is no vertebral body at C1.

Which of the following thoracic vertebra(e) possess no facets for costotransverse joints?

T11-12

The zygapophyseal joints for the typical cervical vertebra lie at an angle of ____ in relation to the midsagittal plane.

90

The most prominent aspect of the thyroid cartilage corresponds to the vertebral level of:

C5.

The zygapophyseal joints for the thoracic spine lie at an angle of ____ in relation to the midsagittal plane.

70

T2-3 intervertebral disk space is found at the level of the:

jugular notch.

The gonion corresponds to the vertebral level of:

C3

The xiphoid process corresponds to the vertebral level of:

T10

Along with increasing the SID, what other factor will improve detail for lateral and oblique projections of the cervical spine?

Using a small focal spot

Which of the following pathologic conditions is defined as "a condition of the spine characterized by rigidity of a vertebral joint"?

Spondylosis

Which of the following pathologic conditions will require a decrease in manual technical factors?

Advanced osteoporosis

Which factor is most important to open up the intervertebral joint spaces for a lateral thoracic spine projection?

Keep vertebral column parallel to tabletop

Which position and/or projection of the cervical spine will best demonstrate the zygapophyseal joint spaces between C1 and C2?

AP open mouth

Along with the upper incisors, what other bony landmark must be aligned for the AP open-mouth projection?

Base of skull

How much CR angulation is required for the AP axial projection for the cervical spine?

15 to 20 cephalad

Why are the anterior oblique projections (RAO/LAO) preferred over the posterior oblique projections of the cervical spine?

Less thyroid and breast dose

Which of the following positions will demonstrate the left intervertebral foramina of the cervical spine?

LAO

Which of the following positions will best demonstrate the zygapophyseal joints of the cervical spine?

Lateral

Which of the following is not a correct criterion for the AP axial C spine projection?

All of the above are correct criteria. A. C3 to T2 or T3 vertebral bodies should be visible. C. Center of the collimation field is at C4.

B. Spinous processes are seen to be equal distances from the vertebra body lateral borders.

Which of the following factors does not apply to a lateral projection of the cervical spine?

Suspend respiration upon full inspiration.

Why is the chin extended for a lateral projection of the cervical spine?

To prevent superimposition of the mandible upon the spine

The PA projection (Judd method) is intended to demonstrate the zygapophyseal joint between C1 and C2.

False

The posterior cervical oblique projections demonstrate the intervertebral foramina and pedicles on the side closest to the image receptor.

False

The AP axial-vertebral arch projection may be performed to better demonstrate the:

articular pillars of C4-7.

What type of CR angle must be used when performing the AP axial C spine projection erect?

20 cephalad

What type of CR angle is required for posterior oblique (LPO/RPO) positions of the cervical spine?

15 cephalad

Which of the following factors will enhance the visibility of the vertebral bodies during a lateral projection of the thoracic spine?

Use a breathing technique

Which of the following positions will best demonstrate the left zygapophyseal joints of the thoracic spine?

RPO

How much rotation of the body is required for an LAO projection of the thoracic spine (from the plane of the table)?

70

Which of the following projections will project the dens within the shadow of the foramen magnum?

AP projection (Fuchs method)

Situation: A radiograph of an AP open-mouth projection of the cervical spine reveals that the zygapophyseal joints are not symmetric. No fracture or subluxation are present. Which one of the following positioning errors most likely lead to this radiographic outcome?

Rotation of the spine

Situation: A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral joints are not open. The following factors were used for this projection: 5 cephalad angle, 40-inch (100 cm) SID, grid, slight extension of the skull, and the CR centered to the thyroid cartilage. Which of the following modifications should be made during the repeat exposure?

Increase the CR angulation.

Situation: A radiograph of an AP thoracic spine projection reveals that the upper thoracic spine is overexposed. The lower vertebrae have acceptable density and contrast. Which one of the following modifications will improve the visibility of the upper thoracic spine?

Use a compensating (wedge) filter.

Situation: A radiograph of a lateral thoracic spine reveals that there is excessive density along the posterior aspect of the spine. Even with good collimation, the scatter radiation reaching the image receptor obscures the spinous processes. What can the technologist do to improve the visibility of the posterior elements of the spine?

Place a lead mat on the tabletop just posterior to the patient.

Situation: A radiograph of an AP open-mouth projection reveals that the base of the skull is superimposed over the dens. What positioning error led to this radiographic outcome?

Excessive extension of the skull

Situation: A radiograph of a lateral projection of the cervical spine reveals that the ramus of the mandible is superimposed over the spine. What could the technologist have done to prevent this?

Increase the extension of the skull.

Situation: A radiograph of an RAO of the cervical spine reveals that the lower intervertebral foramina are not open. The upper vertebral foramina are well visualized. Which positioning error most likely lead to this radiographic outcome?

Insufficient rotation of the upper body

Situation: A patient comes to the radiology department for a cervical spine routine. The study is ordered for nontraumatic reasons. The AP open-mouth projection reveals that the base of the skull and upper incisors are superimposed, but they are obscuring the upper portion of the dens. On the repeat exposure, what should the technologist do to demonstrate the entire dens?

Perform the Fuchs or Judd method.

Situation: A patient enters the ER because of a motor vehicle accident. The patient is on a back board and wearing a cervical collar. The technologist is concerned about the artifacts that the collar will project on the spine during the horizontal beam lateral projection. What should the technologist do in this situation?

Leave the collar on during the exposure

Situation: A lateral projection of the thoracic spine reveals that the upper aspect, which is a primary area of interest on this patient, is obscured by the patient's shoulders. Which of the following changes will best demonstrate this region of the spine?

Perform a cervicothoracic (swimmer's) lateral position

Situation: A patient enters the ER with a cervical spine injury as a result of a fall. The initial horizontal beam lateral projection reveals no subluxation or fracture. The ER physician is concerned about a whiplash injury. Which of the following routines would be most helpful in diagnosing this type of injury?

Patient in hyperflexion and hyperextension lateral positions

Situation: A patient comes to radiology for a thoracic spine routine. The patient has a history of arthritis of the spine. The radiologist requests that additional projections be taken to demonstrate the zygapophyseal joints. What positions and/or projections would be ideal to demonstrate these structures?

70 oblique projections

An RPO position of the cervical spine requires a 45 oblique of the body with a 15 caudad CR angle.

False

The breast dose for a posterior oblique thoracic spine is more than four times the dose of an anterior oblique.

True

The anterior oblique thoracic spine demonstrates the upside zygapophyseal joints.

False

For an average-size adult, which of the following would receive the highest skin dose?

Lateral thoracic spine

The thyroid dose for a posterior cervical oblique is ____ greater than that of the anterior oblique.

More than 10 times

Situation: A digital (CR) radiograph taken of a lateral thoracic spine projection demonstrates poor visibility of the spine. The image was taken on a full 14 17-inch (35 43 cm) IR. The following factors were used during the exposure: 80 kV, 80 mAs, 40-inch (102 cm) SID, and collimation to the size of the IR. Which one of the following modifications will result in a more diagnostic image?

Collimate to spine

Situation: Patient comes to radiology for a follow-up study of the cervical spine. The patient had spinal fusion between C5-6 performed 6 months earlier. His physician wants to assess the cervical spine for anteroposterior mobility. Which of the following projections would provide this assessment?

Hyperflexion and hyperextension projections

Which one of the following projections will best demonstrate a compression fracture of the thoracic spine?

Lateral projection

Which imaging modality will best demonstrate HNP in the cervical spine?

MRI

Situation: A patient enters the ER due to a MVA. He is on a back board and in a cervical collar. The initial lateral cervical spine projection demonstrates C1 to C6. The patient has broad and thick shoulders. Because the hospital is in a rural setting, no CT scanner is available. Which of the following modifications would best demonstrate the lower cervical spine?

Perform the horizontal beam cervicothoracic (swimmer's) lateral position.

Situation: A patient comes to radiology for a follow-up study for a clay shoveler's fracture. Which of the following projections will best demonstrate this fracture?

Lateral cervical spine

Comminuted fracture of the anterior and posterior arches of C1 caused by an "on-end" impact trauma demonstrated by the offset or spreading of lateral masses:

Jefferson fracture

A disease more common in teenage boys than girls, resulting in spinal curvature

Scheuermann disease

An inflammation of the vertebrae, more common in men ages 20 to 40 years, causing calcification and forming bony ridges between vertebrae, resulting in stiffness and lack of spinal column mobility

Ankylosing spondylitis

Herniation of intervertebral disk into the spinal canal

Herniated nucleus pulposus

Abnormal convex thoracic curvature

Kyphosis

Normal or abnormal: concave lumbar curvature

Lordosis

Fracture through pedicles of C2, usually resulting in anterior subluxation of C2 on C3

Hangman's fracture

Comminuted fragments from anteroinferior and posterior vertebral borders displaced into the spinal canal, frequently resulting in quadriplegia neurologic damage

Teardrop burst fracture

Inflammation of the vertebrae

Spondylitis

A fracture of the vertebral body in which the anterior margin collapses, frequently associated with osteoporosis

Compression fracture