WEEK 16 Swimmer’s View and T-Spine Projections

Flashcards covering the key concepts of Swimmer’s view and T-Spine projections, focusing on positioning, technical considerations, and procedures.

What is the central ray (CR) direction for the Swimmer’s view?

Perpendicular

What should be done if the shoulder can't be depressed away from the image receptor (IR) in the Swimmer’s view?

Angle the CR 5° caudad.

What is the central point (CP) for the Swimmer’s view?

MCP at the level of C7/T1 or 2 inches (5 cm) above the sternal notch.

Which spinal levels must be included in a Swimmer’s view?

C5 to T3.

What structure is often superimposed by the raised clavicle in the Swimmer’s view?

C7.

What breathing instruction is given for the Swimmer’s view?

suspend after full Expiration.

What is the preferred patient position for a Swimmer’s view?

Lateral, left side to the IR, can be upright or recumbent.

How should the arm closest to the IR be positioned in the Swimmer’s view?

Raised—upright: flex elbow and rest forearm on head; recumbent: head rests on raised arm.

How should the arm away from the IR be positioned in the Swimmer’s view?

Down the patient’s side, shoulder depressed and gently guided posteriorly.

Why is the shoulder guided posteriorly in the Swimmer’s view?

To separate the humeral heads anterior/posterior for clearer spine visualization.

What are key positioning checks in the Swimmer’s view?

Spine aligned, no tilt, head and spine lateral, MSP parallel to IR, MCP perpendicular to IR.

What filters are used in the Swimmer’s view?

Ingot filter on shoulder away from IR, decubitus filter on the tube.

Why is the Swimmer’s view performed?

To visualize C5–T2, especially when standard lateral C-spine doesn’t show this region well.

What makes the C5–T2 region important to image?

It is a common site for fractures due to the junction of cervical and thoracic curves.

When is a Swimmer’s view typically used?

As part of thoracic spine series or in trauma when standard lateral views are inadequate.

What technical consideration is important for the Swimmer’s view?

Higher exposure factors are needed due to the thickness of the area.

What is the central ray (CR) direction for the AP T-Spine projection?

Perpendicular.

What is the central point (CP) for the AP T-Spine projection?

Level of T7: 3–4 inches below the sternal notch or midway between the sternal notch and xiphoid process.

What spinal levels must be included in the AP T-Spine projection?

C7 to L1 to include all 12 thoracic vertebrae.

What breathing instruction is used for the AP T-Spine projection?

Expiration.

How should the patient be positioned for an AP T-Spine projection?

Supine and straight on the table, spine aligned with long axis of table.

What alignment check is used to avoid tilt in an AP T-Spine?

Use the 'nose to toes' method to ensure straight alignment.

What structures should be equidistant from the table to avoid rotation?

Shoulders, lower ribs, and ASIS.

What head support should be used during an AP T-Spine projection?

Remove pillow; use a thin sponge under the head.

What is the purpose of flexing the knees and supporting with a sponge in AP T-Spine?

To reduce lumbar lordosis and stabilize the patient.

Why is tight collimation used in the AP T-Spine?

To reduce visualization of lungs and improve spine detail.

Where should the superior edge of the IR be placed for the AP T-Spine?

Approximately 2 inches above the shoulders.

What region is the filter placed over during AP T-Spine imaging?

Over T1–T4 (filter not needed in lab settings).

How does the anode heel effect benefit AP T-Spine imaging?

Positioning the cathode end toward the feet increases radiation to the lower T-spine, improving image quality.

What is a risk if the IR is placed incorrectly in an AP T-Spine projection?

Image quality may be irreversibly and negatively affected.

What is the central ray (CR) direction for the Lateral T-Spine projection?

Perpendicular.

What CR angle should be used if shoulders are wide and spine is not parallel to the tabletop in a Lateral T-Spine?

10–15° cephalad.

What is the central point (CP) for the Lateral T-Spine projection?

Level of T7 in the posterior half of thorax.

What spinal levels should be included in the Lateral T-Spine projection?

C7 to L1.

What breathing instruction is given for the Lateral T-Spine?

Expiration.

What is the preferred patient position for a Lateral T-Spine?

Left lateral recumbent, if possible.

How should the arms be positioned in a Lateral T-Spine projection?

Both arms brought forward.

How should the legs be positioned in a Lateral T-Spine projection?

Knees and hips flexed with sponge between knees to prevent pelvic rotation.

Where should the superior edge of the IR be placed in a Lateral T-Spine projection?

Approximately 2 inches above the shoulders.

What should you do if the shoulders are wider than the hips in a Lateral T-Spine?

Use sponges to correct angle or angle the beam to compensate for misalignment.

What are indicators of acceptable positioning in a Lateral T-Spine?

Open intervertebral spaces, open intervertebral foramina, superimposed posterior vertebral margins.

What imaging issue may require a Swimmer’s view during a Lateral T-Spine?

Upper T-spine may be obscured by the shoulders.

Why might ribs appear unsuperimposed in a Lateral T-Spine?

Due to the divergent X-ray beam.

What technique may cause the diaphragm, ribs, and lung markings to appear blurred?

Breathing technique (long exposure time).

What is the first step for proper collimation in a Lateral T-Spine?

Center transversely at the level of the inferior angle of the scapula.

How do you find the MCP for lateral T-spine collimation?

Visually divide the thorax into anterior and posterior halves.

How do you ensure the spinous processes are not clipped in a Lateral T-Spine projection?

Allow light spill posterior to the MCP but not past it anteriorly.

What should you do if you see light anterior to the MCP during collimation?

Move the patient anteriorly.

What should you do if there's too much light spill posteriorly after repositioning?

Slightly close the collimators.