3412 Practical #1 cervical spine

C spine AP axial - positioning

- upright or supine with back flat against IR and no rotation of head

- tilt head back until occlusal plane and base of skull is perpendicular to IR (imaginary line from base of mandible to base of skull should be parallel to CR)

C spine AP axial - CR

- 15-20 degrees cephalad (15 if supine or less lordotic curvature, 20 if upright or more lordotic curvature)

- lower margin of thyroid cartilage (to pass through C4) and MSP

C spine AP axial - technique (grid)

85 kvp at 2.5 mas - 40 inch SID

85 kvp at 8 mas - 72 inch SID

C spine AP axial - technique (non- grid)

85 kvp at 1 mas - 40 inch SID

85 kvp at 2-3.2 mas - 72 inch SID

C spine AP axial - evaluation

- see C3 - T2/T3 , C1 and C2 covered by mandible / skull

- open intervertebral disk spaces

- central spinous processes and equal SC joints

C spine obliques (LPO and RPO) - SID, GRID, IR

72 inches or 60 inches

Yes GRID

10 by 12 lengthwise

C spine obliques (LPO and RPO) - positioning

- upright or supine

- rotate body and head 45 degrees to LPO and RPO (both done for comparison) (LAO and RAO are options)

- elevate chin slightly

C spine AP axial - SID, GRID, IR

40 inches (may see 60-72 inches)

Yes GRID

10 by 12 lengthwise

C spine obliques (LPO and RPO) - CR

- 15 degrees cephalad

- lower margin of thyroid cartilage (to pass through C4) and SCM muscle or earlobe

C spine obliques (LPO and RPO) - technique (grid)

85 kvp at 3 mas - 40 inch SID

85 kvp at 10 mas - 72 inch SID

C spine obliques (LPO and RPO) - technique (non grid)

85 kvp at 1 mas - 40 inch SID

85 kvp at 2-3.2 mas - 72 inch SID

C spine obliques (LPO and RPO) - evaluation

- open intervertebral foramina and profiled pedicles of side up, C1 - C7

C spine obliques (LPO and RPO) - trauma or supine

- place top of IR above ear and medial edge even with spine (no grid)

- angle CR 45 degrees medial and 15 degrees cephalad

- opens foramina closest to the tube

C spine lateral - SID , GRID, IR

60 or 72 inches

YES grid

10 by 12 lengthwise

C spine lateral - positioning

- erect lateral with no rotation of head, left shoulder touching IR for left lateral (can be right lateral)

- elevate chin slightly

- depress shoulders (weights or sandbags)

C spine lateral - CR

- upper thyroid cartilage , C4 and MCP

- top of IR at top of ear

C spine lateral - technique (grid)

85 kvp at 16 mas - 72 inch SID

C spine lateral - technique (non grid)

85 kvp at 3.2 mas - 72 inch SID

C spine lateral - evaluation

- C1 - C7 , intervertebral disk spaces, spinous processes , zygapophyseal joints

C spine lateral - trauma or supine

- cross fire with grid

- get patient as close as possible to IR

- may have someone pull shoulders or use sheet

C spine swimmers lateral - SID, GRID, IR

60 or 72 inches

Yes GRID

10 by 12 lengthwise

C spine swimmers lateral - positioning

- erect lateral with no rotation of head , left shoulder touching IR for left lateral (can be right lateral)

- raise arm closest to IR above/ behind head , bend elbow , place hand on back of head for support

- arm further from IR should be down to side with shoulder rolled anteriorly

C spine swimmers lateral - CR

T1 , about 1 inch above jugular notch , and MCP

C spine swimmers lateral - technique (grid)

85 kvp at 32 mas - 40 inch SID

85 kvp at 105 mas - 72 inch SID

C spine swimmers lateral - evaluation

- at least C4 to T3 with disk spaces

- humeral head and arm closest to IR behind vertebral bodies , other humeral head anterior

C spine swimmers lateral - trauma or supine

- cross fire with grid

- get patient as close as possible to IR

- cannot move arms if fractures are identified

odontoid open mouth - SID, GRID, IR

40 inches

Yes GRID

8 by 10 lengthwise

odontoid open mouth - positioning

- upright or supine with back and head flat against IR , no rotation of head

- open mouth as wide as possible

- tilt chin to align bottom of upper teeth with base of skull

odontoid open mouth - CR

perpendicular and enters center of mouth

odontoid open mouth - technique (grid)

85 kvp at 9 mas - 40 inch SID

odontoid open mouth - technique (non grid)

75 kvp at 1.8-2 mas - 40 inch SID

odontoid open mouth - evaluation

- odontoid process free of superimposition, vertebral body of C2 , lateral masses of C1 , open C1/C2 zygapophyseal joint spaces

- superimposition of bottom of upper teeth with base of skull

- if teeth superimpose odontoid, repeat with greater extension, if base of skull superimposes odontoid, repeat with greater flexion

odontoid open mouth - trauma

- unable to move neck/ head

- place cassette under head/ neck

- open mouth as much as possible

- angle CR to be parallel to imaginary line between bottom of upper teeth and base of skull

odontoid fuchs method - SID , GRID, IR

40 inches

Yes GRID

8 by 10 lengthwise

odontoid fuchs method - positioning

- supine with back flat against IR , no rotation of head

- tilt chin up and head back to bring MML as close as perpendicular as possible

odontoid fuchs method - CR

- angle as necessary to be parallel to MML

- enter just underneath the middle of mandible

odontoid fuchs method - technique (grid)

85 kvp at 16 mas - 40 inch SID

odontoid fuchs method - technique (non grid)

75 kvp at 3.2-4 mas - 40 inch SID

odontoid fuchs method - evaluation

projects odontoid process in the center of the foramen magnum

odontoid fuchs method - trauma

- unable to move neck/head

- place IR under head/neck

- angle CR cephalad to be parallel MML (usually 45 degrees)