Spine and Skull Anatomy Review

These flashcards cover key concepts from the spine and skull anatomy lecture notes, focusing on the various projections, structures, and techniques involved in imaging.

What are the main segments of the spine?

Cervical, Thoracic, Lumbar, Sacrum, Coccyx.

What is the purpose of the AP Axial projection for the Cervical spine?

To visualize the C3-T1 intervertebral disc spaces.

What position is needed for the Lateral projection of the Thoracic spine?

Upright, recumbent, or cross-table in true lateral position.

What angle is used for the AP Axial Coccyx projection?

10 degrees caudad.

What does the term 'Scottie Dogs' refer to in lumbar obliques?

It is an anatomical landmark used to identify lumbar vertebrae in oblique views.

In which projection of the sacrum are the sacral foramina visualized?

AP Axial Sacrum.

What anatomical structures are evaluated during the PA Axial projection of the skull?

Petrous ridges in the lower 1/3 of the orbits.

Which sinuses are visualized during the SMV projection?

Sphenoidal and maxillary sinuses.

What is the primary view for visualizing the SI joints?

AP Axial and Oblique projections.

In which projections for the Ribs are the ribs above and below the diaphragm visualized?

AP and PA projections for ribs above the diaphragm, and AP for ribs below the diaphragm.

Cervical Spine: AP Axial

Pt/Part Position: Upright or Supine, occlusal plane perp

CR: 15 - 20 cephalic, enters C4 (inferior to most prominent point of thyroid)

SID: 40”

What’s seen: C3 -T1, Intervertebral disc spaces open

Cervical Spine: Lateral (Grandy Method)

Pt/Part Position: Upright or X-table. Depress shoulders as much as possible. Elevate chin slightly to avoid superimposition of mandible rami and spine.

CR: Horizontal, enter C4

SID: 60 - 72”

What’s seen: Zygapophyseal joints, all 7 cervical vertebra and part of T1, no mandible and spine overlap

Cervical Spine: Odontoid (open mouth)

Pt/Part Position: Upright or Supine, occlusal plane perp

CR: Perp entering midpoint of mouth

SID: 30”

What’s seen: Entire Atlas, Axis & Dens, C1/C2, Zygapophseal joint (lateral masses)

Cervical Spine: Fuch (AP)

Pt/Part Position: Supine, lift chin until mental point and mastoid tips are aligned and perp

CR: Perp entering MSP, just distal to point of chin

SID: 40”

What’s seen: Entire dens in foramen magnum

Cervical Spine: AP/PA Axial Obliques

Pt/Part Position: Upright preferred, 45 degree oblique, extend chin if needed

CR:

AP: 15 - 20 degrees cephalic, enters C4

PA: 15-20 degrees caudad enters C4

SID: 60 - 72”

What’s seen: Interveterbal foramina, C3 - C7

Thoracic Spine: AP

Pt/Part Position: Upright or Supine

CR: Perp to T7 (3-4'“ below jugular notch or midpoint between jugular point and xiphoid) *Light 1.5 - 2" inches above shoulders

SID: 40”

What’s seen: All 12 thoracic vertebrae, spinous process in midline

*Use of anode heel affect

Thoracic Spine: Lateral

Pt/Part Position: Upright, recumbent, or x table, true lateral, arms at right angles to body

CR: Enters posterior half of thorax at T7 *Light 1.5 - 2'“ above shoulders

SID: 40”

What’s seen: Interveterbral foramina, ribs superimposed posteriorly, open intervertebral joint spaces

Thoracic Spine: Cervicothoracic Lateral (Swimmers)

Pt/Part Position: Upright or recumbent, extend arm closest to IR over head an depress other shoulder

CR: Pass through intervetrbal disc space of C7 - T1

SID: 60 - 72”

What’s seen: C4 - T3 clearly demonstrated, humeral heads separated

Thoracic Spine: AP/PA obliques

Pt/Part Position: Upright or recumbent, 70 degree oblique

CR: Enters level of T7

SID: 40”

What’s seen: Zygapophyseal Joints, all 12 thoracic vertebrae

Lumbar Spine: AP

Pt/Part Position: Upright or Supine, flex knees to reduce lumbar lordotic curve

CR: Perp to L4 (Iliac Crest) to see lumbosacral OR L3 (1.5” above crest) to see lumbar only

SID: 40”

What’s seen: All 5 lumbar vertebrae, open disc spaces, SI joints included

Lumbar Spine: Lateral

Pt/Part Position: Upright, recumbent, true lateral, if lumbar not horizontal angle caudad 5 degrees for men and 8 degrees for women

CR: Perp to coronal plane, L4 for lumbosacral, L3 for lumbar only

SID: 40”

What’s seen: Intervertebral foramina, lower thoracic to sacrum, superimposed iliac crests

Lumbar Spine: L5/S1 Lumbosacaral Junction “Spot”

Pt/Part Position: Recumbent, true lateral

CR: 2” posterior & 1.5” inferior to ASIS, runs parallel to inter iliac line (crests)

SID: 40”

What’s seen: Open lumbosacral joint

Lumbar Spine: AP/PA Obliques

Pt/Part Position: Upright or recumbent, 45 degree oblique

CR:

AP: 1” above iliac crest & 2” medial to elevated ASIS

PA: 1" above crest & 2” lateral from the spine on elevated side

SID: 40”

What’s seen: Zygapophyseal joints, “scotty dogs”, T12 to sacrum

Spine - SI Joints: AP Axial

Pt/Part Position: Supine

CR: 30 - 35 degrees cephalic midway between ASIS & pubic symphysis

SID: 40”

What’s seen: Sacroiliac joints open, L5 - S1 joint open as well

SI Joints: Oblique

Pt/Part Position: Recumbent RPO or LPO, 25 - 30 degree oblique. Elevate affected side

CR: Enters 1” medial to elevated ASIS

SID: 40”

What’s seen: SI joint of interest open

Sacrum: AP Axial Sacrum

Pt/Part Position: Upright or Supine

CR: 15 degrees cephalic, enters midway between ASIS & public symphysis

SID: 40”

What’s seen: Sacral foramina visualized, sacrum not foreshortened

Coccyx: AP Axial

Pt/Part Position: Upright or Supine

CR: 10 degrees caudad, enters 2” superior to pubic symphysis

SID: 40”

What’s seen: Coccyx free of superimposition

Sacrum and Coccyx: Lateral

Pt/Part Position: Recumbent or upright

CR:

Sacrum: enters 3-4” posterior to ASIS

Coccyx: 3-4” posterior & 2” inferior to ASIS

SID: 40”

What’s seen: Lateral sacrum or coccyx centered, coccyx segments all visualized

What positions show the intervertebral foramina?

Cervical - Oblique

Thoracic - Lateral

Lumbar - Lateral

What positions show the zygapophyseal joints?

Cervical - Lateral

Thoracic - Oblique

Lumbar - Oblique

AP Oblique projections for spines

Cervical (French): farthest from IR
Thoracic (Fried): farthest from IR
Lumbar (Chicken): closest to IR
SI Joints (Fingers): farthest from IR

Name the parts of the scotty dog

***

Skull - Lateral

Pt/Part Position: Upright or recumbent, can oblique patient

Positioning Line: IOML parallel, Interpupillary line perp

CR: Enters 2” above EAM

Evaluation Criteria: Entire cranium, no rotation or tilt, superimposed orbital roofs and rami

Skull - PA Axial - Caldwell (can do PA also)

Pt/Part Position: Seated or Prone, forehead & nose on IR

Positioning Line: OML perp

CR: 15 degrees caudad, exit nation

Evaluation Criteria: Petrous ridges in lower 1/3 of orbits,

*If PA - (no axial): Petrous ridges fill orbits

Skull - SMV (submentovertical)

Pt/Part Position: seated, lean back so head vertex is on IR

Positioning Line: IOML parallel

CR: Enters between mandibular angles (gonion), passes through 3/4” anterior to EAM

Evaluation Criteria: Superimposed mental point & anterior frontal bone, symmetric petrous parts

Sinuses - Lateral

Pt/Part Position: Upright or recumbent, can oblique patient

Positioning Line: IOML parallel, interpulilary line perp

CR: Enters ½ - 1” posterior to outer canthus

Evaluation Criteria: Shows all 4 sinuses, no rotation

Sinuses - PA Axial Caldwell

Pt/Part Position: Seated or prone, forehead & nose on IR

Positioning Line: OML perp

CR: Horizontal, tilt IR 15 degrees, exit nasion

Evaluation Criteria: Petrous ridges in lower 1/3 of orbits, all 4 sinuses seen (sphenoid just between ethmoid)

Sinuses - SMV (submentovertical)

Pt/Part Position: Seated, lean back so head vertex on IR

Positioning Line: IOML parallel

CR: Enters between mandibular angles (gonion), passes through ¾ anterior to EAM

Evaluation Criteria: Superimposed mental point & anterior frontal bone, symmetric petrous parts

Skull - AP Axial - Towne

Pt/Part Position: Seated or supine

Positioning Line: OML perp is preferred, IOML as backup

CR:

If OML- 30 degrees caudad, enter 2.5” above glabella

if IOML - 37 degrees caudad, enter 2.5” above glabellaEvaluation Criteria: Foramen magnum with dorm sellae and posterior clinoids inside, entire occipital bone

Sinuses - AP Axial Towne

Not done

Skull - Parietoacanthial (Waters)

Not done for skull

Sinuses - Parietoacanthial (waters)

Pt/Part Position: Seated/upright, chin on bucky

Positioning Line: OML at 37 degrees

CR: Perp exiting the acanthion

Evaluation Criteria: Petrous ridges just below the maxillary sinus, frontal and ethmoid sinuses distorted. *Sphenoid sinus only seen of mouth opened

How much degree difference is there between the OML and OIML

7 degree

What should you do to your patient to get the skull as close to the IR as possible?

Oblique your patient

Sinuses should always be done _____ to visualize air/fluid levels

upright

What sinuses are the largest?

Maxillary

Facial Bones - Lateral

Pt/Part Position: upright or recumbent, true lateral

Positioning Line: IOML parallel, Interpupil perp

CR: Enters zygoma, halfway between outer cants and EAM

Evaluation Criteria: All facial bones included, zygoma centered. Superimposed orbital roofs and mandible.

Facia Bones - PA Axial Caldwell

Pt/Part Position: upright or prone, forehead and nose on IR

Positioning Line: OML perp

CR: 15 degrees caudad, exit nasion

Evaluation Criteria: Petrous ridges in lower 1/3 of orbits

Facial bones - parietoacanthial modified shallow waters

Pt/Part Position: Upright, chin on bucky

Positioning Line: OML at 55 degrees

CR: Perp exiting the acanthion

Evaluation Criteria: Petrous ridges below orbits (in maxillary sinuses)

Sternum - Oblique

Pt/Part Position: Upright, RAO, 15 - 20 degree oblique

CR: Midway between jugular notch and xiphoid (apron T7) and 1” lateral on elevated side

Evaluation Criteria: Sternum visualized over heart shadow

*use breathing technique to blur ribs

Sternum- Lateral

Pt/Part Position: Upright, true lateral, lock hands behind back and roll shoulders back

CR: Through mid sternum

Evaluation Criteria: Full inspiration for contrast, full sternum visualized

*Top of IR 1.5” above sternal notch

SC Joints - PA

Pt/Part Position: Upright or prone

CR: Enters T2 - T3

Evaluation Criteria: Both SC joints equally centered

SC Joints - Oblique - Bilateral

Pt/Part Position: Upright or prone, RAO or LAO, 10 - 15 degree oblique

CR: Enters T2 - T3

Evaluation Criteria: Joint of interest open & projected free of the spine

*RAO = right SC joint, LAO=left SC joint

Ribs - AP posterior ribs above diaphragm

Pt/Part Position: Upright or supine

CR: Enters apron. T7

Evaluation Criteria: Ribs 1-9 seen above diaghram

Ribs - PA anterior ribs above diaphragm

Pt/Part Position: Upright or supine

CR: Enters T7

Evaluation Criteria: Ribs 1 -10 seen above diaphragm

Ribs - AP posterior ribs below diaphragm

Pt/Part Position: Upright or supine

CR: Enters center of IR with bottom of plate 1.5” below costal margin (iliac crest)

Evaluation Criteria: Posterior ribs 8-12 seen below diaphragm

Ribs - AP oblique RPO or LPO

Pt/Part Position: Upright or supine, 45 degree oblique

CR:

Upper ribs: IR 1 ½ above shoulder

Lower ribs: IR 1 ½ below inferior costal margin or at crest

Upper: CR perpendicular, half way between MSP and lateral boarder of affected ribs

Lower: CR midway between crest and costal margin

Evaluation Criteria: Axillary portion of ribs seen for injured side, side of interest elongated

AP= Injured side closest to IR

PA = Injured side furthest from IR (PA away)

How does the heart, diaphragm and stomach lie in hypersthenic patients?

…

How does the heart, diaphragm and stomach lie in sthenic patients?

…

How does the heart, diaphragm and stomach lie in hyposthenic patients?

…

How does the heart, diaphragm and stomach lie in asthenic patient?

…….