L-spine/sacrum/coccyx

45 °

What is the location of the zygapophyseal joints in relation to the midsagittal plane ?

CR angled 5 ° -8 ° caudad to be parsellel to interilial line

When performing L5 - S1 what is recommended if the waist is not supported ?

Bottom edge of IR 1-2 in below iliac crest

CR for Right & Left bending scolosis

Males : CR 30 ° cephalad Females : CR 35 ° cephalad

CR angulation for AP axial projections of : SI joints

90 °

What is the location of the intervertebral foramina in relation to the midsagittal plane ?

Over rotated

When visualizing an oblique Lumbar spine, the Scotty dog's pedicle is placed more anterior in the vertebral body if the patient is over or under rotated?

Midsagittal plane

What planes should be lined up for the AP lumbar?

Midcoronal plane

When positioning a pt, what planes should be lined up for the Lateral L-Spine

Suspend on expiration

What is the respiration for the Lumbar Projections ?

Superior aspect of соссух

Where is the base located on the coccyx ?

Apex

What is the pointed tip of coccyx called?

• 14x17: CR @ lvl of iliac crest (L4-L5)
• 11x14: CR @ lvl of L3

CR location for an AP L-spine when using a 14x17 & 11x14 IR?

Reduce lordotic curvature

Why are knees and hips flexed for positioning an AP projection of the lumbar ?

Upside

Anterior oblique shows which side the upside or downside zygapophyseal joint ?

Sacrum/coccyx lie posteriorly to ASIS

Where is the sacrum/coccyx in relation to the ASIS?

• Sacrum: kVp 75-90
Decrease
• Coccyx: kVp 75-85

How should the exposure factors be changed between a lateral coccyx & sacrum ?

• Superior articular Process
• Transverse Process
• zygapophyseal joint
• Pedicle
• Pars interarticularis
• Inferior articular Process

What bony anatomy makes up a Scottie dog?

-RPO : Right zygapophyseal joints -LPO : Left zygapophyseal joints

Which joint is visualized for zygapophyseal joints Downside

L5 - S1 joint space

Which joint is visualized for each of the obliques of SI joints ?

CR @ lvl of iliac crest L4-L5

CR for AP (or PA) L-Spine

Bottom edge of IR 1-2 in below iliac crest

CR for Lateral Hyperextension/Hyperflexion

CR 3-4 in posterior to ASIS

CR for Lateral Sacrum/Coccyx

@ lvl of T9-TIO

Xiphoid process

Apex of sacrum

Label D

Articular surface (sacroiliac joint)

Label G

Transverse process

Label B (nose)

zygapophyseal

Label F (btwn L4-L5)

PA places the intervertebral spaces more closely parallel to the diverging rays

Advantages of PA vs AP for lumbar ?

Inferior articular proces

Label D (leg)

So anatomy isn't obscured

Why is a lower bowel prep recommended when performing an AP axial view of the sacrum and coccyx ?

Against the IR

When radiographing a lateral projection of the spine for scoliosis where should the convexity of the spine be placed ?

Abnormal lateral curvature ; Dextro- to right , Levo- to left

Define scoliosis

Abnormal or convex curvature of thoracic spine

Define kyphosis

Abnormal anterior concavity of lumbar spine

Define Lordosis

Right zygapophyseal joints

LAO lumbar spine would show which joint ?

Zygapophyseal joints

Obliquing the lumbar spine 30 , 45 , and 50 degrees best visualizes which anatomy ?

Increase

When performing the Lateral L5 - S1 do you increase or decrease technique as compared to the lateral Lumbar ?

Lead shield or blocker & close collimation

What is recommended to reduce scatter to IR of Lateral sacrum & coccyx

Zygapophyseal joint

A 45° RPO shows which joint?

• RPO: Right zygapophyseal joint
• LPO: Left zygapophyseal joint

Which position is used for the Zygapophyseal joints to show downside or closest to the IR ?

Coccyx; Elderly be of fall risk

Proper name for tail bone is ? Also , who is most likely to fracture this bone ? Why ?

Pt is rotated 25°-30° posterior oblique

How is the patient positioned for the Oblique SI joints?

Males: 30° & Females: 35° cephalad angle

Where is the CR located and if an angle is used what is it for males and females for the AP SI joints ?

L2-L3

1-1 1/2 in. above the iliac crest corresponds to what vertebral level & anatomical landmark?

L4-L5

Iliac Crest is located at what vertebral lvl?

ASIS @ same lvl as S1-52

What lvl of the spine is the ASIS located?

• Lateral L-Spine: kVp 80-90
Increase
• Lateral L4-51: kVp 85-95

How should the exposure factors be changed between a lateral lumbar & L5-S1?

45°

What degree of obliquity visualizes L1-L5 L-spine?

RAO : Left zygapophyseal joints LAO Right zygapophyseal joints

Which joint is visualized for zygapophyseal joints Upside

SI (Sacroiliac) Joints farthest from IR

Which joint is visualized for each of the obliques of SI joints ?

SI joints equidistant from spinous processess of spinous processes in midline of Verkbral colu Transverse processes equal length & open intervertebral joint spaces

What is the way to determine if there is rotation in an AP Lumbar ?

Pt positioned correctly correct technique

What can a technologist do to ensure optimal exposure of the lateral lumbar spine ?

CR 30° (males)/35° (females) cephalad, & to lvl of ASIS

CR for AP Axial L5-S1 L-Spine

Perpendicular to L3

CR for RPO/LPO L-Spine

CR @ lvl of iliac crest (L4-L5)

CR for Lateral L-Spine

CR 1.5 in. inferior to iliac crest & 2 in. posterer to ASIS; 5°-8° caudad

CR for Lateral L5-S1

CR 15° cephalad directed 2 in superior to pubic symphysis

CR for AP Axial Sacrum

CR 10° caudad directed 2 in superior to pubic symphysis

CR for AP Axial Coccyx

CR 30° (males)/35° (females) cephalad, & 2 in below lvl of ASIS

CR for AP Axial SI Joints

CR 1 in medial to upside ASIS

CR for Posterior Oblique (RPO/LPO) SI Soints

@ lvl of superior border of symphysis pubis

Prominence of Greater Trochanter

lvl as 1st or 2nd sacral segment

ASIS

same lvl as junction of L4-L5 vertebrae

Superior portion of iliac crest

@ lvl of L2-L3

Lower costal margin

Lumbar vertebrae, fractures, scoliosis & neoplastic processes

What are the pathologic indications for AP (or PA) L-Spine

Defects of pars interarticularis

What are the pathologic indications for RPO/LPO L-Spine

Fractures, spondylolisthesis, neoplastic processes, & osteoporosis

What are the pathologic indications for Lateral L-Spine

Spondylolisthesis of L4-L5 or L5-S1 & other L5-S1 pathologies

Lateral L5 - S1

Pathology of Sacrum & fractures; Pathology of coccyx & Fractures

AP Axial Sacrum/Coccyx

Pathology of sacrum & coccyx

What are the pathologic indications for Lateral Sacrum/Coccyx

PA: Scoliosis

What are the names for (Ferguson Method)

Perpendicular to the IR(Bottom of IR 2 in below iliac crest)

CR for Right & Left Bending: Scoliosis

Bottom of IR 1-2 in. below iliac crest

CR for Lateral Hyperflexion & Hyperextension

Left superior articularprocess

Label A

Left ala or wing of sacrum

Label B

Pelvic (anterior) sacral foramina

Label C

Sacral canal (btwn superior articular processes)

Label E

Sacral promontory (also seen on frontal view)

Label F

Coccyx

Label H

Apex of coccyx

Label I

Horn (cornu) of coccyx

Label J

Horn (cornu) of sacrum

Label K

Median sacral crest

Label L

Superior articular process

Label A (ear)

Pedicle

Label C (eye)

Par interarticularis

Label E (neck)

Larger & more blunt

Compared to spinous processes of the cervical & thoracic spine, the lumbar spinous processes are?