C & T Spine

What cervical level is the thyroid cartilage at?

C4

What cervical level is the top of shoulders at?

C6/C7

Explain patient prep for cervical x-rays

remove earrings, hair bands, wigs, glasses, dentures, necklaces, etc.

What is Aurora’s C-spine routine?

AP, lateral, open mouth (sometimes obliques)

What is the name for the lateral cervical spine method?

the Grandy method

Explain the patient and CR positioning for the Grandy method

patient

• erect at upright bucky, left lateral (MSP parallel to IR)

• depress shoulders (use weights if necessary)

• elevate chin (to prevent superimposition of mandibular rami on spine)

• expiration to depress shoulders

CR/IR

• 10 × 12 LW

• 72” SID

• horizontal

• perpendicular to C4 (thyroid cartilage)

• top of IR 2” superior to EAM

What is demonstrated on a lateral C-spine (Grandy method)

• posterior arch of C1 and spinous process of C2 are in profile w/o skull superimposition

• C1 and C2 without mandibular superimposition

• visible C1 through T1 interspace

• rotation/tilt determined by mandible and zygapophyseal joints

• marker placed anterior

• sent as a right lateral

Explain the patient and CR positioning for the AP C-spine obliques

patient

• seated or standing erect

• turn body and head 45^o

  • both obliques are done

• elevate chin

• do not rotate head laterally

CR/IR

• 10 × 12 LW

• 72” SID (40” if supine)

• 15-20^o cephalic angle through C4

What is demonstrated on an AP oblique C-spine?

• open C2-C7 disc spaces

• intervertebral foramina of side up

  • LPO - right foramina

  • RPO - left foramina

• marker placed side down

• sent as if someone is standing in front of you

What changes when you do C-spine obliques PA instead of AP?

• 15-20^o caudal angle exiting through C4

• intervertebral foramina of side down

  • LAO - left foramina

  • RAO - right foramina

• marker placed side down

• sent as if someone is standing in front of you

Explain the patient and CR positioning for AP C-spine

patient

• AP supine or erect with MSP to midline of IR

• extend head so a line from occlusal plane (front teeth) to mastoid tips is perpendicular to IR

CR/IR

• 10 × 12

• 40” SID

• 15-20^o cephalic angle to C4

  • to align beam with intervertebral spaces

What is demonstrated on an AP C-spine?

• chin elevated to see C3-T1

• no rotation (spinous processes down midline; mandibular angles equidistant to vertebrae)

• spinous processes sit in lower portion of the vertebral bodies

• marker placed up or down on either side

• sent as if someone is standing in front of you

Explain the patient and CR positioning for C-spine odontoid

patient

• AP supine or erect with MSP aligned with the middle of IR

• open mouth wide

• occlusal surface of upper incisors to tips of mastoid is perpendicular to IR

• hold breath

CR/IR

• 10 × 12 LW (collimate!)

• 40” SID

What is demonstrated on a C-spine odontoid?

• atlas and axis through open mouth

• C1/C2 zygapophyseal joint

• odontoid process

• C2 vertebral body and lateral masses of C1

• sent as if person is standing in front of you

• marker placed on either side

How can you tell if a patient is over or under extended on an odontoid image?

overextended: base of skull is lower than the teeth

underextended: teeth are lower than base of skull

Explain the patient and CR positioning for AP T-spine

patient

• AP supine or erect

  • don’t use big pillow; can flex knees to reduce kyphotic curve

• full expiration for more uniform density

CR/IR

• 14 × 17 LW

• 40” SID

• perpendicular to T7

• top of IR 1-2” above shoulder

What is demonstrated on an AP T-spine?

• C7 through L1

• intervertebral disc spaces open

• any scoliosis

• collimated side to side

• marker placed up on either side

Explain the patient and CR positioning for lateral T-spine

patient

• left lateral erect or recumbent

• spine parallel to IR

• shoulders forward

• BREATHING TECHNIQUE (or expiration)

CR/IR

• 14 × 17 LW

• perpendicular to T7

• top of IR 1½-2” above shoulders

• posterior to MCP

• use a lead strip!

• if spine isn’t parallel: cephalic angle 10^o for females and 15^o for males

What is demonstrated on a lateral T-spine?

• blurred ribs (breathing technique)

• thoracic bodies, interspaces, intervertebral foramina, pedicles

• T1-T4 may not be well demonstrated because of shoulder overlap

• marker placed anterior midway down (take advantage of the kyphotic curve)

• sent as a right lateral

In the odontoid view, if the occlusal surface of the upper teeth and base of skull are superimposed, can the position be improved?

NO

Explain the patient and CR positioning for C-spine Fuchs method

patient

• erect or supine

• elevate chin so MML is perpendicular to IR

CR/IR

• 10 × 12 LW

• 40” SID

• CR must be parallel to MML (use angle if patient can’t get there)

• entering just inferior to tip of chin

What is demonstrated on a C-spine Fuchs method?

• AP projection of the odontoid process lying within the shadow of the foramen magnum

• collimate!

• marker placed up or down on either side

Explain the Judd method

• prone version of the Fuchs method

  • laying prone with chin extended to rest on table

• CR

  • 1” inferior to mastoid tip OR 1” inferior to angle of mandible

Explain the patient and CR positioning for AP/Lat soft tissue neck

patient

• same positioning as AP and Lat C-spine

• extend chin

• breathe in slowly through nose during exposure (to fill trachea with air)

CR/IR

• perpendicular central ray for both images

• AP: 40” SID

• Lat: 72” SID

• use ~10kV less than normal

What is demonstrated on a soft tissue neck?

• nasopharynx through C7

• enlarged tonsils, epiglottis, and/or foreign bodies

• visualized hyoid, trachea, esophagus, nasopharynx, oropharynx

Explain the patient and CR positioning for C-spine flexion

• lateral position, depress shoulders

• drop head forward to put chin as close to chest as possible

• body of mandible should be vertical in a normal patient

• CR

  • horizontal and perpendicular to C4

  • 72” SID

Explain the patient and CR positioning for C-spine extension

• lateral position, depress shoulders

• elevate chin as much as possible

• body of mandible should be horizontal in a normal patient

• CR

  • horizontal and perpendicular to C4

  • 72” SID

Why are C-spine flexion and extension done?

demonstrates range of motion

What is demonstrated on a C-spine flexion/extension?

• ligament stability

• rule out whiplash injuries

• post spinal fusion

• hyperflexion: spinous processes elevated and separated

• hyperextension: spinous processes are depressed

• annotated with flexion or extension

• marker anterior

• sent as a right lateral

What are the C-spine trauma views?

• AP, lateral, and open mouth in collar

• clear the images with the rad

• repeat AP, lateral, and open mouth out of collar

Explain the trauma lateral C-spine image

• shoot-thru lateral

• recumbent on cart or table

• DO NOT remove collar or move head

• keep arms relaxed down

• CR

  • horizontal

  • perpendicular to C4

  • 40-72” SID

What is demonstrated on a C-spine trauma lateral?

• vertebral bodies, intervertebral joint spaces, articular pillars, spinous process, zygapophyseal joints

• any fractures or subluxation

• annotate x-table

• marker anterior

Explain the trauma open mouth C-spine image

• slide patient onto table or leave in cart (use grid)

• done supine

• may need to angle

What are the “five lines” on a lateral c-spine image?

1. anterior prevertebral soft tissues

2. anterior vertebral body line

3. posterior vertebral body line

4. spinolaminar line

5. spinous process line

When is swimmers view done?

• to visualize C7-T1 when is cannot be viewed on the lateral image

• to visualize upper thoracic region when it cannot be viewed on a lateral T-spine image

What is another name for the swimmers view?

Twining position

Explain the patient and CR positioning for swimmers view

patient

• lateral erect or shoot-thru

• elevate arm closest to IR

• depress and rotate arm furthest from IR anteriorly

CR/IR

• 10 × 12 LW

• 72” SID for upright

• 40” SID for recumbent

• perpendicular to C7-T1 if shoulder is well depressed

  • 3-5 degree caudal angle if shoulder is not well depressed

• 1” above jugular notch (top of shoulder)

What is demonstrated on a swimmers view?

• lateral view of cervicothoracic area between shoulder shadows

• breathing technique (or expiration)

What technical factors are used for C-spine images?

80 kVp for all

Lateral: 12-16 mAs

Oblique: 12-16 mAs

AP: 4-5 mAs

Open mouth: 6-8 mAs

Fuchs: 10-12 mAs

What technical factors are used for T-spine images?

80 kVp for all

AP: 12-16 mAs

Lateral: 20-25 mAs

Swimmers: 25-32 mAs