Spine

2nd semester lab lecture 1

routine views for c-spine

lateral, AP, both obliques

what extra view do you add to a c-spine if there is a known injury

odontoid

why do you do a felxion/extension

range of motion

post-op

when do you perform the flexion/extension

after lateral

where do you shield the pt. for lateral c-spine

side of body

what is the SID for lateral c-spine

72 inches

why do you extend the chin slightly for lateral c-spine

so the mandible doesn’t superimpose the vertebrae

where do you center for lateral c-spine

upper C4

breathing instructions for lateral c-spine

full expiration

why do you take image on full expiration for c-spine

lower shoulders

what should you see on a lateral c-spine

zygapophyseal joints, spinous process, vertebral body

collimation for lateral c-spine

skin margin, bottom of EAM

where is the shield for an AP c-spine

on the front of the pt.

what is the SID for AP c-spine

40 inches

what do you angle for AP c-spine

15-20 degrees cephalad

why do you angle for AP c-spine

open joint spaces

when are you most likely to angle 15 degrees cephalad for an AP c-spine

when the pt. is supine

where do you center for AP c-spine

upper C4

collimation for AP c-spine

skin margins and above the chin

what must be included in all spine x-rays

1 vertebra above and below area of interest

why is the anterior oblique preferred

reduce radiation to thyroid

why do you suspend breathing and not swallow for AP c-spine

reduce motion and keep air out

what should you see on AP c-spine

C3-T2

rotation for oblique c-spine

45 degrees

angle for oblique c-spine

15 degrees cephalad

what is the SID for oblique c-spine

40 inches

where do you center for oblique c-spine

lower C4

where should you vertical line be on an oblique c-spine

on or slightly in front of tragus

breathing instructions for oblique c-spine

suspend breathing

what should you see on a poster oblique c-spine

intervertebral foramina on side away from IR

how do you angle for anterior oblique c-spine

15 degrees caudad

where do you center for posterior oblique c-spine

upper C4

if you are doing a posterior oblique of the c-spine (LPO) what intervertebral foramina do you see

right

if you are doing an anterior oblique of the c-spine (LAO) what intervertebral foramina do you see

left

another name for AP open mouth

odontoid

what should you see on an odontoid

C1-2, dens, C1 lateral mass

what should be perpendicular to the IR for AP open mouth

EAM and top of teeth

where do you center for odontoid

to the open mouth

collimation for odontid

4×4

how do you fix an AP open mouth projection if you can see the pt. teeth

bring head back

how do you fix the AP open mouth projection if you can see the base of the pt. skull

being head forward

another name for swimmers

cervicothoracic

why do you do a swimmers

when you can’t see C7

where do you center for c-spine swimmers

T1

SID for c-spine swimmers

72 inches

collimation for swimmers

skin margins, bottom of ear, 1-2 inches down the shoulder

where does the marker go for swimmers

in front

what should you see on a swimmers

C7 and T1

what could you do to better see C7 on a broad shouldered pt.

angle 3-5 degrees caudad

how do you position the pt. for flexion of c-spine

bring chin down

what must you do with your markers to differentiate flexion/extension and neutral

move them some way

SID for flexion/extension for c-spine

72 inches

where do you center for flexion/extension of c-spine

upper C4

breathing instructions for flexion/extension of c-spine

suspend after full expiration

how do you position the patient for extension of the c-spine

lift the head to the sky

what can you do if you can not see te top of the odontoid process

fuchs & judd (tip shot)

if someone cannot hold their chin still (Parkinson’s) what can be done

ottonello (wagging jaw)

how is the pt. positoned for CTL c-spine

supine

where is the IR for CTL c-spine

by shoulder

where do you center for CTL c-spine

upper C4

what is the SID for CTL c-spine

60-72 inches

when do you make the exposure for CTL c-spine

expiration

what side do you mark for CTL c-spine

upside

anode heel effect

used to keep contrast the same in different areas of the spine

ways to accomplish uniform density

anode heel effect, saline bag, compensation filter

routine views for T-spine

AP, lateral, swimmers

why do you bend the pt. knees for AP T-spine

straighten the spine and reduce OID

where do you center for AP T-spine

T7

breathing instructions for AP T-spine

suspend breathing on expiration

why do you suspend breathing on expiration for AP T-spine

reduce air volume, and to achieve uniform brightness

what do you see on AP T-spine

C7-L1, Intervertebral joint spaces, thoracic bodies

what is the SID for AP T-spine

40 inches

what do you use to reduce scatter radiation in a lateral T-spine

lead blocker

how to you achieve a true lateral for T-spine

stack knees and feet on top of each other

Where do you center for lateral T-spine

T7, a little back from the center of the body

breathing instructions for lateral T-spine

orthostatic breathing

SID for lateral T-spine

40 inches

what do you see on a lateral T-spine

Intervertebral foramina, and intervertebral joint spaces

where do you center for swimmers of T-spine

2-3 inches down from shoulder, at mid-humerus

SID for swimmers T-spine

40 inches

breathing instructions for swimmers T-spine

orthostatic breathing

what should you see on swimmers t-spine

C7-T3

what is used to reduce scatter radiation for swimmers T-spine

lead-blocker

what do you see on T-spine obliques

zygapophyseal joints

what is the level of obliquity for anterior oblique T-spine

70 degrees

what is the level of obliquity for posterior oblique T-spine

20 degrees

what do you see on a posterior oblique of the T-spine

the side furthest away from the IR

*what do you see on an anterior oblique of the T-spine

the side closest to the IR

routine views for sacrum

Ap axial, lateral

pt. position for AP axial sacrum

supine with legs straight

angle for AP axial sacrum

15 degrees cephalad

where do you center for AP axial sacrum

2inches down from ASIS

*2 inches above pubic symphysis

SID for AP axial sacrum

40 inches

what should you see on an AP axial sacrum

L5-S1 joint, SI joint

breathing instructions for AP axial sacrum

suspend breathing

is there an angle for lateral sacrum

no

where do you center for lateral sacrum

3-4 inches posterior to the ASIS

what do you see on a lateral sacrum

L5-S1 joint

how can you reduce scatter radiation for a lateral sacrum

lead blocker

routine views for coccyx

AP axial and lateral