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c and t spine
| Question | Answer |
|---|---|
| What are the basic positions for a routine C-spine exam? | Ap Open mouth, AP Axial, Bilateral Obliques, Lateral and a Swimmers if needed. |
| On an AP Open Mouth C-Spine what structures do you want superimposed? | Upper incissors superimposed over base of skull |
| What is demonstrated on an AP Open Mouth C-spine? | Atlas, axis, (C1-C2) and dens seen in entirety. |
| How much do you angle on an AP axial C-spine? | 15° to 20° cephalad (lower thyroid cartilage (C5-C6) |
| What is deomnstrated on an AP Axial C-spine? | Intervertebral disk spaces open Base of skull will superimpose C1-C2 |
| Where do you angle on a PA oblique C-spine? | CR 15° caudad to C4 PA angle caudal and anterior angle cephalad) |
| What is deomnstrated on a oblique c-spine? | intervertebral foramina |
| Where do you center for a Lateral C-spine? | C4 (level of adam's apple) |
| What is demonstrated on a lateral c-spine? | intervertebral join spaces and zygopaphaseal joint |
| Cervicothoracic Lateral is also called? | Swimmer's |
| What is the positioning criteria for a Cervicothoracic lateral position (Swimmer's)? | True lateral position Separate shoulders CR to T1, 1 inch (2.5 cm) above jugular notch Extend arm closest to IR up and rest on head |
| What is demonstrated on a Cervicothoracic Lateral (Swimmer's)? | C4 to T3 clearly demonstrated Humeral heads separate (Good position when C7- T1 are not visualized on a lateral C-spine) |
| Name the special projections for the c-spine. | Hyperflexion and hyperextension laterals AP (Fuch method) and PA (Judd method) for odontoid AP “wagging jaw” (Ottonello method) AP axial—vertebral arch (pillar) projection |
| On a lateral hyperflexion C-spine, where should the patient be looking? | At their toes- hyperflexion is extending the neck in a forward downward motion |
| On a lateral hyperextension c-spine where should the patient be looking? | at the ceiling. Hyperextension is extending the neck back in an upward postion. |
| What is demonstrated on a lateral hyperextension/hyperflexion? | C1-C7 visualized Hyperflexion: spinous processes well separated Hyperextension: spinous processes in close proximity |
| If you can not visualize the dens on an AP Open mouth, what are the alternate projections for Dens? | AP Fuchs Method or the PA Judd Method |
| What is the MML? | The mentomeatal line- an invisible line from the mental point on the mandible to the EAM. - |
| Where do you want your CR on an AP Fuchs? | CR to inferior mandible and parallel to MML |
| Where do youn want your CR on a PA Judd? | CR level of mastoid processes and parallel to MML |
| What does the AP Fuch method and PA Judd method demonstrate? | Dens within foramen magnum |
| What is another name for the AP “Wagging Jaw” Projection? | Ottonello method |
| What is the positioning criteria for the AP Wagging Jaw (Ottonello method)? | CR perpendicular to C4 level Mandible moves during exposure. |
| What does the AP Wagging Jaw (Ottonello)demonstrate? | C1-C7 vertebrae with mandible blurred |
| What is another name for the AP Axial—Vertebral Arch Projection | Pillars |
| What is the positioning criteria for the AP Axial vertebral Arch Projection (Pillars)? | Hyperextend neck. CR 20° to 30° caudal angle CR to lower margin of thyroid cartilage (C5 |
| What does the AP axial vertebral arch projection (Pillars) demonstrate? | the articulations (zygopaphaseal joints) between lateral masses (or pillars)are open and well demonstrated (good exam for detecting whiplash injuries |
| Thoracic Spine Routine | Basic: AP Lateral Special: Oblique |
| Where do you want your CR on an AP T-spine? | CR to T7—3 to 4 inches (8 to 10 cm) below jugular notch |
| What should be demonstrated on an AP T-spine? | C7 to L1 demonstrated, thoracic vertebral bodies, intervertebral joint spaces, spinous and transverse processes, posterior ribs, and costovertebral articulations |
| On a lateral T-spine where do you want your CR? Is there a breathing technique? | CR perpendicular to T7 (just below ridge of scapula) Breathing technique preferred Deep breath in- blow it out and hold it out. |
| What should be demonstrated on a lateral T-spine? | T1 to L1 demonstrated Intervertebral disk spaces open (remember lift) |
| What is the angle on AP and PA obliques of the t-spine? | 20 degrees from lateral or 70 degrees from AP |
| What is demonstrated on an obliqued T-spine? | All 12 thoracic vertebrae demonstrated Zygapophyseal joint open |
| If you use Use compensating filter for AP projection. Breathing technique (lateral) Proper part–IR alignment Lead blocker behind patient What position is your patient in? | Lateral T-spine |
| What does the AP open mouth demonstrate? | C1 and C2 |
| How are the zygapophyseal joints of C3-C7 visualized radiographically? How are the zygapophyseal joints of C3-C7 visualized radiographically? | true lateral projection |
| How is the spinous process of the thoracic region best viewed radiographically? | lateral |
| What is the purpose of the 15 to 20 degree angle for the AP axial projection of the cervical spine? | To open the intervertebral disk space. |
| For an AP axial of the cervical spine, a plane through the tip of the mandible and _______ should be parallel to the angled central ray. | base of the skull |
| What are two important benefits of an SID longer than 40-44 inches for the lateral cervical spine projections? | Less divergence of x-ray beam to reduce shoulder superimposition of C7, and compensates for increased OID; reducing magnification. |
| What central ray angulation must be used with a posterior oblique projection of the cervical spine? | 15 degrees cephalad |
| Which foramina are demonstrated with a left posterior oblique (LPO) position of the cervical spine? | right side or upside |
| What is the recommended SID for a lateral projection of the cervical spine? | 60" - 72 |
| The lateral projection of the cervical spine should be taken during _________. | experiration to maximize shoulder depression |
| The proper name of the method for performing the cervicothoracic (swimmer's lateral) projection is the________. | Twining method |
| Where should the central ray be placed for a cervicothoracic (swimmer's lateral) projection? | T1 1 inch above jugular notch, or at the vertebral prominence (C7) |
| Which region of the spine must be demonstrated with a cervicothoracic (swimmer's lateral) projection? | C4 - T3 |
| Which one of the following projections is considered a "functional study" of the cervical spine. AP wagging jaw projection, AP open mouth position, Fuchs or Judd method, Hyperextension and flexion lateral positions | Hyperextension and flexion lateral positions |
| Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection? | Scoliosis series |
| Which two things can be done to produce equal density along the entire thoracic spine for the AP projection (especially for a patient with a thick chest)? | correct use of anode-heel effect; use of compensating (wedge) filter |
| What is the purpose for using a brething technique for a lateral projection of the thoracic spine? | To blur out rib and lung markings that obscure detail of thoracic vertebrae |
| Anterior | same side or down side |
| posterior | opposite side or upside |
| Which zygopophyseal joints are demonstrated in a right anterior oblique (RAO) projection of the thoracic spine? | The right downside |
| Which one of the following projections delivers the greatest skin dose to the patient? AP thoracic spine projection, Lateral cervical spine projection, Swimmer's lateral projection, Fuchs or Judd method. | Swimmer's Lateral (twining method, cervicothoracic) |
| Which one of the following structures is best demonstrated with an AP axial vertebral arch projection? | Articular pillar (lateral masses) of cervical spine. |
| What central ray angle must be used with the AP axial-vertebral arch projection? | 20 to 30 degrees caudal |
| Which skull positioning line is aligned perpendicular to the IR for a PA (Judd) projection for the odontoid process? | Mentomeatal line (MML) |
| Which zygopophyseal joints are best demonstrated with a LPO position of the thoracic spine? | right (upside) |
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