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Merrills Ch 8 pt 2
Vertebral Column- pt 2
| Question | Answer |
|---|---|
| AP projection of dens is also known as what? | Fuchs method |
| IR for AP Fuchs | 8 x 10" (18 x 24 cm) ↔ |
| Patient position for AP Fuchs | supine w/ chin extended (MML near ⊥ to tabletop) |
| Location of IR for AP Fuchs | Center IR @ tips of mastoid processes |
| CR for AP Fuchs | ⊥ to IR just distal to chin tip |
| Area of interest for AP Fuchs | Dens w/in foramen magnum |
| PA projection of dens is also known as what? | Judd method |
| Patient position for PA Judd | prone w/ chin extended (MML near ⊥ to tabletop) |
| IR for PA Judd | 8 x 10" (18 x 24 cm) ↔ |
| Location of IR for PA Judd | ⊥ to MML @ inferior tip of mandible |
| CR for PA Judd | ‖ to MML 1" (2.5 cm) inferoposterior to mastoid tips & ∠s of mandible; ∠ as needed |
| Area of interest for PA Judd | Dens w/in foramen magnum |
| Respiration for AP Fuchs | Suspend |
| Respiration for PA Judd | Suspend |
| AP projection of atlas & axis is also known as what? | Open mouth technique |
| IR for AP open mouth | 8 x 10" (18 x 24 cm) |
| Patient position for AP open mouth | supine |
| Location of IR for AP open mouth | IR CTR @ C2; occlusal plane ⊥ to IR |
| CR for AP open mouth | ⊥ @ midpoint of open mouth |
| Respiration for AP open mouth | Phonate "ah" upon exposure |
| Area of interest for AP open mouth | C1 & C2 through open mouth |
| IR for AP axial C-spine | 8 x 10" (18 x 24 cm) ↕ |
| Patient position for AP axial C-spine | supine or upright |
| Location of IR for AP axial C-spine | CTR IR @ C4 w/ occlusal plane ⊥ to IR |
| CR for AP axial C-spine | 15-20° cephalad @ C4 |
| Respiration for AP axial C-spine | Suspend |
| Area of interest for AP axial C-spine | C3- T2/3; ? C-ribs |
| SID for AP open mouth | 30" (76 cm) to ↑ view of odontoid area |
| True or false? AP Fuchs should not be attempted if fx or degenerative disease of upper cervical region is suspected. | True |
| Lateral projection of C-spine is also known as what? | Grandy method |
| IR for lateral C-spine, Grandy method | 8 x 10" (18 x 24 cm) ↕ |
| SID for lateral C-spine, Grandy method | 60- 72" SID due to ↑ OID; helps show C7 |
| Patient position for lateral C-spine, Grandy method | seated or standing, midsagittal plane ‖ to IR; Ⓡ or Ⓛ position |
| Location of IR for lateral C-spine, Grandy method | CTR coronal plane that passes thru mastoid tips to IR midline |
| CR for lateral C-spine, Grandy method | ⊥ @ C4; shoulder FARTHEST from IR proj ↓ lower c-spine |
| Area of interest for lateral C-spine, Grandy method | C3-C7 Zygapophyseal joints |
| Respiration for lateral C-spine, Grandy method | Suspend @ expiration ∴ ↓ shoulders |
| True or false? Sandbags can be attached to each of patient's wrists in lateral C-spine, Grandy method? | True |
| True or false? Lateral C-spine, hyperflexion or hyperextension can be performed as long as patient as sufficient support. | False; only attempt once C-spine pathology or fx has been r/o. |
| Area of interest for lateral C-spine, hyperflexion & hyperextension | Motility of C-spine; includes intervertebral disks & zygapophyseal joints |
| Location of spinous processes in lateral C-spine, hyperflexion | elevated & widely separated |
| Location of spinous processes in lateral C-spine, hyperextension | depressed in close appoximation |
| IR for lateral C-spine, hyperflexion & hyperextension | 24 x 30 cm ↕ |
| Patient position for lateral C-spine, hyperflexion & hyperextension | seated or standing; chin dropped or chin extended; Ⓡ or Ⓛ position |
| CR for lateral C-spine, hyperflexion & hyperextension | ⊥ @ C4 |
| Location of IR for lateral C-spine, hyperflexion & hyperextension | IR CTR @ C4 & top 2" (5 cm) ↑ EAM |
| Respiration for lateral C-spine, hyperflexion & hyperextension | Suspend |
| SID for lateral C-spine, hyperflexion & hyperextension | 60- 72" SID due to ↑ OID; helps show C7 |
| EAM | External acoustic meatus |
| MML | Mentomeatal line |
| Occlusal plane | line from the lower edge of the upper incisors to the tip of the mastoid process |
| SID for AP axial oblique C-spine, RPO & LPO | 60- 72" SID due to ↑ OID |
| Area of interest for AP axial oblique C-spine, RPO & LPO | Cervical intervertebral foramina; C2/C3- C7/T1 |
| IR for AP axial oblique C-spine, RPO & LPO | 8 x 10" (18 x 24 cm) ↕ |
| Patient position for AP axial oblique C-spine, RPO & LPO | supine or upright* (seated or standing); elevate/protrude chin |
| Body rotation for AP axial oblique C-spine, RPO & LPO | 45° ∠ |
| Location of IR for AP axial oblique C-spine, RPO & LPO | IR CTR to body of C3 |
| 1" (2.5 cm) ↑ to the most prominent point of the thyroid cartilage | C3 |
| CR for AP axial oblique C-spine, RPO & LPO | 15- 20° cephalad @ C4; w/ ∠ of foramina |
| Respiration for AP axial oblique C-spine, RPO & LPO | Suspend |
| Side of interest for AP axial oblique C-spine, RPO & LPO | side FARTHEST from IR |
| True or false? Hyperflexion & hyperextension of AP oblique C-spine is performed to demonstrate fx, obscure dislocations & subluxations of the articular processes. | True |
| IR for PA axial oblique C-spine, RAO & LAO | 8 x 10" (18 x 24 cm) ↕ |
| SID for PA axial oblique C-spine, RAO & LAO | 60- 72" SID due to ↑ OID |
| Patient position for PA axial oblique C-spine, RAO & LAO | prone or upright* (seated or standing); chin elevated & protruded |
| Location of IR for PA axial oblique C-spine, RAO & LAO | CTR IR @ C5 |
| Body rotation for PA axial oblique C-spine, RAO & LAO | 45° ∠ ∴ foramina openings ‖ w/ IR |
| Respiration for PA axial oblique C-spine, RAO & LAO | Suspend |
| CR for PA axial oblique C-spine, RAO & LAO | 15- 20° caudal @ C4; w/ ∠ of foramina |
| Side of interest for PA axial oblique C-spine, RAO & LAO | side CLOSEST to IR |
| Area of interest for PA axial oblique C-spine, RAO & LAO | Intervertebral foramina & pedicles |
| What is the Lateral projection of the cervicothoracic region also known as? | "Swimmer's" technique |
| IR for Lateral Swimmer's | 24 x 30 cm ↕ |
| Patient position for Lateral Swimmer's | recumbent or upright |
| Area of interest for Lateral Swimmer's | cervicothoracic vertebrae between shoulders |
| Location of IR for Lateral Swimmer's | CTR IR @ C7-T1, 2" (5 cm) ↑ jugular notch |
| CR for Lateral Swimmer's | ⊥ to C7-T1 or 3-5° caudal when unable to ↓ shoulder |
| Respiration for Lateral Swimmer's | Suspend; breathing tech if pt able & can be immobilized |
| 2" (5 cm) ↑ jugular notch | C7-T1 interspace |
| IR for AP T-spine | 35 x 43 cm (14" x 17") or 18 x 43 cm ↕ |
| Location of IR for AP T-spine | Top of IR 1½- 2" (3.8- 5 cm) ↑ shoulders ∴ T7 in CTR of image |
| Position of patient for AP T-spine | supine or upright |
| CR for AP T-spine | ⊥ to IR @ ½ btwn jugular notch & xiphoid process |
| Respiration for AP T-spine | Shallow breaths; or suspend @ expiration |
| Area of interest for AP T-spine | T1-T12 w/ uniform density |
| IR for Lateral T-spine, Ⓡ or Ⓛ | 35 x 43 cm (14" x 17") or 18 x 43 cm ↕ |
| Area of interest for Lateral T-spine, Ⓡ or Ⓛ | thoracic vertebral bodies & intervertebral foramina |
| Location of IR for Lateral T-spine Ⓡ or Ⓛ | Top of IR 1½- 2" (3.8- 5 cm) ↑ shoulders ∴ T7 in CTR of image |
| inferior ∠ of scapulae | T7 |
| Patient position for Lateral T-spine, Ⓡ or Ⓛ | lateral recumbent (Ⓡ or Ⓛ* position), upright |
| CR for Lateral T-spine, Ⓡ or Ⓛ | ⊥ @ T7; 10 cephalad for ♀ & 15 cephalad for ♂ to T7 if vertebral column not elevated |
| Respiration for Lateral T-spine, Ⓡ or Ⓛ | Normal breathing or suspend @ expiration |
| Area of interest for AP/PA (opt) L-spine | Lumbar vertebrae: bodies, IV disk spaces, laminae, spinous & transverse processes. w/larger IR also shows abd viscera & air/gas patterns |
| SID for AP/PA L-spine | 48" (122 cm); ↓ distortion, opens intervertebral joint spaces ↑, & and ↑ quality of exam |
| IR for AP/PA L-spine | 35 x 43 cm (14 x 17") for lumbosacral spine; or 30 x 35 cm (12 x 14") for L-spine only |
| Patient position for AP/PA L-spine | recumbent or upright |
| Location of IR for AP/PA L-spine | L-spine & sacrum: CTR IR @ L4; L-spine only: 1½" (3.8 cm) ↑ iliac crest @ L3 |
| CR of IR for AP/PA L-spine | For L-S exam: ⊥ @ L4; For Lumbar exam: ⊥ & 1½" (3.8 cm) ↑ L3 |
| Respiration for AP/PA L-spine | Suspend @ expiration |
| Level of iliac crests | L4 |
| IR for Lateral Lumbar & Lumbosacral vertebrae | 35 x 43 cm (14 x 17") for lumbosacral spine; or 30 x 35 cm (12 x 14") for L-spine only |
| Patient position for lateral lumbar & lumbosacral vertebrae | upright or recumbent (same as AP/PA), lying ON AFFECTED side |
| Location of IR for Lateral Lumbar & Lumbosacral vertebrae | L-spine & sacrum: CTR IR @ L4; L-spine only: 1½" (3.8 cm) ↑ iliac crest @ L3 |
| CR for Lateral Lumbar & Lumbosacral vertebrae | For L-S exam: ⊥ @ L4; For Lumbar exam: ⊥ & 1½" (3.8 cm) ↑ L3 |
| Respiration for Lateral Lumbar & Lumbosacral vertebrae | Suspend @ expiration |
| Area of interest for Lateral Lumbar & Lumbosacral vertebrae | L-vertebrae; intervertebral foramina of L1-L4 |
| IR for Lateral L5-S1 | 8 x 10" (18 x 24 cm) |
| Location of IR for Lateral L5-S1 | CTR on coronal plane 2" (5 cm) posterior to ASIS & 1½" (3.8 cm) ↓ to the iliac crest |
| Patient position for Lateral L5-S1 | lateral recumbent |
| CR for Lateral L5-S1 | ‖ w/ interiliac line; or if spine not horizontal 5° caudal for ♂ & 8° caudal for ♀ |
| Respiration for Lateral L5-S1 | Suspend |
| provides a standardized & accurate reference point from which to CTR the L5-S1 junction | ASIS |
| Area of interest for Lateral L5-S1 | Lateral lumbosacral junction; L4- L5, and upper sacrum |
| imaginary line between both iliac crests | interiliac plane |
| What are AP or PA axial projection of L-S jct & SI joints also known as? | Ferguson method |
| IR for AP/PA axial L5-S1/SI joints | 8 x 10" (18 x 24 cm) or 24 x 30 cm ↕ |
| Location of IR for AP/PA axial L5-S1/SI joints | IR ctr to CR |
| Patient position for AP/PA axial L5-S1/SI joints | supine (PA axial, prone) |
| CR for AP/PA axial L5-S1/SI joints | 30° cephalad ♂ & 35° ♀; 1½" (3.8 cm) ↑ to pubic symphysis (30-35° caudal @ L4 for PA axial) |
| Respiration for AP/PA axial L5-S1/SI joints | Suspend |
| Area of interest for AP/PA axial L5-S1/SI joints | Lumbosacral joint & both SI joints |
| CR Variation for PA axial L5-S1/SI joints | (Meese) ⊥ & CTR to ASIS @ 2" (5 cm) distal to spinous process of L5 |
| IR for AP oblique Zygapophyseal joints, RPO & LPO | 35 x 43 cm (14 x 17") or 30 x 35 cm ↕; 8 x 10" (18 x 24") for the last zygapophyseal joint |
| Location of IR for AP oblique Zygapophyseal joints, RPO & LPO | IR ctr to CR |
| Patient position for AP oblique Zygapophyseal joints, RPO & LPO | recumbent or upright; affected side closest to IR |
| Respiration for AP oblique Zygapophyseal joints, RPO & LPO | Suspend @ expiration |
| CR for AP oblique Zygapophyseal joints, RPO & LPO | For lumbar region, 2" (5 cm) medial to ↑ ASIS & 1½" (3.8 cm) ↑ iliac crest @ L3; For 5th Z-joint, 2" (5 cm) medial to ↑ ASIS & ½way btwn ASIS and iliac crest. |
| Area of interest for AP oblique Zygapophyseal joints, RPO & LPO | Zygapophyseal joints & articular processes of side closes to IR |
| plane of the zygapophyseal joints | 30-60° to the MS plane in most patients; varies |
| Side of interest for AP oblique Zygapophyseal joints, RPO & LPO | side closest to IR |
| Body rotation for AP oblique Zygapophyseal joints, RPO & LPO | 45°, but can be up to 60° to show L5-S1 Z-joint |
| Show when pt properly positioned or AP oblique of L-spine/ Z-joints | "Scottie dogs" |
| IR for PA oblique Z-joint projection, RAO & LAO | 35 x 43 cm (14 x 17") or 30 x 35 cm ↕; 8 x 10" (18 x 24") for the last zygapophyseal joint |
| Location of IR for PA oblique Z-joint projection, RAO & LAO | IR ctr @ L3 |
| Patient position for PA oblique Z-joint projection, RAO & LAO | upright or recumbent prone*; also semisupine |
| CR for PA oblique Z-joint projection, RAO & LAO | ⊥ to L3, 2" (5cm) lateral to palpable spinous process |
| Respiration for PA oblique Z-joint projection, RAO & LAO | Suspend @ expiration |
| Area of interest for PA oblique Z-joint projection, RAO & LAO | Zygapophyseal joints (esp 5th) & articular processes of side farthest from IR |
| Side of interest for PA oblique Z-joint projection, RAO & LAO | joints FARTHEST from IR |
| Body rotation for PA oblique Z-joint projection, RAO & LAO | 45°, but can be up to 60° to show L5-S1 Z-joint |
| IR for PA projection, lumbar intervertebral disks, weight bearing method, Ⓡ or Ⓛ bending | 35 x 43 cm (14" x 17") ↕ |
| What is PA projection, lumbar intervertebral disks, also known as? | Weight-bearing method; Ⓡ or Ⓛ bending |
| Patient position for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending | standing |
| CR for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending | ⊥ to L3; 15-20° caudad or thru L4/L5 or L5-S1 if area of interest |
| Respiration for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending | Suspend |
| Location of IR for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending | IR CTR @ L3 |
| Area of interest for PA projection, lumbar intervertebral disks, weight-bearing method, Ⓡ or Ⓛ bending | mobility of intervertebral joints; localize to site of lesion in pts w/ disk protrusion |
| True or false? AP L-spine bending is preferred over PA L-spine bending for comfort of patient. | False; PA pref'd due to ↓ pt rad |
| IR for AP projection, L-spine Ⓡ or Ⓛ bending | 24 x 30 cm (10 x 12") or 35 x 43 cm (14" x 17") ↕ |
| Patient position for AP projection, L-spine Ⓡ or Ⓛ bending | supine |
| Location of IR for AP projection, L-spine Ⓡ or Ⓛ bending | IR CTR to CR |
| Respiration for AP projection, L-spine Ⓡ or Ⓛ bending | Suspend |
| CR for AP projection, L-spine Ⓡ or Ⓛ bending | ⊥ to L3 |
| Area of interest for AP projection, L-spine Ⓡ or Ⓛ bending | max Ⓡ or Ⓛ lat flex; early scoliosis; motion of spinal fusion; localize herniated disk |
| IR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | 35 x 43 cm (14" x 17") ↕ |
| Patient position for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | lateral recumbent; 1st knees fwd & 2nd lean thorax bkwd |
| Location of IR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | IR CTR @ spinal fusion |
| Respiration for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | Suspend |
| CR for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | ⊥ to spinal fusion area or L3 |
| Area of interest for Lateral projection, L-spine Ⓡ or Ⓛ hyperflexion & hyperextension | motion in spinal fusion area, or localize herniated disk |
| prep for sacrum & coccyx exams | bowel free of gas & fecal material; bladder empty |
| IR for AP or PA axial Sacrum | 24 x 30 cm (10 x 12") |
| IR for AP or PA axial Coccyx | 8 x 10" (18 x 24 cm) |
| Location of IR for AP or PA axial Sacrum | IR CTR to CR |
| Location of IR for AP or PA axial Coccyx | IR CTR to CR |
| Patient position for AP axial Sacrum or Coccyx | supine |
| Patient position for PA axial Sacrum or Coccyx | prone |
| Respiration for AP or PA axial Sacrum or Coccyx | Suspend |
| CR for AP axial Sacrum | 15° cephalad @ 2" ↑ to pubic symphysis |
| CR for PA axial Sacrum | 15° caudad @ sacral curve |
| CR for AP axial Coccyx | 10° caudad @ 2" ↑ to pubic symphysis |
| CR for PA axial Coccyx | 10° cephalad @ coccyx |
| Area of interest for AP or PA axial Sacrum & Coccyx | Sacrum or Coccyx free of superimposition |
| True or false? Females can be shielded for sacrum & coccyx x-rays. | False |
| IR for Lateral projection of sacrum, Ⓡ or Ⓛ | 24 x 30 cm (10 x 12") |
| IR for Lateral projection of coccyx, Ⓡ or Ⓛ | 8 x 10" (18 x 24 cm ↕) |
| Area of interest for Lateral projection of sacrum & coccyx, Ⓡ or Ⓛ | lateral sacrum & coccyx |
| Location of IR for Lateral sacrum & coccyx, Ⓡ or Ⓛ | IR CTR to CR w/ sacrum or coccyx to midline of grid |
| CR for Lateral sacrum, Ⓡ or Ⓛ | ⊥ to ASIS level @ point 3½" (9 cm) posterior |
| CR for Lateral coccyx, Ⓡ or Ⓛ | ⊥ toward point 3½" (9 cm) posterior to ASIS & 2" (5 cm) ↓ |
| Respiration fof Lateral sacrum & coccyx | Suspend |
| What is AP/PA* scoliosis series also known as? | Ferguson method |
| IR for PA projection of thoracolumbar spine, scoliosis series, Ferguson method | 14 x 36" (35 x 90 cm) or 14 x 17" (35 x 43 cm) ↕ |
| Position of patient for PA thoracolumbar spine, scoliosis series, Ferguson method | seated or standing |
| Location of IR for PA thoracolumbar spine, scoliosis series, Ferguson method | Bottom of IR 1" (2.5 cm) ↓ to iliac crests |
| CR for PA thoracolumbar spine, scoliosis series, Ferguson method | ⊥ to midpoint of IR |
| True or False? Patient support or compression bands are NOT to be used in PA thoracolumbar, Ferguson method radiographs. | True |
| Respiration for PA thoracolumbar spine, scoliosis series, Ferguson method | Suspend |
| How many radiographs are taken for PA thoracolumbar spine, scoliosis series, Ferguson method | 2; 1st normal seated/standing & 2nd w/ hip or foot elevated |
| Area of interest for PA thoracolumbar spine, scoliosis series, Ferguson method | comparison to distinguish deforming or primary curve from compensatory curve in patients w/ scoliosis |
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