Published on 03/05/2015 by admin Show
Filed under Radiology Last modified 03/05/2015 Print this page Average : Your rating: none, Average: 0 (0 votes) Rate it This article have been viewed 3735 times Chapter 6 Vertebral Column• Intervertebral foramina and zygapophyseal joints • Topographic landmarks Cervical Spine AP (open mouth) C1-C2 (R) AP (PA) dens (Fuchs and Judd methods) (S) AP open mouth and AP (PA) dens critique AP axial (R) Oblique (R) AP axial and oblique critique Lateral, erect (R) Lateral cervicothoracic (swimmer’s) (R) Lateral and swimmer’s critique Lateral hyperflexion and hyperextension (S) Hyperflexion and hyperextension critique Trauma series: horizontal beam lateral, AP axial, obliques, cervicothoracic lateral (S)Thoracic Spine AP (R) Lateral (R) AP and lateral critique Oblique (S)Lumbar Spine AP (PA) (R) AP (PA) critique Lateral (R) Lateral L5-S1 (R) Lateral and lateral L5-S1 critique Oblique (R) Oblique critique Scoliosis series (Ferguson method) (S) AP right and left bending (S) Lateral hyperflexion and hyperextension (S) Lateral hyperflexion and hyperextension critiqueSacrum and Coccyx AP axial sacrum (R) AP axial coccyx (R) AP axial sacrum and coccyx critique Lateral sacrum (and coccyx) (R) Lateral coccyx (R) Lateral sacrum and coccyx critiqueSacroiliac Joints AP axial (R) Posterior oblique (R) Posterior oblique critique(R) Routine, (S) Special Intervertebral Foramina and Zygapophyseal JointsCertain lateral and oblique projections best demonstrate these important foramina and joints of the spine as follows:
Topographic LandmarksFig. 6-1Cervical spine landmarks. Fig. 6-2Sternum and thoracic spine landmarks. Fig. 6-3Lower spine landmarks. AP for C1-C2*(Atlas and Axis) Fig. 6-4 AP open mouth for C1-C2. • 18 × 24 cm L.W. (8 × 10″) • Grid • AEC not recommended because of small field Position• Supine, patient centered to CR and centerline • Adjust head without opening mouth—biting surface of upper incisors (junction of lips) aligned with base of skull (mastoid tips). • Center IR to CR • As a last step before making exposure—open mouth wide without moving head (make final check for head alignment). Central Ray:CR ⊥ through midportion of open mouth (to C1-C2) SID:40-44″ (102-113 cm) Collimation:Close collimation to C1-C2 region Respiration:Suspend during exposure. AP for Dens (Odontoid Process)*(AP Fuchs Method [and PA Judd Method]) Warning: Do not attempt on possible cervical trauma. Fig. 6-5AP Fuchs for dens (within foramen magnum outline). Fig. 6-6PA Judd method. • 18 × 24 cm L.W. (8 × 10″) • Grid • AEC not recommended Position• Supine or erect, MSP aligned to centerline, no rotation • Elevate chin until MML is near ⊥ to IR (may require some cephalic CR angle if chin cannot be elevated sufficiently) Note:May also be taken PA (Judd method) with chin against tabletop, with same CR alignment. • Center IR to exiting CR. Central Ray:CR parallel to MML directed to tip of mandible (AP) SID:40-44″ (102-113 cm) Collimation:Close collimation to C1-C2 region Respiration:Suspend during exposure. AP Open Mouth and AP (PA) DensEvaluation CriteriaAnatomy Demonstrated:• Open mouth: Dens, lateral masses of C1, and C1-C2 zygapophyseal joints • AP Fuchs: Dens within foramen magnum (odontoid process) Fig. 6-7AP open mouth—dens. Fig. 6-8AP (AP Fuchs—dens). Position:• Open mouth: Upper incisors and base of the skull superimposed. Entire dens demonstrated within foramen magnum • AP Fuchs: Tip of mandible not superimposed over dens. Symmetric appearance of mandible Exposure• Optimal density (brightness) and contrast • Sharp outline of dens; no motion AP Axial Cervical Spine*• 18 × 24 cm L.W. (8 × 10″) • Grid Fig. 6-9Erect (CR 15°–20° cephalad). Position• Supine or erect, center midsagittal plane to CR (and to centerline of IR) • Raise chin slightly as needed so the CR angle superimposes the mentum of the mandible over the base of the skull (to prevent mandible from superimposing more than C1-C2). • Center IR to projected CR. Central Ray:CR 15°–20° cephalad, to enter at C4 (inferior border of thyroid cartilage) SID:40-44″ (102-113 cm) Collimation:On four sides to C spine region Respiration:Suspend during exposure. Fig. 6-10Supine (CR 15°–20° cephalad). Oblique Projections, Cervical Spine*Right and left obliques taken for comparison (as either posterior or anterior obli’s); anterior obli’s result in less thyroid dose. • 18 × 24 cm (8 × 10″) or 24 × 30 cm (10 × 12″), L.W. • Grid (screen optional for small patient or pediatrics) Fig. 6-11LPO; CR 15° cephalad. Fig. 6-12RAO; CR 15° caudad. Position• Erect preferred (sitting or standing), entire torso and head turned 45° to IR, C spine aligned to CR (and centerline of IR) • Raise chin slightly, looking straight ahead (or turn head slightly toward IR to prevent superimposing C1 by mandible). • Center IR to projected CR. Central Ray (Posterior Obliques):CR 15°–20° cephalad, to enter at C4. Caudal angle required for anterior obliques. SID:60-72″ (153-183 cm) Collimation:To C spine region Respiration:Suspend during exposure. AP Axial and Oblique Cervical SpineFig. 6-13AP
axial. Fig. 6-14
RPO. Evaluation CriteriaAnatomy Demonstrated:• AP axial: C3 to T2 vertebral bodies and intervertebral joints • Oblique: Intervertebral foramina open and pedicles • LPO/RPO projections: Demonstrate upside intervertebral foramina • LAO/RAO projections: Demonstrate downside intervertebral foramina Position:• AP axial: Intervertebral joints open and spinous processes equidistant to midline • Oblique: 45° (AP or PA): Intervertebral foramina uniformly open and pedicles in profile Exposure:• Optimal density (brightness) and contrast; no motion • Soft tissue and bony margins and trabecular markings sharp Lateral Cervical Spine*Fig. 6-15Erect lateral, 183 cm (72″) SID. • 24 × 30 cm L.W. (10 × 12″) • Grid (screen optional for small patient or pediatrics) Position• Erect (sitting or standing) in lateral position, C spine aligned and centered to CR (and centerline of IR) • Top of IR ≈1-2″ (3-5 cm) above level of EAM • Raise chin slightly (to remove mandible angles from spine). • Relax and depress both shoulders evenly (weights in each hand may be necessary to visualize C7). Note:See following page for swimmer’s lateral if C7 is still not visualized. Central Ray:CR ⊥, to level of C4 (upper thyroid cartilage) SID:60-72″ (153-183 cm) (Longer SID provides for better visualization of C7 because of less divergent rays.) Collimation:On four sides to C spine region Respiration:Expose on complete expiration. Lateral Cervicothoracic Spine*Swimmer’s (Twining Method) C5-T3 Region • 24 × 30 cm L.W. (10 × 12″) • Grid Fig. 6-16Cervicothoracic (swimmer’s) lateral. Position• Erect preferred, align C-spine to CR (and centerline of IR). • Elevate arm and shoulder closest to IR and rotate this shoulder slightly anteriorly or posteriorly. • Opposite arm down, relax and depress shoulder, with slight opposite rotation (from other shoulder) to separate humeral heads from vertebra. May also be taken in lateral recumbent position with one arm and shoulder down and one up—Pawlow method. Central Ray:CR ⊥, centered to T1 (approximately 1″ [2.5 cm] above level of jugular notch). Optional 3°–5° caudad to separate the two shoulders SID:60-72″ (153-183 cm) Collimation:Collimate closely to area of interest Respiration:Expose on full expiration or orthostatic (breathing) technique. Erect Lateral and Cervicothoracic (Swimmer’s) LateralFig. 6-17
Erect lateral. Fig. 6-18Cervicothoracic (swimmer’s)
lateral. Evaluation CriteriaAnatomy Demonstrated:• Lateral: C1-C7 (minimum) demonstrated • Swimmer’s: Vertebral bodies from C5-T3 (minimum) demonstrated Position:• Lateral: Near superimposition of zygapophyseal joints; no superimposition of mandible on C spine • Swimmer’s: Separation of humeral heads from C spine; vertebral bodies in lateral perspective Exposure:• Optimal density (brightness) and contrast of lower cervical and upper thoracic spine; no motion • Soft tissue and bony anatomy visible
Lateral Cervical Spine Hyperflexion—Hyperextension*Warning: Do NOT attempt on possible trauma patients. • 24 × 30 cm L.W. (10 × 12″) • Grid or nongrid Fig. 6-19Hyperflexion. Fig. 6-20Hyperextension. PositionBuy Membership for Radiology Category to continue reading. Learn more here You may also need
RelatedBontragers Handbook of Radiographic Positioning and Techniques Where is the IR centered for the lateral projection of the cervicothoracic region swimmer's technique?Vertebral Column. When positioning for an AP thoracic spine image how far above the shoulders should the IR be positioned?Place the IR against the left side of the patient. Adjust the height of the cassette so the upper border is 1 1/2 to 2-inches above the shoulder. The upper border of the illuminated field should be above the shoulders and on each side.
Where is the central ray directed for a lateral projection of the lumbar spine?The central ray should be directed approximately 1.5 inches (2–3 fingerbreadths) inferior to the iliac crest and 2 inches posterior to the anterior superior iliac spine (ASIS).
What is the angle for Fuchs?Instead of lifting the chin, the beam is angled ~35-40° upward and sent in just under the chin.
|