Anatomy And Positioning - Thoracic & Lumbar Spine, Sacrum & Coccyx

Front 1

Which thoracic vertebrae are "typical" and which ones are similar to cervical and which ones to lumbar vertebrae?

Back 1

T5-8 are typical
T1-4 are similar to cervical
T 9-12 are similar to lumbar

Front 2

What articulation do thoracic vertebrae have that the others do not?

Back 2

rib articulations
what are these? (3 types)

Hint 2

Inferior costal facet
Superior costal facet
Costal tubercle facet

Front 3

What is the direction of thoracic Zygoapophyseal Joints on the thoracic vertebrae in relation to the MSP and MCP?

Back 3

20 deg off of MCP and 70 deg off of MSP
so what projection would we use to see this part of the anatomy?

Hint 3

oblique 20 or 70 deg

Front 4

What is the direction of thoracic intervertebral foramina in relation to the MSP?

Back 4

90 degrees
so what projection would we use to see this part of the anatomy?

Hint 4

lateral

Front 5

What is the "anode heel effect" and when would you use it?

Back 5

It is used on a Thoracic spine projection to help even out the density since the lower part of the region is thicker than the upper. The cathode end of the tube puts out more x-rays so you would have that end facing down. Lateral is opposite

Front 6

You have to do an AP thoracic spine projection on your next patient. What cassette do you put in the bucky, its orientation and location and what is the CR?

Back 6

14 x 17 lengthwise centered on T7, top of cassette is 1 1/2" above shoulder, CR is perp to center of IR. Pt is supine with support under knees.
Why is the support important?

Hint 6

1. makes the patient more comfortable and 2. most importantly straightens out kyphotic curve of thoracic spine

Front 7

Thoracic spine AP- pt position, IR size, location and orientation and CR?

Back 7

14 x 17 lengthwise centered on T7, top of cassette is 1 1/2" above shoulder, CR is perp to center of IR

Front 8

What should we see on a AP thoracic spine image?

Back 8

see vertebrae from C7 to L1

How about lateral thoracic?

Hint 8

need to see intervertebral disk spaces

Front 9

Oblique Thoracic spine- how do we position patient to see zagapoposeal joints closest to IR?

Back 9

70 to 75 deg LAO or RAO, have pt put arm closest to bucky on top of bucky to help stablize pt

projections so see joints furthest away from IR?

Hint 9

RPO and LPO

Front 10

What is the thoracic swimmers done for and how does it differ from cervical swimmers?

Back 10

It is done to see T1-2 and is centered on T1-2. No difference from the cervical

Front 11

What angle do we position the patient for a lumbar oblique and why?

Back 11

45 deg as the zagapopaseal joints are 30-50 deg from MSP

Front 12

what is spinal bifida?

Back 12

an opening in the lamina of lumbar vertebra exposing the spinal column

what is spondylolisthesis?

Hint 12

a defect of the pars interarticularis that may look like a dislocation in the lumbar vertebrae

Front 13

What is the advantages of doing the lumbar projection PA rather than AP?

Back 13

1. the lordotic curve is facing the tube
2. more comfortable for the patient
3. intervertebral disks more parallel
4. decreased gonadal dose

Front 14

On AP lumbar why is it important to have pt flex legs

Back 14

to decrease lorditic curve of lumbar spine

Front 15

Where do we center the cassette for a lumbar AP?

Back 15

1 1/2" above Iliac crest - L3

what should we see on a good lumbar AP?

Hint 15

see from T12 to Sacrum
intervertebral disk space open
spineous processes centered

Front 16

What is the lumbar axial L5-S1(spot) done for?

Back 16

To see the lumbosacral junction.
(see SI joints as well in good image)

Pt and IR placement and CR for this projection?

Hint 16

8x10 lengthwise, centered at 1 1/2" above sym pubs or just below ASIS.
Pt supine with legs extended. CR is 30 deg cephalic (35-female) centered MSP and center IR

Front 17

On regular lateral lumbar L5-S1 projection where do we center the CR?

Back 17

@ spot 2" posterior and 1" superior to ASIS
how do we position pt and direct CR?

Hint 17

pt supine lateral with hips and knees flexed
CR is parallel if support used, otherwise 5-8 deg caudad

Front 18

Lateral Lumbar projection, what is the CR placement and angle

Back 18

Centered at L3 and 1 1/2" posterior to MCP, angled 5-8 deg caudad unless sponge is used
what do we strive to see in this projection?

Hint 18

open disk spaces and intervertebral foramina

Front 19

What do we see in RPO lumbar oblique?

Back 19

RIGHT zagapophyseal joints
and what angle is the pt positioned at?

Hint 19

45 deg

Front 20

What do we see on a lumbar oblique image when it is done right?

Back 20

you see a "scotty dog"

Front 21

AP Axial Sacrum, CR location and angle?

Back 21

with pt supine @ spot between ASIS and symphysis pubis and 15 deg cephalic
what do we see in this image?

Hint 21

SI joints and sacrum

Front 22

CR center and angle for AP Coccyx?

Back 22

2" above symphysis pubis and 10 deg caudad

Front 23

Positioning for Lateral coccyx?

Back 23

pt lateral with hips and knees flexed, body supported so long axis of spine is horizontal
what is centered on IR?

Hint 23

coccyx

Front 24

Positioning and CR for lateral sacrum?

Back 24

perp to level of ASIS and 3" posterior to MCP

Front 25

When positioning for AP Coccyx what is important to remember when collimating?

Back 25

collimate tightly widthwise