Unit 7 - Cranium and Vertebral Column

Question	Answer
AP axial cervical spine evaluation criteria Image: Ap Cspine (image/jpeg)	C3-C7 visible no rotation spinous processes lined up to midsagittal plane (MSP) SC joints are symmetric and equidistant from spine mastoid tips are equidistant from spine
Image: Ap Cspine Chin Depressed Over C3 (image/jpeg)	chin depressed over C3
Image: Ap Cspine Rotated Into Oblique (image/jpeg)	rotation to the left
Oblique C-Spine evaluation criteria Image: Oblique Cspine (image/jpeg)	RAO and LAO show IVF closest to IR RPO and LPO show IVF farther from IR open IVF pedicles in profile
Image: Rao Cspine No 15 Caudal Angle (image/jpeg)	no cephalic angle
Image: Lao Cspine Underrotation (image/jpeg)	underrotation
Image: Rao Cspine Overrotation (image/jpeg)	overrotation
Lateral C-Spine evaluation criteria Image: Lateral C Spine (image/jpeg)	all 7 vertebrae are visible spinous processes in profile right and left zygapophyseal joints (z. jt.) and articular pillars are superimposed posterior arch and spinous process of C2 are in profile intervertebral disk spaces open
Image: Lateral C Spine Head Tilted Toward Ir (image/jpeg)	mandibular rami are not superimposed: pt. rotated articular pillars and z. jt.s are separated: pt. head tilted away from IR
Image: Lateral C Spine Sella Turcica Clipped, Rotation (image/jpeg)	base of skull and sella turcica coned off z. jt.s closed: rotation
Image: Lateral Cspine Head Tilted Toward Ir (image/jpeg)	mandible not superimposed: head is tilted z. jt.s are separated
Image: Lateral Cspine Shoulders Elevated (image/jpeg)	C7 is invisible behind the shadow of the shoulders - give pt weights to relax shoulders down
AP Open Mouth evaluation criteria Image: Ap Open Mouth Ondontoid (image/jpeg)	atlas and axis, ondontoid, lateral masses of C1, and z. jt.s of C1-C2 are well visualized without superimposition
Image: Ondontoid Head Tilted Forward (image/jpeg)	teeth are superimposed over the dens: head is tilted forward
Image: Ondontoid Head Extended (image/jpeg)	base of the skull superimposes the dens: head is extended too far
Image: Ondontoid Rotation To The Right (image/jpeg)	dens is situated to the left of the MSP: pt's head is rotated towards the right
AP Thoracic Spine evaluation criteria Image: Ap Tspine (image/jpeg)	all 12 thoracic vertebrae are visible with no rotation, flexion, extension, or tilt collimation is evident exposure is taken after expiration to reduce lung volume and create more uniform density patient positioned so the thorax is under the cathode side of the beam (annode-heel effect)*
Image: Ap Tspine Inspiration (image/jpeg)	exposure was taken on full inspiration: lung fields are overexposed and density is not well distributed
Image: Ap Tspine Knees Extended (image/jpeg)	intervertebral joint spaces are obscured: pt's legs/knees were extended when they should've been flexed
Lateral T-Spine Evaluation Criteria Image: Lateral Tspine (image/jpeg)	thoracic bodies of T4-T12 are seen with open IVF and no rotation *exposure taken using a breathing technique to blur out the ribs and lung markings
Image: Lateral Tspine Breathing Technique (image/jpeg)	ribs are not blurred out: inadequate breathing technique lower thoracic vertebral bodies are obscured: pt's hips were not supported so spine is curved laterally
Image: Lateral Tspine Rotation 2 (image/jpeg)	posterior ribs and vertebral bodies aren't superimposed: pt rotated
Swimmer's Lateral T-Spine Evaluation Criteria Image: Swimmers Tspine (image/jpeg)	C5-T3 included humerus should be above head and aligned with vertebral column humerus away from IR should be anterior to spine intervertebral disk spaces should be open
Image: Cervicothoracic Swimmers 2 (image/jpeg)	acceptable (bontrager's demonstration picture)
Image: Swimmers Rotation (image/jpeg)	posterior ribs and vertebral bodies aren't superimposed: patient is rotated
Image: Swimmers Tilt (image/jpeg)	intervertebral disk spaces closed: c-spine is not parallel to IR
AP Lumbar evaluation criteria Image: Ap Lumbar (image/jpeg)	T12-sacrum are included intervertebral disk spaces are opened patient positioned with knees and hips flexed sacrum/coccyx centered to MSP and pelvic inlet
Image: Ap Lumbar Rotation To The Left (image/jpeg)	spinous processes are shifted to the right of the midline and the sacrum/coccyx shifted to the right of MSP: patient's hips rotated towards the left
extreme scoliosis Image: Extreme Scoliosis (image/jpeg)	slight scoliosis Image: Slight Scoliosis (image/jpeg)
Image: Ap Lumbar Knees Need To Be Flexed (image/jpeg)	intervertebral disk spaces are closed: the knees and hips need to be flexed
Oblique Lumbar evaluation criteria Image: Oblique Lumbar (image/jpeg)	scotty dogs should be visible open z. jts LPO and RPO show the z jt closest to IR LAO and RAO show the z jt farther from IR
Image: Scottie Dog 2 (image/jpeg)	Scottie Dog
Image: Oblique Lspine Underrotation (image/jpeg)	underrotation
Image: Oblique Lspine Overrotation (image/jpeg)	overrotation
Lateral Lumbar evaluation criteria Image: Lateral Lumbar (image/jpeg)	open intervertebral foramina (IVF) open intervertebral disk spaces
Image: Lateral Lspine Unsupported Waist (image/jpeg)	intervertebral disk spaces closed - hips/waist was not supported
L5-S1 spot evaluation criteria Image: L5 S1 Spot (image/jpeg)	lumbosacral joint open IVF clearly demonstrated right/left pedicles superimposed
Image: Spot Lspine Unsupported Waist (image/jpeg)	iliac wings are not superimposed - pelvis is tilted from being unsupported
Image: Spot Lspine Rotation (image/jpeg)	femoral heads aren't superimposed: pelvis is rotated
PA Skull 0 degrees evaluation criteria Image: Pa Skull (image/jpeg)	petrous ridges fill the orbits orbits are symmetric and equidistant from MSP
Image: Pa Skull Oml Not Perpendicular (image/jpeg)	petrous ridges aren't filling the orbits chin isn't tucked enough to get OML perpendicular to IR
Image: Pa Skull Ridges Above Orbits (image/jpeg)	petrous ridges are seen above the orbital rims chin is tucked too much - OML isn't perpendicular
PA Caldwell 15 evaluation criteria Image: Pa Caldwell (image/jpeg)	petrous ridges are seen within lower 1/3 of orbits OML is perpendicular to IR
Image: Caldwell Cephalic (image/jpeg)	CR angle was 15 cephalic: orbits are magnified, skull is foreshortened in trauma cases this is acceptable
Image: Caldwell Too Caudal (image/jpeg)	head is tilted petrous ridges are below orbital floors: CR was angled too caudal
AP Axial Towne Method evaluation criteria Image: Ap Townes (image/jpeg)	dorsum sellae is seen within the foramen magnum petrous pyramids are symmetric
Image: Towne Rotation To The Left (image/jpeg)	dorsum sellae is off center to the right: patient's face is turned to the left
Image: Towne Oml Not Perpendicular (image/jpeg)	dorsum sellae is not within foramen magnum head is not flexed enough OR we need more tube angle
Image: Towne Over Flexion (image/jpeg)	posterior arch of C1 is seen within foramen magnum: head is over flexed, OR the tube angle is too caudal
Lateral Skull evaluation criteria Image: Lateral Skull (image/jpeg)	superimposed facial bones sella turcica and clivus are in profile
Image: Lat Skull Tilt (image/jpeg)	structures aren't superimposed vertically TILT
Image: Lat Skull Rotation (image/jpeg)	facial features aren't superimposed horizontally ROTATION
Parietoacanthial Waters Modified and Transoral evaluation criteria Image: Pa Waters (image/jpeg)	PETROUS RIDGES ARE BELOW THE MAXILLARY SINUSES facial features and sinuses are symmetric no rotation SPHENOID sinus is best viewed on the transoral projection MML or LML perpendicular to IR
Image: Modified Waters Petrous Ridges In The Maxillary Sinuses (image/jpeg)	since this is a modified waters view, it's okay that the petrous ridges are within the maxillary sinuses acceptable image
Image: Waters Petrous Ridges In Sinuses (image/jpeg)	standard PA waters: -petrous ridges are within the maxillary sinuses: MML is not perpendicular to IR -head must be extended backward
Image: Waters Overextension (image/jpeg)	transoral waters: petrous ridges are low, and upper teeth are in maxillary sinuses head is overextended - flex head forward to bring MML perpendicular to IR
if a patient is rotated with the right side more anterior on the AP C-spine, which SC joint will be lying more over the spine?	Right SC joint side closest to IR will be open
Which positioning line is used to position the head for the AP c-spine?	AML
On this oblique of the c-spine you will see the IVF closest to the IR	RAO/LAO
On this oblique of the l-spine, you will see the zygapophyseal joints of the side closest to the IR	RPO/LPO
On this view of the t-spine you will see the zygapophyseal joints	Lateral
On this oblique of the l-spine, you will see the zygapophyseal joints on the side farthest from the IR	RAO/LAO
On this oblique of the c-spine you will see the IVF farthest from the IR	RPO/LPO
Which direction will you angle the CR for an AP oblique c-spine?	15-20 cephalic
Which direction will you angle the CR for a PA oblique c-spine?	15-20 caudal
For an oblique c-spine, the _________ obliques provide less absorbed dose to the thyroid gland	anterior
how can you determine if there was a tube angle on an oblique c-spine projection?	the disc spaces will be open but the IVF will be closed
On a lateral c-spine, if the head is tilted towards the IR we will see the ....	vertebral foramen of C1
On a lateral c-spine, if the head is tilted away from the IR, we will see .....	posterior arch of C1 still in profile, but the rami of the mandible are not superimposed and the base of the skull
On the AP open mouth projection of the c-spine, the teeth are superimposing the dens. How do we correct this problem on the repeat image?	extend head back
On the AP open mouth projection of the c-spine, the base of the skull is superimposing the dens. What will we do on the repeat?	flex head forward
how can you determine which side was rotated more anteriorly on a lateral lumbar/lateral L5-S1?	the femoral heads should be superimposed. The side that is farther from the IR will be more magnified if the magnified femoral head is more anterior, the patient is rotated
There's trauma and you need to do a PA Caldwell skull projection. You can't get the OML perpendicular to the IR because of the C-collar. What will you do?	angle your CR perpendicular to the OML, (caudal if PA, cephalic if AP) then add an additional 7 degrees to the tube angle

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Unit 7 - Cranium and Vertebral Column

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