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Jarrett Spinal Rad I

NYCC Spring 2010 Dr. Jarrett-Pulliam Final exam

QuestionAnswer
what are the standard radiographs for the cervical spine APOM, AP cervical, lateral cervical neutral projections
What are the standard views for the thoracic spine? AP thoracic, lateral thoracic neutral
What are the standard views for the lumbar spine? AP lumbar, Lateral lumbar neutral
What is the tube setup for RAO and LAO cervical oblique projections? RAO/LAO cervical tube tilt is 15deg. caudad/tail (shoot them from above and behind!)
What is the tube setup for RPO and LPO cervical oblique projections? 15 deg. cephalad (kneel and aim the bow and arrow UP if they come face on - pin their shoulder to the bucky!)
What do lumbar obliques visualize? SCOTTY DOG!
describe the parts of the Scotty dog! nose: transverse process, ears: superior articular process/facet, eye: pedicle, neck: pars interarticularis (a "collar" indicates a fracture), front feet: inferior articular process/facet, body: lamina
spondylolytic spondylolisthesis? a fracture at the "collar" or neck of the Scotty dog - the pars interarticularis - with an anterior displacement
What lines can be used to see spondylolisthesis at L5/S1? Ulmann's line, Meyerding's grading method, and George's line can be used on L5/S1
What lines can be used to see spondylolisthesis at L4/L5? Meyerding's grading method and Georges line can be used L4/L5 (NO Ulmann's - that is just for sacral base to L5 relationship)
What term would be synonymous with spondylolisthesis? ANTEROlisthesis
What line demonstrates joint laxity? George's line, Van Akkerveeken's measurement can be used
What conditions can cause joint laxity? Compression fractures, DJD, Declining disc spaces
Which side of the diaphragm comes up higher? the Right because the heart presses down on the left
What is the minimal normal limit for the sagittal dimension of the spinal canal in the cervical spine? 12 mm. minimum for cervical sagittal
What is the minimum normal limit for the sagittal dimension of the spinal canal in the thoracic spine? 12 mm. minimum for thoracic sagittal
What is the minimum normal limit for the sagittal dimension of the spinal canal in the LUMBAR spine? 15 mm. minimum for the LUMBAR sagittal
What is the minimum normal limit for a coronal dimension of the spinal canal/interpediculate distance for the Cervical spine? minimum 24 mm. cervical interpediculate/coronal
Numbers for minimums of Coronal/INterpediculate Cervical, Thoracic, Lumbar? 24,14,21 mm. (C,T,L)
Minimum normal interpediculate/Coronal distance for thoracic spine? 14 mm.
Minimum normal interpediculate/Coronal for Lumbar spine? 21 mm. 21 mm. 21 mm. 21 mm. 21 mm. 21 mm.
21 mm. the minimum interpediculate/coronal dimension of the lumbar spine
14 mm. the minimum interpediculate/coronal dimension for the thoracic spine
24 mm. the minimum interpediculate/coronal dimension for the cervical spine
Best projection to visualize the odontoid space? APOM (A - P Open Mouth)
What radiographs can visualize the atlantodental interspace? (ADI) Lateral cervical neutral, flexion, extension
ADI AtlantoDental Interspace
What view best illustrates an ADI problem? lateral cervical FLEXION for ADI
What can cause a problem with the ADI? Down's syndrome, rheumatoid arthritis, trauma, etc.
Ossiculum terminale? Tip of dens/odontoid process does not fuse with remainder of body. Some cartilage remains (should fuse by 10-12 yrs. of age)
Odontoideum? odontoid process does not join C2 vertebral body. (should fuse between 5-7 yrs. old)
4 indications of congenital Block vertebrae? anterior concavity (wasp waist), rudimentary disc space (faint calcification), fused facets 50%, malformed spinous process
triad of radiographic findings for a Schmorl's node? anterosuperior endplate placement, reduced supradjacent disc space, increase in A-P diameter for vertebral body
does a Schmorl's node involve the entire endplate? no
do nuclear impressions involve the entire endplate? no
what causes nuclear impressions? notochord persistence
what can the wavy gravy appearance of the endplates be described as cupid's bow
What can McNab's line or Hadley's S Curve help determine? facet imbrication (subluxation)
normal range for lumbosacral angle 26-57 degrees (30-60)
normal adult ADI (atlantodental interspace) 1-3 mm.
normal child ADI 1-5 mm.
1-3 mm. normal adult ADI
1-5 mm. normal child ADI
spondyloptosis L5 slips off sacral base
At which segments do we use Eisenstein's method for sagittal canal measurement? L1-L4 because the spinolaminar line is not visualized at those segments
"eyes of the spine" pedicles (Scotty Dog eye)
How can you determine right from left in AP thoracic if there is no marker? Heart shadow on left, right side of diaphragm higher due to heart on left, arch of descending aorta on left, Gastric/Fundus air bubble (Meganblasse) on left, splenic flexure on left, sigmoid colon on left
Offset limit for George's line? 2 mm. (because the 2 of us are moving into George's house;-)
Can spina bifida be visualized on AP lateral projections? yes, by the absence of spinolaminar lines.
Can spina bifida be visualized on AP projections? yes.
what is missing on an AP lateral projection to indicate the presence of spina bifida? the absence of spinolaminar lines
4 clinical indications for taking plain film radiographs: rule out child abuse, whiplash from MVA, person over 30 with unremitting back pain, aparent scoliosis or trauma if possible fracture present
Lumbar gravity line measurement From midpoint of L3 vertebral body, drop a line straight down. Line should pass in under 10mm. of sacrum
How do you measure lumbar IVD angles and what are the norms for each of the 5 lumbar spaces? on Lateral projection, lines are drawn on superior and inferior vertebral endplates posteriorly to intersection. Angles in degrees should be: 8.10.12.14.14 for L1-5 respectively
8.10.12.14.14 lumbar IVD angle norms.
How do you visualize the right IVF's of the cervical spine? RAO or LPO
How do you visualize the left IVF's of the cervical spine? LAO or RPO
What is another name for lateral flexion and extension radiographs? stress views
Why is the disc space of L5/S1 not visualized in AP lumbar projections? the sacral tilt/lumbosacral lordosis
how do we get a radiograph of the L5/S1 disc space? angulated AP lumbosacral SPOT projection
SPOT projection tilt for L5/S1 disc space due to lumbosacral angle
normal measurement for retropharyngeal soft tissue space? 0-7mm.
0-7 mm. retropharyngeal
retrotracheal soft tissue space normal measurement? 0-21 mm.
0-21 mm. retrotracheal ("t" for "twenty-one")
what clinical conditions might reduce the retropharyngeal (0-7 mm) or the retrotracheal (0-21 mm) spaces? inflammation from an infection, swelling from trauma, cancerous growth impinging on the space
best projection for cervico-thoracic junction? AP cervical
best projection for cervical rib? AP cervical
best projection for clasp-knife deformity? AP lumbar, AP lumbopelvic
What are a bunch of non-standard cervical views? R and L anterior obliques, R and L posterior obliques, swimmer's view (C/T junction), R and L lateral flexion APOM, R and L lateral flexion and extension lateral cervical projections, articular pillar projections
Created by: hecutler
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