Spine_ii

X-Ray-Positioning SPINE Dr. Fritsch

Cervical Spine Series • Minimal Series – 5 views – – – – –

Neutral Lateral APOM APL5 LAO or RPO Oblique RAO or LPO Oblique

• Additional Views: – Flexion & Extension Lateral – Swimmers View

Cervical Spine Series

Cervical Spine – Neutral Lateral •

Neutral Lateral Cervical Spine

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Structures Demonstrated •

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Film: •

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taken at the level of C5 in the sagittal plane patient should be placed perpendicular to the bucky with their shoulder resting against it, and with their head in a neutral posture.

Central Ray: •

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70 – 90

Patient Position: •

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10x12 film placed vertically; blocker ↓, marker ↓

FFD: 72″ kVp Range: Measurement: •

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all 7 cervical vertebra, and the soft tissues of the neck

centered at the sternocleidomastoid with the upper outline of the crosshairs adjacent to the mandibular angle

Collimation: set so that the light falls directly posterior to the orbits horizontally and so that light shines above the skull vertically Special Instructions: •

film taken on suspended inspiration

Cervical Spine – Neutral Lateral

Cervical Spine – Neutral Lateral

Cervical Spine - APOM •

Anterior-Posterior Open Mouth (APOM)

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Structures Demonstrated: C1/C2 Film: top portion of 7x17 film or single small film; blocker ↑, marker ↑ FFD: 40″ kVp Range: 70-80 Tube Tilt: None Measurement: chin to occiput sagittal plane Patient Position: • patient positioned with mouth open, place thumbs on posterior occiput and inferior molars; level thumbs are optimal for positioning Central Ray: • passes through the patient’s open mouth Collimation: • set such that the light falls directly below the patient’s nose vertically and shines light on either side of the patient’s mandible horizontally Special Instructions: None.

Cervical Spine - APOM

Cervical Spine – APL5 •

Anterior Posterior Lower Cervical Spine – APL5

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Structures Demonstrated: •

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Film: 10x12 blocker ↑, marker ↑ FFD: 40″; tube set at 37″ due to tube tilt kVp Range 70-80 Tube Tilt: 150 cephalad Measurement: taken at the level of C5 in the sagittal plane Patient Position: •

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centered just below the thyroid cartilage at the sagittal midline

Collimation: •

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patient standing with chin slightly elevated; inferior border of mandible about level

Central Ray: •

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lower 5 cervical vertebra, cervicothoracic junction, soft tissues of the neck and the lung apices

set such that the light falls below the lower lip vertically and so there is light on either side of the patient‘s neck horizontally

Special Instructions: film taken on suspended inspiration

Cervical Spine – APL5

Cervical Spine – APL5

Cervical Spine – Anterior Oblique • Anterior Cervical Oblique – Structures Demonstrated:

• film taken to view the entire cervical spine, particularly the intervertebral foramina (IVF). The right anterior oblique (RAO) demonstrates the right IVF, while the LAO demonstrates the left IVF.

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Film: 10x12 film placed vertically; blocker ↑, marker ↑ FFD: 40″; tube set at 37″ due to tube tilt kVp Range: 80 Tube Tilt: 150 caudad Measurement: taken at the level of C5 in the sagittal plane Patient Position:

• patient positioned with shoulders 450 to film (bucky) and the sagittal plane of the head parallel to the film (bucky)

– Central Ray:

• set at the level of C4 –C5

– Collimation: Light behind orbit, light vertically above ear. – Special Instructions: film taken with suspended inspiration

Cervical Spine – Anterior Oblique

Cervical Spine – Anterior Oblique

Cervical Spine – Posterior Oblique •

Posterior Cervical Oblique

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Structures Demostrated: •

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Film: FFD: kVp Range: Tube Tilt: Measurement: •

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taken at the level of C5 in the sagittal plane

set at the level of C4 –C5

Collimation: •

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10x12 film placed vertically; blocker ↑, marker ↑ 40″; tube set at 37″ due to tube tilt 80 150 cephalad

Patient Position: patient positioned with shoulders 450 to film (bucky) and the sagittal plane of the head parallel to the film (bucky) Central Ray: •

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entire cervical spine, particularly the intervertebral foramina (IVF). The right posterior oblique (RPO) demonstrates the left IVF, while the LPO demonstrates the right IVF.

Light behind orbit, light vertically above ear.

Special Instructions: •

film taken with suspended inspiration

Cervical Spine – Posterior Oblique

Cervical Spine – Flexion Lateral •

Flexion Lateral Cervical Spine

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Structures Demonstrated: •

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Film: 10x12 film placed vertical; blocker ↓, marker ↓ FFD: 72″ kVp Range: 70-80 Measurement: •

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set as with the neutral lateral prior to moving the patient into flexion

Collimation: •

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set like the neutral lateral view initially, then move the patient into maximum flexion with their chin tucked

Central Ray: •

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taken at the level of C5 in the sagittal plane

Patient Position: •

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base of the occiput through the 7 cervical vertebra

set to film size and be sure to exclude the orbits

Special Instructions: •

film taken on suspended inspiration

Cervical Spine – Flexion Lateral

Cervical Spine – Flexion Lateral Flexion

Extension

Cervical Spine – Extension Lateral •

Cervical Extension Lateral

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Structures Demostrated: •

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Film: 10x12 film placed vertical; blocker ↓, marker ↓ FFD: 72″ kVp Range: 70-80 Measurement: •

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set as with the neutral lateral prior to moving the patient into extension

Collimation: •

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set like the neutral lateral view initially, then move the patient into maximum extension with their chin elevated

Central Ray: •

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taken at the level of C5 in the sagittal plane

Patient Position: •

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base of the occiput through the 7 cervical vertebra

set to film size and be sure to exclude the orbits

Special Instructions: •

film taken on suspended inspiration

Cervical Spine – Extension Lateral

Cervical Spine – Extension Lateral Flexion

Extension

Cervical Spine – Swimmers View •

Swimmer’s View

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Structures Demonstrated: •

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Film: •

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enters at the level of the mid trap.

Collimation: •

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patient positioned in posterior oblique fashion with the shoulders at a100 – 200 angle; patient reaches forward and up with the arm nearest the bucky, and down and back with the arm nearest the tube

Central Ray: •

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taken in the sagittal plane from the middle trapezius to the contra-lateral axilla

Patient Position: •

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10x12 film placed vertically; blocker ↓, marker ↓

FFD: 40″ kVp: 90 Measurement: •

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view the cervicothoracic junction, C6/C7 – T3/T4

set to film size

Special Instructions: •

film taken on suspended inspiration

Thoracic Spine Series

• Minimal Series – 2 views – AP Thoracic – Lateral Thoracic

Thoracic Spine – Anterior Posterior •

AP Thoracic

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Structures Demonstrated: •

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Film: 7x17 film placed vertically; blocker ↓, marker ↓ FFD: 40″ kVp: 80 Measurement: •

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sagittal midline, midway between the episternal notch and xiphoid process; ie. the nipple line

Collimation: •

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patient supine sagittal plane parallel to the bucky

Central Ray: •

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taken in the sagittal plane at the level of T6

Patient Position: •

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film taken to view the entire thoracic spine and posterior rib heads

set to film size

Special Instructions: •

film taken on suspended inspiration

Thoracic Spine – Anterior Posterior

Thoracic Spine – Anterior Posterior

Thoracic Spine – Lateral View •

Lateral Thoracic

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Structures Demonstrated: • film taken to view the entire thoracic spine Film: 14x17 film placed vertically; blocker ↑, marker ↑ FFD: 40″ kVp: 90 Measurement: Perpendicular to T-6 Patient Position: • patient in a left lateral , recumbent position Central Ray: set at the nipple line Collimation: • collimate to a 7x17 Special Instructions: • film taken on suspended inspiration

Thoracic Spine – Lateral View

Lumbar Series • Minimal Lumbar Series – AP Lumbar – Lateral Lumbar – AP &/or Lateral Lumbosacral Spot

• Extra Views – Posterior or Anterior Obliques

Lumbar Spine – AP •

AP Lumbosacral

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Structures Demonstrated: • Lumbar bodies, transverse processes, and the intervertebral disk spaces. Film: 7x17 film placed vertically; blocker ↓, marker ↓ FFD: 40″ kVp: 80 Measurement: • taken in the sagittal plane at the level of L3-L4 Patient Position: • patient in a true AP position Central Ray: set at sagittal midline at the level of L3-L4 Collimation: to film size. Special Instructions: film taken on suspended expiration

Lumbar Spine – AP

NO BELT!!

Lumbar Spine – AP

Lumbar Spine – Lateral •

Lateral Lumbosacral

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Structures Demonstrated: • The lateral aspect of the intervertebral disk spaces. Film: 7x17 film placed vertically; blocker ↑, marker ↑ FFD: 40″ kVp: 90 Measurement: • taken in the coronal plane at the level of L3-L4. Patient Position: • Patient is recumbent on the left side. Central Ray: • set at the level of L3 –L4 Collimation: to film size

Lumbar Spine – Lateral

Lumbar Spine – Lateral

Lumbar Spine – AP Spot •

AP Lumbosacral (Angulated) Spot

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Structures Demonstrated: • to view L5/S1 articulation and the SI joints Film: • 10x12 film placed horizontally; blocker ↓, marker ↓ FFD: 40″; tube set at 35″ due to tube tilt kVp: 80 Tube Tilt: 250 cephalad Measurement: • taken in the sagittal plane at midline, between the level of the ASIS and pubic symphysis Patient Position: patient is supinated. Central Ray: • set at the sagittal midline, halfway between the level of the ASIS and the pubic symphysis Collimation: • set to film size

Lumbar Spine – AP Spot

Lumbar Spine – AP Spot

Lumbar Spine – Lateral Spot •

Lateral Lumbosacral (L5/S1) Spot –

Structures Demonstrated: •

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Film: 10x12 film placed vertically; blocker ↓, marker ↓ FFD: 40″ kVp: 90 Measurement: •

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to view the L4/L5 and L5/S1 articulations

taken in the coronal plane at a level 2″ below the iliac crests

Patient Position: Left lateral recumbent position. Central Ray: set 2″ below iliac crests between the ASIS and PSIS Collimation: Collimate to L5-S1

Lumbar Spine – Lateral Spot

Lumbar Spine – Lateral Spot

Lumbar Spine – Anterior Oblique •

Anterior Oblique (RAO/LAO) – Structures Demonstrated: •

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Film: 14x17 film placed vertically; blocker ↓, marker ↓ FFD: 40″ kVp: 80 Measurement: •

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set 1″ above the iliac crests and 1 ½″ off the sagittal midline towards the high side

Collimation: •

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patient positioned 450 obliquely to the bucky with the front of the patient against the bucky

Central Ray: •

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taken in the coronal plane 1″ above the iliac crests, at about the level of L3

Patient Position: •

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film taken to view L1 – S1, especially the pars inter-articularis. Recall that RAO demonstrates the left “pars interarticularis” and the LAO demonstrates the right “pars interarticularis”

set to film size

Special Instructions: •

film taken on suspended expiration

Lumbar Spine – Anterior Oblique

Lumbar Spine – Posterior Oblique •

Posterior Oblique (RPO/LPO)

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Structures Demonstrated: •

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Film: 14x17 film placed vertically; blocker ↓, marker ↓ FFD: 40” kVp: 80 Measurement: •

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patient positioned 450 obliquely to the bucky with the back of the patient against the bucky

Central Ray: •

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taken in the coronal plane 1″ above the iliac crests, at about the level of L3

Patient Position: •

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to view L1 – S1, especially the pars inter-articularis. Recall that RPO demonstrates the right “pars” and the LPO demonstrates the left “pars”

set 1″ above the iliac crests and 1 ½″ off the sagittal midline towards the high side

Collimation: set to film size Special Instructions: •

film taken on suspended expiration

Lumbar Spine – Posterior Oblique

Oblique Pneumonic • CLAPS • C & A see S – Cervical & Anterior see Same side (IVF)

• L & P see S – Lumbar & Posterior see Same side (pars, scotty dog) – Lumbar spine does not show sacrum

Sacrum & Coccyx • Minimal Series: – AP Sacrum – AP Coccyx – Lateral Sacrum – Lateral Coccyx

AP Sacrum •

AP Sacrum –

Structure Demonstrated: •

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Film: •

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patient is supinated

Central Ray: •

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taken in the sagittal plane, at midline, between the ASIS and the pubic symphysis

Patient Position: •

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10x12 film placed horizontal; blocker ↓, marker ↓

FFD: 40″; tube set at 37″ due to tube tilt kVp: 80 Tube Tilt: 150 cephalad Measurement: •

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The sacrum will be free from the foreshortening of the sacral curvature.

set at sagittal midline between the level of the ASIS and the pubic symphysis

Collimation: •

set to film size

AP Sacrum

Lateral Sacrum •

Lateral Sacrum – film taken to view the sacrum – – – – – – – – – –

Film: 10x12 film placed vertically; blocker ↑, marker ↑ FFD: 40″ kVp: 90 Correction Factor: -2 ½ Tube Tilt: None Measurement: taken in the coronal plane 2″ below the iliac crests Patient Position: patient in true lateral position Central Ray: set 2″ below the iliac crests between the ASIS and PSIS Collimation: set to film size Special Instructions: film taken on suspended expiration

Lateral Sacrum

AP Coccyx •

AP Coccyx

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film taken to view the coccyx

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Film: 8x10 film placed vertically; blocker ↑, marker ↑ FFD: 40″; tube set at 38″ due to tube tilt kVp: 80 Tube Tilt: 100 caudad if taken AP, or 100 cephalad if taken PA Measurement: taken in the sagittal plane 2″ above the pubic symphysis Patient Position: patient in true AP position, or PA position Central Ray: set at sagittal midline 2″ above the pubic symphysis Collimation: set to film size Special Instructions: film taken on suspended expiration

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AP Coccyx

Sacrum & Coccyx •

Lateral Coccyx

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film taken to view the coccyx

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Film: 8x10 film placed vertically; blocker ↑, marker ↑ FFD: 40″ kVp: 90 Tube Tilt: None Measurement: taken in coronal plane at the region of the coccyx, which will be considerably posterior to the middle of the pelvis. DO NOT use lateral lumbar measurement. Patient Position: patient in true lateral position Central Ray: set at the level of the coccyx Collimation: set to film size Special Instructions: film taken on suspended expiration

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Lateral Coccyx

Sacro-Iliac Joints • Minimal Series: – R & L Anterior S-I joints Or R & L Posterior S-I joints

Sacro-iliac Joints •

Anterior Sacroiliac Joint :

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Structures Demonstrated: • film taken to specifically view either the right or left SI joint in its plane Film: 10x12 film placed vertically; blocker ↓, marker ↓ FFD: 40″; tube set at 37″ due to tube tilt (or 35″ if you use 250 tube tilt) kVp: 80 Tube Tilt: 100 – 150 cephalad; some texts suggest 250 Measurement: taken in the sagittal plane at the level of the ASIS Patient Position: • Patient is semisupinated on the table. Oblique the patient 30 degrees. Central Ray: • set 1″ medially from the ASIS of the side you want to view Collimation: set to film size

Sacro-iliac Joints - Anterior

Sacro-iliac Joints - Posterior •

Posterior Sacro-iliac Joints

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Structures Demonstrated: • film taken to specifically view either the right or left SI joint in its plane Film: • 10x12 film placed vertically; blocker ↓, marker ↓ FFD: 40″; tube set at 37″ due to tube tilt (or 35″ if you use 250 tube tilt) kVp: 80 Tube Tilt: • 100 – 150 cephalad; some texts suggest 250 Measurement: • taken in the sagittal plane at the level of the ASIS Patient Position: • Patient is semipronated. The unaffected side is elevated 30 degrees from the table. Central Ray: set 1″ medially from the PSIS of the side you want to view Collimation: set to film size

Sacro-iliac Joints - Posterior

THE END X-Ray-Positioning SPINE Dr. Fritsch