Cervical Spine Imaging Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the correct patient position for a lateral projection of the C-spine?

Patient must be in a prone position

Patient should lie completely flat without head elevation

Patient should be positioned supine or erect (correct)

Patient must be seated upright only

Where should the midcoronal plane be centered during a C-spine lateral projection?

Along the sagittal plane near the neck

Passing through the mastoid tip centered to the imaging receptor (correct)

At the level of the EAM

At the level of the jugular notch

What should be done with the chin during the C-spine lateral projection?

Rotate the chin towards the unaffected side

Depress the chin completely

Protract the chin to prevent mandibular superimposition (correct)

Tilt the chin back slightly

What is the recommended central ray direction for the lateral projection of the C-spine?

Perpendicular to a point 1-inch distal to the adjacent mastoid tip Signup and view all the answers

Why is a 72-inch SID recommended for the C-spine lateral projection?

To reduce magnification to compensate for larger OID Signup and view all the answers

What is the effect of supine positioning on the cervical spine?

It results in a more straight cervical spine. Signup and view all the answers

How should the CR be positioned to accurately open intervertebral disk spaces during C-Spine imaging?

Parallel with the intervertebral disk spaces. Signup and view all the answers

What must be ensured for the spinous processes in C-Spine imaging?

They should align with the midline of the cervical bodies. Signup and view all the answers

What indicates a rotation of the cervical spine during imaging?

Asymmetric positions of the medial ends of the clavicles. Signup and view all the answers

Which cervical vertebra should be centered during a C-Spine AP Axial projection?

C4 Signup and view all the answers

What is a sign that the intervertebral disk spaces are not properly visualized?

The vertebral bodies appear distorted. Signup and view all the answers

What positioning error is indicated if the mandibular angles and mastoid tips are not at equal distances from the cervical vertebrae?

The patient is rotated. Signup and view all the answers

In a correctly positioned C-Spine AP Axial projection, how should the articular pillars and pedicles appear?

Symmetrically demonstrated lateral to the vertebral bodies. Signup and view all the answers

What happens to the vertebral bodies and spinous processes when the patient is positioned correctly for an AP axial projection?

Vertebral bodies move toward the side closer to the IR and spinous processes move toward the side farther from the IR Signup and view all the answers

In a kyphotic patient, how does the curvature of the cervical vertebrae adjust?

It demonstrates excessive lordotic curvature Signup and view all the answers

What angle adjustment is typically necessary for an AP axial projection of the cervical vertebrae?

An increase in degree of CR angulation from routine procedure Signup and view all the answers

What is the effect of too much cephalic angulation during the AP axial projection?

Closed intervertebral disk spaces and elongated uncinate processes Signup and view all the answers

What is indicated when the jaw is positioned lower than the skull during imaging?

Insufficient cephalic angulation Signup and view all the answers

How should the head be positioned to achieve an effective AP axial projection?

With the chin elevated and mouth closed Signup and view all the answers

What is a typical consequence seen if intervertebral spaces are demonstrated closed during imaging?

Distorted vertebral bodies Signup and view all the answers

What could indicate that the spinous processes are demonstrated incorrectly in a cervical spine image?

They overlap with the inferior adjoining vertebral body Signup and view all the answers

Study Notes

Course Agenda

Course Plan Overview
Discussion on Clinical Experience
Lecture

Cervical Spine Imaging Objectives

Perform Basic Cervical Spine Projections
Understand Indications for Cervical Spine Imaging
Develop Basic Image Critique Skills

Cervical Vertebrae Anatomy

C1 (Atlas): Located at the top of the spine, no spinous process or body, forms articulation with occipital bone, dens (odontoid process) situated in the anterior ring
C2 (Axis): Has a strong odontoid process, superior articular processes join with inferior processes of succeeding cervical vertebrae
C3-C6 (Typical Vertebrae): Narrow and thin processes; Spinous processes are short with double pointed tips
C7: Has a long prominent spinous process, easily palpable at the base of the neck, called vertebra prominens

Cervical & Lumbar Spinal Curves

Concave posteriorly - Lordotic Curve
Compensatory Curves

Thoracic & Sacral Spinal Curves

Convex posteriorly - Kyphotic Curve
Primary Curves

Cervical Vertebrae Views

AP "Open Mouth" Projection (C1-C2)
AP Axial Projection (C3-C7)
Lateral Projection
Cervical Thoracic Swimmer's Lateral (Twining Method)
Anterior & Posterior Oblique Projections
Lateral Projections (Flexion and Extension)
AP Axial Projection (Ottonello Method) - Wagging Jaw
AP/PA Projection (Fuchs Method)

Patient Preparation for Cervical Spine Imaging

Remove preventable artifacts (earrings, chains, hairpins, barrettes, braids, wet hair, extensions, dentures, partial plates, retainers, clothing, shirts, bra straps, gum or candy)
Pregnancy screening/child-bearing age assessment (pg 3)

Cervical Spine X-ray Indications

Chronic neck pain
Acute neck pain
Rule out fracture
Rule out disc herniation
Arthritis (degenerative bone/disc or joint disease)
Limited range of motion
Pathology (rule out metastasis, osteoporosis)
Radiculopathy (numbness or pain in arms, hands or fingers due to nerve root compression)

Important Landmarks for Cervical Spine Imaging

Meatus (opening leading to the inferior of the body)
Glabelloalveolar (GAL)
Glabellomeatal (GML)
Orbitomeatal (OML)
Infraorbitomeatal (IOML)
Acanthiomeatal (AML)
Lips-meatal (LML)
Mentomeatal (MML)
Interpupillary Line
Occlusal Plane

C-Spine Open Mouth Projection (C1/C2 Odontoid)

Patient Position: AP supine or erect, face forward, mandibular angles & mastoid tips equidistant from IR, tuck chin until a line connecting lower incisors & mastoid tip is perpendicular to IR
Instruct patient to open mouth as wide as possible

C-Spine Open Mouth Projection (C1/C2 Odontoid) Central Ray

No angulation, CR perpendicular to IR
Angle 5 degrees cephalically
Center the CR to the MSP & midpoint of the open mouth
Instruct patient to keep mouth wide open & to AHHHHH
75 +/- 5 kV range

C-Spine Open Mouth Projection (C1/C2 Odontoid) Image Analysis

Atlas symmetrically seated on axis
Spinous process of axis aligned with midline
Mandibular rami equidistant from dens
Atlantoaxial joint open, dens center of exposure field

Cervical Rotation (Image Analysis)

Distance between mandibular rami & lateral masses
Side with greater distance indicates the side of rotation

Cervical Projection (Image Analysis)

Lateral cervical projection demonstrates how the upper incisors, occipital base, & mastoid tip relate perpendicularly.
Upper incisors positioned at long OID, causing magnification.
5 degrees cephalic needed to project magnified upper incisors away from the dens.

Cervical Projection (Trauma)(Image Analysis)

Angle CR at least 10 degrees down since head is extended
Use IOML to determine angulation
Don't adjust head rotation/tilting if patient cannot open mouth

Cervical Collar Limitations

Sometimes collar prevents jaw lowering
Have the ordering physician or nurse remove the front of the collar so the patient can drop the jaw without adjusting the head/neck
After the projection is taken, have the ordering physician return the front of the cervical collar to its proper position

Not Enough Angulation for Trauma

Upper incisors demonstrated superior to the dens
Dens superimposed over occipital base
Need 10-degrees caudal angle

Too Much Angulation for Trauma

Occipital base superior to the dens
Upper incisors superimposed over the dens

C-Spine AP Axial Projection

Patient position: AP supine or erect, face forward, mandibular angles & mastoid tips equidistant from IR, align the lower surface of upper incisors & tip of mastoid process perpendicular to IR
Align the midline of the neck, with the midline of the IR and grid.
Central Ray: Directed through C4, at an angle of 15 to 20 degrees cephalad. Use 75 +/- 5 kV range

C-Spine Lateral Cervicothoracic (Swimmers/Twinning) Method

Goal: Separate overlapping structures
Performed when C7/T1 not demonstrated on lateral cervical spine
Patient position: Erect or recumbent lateral, flex knee & hips for support (trauma only), ensure weight on feet, align MCP perpendicular with IR, elevate arm positioned closer to IR as high as patient can, place opposite arm against patient's side, instruct the patient to depress the shoulder, place head in lateral position

C-Spine Lateral Cervicothoracic (Swimmers/Twinning) Method - Central Ray

Center CR to the MCP at a level 1 inch superior to the jugular notch or at the level of the vertebral prominens
SID 72 inch
80 +/- 5 kV range (increase 5-10 if patient unable to depress shoulder)
CR angulation: 5 degrees caudal if clavicle obscures exposure

C-Spine Lateral Cervicothoracic (Swimmers/Twinning) Method - Image Analysis

Rt & Lt cervical zygapophyseal joints, articular pillars, & posterior ribs are superimposed
The humerus that is elevated is aligned with the vertebral column
C5-C7 are demonstrated without shoulder superimposition
Intervertebral disk spaces are open
Vertebral bodies are demonstrated without distortion
T1 is at the center of the exposure field; collimate to area of interest to avoid scatter, and place marker in exposure field.

Additional Views (uncommon)

These include, but aren't limited to, the following: AP projection—Fuchs’s method; AP projection—Ottonello method; AP axial projection—vertebral arch (pillars).

AP Projection—Fuchs’s Method

Patient position: Supine, extend chin until tip of chin and tip of the mastoid process are vertical
Central Ray: Perpendicular to the midpoint of the IR, enters the neck on the MSP just distal to the tip of chin
Evaluation criteria: Entire dens within the foramen magnum

AP Projection—Ottonello Method

Often called “Wagging Jaw”
Patient performs a chewing motion of the mandible during exposure
Immobilize the head to prevent movement
Long exposure time is necessary

AP Axial Projection—Vertebral Arch (Pillars)

CR angulation projects the vertebral arch free of anteriorly vertebral bodies & transverse processes
Useful for visualizing cervicothoracic spinous processes in whiplash injury
Position: MSP perpendicular to the table, then fully extend patient’s neck. If full extension can't be tolerated, an AP axial oblique projection is recommended.
Central ray: Directed at C7 at a 25° caudad angle

AP Axial Projection—Vertebral Arch (Pillars) - Evaluation Criteria

Vertebral arch structures without overlapping of the vertebral bodies & transverse processes
Articular processes
Open zygapophyseal joints between the articular processes

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on the proper techniques and positioning for lateral radiography of the cervical spine. This quiz covers key aspects such as centering, chin positioning, and central ray direction, along with the rationale for recommended SID distances. Enhance your understanding of radiographic practices for the C-spine.