Radiographic Techniques: Thoracic Spine Projections

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Questions and Answers

What is the purpose of positioning the cathode side of the tube toward the feet during an AP projection?

To improve the clarity of the costovertebral articulation

To decrease exposure time for the thoracic region

To obtain a more uniform density of the thoracic spine (correct)

To increase the contrast of the imaging

In a lateral projection, why should the left side be against the table?

To minimize patient discomfort during imaging

To adjust for the curve of the spine effectively

To keep the spine aligned with the imaging receptor

To place the heart closer to the imaging receptor

What is the recommended central ray angle for a lateral projection without support for males?

No angle specified

10° caudad

10-15° cephalad (correct)

15° caudad

What is the significance of body rotation in the Fuchs method?

It demonstrates the cervicothoracic spinous process effectively Signup and view all the answers

What adjustment is necessary for patients with accentuated dorsal kyphosis during imaging?

Increasing the required degree of rotation Signup and view all the answers

What is the primary characteristic of Scoliosis?

Lateral deviation of the spine Signup and view all the answers

Which condition is associated with failure of the posterior encasement of the spinal cord to close?

Spina Bifida Signup and view all the answers

What type of fracture occurs due to hyperflexion force through the vertebral body?

Chance fracture Signup and view all the answers

Which projection demonstrates the intervertebral foramina of the side positioned farther from the image receptor?

AP oblique Signup and view all the answers

What is the purpose of the Flexion-Extension lateral projection in cervical spine imaging?

To assess for spinal stability Signup and view all the answers

In which scenario should the Fuchs view not be used?

Trauma setting Signup and view all the answers

What is Spondylolisthesis primarily characterized by?

Forward displacement of a vertebra over another Signup and view all the answers

Which type of fracture involves triangular fragments avulsed from an anteroposterior border?

Teardrop Burst fracture Signup and view all the answers

What is the recommended patient position for the Fuchs Method?

Supine with the chin extended Signup and view all the answers

What is the central ray position for the Smith-Abel Method?

35 degrees caudad Signup and view all the answers

What is the purpose of the anterior to the EAM positioning?

To visualize the cervical spine Signup and view all the answers

Which projection is recommended when the upper half of the dens is not clearly shown in the open-mouth position?

Fuchs Method Signup and view all the answers

In the Judd Method, what is the orientation of the chin and the mastoid tip?

Perpendicular to the image receptor Signup and view all the answers

What is the recommended neck position for the Smith-Abel Method?

Extended slightly Signup and view all the answers

Why is the mouth opened wide during the various imaging methods?

To enhance visualization of structures Signup and view all the answers

What is a contraindication for the Judd Method?

Patient has an unhealed fracture Signup and view all the answers

What is the primary purpose of the AP view in thoracic spine imaging?

To visualize the entire thoracic spine Signup and view all the answers

In which situation is the horizontal beam lateral projection predominantly used?

Assessment in trauma cases Signup and view all the answers

What characteristic of the lateral view makes it ideal for examining suspected fractures?

It allows for the opening of intervertebral joints and neural foramen Signup and view all the answers

Which view is specifically referred to for evaluating scoliosis?

Bolster view Signup and view all the answers

What is the primary benefit of the flexion-extension view in spinal imaging?

Assessing spinal stability Signup and view all the answers

The PA/AP view should demonstrate which of the following anatomical landmarks?

T11/T12 and the sacrum Signup and view all the answers

Which projection is utilized to visualize the articular facets and pars interarticularis of the lumbar spine?

Oblique view Signup and view all the answers

What orientation is required for the head during the AP oblique projection of the atlanto-occipital joints?

45-60 degrees away from side of interest Signup and view all the answers

What is the position of the patient for a PA axial projection of the vertebral arch?

Prone with head rested against the IR Signup and view all the answers

What is the central ray (CR) angle for the AP axial oblique projection?

30-40o caudad Signup and view all the answers

In which scenario would the swimmer's technique be utilized?

When the shoulder obscures C7 on a lateral cervical spine projection Signup and view all the answers

What is the required CR angle for the swimmer's technique when the shoulder cannot be sufficiently depressed?

3-5 degrees caudad Signup and view all the answers

What is the recommended patient position for the AP projection of the thoracic vertebrae?

Supine or upright with hips and knees flexed Signup and view all the answers

What is the purpose of using a breathing technique during the swimmer's technique?

To blur lung anatomy for clarity Signup and view all the answers

How should the neck be positioned for a PA axial projection of the vertebral arch?

Hyperextended Signup and view all the answers

How far should the patient’s head be rotated for the AP axial oblique projection?

45-50 degrees, or 60-70 degrees depending on the region Signup and view all the answers

Study Notes

AP Projection

The cathode side of the tube should be placed toward the feet to obtain a uniform density of the thoracic spine.
This is based on the heel effect of the x-ray tube, where the intensity is greater at the cathode end.

Lateral Projection

Performed with either the patient lateral recumbent or upright.
The patient is positioned against the table with the left side closer to the image receptor to place the heart nearer to the IR.
The MSP is parallel to the IR, and the hips & knees are flexed.
The arms are at a right angle to the body to elevate the ribs.
A support is placed under the lower thoracic spine.
The central ray is perpendicular to the IR with support, and 10-15 degrees cephalad without support.
In females, the CR should be 10 degrees cephalad, and in males, 15 degrees cephalad.

Fuchs Method

Also known as the AP oblique projection.
The patient is positioned supine or upright, with the body rotated 20 degrees posteriorly.
The MCP is 70 degrees from the IR.
The central ray is perpendicular to the IR, and the radiographic target is T7.
This projection is utilized to demonstrate the zygapophyseal or apophyseal joints, which are furthest from the IR, and the T12 inferior articular processes in RPO/LPO 45 degrees.

Pathology - Thoracic Spine

Scoliosis: Lateral deviation of the spine with possible vertebral rotation.
Spina Bifida: Failure of the posterior encasement of the spinal cord to close.
Spondylolisthesis: Forward displacement of a vertebra over a lower vertebra, usually L5-S1.
Spondylolysis: Separation of the pars interarticularis.
Chance Fracture: Fracture through the vertebral body caused by hyperflexion force.
Whiplash Injury: Damage to the ligaments, vertebrae, or spinal cord caused by sudden jerking back of the head and neck.

Cervical Spine Series

Consists of multiple x-ray views to examine the bony structures of the cervical spine.
Commonly utilized for trauma cases, and radiographers should be familiar with the techniques.

Standard Projections - Cervical Spine

AP: Demonstrates the vertebral bodies and intervertebral spaces.
Lateral: Demonstrates the zygapophyseal joints, soft tissue structures around the cervical spine, spinous processes, and anterior-posterior relationship of the vertebral bodies.
Odontoid: Also known as a 'peg' projection, it demonstrates the C1 (atlas) and C2 (axis).
AP Oblique: Demonstrates the intervertebral foramina of the side positioned farther from the image receptor.
PA Oblique: Demonstrates the intervertebral foramina of the side positioned closer to the image receptor.

Additional Projections - Cervical Spine

Cervicothoracic: Modified lateral projection of the cervical spine to visualize the C7/T1 junction.
Flexion-Extension Lateral: Specialized projections of the cervical spine often requested to assess for spinal stability.
Fuchs View: Non-angled AP radiograph of C1 and C2, not recommended in trauma cases.

Thoracic Spine Series

Includes two standard x-ray views and various additional views based on clinical needs.
Utilized for trauma cases, postoperative imaging, and assessment of chronic conditions.

Standard Projections - Thoracic Spine

AP View: Images the entirety of the thoracic spine, consisting of twelve vertebrae, demonstrating intervertebral joints in profile.
Lateral View: Demonstrates intervertebral joints and neural foramen, with the superimposition of the posterior spinous processes.

Modified Trauma Projections - Thoracic Spine

Horizontal Beam Lateral: Visualization of thoracic vertebral bodies, pedicles, and facet joints taken supine.

Additional Projections - Thoracic Spine

Flexion-Extension View: Functional view used to assess spinal stability.
Bolster View: Specialized view for scoliosis often performed under the guidance of an orthopedic surgeon.

Lumbar Spine Series

Consists of two standard x-ray views, with additional views taken based on clinical requirements.
Commonly used in trauma cases, for postoperative assessments, and to evaluate chronic conditions like ankylosing spondylosis.

Standard Projections - Lumbar Spine

PA/AP View: The entire lumbar spine should be visible, with a demonstration of T11/T12 superiorly and the sacrum inferiorly.
Lateral View: Visualization of lumbar vertebral bodies, pedicles, and facet joints.

Modified Trauma Projections - Lumbar Spine

Horizontal Beam Lateral: Visualization of lumbar vertebral bodies, pedicles, and facet joints taken supine.

Additional Projections - Lumbar Spine

Oblique View: Used to visualize the articular facets and pars interarticularis of the lumbar spine.
Flexion-Extension View: Functional view used to assess spinal stability.

Atlanto-Occipital Joints

AP Oblique Projection: Performed with the patient supine and the head rotated 45-60 degrees away from the side of interest.
OML: Perpendicular to the IR.
Radiographic target: 1 inch anterior to the EAM.
Central ray: Perpendicular to the IR.

AP Oblique Projection - Atlanto-Occipital Joints

Demonstrates the Atlanto-occipital joints between the orbit and ramus of the mandible.
The dens is well demonstrated.
An alternative projection when the patient cannot be adjusted into the open-mouth position.

Fuchs Method - AP Projection C1 & C2

Performed with the patient supine, chin extended, and chin tip and mastoid tip perpendicular to the IR.
The MSP is perpendicular to the IR, and the radiographic target is distal to the chin tip.
The central ray is perpendicular to the IR.
Demonstrates the dens within the foramen magnum.
Recommended when the upper half of the dens is not clearly shown in the open-mouth position.

Smith-Abel Method - AP Axial Projection C1 & C2

Patient is supine with their neck slightly extended and mouth opened wide.
The head is passively rotated 10 degrees to the side.
The central ray is 35 degrees caudad, with the radiographic target targeting the laminae and articular facets of the upper vertebrae.
This method is recommended for visualization of the posterolateral elements of the upper vertebrae.

Judd Method

PA Projection C1 and C2.
Performed with the patient prone, neck extended, chin against the table, and the image receptor centered to the throat, at the level of the upper margin of the thyroid cartilage.
The OML is 37 degrees to the IR, and the MSP is perpendicular to the IR.
The chin and mastoid tip are perpendicular to the IR.
The radiographic target is distal to the level of mastoid tips at the MSP.
The central ray is perpendicular to the IR.
contraindication: Patient with unhealed fracture, degenerative disease, or suspected fracture of the upper cervical region.

Vertebral arch/pillars/lateral mass projection

PA axial projection:
- Performed with the patient prone, head resting against the IR, neck fully extended, and MSP perpendicular to the IR.
- The radiographic target is C7.
- The CR is 40 degrees cephalad (35-45 degrees range).
- Demonstrates vertebral arch structures.
AP axial oblique projection:
- Performed with the patient supine, and the head rotated 45-50 degrees (C2-C7 articular processes) or 60-70 degrees (C6-T4 articular processes).
- The jaw is turned away from the side of interest.
- The radiographic target is C7.
- The CR is 35 degrees caudad (30-40 degrees range).
- Demonstrates vertebral arch structures.
- Used to demonstrate vertebral arches when the patient cannot hyperextend their head for the AP/PA axial projection.
- PA axial oblique: reverse the CR direction to cephalad.

Swimmer's Technique - Lateral Projection

Performed in either the lateral recumbent (Pawlow) or upright (Twinning) position.
The humeral head is moved anteriorly or posteriorly, and the shoulder is depressed away from the IR.
The MSP is parallel to the IR.
The radiographic target is the C7-T1 interspace.
The central ray is perpendicular to the IR if the shoulder can be depressed well, and 3-5 degrees caudad if the shoulder can't be depressed sufficiently.
Performed when shoulder superimposition obscures C7 on a lateral cervical spine projection.
Used when a lateral projection of the upper thoracic vertebra is needed.

Swimmer's Technique - Monda Recommendation

The central ray should be 5-15 degrees cephalad to better demonstrate IV disk spaces when the spine is tilted due to broad shoulders or a non-elevated lower spine.

Thoracic Vertebrae - AP Projection

Performed with the patient supine or upright, MSP perpendicular to the IR, and hips & knees flexed to reduce kyphosis.
A support is placed under the knees.
The radiographic target is T7 (between the jugular notch and xiphoid process).
The central ray is perpendicular to the IR.
The respiration technique is shallow breathing or suspension at the end of full expiration.

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Description

This quiz covers essential radiographic techniques for imaging the thoracic spine, including AP, lateral, and Fuchs method projections. You will learn about patient positioning, central ray orientation, and the impact of technical factors on image quality. Test your knowledge and understanding of these critical procedures.