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Questions and Answers
What is the positioning of the patient for a thoracic vertebrae X-ray?
What is the positioning of the patient for a thoracic vertebrae X-ray?
The patient is positioned supine on the X-ray table with the median sagittal plane perpendicular to the tabletop and coincident with the midline of the Bucky.
Where should the upper edge of the CR cassette be positioned during a thoracic vertebrae X-ray?
Where should the upper edge of the CR cassette be positioned during a thoracic vertebrae X-ray?
Just below the prominence of the thyroid cartilage.
What should the vertical collimated beam be centered to for a thoracic X-ray?
What should the vertical collimated beam be centered to for a thoracic X-ray?
2.5 cm below the sternal angle.
The image density in a thoracic vertebrae X-ray should be high to demonstrate bony detail.
The image density in a thoracic vertebrae X-ray should be high to demonstrate bony detail.
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The patient should be positioned in the _____ decubitus position for a lateral view.
The patient should be positioned in the _____ decubitus position for a lateral view.
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What should the collimated vertical beam be at right angles to during a lateral view of the thoracic vertebrae?
What should the collimated vertical beam be at right angles to during a lateral view of the thoracic vertebrae?
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What identification feature helps to confirm L1 inclusion in the thoracic X-ray?
What identification feature helps to confirm L1 inclusion in the thoracic X-ray?
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Which of the following anterior surface markings can be used as a guide to centering points? (Select all that apply)
Which of the following anterior surface markings can be used as a guide to centering points? (Select all that apply)
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What is the common fault when centering the image receptor and beam for a thoracic X-ray?
What is the common fault when centering the image receptor and beam for a thoracic X-ray?
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What should the position of the patient's arms be during a lateral view X-ray of the thoracic vertebrae?
What should the position of the patient's arms be during a lateral view X-ray of the thoracic vertebrae?
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High-contrast images are desirable for diagnosing thoracic vertebrae.
High-contrast images are desirable for diagnosing thoracic vertebrae.
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Study Notes
Thoracic Vertebrae Radiographic Techniques
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Positioning for PA Thoracic Vertebrae:
- Patient is positioned supine, with the median sagittal plane perpendicular to table and Bucky.
- CR cassette is positioned just below thyroid cartilage to include upper thoracic vertebrae.
- X-ray beam is centered at right-angles to the image receptor 2.5 cm below the sternal angle.
- Ensure tight collimation to spine.
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Essential image characteristics for PA Thoracic Vertebrae:
- Image should include vertebrae from C7 to L1.
- Image density should be sufficient for bony detail in both upper and lower thoracic vertebrae.
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Common faults:
- Too low image receptor and beam centering may exclude upper thoracic vertebrae.
- Lower vertebrae may be excluded. Identify L1 by absence of a rib attached to it.
- High radiographic contrast causes high density over vertebrae.
Lateral Thoracic Vertebrae
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Positioning for Lateral Thoracic Vertebrae:
- Patient is positioned in lateral decubitus on the table, with the median sagittal plane parallel to receptor.
- Midline of axilla coincides with table midline.
- Arms should be raised above the head and supported with a pillow.
- The upper edge of the cassette is positioned 3-4 cm above C7 spinous process.
- The vertical x-ray beam is centered at right-angles to the long axis of the thoracic vertebrae.
- Center point is usually just below the inferior angle of the scapula.
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Essential image characteristics for Lateral Thoracic Vertebrae:
- Upper 2-3 vertebrae may be obscured by shoulders.
- Look for the absence of a rib attached to L1 at the lower border of the image.
- Posterior ribs should be superimposed demonstrating proper patient position.
- Image density should ensure proper diagnosis.
Localised Projections
- Posterior surface markings are convenient for lateral projections.
- C7 spinous process is used as a reference point for counting down to locate upper and middle thoracic vertebrae.
- L3 spinous process at the level of the lower costal margin is used as the reference point to count upwards and locate the lower thoracic vertebrae.
Lumbar Vertebrae Projections
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PA Lumbar Vertebrae
- Patient is positioned supine with the median sagittal plane coinciding with the midline of the table and Bucky.
- Anterior superior iliac spines should be equidistant from the table.
- Hips and knees are flexed, feet flat on the table, to reduce lumbar arch.
- Cassette is centered at the level of the lower costal margin.
- Exposure taken on arrested expiration.
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Essential image characteristics for PA Lumbar Vertebrae:
- Image includes T12 downwards, and the sacro-iliac joints.
- Sacroiliac joints should be equidistant from the spine to assess rotation.
- Adequate image density for diagnosis.
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Common faults:
- Sometimes the sacroiliac joint is missed. An additional projection is required.
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Lateral Lumbar Vertebrae:
- Patient is positioned in lateral decubitus on the table.
- Arms should be raised and resting on a pillow in front of the patient's head.
- Knees and hips are flexed for stability.
- The coronal plane through the center of the spine coincides with the midline of the Bucky.
- Non-opaque pads may be placed under the waist and knees to bring the vertebral column parallel to the image receptor.
- Cassette is centered at the level of the lower costal margin.
- Exposure is taken on arrested expiration.
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Essential image characteristics for Lateral Lumbar Vertebrae:
- The image should include T12 downwards, including the lumbosacral junction.
- Superimposition of the posterior and anterior margins of the vertebral body.
- The spinous processes should be visible on the image, with sufficient density for diagnosis.
- Common faults: - High-contrast images may result in insufficient or high image density. - Spinous processes may be excluded from the image due to collimation. - Poor superimposition of the anterior and posterior margins of the vertebral bodies indicates the patient rolled too far forward or backward during positioning. - Failure to demonstrate a clear intervertebral disc space could be due to the spine not being perfectly parallel with the receptor, scoliosis or other pathology.
Lateral Lumbar Flexion & Extension
- These are requested to assess lumbar spine mobility and stability.
- Performed with the patient seated on a stool with either side against the vertical Bucky.
- For flexion, patient leans forward, flexing the lumbar region and gripping the front of the seat.
- For extension, patient leans backward, extending the lumbar region and gripping the back of the seat or support.
- Centered at the level of the lower costal margin, exposure taken on arrested expiration.
AP Axial Lumbar
- Patient is positioned supine with the median sagittal plane coinciding with the midline of the table and Bucky.
- ASIS should be equidistant from the tabletop.
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Essential image characteristics for AP Axial Lumbar:
- The image should include the lumbosacral junction.
- Sacroiliac joints should be equidistant from the spine.
- Posterior and anterior margins of the vertebral body should be superimposed.
- Sufficient image density for diagnosis.
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Common faults:
- Sacroiliac joint may be missed.
Additional Considerations
- Short exposure time is recommended for lateral flexion and extension projections to minimize patient movement.
- Software applications are recommended for managing high-contrast images.
- Thorough understanding of anatomical landmarks is crucial for accurate patient positioning and centering of the x-ray beam.
- For localized projections, palpation of posterior surface markings is essential for locating specific vertebrae and centering the beam appropriately.
- Proper use of collimation is crucial for limiting the exposure area and reducing the risk of scatter radiation.
- Optimizing the image density is essential for achieving the desired level of detail for diagnosis.
- It is always important to carefully assess the image for any signs of rotation, distortion, or exclusion of relevant anatomy.
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Description
This quiz covers the positioning and essential image characteristics for PA and lateral thoracic vertebrae radiographic techniques. Understand how to obtain proper imaging to include the necessary vertebrae and avoid common faults. Test your knowledge on the technical details critical for radiologic imaging.
