Examples of artifacts
Dentures, earrings, glasses, hair pins, hearing aids, chewing gum
Non-trauma sectional series
lateral
APOM
AP
trauma series
lateral APOM AP anterior obliques flexion/extension
lateral SID
72”
lateral film size
8x10
where should the horizontal central ray be for a lateral?
C4
patient placement for lateral
line from bottom of front teeth to mastoid parallel to floor
where should the vertical central ray be for a lateral?
through mastoid
where should the top of the light field be for a lateral?
just above the ear
where/what should the anatomical marker be placed for a lateral cervical?
side closest to the film under the chin
what are the breathing instructions for lateral?
exhale and stop breathing
how should you collimate for lateral?
to the soft tissue
what are the criteria for the lateral cervical image?
anatomy from occipital base to T1
all disc spaces and Z joints open
spinouses in profile
mandibular angles anterior to the bodies
if you cannot see the vertebra in an xray, what do you need to do?
double mAs and increase kVp by 10-15%
how do you measure for an APOM?
mouth open, finger at side of open mouth
patient placement for APOM
upper occlusal plate to base of occiput parallel to the floor
central ray for APOM
center of mouth
collimation for APOM
collimate vertically to below lens of eyes and horizontally to mastoids
breathing instructions for APOM
don’t breathe don’t move
film size for APOM
8x10
what should you be able to see in an APOM?
all C1 and C2
lateral masses equidistant from mandibular rami
upper occlusal plate and occipital base superimposed
mouth open
where should the anatomical marker be for APOM?
out of the way of pertinent anatomy
film size for AP cervical
8x10
where is the ID blocker placed for AP cervical?
up and out of the way
patient placement for AP cervical
line from bottom of front teeth to mastoid parallel to floor
central ray placement for AP cervical
C4 (thyroid cartilage)
SID for AP cervical
40” 15 degree cephalic tube tilt
breathing instructions for AP cervical
don’t breathe, don’t move
image criteria for AP cervical
C3-T1 and lung apices
disc spaces open, uncinates visible, spinouses at bottom of bodies
spinouses midline, pedicles and pillars equidistant from sides of bodies
bottom of mandible superimposed over based of occiput
C4 is center of image
what are the views that are taken in order for a trauma series?
lateral APOM AP obliques flexion/extension
how do you determine traumatic vs non-traumatic views?
is there clinical evidence of fracture?
use clinical indicators rather than automatically turning to imaging
ACR now considers high-resolution CT a better choice of modality to exclude fracture
SID for anterior cervical oblique
72” with 15 degree caudal tube tilt
how do you measure for anterior cervical oblique?
same as lateral
what film size do you use for anterior cervical oblique?
8x10
patient placement for anterior oblique
rotate patient 45 degrees from PA position
line from the bottom of the front teeth to the mastoid parallel to the floor
breathing instructions for patient for anterior cervical oblique
don’t breathe, don’t move
where do you place the anatomical marker for anterior cervical oblique?
right marker over right shoulder
left marker over left shoulder
what do you need to see in anterior obliques?
base of occiput to T1 IVFs open disc spaces open no Z joints or unincates seen mandible clear of vertebrae
SID flexion/extension
72”
film size for flexion/extension
10x12
patient instructions for flexion lateral
tuck chin an dflex to patient’s tolerance
exhale and stop breathing
where should the central ray be for flexion/extension?
mid cervicals
what is the film criteria?
VP in in collimation field
patient instructions for extension?
elevate chin and extend to patient’s tolerance
exhale and stop breathing
why do we need flexion/extension for trauma?
to demonstrate both ligament instability and range of motion
measurements for swimmer’s
under arms/axilla to axilla
patient placement for swimmer’s
dependant arm (closest to film is raised) seated!
central ray placement for swimmer’s
center to T1, then center fil to CR
what film size for swimmer’s?
10x12
SID for swimmer’s
40”
patient instructions for swimmer’s
breathe out and hold
why does the patient need to lift the arm for swimmers?
it acts as a natural filter for the cervical spine
accessory views
posterior obliques
fuchs
what is fuch’s used for?
visualize the dens
what SID is the posterior cervical oblique taken at?
82” 15 degree cephalic tube tilt
patient positioning
rotate 45 degrees from AP position
patient instructions
don’t breathe, don’t move
why are anterior obliques preferred?
radiation protection
shooting into concavity
xrays that are set up at 72”
all lateral cervicals all cervical obliques PA chest lateral chest AP full spine