Chapter 8 Flashcards
1
Q
What are intervertebral disks?
A
Tough fibrocartilaginous disks separate typical adult vertebrae. These cushion like disks are tightly bound to the vertebrae for spinal stability, but allow for flexibility and movement of the vertebral column.
2
Q
Cervical vertebrae
A
7
3
Q
Thoracic Vertebrae
A
The next 12 vertebrae are the thoracic vertebrae, and each of these connects to a pair of ribs. Because all vertebrae are posterior or dorsal in the body.
4
Q
Lumbar Vertebrae
A
The largest individual vertebrae are the five lumber vertebrae. These vertebrae are the strongest in the vertebral column because the load of body weight increases toward the inferior lumbar vertebrae are common sites of injury and pathology.
5
Q
Sacrum and Coccyx
A
The sacrum and coccyx develop as multiple separate bones and then fuse into two distinct bones. A newborn has 5 sacral segments and from three to five (average, four) coccygeal segments, for an average of 33 separate bones in the vertebral column of a young child. The adult body has 26 bones.
6
Q
Vertebral Column Curvatures
A
composed of a series of anterposterior curves. The terms conmcave (a rounded inward or depressed surface like cave) and convex (a rounded outward elevated surface) are used to describe these curves. The cervical and lumber regions have concave curvatures and are described as .lordotic. The thoracic and sacral region have convex curvatures.
7
Q
Vertebral Column Curvatures
A
Soon after birth, the thoracic and sacral (pelvic) curves begin to develop. These two convex curves are called primary curves. As children begin to raise their head and sit up, the first compensatory concave curve forms in the cervical region. The second compensatory concave curve, the lumbar curvature, develops when children learn to walk.
8
Q
Lordoses
A
abnormal anterior concavity of the lumber spine
9
Q
kyphosis
A
abnormal condition characterized by increased convexity of the thoracic spine curvature
10
Q
scoliosis
A
an exaggerated lateral curvature of the spine
11
Q
typical vertebral anatomy
A
1) the body–thick, weight bearing anterior part of the vertebra. Its superior and inferior surfaces are flat and rough for attachment of the intervertebral disks. 2) vertebral arch– the second part consists of a ring or arch of bone that extends posteriorly from the vertebral body. The postereior surface of the body and arch form a circular opening, the vertebral foramen, which contains the spinal cord.
12
Q
vertebral arch (superior perspective)
A
pedicles which extend posteriorly from either side of the vertebral body, form most of the sides of the vertebral arch. The posterior part of the vertebral arch is formed by two somewhat flat layers of bone called laminae. Each lamina extends posteriorly from each pedicle to unite in the midline. Extending laterally from approximately the junction of each pedicle and lamina is a projection termed the transverse process. The spinous process extends posteriorly at the midline junction of the two laminae. The spinous processes, the most posterior extensions of the vertebrae, can be palpated along the posterior surface of the neck and back.
13
Q
summary of vertebral arch
A
the typical vertebra consists of two pedicles and two laminae that form the vertebral arch and the vertebral foramen containing the spinal cord, two transverse processes extending laterally, one spinous process extending posteriorly, and the large anterior body. Each typical vertebra also has four articular processes, two superior and two inferior, which comprise the important joints of the vertebral column.
14
Q
vertebral anatomy
3) joints in the vertebral column
A
the vertebral column would be rigidly immovable without the intervertebral disks and the zygapophyseal joints. Respiration could not occur without the spine, which serves as a pivot point for archlike movement of the ribs.
15
Q
joints in the vertebral column (intervertebral joints)
A
The intervertebral joints are ampiathrodial joints that are found between the vertebral bodies. The intervertebral joints provide spinal stability, but they also allow for flexibility and movement of the vertebral column.
16
Q
joints in the vertebral column (zygapophyseal joints)
A
The four articular processes are seen projecting from the area of the junction of the pedicles and laminae. The term facet sometimes is used interchangeably with the term zygapophyseal joint, but the facet is actually only the articulating surface instead of the entire superior or inferior articular process.
17
Q
joints in the vertebral column (costal joints)
A
not involved in the stability of the spinal column itself, a third type of joint is located along a portion of the vertebral column. In the thoracic region, the 12 ribs articulate with the transverse processes and vertebral bodies. These articulations of the ribs to the thoracic vertebra, referred to as costal joints.
18
Q
typical vertebral anatomy- (intervertebral foramina)
A
along, the upper surface of each pedicle is a half moon shaped area termed the superior vertebral notch, and along the lower surface of each pedicle is another half moon shaped area called the inferior vertebral notch. When the vertibrae are stacked, the superior and inferior vertebral notches line up. These two half moon shaped areas form a single opening, the intervertebral foramen. Therefore, between every two vertebrae are two intervertebral foramina, one on each side, through which important spinal nerves and blood vessels pass.
19
Q
typical vertebral anatomy- intervertebral disk
A
typical adult vertebrae are seperated by tough fibrocartilaginous disks between the bodies of every two vertebrae, except between the first and second cervical vertebrae. (The first cervical vertebrae has no body.) These fibrocartilage disks provide a resilient cushion between vertebrae, helping to absorb shock during movement of the spine. Each disks consists of an outer fibrous portion termed the annulus fibrosus and a soft, semigelatinous inner part termed the nucleus pulposus. When this soft inner part protrudes through the outer fibrous layer, it presses on the spinal cord and causes severe pain and numbness that radiates into the lower limbs. This condition is known as a slipped disk, is termed the herniated nucleus pulposus (HNP).
20
Q
characteristics of cervical vetebrae
A
The cervical vertebrae show little resemblance to the lumbar or thoracic vertebrae, which are more typical in appearance. The unique characteristics of cervical vertebrae are transverse foramina, bifid spinous process tips, and overlapping vertebral bodies. Each cervical vertebrae and vertebral body continues to get larger, progressing down to the seventh cervical vertebra.
C1 (atlast) C2 (axis) are unusual. The 3rd through 6th cervical vertebrae, are typical cervical vertebrae. The last, or seventh, cervical vertebra, the vertebral prominens, has many thoracic vertebrae features, including an extra long and more horizontal spinous process (vertebral prominens).
21
Q
characteristics of cervical vertebrae (superior perspective)
A
The transverse processes are small and arise from both the pedicle and the body, rather than from the pedicle-lamina junction. The hole in each transverse process is called a transverse foramen. The vertebral artery and veins and certain nerves pass through these successive transverse foramina. Therefore, one unique characteristic of all cervical vertebrae is that each has three foramina that run vertically, the right and left transverse foramina and the single large vertebral foramin. The spinous processes of c2 through c6 are fairly short and end in double pointed bifid, a second unique characteristic typical of cervical vertebrae.
22
Q
characteristics of cervical vertebrae (lateral perspective) in shape, with the anterior edge slightly more inferior, which causes slight overlapping of the vertebral column
A
When viewed from the lateral perspective, typical c3-c6. Cervical vertibral bodies are small and oblong in shape, with the anterior edge slightly more inferior, which causes slight overlapping of the vertebral bodies.
Located behind the transverse process at the junction of the pedicle and lamina are the cervical articular processes. Between the superior and inferior articular processes is a short column (pillar) of bone that is more supportive than the similar area in the rest of the spinal column. This column of bone is called the articular pillar, sometimes called the lateral mass, when one is referring to C1.
23
Q
cervical zygapophyseal joints
A
the superior and inferior articular processes, located rover and under the articular pillars, are directly lateral to the large vertebral foramen. The zyga joints of the second through seventh cervical vertebra are located at right angles, 90 degrees, to the midsagittal plane thus are visualized only in the true lateral position.
24
Q
cervical intervertebral foramina
A
the intervertebral foramina can be identified by the pedicles, which form the superior and inferior boundaries of these foramina. The intervertebral foramina are situated at a 45 degree angle to the midsagittal plane, open anterirly. They also are directed at a 15 degree inferior angle because of the shape and overlapping of the cervical vertebrae. Therefore, to open up and demonstrate the cervical intervertebral foramina radiographically a 45 oblique position combined with a 15 degree cephalad angle of the x-ray beam is required.
25
Atlas (C1)
The first cervical vertebra, least resembles a typical vertibra. Anteriorly, there is no body but simply a thick arch of bone called the anterior arch. The anterior arch includes a small anterior tubercle.
The dens or odontoid process is part of the second cervical vertebra but a superior perspective of C1 shows its location and how it is held in place by the transverse atlantal ligament.
Rather than two laminae and a spinous process found in typical vertebrrae, C1 has a posterior arch that generally bears a small posterior tubercle at the midline.
Each of the left and right C1 superior articular processes presents a large depressed surface called a superior facet for articulation with the respective left and right occipital condyles of the skull. These articulations between C1 and the occipital condyles of the skull, are called occipitoatlantal joints. The transverse processes of C1 are smaller but still contain the transverse foramina distinctive of all cervical vertebrae.
The Articular pillars, the segments of bone between the superior and inferior articular processes, are called lateral masses for C1. Because the lateral masses of C1 support the weight of the head and assist in roation of the head, these portions are the most bulky and solid parts of C1.
26
Axis (C2)
The dens or odontoid process, the conical process that projects up from the superior surface of the body.
27
Relationship of C! and C2.
Normally, articulations between C2 and C1, the atlantoaxial joints, are symmetric. Accordingly, the relationship of the dens to C1 also must be perfectly symmetric.
28
Characteristics of Thoracic Vertebrae
T5, T6, T7, and T8 are considered typical thoracic vertebrae. The upper four thoracic vertebrae are smaller and share features of the cervical vertebrae. The lower four thoracic vertebrae are larger and share share characteristics of the lumbar vertebrae.
29
Rib articulations
all thoracic vertebrae have facets for articulation with ribs, L! and L2, do not show facets for rib articulations.
30
Costovertebral joints
Each thoracic vertebra has a full facet or two partial facets, called demifacets, on each side of the body. Each facet or combination of two demifacets accepts the head of a rib to form a costovertebral joint.
Vertebrae with two demifacets share articulations with the heads of ribs. For example, the head of the fourth rib straddles or articulates with demifacets on the vertebral bodies of both T3 and T4. The superior portion of the rib head articulates with the demifacet on the inferior margin of T3 and the inferior portion of the rib head articulates with the demifacet on the superior margin of T4.
T1 has a full facet and a demifacet on its inferior margin. T2 through T8 have demifacets on their upper and lower margins. T9 has only one demifacet on its upper margin. T10 through T12 have full facets. Rib 1 articulates with T1 only, rib 2 articulates with T1 and T2, and so forth. Ribs 11 and 12 articulate only with T11 and T12.
31
Costotransverse Joints
In addition to costovertebral joints, all of the first 10 thoracic vertebrae also have facets (one on each transverse process) that articulate with the tubercles of ribs 1 through 10. These articulations are termed costotransvere joints. T11 and T12 do not show facets at the ends of the transverse process for rib articulations. Thus, as the first 10 pairs of ribs arch posteriorly from the upper 10 vertebral bodies, the tubercle of each rib articulates with one transverse process to form a costotransverse joint. Ribs 11 and 12, articulate only at the costovertebral joints.
32
Lateral oblique perspective
The superior articular processes (facing primarily posteriorly) and the inferior articular processes (facing more anteriorly) are shown to connect the successive thoracic vertebrae to form the zygapophyseal joints.
On each side, between any thoracic vertebrae, are intervertebral foramina, which are defined on the superior and inferior margins by the pedicles.
33
thoracic zygapophyseal joints
The structure and angles of the facets of the inferior and superior articular processes making up the zyga joints differ markedly from those of the cervical and lumbar vertebrae. In the thoracic vertebrae, the zyga joints form an angle of 70 to 75 degree from the midsagittal plane.Therefore, for example, to open up and demonstrate the thoracic zyga jonts radiographically, a 70 to 75 oblique position with a perpendicular central ray is required.
34
thoracic intervertebral foramina
the openings of the intervertebral foramina on the thoracic vertebra are located at right angles, or 90 degree (lateral) to the midsagittal plane.
35
unique C1-C2 joint classifications
There are three joints involved between C!-C2 vertebrae. The first two joints are the right and left lateral antlantoaxial joints between the inferior articular surface of C1 (Atlas) and superior artilcular surface of C2 (axis). The third joint between C1-C2 is the medial atlantoaxial joint. This articulation is located between the dens of C2 an the anterior arch of C1 and is held in place by the transverse atlantal ligament.
36
AP Cervical Spine Image
Usually the first two or three thoracic vertebrae, as well as C7 to C3 are seen well on this position. T1 , can be identified by the attachment of the first pair of ribs.
37
Lateral Cervical Spine Image
The single most important radiograph clinically for a cervical spine series is a well-positioned lateral. All seven cervical vertebrae and the alignment with T1 should be demonstrated. 1) Dens are seen extending up through the anterior arch of C1. 2) Posterior arch of the atlas, C1, 3) Body of C3 D) zygapophyseal joint betweeen C4-C5 (best shown on a lateral projection for the cervical spine) E) Body of C7, F) Spinous process of C7, vertebra prominens.
38
Oblique Cervical Spine Image
The oblique position demonstrates the cervical intervertebral foramina. Spinal nerves to and from the cord are transmitted through these intervertebral foramina.
A) Posterior arch and tubercle of C1 B) Intervertebral foramen between C4 and C5 (count down from C!)
C) Pedicle of C) D) Body of C7.
39
Lateral Thoracic Spine
Intervertebral Foramina between T11 and T12 (this is best demonstrated on a lateral image of the T spine.)
40
Summary of Cervical Vertebrae
Three foramina each, more dominant articular pillars,
C1 (Atlas) No body but anterior and posterior arches, No spinous process, but posterior tubercle with bifid tip, lateral masses (articular pillars), superior facets for occipitoatlantal articulations.
C2, (Axis) Contains odontoid process (dens)
C2-C6 short spinous processes with bifid tips.
C7 called vertebra prominens because of its long spinous process.
41
Summary of Thoracic Vertebrae
All thoracic vertebrae 1) Contain facets for rib articulations (facets or demifacets) 2) T1-T10 Contain facets on transverse proceses for rib articulations. 3) T1-T10 contain facets on transverse processes for rib articulations. T1-T9 contain demifacets for rib articulation T10-T12 contain single facet for rib articulation.
42
Intervertebral foramina versus Zygapophyseal joints
Two anatomic areas of the spine that generally need to be demonstrated by the proper radiographs are the intervertebral foramina and zyga joints.
43
Cervical Spine Skeleton
The zyga joints visualize well in the lateral position.
The intervertebral foramina are visualized in a 45 degree oblique. It is important to know that the LPO position opens up the foramina on the right side and a 15 degree dephalad angle is needed. Therefore, on a posterior oblique cervical spine radiograph, the upside (side farthest from IR) is the side on which the intervertebral foramina are opened well. If this were taken in an anterior oblique position, with the foramina closest to the image receptor, the downside would be open and a 15 degree caudad angle would be required.
44
Cervical spine
The zyga joints are superimposed on the joints on the opposite side in the lateral position. It is important to remember that the zyga joints are located between the articular pillars of each vertebra.
The oblique cervical spine shows the circular intervertebral foramina opened. In each oblique radiograph, only one set of foramina are opened, whereas the ones on the opposite side are closed.
45
thoracc spine skeleton
The lateral position of the thoracic spine best shows the intervertebral foramina. A 70 degree oblique is necessary to open up the zyga joints on the t-spine. The posterior oblique position would show the upside, while the anterior would show the downside.
46
Topographic landmarks
```
The mastoid tip --C1
External Acoustic Meatus--EAM
Gonion--C3
Thyroid Cartilage or Adam's Apple-- C5
Spinous Process--C7
Jugular notch --T2-T3
Sternal Angle T4-T5
Xiphoid Process T9-T10
```
47
Radiation
The thyroid dose of radiation can be reduced significantly by positioning the patient in an anterior oblique rather than a posterior oblique.
48
thoracic spine
is usually obtained with the use of an orthostatic (breathing) technique.to blur structures that overlie the thoracic vertebra. It involves taking shallowting breathes during the exposure time, with a low mA setting and 3 to 4 seconds exposure time. The thorax must not move.
49
Focal spot
The use of small focal spot can improve spatial resolution.
50
Scatter radiation
When the air gap technique is considered is during a lateral cervical. Placement of the IR far from the spine during lateral cervical radiography creates an air gap that reduces the amount of scatter radiation that reaches the IR This increased OID also contributes to greater magnification of the image, which accounts for an increase in SID to compensate.
51
Myelography
MRI and CT are replacing myelography as the modality of choice.
52
CT
used for evaluating spinal trauma such as fractures, subluxations, herniated disks, tumors, and arthropathies such as rheumatoid arthritis and osteoarthritis.
53
MRI
demonstrating soft tissue structures associated with the spine, such as the intervertebral disks and the spinal cord itself.
54
clay shoveler's fracture
the fracture, which results from hyperflexion of the neck, results in avulsion fractures on the spinoous processes of C6-T1. The fracture is best demonstrated on a lateral cervical spine.
55
Compression fracture
frequently associated with osteoporosis, a compression fracture often involves collapse of a vertebral body, Seen best in a lateral position.
56
spondylitis
is inflammation of the vertebra.
57
spondylosis
characteristic of this condition is neck stiffness due to age-related degeneration of intervertebral disks.
58
kyphosis
abnormal or exaggerated convex thoracic curvature
59
AP Open Mouth Projection
Involving C!-C2, demonstrates odontoid and Jefferson fractures. Make sure that the patient keeps their tongue in the lower jaw to keep it from superimposing the atlas and axis. Optimal flexion/extension of the neck, indicated by superimposition of the lower margin of the upper incisors on the base of the skull. Neither the teeth nor the skull base base should superimpose the dens. If the teeth are superimposed on the upper dens, reposition by slight hyperextension of the neck or angel the CR slightly cephalic. If the base of the skull is superimposed on the upper dens, reposition by slight hyperflexion of the neck or angle the CR slightly caudal (the base of the skull and/or the supper incisors will be projected about 1 inch for every 5 degree of caudal angulation. No rotation indicated by equal distances from lateral masses and/or transverse processes of C1 to condyles of mandible, and by center alignment of spinouse process of C2
60
AP Axial Projection: Cervical Spine
Pathology involving the mid and lower C-Spine (C3-C7), SID 40" Adjust head so that a line from lower margin of upper incisors to the base of the skull (mastoid tips) is perpendicular to table and/or IR. Line from tip of mandible to base of skull should be parallel angled CR No rotation of thorax.
Angle CR 15 to 20 degrees
Direct CR to margin of thyroid cartilage to pass through C4
Cephalic angulation directs the beam between the overlapping cervical vertebral bodies to demonstrate the intervertebral disk spaces.
C3-T2 vertebral bodies; space between pedicles and intervertebral disk spaces clearly seen.
No rotation indicated by spinous processes and sternoclavicular joints (if visible) equidistant from the spinal column lateral border, the mandible and the base of the skull should superimpose the first two cervical vertebra
61
Anterior and Posterior Oblique Positions: Cervical Spine
Anterior Oblique (RAO-LAO are preferred because of reduced thyroid doses.Protract chin to prevent mandible from superimposing vertebrae. Elevating the chin too much will superimpose base of skull over C1.
Anterior Oblique--direct CR 15 degree caudad to C4
Posterior Oblique--direct CR 15 degree dephalad to C4
Anatomy demonstrated---Anterior: Oblique: intervertebral foramina and pedicles on the side of the patient closes to the IR
Posterior: Oblique: intervertebral foramina and pedicles on the side of the patient farthest from the IR.
Intervertebral disk spaces and intervertebral foramina of interest (C2 through C7) should be open and uniform in size and shape. The pedicles of interest should be demonstrated in full profile and the opposite, on-end pedicles demonstrated in full profile and the opposite, on end pedicles should be aligned along the anterior cervicle body. On end pedicles aligned along the anterior cervical boy and pedicles aligned at the midline of the cervical body and visualization of zygapopphyseal joints indicate over rotation.
Obscured intervertebral foramina and pedicles indicate under rotation. The mandibular rami should not superimpose the upper cervical vertebrae and the base of the skull should not superimpose C1.
62
Lateral Position: C-Spine
Spondylosis and osteoarthritis SID 60 to 72 inches, Direct CR horizontal to C4, full expiration (for maximum shoulder depression), long 72 inches SID compensates for increased OID and provides for greater spatial resolution.
Cervical vertebral boies, intervertebral joint spaces, articular pillars, spinous processes, and zyga joints.
C1 through C7-T1, intervertebral joint spaces are clearly seen. If upper margin of T1 is not demonstrated additional images such as the cervicothoracic lateral should be obtained. The rami of the mandible do not superimpose C! to C2. The right and left articular pillars and zyga joints should be superimposed for each vertebra. The bodies should be free of superimposition of the articular pillars and the spinous process seen in profile.
63
Cervicothoracic (swimmer's) lateral position: Cervical spine (twining method for C5-T3) Direct CR to T1, which is approximately 1 inch above level of jugular notch anteriorly and at the level of vertebra prominens posteriorly.
Vertebral bodies and intervertebral disk spaces of C5-T3 are shown. The humeral head and arm farthest from the IR are magnified and appear distal to T4 or T5.
Minimal vertebral rotation indicated by superimposition of cervical zyga joints and articular pillars, and posterior ribs. The humeral heads should be separated vertically.
Okay
64
Lateral Positions--Hyperflexion and Hyperextension: Cervical Spine
SID C1-C7, No rotation of head is indicated by superimposition of mandibular rami, for hyperflexion: spinous processes should be well separated. For hyperextension: spinous process shouldd be in close proximity. Direct CR to C4
65
AP or Pa projection for C1-C2 (dens): C-spine (fuchs method (AP0 or Judd method (PA)
SID 40O
Elevate Chin as needed to bring MML (mentomeatal line)
Dens should be centered within the foramen magnum. No rotation indicated by the symmetric appearance of the mandible arched over the foramen magnum. Correct extension of head and neck indicated by the tip of the mandible clearing the superior portion of the dens and foramen magnum.
66
AP Projection: T-spine
The anode heel effect will create more uniform density throughout the thoracic spine. Place patient so the more intense aspect of the beam (cathode side) is over the thoracolumbar region.
flex knees and hips to reduce thoracic curvature.
direct CR to T7
Anatomy demonstrated: Thoracic vertebral bodies, intervertebral joint spaces, spinous and transverse processes, posterior ribs, and costovertebral articulations.
The spinal column from C7 to L! centered to the midline of the IR, No rotation indicated by sternoclavicular joints equidistant from the spine.
67
Lateral Position: Thoracic Spine
Pathology involving the thoracic spine, such as compression fractures, subluxation, or kyphosis
Direct CR to T7
Anatomy demonstrated: Thoracic vertebral bodies, intervertebral joint spaces, and intervertebral foramina, T1 to T3 will not be visualized, Obtain a lateral image using a cervicothoracic (swimmer's) lateral if the upper thoracic vertebrae are of special interest.
Intervertebral disk spaces should be open.
No rotation indicated by superimposition of posterior aspects of vertebral bodies
68
Oblique Position ---Anterior or Posterior Oblique: T-Spine
Pathology involving the Zyga jonts.
Rotate the body 20 degrees from true lateral to create a 70 degrees oblique from plane of table. Ensure equal reotation of shoulers and pelvis.
CR to T7
Zyga jonts: Anterior Oblique (RAO and LAO) demonstrate the downside zyga joints and posterior oblqiue positions (RPO and LPO) demonstrate the upside.
69
Hip
is proximal
70
List the number of bones found in each division in the adult vertebral column.
```
Cervical 7
Thoracic 12
Lumbar 5
Sacrum 1
Coccyx 1
Total 26
```
71
List the two primary or posterior convex curves seen in the vertebral column.
Thoracic and Sacral
72
Indicate which two portions of the vertebral column are classified as secondary or compensatory curves.
Cervical and lumber
73
Which are the convex curves
Thoracic and Sacrum
74
Which are the concave curves
Cervical and Lumbar
75
Which are the secondary curves
Cervical and lumbar
76
Which are the primary Curve
Thoracic and Sacrum
77
Develops as a child learns to hold head erect
Cervical
78
An abnormal or exaggerated, "sway back" lumbar curvature is called
lordosis
79
An abnormal lateral curvature seen in the thoracolumbar spine is callled
scoliosis
80
The two main parts of a typical vertebra are the
body and the vertebral arch
81
The ? are two bony aspects of the vertebral arch that extend postriorly from each pedicle to join at the midline.
Lamina
82
The ? foramina are created by two small notches on the superior and inferior aspects of the pedicles.
Intervertebral
83
The opening, or passageway, for the spinal cord is the
Vertebral spinal canal
84
The spinal cord begins with the ? of the brain and extends down to the ? vertebra, where it tapers and ends. This tapered ending is called the ?
Medulla Oblongata
lower border of L1
conus medullaris
85
Which structures pass through the intervertebral foramina?
Spinal nerves and blood vessels
86
Which of the following is found between the superior and inferior articular processes?
Zyga joints
87
Only T1, T11, and T12 have full facets for. articulation with ribs
True
88
The Zyga joints of all cervical vertebrae are visualized only in a true lateral position.
true
89
List the outer and inner aspect
| of the intervertebral disk
Outer Aspect--Annulus Fibrosus
| Inner Aspect--Nucleaus Pulposus
90
The condition involving a "slipped disk" is correctly referred to as
Herniated nucleus pulposus
91
List the alternative names for the following cervical vertebrae
C!--Atlas
C2-Axis
C7-Vertebra Prominens
92
List three features that make the cervical vertebrae unique
Transverse foramina
bifid spinous process
overlapping vertebral bodies
93
A short column of bone found between the superior and articular processes in a typical cervical vertebra s alled
articular pillar
94
What is the term for the same structure, identified in the previous question, for the C1 vertebra.
Lateral mass
95
The zyga joints for the second through seventh cervical vertebrae are at a ? angle to the midsagittal plane: the thoracic vertebra are at a ? angle to the midsaggital plane.
90: 70 degrees
| 75 degrees
96
What is the name of the joint found between the superior articular presses of C1 and the occipital condyles of the skull?
occipitoatlantal articulations
97
The modified body of C2 is called the ? or ?
Dens or Odontoid process
| `
98
A lack of symmetry of the Zyga joints between C1 and C2 may be caused by injury or may be associated with
Rotation of the skull
99
What is the unique feature of all thoracic vertebrae that distinguishes them from other vertebrae?
presence of facets for articulation with ribs
100
Which specific vertebrae are classified a typical thoracic vertebrae (they least resemble cervical or lumbar vertebrae)?
T5-T8
101
For the central ray to pass through and "open: the intervertebral spaces on a 45 degree posterior oblique projection of the cervical vertebrae, what central ray angle (if any) is required?
15 degree cephalic
102
Upper portion of sternum
manubrium
103
superior margin of this upper section (landmark)
jugular (supersternal) notch
104
Center portion of sternum
Body
105
Joint between top and center portions (landmark)
sternal angle
106
Most inferior aspect of sternum (landmark)
xiphoid process
107
Gonion
C3
108
xiphoid process
T9-T10
109
thyroid cartilage
C4-C6
110
Jugular Notch
T2-T3
111
Sternal Angle
T4-T5
112
Mastoid tip
C1
113
Vertebra Prominens
C7-T1
114
3 to 4 inches below jugular notch
T7
115
In addition to gonads, which other radiosensitive organs are of greatest concern during cervical and thoracic spine radiography?
Thyroid, parathyroid glands, and breasts
116
List the two advantages of using high KV exposure factors for spine radiography, especially on an AP T-Spine radiograph.
Increase in exposure, decrease in patient dose, latitude (wide range of density)
117
When using digital imaging for spine radiography, it is important to use close collimation, grids, and lead masking.
True
118
If close collimation is used during conventional (analog) radiography of the spine, the use of lead masking (blockers) is generally not required.
false
119
To a certain degree, magnetic resonance imaging (MRI) and computed tomography (CT) are replacing myelography as the imaging modalities of choice for the diagnosis of a ruptured intervertebral disk.
true
120
Nuclear medicine is often performed to diagnose bone tumors of the spine.
true
121
To ensure that the intervertebral joint spaces are open for lateral thoracic spine projections, it is important to:
keep the vertebral column parallel to the image receptor (IR)
122
For lateral and oblique projections of the cervical spine, it is important to minimize magnification and maximize detail by: (more than one answer may be used.)
using a small focal spot
| increasing source image receptor distance (SID)
123
Fracture through the pedicles and anterior arch of C2 with forward displacement upon C3.
Hangman's fracture
124
Inflammation of the vertebrae
spondylitis
125
abnormal or exaggerated convex curvature of the thoracic spine
kyphosis
126
comminuted fracture of the vertebral body with posterior fragments displaced into the spinal canal
teardrop burst fracture
127
avulsion fracture of the spinous process of C7
clay shoveler's fracture
128
abnormal lateral curvature of the spine
scoliosis
129
a form of rheumatoid arthritis
ankylosing spondylitis
130
impact fracture from axial loading of the anteerior and posterior arch of C1
Jefferson fracture
131
mild form of scoliosis and kyphosis developing during adolescence
scheuermann disease
132
produces the "bow tie" sign
unilateral subluxation
133
Scoliosis
erect (AP/PA) and lateral spine including bending laterals
134
teardrop burst fracture
lateral cervical
135
jefferson fracture
AP open mouth C1-C2, tomography following lateral projection
136
scheuermann disease
scoliosis series
137
unilateral subluxation of cervical spine
lateral cervical spine
138
HNP
lateral of affected spine
139
What are the major differences between spondylosis and spondylitis?
spondyltis is an inflammatory process of the vertebrae. spondylosis is a condition of the spine characterized by rigidity of a vertebral joint.
140
Many geriatric patients have a fear of falling off the radiographic table.
true
141
What is the name of the radiographic procedure that requires the injection of contrast media into the subarachnoid space?
myelography
142
Which imaging modality is ideal for detecting early signs of osteomyelitis?
nuclear medicine
143
Which two landmarks must be aligned for an AP "open mouth" projection?
lower margin of upper incisors and base of skull
144
the tip of the odontoid process does not have to be demonstrated on the AP "open mouth" projection because it is best seen on the lateral projection.
false
145
What is the purpose of the 15 to 20 degree angle for the AP axial projection of the cervical spine.
to open up the intervertebral disk spaces
146
for an axial of the cervical spine, a plane through the tip of the mandible and ? should be parallel to the angled central ray.
base of skull
147
Less CR angle is required for the AP axial projection of the cervical spine if the examination is performed supine rather than effect.
true
148
What are the two important benefits of an SID longer than 40 to 44 inches for the lateral cervical spine projection?
compensates for increase object image receptor distance, OID, reduces magnification
less divergence of xray beam to reduce shoulder superimposition of C7
149
What central ray angulation must be used with a posterior oblique projection of the cervical spine?
15 degree cephalad
150
Which foramina are demonstrated with a left posterior oblique (LPO) position of the cervical spine?
right intervertebra foramina (upside)
151
which foramina are demonstrated with a left anterior oblique (LAO) position of the cervical spine?
left intervertebra foramina (downside)
152
In addition to extending the chin, which additional positioning technique can be performed to ensure that the mandible is not superimposed over the upper cervical vertebrae for the oblique projections?
rotate the skull into a near lateral position
153
What is the recommended SID for a lateral projection of the cervical spine?
60 to 72 inches
154
The lateral projection of the cervical spine should be taken during (inspiration, expiration, or suspended respiration). Why?
Expiration for maximum should depression
155
Which specific projection must be taken first if trauma to the cervical spine is suspected and the patient is in a supine position on a backboard?
Lateral, horizontal beam projection
156
The proper name of the method for performing the cervicothoracic lateral (swimmer's) position is the
twining method
157
Where should the central ray be placed for a cervicothoracic lateral (swimmer's position?
To T1; 1 inches above the jugular notch arteriorly or level of vertebra prominens posteriorly.
158
Which region of the spine must be demonstrated with a cervicothoracic lateral (swimmer's) position?
C5 to T3
159
Which one of the following projections to considered a "functional study" of the cervical spine?
hyperextension and hyperflexion lateral positions
160
When should the Judd or Fuchs method be performed?
If unable to demonstrate the upper portion of the dens w/ the AP "open mouth" projection.
161
Which AP projection of the cervical spine demonstrates the entire upper cervical spine with one single projection?
AP Wagging jaw projection "Ottonello Method"
162
Which two things can be done to produce equal density along the entire thoracic spine for the AP projection (especially for a patient with a thick chest)?
correct use of anode heel effect, use of compensating (wedge) filter
163
What is the purpose of using an orthostatic (breathing) technque for a lateral projection of the thoracic spine?
To blur out rib and lung markings that obscure detail of thoracic vertebrae.
164
Which zygapophyseal joints are demonstrated in a right anterior oblique (RAO) projection of the thoracic spine?
right downside
165
Which one of the following projections delivers the greatest skin dose to the patient?
cervicothoracic lateral position
166
The thyroid dose used during a posterior oblique cervical spine projection is more than 10 times greater than the dose used for an anterior oblique projection of the cervical spine.
true
167
Which of the following structures is best demonstrated with an AP axial vertebral arch projection?
articular pillars (lateral masses) of cervical spine
168
What central ray angle must be used with the AP axial vertebral arch projection?
20 to 30 degree cauded
169
What ancillary device should be placed behind the patient on the tabletop for a recumbent lateral projection of the T-spine?
lead mat or masking
170
Which skull positioning line is aligned perpendicular to the IR for a PA (Judd) projection for the odontoid process?
mentomeal line (MML)
171
Which zygapophyseal joints are best demonstrated with an LPO position of the thoracic spine?
right
172
How much rotation of the body is required for an oblique position of the thoracic spine from a true lateral position?
20 degrees from lateral positon
173
A radiograph of an AP "open mouth" projection of the cervical spine reveals that the base of the skull is superimposed over the upper odontoid process. Which specific positioning error is present on this radiograph?
extensive extension of the spine
174
A radiograph of an AP axial projection of the cervical spine reveals that the intervertebral disk spaces are not open. The following position factors were used: extension of the skull, central ray angled 10 degrees cephalad, central ray centered to the thyroid cartilage, and no rotation or tilt of the spine. Which of these factors must be modified to produce a more diagnostic image?
Increase central ray angulation to 15 degrees cephalid
175
A radiograph of a right posterior oblique (RPO) cervical spine projection reveals that the lower intervertebral foramina are not open. The upper intervertebral foramina are well visualized. What positioning error most likely led to this radiographic outcome?
When the lower intervertebral foramina are narrowed while the upper foramina are well demonstrated, the positioning error most often is under rotation of the upper body. The upper body must be rotated 45 degrees.
176
A radiograph on a lateral projection of the cervical spine reveals that C7 is not clearly demonstrated. The following factors were used: erect position, 44 inch SID, arms down by the patient's side, and exposure made during inspiration. Which two of these factors should be changed to produce a more diagnostic image during the repeat exposure.
initiate exposure during suspended respiration and increase SID to 72 inches.
177
A radiograph of an AP "Wagging jaw" (otonello method) projection taken at 75 KV, 20 MAS, and 0.5 second demonstrates that part of the image of the mandible is still visible and obscuring the upper cervical spine. Which modification needs to be made to produce a more diagnostic image during the repeat exposure.
Reduce MAS and increase exposure time to produce more blurring of the mandible
178
A radiograph of a lateral thoracic spine reveals that lung makings and ribs make it difficult to visualize e vertebral bodies. The following factors were used: recumbent position 40 inch SID, short exposure time, and exposure one of these exposure made during expiration. Which one of these factors must be modified to produce a more diagnostic image during repeat exposure?
Use of an orthostatic (breathing) technique to blur lung marking and ribs more effectively
179
A radiograph of an AP projection of the thoracic spine reveals that the upper thoracic spine is greatly overexposed but the lower vertebrae are well visualized. The head of the patient was placed at the anode end of the table. What can be modified during the repeat exposure to produce a more diagnostic image?
Use a compensating (wedge) filter with the thickest part of the filter placed over the upper thoracic spine to equalize the density along the thoracic spine.
180
A radiograph of a cervicothorcic lateral position demonstrates superimposition of the humeral heads over the upper thoracic spine. Because of an arthritic condition, the patient is unable to rotate the shoulders any father apart. What can the technologist do to further separate the shoulders during the repeat exposure?
Angle CR 3 degree to 5 degree caudad
181
A patient with a possible cervical spine injury enters the emergency room. The patient is on backboard. Which projection of the C-spine should be taken first?
Horizontal beam lateral projection
182
A patient who has been in a motor vehicle accident (MVA) enters the emergency room. The basic projections of the cervical spine reveal no subluxation (partial dislocation ) or fracture. The physician wants the spine evaluated for whiplash injury. Which additonal projections would best demonstrate this type of injury?
hyperextension and hyperflexion lateral position
183
A patient comes to the radiology department for a cervical spine series. An AP "open mouth" radiograph indicates that the base of the skull and lower edge of the front incisors are superimposed, but the top of the dens is not clearly demonstrated. What would the technologist do to the upper portion of the dens? ( a horizontal beam lateral projection odhas ruled out of C-spine fracture or subluxation.)
perform either the AP fuchs or PA Judd method
184
A patient comes to the radiology department ion.for a routine cervical spine series. The lateral projection demonstrates only the C! to C6 region.The radiologists wants to see C7-T1. What additional projection can be taken to demonstrate this region of the spine.
cericothoracic (swimmer's) lateral position
185
A paitient enters the ER with a possible cervical spine fracture, but the initial projections do not demonstrate any gross fracture or suluxation. After reviewing the initial radiographs, the ER physician suspects either a congenital defect or fracture of the articular pillars of C4. He wants an additional projection taken to better see this aspect of the vertebrae. What additional projection can be taken to demonstrate the articular pillars of C4?
AP axial-vertebral arch (pillar) pprojection
186
A patient comes to the ER with a possible Jefferson Fracture. Other than a lateral projection or a CT scan, what specific radiographic projection will best demonstrate this type of fracture?
AP open mouth projection. The patient's mouth must be carefully opened w/o any movement of the cervical spine.
187
A patient comes to the radiology department with a clinical history of Scheuermann disease. Which radiographic procedure is often performed for this condition?
Scoliosis series
188
At which vertebral level does the solid spinal cord terminate?
L1 (sometimes L2)
189
How many segments make up the sacrum in the neonate?
5 segments
190
Which of the following divisions of the spine is described as possessing a primary curve? There may be more than one correct answer.)
thoracic
| sacral
191
The lumbar possesses a concave posterior spinal curvature.
true
192
An abnormal or exaggerated thoracic spinal curvature with increased convexity is called
kyphosis
193
An abnormal or exaggerated lateral spinal curvature is called
Lordosis
194
What is the correct term for the conditioning involving a "slipped disk"?
herniated nucleau pulposis
195
Which foramina are created by the superior and inferior vertebral notches?
intervertebral foramina
196
Which joints are found between the superior and inferior articular processes?
zygapophyseal joints
197
Which one of the following structures makes up the inner aspect of the intervertebral disk?
nucleaus pulposus
198
The carotid artery and certain nerves pass through the cervical transverse foramina.
false
199
The thoracic spine possesses facets for rib articulations and bifid spinouse processes.
false
200
The intervertebral foramina for the cervical spine lie at a ? degree angle to a midsagittal plane.
45
201
Which ligament holds the dens against the anterior arch of C1?
transverse atlantal ligament
202
The large joint space between C1 and C2 is called the
zyga joint
203
Two partial facets found on the thoracic vertebrae are called
demifacets
204
Which of the following thoracic vertebrae do not possess a facet for the costotransverse joint?
T11 and T12
205
What are two distinctive features of all cervical vertebrae that make them different from any other vertebrae?
each has 3 foramina and bifid spinous process
206
What is the one feature of all thoracic vertebrae that makes them different from any other vertebrae?
facets for articulations w/ribs
207
which position of the thoracic spine best demonstrates the intervertebral foramina?
lateral
208
Which position or projection of the cervical spine best demonstrates the zyga joints between C3-C7?
lateral
209
Which specific joint spaces are visualized with a left anterior oblique (LAO) projection of the thoracic spine?
left zyga joint (downside)
210
vertebra prominens
C7-T1
211
Jugular notch
T2-T3
212
3 to 4 inches below jugular notch
T7
213
Gonion
C3
214
Sternal Angle
T4-T5
215
Thyroid Cartilage
C4-C6
216
Which of the following imaging modalities is not normally performed to rule out a herniated nucleus pulposus (HNP)?
nuclear medicine
217
An avulsion fracture of the spinous processes of C6-T1 is called a
Clay shoveler's fracture
218
Scheuermann disease is a form of
scoliosis and/or kyphosis
219
HNP most frequently develops at the L2-L3 vertebral level.
false
220
Which two things can be done to minimize the effects of scatter radiation on lateral projections of the thoracic and lumbar spine?
close collimation
| lead mat behind the patient
221
Which position or projection best demonstrates the zygapophyseal joints between C1-C2?
AP open mouth projection.
222
How much and in what direction (caudad and cephalad) should the central ray be angled for each of the following projections?
An AP axial projection of the cervical spine?
15-20 degree caphalad
An anterior oblique projection of the cervical spine? 15 degree caudad
A posterior oblique projection of the cervical spine?
15 degrees cephalad
223
Which one of the following projections of the cervical spine demonstrates the left intervertebral foramen?
left anterior oblique
224
In addition to using a long SID, list the two positioning techniques you can use to lower the shoulders to visualize C7-T1 for a lateral projection of the cervical spine.
suspend on expiration
| hold weight
225
Which position or projection demonstrates the lower cervical and upper thoracic and upper thoracic spine (C4 to T3) in a lateral perspective? (fracture?subluxation has been ruled out).
Swimmer's
226
List the two positions or projections that will projects that will project the dens in the center of the foramen magnum.
PA (Judd)
| AP (Fuch's)
227
A lateral cervical spine radiograph demonstrates that the zyga joint spaces are not superimposed. Which type of positioning error(s) may lead to this radiographic outcome?
Tilt and or rotation of the spine
228
A radiograph of a lateral thoracic spine projection reveals that the intervertebral foramina and intervertebral joint spaces are not clearly demonstrated. Which type of problems can lead to this radiographic outcome?
spine not parallel to IR
229
A patient who was involved in a motor vehicle accident 3 days ago is experiencing severe neck pain and comes to the radiology department for a cervical spine series. The patient is not wearing a cervical collar. Should the technologists take a horizontal beam lateral projection and have it cleared before proceeding with the study? Explain
Have physician evaluate the horizontal beam lateral projection to rule out fracture, subluxation, or other indicatives of cervical instabilities prior to other x-rays.
230
A patient with a possible Jefferson fracture enters the ER. Which specific radiographic position best demonstrates this type of fracture?
AP open mouth C1--C2 or CT
231
A radiograph of an AP open mouth projection of the cervical spine demonstrates the upper incisors superimposed over the top of the dens. What specific positioning error is present on this radiograph?
head is not tilted enough
232
A patient comes to the radiology department for a follow-up study for a clay shoveler's fracture. Which spine projections will best demonstrate this type of fracture?
lateral, AP cervical or CT
233
Which one of the following technical factors is most important in producing a high quality CR image?
collimate as close as possible
234
Which of the following imaging modalities is recommended for a "teardrop burst" fracture?
CT
235
A patient comes to the radiology department for a follow-up study 6 months after having spinal fusion surgery of the lower cervical spine (C5-C6). The surgeon wants to check for anteriorposterior mobility of the fused spine. Beyone the basic cervical spine projections, what additional projections can be taken to assess mobility of the spine?
Lateral positions --hyperflexion and hyperextention
