Clinical Anatomy, Positioning and Image analysis

Question 1

Movement Type of the Sternoclavicular Joint

Answer 1

Movement Type: Plane or Gliding
Description: Allows limited movement in multiple directions, primarily gliding movements.

Question 2

Movement Type of the Scapulohumeral Joint

Answer 2

Movement Type: Spheroidal (Ball and Socket)
Description: Allows a wide range of movements including flexion, extension, abduction, adduction, and rotation.

Question 3

Movement Type of the Acromioclavicular Joint

Answer 3

Movement Type: Plane or Gliding
Description: Allows limited gliding and rotational movements, contributing to the overall movement of the shoulder girdle.

Question 4

AC Joint Separation

Answer 4

Description: Trauma to the upper shoulder region resulting in partial or complete tear of the AC or coracoclavicular (CC) ligament, or both.
Cause: Often from a fall onto the tip of the shoulder with the arm in adduction.
Classification: Ranges from a sprain to complete separation of the distal clavicle from the acromion.
Prevalence: Represents nearly half of all athletic shoulder injuries.

Question 5

Acromioclavicular Dislocation

Answer 5

Description: Injury where the distal clavicle is displaced superiorly.
Cause: Most commonly caused by a fall.
Prevalence: More common in children than adults.

Question 6

Bankart Lesion

Answer 6

Description: Injury of the anteroinferior aspect of the glenoid labrum, often resulting in a small avulsion fracture in the anteroinferior region of the glenoid rim.

Cause: Often caused by anterior dislocation of the proximal humerus. Repeated dislocation can exacerbate the injury.

Question 7

Bursitis

Answer 7

Description: Inflammation of the bursae, or fluid-filled sacs enclosing the joints.
Common Joint: Shoulder.
Causes: Repetitive motion, trauma, rheumatoid arthritis, infection.
Effects: Formation of calcification in associated tendons, leading to pain and limitation of joint movement.

Question 8

Hill-Sachs Defect

Answer 8

Description: Compression fracture of the articular surface of the posterolateral aspect of the humeral head.
Associated With: Often linked to an anterior dislocation of the humeral head.

Question 9

Idiopathic Chronic Adhesive Capsulitis (Frozen Shoulder)

Answer 9

Description: Disability of the shoulder joint caused by chronic inflammation in and around the joint.
Characteristics: Pain and limitation of motion.
Idiopathic: Of unknown cause.

Question 10

Impingement Syndrome

Answer 10

Description: Impingement of the greater tuberosity and soft tissues on the coracoacromial ligamentous and osseous arch, generally during abduction of the arm.

Question 11

Osteoarthritis (Degenerative Joint Disease, DJD)

Answer 11

Description: Non-inflammatory joint disease characterized by gradual deterioration of articular cartilage with hypertrophic bone formation.
Prevalence: Most common type of arthritis, typically occurs in persons older than 50 years, bariatric persons, and athletes.

Question 12

Osteoporosis

Answer 12

Description: Reduction in the quantity of bone or atrophy of skeletal tissue.
Prevalence: Occurs in postmenopausal women and elderly men.
Effects: Results in scanty and thin bony trabeculae.
Associated Fractures: Most fractures in women older than 50 years are related to osteoporosis.

Question 13

Rheumatoid Arthritis (RA)

Answer 13

Description: Chronic systemic disease characterized by inflammatory changes in connective tissues.
Initial Inflammation: Begins in synovial membranes, can involve articular cartilage and bony cortex.
Prevalence: More common in women than men.
Radiographic Evidence: Loss of joint space, destruction of cortical bone, and bony deformity.

Question 14

Rotator Cuff Pathology

Answer 14

Description: Acute or chronic traumatic injury to one or more of the rotator cuff muscles: teres minor, supraspinatus, infraspinatus, and subscapularis.
Common Injury: Impingement of the supraspinatus tendon beneath the acromion, often caused by a subacromial bone spur.
Consequences: Partial or complete tear of the supraspinatus tendon, visible on MRI and sonographic examination.

Question 15

Shoulder Dislocation

Answer 15

Description: Traumatic removal of the humeral head from the glenoid cavity.
Prevalence: 95% are anterior dislocations, where the humeral head is projected anterior to the glenoid cavity.

Question 16

Tendonitis

Answer 16

Inflammatory condition of the tendon, usually resulting from a strain.

Question 17

External Rotation of the Arm on xray

Answer 17

Indicator: Greater tubercle in profile laterally.

Question 18

Internal Rotation of the Arm

Answer 18

Indicator: Lesser tubercle in profile medially.

Question 19

AP Proximal Humerus (External Rotation)

Answer 19

Epicondyles: Parallel to IR
Greater Tubercle: Lateral (in profile)
Lesser Tubercle: Anterior

Question 20

Lateral Proximal Humerus (Internal Rotation)

Answer 20

Epicondyles: Perpendicular to IR
Greater Tubercle: Anterior
Lesser Tubercle: Medial (in profile)

Question 21

Oblique Proximal Humerus (Neutral Rotation)

Answer 21

Epicondyles: 45° to IR
Greater Tubercle: Not in profile
Lesser Tubercle: Anteriorly (not in profile)

Question 22

AP Humerus Positioning

Answer 22

Patient Position: Erect or supine

IR Adjustment: Shoulder and elbow joints equidistant from ends of IR

Body Rotation: Toward affected side to bring shoulder and proximal humerus into contact with cassette

Humerus Alignment: Align with long axis of IR or diagonal placement if needed to include both shoulder and elbow joints

Arm Position: Extend hand and forearm as far as tolerated

Arm Adjustment: Abduct arm slightly and gently supinate hand so that epicondyles of elbow are parallel and equidistant from IR

Question 23

Technical factors for Humerus

Answer 23

Minimum SID: 100 cm or 110 cm
IR Size: Portrait (large enough to include entire humerus) – aim to include both joints
Grid: Use grid for humerus ≥10 cm thickness; non-grid for <10 cm thickness
kVp Range: 70–85

Question 24

Lateromedial Humerus Projection

Answer 24

Patient Position: Erect with back to IR
Elbow Flexion: Partially flexed
Body Rotation: Rotate toward affected side to bring humerus and shoulder in contact with cassette
Arm Position: Internally rotate arm; epicondyles perpendicular to IR

Question 25

Mediolateral Humerus Projection

Answer 25

Patient Position: Face patient toward IR and oblique 20° to 30° from PA Elbow Flexion: Flex elbow 90° Body Rotation: Adjust as needed for close contact of humerus with IR

Question 26

Lateral Mid and Distal Humerus Trauma Position

Answer 26

Position: With patient recumbent, perform image as a horizontal beam lateral, placing support under the arm. Elbow Flexion: Flex elbow if possible; do not attempt to rotate arm. Projection: Should be 90° from AP. Image Receptor Placement: Gently place IR between arm and thorax (top of IR to axilla). CR (Central Ray): Perpendicular to midpoint of distal two-thirds of humerus.

Question 27

Angles of Proximal Femur

Answer 27

Neck to Shaft: ≈ 125° Longitudinal: ≈ 10° Anterior Angle: ≈ 15° to 20°

Question 28

Anatomic Position of femur

Answer 28

Long axes of feet vertical Femoral necks partially foreshortened Lesser trochanters partially visible

Question 29

15° to 20° Medial Rotation of lower limb

Answer 29

Long axes of feet and lower limbs rotated internally 15° to 20° Femoral heads and necks in profile True AP projection of proximal femora Lesser trochanters not visible or only slightly visible

Question 30

External Rotation

Answer 30

Long axes of feet and lower limbs equally rotated laterally in a normal relaxed position Femoral necks greatly foreshortened Lesser trochanters visible in profile internally

Question 31

Typical Rotation with Hip Fracture

Answer 31

Long axis of left foot externally rotated (on side of hip fracture) Unaffected right foot and limb in neutral position Lesser trochanter on externally rotated (left) limb more visible; neck area foreshortened

Question 32

Anteroposterior (AP) Compression Injury

Answer 32

Characteristic features: Symphyseal diastasis Sacroiliac joint diastasis

Question 33

What is Symphyseal Diastasis?

Answer 33

Symphyseal diastasis is the separation or widening of the pubic symphysis, often occurring due to trauma, pregnancy, or childbirth, leading to pelvic instability and pain. Symptoms include pelvic pain, difficulty walking, and tenderness around the pubic area, especially after physical exertion.

Question 34

What is Sacroiliac Joint Diastasis?

Answer 34

Sacroiliac joint diastasis is the abnormal separation or widening of the sacroiliac joint, which can cause lower back pain and pelvic instability, often due to trauma or pregnancy-related factors. Symptoms include lower back pain, pain in the buttocks or legs, and instability when standing or walking.

Question 35

Vertical Shear Injury

Answer 35

Vertically oriented fractures of the pubic rami are typically ipsilateral (same-sided)

Question 36

What are the characteristics of a posterior hip dislocation?

Answer 36

Most common type of hip dislocation. Affected lower extremity is usually shortened, adducted, and internally rotated. Femoral head is displaced posteriorly, superiorly, and slightly laterally to the acetabulum, and internally rotated, obscuring the lesser trochanter on the AP view. On a well-centered AP film, the posteriorly dislocated femoral head appears smaller than the contralateral hip due to geometric magnification.

Question 37

What are the characteristics of an anterior hip dislocation?

Answer 37

Less common, occurring in 5-18% of cases. Projects a larger-appearing femoral head. Lesser trochanter is more visible due to external rotation. Hip is abducted, and the femoral head is usually inferior to the acetabulum. Shenton's line is broken.

Question 38

How should a patient be positioned for an AP (Mid and Distal) Femur X-ray?

Answer 38

Place the patient in the supine position, with the femur centered to the midline of the table. Provide a pillow for the head. Align the femur to the CR and to the midline of the table or IR. Rotate the leg internally approximately 5° for a true AP view, similar to an AP knee. For the proximal femur, rotate the leg 15° to 20° internally, as for an AP hip. Ensure that the knee joint is included on the IR, considering the x-ray beam's divergence. The lower margin of the IR should be approximately 5 cm below the knee joint.

Question 39

What are the technical factors for an AP (Mid and Distal) Femur X-ray?

Answer 39

CR Position: Perpendicular to femur and IR. Direct CR to the midpoint of the IR. Minimum SID: 100/110 cm IR Size: 35 × 43 cm, portrait Grid: Use a grid kVp Range: 75–85

Question 40

What is the patient and part position for a Lateral (Mid and Distal) Femur X-ray?

Answer 40

Patient Position: Place patient in the lateral recumbent position, or supine for trauma patients. Part Position: Flex knee approximately 45° with the patient on the affected side. Align femur to the midline of the table or IR. Place the unaffected leg behind the affected leg to prevent over-rotation. Adjust IR to include the knee joint (lower IR margin should be approximately 2 inches [5 cm] below the knee joint). A second IR may be needed to include the proximal femur and hip in adults. For trauma patients, perform in AP position with a horizontal beam.

Question 41

What are the key considerations for imaging the Lateral Mid and Proximal Femur?

Answer 41

Position: Same as for mid-distal femur. IR Adjustment: Adjust IR to include the hip joint, considering the divergence of the x-ray beam. Palpate the ASIS and place the upper IR margin at this level. Image Evaluation: Ensure proper anatomy demonstration, true lateral positioning, and correct exposure factors.

Question 42

What are the key considerations for imaging the Lateral Mid and Proximal Femur?

Answer 42

Position: Same as for mid-distal femur. IR Adjustment: Adjust IR to include the hip joint, considering the divergence of the x-ray beam. Palpate the ASIS and place the upper IR margin at this level. Image Evaluation: Ensure proper anatomy demonstration, true lateral positioning, and correct exposure factors.

Question 43

What is the patient positioning for an AP Pelvis radiograph?

Answer 43

Patient Position: Supine with arms at sides or across upper chest; provide a pillow for the head and support under knees. Can be done erect if lower limbs are corrected and no fracture is suspected. Part Position: Align the midsagittal plane of the patient to the centerline of the table and CR. Ensure ASIS is equidistant from the table-top on both sides. Rotate limbs internally 15° to 20° (non-trauma).

Question 44

What are the technical factors for an AP Pelvis radiograph?

Answer 44

Minimum SID: 100/110 cm IR Size: 35 × 43 cm, landscape Grid: Use a grid kVp Range: 80–90

Question 45

How should the patient and part be positioned for an AP Hip radiograph?

Answer 45

Patient Position: Supine, with arms at sides or across superior chest. Part Position: Locate femoral neck and align it to CR and to midline of table/IR. Ensure no rotation of pelvis (equal distance from ASISs to table). Rotate affected leg internally 15°.

Question 46

What are the technical factors for an AP Hip radiograph?

Answer 46

Minimum SID: 100/110 cm IR Size: 35 × 43 cm, portrait Grid: Yes kVp Range: 80-85

Question 47

What is the positioning for a Rolled Lateral Hip radiograph?

Answer 47

Patient Position: Roll towards the affected side, then roll hips back to avoid superimposing the unaffected side. Knee Position: Flex the affected knee to around 45°. Alignment: Align the femur to the midline of the table.

Question 48

Volvulus

Answer 48

Abnormal twisting of a portion of the gastrointestinal tract, usually the intestine, which can impair blood flow. Volvulus can lead to gangrene and death of the involved segment of the gastrointestinal tract, intestinal obstruction, perforation

Question 49

Intussusception

Answer 49

Telescoping of a section of bowel into another loop, which creates an obstruction

Question 50

Ulcerative Colitis

Answer 50

Inflammation of the colon

Question 51

Ascites

Answer 51

Fluid accumulation

Question 52

What are the technical factors for abdomen imaging?

Answer 52

kVp: 70-85 Exposure Time: Short mAs: Adequate Minimum SID: 100/110 cm IR Size: 35 × 43 cm, portrait Grid: Yes

Question 53

What is the patient and part position for an AP abdomen?

Answer 53

Patient Position: Supine with midsagittal plane centered to midline of table or IR. Arms placed at sides, away from body. Legs bent with support under knees to lessen lordotic lumbar curvature. Part Position: Center of IR to level of iliac crests, with bottom margin at symphysis pubis. Ensure no rotation of pelvis or shoulders (both ASIS should be equidistant from the tabletop).

Question 54

What is the patient and part position for an erect abdomen?

Answer 54

Patient Preparation: Patient should be erect for at least 10 minutes prior to the image. Patient Position: Stand with back against the upright bucky, legs slightly apart. Arms at sides and away from the body. Midsagittal plane (MSP) perpendicular to the bucky. Part Position: Center IR in the midline, at the level of the iliac crests (to include the diaphragms). CR perpendicular to the center of the IR.

Question 55

What are the key anatomical features and position of the kidneys?

Answer 55

Location: Extend from the upper border of T12 on the left side to the lower border of L3 on the right side. Usually 3 - 3.5 vertebral bodies in length. Position: Sit obliquely in the abdomen (upper poles nearest the vertebrae, lower poles more anterior). Surrounding Structures: Encased by perinephric fat. Mobility: Move with inspiration and drop in the erect position.

Question 56

What position is used to demonstrate the cervical intervertebral foramina?

Answer 56

Position: 45° oblique (upside, posterior oblique)

Question 57

What position is used to demonstrate the cervical zygapophyseal joints?

Answer 57

Position: Lateral

Question 58

What position is used to demonstrate the thoracic intervertebral foramina?

Answer 58

Lateral

Question 59

What position is used to demonstrate the thoracic zygapophyseal joints?

Answer 59

70* oblique

Question 60

What are the imaging positions and structures demonstrated for lumbar vertebrae?

Answer 60

Lumbar Intervertebral Foramina: Lateral Lumbar Zygapophyseal Joints: 45° oblique (downside, LPO, or RPO)

Question 61

What are the key considerations for cervical spine positioning?

Answer 61

SID: 150-180 cm Focal Spot: Small Shielding: Use proper collimation, exposure factors, and minimize repeats kVp Range: Medium (70-85 kVp)

Question 62

What is the patient positioning for the AP Open Mouth (Odontoid Peg)?

Answer 62

Position: Supine or erect Arms: By sides Head: On table surface; immobilize if needed

Question 63

What is the part position for the AP Open Mouth (Odontoid Peg)?

Answer 63

Align: Midsagittal plane to CR and midline of table/IR Head Position: Line from lower margin of upper incisors to base of skull (mastoid tips) perpendicular to table/IR; or angle CR accordingly Ensure: No rotation (equal distance of mandibular angles and mastoid tips from IR) Mouth: Wide open during exposure; do this last as it’s difficult to maintain

Question 64

What is the part position for the AP Cervical Spine?

Answer 64

Align: Midsagittal plane to CR and midline of table/IR Head Position: Line from lower margin of upper incisors to base of skull (mastoid processes) perpendicular to table/IR; line from tip of mandible to base of skull parallel to angled CR Ensure: No rotation of head or thorax Breathing: Suspend respiration; patient should not swallow during exposure CR Angulation: 15° cephalad for supine or less lordotic curvature 20° cephalad for erect or more lordotic curvature More than 20° for kyphotic patients

Question 65

What are the evaluation criteria for the AP Axial C-Spine?

Answer 65

Anatomy Demonstrated: C3 to T2 region Position: No rotation Intervertebral disk spaces open Base of skull and mandible superimpose C1-C2

Question 66

What is the part position for the PA 45° Oblique C-Spine projection?

Answer 66

CR: 15° caudad to C4 Part Position: Align midsagittal plane to CR and midline of table/IR Arms at sides; adjust if recumbent Rotate body and head into 45° oblique position Protract chin to avoid mandible superimposing vertebrae Elevate chin to place acanthiomeatal line (AML) parallel to the floor Avoid excessive skull and neck extension to prevent base of skull from superimposing posterior arch of C1

Question 67

What is the part position for the Lateral Position (Nontrauma) C-Spine projection?

Answer 67

Patient Position: Lateral, either sitting or standing, with shoulder against vertical IR Part Position: Align midcoronal plane to CR and midline of table/IR Center CR to C4 (level of upper margin of thyroid cartilage) Top of IR should be about 1 to 2 inches (2.5 to 5 cm) above the external auditory meatus (EAM) Depress shoulders as much as possible; ask patient to drop shoulders down and forward Elevate chin to place acanthiomeatal line (AML) parallel with the floor Protract chin to avoid superimposition of the mandible on upper vertebrae Suspend respiration on full expiration to depress shoulders

Question 68

What is the Acanthiomeatal Line (AML)?

Answer 68

The acanthiomeatal line (AML) is an anatomical reference line used in radiography. It runs from the acanthi (the point at the base of the nose where the upper lip meets the nose) to the external auditory meatus (the ear canal). This line is commonly used to position the head in various imaging studies to ensure accurate alignment.

Question 69

What is the patient position for the AP Thoracic Spine projection?

Answer 69

Supine with arms at sides, head on a thin pillow; if erect, distribute weight on both feet Part Position: Align midsagittal plane to CR and midline of table/IR Flex knees and hips to reduce thoracic curvature Ensure no rotation of thorax or pelvis

Question 70

What is the patient position for the Lateral Thoracic Spine projection?

Answer 70

Position: Lateral recumbent with head on pillow and knees flexed; erect position can also be done Part Position: Align posterior half of thorax (between midcoronal plane and posterior aspect of thorax) to CR and midline of table/IR Raise arms to right angles to body with elbows flexed Support waist so entire spine is near parallel to table; palpate spinous processes to determine alignment Flex hips and knees with support between knees Ensure no rotation of shoulders or pelvis

Question 71

What is a herniated nucleus pulposus (HNP) and its common symptoms?

Answer 71

Definition: A condition where the soft inner part of an intervertebral disk (nucleus pulposus) protrudes through the fibrous outer layer, pressing on spinal cord or nerves. Cause: Often due to trauma or improper lifting. Common Level: Most frequent at L4–L5 levels. Symptoms: Can cause sciatica, which is irritation of the sciatic nerve that passes down the posterior leg.

Question 72

What is lordosis and its causes?

Answer 72

Definition: The normal concave curvature of the lumbar spine, which may become abnormal or exaggerated. Causes: Can result from pregnancy, obesity, poor posture, rickets, or tuberculosis of the spine. Imaging: A lateral projection of the spine best demonstrates the extent of lordosis.

Question 73

How do metastases appear on spinal imaging?

Answer 73

Osteolytic Lesions: Destructive lesions with irregular margins. Osteoblastic Lesions: Proliferative bony lesions of increased density. Combination Lesions: Moth-eaten appearance of bone from a mix of destructive and blastic lesions.

Question 74

What is scoliosis and the types of curvature?

Answer 74

Definition: Lateral curvature of the vertebral column with some rotation of the vertebrae. Types: Dextroscoliosis: Exaggerated curvature to the right. Levoscoliosis: Exaggerated curvature to the left.

Question 75

What is spina bifida and its common location?

Answer 75

Definition: A congenital condition where the posterior aspects of the vertebrae fail to develop, exposing part of the spinal cord. Common Location: Occurs most often at L5.

Question 76

Spondylolisthesis

Answer 76

Definition: Forward movement of one vertebra in relation to another, commonly due to a developmental defect in the pars interarticularis or severe osteoarthritis. Common Levels: Most common at L5–S1, but can also occur at L4–L5.

Question 77

What is spondylolysis and its imaging appearance?

Answer 77

Definition: Dissolution of a vertebra. Imaging Appearance: On oblique projection, the neck of the Scottie dog appears broken. Common Level: Most common at L4 or L5.

Question 78

What are the patient and part positioning requirements for an AP Lumbar Spine X-ray?

Answer 78

Patient Position: Supine on the table, head on a pillow. Arms at sides or on chest. Part Position: Align the midsagittal plane to CR and midline of the table/grid. Flex knees and hips to reduce lordotic curvature. Ensure no rotation of the thorax or pelvis.

Question 79

What are the patient and part positioning requirements for a Lateral Lumbar Spine X-ray?

Answer 79

Patient Position: Lateral recumbent position, head on a pillow. Knees flexed with support between knees and ankles for comfort and to maintain a true lateral position. Part Position: Align midcoronal plane to CR and midline of table/IR. Use radiolucent support under waist to place the spine near parallel to the table (palpate spinous processes for alignment). Ensure no rotation of the thorax or pelvis exists. No support: 5° to 8° caudad angulation of CR

Question 80

What are the positioning and technical factors for a AP L-Spine X-ray?

Answer 80

100cm, grid, kVp range: 75-90 Direct CR to level of L3, which may be localized by palpation of lower costal margin - 4cm above iliac crest. This tighter collimation will include primarily the 5 lumbar vertebrae.

Question 81

What are the evaluation criteria for a Lateral Lumbar Spine X-ray?

Answer 81

Anatomy Demonstrated: T12 to distal sacrum Intervertebral Disk Spaces: Open Intervertebral Foraminal Spaces: Open Exposure Factors: Optimal

Question 82

What are the positioning and technical factors for a Lateral L5-S1 X-ray?

Answer 82

Patient and Part Position: Similar to lateral lumbar spine position. CR Positioning: Perpendicular to IR with sufficient waist support, or angled 5° to 8° caudad with less support. CR Location: Direct CR 4 cm inferior to iliac crest and 5 cm posterior to ASIS. IR Alignment: Center IR to CR. 85-95kVp

Question 83

What are the characteristics of a compression fracture?

Answer 83

Shape: Wedge-shaped. Cortical Break: In upper anterior wall of vertebral body. Sclerotic Band: Horizontal sclerotic band of impaction. Endplate Fracture: Fracture of superior endplate. Posterior Cortex: Intact.

Question 84

What are the characteristics of a burst fracture?

Answer 84

X-ray Appearance: Loss of Vertebral Height: Both the anterior and posterior vertebral body heights are reduced, distinguishing it from compression fractures that typically affect only the anterior portion. Retropulsion of Bony Fragments: Fragments of the vertebra can be pushed backward into the spinal canal, potentially compressing the spinal cord or nerves. Widening of Interpedicular Distance: The space between the pedicles may be increased due to lateral displacement of bony fragments. Possible Kyphotic Deformity: The fractured vertebra may tilt, leading to abnormal curvature or kyphosis at the injury site.

Question 85

What does the Winking Owl sign indicate?

Answer 85

Indicative of: Absent pedicle Common Cause: Metastases

Question 86

LPO (Left Posterior Oblique)

Answer 86

Positioning: Patient is semi-supine with left side closer to the image receptor (IR). Rotate the patient 45°, angling their right side away from the IR. Cervical Spine: CR angled 15-20° cephalad to visualize opposite intervertebral foramina. Thoracic and Lumbar Spine: No CR angle needed. Structures Demonstrated: Cervical: Right intervertebral foramina. Thoracic: Right zygapophyseal joints. Lumbar: Left zygapophyseal joints.

Question 87

LAO (Left Anterior Oblique)

Answer 87

Positioning: Patient is semi-prone with left side closer to the IR. Rotate the patient 45°, angling their right side away from the IR. Cervical Spine: CR angled 15-20° caudad to visualize same-side intervertebral foramina. Thoracic and Lumbar Spine: No CR angle needed. Structures Demonstrated: Cervical: Left intervertebral foramina. Thoracic: Left zygapophyseal joints. Lumbar: Right zygapophyseal joints.

Question 88

RPO (Right Posterior Oblique)

Answer 88

Positioning: Patient is semi-supine with right side closer to the IR. Rotate the patient 45°, angling their left side away from the IR. Cervical Spine: CR angled 15-20° cephalad to visualize opposite intervertebral foramina. Thoracic and Lumbar Spine: No CR angle needed. Structures Demonstrated: Cervical: Left intervertebral foramina. Thoracic: Left zygapophyseal joints. Lumbar: Right zygapophyseal joints.

Question 89

RAO (Right Anterior Oblique)

Answer 89

Positioning: Patient is semi-prone with right side closer to the IR. Rotate the patient 45°, angling their left side away from the IR. Cervical Spine: CR angled 15-20° caudad to visualize same-side intervertebral foramina. Thoracic and Lumbar Spine: No CR angle needed. Structures Demonstrated: Cervical: Right intervertebral foramina. Thoracic: Right zygapophyseal joints. Lumbar: Left zygapophyseal joints.

Question 90

Cervical LPO (Left Posterior Oblique)

Answer 90

Shows: Right intervertebral foramina (opposite side). CR: 15-20° cephalad.

Question 91

Cervical LAO (Left Anterior Oblique)

Answer 91

Shows: Left intervertebral foramina (same side). CR: 15-20° caudad.

Question 92

Cervical RPO

Answer 92

Shows: Left intervertebral foramina (opposite side). CR: 15-20° cephalad.

Question 93

Cervical RAO (Right Anterior Oblique)

Answer 93

Shows: Right intervertebral foramina (same side). CR: 15-20° caudad.

Question 94

Thoracic LPO (Left Posterior Oblique)

Answer 94

Shows: Right zygapophyseal joints (opposite side). CR: No angle.

Question 95

Thoracic LAO (Left Anterior Oblique)

Answer 95

Shows: Left zygapophyseal joints (same side). CR: No angle.

Question 96

Thoracic RPO (Right Posterior Oblique)

Answer 96

Shows: Left zygapophyseal joints (opposite side). CR: No angle.

Question 97

Thoracic RAO (Right Anterior Oblique)

Answer 97

Shows: Right zygapophyseal joints (same side). CR: No angle.

Question 98

Lumbar LPO (Left Posterior Oblique)

Answer 98

Shows: Left zygapophyseal joints (same side). CR: No angle.

Question 99

Lumbar LAO (Left Anterior Oblique)

Answer 99

Shows: Right zygapophyseal joints (opposite side). CR: No angle.

Question 100

Lumbar RPO (Right Posterior Oblique)

Answer 100

Shows: Right zygapophyseal joints (same side). CR: No angle.

Question 101

Lumbar RAO (Right Anterior Oblique)

Answer 101

Shows: Left zygapophyseal joints (opposite side). CR: No angle.

Question 102

Cervical Spine Breathing Instructions

Answer 102

Breath-hold: "Hold your breath." Prevents motion to capture fine details in the cervical region.

Question 103

Thoracic Spine Breathing Instructions

Answer 103

Breath-hold at end of expiration: "Take a shallow breath and hold it, or hold your breath after you breathe out." Reduces lung and diaphragm motion, enhancing soft tissue contrast.

Question 104

Lumbar Spine Breathing Instructions

Answer 104

Breath-hold after expiration: "Breathe out fully, then hold your breath." Minimizes diaphragm movement, improving lumbar vertebrae clarity.

Question 105

Lateral Thoracic Spine Breathing Technique

Answer 105

Slow, continuous breathing: "Take slow, gentle breaths during the scan." Blurs lung tissue to focus on the vertebrae; used with a longer exposure time for clearer thoracic spine images.