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2017SP POSITIONING II > EXAM #4 (CERVICAL SPINE) > Flashcards

EXAM #4 (CERVICAL SPINE) Flashcards

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1
Q

[Anatomy: Cervical Vertebrae ]

?x in number

Occupy the _____ region

Unique features:

_____ _____ located on transverse processes

_____ _____ processes

A

[Anatomy: Cervical Vertebrae]

Seven in number

Occupy the neck region

Unique features:

Transverse foramina located on transverse processes

Bifid spinous processes

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2
Q

[Anatomy: Cervical Vertebrae]

First two are atypical to join with skull:
_____ or _____
_____ or _____

_____ is also atypical to join with _____

A

[Anatomy: Cervical Vertebrae]

First two are atypical to join with skull:
C1 or atlas
C2 or axis

C7 is also atypical to join with T-spine

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3
Q

[Anatomy: C1 (Atlas) ]

Consists of:

What four things and how many?

A

[Anatomy: C1 (Atlas)]

Consists of:

Anterior arch
Posterior arch
Two lateral masses
Two transverse processes

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4
Q

[Anatomy: C1 (Atlas)]

C1 has no _____ _____

_____ _____ _____ receive the condyles of the occipital bone

A

[Anatomy: C1 (Atlas)]

C1 has no vertebral body

Superior articular processes receive the condyles of the occipital bone

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5
Q

[Anatomy: C2 (Axis) ]

Has a _____ process, called the _____ or _____, on upper, anterior of body

_____ is received into _____ _____ of C1

A

[Anatomy: C2 (Axis)]

Has a conical process, called the dens or odontoid, on upper, anterior of body

Odontoid is received into anterior ring of C1

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6
Q

[Also note about C2: the Axis ]

Odontoid process (Dens)

Largest _____ of C-spine

Tallest _____ _____ of C-spine

Allows _____ of head (pivot)

A

[Also note about C2: the Axis]

Odontoid process (Dens)

Largest body of C-spine

Tallest spinous process of C-spine

Allows rotation of head (pivot)

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7
Q

[Anatomy: C7]

Also called the _____ _____ because of its long, prominent spinous process

Easily _____

A

[Anatomy: C7]

Also called the vertebra prominens because of its long, prominent spinous process

Easily palpated

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8
Q

[Also note about C3 through C7 ]

Each has ?x foramina:
L + R _____ foramina
_____ foramen

Spinous process has _____ tips

A

[Also note about C3 through C7]

Each has 3 foramina:
L + R transverse foramina
Vertebral foramen

Spinous process has bifid tips

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9
Q

[Also note about C3 through C7]

Articular pillars

C7 _____ _____ –long spinous process

A

[Also note about C3 through C7]

Articular pillars

C7 vertebra prominens –long spinous process

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10
Q

[Intervertebral foramina]

Formed by articulation with vertebrae above and below at _____ _____

A

[Intervertebral foramina]

Formed by articulation with vertebrae above and below at vertebral notch

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11
Q

[Intervertebral foramina]

Transmission of _____ _____ + _____ _____

A

[Intervertebral foramina]

Transmission of spinal nerves + blood vessels

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12
Q

[Intervertebral foramina]

Seen on what position?

A

[Intervertebral foramina]

Seen on 45° obliques

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13
Q

[Zygapophyseal Joints ]

Articulations between _____ _____ of the vertebral arches

A

[Zygapophyseal Joints]

Articulations between articular processes of the vertebral arches

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14
Q

[Zygapophyseal Joints]

Allow passage for the _____ _____.

A

[Zygapophyseal Joints]

Allow passage for the nerve roots.

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15
Q

[Zygapophyseal Joints]

Seen in _____ C?-C?

Seen in _____ C?-C?

A

[Zygapophyseal Joints]

Seen in Lateral C2-C7

Seen in AP C1-C2

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16
Q

[Patient Preparation]

Patient preparation for cervical spine (C-spine) procedures requires removal of artifacts from the anatomy of interest:

Earrings
Necklaces
Eyeglasses
False teeth
Clothing artifacts
A

[Patient Preparation]

Patient preparation for cervical spine (C-spine) procedures requires removal of artifacts from the anatomy of interest:

Earrings
Necklaces
Eyeglasses
False teeth
Clothing artifacts
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17
Q

[IR/Collimated Field Size]

Typically a 10”x12” IR is used for the radiography of the _____ _____.

If available, an 8”x10” IR can be used for the _____ and _____ projections.

A

[IR/Collimated Field Size]

Typically a 10”x12” IR is used for the radiography of the Cervical Spine.

If available, an 8”x10” IR can be used for the AP and Odontoid projections.

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18
Q

[SID ]

A __” SID will be used for the Lateral and Oblique projections, and a __” SID will be used for the AP and Odontoid projections.

Theoretically, a __” to __” SID is recommended for projections with increased OID

A

[SID]

A 72” SID will be used for the Lateral and Oblique projections, and a 40” SID will be used for the AP and Odontoid projections.

Theoretically, a 60” to 72” SID is recommended for projections with increased OID

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19
Q

[Patient Instructions ]

Respiration is suspended during most _____ essential projections:

Lateral (Grandy) breathing technique: ?

AP open-mouth position: ?

Swimmer’s technique can use breathing technique to blur _____ anatomy

A

[Patient Instructions]

Respiration is suspended during most C-spine essential projections:

Lateral (Grandy) breathing technique: suspension after full expiration to depress shoulders

AP open-mouth position: patient phonates “ah” to depress tongue to floor of mouth

Swimmer’s technique can use breathing technique to blur lung anatomy

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20
Q

[AP Dens (Fuchs)]

Fuchs method contraindicated if _____ _____ or _____ is suspected

Only upper part of _____ is demonstrated

A

[AP Dens (Fuchs)]

Fuchs method contraindicated if cervical fracture or disease is suspected

Only upper part of dens is demonstrated

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21
Q

[AP C1-C2, Open Mouth]

Part position:

Align edge of upper _____ and _____ tip perpendicular to IR

Mouth open as wide as possible

A

[AP C1-C2, Open Mouth]

Part position:

Align edge of upper incisors and mastoid tip perpendicular to IR

Mouth open as wide as possible

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22
Q

[AP C1-C2, Open Mouth ]

CR:

Directed perpendicular to the IR

Enters patient at midpoint of _____ _____

A

[AP C1-C2, Open Mouth]

CR:

Directed perpendicular to the IR

Enters patient at midpoint of open mouth

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23
Q

[AP Axial C-Spine]

Part position:

_____ in same horizontal plane

_____ aligned with long axis of IR

_____ in center of IR

_____ of head perpendicular

Extend chin to place _____ _____ perpendicular to tabletop

A

[AP Axial C-Spine]

Part position:

Shoulders in same horizontal plane

MSP aligned with long axis of IR

C4 in center of IR

MSP of head perpendicular

Extend chin to place occlusal plane perpendicular to tabletop

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24
Q

[AP Axial C-Spine ]

CR: ?

A

[AP Axial C-Spine]

CR: Directed through C4 at 15 to 20 degrees cephalad

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25
[Lateral C-Spine (Grandy) ] Lateral projection demonstrates...?
[Lateral C-Spine (Grandy)] Lateral projection demonstrates zygapophyseal joints of cervical spine.
26
[Lateral C-Spine (Grandy) ] Part position: _____ perpendicular to IR _____ parallel to IR _____ in center _____ in same horizontal plane, relaxed down _____ elevated and _____ protruded
[Lateral C-Spine (Grandy)] Part position: MCP perpendicular to IR MSP parallel to IR C4 in center Shoulders in same horizontal plane, relaxed down Chin elevated and mandible protruded
27
[Lateral C-Spine (Grandy) ] CR: ?
[Lateral C-Spine (Grandy)] CR: Horizontal and perpendicular to C4
28
[Lateral C-Spine (Grandy)] Note: If top third of _____ is not demonstrated, lateral of _____ is required.
[Lateral C-Spine (Grandy)] Note: If top third of T1 is not demonstrated, lateral of cervicothoracic is required.
29
[Trauma Lateral Cervical Spine ] Why is it done?
[Trauma Lateral Cervical Spine] Performed first and checked by physician before proceeding with other projections
30
[Trauma Lateral Cervical Spine ] Dorsal decubitus position _____ relaxed Head without _____; ask patient to look straight ahead without moving head or neck Vertical IR placed at top of _____ in holder
[Trauma Lateral Cervical Spine] Dorsal decubitus position Shoulders relaxed Head without rotation; ask patient to look straight ahead without moving head or neck Vertical IR placed at top of shoulder in holder
31
[Trauma Lateral Cervical Spine ] Horizontal CR centered to midpoint of IR Image should demonstrate entire _____ from _____ _____ to top of _____ If all ?x cervical vertebrae are not seen, then a lateral projection of the _____ spine is required
[Trauma Lateral Cervical Spine] Horizontal CR centered to midpoint of IR Image should demonstrate entire C-spine from sella turcica to top of T1 If all seven cervical vertebrae are not seen, then a lateral projection of the cervicothoracic spine is required
32
[Lateral C-Spine Hyperflexion and Hyperextension] What must be ruled out before attempting these projections? What is demonstrated?
[Lateral C-Spine Hyperflexion and Hyperextension] Fracture and/or pathology must be ruled out before attempting these positions Used to demonstrate absence of normal movement from trauma or disease
33
[Lateral C-Spine Hyperflexion and Hyperextension] Part position: Same as for lateral (Grandy) Hyperextension: ? Hyperflexion: ?
[Lateral C-Spine Hyperflexion and Hyperextension] Part position: Same as for lateral (Grandy) Hyperextension: Have patient relax head as far back as possible Hyperflexion: Have patient put chin as close to chest as possible
34
[Lateral C-Spine Hyperflexion and Hyperextension] CR: ?
[Lateral C-Spine Hyperflexion and Hyperextension] CR: Horizontal and perpendicular to C4
35
[AP Axial Oblique C-Spine] Intervertebral foramina on side CLOSER/FARTHER from IR are demonstrated. Both sides are examined for comparison. RPO = _____ side intervertebral foramina LPO = _____ side intervertebral foramina
[AP Axial Oblique C-Spine] Intervertebral foramina on side FARTHER from IR are demonstrated. Both sides are examined for comparison. RPO = left side intervertebral foramina LPO = right side intervertebral foramina
36
[AP Axial Oblique C-Spine] Patient position: Upright, seated or standing, in ?x-degree posterior oblique position (preferred) Recumbent ?x-degree posterior oblique position
[AP Axial Oblique C-Spine] Patient position: Upright, seated or standing, in 45-degree posterior oblique position (preferred) Recumbent 45-degree posterior oblique position
37
[AP Axial Oblique C-Spine] Part position: Head and body at ?x-degree angle from IR _____ centered to IR IR centered to _____ Chin _____ and _____
[AP Axial Oblique C-Spine] Part position: Head and body at 45-degree angle from IR C-spine centered to IR IR centered to C3 Chin elevated and protruded
38
[AP Axial Oblique C-Spine ] CR: ?
[AP Axial Oblique C-Spine] CR: Directed to C4 at 15 to 20 degrees cephalad
39
[PA Axial Oblique C-Spine ] Intervertebral foramina on side CLOSER/FARTHER to IR are demonstrated. Both sides are examined for comparison. RAO + LAO
[PA Axial Oblique C-Spine] Intervertebral foramina on side CLOSER to IR are demonstrated. Both sides are examined for comparison. RAO + LAO
40
[PA Axial Oblique C-Spine ] Patient position: Upright, seated or standing, in ?x-degree anterior oblique position (preferred) Recumbent ?x-degree anterior oblique position
[PA Axial Oblique C-Spine] Patient position: Upright, seated or standing, in 45-degree anterior oblique position (preferred) Recumbent 45-degree anterior oblique position
41
[PA Axial Oblique C-Spine] Part position: Head and body at ?x-degree angle to IR _____ in center of IR _____ at level of C5 Chin _____ and _____
[PA Axial Oblique C-Spine] Part position: Head and body at 45-degree angle to IR C-spine in center of IR IR at level of C5 Chin elevated and protruded
42
[PA Axial Oblique C-Spine ] CR: ? PA = cephalad/caudal AP = cephalad/caudal
[PA Axial Oblique C-Spine ] CR: Directed to C4 at 15 to 20 degrees caudad PA = caudal AP = cephalad
43
[Cervicothoracic Region ] Lateral (swimmer's technique): covered last week Remember that this projection is needed when _____ is not well demonstrated on lateral _____ projection.
[Cervicothoracic Region] Lateral (swimmer's technique): covered last week Remember that this projection is needed when C7 is not well demonstrated on lateral C-spine projection.
44
Cervicothoracic Spine: If top third of _____ is not demonstrated on lateral C-Spine projection, a lateral of _____ is required.
Cervicothoracic Spine: If top third of T1 is not demonstrated on lateral C-Spine projection, a lateral of cervicothoracic is required.
45
[Lateral (swimmer’s technique)] Pawlow: ? Twining: ? Fletcher: ? Monda: ?
[Lateral (swimmer’s technique)] Pawlow: recumbent Twining: upright Fletcher: 3-5° caudad Monda: 5-15° cephalad
46
[Lateral Cervicothoracic Swimmer's ] Patient position: Upright, seated or standing, in true lateral position Recumbent true lateral position with head resting on arm or other firm support Note: Can also be done cross-table (pt. supine - dorsal decubitus)
[Lateral Cervicothoracic Swimmer's] Patient position: Upright, seated or standing, in true lateral position Recumbent true lateral position with head resting on arm or other firm support Note: Can also be done cross-table (pt. supine - dorsal decubitus)
47
[Lateral Cervicothoracic Swimmer's] What joints are demonstrated?
[Lateral Cervicothoracic Swimmer's] C3-C7 lateral cervical zygapophyseal joints
48
[Lateral Cervicothoracic Swimmer's ] Part position: _____ centered to midline of grid Extend arm CLOSER/FARTHER to IR above head and rotate humeral head ANTERIORLY/POSTERIORLY If upright, flex elbow and rest forearm on _____ _____ shoulder further from IR, if possible Head and body in true lateral position _____ interspace in center
[Lateral Cervicothoracic Swimmer's] Part position: MCP centered to midline of grid Extend arm CLOSER to IR above head and rotate humeral head ANTERIORLY If upright, flex elbow and rest forearm on head Depress shoulder further from IR, if possible Head and body in true lateral position C7-T1 interspace in center
49
[Lateral Cervicothoracic Swimmer's ] CR: ?
[Lateral Cervicothoracic Swimmer's] CR: Perpendicular to C7-T1 interspace if shoulder away from IR is depressed If shoulder cannot be depressed, angle 3 to 5 degrees caudad
50
What do you need to see in the Lateral Cervicothoracic Swimmer's Projection?
Lower cervical and upper thoracic vertebra, not appreciably rotated from true lateral Humeral heads minimally superimposed on vertebral column Adequate x-ray penetration through shoulders
51
[AP Dens (Fuchs) ] IMAGE EVALUATION: Entire _____ within _____ _____ No _____ _____, _____, and _____ symmetric Soft tissue and bony trabecular detail
[AP Dens (Fuchs)] Entire dens within foramen magnum No rotation Mandible, cranium, and vertebrae symmetric Soft tissue and bony trabecular detail
52
[AP C1 and C2 Open-Mouth Position ] IMAGE EVALUATION: _____, _____, _____, and _____ between the _____ and _____ cervical vertebrae Entire articular surfaces of the _____ and _____ (to check for lateral displacement) Mouth open wide
[AP C1 and C2 Open-Mouth Position] IMAGE EVALUATION: Dens, atlas, axis, and articulations between the first and second cervical vertebrae Entire articular surfaces of the atlas and axis (to check for lateral displacement) Mouth open wide
53
[AP C1 and C2 Open-Mouth Position] IMAGE EVALUATION: Superimposed occlusal plane of the upper central _____ and the _____ of the _____, demonstrating proper neck flexion If the upper _____ are projected over the dens, the neck is flexed TOO MUCH/LITTLE toward the chest If the base of the skull is projected over the dens, the neck is extended TOO MUCH/LITTLE Shadow of the _____ not projected over the atlas and axis _____ _____ equidistant from dens, demonstrating proper head rotation Soft tissue and bony trabecular detail
[AP C1 and C2 Open-Mouth Position] IMAGE EVALUATION: Superimposed occlusal plane of the upper central incisors and the base of the skull, demonstrating proper neck flexion If the upper incisors are projected over the dens, the neck is flexed TOO MUCH toward the chest If the base of the skull is projected over the dens, the neck is extended TOO MUCH Shadow of the tongue not projected over the atlas and axis Mandibular rami equidistant from dens, demonstrating proper head rotation Soft tissue and bony trabecular detail
54
[AP Axial C-Spine ] IMAGE EVALUATION: Area from superior portion of _____ to _____ and surrounding soft tissue Shadows of the _____ and _____ superimposed over the atlas and most of the axis Open intervertebral disk spaces
[AP Axial C-Spine] IMAGE EVALUATION: Area from superior portion of C3 to T2 and surrounding soft tissue Shadows of the mandible and occiput superimposed over the atlas and most of the axis Open intervertebral disk spaces
55
[AP Axial C-Spine] IMAGE EVALUATION: _____ plane of head and neck perpendicular to plane of IR, without tilt or rotation _____ _____ equidistant to the pedicles and aligned with the midline of the cervical bodies _____ _____ and _____ _____ equidistant to the vertebrae Soft tissue and bony trabecular detail
[AP Axial C-Spine] IMAGE EVALUATION: Midsagittal plane of head and neck perpendicular to plane of IR, without tilt or rotation Spinous processes equidistant to the pedicles and aligned with the midline of the cervical bodies Mandibular angles and mastoid processes equidistant to the vertebrae Soft tissue and bony trabecular detail
56
[Lateral C-Spine (Grandy) ] IMAGE EVALUATION: All ?x cervical vertebrae and at least one third of the _____ (otherwise a separate radiograph of the _____ region is recommended) _____ in the center of the radiograph Neck extended so that _____ _____ are not overlapping the _____ or _____
[Lateral C-Spine (Grandy)] IMAGE EVALUATION: All seven cervical vertebrae and at least one third of the T1 (otherwise a separate radiograph of the cervicothoracic region is recommended) C4 in the center of the radiograph Neck extended so that mandibular rami are not overlapping the atlas or axis
57
[Lateral C-Spine (Grandy)] IMAGE EVALUATION: No _____ or _____ of the cervical spine Superimposed _____ _____ and open _____ disk spaces Superimposed or nearly superimposed _____ of the _____ _____ _____ shown in profile Soft tissue and bony trabecular detail
[Lateral C-Spine (Grandy)] IMAGE EVALUATION: No rotation or tilt of the cervical spine Superimposed zygapophyseal joints and open intervertebral disk spaces Superimposed or nearly superimposed rami of the mandible Spinous processes shown in profile Soft tissue and bony trabecular detail
58
[Lateral C-Spine Hyperflexion and Hyperextension] IMAGE EVALUATION: All ?x cervical vertebrae in true lateral position No _____ or _____ of the cervical spine Superimposed _____ _____ and open _____ disk spaces Superimposed or nearly superimposed _____ of the _____ _____ _____ shown in profile Soft tissue and bony trabecular detail
[Lateral C-Spine Hyperflexion and Hyperextension] IMAGE EVALUATION: All seven cervical vertebrae in true lateral position No rotation or tilt of the cervical spine Superimposed zygapophyseal joints and open intervertebral disk spaces Superimposed or nearly superimposed rami of the mandible Spinous processes shown in profile Soft tissue and bony trabecular detail
59
[Lateral C-Spine Hyperflexion and Hyperextension] Hyperflexion position: Body of _____ almost vertical, if normal All ?x spinous processes in profile, _____ and widely _____
[Lateral C-SpineHyperflexion and Hyperextension] Hyperflexion position: Body of mandible almost vertical, if normal All seven spinous processes in profile, elevated and widely separated
60
[Lateral C-Spine Hyperflexion and Hyperextension] Hyperextension position: Body of _____ almost horizontal, if normal All ?x spinous processes in profile, _____ and closely _____
[Lateral C-SpineHyperflexion and Hyperextension] Hyperextension position: Body of mandible almost horizontal, if normal All seven spinous processes in profile, depressed and closely spaced
61
[AP Axial Oblique C-Spine ] IMAGE EVALUATION: All ?x cervical and the first thoracic vertebrae Appropriate ?x-degree rotation of body and neck Open _____ _____ CLOSEST/FARTHEST from the IR, from C__-__ to C__-T__ Uniform size and contour of the foramina
[AP Axial Oblique C-Spine] IMAGE EVALUATION: All seven cervical and the first thoracic vertebrae Appropriate 45-degree rotation of body and neck Open intervertebral foramina FARTHEST from the IR, from C2-3 to C7-T1 Uniform size and contour of the foramina
62
[AP Axial Oblique C-Spine] IMAGE EVALUATION: Appropriately elevated _____ _____ not overlapping the _____ and _____ _____ bone not overlapping the _____ and _____ Open _____ disk spaces Soft tissue and bony trabecular detail
[AP Axial Oblique C-Spine] IMAGE EVALUATION: Appropriately elevated chin Mandible not overlapping the atlas and axis Occipital bone not overlapping the atlas and axis Open intervertebral disk spaces Soft tissue and bony trabecular detail
63
[PA Axial Oblique C-Spine ] IMAGE EVALUATION: All ?x cervical and the first thoracic vertebrae Appropriate ?x-degree rotation of body and neck Open _____ _____ CLOSEST/FARTHEST from the IR, from C__-__ to C__-T__ Uniform size and contour of the foramina
[PA Axial Oblique C-Spine] IMAGE EVALUATION: All seven cervical and the first thoracic vertebrae Appropriate 45-degree rotation of body and neck Open intervertebral foramina CLOSEST from the IR, from C2-3 to C7-T1 Uniform size and contour of the foramina
64
[Old-time / Old school Method “AP Ottonello Method” ] _____ shadow blurred C__-C__ Have patient “wag” jaw during long exposure (?x - ?x seconds) Alternate to _____ _____ projection
[Old-time / Old school Method “AP Ottonello Method”] Mandibular shadow blurred C1-C7 Have patient “wag” jaw during long exposure (1 - 4 seconds) Alternate to AP axial projection

2017SP POSITIONING II (9 decks)

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