Imaging lumbar spine - exam 3

Question 1

Who should get imagining with low back P!

Answer 1

> 50 yrs. of age w/ hx of cancer
saddle parathesis
bowel and bladder dysfunction
specific neurological deficits (spinal m. brain, spinal cord)
progressive/disabbling symptoms
no improvement after 6 wks. of conservative Rx

Question 2

Imaging does improve outcomes? T or F

Answer 2

False; DOES NOT

Question 3

Black:
Gray:
White:
Bright white:
Solid white:

Answer 3

Air
Soft tissue
Bone
Dyes
Metal

Question 4

Viewing -AP and PA projections
—place on the viewer as if the ______________
—exception

Answer 4

–patient were facing you and in an anatomical position
–hands and feet viewed with toes or fingers pointing up

Question 5

________ view is in the path of the beam
identify at least _____ markers such as _______ and _________

Answer 5

Lateral
2; PHI and side of body

Question 6

ABCS:

Answer 6

alignment, bone density, cartilage space, soft tissue

Question 7

misalignment indicated fx/dislocation and possible cord compromise -

Answer 7

alignment

Question 8

bone density - outer __________ bone brighter white than inner _________ bone

Answer 8

cortical; cancellous

Question 9

narrowing, sclerosis, growth plates -

Answer 9

cartilage space

Question 10

Soft tissue:

Answer 10

muscle wasting, capsular distension from swelling
periosteal disruption or rasing

Question 11

Routine radiographs: (4)

Answer 11

AP
Lateral
Right and Left Oblques
Lateral L5, S1

Question 12

Normal findings for AP view:

Answer 12

vertically aligned vertebral bodies
preserved intervertebral spaces
midline SPs
—tear drop shaped
—smaller spacing in lower segments

Question 13

Normal findings for AP view: Articular Processes (2)

Answer 13

—casts a butterfly-shaped shadow on vertebral bodies
—joints not specifically visible but alignment is noted

Question 14

Normal findings for AP view: Pedicles (2)

Answer 14

oval densities
equidistance from SPs

Question 15

Normal findings for Lateral view:
_______parallel lines
_______ and ______ border?
vertebral bodies are ________ w/ ______heads
________intervetbral spaces
intervertebral or lateral foramen L5, S1 is the ________
_________observe L5, S1 due to illiac crest

Answer 15

3 parallel lines
ant. vertebral border ; post. vertebral borders
boxed; smooth
perserved
smallest
CAN NOT

Question 16

Normal findings for lateral view:
Should remain __________ whether the low back is in neutral, flexed, or extended

Answer 16

constant

Question 17

Normal finding for Lateral L5, S1:
close up of _________junction
normal vertebral alignment by _____ parallel lines
_______disc spaces

Answer 17

lumbosacral
3
well preserved

Question 18

Normal finding for Lateral L5, S1: WB views
What is Barges Angle -
— _____º average

What is Ferguson’s Angle-
—_____º average

Answer 18

angle between sacral base and vertical line
53º

angle between sacral base and horizontal line
41º

Question 19

Normal findings for Lateral L5, S1: WB views
Smaller Barges and Larger Fergusons indicates:

Answer 19

more lordosis
greater facets compression, ant. shearing forces and lateral foramen narrowing

Question 20

Normal findings for Lateral L5, S1: WB views
Larger Barge’s and smaller Fergusons indicates:

Answer 20

less lordosis
greater vertebral body and discal compression

Question 21

The oblique view is best for picking up: (2)

Answer 21

spondylolysis and spondylolisthesis on radiograph

Question 22

The normal oblique view you should see what structures

Answer 22

articular processes, facets, pars interarticularis , and pedicles - Scottie Dogs

Question 23

what are major advantages of CT scan?

Answer 23

less overlap of structures due to slicing
able to locate subtle bone changes

Question 24

what are major disadvantages of CT scan/

Answer 24

greater radiation exposure
limited with soft tissue abnormalities

Question 25

how do you start to understand a CT image?

Answer 25

start with scout image locate specific slice position and image

Question 26

how do you read transverse plane slices of CT?

Answer 26

patient is supine so anterior surface is at the top of each image slice looking upward at the anatomic structures from below so your right is patient's left

Question 27

how are sagittal plane slices viewed on CT image?

Answer 27

left to right

Question 28

what are MRIs best at looking at?

Answer 28

Slicing and positioning as with CT

Question 29

what are major advantages of MRI?

Answer 29

less overlap like CT due to slicing excellent at soft tissue abnormalities, cancellous bone, staging metastasis no radiation like with CT and X ray high resolution

Question 30

what are major disadvantages of MRI?

Answer 30

contraindications with magnetic implants except for stable joint implants precaution with claustrophobia

Question 31

In a T2 image, fluid is ____

Answer 31

bright

Question 32

In a T1 image, fluid is _____

Answer 32

dark

Question 33

in a T1 image bright signals are from and dark signals are from:

Answer 33

bright: fat and bone marrow dark: cortical bone and fluid

Question 34

what are T1 best for demonstrating?

Answer 34

anatomical definition of structure

Question 35

in a T2 image bright signals occur from?

Answer 35

fluid and water

Question 36

what are T2 best for demonstrating?

Answer 36

swelling and neoplasms particularly in cancellous bone

Question 37

what two structures are often gray in both T1 and T2 images?

Answer 37

nerve muscle

Question 38

how does inflammation present on T1 images? T2?

Answer 38

low (dark) high (white)