Where are ID blockers?
up and out of the way of anatomy
Where should the side markers be (generally)?
within collimation, but not in the way of anatomy
What are the breathing instructions for all views?
exhale and hold
What does expiration do to the diaphragm?
elevates it
what is the general flow of a setup for lumbopelvic views?
set SID align cassette in bucky measure for all set-ups in the series set control panel apply gonad shield (if needed) position patient center CR, part and cassette
the center of the “lumbopelvic” area is ___the iliac crest
below
the center of the lumbar spine is ____the iliac crest
above
where do you measure for AP lumbopelvic?
A-P at the thickest part the abdomen
when do you apply a gonad shield?
for AP lumbopelvic and full spine only
film size for APLP?
14x17
collimation for APLP?
14x17
central ray for APLP goes where for females?
1” below the crest
central ray for APLP goes where for males?
2” below the crest
what should be included in the APLP?
L1-ischial tuberosities, bottom of collimation light just below greater trochanters
top of light 1” below xyphoid
if you cannot get all the anatomy on an APLP, what should you do?
ALWAYS get the ischial tuberosities
the lumbars that got cut off can be spot shot
where should the anatomical marker be for APLP?
mid-film, along edge of collimation
gonad shielding for APLP
males: tip of shield should be just below the pubic arch (1 1/2” below top of symphysis)
females: tip of heart should be just above the pubic symphysis, position widest part just medial and inferior to the ASIS
what should you look for in an APLP?
symmetry of iliac wings and obturator foramina
where should you measure for a lateral lumbar?
right to left, rest calipers on iliac crest
where is the CR located for a lateral llumbar?
1” above the crest and midway between ASIS and PSIS (on midaxillary line)
film size for lateral lumbar?
14x17
collimation for lateral lumbar?
10X17
If the patient has a lateral curve, what should you do for their lateral lumbar?
place the convexity next to the bucky
for lateral lumbar, what do you do with females patients with hips larger than the waist?
add a filter down to the crest
does the lateral lumbar include the whole pelvis and sacrum?
no
why do we need to collimate for lateral lumbar?
reduces scatter fog/higher contrast
critical for CR and DR
produces better image
large enought to accommodate hyperlordosis or XL patients
what features should you see on a lateral lumbar?
posteiror ribs superimposed IVFs open iliac crests superimposed and mid film no "hourglassing" if L5/S1 is too light, do additional lateral "spot shot"
where should yo umeasure for an L5/S1 lateral spot shot?
measure right to left, 2-3” below crest
film size for L5/S1 lateral spot shot?
10x12 vertical
how should patient be positioned for L5/S1 lateral spot shot?
side next to bucky, arms up
where should CR be for L5/S1 lateral spot shot?
2-3” below crest and 1” posterior to midline
what is the collimation for L5/S1 lateral spot shot?
8x10
do we need a shield for L5/S1 lateral spot shot?
no
How do we measure for anterior oblique lumbar?
A-P at the thickest part of the abdomen (same as APLP)
film size for anterior oblique lumbar?
10x12
Where do you center for anterior oblique lumbar?
1” above crest and 1” lateral to spine toward side of interest
R pars- right side of the spine
L pars- left side of the spine
RAO, what do you see?
left pars
LAO, what do you see?
right pars
how far do you rotate for upper lumbars anterior oblique lumbar?
45 degrees
how far do you rotate for lower lumbars for anterior oblique lumbar?
30 degrees
why would we do a recumbent anterior oblique?
stabilizes patient
compresses soft tissue, requiring 30% less mAs
SAME CR, part, IR alignment as upright
what part of the body do you put next to the bucky for a posteiror oblique?
side of interest
What film size is required for posterior oblique?
10x12
Where is the CR for posteiror oblique?
1” above the crest, approximately 2” medial to ASIS closes to tube
RPO sees what?
right pars
LPA sees what?
left pars
what obliques are preferred?
Anterior
less exposure to patient
shooting into natural curvature
what should you see in obliques?
scottie dogs should be apparent and similar from one level to next
no IVFs
iliac crest will be asymmetrical
centering point slightly above crest
where do you measure for AP sacrum?
anterior to posterior at mid-pelvis (midway between ASIS and PS)
where is CR for AP sacrum?
perpendicular to sacrum with a 15 degree cephalic tube tilt
do we shield for an AP sacrum?
no
what are the breathing instructions for AP sacrum?
don’t breathe, don’t move
how is patient postitioned for AP sacrum?
recumbent
film size for lateral sacrum?
10x12 vertical
how is patient positioned for AP sacrum?
recumbent
where is the CR for lateral sacrum?
3” below the crest and 1” posterior to midaxillary plane
do we need a shield for lateral sacrum?
no
why does the CR need to be slightly posteiror to the spine when shooting a lateral sacrum?
because the sacrum is slightly posterior to the midaxillary plane
how do you measure for an AP coccyx?
A-P at mid pelvis
film size for AP coccyx?
10x12 vertical
collimation for AP coccyx?
4x4
CR for AP coccyx?
center mid pelvis with a 10 degree caudal tube tilt
describe a lateral sacrum and coccyx “combo”
measure as for lateral sacrum 10x12, vertical load cassette with 2 films or filter coccyx or adjust image digitally
film size for AP full spine?
14x36
describe patient placemtn for AP full spine
back to full spine bucky
arms abducted
upper occlusal plane parallel to floor
collimation for AP full spine?
open so it is just below the eyes and 3” below the pubic symphysis and 14” wide
SID for AP full spine?
72”
filter for AP full spine?
filter upper thoracics (down to axilla)
breathing instructions for AP full spine?
inhale and hold
full spine sectional series?
AP cervical spine APOM cervical spine Lat cervical spine AP thoracic spine Lat thoracic spine AP lumbo-pelvic spine Lat lumbar spine
full spine series?
AP 14x36 APOM lat cervical spine lat thoracic spine lat lumbar spine