Chapter 9 lumbar spine, sacrum, and coccyx,

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Radiographic Positioning
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1

1. A portion of the lamina located between the superior and inferior process is called the?

Pars interarticularis

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2. The superior and inferior vertebral notches join together to form the?

Intervertebral foramina

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3. Which radiographic position best demonstrates the intervertebral foramina?

Lateral position

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4. The small foramina found in the sacrum are called?

Pelvic sacral foramina

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5. The anterior and superior aspect of the sacrum that forms the posterior wall of the pelvic inlet is called the?

promontory

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6. What is another name for the sacral horns?

cornua

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7. The sacroiliac joints lie at an oblique angle of? to the coronal plane

30 degrees

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8. What is the formal term for the tail bone?

coccyx

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9. What is the name for the superior broad aspect of the coccyx?

base

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10. Classification, mobility, and movement type for Zygapopseal joint?

synovial, dIarthroidal, plane, or gliding

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11. Classification, mobility, and movement type for Intervertebral Joints

cartilaginous, amphiarthrodial, no movement

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12. List the specific joints or foramina that are demonstrated with the LPO position

Left zygapophyseal joints

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13. List the specific joints or foramina that are demonstrated with the RAO position

Left zygapophyseal joints

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14. List the specific joints or foramina that are demonstrated with the Lateral position

Intervertebral foramina

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15. List the specific joints or foramina that are demonstrated with the RPO position

Right zygapophyseal joints

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16. List the specific joints or foramina that are demonstrated with the LAO position

Right zygapophyseal joints

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17. The degree of obliquity required for an oblique projection at the T12- L1 level is approximately

50 degrees

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18 The L5-S1 level spine requires a ___ degree oblique

30 degrees

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19. A ___ oblique is performed for the general lumbar spine.

45 degrees

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20. ASIS is at what vertebral level

S1-S2

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21. Xiphoid process is at what vertebral level

T9-T10

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22. Lower costal margin is at what vertebral level

L2-L3

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23. Iliac crest is at what vertebral level

L4-L5

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24. Symphysis pubis is at what vertebral level

Tip of coccyx

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25. True or False: The use of higher kV and lower mA seconds for a lumbar spine improves contrast but increases patient dose?

False

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26. True or False: Placing a lead blocker mat behind the patient for a lateral spine position improves image quality?

True

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27. True or False: Gonadal shielding should always be used for male and female patients for studies of the lumbar, sacrum and coccyx.

False

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28. True or False: The anteroposterior (AP) projection of the lumbar spine opens the intervertebral joint spaces better than the PA projection.

False

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29. True or False: The knees and hips should be extended for an AP projection of the lumbar spine.

False

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30. True or False: An increased SID of 44 or 46 reduces distortion of spine anatomy.

True

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31. True or False: The lead blocker mat and close collimation must not be used when performing digital imaging or the lumbar spine.

False

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32. What is the best modality that demonstrates the pathological features of osteoporosis

Bone densitometry

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33. What is the best modality that demonstrates the pathological features of soft tissues of lumbar spine

MRI

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34. What is the best modality that demonstrates the pathological features of structures within the subarachnoid space

MRI

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35. What is the best modality that demonstrates the pathological features of Inflammatory condition such as pagets disease

Nuclear Medicine

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36. What is the best modality that demonstrates the pathological features of compression fractures of the lumbar spine

CT

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37. Lateral curvature of the vertebral column

scoliosis

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38. Fracture of the vertebral body caused by hyperflexion force

Chance Fracture

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39. Congenital defect in which the posterior elements of the vertebral fail to unite.

Spina bifida

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40. Most common at the L4-L5 level and may result in sciatica

Herniated nucleus pulposus

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41. Forward displacement of one vertebra onto another vertebra

Spondylolisthesis

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42. Inflammatory condition that is most common in males in their thirties

Ankylosing spondylitis

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43. Dissolution and separation of the pars interarticularis

Spondylolysis

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44. A type of fracture that rarely causes neurologic deficits

Compression fracture

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45. CR is centered at the level of ____ for an AP and lateral lumbar spine projections

Illiac crest

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46. What two structures can be evaluated to determine whether rotation is present on a radiograph of an AP projection of the lumbar spine?

Sacroiliac joints and Spinous process

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47. How much rotation is required to properly visualize the zygapophyseal joints at L5-S1?

30 degrees

48

48. What set of zygapophyseal joints is demonstrated with an LAO position?

Right (upside)

49

49. The _______ which is the eye of the "scottie dog" should be near the center of the vertebral body on a correctly obliqued lumbar spine?

Pedicle

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50. Which positioning error has been committed if the "eye of the scottie dog" are projected too far posterior with a 45 oblique position of the lumbar spine

excessive rotation

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51. Which position or projection of the lumbar spine series best demonstrates a possible compression fracture?

Lateral

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52. A patient with a wide pelvis and narrow thorax may require a CR angle of ___ with caudad or cephalad for a lateral position of the lumbar spine

5 to 8 degress caudad

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53. How should the spine of a patient with scoliosis be positioned for a lateral position of the lumbar spine

With the sag or convexity of the spine closest to the IR

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54. Why should the knees and hips be flexed for an AP lumbar spine projection?

Reduces lumbar curvature, which opens the intervertebral disk space

55

55. True or False: the female ovarian dose used for a PA lumbar spine projection is approximately 30 percent less than the dose from an AP projection

True

56

56. Where is the CR centered for a lateral L5-S1 projection of the lumbar spine

1 1/2 inches inferior to the iliac crest and 2 inches posterior to ASIS

57

57. What amount of CR angle is required for an AP axial L5-S1 projection on a male patient.

30 degrees cephalad

58

58. True or False: PA or AP projection for a scoliosis series frequently includes one erect and one recumbent position for comparison.

Ture

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59. True or False: A PA projection for a scoliosis series produces only about 1/10 the dose to the breasts as compared with the AP projection, even if proper collimation is used.

True

60

60. Which techniques or devices produce a more uniform density along the vertebral column for an AP/PA scoliosis projection.

Compensation filter

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61. Which side of the spine should be elevated for the second exposure for the AP/PA projection scoliosis series (by having patient stand on a block with one foot.

The convex side of the spine

62

62. During the AP (PA) right and left bending projections of the lumbar spine, the ___ must remain stationary during positioning.

Pelvis

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63. Which projections should be taken to evaluate flexibility following spinal fusion surgery?

Hyperextension and hyperflexion projections

64

64. How much CR angle is required for an AP projection of the sacrum for a typical male patient?

15 degrees cephalad

65

65. If a patient can not lie on his back for the AP sacrum because it is too painful, what alternative projection can be taken to achieve a similar view of the sacrum?

A PA with 15 degrees Caudad CR angle

66

66. Where is the CR for an AP projection of the coccyx.

2 inches superior to the pubis symphysis

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67. True or False: The AP projection of the sacrum and coccyx can be taken as one single projection to decrease gonadal dose.

False

68

68. Patients should be asked to empty the urinary bladder before performing which projection fo the vertebral column?

AP of sacrum and coccyx

69

69. In addition to good collimation, what should be done to minimize overall "fogging" on a lateral lumbar spine or lateral sacrum and coccyx radiograph

Place led blocker table top behind patient

70

70. Which SI joint is visualized with an RPO position

Left

71

71. How much rotation of the body is required for oblique position of SI joints

25 to 30 degrees

72

72. What type of CR angle is recommended of the AP axial projection of the SI joints on a female patient

35 cephalad

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73. Where is the CR centered for an oblique projection of the SI joints.

1 inch medial from upside ASIS joint

74

74. A radiograph of an AP projection of the lumbar spine reveals that the spinous processes are not midline to the vertebral column and distortion of the vertebral bodies is present. Which positioning error is present on this radiograph

rotation of the spine

75

75. A radiograph of an LPO projection of the lumbar spine reveals that the downside pedicles and zygapophyseal joints are projected over the anterior portion of the vertebral bodies. Which positioning error is present on this radiograph

Insufficient rotation of the spine

76

76. A radiograph of a lateral projection of a female lumbar spine reveals that the mid- to lower intervertebral joint spaces are not open. The technologist supported the midsection of the spine with sponges to straighten the spine. What else can be done to open the joint spaces during the repeat exposure?

If the patient has a wide pelvis, CR can be angled 5 to 8 degrees caudad

77

77. A radiograph of a lateral L5-S1 projection reveals that the joint space is not open. The technologist did support the middle aspect of the spine with a sponge. What else can the technologist do to open up the joint space during the repeated exposure?

Place additional support beneath the spine, or use a 5 to 8 degree caudad angle

78

78. A radiograph of an AP axial coccyx reveals that the distal tip is superimposed over the symphysis pubis. What must the technologist do to eliminate this problem during the repeat exposure

Increase CR angle is required to separate the coccyx from the symphysis pubis.

79

79 . A radiograph of an oblique position of the lumbar spine reveals that the downside pedicle and zygapophyseal joint are posterior in relation to the vertebral body. what modification of the position must be made during the repeat exposure to produce a more diagnostic image

Decrease rotation of the body and spine.

80

80. A patient comes to the radiology department for a follow-up study for a comparison fracture of L3. The radiologist requests that the collimated projections be taken of L3. Which specific projections and centering would provide a quality study of L3 and the intervertebral joint spaces.

AP or PA and collimated lateral projections would provide the best view. The CR should be about 2 inches above iliac crest.

81

81. A patient with injury to the coccyx enters the ER. When attempting the AP projection, the patient complains that it is too uncomfortable to lie on his back. He is unable to stand. What other options are available to complete the study?

Perform PA rather than an AP projection and reverse the direction of the CR from caudad to cephalad.

82

82. A patient with a clinical history of spondylolisthesis at the L5-S1 level comes to the radiology department. Which specific lumbar spine position is most diagnostic in demonstrating the extent of this condition?

A lateral postion would demonstrate the degree of forward displacement.

83

83. A positioning series for SI joints is performed on a patient. The resultant radiographs do not demonstrate the inferior portion of the joints. What can be done during the repeat exposure to demonstrate this aspect of the SI joints

The CR should be angled 15 to 20 cephalad.

84

84. A patient comes into the radiology department for a lumbar spine series. He has a clinical history of advanced spondylolysis. Which specific projection of the lumbar spine series will best demonstrate this condition

Although AP and lateral projections of the lumbar spine are helpful, posterior or anterior oblique positions best demonstrate advanced signs pf spondylolysis

85

85. A patient comes to the radiology department with a clinical history of HNP, Which of the following imaging modalities provide the most diagnostic study for this condition?

MRI

86

86. A patient comes to the radiology department for a lumbar spine series. She has a clinical history of severe kyphosis. How should the lumbar spine series be modified for this patient?

Routine lumbar spine projections should be performed erect.