Radiographic Lines

1
Radiographic Lines

• Cervical 9
• Cervical Lordosis
• Stress lines of cerv. Spine
• Cervical gravity Line
• Georges line
• ADI
• Posterior cervical line
• Sagital dimension of cerv. Spinal canal
• Atlanto Axial Alignment
• Pre-vertebral soft tissue
• 9 cervical Lords stress gravity GAPS AAAnd
  pre-vertebral soft tissue

• Skull 4
• Sella turcica
• Basilar Angle
• McGregors line
• Chamberlains line
• McGregor sells chamberlains bass 4 skulls.

2
Radiographic Lines

• Lumbar 12
• Inter-vertebral Disc Height
• Lumbar inter-vertebral disc angles
• Lumbar lordosis
• Lumbo-sacral angle
• Lumbo-sacral disc angle
• Hadleys S curve
• Vanakkerveekens measurement of lumbar instability
• Lumbar gravity line
• Static vertebral malposition
• Lateral Bending sign
• Ullmans Line
• Meyerding Rating System
• ILLLL HVL SLUM

• Thoracic 4
• Riser-Ferguson (SC)
• Thoracic cage dimension
• Cobbs Angle (SC)
• Thoracic Kyphosis
• Riser-Ferguson Caged Cobbs Kyphosis

3
Radiographic Lines

• Lower Ext 15
• Boehlers angle
• Kleins Line
• Skinners line
• Center edge angle/ Wibergs
• Hip joint space
• Acetabular angle
• Pre-sacral space
• Symphysis pubis width
• Heel Pad Measurement
• Patellar malalignment
• Iliac angle and index
• Protrusio acetabuli / Kohlers line
• Shentons line
• Ilio femoral line
• Femoral Angle
• Boehlers use CKlein on their Skin, not their
  CHAPS, heel, or patella, IPSIlateral for Females

• Upper Ext 5
• Glenohumeral joint space
• Metacarpal sign
• Acromiohumeral joint space
• Acromiclavicular joint space
• Radio-capitellar line
• Glen Met Acromio Humer Acromio Clavi over the
  Radio

4
Skull

• Sella turcica size
• 5mm to 16mm
• Avg is 11mm
• Pituitary masses can cause enlargement

5
Skull

• Basilar Angle
• Avg. 137 degrees
• 123 to 152 degrees
• Basilar impression and platybasia widen angle
• Nasion to sella turcica to basion
• Beyond 152 degrees platybasia, could be
  congenital or caused by pagets

6
Skull

• McGregors line
• Males 8mm
• Females 10mm
• Basilar impression when odontoid more than
  maximum distance above
• Caused by atlas occipitalization, platybasia, and
  bone softening such as pagets or osteomalacia
• Hard palate to occiput
• Note relative odontoid apex

7
Skull

• Chamberlains line
• Basilar impression when odontoid more than
  maximum distance above
• Hard Palate to opisthion
• Caused by atlas occipitalization, platybasia, and
  bone softening such as pagets or osteomalacia

8
Cervical

• Cervical Lordosis
• Role is unclear. Decreased following trauma,
  muscle spasm, spondylosis, and patient tucking
  the chin at time of exposure.

9
Cervical

• Stress Lines of Cervical Spine
• Flexion C5-C6 joint
• Extension C4-C5 joint
• Go through C2 and C7 vertebral bodies and note
  intersection
• Muscle spasm, joint fixation, and/or disc
  degeneration may decrease

10
Cervical

• Cervical Gravity Lines
• Vertical line from odontoid apex
• Passes through C7 body

11
Cervical

• Georges Line
• Alignment of posterior body margins
• A to P vertebral mal-positions when line not
  smooth
• Such as fractures, dislocation, anterolisthesis
  or retrolisthesis

12
Cervical

• AtlantoDental
• Interspace (ADI)
• C1 anterior tubercle odontoid
• Adult 1mm-3mm
• Child 1mm-5mm
• Transverse ligament rupture or instability.
  Trauma, Downs, and inflammatory arthritis may
  increase the measurement

13
Cervical

• Posterior Cervical Line
• Spinolaminar junction lines
• AP vertebral malposition when line is not smooth,
  especially at C1 and C2

14
Cervical

• Sagittal Dimension of the cervical spine
• Posterior body-spinolaminar junction.
• 12mm minimum
• Spinal stenosis when less than 12mm. Intraspinal
  tumor when enlarged.

15
Cervical

• Atlanto Axial Alignment
• C1 lateral mass-C2 articular pillar margin
  alignment
• Jeffersons or odontoid fractures or alar
  ligament instability when margins overlap

16
Cervical

• Prevertebral Soft tissue
• Anterior bodies-posterior air shadow margins
• Retropharyngeal 7mm
• C2,3,4
• Retrolaryngeal 7-20mm
• C4,5
• Retrotracheal 20mm
• C5,6,7
• Soft tissue masses (tumor, infection, hematoma)
  increase the measurements

17
Thoracic

• Riser-ferguson
• Centers of end and apical segments joined and the
  angle measured
• Used for Scoliosis Evaluation

18
Thoracic

• Thoracic Cage
• Posterior sternum-anterior T8 body
• Male 14cm
• Female 12cm
• Straight back syndrome when the distance is less
  than 13cm in males and 11cm in females

19
Thoracic

• Cobbs Angle
• End vertebral endplate lines then intersecting
  perpendiculars and the angle measured.
• Used for scoliosis evaluation

20
Thoracic

• Thoracic Kyphosis
• T1 superior endplate-T12 inferior endplate, then
  intersecting perpendiculars and the angle
  measured
• Used for Kyphosis evaluation (Scheuermanns
  fractures)

21
Lumbar

• Intervertebral Disc Height
• Hurxthal method (A) endplate to endplate
• Farfan Method (B) Ant Height divided by disc
  diameter, posterior height divided by disc
  diameter, then as ratio to each other
• If decreased, then DJD, surgery, infection

22
Lumbar

• Lumbar Inter-vertbral disc angles
• At each disc endplate lines are drawn and the
  angles measured
• Altered in various pathologies

23
Lumbar

• Lumbar lordosis
• L1 endplateS1 endplate perpendiculars and angle
  formed
• 50-60 degrees
• Altered in various pathologies

24
Lumbar

• Lumbosacral angle
• Endplate of S1 to horizontal line angle
• 41 degrees is average
• 26-57 degree range
• Altered in various pathologies

25
Lumbar

• Lumbosacral Disc Angle
• Angle between opposing endplates of L5 and S1
• 10-15 degree range
• Altered in various pathologies

26
Lumbar

• Hadleys S curve
• A line along the inferior surface of the TVP, AP
  and across the joint
• Should be smooth
• Facet subluxation could be present if S is
  Broken

27
Lumbar

• Van akkerveekens measurement of lumbar
  instability
• Endplate lines are opposing segments. Measure
  from the posterior body to the point of
  intersection
• Should be equal measurements
• Max is 1.5 mm difference
• Nuclear, annular and posterior ligament damage if
  more than 1.5 mm difference

28
Lumbar

• Lumbar Gravity Line
• A perpendicular line is drawn from the center
  point of the L3 body
• Intersects sacral base
• Altered in various pathologies

29
Lumbar

• Static Vertebral malposition / Houston conference
  listings / medicare listings
• Numerous terms are applied to describe static
  vertebral malpositions
• Altered in various pathologies

30
Lumbar

• Lateral Bending Sign
• Spinous position
• Intersegmental wedging
• Usually toward concavity
• Gradually increase away from sacrum
• Disc herniation at level failing to laterally flex

31
Lumbar

• Ullmans Line
• Endplate line through S1, perpendicular from
  sacral promontory
• L5 should be behind the line
• Detection of subtle spondylolisthesis when L5
  body crosses perpendicular line

32
Lumbar

• Meyerding Rating System
• Sacral base divided into quarters. Relative
  position of the posterior body of L5 is made.
• Grading severity of spondylolisthesis

33
Percentage Method/Anterolisthesis

• The displacement between the posterior sacral
  base and the posterior aspect of L5 vertebrais
  measured along a plane paralleling the disc in
  millimeters
• The measured displacement is then divided by the
  length of the sacral promontory and multiplied by
  100
• The main advantage is the removal of any
  geometrical magnification

34
Lower Extremity

• Kleins Line
• Tangential line to outer femoral neck. Head just
  overlaps laterally
• Slipped epiphysis suspected if head does not
  intersect line.

35
Lower Extremity

• Boehlers angle
• Three superior points joined on the calcaneus,
  posterior angle is measured
• Avg. 30-35 degrees
• 28-40 degrees is the range
• Calcaneal fractures may reduce the angle to less
  than 28 degrees

36
Tear Drop Distance

• Distance between the most medial margin of the
  femoral head and the outer cortex of the pelvic
  tear drop is measured
• Average 9, Minimum 6, Maximum 11
• Probably early Legg-Calve-Perthes,Septic arthritis

37
Tear Drop Distance
38
Lower Extremity

• Skinners line
• Femoral shaft line. Perpendicular second line
  tangential to the tip of the greater trochanter
• Passes through or below fovea capitus
• Hip joint abnormality if line passes above fovea
  capitus

39
Lower Extremity

• Center edge Angle / Wibergs
• From the center of the femoral head, vertically
  and acetabular edge, lines are drawn.
• The angle is then measured
• Avg. 36 degrees
• 20-40 degrees is range
• A shallow acetabulum may precipitate DJD

40
Lower Extremity

• Hip Joint Space
• Femoral head-acetabulum distance
• Superior 3-6mm
• Axial 3-7mm
• Medial 4-13mm
• Various joint diseases increase the space
• DJD, RA, Degenerative RA

41
Lower Extremity

• Acetabular Angle
• Y-Y line drawn. Second line from medial to
  lateral acetabular surfaces. Angle measured
• Avg. 20 degrees
• 12-29 degrees is the range
• Congenital hip dislocation widens the angle.
• Downs syndrome decreases the angle

42
Lower Extremity

• Pre-sacral space
• Soft tissue density between the rectum and
  anterior sacral surface
• Child 3mm (1-5)
• Adult 7mm (2-20)
• Diastasis and inflammatory joint disease may
  widen the joint.

43
Lower Extremity

• Symphysis Pubis Width
• The distance between opposing articular surfaces,
  Halfway between the superior and inferior margins
• Male6mm (4.8-7.2)
• Female 5mm (3.8-6.0)
• Diastasis and inflammatory joint disease may
  widen the joint.

44
Lower Extremity

• Heel Pad Measurement
• Shortest distance between the calcaneus and
  plantar skin surface
• Male 19mm 25mm
• Female 19mm 23mm
• Acromegaly produces skin overgrowth exceeding the
  max measurement

45
Lower Extremity

• Patellar mal-alignment
• Patella length-patella tendon ratio
• 11
• Chondromalacia patellae factor if the ratio is
  exceeded more than 20

46
Lower Extremity

• Iliac Angle and index
• Y-Y line drawn. Second line along lateral iliac
  wing and iliac body
• Sum of right and left iliac and acetabular angles
  divided by 2
• Avg. 68 degrees
• 60 to 80 degrees is possible sign of Downs
  syndrome
• Probable Downs if below 60 degrees

47
Lower Extremity / HIP

• Protrusio Acetabuli / Kohlers Line
• Pelvic inlet-outer obturator. Acetabulum should
  be lateral to the line
• Could be Pagets disease when acetabulum is
  medial to the line

48
Lower Extremity

• Shentons line
• Smooth curvilinear line along ilium and onto
  femoral neck and superior obturator border
• Femur dislocation or fracture if line is
  interrupted

49
Lower Extremity

• Iliofemoral line
• Smooth curvilinear line along ilium and onto
  femoral neck
• Should be bilaterally symmetrical
• Asymmetry may denote hip joint abnormality

50
Lower Extremity

• Femoral Angle
• Lines through the femoral shaft and neck
• 120-130 degrees is the range
• Coxa vara less than 120 degrees
• Coxa Valga Greater than 130 degrees

51
Upper Extremity

• Glenohumeral joint space
• Average humeral head-glenoid distance (superior,
  middle, inferior)
• 4-5 mm
• Degenerative and crystal arthritis diminish the
  space. Posterior dislocation may widen it.

52
Upper Extremity

• Metacarpal sign
• Tangential line through the fourth and fifth
  metacarpal heads. Third head should be proximal
  to this line
• Turners Syndrome, post fracture deformity

53
Upper Extremity

• Acromiohumeral joint space
• Acromion-humeral head
• Avg. 9mm
• 7mm-11mm is the range
• Rotator cuff tear decreases distance.
• Subluxation and dislocation increase the distance

54
Upper Extremity

• Acromioclavicular joint space
• Avg. acromion-clavicular distance (superior,
  inferior)
• Male 3.3mm (2.5-4.1mm)
• Female 2.9mm (2.1-3.7mm)
• Degenerative arthritis will decrease distance
• Separation and resorption will widen distance

55
Upper Extremity

• Radio-capitellar line
• Radius axis line through the elbow joint
• Passes through capitellar center
• Radius subluxation/dislocation if line misses the
  capitellar head