Radiography of cspine and dorsal spine

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Spineradiography

• By
• SANGEETHA

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THE SPINAL CORD
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Spine anatomy

• The spine has 3 major components
• The spinal column (bones and discs)
• Neural elements( the spinal cord and nerve roots)
• Supporting structures( muscles and ligaments)

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Cont..

• The spine has four natural curves
• The cervical and lumbar curves are lordotic.
• The thorasic and sacral curves are kyphotic.
• The curves help to distribute mechanical stress
  as the body moves.
• Pathologic Lateral Curvature
• Scoliosis

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Functions of the spine

• Spinal cord protection.
• Muscle attachments.
• Curves provide shock absorbing capabilities.
• Movements-Flexion , extension , lateral flexion.

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Atlas c1

• No bodyspinous processes
• Circular in shape(ring shape).
• Anterior and poserior arches
• 2lateral massestransverse processes

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Axis-c2

• Body with bony peg(dens /odontoid process)
• Very small transverse process.
• Large,flat ovoid articular facets.
• Broad pedicles ,thick laminae
• Transverse process has Lshaped foramina for
  vertebral artery

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Typical cervical vertebrae

• Body is small,oval in shape with triangular
  central canal.
• Transverse process contains transverse foramina
  through which passes vertebral artery and vein.
• Pedicles ,small ,short directed postero laterally
• C3-6 spinous processes usually short and bifid.
• C7 marked by longest spinous processes.

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Typical cervical vertebrae
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Thorasic vertebrae

• The body is small and heart shaped,
• Vertebral canal is circular.
• There are costal facets on the body and
  transverse process.
• Spine is long and directed downwards and
  backwards.

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Thorasic vertebrae
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indication

• TRAUMA
• DEGENERATIVE DISEASES
• INFECTIOUS DISEASES
• INFLAMMATORY DISEASES
• PRIMARY TUMORS
• VASCULAR DISORDERS

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Modalities of imaging

• X ray
• CT
• MRI

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Views and positions for spine radiography
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Cervical spine

• BASIC VIEWS
• LATERAL
• ANTERO POSTERIOR
• ALTERNATE VIEWS
• TRANS LATERAL TRAUMA
• Lateral-flexion extension
• Obliques

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Patient preparation

• 10 day rule should be followed.
• Any radioopaque metals from the area of interest
  should be removed
• Preferably change to hospital gown.

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Lateral protocol

• For non-trauma cases, position the patient in a
  lateral position, either seated or standing, with
  the patient's shoulder against a vertical
  cassette holder.
• MSP parallel to detector
• Ask the patient to elevate the chin slightly (to
  prevent superimposition of the upper cervical
  spine by the mandible).
• As a final step before exposure, ask the patient
  to relax and drop the shoulders down and forward
  as far as possible.
• Ssd-150cm ,to reduce magnification and improve
  the sharpness of image.
• Centering at the level of c4.

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lateral
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Trans lateral-trauma

• When radiographing a trauma patient, do not
  remove cervical collar and do not manipulate the
  head or neck.
• patient in the supine position on a stretcher or
  radiographic table, support the cassette
  vertically against their shoulder
• or place the stretcher next to a vertical grid
  device
• If possible ask the patient attender to pull the
  shoulder down .

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Parts visualized in lateral

• C-1 through C-7 cervical vertebral bodies
• intervertebral disc spaces
• articular pillars
• spinous processes
• apophyseal joints should be demonstrated.

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Fractured spinous process
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Fractured c7 spinous process
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tear drop fracture-usually due to severe flexion
injury
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AP VIEW-protocol

• Supine or erect
• MSP perpendicular to the detector.
• Inter pupilary line parallel to the detector.
• Neck extended if possible(the line joining the
  tip of the mastoid process and the inferior
  border of upper incissors are at rt.angles to the
  film.
• CENTERING at the level of c4.

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ap
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Cont.

• The height of the cervical vertebral bodies
  should be approximately equal
• The height of each joint space should be roughly
  equal at all levels.
• Spinous process should be in midline and in good
  alignment.

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PARTS VISUALISED

• bodies of the C-3 to C-7 vertebrae (in young
  patients the C-l and C-2 vertebrae may be
  visible)
• intervertebral disk spaces.
• The spinous processes are seen almost on end,
  casting oval shadows that resemble teardrops

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Ap (open mouth)

• Erect or supine with posterior aspect of head and
  shoulder against the detector.
• MSP perpendicular to the detector
• Neck extended max possible(the line joining the
  tip of the mastoid process and the inferior
  border of upper incissors are at rt.angles to the
  film.
• ask the patient to open the mouth wide.
• Centering at the level of inferior border of the
  upper incissors

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Ap-open mouth view
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Parts visualized

• The dens (odontoid process)
• vertebral body of C-2
• the lateral masses of C-1
• apophyseal joints between C-1 and C-2 should be
  clearly demonstrated through the open mouth.

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Fracture of peg
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Cervicothoracic (swimmers view)

• The swimmers view may be employed for better
  demonstration of C-7, T-1, and T-2 vertebrae,
  which on the standard lateral projection are
  obscured by the overlapping clavicle and soft
  tissues of the shoulder girdle.
• Position the patient in a lateral position
  (sitting or standing) against a vertical grid
  device (this view can be performed in the
  recumbent position if the patients condition
  requires it).
• elevate the arm adjacent to the vertical grid and
  flex it, resting the forearm on their head for
  support, while the other arm is depressed and
  moved slightly anterior, which will place the
  vertebral head anterior to the vertebrae.

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Cont.

• Suspend the patients breathing in full
  expiration when making the exposure.
• patient placed prone on the table with the left
  hand abducted 180 and their right arm by their
  side, as if swimming. The cassette is placed
  against the right side of the neck, as for the
  standard cross-table lateral view.
• centered to T-1 if the shoulder is well
  depressed. If the shoulder is not well depressed,
  a caudal angle of 5 is necessary to separate the
  two shoulders.

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Swimmers
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swimmers
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RTlt obliques

• Alternate view done as per physician request.
• To visualize tumor of posterior root
  ganglion,intervertebral foramina and vertebral
  arches,and both side obliques are done for
  comparisons.
• Same as AP position.
• Plane of trunk is then rotated 45 degree.
• Head is rotated so that MSP is parallel to IR to
  avoid superimposing of mandible on vertebrae.
• Centering with a cephalic tilt of 5-15 degrees
  centered at the level of prominence of thyroid
  cartilage.

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Parts visualized

• C-3 to T-2 or T-3 vertebral bodies.
• apophyseal joints.
• intervertebral disk spaces.

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lateral Flexionextension

• On request ,mostly to access the degree of
  movement )
• Position as in lateral.
• Ask the patient to
• extend neck and raise the chin as much as
  possible.
• Flex the neck and tuck the chin as much as
  possible
• Centering at the midcervical region.

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THORACIC VERTEBRAE

• VIEWS AND POSITIONS

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Thoracic spine

• BASIC VIEWS
• ANTERO POSTERIOR
• LATERAL
• ALTERNATE VIEWS
• Obliques

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Ap dorsal spine

• Supine or erect
• Patient with posterior aspect of body in contact
  with table.
• MSP perpendicular to IR.
• Upper level of cassette just above the thyroid
  cartilage ,to include the first of dorsal
  vertebrae.
• Centering 2.5 cm below the sternal angle(T4,5)

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Parts visualized

• Vertebral bodies
• intevertebral joint spaces
• posterior rib ends
• costovertebral joints

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Lateral dorsal spine

• Erect or decubitus
• MSP is parallel to IR.
• Arms are raised and folded over the head.
• Non-opaque pads are placed beneath the waist and
  in between the knees.
• Upper edge of the cassette should be 3-4cm above
  the spinous process of c7 vertebrae.
• Centering centre along the mid axillary line at
  the level of T5.

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Parts visualized

• Thoracic vertebral bodies
• intervertebral spaces
• intervertebral foramina,
• poor visualization of upper 1, 2 and possibly 3
  vertebrae

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Burst fracture of t12
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Compression fracture
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RTlt obliques

• Same as AP position.
• Plane of trunk is then rotated 45 degree
• Centering CR is centered along the mid
  clavicular line on the side near the tube at a
  level 2.5cm below sternal angle.

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Radiation protection

• Direct lead gonad protection.
• Good technique with attention to collimation will
  reduce the radiation dose to the thyroid, breast
  tissue and the gonads.
• Avoid repeats as much as possible.

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conclusion

• All the above mentioned projections are
  manipulated according to the patient condition
  and the need.
• Side markers ,patient name ,id,date ,age
  information should be included in all the
  radiographs.
• for a more detailed and conclusive study CT OR
  MRI can be opted for since multi planar
  reconstruction is possible in these modalities
  giving a better view.

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