XR205 Torso Skeleton

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Shutrbug20
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98165
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XR205 Torso Skeleton
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2011-08-29 23:13:23
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Cervical Spine
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Bontrager Chapter 9
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  1. Vertebral Column Characteristics
    • 1. Provides flexible supporting column for trunk and head
    • 2. Transmits weight of upper body to lower limbs
  2. Spinal Canal
    • 1. Begins at base of skull
    • 2. Extends distally into sacrum
  3. Spinal Cord
    • 1. Enclosed and protected by Spinal Canal
    • 2. Begins at Madulla Oblongata of brain
    • 3. Passes through Foramen Magnum of skull to lower border of L1 (point called Conus Medullars)
    • 4. Conus may extend as low as body of L2
  4. Lumbar Puncture Site
    • 1. Below Conus Medullars
    • 2. L3-L4
  5. Intervertebral (IV) Disks
    Characteristics (4)
    • 1. Tough fibrocartilaginous disks
    • 2. Cushionlike
    • 3. Spinal stability
    • 4. Allow flexability and movement of column
  6. Vertebral Column
    Characteristics (5) Sections
    • 1. Cervical = 7
    • 2. Thorasic = 12 (connects to ribs)
    • 3. Lumbar = 5 (largest, strongest, load of body weight)
    • 4. Sacral = Newborn = 5, Adult = 1
    • 5. Coccyx = Newborn = 4, Adult = 1
  7. Lumbar Disks
    Most common site for injury / pathologies
  8. Total Bones of Spine
    • 1. Newborn = 33
    • 2. Adult = 26
  9. V-Column Curvatures
    Viewed as from Posterior
    • 1. Concave = Cervical and Lumbar
    • 2. Convex = Thorasic and Sacral (Primary Curves)
  10. V-Column Curvatures
    1st Compensatory Concave Curve
    Cervical Spine when baby holds head up
  11. V-Column Curvatures
    2nd Compensatory Concave Curve
    Lumbar Spine when baby begins to walk
  12. Lordosis
    • Lumbar region exagerated
    • Swayback
  13. Kyphosis
    • Thorasic region exagorated
    • Humpback
  14. Scoliosis
    • Thorasic region exagerated lateral
    • "S" curve
    • Can create tilting of pelvis producing limp or uneven walk
  15. Vertebral Anatomy
    Body
    • 1. Thick, weight bearing
    • 2. Anterior part = flat rough superior / inferior surfaces for attachment of IV Disks
  16. Vertebral Anatomy
    Arch
    • 1. Extends posteriorly from body
    • 2. Form circle opening = vertebral foramen
    • 3. Stacked vertebrae = Spinal Canal
  17. Vertebral Anatomy
    Superior Perspective
    • 1. Pedicles extend posteriorly from L&R of body
    • 2. Posterior part of arch formed by 2 flat layers called Laminae
    • 3. Each lamina extends posteriorly towards midline and form Spinous Process
    • 4. Extending laterally from each Pedicle and Lamina = Transverse Process
  18. Vertebral Anatomy
    Lateral Perspective
    • 1. Pedicles extend posteriorly from body to Transverse Process
    • 2. Lamina extends posteriorly from transverse process to Spinous Process
  19. Lateral View
    • 1. R&L superimposed Superior Articular Processes
    • 2. R&L superimposed Inferior Articular Processes
  20. Vertebral Order
    • 1. Body
    • 2. Pedicle
    • 3. Transverse Process
    • 4. Lamina
    • 5. Spinous Process
  21. Spine Characteristics
    • 1. Rigid without V-Disks and Z-Joints
    • 2. Respiration not possible without spine = serves as pivot point for arclike movement of ribs
  22. Intervertebral Joints
    Characteristics
    • 1. Amphiarthrodial
    • 2. IV Disks in joint space
    • 3. Provide spinal stability, flexability, movement
  23. Zygapophyseal Joints
    Characteristic
    • 1. Four Articular Processes projecting from area of junction of Pedicles and Lamina
    • 2. Sometimes refered to as Facets
  24. Costal Joints
    • 1. Thorasic region
    • 2. 12 ribs articulate with transverce processes
  25. Intervertebral Foramina
    Characteristics
    • 1. Upper surface each Pedicle has half moon shaped area (Superior Vertebral Notch)
    • 2. Lower surface each Pedicle has half moon shaped area (Inferior Vertebral Notch)
    • 3. When stacked, 2 half moons form single opening (Intervertebral Foramen)
    • 4. Every 2 Vertebra = 2 IV Foramina (1 on each side)
    • 5. Spinal nerves and blood veels pass through
  26. Intervertebral Disks
    • 1. Between every 2 Vertebrae except C1-C2
    • 2. Each disk has outer fibrous portion (Annulus Fibrosus)
    • 3. Each disk has inner part semigelatinous (Nucleus Pulposus)
  27. Intervertebral Disks
    Injury
    • 1. When inner protrudes through outer
    • 2. Presses on Spinal Cord
    • 3. Causes pain / numbness and radiates lower limbs
    • 4. This is called Slipped Disks / Herniated Nucleus Pulposus (HNP)
  28. Cervical Spine
    Characteristics
    • 1. Transverse Foramina
    • 2. Bifid Spinous Process Tips
    • 3. Overlapping Vertebral Bodies (anteriorly)
  29. Cervical Spine
    Typical C-Spine Vertebra
    • 1. C3-C6
    • 2. C7 more like T-Spine (long horizontal process)
  30. Cervical Spine
    Superior View
    • 1. Transverse (hole) Foramen in each Transverse Process
    • 2. Vertebral artery / vein and nerves pass through
    • 3. 3 Foramina run vertically (L&R Transverse Foramin and Vertebral Foramina)
    • 4. C2-C6 Spinous Process = short bifid tip
  31. Cervical Spine
    Lateral View
    • 1. Vertebral bodies = small and oblong
    • 2. Anterior edge more inferior causing slight overlapping of bodies (tipped forward)
    • 3. Cervical Articular Processes (Superior and Inferior) = posterior to Pedicle / anterior to Lamina
    • 4. Articular Pillar (Lateral Mass) = Between Superior and Inferior Articular Processes
  32. Cervical Spine
    Zygapophyseal Joints
    • 1. Located between Superior / Inferior Articular Processes
    • 2. Located over / under Articular Pillars
    • 3. C2-C7 = 90* to midsagittal
    • 4. Visualized only on true AP projection
  33. Cervical Spine
    Intervertebral Foramina
    • 1. Located at 45* angle to midagittal plane
    • 2. Open anteriorly
    • 3. Directed at 15* Inferior angle
    • 4. 45* Oblique with 15* Cephalad CR angle
  34. Cervical Spine
    Atlas (C1)
    • 1. No body, thisk Arch (Anterior Arch) and anterior tubercle
    • 2. Transverse Atlantal Ligament holds "Dens" from C2 in place
    • 3. Posterior Arch with small posterior tubercle
  35. Cervical Spine
    Atlas (C1)
    Superior Facet
    • 1. Superior Articular Processes (Facet) articulate with skull
    • 2. Atlantooccipital Articulations
    • 3. Occipital Condyles
  36. Cervical Spine
    Atlas (C1)
    Transverse Process
    1. Small but still contain Transverse Foramina
  37. Cervical Spine
    Axis (C2)
    • 1. Contains Dens (Odontoid Process)
    • 2. Acts as pivot point
  38. Cervical Spine
    Basic Projections
    • 1. AP Axial
    • 2. AP Open Mouth
    • 3. L&R Obliques
    • 4. Lateral
  39. Cervical Spine
    AP C-Spine X-Ray
    • 1. C1-C2 not visible
    • 2. C3-C7 visible
    • 3. T1 with 1st rib attached to Spinous Process
    • 4. Spinous Process small white spot on vertebral body
  40. Cervical Spine
    Lateral C-Spine X-Ray
    • 1. Single most important view
    • 2. C1-C7 and T1 visible
    • 3. All processes
    • 4. Anterior bodies with lipped front edge
    • 5. Dens visible
    • 6. Zygapophyseal Joints visible
    • 7. C1 Arch and C7 Body
  41. Cervical Spine
    Oblique C-Spine X-Ray
    • 1. C2-C7 IV Foramina
    • 2. C1 posterior arch and tubercle
    • 3. C3-C7 Pedicles
    • 4. C2-C7 vertebral bodies
  42. Cervical Spine
    Joints / Foramina
    • 1. Zygapophyseal Joints 90* to midsagittal plane (L&R Lateral projections)
    • 2. Intervertebral Foramina 45* anterior to midsagittal plane (L&R Oblique projections)
  43. Cervical Spine
    Joints / Foramina
    45* Oblique
    • 1. LPO = Right Foramen = Upside = 15* Cephalad
    • 2. RPO = Left Foramen = Upside = 15* Cephalad
    • 3. LAO = Left Foramen = Downside = 15* Caudad
    • 4. RAO = Right Foramen = Downside = 15* Caudad
  44. Cervical Spine
    Landmarks
    • 1. C1 = Mastoid Process (tip) or 1" below EAM
    • 2. C3 = Gonion
    • 3. C5 = Thyroid Cartilage (C4-C6)
    • 4. C7 = Spinous Process (Vertebral Prominens)
    • 5. T1 Body = Spinous Process
  45. Thyroid Dose
    Reduce
    Use L/RAO rather than L/RPO
  46. Cervical Spine
    Technical Factors
    • 1. kV = 70-80
    • 2. Small focal spot
    • 3. SID = 60-70"
  47. Cervical Spine
    Pathologies
    Myelography
    • 1. Fluoroscopic exam with contrast for lesions in Spinal Canal, Disks, or Nerve roots
    • 2. MRI and CT are replacing
  48. Cervical Spine
    Pathologies
    Clay Shoveler's Fracture
    • 1. Hyperflexion of neck
    • 2. Avulsion fractures on C6-T1
    • 3. Lateral projection is best
  49. Cervical Spine
    Pathologies
    Hangman's Fracture
    • 1. Fracture through Pedicles of C2
    • 2. Extreme hyperextension
    • 3. Lateral projection is best
  50. Cervical Spine
    Pathologies
    Jefferson's Fracture
    • 1. Landing on head (Axial loading)
    • 2. Comminuted fractures
    • 3. A&P Arches of C1 fractured as skull slams into ring
    • 4. AP Open Mouth and Lateral projections are best
  51. Cervical Spine
    Pathologies
    Odontoid Fracture
    • 1. Involves "Dens" and Lateral Masses or Arches of C1
    • 2. AP Open Mouth is best
  52. Cervical Spine
    Pathologies
    Teardrop Burst Fracture
    • 1. Compression with hyperflexion
    • 2. Body is comminuted with triangular fragments into Spinal Canal
    • 3. Neurological damage high probability
    • 4. AP and Lateral projections are best followed up with CT Scan
  53. Use of higher KV and thicker/dense tissue =
    Increased Scatter - How control
    • 1. Close collimation
    • 2. Lead blocker on table top behind patient
    • 3. Grid
  54. What does Collimation Reduce
    Production of Scatter
  55. Lead Blockers / Grid
    Prevent
    Scatter from reaching IR
  56. Osteoporosis
    • 1. Loss of bone mass
    • 2. Bone Densitometry = Gold standard for measuring
    • 3. Decrease Technical Factors
  57. Scheuermann's Disease
    • 1. During Adolesence
    • 2. Abnormal spinal curvature of Kyphosis / Scoliosis
    • 3. More common in boys
  58. Ankylosing Spondylitis
    • 1. Affects males 20-40
    • 2. Pain, Stiffness, Inflammation of spine & rib joints
    • 3. Paraspinal calsification, ossification / ankylosis (union of bone) of spinal joint
    • 4. May cause complete rigidity of spine and thorax
  59. AP Open Mouth
    Projection (of what)
    • 1. C1-C2 Fractures including Odontoid and Jefferson Fractures
    • 2. If upper Dens can't be demonstrated, use Fusch or Judd Method
  60. AP Open Mouth
    Structures Visible
    • 1. Dens, C2 Body, Lateral Mass C1
    • 2. Z-Joints between C1-C2 Clearly Seen
  61. AP Open Mouth
    Position Errors
    • 1. Upper Incisors superimposed on base of skull (Perfect Image)
    • 2. If teeth on Dens = Skull flexed = slight hyperextension to fix
    • 3. If base of skull on Dens = skull extended = slight hyperflexion to fix
  62. AP Axial
    Projection (of what)
    • 1. C3-C7, Clay Shoveler's Fracture
    • 2. Compression fractures
    • 3. Herniated Nucleus Pulposus (HNP)
  63. AP Axial
    Position Characteristics
    • 1. Adjust head so line from Occlusal (chewing surface) plane to base of skull is perpendicular to IR
    • 2. Line from tip of Mandible to base of skull parallel to CR angle
    • 3. CR = 15* when Supine, 20* when Erect
    • 4. C3-T2-T3 Vertebral Bodies, Space between Pedicles and IV Disk Space
  64. A&P Oblique
    Projection (of what)
    • 1. Stenosis of IV Foramina
    • 2. Shoot L&R Oblique for comparison
    • 3. AO preferred to reduce Thyroid/Brest Dose
  65. A&P Oblique
    Structures Visible
    • 1. AO = IV Foramina and Pedicles on Downside
    • 2. PO = IV Foramina and Pedicles on Upside
    • 3. AO/PO = IV Disk/Foramina C2-C7 open, Pedicles in full profile (45*)
  66. A&P Oblique
    Positioning Characteristics
    • 1. Erect position preferred
    • 2. AO = 15* Caudad to C4 (upper margin of Thyroid)
    • 3. PO = 15* Cephalad to C4 (lower margin of Thyroid)
  67. A&P Oblique
    Position Errors
    • 1. Z-Joints visible = Overrotation
    • 2. Obscured IV Foramina / Pedicles = Underrotation
    • 3. Ramus of Mandible must be out of way
    • 4. Base of Skull out of way
  68. Lateral
    Projection (of what)
    • 1. Spondylosis and Osteoarthritis
    • 2. Erect position preferred
  69. Lateral
    Structures Visible
    • 1. C-Spine Vertebral Bodies
    • 2. IV Joint Space
    • 3. Articular Pillars
    • 4. Spinous processes and Z-joints
  70. Lateral
    Position Characteristics
    • 1. Top of IR needs to be 1" above EAM
    • 2. Extend chin forward to prevent superimposition of mandible on upper v-bodies
    • 3. CR perp to IR to C4 at 72"
    • 4. Full expiration for full shoulder depression
  71. Lateral
    Position Errors
    • 1. If C7-T1 not visible = use Swimmer's Method
    • 2. Raise chin = no mandible on C1-C2
  72. Cervicothorasic
    (Swimmer's) Lateral
    (Twining Method)
    • 1. C4-T3 area
    • 2. Compression fractures and sublaxation
    • 3. Use when C7-T1 not on Lateral
    • 4. May angle 3-5* Caudad to separate shoulders
  73. Fusch AP or Judd PA
    • 1. Dens and C1 Ring and Foramen Magnum
    • 2. CR = inferior tip of mandible in line w/ EAM or MML
    • 3. MML = perp to table / IR, CR parallel
  74. AP Axial (Pillars)
    • 1. Posterior Vertebral Arch C4-C7
    • 2. Check for Whiplash C-T Vertebral Spine
    • 3. CR = 20-30* caudal to lower thyroid (40")

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