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Chapter 9/19 Sacrum/Coccyx Sacrum • 5 fused vertebrae • 4 sets of ________________ – Pelvic (Anterior) & Posterior Sacrum • _________ – Wings of sacrum • Superior articulating process – ______________formed with 5th l-spine vertebra inferior articulating process Sacrum • _____________ – Anterior protrusion • _____________ – Continuation of vertebral Foramen Sacrum • ________________ – Fused spinous processes • _______________ – Joint surface of SI joint • ______________ – Inferior articulating process Coccyx • Tailbone • ___________coccyx segments • Most distal aspect of spinal column Coccyx • Transverse process • _________ • _________ • Larger at the base and cones toward apex Imaging the sacrum Routine • AP • Lateral • 80 kVp AP Sacrum • Pt supine • _____________tube angle • Between _________________ • CR mid sagittal and _________to ASIS Lateral Sacrum • Pt in true lateral • Flex knees • CR at the __________and __________to posterior sacral surface • Or _____________to ASIS Imaging the Coccyx Routine • AP • Lateral • 75 kVp AP Coccyx • Pt supine • ___________angle • _____________to Symphysis Pubis • CR Mid sagittal and ______________ Lateral Coccyx • • • • • Pt in true lateral Knees flexed ______________to ASIS ______________to ASIS Collimate Close all 4 sides Chapter 19 _____________ Myelogram Myelogram • Study to look at spinal cord and nerves root branches • Indications – _____________ – ____________________ Myelogram • Requires an injection into the ________________ • Menenges – Dura Mater – _________ – Pia Mater Contraindications • Sensitivity to Iodine • Blood in ___________ • Arachnoiditis • Increased _____________ • Recent _________ Equipment • Myelogram tray • X-ray table that can ______________ – Foot board – Shoulder holder • X-table cassette holder Equipment • _______ • X-table holder • Pillow for abdomen • ______________________ Contrast • Water Soluble – ___________ • Marked for ____________ Use Injection • X-table and AP scout • Done by radiologist • Lumbar – ________ – Through ______________ Injection • Cervical – _______________bone • Injected _____________to avoid excessive mixing of contrast and _____ Lumbar injection • Generally ___________ – Spinal cord branches and not solid • Pt prone – Pillow ____________to open disc spaces • Lt Lateral with spine __________ • Sterile Cervical Injection • Done if Lumbar is contraindicated • Pt sitting ________ with neck _________ • Or pt __________ with neck flexed • Contrast should not enter _________ – ___________the neck What happens • A ___________is done first – Evaluates appearance of CSF (blood present) • Contrast injected – Make sure it is __________use What Happens • Needle is removed • Pt is tilted _________________________ – By gravity contrast is spread through the spinal canal Imaging • __________ has taken over • Cervical – X-Table, X-table swimmers • Thoracic – Lateral, X-Table, AP/PA • Lumbar – Semierect X-Table, X-table lateral, AP/PA, Obliques Post Exam Care • Bandage the injection site • Place pt semi erect _______________. • Restricted to the bed. Complications • • • • Air into the ____________ of the brain Spinal needle irritating nerves Excessive ______________ bleeding Contrast into ventricular areas – Can cause _______________ • Reaction to contrast
