Download b. lateral

Positioning I
Vertebral Column
Quiz:
Vertebral Column anatomy: Pgs. 374-387 Vol. 1 Ch. 8 Merrill’s
External Landmarks Table 3-1 Pg. 63 Merrill’s
I.
CERVICAL SPINE
Upright Lateral: Grandy Method
AP Axial
RPO Axial
LPO Axial
AP Atlas/Axis
A. LATERAL Pg. 400, 401
Lateral is to be taken UPRIGHT whenever possible: Grandy Method Pg. 422-3
MUST include all 7 cervical vertebrae and at least the top of T1
or take lateral PAWLOW method: see thoracic spine protocols
Field Size: 8 x 10 or 10 x 12 Bucky
SID: 72 inches
kVp: 70
respiration: expiration in order to depress the shoulders
CR: directed horizontally to C-4 and centered to the cassette
which has been placed with the top edge approx. 1 inch
above the EAM
Patient seated or standing with the cassette in an upright cassette holder or in the
wall bucky. The adjacent shoulder is against the cassette or bucky with the pt. In
the true lateral position. Elevate the chin slightly to prevent superimposition of
the mandible over the spine. Depress the shoulders and rotate them either
anteriorly or posteriorly. Place equal weights in each of the pt’s hands in order
to pull down on the shoulders.
Alternate positon: for severe trauma patient on backboards/in collars/ not allowed to be upright
DO THIS VIEW FIRST WITHOUT MOVING THE PATIENT!
Cross-table Lateral (dorsal decubitus) position
1.
2.
3.
Vol. II Pg. 35
Take film without moving patient from the backboard & without removing collar
Film is read by a radiologist
If the film is negative you must receive a written order from the referring physician or ER
doctor in order to remove the collar and move the patient from the backboard in order to
complete the remainder to the protocol
Patient remains supine on the stretcher/backboard. Leave the cervical collar on (check for jewelry
that may be hidden by the collar). Place the cassette or bucky adjacent to the patient’s shoulder. It may be
necessary to pull the patient’s shoulders down. Use the same technical factors as for the upright lateral.
If all 7 cervical vertebrae plus at least the top of T1 are not visualized then an additional X-table
(dorsal decubitus) in the “swimmer’s” position will be required. Vol. II Pg. 36
Hyperflexion/hyperextension views
Pgs. 402, 403
TAKEN ONLY ON REQUEST.
Must NOT be taken until pathology/fracture has been ruled out on the neutral lateral view
Patient in upright lateral position as for routine lateral C-spine
Same technical factors as routine lateral C-spine
Hyperflexion: have the patient drop his head forward and draw chin as close to the chest as
possible
Hyperextension: have the patient elevate his chin as much as possible
Mark the film, indicating flexion & extension
B.
AP Axial Pgs. 398, 399
Field Size: 8 x 10 Bucky
kVp: 70
Respiration: suspended
CR: 15-20 degrees cranial entering at approx. C-4
C. AP of Atlas and Axis (Open-mouth method) Pgs. 393, 394
Field Size: 8 x 10 Bucky
kVp: 70
CR: perpendicular to the midpoint of the open mouth.
Adjust the head so that a line from the lower edge of the
upper incisors to the tip of the mastoid process is perpendicular to the plane of the film.
Respiration: suspended
(note: Merrill’s recommends phonation (ah-h-h-h) to affix the
tongue to the floor of the mouth)
D.
AP Axial Obliques:
RPO and LPO Pgs. 404, 405
Field Size: 8 x 10 Bucky
kVp: 70
Respiration: suspended
Position the patient in a 45 degree oblique and center
the cervical spine to the midline of the table
CR: 15-20 degrees cranial, entering at approx. C-4
AP Axial Obliques: the foramina farthest from the film are demonstrated;
RPO demonstrates left foramina
LPO demonstrates right foramina
(Note: some depts. allow or prefer prone obliques—RAO/LAO—Rockwood
Clinic prefers UPRIGHT RAO/LAO when possible)
II.
THORACIC SPINE
AP
LATERAL
PAWLOW
A. AP
Pgs. 415-417
Patient is supine on the table with midsagittal centered
Field Size: 7 x 17 Bucky
CR: perpendicular to T-7 (halfway between jugular notch and xiphoid process)
Respiration: expiration for more uniform density
kVp: 80
Note: because of the varying densities in the thoracic region it may be necessary
to take an additional 8 x 10 or 10 x 12 of the upper thoracic region if it is
too dark—or of the lower thoracic region if it is too light
B.
LATERAL Pgs. 418-420
Patient in true lateral position, placing the midaxillary line of the body to the midline of the table; adjust the vertebral column so it is horizontal to the table by
placing sponges under the lower thoracic spine OR use the tube angulation method
to compensate (average: 10 degrees cranial for females and 15 degrees cranial
for males)
Field Size: 14 x 17 Bucky
CR: perpendicular or angled to T7
Respiration: quiet breathing
kVp: 70
C. PAWLOW METHOD—cervicothoracic region—lateral projection Pgs. 413, 414
Patient positioned in lateral “swimmer’s” position
Field Size: 8 x 10 Bucky
CR: angled 3-5 degrees caudally to the level of T2-3 (Note: T2-3 for upper thoracic
Respiration: suspended
C7-T1 for lower cervical)
kVp: 75
NOTE: MONDA modification of Pawlow: angle 5-15 degrees cranial
III.
THORACOLUMBAR SPINE
AP
Lateral
A.
AP
Field Size: 7 x 17 Bucky
CR: perpendicular to T12-L1
Respiration: suspended
kVp: 70
B.
LATERAL
Field Size: 14 x 17 Bucky
CR: perpendicular to T12-L1
Respiration: suspended
kVp: 80
IV.
LUMBOSACRAL SPINE
AP
AP AXIAL
RPO & LPO
LATERAL
LAT. SACRUM/COCCYX
LAT L5/S1 if not wellvisualized
A.
AP pgs. 424-427
Field Size: 7 x 17 Bucky
CR: perpendicular to the level of the iliac crests (L4)
Respiration: expiration
kVp: 70
B.
AP AXIAL—Lumbosacral Junction pgs. 436,437
Field Size: 10 x 12 Bucky LW
CR: 30-35 degrees cephalad
Enters 1.5 inches superior to symphysis pubis
Respiration: suspended
kVp: 70
C.
AP Oblique
RPO & LPO—zygapophyseal joints: AP Oblique positions
Pgs. 432 ,433
Field Size: 10 x 12 Bucky LW
CR: 2 inches medial to elevated ASIS and 1.5 inches superior to iliac crest
OBLIQUE the patient 45 degrees, centering the spine to the
midline of the table
Respiration: suspended
kVp: 70
D.
LATERAL pgs 428,429
Position the patient in the true lateral position (either lateral, most techs take
left laterals for tech convenience) and center the midaxillary line to the center of
the table with the patient in the true lateral position. Adjust the spine so that it is
horizontal to the table (or utilize the tube angulation method to compensate for the
angulation of the spine.)
Field Size: 14 x 17 Bucky
CR: perpendicular to the level of the iliac crests
or angled: average: 5 degrees caudal for males/8 degrees caudal for
females
Respiration: expiration
kVp: 80
E.
LATERAL SACRUM/COCCYX Pg. 446,447
Pt. in true lateral position
Field Size: 10 x 12 Bucky LW
CR: perpendicular to a point slightly inferior & 3.5 inches posterior to
the ASIS
Respiration: suspended
kVp: 80
Additional lateral cone-down of the L5-S1 junction if the junction is not wellvisualized and “OPEN” on one of the routine laterals Pgs. 430,431
Field Size: 8 x 10 Bucky-----CONE DOWN or use extension cone
Respiration: suspended
kVp: 85
With the patient in the true lateral position the CR is perpendicular or angled* as
needed to “open” the L5-S1 junction, entering a point 2 inches posterior to ASIS
& 1.5 inferior to iliac crest
*average 5 degrees caudal for males/ 8 degrees caudal for females
Using lead stripping is helpful to reduce scatter radiation on the lateral projections—place
a lead rubber strip on the table, posterior to the patient. This will absorb the scatter
radiation. Close collimation is also necessary.
V.
Lumbar Bending Series---Hyperflexion, Hyperextension & Bending
Pgs. 454-457
AP with Right Bending
AP with Left Bending
Lateral Hyperflexion
Lateral Hyperextension
Upright whenever possible!
Field Size: 10 x 12 Bucky LW
CR: perpendicular to L5
Respiration: suspended
kVp: AP—70
Lat—80
#1—AP with maximum bending to the right
#2—AP with maximum bending to the left
#3—Lateral with maximum flexion
#4—Lateral with maximum extension
(May be taken in any order—Mark the films with arrows indicating the direction of the movement.
The degree of bending, flexion or extension should not
be forced)
This method of examination is used to localize a herniated disk as shown by limitation of motion at
the level of the lesion. Also is used to determine the degree of motion in an area of a fusion
VI.
SACRUM
AP Axial
Lateral
VII. COCCYX
AP Axial
Lateral
NOTE: (if sacrum and coccyx are both ordered
then do both AP axials and one lateral of both)
A. AP Axial Sacrum Pg. 444
Field Size: 8 x 10 Bucky LW
CR: 15 degrees cephalad entering 2 inches superior to symphysis pubis
Respiration: suspended
kVp: 70
B. AP Axial Coccyx Pg. 445
Field Size: 8 x 10 Bucky LW
CR: 10 degrees caudally entering 2 inches superior to symphysis pubis
Respiration: suspended
kVp: 70
B. Lateral of both Pg. 446 ,447
Field Size: 10 x 12 Bucky LW
Patient is positioned in true lateral position, centering the body so that
the coronal plane passing 3” posterior to the midaxillary line is centered
to the table
CR: perpendicular to the ASIS or slightly below to demonstrate
the sacrum and coccyx
kVp: 80
respiration: suspended
VIII.
SACROILIAC JOINTS
AP Axial
RPO & LPO
A. AP Axial
(Same as AP axial for L/S junction)
B. RPO & LPO
pgs. 438,439
Field Size: 8 x 10 Bucky LW
Oblique the patient 25-30 degrees
Align the body so that the sagittal plane passing
1” medial to ASIS of elevated side is centered
CR: perpendicular to the level of the elevated
ASIS and 1” medial
Respiration: suspended
kVp: 70
Note: demonstrates the SI joint on the “UP” side
RPO demonstrates LEFT SI JOINT
LPO demonstrates RIGHT SI JOINT