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L spine and etc… No running with Keys!. Ouch!. X-table lateral Skull. Routine films L-S spine. AP AP axial RPO & LPO Lateral Lateral sacrum/coccyx **Cone down view of L5-S1 **May not need to do if space is open on lateral films. AP L-Spine. Arrows demonstrating

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l spine and etc no running with keys
L spine and etc… No running with Keys!

Ouch!

X-table lateral

Skull

routine films l s spine
Routine films L-S spine
  • AP
  • AP axial
  • RPO & LPO
  • Lateral
  • Lateral sacrum/coccyx
  • **Cone down view of L5-S1 **May not need to do if space is open on lateral films
ap l spine
AP L-Spine

Arrows demonstrating

spina bifida

structures shown
Structures shown:
  • AP of T-12 and all five lumbar to Sacrum
good film
Good Film:
                • Cone to the lateral margins of psoas muscles
                • Rotation? –

- The SI jnts should be equal distance from the

vertebral column

-Spinous processes in the center of spine

  • No artifacts elastic in pants, bra, belly rings
  • Good exposure do you see bony detail and

tissue(can you see the psoas muscle?)

  • Open intervertebral joints
  • Are they on the film?5 lumbar bodies, intervertebral disk space, spinous and transverse processes
structures shown1
Structures Shown
  • Lumbosacral junction open and both SI jnts
good film1
Good film
  • The lumbosacral junction and sacrum should be seen without rotation
  • Both SI jnts free from superimpositions from the pubis (did you angle enough?)
  • Open intervertebral space between L5-S1
  • *** check protocols at clinical site to see if they do this view
oblique
Oblique

RPO

L-S Spine

scotty
Scotty

**

1.Superior articular process.

2. Pedicle

3. Inferior articular process

4. Pars interarticularis

5.Transverse process

6. Lamina ( Scotty\'s body)

6.

**

**Zygapophyseal joint is between one of Scotty’s feet and another Scotty’s ear they are also called facet joints or apophyseal joints

rpo lpo
RPO/LPO:
  • Shows the (Superior/Inferior) articular processes and the zygapophyseal joints of the side closest to IR :So in the RPO position the right side is down . It will demonstrate the right zygapophyseal joint (the one closest to the IR) and the right articular processes open
  • Always do both obliques for comparison of both sides
structures shown2
Structures shown
  • All five lumbar and the zygapophyseal joints closest to the IR open
good film2
Good Film:
  • All 5 lumbar and top of sacrum on the image
  • The zygapophyseal joints closest to the IR- open
  • When the joint is not well demonstrated and the pedicle is anterior on the vertebral body, the patient is not rotated enough, and when the pedicle is posterior on the vertebral body, the patient is rotated too much
  • Check site protocols:*** SI joint on ? ,3-5 lumbar on, all five on no SI jnts on….
slide15
Rotation: Roll up more or less?the pedicle (eye) is anterior on the vertebral body, the patient is not rotated enough

Posterior

*

Posterior

Anterior

LPO

slide16
Rotation: Roll up more or less?Pedicle is posterior on the vertebral body, the patient is rotated too much.

Posterior

*

LPO

L

L

structure shown
Structure Shown:
  • All 5 lumbar bodies and the their interspaces, the spinous processes, the lumbosacral junction
good film3
Good Film:
  • All 5 lumbar and top of sacrum in the lateral projection
  • Open intervertebral disk spaces and intervertebral foramina
  • The posterior margins of each vertebral body should be superimposed
  • Spine down center of the film
  • Iliac crests superimposed
  • Spinous processes in profile and on the film
rotation
Rotation

Left Lateral L-S Spine

slide26

Angle? B, The interiliac (IL) line is perpendicular, and the central ray (CR) is perpendicular. C, Typical lumbar spine curvature if pts has big hips. Angle the CR caudal and parallel to the IL. D, Typical lumbar spine position in a patient with big shoulders. The IL demonstrates that the CR must be angled cephalic to open the joint space

C

structures shown3
Structures shown:
  • All of 5th lumbar vertebrae, and the upper sacrum with a open lumbosacral joint.
good film4
Good Film:
  • The lumbosacral joint should open and in the center of the film
  • Coned well- all of the 5th lumbar on and the top of the sacrum on the image
  • Iliac crest superimposed (rotation) (postion)
slide29
Open?

Big hips angle

down

routine views
Routine Views:
  • Sacrum/Coccyx
  • AP axial
  • Lateral
structures shown4
Structures Shown
  • The entire sacrum free of superimposition
good film5
Good film:
  • The pubic bones should not overlap the sacrum
  • No foreshortening (angle 15 degrees up)
  • Good even contrast
  • No rotation
  • Sacrum centered to film
  • Good collimation
  • Fecal material should not overlap the sacrum
slide35
Here is a list of some of physical traumas that tailbone sufferers have experienced and reported from Tailbone.com:

Auto Accident, rear-end collisionAuto Accident, vertical fall from a cliffChild birth (vaginal) deliveryDead-lifting of heavy weights or barbellsFall on the buttocks down the stairs or laddersFall on the buttocks during Cheerleading Stunts (Throw & catch or Pyramids) Fall on the buttocks during gymnastics on a balance beam Fall on the buttocks during ice skatingFall on the buttocks during roller blading or in-line skatingFall on the buttocks during roller skatingFall on the buttocks during skiingFall on the buttocks during snow boardingFall on the buttocks from a swingFall on the buttocks in a bath tubFall on the buttocks in a bathroomFall on the buttocks on a frozen sidewalkFall on the buttocks on a oily or greased floorFall on the buttocks while skate boardingHorseback riding or falling from a horseMartial Art accidental contact with buttocksProlonged sittingSexual intercourseSitting during PregnancySitting on a bicycle seat with gel paddingSitting on a broken car seat or office chairSitting on a thinly padded bicycle seatSitting on hard surfaces such as stadium bleachersSlip and fall on a hard slippery/wet tile floorSports injury, accidental kick in the buttocksStraddle injury on a fence top or tree limbWater slide drops and jumps

structures shown5
Structures Shown
  • The whole coccyx and distal sacrum free of superimposition
good film6
Good Film
  • The coccygeal segments should not be superimposed by pubic bones (angle)
  • Good even contrast
  • Coccyx should be centered to film and seen in its entirety
  • No rotation
  • Good collimation
  • Do they need to use the

restroom?

structures shown6
Structures Shown
  • The lateral aspect of the entire sacrum and entire coccyx (**for L-S spine it is okay to clip coccyx)
good film7
Good Film:
  • The sacrum and coccyx should be seen clearly with even contrast
  • Good collimation
  • Superimposed iliac crest
si joints
SI joints
  • AP Axial (same as “up shot” on L-S spine)
  • RPO/LPO
ap axial si joints
AP Axial SI joints

Same as AP axial for L-S spine Junction

structures shown7
Structures shown:
  • Shows the sacroiliac joint farthest from the IR and an oblique projection of the adjacent structures

**Always do both obliques for comparison

good film8
Good Film:
  • Open SI joint space with minimal overlapping of the ilium and sacrum
  • Joint centered on the film
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