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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. 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!

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  1. L spine and etc… No running with Keys! Ouch! X-table lateral Skull

  2. 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

  3. AP L-Spine Arrows demonstrating spina bifida

  4. Structures shown: • AP of T-12 and all five lumbar to Sacrum

  5. 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

  6. AP AXIAL (Ferguson Method)

  7. Structures Shown • Lumbosacral junction open and both SI jnts

  8. 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

  9. Oblique RPO L-S Spine

  10. 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

  11. 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

  12. Structures shown • All five lumbar and the zygapophyseal joints closest to the IR open

  13. 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….

  14. RPO/LPOfor the zygapophyseal joints or the interarticular processes LPO RPO

  15. 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

  16. Rotation: Roll up more or less?Pedicle is posterior on the vertebral body, the patient is rotated too much. Posterior * LPO L L

  17. Lateral

  18. Structure Shown: • All 5 lumbar bodies and the their interspaces, the spinous processes, the lumbosacral junction

  19. 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

  20. What?

  21. Rotation Left Lateral L-S Spine

  22. Tube angle or build patient up

  23. Lateral Sacrum (we go over this later with sacrum/coccyx)

  24. Coned Down

  25. Lateral L5-S1

  26. 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

  27. Structures shown: • All of 5th lumbar vertebrae, and the upper sacrum with a open lumbosacral joint.

  28. 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)

  29. Open? Big hips angle down

  30. Routine Views: • Sacrum/Coccyx • AP axial • Lateral

  31. AP Axial Sacrum

  32. Structures Shown • The entire sacrum free of superimposition

  33. 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

  34. AP Axial coccyx

  35. 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

  36. Structures Shown • The whole coccyx and distal sacrum free of superimposition

  37. 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?

  38. Lat. Sacrum/coccyx

  39. Structures Shown • The lateral aspect of the entire sacrum and entire coccyx (**for L-S spine it is okay to clip coccyx)

  40. Good Film: • The sacrum and coccyx should be seen clearly with even contrast • Good collimation • Superimposed iliac crest

  41. SI joints • AP Axial (same as “up shot” on L-S spine) • RPO/LPO

  42. AP Axial SI joints Same as AP axial for L-S spine Junction

  43. RPO/LPO SI joints R L LPO RPO

  44. Structures shown: • Shows the sacroiliac joint farthest from the IR and an oblique projection of the adjacent structures **Always do both obliques for comparison

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

  46. Final Tuesday Dec 7th 2011 7:30-9:30

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