L spine and etc no running with keys
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L spine and etc… No running with Keys! PowerPoint PPT Presentation


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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!

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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


  • Ap axial ferguson method

    AP AXIAL (Ferguson Method)


    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….


    Rpo lpo for the zygapophyseal joints or the interarticular processes

    RPO/LPOfor the zygapophyseal joints or the interarticular processes

    LPO

    RPO


    L spine and etc no running with keys

    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


    L spine and etc no running with keys

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

    Posterior

    *

    LPO

    L

    L


    Lateral

    Lateral


    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


    L spine and etc no running with keys

    What?


    Rotation

    Rotation

    Left Lateral L-S Spine


    Tube angle or build patient up

    Tube angle or build patient up


    Lateral sacrum we go over this later with sacrum coccyx

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


    Coned down

    Coned Down


    Lateral l5 s1

    Lateral L5-S1


    L spine and etc no running with keys

    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)


    L spine and etc no running with keys

    Open?

    Big hips angle

    down


    Routine views

    Routine Views:

    • Sacrum/Coccyx

    • AP axial

    • Lateral


    Ap axial sacrum

    AP Axial Sacrum


    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


    Ap axial coccyx

    AP Axial coccyx


    L spine and etc no running with keys

    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?


    Lat sacrum coccyx

    Lat. Sacrum/coccyx


    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


    Rpo lpo si joints

    RPO/LPO SI joints

    R

    L

    LPO

    RPO


    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


    Final tuesday dec 7 th 2011 7 30 9 30

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


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