Presentation on theme: "1 2 TECHNICAL ASPECTS A moving or a stationary grid must be used. Relatively high kV is used, range is (80 - 95) KVp, (95 -100) kVp for lateral L/S)"— Presentation transcript:
2 TECHNICAL ASPECTS A moving or a stationary grid must be used. Relatively high kV is used, range is ( ) KVp, ( ) kVp for lateral L/S) to increase exposure latitude and reduces patient’s dose. All part supports and pads mentioned are radiolucent. The anode heel-effect must be observed, with anode at the head side (a wedge-filter or graduated screens can be used instead) to produce overall uniform spine density. Radiosensitive areas must be well covered by shields. Collimation must be strictly applied in all projections to improve image contrast and reduce patient’s dose and amount of scatter. Optimal density and contrast are necessary for an optimal image quality.
3 AP thoracic (dorsal) spine B AP thoracic (dorsal spine): For #s and pathology (compression, kyphosis, and subluxation). Patient supine with head under anode side to observe the heel- effect, both knees and hips flexed and arms stretched by the side. Exposure at end of arrested expiration to reduce volume of air in thorax for more uniform density of whole dorsal vertebrae. Film: HD 35x43 cm, lengthwise. CP: T inches ( 3 – 5 cm) below the sternal angle, or 3 -4 inches ( 8 – 10 ) cm below jugular notch) as for the PA chest. CR: 90 Vertically to the thoracic spine
4 Lateral thoracic (dorsal) spine B Lateral thoracic spine: For pathology (compression, kyphosis, or subluxation). Patient in a lateral recumbent, both knees flexed and arms stretched at right angles, waist supported, anode heel-effect should be well observed. Exposure at end of arrested expiration, or during quiet breathing using low mA and long exposure time (3 - 4 s) to diffuse the lung and ribs shadows. A lead blocker sheet near patient’s back helps stop scatter rays from reaching the film, thus improves image quality. Film: HD 35x43 cm, lengthwise. CP: T7 CR: 90 Vertically to the thoracic spine
6 PAO (or APO) thoracic spine S Zygapophyseal joints of the thoracic spine. Patient in a lateral recumbent or in lateral erect, body rotated 20 from true lateral, arm nearest couch must be down, arm nearest tube must be up and forward. Exposure at end of suspended full expiration. Film: HD 35x43 cm. Lengthwise. CP: T7. CR: 90 to film center.
7 AP lumbar spine B For #s, pathology (scoliosis and neoplastic processes of the thoracic spine). Patient supine or erect, knees flexed with soles of feet on the couch top, arms at the sides or on the chest, exam can be done in the erect position, exposure must be during a quiet breathing at low mA and long exposure time to diffuse colonic gas shadows. Exposure at end of full expiration. Film: HD 35x43 cm. Lengthwise. CP: Large film (35x43) cm: L4 – L5 (level of iliac crest). Small film (30x35) cm: L3 (level of lower costal margins). CR: 90 to film center.
spinous process L 5 sacroiliac joint 8
9 Lateral Lumbar Spine B Lateral lumbar vertebral bodies, spinous processes, L5 – S1 junction, and sacrum. Rules-out compression # of lumbar bodies. Patient in a lateral recumbent, knees flexed, support between knees and ankles, pad under the waist, a piece of lead rubber behind the lumbar region on couch top to improve contrast (by absorbing scatter). Exposure at end of arrested expiration. Film: HD 35x43 cm CP: Large film: L4 – L5 (level of iliac crest). Small film: L3 (level f lower costal margins). CR: 90 V to center of film NB/ Lateral for trauma can be done with patient in (supine decubitus), with same CP and horizontal beam.
L5-S1 joint sacrum 10
11 AP axial lumbosacral joint (L5-S1) S For pathology of AP (L5 – S1) articulation and AP sacro -iliac joints. Patient supine, legs extended, both knees flexed slightly over support, arms at sides or on the chest. Film: HD 18x24 cm crosswise CP: Level of ASIS. CR: 30 cephalic (males), 35 cephalic (females).
L5-S1 joint sacroiliac joint 12
13 Lateral lumbosacral spine (L5 – S1) B For lat L5 – S1 joint space. Patient in a lateral recumbent, the knees flexed, support between knees and the ankles, pad under the waist, rubber sheet behind the lumbar region. Film: HD 18x24 cm lengthwise. CP: 1.5 inch ( 4 cm ) inferior to iliac crest, 2 inches ( 5 cm ) posterior to ASIS. CR: 90 V to film center (with sufficient waist support), 5 -10 caudal for waist (with no support). NB/ Close collimation is necessary because of the high amount of secondary radiation produced in this view.
L5-S1 joint sacrum 14
15 AP axial sacrum B AP sacrum (not foreshortened), S.I. joints, and L5 – S1 junction. Patient supine, legs extended, support under the knees. Exposure during arrested expiration. Film: HD 24x30 cm CP: Midway between level of the symphysis pubis and ASIS. CR: 15 cephalad. NB/ For lateral sacrum: Patient in true lateral recumbent, CR 90 vertically 5 cm anterior to posterior sacral surface at level of ASIS.
sacroiliac joint 16
17 AP axial coccyx B For pathology of the coccyx. Urinary bladder should be Emptied before this examination Cleansing enema must Also be done to clean the colon of fecal material. Patient supine, legs extended, support under the knees Film: HD 24x30 cm CP: 2 inches 5 cm superior to the symphysis pubis. CR: 10 caudad.
18 Lateral coccyx B For pathology of the coccyx. (urinary bladder and the colon should be emptied before examination from their contents. Cleansing enema is used for the colon. Patient in a lateral recumbent, knees flexed, support under the waist Film: HD 18x24 cm CP: 5 cm distal to level of ASIS, and 5 cm anterior to posterior surface of sacrum and coccyx. CR: 90 V to film center.
19 TABLE 4 (Exposure Factors) PROJECTIONkVpmAs AP Thoracic Spine907 Lateral Thoracic Spine8050 AO Thoracic Spine8026 AP Lumbar Spine8015 AP Axial Lumbosacral Spine Joint (L5 – S1)8020 Lateral Lumbosacral Spine Joint (L5 – S1)10050 Lateral Lumbar Spine9065 AO Lumbar Spine8515 Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa
20 TABLE 4 (Exposure Factors) PROJECTIONkVpmAs AP Axial Sacrum8015 AP Axial Coccyx8015 Lateral Coccyx9055 Layout and design by A Musa, Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Copyright 2003 A Musa