When taking an AP Cervical Open Mouth x-ray, what is the ideal position for the patient?
Supine; Although we comp with the patient standing
When taking an AP Oblique x-ray of the cervical spine the body is at ____*, the tube is at ____*, and the central ray is through _____.
45,15-20, C4
When taking an x-ray of the cervical spine in the lateral position what are the tube angulation and the SID?
Perpendicular to C4, 72"
Where is the central ray for the AP Cervical Open Mouth projection?
Centered to the open mouth
What is the proper tube angulation for an AP projection of the coccyx?
10* caudal
What is the name of the most anterior portion of the thoracic vertebrae?
Body
The brain and spinal cord make up what part of the nervous system?
Central
How many cervical vertebrae are there?
7
How many thoracic vertebrae are there?
12
How many lumbar vertebrae are there?
5
The natural curve of the lumbar spine is classified as what type? (Convex or Concave?)
Convex anteriorly, concave posteriorly
Which vertebrae have demifacets for articulation with the ribs?
Thoracic
What is another name for C1?
Atlas
What position/projection is necessary to demonstrate the intervertebral foramina of the cervical spine?
45* Oblique
How much should the body be rotated for the oblique position of the sacroiliac joints?
25-30*
Long exposure time (Shallow breathing technique) is useful in what projection?
Lateral thoracic spine
What are the functions of the vertebral column?
Encloses and protects the spinal cord; supports the trunk and skull superiorly; provides for attachment of ribs and muscles.
How many bones make up the vertebral column?
33
Which vertebrae are true and how many are there?
The upper 24 vertebrae are true. The pelvic region is false.
Where does the vertebral column articulate with the hips?
SI Joints
At what angle do the intervertebral foramina lie on the cervical vertebrae?
45* anteriorly and 15* inferiorly to MSP
The Z-Joints of the Thoracic Spine form what angle with the MSP?
70-75*
How much should you rotate the patient from MCP when you are shooting an AP Oblique Projection of the thoracic vertebrae?
15-20*
The Z-Joints of the Lumbar Spine form what angle with the MSP?
30-60*
Dorsal Decubitus Lateral is also known as what projection?
Cross Table C-Spine
When using the anode heel effect you should place the cathode side at which end of the body?
Feet
What should you place behind the patient when shooting a lateral projection?
Lead rubber
On the lateral L-spine how should you position the knees?
Flexed and superimposed over each other
What classification of bones are the vertebrae?
Irregular
How many sacral bones occupy the vertebral column?
5
How many coccygeal bones occupy the vertebral column?
3-5
The cervical and lumbar vertebrae are ____ anteriorly and are called ____ curves.
Convex; lordotic
The thoracic and pelvic curves are _____ anteriorly and are called _____ curves.
Concave; kyphotic
Which spinal curves are considered primary curves?
Thoracic and Pelvic
At what age does the cervical spine begin to develop? Lumbar spine?
3-4 months when child is able to hold the head up; 1-1.5 when child begins to walk
The lumbar and pelvic curves are more pronounced in ______ (men or women)?
Women
Any abnormal increase in the thoracic curvature is called what?
Kyphosis
Any abnormal increase in the lumbar curvature is called what?
Lordosis
Any abnormal increase in the lateral curvature of the spine is called what?
Scoliosis
What are the 2 main parts of the typical vertebrae?
Vertebral body and vertebral arch
The vertebral arch and body enclose a space called the _____?
Vertebral foramina
The vertebral bodies are separated by what?
Intervertebral disks
What makes up 1/4 of the length of the vertebral column?
Intervertebral disks
Each disk has a central mass called the ____, which is surrounded by the ____.
Nucleus pulposis; annulus fibrosis
This condition occurs when the nucleus ruptures or protrudes into the vertebral canal.
Herniated nucleus pulposis or more commonly called a slipped disk
______ allow for transmission of spinal nerves and blood vessels.
intervertebral foramina
The transverse processes are made up of ___ and ____.
Lamina and pedicles
These join at the midline to form the spinous processes.
Laminae
A congenital defect of the vertebral column in which the laminae fail to unite posteriorly.
Spina bifida
What 2 parts of the vertebrae form the Z-Joint?
Superior and Inferior articulation processes
What makes C1 (atlas) unique?
Contains lateral masses but has no body.
What is the strong conical process that arises from C2?
The Odontoid process (dens)
C7 is also called _____, what makes it unique?
Vertebral prominens; the spinous process is easy palpable as it is almost horizontal
Name 2 anatomical features that make the cervical spine unique.
They have transverse foramina and they have a bifid spinous process
These are for the transmission of the vertebral artery and veins.
Transverse foramina
In order to see the z- joints on the cervical vertebrae what position/projection is necessary?
Lateral (see table below)
How many thoracic vertebrae articulate with the tubercle of the rib?
10
How many thoracic vertebrae articulate with the head of the rib?
12
How much should you rotate the patient from the lateral position to demonstrate the z- joints of the thoracic vertebrae?
15-20*
Which vertebrae have mamillary processes?
Lumbar
The part of the lamina between the superior and inferior processes is called the _____ on the lumbar vertebra.
Pars interarticularis
At what angle do the z-joints of the lumbar spine lie?
30-60* posteriorly from MSP
This condition is characterized by the anterior displacement of one vertebra over another caused by a bony defect in the pars interarticularis. This condition almost exclusively involves the lumbar spine.
Spondylolisthesis
What projection would you use to demonstrate Spondylolisthesis?
Oblique b/c that is where the "neck" of the "Scottie dog" is seen.
Where is the base located on the sacrum/coccyx? The apex?
Superiorly; inferiorly - the base of the coccyx articulates w/ the apex of the sacrum
Whose sacrum (males or female?) is more acutely curved?
Female
At the superior ridge of the sacrum there is a prominent ridge, what is it called?
Sacral promontory
On each side of the sacral base is a large, wing like lateral mass called the ___?
Ala
The pelvis and the sacrum articulate at the ____, more specifically the _____ surfaces.
SI Joints; auricular surface
What type of joint is the atlanto-occipital joint?
Ellipsoidal
What type of joint is the atlantoaxial joint?
Gliding at the lateral aspect; pivot at the medial aspect (dens)
This is an avulsion fracture of the spinous process in the lower cervical and upper thoracic region.
Clay Shoveler's
This is a fracture of the anterior arch of C2 due to hyperextension
Hangman's Fracture
What is a Jefferson fracture?
Comminuted fracture of the ring of C1
When would you use the Fuch's method?
When the dens has not been clearly demonstrated in the open-mouth position.
What is the correct patient position for the Fuch's method?
Supine with chin extended until tip of the chin and tip of mastoid process are vertical.
Where do you center the IR for the Fuch's method?
Center to level of mastoid tips
What is the respiration phase for the Fuch's method?
Suspended.
Where is the central ray directed for the Fuch's method?
Perpendicular to MSP just distal to the tip of the chin
Where should you view the dens?
Within the foramen magnum
What is the recommended SID for the open-mouth projection?
30"
What is the recommended patient position for the open-mouth projection?
Supine
What anatomical landmarks should you use when positioning for the open-mouth projection?
Upper incisors and the mastoid tips
What is the respiration phase for the open-mouth projection?
Phonate "ah"
Where is the IR centered for the open-mouth projection?
C2
Why should you have the patient say "ah"?
To depress the tongue out of the way of the dens and will prevent movement of the mandible
Where is the central ray directed for the open-mouth projection?
Entering midpoint of open mouth
Which 2 patient positions could you use on an AP Axial projection of the c-spine?
Upright or supine
Why do you have the patient extend the chin in an AP Axial projection of the c-spine?
To prevent superimposition of the mandible and midcervical vertebrae
What is the respiration phase for the AP Axial projection of the c-spine?
Suspend
Where/how is the central ray directed for the AP Axial projection of the c-spine?
15-20* cephalad entering at the level of C4
How many vertebrae should you see on the AP Axial projection of the c-spine?
You should see the lower 5 cervical vertebrae and the first 2 thoracic (C3- T2)
The lateral projection of the cervical spine is also called what?
The Grandy method
What is the recommended SID for the Grandy method? Why?
60-72" because of the increase OID created by the shoulder, the larger SID demonstrates C7 better.
Where should the top of the IR be for the Grandy method?
1" above EAM (about the top of the ear)
How should you position the patient's shoulders for the Grandy method?
If the patient has round shoulders rotate them anteriorly otherwise rotate them posteriorly, also make sure they are on the same plane and depress them as much as possible.
What is the respiration phase for the Grandy method? Why?
Suspend at the end of full expiration, this will help depress the shoulders
Where is the central ray directed for the lateral projection of the cervical spine?
Perp to C4
What should be seen on the lateral projection of the cervical spine?
C1- 1/3 of T1
What projection should you use if C7-T1 is not clearly seen?
Swimmers
What is the recommended SID for the AP Axial Oblique projection of the c-spine?
60-72"
What much should you rotate the patient for the AP Axial Oblique projection?
45* and the head should be lateral
The AP Axial Oblique projection should have a central ray angle of how many degrees? Where is it directed?
15-20* cephalad entering C4
What is being demonstrated on the oblique projection of the cervical spine?
Intervertebral foramina
What is the respiration phase for the oblique projection of the c-spine?
Suspended
True or False: You should be able to clearly view the intervertebral foramina on C1 and C2 on the oblique projection?
False
What is another name for the AP projection of the c-spine?
Ottonello
What technique do you use on the AP projection to blur and sometimes obliterate the mandibluar shadow?
An even chewing method during the exposure.
The swimmers technique has 2 methods, what are they?
Recumbent (Powlow) and Upright (Twining)
If the patient cannot depress the shoulder how should you angle to tube for the swimmers technique?
3-5* caudal
Monda recommended angling the tube _____ on the Swimmers position to better demonstrate the disk spaces.
5-15* cephalad
What is the respiration phase for the Swimmers Technique?
Suspended; or if the patient can be immobilized you can use slow shallow breathing.
All of the joints in the vertebrae are synovial, freely moveable except which one?
Intervertebral Joints
The intervertebral joint is what kind of joint?
Cartilaginous, Symphysis Slightly Moveable
L1-L3 have an average angle range of what?
0-30*
L3-L4 have an average angle range of what?
15-45*
L4-S1 have an average angle range of what?
45-60*
On which projections can you use a compensating filter on?
AP T-Spine, Swimmers
Which 2 positions are acceptable for the AP T-Spine?
Upright and Supine (Supine is recommended)
How should the legs be positioned for the AP T-Spine?
Hip and legs flexed
Where should the superior border of the IR be placed for the AP T-spine?
1 1/2-2" above the shoulders (The same is true for the lateral t-spine)
What is the respiration phase for the AP and lateral T-spine?
Shallow breathing or suspend on expiration
What 2 bony landmarks can you use to help center for the AP T-Spine?
Xiphoid Process and Jugular Notch
Approximately where should the CR enter for the AP T-Spine?
T7
True or False: You can place the patient in a lateral recumbent position or an upright position for the lateral T-spine projection?
True
Why do you place the patient in a left lateral position rather than a right (for lat t-spine)?
To reduce magnification of the heart
What should you place under the patients head to ensure that the long axis of the spine is horizontal (for lat t-spine)?
A firm pillow
Which half of the thorax should be placed at the midline of the grid (for lat t-spine)?
Posterior half
How should you position the patients' knees (for lat t-spine)?
Flexed and superimposed
How are the patients arms positioned (for lat t-spine)?
Positioned at a right angle to the body
Although using a sponge to put the long axis of the t-spine horizontal is the preferred method, what else could you do if the long axis of the t-spine isn't horizontal for lateral t-spine?
You can angle to tube 10-15* cephalad. (10* for women 15* for men b/c of the broad shoulders)
True or False: The c-spine "Swimmers lateral" is the same projection as the t-spine "swimmers lateral"?
True
True or False: On the lateral t-spine T1-T3 will not be well visualized?
True
Which joints are demonstrated on the oblique projection of the t-spine?
Z-joints
On an AP oblique t-spine, which Z Joints CLOSEST OR FARTHEST are demonstrated?
Farthest
How much do you rotate the patient (from the AP position) for an oblique t-spine projection?
70*
With reference to the patient where you place the top of the light on the oblique proj. of the t-spine?
1 1/2 - 2" above shoulder (center at T7)
What is the respiration phase for the oblique t-spine?
Suspend on expiration
If possible what should be cleared from the intestinal tract for the AP Lumbar projection?
Gas and fecal matter
What effect does flexing the knees have on the curve of the lumbar spine (for the AP lumbar proj)?
It reduces lordosis
What is the recommended SID for all lumbar projections?
48"
Where should you place the patient's arms for the AP Lumbar projection?
Flex elbow and place hands on the chest
Why should you place a sponge under the patient's lower back?
To prevent rotation
When using a 14x17" film where should you center the IR? 11x14"? (This is for AP and Lateral proj)
L4 for 14x17; L3 for 11x14"
What is the respiration phase for AP l-spine?
Suspend on expiration
Where do you direct the CR for a lumbosacral projection? Lumbar? (This is for AP and Lateral proj)
L4 for l.s. and L3 for lumbar
Why do some Doctors request that you leave the collimation wide open on an AP l-spine?
Trauma, visualization of the liver, kidney, spleen, psoas muscles margins, and air or gas patterns
What is the respiration phase for the AP and lateral L-spine?
Suspend on expiration
If the spine cannot be moved into a horizontal position by using a ___, then you should place an angulation of __ to __ degrees.
Sponge; 5-8* caudal
Which vertebrae should be visualized on this image? (lateral l-spine)
Lower thoracic to sacrum (or to coccyx when using the bigger film)
Is the L5 intervertebral foramina visualized on the lateral projection of the L-spine?
No because of its obliquity you see them better on the oblique projection.
Which AEC chambers should you use for the lateral l-spine?
Center pod
What position is the patient in for the L5-S1 lateral projection?
Lateral recumbent
What is another name for the L5-S1 lateral projection?
The spot
If possible, how should the legs be positioned for the spot projection?
Extended the legs and superimpose the knees
Where should you place a sponge for the spot projection to try and get the spine into a horizontal position?
Under the lower thorax
What is the respiration phase for the spot projection?
Suspend
Where is the central ray angled for the spot projection?
2" posterior to ASIS and 1 1/2" inferior to crest
If using a sponge does not help with getting the spine horizontal, what other technique could be used?
Angle the tube 5-8* caudal
Francis identified another method to demonstrate the L5-S1 joint space, what is it?
Draw an imaginary line between the two crests (iteriliac plane) and adjust the central ray angulation to be parallel with it.
The AP Oblique projections should demonstrate which joints?
Z joints
With the patient in the RAO position, which Z Joints are being demonstrated on an oblique l-spine?
Left side (farthest)
True or false: the patient may be in either an upright or supine position for the AP oblique l-spine?
True
How much should you rotate the patient on an oblique l-spine?
45*
On which plane does the spine lie for the oblique projection of the l-spine?
2" medial to ASIS
How much should you rotate the patient to demonstrate the Z joint of L5-S1 in an oblique projection (not lateral!)?
As much as 60*
What is the respiration phase for the AP Oblique projection of the l-spine?
Suspend on expiration
Where is the central ray directed for the oblique l-spine?
2" medial to ASIS and 1 1/2" above crest
Where should you direct the central ray for the oblique l-spine of the 5th Z joint?
2" medial to ASIS and up to a point midway between ASIS and Crest
What does the ear of the "Scottie Dog" represent?
Superior articular process
What does the nose of the "Scottie Dog" represent?
Transverse process
What does the eye of the "Scottie Dog" represent?
pedicle
What does the collar of the "Scottie Dog" represent?
Pars interarticularis
What does the body of the "Scottie Dog" represent?
lamina
What does the leg of the "Scottie Dog" represent?
Inferior articular process
What is another name for the AP or PA axial projection of the lumbosacral junction and SI joints?
Ferguson method
How should the lower limbs be positioned for the Ferguson method?
Extended or you can abduct the thighs
What is the respiration for the Ferguson method?
Suspend
Ferguson originally recommended a ____ degree angle but it has been modified and now we use __-__ degrees ______ for the AP projection.
45*; 30* for males-35* for women cephalad
Where do you direct the central ray?
1 1/2" above pubic symphysis
If the patient is in the prone position how would you direct the central ray?
35* caudal entering the spinous process of L4
For the AP Oblique projection of the SI joints which side, CLOSEST OR FARTHEST, is being demonstrated?
Farthest
How much do you rotate the patient for the AP Oblique projection of the SI joints?
25-30*
Align the body so that a sagittal plane passing ___" medial to the ASIS of the ______ side of the patient is centered to the midline of the grid. (AP Oblique projection of the SI joints)
1"; elevated
Where should you center the IR for AP Oblique projection of the SI joints?
At level of ASIS
What is the respiration phase for the AP Oblique projection of the SI joints?
Suspend
Where should you direct the central ray?
Perpendicular entering 1" medial to elevated ASIS
If you were to use an axial angle for an AP Oblique of the SI joints how much and in which direction would you use? Where would you center the central ray?
20-25* cephalad entering 1" medial and 1 1/2" distal to ASIS
For the AP or PA axial projections of the sacrum and coccyx where should you place the hands?
Flex elbows and place the hands on the chest.
Can women be shielded for the axial projections of the sacrum/coccyx?
No
What is the respiration phase for the axial projections of the sacrum/coccyx?
Suspended
When the patient is in the supine position where do you direct the central ray for the axial projection of the sacrum?
15* cephalad entering 2" superior to pubic symphysis
With the patient in the prone position where do you direct the central ray for the axial projection of the sacrum?
15* caudal entering at the clearly visible sacral curve
When the patient is in the supine position where do you direct the central ray for the axial projection of the coccyx?
10* caudal entering 2" superior to pubic symphysis
With the patient in the prone position where do you direct the central ray for the axial projection of the coccyx?
10* cephalad entering the coccyx
Why do you use an angle for the sacrum and coccyx?
To purposely elongate them.
Which side should you have the patient laying on for the lateral sacrum/coccyx?
The indicated side (affected side?)
How are the legs positioned for the lateral sacrum/coccyx?
Flex hips and superimpose the knees
What is the respiration phase for lateral sacrum/coccyx?
Suspend
Where is the central ray directed for the lateral sacrum?
Perpendicular 3 1/2" posterior to ASIS
Where is the central ray directed for the lateral coccyx?
Perpendicular 3 1/2" posterior and 2" inferior to ASIS
What scale of contrast should be seen with all sacrum/coccyx views?
Short scale
The PA projection of the thoracolumbar region (which is a scoliosis projection) is also called what?
Ferguson
What is the bony thorax formed by?
12 ribs, 12 thoracic vertebrae, and the sternum
What is the purpose of the bony thorax?
The enclose and protect the heart and lungs
Which end, top or bottom, of the thorax is narrower?
Top
The sternum is also called the _____?
Breastbone
What type of bone is the sternum?
Flat
How long is the sternum?
6 inches
How many parts of the sternum are there? Name them?
3; Manubrium, body, xiphoid process
What does the sternum support at the superior manubrial angles?
Clavicles
How many ribs attach directly to the sternum?
7
What is the widest portion of the sternum?
Manubrium
What is the depression on the superior border of the Manubrium called?
Jugular notch
What is the longest part of the sternum? How long is it?
The body, it is 4 inches long
The Manubrium joins the sternal body at what articulation?
Sternal angle
The sternal angle lies at what vertebral level?
T4-T5 interspace
This process is cartilaginous in the early stages of life but ossifies later in life. It is also the smallest portion of the sternum.
Xiphoid process
This portion of the sternum deviates slightly from the midline of the body.
Xiphoid process
At what level does the xiphoid process lie?
T10 (remember that X is the roman numeral for 10)
The xiphoid process is a useful landmark in locating what organs?
Superior border of the liver and the inferior border of the heart.
How many ribs are there in a normal body?
12
True or False:: The ribs are numbered according to what vertebrae they are attached to.
True
What type of bone are the ribs?
Flat
Ribs attach to the sternum by a piece of _______ cartilage.
Hyaline
Which ribs attach directly to the sternum?
1-7
How do ribs 8-10 attach anteriorly?
Through the costal cartilage of the 7th rib
What are the first seven ribs called?
True ribs
Which ribs are false?
8-12
Which ribs are floating?
11-12
Why are the last 2 ribs considered floating?
Because they do not articulate anteriorly
The ribs are situation on an oblique plane so that their anterior ends sit ____ inches below the level of their vertebral ends.
3-5"
What are the spaces b/w ribs called?
Intercostal space
Where do cervical ribs attach?
C7
Lumbar ribs are often confused as what?
Fractured transverse process of the L1 vertebrae
True or False:: The first rib is the shortest and narrowest.
False; the first rib is the shortest and widest
Which rib would be the longest?
7th
Which rib would be the narrowest?
12th
A typical rib consists of what?
Head, neck, tubercle, and body
Ribs have facets on their heads for articulation with the ________.
Vertebral body.
What is the articulation between the vertebral body and the head of the rib called?
Costovertebral joint
The tubercle of the rib has a facet for articulation with the _________.
Transverse process
What is the articulation between the tubercle of the rib and the transverse process of the rib called?
Costotransverse joints
Which vertebrae do not have a tubercular facets or neck?
11 and 12
Each rib has a costal groove located on the _____ _____ border. It contains _____, ____, and _____.
Inferior, internal border. It contains arteries, veins, and nerves.
How many joints are there in the bony thorax?
8
Which joints are the only point of articulation between the upper limbs and the trunk?
SC Joints
The sternocostal and costochondral joints are classifies as what?
Cartilaginous, synchondroses immovable joints.
Which ribs only articulate with 1 vertebral body?
1, 10, 11, 12
On deep inspiration the anterior ends of the ribs are carried __________, while the necks are rotated _____.
Anterior ends are carried anteriorly, superiorly, and laterally. The necks are rotated inferiorly.
On deep expiration the anterior ends of the ribs are carried __________, while the necks are rotated _____.
Anterior ends are carried inferiorly, posteriorly, and medially. The necks are rotated superiorly.
In which body habitus does the diaphragm sit at a higher level?
Hypersthenic
For sthenic patients the diaphragm sits at what level?
Posteriorly at 6th or 7th costal cartilage to the level of 9th or 10th thoracic spine when in upright pos.
Which side of the diaphragm sits at a lower level?
Left
The diaphragm reaches its highest level when the patient is in what position?
Supine-( lowest when they are upright)
Rib injuries are painful, even minor ones; therefore you should exam the patient in which position?
The position in which they come in.
Why is it important to have women with large breasts tape them back for the lateral sternum?
b/c the breast tissue will interfere with the inferior portion of the sternum (xiphoid process)
When doing the PA oblique projection of the sternum which patient position should you use and why?
RAO- to use the heart shadow for contrast
What is the recommended SID for the RAO sternum?
30"- to blur posterior ribs
What is the average rotation of the patient in the RAO position?
15-20*
What should be centered to the grid for the RAO sternum?
The sternum
Where should the top of the IR be placed for the RAO sternum?
1 1/2" above jugular notch
What is the respiration phase for the RAO sternum?
Slow shallow breathing or suspend on expiration
In a trauma situation the patient is brought in on a back board, and the doctor orders an oblique sternum. Which patient position would be suitable in this scenario?
LPO or AP and angle the tube medially
Where is the CR directed for the RAO sternum?
Entering the elevated side @ T7 approx 1" lateral to midsagittal plane
What is the SID for the lateral sternum?
72"
True or False:: The patient may be sitting or standing for the lateral sternum?
true
Describe how you should position the patient's arms for the lateral sternum?
Have the patient lock their hands behind their back; or above the head for recumbent positions
Where should the top of the IR be placed for the lateral sternum?
1 1/2" above jugular notch
For a lateral projection of just the SC joints where should you center the IR?
At the level of jugular notch (use an 8x10 portrait)
What is the respiration phase for the lateral sternum?
Suspend on deep inspiration
Where should the CR enter the patient for the lateral sternum?
The lateral border of the sternum
True or False:: The SC joints should be superimposed on the lateral sternum projection
True
What is the difference between the upright and recumbent lateral sternum?
You should have the patient put their hands above their head instead of behind their back for the recumbent position.
Can you use a cross table projection to obtain a lateral sternum?
Yes
What is the recommended patient position for the PA projection of the SC joints?
Prone
Where should you center the IR for the PA projection of the SC joints?
At the level of the spinous processes of T3
How should you place the arms for this projection for the PA proj of SC joints?
At the patients sides
For a bilateral projection of the SC joints how should you position the patients head?
Rest the head on the chin
For a unilateral proj. of the SC joints how should you position the patients head?
Turn the head to face the affected side and rest the cheek on the table.
What is the benefit of turning the head towards the affected side?
Turning the head toward the affected side turns the spine slightly away from the side being examined thus allowing better visualization.
What is the respiration phase for the SC joints?
Suspend on expiration
Where is the CR for the SC joints?
Midsag @ T3
What should be demonstrated on the SC joints?
SC joints and medial portion of the clavicles
What patient position should you use for the PA oblique projection of the SC joints?
RAO and LAO
The PA oblique projection of the SC joints is also called what?
Body rotation
What size IR should you use for all sternum projections?
8x10
Which side should be closest to the IR for the oblique proj of the SC joints?
Affected side
How much should you rotate the patient for the oblique SC joints?
10-15*
True or false:: The shoulders should be on the same plane for the oblique proj?
True
What is the respiration phase for the oblique proj of SC joints?
Suspend on expiration.
Where is the CR directed for the oblique proj of the SC joints?
Perp to the SC joint closest to the IR. CR enters T2-T3 & 1-2" lateral from MSP.
If the CR enters the right side, which SC joint is being demonstrated?
Left; and vice versa
Instead of using the body rotation method how else could you get an oblique projection of the SC joints?
Place patient in prone position and angle tube 15* toward MSP
What size IR should you use for most projections of the ribs?
14x17
True or false:: patients can be upright or recumbent for projections of the ribs.
True
If the patient is complaining of pain on anterior ribs which patient position should you use? Posterior ribs?
PA; AP
The axillary portion of the ribs is best demonstrated on which projection?
Obliques
Why would you need to use a lateral projection of the ribs?
To demonstrate air/fluid levels
Which positions would the ribs be free from superimposition of the heart?
LAO or RPA
What scale of contrast would you want for the ribs?
Short scale
What IR orientation should be used for the upper ribs?
Portrait
What IR orientation should be used for the lower ribs?
Transverse
Where should the top of the light be placed for the upper ribs?
1 1/2" above the shoulders
When taking unilateral projections of the ribs what size IR should you use?
11x14 or 30x35 cm
What is the respiration phase for the upper ribs?
Suspend on inspiration
Where is the CR directed for the upper ribs?
Enters @ T7
What is a useful technique for demonstrating 7-9 ribs?
Angle tube 10-15* caudal
Which projection would best demonstrate the anterior ribs above the diaphragm?
PA(pg 489 the posterior ribs will be seen but the anterior ribs are seen in better detail b/c they are closer to the IR)
The AP proj of the ribs will better demonstrate which ribs?
Posterior ribs
When the patients position permits how should you position the patient for images of ribs above the diaphragm? Below the diaphragm? (this is true for both PA/AP proj and obliques)
Upright; recumbent
What is the respiration phase for the lower ribs?
Suspend on expiration
Where should the lower edge of the IR be placed for images of the lower ribs?
At crest
How much do you rotate the patient for the axillary proj of the ribs?
45*
True or false: It doesn't matter where the patient's arms are positioned for proj of the ribs?
False; they need to be out of the way
The digestive system consists of the ____ and certain _____?
Alimentary tract and certain accessory organs.
How many and what are the accessory organs?
The teeth, salivary glands, and the liver and pancreas.
What is the largest gland in the body?
The liver.
What divides the liver into right and left lobes?
The falciform ligament
Two minor lobes are located on the _____ side of the right lobe, and what are they called?
Medial side, which are called the caudate and quadrate lobe.
What is the hylum of the liver called, and where is it located?
The porta hepatis is located transversely between the two minor lobes.
The _____ and the _____, which convey blood to the liver, enter the porta hepatis and branch out through the liver substance.
The portal vein and the hepatic artery.
The portal vein ends in the _____, and the hepatic artery ends in the _____ that communicate with _____.
Sinusoids, capillaries, that communicate with sinusoids.
The liver also receives blood from the _____.
The portal system.
The portal system consists of veins arising from _____.
The walls of the stomach, the greater part of the gi tract, the gallbladder, pancreas, and spleen.
What carries blood from the liver to the inferior vena cava?
The hepatic veins through the liver sinusoids.
How much bile does the liver create each day?
1-3 pints.
What is bile responsible for?
The digestion of lipids. (fats)
The two hepatic ducts emerge from the _____.
Porta hepatis.
Hepatic and cystic ducts are approximately how long?
1 1/2"
The hepatopancreatic ampulla opens on an elevation known as the _____.
The major duodenal papilla.
The gallbladder functions to concentrate the bile by absorbing the _____.
The water content.
The muscle contraction of the gallbladder is controlled by _____.
Cholecystokinin.
The broad lower aspect of the gallbladder is termed the _____.
The fundus.
The gallbladder sits in a depression on the posterior aspect of the liver called the _____.
The gallbladder fossa.
What body habitus would the gallbladder be low and near the spine?
Asthenic
What are the four parts of the pancreas?
The head, neck, body, and the tail.
Which end is proximal to the hepatopancreatic duct?
The head of the pancreas
What vertebral level does the head of the pancreas lie?
L2 or L3
The pancreas is both a _____ and _____ type of gland.
Exocrine gland and endocrine gland.
What is produced by the exocrine portion?
Pancreatic juices.
What is produced by the endocrine function?
Insulin and glucagon.
The endocrine portion of the gland consists of _____ cells.
Islet cells, otherwise known as islets of langerhans.
The islet cells releases its glucagon and insulin secretions through _____ and not through the _____.
Capillaries, not through the pancreatic duct.
What body system is the spleen part of?
The lymphatic system.
AAA stands for what?
Abdominal aortic aneurysm.
ERCP stands for what?
Endoscopic retrograde cholangiopancreatography.
NPO means what?
Nothing by mouth, or nil per os
PTC stands for what?
Percutaneous transhepatic cholangiography
RUQ stands for what?
Right upper quadrant
Why would you perform a left lateral decubitus instead of a right lateral decub? (abdominal)
The stomach lies on the left side, and would obscure any peritoneal free air.
Where does the abdominal cavity extend from?
The diaphragm to the superior aspect of the bony pelvis
What organs does the abdominal cavity contain?
Stomach, small and large intestine, liver, gallbladder, spleen, pancreas and kidneys
What organs does the pelvic cavity contain?
Rectum, sigmoid of the large intestine, urinary bladder, and the reproductive organs.
The abdominopelvic cavity is enclosed in a double-walled seromembranous sac called what?
Peritoneum
What is the outer portion of this sac called?
Parietal peritoneum
What is the inner portion of the sac called?
Visceral peritoneum
The peritoneum forms folds called what?
Mesentery and omenta
What is the space called between the two layers of the peritoneum?
Peritoneal cavity
What is the retroperitoneum?
The cavity behind the peritoneum
What is the largest gland in the body?
Liver
The liver is divided into two lobes at what?
Falciform ligament
What portions convey blood to the liver?
The portal vein and the hepatic artery
What does the liver produce?
Bile
What does the biliary system of the liver consist of?
The bile ducts and gallbladder
What do the two main hepatic ducts emerge to form?
Common hepatic duct
What forms the common bile duct?
Common hepatic duct and cystic duct
What do the common bile duct and pancreatic duct enter into?
Hepatopancreatic ampulla or ampulla of vater
What is the hepatopancreatic ampulla controlled by?
Sphincter of the hepatopancreatic ampulla or sphincter of oddi
The muscle contraction of the gallbladder is activated by what hormone?
Cholecystokinin
Where is the gallbladder located?
Lodged in a fossa on the inferior surface of the right lobe of liver
What are the parts of the pancreas?
Head, neck, body, and tail
What do the exocrine cells of the pancreas produce?
Pancreatic juice
What does the endocrine portion of gland consist of?
Islet cells
What do the islet cells produce?
Insulin and glucagon
What is the function of the spleen?
Produce lymphocytes and store and remove dead or dying RBC
Where is the spleen located?
Left upper quadrant, below diaphragm and behind the stomach
The cystic duct enables bile from the liver to be stored where?
Gallbladder
What organ lies in the duodenal loop?
Pancreas
What is the name of the main bile duct that leads directly from the liver?
Hepatic ducts
What is the name of the duct that transports bile from the gallbladder?
Cystic duct
The digestive system consists of what two parts?
The accessory glands and the alimentary canal.
What are the four accessory glands?
Salivary glands, liver, gallbladder, and pancreas.
These glands secrete digestive enzymes where?
The alimentary canal.
The alimentary canal extends from where to where?
The mouth to the anus.
The esophagus is approximately how long and how wide?
10 inches long, 3/4 inches in diameter.
The esophagus and the rest of the alimentary canal has how many layers?
Where is the IR centered for all esophageal studies?
T5-T6
What is the patient position for the oblique esophagus?
RAO or LPO
The body forms and angle of _____ degrees from MSP, when performing oblique esophageal studies.
35-40*
For the RAO position of the esophagus, how should you position the patient's arms?
The right arms should be down at the patient's side the left arm should be resting on the pillow (For the LPO position the left arm will be down and right up)
For the oblique study of the esophagus, center the elevated size black inches lateral to MSP.
2"
Why is the recumbent position preferred over the upright position for the esophageal exams?
The contrast will flow against gravity making the images have better contrast.
The contrast filled esophagus should be demonstrated from _____ to _____.
Lower part of neck to esophogastric junction.
What should the esophagus be superimposed over in the AP/PA projection?
The t-spine
The lesser curvature starts at the esophogastric junction and ends at the what?
