Babeh Edi

Spine Cervical Lateral

Indications for imaging Trauma, pain, rheumatoid arthritis, upper limb paraethesia, vertebral artery syndrome. Anatomy  Demonstrated Cervical vertebra bodies, articular pillars apophysial  joints and spinous processes.  Cervical Spine Lateral  Anatomy Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Basic Patient Position The patient stands or sits erect with the median saggital plane parallel to the bucky, the chin is raised to prevent superimposition of the mandible, the arms internally rotated to project the heads of the humeri away from the vertebral bodies. Cervical Spine Lateral  Patient Position Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London Radiation protection There are many local rules for gonad protection however the following should be taken into account. In males and females direct lead rubber gonad protection can be applied at all times, avoid the breast tissue particularly in young females, collimate to prevent irradiation of the eyes. Central Ray The horizontal central ray is centered midway between the skin surfaces of the neck at the level of the cricothyroid cartilage. Exposure is made on suspended expiration. Exposure Factors Kv mAS FFD (cm) Grid Focus AEC Cassette 85 10 180 No Fine No 24 x 30  cm Evaluation of the Image ID and markers must be present and correct in the appropriate area of the film Evidence of collimation on four sides equally around the centering point. Optimal exposure should penetrate all the bone structures and contrast should be low enough to visualise fully the bone and soft tissue structures. Limits of the examination, anteriorly and posteriorly the skin surfaces, superiorly the pituitary fossa inferiorly the body of T1. The rami of the mandibles should be superimposed and anterior to the vertebra. All the intervertebral joints spaces, between the bodies and the facets should be visualised.   Cervical Spine Lateral Radiograph http://www.vh.org/ Interpretation Technique (Mnemonic: ABCDS) Adequate film and Alignment Bony landmarks Cartilaginous space Discs Soft tissue spaces Adequate film criteria Visualize all seven vertebrae (including C7-T1) Maneuvers to enhance view of lower C-Spine C7-T1 Pull down on arms during cross-table lateral Swimmer's View Cervical Spine CT Alignment Assessment criteria Landmarks should line up with <3mm discrepancy Landmarks Anterior vertebrae Posterior vertebrae Facets Spinous process (Spinolaminar line) Middle of anterior spinous process lines up C1-C3 Normal variants: Pseudosubluxation of C2 and C3 Normal in children Seen in 20% of children under age 8 years Abnormal findings Subluxation of >=3 mm is abnormal Angulation >11 degrees is unstable Bony landmarks Trace unbroken outline of each vertebrae Trace odontoid outline from C2 vertebrae Cartilaginous space Predental space Distance from dens to C1 body Normal values Adult: 3mm Child: 5mm Discs Assess symmetry of disc spaces Soft Tissue spaces Soft Tissue stripe Normal C2 stripe: 5 mm Normal C5 stripe: 2 mm Normal Fat tissue stripe <3 mm Related Projections Cervical spine AP C1-2 Cervical spine AP C3-C7 Cervical spine obliques Additional modalities CT MRI