Wednesday, 25 April 2012

Spine

Lumbar Spine Lateral

Indications for imaging
Congenital abnormalities, trauma, pain, metastasis's.
Anatomy  Demonstrated
Lumbar vertebra.

Lumbar Spine Rt Lateral
Meschan, I. 1955 An Atlas of Normal Radiographic Anatomy Saunders, London
Basic Patient Position
The patient lies on the table with their long axis in line with the long axis of the table, a line at a tangent to the third lumbar vertebra should be in line with the midline of the table. The hips and knees are flexed for stability and the hands are placed on a pillow in front of the patients face.
Ensure the line of the spinous processes are parallel to the table if not use pads to adjust the position.


Lumbar Spine Lt 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. The 28 day rule should be applied for female patients.
In males direct lead rubber gonad protection can be applied at all times, in females positioning rules will determine protection in females.

BMJ Article about dose reduction in Lumbar spine lateral imaging
Ref: Northwest Medical Physics.
NEWSLETTER NO 41 – MAY 2006
DIAGNOSTIC X-RAY AND NUCLEAR MEDICINE
Central Ray
The vertical central ray is centered in line with the highest point of the iliac crest at a point midway between the lower costal margin and the iliac crest of the raised side.
Exposure is made on suspended expiration.
Exposure Factors
Kv mAS FFD (cm) Grid Focus AEC Cassette
90 90 100 Yes Broad Yes 30 x 40 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, superiorly the upper border of T12, inferiorly the first sacral segment, posteriorly the skin surface, anteriorly the aorta.
All the vertebra should be projected in lateral profile with visualisation of the joint spaces.


  Lumbar Spine Rt Lateral Radiograph
Related Projections
Lumbar spine AP
Lumbar spine obliques.
Lumbar spine L5/S1 junction.
Additional modalities
CT
MRI

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