Chapter 9 LUMBAR SPINE Want to see bony trabecular pattern and cortical outline Tight Collimation

AP Projection Make sure soft tissue and psoas muscles are well defined Spinous process should be midline of the vertebral bodies Sacrum & coccyx aligned with the Pubic Symphosis Shoulders and ASISs are equal distance from the IR Flex the knees to o reduce the curvature of the spine o for patient comfort 14x17 LW o (lumbosacral) with o Central Ray enters at the Crest 11x14 LW o (just Lumber) o Central Ray enters 1 above the crest

To Detect Rotation Spinous Process should be midline to the vertebral bodies if not then patient is rotated o AP will roll toward the side up (farthest from the IR) Sacrum/coccyx should be in line with the Pubic Symphosis o Will roll toward the elevated side

AP Oblique Projection Demonstrates the Zygoapopliseal Joint Spaces for side down (Ear of one Scottie and leg of another Scottie Dog) Z Joint spaces should be at the midpoint of the vertebral body and the lateral border Midcoronal Plane angled 45*

If Rotation Under Rotated o Eye of Scottie dog will be in the vertebral body o Dog moves toward side down Over Rotated o Zygo Joints will move toward lateral border (Back of Scottie Dog) of Spine o Dog backs up toward side up

Central Ray Enters at L3 Enters 1 above (superior) to Crest & 2 medial to elevated ASIS Have patient turn head toward side down and muscle in neck should line up with Central Ray

Lateral Position Lead strip posterior to patient to collect scatter Will visualize the intervertebral foramen Spinous process will be in profile Patient shoulders/posterior ribs/iliac crest should be perpendicular to the IR o Interiliac Line should be perpendicular (Line between both iliac crests) Patients arms should be 90* from the body Patients legs should be bent o To prevent patient from rolling anteriorly or superiorly o Place a pillow between knees To align the pelvis

To Detect Rotation Rotation can be in upper or lower lumbar spine More common for patients to be rotated anteriorly Foramina o Closing shows rotation Posterior aspects of the vertebral bodies o R/L Posterior aspects should be superimposed

Sagging Spine No Sponge angle slightly toward caudadly Lower intervertebral Foramin will close o Place radiolucent sponge under patient Makes spine parallel to IR

Central Ray Will enter midcoroal o 14x17 enters at the Crest o 11x14 enters 1 1/2 superior to the crest

Flexion / Extension L5 / S1 Patient still in lateral position 8x10 cassette Angle Central Ray 5-8* caudad o 5* for men o 8* for women Central ray will enter 1 inferior to iliac crest and 2 posterior to ASIS Used to evaluate the patients mobility

Rotation Intervertebral Foramen o Should be open Greater Sciatic Notches o Should be superimposed Femoral heads o should be superimposed

Sacrum AP Axial Projection No Urine / Gas / Fecal matter to superimpose the sacrum Patients legs should be kept straight

Rotation Ischial Spine should be aligned with pelvic rim Sacrum and Coccyx aligned with Pubic Symphosis

Central Ray Lateral Flex knees Pillow between the knees Central Ray enters 3 1/2 posterior to the ASIS 15* cephalic Enters 2 superior to pubis symphosis 10x12 cassette LW

Coccyx AP Axial Projection Lateral Flex the knees Pillow between knees CR 3 1/2 posterior to ASIS and 2 inferior to ASIS No Urine / GAS OR FECAL MATTER Positioned same as sacrum Central Ray 10* caudad 8x10 cassette CR enters 2 superior to pubic symphosis