1. Lumbar Vertebrae, Sacrum and Coccyx Chapter 8

2. Lumbar AP Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (14 x 17 lw)

3. Lumbar AP Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized –Vertebral bodies, pedicles, spinous processes, laminae, and pars interarticulari are demonstrated

4. Lumbar AP True AP with no rotation –The spinous processes are in the midline of the vertebral body –The distance from the spinous process to each side of the vertebral body is equal –The sacrum and coccyx should be centered within the inlet pelvis and aligned with the symphysis

5. Lumbar AP Detecting rotation –If the spinous processes are closer to one side of the vertebral body than the other –The side that the spinous process and lateral border of the vertebral body forms the greatest distance is the side rotated toward –Rotation can be either at the top (shoulders) or bottom (hips) or both

6. Lumbar AP The Intervertebral disk spaces are open and the vertebral bodies are demonstrated without distortion (flex knees) No foreshortening (hips or shoulders higher than the other) –The top and bottom of vertebral bodies are demonstrated if foreshortening is present

7. Lumbar AP Align long axis of lumbar spine with film Center L-4-5 to center of film

10. Lumbar Posterior Oblique Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (14 x 17 lw or 11 x 14 lw)

11. Lumbar Posterior Oblique Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized –Vertebral bodies, pedicles, spinous processes, laminae, and pars interarticulari are demonstrated

12. Lumbar Posterior Oblique Accurately rotated lumbar –Scotty dogs are visualized Ear – superior articular process Eye – pedicle (near the center of the body) Neck – pars interarticularis Feet – inferior articular process Body - lamina

13. Lumbar Posterior Oblique Degree of obliquity –Obliques too much The “nose” of the Scotty dog is distorted (too short) and zygapophseal joint is closed –Not obliqued enough The “eye” or pedicle of the Scotty dog appears too close to the lateral border of the spine

14. Lumbar Posterior Oblique The long axis of the lumbar vertebral column is aligned with the long axis of the collimated field The 3 rd vertebra is in the center of the collimated field with T12 and 1 st sacral segments visualized

16. Lumbar Lateral Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (14 x 17 lw)

17. Lumbar Lateral Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized –Vertebral bodies, pedicles, spinous processes, laminae, and pars interarticulari are demonstrated

18. Lumbar Lateral The lumbar vertebra are demonstrated in a true lateral position The intervetebral foramina are clearly visualized The spinous process are in profile The right and left pedicles and the posterior surfaces of each vertebral body are superimposed

19. Lumbar Lateral Detecting rotation –Evaluate the superimposition of the right and left posterior surfaces of the vertebral bodies

20. Lumbar Lateral To detect anterior or posterior rotation –Locate 12 th rib –Find magnified posterior rib –If magnified rib is anterior the patient is rotated then patient is rotated toward the anterior surface toward the film –If magnified rib is posterior the patient is rotated then the posterior surface is rotated closest to the film.

21. Lumbar Lateral The intervetebral disk spaces are open Vertebral bodies are demonstrated without distortion –Align the vertebral column parallel to the table top

24. Lumbar L5 – S1 Spot Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (8 x 10 lw)

25. Lumbar L5 – S1 Spot Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized

26. Lumbar L5 – S1 Spot True positioning –The 5 th lumbar vertebra and sacrum are visualized –The intervetebral foramina are clearly visualized –Right and left pedicles are superimposed –Greater sciatic notches and pelvic wings are superimposed

27. Lumbar L5 – S1 Spot

28. Sacrum AP Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (10 x 12 lw)

29. Sacrum AP The ischial spines are equally demonstrated and are aligned with the pelvic brim Medial sacral crest and coccyx are aligned with the symphysis

30. Sacrum AP Detecting rotation –Sacrum will rotate toward the side that is up –May also use pelvis criteria for detecting rotation

31. Sacrum AP The 1-5 sacral segments are not foreshortened –The sacral foramina are equally spaced –The symphysis does not superimpose any portion of the sacrum

34. Sacrum Lateral Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (10 x 12 lw)

35. Sacrum Lateral Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized

36. Sacrum Lateral The median sacral crest is demonstrated in profile The greater sciatic and pelvic wings are nearly superimposed L5 – S1 disk space is open

37. Sacrum Lateral The long axis of the sacrum is aligned with the film The 3 rd sacral segment is in the center of the film

39. Coccyx AP Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (8 x 10 lw)

40. Coccyx AP Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized

41. Coccyx AP The coccyx is aligned with the symphysis and is at equal distances from the lateral walls of the pelvic inlet

42. Coccyx AP Detecting rotation –The coccyx will move in the same direction (toward) as the side that is up

43. Coccyx AP The coccyx is in the center of the film The symphysis, pelvic brim and 5 th sacral segment are included on the film

46. Coccyx Lateral Facility Identification Correct Marker Placement No Preventable Artifacts Correct Film Size (8 x 10 lw)

47. Coccyx Lateral Density –Controlled by mAs –Overall the density is not too dark or too light Contrast –Optimal kVp 75-85 –Bony trabecular patters and cortical outlines are well visualized

48. Coccyx Lateral The median sacral crest is demonstrated in profile The greater sciatic notches are nearly superimposed

49. Coccyx lateral Determining rotation –It is most common for the patient to be rotated anteriorly toward the table top if they do not have a sponge between the knees

50. Coccyx lateral The first coccygeal vertebra is in the center of the film S5 – the third coccygeal vertebra on film Inferior median sacral crest are also on film

52. THE END