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Taking the Blair Spinographs

Taking the Blair Spinographs. Why Take X-Rays. Examples of Asymmetry Anterior Condyle 79% Turned Foramen Magnum 77% Short Condyle 83% Vertical Medial Line off Center 66% Tilted Occiput 57% Odontoid off Center 57% Entire FM and Condyles off Center 62%

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Taking the Blair Spinographs

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  1. Taking the Blair Spinographs

  2. Why Take X-Rays Examples of Asymmetry • Anterior Condyle 79% • Turned Foramen Magnum 77% • Short Condyle 83% • Vertical Medial Line off Center 66% • Tilted Occiput 57% • Odontoid off Center 57% • Entire FM and Condyles off Center 62% • Tilted Foramen Magnum 57%

  3. Dr. Blair’s Research • "When the true longitudinal misalignment presents lateral mass anteriority, it simultaneously presents atlanto superiority and laterality toward the converged direction of the articulation presenting true longitudinal misalignment. • "When the true longitudinal misalignment presents lateral mass posteriority, it simultaneously presents atlanto inferiority and laterality toward the diverged direction of the articulation presenting true longitudinal misalignment".

  4. Long Axis of Articulation of the Condyle From Sherman College of Straight Chiropractic Web Site • The Base Posterior radiograph shows the anatomy of the occipital condyles and Atlas Lateral Masses, with the Foramen Magnum. • The Long Axis of the condyle is a straight line down the longest measure of the articulating surface of the condyle. Right and Left Convergence angles. Bisecting Long axis of the articulating Condyle.

  5. Atlas Motion From the Base Posterior From the Left Protracto View http://www.sherman.edu/research/anim/blair.html

  6. X-Ray Definitions and Procedures Base Posterior APOM Protracto Views Stereo Lateral Cervicals

  7. X-Ray Alignment

  8. X-Ray Alignment

  9. APOM • The “Blair” APOM is similar to the PUC open mouth. • Cephalic tube tilt at (about) 10o. • Central ray goes through a point ¼ inch above the lower molar and the transverse process of atlas.

  10. Neutral Lateral • 72” FFD • Patient positioned with shoulders perpendicular to the bucky • CR at C4 • 10 X 12 Film

  11. AP Cervical • 40” FFD • CR at C4 • 8 X 10 film • Cephalic tube tilt

  12. Base Posterior • Taken with buckey 90 degrees to tube. • To obtain Convergence angles. • Only film taken where patient can be moved out of normal head tilt.

  13. Convergence Angles • Bisected condyle give convergence angles. • Used for angles to take Protracto View. • Used for Line of Drive adjusting angles for C1.

  14. Taking the Base Posterior • Buckey and Tube are 90o to each other. • Tube is at 48 inched FFD. • Absolutely NO head tilt. • Taken with the central ray through the center of the mandible and the EAM.

  15. Squash Head Bad Good

  16. Taking the Base Posterior • Patient is placed in the posture constant chair with their hips all the way back against the back of the chair. • The knees and ankles are moved to the side posts of the chair to allow room for the tube.

  17. Taking the Base Posterior • Place a dot in the center of the menti and one at the angle of the mandible. • Bisect the mandible and place a dot in the middle. • Place Ear Markers in the EAM for reference points.

  18. Taking the Base Posterior • The patient looks straight ahead with their back against the chair. • Look on the face to compare shadows on the face. Under and over the eyes, cheek bones, under and over the nose. • You may move the head if you need to.

  19. Taking the Base Posterior • Place the tube at 48” FFD with the central ray bisecting the middle of the mandible and the EAM. • Set the buckey perpendicular to the tube.

  20. Taking the Base Posterior • Once the head is in the correct position, tighten the head clamps to a comfortable level for the patient and take the picture.

  21. Taking the Base Posterior • Here is a marked Base Posterior. The condyles have been bisected and the ear marker line is drawn. • There is to be little to no head tilt seen on the Base Posterior.

  22. Taking the Protracto View

  23. Taking the Protracto View • The Central Ray (CR) is set at a caudle tube tilt from 48” FFD. • The CR tube tilt is set to intersect the bottom 1/3 of the maxillary sinus and opposite transverse process of atlas. Or set at the APL and intersects the Atlas TP.

  24. Taking the Protracto View

  25. Blair Protracto View • Taken as an Oblique Nasium. • Oblique angle = convergence angle of condyle from BP. • Slope and Convexity angles are taken from Protracto view • To find the Atlas start at lower spine, move up to dens, move lateral toward chin to find the joint in question. Left Protracto View

  26. ASR (Anterior Superior Right) • Atlas has moved Anterior Superior and to the right. • Overlap is seen • Use the Anterior tubercle of Atlas as the indicator for labeling the misalignment . Right Protracto View

  27. PIL (Posterior Inferior Left) • Anterior Tubercle has moved Posterior, Inferior and left. • An underlap is seen on the right Protracto View. Right Protracto View

  28. Slope and Convergence Angles Left Protracto View Left Protracto View • Left Slope Angle • Right Convexity Angle Right Protracto View • Right Slope Angle • Left Convexity Angle Right Protracto View

  29. Stereo Laterals • Taken at 48” or 72” with a 5o caudal tube tilt through the axis. • Used to locate C2-C7 misalignments. • A Stereo Image is obtained by using 4” of total tube shift with the transverse tube arm. • May have to move the patient 4” side to side

  30. Right Lateral Stereo • A Right Lateral Stereo, Right Shift. • A Right Stereo Lateral, Left Shift. RIGHT STEREO R STEREO R LEFT STEREO L STEREO

  31. Left Lateral Stereo • A Left Lateral Stereo, Right Shift. • A Left Lateral Stereo, Left Shift.

  32. Lateral Stereo • Place the “Left Stereo” marker on the “Patient’s left” side of the film for the Left Stereo Shift. • Place the “Right Stereo” marker on the “patients right” side of the film for the Right Stereo Shift. This is to limit confusion as to which side of the patient you are looking at.

  33. Taking the Lateral Stereo • Right Cervical Lateral has the patients right shoulder against the buckey. • Left Cervical Lateral has the persons left shoulder against the buckey. Right Lateral Cervical

  34. Taking the Lateral Stereo • This patient is positioned for a right Lateral Stereo view. • Her right shoulder is against the buckey with a 5-7o rotation toward the buckey. • The apron is lowered off the shoulders so to not interfere with the exposure.

  35. Taking the Lateral Stereos • The CR is set by positioning a level ray at the TP of C2 and set the center of the film to the CR. Raise the tube up to the EAM and caudal tilt the CR back down to the center of the film. • DO NOT collimate yet.

  36. Taking the Lateral Stereo • Left and Right Shifts for the Right Lateral Stereo • The tube is shifted to the patients left (or patient moved to their right) for the Left Stereo Shift. • The tube is shifted to the patients right (or patient moved to their left) for the Right Stereo Shift

  37. Taking the Lateral Stereo • When you shift the tube laterally to the patients left or move the patient to their right (for a Left Stereo Shift), collimate the left side into the edge of the film, as well as, the top and bottom of the film. • You should not have to collimate again for the right shift. Right Lateral Cervical, Left Shift

  38. Lateral Cervical Stereos Left Lateral Cervical Right Shift Left Shift Right Lateral Cervical

  39. A_P P-A

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