Lumbar Vertebrae, Sacrum and Coccyx

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 3rd vertebra is in the center of the collimated field with T12 and 1st 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 12th 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 5th 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 3rd 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 5th 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