1

C-Spine APAxial APOpenMouth

IR 8”x10”LW 8”x10”LW

Grid Yes Yes

SID 40” 30”

FocalSpot Large Large

Patient§ Supineoruprightagainstbucky§ Extendchinsoocclusalplaneis

perpendicular§ Suspendrespiration

§ Supineorupright§ Armsstraightatsides§ Openmouthwideaspossible§ Upperincisorstotipofmastoid

processisperpendicular§ Say“Ahhh”

CRAngle 15°-20°Cephalic 0°

CR§ 15°-20°Cephalic§ EntersatorslightlyinferiortoC-4

ormostprominentpointofthyroidcartilage

§ Entersmidpointofopenmouth

Structures § Body(separatedbyintervertebraldisks)

§ Pedicles§ Superior&InferiorVertebralNotch

EvaluationCriteria

§ Collimation§ AreafromsuperiorportionofC-3to

T-2&surroundingsofttissue§ Shadowsofmandibleandocciput

superimposedoveratlas&mostofaxis

§ Openintervertebraldiskspaces§ Spinousprocessesequidistantto

pedicles&alignedtomidline§ Mandibularangles&mastoid

processesequidistanttovertebrae

§ Collimation§ Dens,atlas,axis,andarticulations

betweenC-1&C-2§ Allarticularsurfacesofatlas&axis§ Superimposedocclusalplaneofupper

incisors&baseofskull§ Mouthopenwide§ Tongueshadownotoveratlas/axis§ Mandibularramiequidistantfrom

dens

2

C-Spine APAxialObliques(RPO/LPO)

PAAxialObliques(RAO/LAO)

IR 8”x10”LW 8”x10”LW

Grid Yes Yes

SID 60”-72” 60”-72”

FocalSpot Large Large

Patient§ SupineoruprightfacingCR§ Adjustbody&headat45°§ Protrudechin§ Suspendrespiration

§ ProneoruprightwithfrontfacingIR§ Rotatebody&head45°§ Suspendrespiration

CRAngle 15°-20°Cephalic 15°-20Caudal

CR § 15°-20°Cephalic§ DirectedatC-4

§ 15°-20°Caudal§ DirectedatC-4

Structures§ C-1=Nobody,justanteriorarch,

posteriorarch,lateralmass,transverseprocess,transverseforamen,superiorarticularprocess)

§ C-2=odontoid/dens,superiorarticularprocess,lamina,inferiorarticularprocess,transverseprocess

EvaluationCriteria

§ Collimation§ Openintervertebralforamina

FARTHESTfromC2-C3toC7-T1§ Openintervertebraldiskspaces§ Uniformsize&contourofforamina§ Elevatedchinthatdoesn’toverlap

atlas&axis§ Occipitalbonenotoverlappingaxis§ C1-C7&T-1

§ Collimation§ Openintervertebralforamina

CLOSESTtoIRfromC1-C2&C7-T1§ Openintervertebraldiskspaces§ Elevatedchin&protrudedjawso

angleofmandibledoesn’toverlapC1orC2

§ Occipitalbonenotoverlappingaxis§ All7cervicalvertebrae&1stthoracic

3

C-Spine Lateral(Grandy)

Lateral(Flexion&Extension)

Lateral(Swimmer’s/Cross-table)

IR 8”x10”LW 10”x12”LW 10”x12”LW

Grid Yes Yes Yes

SID 60”-72” 60”-72” 60”-72”

FocalSpot Large Large Large

Patient

§ Truelateral§ Seatedorstanding§ TopofIR1”aboveEAM§ Depressshouldersas

muchasable(usesandbagsifneeded)

§ Elevatechinslightly§ Exposeendofexhalation

§ Truelateral§ Seatedorstanding§ TopofIR2”aboveEAM§ Flex-drophead

forward,chinclosetochest

§ Extend-elevatechin§ Suspendexpiration

§ LateralRecumbent-headelevatedonarm

§ Upright-flexelbow,restforearmonhead

§ Dependentarmabovehead

§ Suspendrespiration

CRAngle 0° 0° 0°

CR§ EntersatC-4§ Outershoulderprojected

belowlowercervicalvertebrae

§ EntersatC-4 § EntersC7-T1interspace(2”abovejugularnotch)

Structures§ C-7=largestcervical

vertebrae(VertebralProminens)

§ InferiorArticularProcesses

§ ArticularPillar§ Transverseforamen

EvaluationCriteria

§ All7vertebrae&1/3rdofT-1

§ NeckextendedsomandibularraminotoverlappingC-1orC-2

§ Superimposedmandibularrami

§ Norotationortiltofc-spineforopenzygapophysealjoints&intervertebraldiskspaces

§ Spinousprocessesinprofile

§ C-4incenterofx-ray§ Bone&softtissuedetail

§ Flex:§ Bodyofmandible

vertical§ All7spinousprocesses

inprofile§ All7vertebraelateral§ Extend:§ Bodyofmandible

horizontal§ All7vertebraeinlateral

§ Collimation§ Lowercervical&upper

thoracicvertebrae§ Norotation§ Humeralheads

minimallysuperimposedonvertebralcolumn

§ Adequatex-raypenetrationthroughshoulderregion

4

C-Spine Fuch’s TraumaC-Spine SoftTissueNeck

IR 8”x10”CW 10”x12”LW 8”x10”LW

Grid Yes Yes Yes

SID 40” 40” 60”-72”

FocalSpot Large Large Small

Patient

§ Supineorseated§ Extendchinsotipofchin

&tipofmastoidprocessarevertical

§ Suspendrespiration

§ Supineonbackboardincollar

§ Relaxshoulders

§ SupineorUpright§ Truelateral§ Depressshoulders§ Extendheadslightly§ Exposureoninspiration

CRAngle 0° 15°-20°Cephalic 0°

CR § EntersneckonMSPjustdistaltotipofchin

§ 15°-20°Cephalic§ EnteratC-4§ Collimateto1”beyond

skintoreducescatter

§ Enter1”belowEAM§ TopofIRatlevelofEAM

tojugularnotch

Structures § Laminae§ SpinousProcess

§ TransverseProcess§ SuperiorArticular

Process

§ ZygapophysealJoint§ IntervertebralForamen

EvaluationCriteria

§ Collimation§ Entiredenswithinthe

foramenmagnum§ Symmetryofmandible,

cranium,&vertebrae§ Norotation

§ Lower5zygapophysealjoints(90°fromMSP)

§ All7cervicalvertebrae&upper3rdofT-1

§ Nomandibleoverlap§ Norotation/tilt§ Superimposedmandible

rami§ Spinousprocessesin

profile

§ Collimation§ Areafromnasopharynx

toapexoflungs§ Nosuperimpositionof

tracheabyshoulders§ Norotation§ Throatfilledwithair

5

T-Spine AP APOblique(LPO/RPO)

IR 14”x17”LW 14”x17”LW

Grid Yes Yes

SID 40” 40”

FocalSpot Large Large

Patient§ Supineorupright§ Flexhips&knees§ Exposureonfullexpiration

§ Standingorsupine§ Rotatebody20°posterior§ IR1.5”-2”aboveshoulders§ Dependentarmbroughtforward§ Independenthandplacedonhip§ Exposeatendofexpiration

CRAngle 0° 0°

CR § Enterhalfwaybetweenjugularnotch&xiphoidprocess § EnterslevelofT-7

Structures§ Body§ IntervertebralDiskSpaces§ CostotransverseJoint/Articulation

§ TransverseProcesses§ CostovertebralArticulations§ SpinousProcess

EvaluationCriteria

§ Collimation§ All12vertebrae§ Allvertebraeshownwithuniform

density§ Spinousprocessesatmidlineof

vertebralbodies§ Vertebralcolumnalignedtomiddle

ofx-ray§ Ribs,shoulders,lungs,&diaphragm

on14”x17”

§ ShowszygapophysealjointsFARTHESTfromIR

§ All12thoracicvertebrae§ Wideexposurelatitude

6

T-Spine PAOblique(LAO/RAO) Lateral

IR 14”x17”LW 14”x17”LW

Grid Yes Yes

SID 40” 40”

FocalSpot Large Large

Patient

§ Standingorprone§ Rotatebody20°anterior§ IR1.5”-2”aboveshoulders§ Flexelbowofdependentarm&rest

handonhip§ Grabsideofbuckywith

independenthand§ Exposeatendofexpiration

§ LeftLateralRecumbent§ Flexhips&knees§ Placekneesexactlysuperimposed§ Armsatrightanglestobody§ Exposeatendofexpiration

CRAngle 0° 0°

CR § EnterslevelofT-7

§ EnteratT-7(inferioranglesofthescapulae)

§ Entersposteriorhalfofthorax§ Canbeangled10°Cephalicinfemale

or15°inmales

Structures§ Ribs§ Pedicle§ SuperiorArticularProcess

§ InferiorArticularProcess§ IntervertebralForamina§ Lamina§ ZygapophysealJoints

EvaluationCriteria

§ ShowszygapophysealjointCLOSESTtoIR

§ All12thoracicvertebrae§ Wideexposurelatitude

§ Collimation§ Vertebraeclearlyseenthroughrib&

lungshadows§ 12vertebraecentered;

superimpositionofshouldersonuppervertebraemaycauseunderexposure

§ Ribssuperimposedposteriorlytoindicatenorotation

§ Openintervertebraldiskspaces§ Widelatitudeofexposure§ CRcollatedtoreducescatter

7

L-Spine AP APOblique(LPO/RPO)

IR 14”x17”LW 14”x17”LW

Grid Yes Yes

SID 40” 40”

FocalSpot Large Large

Patient§ Supine§ Flexelbowswithhandsonchest§ Flexhips&knees

§ AFFECTEDsideUProtated45°§ Exposeatendofexpiration

CRAngle 0° 0°

CR§ Entersatiliaccrestforlumbosacral

view§ Enter1.5”abovecrestforlumbar

§ 1”-1.5”aboveiliaccrest§ 2”medialtoelevatedASIS

Structures§ Body§ IntervertebralDiskSpaces§ Lamina

§ SpinousProcesses§ TransverseProcesses

EvaluationCriteria

§ Collimation§ Areafromlowerthoracicvertebrae

tosacrum§ Beamcollimatedtolateralmarginof

psoasmuscles§ Noartifactacrossmid-abdomen

fromanyelasticinunderclothes§ X-raypenetrationofallvertebral

structures§ Openintervertebraljoints§ SIjointsequidistantfromvertebral

column§ Symmetricvertebrae,withspinous

processescenteredtobodies

§ ZygapophysealjointsCLOSESTtoIR§ Collimation§ Areafromlowerthoracicvertebraeto

sacrum§ ZygapophysealjointsclosestoIR

open&uniformlyvisiblethroughvertebralbodies

§ Whenjointisnotwellseen,andpedicleisanterior,thebodyisn’trotatedenough

§ Whenjointisn’twellseen,andpedicleisposterior,thepatientisrotatedtoomuch

§ VertebralcolumnparallelwiththetablesothatT12-L1andL-2intervertebraljointspacesremainopen

8

L-Spine AP(BendingViews)

PAOblique(RAO/LAO)

IR 14”x17”LW 14”x17”LW

Grid Yes Yes

SID 40” 40”

FocalSpot Large Large

Patient

§ Supine§ 1st:maxrightbending§ 2nd:maxleftbending§ Crosspatient’slegonoppositeside

fromflexedsideoverotherleg§ Moveheelstowardflexedside§ Suspendrespiration

§ Prone§ AFFECTEDsideDOWNrotated45°

CRAngle 0° 0°

CR § EntersatL-3(1”-1.5”aboveiliaccrest)onMSP

§ EntersL-3(1”-1.5”aboveiliaccrest)§ Enterelevatedsideabout2”lateralto

palpablespinousprocess

Structures § IntervertebralForamen§ SacralPromontory

§ GreaterSciaticNotch§ InferiorArticularSurface(Foot)

EvaluationCriteria

§ Siteofspinalfusioncenterd&includingthesuperiorandinferiorvertebrae

§ Norotationofpelvis(symmetricilia)

§ Bendingdirectionscorrectlyidentifiedwithleadmarkers

§ Sufficientradiographicdensitytoshowthedegreeofmovementwhenvertebraearesuperimposed

§ JointsFARTHESTfromIR§ Areafromlowerthoracicvertebraeto

thesacrum§ ZygapophysealjointsfarthestfromIR§ Whenjointisnotwellseen,andthe

pedicleisanterior,thepatientisnotrotatedenough

§ Whenjointisnotwellseen,andthepedicleisposterior,thepatientisrotatedtoomuch

§ VertebralcolumnparallelwithtablesothatT12-L1andL1-L2intervertebraljointspacesremainopen

9

L-Spine Lateral Lateral(Lumbosacral)

Lateral(Flexion/Extension)

IR 14”x17”LW 8”x10”LW 14”x17”LW

Grid Yes Yes Yes

SID 40” 40” 40”

FocalSpot Large Large Large

Patient

§ Lateralrecumbent§ Flexhips&knees§ Dependentarmatright

angletobody§ Superimposeknees

exactly§ Exposeatexpiration

§ Lateralrecumbent§ Dependentarmatright

angletobody§ Fullyextendhips§ Suspendrespiration

§ Lateralrecumbent§ 1st:leanforward&draw

upthighs§ 2nd:leanthoraxback&

posteriorlyextendthighs/limbs

§ Suspendrespiration

CRAngle 0° 0° 0°

CR

§ EntersL-4(iliaccrest)§ Ifspineisn’tadjusted

horizontal,angleCRtolumbarcolumn(5°formen&8°forwomen)

§ Center2”posteriortoASIS&1.5”inferiortoiliaccrest

§ Canangle5°caudalformen&8°forwomen)

§ EntersspinalfusionareaorL-3

Structures§ SuperiorArticular

Surface(Ear)§ LumbosacralJunction

§ TransverseProcess(Nose)

§ ZygapophysealJoint

§ Pedicle(Eye)§ ParsInterarticularis

(Neck)

EvaluationCriteria

§ Collimation§ Areafromlower

thoracicvertebraetococcyxusing14x17

§ Openintervertebraldiskspacesandintervertebralforamina

§ Superimposedposteriormarginsofeachvertebralbody

§ Vertebraealigneddownthemiddleoftheimage

§ Nearlysuperimposediliaccrests

§ Spinousprocessesinprofile

§ Collimation§ Openlumbosacral

intervertebraljoint§ IncludeallofL-5&

uppersacrum§ Lumbosacraljointinthe

centerofthex-ray§ Iliaccrestsclosely

superimposingeachotherwhenCRisnotangled

§ Siteofspinalfusioninthecenterofradiograph

§ Norotationofthevertebralcolumn(posteriormarginsofvertebralbodiesaresuperimposed)

§ Hyperflexionandhyperextensionidentificationmarkerscorrectlyusedforeachrespectiveprojection

10

Scoliosis PA(Ferguson)

PA(2ndwithElevatedFoot)

IR 14”x17”LW 14”x17”LW

Grid Yes Yes

SID 60”-72” 60”-72”

FocalSpot Large Large

Patient§ SittingorStandingfacingbucky§ Tocheckspinalcurvature§ Include1”ofiliaccrestonIR§ Suspendrespiration

§ Elevatepatient’shiporfootonthesamesideoftheprimarycurveabout3”-4”byusingbookorblockunderfootorbuttocks

§ Suspendrespiration

CRAngle 0° 0°

CR § Bottomoflighttoinclude1”ofiliaccrests

§ Bottomoflighttoinclude1”ofiliaccrests

Structures § Allanatomyvisualized § PrimaryCurve§ CompensatoryCurve

EvaluationCriteria

§ Collimation§ Thoracic&lumbarvertebraeto

includeabout1”ofiliaccrests§ Vertebralcolumnaligneddown

centerofx-ray§ Correctidentificationmarker

§ Collimation§ Thoracic&lumbarvertebraeto

includeabout1”ofiliaccrests§ Vertebralcolumnaligneddown

centerofx-ray§ Correctidentificationmarker

11

Sternum PAOblique(RAO) Lateral LateralRecumbent

(Cross-Table)

IR 10”x12”LW 10”x12”LW 10”x12”LW

Grid Yes Yes Yes

SID 30” 72” 72”(ormaxdistance)

FocalSpot Large Large Large

Patient

§ Prone§ RAOposition-15°-20°§ Supportbodyon

forearm&flexedknee§ TopofIR1.5”above

jugularnotch§ Exposeonexpiration

§ Lateralposition§ Lockhandsbehindback§ TopofIR1.5”above

jugularnotch§ Suspendoninspiration

§ Lateralrecumbent§ Flexhips&knees§ Extendarmsoverhead§ Restheadonarms§ Suspendoninspiration

CRAngle 0° 0° 0°

CR § EnterselevatedsideatT-7&1”lateraltoMSP

§ Enterslateralborderofmid-sternum

§ Enterslateralborderofmid-sternum

Structures§ Clavicle§ JugularNotch§ SCJoint

§ Ribs§ Manubrium§ Body

§ XiphoidProcess§ SternalAngle§ SternocostalJoint

EvaluationCriteria

§ Collimation§ Entiresternumfrom

jugularnotchtotipofxiphoidprocess

§ Reasonablegoodvisibilityofsternumthroughthorax,includingblurredpulmonarymarkings

§ Minimallyrotatedsternum&thorax

§ Sternumprojectedfreeofvertebralsuperimposition

§ Minimallyobliquevertebrae

§ Sternumprojectedoverheart

§ Collimation§ Sternuminentirety§ Manubriumfreeof

superimpositionbysofttissueofshoulders

§ Sternumfreeofsuperimpositionbyribs

§ Lowerportionofsternumunobscuredbybreastsoffemalepatient

§ Collimation§ Lateralimageofsternum

initsentirety§ Sternumfreeof

superimpositionbysofttissuesoftheshouldersorarms

§ Sternumfreeofsuperimpositionbyribs

§ Inferiorportionofsternumunobscuredbybreastsoffemalepatient

12

SCJoints PA(Unilateral&Bilateral)

PAOblique(RAO/LAO)

IR 8”x10”CW 8”x10”CW

Grid Yes Yes

SID 40” 40”

FocalSpot Large Large

Patient

§ Prone§ Armsatsidewithpalmsup§ Bilateral-restheadonchin§ Unilateral-turnheadtofaceaffected

side§ Suspendonexpiration

§ Prone§ AFFECTEDsideDOWN§ Obliquebody10°-15°§ Suspendonexpiration

CRAngle 0° 0°

CR § EnterT-3(posteriortojugularnotch)

§ EnterT2-T3(3”distaltovertebralprominens)&1”-2”lateralfromMSP

Structures § SCJoints§ MedialportionsofClavicles § ShowsSCJointCLOSESTtoIR

EvaluationCriteria

§ Collimation§ BothSCjointsandthemedialends

oftheclavicles§ SCjointsthroughthesuperimposing

vertebral&ribshadows§ Norotationpresentonbilateral

exam;slightrotationpresentonunilateral

§ Collimation§ SJjointofinterestinthecenterofx-

ray,withmanubrium&medialendofclavicleincluded

§ OpenSJjointspace§ SCjointofinterestimmediately

adjacenttovertebralcolumnwithminimalobliquity

§ ReasonablygoodvisibilityoftheSCjointthroughthesuperimposingrib&lungfield