Cervical Spine Case Study
Diagnostic Imaging Techniques
After going through medical and physical examinations, doctor requested X-ray to be done to ensure that diagnosis was correct and source of pain. Two projections was ordered. There are Antero-posterior projection and Lateral projection of the Cervical spine.
Technical Details
Projection kVp mA time (s) mAs SID Focal Spot Size Grid/ Bucky Image receptor
AP 65 200 0.080 16 100 Fine Grid 24cm by 30cm
Lateral 70 200 0.100 20 180 Fine Non-Grid 24cm by 30cm
Rationale for choice of factors
Two projections was done so that better view of the cervical spine can be seen. Choice for kVp and mAs for both projections was used to sufficiently penetrate to be able to see the soft tissue and bony trabeculations. High kVp was …show more content…
used compared to theory because patient’s size is huge as such requires higher kVp to penetrate through. SID was at 100cm for AP projection so as to minimise magnification of the cervical spine and 180cm for lateral projection to help overcome OID (object to image receptor distance) to reduce magnification and improve the sharpness of the image. Cassette size 24cm by 30cm was used so as to include all the details of the cervical spine on the x-ray image. Fine focal spot size was chosen so that bony details can be seen on radiographic image. Non-grid was used for lateral cervical spine to take advantage of the air-gap technique.
Radiographic Techniques
For Anterio-Posterior Projection of Cervical Spine
- Patient was asked to stand upright with the posterior part of the body close to the erect bucky.
- Patient’s head and neck were in contact with the erect bucky
- Patient was asked to open up his legs at shoulder width for the stability of the patient and to minimise motion blurriness.
- Patient’s shoulder was adjusted so that it was parallel with the erect bucky to prevent rotation of the cervical spine.
- The mid-sagittal plane of the body was aligned to the midline of the erect bucky and perpendicular to the image receptor
- Patient was asked to look up as high as possible enough for the occlusal plane to be perpendicular to the bucky so that the mandible was not superimposing the midcervical vertebrae.
- The erect bucky was adjusted such that the center of the image receptor was aligned at the C4 of the cervical spine.
- The central ray was angled at 15 degree cephalad and directed through the C4.
- The colliminator field is adjusted such that includes the lower five cervical bodies and upper two or three thoracic bodies.
- Left marker was placed on the erect bucky away from the area of interest but within the collimination on the left side of the neck.
For Lateral Projection for Cervical spine
- A new clean cassette size 24cm by 30cm was placed in the erect bucky using off grid technique for the lateral projection of the cervical spine.
- Patient was asked to turn sideways standing upright with the affected side of the neck closer to the cassette which was the left such that the left shoulder rest against the device for support.
- Patient’s shoulders were adjusted so that the shoulders lie in the same horizontal plane as the erect bucky.
- The long axis of the cervical vertebrae was aligned such that it was parallel to the erect bucky.
- The mid-coronal plane that passes through the mastoid tips was aligned such that the coronal plane was centered to the vertical line of the erect bucky
- Patient was asked to place his hands at the back and pulled the shoulder downwards so as to depress the shoulders as much as possible to prevent from superimposing on the cervical vertebrae.
- Patient’s chin was elevated slightly to prevent the mandibular rami from superimposing the cervical spine.
- Patient was asked to look straight ahead at a particular spot so as to minimise motion of neck.
- The central ray was perpendicular and horizontally at C4 of the cervical spine.
- The colliminator field is adjusted so as to include the top of the ear superiorly and soft tissue of the neck anteriorly so that it includes all seven of the cervical bodies.
- Left marker was placed on the erect bucky away from area of interest within the collimination since left side was closer to the erect bucky.
Radiological Findings
Radiographic Criteria (all in present tense) eedit!!!
For Antero-posterior (AP) Projection of Cervical Spine
§ The areas from superior portion of C3 to T12 should be visible on the radiographic image.
§ There should be a superimposition of the shadows of the mandible and occipital over the atlas and most of the axis seen on the radiographic image showing that the patient extend the chin enough to be able to see fully the cervical vertebrae well.
§ The cervical spine was not seen rotated on the radiographic image as the spinous processes were equidistant to the pedicles and were aligned with the midline of the cervical vertebrae.
§ The equidistant of the mandibular angles and mastoid processes to the vertebrae as shown on the radiographic image also indicated that the neck was over rotated or under rotated, but parallel to the erect bucky.
For Lateral Projection of the Cervical Spine
§ On the radiographic image, all of the seven cervical vertebrae and T1 were clearly shown indicating sufficient depression of the shoulder.
§ The mandibular rami were not superimposing the atlas or axis as seen on the radiographic image showing that the neck
extended.
§ The superimposition of the open zygapophyseal joints and intervertebral disk spaces as seen on the radiographic image indicates that there was no rotation or tilting of the neck.
§ The spinous processes were clearly projected on the radiographic image.
After going through medical and physical examinations, doctor requested X-ray to be done to ensure that diagnosis was correct and source of pain. Two projections was ordered. There are Antero-posterior projection and Lateral projection of the Cervical spine.
Technical Details
Projection kVp mA time (s) mAs SID Focal Spot Size Grid/ Bucky Image receptor
AP 65 200 0.080 16 100 Fine Grid 24cm by 30cm
Lateral 70 200 0.100 20 180 Fine Non-Grid 24cm by 30cm
Rationale for choice of factors
Two projections was done so that better view of the cervical spine can be seen. Choice for kVp and mAs for both projections was used to sufficiently penetrate to be able to see the soft tissue and bony trabeculations. High kVp was …show more content…
used compared to theory because patient’s size is huge as such requires higher kVp to penetrate through. SID was at 100cm for AP projection so as to minimise magnification of the cervical spine and 180cm for lateral projection to help overcome OID (object to image receptor distance) to reduce magnification and improve the sharpness of the image. Cassette size 24cm by 30cm was used so as to include all the details of the cervical spine on the x-ray image. Fine focal spot size was chosen so that bony details can be seen on radiographic image. Non-grid was used for lateral cervical spine to take advantage of the air-gap technique.
Radiographic Techniques
For Anterio-Posterior Projection of Cervical Spine
- Patient was asked to stand upright with the posterior part of the body close to the erect bucky.
- Patient’s head and neck were in contact with the erect bucky
- Patient was asked to open up his legs at shoulder width for the stability of the patient and to minimise motion blurriness.
- Patient’s shoulder was adjusted so that it was parallel with the erect bucky to prevent rotation of the cervical spine.
- The mid-sagittal plane of the body was aligned to the midline of the erect bucky and perpendicular to the image receptor
- Patient was asked to look up as high as possible enough for the occlusal plane to be perpendicular to the bucky so that the mandible was not superimposing the midcervical vertebrae.
- The erect bucky was adjusted such that the center of the image receptor was aligned at the C4 of the cervical spine.
- The central ray was angled at 15 degree cephalad and directed through the C4.
- The colliminator field is adjusted such that includes the lower five cervical bodies and upper two or three thoracic bodies.
- Left marker was placed on the erect bucky away from the area of interest but within the collimination on the left side of the neck.
For Lateral Projection for Cervical spine
- A new clean cassette size 24cm by 30cm was placed in the erect bucky using off grid technique for the lateral projection of the cervical spine.
- Patient was asked to turn sideways standing upright with the affected side of the neck closer to the cassette which was the left such that the left shoulder rest against the device for support.
- Patient’s shoulders were adjusted so that the shoulders lie in the same horizontal plane as the erect bucky.
- The long axis of the cervical vertebrae was aligned such that it was parallel to the erect bucky.
- The mid-coronal plane that passes through the mastoid tips was aligned such that the coronal plane was centered to the vertical line of the erect bucky
- Patient was asked to place his hands at the back and pulled the shoulder downwards so as to depress the shoulders as much as possible to prevent from superimposing on the cervical vertebrae.
- Patient’s chin was elevated slightly to prevent the mandibular rami from superimposing the cervical spine.
- Patient was asked to look straight ahead at a particular spot so as to minimise motion of neck.
- The central ray was perpendicular and horizontally at C4 of the cervical spine.
- The colliminator field is adjusted so as to include the top of the ear superiorly and soft tissue of the neck anteriorly so that it includes all seven of the cervical bodies.
- Left marker was placed on the erect bucky away from area of interest within the collimination since left side was closer to the erect bucky.
Radiological Findings
Radiographic Criteria (all in present tense) eedit!!!
For Antero-posterior (AP) Projection of Cervical Spine
§ The areas from superior portion of C3 to T12 should be visible on the radiographic image.
§ There should be a superimposition of the shadows of the mandible and occipital over the atlas and most of the axis seen on the radiographic image showing that the patient extend the chin enough to be able to see fully the cervical vertebrae well.
§ The cervical spine was not seen rotated on the radiographic image as the spinous processes were equidistant to the pedicles and were aligned with the midline of the cervical vertebrae.
§ The equidistant of the mandibular angles and mastoid processes to the vertebrae as shown on the radiographic image also indicated that the neck was over rotated or under rotated, but parallel to the erect bucky.
For Lateral Projection of the Cervical Spine
§ On the radiographic image, all of the seven cervical vertebrae and T1 were clearly shown indicating sufficient depression of the shoulder.
§ The mandibular rami were not superimposing the atlas or axis as seen on the radiographic image showing that the neck
extended.
§ The superimposition of the open zygapophyseal joints and intervertebral disk spaces as seen on the radiographic image indicates that there was no rotation or tilting of the neck.
§ The spinous processes were clearly projected on the radiographic image.