Thoracic Spine Case Study

Patient Information:
A 27 year old male patient presented to Georgia Physician South in Blackshear. The Patient related a current medical history of having back spasms. He had no previous history or surgery to his back.
Positioning Evaluation:
Routine views for a thoracic spine x-ray include AP and Lateral. Patient positioning for the AP is erect back against image receptor with arms down by side and head in neutral position. Part positioning includes align midsagittal plane to central ray and midline of wall bucky and/or image receptor. Patient position for the lateral is erect with arms outstretched and weight evenly distributed on both feet. Part positioning includes align the posterior half of the thorax to central ray and midline of
wall bucky and/ or image receptor. Raise the patient’s arms to right angles or higher when erect. The entire spine is parallel to wall bucky. Palpate the spinous processes to determine alignment. Ensure that no rotation of shoulders or pelvis exists.
Radiation Protection Evaluation:
Patient was shielded with a Gonad shield.
Collimation was acceptable. More collimation towards the thoracic spine could have been used.
Technical Factors:
Technical factors for the AP thoracic spine included 37.5 mAs at 80 kVp. No deviation index was present due to film screen. Technical factors for the lateral thoracic spine included 60 mAs at 80 kVp. No deviation index was present due to film screen. Coloring of the anatomy on film indicated exposure technique was in an acceptable range.
Marker Evaluation:
A right marker was used to mark and indicate the right side of the patient. For the AP the right marker was placed on the bottom to the right of the spine. For the lateral the left marker was placed posterior to denote the side closest to the IR. Both markers were clearly
visible.
Image evaluation:
Structures on the AP thoracic spine include the second thorough eleventh thoracic vertebral bodies, intervertebral joint spaces, spinous and transverse processes, posterior ribs, and costovertebral articulations.
A repeat film was required. Improvement includes insuring all twelve vertebral bodies are noted. The lateral thoracic spine included all twelve vertebral bodies. It presents the intervertebral joint spaces and intervertebral foramina.
Landmarks used in Thoracic spine positioning include the jugular notch which corresponds to level T2 and T3. T1 is about 1.5 inches superior to the level of the jugular notch. The first thoracic vertebra can be located by palpating posteriorly at the vase of the neck for the prominent spinous process of C7, the vertebra prominens. The most frequently used landmark is the level of T7. Anteriorly it is located about 3 to 4 inches inferior to the jugular notch or at the midpoint of the jugular notch and the xiphoid
process.