lumbar spine x ray spine radiographic views

1. Radiographic views of
Lumbar spine
Chandan Prasad Rajbhar
Tutor
College of paramedical sciences
TMU, Moradabad

2. Common Clinical Indication
• Ankylosing spondylitis
• Fractures
• Herniated nucleus pulposus
• Lordosis
• Metastases
• Scoliosis
• Spina bifida
• Spondylolisthesis
• Spondylolysis

3. ALL RADIOGRAPHIC VIEWS MUST INCLUDE
• Anatomy
• Labelled diagram (if possible)
• Clinical indication
• Patient preparation
• Patient positioning
• Part positioning
• CR
• Technical factors
• Image review and evaluation
• Anatomical evaluation

4. AP (OR PA) PROJECTION: LUMBAR SPINE
• Pathology of the lumbar vertebrae,
including fractures, scoliosis, and
neoplastic processes.
• Patient Position—Supine Position
• Part Position
• Align midsagittal plane to CR and
midline of table and/or grid.
• Flex knees and hips to reduce lordotic
curvature.
• Ensure that no rotation of thorax or
pelvis exists.
CR perpendicular to IR.
Larger IR (35 × 43): Direct CR to level of iliac
crest (L4-L5
interspace). This larger IR will include lumbar
vertebrae, sacrum, and possibly coccyx.

5. AP (OR PA) PROJECTION: LUMBAR
SPINE

6. OBLIQUES—POSTERIOR (OR ANTERIOR) OBLIQUE POSITIONS:
LUMBAR SPINE
• Defects of the pars interarticularis (e.g.,
spondylolysis).
• Both right and left oblique projections
obtained.
• Patient Position
• Posterior or Anterior Oblique Positions
Position patient semi supine (RPO and left
posterior oblique [LPO]) or semiprone (RAO
and left anterior oblique [LAO])
• Part Position
• Rotate body 45° and align spinal column to
midline of table and/or IR.
• Ensure equal rotation of shoulders and pelvis.
Flex knee for stability and bring arm furthest
from IR across chest.
• Support shoulders and pelvis with radiolucent
sponges to maintain position.
Central Ray Direct CR to L3 at the level of the
lower costal margin (1-2 inches [3-5 cm]) above
iliac crest and 2 inches (5 cm) medial
to upside ASIS.

7. OBLIQUES—POSTERIOR (OR ANTERIOR) OBLIQUE POSITIONS:
LUMBAR SPINE
45 degree
RPO

8. LATERAL POSITION: LUMBAR SPINE
• Pathology of the lumbar vertebrae
including fractures, spondylolisthesis,
neoplastic processes, and
osteoporosis.
• Patient Position—Lateral Position
• Part Position
• Align midcoronal plane to CR and
midline of table and/or IR.
• Place radiolucent support under waist
as needed to place the long axis of the
spine near parallel to the table
(palpating spinous processes to
determine
• Ensure that no rotation of thorax or
pelvis exists.
Central ray
For Larger IR (35 × 43): Center to level
of iliac crest (L4-L5). This projection
includes lumbar vertebrae, sacrum,
and possibly coccyx.

9. LATERAL POSITION: LUMBAR SPINE

10. LATERAL L5-S1 POSITION: LUMBAR SPINE
• Spondylolisthesis involving L4-L5 or L5-S1
and other L5-S1 pathologies
• Patient Position—Lateral Position
• Part Position
• Align midcoronal plane to CR and midline
of table and/or IR.
• Place radiolucent support under waist as
needed to place the long axis of the spine
near parallel to the table (palpating
spinous processes to determine)
• Ensure that no rotation of thorax or pelvis
exists.
Central Ray
CR perpendicular to IR with sufficient waist support,
or angle 5° to 8° caudad with less support.
• Direct CR 1.5 inches (4 cm) inferior to iliac crest
and 2 inches (5 cm) posterior to ASIS.

11. LATERAL L5-S1 POSITION: LUMBAR SPINE

12. PA (AP) PROJECTION: SCOLIOSIS SERIES
• To determine the degree and severity of scoliosis.
• A scoliosis series frequently includes two AP (or PA)
images taken for comparison, one erect and one
recumbent.
• Patient Position—Erect and Recumbent Position.
• Part Position
• Align midsagittal plane to CR and midline of table
and/or IR.
• Ensure that no rotation of thorax or pelvis exists, if
possible.
• Scoliosis may result in twisting and rotation of
vertebrae, making some rotation unavoidable.
• Place lower margin of IR a minimum of 1 to 2 inches
(3 to 5 cm) below iliac crest (centering height
determined by IR size and/or area of scoliosis)
Central Ray
CR perpendicular to IR.

13. PA (AP) PROJECTION:
SCOLIOSIS SERIES

14. ERECT LATERAL POSITION: SCOLIOSIS SERIES
• Spondylolisthesis, degree of kyphosis,
or lordosis.
• Patient Position—Erect Lateral
Position
• Part Position
• Align midcoronal plane to CR and
midline of table and/or IR.
• Ensure that no rotation of thorax or
pelvis exists.
• Place lower margin of IR a minimum of
1 to 2 inches (3 to 5 cm) below level of
iliac crests (centering determined by
IR size and patient size).
Central Ray
CR perpendicular to IR.
Centre IR to CR

15. ERECT LATERAL
POSITION: SCOLIOSIS
SERIES

16. PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS
SERIES
• This method assists in differentiating deforming (primary) curve from compensatory curve.
• Two images are obtained—one standard erect AP or PA and one with the foot or hip on the
convex side of the curve elevated.
• Patient Position—Erect
• Place patient in an erect (seated or standing) position facing the table, with arms at side.
• For second image, place a block under foot (or hip if seated) on convex side of curve so that
the patient can barely maintain position without assistance.
• Part Position
• Align midsagittal plane to CR and midline of table and/or IR.
• Ensure that no rotation of thorax or pelvis exists, if possible.
• Place IR to include a minimum 1 to 2 inches (3 to 5 cm) below the iliac crest.

17. PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS
SERIES
PA erect
PA with block under foot on
convex side of curve

18. PA (AP) PROJECTION—FERGUSON METHOD: SCOLIOSIS
SERIES
Without lift With lift

19. AP (PA) PROJECTION—RIGHT AND LEFT BENDING: SCOLIOSIS
SERIES
• Assessment of the range of motion of the
vertebral column.
• Patient Position—Erect or Recumbent Position
• Part Position
• Align midsagittal plane to CR and midline of table
and/or IR.
• Ensure that no rotation of thorax or pelvis exists,
if possible.
• Place bottom edge of IR 1 to 2 inches (3 to 5 cm)
below iliac crest.
• With the pelvis acting as a fulcrum, ask patient to
bend laterally (lateral flexion) as far as possible to
either side.
• If recumbent, move both the upper torso and legs
to achieve maximum lateral flexion.
• Repeat above steps for opposite side.
CR
• CR perpendicular to IR.

20. AP (PA)
PROJECTION—RIGHT
AND LEFT BENDING:
SCOLIOSIS SERIES
its L bending

21. LATERAL POSITIONS—HYPEREXTENSION AND HYPERFLEXION:
SPINAL FUSION SERIES
• Assessment of mobility at a spinal fusion site.
• Two images are obtained with the patient in the lateral position (one in hyper flexion and one
in hyperextension).
• Patient Position—Recumbent Lateral Position
• Part Position
• Align midcoronal plane to CR and midline of table and/or IR.
• Hyperflexion
• Using pelvis as fulcrum, ask patient to assume fetal position (bend forward) and draw legs up
as far as possible.
• Hyperextension
• Using pelvis as fulcrum, ask patient to move torso and legs posteriorly as far as possible to
hyperextend long axis of body.
• Ensure that no rotation of thorax or pelvis exists

22. LATERAL POSITIONS—HYPEREXTENSION AND HYPERFLEXION:
SPINAL FUSION SERIES
Hyperflexion Hyperextension
Central Ray
CR perpendicular to IR.
Direct CR to site of fusion if known or to center of IR.

23. Hyperflexion Hyperextension

24. Thank You