This presentation will be helpful for Diploma, B.Sc. as well as M.Sc. students of radiology. I am sure they will grasp more information from this presentation and an explanation of pathologies related to this topic will also help you. This presentation will also help for making perfect position while taking radiography of Lumber spine, sacrum, and coccyx including specialized/functional views.

1. RADIOGRAPHY OF SPINE
Mr. SAMEER AHMAD GANAIE
ASSISTANT PROFESSOR COPMS ADESH UNIVERSITY, BATHINDA PUNJAB

2. CONTENTS
 Objective
 Purpose
 Landmarks
 Anatomy of Lumber Spine
 Anatomy of Sacrum
 Indications
 Positioning
 Basic and Special views
 Radiation Protection During Radiography
 References

3. OBJECTIVE
X-ray of the Whole spine is performed to
evaluate any area of the spine (Cervical,
thoracic, Lumber, Sacral, or Coccygeal)

4. PURPOSE
 The main purpose of Radiography of spine is to diagnose or treat
patients by imaging of the internal structures of the body to assess
the presence or absence of disease, foreign objects, and structural
damage or any congenital anomaly.

5. LANDMARKS

6. ANATOMY OF LUMBAR SPINE
 5 vertebrae L1-L5
 5 intervertebral discs
 Lumbar lordosis
 30°–80°
 The apex of lumbar lordosis L3-L4

7. ANATOMY

8. ANATOMY OF SACRUM

9. INDICATIONS
 FRACTURES
 LOW BACK PAIN
 DISLOCATIONS

10. SPONDYLOLISTHESIS

11.  SCOLIOSIS

12. EXCESSIVE LORDOSIS

13. HERNIATED DISKS

14. LUMBAR SPINE
POSITIONING

15. AP VIEW

16. CENTRAL RAY
Directed towards the midline at the level of
the lower costal margin (L3).
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM

17. STRUCTURES SHOWN
Lumbar vertebral
bodies,
disk spaces,
spinous and
transverse processes,
lateral margin of
psoas muscle,
SI joints,
the sacrum

18. EVALUATION CRITERIA
 Lumbar vertebral bodies, disk spaces, spinous and transverse processes, lateral
margin of psoas muscle, SI joints, and the sacrum should be clearly demonstrated.
 There should be no rotation of the vertebral column.
 Spinous processes should be in the midline of the vertebral bodies.
 Right and left transverse processes equal in length.
 Sacroiliac joints demonstrate equal distance from the spine.
 Optimal exposure should clearly demonstrate soft tissues as well as margins of
psoas muscle and bony vertebrae.

19. LATERAL VIEW

20. CENTRAL RAY
 Directed perpendicular to a point 7.5 cm anterior to the
third lumbar spinous process at the level of the lower
costal margin.
TECHNIQUES
 70 – 80 KVP
 100-150 MAS
 SID 100 CM

21. STRUCTURES SHOWN
Lumbar vertebral
bodies,
intervertebral
foramina,
disk spaces,
spinous processes,
LS joint,
sacrum

22. EVALUATION CRITERIA
 Lumbar vertebral bodies, intervertebral foramina, disk spaces, spinous and
transverse processes, SI joints, and sacrum should be clearly demonstrated.
 There should be no rotation of the vertebral column
 Nearly superimposed iliac crests
 Superimposed posterior margins of each vertebral body.
 Open intervertebral disc spaces.
 The vertebrae should be aligned down in the middle of the radiograph.
 Optimal exposure should demonstrate clearly soft tissues as well as joint spaces and
bony vertebrae.

23. LATERAL HORIZONTAL VIEW

24. CENTRAL RAY
Directed horizontally a point 7.5 cm anterior to the
third lumbar spinous process at the level of the
lower costal margin.(parallel to a line joining the
anterior superior iliac spines)
TECHNIQUES
70 – 80 KVP
100-150 MAS
SID 100 CM

25. STRUCTURES SHOWN
Lumbar
vertebral bodies,
intervertebral
foramina,
disk spaces,
spinous
processes,
LS joint,
sacrum

26. EVALUATION CRITERIA
 Lumbar vertebral bodies, intervertebral foramina, disk spaces, spinous processes, and sacrum
should be clearly demonstrated.
 There should be no rotation of the vertebral column
 Nearly superimposed iliac crests
 Superimposed posterior margins of each vertebral body.
 Open intervertebral disc spaces.
 The vertebrae should be aligned down in the middle of the radiograph.
 Optimal exposure should demonstrate clearly soft tissues as well as joint spaces and bony
vertebrae.

27. LATERAL FLEXION AND EXTENSION

28. CENTRAL RAY
Directed perpendicular to a point 7.5 cm anterior to
the third lumbar spinous process at the level of the
lower costal margin.
TECHNIQUES
70 – 80 KVP
100-150 MAS
SID 100 CM

29. STRUCTURES SHOWN
Lumbar vertebral bodies, intervertebral
foramina, disk spaces, spinous processes joint, sacrum

30. EVALUATION CRITERIA
 Lumbar vertebral bodies, intervertebral foramina, disk spaces, spinous processes and
sacrum should be clearly demonstrated.
 There should be no rotation of the vertebral column
 Nearly superimposed iliac crests
 Superimposed posterior margins of each vertebral body.
 Open intervertebral disc spaces.
 The vertebrae should be aligned down in the middle of the radiograph.
 Optimal exposure should demonstrate clearly soft tissues as well as joint spaces and bony
vertebrae.

31. OBLIQUE VIEW

32. CENTRAL RAY
Directed perpendicular to midclavicular line
on the raised side at the level of the lower
costal margin
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM

33. STRUCTURES SHOWN

34. EVALUATION CRITERIA
 Demonstrate the articular process and facet joints of the side closest to the
cassette. They should be open and uniformly visible through the vertebral
bodies.
 Adequate rotation of the spine is evidenced by the position of the pedicles.
If the pedicle is anterior on the vertebral body, the patient is not rotated
enough, if the pedicle is posterior on the vertebral body, the patient is
rotated too much
 When the patient has been properly positioned in a 30°-45° oblique
position, the articular process and facet joints have the appearance of
"Scottie dogs."

35. LUMBO-SACRAL JUNCTION

36. AP VIEW

37. Directed to the midline at the level of the
anterior superior iliac spines with 10–20
degrees cranially angulation
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM
CENTRAL RAY

38. STRUCTURES SHOWN
4th and 5th
Lumbar vertebral
bodies,
intervertebral
foramina, disk
spaces, spinous
processes joint,
sacrum

39. EVALUATION CRITERIA
 There should be no rotation of the vertebral column.
 Spinous processes in the midline of the vertebral bodies.
 Right and left transverse processes equal in length.
 Symmetric vertebrae.
 Sacroiliac joints demonstrate equal distance from the spine.
 Optimal exposure should clearly demonstrate soft tissues as well as
margins of psoas muscle and bony vertebrae

40. LATERAL VIEW

41. CENTRAL RAY
Directed perpendicular to level of the tubercle of
the iliac crest or midway between the level of the
upper border of the iliac crest and the anterior
superior iliac spine.
TECHNIQUES
70 – 80 KVP
100-150 MAS
SID 100 CM

42. STRUCTURES SHOWN

43. EVALUATION CRITERIA
 There should be no rotation of the vertebral column.
 Nearly superimposed iliac crests
 Superimposed posterior margins of each vertebral body.
 Open intervertebral disc spaces.
 The L5-S1 lumbosacral junction lateral projection should demonstrate the lower one or two
lumbar vertebrae and the upper sacrum with lumbosacral joint in the center of the radiograph.
 Optimal exposure should demonstrate clearly soft tissues as well as joint spaces and bony
vertebrae.

44. OBLIQUE VIEW

45. CENTRAL RAY
Directed perpendicular to the midline at the
level of the anterior superior iliac spines.
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM

46. STRUCTURES SHOWN
articular process
facet joints ,
4th and 5thlumbar
vertebrae,
Proximal sacrum

47. EVALUATION CRITERIA
 Demonstrate the articular process and facet joints of the side
closest to the cassette. They should be open and uniformly
visible through the vertebral bodies.
 Adequate rotation of the spine is evidenced by the position of
the pedicles. If the pedicle is anterior on the vertebral body,
the patient is not rotated enough, if the pedicle is posterior on
the vertebral body, the patient is rotated too much.

48. SACRUM

49. AP VIEW

50. CENTRAL RAY
 Directed perpendicular to a point midway between the
level of the anterior superior iliac spines and the
superior border of the symphysis pubis with tube
angulation of 10–25 degrees cranially
TECHNIQUES
 70 – 80 KVP
 55-65 MAS
 SID 100 CM

51. STRUCTURES SHOWN
SACRUM

52. EVALUATION CRITERIA
 No motion since blurring can occur
 Optimum contrast and density to demonstrate vertebral bodies and
soft tissue
 No rotation

53. LATERAL

54. CENTRAL RAY
Directed perpendicular to the long axis of the
sacrum and to a point at a level midway between
the posterior superior iliac spines and the sacro-
coccygeal junction.
TECHNIQUES
70 – 80 KVP
100-150 MAS
SID 100 CM

55. STRUCTURES SHOWN

56. EVALUATION CRITERIA
 No motion since blurring can occur
 Optimum contrast and density to demonstrate vertebral bodies and
soft tissue
 No rotation

57. COCCYX

58. AP VIEW

59. CENTRAL RAY
Directed to a point in the midline 2.5 cm
superior to the symphysis pubis with tube
angulation of 15 degrees caudally
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM

60. STRUCTURES SHOWN
COCCYX

61. EVALUATION CRITERIA
 No motion since blurring can occur
 Optimum contrast and density to demonstrate vertebral bodies and
soft tissue
 No rotation

62. LATERAL VIEW

63. CENTRAL RAY
Directed perpendicular to long axis of the
sacrum and towards the palpable coccyx.
TECHNIQUES
70 – 80 KVP
100-150 MAS
SID 100 CM

64. STRUCTURES SHOWN

65. EVALUATION CRITERIA
 No motion since blurring can occur
 Optimum contrast and density to demonstrate vertebral bodies and
soft tissue
 No rotation

66. CHASSARD-LAPINE METHOD

67. CENTRAL RAY
Directed perpendicular to ischial tuberosities
TECHNIQUES
70 – 80 KVP
55-65 MAS
SID 100 CM

68. STRUCTURES SHOWN

69. EVALUATION CRITERIA
 No motion since blurring can occur
 Optimum contrast and density to demonstrate soft tissue
 No rotation

70. RADIATION PROTECTION
Collimate the beam to region of
interest
Follow 10 day rule

71. References
 Clark’s positioning.
 Bhargava (For Residents and Technicians)

72. SAMEERAHMADGANAIE(JAMMU&KASHMIR)