This document provides guidance on evaluating head CT scans and cervical spine x-rays. For head CTs, the key things to examine are midline structures, symmetry between sides, basal cisterns, and ventricles. Cervical spine x-rays should be evaluated for fractures, alignment of vertebrae, and abnormal spacing between vertebrae. CT and MRI may also be useful to identify ligament or bone marrow injuries in the cervical spine. The document emphasizes the importance of systematic evaluation of standard imaging views of the head and neck for trauma.

1. HEAD AND CERVICAL SPINE
- Emergency Radiologic Approach -
Ranieri Falcão Aguiar
Radiology Fellow
Radiology Department
Sir Charles Gairdner Hospital
12-06-2014

2. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
Fundamentals of Diagnostic Radiology, 3rd ed.

3. Head ct - approach
1. Midline
2. Symmetry
Fundamentals of Diagnostic Radiology, 3rd ed.

4. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
Fundamentals of Diagnostic Radiology, 3rd ed.

5. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
Fundamentals of Diagnostic Radiology, 3rd ed.

6. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
Fundamentals of Diagnostic Radiology, 3rd ed.

7. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
Fundamentals of Diagnostic Radiology, 3rd ed.

8. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
Fundamentals of Diagnostic Radiology, 3rd ed.

9. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
Fundamentals of Diagnostic Radiology, 3rd ed.

10. Head ct - approach
1. Midline
2. Symmetry
3. Basal cisterns
4. Ventricles
EMERGENCY CT CHECKLIST
1.Is the middle of the brain in the middle of the head?
2.Do the two sides of the brain look alike?
3.Can you see the smile and the pentagon or Jewish star?
4.Is the fourth ventricle in the midline and more or less
symmetrical?
5.Are the lateral ventricles huge, with effaced sulci?
Fundamentals of Diagnostic Radiology, 3rd ed.

11. Fundamentals of Diagnostic Radiology, 3rd ed.

12. What to look for?
• Fractures
• Calvarium
• Skull base
• Orbit
• Facial bones
• Hemorrhage
• Epidural hematoma
• Subdural hematoma
• Subarachnoid
• Intraventricular
• Intracerebral hematoma
• Cortical contusions
• Diffuse axonal injury
Fundamentals of Diagnostic Radiology, 3rd ed.

13. fractures
Fundamentals of Diagnostic Radiology, 3rd ed.

14. fractures
Fundamentals of Diagnostic Radiology, 3rd ed.

15. Epidural hematomas
Fundamentals of Diagnostic Radiology, 3rd ed.

16. Subdural hematomas
Fundamentals of Diagnostic Radiology, 3rd ed.

17. Subdural hematomas
Fundamentals of Diagnostic Radiology, 3rd ed.

18. Subdural hematomas
Fundamentals of Diagnostic Radiology, 3rd ed.

19. Subdural hematomas
Fundamentals of Diagnostic Radiology, 3rd ed.

20. Subarachnoid hemorrhage
Fundamentals of Diagnostic Radiology, 3rd ed.

21. Diffuse axonal injury
Fundamentals of Diagnostic Radiology, 3rd ed.

22. Cortical contusions
Fundamentals of Diagnostic Radiology, 3rd ed.

23. CERVICAL SPINE

24. Cervical spine - RADIOGRAPHS
STANDARD VIEWS
•Lateral
•Antero-posterior
•Open mouth

25. CERVICAL SPINE - ANATOMY
• SPECIFIC ANATOMY
• C1
• C2
• SUBAXIAL
SPECIFIC FRACTURES

26. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

27. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

28. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

29. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

30. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

31. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

32. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

33. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

34. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

35. X-ray adequacy
Fundamentals of Diagnostic Radiology, 3rd ed.

36. alignment
Fundamentals of Diagnostic Radiology, 3rd ed.

37. Diag. and Surgical Imaging Anatomy
Brain, Head&Neck, Spine. 2006

38. alignment

39. distances
Fundamentals of Diagnostic Radiology, 3rd ed.

40. distances
Fundamentals of Diagnostic Radiology, 3rd ed.
ABOVE C4 < 1/3rd
OF VERTEBRAL BODY
BELOW C4 < 1 VERTEBRAL BODY
*NOT SENSITIVE

41. distances

42. ROTATED

43. TEARDROP FRACTURE
A-Z of Emergency Radiology, 1st
ed. 2004

44. JEFFERSON’S FRACTURE
A-Z of Emergency Radiology, 1st
ed. 2004

45. HANGMAN’S FRACTURE
A-Z of Emergency Radiology, 1st
ed. 2004

46. LOCKED FACETS
A-Z of Emergency Radiology, 1st
ed. 2004

48. C-spine
TO SUM UP
1.3 STANDARD VIEWS
2.XRAY QUALITY
3.ALIGNMENT  3 LINES
4.FOLLOW BONE CORTICES
5.DISTANCES
• ATLANTO-DENS INTERVAL
• PRE VERTEBRAL SOFT TISSUE
• C1 LATERAL MASSES (OPEN MOUTH VIEW)
• SPINOUS PROCESS AND DISK SPACES
6.CT
7.MRI  LIGAMENTOUS OR MEDULLARY INJURIES

49. THANK YOU!