Radiographic views of thoracic spine
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This document provides information on taking radiographic views of the thoracic spine, including: - Common clinical indications that would warrant thoracic spine x-rays such as compression fractures or scoliosis. - Instructions for setting up three standard views - the AP, lateral, and oblique positions. For each view, it describes the clinical indications, patient positioning, part positioning, and technical factors. - For the AP view, it instructs to position the patient supine or erect with their midline and midsagittal plane aligned and to direct the CR to T7. For the lateral view, it describes positioning the patient laterally with their spine parallel to the table and directing the CR to T
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Neck Flexion
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2- Tension of posterior muscles of neck
3- Apposition of lower lips of vertebral bodies anteriorly with surfaces of subjacent vertebrae
4- Compression of intervertebral fibrocartilages in front
Fixation:
1- Contraction of anterior abdominal muscles
2-Weight of thorax and upper extremities
Normal & Good
Position: Supine.
Stabilization: Stabilize lower thorax.
Desired Motion: Patient flexes cervical spine through range of motion.
Resistance: Is given on forehead
Note
If there is a difference in strength of the two Sternocleidomastoideus muscles, they may be tested separately by rotation of head to one side and flexion of neck.
Resistance is given above ear.
Fair & Poor
Position: supine.
Stabilization: Stabilize lower thorax.
Desired Motion: Patient flexes cervical spine through full ROM for fair grade and through partial range for poor.
Trace & Zero
The Sternocleidomastoideus muscles maybe palpated on each side of neck as patient attempts to flex.
Muscles contribute to Neck Extension
Splenius capitis
Origin: Lower ligament nuchae, spinous processes and supraspinous ligaments T1-3
Insertion: Lateral occiput between superior and inferior nuchal lines
Nerve supply: Greater occipital nerve
Trapezius (superior fibers)
Origin: Base of the skull & posterior
ligaments of the neck
Insertion: Posterior aspect of the lateral 3rd of clavicle
N. supply: Greater occipital nerve
Splenius cervicis
Origin: Spinous processes and supraspinous ligaments of T3-T6
Insertion: Posterior tubercles of transverse processes of C1-C3
Action: Neck Extension
Nerve supply:
Semispinalis capitis
Origin: Transverse processes of first 6 or 7 thoracic and 7th cervical vertebrae & Articular processes of fourth, fifth and sixth cervical vertebrae
Insertion: Between superior & inferior nuchal lines of occipital bone
Nerve supply: Greater occipital nerve
Note
Factors Limiting Motion:
1-Tension of anterior longitudinal ligament of spine
2-Tension of ventral neck muscles
3-Approximation of spinous processes
Fixation:
1-Contraction of spinal extensor muscles of thorax and depressor muscles of scapulae and clavicles
2- Weight of trunk and upper extremities
Normal & Good
Position: Prone with neck in flexion.
Stabilization: Stabilize upper thoracic area and scapulae.
Desired Motion: Patient extends cervical spine through ROM.
Resistance: Is given on occiput.
Fair & Poor
Position: Prone with neck flexed.
Stabiliza
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Radiographic views of thoracic spine
- 1. Radiographic views of Thoracic Spine Chandan Prasad Rajbhar Tutor College of paramedical sciences TMU, Moradabad
- 2. Common Clinical Indication • Clay shoveler’s fracture • Compression fracture • Herniated nucleus pulposus (HNP) • Kyphosis • Scoliosis • Osteoporosis • Osteoarthritis • Spondylitis, ankylosing spondylitis
- 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 PROJECTION: THORACIC SPINE • Pathology involving the thoracic spine, such as compression fractures, subluxation, or kyphosis • Patient Position—Recumbent and Erect Position • Position patient supine (preferred) with arms at side and head on table or on a thin pillow. • If patient cannot tolerate the supine position, place erect with arms at side and weight evenly distributed on both feet. • Part Position • Align midsagittal plane to CR and midline of table and/or IR. • Flex knees and hips to reduce thoracic curvature. • Ensure that no rotation of thorax or pelvis exists. CR perpendicular to IR. Direct CR to T7 (3 to 4 inches [8 to 10 cm] below jugular notch or 1 to 2 inches [3 to 5 cm] below sternal angle). Centering is similar to that used with AP chest
- 6. LATERAL POSITION: THORACIC SPINE • Pathology involving the thoracic spine, such as compression fractures, subluxation, or kyphosis. • Patient Position—Lateral Recumbent or Erect Position • Position patient in the lateral recumbent position (preferred), with head on pillow and knees flexed. For the erect position, place arms outstretched, with weight evenly distributed on both feet. • Part Position • Align posterior half of thorax (between midcoronal plane and posterior aspect of thorax) to CR and midline of table and/or IR. • Raise patient’s arms to right angles to body with elbows flexed. • Support waist so entire spine is near parallel to table. Palpate spinous processes to determine alignment. • Flex hips and knees, with support between the knees. • Ensure that no rotation of shoulders or pelvis exists. CR perpendicular to long axis of thoracic spine. • Direct CR to T7 (3 to 4 inches [8 to 10 cm] below jugular notch or 7 to 8 inches [18 to 21 cm] below the vertebrae prominens).
- 8. OBLIQUE POSITION—ANTERIOR OR POSTERIOR OBLIQUE: THORACIC SPINE • Pathology involving the zygapophyseal joints of the thoracic spine. • Both right and left oblique projections are taken for comparison. • Patient Position—Oblique Anterior or Posterior Recumbent or Erect Positions • Initially position patient in the lateral recumbent position (preferred), with head on pillow and knees flexed. For the erect position, ensure equal distribution of weight on both feet. • Part Position • Rotate the body 20° from true lateral to create a 70° oblique from plane of table. Ensure equal rotation of shoulders and pelvis. • Flex hips, knees, and arms for stability as needed. • Align spinal column to CR and midline of table and/or IR
- 9. OBLIQUE POSITION—ANTERIOR OR POSTERIOR OBLIQUE: THORACIC SPINE CR perpendicular to IR Direct CR to T7 (3 to 4 inches [8 to 10 cm] below jugular notch or 2 inches [5 cm] below sternal angle).
- 10. Thank You