Beruflich Dokumente
Kultur Dokumente
SS: Atlas & axis; atlanto-occipital joints Hyperflexion: head drop forward; draw
Pancoast, Pendergrass & Schaeffer chin as close as possible to the chest
Recommendation: Hyperextension: chin elevated as much as
Head rotated slightly possible
Rationale: to prevent superimposition of RP: C4
laminae & atlas CR: Horizontal
SS: IV disks & zygapophyseal joints
D.) CERVICAL VERTERBRAE SS in Hyperflexion:
C1-C7
AP AXIAL PROJECTION Elevated & widely separated spinous
PP: Supine/upright; chin extended; occlusal plane processes
┴ to IR (prevents superimposition of mandible & SS in Hyperextension:
midcervical vertebrae) C1-C7
RP: C4 Depressed spinous processes
CR: 15-20o cephalad ER:
SS: C3-T2 For functional studies (motility) of cervical
Interpediculate spaces vertebrae
IV disk spaces To demonstrate normal AP movement or
Superimposed transverse & articular absence of movement
processes
ER: Used to demonstrate the presence or absence of AP AXIAL OBLIQUE PROJECTION
cervical ribs Barsony & Koppenstein: described this projection
PP: Supine or upright (more comfortable);
GRANDY METHOD RPO/LPO; body rotated 45o; chin
LATERAL PROJECTION protruded/elevated
PP: Seated/upright; patient in true lateral position; RP: C4
shoulder rotated posteriorly or anteriorly (round CR: 15-20o cephalad
shouldered); chin slightly elevated (prevents SS: Intervertebral foramina & pedicles (farthest
superimposition of mandibular rami & spine); MSP from IR)
// to IR Boylston Suggestion:
RP: C4 Functional studies in oblique projection
CR: Horizontal Rationale: to demonstrate fx of articular
SS: C1-C7 process dislocation/subluxation
Articular pillars
Zygapophyseal joints (C3-C7) PA AXIAL OBLIQUE PROJECTION
Spinous processes PP: Prone or upright (more comfortable);
RAO/LAO; body rotated 45o; shoulder rested
LATERAL PROJECTION against IR; chin protruded/elevated
Hyperflexion & Hyperextension RP: C4
PP: Seated/upright; patient in true lateral position; CR: 15-20o caudad
MSP // to IR
VERTEBRAL COLUMN
RP: T7 (b/n jugular notch & xiphoid process) F.) LUMBAR-LUMBOSACRAL VERTEBRAE
CR: ┴
SS: T1-T12 AP PROJECTION
IV disk spaces PP: Supine/upright; elbow flexed; hands on upper
Transverse processes chest
Costovertebral articulation Hips & knees flexed
o Reduces lumbar lordosis
LATERAL PROJECTION o Places back in contact w/ table
PP: Lateral recumbent or upright (Oppenheimer); o Reduces distortion of vertebral
left side against the table (places heart closer to IR) bodies
MSP // to IR; hips & knees flexed; arms at right o Better delineation of IV disk
angle to body (to elevate ribs enough); place RP: L4 (for lumbosacral); L3 (for lumbar spine
support under lower thoracic spine only)
RP: T7 CR: ┴
CR: ┴ (w/ support); 10-15o cephalad (w/o support); SS: Lumbar bodies
10o (female) or 15o (male) IV disk spaces
SS: T1-T12 Interpediculate spaces
IV disk spaces Laminae
Intervertebral foramina Spinous & transverse processes
Lower spinous processes Sacrum, coccyx & pelvic bones (larger IR)
RP: 2 in. posterior to ASIS & 1.5 in. inferior to iliac H.) LUMBOSACRAL JOINTS & SACRAL
crest JOINTS
CR: ┴ (w/ support); 5-8o caudad (w/o support); 5o
(male) or 8o (female) FERGUSON METHOD
SS: Lumbosacral junction AP AXIAL PROJECTION
PP: Supine; lower limb extended; thigh abducted;
G.) ZYGAPOPHYSEAL JOINTS RP: 1.5 in. superior to pubic symphysis
CR: 45o cephalad (Ferguson); 30-35o cephalad; 30o
AP OBLIQUE PROJECTION (male) or 35o (female);
PP: Semisupine/upright; RPO/LPO; body rotated SS: Lumbosacral joint; symmetric sacroiliac joints
45o or 60o (L5-S1 zygapophyseal joints & articular Meese Recommendation:
processes); PP: Prone (places sacroiliac joints nearly //
RP: to CR)
Lumbar region: 2 in. medial to elevated ASIS & RP: 2 in. distal to L5 (level of ASISs)
1.5 in. superior to iliac crest (L3) CR: ┴
5th zygapophyseal joint: 2 in. medial to elevated
ASIS & midway b/n iliac crest & ASIS FERGUSON METHOD
CR: ┴ PA AXIAL PROJECTION
SS: Zygapophyseal/apophyseal joints (closest to IR) PP: Prone
Scottie dog RP: L4
o Superior articular process (ear) CR: 35o caudad
o Transverse process (nose) SS: Lumbosacral joint; symmetric sacroiliac joints
o Pedicle (eye)
o Part interarticularis (neck) I.) SACROILIAC JOINTS
o Lamina (body)
o Inferior articular process (foot) AP OBLIQUE PROJECTION
Note: PP: Semisupine; RPO/LPO; body rotated 25-30o
Majority (L3-S1) of zygapophyseal joints RP: 1 in. medial to elevated ASIS
(45o body rotation) CR: ┴
L1-L2 & L2-L3 (AP; 25% only) SS: Sacroiliac joint (farthest from IR)
L4-L5 & L5-S1 (LATERAL; small %age)
AP AXIAL OBLIQUE PROJECTION
PA OBLIQUE PROJECTION PP: Semisupine; RPO/LPO; body rotated 25-30o
PP: Semiprone/upright; RAO/LAO; body rotated RP: 1 in. distal to elevated ASIS
45o or 60o (L5-S1 zygapophyseal joints & articular CR: 20-25o cephalad
processes) SS: Sacroiliac joint (farthest from IR)
RP: 1.5 in. superior to iliac crest & 2 in. lateral to
palpable spinous process PA OBLIQUE PROJECTION
CR: ┴ PP: Semiprone; RAO/LAO; body rotated 25-30o
SS: Zygapophyseal/apophyseal joints (farthest from RP: 1 in. medial to elevated ASIS
IR) CR: ┴
Scottie dog SS: Sacroiliac joint (closest to IR)
VERTEBRAL COLUMN
CR: ┴
VERTEBRAL COLUMN
RULES OF OBLIQUE
Anatomy of
Projection Position/Degrees Structure Shown Central Ray
Interest
LPO – 45o Right IF (side up) 15-20o cephalad
CERVICAL AP Oblique
RPO – 45o Left IF (side up) 15-20o cephalad
(Intervertebral
LAO – 45o Left IF (side down) 15-20o caudad
Foramina) PA Oblique
RAO – 45o Right IF (side down) 15-20o caudad
LPO – 70o Right ZJ (joints up) ┴
THORACIC AP Oblique
RPO – 70o Left ZJ (joints up) ┴
(Zygapophyseal
LAO – 70o Left ZJ (joints down) ┴
Joints) PA Oblique
RAO – 70o Right ZJ (joints down) ┴
LPO – 45o Left ZJ (joints down) ┴
LUMBAR AP Oblique
RPO – 45o Right ZJ (joints down) ┴
(Zygapophyseal
LAO – 45o Right ZJ (joints up) ┴
Joints) PA Oblique
RAO – 45o Left ZJ (joints up) ┴
LPO – 25-30o Right SIJ (joint up) ┴
AP Oblique
SACROILIAC RPO – 25-30o Left SIJ (joint up) ┴
JOINTS LAO – 25-30o Left SIJ (joint down) ┴
PA Oblique
RAO – 25-30o Right SIJ (joint down) ┴
LPO – 45o Left AR (side down) ┴
AP Oblique
RPO – 45o Right AR (side down) ┴
AXILLIARY RIBS
LAO – 45o Right AR (side up) ┴
PA Oblique
RAO – 45o Left AR (side up) ┴
ZYGAPOPHYSEAL INTERVERTEBRAL
ANATOMY
JOINTS FORAMINA
Cervical Lateral Oblique – 45o
Thoracic Oblique – 70o Lateral
Lumbar Oblique – 45o Lateral