Central Osseous System

Spine Radiography

)Part 4(
 PA projection (scoliosis)
• A scoliosis series frequently includes two
AP or (PA) images taken for comparison
one erect and one recumbent
Technical factors:
• IR: 35*43 cm lengthwise
• Kvp: 90 Kv
• Suspend breathing on expiration
Patient position:
• Position patient in the erect & recumbent
position with weight evenly distributed on
both feet for the erect position
• Align midsagittal plane to CR, with arms at
sides)
• Ensure no rotation of pelvis
• Place lower margin of IR a minimum of 1
to 2 inches below iliac crests
• Deformities of adjacent areas of ribs and
pelvis must be evaluated
Central ray:
• CR directed to midpoint of IR

Note: a PA rather than AP is recommended

(90% reduction in dosage to the breasts)
Radiographic criteria
• Structure shown: lumber & thoracic
vertebra as well as approximately 2 inches
below iliac crests
• Position: thoracic & lumber vertebra are
demonstrated in a true an AP projection
• Some rotation of pelvis and/or thorax may
be apparent because scoliosis generally is
accomplished by a twisting or rotation of
involved vertebra
Hyperflexion and hyperextension
of LS (lateral)
• Two images are obtained with the patient
in the lateral position.
Patient position:
• Position in lateral recumbent with support
between knees.
• Hyper flexion: 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 legs posteriorly as far
as possible to hyperextend long axis of
body. Ensure no rotation of thorax or
pelvis exists
Hyperflexion and hyperextension
of LS (lateral)
Exposure factors
• 85-95 kV
• 35*43
• Lead mat is used
• Exposure is made on suspended
expiration
• CR: Center CR to site of fusion if known or
to center to IR
• Structure shown: a lateral view of the
lumber vertebra in hyperflexion &
hyperextension
• True lateral position of patient is indicated
by superimposed posterior vertebral
bodies
• Vertebral column should be in center of
collimated IR
 Sacro Iliac Joints PA
• Indications for imaging
Trauma, congenital abnormalities, assessment
of fracture and joint dislocations  
• Anatomy  Demonstrated
Sacro iliac joints.
Exposure factors
• 75-80 kV
• 24*30
• Exposure is made on suspended expiration
Basic Patient Position
• The patient lies prone
on the table midline
aligned to the midline
of the table
• Coronal plane parallel
to the table, a support
under the ankles to
aid comfort.
• Central Ray
The central ray is angles 20 degrees
caudally and centered in the midline at the
level of the posterior superior iliac spines
Evaluation of the Image
• ID and markers must be
present and correct in the
appropriate area of the film
• Evidence of collimation on
four sides equally around the
centering point.
• Optimal exposure should
penetrate all the bone
structures and contrast
should be low enough to
visualise fully the bone and
soft tissue structures.
• Limits of the examination, the
iliac bone surrounding the
joint on all sides.
• the lumbar sacral articulation
should be projected open, the
sacroiliac joints will appear
open or nearly open.
  Sacro Iliac Joints AP Oblique
• Indications for imaging
Trauma, pain.  
• Anatomy  Demonstrated
Sacro iliac joint. (Raised side in posterior oblique
position)
• Exposure factors
• 75-80 kV
• 24*30
• Exposure is made on suspended expiration
• Basic Patient Position
The examination may be performed either prone
or supine, supine will be described here
• In the supine position the joint space on the
raised side is visualised. (right joint with LPO &
left joint with RPO)
• The patient lies supine on the table midline, from
this position the patient is rotated so the affected
side is raised and the midsaggital plane is at an
angle of 30 degrees from horizontal, and the
patient supported on radio lucent pads.
• Central Ray
CR is directed to a point 1 inch medial to
upside ASIS
• In order to demonstrate the inferior or
distal part of the joint more clearly, the CR
may be angled 15-20 cephalad
• Evaluation of the Image
• ID and markers must be present
and correct in the appropriate
area of the film
• Evidence of collimation on four
sides equally around the centering
point.
• Optimal exposure should
penetrate all the bone structures
and contrast should be low
enough to visualise fully the bone
and soft tissue structures
• The ala of ilium and the sacrum
should have no overlap (correct
obliquity)
 Thank You

May Allah Bless All of You

Dr. Marwan Al-Shibli