spine and pelvis topics obviously ct and lumbar spine um cross table spine work scoliosis sacrum coccyx si joints hip make sure you know trauma and non-trauma hip views pelvis know your pelvis anatomy i'm going to bet you all sorts of money that there's going to be pelvis anatomy on your boards uh review the inlet outlet views judy views those specialty views that you might not do a lot of clinical myelogram and hsg are also included in this section some spine study tips obviously anatomy go through your anatomy do you know pedicle versus lamina um and what i remember from my anatomy class is my teacher taught me to do this so your hands are spinous process your um humorous or the pedicle forearms are your lamina because your pedicle um is closer to your body or your person so p is closer to your person or the body of your vertebrae if that will help you uh landmarks know those landmarks topographical landmark levels obviously central rays sids when would you ever increase your sid might be a trauma or cross table situation if you can't get to 40. two bengals no youtube angles for c-spine ap versus pa when would you when would you change that oblique degrees you're going 45 degrees um usually for c l t spines the outlier at that 70 75 which you probably have never done or never seen an oblique t-spine but make sure you go through that positioning chart know what is visualized on a posterior oblique versus an anterior oblique for ctnl so pay attention to those what anatomy is visualized on the lateral number c spine is different from your t l what you see in a lateral t spine questions you might uh see these questions pop up about orthostatic breathing i want you to review the anode heel effect i always use the term fat cat the fat goes under the cat for the cathode we use a right lateral flexion extension views could be for c-spine or lumbar spine right and left bending views are done in the ap position so standing right and left and then scoliosis potentially is usually a question about pa versus ap uh regarding breast tissue dose and you want your increased sid obviously so c-spine some things to remember 15 to 20 degrees cephala you're going to see four what is demonstrated in the open mouth or odontoid which you might um also refer to it as lateral why do we do it at 72 inches why oid right if they're standing up against that wall stand their shoulder is here but their spine's here we have to compensate for this much oid by increasing our sid what do you see on lateral c-spine do you see circles no you're going to see the circles on the oblique so the obliquity here should be 45 degrees oblique you see nice open intervertebral foramina or the os make sure you know what you can see on a posterior cervical spine oblique so which side are you seeing are you seeing the side closest to the image receptor or side away watch for that um versus the lateral and then potentially questions about if you were to do a posterior oblique which way would your tube be angled versus an anterior oblique which where would your two be angled so if they're posterior you're angling up anterior angling down swimmers go back to your textbook for central ray for swimmers the central way you may use at the clinical site might not be the exact textbook when would you use flexion extension views potentially for looking for whiplash um and just keep in mind that a doctor has to remove that cervical collar as technologists we are not to remove that cervical collar uh ap dens or fuchs method is this ap version here which drops that dens right in the middle of the foramen magnum or reverse is the pa the judd method here again shows us the same image what is the advantage of the pa over ap decrease thyroid dose t-spine i would say there's not a ton to t-spine um it's fairly straightforward central ray t7 almost identical to chest you might see some questions on the orthostatic breathing or the anode heal effect what do you see on a lateral t-spine do you see circles yes you see the o's right interfertible foramina so you're looking at the o's on the lateral lumbar spine uh we've got a couple choices for lumbar spine here so we have a central ray for the ap most of the textbooks are going to tell you to center at crest our textbook specifies 1417 um is a different centering than an 11 by 14 cassette but for the most part you're going to crest you want to bend the knees on the ap water bend the knees reduce that lordotic curve in the lumbar spine lateral where should you center you want to be um anterior to the postal posterior surface ideally don't center too far back the l5 s1 spot what would change your centering or what would change maybe your tube angle things to keep in mind would be the shape of the pelvis remember female and male pelvis are different shapes what line do you need to line up for the l5 s1 and that's the inter iliac line that line goes from iliac crest to iliac crest what would be demonstrated on the flexion extension views for the lumbar and that's that spondylolisthesis which is that fun word to sort of spit out there but that's that forward motion of the vertebrae on top of each other obliques 45 degree obliques you're gonna center two inches medial to the asis what are we looking at we're looking at those z's we're looking for the z's here or the scottie dogs they're also referred to make sure you know what anatomy is on the scotty dog especially the eye right because that is our indicator of proper centering for an oblique where is the eye on the vertebrae is it too far forward is it too far back and be able to sort of determine rotation as far as that goes if you keep in mind that the nose is the transverse process where do you see the transverse process the most you see it on the ap right so if you are still seeing a good amount of transverse process then you're actually not obliqued enough all right so watch for that this was a tip uh i will give credit to our kettering [Music] teacher on this one he has a fun way of remem remembering poster versus anterior position so he uses fresh fried chicken for posterior so c-spine you're gonna see the foramina farthest so this is fresh t-spine is the z's and farthest l-spine is also c z's but closest so chicken um and then it's reversed for anterior my tip is memorize one simply memorize ctl posterior and in your head just remember anterior will be opposite if it's too much for you what are you seeing are you seeing foramina are you seeing pedicles are you seeing o's can you see circles can you see these what does that mean in your brain picture your spine image what are you seeing on the screen what are you visualizing scoliosis so scoliosis i would say most likely what kind of questions would they ask about this i would definitely recommend [Music] reviewing sort of the rad safety essentially components of scoliosis why would pa versus ap reduce breast tissue most often your patients are teenagers and we're going to use a longer sid there's the ferguson method which uses a block to elevate the hip on the convex side and then the cob method is a measurement tool for the radiologists so you might see that terminology for scoliosis sacrum coccyx or si joints ap sacrum 15 up ap coccyx 10 down 15 to the nose 10 to the toes you guys know that one s i joints ap cephalic angle will be 30 degrees for males 35 for females remember these obliques are not as steep all right it's less than you think and another credit to the kettering teacher here for the helpful si joint hit if you can see in the image here he's holding his hands off at a little bit of an angle at the pelvis and that is how the s i joints lie in your pelvis so turn yourself into the oblique and you can see here at this picture in this oblique which joint would open it would be this joint up here would be your open one this joint on this side over here will be closed where should you center go back to your textbook centering for that one and just remember for posterior obliques you're demonstrating side up well what if you flipped it and your patient was now prone and you're doing an anterior oblique which one will be open are you able to think through that process can you figure that out it's usually always the opposite all right hip and pelvis i want you to really spend some time on both of these anatomy pictures both this one and the side version ap hip you guys know we're going to internally rotate that leg 15 to 20 degrees why why do we do that put the femoral neck in true ap position right the frog lateral you want to abduct the leg 40 degrees from vertical let it drop out what do you what is your cross table option the daniels miller or the clements nakayama the clements nakamura is for when both hips are fractured uh the obliques or the juday methods or the 45 degree obliques um and then we're going to look at the same side right aside up and side down the axial pelvis or inlet and outlet views inlet is the 40 degrees coddle demonstrates symphysis pubis anterior initial bones outlet is separated out by male and female pelvis the female pelvis or the degrees for anything in the female pelvis is going to be higher than the male almost every time right this is looking for the pelvic rami without foreshortening all right milograms uh the contrast media is administered via spinal puncture it's into the subarachnoid space through intrathecal injection preferred site is l3l4 make sure you know that um and this term here the conus medullaris is at the lower oh i jumped ahead lower border of l1 and they have to inject lower than this level you might want to review the term cisternal puncture that's between the atlantal occipital joint space i doubt it that'll be on there but you now remember the term we just kind of refreshed it why do we use water soluble where is it deposited and primary pathology for myelogram is the h p make sure you know what h and p stands for and then to round up here is hsg so hsg is included in the pelvis section um what kind of questions could they ask on hsg they could ask anatomy uh it could be something about infertility um that this exam would be performed along with an ob gyn it could be both diagnostic and therapeutic right because sometimes we open up those fallopian tubes and then why are we doing it we're looking to check patency of the fallopian tubes and see if they're open okay