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WorksheetsCervical Spine Radiographic Projections
Total questions: 88
Worksheet time: 45mins
Which projection/method uses a 15-20° cephalad CR through C4 and requires the patient to extend their chin while supine or upright?
AP Axial
Lateral/Grandy
PA Axial Oblique
AP Axial Oblique
For the Lateral/Grandy projection, what is the correct patient position and part position?
Seated or Standing; Coronal plane centered to midline of grid in lateral position, depress shoulders
Supine; Sagittal plane centered to midline of grid, elevate chin
Prone; Coronal plane perpendicular to IR, flex knees
Standing; Oblique position with head rotated 45 degrees, raise arms
The AP Axial Oblique projection requires the patient to rotate 45° with the adjacent shoulder resting against the grid device.
True
False
What is the breathing instruction for the Lateral/Grandy projection?
Suspend at end of full expiration
Inhale deeply and hold breath
Breathe normally during exposure
Suspend at end of full inspiration
For the AP/Open Mouth projection of the cervical spine, what is the correct patient position?
Upright, Seated, or Supine
Prone with chin tucked
Lateral decubitus with head turned
Standing with neck hyperextended
For the AP/Fuchs projection, what is the correct SID (Source to Image Distance)?
40”
36”
48”
72”
For the Lateral Flexion & Extension projection, what is the correct breathing instruction?
Suspend
Inhale deeply and hold
Exhale completely and hold
Breathe normally
Which projection/method requires the patient to phonate 'ah' during exposure?
AP/Open Mouth
Lateral Cervical Spine
PA Chest
AP Pelvis
What is the evaluation criteria for the AP/Fuchs projection?
Entire dens within foramen magnum; No rotation
Mandible superimposed over dens; Open mouth
Petrous ridges projected below orbits; Symmetrical mastoids
Dens not visualized; Excessive rotation
For the Lateral Flexion & Extension projection, what is the correct CR (Central Ray) position?
Horizontal and ⟂ to C4
Vertical and ⟂ to T1
Horizontal and ⟂ to L3
Angled 15° cephalad to C7
Which projection/method requires the upper incisors and mastoid tip to be aligned and perpendicular to the IR?
AP/Open Mouth
Lateral Cervical Spine
PA Axial Skull
Waters View
For the AP/Fuchs projection, what is the correct part position?
MSP centered to midline of grid; Extend chin until tip of chin and tip of mastoid process are vertical
MSP rotated 15 degrees; Chin tucked to chest
Head tilted 30 degrees; MSP off-center
MSP centered; Chin extended so that nose and forehead touch the table
Which projection/method demonstrates the motility of the cervical spine and all seven spinous processes and vertebrae?
Lateral Flexion & Extension
AP Open Mouth
Oblique Cervical
AP Cervical
What is the recommended projection/method for imaging the cervicothoracic region according to the table?
Lateral R or L, Swimmer’s Technique
AP Thoracic Spine
Oblique Cervical Spine
PA Chest
What is the recommended FOV size for the cervicothoracic region radiograph?
IP-10x12” LW (24x30cm)
IP-8x10” LW (20x25cm)
IP-14x17” CW (35x43cm)
IP-7x17” LW (18x43cm)
What is the recommended SID for the cervicothoracic region radiograph?
40”
72”
60”
30”
What is the recommended patient position for the cervicothoracic region radiograph?
Upright
Supine
Prone
Lateral
How should the part position be set for the cervicothoracic region radiograph?
Pt in lateral position with MCP centered to grid. Elevate arm adjacent to bucky and rest forearm on head and depress opposite shoulder. Move humeral head of arm closest to the IR anteriorly and the humeral head of the arm away from the IR posteriorly.
Pt in supine position with arms at sides and MCP centered to grid. No elevation of arms required.
Pt in prone position with both arms extended above the head and MCP centered to grid.
Pt in lateral position with both arms down and MCP centered to grid. No movement of humeral heads required.
What is the recommended central ray (CR) direction for the cervicothoracic region radiograph?
⊥ or angled 5° caudal to C7-T1.
Angled 15° cephalad to C3-C4.
Perpendicular to T12-L1.
Angled 10° caudal to L5-S1.
What radiation protection measures should be taken during the cervicothoracic region radiograph?
Shield gonads, Collimate
Remove all shielding, Use high kVp only
No protection needed, Use open collimation
Shield only the arms, No collimation
What breathing technique is recommended for the cervicothoracic region radiograph?
Suspend or Breathing technique
Deep inspiration
Valsalva maneuver
Rapid shallow breathing
What are the evaluation criteria for a successful cervicothoracic region radiograph?
Lower cervical and upper thoracic ≈ C5 to T4, Penetrated shoulder region
Only the cervical spine is visible, no thoracic region
Image must show the lumbar spine and pelvis
Shoulder region should be completely excluded from the image
What is the recommended FOV size for an AP projection of the thoracic region?
IP-14x17” LW (35x43cm)
IP-10x12” LW (25x30cm)
IP-17x17” LW (43x43cm)
IP-8x10” LW (20x25cm)
For the AP projection of the thoracic region, the patient should be positioned:
Prone
Supine or Upright
Lateral
Sitting
Fill in the blank: For the AP projection, the central ray (CR) is directed ______ to T7, halfway between jugular notch and xyphoid process.
perpendicular
parallel
oblique
horizontal
Which of the following is a breathing instruction for both AP and Lateral projections of the thoracic region?
Suspend at the end of full inspiration
Suspend at the end of full expiration or shallow breathing technique
Take a deep breath and hold
Breathe normally
For the lateral projection of the thoracic region, the vertebral column should be parallel with the plane of the film.
True
False
What is the recommended SID for the lateral projection of the thoracic region?
40”
48”
36”
60”
Fill in the blank: For the AP projection, the evaluation criteria include all 12 vertebrae, good collimation, no rotation, and ______ penetration.
adequate
poor
excessive
minimal
Which projection may require the inclusion of swimmer’s lateral for the upper region?
AP
Lateral
Oblique
PA
What is the recommended FOV size for the AP projection of the lumbar spine?
8x10” (20x25 cm)
14x17” (35x43 cm)
10x12” (25x30 cm)
18x24” (45x60 cm)
For the AP projection of the lumbar spine, what is the suggested SID to reduce distortion and open intervertebral disk spaces?
30”
40”
48”
60”
What is the correct patient position for the AP projection of the lumbar spine?
Prone
Supine or Upright
Lateral
Oblique
Fill in the blank: For the AP projection of the lumbar spine, the central ray (CR) is perpendicular to MSP at the level of the iliac crest for L4 (8x17”), or ___ above crest for L3 (8x14”).
1 ½”
2”
½”
3”
Which of the following is NOT an evaluation criterion for the AP projection of the lumbar spine?
A) Area from lower thoracic to sacrum including all 5 lumbar vertebrae
B) No artifact from elastic clothing
C) Open intervertebral joints
D) Spinous processes
What is the recommended FOV size for the Lateral projection of the lumbar spine?
8x10” (20x25 cm)
14x17” (35x43 cm)
10x12” (25x30 cm)
18x24” (45x60 cm)
For the Lateral projection of the lumbar spine, what is the correct patient position?
Prone
Supine or Upright
Lateral, true lat on affected side
Oblique
Fill in the blank: For the Lateral projection of the lumbar spine, if the spine is not horizontal, angle ___ caudal.
5-8°
10-12°
2-4°
15-20°
Which of the following is an evaluation criterion for the Lateral projection of the lumbar spine?
No rotation
Collimation to lateral margin of psoas muscles
Area from lower thoracic to sacrum
Arms outside of exposure field
For the Lateral, R or L L5-S1 Lumbosacral Junction projection, what is the recommended patient position?
Lateral recumbent
Supine with knees flexed
Prone with arms extended
Erect with back against the table
For the AP Oblique, RPO and LPO projection, how many degrees should the patient be rotated from supine in LPO or RPO position?
45°
15°
60°
90°
For the PA Oblique, RAO and LAO projection, what is the recommended breathing instruction?
Suspend at the end of expiration
Take a deep breath and hold it
Breathe normally during exposure
Suspend at the end of inspiration
Which evaluation criteria is correct for the Lateral, R or L L5-S1 Lumbosacral Junction projection?
All 5 lumbar vertebrae
Open joint in center of IR
Zygapophyseal joints closest to IR
Area from lower thoracic to sacrum
For the AP Oblique, RPO and LPO projection, which of the following is an evaluation criterion?
No rotation
Zygapophyseal joints closest to IR (side down)
Vertebral column parallel with tabletop
Tight collimation to 6x8”
Which projection/method is used for imaging the SI joints and lumbosacral junction according to the table?
AP Axial (Ferguson Method)
AP Oblique (RPO and LPO)
PA Oblique (RAO and LAO)
Lateral Decubitus
What is the patient position for the AP Axial SI joints and Lumbosacral Junction (Ferguson Method)?
Prone
Supine
Lateral
Upright
Fill in the blank: For the AP Axial SI joints and Lumbosacral Junction (Ferguson Method), the cephalic angulation is ___° for males and ___° for females.
30° for males and 35° for females.
25° for males and 30° for females.
20° for males and 25° for females.
35° for males and 40° for females.
For the AP Oblique (RPO and LPO) projection, the patient is rotated 25-30° in a posterior oblique with the side of interest elevated.
True
False
What is the field of view (FOV) size used for all the sacroiliac joint projections listed in the table?
8x10” (20x25 cm)
10x12” (24x30 cm)
14x17” (35x43 cm)
6x10” (15x24 cm)
What is the patient position for the AP and PA Axial Sacrum projection?
Supine or Prone
Lateral decubitus
Erect
Trendelenburg
What is the central ray (CR) direction for the AP Axial Sacrum projection?
15° cephalad entering 2” superior to pubic symphysis
10° caudad entering at the level of ASIS
20° cephalad entering at the iliac crest
Perpendicular entering at the level of the greater trochanter
What is the evaluation criteria for the AP and PA Axial Sacrum projection?
Sacrum free of foreshortening; Pubic bone not overlapping sacrum; No rotation
Sacrum overlapped by pubic bone; Foreshortened sacrum; Rotation present
Sacrum not visible; Pubic bone clearly seen; Rotation present
Sacrum elongated; Pubic bone overlapping sacrum; No rotation
What is the patient position for the AP and PA Axial Coccyx projection?
Supine or Prone
Erect
Lateral recumbent
Sitting
What is the central ray (CR) direction for the AP Axial Coccyx projection?
10° caudad entering 2” superior to pubic symphysis
10° cephalad entering 2” inferior to pubic symphysis
15° caudad entering at the level of the iliac crest
Perpendicular to the coccyx entering at the sacral promontory
What is the evaluation criteria for the AP and PA Axial Coccyx projection?
Coccyx in center of IR; Coccyx segments not superimposed by pubic bone; No rotation; Short scale contrast
Coccyx superimposed by pubic bone; Long scale contrast; Excessive rotation
Coccyx off-center; Coccyx segments superimposed by femur; No contrast
Coccyx in upper third of IR; Coccyx segments superimposed by sacrum; Overexposed image
What is the patient position for the Lateral, R or L Sacrum projection?
Lateral Recumbent
Prone
Supine
Erect
What is the evaluation criteria for the Lateral, R or L Sacrum projection?
Entire sacrum with short scale contrast; No rotation
Only the coccyx is visible; High scale contrast
Pelvic bones are superimposed; Long scale contrast
Sacrum is foreshortened; Excessive rotation
What is the patient position for the Lateral, R or L Coccyx projection?
Lateral Recumbent
Supine
Prone
Erect
What is the evaluation criteria for the Lateral, R or L Coccyx projection?
Coccyx in center of IR; No rotation; Short scale contrast
Coccyx in upper right of IR; Excessive rotation; Long scale contrast
Sacrum in center of IR; No rotation; Long scale contrast
Coccyx in lower left of IR; Rotation present; Short scale contrast
What is the recommended projection/method for reducing radiation dose to radiation-sensitive areas in the Scoliosis Series?
AP
PA
Lateral
Oblique
What is the typical FOV size used for both AP/PA and Lateral projections in the Scoliosis Series?
14x17” or 14x36”
10x12” or 8x10”
7x17” or 11x14”
24x30” or 18x24”
What is the recommended SID (Source to Image Distance) for Scoliosis Series radiographs?
40-60”
30-40”
72-84”
100-120”
For the AP or PA projection in the Scoliosis Series, what is the correct patient position?
Prone
Seated or standing, with a second image recumbent
Supine only
Lateral decubitus
In the Lateral projection of the Scoliosis Series, which side of the curve should be placed against the IR?
The convex side of the curve
The concave side of the curve
Either side of the curve
The upper side of the curve
What is the breathing instruction for both AP/PA and Lateral projections in the Scoliosis Series?
Suspend on inspiration
Suspend on expiration
Deep breath in
Shallow breathing
For the AP/PA projection, what is the evaluation criteria regarding the vertebrae and iliac crests?
Thoracic and lumbar vertebrae are demonstrated to include 1-2 inches of iliac crests
Only cervical vertebrae are demonstrated with no iliac crests visible
Thoracic vertebrae are excluded and only lumbar vertebrae are shown
Iliac crests are not included in the image at all
The collimation for scoliosis series radiographs should be adjusted to the anatomy of interest and the width of the FOV should be less than the width of the IP.
True
False
What is the patient position for the Cervical Fusion Lateral Projection, R or L (2 Exposures made, one in Hyperflexion and one in Hyperextension)?
Seated or Standing
Prone
Supine
Recumbent
For the Lumbar AP Projection (2 Exposures made, one in Rt and Lt Bending), what is the preferred patient position?
Supine (preferred) or Upright
Prone only
Lateral decubitus
Trendelenburg position
In the Lumbar Lateral, R or L (2 Exposures in Flexion and Extension), what is the correct patient position?
Upright or Lateral Recumbent
Prone with arms above head
Supine with knees bent
Seated with legs crossed
For the Cervical Fusion Lateral Projection, what is the correct part position for extension?
Chin is elevated as much as possible
Chin is tucked toward the chest
Head is rotated to the left
Shoulders are raised upward
For the Cervical Fusion Lateral Projection, what is the correct part position for flexion?
Patient drops head forward drawing chin to chest as much as possible
Patient tilts head backward as far as possible
Patient turns head to the right side
Patient keeps head in neutral position
For the Lumbar AP Projection, what should be done with the patient's legs and shoulders?
Cross patient's leg on opposite side to be flexed over the other leg (Rt bend, cross Lt leg over Rt). Move heels and shoulders toward side flexed.
Keep both legs straight and arms at the sides.
Flex both knees and place arms above the head.
Rotate shoulders and legs in opposite directions.
For the Lumbar Lateral, what is the part position for flexion?
In lateral position, patient bends forward
In supine position, patient bends backward
In prone position, patient keeps legs straight
In lateral position, patient keeps arms raised
For the Lumbar Lateral, what is the part position for extension?
In lateral position, patient bends backward
In lateral position, patient bends forward
Patient stands upright with arms raised
Patient lies prone with legs extended
What is the central ray (CR) direction for the Cervical Fusion Lateral Projection?
Horizontal and perpendicular to C4
Vertical and angled 15 degrees cephalad to C7
Horizontal and perpendicular to T1
Angled 10 degrees caudad to C3
What is the evaluation criteria for the Cervical Fusion Lateral Projection?
Demo. motility of C-Spine; All seven spinous processes and vertebrae; Flexion: body of mandible almost vertical; Extension: body of mandible horizontal
Demo. motility of Thoracic Spine; Only five vertebrae; Flexion: body of mandible horizontal; Extension: body of mandible vertical
Demo. motility of Lumbar Spine; All seven spinous processes and vertebrae; Flexion: body of mandible horizontal; Extension: body of mandible vertical
Demo. motility of C-Spine; Only five spinous processes; Flexion: body of mandible vertical; Extension: body of mandible horizontal
The arrow is pointing to this, where the spinal cord traverses through.
Vertebral Foramen
Foramen
Intervertebral Foramen
Hole in vertebra
How many vertebrae are in the thoracic region of the vertebral column?
8
7
12
11
What type of bone is highlighted in red?
long
short
irregular
flat
The vertebral column protects which of the following structures?
Heart
Lungs
Spinal cord
Liver
The sacrum is formed by the fusion of how many vertebrae?
3
5
7
9
Which of the following is a correct evaluation criterion for a lateral projection of the cervical spine?
Thoracic vertebrae excluded from the image
Mandible superimposed over cervical vertebrae
Only the lower cervical vertebrae visible
All seven cervical vertebrae and soft tissue included
What is the recommended central ray (CR) angle for the AP Axial Sacrum projection?
Perpendicular
20° cephalad
10° caudad
15° cephalad
For the lateral projection of the thoracic spine, which breathing technique helps blur the ribs and lung markings?
Inhale deeply and hold breath
Breathe normally during exposure
Suspend at end of inspiration
Suspend at end of expiration
Which projection is best for visualizing the zygapophyseal joints of the lumbar spine?
PA Chest
Lateral
AP Axial
AP Oblique (RPO and LPO)
For the AP Axial projection of the sacroiliac joints, what is the recommended central ray (CR) angulation?
Perpendicular to the joint
45° cephalad
15° caudad
30° cephalad for males, 35° cephalad for females
