1. Thoracic vertebrae contain facets for rib articulation and facets on transverse processes for articulation of the first 10 ribs.
2. Radiographs of the thoracic spine are commonly indicated to evaluate fractures, tumors, scoliosis, osteoarthritis, and other spinal abnormalities.
3. Proper patient positioning and shielding are required to obtain diagnostic AP, lateral, and oblique views of the thoracic spine while minimizing radiation exposure.
1. Thoracic vertebrae contain facets for rib articulation and facets on transverse processes for articulation of the first 10 ribs.
2. Radiographs of the thoracic spine are commonly indicated to evaluate fractures, tumors, scoliosis, osteoarthritis, and other spinal abnormalities.
3. Proper patient positioning and shielding are required to obtain diagnostic AP, lateral, and oblique views of the thoracic spine while minimizing radiation exposure.
Original Description:
Highlights anatomy and radiographic technique of the thoracic spine
1. Thoracic vertebrae contain facets for rib articulation and facets on transverse processes for articulation of the first 10 ribs.
2. Radiographs of the thoracic spine are commonly indicated to evaluate fractures, tumors, scoliosis, osteoarthritis, and other spinal abnormalities.
3. Proper patient positioning and shielding are required to obtain diagnostic AP, lateral, and oblique views of the thoracic spine while minimizing radiation exposure.
1. Thoracic vertebrae contain facets for rib articulation and facets on transverse processes for articulation of the first 10 ribs.
2. Radiographs of the thoracic spine are commonly indicated to evaluate fractures, tumors, scoliosis, osteoarthritis, and other spinal abnormalities.
3. Proper patient positioning and shielding are required to obtain diagnostic AP, lateral, and oblique views of the thoracic spine while minimizing radiation exposure.
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Thoracic spine
Objectives • Radiological anatomy • Indication • Equipments required • Radiation protection • Patient preparation • Technique • Evaluation • Radiological consideration • references Radiological anatomy Characteristics of thoracic vertebrae Thoracic spine Articulation • An important distinguishing feature of all thoracic vertebrae is their facets for articulation with ribs. Each of the 12 thoracic vertebrae is associated closely with one pair of ribs that the two lumbar vertebrae, L1 and L2, do not show facets for rib articulations. Joints Costotransverse Joints In addition to costovertebral joints, all of the first 10 thoracic vertebrae also have facets (one on each transverse process) that articulate with the tubercles of ribs 1 through 10. These articulations are termed costotransverse joints. that T11 and T12 do not show facets at the ends of the transverse process for rib articulations. Thus, as the first 10 pairs of ribs arch posteriorly from the upper 10 vertebral bodies, the tubercle of each rib articulates with one transverse process to form a costotransverse joint. Ribs 11 and 12, however, articulate only at the costovertebral joints. Costovertebral joint • Each thoracic vertebra has a full facet or two partial facets, called demi-facets ,on each side of the body. Each facet or combination of two demifacets accepts the head of a rib to form a costovertebral joint. Vertebrae with two demi- facets share articulations with the heads of ribs. THORACIC ZYGAPOPHYSEAL JOINTS • The structure and angles of the facets of the inferior and superior articular processes making up the zygapophyseal joints differ markedly from those of the cervical and lumbar vertebrae. In the thoracic vertebrae, the zygapophyseal joints form an angle of 70° to 75° from the midsagittal plane (MSP). Superior and lateral The normal anatomic structures of a typical vertebra (vertebral body, pedicles, intervertebral foramina, superior and inferior articular processes, laminae, transverse processes, spinous processes). A unique characteristic of the thoracic region is that the long spinous process is projected so far inferiorly, as is best seen on a lateral view For example, when an AP radiographic projection of the thoracic spine is viewed, the spinous process of T4 will be superimposed on the body of T5. Lateral oblique The superior articular processes (facing primarily posteriorly) and the inferior articular processes facing more anteriorly) are shown to connect the successive thoracic vertebrae to form the zygapophyseal (apophyseal) joints. On each side, between any thoracic vertebrae, are intervertebral foramina, which are defined on the superior and inferior margins by the pedicles Lateral 0blique Thoracic intervertebral foramina • The openings of the intervertebral foramina on the thoracic vertebra are located at right angles, or 90°, to the midsagittal plane. summary Thoracic vertebrae All thoracic vertebrae Contain facets for rib articulations (facets or demifacets) T1-T10 Contain facets on transverse processes for rib articulations T1-T9 Contain demifacets for rib articulation T10-T12 Contain single facet for rib articulation Indication • Fractures such as compression, subluxation , • Tumours • Scoliosis' • Osteoarthritis • Bone spurs • Pinched nerve • Kyphosis • Birth defects that affect the spine Equipment's required
• Cassettes according to patient size such as 24 ×
30cm, for smaller patients; 35 × 43 cm, for long forearms. • Detail screen • Anatomical markers • Lead apron, lead sheet, conardo • Sand bag • Foam pad • Lead rubber Radiations protection
• Patient identification • Proper patient positioning. • Beam collimation (to only the area of interest) • The correct use of automatic exposure control • Use fast screens and films-high speed • Use of lead aprons, Gonad shields • Give proper instructions to the patient • Short exposures • Instruct the attendants to wait from outside • Primary beam shouldn’t be in the direction of waiting area • Doors closed during exposure Patient preparation
• Confirm patient’s information
• Create rapport with patient • Take brief history from patient or attendant • Explain procedure to patient and seek consent • Give instruction to patient to remove any radio opaque objects • Position the patient Technique –AP basic
• Shielding: shield all radio sensitive tissue outside
region of interest Antero – posterior basic
• To dat
• The arms at the side and the head on table or
on a thin pillow. If the patient cannot tolerate spine Lateral - basic According to bontrager’s textbook 9th Note Note • According to Clark and positioning bk pg 181
• The vertebrae will be demonstrated optimally if auto-
tomography is used to diffuse the lung and rib shadows. This involves setting a low mA(10-20 mA) and long exposure(3-5s). The patient is allowed to breath normally during exposure. Anterior or posterior oblique Patient positioning – oblique anterior or posterior recumbent or erect positioning • Patient in lateral recumbent • For erect patients; Ensure position with head on pillow equal distribution of weight and knees flexed, rotate body on both feet 20 degrees from lateral to • Align spinal column to create a 70 degree oblique centring ray and midline table from the plane of table and image receptor • Ensure equal rotation of shoulders and pelvis, flex hip, • NB: Anterior oblique are knees and arms for stability recommended because of significantly lower breast dose Anterior oblique position(recumbent)
Anterior oblique LAO or RAO
• Place arm nearest to table down and posterior arm nearest tube forward Posterior oblique position(recumbent)
Posterior oblique LPO or RPO
• Place arm nearest to table up and forward arm nearest to tub e down and posterior Erect anterior oblique position Erect position RAO • Distribute patient weight equally on both feet • Rotate total body, shoulders and pelvis 20 degrees anterior from lateral • Flex elbow and place arm nearest to IR on hip • Raise opposite arm and rst on top head Centring ray Respiration • CR perpendicular to image • Suspend respiration on full receptor (8 t0 10 cm)below expiration jugular notch or 5cm below sternal angle
Recommended collimation • Collimate on two sides of anatomy ( four sides if possible) Evaluation criteria
Anatomy demonstrated. Position :The zygapophyseal
Zygapophyseal joints: joints of the side of interest Anterior oblique positions should be open. However, the demonstrate the downside amount of kyphosis will zygapophyseal joints and determine how many posterior oblique positions zygapophyseal joints will be demonstrate upside joints clearly seen.
Exposure: clear demonstration
of bony markings and trabecular markings of thoracic vertebrae. Localized projections References • Textbook of radiographic positioning and related anatomy by Kenneth L Bontrage and John P Lampignano 8th and 9th edition • Clark’s positioning in radiography 12th edition • X-ray patient positioning manual
