Radiologic T/S Eval

Question 1

List general indications for radiography of the T-spine and ribs

Answer 1

1. Trauma
2. pain radiating around the chest wall
3. ROM limitations
4. Pre-op/post-op
5. Malignancies
6. Osteoporosis/compression fracture
7. Arthropathy
8. Health conditions associated with spinal abnormality
9. Evaluation of scoliosis and kyphosis
10. Suspected congenital abnormality
11. Monitoring known abnormality
12. suspected instability

Question 2

list views available with a radiologic evaluation of the T-spine

Which view is best for z joint in the t-spine?

Answer 2

1. AP
2. Lateral
3. Other possibilities:
   
   1. Swimmer’s lateral view of the upper thoracic region
   2. Oblique views → z-joints
   3. Thoracolumbar/coned views

Question 3

list radiologic views for the sternum

Answer 3

1. RAO for sternum (posterior oblique projection)
2. RAO and LAO for SC joints
3. Lateral views

Question 4

list radiologic views for the ribs

Answer 4

1. Rib sections → AP, PA, oblique
   
   1. anterior, posterior, axillary
   2. R/L
   3. Upper (1-9)/ Lower (8-12)
2. Chest x-rays

Question 5

what can be seen in a lateral view of the T-spine? (6)

Answer 5

1. should be able to compare anterior, posterior bodies, spinolaminar lines, and articular pillars → should be smooth lines
2. disc heights
3. pedicles superimposed pairs
4. open lateral foramina
5. partial viewing of some z-joints
6. bodies box-like

Question 6

what is best seen with a posterior oblique (RAO position) radiograph of the T-spine? (6)

Answer 6

1. anterior and posterior ribs
2. lungs
3. manubrium and sternal body
4. sternal angle
5. sternal body/xiphoid process junction
6. sternocostal joints

Question 7

list general indications for CT of the T-spine (9)

Answer 7

1. Acute trauma (Adults)
2. degenerative conditions
3. post-op assessment
4. infection
5. image-guided intervention procedures
6. neoplasm
7. inflammatory lesions
8. congenital/developmental conditions
9. Cord Syrinxes/masses (with MRI contraindicated)

Question 8

list general indications for MRI of the T-spine

Answer 8

1. Acute trauma with suspected cord encroachment
2. DDD
3. neoplasms
   
   1. dx and intervention f/u
4. intrinsic spinal cord pathology
5. congenital/developmental conditions
6. cord masses
7. pre and post-op assessments
   
   1. soft tissues
   2. vertebroplasty/kyphoplasty
8. meningeal abnormalities
9. infection (disc space infections, epidural abscess, etc.)

Question 9

List the ACR appropriateness criteria for imaging in the thoracic region

Answer 9

1. suspected spine trauma
2. suspected spine trauma - child
3. rib fractures
4. imaging in the diagnosis of TOS
5. Back pain - child
6. Scoliosis - child
7. Management of vertebral compression fractures