Lumbar/ Lumbosacral Vertebrae Study

AP Projection

1. Patient in supine position;
2. Flex at the level of the elbows and rest the hands in upper chest;
3. Aligned the midsagital plane;
4. Flex the knees to reduce lumbar lordosis.

Central ray perpendicular to the middle of L3 and iliac crest (lumbosacral study) or at the level of L3 (lumbar study).

Respiration: Suspended at the end of expiration.

Evaluation Criteria:

• Visualization of T12 to S1or to the end of sacrum;
• Intervertebral joints open;
• No rotation: symmetry of the vertebrae with spinous process at the center of the bodies;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1.  Patient in a lateral recumbent position;
2. Flex the knees and overlap both of them;
3. Flex at the level of the elbows with the hands at the side of the head.

Central ray perpendicular ,to the middle of L3 and iliac crest (lumbosacral study) or at the level of L3 (lumbar study), at the midcoronal plane.

Respiration: Suspended at the end of expiration.

Evaluation Criteria:

• Visualization of T12 to S1 or to the end of sacrum;
• Disk spaces open;
• Posterior margins of vertebrae superimposed;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

PA Oblique Projection

1. Patient in prone position;
2. Rotation the body 45º approximately;
3. Support this position with the forearm and with the knee flexed;

Central ray perpendicular at the level L3, 5cm lateral to the elevate side.

Respiration: Suspended at the end of expiration.

Evaluation Criteria:

• Visualization from lower thoracic vertebrae to sacrum;
• Good visualization of scotty dog;
• L3 in the center of the image;
• Iliac crest of the side in the table it is almost in profile position;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection- Hyperflexion and Hyperextension

1. Patient in lateral recumbent position;

                  a) Hyperflexion: lean forward as much as possible;
                  b) Hyperextension: lean backward as much as possible.

Central ray perpendicular to L3.

Respiration: Suspended.

Evaluation Criteria:

• No rotation: posterior margins of vertebrae superimposed;
• Spinal Fusion in the center of image;
• Visualization of T12 to S1;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Thoracic vertebrae

AP Projection

1.  Patient in supine position;
2. Upper limbs extend along the side of the body;
3. Aligned the midsagital plane;
4. Flex the knees.

Central ray perpendicular to the middle of the sternum.

Respiration: Suspended.

Evaluation Criteria:

• Visualization of the all 12 thoracic vertebrae;
• No rotation;
• Spinous process centered and aligned;
• Thoracic vertebrae in the center of the image;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).

Lateral Projection

1.  Patient in a lateral recumbent position;
2. Flex the knees and overlap both of them;
3. Flex at the level of the elbows with the hands at the side of the head.

Central ray perpendicular to T7.

Respiration: Suspended at the end of the inspiration.

Evaluation Criteria:

• Visualization of the thoracic vertebral totally;
• The thoracic vertebrae in the center of the image;
• No rotation;
• Ribs overlapped;
• Disk spaces open;
• Appropriate exposure values (visualization of the all bony trabeculation and soft tissue).