Deck 9: Image Analysis of the Lumbar Vertebrae, Sacrum, and Coccyx

Question 1

Appropriate positioning procedures for a lateral lumbar projection include
1)align the vertebral column parallel with the imaging table.
2)align the shoulders, posterior ribs, and posterior pelvic wings perpendicular to the imaging table.
3)for a patient with scoliosis, the patient is positioned on the imaging table so that the central ray is directed into the abnormal spinal curve.
4)flex the patient's knees and place a pillow or radiolucent sponge between them.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Answer 1

1, 2, 3, and 4

Question 2

For an AP axial sacral projection, the
1)patient should empty the bladder and colon before the procedure.
2)central ray is angled 15 degrees cephalically.
3)ASISs are positioned at equal distance to the imaging table.
4)hips and knees are flexed.

A) 1 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Answer 2

1, 2, and 3 only

Question 3

A lateral lumbar projection with accurate positioning demonstrates
1)open intervertebral disk spaces.
2)the intervertebral foramina.
3)distorted vertebral bodies.
4)the zygapophyseal joints.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 3 only
D) 1 and 4 only

Answer 3

1 and 2 only

Question 4

A left lateral lumbar projection with poor positioning demonstrates rotation. The posterior ribs that are most magnified and projected inferiorly are rotated anteriorly. How should the patient be repositioned for an optimal projection to be obtained?

A) Rotate the patient's right side posteriorly.
B) Angle the central ray caudally.
C) Rotate the patient's left side posteriorly.
D) Position the vertebral column parallel with the imaging table.

Question 5

An AP oblique lumbar projection (RPO or LPO position) with accurate positioning demonstrates
1)the superior and inferior articular processes in profile.
2)"Scotty dogs" that are stacked on top of one another.
3)the obturator foramina.
4)the pedicles situated closest to the IR in the center of the vertebral bodies.

A) 1 and 2 only
B) 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 6

An AP lumbar projection with accurate positioning demonstrates
1)open intervertebral disk spaces.
2)the vertebral bodies without distortion.
3)the spinous processes aligned with the midline of the vertebral bodies.
4)the sacrum and coccyx aligned with the symphysis pubis.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 3, and 4 only
D) 1, 2, 3, and 4

Question 7

For an AP lumbar projection, the
1)ASISs are positioned at equal distances from the imaging table.
2)patient's legs are extended.
3)long axis of the vertebral column is aligned with the short axis of the collimated field.
4)central ray is centered to the iliac crest when a 14- × 17-inch (35- × 43-cm) IR is used.

A) 1 and 4 only
B) 2 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 8

For a lateral sacral projection, the
1)patient's legs are flexed.
2)midcoronal plane is aligned parallel with the imaging table.
3)posterior ribs and the posterior pelvic wings are aligned perpendicular to the imaging table.
4)longitudinal axis of the sacrum is aligned with the short axis of the collimated field.

A) 1 and 3 only
B) 2 and 3 only
C) 1, 2, and 3 only
D) 2 and 4 only

Question 9

An AP lumbar projection with poor positioning that demonstrates closed intervertebral disk spaces
1)also demonstrates distorted vertebral bodies.
2)was obtained with the patient rotated.
3)was obtained with the patient's legs extended.
4)also demonstrates the sacrum and coccyx rotated toward the left side.

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 3 only
D) 2 and 4 only

Question 10

For a lateral lumbar projection obtained with maximum extension, the
1)patient arches the back by extending the shoulders and legs as far posteriorly as possible.
2)lumbar vertebral column demonstrates an increase in lordotic curvature.
3)lumbar vertebral column demonstrates a decrease in lordotic curvature.
4)patient rolls into a tight ball.

A) 1 and 2 only
B) 1 and 3 only
C) 2 and 4 only
D) 3 and 4 only

Question 11

An AP oblique lumbar projection (RPO or LPO position) obtained with the patient underrotated demonstrates
1)obscured zygapophyseal joints.
2)the pedicles closer to the lateral surface of the vertebral bodies than the midline.
3)the intervertebral foramina.
4)the inferior and superior articular processes in profile.

A) 1 and 2 only
B) 2 and 3 only
C) 3 only
D) 1, 2, and 4 only

Question 12

An AP axial sacral projection obtained with a perpendicular central ray demonstrates
1)an elongated sacrum.
2)the sacrum and symphysis pubis without alignment.
3)a foreshortened sacrum.
4)the symphysis pubis superimposed over the lower sacral segments.

A) 1 and 4 only
B) 2 only
C) 3 only
D) 3 and 4 only

Question 13

A lateral sacral projection with accurate positioning demonstrates
1)the long axis of the sacrum aligned with the long axis of the collimated field.
2)near-superimposition of the greater sciatic notches.
3)an open L5-S1 intervertebral disk space.
4)the median sacral crest in profile.

A) 1 and 2 only
B) 1, 2, and 3 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 14

An AP axial sacral projection with poor positioning demonstrates that the symphysis pubis rotated toward the patient's right side. How was the positioning setup mispositioned for such a projection to be obtained?

A) The central ray was angled too cephalically.
B) The patient was in an RPO position.
C) The patient's legs were extended.
D) The patient was in an LPO position.

Question 15

For an AP oblique lumbar projection (RPO or LPO position), the
1)patient's thorax is rotated until the midcoronal plane is at a 45-degree angle with the IR.
2)side of interest is positioned closer to the IR.
3)central ray is centered 2 inches (5 cm) medial to the elevated ASIS at a level 1.5 inches (4 cm) superior to the iliac crest.
4)long axis of the vertebral column is aligned with the short axis of the collimated field.

A) 1 and 3 only
B) 2 and 4 only
C) 1, 2, and 3 only
D) 1, 2, 3, and 4

Question 16

A spot lateral L5-S1 projection with accurate positioning demonstrates
1)the L5-S1 intervertebral disk space in the center of the collimated field.
2)an open L5-S1 intervertebral disk space.
3)obscured intervertebral foramina.
4)near-superimposition of the greater sciatic notches.

A) 1 and 2 only
B) 2 and 3 only
C) 1 and 4 only
D) 1, 2, and 4 only

Question 17

An AP lumbar projection obtained with the patient rotated toward the right side demonstrates
1)the spinous processes positioned closer to the left pedicles.
2)the sacrum and coccyx rotated toward the right side.
3)closed intervertebral disk spaces.
4)distorted vertebral bodies.

A) 1 only
B) 1 and 2 only
C) 1 and 3 only
D) 3 and 4 only

Question 18

A lateral lumbar projection demonstrates closed L4-L5 and L5-S1 intervertebral disk spaces. How should the positioning setup be adjusted for an optimal projection to be obtained?
1)Angle the central ray until it parallels the interiliac line.
2)Rotate the patient into a true lateral position.
3)Align the central ray perpendicular to the L5-S1 vertebral column area.
4)Align the vertebral column parallel with the imaging table.

A) 1 and 4 only
B) 2 only
C) 3 and 4 only
D) 1, 3, and 4 only

Question 19

An AP axial sacral projection with accurate positioning demonstrates
1)the long axis of the median crest aligned with the long axis of the collimated field.
2)foreshortening of the first through fifth sacral segments.
3)the median sacral crest positioned closer to the right side.
4)the ischial spines equally demonstrated and aligned with the pelvic brim.

A) 1 and 2 only
B) 1 and 4 only
C) 2 and 3 only
D) 1, 2, and 4 only

Question 20

For a spot lateral L5-S1 projection,
1)the vertebral column is aligned parallel with the imaging table.
2)a high kVp is used to penetrate the hips and pelvis.
3)the shoulders and ASISs are positioned at equal distances from the imaging table.
4)the knees are flexed.

A) 1 and 2 only
B) 3 and 4 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 21

A lateral sacral projection with poor positioning demonstrates a closed L5-S1 intervertebral disk space and foreshortening of the sacrum. How could the positioning setup have been mispositioned for such a projection to be obtained?
1)The patient was rotated.
2)The central ray was angled too cephalically.
3)The vertebral column was not aligned parallel with the imaging table.
4)The patient's legs were extended.

A) 1 only
B) 2 and 3 only
C) 3 only
D) 1 and 4 only

Question 22

For an AP axial coccygeal projection, the
1)central ray is angled 10 degrees cephalically.
2)shoulders and ASISs are positioned perpendicular to the imaging table.
3)patient should empty the bladder and colon before the examination.
4)central ray is centered to the midsagittal plane at a level 2 inches (5 cm) superior to the symphysis pubis.

A) 1 and 3 only
B) 2 and 4 only
C) 3 and 4 only
D) 1, 2, 3, and 4

Question 23

A less than optimal AP axial sacral projection demonstrating sacral foreshortening

A) will also demonstrate the symphysis pubis superimposing the fifth sacral segment.
B) was obtained with the patient rotated toward the right side.
C) was obtained with too much cephalic central ray angulation.
D) was obtained with an insufficient amount of cephalic central ray angulation.

Question 24

An AP axial coccygeal projection with accurate positioning demonstrates the
1)coccyx aligned with the symphysis pubis.
2)longitudinal axis of the coccyx aligned with the longitudinal axis of the IR.
3)first through third coccygeal vertebrae.
4)coccyx without foreshortening.

A) 1 and 3 only
B) 2 and 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 25

An AP lumbar vertebrae projection demonstrating greater distances from the right pedicles to the spinous processes than from the left pedicles to the spinous processes

A) was obtained with the patient's right side positioned closer to the IR than the left side.
B) will also demonstrate the sacrum and coccyx rotated toward the right inlet pelvis.
C) will require the patient to be rotated toward the right side to obtain an optimal projection.
D) was obtained with the patient's legs extended.

Question 26

A left lateral coccygeal projection with accurate positioning demonstrates
1)the median sacral crest in profile.
2)the first coccygeal vertebra in the center of the collimated field.
3)almost superimposed greater sciatic notches.
4)a left marker.

A) 1 and 4 only
B) 2 and 3 only
C) 2, 3, and 4 only
D) 1, 2, 3, and 4

Question 27

A left lateral sacral projection demonstrates the greater sciatic notches without superimposition and the superiorly situated femoral head anteriorly. How should the positioning setup be adjusted for an optimal projection to be obtained?

A) Rotate the right side of the pelvis anteriorly.
B) Position a radiolucent sponge between the lateral body surface and the imaging table to eliminate lumbar sagging.
C) Angle the central ray caudally.
D) Rotate the right side of the pelvis posteriorly.

Question 28

The posterior surfaces of the vertebral bodies are demonstrated without superimposition on a left lateral lumbar vertebrae projection. The most magnified ribs are demonstrated posteriorly. How should the positioning setup be adjusted to obtain an optimal projection?

A) Rotate the side positioned farthest from the IR posteriorly until the midsagittal plane is perpendicular to the IR.
B) Rotate the right side anteriorly until the midcoronal plane is perpendicular to the IR.
C) Rotate the patient until the midsagittal plane is perpendicular to the IR.
D) Align the midsagittal plane parallel with the IR.

Question 29

For a lateral coccygeal projection,
1)the longitudinally and transversely collimated fields can be closed to a 4-inch (10-cm) field size.
2)the posterior ribs and the posterior pelvic wings are positioned perpendicular to the imaging table.
3)the patient's legs are extended.
4)a small focal spot improves recorded detail sharpness.

A) 1 and 4 only
B) 2 and 3 only
C) 1, 2, and 4 only
D) 1, 2, 3, and 4

Question 30

An AP axial coccygeal projection demonstrates the symphysis pubis superimposed over the second and third coccygeal vertebrae. How was the positioning setup mispositioned for such a projection to be obtained?

A) The patient was rotated.
B) The central ray was angled too caudally.
C) The central ray was angled too cephalically.
D) The patient's legs were extended.