Deck 9: Lumbar Spine, Sacrum, and Coccyx

Question 1

Why should the hips and knees be flexed for an anteroposterior (AP) projection of the lumbar spine?

A)For patient comfort
B)To reduce the lumbar curvature
C)To demonstrate any possible spondylolisthesis
D)Both A and B

Answer 1

Both A and B

Question 2

The small section of bone found between the superior and inferior articular processes of the lumbar spine is termed:

A)pillar.
B)transverse processes.
C)articular facets.
D)pars interarticularis.

Answer 2

pars interarticularis.

Question 3

The intervertebral joints in the lumbar spine are classified as:

A)synovial/diarthrodial.
B)fibrous/synarthrodial.
C)cartilaginous/amphiarthrodial.
D)fibrous/amphiarthrodial.

Answer 3

cartilaginous/amphiarthrodial.

Question 4

The anterior projecting bony process of the sacrum that forms part of the inlet of the true pelvis is the:

A)promontory of the sacrum.
B)body of S1.
C)apex of coccyx.
D)sacral foramina.

Question 5

The intervertebral foramina of the lumbar spine are located at an angle of _____ in relation to the midsagittal plane.

A)45°
B)30° to 35°
C)70° to 75°
D)90°

Question 6

The average degree of rotation required to demonstrate the L3-4 zygapophyseal joints is:

A)50°.
B)30°.
C)20° to 25°.
D)45°.

Question 7

Which one of the following structures of the sacrum is considered to be the most posterior?

A)Median sacral crest
B)Promontory
C)Superior articular processes
D)Spinous processes

Question 8

Which aspect of the Scottie dog is the inferior articular process?

A)A
B)B
C)C
D)D

Question 9

Another term for the sacral horns is the:

A)base of the sacrum.
B)promontory of the sacrum.
C)cornu of the sacrum.
D)median sacral crest.

Question 10

What is the term for the superior aspect of the coccyx?

A)Base
B)Apex
C)Superior margin
D)Sacrococcygeal junction

Question 11

Which aspect of the Scottie dog is the superior articular process?

A)A
B)B
C)C
D)D
E)E

Question 12

The zygapophyseal joints of the upper lumbar vertebrae are ____ in relationship to the midsagittal plane.

A)30°
B)50°
C)45°
D)90°

Question 13

Which specific aspect of the sacrum articulates with the ilium to form the sacroiliac joint?

A)Promontory
B)Cornu
C)Auricular surface
D)Inferior articular processes

Question 14

Which aspect of the Scottie dog is the pedicle?

A)A
B)B
C)C
D)D

Question 15

Which aspect of the Scottie dog is the transverse process?

A)A
B)B
C)C
D)D

Question 16

Which of the following structures is located at the level of the ASIS?

A)S1-2 (sacral segments)
B)Tip of coccyx
C)L5-S1 joint space
D)L4-5 joint space

Question 17

What type of joint movement occurs with the zygapophyseal joints?

A)Ginglymus
B)Plane
C)Ellipsoidal
D)Pivot

Question 18

Which of the following topographic landmarks corresponds with the L4-5 vertebral level?

A)Xiphoid process
B)Lower costal margin
C)Anterior superior iliac spine (ASIS)
D)Iliac crest

Question 19

Which of the following should be done to reduce scatter radiation from reaching the image receptor for the lateral lumbar, sacrum, and coccyx projections?

A)Use a lower kV.
B)Place a lead mat on the tabletop behind the patient's lower back and pelvis.
C)Increase the source image receptor distance (SID) to 44 inches (113 cm).
D)Use a smaller image receptor.

Question 20

What is the joint classification of the zygapophyseal joints?

A)Cartilaginous/amphiarthrodial
B)Synovial/diarthrodial
C)Fibrous/synarthrodial
D)Symphyses/amphiarthrodial

Question 21

What CR angulation should be used for an AP axial projection of the L5-S1 joint space on a male patient?

A)20° cephalad
B)30° cephalad
C)35° caudad
D)40° to 45° cephalad

Question 22

Sciatic type of pain resulting from a "slipped disk" indicates:

A)spondylolisthesis.
B)herniated nucleus pulposus.
C)ankylosing spondylitis.
D)spina bifida.

Question 23

Where is the CR centered for an AP axial projection of the sacrum?

A)At the level of the ASIS
B)At the level of the symphysis pubis
C)1 to 1 1/2 inches (3 to 4 cm) below the iliac crest
D)2 inches (5 cm) above the symphysis pubis

Question 24

Which labeled structure is the inferior articular process?

A)A
B)B
C)C
D)D
E)E

Question 25

Which of the following statements is NOT true about the lateral L5-S1 projection?

A)If the waist is not supported, the CR must be angled 5° to 8° caudad.
B)A lead mat should be placed on the tabletop behind the patient, and there should be close collimation to improve image quality.
C)A 14- × 17-inch (35- × 43-cm) IR is required.
D)The CR is centered 1.5 inches (3 to 4 cm) inferior to the iliac crest and 2 inches (5 cm) posterior to the ASIS.

Question 26

The radiographic appearance on an oblique lumbar spine in which the neck of the Scottie dog appears broken suggests the presence of:

A)spondylolisthesis.
B)spina bifida.
C)a compression fracture.
D)spondylolysis.

Question 27

An anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called:

A)a teardrop burst fracture.
B)a Chance fracture.
C)a compression fracture.
D)spondylolysis.

Question 28

A key advantage of a posteroanterior (PA) projection taken during a pediatric scoliosis study as compared with the AP projection is that it reduces:

A)breast dose by 90%.
B)female ovarian dose by 25% to 30%.
C)breast dose by 15% to 20%.
D)breast and thyroid dose by 150%.

Question 29

Which labeled structure is the pars interarticularis?

A)A
B)B
C)C
D)D
E)E

Question 30

An average of ____ segment(s) make up the adult coccyx.

A)one
B)four
C)five
D)three

Question 31

A destructive type of lesion with irregular margins and increased density is an indication of possible:

A)osteoblastic type of metastases.
B)osteolytic type of metastases.
C)spondylolisthesis.
D)spondylolysis.

Question 32

Which labeled structure in the figure is the superior articular process?

A)A
B)B
C)C
D)D
E)E

Question 33

Which labeled structure is the spinous process?

A)A
B)B
C)C
D)D
E)E

Question 34

Which of the following is a condition of unknown cause in which calcification of bony ridges between vertebrae occurs, creating a lack of mobility with a "bamboo" appearance?

A)Scheuermann disease
B)Ankylosing spondylitis
C)Spondylolisthesis
D)Osteoblastic type of metastases

Question 35

What CR angle should be used for a lateral sacrum/coccyx projection?

A)15° cephalad
B)30° cephalad
C)None.CR is perpendicular to the image receptor.
D)10° cephalad

Question 36

An abnormal lateral curvature of the spine is a congenital condition termed:

A)spina bifida.
B)spondylolisthesis.
C)lordosis.
D)scoliosis.

Question 37

A radiograph of a left posterior oblique (LPO) projection of the lumbar spine reveals that the downside pedicle is projected too far posterior on the vertebral body.What specific positioning error is present on this radiograph?

A)Excessive rotation of the spine
B)Insufficient rotation of the spine
C)Tilt of the spine
D)Incorrect CR placement

Question 38

What type of CR angulation is required for an AP axial projection of the coccyx?

A)10° caudad
B)15° cephalad
C)10° cephalad
D)Perpendicular to the cassette

Question 39

A fracture through the vertebral body and posterior elements caused by lap seat belts during an auto accident involving sudden deceleration is a ____ fracture.

A)compression
B)Jefferson
C)teardrop burst
D)Chance

Question 40

Where is the central ray (CR) centered for an AP projection of the lumbar spine with a 14- × 17-inch (35- × 43-cm) IR?

A)At the iliac crest
B)At the ASIS
C)1 to 1.5 inches (2.5 to 3 cm) above the iliac crest
D)At the lower costal margin

Question 41

How much obliquity of the body is required for posterior oblique (LPO/RPO) positions for the sacroiliac joints?

A)45°
B)10° to 15°
C)60° to 70°
D)25° to 30°

Question 42

A radiograph of an AP axial L5-S1 projection reveals that the joint space is not open.The following factors were used on this female patient: 80 kV, 40-inch (102-cm) SID, grid, 35° caudad angle, and CR centered to the ASIS.Which of the following factors needs to be modified to produce a more diagnostic image?

A)Increase the CR angulation.
B)Decrease the CR angulation.
C)Change the direction of the CR angulation.
D)Center the CR higher to place it parallel to the joint space.

Question 43

A radiograph of an AP axial sacrum reveals that it is foreshortened and the sacral foramina are not clearly seen.The patient was in an AP supine position, and the technologist angled the CR 5° to 7° cephalad.What specific positioning error is present on this radiograph?

A)Excessive CR angulation
B)Rotation of the sacrum
C)Insufficient CR angulation
D)Wrong direction of the CR angle

Question 44

Radiographs of oblique projections of the SI joints do not clearly demonstrate the inferior/distal aspect of the joints.What can the technologist do to better demonstrate this region?

A)Increase rotation of the pelvis.
B)Initiate exposure upon expiration.
C)Angle the CR 15° to 20° cephalad.
D)Perform positions erect.

Question 45

A radiograph of an AP axial coccyx reveals that the symphysis pubis is superimposed over the distal end of the coccyx.Which of the following modifications will correct this problem during the repeat exposure?

A)Decrease the CR angulation.
B)Increase the CR angulation.
C)Slightly oblique the patient.
D)Ask the patient to empty her bladder.

Question 46

A young female patient comes to radiology for a scoliosis study.The patient has had this series performed frequently.How much will the breast dose be decreased if a PA rather than an AP projection is taken?

A)15%
B)90%
C)35%
D)It will not make a significant difference with good collimation.

Question 47

A patient comes in with a possible compression fracture of L3.Which one of the following positioning routines would best demonstrate the body of L3 and the intervertebral joint spaces above and below it?

A)Collimated R and L posterior oblique and AP projections
B)Collimated PA and lateral projections
C)Erect AP and lateral projections
D)Collimated LPO and RPO positions

Question 48

A radiograph of an AP projection of the lumbar spine on an average-size patient reveals that the psoas major muscles and transverse processes are not visible.The following analog factors were used for this projection: automatic exposure control (AEC) with center ionization chamber, 95 kV, 40-inch (102-cm) SID, grid, and 14- × 17-inch (35- × 43-cm) image receptor.Which of the following modifications will be most effective in demonstrating these structures?

A)Decrease the kV.
B)Activate all three ionization chambers.
C)Decrease the mAs.
D)Increase the kV.

Question 49

A radiograph of the left sacroiliac joint demonstrates it open and clearly seen.Which of the following positions was performed?

A)LPO
B)RPO
C)RAO
D)AP

Question 50

A patient comes to radiology for a follow-up study of the lumbar spine.The patient had a spinal fusion performed at the L3-4 level 4 months earlier.Which of the following would best demonstrate the degree of movement at the fusion site?

A)Lateral hyperextension and hyperflexion projections
B)Ferguson method
C)AP and lateral erect projections
D)Right and left 45° oblique projections

Question 51

A radiograph of a lateral projection of the lumbar spine reveals that the mid- to lower-intervertebral joint spaces are not open.The patient's waist was supported and the CR was perpendicular to the IR.Which of the following modifications will help open these joint spaces during the repeat exposure?

A)Increase the SID for less divergence of the x-ray beam.
B)Decrease waist support and/or angle the CR 5° to 8° cephalad.
C)Have the patient hold her breath on a deeper inspiration to expand the thorax and straighten the spine.
D)Increase waist support and/or angle the CR 5° to 8° caudad.

Question 52

The long axis of the sacrum is generally angled more posteriorly in males than females.

Question 53

Where is the CR centered for posterior oblique projections of the SI joints?

A)1 inch (2.5 cm) medial to upside ASIS
B)2 inches (5 cm) medial to upside ASIS
C)Centered at upside ASIS
D)1 inch (2.5 cm) medial and inferior to upside ASIS

Question 54

A geriatric patient comes to radiology for a lumbar spine series.She has severe kyphosis of the thoracolumbar spine.Which one of the following modifications should be applied to this patient?

A)Perform all positions erect.
B)Perform all positions recumbent; include flexion and extension projections.
C)Include the entire spine for all projections regardless of what was ordered by the physician.
D)Use high (90 kV) for all projections.

Question 55

A patient comes to radiology for a study of the lumbar spine.The initial radiographs demonstrate potential pathology involving the L5-S1 zygapophyseal joint.Which of the following positions and/or projections would best demonstrate this joint space?

A)Lateral L5-S1 position
B)Right and left 30° oblique projections
C)Right and left 50° oblique projections
D)Closely collimated and lateral position of L5-S1 region

Question 56

Which of the following fractures is due to a hyperflexion force injury?

A)Compression
B)Burst
C)Chance
D)Metastatic

Question 57

A patient comes to radiology for a study of the lumbar spine.He has a clinical history of spondylolisthesis of L5.Which of the following projections will best demonstrate the severity of this condition?

A)30° oblique projections
B)50° oblique projections
C)Lateral L5-S1 projection
D)AP axial L5-S1 projection

Question 58

A female is more likely to suffer a fracture of the coccyx due to a backward, sitting type of fall than a male.

Question 59

For a lateral L5-S1 projection, the CR must be parallel to the:

A)midsagittal plane.
B)midcoronal plane.
C)interiliac line.
D)transverse plane.

Question 60

A female patient is brought to the emergency department (ED) because of a motor vehicle accident (MVA).Her chief complaint is pain in the lower lumbar region.The ED physician orders a lumbar series.Upon questioning, the technologist learns that the patient is pregnant.The ED physician is made aware of the pregnancy but still wants the lumbar spine series performed.What can the technologist do to minimize dose to the fetus and mother?

A)Use higher kV than normal; reduce mAs accordingly.
B)Use smallest IR possible.
C)Collimate as much as feasible.
D)All of the above should be done.

Question 61

If the waist is supported properly, an average-size patient does not require any CR angulation for the lateral lumbar spine projection.

Question 62

The LPO position for sacroiliac joints will best demonstrate the right joint.

Question 63

The second projection for the Ferguson method of the scoliosis series requires that the concave side of the curve be built up 3 to 4 inches (8 to 10 cm) by placing blocks beneath the patient's foot.

Question 64

Magnetic resonance imaging (MRI) is superior to computed tomography (CT) for evaluation of spinal cord and intervertebral disks.

Question 65

Gonadal shielding must always be used on adult female patients for the lumbar spine series.

Question 66

The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine.

Question 67

The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine.

Question 68

If the patient has scoliosis, the convexity of the spine should be down toward the image receptor for the lateral spine projection.

Question 69

Lateral projections of the sacrum and coccyx must be performed as two separate exposures.

Question 70

The anterior oblique (RAO and LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor.

Question 71

The pelvis must remain stationary for the AP right and left bending projections of the scoliosis series.

Question 72

The use of digital radiography is not recommended for studies of the sacrum and coccyx.

Question 73

The "nose" of the Scottie dog represents the spinous process of a lumbar vertebra.

Question 74

Bone densitometry produces very little skin dose to the patient.

Question 75

Conventional radiography does not detect bone loss from conditions such as osteoporosis until bone mass has been reduced at least 30%.