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.
Zygapophyseal joints:
Anterior oblique positions
demonstrate the downside
zygapophyseal joints and
posterior oblique positions
demonstrate upside joints
Position :The zygapophyseal
joints of the side of interest
should be open. However, the
amount of kyphosis will
determine how many
zygapophyseal joints will be
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