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Radiographic Lines

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  1. Skull – 4 Sella turcica Basilar Angle McGregors line Chamberlains line McGregor sells chamberlains bass 4 skulls. Cervical – 9 Cervical Lordosis Stress lines of cerv. Spine Cervical gravity Line Georges line ADI Posterior cervical line Sagital dimension of cerv. Spinal canal Atlanto Axial Alignment Pre-vertebral soft tissue 9 cervical Lords stress gravity GAPS AAAnd pre-vertebral soft tissue Radiographic Lines

  2. Thoracic – 4 Riser-Ferguson (SC) Thoracic cage dimension Cobb’s Angle (SC) Thoracic Kyphosis Riser-Ferguson Caged Cobb’s Kyphosis Lumbar – 12 Inter-vertebral Disc Height Lumbar inter-vertebral disc angles Lumbar lordosis Lumbo-sacral angle Lumbo-sacral disc angle Hadley’s S curve Vanakkerveekens measurement of lumbar instability Lumbar gravity line Static vertebral malposition Lateral Bending sign Ullman’s Line Meyerding Rating System ILLLL HVL SLUM Radiographic Lines

  3. Lower Ext – 15 Boehler’s angle Klein’s Line Skinners line Center edge angle/ Wiberg’s Hip joint space Acetabular angle Pre-sacral space Symphysis pubis width Heel Pad Measurement Patellar malalignment Iliac angle and index Protrusio acetabuli / Kohler’s line Shenton’s line Ilio femoral line Femoral Angle Boehlers use CKlein on their Skin, not their CHAPS, heel, or patella, IPSIlateral for Females Upper Ext – 5 Glenohumeral joint space Metacarpal sign Acromiohumeral joint space Acromiclavicular joint space Radio-capitellar line GlenMetAcromioHumer & AcromioClavi over the Radio Radiographic Lines

  4. Skull Sella turcica size • 5mm to 16mm • Avg is 11mm • Pituitary masses can cause enlargement

  5. Skull Basilar Angle • Avg. 137 degrees • 123 to 152 degrees • Basilar impression and platybasia widen angle • Nasion to sella turcica to basion

  6. Skull McGregors line • Males: 8mm • Females: 10mm • Basilar impression when odontoid more than maximum distance above • Hard palate to occiput • Note relative odontoid apex

  7. Skull Chamberlains line • Basilar impression when odontoid more than maximum distance above • Hard Palate to opisthion

  8. Cervical Cervical Lordosis • Role is unclear. Decreased following trauma, muscle spasm, spondylosis, and patient tucking the chin at time of exposure.

  9. Cervical Stress Lines of Cervical Spine • Flexion C5-C6 joint • Extension C4-C5 joint • Go through C2 and C7 vertebral bodies and note intersection

  10. Cervical Cervical Gravity Lines • Vertical line from odontoid apex • Passes through C7 body

  11. Cervical Georges Line • Alignment of posterior body margins • A to P vertebral mal-positions when line not smooth

  12. Cervical AtlantoDental Interspace (ADI) • C1 anterior tubercle – odontoid • Adult 1mm-3mm • Child 1mm-5mm • Transverse ligament rupture or instability. Trauma, Down’s, and inflammatory arthritis may increase the measurement

  13. Cervical Posterior Cervical Line • Spinolaminar junction lines • AP vertebral malposition when line is not smooth, especially at C1 and C2

  14. Cervical Sagittal Dimension of the cervical spine • Posterior body-spinolaminar junction. • 12mm minimum • Spinal stenosis when less than 12mm. Intraspinal tumor when enlarged.

  15. Cervical Atlanto Axial Alignment • C1 lateral mass-C2 articular pillar margin alignment • Jefferson’s or odontoid fractures or alar ligament instability when margins overlap

  16. Cervical Prevertebral Soft tissue • Anterior bodies-posterior air shadow margins • Retropharyngeal 7mm • C2,3,4 • Retrolaryngeal 7-20mm • C4,5 • Retrotracheal 20mm • C5,6,7 • Soft tissue masses (tumor, infection, hematoma) increase the measurements

  17. Thoracic • Riser-ferguson • Centers of end and apical segments joined and the angle measured • Used for Scoliosis Evaluation

  18. Thoracic Thoracic Cage • Posterior sternum-anterior T8 body • Male: 14cm • Female: 12cm • Straight back syndrome when the distance is less than 13cm in males and 11cm in females

  19. Thoracic Cobb’s Angle • End vertebral endplate lines then intersecting perpendiculars and the angle measured. • Used for scoliosis evaluation

  20. Thoracic Thoracic Kyphosis • T1 superior endplate-T12 inferior endplate, then intersecting perpendiculars and the angle measured • Used for Kyphosis evaluation (Scheuermann’s fractures)

  21. Lumbar Intervertebral Disc Height • Hurxthal method (A) – endplate to endplate • Farfan Method (B) – Ant Height divided by disc diameter, posterior height divided by disc diameter, then as ratio to each other • If decreased, then DJD, surgery, infection

  22. Lumbar Lumbar Inter-vertbral disc angles • At each disc endplate lines are drawn and the angles measured • Altered in various pathologies

  23. Lumbar Lumbar lordosis • L1 endplate–S1 endplate; perpendiculars and angle formed • 50-60 degrees • Altered in various pathologies

  24. Lumbar Lumbosacral angle • Endplate of S1 to horizontal line angle • 41 degrees is average • 26-57 degree range • Altered in various pathologies

  25. Lumbar Lumbosacral Disc Angle • Angle between opposing endplates of L5 and S1 • 10-15 degree range • Altered in various pathologies

  26. Lumbar Hadley’s “S” curve • A line along the inferior surface of the TVP, AP and across the joint • Should be smooth • Facet subluxation could be present if “S” is Broken

  27. Lumbar Van akkerveekens measurement of lumbar instability • Endplate lines are opposing segments. Measure from the posterior body to the point of intersection • Should be equal measurements • Max is 1.5 mm difference • Nuclear, annular and posterior ligament damage if more than 1.5 mm difference

  28. Lumbar Lumbar Gravity Line • A perpendicular line is drawn from the center point of the L3 body • Intersects sacral base • Altered in various pathologies

  29. Lumbar Static Vertebral malposition / Houston conference listings / medicare listings • Numerous terms are applied to describe static vertebral malpositions • Altered in various pathologies

  30. Lumbar Lateral Bending Sign • Spinous position • Intersegmental wedging • Usually toward concavity • Gradually increase away from sacrum • Disc herniation at level failing to laterally flex

  31. Lumbar Ullman’s Line • Endplate line through S1, perpendicular from sacral promontory • L5 should be behind the line • Detection of subtle spondylolisthesis when L5 body crosses perpendicular line

  32. Lumbar Meyerding Rating System • Sacral base divided into quarters. Relative position of the posterior body of L5 is made. • Grading severity of spondylolisthesis

  33. Lower Extremity Klein’s Line • Tangential line to outer femoral neck. Head just overlaps laterally • Slipped epiphysis suspected if head does not intersect line.

  34. Lower Extremity Boehler’s angle • Three superior points joined on the calcaneus, posterior angle is measured • Avg. 30-35 degrees • 28-40 degrees is the range • Calcaneal fractures may reduce the angle to less than 28 degrees

  35. Lower Extremity Skinner’s line • Femoral shaft line. Perpendicular second line tangential to the tip of the greater trochanter • Passes through or below fovea capitus • Hip joint abnormality if line passes above fovea capitus

  36. Lower Extremity Center edge Angle / Wiberg’s • From the center of the femoral head, vertically and acetabular edge, lines are drawn. • The angle is then measured • Avg. 36 degrees • 20-40 degrees is range • A shallow acetabulum may precipitate DJD

  37. Lower Extremity Hip JointSpace • Femoral head-acetabulum distance • Superior = 3-6mm • Axial = 3-7mm • Medial = 4-13mm • Various joint diseases increase the space • DJD, RA, Degenerative RA

  38. Lower Extremity Acetabular Angle • Y-Y line drawn. Second line from medial to lateral acetabular surfaces. Angle measured • Avg. 20 degrees • 12-29 degrees is the range • Congenital hip dislocation widens the angle. • Down’s syndrome decreases the angle

  39. Lower Extremity • Pre-sacral space • Soft tissue density between the rectum and anterior sacral surface • Child: 3mm (1-5) • Adult: 7mm (2-20) • Diastasis and inflammatory joint disease may widen the joint.

  40. Lower Extremity • Symphysis Pubis Width • The distance between opposing articular surfaces, Halfway between the superior and inferior margins • Male:6mm (4.8-7.2) • Female: 5mm (3.8-6.0) • Diastasis and inflammatory joint disease may widen the joint.

  41. Lower Extremity Heel Pad Measurement • Shortest distance between the calcaneus and plantar skin surface • Male: 19mm – 25mm • Female: 19mm – 23mm • Acromegaly produces skin overgrowth exceeding the max measurement

  42. Lower Extremity Patellar mal-alignment • Patella length-patella tendon ratio • 1:1 • Chondromalacia patellae factor if the ratio is exceeded more than 20%

  43. Lower Extremity Iliac Angle and index • Y-Y line drawn. Second line along lateral iliac wing and iliac body • Sum of right and left iliac and acetabular angles divided by 2 • Avg. 68 degrees • 60 to 80 degrees is possible sign of Down’s syndrome • Probable Down’s if below 60 degrees

  44. Lower Extremity/ HIP Protrusio Acetabuli / Kohler’s Line • Pelvic inlet-outer obturator. Acetabulum should be lateral to the line • Could be Paget’s disease when acetabulum is medial to the line

  45. Lower Extremity Shenton’s line • Smooth curvilinear line along ilium and onto femoral neck and superior obturator border • Femur dislocation or fracture if line is interrupted

  46. Lower Extremity Iliofemoral line • Smooth curvilinear line along ilium and onto femoral neck • Should be bilaterally symmetrical • Asymmetry may denote hip joint abnormality

  47. Lower Extremity Femoral Angle • Lines through the femoral shaft and neck • 120-130 degrees is the range • Coxa vara: less than 120 degrees • Coxa Valga: Greater than 130 degrees

  48. Upper Extremity Glenohumeral joint space • Average humeral head-glenoid distance (superior, middle, inferior) • 4-5 mm • Degenerative and crystal arthritis diminish the space. Posterior dislocation may widen it.

  49. Upper Extremity Metacarpal sign • Tangential line through the fourth and fifth metacarpal heads. Third head should be proximal to this line • Turners Syndrome, post fracture deformity

  50. Upper Extremity Acromiohumeral joint space • Acromion-humeral head • Avg. 9mm • 7mm-11mm is the range • Rotator cuff tear decreases distance. • Subluxation and dislocation increase the distance