Radiographic Lines
description
Transcript of Radiographic Lines
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Radiographic LinesSkull – 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
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Radiographic LinesThoracic – 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
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Radiographic LinesLower 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
Glen Met Acromio Humer & Acromio Clavi over the Radio
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SkullSella turcica size
– 5mm to 16mm– Avg is 11mm– Pituitary masses
can cause enlargement
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SkullBasilar Angle
– Avg. 137 degrees– 123 to 152 degrees– Basilar impression and
platybasia widen angle• Nasion to sella turcica
to basion• Beyond 152 degrees
platybasia, could be congenital or caused by paget’s
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SkullMcGregors line
– Males: 8mm– Females: 10mm– Basilar impression when
odontoid more than maximum distance above
– Caused by atlas occipitalization, platybasia, and bone softening such as paget’s or osteomalacia
• Hard palate to occiput– Note relative odontoid apex
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SkullChamberlains line
– Basilar impression when odontoid more than maximum distance above
– Hard Palate to opisthion– Caused by atlas
occipitalization, platybasia, and bone softening such as paget’s or osteomalacia
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CervicalCervical Lordosis
– Role is unclear. Decreased following trauma, muscle spasm, spondylosis, and patient tucking the chin at time of exposure.
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CervicalStress Lines of
Cervical Spine– Flexion C5-C6 joint– Extension C4-C5 joint– Go through C2 and C7
vertebral bodies and note intersection
– Muscle spasm, joint fixation, and/or disc degeneration may decrease
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CervicalCervical Gravity Lines
– Vertical line from odontoid apex
– Passes through C7 body
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CervicalGeorges Line
– Alignment of posterior body margins
– A to P vertebral mal-positions when line not smooth
– Such as fractures, dislocation, anterolisthesis or retrolisthesis
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CervicalAtlantoDentalInterspace (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
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CervicalPosterior Cervical Line
– Spinolaminar junction lines
– AP vertebral malposition when line is not smooth, especially at C1 and C2
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CervicalSagittal Dimension of
the cervical spine– Posterior body-
spinolaminar junction.– 12mm minimum– Spinal stenosis when less
than 12mm. Intraspinal tumor when enlarged.
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CervicalAtlanto Axial Alignment
– C1 lateral mass-C2 articular pillar margin alignment
– Jefferson’s or odontoid fractures or alar ligament instability when margins overlap
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CervicalPrevertebral 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
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Thoracic• Riser-ferguson
– Centers of end and apical segments joined and the angle measured
– Used for Scoliosis Evaluation
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ThoracicThoracic 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
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ThoracicCobb’s Angle
– End vertebral endplate lines then intersecting perpendiculars and the angle measured.
– Used for scoliosis evaluation
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ThoracicThoracic Kyphosis
– T1 superior endplate-T12 inferior endplate, then intersecting perpendiculars and the angle measured
– Used for Kyphosis evaluation (Scheuermann’s fractures)
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LumbarIntervertebral 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
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Lumbar
Lumbar Inter-vertbral disc angles– At each disc endplate
lines are drawn and the angles measured
• Altered in various pathologies
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LumbarLumbar lordosis
– L1 endplate–S1 endplate; perpendiculars and angle formed
– 50-60 degrees• Altered in various
pathologies
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LumbarLumbosacral angle
– Endplate of S1 to horizontal line angle
– 41 degrees is average– 26-57 degree range
• Altered in various pathologies
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LumbarLumbosacral Disc Angle
– Angle between opposing endplates of L5 and S1
– 10-15 degree range• Altered in various
pathologies
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LumbarHadley’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
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LumbarVan 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
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LumbarLumbar Gravity Line
– A perpendicular line is drawn from the center point of the L3 body
– Intersects sacral base• Altered in various
pathologies
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LumbarStatic Vertebral
malposition / Houston conference listings / medicare listings– Numerous terms are
applied to describe static vertebral malpositions
• Altered in various pathologies
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LumbarLateral Bending Sign
– Spinous position– Intersegmental
wedging– Usually toward
concavity– Gradually increase
away from sacrum• Disc herniation at
level failing to laterally flex
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LumbarUllman’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
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LumbarMeyerding Rating
System– Sacral base divided
into quarters. Relative position of the posterior body of L5 is made.
• Grading severity of spondylolisthesis
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Percentage Method/Anterolisthesis
• The displacement between the posterior sacral base and the posterior aspect of L5 vertebrais measured along a plane paralleling the disc in millimeters
• The measured displacement is then divided by the length of the sacral promontory and multiplied by 100
• The main advantage is the removal of any geometrical magnification
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Lower ExtremityKlein’s Line
– Tangential line to outer femoral neck. Head just overlaps laterally
• Slipped epiphysis suspected if head does not intersect line.
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Lower ExtremityBoehler’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
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Tear Drop Distance
• Distance between the most medial margin of the femoral head and the outer cortex of the pelvic tear drop is measured
• Average: 9, Minimum: 6, Maximum: 11• Probably early Legg-Calve-Perthes,Septic
arthritis
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Tear Drop Distance
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Lower ExtremitySkinner’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
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Lower ExtremityCenter 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
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Lower Extremity
Hip Joint Space– Femoral head-
acetabulum distance– Superior = 3-6mm– Axial = 3-7mm– Medial = 4-13mm
• Various joint diseases increase the space– DJD, RA,
Degenerative RA
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Lower ExtremityAcetabular 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
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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.
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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.
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Lower ExtremityHeel 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
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Lower ExtremityPatellar mal-alignment
– Patella length-patella tendon ratio
– 1:1• Chondromalacia
patellae factor if the ratio is exceeded more than 20%
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Lower ExtremityIliac 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
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Lower Extremity / HIPProtrusio 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
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Lower ExtremityShenton’s line
– Smooth curvilinear line along ilium and onto femoral neck and superior obturator border
• Femur dislocation or fracture if line is interrupted
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Lower ExtremityIliofemoral line
– Smooth curvilinear line along ilium and onto femoral neck
– Should be bilaterally symmetrical
• Asymmetry may denote hip joint abnormality
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Lower ExtremityFemoral 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
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Upper ExtremityGlenohumeral 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.
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Upper ExtremityMetacarpal sign
– Tangential line through the fourth and fifth metacarpal heads. Third head should be proximal to this line
• Turners Syndrome, post fracture deformity
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Upper ExtremityAcromiohumeral joint
space– Acromion-humeral head– Avg. 9mm – 7mm-11mm is the range
• Rotator cuff tear decreases distance.
• Subluxation and dislocation increase the distance
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Upper ExtremityAcromioclavicular joint
space– Avg. acromion-clavicular
distance (superior, inferior)– Male: 3.3mm (2.5-4.1mm)– Female: 2.9mm (2.1-
3.7mm)• Degenerative arthritis will
decrease distance• Separation and resorption
will widen distance
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Upper ExtremityRadio-capitellar line
– Radius axis line through the elbow joint
– Passes through capitellar center
• Radius subluxation/dislocation if line misses the capitellar head