In the right posterior oblique view, the right apophyseal joints are visualized. For example, in a right anterior oblique view, the left apophyseal joints are visualized. In this case, the side farthest from the film is the side that is visualized. The central ray is positioned two inches above the iliac crest, and the spine centered to the midline of the bucky. Exposure should be made upon expiration.Īnterior oblique views are performed with the body rotated 30-45 degrees away from the bucky. (The side that is closest to the bucky is the side examined.) The central ray is positioned approximately two inches above the iliac crest (元) and two inches medial to the ASIS of the side that is away from the film. Right and left posterior oblique views of the lumbar spine are performed with the body rotated approximately 30-35 degrees toward the side being examined. The rules by which foramina are demonstrated are: posterior obliques demonstrate the contralateral foramina, i.e., RPO demonstrates the left foramina the anterior obliques demonstrate the homolateral structures, and RAO shows the right foramina. Remember, the oblique views of the cervical spine demonstrate the intervertebral foramina, uncovertebral joints, apophyseal joints and pedicles. If you are using "RPO" or "RAO" markers, it doesn't matter. To identify anterior from posterior oblique views, if you are only using "R" and "L" markers, the marker should be placed in front of the spine for anterior obliques and behind the spine for posterior obliques. The central ray should be at the C4 level. The head is then positioned parallel to the bucky and the chin is tilted slightly upward.įor both cervical anterior and posterior oblique views, the tube should be tilted 15 degrees: caudad for anterior obliques and caphald for posterior obliques. With posterior oblique views, the patient faces the tube and the body is rotated 45 degrees away from the film. When the patient tilts the head away, it's difficult to determine if the foramina are narrowed due to pathology or positioning. Patients tend to want to tilt their heads away from the bucky. The head is then positioned parallel with the plane of the bucky, with the chin tilted upward slightly. With anterior obliques, the patient faces the bucky and the body is rotated 45 degrees away from the film. Likewise, a LAO position is an oblique view, with the left anterior body surfaces in contact with or closest to the film, table or bucky. Therefore, a RPO position means an oblique view, with the right posterior body surfaces in contact with or closest to the film, table or bucky. Oblique positions are determined by the right or left side of the patient and the anterior or posterior surface being closest to the film. The side (right or left) closest to the film is always marked. It doesn't matter which way you choose to perform the view as long as you are consistent and label them to identify which foramina or facet is closest to the film. There are two ways to perform oblique positions in a cervical or lumbar series: anterior to posterior and posterior to anterior. The lateral view of an extremity should of course be labeled the same as the AP. With larger structures such as the knee, for example, the condyle closest to the film is the smallest.Īgain, however, lateral views of the spine are not labeled as to which side is closest to the film. The side that is closest to the film is the side that has the least distortion, but that is difficult to see when the structures are small. In the lateral projection of the axial skeleton, the sides are not generally labeled because it is too difficult to see the difference. In the AP projection, it is obvious that only right or left needs to be labeled. I'm here to remind you to label your patients' films right and left. I think the results might not reflect well on our profession. This might actually be an interesting study for ChiroPoll, but I do not want to know the actual numbers. In my own private study, questioning my colleagues and clients, almost a third of us (maybe more) do not take the time to label films. I know every one of us would agree, but not everyone does it. When films are sent out of our office for any reason, it is very helpful to have right/left labels on the film. We tend to forget that not everyone puts an ID marker in the left-hand corner of the file, or that doctors always take posterior obliques of the cervical spine. It certainly helps to label the right side from the left when performing studies of the spine or any extremity.
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