Revision 9 for 'Lumbar spine (oblique view)'

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Lumbar spine (oblique view)

The lumbar spine oblique view is used to visualize the articular facets and pars interarticularis of the lumbar spine. 

Patient position

  • the radiographs can be performed with the patient in the erect or supine position
    • erect
      •  two radiographs performed with patient at RAO 35-45°  and LAO 35-45°  
    • supine
      •  two radiographs performed with patient at RPO 35-45°  and LPO 35-45°  
  • ensure arms are removed from the region of interest 
  • using a 45° radiolucent sponge in the supine position will assist the patient in maintaining the correct position, whilst flexing the knees will also provide stability. 

Technical factors

  • left and right oblique positions
  • expiration (to minimize superimposition of the diaphragm over the upper lumbar spine) 
  • centering point
    • PA erect
      • 2.5 cm above the iliac crests and 3 cm lateral from the spinous processes towards the upside. RAO and LAO will demonstrate the facet joints on the upside, for example, the LAO position will show the right facet joint
    • AP supine
      • 2.5 cm above the iliac crests and 5 cm medial from the ASIS on the upside. RPO and LPO will demonstrate the facets joints on the downside, for example for RPO will show the right facet joint 
  • collimation
    • superiorly to include the T12/L1 junction 
    • inferior to include the L5/S1 junction 
    • anterior to include the anterior border of the lumbar vertebral bodies 
    • posterior to include all elements of the posterior column, particularly the spinous processes 
  • orientation  
    • portrait
  • detector size
    • 35 cm x 43 cm 
  • exposure
    • 70-80 kVp
    • 60-80 mAs 
  • SID
    • 110 cm
  • grid
    • yes (ensure the correct grid is selected if using focused grids)

Image technical evaluation

  • the entire lumbar spine should be visible from T12/ L1- L5/S1
    • check department protocol before imaging, as focused imaging of the lower lumbar vertebrae may be required 
  • a well positioned oblique lumbar radiograph will demonstrate the scottie dog sign, showing the articular processes and facet joints  
  • adequate image penetration and image contrast is evident by clear visualization of lumbar vertebral bodies, with both trabecular and cortical bone demonstrated
  • pedicles should be in the central of the vertebral bodies 

Practical points

  • to correct poor positioning consider the location of the pedicles
    • if they are anterior on the vertebral body- rotate the patient more
    • if they are posterior on the vertebral body- rotate the patient less

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