Prikaz anatomskih struktur pri slikanju ledvene hrbtenice anteroposteriorno in posteroanteriorno : diplomsko delo

Vratanar, Anita (author), Medič, Mojca (mentor), Starc, Tina (reviewer)

Uvod: Pri prikazu anatomskih struktur ledvene hrbtenice je najbolj dostopna diagnostična metoda rentgensko slikanje. Standardni radiografski pregled za oceno ledvenega dela hrbtenice vključuje anteroposteriorno in stransko projekcijo. Po potrebi se lahko izvede slikanje hrbtenice pod različnimi koti. Pomembno je, da prikažemo vse kar protokol slikanja ledvene hrbtenice zahteva. Namen: Namen diplomskega dela je prikazati in oceniti po kriterijih za kakovost rentgenograma anatomske strukture ledvene hrbtenice pri rentgenskem slikanju v AP in PA legi ter pri spremembi kota med hrbtom in podlago do 45 stopinj. Metode dela: Prva metoda je bila deskriptivna. Vključevala je pregled domače in tuje strokovne literature pridobljene v knjižnici Zdravstvene fakultete Univerze v Ljubljani, Osrednji knjižnici Mozirje ter na spletu. Druga metoda je bila raziskovalno delo, pri katerem smo s pomočjo fantoma primerjali prikaze anatomskih struktur pri ledveni hrbtenici, ko je le ta pod različnimi koti. Rezultati: Medvretenčni prostori so na PA sliki bolj odprti. Na PA sliki vidimo pri L1 in L2 bolj enojne strukture telesa kot na AP sliki. Z večanjem kota pride do vse večje povečave leve strani, ki je v vsakem naslednjem rentgenogramu bolj dvignjena od podlage. Širina vretenca se spreminja z vsakim posnetkom, največje odstopanje se pojavi pri 10° in 30° kotu. Razberemo, da je v osnovnem položaju desen odrastek daljši od levega, najmanjša razlika med njima je pri 5° podlogi. Sakroiliakalna sklepa se začneta rotirati. Rotacija je vidna tudi po križničnih linah, ki se vse bolj odmikajo k podloženi levi strani. Desni SIS se na vseh rentgenogramih prekriva in je zaprt, medtem ko se levi do 20° kota odpira, nato pa pride do prekrivanja in je zaprt. Trni ledvenih vretenc se s podlaganjem pomikajo proti levi strani, do 30° kota so še vidni na telesu vretenca, pod večjim kotom pa jih že vidimo iz polstranskega prikaza. Razprava in zaključek: Anatomske strukture se pri majhnih spremembah položaja fantoma ali kota prikažejo drugače. Z večanjem kota med podlago in fantomom prihaja do vse večje distorzije velikosti in oblike, rentgenogrami pa niso več simetrični. Pomembna je natančna nastavitev pacienta, s tem mu prihranimo dozo in omogočimo, da so rentgenogrami ocenjeni in odčitani kakovostno.

• Language: Slovenian
• Keywords: diplomska dela, radiološka tehnologija, hrbtenica, slikanje ledvene hrbtenice, AP in PA projekcija ledvene hrbtenice, slikanje ledvene hrbtenice polstransko, anatomske strukture ledvene hrbtenice
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [A. Vratanar]
• Year: 2020
• Number of pages: 27 str., [2] str. pril.
• PID: 20.500.12556/RUL-124140
• UDC: 616-07
• COBISS.SI-ID: 45585923
• Publication date in RUL: 06.01.2021

Secondary language

• Language: English
• Title: Presentation of anatomical structures when imaging the lumbar spine anteroposterior and posteroanterior : diploma work

Abstract

Introduction: The most available diagnostic method when presenting the anatomic structures of the lumbar spine is radiography. The standard radiographic examination used for the evaluation of the lumbar spinal region includes anteroposterior and lateral projection. If needed, the spinal imaging can be performed at different angles. It is essential that everything the lumbar spine protocol requires is presented. Purpose: The aim of the thesis is to demonstrate and assess the anatomic structures of the lumbar spine in AP and PA position, and the difference at the angle between the back and the grounding up to 45°, according to the radiography quality criterium. Methods: The first method used was descriptive, including an overview of Slovenian and foreign professional literature, obtained from the library of the Zdravstvena fakulteta in Ljubljana, and the Osrednja knjižnica Mozirje library, as well as sources online. The second method used was research work where we compared the demonstrations of anatomic structures of the lumbar spine when positioned at different angles with the help of the phantom. Results: The intervertebral space in the PA view is more open. The PA view shows more unified structures of the body at L1 and L2 compared to the AP view. With the extension of the angle comes an extended magnification of the left side, which is lifted more from the support in every following radiograph. The width of the vertebra changes with every imaging, the biggest deviation being at 10° and 30°. We discern that in the basic position the right spinous process is longer than the left one, the smallest difference between them being at 5° support. The sacroiliac joints begin to rotate. The rotation is also visible in cruciate ligaments which tend to move to the supported left side. The right SIS is overlapped in all radiographs and it is closed, while the left one opens up to 20°, then it overlaps and closes. The spinous process of the lumbar vertebrae, when supported, tends to move to the left side. Up to 30°, the spinous process is visible on the body of the vertebra; at a bigger angle, however, it is visible from the oblique view. Discussion and conclusion: The anatomic structures are shown differently even when dealing a small change in the position of the phantom or the angle. The increase of the angle between the support and the phantom causes bigger and bigger distortion of size and shape, the radiographs are not symmetrical anymore. The precise setting of the patient is important; by doing so, we reduce the radiation dose and enable the radiographs to be evaluated and read qualitatively.

• Keywords: diploma theses, radiologic technology, spine, lumbar spine imaging, AP and PA projection of lumbar spine, oblique view of the spine, lumbar spine anatomic structures