Radiographic Lines
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Skull – 4
Sella turcica
Basilar Angle
McGregors line
Chamberlains line
McGregor sells
chamberlains bass 4
skulls.
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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
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Thoracic – 4
Riser-Ferguson (SC)
Thoracic cage dimension
Cobb’s Angle (SC)
Thoracic Kyphosis
Riser-Ferguson Caged
Cobb’s Kyphosis
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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
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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
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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
Skull
Sella turcica size
– 5mm to 16mm
– Avg is 11mm
– Pituitary masses
can cause
enlargement
Skull
Basilar 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
Skull
McGregors 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
Skull
Chamberlains 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
Cervical
Cervical Lordosis
– Role is unclear.
Decreased following
trauma, muscle
spasm, spondylosis,
and patient tucking
the chin at time of
exposure.
Cervical
Stress 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
Cervical
Cervical Gravity Lines
– Vertical line from
odontoid apex
– Passes through C7
body
Cervical
Georges Line
– Alignment of posterior
body margins
– A to P vertebral malpositions when line not
smooth
– Such as fractures,
dislocation,
anterolisthesis or
retrolisthesis
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
Cervical
Posterior Cervical Line
– Spinolaminar junction
lines
– AP vertebral malposition
when line is not smooth,
especially at C1 and C2
Cervical
Sagittal Dimension of
the cervical spine
– Posterior bodyspinolaminar junction.
– 12mm minimum
– Spinal stenosis when
less than 12mm.
Intraspinal tumor when
enlarged.
Cervical
Atlanto Axial Alignment
– C1 lateral mass-C2
articular pillar margin
alignment
– Jefferson’s or odontoid
fractures or alar
ligament instability when
margins overlap
Cervical
Prevertebral Soft tissue
– Anterior bodiesposterior 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
Thoracic
• Riser-ferguson
– Centers of end and
apical segments
joined and the angle
measured
– Used for Scoliosis
Evaluation
Thoracic
Thoracic Cage
– Posterior sternumanterior T8 body
– Male: 14cm
– Female: 12cm
• Straight back
syndrome when the
distance is less than
13cm in males and
11cm in females
Thoracic
Cobb’s Angle
– End vertebral endplate
lines then intersecting
perpendiculars and the
angle measured.
– Used for scoliosis
evaluation
Thoracic
Thoracic Kyphosis
– T1 superior endplateT12 inferior endplate,
then intersecting
perpendiculars and the
angle measured
– Used for Kyphosis
evaluation
(Scheuermann’s
fractures)
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
Lumbar
Lumbar Inter-vertbral
disc angles
– At each disc endplate
lines are drawn and
the angles measured
• Altered in various
pathologies
Lumbar
Lumbar lordosis
– L1 endplate–S1
endplate;
perpendiculars and
angle formed
– 50-60 degrees
• Altered in various
pathologies
Lumbar
Lumbosacral angle
– Endplate of S1 to
horizontal line angle
– 41 degrees is average
– 26-57 degree range
• Altered in various
pathologies
Lumbar
Lumbosacral Disc Angle
– Angle between opposing
endplates of L5 and S1
– 10-15 degree range
• Altered in various
pathologies
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
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
Lumbar
Lumbar Gravity Line
– A perpendicular line is
drawn from the center
point of the L3 body
– Intersects sacral base
• Altered in various
pathologies
Lumbar
Static Vertebral
malposition / Houston
conference listings /
medicare listings
– Numerous terms are
applied to describe static
vertebral malpositions
• Altered in various
pathologies
Lumbar
Lateral Bending Sign
– Spinous position
– Intersegmental
wedging
– Usually toward
concavity
– Gradually increase
away from sacrum
• Disc herniation at
level failing to laterally
flex
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
Lumbar
Meyerding Rating
System
– Sacral base divided
into quarters. Relative
position of the
posterior body of L5 is
made.
• Grading severity of
spondylolisthesis
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
Lower Extremity
Klein’s Line
– Tangential line to outer
femoral neck. Head
just overlaps laterally
• Slipped epiphysis
suspected if head
does not intersect
line.
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
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
Tear Drop Distance
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
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
Lower Extremity
Hip Joint Space
– Femoral headacetabulum distance
– Superior = 3-6mm
– Axial = 3-7mm
– Medial = 4-13mm
• Various joint diseases
increase the space
– DJD, RA,
Degenerative RA
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
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.
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.
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
Lower Extremity
Patellar mal-alignment
– Patella length-patella
tendon ratio
– 1:1
• Chondromalacia
patellae factor if the
ratio is exceeded
more than 20%
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
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
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
Lower Extremity
Iliofemoral line
– Smooth curvilinear line
along ilium and onto
femoral neck
– Should be bilaterally
symmetrical
• Asymmetry may
denote hip joint
abnormality
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
Upper Extremity
Glenohumeral joint space
– Average humeral headglenoid distance (superior,
middle, inferior)
– 4-5 mm
• Degenerative and crystal
arthritis diminish the
space. Posterior
dislocation may widen it.
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
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
Upper Extremity
Acromioclavicular joint
space
– Avg. acromion-clavicular
distance (superior, inferior)
– Male: 3.3mm (2.5-4.1mm)
– Female: 2.9mm (2.13.7mm)
• Degenerative arthritis will
decrease distance
• Separation and resorption
will widen distance
Upper Extremity
Radio-capitellar line
– Radius axis line
through the elbow
joint
– Passes through
capitellar center
• Radius
subluxation/dislocati
on if line misses the
capitellar head