The cervicothoracic junction and/or the thoracolumbar junction is/are not entirely included on the exam.   [Yes/No]

The exam is over or under penetrated.   [Yes/No]

The exam is limited by overlying structures, bones or soft tissues, patient positioning, support devices, or motion.   [Yes/No]

The prevertebral or paravertebral soft tissues are abnormal.   [Yes/No]

The right or left paravertebral line is widened.   [Yes/No]

The vertebral bodies are abnormally aligned.   [Yes/No]

The anterior and posterior vertebral body lines are abnormal or interrupted.   [Yes/No]

The visualized spinous processes are malaligned or distracted on the AP and/or lateral view(s).   [Yes/No]

There is exaggeration, reversal, or straightening of the normal kyphosis or there is scoliosis of the thoracic spine.   [Yes/No]

There are more or less than the expected 12 rib-bearing vertebral bodies.   [Yes/No]

There are cervical ribs at the cervicothoracic junction, or hypoplastic or rudimentary ribs at the thoracolumbar junction.   [Yes/No]

There is a fracture or distraction of a vertebral body, rib, transverse or spinous process, pedicle, or other posterior element.   [Yes/No]

There is anterior wedging and/or compression of a vertebral body.   [Yes/No]

There is an endplate avulsion, compression, or other fracture.   [Yes/No]

There is displacement of a fracture fragment into the soft tissues or spinal canal.   [Yes/No]

There is a lytic, sclerotic, or blastic lesion or erosion of a pedicle or other posterior element.   [Yes/No]

There is evidence of a lytic, sclerotic, or blastic lesion, or disruption of the trabecular pattern of a vertebral body, end plate, or rib.   [Yes/No]

There is focal or diffuse abnormal mineralization of the thoracic spine.   [Yes/No]

There is distraction or focal widening of a disc space.   [Yes/No]

There is disc space narrowing with or without erosive or sclerotic changes of the end plates or subchondral bone other than from degenerative change.   [Yes/No]

There is anterior, lateral, or posterior spondylolisthesis, subluxation, or rotational abnormality at a disc space.   [Yes/No]

There is widening, rotational abnormality, or displacement of facets at any motion segment.   [Yes/No]

There is facet joint narrowing or sclerosis other than from degenerative change.   [Yes/No]

There is narrowing or encroachment of a neural foramen other than from degenerative change.   [Yes/No]

There are degenerative changes present that might explain the patient’s symptoms.   [Yes/No]

There is abnormality of the soft tissues and bones of the included neck other than from degenerative change.   [Yes/No]

There is abnormality of the soft tissues and included bones of the upper extremities, clavicles, and sternum other than from degenerative change.   [Yes/No]

There is abnormality of the included lungs, mediastinum other than the previously evaluated paravertebral soft tissues, trachea and more distal airways, diaphragm, stomach, bowel, or bowel gas pattern.   [Yes/No]

There is free intraperitoneal or retroperitoneal air, or other abnormal air in the included abdomen.   [Yes/No]

There are vascular calcifications or other soft tissue calcifications present.   [Yes/No]

There is a foreign body or there are post surgical changes of the bones or soft tissues of the included neck, thorax, or abdomen.   [Yes/No]

There is an abnormality or complication of post surgical hardware/device.   [Yes/No]

There are support lines or tubes in an abnormal position.   [Yes/No]

There are other existing conditions that might be contributing to symptoms which can or should be further evaluated non-emergently.   [Yes/No]