The thoracolumbar junction and/or the lumbosacral 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 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 reversal or straightening of the normal lordosis or scoliosis of the lumbar spine.   [Yes/No]

There are more or less than the expected 5 non rib-bearing vertebral bodies.   [Yes/No]

There is a transitional motion segment at the lumbosacral junction (sacralization of L5 or lumbarization of S1).   [Yes/No]

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

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

There is an end plate avulsion or other fracture.   [Yes/No]

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

There is lucency or defect of the pars interarticularis from spondylolysis.   [Yes/No]

There is an abnormality of a pedicle or lamina on the frontal or lateral view.   [Yes/No]

There is a fracture, erosion, sclerosis, lytic, or blastic lesion of a pedicle or lamina.   [Yes/No]

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

There is a fracture or interruption of the arcuate lines of the sacrum.   [Yes/No]

There is erosion, sclerosis, narrowing, or other abnormality of a sacral foramen or the SI joints.   [Yes/No]

There is focal or diffuse abnormal mineralization of the lumbosacral 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 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 abnormal bowel or bowel gas pattern.   [Yes/No]

There are gallstones, vascular, renal, pelvic, or other soft tissue calcifications present.   [Yes/No]

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

The included thoracic spine, ribs, and remainder of the bony pelvis are abnormal.   [Yes/No]

There is abnormality of the lower chest and/or diaphragm.   [Yes/No]

There is a foreign body or there are post surgical changes of the bones or soft tissues of the included lower thorax, abdomen, and pelvis.   [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]