COURSE RAD331

Coyrights© A.Musa, College of Applied Medical Sciences, King Saud University, Riyadh., 1427h.

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 TECHNICAL ASPECTS

In all cervical spine views, a moving or a stationary grid must be used

(lateral is an exception, where an air-gap technique is generally
used).
Minimum kVp range is (70 - 80) KVp. Table 2 gives the various kVp,
mAs, and FFD values.
Optimal exposure is required to show soft tissue as well as proper bone
density of the entire cervical spine. A small focus improves image detail.
Collimation must strictly be applied in all projections.
Exposure on fully suspended expiration.

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PA Cervical spine (C1 – C2, dens) Judd Method S

To show pathology involving the odontoid process

(dens) and C1 and C2 structures. Done when the
dens is not clearly shown by the (open -mouth
technique). The Judd method is a reverse (counter)
of the Fuch method, but produces less dose to the
thyroid.
Patient prone, chin resting on tabletop and extended
so that MML is 90 to table.
Film: HD 18x24 cm.
CP: Through mid-occipital bone, 2.5 cm inferopo-
sterior to the mastoid tips and angles of the
mandible.
CR: Parallel to MML.

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AP Cervical spine (C1 – C2) Open Mouth B

To show pathology involving C1 and C2 (dens).

Patient supine (AP) or erect, chin elevated, the

head adjusted so that with the mouth is open, a
line from lower margin of upper incisors to the
mastoid tips is 90 to couch. Mouth should be
wide open during exposure. Grid is not essential
for this view.
Film: HD 18x24 cm.

CP: Center of open mouth.

CR: 90 to film center. A wooden block must be
used to hold the mouth open.

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AP Cervical Wagging-Jaw method S

To show pathology involving entire cervical spine with

mandible blurred-out (similar to tomography).
Patient supine, head on couch and adjusted so that a line
from lower margin of upper incisors to base of the skull is
90 to the couch, the mandible should be continually
moving during exposure without moving the head.
Film: HD 18x24 cm.
CP: Upper margin of the thyroid cartilage (C4 – C5).
CR: 90 to center of film.

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AP Axial Cervical (C3 – T3) B

To show pathology of the mid and lower cervical

spine (C3 – T3).

Patient supine (AP) or erect, a line from the occlusal

plane to the mastoid tips must be 90 to the couch.
Film: HD 24x30 cm. A grid is not necessary for this
view.

CP: Level of lower margin of the thyroid cartilage

to pass through C5 – C6 ( 5 cm above level
of EAM).
CR: 15- 20 cephalad.

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PAO Cervical spine B

Intervertebral foramina and pedicles. AOs are preferred

because of reduced thyroid doses.
Patient erect, arms at sides, body and head rotated 45,
chin extended.
Film: HD 18x24 cm.
CP: Level of upper the margin of thyroid cartilage to
pass through C4.
CR: 15- 20 caudad.

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Lateral Cervical spine B

For pathology involving vertebral bodies, the intervertebral

spaces, spinous processes, and zygoapophyseal joints .

Patient in erect lateral (stand or sit), shoulder depressed (with

equal weights), forward, and against vertical film, cassette top
margin 5 cm above EAM.
Film: HD 24x30 cm.

CP: Level of upper margin of thyroid cartilage to pass

through C4 – C5.

CR: 90 to film center, FFD 150 cm.

NB/ For lateral atlanto-occipital articulation, CP is 2.5 cm
below and 2.5 cm behind EAM (just above the tip of
mastoid) with CR 90 to film center, film size 18x24 cm.

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Lateral Cervical spine (trauma case) B

To show pathology in cervical spine (#s and

subluxations).
Patient in supine on a stretcher or on couch.
Film: HD 24x30 cm.
CP: 2.5 cm above level of upper margin of thyroid
cartilage, to pass through C4.
CR: Horizontally 90 to film center.

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Cervicothoracic Lat Cerv Spine (Swimmer’s lat), B
(Twining method)

For cervical and thoracic vertebral bodies, intervertebral

disc spaces, zygapophyseal joints of C4 – T3.
Patient erect (or sitting), patient’s arm and shoulder close to
film raised up, elbow flexed, forearm resting on the head,
other arm and shoulder by the side and slightly anterior,
Film: HD 24x30.
CP: 2.5 cm above the jugular notch (opposite T1) – or at
level of vertebra prominens.
CR: Horizontally 90 to film center.

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Lateral Cervical (Hyperflexion and hyperextension) S

Functional study the dynamics (motion/ lack of motion) of the

cervical vertebrae, to rule-out a ‘whiplash’ injury.
Patient sits or stands in the erect lateral, shoulders depressed
(weights may be used), neck hyper-flexed (chin touches the
chest) or hyperextended (head leaned back), as required.
Film: HD 24x30 cm.
CP: Level of upper margin of thyroid cartilage to (C4 – C5).
CR: Horizontally 90 to film (FFD: 180 cm).

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AP/ AP Axial Clavicle B

For #s/ dislocations of the clavicle and acromioclavicular

joint.
Patient supine or erect, arms at sides, chin raised, back
of shoulder in contact with the film or couch top.
Film: HD 24x30 cm.
CP: Mid-clavicle.
CR: AP: 90 horizontal. AP axial: 15- 30 cephalad.
Exposure on arrested inspiration.

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AP ACROMIOCLAVICULAR JOINTS (ACJs) B

For #s/ joint separation. Done with /without stress weights

(8 – 10 pounds, 10 – 15 for large adult patients), cassette
crosswise.
Patient erect, back of shoulders against film, 2 films taken in
the same position (one with the weights, other without), film
2” above shoulders, 35x43 film.
CP: Midpoint between clavicles.
CR: 90 horizontal to film center.

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 TABLE 2 (Exposure Factors)

PROJECTION kVp mAs

AP Cervical (C1 – C2, Dens), Judd Method 75 15
AP Cervical (C1 – C2), ‘Open-Mouth Technique’ 75 15
AP Cervical (C1 Ring), ‘Wagging Jaw Technique’ 75 15
AP Axial (C3 – C7) 75 10
APO Cervical 75 10
Lateral Cervical (trauma case) 75 28
Lateral Cervical (hyperflexion/ hyperextension) 75 28
Cervicothoracic Lateral (C4 – T3), ‘Swimmer’s View’ 80 120

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 TABLE 2 (Exposure Factors)

PROJECTION kVp mAs

Lateral Cervical 75 28
AP Axial Cervical (Vertebral Arch – Pillars) 75 12
AP/ AP Axial clavicle 70 8
ACJs (Bilateral) 65 20
AP Scapula 75 7
Lateral Scapula 75 13

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