Cervical Spine X-Ray Projections PDF

Lec 7 Dr.ibrahim murad Cervical spine for C3- C7, shown structure Lateral – flexion and extension (Figs 6.13a, 6.13b) These projections may be required, but only at the request of a medical officer, to supplement the basic projections in cases of trauma, e.g. subluxation, or pathology, e.g....

Lec 7 Dr.ibrahim murad Cervical spine for C3- C7, shown structure Lateral – flexion and extension (Figs 6.13a, 6.13b) These projections may be required, but only at the request of a medical officer, to supplement the basic projections in cases of trauma, e.g. subluxation, or pathology, e.g. rheumatoid arthritis (and often before surgery to assess movement in the neck for insertion of an endotracheal tube). The degree of movement and any change in the relationship of the cervical vertebrae can also be assessed. If an injury is suspected or is being followed up, then an experienced trauma doctor must be present to supervise flexion and extension of the neck. Position of patient and image receptor The patient is positioned as for the lateral basic or lateral supine projections; however, erect positioning is more convenient. The patient is asked to flex the neck and to tuck the chin in towards the chest as far as is possible. For the second projection, the patient is asked to extend the neck by raising the chin as far as possible. Immobilisation can be facilitated by asking the patient to hold on to a solid object, such as the back of a chair. The image receptor is centred to the mid-cervical region and if using a CR cassette this may have to be placed transversely, depending on the degree of movement and the cassette size used. If imaged supine, the neck can be flexed by placing pads under the neck. Extension of the neck can be achieved by placing pillows under the patient’s shoulders. Direction and location of the X-ray beam The collimated horizontal beam is centred over the mid cervical region (C4). Essential image characteristics (Figs 6.13c) The final image should include the entire cervical vertebra, including the atlanto-occipital joints, the spinous processes and the soft tissues of the neck. Right and left posterior oblique – erect (Fig. 6.14a) Oblique projections are requested mainly to supplement the basic projections in cases of trauma. The images demonstrate the intervertebral foramina, the relationship of the facet joints in suspected dislocation or subluxation. Oblique projections have also been used with certain pathologies, such as degenerative disease. Position of patient and imaging receptor The patient stands or sits with the posterior aspect of their head and shoulders against the vertical Bucky.  The head can be rotated, and the median sagittal plane of the trunk is rotated through 45° for right and left sides thus avoiding superimposition of the mandible on the vertebra. The image receptor is centred at the prominence of the thyroid cartilage. Direction and location of the X-ray beam: The collimated beam is angled 15 cranially from the horizontal and the central ray is directed to the middle of the neck on the side nearest the tube. Essential image characteristics (Figs 6.14b, 6.14c) The intervertebral foramina should be demonstrated clearly. C1 to T1 should be included within the image. The mandible and the occipital bone should be clear of the vertebrae. Radiological considerations Complex radiographic projections are less often needed where magnetic resonance imaging (MRI) and/or CT are available. Right and left posterior oblique – supine (Figs 6.15a, 6.15b) This positioning is often necessary in cases of severe injury, particularly if other basic projections have failed to demonstrate the lower cervical vertebrae. Position of patient and image receptor The patient remains in the supine position on the trolley. To avoid moving the neck, the CR cassette should ideally be placed in the cassette tray underneath the trolley. If no cassette tray is available, then the cassette can be slid carefully into position without moving the patient’s neck. Direction and location of the X-ray beam The collimated beam is angled 30–45° to the median sagittal plane. The central ray is directed towards the middle of the neck on the side nearest the tube at the level of the thyroid cartilage. Radiological considerations If this and the swimmers’ projections are not successful, the patient may require more complex imaging (e.g. CT). Lateral swimmers’ (Figs 6.16a–6.16c) In all trauma radiography, it is imperative that all of the cervical vertebrae and the cervico-thoracic junction are demonstrated. This is particularly important, as this area of the spine is particularly susceptible to injury. The superimposition of the shoulders over these vertebrae and subsequent failure to produce an acceptable image is a problem to all radiographers. In the majority of cases, the use of the swimmers’ lateral will produce an image that reveals the alignment of these vertebrae and provides an image suitable for diagnosis. Position of patient and image receptor This projection is usually carried out with the patient supine on a trauma trolley. The trolley is positioned adjacent to the vertical Bucky, with the patient’s median sagittal plane parallel with the receptor. The arm nearest the receptor is folded over the head, with the humerus as close to the trolley top as the patient can manage. The arm and shoulder nearest the X-ray tube are depressed as far as possible. The detector system should be raised or lowered, such that the line of the vertebrae should coincide with the middle of the receptor. This projection can also be undertaken with the patient erect, either standing or sitting. Direction and location of the X-ray beam The collimated horizontal central ray is directed to the midline of the image receptor at a level just above the shoulder remote from the receptor. Fig. 6.16a Patient positioning for lateral swimmers’ projection – supine Fig. 6.16b Patient positioning for lateral swimmers’ projection – erect Essential image characteristics (Fig. 6.16d)  It is imperative to ensure that the C7/T1 junction has been included on the image.. THANK YOU