AP Axial Cervical spine (C1

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Cervical Spine

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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.
• 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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AP Cervical spine (C1 C2) Open Mouth
?B

• To show pathology involving C1 and C2 (dens).
• Patient supine (AP) or erect, the head adjusted
  so that with the mouth is open, a line from lower
  margin of upper incisors to the mastoid tips is
  perpendicular to the film. Mouth should be wide
  open during exposure.
• Film HD 18x24 cm lengthwise.
• CP Center of open mouth.
• CR 90? to film center.

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• Dens
• Body
• ( C2 )
• Lateral
• Mass
• (C1)

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AP Axial Cervical (C3 C7)
?B

• To show pathology of the mid and lower cervical
  spine (C3 C7).
• Patient supine (AP) or erect, a line from the
  occlusal plane to the mastoid tips must be 90? to
  the couch.
• Film 24x30 cm. Lengthwise.
• CP Level of lower margin of the thyroid
  cartilage
• to pass through c4.
• CR 15?- 20? cephalad.

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Anterior and Posterior oblique Cervical spine
?B

• Pathology involving cervical spine. AOs are
  preferred because of reduced thyroid doses.
• Patient erect, arms at sides, body and head
  rotated 45?, chin extended.
• Film 18x24 cm.
• CP Level of upper the margin of thyroid
  cartilage to
• pass through C4.
• CR AO 15?- 20? caudad.
• PO 15?- 20? cephalad

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• C1
• C2
• pedicles
• Intervertebral
• foramen

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Lateral Cervical spine
?B

• For pathology involving cervical spine .
• Patient in erect lateral (stand or sit), shoulder
  depressed (with equal weights), forward, and
  against vertical film, cassette top margin 1 inch
  above EAM.
• Film 24x30 cm lengthwise .
• CP Level of upper margin of thyroid cartilage
  to pass
• through C4 C5.
• CR 90? to film center, FFD 180 cm.

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• C1
• spinous
• process C2
• C7

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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 lengthwise.
• CP level of upper margin of thyroid
• cartilage, to pass through C4.
• CR Horizontally 90? to film center.
• FFD 180 cm

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Cervicothoracic Lat Cerv Spine (Swimmers
lat), ?B (Twining method)

• For cervical and thoracic vertebra demonstrated.
• Patient erect (or sitting), patients 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 24x30 lengthwise .
• CP 1 inch above the level of jugular notch
  (opposite T1)
• 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.
• 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 24x30 cm.
• CP Level of upper margin of thyroid cartilage
  to (C4).
• CR Horizontally 90? to film (FFD 180 cm).

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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) , and produces less dose to the
  thyroid.
• Patient prone, chin resting on tabletop and
  extended so that MML is 90? to table.
• Film 18x24 cm.
• CP Through mid-occipital bone, 1 inch
  inferopo-
• sterior to the mastoid tips and
  angles of the
• mandible.
• CR Parallel to MML.90 to film

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• Mandible
• dens
• Foramen
• magnum
• Occipital
• bone

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AP Cervical Wagging-Jaw method
?S

• To show pathology involving entire C1 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).
• CR 90? to center of film.

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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), Swimmers 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