Cervical Spine

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.

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.

Dens Body ( C2 ) Lateral Mass (C1)

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.

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

C1 C2 pedicles Intervertebral foramen

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.

C1 spinous process C2 C7

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

Cervicothoracic Lat Cerv Spine (Swimmer’s lat), B (Twining method) For cervical and thoracic vertebra demonstrated. 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: 24x30 lengthwise . CP: 1 inch above the level of jugular notch (opposite T1) CR: Horizontally 90 to film center.

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).

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

Mandible dens Foramen magnum Occipital bone

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.

TABLE 2 (Exposure Factors) PROJECTION kVp mAs AP Cervical (C1 – C2, Dens), Judd Method 75 15 AP Cervical (C1 – C2), ‘Open-Mouth Technique’ AP Cervical (C1 Ring), ‘Wagging Jaw Technique’ AP Axial (C3 – C7) 10 APO Cervical Lateral Cervical (trauma case) 28 Lateral Cervical (hyperflexion/ hyperextension) Cervicothoracic Lateral (C4 – T3), ‘Swimmer’s View’ 80 120

TABLE 2 (Exposure Factors) PROJECTION kVp mAs Lateral Cervical 75 28 AP Axial Cervical (Vertebral Arch – Pillars) 12 AP/ AP Axial clavicle 70 8 ACJs (Bilateral) 65 20 AP Scapula 7 Lateral Scapula 13