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Plain Films - Cervical Spine

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Routine C Spine

  • AP C spine
  • Odontoid
  • Lateral

Any other views done only on request of referring Dr or Radiologist, eg

  • Obliques 45 deg or 60 deg
  • Flexion / extension
  • Swimmers Lateral for T1 / T2 junction

Trauma C Spine

  • Lateral C spine done initially in receiving rm. 
  • Further views may be requested - these should be done in X Ray Dept.  
  • Must include clivus on lateral C spine

Swimmers Lateral

To image the C7/T1 junction:

  • Position patient bed against upright bucky. Move patient on spine board over to edge of bed nearest to bucky. Put brakes on bed.
  • Have patient raise arm nearest to bucky and stretch downward with the other while keeping head straight. You will probably need two holders to assist with this.
  • Centre on C7/T1 Collimate closely to area of interest.
  • Place Pb shielding on anterior aspect of neck/chest area & /or use AL wedge filter to give more even exposure.
    Use bucky and grid -AEC or manual exp or grid +cassette.


  • Depending on patient size, use digital plate or CR +/- grid under trauma trolley, or lift patient on spine board onto XR table
  • If patient still has hard collar on, he won't be able to lift his chin or open his mouth much .You may have to alter angling cranially slightly to compensate. You need to superimpose occiput and teeth.
  • Or, if CED staff are agreeable, remove collar & do AP films without: someone will have to hold head.
  • NB: when lifting immobilised patients always ensure that there are enough people to lift safely .You can call on parents to help, or get extra staff from CED, or Orderlies.

C Spine for stability in Down Syndrome

  • Lat whole C Spine in Neutral position.
  • CONED LAT C 1-3 in flex and extend, including Clivus.

These films are to assess the degree of forward / back movement of peg -often a feature of Down Syndrome, therefore important to cone to upper spine. Can be done supine / horizontal ray using foam pads for flex/ext. Check films with Radiologist before patient leaves.

Flexion and extension views for any other reason should include whole spine.

Trauma Obliques

60 deg oblique to demonstrate the facet joints are sometimes requested but these are much better demonstrated on CT.

Method: Patient will be immobilised and supine. There are 3 options:

  1. Slide cassette under patient from side opposite tube.
    Edge of film should be at patient's midline
    Centre approximately at thyroid cartilage.
    Angle tube 60 deg laterally
    Exposure -slightly more than you give for Lateral
  2. Move patient right over to edge of stretcher (on spine board) and position film perpendicular to spine board but dropped down several inches below it. Angle tube 60 deg
  3. You can also demonstrate the facet joints with a 45deg oblique by angling tube 15 deg cranially for AP obl or 15deg caudally for PA

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Document Control

  • Date last published: 13 October 2017
  • Document type: Imaging Protocol
  • Services responsible: Paediatric Radiology

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