Radiographic Technique 2 A . Tahani Ahmed AL-Hozeam Cervical Spine Radiographic Technique 2 RAD 1204 A . Tahani Ahmed AL-Hozeam

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.

AP Cervical spine (C1 – C2) Open Mouth B To show pathology involving C1 and C2 (dens). Patient supine (AP) or erect position with arms by sides, 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, FFD=100cm. Film: HD 18x24 cm lengthwise. CP: Center of open mouth. CR: 90 to film center. A wooden block must be used to hold the mouth open.

PA Cervical spine (C1 – C2, dens) Judd Method S To show pathology involving the odontoid process (dens) and C1 and C2 structures within the foramen magnum. 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 crosswise. CP: Through mid-occipital bone, 2.5 cm inferopo- sterior to the mastoid tips and angles of the mandible. CR: Parallel to MML.

AP Axial Cervical (C3 – C7) B To show pathology of the mid and lower cervical spine (C3 – C7). Patient supine (AP) or erect with arms by sides , a line from the occlusal plane to the mastoid tips must be 90 to the couch. Film: HD 18x24 cm lengthwise. A grid is not necessary for this view. FFD=100 cm. CP: Level of lower margin of the thyroid cartilage to pass through C4 CR: 15- 20 cephalad.

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 to both arms), ask patient to relax and drop shoulders down and forward as far as possible, extend chin forward ( to prevent superimposition of upper cervical by mandible). Film: HD 18x24 cm lengthwise. CP: Level of upper margin of thyroid cartilage to pass through C4 . CR: 90 to film center, FFD= 150 to 180 cm.

Anterior and Posterior Oblique (PAO) Cervical spine B Intervertebral foramina and pedicles. AOs ( Anterior Obliques) are preferred because of reduced thyroid doses. Patient erect (stand or sit), arms at sides, body and head rotated 45, chin extended to prevent mandible . Film: HD 18x24 cm lengthwise . FFD=150 to 180 cm. Anterior obliques: CP: C4( Level of upper the margin of thyroid cartilage) . CR: 15- 20 caudad. Posterior obliques: CP: C4 (to lower thyroid cartilage ). CR: 15 ْ – 20 ْ cephalad.

Lateral Cervical spine (trauma case) B To show pathology in cervical spine (#s and subluxations). Patient in supine on a stretcher or on radiographic table. Do not move head or neck , support cassette vertically shoulder , depress shoulder. Film: HD 24x30 cm lengthwise . Non –grid cassette. CP: C4(level of upper margin of thyroid cartilage) . CR: Horizontally 90 to film center. FFD= 150 to 180 cm NB/ 1- take the exposure on full expiration. 2- when radiographing trauma patient ,do not remove cervical collar and do not move head or neck until a physician has except.

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 cm lengthwise . CP: 2.5 cm above the jugular notch (opposite T1) CR: Horizontally 90 to film center. FFD= 180 cm . NB/ this is a good projection when C7 to T1 is not visualized on the lateral cervical spine.

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, relax and depress shoulder (weights on each arm may be used), neck hyper-flexed (chin touches the chest) or hyperextended ( chin raised & head leaned back), as required. Film: HD 24x30 cm lengthwise. CP: C4( Level of upper margin of thyroid cartilage ). CR: Horizontally 90 to film (FFD: 180 cm). NB/ Never position on trauma patient before cervical fractures have been ruled out.

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 lengthwise. CP: C4( upper margin of the thyroid cartilage) 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