![]() ![]() The mandible, cranium, and vertebrae should be symmetric. The dens should be clearly demonstrated in the foramen magnum. The patient is asked to suspend respiration when the exposure is taken. Position of part The gonads are shielded. The neck is extended until the tips of the chin and mastoid process are oriented vertically. A support may be placed under the knees for comfort. The patient’s arms are placed by the side of the body and the shoulders are flat on the table. The midsagittal plane of the body is centered and perpendicular to the grid. This position is NOT to be attempted in patients with fracture or degenerative disease of the upper cervical spine. Purpose and Structures Shown An additional view to demonstrate the dens in the foramen magnum. The patient should be asked to stop breathing when the exposure is taken. Position of part Remove necklaces, hair grips, and anything else from the hair. This view is used in patients who cannot sit due to injuries. Purpose and Structures Shown An additional view of the cervical spine for patients with injuries. Video Credit : Jocelyn Caldwell Cervical Spine AP Supine The patient should be turned to the other side for the other oblique view and the process repeated. The patient should be positioned so that he or she is at a 45-degree angle to the cassette holder. Purpose and Structures Shown An additional view of the cervical spine. ![]() Video Credit : CentralazRAD Cervical Spine Oblique In uninjured patients, a 1 kg (2 lb) weight should be placed in each hand. The arms should be by the sides and the shoulders should be as low as possible. The patient should be positioned with the shoulder against the cassette holder. The knob at the back of the head should be at the same level as the lower jaw (chin). The patient should be asked to place the chin against the cassette holder. Purpose and Structures Shown A basic view of the cervical spine. ![]() The density should be appropriate with soft tissues and bony structures well visualized. Radiologists consider a cervical spine X-ray to be of good quality when the lateral view shows all 7 cervical vertebrae plus the C7-T1 junction. Cervicothoracic Region Lateral Twinning Method.It is imperative that the presence of the transitional segment is well communicated and documented so that all treating physicians are using the same terminology.This article discusses radiographic positioning of the cervical spine for the Radiologic Technologist (X-Ray Tech). Often practitioners will focus unnecessarily on the lumbar numbering (i.e., counting caudad from T12 rather than counting cephalad from the sacrum) instead of simply correlating the available imaging (i.e., the sagittal MRI and the lateral fluoroscopic imaging). For example, if a patient has right L5 or S1 symptoms and if the MRI suggests the sacralization of L5, an extrusion at L5-S1, and foraminal narrowing at L5, the key concept is to correlate the fluoroscopic lateral image with the sagittal MRI so that the proper levels are injected ( Figure 3–5). ![]() Subsequently, images obtained during the procedure need be correlated with the same visualized pathoanatomy. Ultimately, it is most important to correlate the patient’s clinical symptoms with the pathoanatomy visualized on the imaging that is obtained. Therefore, if a transitional segment is suspected, an MRI scout image is recommended for the purpose of counting caudad from C2 to the lumbosacral junction. Similarly, some patients may have aberrant segmentation of the cervicothoracic junction, the thoracolumbar junction, or both. 2 This suggests that extra or missing ribs may add to counting confusion. In fact, one study showed that L6 segments do indeed behave like S1 segments in patients with only four lumbar vertebrae, the inferior-most lumbar segment, L4, behaves like an L5. Rarely patients will have six lumbar vertebrae, although some consider these to be lumbarized S1 segments, because an L6 spinal nerve is typically not described. Transitional segments are typically described as involving the lumbarization of the first sacral segment or the sacralization of the fifth lumbar segment. In up to 15% of the population, 1 a transitional segment may occur. For a patient with normal spinal segmentation, identify the level in the anteroposterior (AP) view by counting cephalad from the sacrum this is similar to the process of reading an MRI. ![]()
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