Observation of the lower cervical and upper thoracic spine in muscular patients that cannot be observed on cervical/thoracic lateral views.
Useful in facilities do not have CT.
Ensure that the patient is radiographed in the standing or supine position.
Remove any obstacles.
Erect : Standing with the body side on the cassette.
Lateral decubitus : Side recumbent. Cervical spine parallel to the cassette with the raised arms as pillows.
The coronal plane should be perpendicular to the cassette.
Raise the arm closest to the cassette into a fist, place the forearm over the head, and place the upper arm on the temporal aspect of the head. Dislodge the humeral head from the vertebral body by bringing the elbow joint forward. Lower the shoulder on the side farthest from the cassette and shift it backward. (The direction of displacement can be either forward or backward.)
The center of the cassette should be 2.5 cm headward from the jugular notch.
CR, distance, field size
CR : Vertical incidence toward the center of the neck at a height of 2.5 cm headward from the jugular notch. If the humeral head and vertebral body are not separated vertically, oblique incidence at 3-5° in a cephalocaudal direction.
Distance : 100cm
Field size : Extend to include the lowered humeral head. The right and left sides should be extended to include the thoracic spinous process.
80kV / 20mAs
(Use of high voltage reduces contrast and increases the range of observation possible)
C7/Th1 must be projected centrally.
The C2 spinous process should be included.
Lateral view should show no significant rotation.
Minimal overlap of the humeral head and vertebral body.
The left and right humeral heads should be projected vertically and horizontally apart.