Cervical spine (lateral view)

Cervical spine lateral view is a lateral projection of the cervical spine.

As technology advances, computed tomography (CT) has replaced this projection, yet there remain many institutions (especially in rural areas) where CT is not readily available.

Indications

This projection helps to visualize pathology involving the entire cervical spine orthogonal to the AP view and is often performed in the trauma setting. It also helps to demonstrate any adjacent soft tissue structure, osteoarthritis and spondylosis.

Patient position

• the patient is supine or erect, depending on trauma or follow up  
• the detector is placed portrait, running parallel to the long axis of the cervical spine on the patients left the side 
• inform the patient that the image will be taken on suspended expiration 

Technical factors

• lateral projection
• centering point
  • 2.5 cm above the jugular notch at the level of C4
• collimation
  • superior to C1
  • inferior to T1
  • anterior to include soft tissue
  • posterior to the soft tissue
• orientation  
  • portrait 
• detector size
  • 24 cm x 30 cm
• exposure
  • 50-75 kVp
  • 20-40 mAs
• SID
  • 150-180 cm
• grid
  • yes

Image technical evaluation

• there should be a clear visualization of C1 to T1 (T1 minimum)
• the vertebral bodies are superimposed laterally
• the articular pillars and zygapophyseal joints are superimposed

Practical points

Traction

• this projection may require inferior traction of the arms to better visualize T1, this should only be performed by a qualified individual
• points to keep in mind whilst traction is being applied:
  • full expiration is best for optimal inferior displacement of the shoulders to visualize T1
  • clear communication between yourself and the one performing traction is a must, ensure they are clear when traction is being applied as to avoid motion artifact 
  • ensure individual applying traction is in a lead gown
• if T1 cannot be visualized, a swimmer's lateral projection may be required