Scoliosis (erect lateral view)

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The scoliosis erect lateral view is performed to visualize the thoracic and lumbar vertebrae of interest in profile.

Indications

This projection is done in cases of scoliosis and often done upon first presentation as a useful examination in identifying spondylolisthesis and the degree of kyphosis and/or lordosis .

Patient position

  • patient in erect lateral position
  • arms elevated away from spine 
  • convex side (identified from PA/AP view) or side of largest convexity placed closest to image receptor
  • ensure rotation of hips and shoulders is reduced as much as possible (some rotation inherent to scoliosis may be inevitable)
  • ensure at least 3-5 cm of iliac crests are present on radiograph

Technical Factors

  • lateral projection
  • suspended expiration
  • centering point
    • dependent on area of interest, patient height and detector size
  • collimation
    • superiorly to include all vertebrae of interest
    • inferiorly to include sacral region
    • anteriorly to include all vertebrae (with/without lordosis)
    • posteriorly evidence of spinous processes in their entirety
  • orientation
    • portrait
  • detector size
    • 35 cm x 43 cm
    • 35 cm x 90 cm (if available)
  • exposure
    • 95-100 kVp (digital) 
    • 60-80 mAs
  • SID
    •  100-150 cm
  • grid
    • yes

Image technical evaluation

  • area of scoliosis should be visible with evidence of iliac crests inferiorly
  • no patient rotation indicated by superimposed vertebral bodies
    • it is expected that some rotation would be present, inherent to scoliosis and the associated twisting of the vertebrae
  • bony margins and trabecular patterns should both be clearly visible in thoracic and lumbar vertebrae

Practical points

  • a compensatory wedge filter may be appropriate to achieve an even density throughout the image