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XR Cervical Spine

XRNo contrastSpine
Indications
  • Neck pain/trauma (non-acute or after CT clearance)
  • Radiculopathy
  • Suspected degenerative change/spondylosis
  • Evaluation of alignment/instability
  • Rule out fracture (non-acute)
Patient prep
  • Remove necklaces, earrings, dentures, hairpins, and other radiopaque objects from head/neck
  • Gown
Contrast
None / non-contrast
Technique
  • AP axial: CR 15-20 degrees cephalad to mid-cervical region (C4), through thyroid cartilage
  • Lateral: erect, SID 72 inches, shoulders depressed, CR horizontal to C4
  • Open-mouth (odontoid): CR perpendicular through open mouth to center of mouth, line from lower incisors to mastoid tips perpendicular to IR
  • SID 40 inches (72 inches for lateral); grid; kVp ~70-80
  • Suspended respiration
Series / Sequences
#Series / SequencePlaneNotes
1AP axialFrontalCR 15-20 deg cephalad to C4; demonstrates lower 5 cervical and upper 2 thoracic vertebrae
2LateralSagittalErect, 72-inch SID, depress shoulders to show C7; must include C1-C7/T1 junction
3Open-mouth (AP odontoid)FrontalDemonstrates C1-C2, dens, and lateral masses; open mouth, occlusal plane perpendicular to IR
Key points
  • AP oblique (RPO/LPO, 45 deg, CR 15-20 deg cephalad for PA-oblique caudad) bilaterally for intervertebral foramina/radiculopathy
  • Swimmer's (cervicothoracic lateral) view if C7-T1 not visualized on lateral
  • Flexion and extension laterals for instability evaluation
  • Acute trauma is typically evaluated by CT per ACR; radiographs for non-acute or follow-up
References
• Bontrager's Handbook - Cervical Spine
• Merrill's Atlas Vol 1 - Vertebral Column
• Radiopaedia: Cervical spine series link
• ACR-ASNR-SPR Practice Parameter for the Performance of Spine Radiography
Source: Researched — verify against your institution
‹ PreviousMRI Total Spine (Cervical/Thoracic/Lumbar) With and Without Contrast
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.