C-Spine

AP Axial

AP Open Mouth

8x10 LW

8x10 LW

Grid

Yes

Yes

SID

40

30

Large

Large

IR

Focal Spot

Patient

Supine or upright against bucky

Extend chin so occlusal plane is
perpendicular
Suspend respiration

CR Angle
CR

Structures

15-20 Cephalic
15-20 Cephalic
Enters at or slightly inferior to C-4

or most prominent point of thyroid

cartilage

Enters midpoint of open mouth

Body (separated by intervertebral

disks)

Pedicles
Superior & Inferior Vertebral Notch

Collimation
Area from superior portion of C-3 to
T-2 & surrounding soft tissue
Shadows of mandible and occiput
superimposed over atlas & most of
axis
Open intervertebral disk spaces
Spinous processes equidistant to
pedicles & aligned to midline
Mandibular angles & mastoid
processes equidistant to vertebrae

Collimation
Dens, atlas, axis, and articulations
between C-1 & C-2
All articular surfaces of atlas & axis
Superimposed occlusal plane of upper
incisors & base of skull
Mouth open wide
Tongue shadow not over atlas/axis
Mandibular rami equidistant from
dens

Evaluation
Criteria

Supine or upright
Arms straight at sides
Open mouth wide as possible
Upper incisors to tip of mastoid
process is perpendicular
Say Ahhh

AP Axial Obliques
(RPO/LPO)

PA Axial Obliques
(RAO/LAO)

8x10 LW

8x10 LW

Grid

Yes

Yes

SID

60-72

60-72

Large

Large

C-Spine
IR

Focal Spot

Patient

Supine or upright facing CR

Adjust body & head at 45
Protrude chin
Suspend respiration

CR Angle
CR

15-20 Cephalic

15-20 Caudal

15-20 Cephalic
Directed at C-4

C-1= No body, just anterior arch,

posterior arch, lateral mass,

transverse process, transverse
foramen, superior articular process)

C-2= odontoid/dens, superior

articular process, lamina, inferior
articular process, transverse process

Collimation
Open intervertebral foramina
FARTHEST from C2-C3 to C7-T1
Open intervertebral disk spaces
Uniform size & contour of foramina
Elevated chin that doesnt overlap
atlas & axis
Occipital bone not overlapping axis
C1-C7 & T-1

Collimation
Open intervertebral foramina
CLOSEST to IR from C1-C2 & C7-T1
Open intervertebral disk spaces
Elevated chin & protruded jaw so
angle of mandible doesnt overlap C1
or C2
Occipital bone not overlapping axis
All 7 cervical vertebrae & 1st thoracic

Prone or upright with front facing IR

Rotate body & head 45
Suspend respiration

Structures

Evaluation
Criteria

15-20 Caudal
Directed at C-4

Lateral
(Grandy)

Lateral
(Flexion &
Extension)

Lateral
(Swimmers/
Cross-table)

8x10 LW

10x12 LW

10x12 LW

Grid

Yes

Yes

Yes

SID

60-72

60-72

60-72

Large

Large

Large

C-Spine
IR

Focal Spot

Patient

CR Angle
CR

Structures

True lateral
Seated or standing
Top of IR 2 above EAM
Flex- drop head
forward, chin close to
chest
Extend- elevate chin
Suspend expiration

Enters at C-4
Outer shoulder projected

below lower cervical

vertebrae

Enters at C-4

C-7= largest cervical

vertebrae (Vertebral
Prominens)

Inferior Articular
Processes

All 7 vertebrae & 1/3rd of

T-1
Neck extended so
mandibular rami not
overlapping C-1 or C-2
Superimposed
mandibular rami
No rotation or tilt of cspine for open
zygapophyseal joints &
intervertebral disk spaces
Spinous processes in
profile
C-4 in center of x-ray
Bone & soft tissue detail

Lateral Recumbent-
head elevated on arm
Upright- flex elbow, rest
forearm on head
Dependent arm above
head
Suspend respiration
0

Evaluation
Criteria

True lateral
Seated or standing
Top of IR 1 above EAM
Depress shoulders as
much as able (use
sandbags if needed)
Elevate chin slightly
Expose end of exhalation

Enters C7-T1 interspace

(2 above jugular notch)

Articular Pillar
Transverse foramen

Flex:

Body of mandible
vertical

All 7 spinous processes

in profile
All 7 vertebrae lateral
Extend:
Body of mandible

horizontal
All 7 vertebrae in lateral

Collimation
Lower cervical & upper
thoracic vertebrae
No rotation
Humeral heads
minimally
superimposed on
vertebral column
Adequate x-ray
penetration through
shoulder region

C-Spine

Fuchs

Trauma C-Spine

Soft Tissue Neck

8x10 CW

10x12 LW

8x10 LW

Grid

Yes

Yes

Yes

SID

40

40

60-72

Large

Large

Small

IR

Focal Spot

Patient

Supine or seated
Extend chin so tip of chin
& tip of mastoid process
are vertical

Suspend respiration

CR Angle

15-20 Cephalic

Transverse Process
Superior Articular
Process

Zygapophyseal Joint
Intervertebral Foramen

Lower 5 zygapophyseal
joints (90 from MSP)

All 7 cervical vertebrae

& upper 3rd of T-1

No mandible overlap

No rotation/tilt
Superimposed mandible

rami

Spinous processes in
profile

Collimation
Area from nasopharynx
to apex of lungs
No superimposition of
trachea by shoulders
No rotation
Throat filled with air

CR

Structures

Laminae
Spinous Process

Evaluation
Criteria

0
Enter 1 below EAM
Top of IR at level of EAM
to jugular notch

Collimation
Entire dens within the
foramen magnum
Symmetry of mandible,
cranium, & vertebrae
No rotation

Supine or Upright
True lateral
Depress shoulders
Extend head slightly
Exposure on inspiration

15-20 Cephalic

Enter at C-4

Collimate to 1 beyond
skin to reduce scatter

Enters neck on MSP just

distal to tip of chin

Supine on backboard in
collar

Relax shoulders

AP

AP Oblique
(LPO/RPO)

14x17 LW

14x17 LW

Grid

Yes

Yes

SID

40

40

Large

Large

T-Spine
IR

Focal Spot

Patient

Supine or upright
Flex hips & knees
Exposure on full expiration

CR Angle
CR

Structures

Evaluation
Criteria

Standing or supine
Rotate body 20 posterior
IR 1.5-2 above shoulders
Dependent arm brought forward
Independent hand placed on hip
Expose at end of expiration
0

Enter halfway between jugular

notch & xiphoid process

Enters level of T-7

Body
Intervertebral Disk Spaces
Costotransverse Joint/Articulation

Transverse Processes
Costovertebral Articulations
Spinous Process

Collimation
All 12 vertebrae
All vertebrae shown with uniform
density

Spinous processes at midline of

vertebral bodies

Vertebral column aligned to middle

of x-ray
Ribs, shoulders, lungs, & diaphragm
on 14x17

Shows zygapophyseal joints

FARTHEST from IR
All 12 thoracic vertebrae
Wide exposure latitude

PA Oblique
(LAO/RAO)

Lateral

14x17 LW

14x17 LW

Grid

Yes

Yes

SID

40

40

Large

Large

T-Spine
IR

Focal Spot

Patient

CR Angle

Standing or prone
Rotate body 20 anterior
IR 1.5-2 above shoulders
Flex elbow of dependent arm & rest
hand on hip
Grab side of bucky with
independent hand
Expose at end of expiration

CR

Enters level of T-7

Structures

Ribs
Pedicle
Superior Articular Process

Evaluation
Criteria

Shows zygapophyseal joint

CLOSEST to IR
All 12 thoracic vertebrae
Wide exposure latitude

Left Lateral Recumbent

Flex hips & knees
Place knees exactly superimposed
Arms at right angles to body
Expose at end of expiration

Enter at T-7 (inferior angles of the

scapulae)
Enters posterior half of thorax
Can be angled 10 Cephalic in female
or 15 in males
Inferior Articular Process
Intervertebral Foramina
Lamina
Zygapophyseal Joints
Collimation
Vertebrae clearly seen through rib &
lung shadows
12 vertebrae centered;
superimposition of shoulders on
upper vertebrae may cause
underexposure
Ribs superimposed posteriorly to
indicate no rotation
Open intervertebral disk spaces
Wide latitude of exposure
CR collated to reduce scatter

AP

AP Oblique
(LPO/RPO)

14x17 LW

14x17 LW

Grid

Yes

Yes

SID

40

40

Large

Large

L-Spine
IR

Focal Spot

Patient

CR Angle
CR

Structures

AFFECTED side UP rotated 45

Expose at end of expiration
0

Enters at iliac crest for lumbosacral

view

Enter 1.5 above crest for lumbar

1-1.5 above iliac crest

2 medial to elevated ASIS

Body
Intervertebral Disk Spaces
Lamina

Spinous Processes
Transverse Processes

Zygapophyseal joints CLOSEST to IR

Collimation
Area from lower thoracic vertebrae to
sacrum
Zygapophyseal joints closes to IR
open & uniformly visible through
vertebral bodies
When joint is not well seen, and
pedicle is anterior, the body isnt
rotated enough
When joint isnt well seen, and pedicle
is posterior, the patient is rotated too
much
Vertebral column parallel with the
table so that T12-L1 and L-2
intervertebral joint spaces remain
open

Evaluation
Criteria

Supine
Flex elbows with hands on chest
Flex hips & knees

Collimation
Area from lower thoracic vertebrae
to sacrum
Beam collimated to lateral margin of
psoas muscles
No artifact across mid-abdomen
from any elastic in underclothes
X-ray penetration of all vertebral
structures
Open intervertebral joints
SI joints equidistant from vertebral
column
Symmetric vertebrae, with spinous
processes centered to bodies

AP
(Bending Views)

PA Oblique
(RAO/LAO)

14x17 LW

14x17 LW

Grid

Yes

Yes

SID

40

40

Large

Large

L-Spine
IR

Focal Spot

Patient

CR Angle

Supine
1st: max right bending
2nd: max left bending

Cross patients leg on opposite side

from flexed side over other leg

Move heels toward flexed side
Suspend respiration
0

CR

Enters at L-3 (1-1.5 above iliac

crest) on MSP

Structures

Intervertebral Foramen
Sacral Promontory

Evaluation
Criteria

Site of spinal fusion centerd &

including the superior and inferior
vertebrae
No rotation of pelvis (symmetric
ilia)
Bending directions correctly
identified with lead markers
Sufficient radiographic density to
show the degree of movement when
vertebrae are superimposed

Prone
AFFECTED side DOWN rotated 45

Enters L-3 (1-1.5 above iliac crest)

Enter elevated side about 2 lateral to
palpable spinous process

Greater Sciatic Notch

Inferior Articular Surface (Foot)

Joints FARTHEST from IR

Area from lower thoracic vertebrae to
the sacrum
Zygapophyseal joints farthest from IR
When joint is not well seen, and the
pedicle is anterior, the patient is not
rotated enough
When joint is not well seen, and the
pedicle is posterior, the patient is
rotated too much
Vertebral column parallel with table
so that T12-L1 and L1-L2
intervertebral joint spaces remain
open

Lateral

Lateral
(Lumbosacral)

Lateral
(Flexion/
Extension)

14x17 LW

8x10 LW

14x17 LW

Grid

Yes

Yes

Yes

SID

40

40

40

Large

Large

Large

L-Spine
IR

Focal Spot

Patient

CR Angle

CR

Structures

Lateral recumbent
Dependent arm at right
angle to body

Fully extend hips

Suspend respiration

0
Center 2 posterior to
ASIS & 1.5 inferior to
iliac crest
Can angle 5 caudal for
men & 8 for women)

Superior Articular

Surface (Ear)
Lumbosacral Junction

Transverse Process
(Nose)
Zygapophyseal Joint

Collimation
Area from lower
thoracic vertebrae to
coccyx using 14x17
Open intervertebral
disk spaces and
intervertebral
foramina
Superimposed
posterior margins of
each vertebral body
Vertebrae aligned
down the middle of the
image
Nearly superimposed
iliac crests
Spinous processes in
profile

Collimation
Open lumbosacral

intervertebral joint
Include all of L-5 &
upper sacrum
Lumbosacral joint in the
center of the x-ray

Iliac crests closely

superimposing each
other when CR is not
angled

Lateral recumbent
1st: lean forward & draw
up thighs
2nd: lean thorax back &
posteriorly extend
thighs/limbs
Suspend respiration
0

Enters L-4 (iliac crest)

If spine isnt adjusted
horizontal, angle CR to
lumbar column (5 for
men & 8 for women)

Evaluation
Criteria

Lateral recumbent
Flex hips & knees

Dependent arm at right

angle to body
Superimpose knees

exactly

Expose at expiration

Enters spinal fusion area

or L-3

Pedicle (Eye)
Pars Interarticularis
(Neck)

Site of spinal fusion in the

center of radiograph
No rotation of the
vertebral column
(posterior margins of
vertebral bodies are
superimposed)
Hyperflexion and
hyperextension
identification markers
correctly used for each
respective projection

PA
(Ferguson)

PA
(2nd with Elevated Foot)

14x17 LW

14x17 LW

Grid

Yes

Yes

SID

60-72

60-72

Large

Large

Scoliosis
IR

Focal Spot

Patient

Sitting or Standing facing bucky

To check spinal curvature
Include 1 of iliac crest on IR
Suspend respiration

CR Angle

CR

Bottom of light to include 1 of iliac

crests

Structures

All anatomy visualized

Collimation
Thoracic & lumbar vertebrae to
include about 1 of iliac crests
Vertebral column aligned down
center of x-ray
Correct identification marker

Evaluation
Criteria

Elevate patients hip or foot on the

same side of the primary curve about
3-4 by using book or block under
foot or buttocks
Suspend respiration

Bottom of light to include 1 of iliac

crests

Primary Curve
Compensatory Curve

Collimation
Thoracic & lumbar vertebrae to
include about 1 of iliac crests
Vertebral column aligned down
center of x-ray
Correct identification marker

10

PA Oblique
(RAO)

Lateral

Lateral Recumbent
(Cross-Table)

10x12 LW

10x12 LW

10x12 LW

Grid

Yes

Yes

Yes

SID

30

72

72 (or max distance)

Large

Large

Large

Sternum
IR

Focal Spot

Patient

CR Angle
CR
Structures

Lateral position
Lock hands behind back
Top of IR 1.5 above
jugular notch
Suspend on inspiration

Lateral recumbent
Flex hips & knees
Extend arms over head
Rest head on arms
Suspend on inspiration

Enters elevated side at

T-7 & 1 lateral to MSP

Enters lateral border of

mid-sternum

Enters lateral border of

mid-sternum

Clavicle
Jugular Notch
SC Joint

Ribs
Manubrium
Body

Xiphoid Process
Sternal Angle
Sternocostal Joint

Collimation
Entire sternum from
jugular notch to tip of
xiphoid process
Reasonable good
visibility of sternum
through thorax,
including blurred
pulmonary markings
Minimally rotated
sternum & thorax
Sternum projected free
of vertebral
superimposition
Minimally oblique
vertebrae
Sternum projected
over heart

Collimation
Lateral image of sternum
in its entirety
Sternum free of
superimposition by soft
tissues of the shoulders or
arms
Sternum free of
superimposition by ribs
Inferior portion of
sternum unobscured by
breasts of female patient

Evaluation
Criteria

Prone
RAO position- 15-20
Support body on
forearm & flexed knee
Top of IR 1.5 above
jugular notch
Expose on expiration

Collimation
Sternum in entirety
Manubrium free of

superimposition by soft
tissue of shoulders
Sternum free of
superimposition by ribs
Lower portion of
sternum unobscured by
breasts of female patient

11

PA
(Unilateral & Bilateral)

PA Oblique
(RAO/LAO)

8x10 CW

8x10 CW

Grid

Yes

Yes

SID

40

40

Large

Large

SC Joints
IR

Focal Spot

Patient

CR Angle

Prone
Arms at side with palms up

Bilateral- rest head on chin

Unilateral- turn head to face affected

side

Suspend on expiration
0

CR

Enter T-3 (posterior to jugular

notch)

Structures

SC Joints
Medial portions of Clavicles

Evaluation
Criteria

Prone
AFFECTED side DOWN
Oblique body 10-15
Suspend on expiration

Enter T2-T3 (3 distal to vertebral

prominens) & 1-2 lateral from MSP

Shows SC Joint CLOSEST to IR

Collimation
SJ joint of interest in the center of xray, with manubrium & medial end of
clavicle included
Open SJ joint space
SC joint of interest immediately
adjacent to vertebral column with
minimal obliquity
Reasonably good visibility of the SC
joint through the superimposing rib &
lung field

Collimation
Both SC joints and the medial ends
of the clavicles

SC joints through the superimposing

vertebral & rib shadows

No rotation present on bilateral
exam; slight rotation present on

unilateral

12