![]() This is because normal C-spine X-rays cannot exclude significant injury, and because a missed C-spine fracture can lead to death, or life long neurological deficit.Ĭlinico-radiological assessment of spinal injuries should be managed by experienced clinicians in accordance with local and national clinical guidelines. Bones - Cortical outline/Vertebral body heightĬlinical considerations are particularly important in the context of Cervical spine (C-spine) injury.Alignment - Anterior/Posterior/Spinolaminar.Look at all views available in a systematic manner. ![]() Clinical considerations are of particular importance when assessing appearances of C-spine X-rays.Normal C-spine X-rays do not exclude significant injury.The dens must be center of collimated field of approximately 4 x 4 inches or 10 x 10 cm.īoth bone and soft tissue densities are demonstrated if optimal exposure have used.Ĭlear or sharp bony margins and trabecular markings which is an indication of no motion. Rotation can be imitate pathology by causing unequal spaces between lateral masses and dens. No Rotation: Equal distance from lateral masses and or transverse process of C1 to condyles of mandible, and by center alignment of spinous process of C2. If the skull base is superimposing the upper dens, reposition the patient by slightly hyperflexing the neck or angle central ray slightly caudad it will project about 1inch or 2.5 cm for every 5 degree of caudal angulation. Neither teeth are sperimposed on the upper dens, when making reposition on patient hyperextending the neck or angle the central ray slightly cephalic. Proper flexion or extension of the neck will superimpose the lower margin of the upper incisors with base of the skull. Patient in open mouth the Odontoid process (Dens) and vertibral body of C2, the lateral masses of C1 and zygopopseal joints between C1 and C2 should be clearly demonstrated. If the dens, cannot be demonstrated in this position you may use Fuchs method and Judd method. Important: If patient is instructed to open the mouth, only the lower jaw moves and keep the tongue in the lower jaw to prevent superimposition of tongue's shadow to the atlas and axis. Suspend during exposure to minimize patient motion. note: Do this at last step and make it quick, because patient will be difficult in this position.Ĭentral Ray, Collimation and Respiration:Ĭentral ray is directed to the center of mouth and perpendicular to image receptor or cassette.Ĭollimate to the 4 side of area to be image, approximately 4 x 4 inches or 10 x 10 cm Open mouth and adjust patient head, a line from lower margin of upper incisors to the base of the skull or mastoid tip is perpendicular to the image receptor and x-ray table or align Central Ray accordingly.īe sure that no rotation of patients head or thorax exist.Įnsure that the patient mouth is wide open during exposure. Patient in open mouth demonstrating C1 to C2Īlign midsagittal plane to Central Ray and midline of x-ray table Part Position AP Cervical Spine Open Mouth Head is in table surface, and provide immobilization if needed. Patient is in supine or erect and put arm by sides Use of Grid either stationary of moving grid Odontoid and Jeffeson Fractures will be demonstrated Pathology Demonstrated and Exposure Factorsįractures of C1 and C2 and adjacent soft tissues When performing an x-ray of Cervical spine (AP) and the patient has a neck trauma don't attempt to move the head and neck without consulting first with a physician who reads the previous horizontal beam lateral radiograph of the patient. X-ray examination of cervical spine projecting C1 and C2 with the patient in open mouth.
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