Cervical - Lateral (Flexion)

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Radiographic Positioning

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Name of projection Cervical - Lateral (Hyper Flexion)
Area Covered The cervical spine from C1 down to the C7-T1 joint space and approximately one-third of T1 the first thoracic vertebra
Pathology shownA functional study to demonstrate motion or lack of motion of cervical vertibra, done in conjunction with neutral and hyper extension view they demonstrate natural spinal curvature, range of spinal motion and ligament stability
Radiographic AnatomyCervical Spine Radiographic Anatomy
IR Size & Orientation 24cm x 30cm
Film / Screen Combination Regular
(CR and DR as recommended by manufacturer)
Bucky / Grid Moving or Stationary Grid
FilterCan be used when using film
Exposure 70 kVp
20 mAs
FFD / SID 180 cm
This larger distance helps overcome the OID (object to image receptor distance) to reduce magnification and improve the sharpness of the image.
Central Ray Directed to the level of C4
Perpendicular to the IR
Collimation Centre: C4
Shutter A: Open to include the top of the ear superiorly
Shutter B: Open to include the soft tissue of the neck anteriorly
The collimation may be angled to match the slope of the neck. For example, when the patient stands, C1 is usually more anterior than C7, so the collimation square may be tilted to match this slope.
Markers Anterior to Cervical Spine clear of perivertebral soft tissues
Marker orientation AP
Shielding Gonadal (check your department's policy guidelines)
RespirationSuspended respiration on expiration.
The shoulders are able to relax downwards on expiration which will maximise the chances of being able to visualise the C7-T1 junction on the image.
PositioningEnsure the removal of artefacts that may superimpose the anatomy of interest, such as earrings and other jewellery

Patient erect,
  • The patient is side on to the bucky/IR (usually left side is closest to the IR, however if the patient has torticollis, a wry neck, then direct the central ray to the inner, concave side)
  • Position the midsagittal plane so that it is parallel to the IR
  • Chin should be depressed until it touches the chest or as much as the patient tolerates
Where possible ask the patient to relax their shoulders down and move their finger tips in the direction of their toes on expiration, so that as you expose you have the best chance of penetrating the lower cervical spine area

Area Covered
Special Notes