Cervical Spine

  • Investigating the region
    • AP lower cervical, AP open mouth and lateral cervical.
  • Following direct trauma
    • AP lower cervical, AP open mouth, lateral cervical, right & left cervical obliques.
  • Following trauma, including ligament injury (MVA)
    • AP lower cervical, AP open mouth, lateral cervical, lateral cervical flexion & extension, right and left cervical obliques. (An additional LCN and LCF / LCE study 2 weeks later to evaluate ligamentous stability.)

Thoracic Spine

  • Investigating the region
    • AP thoracic and lateral thoracic.
    • PA chest with chronic pain; if a suspicious finding is found, do a lateral completing the chest series.
  • Following any trauma
    • AP thoracic and lateral thoracic.
    • Rib series with any pin point pain; with trauma a chest series is helpful.

Lumbar Spine

  • Investigating the region
    • AP lumbar and lateral lumbar; + / – lateral L/S spot projection
    • An AP L/S spot tilt projection is very helpful.
  • Following trauma
    • AP lumbar and lateral lumbar; + / – lateral L/S spot projection
    • An AP L/S spot tilt projection is very helpful.
    • An AP pelvis with appropriate pain, avoid the lumbopelvic projection.

Other Anatomical Regions

  • A minimum of two perpendicular projections are required.
  • Two different projections, AP clavicle and an AP tilt clavicle projection.
  • Medial oblique projections are very helpful when appropriate.
  • Positioning is critical with extremity radiographic studies.

Understanding A Suspicious Finding Before Referring Patient Out

  • First, locate the finding in more than a single projection.
  • Retake the projection containing the suspicious finding, using a slightly different angle.
  • Take a contralateral study, not many findings are bilateral.
  • Obtain a previous radiographic study of the same region.
  • Rule out congenital anomalies or variants.
  • Make a detailed differential list.