For years medical imagers have followed the ALARA principle (as low as reasonably achievable) with the knowledge that there is some qualitative increased cancer risk associated with any dose of radiation. The amount of radiation that is directly attributed to medical imaging continues to increase, raising attention to radiation dose control in medical imaging. When evaluating the risk and benefits of different imaging strategies, radiation dose needs to be considered. These radiopharmaceuticals then give off energy in the form of gamma rays detected by a gamma camera or a PET scanner. Nuclear medicine imaging, such as bone scan and positron emission tomography (PET), uses small amounts of radioactive materials called radiopharmaceuticals selected to accumulate in the target organ system. The relaxation times of these protons following the radio wave pulses can be measured and are tissue specific, allowing exquisite soft tissue contrast. While radiographic and CT imaging are obtained by passing photons (X-ray beam) through portions of a patient’s body, MRI uses pulses of specific radio wave frequencies within a constant magnetic field to change hydrogen atom alignment in the patient’s body. The main imaging techniques to evaluate the spine include conventional radiography, computed tomography (CT), magnetic resonance imaging (MRI), bone scan, and positron emission tomography–computed tomography (PET–CT). While conventional radiography and CT are effective in the evaluation of the osseous structures, MR is optimal for the evaluation of soft tissues, including, but not limited to, intervertebral disks, ligaments, paravertebral muscles, and the spinal cord. The osseous spine is connected by intervertebral disks and supporting ligaments. The spine is formed by 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 fused sacral vertebrae, and four small bones extending from the sacrum to form the coccyx. The purpose of this chapter is to discuss the different diagnostic imaging techniques and an imaging-based approach to common spine pathologies. 2.Imaging is an essential tool in diagnosis and management of spine pathology.

2.5 cm above the jugular notch at the level of C4.superiorly to include C2 and inferiorly to include T2.laterally to include the entire cervical spine.the central ray is midline centered at the level of C4 to enter immediately below the hyoid bone.inform the patient that the image will be taken on suspended expiration.the detector is placed portrait, running parallel to the long axis of the cervical spine on the patients left the side.the patient is supine or erect, depending on trauma or follow up.chin should be raised to align the lower margin of the upper incisors to the mastoid tips/base of the skull (unless trauma when the patient is placed in a cervical collar).

patient shoulders should be at equal distances from the image receptor to avoid rotation.

patient positioned erect in AP position (unless trauma when the patient will be supine).

It also helps to demonstrate any adjacent soft tissue structure, osteoarthritis, and spondylosis. This projection helps to visualize pathology involving the entire cervical spine orthogonal to the AP view and is often performed in the trauma setting. This projection helps to visualize pathology relating to C3-C7 in the anatomical position, demonstrating any compression fractures, clay-shoveler fractures, and herniated nucleus pulposus (HNP). LAT:Ĭervical spine lateral view is a lateral projection of the cervical spine.Īs technology advances, computed tomography (CT) has replaced this projection, yet there remain many institutions (especially in rural areas) where CT is not readily available. The anteroposterior (AP) cervical spine projection is part of the cervical spine series.

Cervical spine x ray ap