Cervical Spine X-Ray Positioning Master Guide

Clinical Reference for Standard, Specialized, and Functional C-Spine Radiographic Views

Routine & Essential Views

1. AP Axial View (C-Spine)Standard

Patient PositionStanding or sitting erect, back against the vertical grid, chin slightly elevated to avoid superimposed mandible.

Beam Direction15° to 20° cephalic angle centered at C4.

Clinical IndicationVisualization of lower cervical vertebrae (C3 to T1), spinous processes, and disc spaces.

2. Lateral View (C-Spine)Standard

Patient PositionStanding or sitting with shoulder pressed against detector, chin elevated, shoulders depressed downward as much as possible.

Beam DirectionHorizontal central ray directed perpendicular to C4.

Clinical IndicationEvaluating vertebral alignment, prevertebral soft tissues, disc heights, and curvature (lordosis).

3. Open Mouth (Odontoid) ViewStandard

Patient PositionPatient supine or sitting, mouth wide open, upper incisors and mastoid tip aligned horizontally.

Beam DirectionPerpendicular to the center of the open mouth (targeting C1-C2).

Clinical IndicationVisualization of the dens (odontoid process) of C2, atlas (C1), and atlantoaxial joint space.

4. RPO / LPO Oblique ViewsOblique

Patient PositionBody rotated 45° relative to detector; for RPO/LPO, the beam enters anteriorly and exits posteriorly.

Beam Direction15° cephalic angle directed to C4.

Clinical IndicationDemonstrating the **intervertebral foramina** (IVFs) furthest from the image receptor.

5. RAO / LAO Oblique ViewsOblique

Patient PositionBody rotated 45° with anterior chest/shoulder closest to the detector.

Beam Direction15° caudal angle directed to C4.

Clinical IndicationVisualizing the intervertebral foramina closest to the image receptor.

6. Swimmer’s View (Caudal)Special

Patient PositionLateral position; arm closest to detector raised overhead, opposite arm depressed downward and rotated slightly anteriorly.

Beam DirectionHorizontal central ray directed at C7-T1 junction (3° to 5° caudal if needed).

Clinical IndicationClear visualization of the cervicothoracic junction (C5 to T2) when obscured by shoulders.

7. Flexion Lateral ViewFunctional

Patient PositionLateral position; patient actively bends head and chin forward toward the chest as far as tolerated.

Beam DirectionHorizontal ray centered to C4.

Clinical IndicationAssessing hypermobility, ligamentous stability, and posterior subluxation/instability.

8. Extension Lateral ViewFunctional

Patient PositionLateral position; patient tilts head backward as far as comfortably possible.

Beam DirectionHorizontal ray centered to C4.

Clinical IndicationEvaluating anterior fixation, range of motion, and stability during extension.

9. Trauma Cross-Table LateralEmergency

Patient PositionPatient lies strictly supine on a spine board with cervical collar intact; **do not move patient**.

Beam DirectionHorizontal cross-table ray directed to C4.

Clinical IndicationRule out acute cervical spine fracture or dislocation in trauma settings before collar removal.

📌 Quick Jump Directory (Cervical Views)

1. AP Axial 2. Lateral 3. Open Mouth 4. RPO/LPO 5. RAO/LAO 6. Swimmer’s 7. Flexion 8. Extension 9. Trauma Lateral