AP cervical spine X-ray positioning (trauma)
An extra C-spine view, used when a routine one is not enough. The patient lies on their back, the beam passes front to back (AP), tilted 15° towards the head, and the centring point is the thyroid cartilage.
By the ScanFlo Editorial Team · Updated
In this section · X-ray positioning
- X-ray positioning guides
- Skull positioning
- Face & sinuses positioning
- Soft tissue neck positioning
- C-spine positioning
- Chest positioning
- Shoulder positioning
- Humerus positioning
- Elbow positioning
- Forearm positioning
- Wrist positioning
- Hand positioning
- T-spine positioning
- Abdomen positioning
- L-spine positioning
- Sacrum & SI joints positioning
- Pelvis positioning
- Hip positioning
- Femur positioning
- Knee positioning
- Tibia & fibula positioning
- Ankle positioning
- Foot positioning
Still being checked: a radiographer is reviewing this guide. If your department does it differently, follow your department.
Patient position
Supine. Do not move the neck. Image the patient supine as found.
Centring & collimation
Central ray
APCentre: the thyroid cartilage.
Beam: AP, angled 15° cephalad.
Collimate: C3 to T2
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 100 cm | |
| Receptor | 24 × 30 cm | portrait |
| Placement | Table bucky | Grid in |
| Angulation | 15° | cephalad |
Marker & breathing
- Marker: anatomical side marker on the side being examined, clear of anatomy
- Breathing: Suspend respiration.
Exposure by patient size
Treat these as a starting point. Your detector, your generator and the patient in front of you will all move the numbers.
| Patient size | kV | mAs (chart) | mAs (DR default) |
|---|---|---|---|
| XS | 70 | 3.2 | 1.25 |
| S | 70 | 5 | 2 |
| M | 70 | 6.3 | 2.5 |
| L | 70 | 10 | 4 |
These start from a classic film-screen chart (70 kV, 12.5 mAs at 140 cm) and are adjusted for a digital detector at 100 cm. The DR column is what ScanFlo's console suggests; each step up or down changes the mAs by about a quarter.
Image quality checklist
- C3 to T2 shown.
- The neck was not moved.
- The anatomical side marker is visible, correct and clear of the anatomy.
- Collimation borders are visible on all sides, no wider than the area requested.
Faults & how to fix them
| Fault | Cause | Fix |
|---|---|---|
| Neck moved | Positioning a trauma patient | Image as found; follow the doctor's instruction. |
Common questions
- Where do you centre for a cervical spine AP (after injury) X-ray?
- The centring point is the thyroid cartilage.
- What distance and beam angle does a cervical spine AP (after injury) need?
- 100 cm from the tube to the receptor. The beam passes front to back (AP), tilted 15° towards the head.
- What size receptor, and do you need a grid?
- Use a 24 × 30 cm receptor, portrait, in the table bucky. A grid is needed.
- What should the patient do with their breathing?
- Ask them to stop breathing for the moment of the exposure.
- What goes wrong most often on a cervical spine AP (after injury)?
- Neck moved. Usual cause: positioning a trauma patient. The fix: image as found; follow the doctor's instruction.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a cervical spine ap (after injury) in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.