Lateral cervical spine X-ray positioning
One of the routine C-spine views. The patient stands side-on, the beam passes from side to side, straight on to the receptor with the tube horizontal, and the centring point is C4, at the level of 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
Lateral, erect. Seat the patient with a shoulder against the bucky, shoulders as low as possible, arms by the sides (a 1 kg weight in each hand if uninjured).
Centring & collimation
Central ray
lateralCentre: C4, at the level of the thyroid cartilage.
Beam: lateral, perpendicular to the receptor, horizontal beam.
Collimate: base of skull to T1
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 150 cm | Horizontal beam |
| Receptor | 18 × 24 cm | portrait |
| Placement | Erect (wall) bucky | Grid in |
| Angulation | None | Perpendicular to the receptor |
Marker & breathing
- Marker: R or L marker on the side nearest the detector
- 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 | 8 | 3.2 |
| S | 70 | 12.5 | 5 |
| M | 70 | 16 | 6.3 |
| L | 70 | 25 | 10 |
These start from a classic film-screen chart (70 kV, 12.5 mAs at 140 cm) and are adjusted for a digital detector at 150 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
- C7/T1 junction shown.
- Mandibular angles and posterior vertebral margins superimposed.
- 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 |
|---|---|---|
| C7 hidden by shoulders | Shoulders not depressed | Add weights or a swimmer's view. |
Common questions
- Where do you centre for a cervical spine lateral X-ray?
- The centring point is C4, at the level of the thyroid cartilage.
- What distance and beam angle does a cervical spine lateral need?
- 150 cm from the tube to the receptor. The beam passes from side to side, straight on to the receptor with the tube horizontal.
- What size receptor, and do you need a grid?
- Use an 18 × 24 cm receptor, portrait, in the wall 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 lateral?
- C7 hidden by shoulders. Usual cause: shoulders not depressed. The fix: add weights or a swimmer's view.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a cervical spine lateral in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.