Lateral cervical spine X-ray positioning (flexion)
An extra C-spine view, used when a routine one is not enough. The patient stands side-on, the beam passes from side to side, straight on to the receptor, and the centring point is C4.
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. Only on request and not after injury: lateral as standard, chin brought down onto the chest.
Centring & collimation
Central ray
lateralCentre: C4.
Beam: lateral, perpendicular to the receptor.
Collimate: base of skull to T1
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 150 cm | |
| Receptor | 24 × 30 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
- All cervical bodies shown in flexion.
- Labelled flexion.
- 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 | Shoulders high | Depress the shoulders. |
Common questions
- Where do you centre for a cervical spine lateral in flexion X-ray?
- The centring point is C4.
- What distance and beam angle does a cervical spine lateral in flexion need?
- 150 cm from the tube to the receptor. The beam passes from side to side, straight on to the receptor.
- What size receptor, and do you need a grid?
- Use a 24 × 30 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 in flexion?
- C7 hidden. Usual cause: shoulders high. The fix: depress the shoulders.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a cervical spine lateral in flexion in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.