Lateral lumbar spine X-ray positioning (trauma)
An extra L-spine view, used when a routine one is not enough. The patient lies on their back, the beam passes from side to side, straight on to the receptor with the tube horizontal, and the centring point is L3.
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 turn the patient. Supine, arms folded on the chest, detector vertical against the side.
Centring & collimation
Central ray
lateralCentre: L3.
Beam: lateral, perpendicular to the receptor, horizontal beam.
Collimate: T12 to the sacrum
Distance, receptor & grid
| Setting | Value | Notes |
|---|---|---|
| SID | 100 cm | Horizontal beam |
| Receptor | 18 × 43 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 | 80 | 32 | 12.5 |
| S | 80 | 50 | 20 |
| M | 80 | 63 | 25 |
| L | 80 | 100 | 40 |
These start from a classic film-screen chart (80 kV, 100 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
- T12 to the sacrum shown without moving the patient.
- 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 |
|---|---|---|
| Spine cut off | Detector not centred to the spine | Centre the detector on the mid-coronal line. |
Common questions
- Where do you centre for a lumbar spine lateral (after injury) X-ray?
- The centring point is L3.
- What distance and beam angle does a lumbar spine lateral (after injury) need?
- 100 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 × 43 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 lumbar spine lateral (after injury)?
- Spine cut off. Usual cause: detector not centred to the spine. The fix: centre the detector on the mid-coronal line.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up a lumbar spine lateral (after injury) in a 3D room and score your positioning. See ScanFlo XR →
Written by the ScanFlo team from everyday radiographic practice.