Radiographic Procedures · ARRT 2025
Cervical & Thoracic Spine Positioning for the ARRT Exam
The cervical-thoracic swap (foramina vs zygapophyseal joints), the AP open mouth, 45 degree obliques, the swimmer's lateral, and breathing technique for the ARRT exam.
Overview
Cervical and Thoracic Spine is organized around one swap. In the neck, the zygapophyseal joints sit at 90 degrees to the midsagittal plane and open on a true lateral, while the intervertebral foramina sit at 45 degrees and need a 45 degree oblique with a 15 to 20 degree cephalad angle. In the thoracic spine the two trade places: the foramina open on the lateral and the zygapophyseal joints need a 70 degree oblique with no tube angle. The ARRT exam asks that swap repeatedly; Procedures is worth 72 of 200 scored questions.
The column has 33 separate bones in a young child and an average of 26 in an adult. Cervical vertebrae carry three foramina apiece, C1 is a ring with no body, and the dens belongs to C2. There is no intervertebral disk between C1 and C2, so the first disk sits at C2-C3.
The AP open mouth aligns one line, from the lower margin of the upper incisors to the mastoid tips, perpendicular to the receptor, and it is the only routine projection that shows the atlantoaxial joints. The AP axial angles 15 to 20 degrees cephalad, the lateral is taken at a 60 to 72 inch SID, and the swimmer's lateral rescues C5 to T3 when the shoulders hide C7-T1. The thoracic AP and lateral both center on T7, found 3 to 4 inches below the jugular notch, and the lateral uses a breathing technique: low mA with an exposure of at least 2 to 3 seconds to blur the overlying ribs.
Named fractures anchor the clinical side: Jefferson from axial loading, hangman's from hyperextension, clay shoveler's avulsing a spinous process from C6 to T1. For 2027, the oblique thoracic spine leaves the ARRT content specifications and an AP or PA thoracolumbar projection joins them.
What you’ll learn in this chapter
The 40 lessons in this chapter break down as follows. The full lesson content is unlocked when you start a free account.
Cervical & Thoracic Spine
- Cervical and Thoracic Spine
Anatomy
- The Vertebral Column
- The Typical Vertebra
- Quiz
- What Makes a Cervical Vertebra Cervical
- Atlas and Axis
- Quiz
- Thoracic Vertebrae and the Rib Facets
- Quiz
- Foramina Versus Zygapophyseal Joints
Landmarks
- Topographic Landmarks
- Quiz
Technique
- Technique and Image Quality
Cervical spine
- AP Open Mouth: C1 and C2
- Quiz
- AP Axial Cervical Spine
- Quiz
- Cervical Spine Obliques
- Quiz
- Lateral Cervical Spine
- Quiz
- Swimmer's Lateral, Flexion and Extension
- Three More Cervical Specials
Thoracic spine
- Thoracic Spine: AP and Lateral
- Breathing Technique, and Finding T12
- Quiz
- Thoracic Obliques, and What 2027 Drops
- Quiz
Soft tissue neck
- Soft Tissue Neck
Thoracolumbar
- Thoracolumbar Spine
- Thoracolumbar Fractures and the Denis Columns
- Quiz
Clinical indications
- Fractures and Conditions You Have to Name
Image critique
- Reading Your Own Images
Recap
- What to Carry Out of This Chapter
- Quiz
- Quiz
- Quiz
- Quiz
- Quiz
Key terms in this chapter
These are the 8 terms most likely to appear on the ARRT registry from this chapter. Use them as a flashcard pre-quiz.
- Zygapophyseal Joints
- Joints between the articular processes. Cervical ones sit at 90 degrees to the midsagittal plane and open on a true lateral; thoracic ones sit at 70 to 75 degrees and need a 70 degree oblique.
- Intervertebral Foramina
- The openings for spinal nerves formed between stacked pedicles. Cervical foramina need a 45 degree oblique with a 15 to 20 degree tube angle; thoracic foramina open on the lateral.
- AP Open Mouth
- The C1-C2 projection that aligns the lower margin of the upper incisors with the mastoid tips, perpendicular to the receptor. The only routine cervical view of the atlantoaxial joints.
- Dens (Odontoid Process)
- The pivot peg of C2, strapped against the anterior arch of C1 by the transverse atlantal ligament. Embryologically it began as the body of C1 and fused to C2 during development.
- Swimmer's Lateral
- The cervicothoracic lateral: one arm up, one down, separating the humeral heads vertically so C5 to T3 appear when the routine lateral loses C7-T1 behind the shoulders.
- Breathing Technique
- Low mA with a long exposure of at least 2 to 3 seconds on the lateral thoracic spine. Shallow breathing blurs the ribs and lung markings while the spine stays sharp; AEC cannot be used.
- Vertebra Prominens
- The long spinous process of C7, palpable at the base of the neck, with its tip at about the level of the body of T1. The most dependable landmark in the region.
- Jefferson Fracture
- Comminuted fracture of the anterior and posterior arches of C1 from axial loading, seen as bilateral spreading of the lateral masses on the AP open mouth. Skull rotation can mimic it.
Sample practice question: Head, Spine, and Pelvis
One free sample from the 68-question Head, Spine, and Pelvis bank. See the format, the rationale style, and the difficulty before you sign up.
A 45° posterior oblique projection of the lumbar spine demonstrates the Scotty Dog pattern. A defect appearing as a 'collar' on the dog's neck represents which of the following pathologies?
Show answer and rationale
A, Incorrect: Spondylolisthesis is forward slippage of one vertebra on another, best assessed on lateral imaging.
B, Correct: Correct. The Scotty Dog's neck represents the pars interarticularis. A 'collar' on the neck indicates spondylolysis, a defect or fracture of the pars. This finding is pathognomonic on the 45° lumbar oblique.
C, Incorrect: Disk herniation is not directly visible on plain radiographs and requires MRI for diagnosis.
D, Incorrect: Compression fractures involve loss of vertebral body height and are best demonstrated on lateral views.
Hands-on
Practice the positioning
Open the Positioning Lab to drill body position, central ray, anatomy, and common errors for each projection in this chapter.
- AP Odontoid (Open Mouth) Supine, mouth open wide, CR perpendicular. C1-C2 visualization.
- AP Dens (Fuchs) Supine, head extended, CR perpendicular. Alternate dens visualization.
- AP Axial Cervical Supine, CR 15-20° cephalad, centered C4. Lower cervical survey.
- Lateral Cervical Erect lateral, CR perpendicular to C4, 72" SID. Standard survey.
- Lateral Cervical (Swimmers) Erect lateral, arm raised, CR to C7-T1. Twining method.
- Lateral Cervical (Flexion) Erect lateral, head flexed forward, CR to C4.
- Lateral Cervical (Extension) Erect lateral, head extended backward, CR to C4.
- AP Thoracic Supine, arms at sides, CR perpendicular to T7. Grid required.
- Lateral Thoracic Lateral recumbent, CR perpendicular to T7. Breathing technique.
- AP Lumbar Supine, knees flexed, CR perpendicular to the iliac crest (L4). Grid required.
- Lateral Lumbar Lateral recumbent, knees flexed, CR perpendicular to the iliac crest (L4).
- AP Oblique Lumbar Zygapophyseal Joints 45° oblique, RPO or LPO, CR to L3. Facet joints.
- L5-S1 Lumbosacral Junction Lateral recumbent, CR to L5-S1 junction. Flexed knees.
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Frequently asked questions
What does the ARRT Radiography Radiographic Procedures category cover?
Cervical and Thoracic Spine is organized around one swap. In the neck, the zygapophyseal joints sit at 90 degrees to the midsagittal plane and open on a true lateral, while the intervertebral foramina sit at 45 degrees and need a 45 degree oblique with a 15 to 20 degree cephalad angle. In the thoracic spine the two trade places: the foramina open on the lateral and the zygapophyseal joints need a 70 degree oblique with no tube angle. The ARRT exam asks that swap repeatedly; Procedures is worth 72 of 200 scored questions.
How many lessons are in the Cervical & Thoracic Spine Positioning for the ARRT Exam chapter?
This chapter contains 40 lessons across 11 sections, plus a knowledge-check quiz at the end. The full lesson content is unlocked with a Premium subscription. The free tier includes 3 complete chapters.
Is this chapter aligned with the ARRT 2025 Content Specifications?
Yes. Every chapter on this site maps directly to the ARRT Radiography Content Specifications effective 2025. This chapter falls under the Radiographic Procedures domain of the official ARRT exam blueprint.