Cervical & Thoracic Spine Positioning 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 tube angle, cephalad for a posterior oblique and caudad for an anterior one. 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. Procedures, the largest domain on the ARRT exam, carries 66 of 200 scored questions to 28 February 2027 and 72 from 1 March 2027.

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 (Bontrager also prints a 3 or 4 second minimum in the same chapter).

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, an AP or PA thoracolumbar projection joins the ARRT content specifications, while the cervical and thoracic projection lists stay as they are.