Lateral Cervical is a radiography positioning projection of the Spine. Erect lateral, CR perpendicular to C4, SID 60-72". Standard survey. The centering point is located C4, at the level of the upper margin of the thyroid cartilage; with the IR centred to the CR its top lies about 1 to 2 inches (3 to 5 cm) above the EAM. The central ray is perpendicular to the IR, directed horizontally to C4 (level of the upper margin of the thyroid cartilage). Image-quality criteria include C1 through the C7-T1 joint space clearly seen; if T1 is not shown, add a swimmer's lateral, intervertebral disc spaces open symmetrically. A sample technique is 85 kVp with DR 8 or CR 16 mAs, at an SID of 72 inches (183 cm).
Watch the setup
All steps (4)
- Erect lateral, sitting or standing, with the shoulder against the vertical IR.
- Align the midcoronal plane to the CR and the midline of the IR.
- Depress the shoulders: ask the patient to relax and drop them down and forward as far as possible (last step before the exposure; equal weights on both arms may help).
- Elevate the chin to place the acanthiomeatal line (AML) parallel with the floor, and protract it so the mandible does not superimpose the upper vertebrae.
3D anatomy: BodyParts3D, © The Database Center for Life Science. Posed, rendered and labelled by RadTechPrepper. These animations are licensed CC BY-SA 4.0. Credits
Anatomy demonstrated
- Cervical vertebral bodies C1-C7.
- Intervertebral joint spaces.
- Articular pillars and zygapophyseal joints.
- Spinous processes in profile.
- Cervical vertebral bodies.
Patient preparation
- Verify patient identity using two identifiers.
- Remove neck jewelry, glasses, and hearing aids.
- Erect lateral, sitting or standing, with the shoulder against the vertical IR.
- Align the midcoronal plane to the CR and the midline of the IR.
- Depress the shoulders: ask the patient to relax and drop them down and forward as far as possible (last step before the exposure; equal weights on both arms may help).
- Elevate the chin to place the acanthiomeatal line (AML) parallel with the floor, and protract it so the mandible does not superimpose the upper vertebrae.
- Suspend respiration on full expiration, for maximum shoulder depression.
Position & centering point
C4, at the level of the upper margin of the thyroid cartilage; with the IR centred to the CR its top lies about 1 to 2 inches (3 to 5 cm) above the EAM.
Central ray
Perpendicular to the IR, directed horizontally to C4 (level of the upper margin of the thyroid cartilage).
Exposure / technique
- kVp
- 85
- mAs
- DR 8 / CR 16
- SID
- 72" (183 cm)
- Notes
- Upright erect technique. Bontrager gives SID 60 to 72 inches; a long 72 inch SID offsets the increased OID. Sample technique: DR 8 / CR 16 mAs at 85 kVp, 72 in SID, for an 11 cm part (Merrill's sample chart). Adjust for your equipment.
kVp and mAs are sample values. Use caution when applying them in your department.
Image-quality criteria
- C1 through the C7-T1 joint space clearly seen; if T1 is not shown, add a swimmer's lateral.
- Intervertebral disc spaces open symmetrically.
- Right and left articular pillars and zygapophyseal joints superimposed.
- Soft tissue outline of neck visible.
Common errors
- 1 Neck flexion or extension alters cervical lordosis.
- 2 Rotation or obliquity shifts vertebrae off alignment.
- 3 Shoulders not depressed: they superimpose the lower cervical vertebrae and obscure C7-T1.
- 4 CR not at C4 level misses key structures.
- 5 Chin not raised and protracted (AML parallel to the floor), so the mandible superimposes the upper vertebrae.
- 6 Shoulders not depressed, so the C7-T1 joint space is not clearly seen.
- 7 CR not at C4, the level of the upper margin of the thyroid cartilage.
Clinical indications
- Non-trauma cervical survey (trauma uses a horizontal-beam lateral).
- Evaluation of cervical spondylosis or arthropathy.