Remember to set the exposure before positioning

Remember to remove jewelry that is in the field of interest and dentures/orthodontic appliances where possible

AP C1–C3 – adjust patient so that occipital bone and lower edge of upper incisors are superimposed

AP C1–C3 – patient may overextend the head when opening the mouth

AP – mental region of mandible should be superimposed over the occiput

Check that each intervertebral joint space is consistent

AP C1–C3 – the odontoid process must be clear of the occipital bone

All vertebral bodies should be rectangular – any variation may be due to trauma

AP – ensure C3–T1 are visualised – C1–C3 may be obscured

Acute trauma – use horizontal beam – do not adjust head

Remember to remove jewelry/ear-rings that is in the field of interest

Exposure made on arrested expiration

Must include C7 on the radiograph

Oblique – extend the head back to avoid superimposition of the mandible

Anterior displacement over 3.5 mm – ligaments torn

Vertebral bodies C3–T1 should be the same size – a disparity of 2 mm may be due to a compression #

Check all seven vertebrae are seen on the radiograph

Oblique – demonstrates intervertebral foramina closest to the film (right anterior oblique – right foramina; left anterior oblique – left foramina)

Remember to set the exposure before positioning

Exposure must penetrate the shoulder region

Do not rotate the thorax unless an oblique projection is required

Exposure on arrested respiration

Check that each intervertebral joint space is consistent

Shoulders should be seen separated from each other

All vertebral bodies should be rectangular – any variation may be due to trauma

Must include from C5 to T5

AP – use a wedge filter to prevent the upper thoracic vertebrae being over-penetrated

Flex the knees to aid the patient’s comfort

AP – exposure on arrested inspiration

Lateral – a long exposure with gentle breathing to blur the lung fields and ribs (diffusion technique)

AP – abnormal soft tissue enlargement around the spine is a positive indication of trauma or infection

Check all pedicles are present and intact

Vertebral bodies should be the same height – anteriorly and posteriorly

Lateral – upper spine difficult to visualise due to shoulders. A swimmer’s projection may be required – CT is better

AP – reduce lumbar lordosis – flex knees and support where indicated

AP – ensure sacroiliac joints included on the radiograph

AP and lateral – exposure on arrested expiration – diaphragm should be above L1 – or try breathing technique to blur bowel shadows

Lateral – non-opaque pad under the waist may assist in bringing the spine parallel to the table top

Use gonad shield – but take care not to obscure the area of interest

AP – distance between pedicles gradually widens from L1 to L5

AP – must inspect the transverse processes for #

Check soft tissue changes – may indicate underlying pathology – renal stones mimic skeletal back pain

Lateral – vertebral bodies should be same height anteriorly and posteriorly

Any loss of height or wedging suggests a possible compression #

Do not proceed until you have examined the lateral

L5–S1 – a 5° caudal angulation may open the disc space

L5–S1 – collimation important to reduce scattered radiation

Lateral – place a non-opaque pad under the waist to bring the spine parallel to the table top

Disc space at L5–S1 – usually smaller than at L4–L5

Joint space must be visualised open

Obliques – suspected spondylolisthesis – a defect in pars articularis – look for a collar around the Scottie dog’s neck!

Obliques – will demonstrate superior and inferior articular processes and the zygopophyseal joints of the side nearest the cassette

AP – lower bowel preparation is an advantage

AP – central ray will differ between males and females

Lateral – where indicated place a non-opaque pad under the waist

Must demonstrate the sacrum and sacroiliac joints

Obturator foramina will appear wide open

Symphysis will appear broadened depending upon tube angle

Lateral – must include the L5–S1 joint space on the radiograph