AP lower cervical, AP open
mouth and lateral cervical.
Following direct trauma
AP lower cervical, AP open
mouth, lateral cervical, right & left cervical obliques.
Following trauma, including ligament
injury (MVA)
AP lower cervical, AP open
mouth, lateral cervical, lateral cervical flexion & extension,
right and left cervical obliques. (An additional LCN and
LCF / LCE study 2 weeks later to evaluate ligamentous
stability.)
Thoracic Spine
Investigating the region
AP thoracic and lateral thoracic.
PA chest with chronic pain;
if suspicious findings, do a lateral - completing the
chest series.
Following any trauma
AP thoracic and lateral thoracic.
Rib series with any pin point
pain; with trauma, a chest series is helpful.
Lumbar Spine
Investigating the region
AP lumbar and lateral lumbar;
+ / - lateral L/S spot projection
An AP L/S spot tilt projection
is very helpful.
Following trauma
AP lumbar and lateral lumbar;
+ / - lateral L/S spot projection
An AP L/S spot tilt projection
is very helpful.
An AP pelvis with appropriate
pain, avoid the lumbopelvic projection.
Other Anatomical Regions
A minimum of two perpendicular
projections are required. Two different projections, AP
clavicle and an AP tilt clavicle projection. Medial oblique
projections are very helpful when appropriate. Positioning
is critical with extremity radiographic studies.
Understanding A Suspicious Finding
Before Referring Patient Out
First, locate the finding in more
then a single projection. Retake the projection containing
the suspicious finding, using a slightly different tilt.
Take a contralateral study, not many traumatic findings
are bilateral. Obtain a previous radiographic study of
the same region. Rule out congenital anomalies or variants.
Make a detailed differential list, top 3, and quantify
your differentials.
