An adequate X-ray means seeing vertebrae 1-7 and the first thoracic vertebrae. To ensure this, the swimmers view is used (in the lateral) which means raising one arm and lowering the other. The image is then taken from the side of the raised arm. It ensures that any issues can be spotted.
What is adequacy of the lateral cervical spine?
A professionals discussion on the x-rays of the left view of the lateral cervical spine. Shows the differences between an adequate view of all 7 vertebra,from the first until the junction of the 7th vertebra. The inadequate view is shown,and then the adequate view is brought in with use of the "swimmer's view". A brief discussion of the thoracic vertebra is also made, which starts again from one directly after the 7th vertebra.
adequate view means it is a way of seeing all of the cervical spine. ladithal is vertebras 1-5 . swimmers view is where a patient is asked to raise their arms .
We're going to look at some radiographs of the cervical spine of the neck and try to determine whether they're adequate or not.
What does it mean to be adequate? When you have an adequate view, you can see from the first
vertebrae all the way down to the junction of the seventh cervical vertebra and the first thoracic vertebrae.
I see. We call it adequate because it's adequate to make a diagnosis. That's right.
You want to see the entire cervical spine so that you can make sure that there is not an injury there.
So what are we looking at? What are we directly staring at here? We are looking at the lateral which shows
essentially part of the cervical spine. It shows cervical vertebra one through five. I see.
Just to make myself clear, these are both lateral x-rays--meaning x-rays from the side of a person. That's right.
If I know my anatomy, this person is facing this way. They're actually facing the other way.
Oh, I can see, and there's a little jaw. Okay, I was just testing you. Good job.
Alright, so the person is facing that way. This way is the front. And you were counting the different bones.
Exactly. You were saying this is one, two, three, four, five. That's why you hear people with back
injuries saying they have problems in what do they call it? L5. Yes, exactly. Actually we count even
further forward from there, and we look at exactly at those things that kind of look like squares.
Those are the actual vertebra. Exactly, right there. Exactly. Although we're interested in the entire spine,
we kind of go down. You can see if you look at the fifth square there; below that it's really hard to
see the squares of six and seven. Right, we can't see anything below that. It looks like this person's
shoulder is blocking it. Exactly. You can see that that big white thing there is the person's shoulder
has gotten in the way. They shouldn't have worn those lead shoulder pads. (laughter). It's making
it hard to see if there's something going on down there. So how do you solve that? If you look over
at the other film, it's what we call a swimmer's view. We ask the patient to raise one arm and lower the other.
In doing so, you clear that lower cervical spine and allow better visualization of the entire
spine. I see. And you're taking it from the direction of the raised arm. You take from the side.
And you can see . . . this is the raised arm here, and the other arm on the further side of the patient
is down. That allows us to get the should in position so that it doesn't block like this one does over here.
It's also clearer that this person is facing in this direction. (laughter) So let me see if
we can count. So this is number one. Yes, that's one. One, two, three, four, five, six, and there
we already got to six. We didn't see six over here, and then we've got seven. So you would call this
an adequate view of the neck because now we can look all the way through seven.
Absolutely, we can get all the way down to seven. And ideally you want to see the top of one.
Actually, in this counting system we go one through seven. And then we start back at one again
because we're starting with the thoracic vertebra. Oh, it's like those streets where they start numbering
where it comes one again. Did I number that right? You did. Again, we're looking more to the
front. You've got your numbers perfectly on every spinous process. The little bump that you can feel
when you press on the back of the neck. But we're really more interested in the alignment of the front
of the vertebral body. Okay, so this is one, two, three, four, five, six, and seven. You want to look
at the top of one. If you just continue down right there, sometimes it's difficult to see.
But exactly you want to see if there's an alignment right in front. There's something right here that I cannot really see,
but you're an expert, so maybe you see things that I don't. (laughter) What do we so with
this. We've shown you that you can get a swimmer's view, and it can show you all the way down to c7 and t1.
But on the orginal view as you've shown, you can't see that. So what we did for this patient
was get a swimmer's view. I see, so it's adequate. We have this other slide right over here.
Why is this one interesting? This is the same patient, and now we've taken that same view that we talked about before.
I mean the swimmer's view. This is the same patient as this patient right here, not this patient over on the right. That one looked pretty healthy. Exactly.
But here's an abnormal swimmer's view. The same person as this one, not the other one.
Facing in the same direction in case you want to test me. (chuckle) Okay, good. If you count again, starting with the first vertebra
One, two, three. Three's this one here. I see this whole things three right here. Four, five, six,
and then seven if I see that properly. (It's a little dark there.) Absolutely, the key important
finding there is that as you draw a line along the anterior (or the front) of all those vertebral bodies
if you were to connect them. Right. Just like that. I'll draw a dotted line. Fantastic. And as you
go down. Oh, look at that--seven as it looks like there's a little of a disruption there. Exactly,
and it's pushed back. And the problem is right behind those bones is your spinal cord. So, any kind
of injury like this can potentially injure your spinal cord and lead to permanent paralysis or weakness.
So this is the main thing. So there's two big takeaways from this short little segement: one is that you have
to make sure you have the information to make a diagnosis. For example, this over here you couldn't even
do something useful because you're not able to see the number six and number seven. Exactly, we'd call
it inadequate as you cannot draw any conclusions from that. That's why you would want them to get in
that swimmer's position, raise the arm from the direction you're looking at from the direction you're
looking at and lower the other arm. Correct. And then you can see something like this.
This right over here is cause for trouble because now you can go all the way to seven, and you can actually see
that they are not aligned. Absolutely, this is someone that you wouldn't let get out of your emergency
department without seeing a spine specialist whereas if you didn't have that view, you might falsely be
reassured that everything was okay when in fact there's a serious problem. Wow, very cool. Very good. Thanks a bunch. Thank you.
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