Whilst some are unavoidable, a knowledge of common artifacts can be helpful. It is not uncommon for the AP odontoid peg image to be marred by artifacts.

evidence of injury demonstrated on the other cervical spine projections.mechanism of injury (eg high speed MVA).clinical signs (eg parasthesia, head control, pain).This additional information needs to be considered in the context of: The LPO position in particular shows evidence of symmetry of the C1 lateral masses with respect to the dens and with respect to the body of C2. Note that the space between the central incisor teeth (white line) is no longer superimposed Here are a few alternative techniques that could be considered. On some patients you will not be able to achieve a satisfactory AP demonstration of the odontoid process. You should undertake this procedure under medical supervision and be sure that the object used will not be swallowed or inhaled by the patient and will, preferably, not produce an artifact. If in doubt- check.if still in doubt, don't do them!įorcibly opening an unconscious patient's mouth to perform a peg view is also hazardous. If in doubt, the medical officer requesting the flexion and extension views should be asked to perform the positioning. Flexion and extension views of the cervical spine in trauma patients should only be done under the express (written) request of a medical officer (preferably a consultant neurosurgeon). The most hazardous radiographic practice in a trauma setting is spinal flexion and extension views. It is very easy to fall into the trap of 'goal displacement' wherein producing diagnostic images displaces the goal of patient safety. Immobilisation of the patient's head and neck is more important than achieving the correct position for imaging. A healthy level of paranoia is a good thing. Trauma cervical spine imaging is potentially dangerous to the patient with an unstable cervical spine fracture. Cone to Include the Anatomy of Interest Image 1ĥ. This image has multiple positioning errors.Ĥ.

Cervical spine ap x ray