DO SUPINE OBLIQUE VIEWS PROVIDE BETTER IMAGING OF THE CERVICOTHORACICJUNCTION THAN SWIMMERS VIEWS

Objective - To determine whether a swimmer's view or supine (trauma) o blique views are more likely to visualise the lower cervical spine whe n a lateral view fails to show the cervicothoracic junction. Design - A prospective study comparing two 20 week periods, In the first phase the swimmer's view was performed as an additional view when the cervic othoracic junction was not demonstrated. In the second phase paired su pine oblique views replaced the swimmer's view. Results - 230 patients were included in the first phase, of whom 60 required swimmer's views . In the second phase 62 of 197 patients required supine oblique views . Radiology analysis of 53 pairs of supine oblique views showed that t he vertebral bodies were adequately demonstrated at the cervicothoraci c junction in only 20 patients (38%) compared with 22 in the swimmer's group (37%). The facet joints and posterior elements were, however, c learly seen in 37 (70%) of the supine oblique patients compared with 2 2 (37%) of the swimmer's group (p < 0.001, chi(2) test). Exposure dose calculations showed a substantial reduction for a pair of supine obli que views (1.6 mGy) over a single swimmer's view (7.2 mGy). Conclusion s - In injured patients for whom the standard three view series fails to demonstrate the cervicothoracic junction, swimmer's views and supin e oblique views show the alignment of the vertebral bodies with equal frequency. However, supine oblique films are safer, expose patients to less radiation, and are more often successful in demonstrating the po sterior elements.