ABSTRACT
The objectives of this study were to investigate current practices in
radiographic imaging of the cervical spine in conscious adult patients with suspected
neck injury and to discover reasons behind variations. Jenkins, Curran and Rocke
(1999) undertook a similar survey, and comparison with their findings has formed a
key part of this study.
Questionnaires were sent to superintendent radiographers in charge of
Accident and Emergency X-ray departments in English Trusts with more than 8,500
emergency admissions per year. A response rate of 97% (n= 181/186) was achieved.
82% of respondents have departmental protocols for cervical spine imaging.
No departments use fewer than the three standard projections for clearing the
cervical spine. If the initial three projections do not adequately demonstrate the
cervicothoracic junction (C7/T1), 3% use CT alone, 87% use swimmers projections,
9% supine oblique views, 2% collimated true laterals. Following projectional
radiography, 97% perform CT if sufficient clinical doubts persist after these methods.
There has been a significant (p=0.018) increase since 1999 in CT use once the
swimmers projection fails; fewer hospitals now use obliques at this point, going
straight to CT instead. No significant difference (p=0.644) was found from 1999 to
2009 in choice of first supplementary radiographs; despite recommendation in the
British Trauma Society Guidelines to undertake supine oblique projections,
swimmers remain the most common supplementary radiographs.
In order to explore the reasons behind the various practices, a second
questionnaire was issued to those consenting in the first survey. An 85% response
rate (n= 103/121) was achieved. Correlations were found, in swimmers and oblique
techniques, between the perceived levels of confidence of both referring doctors and
reporting officers (i.e. reporting radiographers and / or radiologists) in interpretation
of the images. Some practitioners undertaking swimmers projections acknowledged
that their technique did not offer the lowest dose that is reasonably achievable.
Several reported a perceived difficulty in interpreting oblique radiographs.
Numerous issues affect the acquisition of cervical spine radiographs. Patient
radiation dose should be a major consideration in selection of technique. This study
highlights a potential need for training in interpretation of obliques. Specific
guidelines for optimum projections should be researched, and protocols issued to
ensure best practice.