Lateral C-Spine Tips

How can I see the entire lateral c-spine on my x-rays?!?

That seems to be the million-dollar question.  Obviously from a physical standpoint, the shoulders are 4-5x thicker than the neck, and you are using the same amount of x-ray to image both in that shot.  So, there are a couple of techniques/methods you can try to resolve this, but nothing is perfect.  

  1. Increase your kVp by 10 and/or double your mAs.  The image you attached shows very limited penetration through the shoulders, so increasing your x-ray will help solve this.  But the more you go up, the more you will burn out the upper c-spine, so you’ll need to find a balance with not over penetrating the upper c-spine but yet still penetrating enough to see the lower.  From what I see in your image, I would start with increasing kVp by 10.  and then maybe doubling the mAs on top of that if you still need to see more.  You could also just use the lateral T-spine technique programmed into your machine (if you have that).  That should adjust things accordingly
  2. Physically changing the amount of material the -rays pass through by using a wedge filter.  A lot of chiropractors we work with use a wedge filter that attaches to the head of the x-ray machine.  They aren’t cheap, but it’s a one-time purchase and they provide good results by physically just putting more material for the x-rays to pass through in the upper c-spine so that it balances out those shoulders better.
  3. Changing your windowing back and forth while you are marking the vertebrae.  By R clicking your mouse, you can adjust the contrast on the image, and you can make it bright for the upper c-spine when you are drawing those and then really dark so you can see through the shoulders while you are drawing those.