Swimmer's View Lateral Cervical Spine Radiograph

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Routine swimmer's view (left images) shows slight anterolisthesis of C7 on T1, in a trauma patient who sustained neck injury but normal CT scan. A repeat swimmer's view focusing at the lower cervical spine was performed and show normal alignment.

Swimmer's View Lateral Cervical Radiograph

• Usually required to visualize C7-T1 junction. In one study, only 20% of cases receiving five-view cervical radiography (AP, lateral, bilateral obliques and odontoid) C7-T1 can be adequately seen.
• Downsides of this view are: high dose, high scatter, difficult positioning, usually not adequate on large patients or patients with shoulder injuries
• To visualize C7-T1 junction, one should avoid arm pulling in patients who sustained a cervical spine injury

Current Practice

• Now, most places replace cervical spine radiography with CT scan because of higher sensitivity for fracture, shorter scan time, and probably less costly (if combined the use of overall resources)
• Some institutions still perform an out-of-collar lateral radiograph after a negative CT scan to ensure no significant change in alignment that may occur in patients with isolated ligamentous injury not shown on CT. This exam usually includes lateral and swimmer's radiographs.

This case show a subtle malalignment seen on routine C7-T1 junction on a routine swimmer's view. This was cleared by repeating the study with a focus at lower cervical spine. Abnormality on the first image is believed to be due to different centering of x-ray beam and superimposition of structures.

Reference:

1. Daffner RH. Cervical radiography for trauma patients a time-effective technique? AJR 2000;175:1309-1311.

2. www.Wikiradiography.com