Demostrating the cervicothoracic junction : a comparison of two radiographic X-RAY techniques

Abstract

The most important projection of a patient with suspected cervical spine trauma is the lateral projection demonstrating C7 as well as T1. It frequently happens that the first and sometimes the second set of images do not demonstrate the cervicothoracic junction C7- T1. Literature underlines this statement through reports by Daffner (Daffner, 2000: Online) where the swimmer's projection needed to be repeated in 41% of their sample. In addition, 34% of the patients required a third radiograph. In this investigation, the swimmer's projection C7- T1 was compared to an alternative method to demonstrate C7-T1 as described in literature. The objectives were to ascertain which technique would yield the better identification of pathology, better image quality and less repeat films. A sample of 45 patients was examined at a tertiary level hospital. Two exposures were done on each member of the sample : the first was the swimmer's projection and the second with the patient reversing the orientation of their arms. The images were evaluated by three radiologists using a standardised checklist. The results revealed that the alternative swimmer's projection has comparable image quality where the p-value of spatial resolution equalled 0.7120 indicating that the overall impression of the two films was equal. The weighted Kappa for repeat rate amongst the three radiologists lies between -1 and 0.5 indicating poor agreement. The results for pathology were inconclusive. The results validate the use of the adapted swimmer's projection as an alternative that could decrease radiation exposure by limiting repeat projections.