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J R Soc Med. 1993 March; 86(3): 141–143.
PMCID: PMC1293902

The adequacy of cervical spine radiographs in the accident and emergency department.


One hundred and twenty radiographs of the cervical spine were performed at the request of the Accident and Emergency (A & E) department over a 6 week period. These consecutive films were reviewed for adequacy of anatomical demonstration of the complete cervical spine. The initial series of three films presented to the A& E staff achieved this objective in only 55% of cases overall, although further radiographic examinations requested before the patient left the department raised this figure to 75% for the lateral view and to 70% for the combined anteroposterior (AP) views. From the data it can be predicted that if every patient whose first 3 films were inadequate had received further investigation, the cervical spine would have been well visualized on approximately 90% of radiographs in each plane. The availability of radiologists for advice and their involvement with senior A & E staff in teaching are important factors in improving this situation.

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Selected References

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  • Annis JA, Finlay DB, Allen MJ, Barnes MR. A review of cervical-spine radiographs in casualty patients. Br J Radiol. 1987 Nov;60(719):1059–1061. [PubMed]
  • Bryan AS. A review of cervical spine X-rays from a casualty department. J R Coll Surg Edinb. 1988 Jun;33(3):143–145. [PubMed]
  • Bachulis BL, Long WB, Hynes GD, Johnson MC. Clinical indications for cervical spine radiographs in the traumatized patient. Am J Surg. 1987 May;153(5):473–478. [PubMed]
  • Pathria MN, Petersilge CA. Spinal trauma. Radiol Clin North Am. 1991 Jul;29(4):847–865. [PubMed]
  • Streitwieser DR, Knopp R, Wales LR, Williams JL, Tonnemacher K. Accuracy of standard radiographic views in detecting cervical spine fractures. Ann Emerg Med. 1983 Sep;12(9):538–542. [PubMed]
  • Borock EC, Gabram SG, Jacobs LM, Murphy MA. A prospective analysis of a two-year experience using computed tomography as an adjunct for cervical spine clearance. J Trauma. 1991 Jul;31(7):1001–1006. [PubMed]

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