Cervical spine trauma imaging: is an additional swimmers projection of the cervico-thoracic junction justified?

NICE Head and Cervical Spine Guidelines (2007) advocate three-view Plain Radiography over CT for the initial assessment of cervical spine trauma. However, they provide no indication of what protocol should be utilised when the cervico-thoracic junction is not visualised by the first attempt. This study aimed to evaluate current practice. A retrospective audit of trauma patients was performed over a two month period (N=107). The results demonstrated that whilst all patients received the standard AP, AP open mouth and lateral projections, 74% of cases failed to demonstrate the cervico-thoracic junction. 67% of this population received an additional Swimmers View with a 74% success rate. The research findings highlight the practical limitations of the plain radiography technique. Whilst further training could perhaps reduce the non-visualisation rate of the cervico-thoracic junction, radiographers could in most cases predict the need for the additional swimmers projection and likelihood of success as part of the justification process. Whilst acknowledging the increase in thyroid dose by utilising CT, direct referral is perhaps justified in these cases, particularly if the patient presents with the clinical symptoms of cervical spine trauma.