Cervical Spine X-Ray: Adapting for Patient Comfort

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Before we begin the cervical spine examination, we must first assess this patient's shoulder pain, as it could limit her ability to rotate or position her neck and shoulders comfortably during imaging. We also need to consider whether the patient's hijab might affect image quality, so we should ask if she is wearing any clips, pins, or magnets that could appear as artefacts on the diagnostic image. A standard lateral cervical spine view requires the patient to depress both shoulders downward to visualise the C7 to T1 junction, but this movement may be too painful for our patient to perform safely. An alternative is the swimmer's view, where the patient extends one arm overhead while the other stays down. However, this projection delivers a higher radiation dose and may not adequately demonstrate the C7 to T1 junction. For the oblique projections, if rotating the head is too painful, we can use a supine AP oblique position, where the patient lies flat on their back and the X-ray tube is angled toward the neck to mimic the oblique view. If the patient is still unable to safely perform any of these projections, we should consult a radiologist and consider alternative imaging modalities such as CT or MRI to ensure an accurate and safe diagnosis.