Norm of Radiography of Skull, Chest and Cervical Spine
Negative for fracture or dislocation.
Usage of Radiography of Skull, Chest and Cervical Spine
Trauma and determination of location and extent of suspected skull fracture or cervical spine damage.
Description of Radiography of Skull, Chest and Cervical Spine
This procedure involves radiographic examination of the skull, chest, and cervical spine to detect skull and spinal injuries resulting from accidents or physically induced. Fractures of the skull are classified by location and type. Types of skull fractures may be penetrating, depressed, bending, linear, or diastatic (involving the skull suture area or areas). The orbits are examined for the presence of free air, which indicates a fractured sinus area. Radiography of the chest and cervical spine identifies the seven cervical spine segments as well as the C7-T1 area and relationship. Definite indications for cervical spine radiographs include neck pain or a tender cervical area. Other indications may include decreased level of consciousness, paresthesias, decreased sensation, weakness, muscle spasm near the cervical area, or decreased anal tone.
Professional Considerations of Radiography of Skull, Chest and Cervical Spine
Consent form NOT required.
During pregnancy, risks of cumulative radiation exposure to the fetus from this and other previous or future imaging studies must be weighed against the benefits of the procedure. Although formal limits for client exposure are relative to this risk:benefit comparison, the United States Nuclear Regulatory Commission requires that the cumulative dose equivalent to an embryo/ fetus from occupational exposure not exceed 0.5 rem (5 mSv). Radiation dosage to the fetus is proportional to the distance of the anatomy studied from the abdomen and decreases as pregnancy progresses. For pregnant clients, consult the radiologist/ radiology department to obtain estimated fetal radiation exposure from this procedure.
- Move the client only the minimal amount necessary to obtain the different radiographic views.
- Maintain strict body alignment throughout transport and transfer of the client. If uncooperative or combative, the client may need to be intubated, paralyzed, and mechanically ventilated to maintain alignment.
- Skull radiography: Conventional plain-film radiography of the skull is performed, including the following views: posteroanterior, anteroposterior in Towne's projection, two lateral views, posteroanterior Waters', and lateral views designed to highlight the facial area.
- Chest and cervical spine radiography: Conventional plain-film radiography of the cervical spine is performed, including the following views: anteroposterior, lateral, both obliques, and one that shows the odontoid process. Risks versus benefits must be considered before flexion and extension views are taken.
- Maintain strict body alignment until radiograph results are known.
- Perform post sedation or paralytic monitoring per institutional protocol if either was used.
Client and Family Teaching
- Results are normally available within 24 hours or immediately in case of emergency.
- Body alignment should be maintained until results are known.
Factors That Affect Results
- Linear skull fractures may not be detected if their location is not on the side of the skull closest to the film. They must be distinguished from vascular grooves of the skull.
- Skull suture area (diastatic) fractures are difficult to detect without a great deal of experience in radiographic interpretation.
- Skull radiograph interpretation should take into consideration clinical findings from scalp and soft-tissue examination.
- Nuclear medicine studies can help pinpoint fractures near the base of the skull that are not demonstrable by conventional radiography.
- Computed tomography of the spine may be needed to detect spinal fractures not demonstrable by conventional radiography.
- Because as many as half of spinal injuries occur below the cervical area, radiographs of the lower spine should also be taken.