86 Fig. 1 Position of the study participants and placement of X-ray source and film cartridge during SLC X-ray the neck and shoulders are the major anatomic factors leading to insufficient view of the CTJ [5, 6]. Traditionally, the swimmer’s view or arm traction is used in these cases [1]. Physicians also use the oblique view in clinical practice when the standard view is insufficient. Computed tomogra- phy (CT) and magnetic resonance imaging (MRI) are ultimately used in the cases in which X-rays have failed [7–9]. The aim of this study was to investigate whether the swimmer’s view and arm traction could enhance the image field on the standard lateral cervical (SLC) X-ray. Fig. 2 Position for the lateral cervical X-ray with traction of both arms Int J Emerg Med (2010) 3:85–90 Materials and methods Study design This study is a comparison of the SLC view with the arm traction view and swimming position view. The study was conducted in a university hospital in October 2007. The study population comprised volunteers from the ED staff, including physicians, nurses, and paramedics. Informed consent was taken from all volunteers. The local Ethics Committee approved this study. The exclusion criteria were pregnancy or suspicion of pregnancy, a history of cervical spinal trauma or operation, and refusing to give informed consent. Data collection Initially, demographics, body weight and height, length of the neck, and the distance between the two shoulders were recorded for each volunteer. Sternomental distance (SMD) was used in order to determine the length of the neck. The distance between two acromions—biacromial distance (BAD)—served as a measure of the distance between two shoulders. Processing SLC X-ray, lateral cervical X-ray in the swimming position, and lateral cervical X-ray with arm traction were performed in the supine position for each volunteer. The supine position was preferred because the typical trauma patients will usually undergo X-ray in the supine position instead of standing up.