Int J Emerg Med (2010) 3:85–90 DOI 10.1007/s12245-010-0159-y ORIGINAL RESEARCH ARTICLE Value of the swimming position and arm traction in visualizing the cervicothoracic junction over the standard lateral cervical X-ray Aydin Toksoy & Firat Bektas & Cenker Eken & Kaan Ceken & Yildiray Cete Received: 13 May 2009 / Accepted: 11 January 2010 / Published online: 23 March 2010 # Springer-Verlag London Ltd 2010 Abstract Background The cervicothoracic junction (CTJ) is often inadequately visualized on lateral cervical X-rays due to anatomic variations and technical factors. Aims 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. Methods The study was conducted in a university hospital in October 2007 with 40 volunteers. 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. The enhancements in the image fields were analyzed. Results There was a statistically significant difference for the increases in the view of cervical spines between SLC X-ray (12.60± 7.48) and either lateral cervical X-ray with arm traction (21.73±9.78; p=0.000) or in the swimming position (21.20± 14.19; p=0.001). Both arm traction and swimming position increased the field of view by approximately 9 mm. Increased visualization of the cervical spine occurred for 24 The views expressed in this paper are those of the author(s) and not those of the editors, editorial board or publisher. A. Toksoy : F. Bektas : C. Eken (*) : Y. Cete Department of Emergency Medicine, Akdeniz University Medical Faculty, 07059 Antalya, Turkey e-mail: cenkereken@akdeniz.edu.tr F. Bektas e-mail: fbektas@akdeniz.edu.tr Y. Cete e-mail: ycete@akdeniz.edu.tr K. Ceken Department of Radiology, Akdeniz University Medical Faculty, 07059 Antalya, Turkey of the 40 participants using the arm traction view (60.0%) and 23 participants (57.5%) using the swimming position view—results found to be statistically similar according to the≥1/3 caudal vertebral height visualized (p=0.902). Using the lateral cervical X-ray view, the number of cervical vertebrae visualized differed according to body mass index (BMI)—seven cervical vertebrae were visualized in partic- ipants with a BMI <25 and six vertebrae were visualized in participants with a BMI ≥25 (p =0.007). Conclusion Lateral cervical X-rays with arm traction and swimming position enhance the view of SLC X-rays. An initial SLC X-ray including the lower third of the cervical spine (with C7), arm traction, and swimming position may be beneficial in visualizing the CTJ. However, patients with an increased BMI are unlikely to benefit from all three methods. Keywords Lateral cervical X-ray . Arm traction . Swimming position . Body mass index . Trauma Introduction For patients presenting with multiple trauma to the emergency department (ED), advanced trauma life support (ATLS) guidelines recommend that lateral and anteroposterior cervical X-rays should demonstrate a complete visualization of: (1) all cervical vertebrae, (2) the cervicothoracic junction (CTJ), and (3) the first thoracic vertebra [1]. The misdiagnosis of cervical spine injury may have terrible consequences, particularly in the cervicothoracic region, where 9–18% of cervical spine injuries are seen [2–4]. However, the CTJ is often inadequately visualized on lateral cervical X-rays due to anatomic variations and technical factors. Body mass index (BMI) and the length of