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What additional projection is needed if T1 is not visible on the C-spine lateral?

  1. A lateral view of the thoracic spine

  2. A lateral projection of the cervicothoracic spine

  3. A reverse Townes view

  4. A supine lateral projection

The correct answer is: A lateral projection of the cervicothoracic spine

The visibility of T1 on the lateral C-spine projection can often be compromised due to the positioning of the shoulders or the lack of adequate radiographic technique. To enhance visualization of the cervicothoracic area, including T1, a lateral projection of the cervicothoracic spine is needed. This specialized projection is designed to capture the area just below the cervical spine, allowing for better imaging of T1 and surrounding structures by lowering the shoulders and aligning the anatomy of interest more effectively. This projection also strategically positions the patient's arms and shoulders to prevent superimposition over the cervical region, enhancing clarity and detail. Therefore, it serves as a more focused approach that targets the visibility of T1 specifically, rather than imaging other unrelated areas like the thoracic spine or applying different angles that may not directly improve the view of T1.