This projection is technically demanding and very hard to replicate consistently. The concept of this projection is to clear the superimposing humeral heads of the cervical spine, the offset of the arms attempts to achieve this. the articular pillars and zygapophyseal joints are superimposed.the vertebral bodies are superimposed laterally.there should be a clear visualization of C7 to T1.
anterior to the extent of the vertebral bodies.2.5 cm above the jugular notch at the level of T1.the opposite arm is placed by the patient's side, as posterior to the patient as possible (maintaining spinal precautions if they are in place).the arm closest to the detector is placed above the patient's head, resting on the head for support.the detector is placed running parallel to the long axis of the cervical spine.the patient is supine or erect, depending on trauma or follow up.It can help to visualize subluxation and fractures involving the inferior cervical spine, superior thoracic spine and adjacent soft tissue. This view is most often performed when a standard lateral view cannot image the cervicothoracic junction due to patients having a dense, muscular shoulder.