Radiology Instructions for X-ray Based CCI Imaging

Dear radiology tech,

This patient may have craniocervical instability and needs a specific set of images. These are broken into two types:

  • Flexion-extension radiographs at the maximum range of motion
  • Open mouth lateral bending views with a maximal ear-to-shoulder range

Instructing the patient to look down slightly and look up slightly or to slightly bend their head sideways will result in you being asked to repeat these images as the maximum range of motion is required for a valid study.


Have the patient bring chin to chest maximally and take an image, making sure that C1 and C2 are clearly visible as well as the T1 vertebrae on the inferior image border. Next, have the patient look upwards and back making sure that maximum extension range is attained. Again, C1-T1 should be easily visible.

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Open Mouth Lateral Bending

The goal here is to keep C1-C2 visible at all times with an emphasis on the corners of the C1-C2 facet joint. In particular, the C1-C2 corner on the side of the lateral bending should be the priority. Both left and right lateral bending views are obtained:

This is an example of an open-mouth view that doesn’t meet the criteria:

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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