How do you optimize open cervical foramina on the oblique views?

• A. Use extreme lateral tilt.
• B. Rotate 15 degrees; place side of interest away from IR.
• C. Rotate about 45 degrees; ensure the side of interest is closest to the IR; align the patient so foramina are not occluded.
• D. Use a straight AP view with no rotation.

Answer: (C)

When imaging the cervical spine obliquely, open foramina are achieved by positioning that separates the foraminal openings from overlying structures while keeping the side of interest closest to the image receptor. Rotating about 45 degrees from the AP position accomplishes this balance: it uncovers the foramina by reducing overlap from the pedicles and vertebral bodies, and placing the side of interest nearest the IR minimizes magnification and superimposition, so the foraminal opening sits in profile and is not obscured.

Extreme lateral tilt distorts the anatomy and does not reliably open the foramina. A straight AP view won’t reveal the foramina in their true profile on oblique imaging, hence it’s not suitable for this purpose.