CT cervical spine (protocol)

Last revised by Joshua Yap on 10 Apr 2023

The CT cervical spine or C-spine protocol serves as an examination for the assessment of the cervical spine. It is usually performed as a non-contrast study. In certain situations, it might be combined or simultaneously acquired with a CT angiography of the cerebral arteries or a CT of the neck. It also forms a part of a polytrauma CT or might rarely be done as a CT myelogram in situations where MRI is contraindicated.

Note: This article aims to frame a general concept of a CT protocol for the assessment of the cervical spine. Protocol specifics will vary depending on CT scanner type, specific hardware and software, radiologist and perhaps referrer preference, patient factors e.g. implants, specific indications.

A typical CT of the cervical spine might look like as follows:

Typical indications include the following 1-4:

The most common purpose of a CT of the cervical spine is the timely diagnosis and classification or exclusion of cervical spine injuries and the evaluation of the osseous spinal canal including 1-3:

In the setting of vertebral metastasis or spinal tumors this also includes the assessment of the following: 

  • patient position

    • supine position 

    • both arms next to the body, shoulders pulled down

  • tube voltage

    • ≤120 kVp

  • tube current

    • as suggested by the automated current adjustment mode 

  • scout

    • from above the temporal bone to the manubrium sterni 

  • scan extent

    • should include the base of the skull and the first thoracic vertebra

  • scan direction

    • craniocaudal

  • scan geometry

    • field of view (FOV): 120-200 mm (should be adjusted to increase in-plane resolution)

    • slice thickness: ≤1 mm, interval: ≤0.75 mm

    • reconstruction algorithm: bone, soft tissue

  • multiplanar reconstructions/reformats

    • sagittal images: sagittal aligned through the center of the dens and the vertebral bodies

    • coronal images: coronal aligned to the transverse processes

    • axial images: perpendicular to the cervical spine and the neck

    • slice thickness: ≤1.5 mm, overlap 50%

ADVERTISEMENT: Supporters see fewer/no ads