Last Updated on February 18, 2025
The swimmer’s view is a lateral X-ray of the cervicothoracic junction that helps demonstrate the upper thoracic and seventh cervical vertebrae (C7/T1 junction). It is an important view for evaluating the relationship between the cervicothoracic junction and upper thoracic vertebrae C7 through T3.
The swimmer’s view X-ray is difficult. Its positioning is difficult and requires high dosing. In the case of trauma patients, this X-ray becomes even more difficult due to issue of positioning.
As technology advances, better imaging is available with CT and therefore swimmer’s view is not frequently done nowadays.
Method of Swimmer’s View Xray
This view is quite demanding technically. Every technician may apply different techniques or ways to achieve the results. But still, the results may be very difficult to replicate .
This x-ray aims to clear the superimposing humeral heads off the cervical spine by positioning arms similar to a swimmer’s advance in water.
As highlighted before, the Swimmer’s view is done less commonly now but could be critical in centers where superior modalities like CT scans is not available for one reason or another.
Following techniques are commonly used to clear the humeral head out of cervicothoracic junction visualization. These techniques do this differently and are most commonly used for this x-ray.
Both Arms Up Method
The patient lies supine and arms are brought forward either by crossing in front of them or on to a bar attached to bucky.
One Arm Up, One Down
In this technique, one arm is raised up like the previous technique, and the other is pulled down.
A sponge under one shoulder can help to separate the humeral heads.
In both the above methods, the patient lies supine on her back, and the beam is directed horizontally.
Supine Lateral
The patient lies on the side and the arms are rolled up and posteriorly. The technique also allows visualization of the thoracic spine as well. The x-ray beam is directed vertically.
How to Assess the Adequacy of Swimmer View X-ray
For the swimmer’s x-ray to be adequate, it should meet the following
- C7 to T1 junction should be visible
- C7- T1 vertebral body should be clearly visible
- Soft tissue anterior to C7 & T1 vertebral bodies.
As noted before, a swimmer’s view X-ray is a difficult X-ray for both the radiographers and the patient because of patient positioning. Many patients do not have enough flexibility in the shoulders to bring the arms in desired positions. In the case of trauma patients, pulling or adjusting the arms may not be desirable for fear of worsening the cervical spine injury.
Older patients may not have enough flexibility to position and wait for exposure.
Therefore Swimmer’s x-ray is not adequate in many cases. One study showed that 45% of the Swimmer’s view radiographs were inadequate.
A CT or MRI evaluation of the cervical spine are convenient and more accurate in the depiction of cervical spine anatomy in trauma patients. These investigations are more sensitive and specific. MRI is able to detect ligamentous injuries and cord injuries much better than that done by CT scan.
Thus, a CT or MRI is a better tool for examining these critical areas and should be employed if available, especially in critical settings.
References
- Rethnam U, Yesupalan RS, Bastawrous SS. The Swimmer’s view: does it really show what it is supposed to show? A retrospective study. BMC Med Imaging. 2008 Jan 15;8:2. doi: 10.1186/1471-2342-8-2. [Pubmed Link]
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Toksoy A, Bektas F, Eken C, Ceken K, Cete Y. Value of the swimming position and arm traction in visualizing the cervicothoracic junction over the standard lateral cervical X-ray. Int J Emerg Med. 2010 Mar 23;3(2):85-90. [doi]
Image Credit: Images were taken from Wikifoundary via Wikiradiography
