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Thorax and Abdomen

Soft Tissue Neck

Anatomy

Students should be able to identify the following structures on radiographic images:

pharynx, nasopharynx, orophaynx, laryngopharyns, larnyx, epiglottis, trachea, hyoid bone

Routine Projections (ARRT Required)

AP Upper Airway

CR Location & Positioning

  • SID: 72 inches (to minimize magnification)
  • Patient position: Upright preferred, facing the tube, MSP perpendicular to IR
  • Adjustments: Arms at sides; shoulders depressed; chin elevated slightly
  • CR: Perpendicular to IR at level of C4 (midway between laryngeal prominence and jugular notch); top of IR at EAM
  • Pt. Instructions: Take a deep breath in and hold it (full inspiration fills airway with air)
  • Exposure: On full inspiration

Evaluation Criteria

  • Coverage (what anatomy must be included and how you verify it’s complete): Air-filled trachea and larynx from nasopharynx through proximal trachea included
  • Rotation checks (how symmetry or alignment tells you if positioning is correct): Sternoclavicular joints equidistant from spine (no rotation)
  • Motion checks (how sharpness confirms patient cooperation/exposure timing): Sharp soft tissue and bony margins (no swallowing motion)
  • Technique checks (what contrast, density, soft tissue visibility, and artifacts to look for): Air column visible through larynx and trachea without over-penetration of cervical spine
  • Clinical aim (what contrast, density, soft tissue visibility, and artifacts to look for): Demonstrate airway patency and identify narrowing, obstruction, or foreign body

Lateral Upper Airway

CR Location & Positioning

  • SID: 72 inches
  • Patient position: Upright preferred, left lateral position, MCP perpendicular to IR
  • Adjustments: Shoulders depressed and pulled back; chin elevated slightly to avoid mandible superimposition
  • CR: Perpendicular to IR at level of C4; top of IR at EAM
  • Pt. Instructions: Quiet inspiration or slow, gentle breathing (especially if epiglottitis suspected)
  • Exposure: During inspiration

Evaluation Criteria

  • Coverage: Air-filled upper airway from nasopharynx through proximal trachea
  • Rotation checks: Cervical vertebrae in true lateral alignment
  • Motion checks: Clear, sharp soft tissue outlines without blur
  • Technique checks: Mandible and hyoid bone not obscuring airway; tracheal air column visible
  • Clinical aim: Demonstrate the epiglottis, larynx, and upper trachea for airway pathology evaluation

Supplemental Projections

Cross-Table Lateral (Trauma or Critical Airway Assessment)

CR Location & Positioning

  • SID: 72 inches
  • Patient position: Supine or seated if unable to stand; IR placed vertically beside neck
  • Adjustments: Do not move neck if trauma suspected; align CR perpendicular to IR at C4
  • Pt. Instructions: Quiet breathing if possible; do not disturb patient airway
  • Exposure: On inspiration

Evaluation Criteria

  • Coverage: Nasopharynx through proximal trachea
  • Rotation checks: Posterior cervical spine superimposed
  • Motion checks: Air column margins distinct; no swallowing or breathing blur
  • Clinical aim: Assess airway patency and epiglottic contour without repositioning unstable patients

 

Hows & Whys of Soft Tissue Neck Radiography

Anatomy

  • How does the air column assist visualization of soft tissue structures?
    The air naturally provides negative contrast, outlining the pharynx, larynx, and trachea against soft tissue.
  • How do the larynx and trachea differ anatomically?
    The larynx houses the vocal cords and epiglottis (C3–C6); the trachea begins inferiorly at C6 and extends to the bronchi at T5.
  • How does the hyoid bone function in airway imaging?
    It acts as a landmark at the level of C3–C4 and should not obscure the laryngeal airway if properly positioned.

Positioning

  • Why are upright positions preferred for soft tissue neck studies?
    Upright positioning prevents airway collapse, reduces aspiration risk, and improves visualization of the air column.
  • Why is the lateral projection essential for suspected epiglottitis?
    The lateral view best demonstrates the swollen epiglottis (“thumb sign”), allowing immediate diagnosis.
  • Why elevate the chin slightly on both projections?
    To prevent superimposition of the mandible over the upper airway.
  • Why should breathing be quiet or gentle during lateral imaging?
    Strained breathing can distort airway size and appearance.
  • Why is full inspiration required for AP projection?
    It expands the tracheal air column, improving visualization of the larynx and subglottic region.

Technique & Image Evaluation

  • How do you confirm no rotation on the AP?
    Sternoclavicular joints are equidistant from the spine; clavicles symmetrical.
  • How do you check for motion?
    Soft tissue outlines (pharynx, trachea) remain distinct, with no blur from swallowing or respiration.
  • How do you know exposure factors are correct?
    Airway structures visible without overexposure; cervical vertebrae visible but not dominant.
  • How do you adjust exposure for radiolucent foreign bodies?
    Slightly increase mAs to enhance soft tissue contrast and visualize airway shape changes.

Clinical Applications

  • Why must technologists exercise caution with suspected epiglottitis?
    Epiglottitis can progress rapidly to complete obstruction; patient should remain upright and not be distressed.
  • Why are both AP and lateral projections required for foreign body localization?
    Two orthogonal views allow triangulation of the object’s position within the airway.
  • Why should technologists avoid supine positioning for airway obstruction?
    Supine posture can worsen obstruction by allowing the tongue or epiglottis to fall backward.
  • Why are soft tissue neck exams critical in pediatrics?
    Children are more susceptible to airway narrowing from inflammation or swelling due to smaller airway diameters.

 

License

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Radiographic Procedures Review Guide Copyright © 2025 by Carla M. Allen and Taylor M. Otto is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, except where otherwise noted.