REDUCING DISTORTION in SCOLIOSIS X-RAYS

Trying to produce a lateral projection on a patient who has scoliosis results in varying degrees of lateral flexion distortion.  For a mild scoliosis, this distortion can be significantly reduced by placing the patient’s convex side nearest the film.  If you fail to set your patient up with the convex side nearest the film, your lateral will show a great deal of lateral flexion distortion that seriously obscures accurate visualization of the disc spaces. 

Many times you will know that the patient has a scoliosis via your examination findings.  If that is the case, you can remember that fact when you take your x-rays, or you can tell your x-ray technician which lateral to take.  Naturally, for a double curve, a lateral thoracic may have to be taken with the patient facing one way, and the lateral lumbar may have to be taken with the patient facing the other way.  The difference that taking the correct lateral can make in reducing distortion is so significant that it is worth a retake in those circumstances where you did not know in advance that the patient had a scoliosis.

Placing the convex side of the curve nearest the film will solve the lateral flexion distortion for curves up to roughly 15°.  For curves greater than that, you still need to place the patient’s convex side nearest the film, but you may also need to follow-up with custom-tilt projections for those levels that are not well visualized.  You determine the degree of tube tilt by observing the AP view.