Lateral lumbar spine x-ray

Structures and Goals shown The lumbar spine in its simplest form.

Patient’s current condition for comfort, lie on your left or right side (lateral recumbent), flexing your knees and hips. The arms are at a straight angle to the body and the elbows are flexed. The knees are positioned on top of one another. The grid’s midline runs through the midcoronal plane. Instead, lumbar spine supine with horizontal beam should be employed in patients with suspected fractures.

Part’s location The gonads have been protected. During the exposure, the patient should be asked to breathe in, breathe out, and then hold their breath. The illustration shows the lumbar vertebral bodies, intervertebral disc spaces, spinous processes, and lumbosac joints in the lower thoracic to coccyx area.

Center Ray:

A central ray that runs perpendicular to the spine’s long axis.

  • Larger IR (30 x 35cm): From the iliac crest to the center (L4 – L5). The lumbar vertebrae, sacrum, and potentially the coccyx are all involved in this position.
  • The image receptor in the center corresponds to the central ray.
  • Center to L3 at the level of the lower costal edge on a smaller film (30 × 35 cm). (Approximately 1.5 inches above the iliac crest.) The five lumbar vertebrae are in this position. IR should be centered on the CR.
  • SID measures 40 inches (100 cm) in length.


On the lateral edges, collimate closely. (Due to the patient’s proximity to the x-ray tube and the divergence of the x-ray beam, the light field seems small.)

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When you exhale, you should stop breathing.

Technical considerations

Lateral projection

Expiration (to minimize superimposition of the diaphragm over the upper lumbar spine)

Centering point

  • The iliac crest’s height
  • The lumbar vertebra, which corresponds to the posterior portion of the abdomen, is exactly over the coronal centering point.
  • The image receptor is perpendicular to the center ray.


  • Superiorly to include the T12/L1
  • Inferior to include the sacrum
  • Anterior to include the anterior border of the lumbar vertebral bodies
  • Posterior to include all elements of the posterior column, particularly the spinous processes



Detector size

35 cm x 43 cm



70-80 kVp

60-80 mAs


110 cm


Yes (ensure the correct grid is selected if using focused grids)

Note: Even with support, a patient with a larger pelvis and a narrow thorax may require a 5° to 8° caudad angle. If the patient has a lateral curvature (scoliosis) of the spine (as determined by viewing the spine from the back with the patient in an erect position and the hospital gown open), the patient should be placed in whichever lateral position lowers the “sag” or convexity of the spine, allowing the intervertebral spaces to open more fully.

Technical analysis of the image

  • The greater sciatic notches, the superior articulating facets, and the superior and inferior endplates should be evident from T12/L1 to L5/S1
  • Superimposition of the greater sciatic notches, the superior articulating facets, and the superior and inferior endplates. This means you’ve gotten a true lateral.
  • Clear imaging of the lumbar vertebral bodies, with both trabecular and cortical images, demonstrates acceptable image penetration and contrast.

Points to Consider

    • When evaluating this imaging for pathology, the three-column notion of thoracolumbar spinal fractures is especially important.
    • When performing horizontal beam laterals, use an erect bucky to use oscillating grids, automatic exposure control, and CR/IR alignment.
    • If the patient has spinal scoliosis, make sure the convexity side is closest to the IR.
    • To lessen spine convexity, place a small radiolucent triangle sponge under the side in touch with the table at waist height. This will utilize the diverging beam and aid in attaining superimposition of the upper and lower endplates for specific patients.
    • A spot scan may be required to provide a sharper view of the L4/L5/S1 articulation.
    • When conducting horizontal beam method in a trauma setting, aim to eliminate as many picture artefacts as possible (i.e. ECG leads, urine catheters).
    • A breathing technique is a radiographic technique used in some departments if imaging equipment allows.

  • When using a CR system, a smaller cassette (30×35) might be used if the sacral area is not to be exhibited. Place the height of the CR 2.5cm above the iliac crests when centering.


Mayo Clinic

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Lateral lumbar spine x-ray