Though it must be emphasized that these features have yet to be validated, a patient involved in a simple rear-end motor vehicle collision who later presents with the complaint of neck pain may not require radiographic evaluation. In addition, radiographic evaluation is recommended for any patient where active neck rotation cannot be completed by the patient in the defined manner. Plain film imaging is also recommended in the setting where examination of the neck is unreliable, such as with distracting painful injuries elsewhere, altered level of consciousness, or evidence of facial or external head injury. Radiography is recommended when high-risk factors are present, such as age greater than 65 years, a defined dangerous mechanism (see the Table), or any report of a sensory abnormality or focal neurologic deficit in the extremities.

Then, when an evaluation occurs in a broad range of settings given the identified low-risk factors, it is postulated that the ability to rotate the neck may reliably predict all individuals who do not require radiography. The next step in the process of validation will be to ensure that these low-risk criteria can also be applied in the settings of community hospitals and primary clinics. Investigators in the CCC study are currently completing a multicentre investigation in Canadian urban teaching hospitals whereby a set of low-risk factors can predict the selection of patients who can then be allowed a supervised assessment of range of motion. The CCC (Canadian C-Spine) study under the direction of Ian Stiell at the University of Ottawa is in the advanced stages of validation in Canada, with a current enrollment of 14 000 patients. The NEXUS study, a decision rule cervical spine radiograph study, has received wide interest in the United States. Initiatives are under way in Canada and the United States to help identify the groups of patients with blunt trauma (whiplash associated disorders, WAD I and less commonly WAD II see the Table in the article 'Incidence of whiplash-associated disorder'В for a definition) where the history and physical examination can clearly exclude significant pathology.Дecision rules regarding the need for radiographs are being validated that will allow selective ordering of imaging studies. Simply stated, radiography is indicated if the possibility of a fracture exists. It is recognized that patients sustaining a cervical injury (whiplash) from a rear-end motor vehicle collision may be seen in a variety of settings including emergency departments, family doctorsвЂ™ offices, and clinics. Some authorities still recommend the routine inclusion of plain film radiography for any case where trauma to the neck occurs and the clinical finding of midline posterior neck tenderness is present. Avoiding radiographs for those patients where the results are predicted to be normal translates to significant savings to our medical system and a reduction in the exposure of patients to ionizing radiation. An estimated 200 000 radiographs of the cervical spine are carried out annually in Canada on patients who have been injured through blunt or secondary trauma to the neck.

The indiscriminate use of radiographs has been primarily driven by the ever-present concern of cervical spine stability.

Cervical spine x ray