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The swimmers technique is named after the swimming stroke referred to as freestyle, front crawl, or Australian Crawl.

The swimmers view is all about getting the humeral heads projected clear of the cervical spine anatomy. It is usually the humeral heads that obscure the cervico-thoracic junction. This technique involves moves both humeral heads anteriorly. This can be achieved by having the patient cross their arms in front of them or by holding onto a bar attached to the upright bucky. This technique is typically successful on patients who have flexibility in their shoulders. Having said that, it is difficult to be sure if this technique will be successful just by looking at a patient. The example above is a case in point- this is a swimmers view image on a broad shouldered man. Note that one of the humeral heads is overlying the spine. In some patients both humeral heads can be moved clear of the spine. This image was taken using film/screen technology. A breathing technique has been employed to blur lung markings. A round cone has been utilized to reduce scatter radiation.

This version of the swimmers technique achieves an unobscured lateral view of the cervico-thoracic junction by positioning one arm up and one arm down. In terms of demonstrating the anatomy, it doesn't matter which arm is raised and which is pulled down. Some radiographers try to raise the right arm (when the patient is in the left lateral position) to reduce the radiation dose to the patient's thyroid. A sponge under one shoulder can help to separate the humeral heads. One of the flaws of this technique is that you tend to laterally flex the patient. This causes a loss of visualisation of the joint spaces.

This technique is sometimes utilised when you have come tantalisingly close to demonstrating the anatomy of interest, but not quite met the criteria. The idea is that if you can just move the shoulders inferiorly a little more, you will achieve a clear view of the vertebra that is obscured by the humeral head(s). The case above successfully uses this technique. This may, in reality, be much the same as the first technique given that the shoulders tend to roll forwards when pulled down. Caution: It is not considered acceptable practise in many institutions to arm-pull in patients with cervical trauma. This is now the case in my institution. A "ski rope" technique can be used in which the patient pulls their own arms down.

This 47 year old patient presented to the Emergency Department in an ambulance after being involved in a MVA. The patient was experiencing neck pain and was referred for a trauma series which included cervical spine imaging. The lateral cervical spine image was achieved with passive lowering of the shoulders. The image did not adequately demonstrate the cervico-thoracic junction. There is artifact from the cervical immobolisation collar.

The radiographer noted that the patient's asthenic body habitus might be well suited to a 'both arms forward' lateral cervico-thoracic junction technique. The patient was asked to reach up with both hands and hold onto the wall bucky arm support shown in the photo below (arrowed) http://farm4.static.flickr.com/3595/3616473980_4d6a80401a.jpg Both humeral heads were projected clear of the cervical/thoracic vertebrae resulting in good demonstration of the cervico-thoracic region. Note that despite the use of DR imaging technology, there is overexposure of the cervical region resulting in partial over-saturation of the image. (bra hardware noted)

This 22 year old patient presented to the Emergency Department following a RTA/MVA. She was examined and referred for cervical spine radiography. The radiographer noticed that when the patient was asked to lower her shoulders the patient rolled her shoulders forward considerably. The ability of the patient to roll her shoulders forward was exploited to achieve demonstration of the upper thoracic vertebra. It is not unusual for patients, particularly younger female patients, to achieve this position.