By R clicking your mouse, you can adjust the contrast on the image, and you can make it bright for the upper c-spine when you are drawing those and then really dark so you can see through the shoulders while you are drawing those. Changing your windowing back and forth while you are marking the vertebrae.On lateral projections, the intervertebral disc spaces and intervertebral foramen as well as the superior. They aren’t cheap, but it’s a one-time purchase and they provide good results by physically just putting more material for the x-rays to pass through in the upper c-spine so that it balances out those shoulders better. Lateral cervical spine x-ray of a female age six years with MPS IVA. Radiologists consider a lumbar spine radiographic film of good quality when it demonstrates the lower ribs, lumbar vertebral bodies, transverse processes, pedicles, spinous processes, sacrum, and sacroiliac joints. A lot of chiropractors we work with use a wedge filter that attaches to the head of the x-ray machine. Physically changing the amount of material the -rays pass through by using a wedge filter.You could also just use the lateral T-spine technique programmed into your machine (if you have that). and then maybe doubling the mAs on top of that if you still need to see more. The alignment of the lateral masses of C1 and C2 can still be assessed. In this image the distance between the peg and the lateral masses of C1 appears narrower on the right (A) compared with that on the left (B) This is because the patients head is slightly rotated. From what I see in your image, I would start with increasing kVp by 10. Gaining a good open-mouth view is often difficult in the context of trauma. But the more you go up, the more you will burn out the upper c-spine, so you’ll need to find a balance with not over penetrating the upper c-spine but yet still penetrating enough to see the lower. The image you attached shows very limited penetration through the shoulders, so increasing your x-ray will help solve this. Increase your kVp by 10 and/or double your mAs.So, there are a couple of techniques/methods you can try to resolve this, but nothing is perfect. Obviously from a physical standpoint, the shoulders are 4-5x thicker than the neck, and you are using the same amount of x-ray to image both in that shot. That seems to be the million-dollar question. How can I see the entire lateral c-spine on my x-rays?!?