Simulation in radiography is often associated with trauma scenarios or rare emergency procedures. But some of the most critical projections to practise in simulation are the ones students will be expected to perform routinely, yet receive surprisingly little hands-on repetition during training. These include erect lumbar spines, flexion & extension C-spines, Judet views, and standard skull series. Technically demanding, easily done poorly, and often performed under pressure, these projections separate competent radiographers from beginners.
Many of these views are treated as basic in name only. In practice, they involve complex positioning, subtle anatomical landmarks, and exact equipment control. They also carry an increased risk of positioning error, poor centring, or inappropriate exposure.
Erect lumbar spines demand awareness of spinal curvature, patient posture, and compensating for lordosis when aligning the detector
Flexion and extension cervical spines require fine control of neck movement, safety screening, and beam-centred consistency across projections
Judet views test a student’s spatial reasoning and knowledge of obliquity, especially when performed without a rotating table
Skull projections involve minute head rotations and beam angulation, where a few degrees of error can obscure anatomy or repeat dose unnecessarily
None of these views are easy. Yet many students encounter them for the first time during high-stakes clinical placements with limited prior practice.
Simulation provides the opportunity to master these projections through deliberate, repetitive practice. It also gives learners real-time feedback and safe failure. That is the ability to make mistakes and immediately understand what went wrong.
These views benefit particularly from simulation because they allow learners to:
Rehearse precise tube angulation and detector alignment
Practice verbal instruction for patient movement in cases like flexion and extension views
Understand beam-centred anatomy in oblique views, like Judet, where the visual target is not directly in front of the student
Adjust technique based on body habitus, especially for erect spines, where alignment must compensate for kyphosis or scoliosis
Simulation allows students to trial positioning and technique without the time pressure or patient discomfort often experienced in busy departments.
A major barrier to proficiency with these views is equipment handling. Students need to be fluent in adjusting:
Table height
Floating tabletop position
Detector angulation and centring
Vertical Bucky movement for erect projections
In real settings, struggling with equipment wastes time and erodes confidence. Simulation that includes a full table and detector controls ensures learners are not encountering this for the first time on placement. If a student is learning to unlock the table or move the detector mid-projection, they are already behind.
In anatomically dense regions like the lumbar spine or skull, exposure is unforgiving. Automatic Exposure Control AEC offers support, but only when chamber selection, centring, and collimation are correct. These are not abstract classroom concepts. They are directly testable in simulation.
Misuse of AEC is common, particularly:
Selecting the wrong chamber for oblique views
Centring too high or too low on erect spines
Overcollimating and allowing excess scatter
Undercollimating and missing key anatomy
Simulation allows these mistakes to be made without clinical consequence and corrected through feedback. It reinforces the link between technical setup and final image quality while encouraging learners to reflect on exposure parameters in relation to patient size and positioning.
These so-called fundamentals are often skipped over because they are not always dramatic or visually complex. But they are the core of daily radiographic practice, and errors in these areas account for a significant proportion of repeat imaging and diagnostic delays.
Simulation is not only about preparing students for the rare. It is about ensuring they can do the expected consistently, safely, and with confidence. The erect lumbar, the Judet view of the flexion and extension cervical spine. These are the views students must get right before anything else.