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As a radiographer, I came across a regular problem in our department. A chap had fallen through a roof and fallen 20 feet. He'd injured his shoulder and had pain in his lower back. He didn't have C-spine tenderness, yet (due to the mechanism of injury) we needed to clear his C-spine first. So our imaging priority was his C-spine, Lateral view. He was a large chap and had bulky shoulders, lying on a spinal board, hard collar in situ( an imaging nightmare!). Due to his shoulder injury, the Cas SHO said it would be impossible to apply traction to that side. So we tried everything we could think of, (5 radiographers with over 30 years experience between us) traction, swimmers, variations of the two, and we had to resort to trauma obliques to show the alignment of C7/ T1 (which our SHO was not confident about interpreting). One of our number mentioned it would be so much easier if we could just sit him up, and let gravity assist us. Now, clearly in this case with the patients lower back pain it would not be suitable, but I was wondering why we couldn't sit patients up if they had no back pain? We were only attempting to x-ray this chaps neck because of his mechanism of injury, and occasionally these patients come for imaging attatched to spinal boards and/or headblocks with no neck/back pain, (except that one they're getting from lying on the spinal board for so long!). Are there guidelines regarding when patients should be immobilised flat on a trolley, or could they be sat up to some degree to facilitate better quality images? While I'm on the issue, I thought spinal boards were an extrication device- they look very uncomfortable and often a patient can have spent over an hour on them before we've finished x-raying everything we've been asked for. I asked a Casualty nurse about it, and was unhelpfully informed that the patient couldn't be removed from the spinal board and clothing couldn't be cut off until we'd cleared the spine. Somehow that doesn't match with my experience, and I would be grateful for some clarification from the 'docs'. As a radiographer I would ideally like to provide the best quality images possible- and the information I have been given by the A and E staff I work with seems confusing at times and conflicting at worst! TIA Vikki Chase