What is the most cranial landmark for a cervical spine radiograph?

• A. Atlas
• B. Axis
• C. Occipital crest
• D. Foramen magnum

Answer: (C)

When positioning for a cervical spine radiograph, you need a reliable, most cranial reference point on the skull to orient the image. The occipital crest fits this role because it is a midline bony ridge on the back of the occipital bone that sits higher on the skull than the other landmarks in the list. It remains superior to the foramen magnum, so it provides the highest, most cranial reference point available. The atlas and axis are part of the cervical spine itself and lie below this crest, while the foramen magnum, though important, is at the base of the skull and not as cranial as the occipital crest. Using the occipital crest helps ensure the upper cervical region is included and allows consistent alignment across patients.