Version July 2025
| Modality | Protocol | Indications |
| Plain radiographs | Upright anteroposterior, open-mouth odontoid, lateral, flexion/extension | Patient with RA with mild occipital/neck pain, or |
| Prior to general anesthesia, or | ||
| Following trauma, in a patient with a normal CT | ||
| Computed tomography | Noncontrast | Following trauma, in a patient with mild neck/occipital pain |
| Myelography | For detecting cord compression, when MRI is not feasible | |
| Contrast | To detect synovial proliferation when MRI and CT myelography are not feasible | |
| Magnetic resonance imaging | Noncontrast | For possible cord compression or radiculopathy |
| STIR | For evaluation of active rheumatoid arthritis | |
| Fat saturated | For evaluation of vertebrobasilar insufficiency (along with other vascular imaging) |
In general, plain radiographs and noncontrast CT are used to detect fracture, while magnetic resonance is used to detect injury to neural tissue (eg, brainstem, spinal cord).
Additional magnetic resonance sequences may help evaluate other issues: STIR is used to detect active rheumatoid arthritis (ie, synovitis), while fat saturated sequences enhance intramural hematoma in a dissecting artery.