BACHELOR OF SCIENCE IN RADIOLOGIC TECHNOLOGY

SKULL RADIOGRAPHY

Presented by:

RT-301 Group Four

Dave RossChristine Joy T. PangilinanMarona Ysabel G. Julabar

Eunice Lorenz M. DatuAnna Therese D. Viray

Ellen B. Cruz

> Hello everyone, I'm Dr. Matindi.> Welcome to Skull Radiography - V.4.0

> We are going to play a game, and you will be receiving exciting prizes.> You will be divided into four groups of four members each.

> The group with the highest number of scores at the end of this game would receive a great reward.

> Everytime that I would appear and ask a question is the time where your scores would be recorded.

Dr. Matindi, We're ready.

OK, Let's begin.

The anatomy of the skull is very complex, and specific attention to detail is required of the technologist.

The skull, or bony skeleton of the head, rests on the superior end of the vertebral column and is divided into two main sets of bones: the 8 cranial bones and the 14 facial bones. 

ANATOMY

Ossification

Hmm...

Morphology

SKULL:PLANES, POINTS & LINE

1. Midsagittal plane (MSP)2. Interpupillary line (IPL)3. Acanthion4. Outer canthus5. Infraorbital margin6. External acoustic meatus (EAM)7. Orbitalmeatal line (OML)8. Infraorbitomeatal line (IOML)

1. Frankpurt Line9. Acanthiomeatal line (AML)10. Mentomeatal line (MML)

1. Between OML & IOML: 7° difference2. Between OML & GML: 8° difference

CRANIAL BONES• The eight bones of the cranium are divided into the

calvaria (skullcap) and the floor. Each of these two areas primarily consists of four bones:

CALVARIA• 1. Frontal• 2. Right parietal • 3. Left parietal• 4. Occipital FLOOR• 5. Right temporal• 6. Left temporal• 7. Sphenoid (sfe′-noid)• 8. Ethmoid (eth′-moid)

1

4

35

2

6

11

10

9

8

7

Hmm...

SKULL SERIESClinical Projections

• BASIC:– PA 0°– Lateral– Towne Method: AP Axial– Caldwell Method: PA Axial 15°or PA Axial 25°

to 30°• SPECIAL:

– Submentovertex (SMV)– Haas Method: PA Axial

PATHOLOGY1. ) Basal Fx

Fx located at the base of the skull2) Blowout Fx

Fx of the floor of the orbit3.) Contre-Coup Fx

Fx to one side of a structure caused by trauma to the other side4.) Depressed Fx

Fx causing a portion of the skull to be depressed into the cranial cavity5.) Le Fort Fx

Bilateral horizontal fxs of the maxillae

Pathology cont…6.) Linear FxIrregular or jagged fx of the skull7.) Tripod FxFx of the zygomatic arch & orbital floor/rim & dislocation of the frontozygomatic suture8.) MastoiditisInflammation of mastoid antrum & air cells9.) Paget’s DiseaseThick, soft bone marked by bowing fxs; cotton wool appearance10.) SinusitisInflammation of one or more of the paranasal sinuses11.) TMJ SyndromeDysfunction of the temporomandibular joint Tripod Fracture

Mastoiditis

Hmm...

Paget's Disease

Hmm...

PROJECTIONS

CRANIUM

What is this part called?

Lateral Projection• Px Position : seated erect or semiprone• Part Position:

– MSP // to IR.– IOML is ┴ to front edge of IR.– IPL is ┴ to IR.

• CR: ┴• RP:

– 2 inches superior to EAM- general survey– ¾ inch superior and ¾ inch anterior to the EAM– sella turcica

• SS: – sella turcica

Lateral Projection:Dorsal Decubitus or Supine Lateral Position

• Px Position:– Seated erect or semisupine.

• Part position:– MSP // to IR.– IOML is ┴ to front edge of IR.– IPL is ┴ to IR.

• CR: ┴• RP: 2 inches superior to EAM• SS: sella turcica

Caldwell MethodPA and PA AxialPx Position: PronePart Position:• MSP and OML ┴ to midline of grid

device• Rest patient's nose and forehead

against table/Bucky surface;• Flex neck as needed to align OML ┴ to

IR;• Center IR to CR. CR: • PA: ┴• PA axial: 15° caudadRP: Nasion

SS:• Greater and lesser

sphenoid wings• Frontal bone• Superior orbital

fissures• Frontal and anterior

ethmoid sinuses• Superior orbital

margins• Crista galli

AP Axial ProjectionTowne Method

• Px Position: Seated erect or supine.• Part Position:

– Center MSP to midline of grid device and adjust to make ┴– Neck flexed, and adjust the OML ┴ to IR.– Cannot flex neck? Place IOML ┴ to IR and then increase CR angulation

7°– Place top of IR at the level of cranial vertex.

• CR: – 30° caudad to OML or 37° caudad to IOML.– Foramen magnum and jugular foramina – 40° to 60°– Posterior portion of the cranial vault – ┴°

• Respiration:– Suspended respiration.

• RP: – 2 and ½ inches superior to glabella and passes through the level of EAM

SS:

• Symmetric view of the petrous pyramid• Posterior portion of the foramen magnum• Posterior clinoid processes within the

shadow of the foramen magnum and dorsum sellae

• Occipital bone• Posterior portion of the parietal bones• Remember: SPPOP

PA Axial projectionHAAS Method

• Px Position: seated erect or prone.• Part position:

– Rest head on forehead and nose.– Arms in comfortable position.– Shoulders to lie in same

transverse plane.– Adjust head so that MSP and

OML are ┴ to IR.• CR: 25° cephalad• Respiration: suspended respiration.• RP:

– 1 and ½ inch inferior to external occipital protruberance (inion) and exiting 1 and ½ inch superior to nasion.

• Dorsum sellae within the shadow of the foramen magnum

• Occipital region of the cranium

• Symmetric view of the petrous pyramid

CRANIAL BASE

Submentovertical ProjectionSchuller Method

Px position:– Seated erect at head unit, or– Supine on elevated table support.

Part position:– Extend neck and rest head on

vertex.– Center and adjust MSP ┴ to IR.– Adjust IOML // to plane of IR if

possible.CR: ┴Respiration:

– Suspended respiration.RP:

– Sella turcica ┴ to IOML entering between angles of mandible.

– ¾” anterior to the level of EAM

• Symmetric projection of the petrosae• Mastoid processes• Auditory tubes (eustachian tubes)• Foramina ovale and spinosum- best shown• Carotid canals• Sphenoidal sinuses• Mandible• Maxillary sinuses• Nasal septum• Dens of the axis• Atlas

Schuller MethodVerticosubmental Projection

use when SMV is contraindicated

Px Position: PronePart Position:Chin on the tableNeck fully extended.MSP ┴ to midline of grid device.Arms at sidesCR: ┴RP: Sella turcica ┴ to IOML entering between angles of mandible; ¾ inch anterior to the level of EAMSS: Cranial baseSphenoidal sinuses

Lysholm MethodAxiolateral Position

Px Position: Seated erect or semipronePart position:• Center the EAM of the side being

examined to the midline of the table• Adjust the head in a true lateral position• Extend neck and place the IOML // with

the transverse axis of the cassette CR: 1 inch (2.5 cm) distal to the lower EAM

at an angle of 30° to 35° caudad

SS:

• Oblique position of the lateral aspect of the base of the cranium closest to film

NOTE:• Lysholm is recommended for patients who

cannot extend their head enough for a satisfactory submentovertical projection

GOOD MORNING

SPINE THORAX PELVIS1 √ - √2 √ √ √3 √ - √4 √ - √5 √ √ √6 √ √ √7 √ √ √8 √ √ √9 √ √ √10 √ √ √11 √ √ √12 √ √ √13 (5) - - -14 (5) √ - -15 - - -

17 9 12

Yesterday's Highlights:External occipital protuberance is also known

as the Inion

Newborn fontanelsAnterior fontanel - dregmaPosterior fontanel - lambdaSphenoidal fontanel - pterionMastoid fontanel - asterion

MorphologyMSP's relationship with the petrous pyramid

PROJECTIONSIn Caldwell's Method, the structures best demonstrated are the frontal bone and the frontal sinus.

In Towne's Method, the reference point, in some books, is the hairline.

Haas' Method is the reverse of Towne's method.

In Towne's method, the structure best demonstrated is the occipital bone. What are the other structures that are being demonstrated if the central ray angulation is 37°?

A. sella turcica and dorsum sellaeB. anterior clinoid process and dorsum sellaeC. dorsum sellae and posterior clinoid processD. anterior clinoid process and sellae turcica

Enumerate the Skull: Planes, Points, and Lines.

Each will be given two points.

!!!

Cranium, Sella turcica, and ear

TEA stands for ?

Top of Ear Attachment

Sella Turcica

EXTERNAL EAR consists of two parts:1. Auricle (oval-shaped, fibrocartilaginous, sound

collecting organ situated on the side of the head)2. EAM (sound conducting canal)

MIDDLE EAR proper consists of:1. Tympanic membrane (eardrum)2. Tympanic cavity (irregularly shaped, air-

containing compartment)3. Auditory ossicles (three small bones)

INTERNAL EAR contains the essential sensory apparatus of hearing and equilibrium and lies on the densest portion of the petrous portion immediately below the arcuate eminence.

Cranial nerve number ?

Valdini MethodPA Axial

Px Position: Seating positionPart position:• Rest the patient’s upper frontal region of the skull on the table

and adjust it so that the MSP is ┴ to the midline of the grid• IOML 50° with IR for demonstration of dorsum sellae, internal

auditory canals and labyrinths of the ear• OML 50° with the IR for demonstration of the external

auditory canals, tympanic cavities and eustachian tubesCR: ┴ to inionRP:• For dorsum sellae - Center to a point 0.5 cm distal to the

nasion• For petrosae - Center to the foramen magnum at or slightly

above the level of the EAM

SS:• DILA (IOML 50°): Dorsum sellae; Internal

Auditory Meatus (IAM); LAbyrinth • ETB “EaT Bulaga” (OML 50°): External auditory

meatus; Tymphanic cavity; Bony part of Eustachian tube

• Dorsum sellae & posterior clinod processes within or above shadow of foramen magnum

• Tubeculum sellae, anterior clinoid processes & sella turcica below shadow of foramen magnum

• Mastoid pneumatization

Sella Turcica: Lateral ProjectionPx Position:• Seated upright or semiprone.• MSP // to the plane of the IR• Radiolucent sponge is required for obese patients.Part position:• MSP // to IR• IPL ┴ to IR• IOML // with transverse axis of the IR.

CR: ┴RP: ¾ inch anterior and ¾ inch superior to the EAMSS: sella turcica region of the cranium

Enumerate the

structures of “D.I.LA.”

Dorsum Sellae andPosterior ClinoidProcesses

AP Axial Projection

• Px Position:– Seated upright or supine.– Arms along side the body.

• Part Position:– MSP ┴ to the midline of the grid device.– IOML ┴ to the plane of the IR.

• CR:– 37° caudal projects the dorsum sellae and posterior clinoid processes within

the foramen magnum.– 30° caudal to IOML projects the dorsum and tubercullum sellae and anterior

cliniod processes through the occipital bone above the level of the foramen magnum.

• RP:– Upper forehead and passing through the head at the level of the EAM

• SS: – Sellar region and petrous pyramid

PA Axial projection

• Px Position:– Patient prone or seated erect– Arms in comfortable position.

• Part Position:– Forehead and nose rested against the VCH.– OML ┴ to IR.– MSP ┴ to IR.

• CR: – 10° cephalad

• RP:– Glabella

• SS: – Tuberculum sellae and clinoid process

Orbit

SOG stands for ?

Supraorbital Groove

Rhese MethodParietoorbital Oblique ProjectionOptic Canal and Foramen

• Px Position: Seated erect or semiprone.

• Part Position:– Center affected orbit to IR– Rest head on zygoma, nose and

chin.– Adjust AML ┴ to IR– Rotate MSP 53° from IR.

• CR: ┴• RP: 1 inch superior and 1 inch

posterior to elevated TEA• SS:

– optic canal– optic foramen

Rhese MethodOrbitoparietal Oblique Projection

• Px Position:– Seated upright or supine position– Arms alongside the body

• Part Position:– Rotate head so that MSP forms

an angle of 53° to the plane of the IR.

– AML ┴ to IR.• CR: ┴• RP: uppermost orbit at inferior and

lateral quadrant • SS:

– optic canal “on end” and optic foramen

Superior Orbital FissuresPA Axial Projection

• Px Position: prone or seated upright– Forearms along side the

head with elbows flexed.• Part Position:

– Forehead and nose rested against the grid device with MSP centered and ┴ to IR.

– OML ┴ to IR.• CR: 20-25° caudad• RP: Exiting at the level of the

inferior margin of the orbit• SS: petrous portion temporal

bone

Bertel MethodPA Axial ProjectionInferior Orbital Fissures• Px Position:

– Prone or seated-upright.– Arms alongside the body.

• Part Position:– Patient’s forehead and nose

rested against the VCH– MSP ┴ to IR.– IOML ┴ to IR

• CR: 20-25° cephalad• RP:

– to enter approx. 3 inch below the external occipital protruberance

– exiting to the nasion• SS:

– orbital floor, orbital fissure, pterygoid lamina.

In Rhese method, the MSP is angulated:

A. 57°B. 51°C. 55°D. 53°

...

In Reese Method, the central ray is directed perpendicularly, however in Bertel Method, the central ray is:

A. 10 - 25° cephaladB. 20 - 25° caudadC. 10 - 15° cephaladD. 20 - 25° cephalad

EYE

Lateral Projection• Px Position: semi-prone• Part Position:

– MSP // to the plane of the IR– OML ┴ to IR

• CR: ┴• RP: outer canthus• SS:

– orbital region– Note: instruct the patient to

look straight ahead for the exposure.

PA Axial Projection

• Px Position: Seated erect or prone.– Forehead and nose in contact

with the IR– Arms along side the head

• Part Position:– OML ┴ to IR

• CR: – 30° caudad

• RP: ¾ inch distal to the nasion through the mid orbits.– Instruct the patient to close the

eyes and to concentrate on holding them still for the exposure.

Modified Parietoacanthial ProjectionModified Water’s Method

• Px Position:– Seated erect or prone– Arms along side the body

• Part Position:– Rest head on the tip of the extended

chin– OML must form 55° in relation to the

plane of the IR.• CR: ┴• RP: Exit to the acanthion• SS:

– orbit, maxillae and zygomatic arches.

In the lateral projection of the eye, the reference point is the:

A. outer canthusB. inner canthusC. glabellaD. mental point

FACIAL BONES (14)• Nasal Bones (2)• Lacrimal Bones (2)• Maxillary Bones (2)• Zygomatic Bones (2)• Palatine Bones (2)• Inferior Nasal Conchae (2)• Vomer (1)• Mandible (1)• Hyoid Bone• Diploe

!!!

Enumerate the 14 Facial Bones.

WELCOME BACK :)

SPINE THORAX PELVIS1 - - -2 20 16 163 - 2 -4 - - -5 - 3 36 1 1 -7 2 2 28 2 2 29 2 - 210 2 2 211 11 12 10LAST SCORE

17 9 12

AccumulatedScore

57 49 49

FACIAL BONES :)

Lateral Projection

• Px Position:– Semiprone or obliquely seated

• Part position:– MSP // to plane of the IR– IPL ┴ to IR

• CR: – ┴

• RP:– Lateral surface of the

zygomatic bone halfway between outer canthus and the EAM

• SS: – Bone of the face

Facial Profile: Lateral Projection

• Px Position: Semiprone or seated position• Part position:

– Head in lateral position and MSP //– IPL ┴ to the plane of the IR.

• CR:– ┴

• RP: – Lateral surface of the zygomatic bone and halfway between the

outer canthus and the EAM• SS:

– Bony and Tissue structure

Water's MethodParietocanthial Projection

Px Position:Patient is seated-erect or proneArms along side the body

Part Position:Rest the patient head on the tip of the

extend chinOML must form 37° in relation to the

plane of the IR.Average patient’s nose will be about ¾

inch away from the grid deviceCR:

┴RP:

Exit to the acanthionSS:

OrbitMaxillaeZygomatic arches.

Modified Parietoacanthial ProjectionModified Water’s Method

• Px Position:– Seated erect or prone– Arms along side the body

• Part Position:– Rest the patient head on the tip

of the extend chin.– OML must form 55° in relation to

the plane of the IR.• CR: ┴• RP: exit to the acanthion• SS:

– Orbit– Maxillae– Zygomatic arches.

Reverse Water’s MethodAcanthioparietal Projection

• Px Position: Supine• Part position:

– Chin up, adjust the extension of the neck so that the OML forms a 37° to the plane of the IR.

– MML ┴ to the IR • CR: ┴• RP: Acanthion• SS: Superior facial bone

CALDWELL Method PA Axial Projection

Px PositionSeated erect or semiprone.

Part PositionRest head on forehead and nose.Position midsagittal plane ┴ to midline of grid device.OML is ┴ to IR.

CRCaldwell method: 15° caudadExaggerated Caldwell method: 30° caudal(for the demonstration of orbital rims, particularly the orbital floor)

RP Exit nasion

In the lateral projection, the IPL is in what relationship with the IR?

A. PerpendicularB. ParallelC. All of the aboveD. None of the above

Nasal bone

NASAL BONE

Lateral Projection• Px Position:

– Semiprone• Part Position:

– MSP // and IPL ┴ to the plane of the IR

– Support the mandible to prevent rotation

• CR: ┴ to the bridge of the nose.• RP: ½ inch distal to the nasion• SS:

– nasal bone– soft structure of the bone.

Tangential projection1. Extraoral FilmPx Position:Recumbent or seated position.Chin supported on a sandbag or an inclined IR. Part PositionHead on the fully extended chinCenter the IR to the midsagittal plane just anterior to the chin Adjust the patient's head so that the midsagittal plane is ┴ to the plane of the IR Respiration: Suspended

2. Intraoral FilmPx PositionSupineRest the head on the table or elevate it on a sponge. With its long axis directed anteroposteriorly and the pebbled surface facing upward, insert the film packet approximately 1 inch (2.5 cm) into the mouth.Center the packet to the MSP, and then instruct the patient to close the lips and teeth so that the film is held in position with its plane ┴ to the glabelloalveolar line Respiration: Suspended

• CR– // to glabelloalveolar line– ┴ to the plane of the image receptor

• SS– A tangential projection of only a portion of the nasal

bones that extend beyond the glabelloalveolar line

CLUE: Two words. The second word ends with letter “e”.

ZygomaticArch

Submentovertical Projection• Px Position:

– Seated upright or supine• Part Position:

– Hyperextend the neck so that IOML is nearly // with the IR

– Rest the head on its vertex.• CR:

– ┴ to IOML• RP:

– Entering to the throat at the level of 1 inch posterior to the outer canthi.

• SS: Zygomatic arch

Tangential Projection• Px Position: seated or supine.• Part Position:

– Seated:• Neck hyperextended and head

resting on vertex.• IOML // as possible to the plane of

the IR.• Rotate the MSP approx.15° toward

the side being examined.• Tilt the top of the head approx.15°

away from the side being examine.• This rotation and tilt ensure that the

CR is tangent to the lateral surface of the skull placing the zygomatic arch onto the IR.

– Supine• Head resting on the vertex• IOML nearly // to IR• Rotate and tilt 15° towards the side

being examined.

• CR: ┴ to the IOML.• RP: 1 inch posterior to outer canthus • SS: Zygomatic arch

May MethodTangential Projection• Px Position:

– Seated upright or prone.• Part Position:

– Completely extend neck so that the IOML is as // with IR as possible.

– Rotate the MSP approx. 15° away from the side being examined.

– Tilt the top of the head away from the side being examined approx.15°.

• CR: ┴ to IOML• RP: 1 ½ inch posterior to outer

canthus• SS:

– patient who have depressed fracture = flat cheek bone

Modified Towne MethodAP Axial projection

Px Position:Seated upright or supine.Center the center of the body to the midline of VCH

Part Position:MSP center the VCHChin slightly depressed so that OML is ┴ to IR.

CR: 30° caudad(37° caudad for patients who cannot flex neck)

RP: 1inch above nasion

SS:Zygomatic arch

What is the CR in the May Method: Tangential Projection, the Submentovertal Projection, and the Tangential Projection of the Zygomatic Arch?

A. Parallel to IOMLB. Perpendicular to IOMLC. Parallel to MMLD. Perpendicular to MML

Mandible

MML stands for ?

Mentomeatal Line

MANDIBULAR SYMPHYSISAP Axial projection• Px Position:

– Seating at edge of the radiographic table.

– Elevate the film packet or IR on a suitable support so that the patient can extend the neck and sustain the chin in a horizontal plane.

• CR: 40-45°• RP: mandibular symphysis

(midway between the lips and the tip of the chin)

• SS: mandibular symphysis and mental foramina

Mandibular RamiPA projection

• Px Position: Seated erect or prone

• Part Position:– Rest forehead and nose on

the grid device– Adjust head so that MSP is

┴ to IR– OML is ┴ to IR

• Respiration: Suspended• CR: ┴• RP: exit to the acanthion• SS: mandibular body and rami

Mandibular RamiPA Axial Projection• Px Position: Seated erect or

prone.• Part position:

– Position MSP ┴ to IR– OML ┴ to IR– Have the patient head rest

forehead and nose on IR holder.

• Respiration: Suspended• CR: 20-25°cephalad• RP: exiting acanthion• SS: mandibular rami

Mandible BodyPA projection

• Px Position: Prone or seated upright

• Part position:– Rest the head on nose and

chin so that the anterior surface of the mandibular symphysis is // to the plane of the IR.

– This places the AML nearly ┴ to the IR plane.

• CR: ┴• RP: level of the lips.• SS: Mandibular body

Mandibular BodyPA Axial Projection

• Px Position:– Prone position or seated upright

• Part Position:– Rest the head on nose and chin

so that mandibular symphysis will be placed // to the plane of the IR.

– MSP is ┴ to the plane of the IR.• CR:

– 30° cephalad.• RP:

– midway between TMJs.• SS:

– Mandibular body and TMJs.• Note: Mouth should be filled

with air.

MandibleAxiolateral Oblique Projection

The goal of this projection is to place the desired portion of the mandible // to the IR.Px Position: Seated erect, semisupine, or semiprone.Part Position:• Place the head in lateral position with

interpupillary line ┴ to IR.• Have patient close mouth & keep teeth together.• Extend neck enough that long axis of mandibular

body is // with the transverse axis of IR, preventing superimposition of cervical spine.

• If projection is being performed on tabletop, position IR so that complete body of mandible is positioned on IR.

• Adjust the rotation of the head so that the area of interest is // to IR as follows:

1) ramus: keep the head in true lateral position;2) body: rotate head 30° toward IR3) symphysis: rotate head 45° toward IR.

• CR: 25° cephalad• RP: Pass through mandibular region of interest.• SS: region of mandible of interest.

MandibleSubmentovertical Projection

• Px Position: Seated-upright or supine

• Part Position:– Hyperextend the neck so that

IOML is nearly // with the IR– Rest the head on its vertex.

• CR: ┴ to IOML• RP: Entering to the throat at the

level of 1 inch posterior to the outer canthi

• SS: – Shows coronoid and condyloid

processes of the rami.

Verticosubmental projection • Px Position: Prone or seated• Part Position:

– Rest chin on the table with neck fully extended

– Position MSP ┴ to midline of grid device

– IOML // to IR– Arms at sides

• CR: ┴• RP: Through the MSP

entering at the level just posterior to the outer canthi.

Temporomandibular ArticulationAP Axial Projection

Px Position: Supine or seated-upright position with the posterior aspect of the skull in contact with the VCH.

CR: 35° caudadRP: Midway between TMJ’s,

3 inches above the nasionSS:

condyles of mandiblemandibular fossae of the temporal bone

Axiolateral Projection• Px Position: seated erect or semiprone• Part Position

– Center a point ½ inch anterior to EAM to IR.

– Rotate MSP 15° toward IR.– Adjust AML // with the transverse

axis of IR– IPL is ┴ to IR.– After first exposure with patient’s

mouth closed, do not permit patient to move.

– Change IR, and, make the 2nd exposure with patient’s mouth fully open.

• CR: ┴ at 25°-30°• RP: 1 inch anterior and 2 inches

superior to the upside EAM• SS: TMJs in an open and closed mouth

Axiolateral Oblique ProjectionPx Position: semi prone or seatedIn TMJ examinations, make one exposure with the mouth closed and, when not contraindicated, one exposure with the mouth open.Part Position:Center a point 1'2 inch ( 1 .3 cm) anterior to the EAM to the JR, and rest the patient‘s cheek on the grid device.Respiration: SuspendCR: 15° caudadRP: exits through the TMJ closest, about 1 ½ inch superior to the upside EAM SS: condyles and neck of mandibles

What is the reference point in Mandibular Symphysis: AP Axial Projection?

...

Paranasal Sinuses

Consists of:

• Maxillary sinuses• Frontal sinuses

• Ethmoidal sinuses• Sphenoidal sinuses

Lateral Projection

Px Position: seated erectPart position:Adjust head to true lateral position.MSP is //IPL is ┴ to IRAdjust IOML horizontal and // with transverse axis of the IR.Respiration: suspendedCR: ┴ or horizontally directedRP: Entering the head to ½ to 1 inch posterior to the outer canthus.SS: paranasal sinuses

Frontal and Anterior Ethmoidal Sinuses

Caldwell MethodPA Axial Projection• Patient position:

– Tilt vertical grid device down 15 degrees.

– Have patient rest head on forehead and nose.

– Position MSP ┴ to midline of IR.

– OML is ┴ to IR.– This positioning places

OML 15 degrees from horizontal central ray

• Respiration: Suspended respiration• CR: ┴ directed to the plane of the IR.• RP: To exit nasion• SS: frontal and anterior ethmoidal sinuses

Maxillary and Sphenoidal SinusesWaters Method

Parietoacanthial ProjectionOpen and Closed mouth

• Px Position: seated erect.• Part position:

– Center and adjust MSP perpendicular to IR, and have patient rest head on extended neck.

– Adjust OML to form 37 degrees to IR. MML is perpendicular to IR

Center IR to acanthion.OPEN MOUTH OPTION:Have patient fully open mouth to demonstrate the sphenoid and maxillary sinuses.CR: Horizontal and perpendicular to IR. RP: exiting acanthionSS: sphenoidal and maxillary sinuses for an open mouth and maxillary sinuses for a closed mouth.

Ethmoidal and Sphenoidal Sinuses

Submentovertical Projection• Px Position:

– Position patient seated erect at head unit

• Part position:– Extend neck and have patient’s

head rest on vertex– Center and adjust MSP ┴ to IR– Adjust IOML // to IR

• Respiration:– Suspended respiration.

• CR: – Horizontal and ┴ to the IOML

• RP: – ¾ inch anterior to the level of the EAM

• SS: – Ethmoidal and Sphenoidal sinuses

Ethmoidal, Sphenoidal and Maxillary Sinuses

PA Projection• Px Position: seated erect.• Part position:

– For posterior ethmoidal sinuses:• Center nasion to IR• Patient’s head is resting on forehead

and nose against VCH• OML is ┴ to IR

– For sphenoidal sinuses:• Center glabella to IR.• Patient’s head is resting on forehead

and nose against VCH• OML is ┴ to IR

– For maxillary sinuses:• Center IR midway between the infraorbital margins and the acanthion.• Patient’s head is resting on forehead and nose against VCH• OML is perpendicular to IR

• Central Ray:– For posterior ethmoidal sinuses:

• Horizontal and perpendicular to IR– For sphenoidal sinuses:

• 10 degrees cephalad passing through the sphenoidal sinuses.– For maxillary sinuses:

• Horizontal and perpendicular to IR.

• Reference point:– For posterior ethmoidal sinuses:

• To exit to the nasion

– For sphenoidal sinuses:• To exit glabella

– For maxillary sinuses:• Midway between infraorbital margins and

acanthion

• Structure shown:– Ethmoidal, sphenoidal and maxillary

sinuses.

Temporal Bone

Petromastoid PortionAxiolateral Oblique ProjectionOriginal Law MethodDouble-tube Angulation• Patient position:

– Head in a true lateral– IPL perpendicular to IR– MSP and IOML parallel to the plane of

IR.• Central Ray:

– directed at the angle of 15 caudad and 15 anteriorly

Reference point: – Enters approx. 2” to, and 2” above, the upper most of external

acoustic meatus (EAM) and exits downside the mastoid process.• Structure shown:

– mastoid cells, the lateral portion of the petrous pyramid and the superimposed internal acoustic meatus (IAM)

Axiolateral Oblique ProjectionModified Law Method (Single Tube

Angulation)• Image Receptor:

– 8 x 10’’• Patient position:

– Position patient seated erect or semiprone.

• Part position:– Position head in lateral position

with affected side closer to IR.– From true lateral position, rotate

MSP 15 degrees toward IR.– IOML is parallel with the

transverse axis of IR– IPL is perpendicular to IR

• Central Ray:– perpendicularly directed at 15

degrees caudad • Reference point:

– Enters 2” posterior and 2” superior to EAM farthest from IR

– Exits 1” posterior to the EAM of the affected side.

• Structure shown:– mastoid cells, the lateral portion

of the petrous pyramid and the superimposed internal acoustic meatus (IAM) and external acoustic meatus (EAM).

Axiolateral ProjectionHenschen, Schuller, and

Lysholm Methods• Image Receptor:

– 8 x 10’’• Patient position:

– Patient in prone position or preferably, seated before VCH.

• Part position– Patient’s head in true lateral

position– MSP parallel to the plane of the

IR– IPL perpendicular to IR– IOML parallel to the transverse

axis of IR. • Central Ray:

– Henschen Method – 15 caudad– Schuller Method – 25 caudad– Lysholm Method – 35 caudad

• Reference point:– exits the EAM closest to IR.

Axiolateral Oblique Projection

Stenvers Method• Image Receptor: – 8 x 10’’

• Patient position:– Position patient seated erect

or prone.• Part position:

– Have patient rest head on forehead, nose, and zygoma.

– Adjust IOML parallel to IR and MSP at 45 degrees.

• Central Ray:– directed 12 degrees cephalad

• Reference point:– Entering 3-4” posterior and ½”

inferior to upside EAM.– Exiting 1” anterior to

downside EAM.• Structure shown:

– petromastoid portion in profile

Axiolateral Oblique Projection

Arcelin Method• Image Receptor:

– 8 x 10’’• Patient position:

– Position patient seated erect or supine centered to table.

• Part position:– Rotate MSP 45 degrees away from

side being examined.• Central Ray:

– directed 10 cephalad• Reference point:

– 1” anterior to the EAM and ¾ above it.

• Structure shown: petrous portion

Axiolateral Oblique Projection

Mayer Method• Image Receptor: 8 x 10’’• Patient position:

– Patient in supine position or seated laterally before VCH.

• Part position:– Rotate head so that MSP will be 45

degrees to the plane of IR, with side under study closest to IR.

– Depressed patient’s chin to place IOML parallel to the transverse axis of the IR.

• Central Ray: – directed 45 caudad

• Reference point: – exits to the EAM closest to IR

• Structure shown: – tympanic cavity and ossicles

Petromastoid Portion AP Axial Projection - Towne

Method• Image Receptor:

– 8 x 10’’• Patient position

– Position patient seated erect or supine.

• Part position– Center midsagittal plane to

midline of grid device and adjust to make perpendicular.

– Have the patient’s neck flexed, and adjust the OML perpendicular to IR.

– When the patient cannot flex neck, place IOML perpendicular to IR.

– Place top of IR at the level of cranial vertex.

• Central Ray: – 30 degrees caudad to OML

or 37 caudad degrees to IOML.

• Respiration:– Obtain radiograph during

suspended respiration.

Reference point: 2 and ½” superior to nasion and passes through the level of EAM

Structure shown: internal acoustic canal, arcuate eminenses, labyrinths, mastoid anthrums, and middle ears.

Styloid Processes PA Axial Projecton - Cahoon Method

• Image Receptor: – 8 x 10’’

• Patient position:– Patient in seated-upright or prone

position.• Part position:

– Patient’s head resting on the forehead and nose.

– MSP perpendicular to IR.– OML perpendicular to IR.

• Central Ray:– directed at angle of 25 cephalad

• Reference point: – nasion

• Structure shown: – styloid process

Jugular ForaminaSubmentovertical Axial Projection -

Kemp Harper Method and Eraso Modification• Image Receptor:

– 8 x 10’’• Patient position:

– Kemp Harper method• For SMV axial projection,

patient is in supine or seated- upright position

• Trunk must be elevated.– Eraso modification

• Same position• Part position:

– Kemp Harper method• MSP of the body and head to

the midline of the grid.• Patient’s head resting on

vertex.• OML parallel to the plane of

IR.

• Eraso modification MSP of the body and head to the midline of the grid.

Patient’s head resting on vertex. OML place 25 degrees to IR

Central Ray: Kemp Harper method

directed at 20 degreesEraso modification

Perpedicularly directed

Reference point: Kemp Harper method

1” distal to the mandibularEraso modification

2” distal to the mandibular

Structure shown: Jugular foramina

• Hypoglossal Canal - Miller Method

• Image Receptor: – 8 x 10’’

• Central Ray: – directed at angle of 12

degrees caudad• Reference point:

– 1” directly anterior to and ½” inferior to the level of EAM

• Structure shown: mandibular condyle

That's the end of our

projections, Dr. Matindi...

LAST...

Enumerate the 22 bones of the Skull (8 cranial bones and 14 facial bones)

AFTERNOON SPINE THORAX PELVIS12 1 - 1

13 1 1 1

14 - 1 1

15 2 - 2

16 2 - -

17 3 3 3

LAST 36 44 30

TOTAL ACCUMULATED SCORE

102 98 87

HIGHEST ACHIEVABLE SCORE

125

> Congratulations!GROUP SPINE (CHAMPION)GROUP THORAX (PERFECT SKULL)GROUP PELVIS (2ndRunnerUp)

> Thank you for your active participation!> See you again next time!

END...