2nd week(THU)+3rd week(SUN).ppt

8/12/2019 2nd week(THU)+3rd week(SUN).ppt

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SkullRadiography


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Cranial bones (8)

Skull Cap (calvarium):

1 Frontal2 Parietal (R,L)

1 Occipital

Skull Base (floor):2 Temporal (R,L)

1 Sphenoid

1 Ethmoid


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Facial bones (14)

2 Maxillary

2 Zygomatic

2 Lacrimal

2 Nasal

2 Palatine

2 Inferior nasal conche

1 Vomer

1 Mandible


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Frontal

ParietalTemporal

Zygoma

Nasal

Vomer

Maxilla

Mandible

Frontal View


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FrontalNasal

Zygoma

MaxillaMandible

ParietalSphenoid

Temporal

Occipital

External Auditory Meatus

Mastoid Process

Lateral View


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VomerFrontal

Parietal

Occipital

Temporal

Foramen

Magnum

Sphenoid

Superior View


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Frontal

(Coronal)

Sagittal

Squamous

Lambdoid

Sutures


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Sagittal

Lambdoid

Sutures

Frontal

Superior Aspect


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9

Skull Landmarks

1. Vertex

2. External Occipital Protuberance (E.O.P.)

3. External Auditory Meatus4. Outer Canthus Of Eye.

5. Infra-orbital point

6. Nasion

7. Glabella


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The Anthropological line

The Isometric Baseline which runs from the inferior orbital margin to the upper border of the external auditory Meatus (EAM )

The Orbital- Meatal Line

The original Baseline which runs from the Nasion through the outer Canthus of the eye to the centre of the external auditory

Meatus.

The Interpupillary line

The line connects the centers of the orbits and is at 90 degree to the median Sagittal plane.The Auricular Line

This line passes at 90 degrees to the anthropological line through the centre of the external auditory meatus.

( Note: there is a difference of 10 to 15 degrees between the Orbital-Meatal line and the anthropological line.)

1 2 3 4

1

2

3

4

Skull positioning lines


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Cranial Topography

Glabella:raised triangular area bet. eyebrows.

Nasion:depression at the bridge of the nose.

Acanthion:nose and upper lip meet

Tragus:cartilage. flap covering ear opening.

Gonion:angle of mandible.

Inion: prominent point of EOP.


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Some Indications for skull Imaging

Linear fractures

Depressed fractures

Basal skull fractures

Gunshot woundsMetastases

osteoplastic lesions

Multiple myeloma

Pituitary adenomasAcoustic neuroma

Sinusitis

Para nasal sinuses polyps

Otitis media


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TECHNICAL ASPECTS

Sitting erect positions are preferred to exclude any air-fluid

levels within the cranial cavities or sinuses.

Patient comfort and skull immobilization are necessary.

Exposure factors range between 75 -85 KVp. A small

focus is to be used with short times and high mA.

A grid (40 lines/inch) must be used.

Good collimation (Narrow cone for small parts) and non-repeats

helps in minimizing the radiation exposure to the patient.

A contact shield should be used over the neck and chest to reduce

the exposure to the thyroid .


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Common Positioning ErrorsRotation and tilt are two of the most common positioning errors.

A. Rotation occurs when the median Sagittal plane is not parallel to the film.

B. Tilt occurs when the Interpupillary line is not at 90 to the film.


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PA Skull (0Occipital-frontal) projection B

For frontal bone, #s and neoplastic processes of the

cranium, Pagets disease, orbits (obscured by

petrous temporal), I.A.M, frontal and ethmoidal

sinuses, dorsum sellae.

Patient nose and forehead against the couch center,

neck flexed so that OML is 90to the couch, MSP

90to couch center, head not rotated, EAMS

equidistant from the couch top.

Film:HD 24x30 cm

CR: 0(that is 90

) to film center ( for frontal bone)

CP: Exits at the glabella

NB/ AP is not recommended as it exposed eyes to

more dose


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PA Skull (15Caldwell) projectionB

For #s, neoplastic processes of frontal, parietal and

facial bones, and for cranium and an unobstructed

view of the orbits, I.A.M, frontal and ethmoidal

sinuses, clinoids, dorsum sellae, zygomatic bones.

Same position as for PAFilm: HD 24x30 cm

CR: 15caudal (for showing the petrous ridges).

CP: Exits at the naison.

25- 30gives better view of orbital rim and floors

and superior orbital fissure.


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PA Axial Skull (Haas projection ) B

An alternate projection for the Townes view if the

patient cannot flex his neck sufficiently

It results in reduced doses to facial structures and to

the thyroid.

It is not recommended, however, for the occipitalbone because of the magnification it produces.

Same position as for PA

Film: HD 24x30 cm

CR: 25cephalic to OML

CP: Through level of EAMs


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PA (or PA Axial) Skull (for mandible ) B

Best for the body of mandible for #s,inflammatory and neoplastic processes.

PA axial well shows rami and elongated

view of condyloid process.

Patient positioned as for PA (0),

chin tucked so that OML is 90to film, MSP

90to the couch top, head not rotated.

Film:HD 24x30 cm

CR and CP :

PA:90to film center (CPto junction of the

lips).

PA axial: 20- 25cephalic (CPto the

acanthion)


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21

AP Axial (Townes projection) B

For occipital bone, cranial #s, neoplasm's, and

Pagets disease. Also for AP dorsum sellae, and

advanced pathology of the temporal bone ,anterior

clinoids, foramen magnum, mastoids,

Patient supine, or in erect AP sitting, chin is

depressed (OML 90to film), no rotation of the head

Film:HD 24x30 cm

CR: 30caudal to orbitomeatal line

37 to infraoribtomeatal line

CP:(2 cm superior to level of EAMs).


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Submentovertex (SMV) B

For base of the skull (Basilar view), occipital

bone, mandible, foramen ovale and foramen

magnum, TMJs, orbits, zygomatic arches,

sphenoid, maxillary sinuses and mastoid

processes.

Patient supine or erect sitting, chin raised,

neck hyper extended till IOML is parallel to

film, MSP 90to couch top. A pillow under

patients back allows for sufficient extension.

Film:HD 24x30 cm.

CR: 90to IOML.

CP: (2cm anterior to level of EAMs)

Midway between angles of mandible


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Submentovertex (SMV) (for mandible) S

Entire mandible.( head .neck ,coronoid andcondyloid processes)

Patient supine or erect sitting, chin raised,

neck hyper extended till IOML is parallel to

film, MSP 90to couch top. A pillow under

patients back allows for sufficient extension.

Film:HD 18x24 cm

CR: 90to IOML.

CP: Midway between angles of mandible(4 cm inferior to mandibular symphysis).


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Submentovertex (SMV) (for zygomatic arches) B

For zygomatic arches(usually taken as a soft-tissue technique).

Patient supine or erect sitting, chin raised, neck

hyper extended till IOML is parallel to film, MSP

90to couch top. A pillow under patients back

allows for sufficient extension.

Film: HD 18x24 cm

CR: 90to film.

CP: Midway between zygomatic arches

(4cminferior to mandibular symphysis).


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Oblique Inferosuperior Tangential (for zygomatic arches) S

For zygomatic arch. Specially useful in case ofdepressed zygomatic arches (skull trauma).

Patient positioned as for the SMV, head rotated 15

toward side of interest, then chin tilted 15toward

side of interest.

Film: HD 18x24 cm

CR: 90to IOML.

CP: Zygomatic arch of interest.


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Lateral Skull (general) B

Same indication as for PA (0). A horizontalbeam is used for trauma cases to show air-fluidlevels in the sphenoid sinus

Patient in a semi prone (Sims position),recumbent or erect sitting, head in a true lateral(required side close to the film), MSP paralleland IPL 90to couch top.

Film:HD 18x24 cm

CR: 90to film center .

CP:5 cm ( 2 inch )superior to EAM .


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Lateral Skull (for lateral Sella Turcica) B

To show evidence of pituitary adenomas.

Same position as for the lateral skull (as inSims position), chin adjusted so that both IPL is90and MSP parallel to couch top.

Film:HD 18x24 cm

CR: 90to film center

CP: 2 cm anterior and 2 cm superior to EAM.

NB/

(1) Both laterals may be done with stress on

macro radiography.(2) A long narrow (slender) cone should be

used.


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Lateral Skull (for lateral facial bones) B

For fractures, neoplastic or inflammatory processesof facial bones, orbits, and the mandible.

Head in true lateral (same position as for lateralskull as in Sims position), chin adjusted so thatboth IPL is 90and MSP parallel to couch top.

Film: HD 18x24 cm


CP: Zygoma (midway between the outer canthus

and EAM)


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Lateral Skull (for sinuses) B

For inflammatory conditions: e.g. :sinusitis, andsinus polyps

For sphenoid, frontal, ethmoidal, and maxillarysinuses.

Patient erect sitting, head in true lateral (IPL 90and MSP parallel to IR)

Film: HD 18x24 cm

CR: 90horizontal to film center

CP: Midway between outer canthus and EAM


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Lateral Skull (for nasal bones) B

For nasal bone fractures.

Head in true lateral (same position as for lateral skull as in Sims position)

Film: HD 18x24 cm


CP: 1.25 cm(.5 inch) inferior to naison

NB/ A long narrow cone should be used.


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Tangential Superoinferior (Axial) (nasal bones) S

For fractures of the nasal bones.

Patient prone or in the erect sitting, chinextended and rested on cassette, anglesupport under film, glabelloalvolar line (GAL)

90to cassette, long narrow cone used

Film: HD 18x24 cm (or occlusal film).

CR: Angle as needed to ensure CR is

parallel to GAL.

CP: Naison (parallel to GAL).


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Axiolateral (Schller for mastoids) S

For pathology of the mastoid air cells.

Patient prone or erect, head in the true lateral,IPL 90to film, MSP parallel to the film.

Film: HD 18x24 cm

CR: 25- 30caudal.CP: downside mastoid tip

(4 cm superior, 4 cm posterior to upside EAM).


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Lateral 15(Modified Law for TMJs) S

For pathology of the mastoid process.

Patient prone or erect, head in lateral,IPL 90to film.

Face( and MSP) parallel , then rotated15toward the film.

Film: HD 18x24 cm

CR: 15caudal to pass through the

downside TMJ.

CP: 4 cm superior to upside EAM


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Axiolateral Oblique (Modified Law for mastoids) B

For advanced pathology of mastoids.Patient prone or erect, each auricle taped

forward, head in lateral, then rotated 15

oblique toward the film, IPL 90to couch, side

of interest down.

Film:HD 18x24 cm

CR: 15 caudal

CP: Exit downside mastoid tip

(1 inch posterior, 1 inch superior to

upside EAM).


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PA Axial Skull (Caldwell projection for sinuses) B

Good for sinuses (frontaland anteriorethmoidalsinuses). Also shows other inflammatoryconditions such as sinus polyps).

Patients nose and forehead against film, neck

extended so that OML is 15from the horizontal

Film: HD 18x24 cm

CR: 90horizontal to film center (or 15caudal

with OML 90to the film).

CP: exit at Naison


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Parietoacanthial (OM) (Waters Method for sinuses ) B

Best for maxillary and frontal sinuses and nasal

Fossa.

Patient erect, neck extended, chin and nose against

couch, head adjusted till MML is 90to the film, OML

makes 37with film.

A long narrow cone should be used.

Film: HD 18x24 cm


CP: Exit at the acanthion.


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Parietoacanthial (OM) (Open-Mouth Waters for sinuses ) B

Same as for Waters..

Same position as for Waters view, but withopen mouth (patient drops his jaw withoutmoving the head).

Film:HD 18x24 cm.


CP: Exit at the acanthion.


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AP Axial (Townes projection for AP Sella Turcica) B

Detects pituitary adenomas in the sella turcica. Also

shows dorsum sellae, posterior clinoids, occipital

bone, petrous pyramids, the foramen magnum,

mastoids air cells, and zygomatic arches

Same position as for Towne (AP)

Film: HD 18x24 cm

CR: 37caudal (for the dorsum sellae and the

posterior clinoids

30caudal (for anterior clinoids)

CP: 4 cm above superciliary arch


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AP Axial (Townes projection for mandible) B

For #s, neoplastic or inflammatory processes of thecondyloid processes of the mandible.

Same position as for Towne AP (OML 90to couch

top.

Film:HD 18x24 cm

CR: 35- 40caudal

CP: Glabella (To pass through midway between

EAMs and angles of the mandible


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Lateral 25- 30(Axiolateral) (for mandible) B

For #s, neoplastic, or for inflammatoryprocesses of the mandible (both sides aredone for comparison) .

Head in true lateral with MSP parallel to the

film, side of interest placed against the film,mouth closed, head then rotated in oblique

30(for the body),

45(for mentum),

10- 15for a (general survey).

Film: HD 18x24 cmCR: 25cephalic.

CP: Mandibular region of interest (body,ramus, .).


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Axioanterior Oblique (Stenvers for mastoids) B

For advanced pathology of temporal bone,e.g., acoustic neuroma. Both sides are to beexamined.

Patient prone or erect, IOML 90to film, chinadjusted so that head is rotated 45obliquewith the couch, side of interest down,downside mastoid region centered to film.

Film:HD 18x24 cm CR: 12cephalic.

CP: 3-4 inch posterior, and .5 inch inferior

to upside EAM to exit through downside

mastoid process.


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Parieto-orbital (Rhese View) for optic foramina S

For bony abnormalities of the optic foramen.Both sides must be done for comparison.

Patient prone or erect, chin, cheek, and noseagainst couch, head adjusted so that theMSP makes 53 with the couch top, the

acanthiomeatal line AML makes 90

to thefilm, a long narrow cone should be used.

Film: HD 18x24 cm

CR: 90to IOML

CP: Downside orbit (7 cm above and 7 cm

behind the up EAM).

Note

Correct position project the optic foramen

into the lower outer quadrant of orbit


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ORTHOPANTOMOGRAPHY (tomography of the mandible) S

For #s of the mandible and TM joint.

Tube and film attached at starting position, chin rest

raised to same level as patients chin, chin rested on

a sterile bite block, patient as close as possible tothe tube stand, chin adjusted until IOML is parallel

with the floor, occlusal plane declines 10from

posterior to anterior, patients lips placed together,

tongue on roof of the mouth.

Film: HD 23x30 cm, or curved non-grid cassette

CP: Fixed CR and FFD. For TMJ, another film

must be done with open mouth.

2nd week(THU)+3rd week(SUN).ppt

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