Skull Radiography techniques and reporting
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Transcript of Skull Radiography techniques and reporting
PATIENT PREPARATION• Ensure that all metal objects are removed from the patient, e.g.
hair clips and hairpins. • Bunches of hair often produce artefacts and thus should be untied. • False teeth containing metal and metal dental bridges should be
removed.
CRANIUM - LATERAL•Semiprone IOML is parallel to cassetteCentral ray : perpendicular , 5cm superior to EAM
CRANIUM – LATERAL DORSAL DECUBITUS
•Position : supineInterpupillary line perpendicular to cassette Central ray: perpendicular 5cm superior to EAM
CHECKLIST• SHAPE AND SIZE• THE THREE LAYERS INNER TABLE, DIPLOE AND
OUTER TABLE.• MINERALIZATION- CIRCUMSCRIBED DENSITIES,
DECALCIFICATION• VASCULAR MARKINGS• CONTOURS –ANY SPICULES / DISCONTINUITIES• CRANIAL SUTURES• CRANIAL CAVITY- CALCIFICATIONS?• SKULL BASE – ANTERIOR, MIDDLE AND
POSTERIOR CRANIAL FOSSA ; AND SELLA• FRONTAL SINUS, ETHMOID SINUS, MAXILLARY
SINUS, SPHENOID SINUS, MASTOID AIR CELLS• FACIAL BONES – ORBIT, NASAL CAVITY, PALATE • CERVICAL SPINE – POSITION AND DENS• SOFT TISSUES.
•
CRANIUM – AP PROJECTION•Position : supineIOML perpendicular to cassette Central ray :perpendicular 5cm above nasion
CHECKLIST• SHAPE AND SIZE• THE THREE LAYERS INNER TABLE, DIPLOE AND
OUTER TABLE.• MINERALIZATION, CIRCUMSCRIBED DENSITIES,
DECALCIFICATION, CONVOLUTIONAL MARKINGS• VASCULAR MARKINGS• CONTOURS –ANY SPICULES / DISCONTINUITIES• CRANIAL SUTURES• CRANIAL CAVITY- CALCIFICATIONS? • CRISTA GALLI• DORSUM SELLAE• FACIAL BONES – ORBITS FILLED BY PETROUS
PYRAMID, MAXILLARY SINUS, NASAL CAVITY ,FRONTAL SINUSES AND POSTERIOR ETHMOID AIR CELLS
• DENS• SOFT TISSUES.
CALDWELL METHOD•PA AXIAL projection•Position : prone/seated OML perpendicular to cassette Central ray - directed to exit nasion 15 degree caudad
•PETROUS PYRAMID PROJECTED IN LOWER THIRD OF ORBITS
•POSTERIOR ETHMOID AIR CELLS
•CRISTA GALLI•FRONTAL SINUSES
CRANIAL BASE -SCHULLER METHOD
•Submentovertical projection
position: IOML parallel to cassette Central ray -perpendicular to IOML between angles of the mandible2cm anterior to level EAM
•PETROUS BONES•MASTOID PROCESSES•MAXILLARY SINUSES •SPHENOID SINUS•DENS•FORAMEN OVALE•MANDIBLE•ZYGOMATIC•SOFT TISSUES
SELLA TURCICA•LATERAL PROJECTION•Position: semiprone/ seated •IOML parallel to cassette •Central ray : perpendicular 2 cm anterior and superior to EAM
•SHAPE OF SELLA , DORSUM SELLA AND CLINOID PROCESSES.
•SPHENOID SINUS •NEUROCRANIUM FOR CALCIFICATION
ORBITPARIETO-ORBITAL OBLIQUE PROJECTION (RHESE METHOD)
•Position : semiprone / seated
•AML perpendicular to cassette
•Mid-sagittal plane 53 degree with cassette
•Central ray :perpendicular, 2.5 cm superior and posterior to upside TEA
•SUPERIOR ORBITAL MARGIN•LATERAL ORBIT MARGIN•OPTIC CANAL AND FORAMEN•MEDIAL ORBITAL MARGIN•LESSER WING OF SPHENOID•ETHMOID SINUS•INFERIOR ORBITAL MARGIN
FACIAL BONES- LATERAL•Position: semiprone / seated
•Mid-sagittal plane parallel to cassette
•Central ray : perpendicular, between outer canthus and EAM
Facial bones-WATER’S METHOD•Parieto canthal projection•WATERS method•Position: prone / seated•Neck hyperextended, OML 37 degree with cassette
•Central ray: perpendicular, exit the acanthion
•FRONTAL SINUS•ORBITS•ZYGOMATIC ARCH•PETROUS RIDGE•MAXILLARY SINUS•MAXILLA•NASAL SEPTUM•MANDIBLE•DENS
NASAL BONES- LATERAL•Position : seated / semiprone
•Mid-sagittal plane parallel to cassette
•Central ray : perpendicular to bridge of nose , 1.3 cm distal to nasion
•NASAL BONE•FRONTONASAL SUTURE•ANGLE BETWEEN NASAL AND FRONTAL BONES
•DENSITIES/ LUCENCIES•CONTOURS•SOFT TISSUE
NASAL BONES- TANGENTIAL•Position: seated / recumbent
•Inclined cassette•Central ray: parallel to glabelloalveolar line
PARANASAL SINUSES• PA AXIAL PROJECTION- CALDWELL• PARIETOCANTHAL PROJECTION- WATER’S• PARIETOCANTHAL PROJECTION – WATER’S WITH OPEN MOUTH
CALDWELL METHOD•PA axial projection•CALDWELL METHOD•Position : extend patient’s head
IOML forms 15 degree with horizontal central rayCentral ray : horizontal – exit at nasion
Maxillay sinuses – WATERS METHOD•Parietocanthal projection•Position:hyperextend patient’s neck
•OML forms 37 degree to cassette
•MML is perpendicular to cassette
•Central ray: perpendicular- exit at the acanthion
Maxillary and ethmoidal sinuses- OPEN MOUTH WATER’S•Parietocanthal projection•OPEN MOUTH WATERS•Position: OML 37 degree to cassette
•MML not perpendicular•Mouth open•Central ray: : perpendicular- exit acanthion
ZYGOMATIC ARCH-SUBMENTOVERTICAL PROJECTION
•Position: upright/ supine
•Hyperextend neck-IOML parallel to cassette
•Central ray : perpendicular to IOML
2.5cm posterior to outer canthi
• SHAPE – A LOW ARCH BROADENED AT BOTH ENDS
• STRUCTURE AND CONTOUR OF THE ZYGOMATIC ARCH
• SKULL AND FACIAL SKELETON• SOFT TISSUE
MAY METHOD•Tangential projection/ MAY method
•Position: prone/uprightNeck extended-rest chin on cassetteMid-sagittal plane rotated 15 degree away from side being examinedCentral ray : perpendicular to IOML-3.8cm posterior to outer canthus
MANDIBLE -AXIOLATERAL OBLIQUE PROJECTION•Position: long axis of of mandibular body parallel to cassette
•Central ray : 25 degree cephalad-to pass through the mandible region of interest
•RAMUS: head in true lateral position
•BODY : rotate head – 30 degree towards cassette
•SYMPHYSIS : rotate head – 45 degree toward cassette
• MANDIBLE SHAPE, WIDTH , ANGLE, MANDIBULAR CANAL AND CONDYLES
• MAXILLA, MAXILLARY SINUS• NASAL CAVITY• DENTITION• SOFT TISSUES
TEMPOROMANDIBULAR JOINTAP AXIAL PROJECTION
•Position : flex neck – OML is perpendicular to cassette
•Central ray : 35 degree caudad , midway between TMJs, 7.5 cm above nasion
TEMPEROMANDIBULAR JOINT -AXIOLATERAL OBLIQUE PROJECTION •Position : mid-sagittal plane 15 degree toward cassette
•Central ray : 15 degree caudad – 3.8 cm superior to EAM
ORTHOPANTOMOGRAPHY• Panoramic tomography, pan
tomography, and rotational tomography
• The x-ray tube and the IR rotate in the same direction around the seated and immobilized patient
• ORBITS AND ZYGOMA • JAWS- HARMONIOUS CURVE• NOSE – SEPTUM• MAXILLARY SINUSES • TEMPOROMANDIBULAR JOINT AND MANDIBULAR ANGLE • DENTITION• SOFT TISSUES
PETROMASTOID• AXIOLATERAL (SCHULLER’S METHOD)• AP AXIAL (TOWNE METHOD)• AXIOLATERAL OBLIQUE (LAWS METHOD)• AXIOLATERAL OBLIQUE- POSTERIOR PROFILE (STENVERS
METHOD)
PETROMASTOID PORTION – SCHULLER’S METHOD
•Axial lateral projectionPosition: Prone or supineIOML parallel to cassetteCentral ray : Directed to exit EAM closest to cassette 25 degree caudad.
• MASTOID ANTRUM• INTERNAL AND EXTERNAL
ACOUSTIC MEATUS• PETROUS PYRAMID- SUPERIOR
RIDGE, CITELLI ANGLE, PNEUMATIZATION, SIGMOID SINUS
• MASTOID PROCESS• TEMPOROMANDIBULAR JOINT –
GLENOID FOSSA , ARTICULAR TUBERCLE AND MANDIBULAR CONDYLE
• SOFT TISSUES
PETROMASTOID PORTION – TOWNE METHOD•AP Axial •Position: Supine/Upright, neck flexed
•OML perpendicular to cassette
•Central ray 300 caudad to OML
PETROMASTOID PORTION- LAWS VIEW• AXIOLATERAL OBLIQUE• Position- head in a true lateral.• IOML parallel to cassette.• Central ray -Directed at an
angle of 15 degrees caudad and 15 degrees anteriorly
• MASTOID ANTRUM• MASTOID AIR CELLS• SUPERIMPOSED INTERNAL
AND EXTERNAL ACOUSTIC MEATUSES
• MANDIBULAR CONDYLE • MASTOID PROCESS • SOFT TISSUES
PETROMASTOID PORTION -STENVERS VIEW• AXIOLATERAL OBLIQUE-
POSTERIOR PROFILE• prone position, or seated .
Head 45 degrees to the cassette
• Central ray-Directed 12 degrees cephalad.
• CALVARIA• PETROUS BONE• EXTERNAL ACOUSTIC MEATUS• INTERNAL ACOUSTIC CANAL• ARCUATE EMINENCE• MASTOID CELL AND MASTOID PROCESS• MANDIBULAR CONDYLE• SOFT TISSUES
Styloid process –CAHOON METHOD•PA axial•Rest forehead on cassette•OML perpendicular to cassette
•Central ray : nasion – 25 degree cephalad
BIBLIOGRAPHY•Ballinger Philip, Frank Eugene, Merill’s Atlas of Radiographic positions and Radiologic Procedures , 9th edition , Missouri , Mosby Publication 1999 , 1-44, 380-465.
•Whitley Stewart, Sloane Charles, Hoadle Graham, Moore Adrian , Clark’s Positioning in Radiography 12th edition, London, Arnold publication 2005,20-47
•Adam A, Dixon A K, Grainger and Allison’s Diagnostic radiology, A textbook of Medical Imaging, 5th edition, China, Elsevier Churchill Livingstone,2008
•Moeller B Torston, Normal findings in Radiology, New york , Thieme,2000,P 1-34.