skull presentation by neha singh.pptx

this is the cranium views data.

1. Cranium views with general anatomy BY: Neha Singh reg. no: 210513006 MRIT 2 nd semester

2. Content: Introduction Surface landmarks Baseline Tube angulation Radiological consideration Patient preparation Equipement preparation Basic views Special views Questions Reference

3. INTRODUCTION The radiographic examination of skull is given under two headings: cranial and facial. Cranium is formed by number of flat and irregular bones. It helps to protect the brain. It has a base upon which brain rests and a vault that surrounds and covers it. In the mature skull the joints(sutures) between the bones are immovable. The bones have numerous perforations through which nerves, blood and lymph vessels pass. The bones of the cranium are: 1frontal bone 1occipital bone 2parietal bone 1sphenoid bone 2temporal bone 1 ethmoid bone

4. Cranium bones :

5. Surface landmarks: GLABELLA: smooth prominence between eyebrows and above the bridge of nose. NASION: it is the depression at the bridge of the nose. VERTEX: it is the most superior portion of the skull or very top of the cranium. INNER CANTHUS: it is the portion where eyelids meet near the nose. OUTER CANTHUS: lateral junction of the eyelids is termed as outer canthus.

6. Base line Two lines are in general use, as they meet at an angle of approximately 10 degree. ORBITO-MEATAL BASE LINE : also known as radiographic base line. It extends from the outer canthus of the eyes to the central point of the external auditory meatus. ANTHROPOLOGICAL BASE LINE : also known as the anatomical base line. It extends from the infra-orbital margin to the upper border of the external auditory meatus.

7. Tube angulation: CRANIO-CAUDAL: it is used to indicate the direction of tube angulation towards feet. CAUDO-CRANIAL: it is used to indicate the direction of tube angulation towards head.

8. Radiological consideration: Head injury R outine skull xray before any special examination i.e , angiography. SOL (space occupying lesion) Calcification (pineal gland present in sella turcica) Bone structure Myeloma (secondary) Encephalitis Destructive bone process at base of skull causing compression of nerves

9. Patient preparation : Before examination, opaque accessories should be removed from the head and neck. This may include hairpins, clips, ear-rings, artificial dentures, glasses and neck ornaments. L.M.P. should be check in young female patients. EQUIPEMENT: to minimize the risk of gross infection the table must be cleaned after use with antiseptic solution and gauze swabs.

10. Basic views: 1. fronto -occipital (AP) 2.occipito-frontal (PA) 3.Lateral view Special views: 1.calds-wells view 2.town’s view 3.SMV( sub-mento vertical view)

11. Fronto -occipital view: POSITION : Patient in supine position, with the head raised on small non-opaque pad. This allows the head to be flexed slightly forward with the chin towards the chest. Hands resting by the side or resting on the chest . Knees, slightly flexed for patient’s comfort. CENTRE: with the straight tube, centre over the glabella. RBL should be perpendicular to the film. KvP : 65-70 MaS : 40-45

12. Occipito -frontal view: POSITION: patient in the prone position, the head is adjusted to bring the nose and forehead towards couch. Hands are placed under the chest to assist immobilization and ankles are supported over a sandbag to avoid pressure on the toes. CENTRE: two inches below the base line. Radiographic base line should be perpendicular to film. Kvp : 65-70 mAS : 40-45 X-ray should be done with grid.

13. Lateral view: POSITION : the patient is placed in prone position with the head turned to bring affected side towards the film. Opposite shoulder being raised and supported on non-opaque object. The head is adjusted to true lateral position with the inter-orbital line perpendicular to film and RBL parallel to film. CENTRE : central ray being 90degree,1inch above the EAM. Kvp : 65-67 mAS : 35-38 Grid should be used.

14. CALD-WELLS VIEW: POSITION: Patient supine, head is raised on a small non-opaque pad so that the head flexed forward. Hands are resting by the side as per patient’s comfort. CENTRE: Tube angled 20degree towards head, central ray should pass through the orbits. RBL should be perpendicular to film. Kvp : 70-75 mAS : 42-45 Grid should be used.

15. Town’s view: POSITION : Patient is in supine position with the chin well down on the chest so that the base line should be perpendicular to the film. Hands resting by the side or above the chest as per patient comfort. CENTRE: tube angle towards the feet. Central ray should pass 2inches above the glabella or centre above the hair line. Kvp : 65-70 mAS : 45-47 Grid should be used.

16. Sub-mento vertical view: POSITION : the patient is in sitting position and neck is allowed to extend backward until the vertex of the skull is in contact with the couch. The possible degree of extension of Neck varies with each patient. The ideal position of the head being obtained when the base line is parellel to film. CENTRE: between the angle of the jaw with the central ray at an angle of 95 degree to the baseline. Kvp : 76-80 mAS : 48-50 Grid should be used.

17. Questions: 1 . Which routine skull view is more preferred and why? 2.In which case town’s view is required? REFERENCE: Clarks book of positioning