skull radiography - Ayush Gupta (BRT, MRIT)

A skull x-ray is an imaging test of skull bones. A skull x-ray works by allowing your doctor to see the bones of the skull and other tissues or foreign objects inside your head.

1. SKULL RADIOGRAPHY Presented by – Mr. Ayush Kumar Gupta (Assistant Professor) Department of Radio-Imaging Technology Mewar university, Chittorgarh

2. SKULL – AP ( Fronto – occipital) Indications – This view demonstrates the fracture, tumors and other deformities and pathologies of the frontal bone, internal auditory canals, frontal sinuses, ethmoid sinuses and wings of the sphenoid. Patient positioning – The patient lies supine on the x-ray table. Both arms and forearms are relaxed at the side. The neck is flexed so that the orbito-meatal baseline is perpendicular to the IR. The median sagittal plane should be perpendicular to the IR.

3. Continue… Central ray - The vertical ray should parallel to the radiographic baseline and is centered over the glabella. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 70-75 mA – 200 mAs – 30-40 Exposure timer – 40/200 = 0.2 sec

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5. SKULL - lateral Indications – This view demonstrates the fracture, tumors and other deformities and pathologies of cranial bones, atlas, the sella turcica, clivus, sphenoid sinus and maxillary sinus. Patient positioning – The patient stands or sits facing the vertical IR. The head is rotated, so the median sagittal plane should parallel to the IR. The inter-orbital line should be perpendicular to the IR.

6. Continue… Central ray - The vertical ray is centered over the midpoint between the glabella and the external occipital protuberance (2” above the EAM). Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 60-70 mA – 200 mAs – 20 Exposure timer – 20/200 = 0.1 sec

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8. SKULL – PA ( Occipito – Frontal) Indications – This view demonstrates the fracture, tumors and other deformities and pathologies of the frontal bone, internal auditory canals, frontal sinuses, ethmoid sinuses and wings of the sphenoid. Patient positioning – The patient lies prone on the x-ray table. Both arms and forearms are relaxed at the side. The neck is flexed so the forehead and nose are touching the table, and the orbito-meatal baseline is perpendicular to the IR. The median sagittal plane should be perpendicular to the IR.

9. Continue… Central ray - The vertical ray should parallel to the radiographic baseline and is centered over the occipital bone to exit at the level of the glabella. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 75-80 mA – 200 mAs – 30-40 Exposure timer – 40/200 = 0.2 sec

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11. SKULL – AP AXIAL (TOWNE’S VIEW) Indications- The view demonstrates the fracture, tumors, and other deformities and pathologies of the occipital bone, petrous pyramids and foramen magnum. Patient positioning – The patient lies supine on the x-ray table. Both arms and forearms are relaxed at the side. The neck is flexed (chin down) so that the orbito-meatal baseline is perpendicular to the IR. The median sagittal plane should be perpendicular to the IR.

12. Continue… Central ray - The central ray is angled caudally at 30 degree with the radiographic baseline (OML) and centered at 6 cm superior to the glabella. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 75-80 mA – 200 mAs – 30-40 Exposure timer – 40/200 = 0.2 sec

13. SKULL – Submento-Vertical View (Base of Skull) Indications- The view demonstrates the fracture, tumors, and other deformities and pathologies of the cranial cavity – zygomatic arch, foramen magnum, occipital bone, foramen ovale, mandible, sphenoid and ethamoid sinuses. Patient positioning – The patient lies supine on the x-ray table. Both arms and forearms are relaxed at the side. The patient shoulders are raised on the support, then the neck is hyperextended, and the head is leaned back, so the vertex of the skull is in contact with the bucky. The radiographic baseline should be parallel to the IR.

14. Continue… Central ray - The vertical ray should be centered over the midway between the angles of mandible ( gonion ). Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 75-85 mA – 200 mAs – 30-40 Exposure timer – 40/200 = 0.2 sec

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17. Mastoid Axio Lateral Oblique (Schuller’s View) 25 degree caudad Indications- The view demonstrates the injury, tumors, deformities and other pathologies like Mastoiditis, cholesteatoma of the petrous portions, temporal bones, mastoid air cells, antrum, mastoid process, auditory meatuses, mandibular condyle and the soft tissues. Patient positioning – The patient lies prone on the x-ray table. The head is rotate laterally, so the median sagittal plane should parallel to the IR. The inter-orbital line should be perpendicular to the IR, and the IOML should parallel to the cassette. The mastoid process is centered to IR, and the auricle closest to the IR is folded.

18. Continue… Central ray - The central ray is angled 25 degrees caudally and centered at 5cm above and the 2.5cm behind the external auditory meatus.. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 50-60 mA – 200 mAs – 10-15 Exposure timer – 10/200 = 0.05 sec

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21. Petrous Bone Anterior Oblique (Stenver’s View) Indications- The view demonstrates the deformities and other pathologies of the temporal bone, the petrous portions, mastoid air cells, antrum, mastoid process, and the soft tissues. Both sides should be examined for comparison. It was also used to assess electrode placement following the insertion of a  cochlear implant . Patient positioning – The patient lies prone on the x-ray table. Both arms and forearms are relaxed at the side. The neck is flexed, so the forehead and nose are touching the table, and the orbito-meatal baseline is perpendicular to IR. The median sagittal plane should be perpendicular to IR. The head is rotated at 45 degrees toward the side under examination.

22. Continue… Central ray - The central ray is angled cephalic 12 degree and centered over the mid-point between the external occipital protuberance and the external auditory meatus. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 70-75 mA – 200 mAs – 20 - 25 Exposure timer – 20/200 = 0.1 sec

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24. Continue… Cochlear implant

25. PARANASAL SINUSES The four paired paranasal sinuses are located within the bones of the skull and the facial bones. The sinuses are air-filled spaces. The function of sinuses are decreasing the weight of the skull, increasing the resonance of speech, and serving as a buffer to protect structures during facial trauma. Maxillary Sinuses – the maxillary sinuses are the largest sinuses located under the eyes. Frontal Sinuses – the frontal sinuses are located above the eyes. Ethamoid Sinuses – the ethamoid sinuses are located between the eyes. Sphenoidal Sinuses – the sphenoidal sinuses are located behind the eyes.

26. Continue… For the evaluation of fractures, tumors, deformities and the other pathologies like sinusitis, polyps of the paranasal sinuses, the common radiographic projections are – PNS WATER’S VIEW – it is used maxillary and frontal sinuses and the nasal fossae. PNS LATERAL – it is used for the sphenoid, frontal, ethamoid and maxillary sinuses. CALDWELL VIEW - it is used for the frontal and ethamoid sinuses.

27. PNS WATER’S VIEW This view is also done in open and closed mouth. Patient positioning – The patient is seated against vertical IR or placed prone on the x-ray table. The neck is extended, and nose and chin are placed on the midline of the table or vertical IR. Both arms and forearms are relaxed at the side. The head is adjusted until the orbito-meatal line forms a 45 degree angle with IR. The anterior nasal spine is positioned to the middle of the IR.

28. CONTINUE… CENTRAL RAY – The vertical ray is centered over the occipital bone to exit the acanthion (the base of the anterior nasal spine.) Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 70-75 mA – 200 mAs – 25 - 30 Exposure timer – 30/200 = 0.15 sec

29. PNS LATERAL Patient positioning – The patient stands or sits facing the vertical image receptor. The head is rotated, so the median sagittal plane should parallel to the IR. The inter-orbital line should be perpendicular to the IR. CENTRAL RAY – The horizontal ray is centered over 2.5cm posterior to the outer canthus of the eye.

30. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 60-70 mA – 200 mAs – 20 - 25 Exposure timer – 20/200 = 0.1 sec

31. CALDWELL VIEW To demonstrate the air-fluid level in sinuses, specially for frontal and ethamoid sinuses. Patient positioning – The patient is seated or placed prone on the x-ray table. The neck is flexed, so the forehead and nose are touching the table or IR. The orbito-meatal line and median sagittal plane should be perpendicular to the IR.

32. Central ray – The central ray is angled 15 degree caudally and centered over the occipital bone so the central ray exit at the nasion. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 60-70 mA – 200 mAs – 20 - 25 Exposure timer – 20/200 = 0.1 sec

33. NASAL BONE - LATERAL The view demonstrates – nasal bone fracture, tumors, foreign bodies, infections and other pathologies. Patient positioning – The patient stands or sits facing the vertical image receptor. The head is rotated, so the median sagittal plane should parallel to the IR. The nasal bone is positioned to the center of IR. The inter – orbital line should be perpendicular to the IR. The patient’s head should in a true lateral position.

34. Central ray – The central ray is centered over the middle of the nasal bones. Both sides should be examined for comparison. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 60-70 mA – 200 mAs – 20 - 25 Exposure timer – 20/200 = 0.1 sec

35. NASAL BONES RIGHT & LEFT

36. MANDIBLE - PA The view demonstrates the fracture, tumors and other deformities and pathologies of the mandible. Patient positioning – The patient lies prone on the x-ray table. Both arms and forearms are relaxed at the side. The neck is flexed so the forehead and nose are touching the table, and the orbito-meatal baseline is perpendicular to the IR. The median sagittal plane should be perpendicular to the IR.

37. Central ray – The central ray is centered over the midpoint between the angles of the mandible. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 70-80 mA – 200 mAs – 16 - 20 Exposure timer – 20/200 = 0.1 sec

38. Images… CR

39. Images… FRACTURE

40. MANDIBLE - lateral Indications – The view demonstrates the fracture, tumors and other deformities and pathologies like swelling, sialolithiasis of the mandible. Patient positioning – The patient is placed supine on the x-ray table. The head is rotated, so the median sagittal plane should parallel and the mandible should be in true lateral position. The side of interest is placed against the IR. The neck is slightly extended to avoid superimposition of the gonion over the cervical spine.

41. Central ray – The central ray is angled 30 degree cranially and centered over 5 cm inferior to the angle of mandible. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 50-60 mA – 200 mAs – 4 - 6 Exposure timer – 4/200 = 0.02 sec

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44. Optic Foramina (Rhese View) PA Oblique Indications – The view demonstrates optic foramina and jugular foramina pathologies and orbital wall fractures, foreign bodies and other pathologies. Patient positioning – The patient is seated against vertical IR or placed prone on the x-ray table. The neck is extended and the nose and chin are placed on the midline of the table or vertical IR. Both arms and forearms are relaxed at the side. The head is rotated towards the side being examined so the midsagittal plane forms 40 degree angle with IR and the nose, chin and zygoma are in contact with the IR.

45. Central ray – The central ray is directed posterior to anterior and the centered over the 7.5 cm and 7.5 cm behind the external auditory meatus. Cassette size – 10”*12” inch or 24*30 cm Exposure factor – FFD – 100 cm KVp – 70-75 mA – 200 mAs – 16 - 25 Exposure timer – 25/200 = 0.125 sec

46. Images…

47. Continue… a – right optic canal b – optic strut c – superior orbital fissure d – ethamoid sinus e – planum sphenoidale f – greater wing of sphenoid