Skull Radiography techniques and reporting

Skull Radiography techniques and reporting

1. RADIOLOGY OF SKULL- TECHNIQUES AND REPORTING -DR. BHAVANA

2. THE SKULL

3. SKULL – ANTERIOR VIEW

4. SKULL – ANTERIOR VIEW

5. SKULL – LATERAL VIEW

6. SKULL – LATERAL VIEW

7. SKULL –BASAL VIEW

8. SKULL –BASAL VIEW

9. SKULL – SAGITTAL SECTION

10. SKULL – SAGITTAL SECTION

11. PARANASAL SINUSES

12. SKULL TOPOGRAPHY

13. EXPOSURE TABLES A s per WHO manual of diagnostic imaging

14. 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.

15. USEFUL ACCESSORIES

16. CRANIUM LATERAL PA PA- AXIAL (CALDWELL) AP-AXIAL (TOWNE)

17. CRANIUM - LATERAL Semiprone IOML is parallel to cassette Central ray : perpendicular , 5cm superior to EAM

18. CRANIUM – LATERAL DORSAL DECUBITUS Position : supine Interpupillary line perpendicular to cassette Central ray: perpendicular 5cm superior to EAM

19. 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.

20. CRANIUM – AP PROJECTION Position : supine IOML perpendicular to cassette Central ray :perpendicular 5cm above nasion

21. 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.

22. CALDWELL METHOD PA AXIAL projection Position : prone/seated OML perpendicular to cassette Central ray - directed to exit nasion 15 degree caudad

23. PETROUS PYRAMID PROJECTED IN LOWER THIRD OF ORBITS POSTERIOR ETHMOID AIR CELLS CRISTA GALLI FRONTAL SINUSES

24. CRANIAL BASE SUBMENTOVERTICAL PROJECTION (SCHULLER’S METHOD)

25. CRANIAL BASE -SCHULLER METHOD Submentovertical projection position: IOML parallel to cassette Central ray -perpendicular to IOML between angles of the mandible 2cm anterior to level EAM

26. PETROUS BONES MASTOID PROCESSES MAXILLARY SINUSES SPHENOID SINUS DENS FORAMEN OVALE MANDIBLE ZYGOMATIC SOFT TISSUES

27. SELLA TURCICA LATERAL PROJECTION

28. SELLA TURCICA LATERAL PROJECTION Position: semiprone / seated IOML parallel to cassette Central ray : perpendicular 2 cm anterior and superior to EAM

29. SHAPE OF SELLA , DORSUM SELLA AND CLINOID PROCESSES. SPHENOID SINUS NEUROCRANIUM FOR CALCIFICATION

30. ORBIT PARIETO-ORBITAL OBLIQUE PROJECTION (RHESE METHOD)

31. 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

32. SUPERIOR ORBITAL MARGIN LATERAL ORBIT MARGIN OPTIC CANAL AND FORAMEN MEDIAL ORBITAL MARGIN LESSER WING OF SPHENOID ETHMOID SINUS INFERIOR ORBITAL MARGIN

33. FACIAL BONES LATERAL PROJECTION PARIETO-ACANTHAL PROJECTION (WATER’S)

34. FACIAL BONES- LATERAL Position: semiprone / seated Mid-sagittal plane parallel to cassette Central ray : perpendicular, between outer canthus and EAM

35. FRONTAL SINUS NASAL BONE SELLA TURCICA MAXILLARY SINUS EXTERNAL AUDITORY MEATUS MANDIBLE

36. 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

37. FRONTAL SINUS ORBITS ZYGOMATIC ARCH PETROUS RIDGE MAXILLARY SINUS MAXILLA NASAL SEPTUM MANDIBLE DENS

38. NASAL BONES LATERAL PROJECTION TANGENTIAL PROJECTION

39. 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

40. NASAL BONE FRONTONASAL SUTURE ANGLE BETWEEN NASAL AND FRONTAL BONES DENSITIES/ LUCENCIES CONTOURS SOFT TISSUE

41. NASAL BONES- TANGENTIAL Position: seated / recumbent Inclined cassette Central ray: parallel to glabelloalveolar line

42. Septal cartilage Nasal bone

43. PARANASAL SINUSES PA AXIAL PROJECTION- CALDWELL PARIETOCANTHAL PROJECTION- WATER’S PARIETOCANTHAL PROJECTION – WATER’S WITH OPEN MOUTH

44. CALDWELL METHOD PA axial projection CALDWELL METHOD Position : extend patient’s head IOML forms 15 degree with horizontal central ray Central ray : horizontal – exit at nasion

45. FRONTAL SINUS ETHMOIDAL SINUS PETROUS RIDGE SPHENOIDAL SINUS MAXILLARY SINUS

46. Maxillay sinuses – WATER S 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

47. FRONTAL SINUS ETHMOIDAL SINUSES MAXILLARY SINUSES PETROUS RIDGE MASTOID AIR CELLS ORBIT

48. 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

49. MAXILLARY SINUS SPHENOIDAL SINUSES

50. ZYGOMATIC ARCH SUBMENTOVERTICAL PROJECTION TANGENTIAL PROJECTION –MAY METHOD

51. ZYGOMATIC ARCH-SUBMENTOVERTICAL PROJECTION Position: upright/ supine Hyperextend neck-IOML parallel to cassette Central ray : perpendicular to IOML 2.5cm posterior to outer canthi

52. SHAPE – A LOW ARCH BROADENED AT BOTH ENDS S TRUCTURE AND CONTOUR OF THE ZYGOMATIC ARCH SKULL AND FACIAL SKELETON SOFT TISSUE

53. MAY METHOD Tangential projection/ MAY method Position: prone/upright Neck extended-rest chin on cassette Mid-sagittal plane rotated 15 degree away from side being examined Central ray : perpendicular to IOML-3.8cm posterior to outer canthus

54. SHAPE AND STRUCTURE OF ZYGOMATIC ARCH SOFT TISSUES

55. MANDIBLE AXIOLATERAL OBLIQUE PROJECTION

56. 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

57. RAMUS: head in true lateral position BODY : rotate head – 30 degree towards cassette SYMPHYSIS : rotate head – 45 degree toward cassette

58. MANDIBLE SHAPE, WIDTH , ANGLE, MANDIBULAR CANAL AND CONDYLES MAXILLA, MAXILLARY SINUS NASAL CAVITY DENTITION SOFT TISSUES

59. Temporomandibular joint AP axial projection Axiolateral oblique projection

60. TEMPOROMANDIBULAR JOINT AP AXIAL PROJECTION Position : flex neck – OML is perpendicular to cassette Central ray : 35 degree caudad , midway between TMJs, 7.5 cm above nasion

61. Condyle Ramus of mandible

62. TEMPEROMANDIBULAR JOINT -AXIOLATERAL OBLIQUE PROJECTION Position : mid-sagittal plane 15 degree toward cassette Central ray : 15 degree caudad – 3.8 cm superior to EAM

63. Mandibular fossa Articular tubercle External auditory meatus Condyle of the mandible

64. 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

65. ORBITS AND ZYGOMA JAWS- HARMONIOUS CURVE NOSE – SEPTUM MAXILLARY SINUSES TEMPOROMANDIBULAR JOINT AND MANDIBULAR ANGLE DENTITION SOFT TISSUES

66. PETROMASTOID AXIOLATERAL (SCHULLER’S METHOD) AP AXIAL (TOWNE METHOD) AXIOLATERAL OBLIQUE (LAWS METHOD) AXIOLATERAL OBLIQUE- POSTERIOR PROFILE (STENVERS METHOD)

67. PETROMASTOID PORTION – SCHULLER’S METHOD Axial lateral projection Position: Prone or supine IOML parallel to cassette Central ray : Directed to exit EAM closest to cassette 25 degree caudad.

68. 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

69. PETROMASTOID PORTION – TOWNE METHOD AP Axial Position: Supine/Upright, neck flexed OML perpendicular to cassette Central ray 30 caudad to OML

70. DORSUM SELLA ARCUATE EMINENCE INTERNAL ACOUSTIC CANAL LABYRINTH MASTOID AIR CELLS

71. 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

72. MASTOID ANTRUM MASTOID AIR CELLS SUPERIMPOSED INTERNAL AND EXTERNAL ACOUSTIC MEATUSES MANDIBULAR CONDYLE MASTOID PROCESS SOFT TISSUES

73. PETROMASTOID PORTION -STENVERS VIEW AXIOLATERAL OBLIQUE- POSTERIOR PROFILE prone position, or seated . Head 45 degrees to the cassette Central ray-Directed 12 degrees cephalad.

74. CALVARIA PETROUS BONE EXTERNAL ACOUSTIC MEATUS INTERNAL ACOUSTIC CANAL ARCUATE EMINENCE MASTOID CELL AND MASTOID PROCESS MANDIBULAR CONDYLE SOFT TISSUES

75. Styloid process –CAHOON METHOD PA axial Rest forehead on cassette OML perpendicular to cassette Central ray : nasion – 25 degree cephalad

76. STYLOID PROCESS RAMUS OF THE MANDIBLE

77. BIBLIOGRAPHY Ballinger Philip, Frank Eugene, Merill’s Atlas of Radiographic positions and Radiologic Procedures , 9 th edition , Missouri , Mosby Publication 1999 , 1-44, 380-465. Whitley Stewart, Sloane Charles, Hoadle Graham, Moore Adrian , Clark’s Positioning in Radiography 12 th edition, London, Arnold publication 2005,20-47 Adam A, Dixon A K, Grainger and Allison’s Diagnostic radiology, A textbook of Medical Imaging, 5 th edition, China, Elsevier Churchill Livingstone,2008 Moeller B Torston , Normal findings in Radiology, New york , Thieme,2000,P 1-34.

78. THANK YOU.