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Skull Radiography techniques and reporting

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Skull Radiography techniques and reporting

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Skull Radiography techniques and reporting

  1. 1. RADIOLOGY OF SKULL- TECHNIQUES AND REPORTING -DR. BHAVANA
  2. 2. THE SKULL
  3. 3. SKULL – ANTERIORVIEW
  4. 4. SKULL – ANTERIORVIEW
  5. 5. SKULL – LATERALVIEW
  6. 6. SKULL – LATERALVIEW
  7. 7. SKULL –BASALVIEW
  8. 8. SKULL –BASALVIEW
  9. 9. SKULL – SAGITTAL SECTION
  10. 10. SKULL – SAGITTAL SECTION
  11. 11. PARANASAL SINUSES
  12. 12. SKULLTOPOGRAPHY
  13. 13. EXPOSURETABLES As per WHO manual of diagnostic imaging
  14. 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. 15. USEFUL ACCESSORIES
  16. 16. CRANIUM • LATERAL • PA • PA- AXIAL (CALDWELL) • AP-AXIAL (TOWNE)
  17. 17. CRANIUM - LATERAL • Semiprone IOML is parallel to cassette Central ray : perpendicular , 5cm superior to EAM
  18. 18. CRANIUM – LATERAL DORSAL DECUBITUS • Position : supine Interpupillary line perpendicular to cassette Central ray: perpendicular 5cm superior to EAM
  19. 19. CHECKLIST • SHAPE AND SIZE • THETHREE LAYERS INNERTABLE, DIPLOEAND OUTERTABLE. • MINERALIZATION- CIRCUMSCRIBED DENSITIES, DECALCIFICATION • VASCULAR MARKINGS • CONTOURS –ANY SPICULES / DISCONTINUITIES • CRANIAL SUTURES • CRANIAL CAVITY- CALCIFICATIONS? • SKULL BASE – ANTERIOR, MIDDLEAND POSTERIOR CRANIAL FOSSA ; AND SELLA • FRONTAL SINUS, ETHMOID SINUS, MAXILLARY SINUS, SPHENOID SINUS, MASTOIDAIR CELLS • FACIAL BONES – ORBIT, NASAL CAVITY, PALATE • CERVICAL SPINE – POSITIONAND DENS • SOFTTISSUES.
  20. 20. CRANIUM – AP PROJECTION • Position : supine IOML perpendicular to cassette Central ray :perpendicular 5cm above nasion
  21. 21. CHECKLIST • SHAPE AND SIZE • THETHREE LAYERS INNERTABLE, DIPLOEAND OUTERTABLE. • 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 SINUSESAND POSTERIOR ETHMOIDAIR CELLS • DENS • SOFTTISSUES.
  22. 22. CALDWELL METHOD • PA AXIAL projection • Position : prone/seated OML perpendicular to cassette Central ray - directed to exit nasion 15 degree caudad
  23. 23. • PETROUS PYRAMID PROJECTED IN LOWER THIRD OF ORBITS • POSTERIOR ETHMOID AIR CELLS • CRISTA GALLI • FRONTAL SINUSES
  24. 24. CRANIAL BASE • SUBMENTOVERTICAL PROJECTION (SCHULLER’S METHOD)
  25. 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. 26. • PETROUS BONES • MASTOID PROCESSES • MAXILLARY SINUSES • SPHENOID SINUS • DENS • FORAMEN OVALE • MANDIBLE • ZYGOMATIC • SOFTTISSUES
  27. 27. SELLATURCICA • LATERAL PROJECTION
  28. 28. SELLATURCICA • LATERAL PROJECTION • Position: semiprone/ seated • IOML parallel to cassette • Central ray : perpendicular 2 cm anterior and superior to EAM
  29. 29. • SHAPE OF SELLA , DORSUM SELLA AND CLINOID PROCESSES. • SPHENOID SINUS • NEUROCRANIUM FOR CALCIFICATION
  30. 30. ORBIT • PARIETO-ORBITAL OBLIQUE PROJECTION (RHESE METHOD)
  31. 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 upsideTEA
  32. 32. • SUPERIOR ORBITAL MARGIN • LATERAL ORBIT MARGIN • OPTIC CANAL AND FORAMEN • MEDIAL ORBITAL MARGIN • LESSERWING OF SPHENOID • ETHMOID SINUS • INFERIOR ORBITAL MARGIN
  33. 33. FACIAL BONES • LATERAL PROJECTION • PARIETO-ACANTHAL PROJECTION (WATER’S)
  34. 34. FACIAL BONES- LATERAL • Position: semiprone / seated • Mid-sagittal plane parallel to cassette • Central ray : perpendicular, between outer canthus and EAM
  35. 35. • FRONTAL SINUS • NASAL BONE • SELLATURCICA • MAXILLARY SINUS • EXTERNAL AUDITORY MEATUS • MANDIBLE
  36. 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. 37. • FRONTAL SINUS • ORBITS • ZYGOMATIC ARCH • PETROUS RIDGE • MAXILLARY SINUS • MAXILLA • NASAL SEPTUM • MANDIBLE • DENS
  38. 38. NASAL BONES • LATERAL PROJECTION • TANGENTIAL PROJECTION
  39. 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. 40. • NASAL BONE • FRONTONASAL SUTURE • ANGLE BETWEEN NASAL AND FRONTAL BONES • DENSITIES/ LUCENCIES • CONTOURS • SOFTTISSUE
  41. 41. NASAL BONES-TANGENTIAL • Position: seated / recumbent • Inclined cassette • Central ray: parallel to glabelloalveolar line
  42. 42. • Septal cartilage • Nasal bone
  43. 43. PARANASAL SINUSES • PA AXIAL PROJECTION- CALDWELL • PARIETOCANTHAL PROJECTION- WATER’S • PARIETOCANTHAL PROJECTION –WATER’S WITH OPEN MOUTH
  44. 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. 45. • FRONTAL SINUS • ETHMOIDAL SINUS • PETROUS RIDGE • SPHENOIDAL SINUS • MAXILLARY SINUS
  46. 46. 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
  47. 47. • FRONTAL SINUS • ETHMOIDAL SINUSES • MAXILLARY SINUSES • PETROUS RIDGE • MASTOID AIR CELLS • ORBIT
  48. 48. Maxillary and ethmoidal sinuses- OPEN MOUTHWATER’S • Parietocanthal projection • OPEN MOUTHWATERS • Position: OML 37 degree to cassette • MML not perpendicular • Mouth open • Central ray: : perpendicular- exit acanthion
  49. 49. • MAXILLARY SINUS • SPHENOIDAL SINUSES
  50. 50. ZYGOMATICARCH • SUBMENTOVERTICAL PROJECTION • TANGENTIAL PROJECTION –MAY METHOD
  51. 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. 52. • SHAPE – A LOW ARCH BROADENED AT BOTH ENDS • STRUCTURE AND CONTOUR OFTHE ZYGOMATIC ARCH • SKULL AND FACIAL SKELETON • SOFTTISSUE
  53. 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. 54. • SHAPE AND STRUCTURE OF ZYGOMATIC ARCH • SOFTTISSUES
  55. 55. MANDIBLE • AXIOLATERAL OBLIQUE PROJECTION
  56. 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. 57. • RAMUS: head in true lateral position • BODY : rotate head – 30 degree towards cassette • SYMPHYSIS : rotate head – 45 degree toward cassette
  58. 58. • MANDIBLE SHAPE,WIDTH , ANGLE, MANDIBULAR CANAL AND CONDYLES • MAXILLA, MAXILLARY SINUS • NASAL CAVITY • DENTITION • SOFTTISSUES
  59. 59. Temporomandibular joint • AP axial projection • Axiolateral oblique projection
  60. 60. TEMPOROMANDIBULAR JOINT AP AXIAL PROJECTION • Position : flex neck – OML is perpendicular to cassette • Central ray : 35 degree caudad , midway betweenTMJs, 7.5 cm above nasion
  61. 61. • Condyle • Ramus of mandible
  62. 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. 63. • Mandibular fossa • Articular tubercle • External auditory meatus • Condyle of the mandible
  64. 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. 65. • ORBITS AND ZYGOMA • JAWS- HARMONIOUS CURVE • NOSE – SEPTUM • MAXILLARY SINUSES • TEMPOROMANDIBULAR JOINT AND MANDIBULAR ANGLE • DENTITION • SOFTTISSUES
  66. 66. PETROMASTOID • AXIOLATERAL (SCHULLER’S METHOD) • AP AXIAL (TOWNE METHOD) • AXIOLATERAL OBLIQUE (LAWS METHOD) • AXIOLATERAL OBLIQUE- POSTERIOR PROFILE (STENVERS METHOD)
  67. 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. 68. • MASTOIDANTRUM • INTERNALAND EXTERNALACOUSTIC MEATUS • PETROUS PYRAMID- SUPERIOR RIDGE, CITELLIANGLE, PNEUMATIZATION, SIGMOID SINUS • MASTOID PROCESS • TEMPOROMANDIBULAR JOINT – GLENOID FOSSA , ARTICULAR TUBERCLEAND MANDIBULAR CONDYLE • SOFTTISSUES
  69. 69. PETROMASTOID PORTION –TOWNE METHOD • AP Axial • Position: Supine/Upright, neck flexed • OML perpendicular to cassette • Central ray 300 caudad to OML
  70. 70. • DORSUM SELLA • ARCUATE EMINENCE • INTERNAL ACOUSTIC CANAL • LABYRINTH • MASTOID AIR CELLS
  71. 71. PETROMASTOID PORTION- LAWSVIEW • 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. 72. • MASTOID ANTRUM • MASTOID AIR CELLS • SUPERIMPOSED INTERNAL AND EXTERNAL ACOUSTIC MEATUSES • MANDIBULAR CONDYLE • MASTOID PROCESS • SOFTTISSUES
  73. 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. 74. • CALVARIA • PETROUS BONE • EXTERNAL ACOUSTIC MEATUS • INTERNAL ACOUSTIC CANAL • ARCUATE EMINENCE • MASTOID CELL AND MASTOID PROCESS • MANDIBULAR CONDYLE • SOFTTISSUES
  75. 75. Styloid process –CAHOON METHOD • PA axial • Rest forehead on cassette • OML perpendicular to cassette • Central ray : nasion – 25 degree cephalad
  76. 76. • STYLOID PROCESS • RAMUS OFTHE MANDIBLE
  77. 77. 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 BTorston, Normal findings in Radiology, New york ,Thieme,2000,P 1-34.
  78. 78. THANKYOU.

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