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Skull Radiography techniques and reporting
This document provides information on various radiological techniques and views for imaging the skull. It discusses different projections for visualizing the entire skull, specific bones like the nasal bones, paranasal sinuses, mandible, zygomatic arch, and petromastoid portion. It also covers tomosynthesis techniques like orthopantomography. For each view, it provides details on patient positioning, central ray angulation, and anatomical structures visible. The document aims to guide radiologists in proper technique and checklist items for interpreting skull radiographs.
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Skull Radiography techniques and reporting
- 1. RADIOLOGY OF SKULL- TECHNIQUESAND REPORTING -DR. BHAVANA
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- 9. SKULL – SAGITTALSECTION
- 10. SKULL – SAGITTALSECTION
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- 13. EXPOSURETABLES As per WHOmanual of diagnostic imaging
- 14. PATIENT PREPARATION • Ensurethat 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.
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- 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 – LATERALDORSAL DECUBITUS • Position : supine Interpupillary line perpendicular to cassette Central ray: perpendicular 5cm superior to EAM
- 19. CHECKLIST • SHAPE ANDSIZE • 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. CRANIUM – APPROJECTION • Position : supine IOML perpendicular to cassette Central ray :perpendicular 5cm above nasion
- 21. CHECKLIST • SHAPE ANDSIZE • 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. CALDWELL METHOD • PAAXIAL projection • Position : prone/seated OML perpendicular to cassette Central ray - directed to exit nasion 15 degree caudad
- 23. • PETROUS PYRAMID PROJECTEDIN LOWER THIRD OF ORBITS • POSTERIOR ETHMOID AIR CELLS • CRISTA GALLI • FRONTAL SINUSES
- 24. CRANIAL BASE • SUBMENTOVERTICALPROJECTION (SCHULLER’S METHOD)
- 25. CRANIAL BASE -SCHULLERMETHOD • 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 • SOFTTISSUES
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- 28. SELLATURCICA • LATERAL PROJECTION •Position: semiprone/ seated • IOML parallel to cassette • Central ray : perpendicular 2 cm anterior and superior to EAM
- 29. • SHAPE OFSELLA , DORSUM SELLA AND CLINOID PROCESSES. • SPHENOID SINUS • NEUROCRANIUM FOR CALCIFICATION
- 30. ORBIT • PARIETO-ORBITAL OBLIQUEPROJECTION (RHESE METHOD)
- 31. ORBITPARIETO-ORBITAL OBLIQUE PROJECTION (RHESEMETHOD) • 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. • SUPERIOR ORBITALMARGIN • LATERAL ORBIT MARGIN • OPTIC CANAL AND FORAMEN • MEDIAL ORBITAL MARGIN • LESSERWING OF SPHENOID • ETHMOID SINUS • INFERIOR ORBITAL MARGIN
- 33. FACIAL BONES • LATERALPROJECTION • 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 • SELLATURCICA • 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 • LATERALPROJECTION • 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 • SOFTTISSUE
- 41. NASAL BONES-TANGENTIAL • Position:seated / recumbent • Inclined cassette • Central ray: parallel to glabelloalveolar line
- 42. • Septal cartilage •Nasal bone
- 43. PARANASAL SINUSES • PAAXIAL PROJECTION- CALDWELL • PARIETOCANTHAL PROJECTION- WATER’S • PARIETOCANTHAL PROJECTION –WATER’S WITH OPEN MOUTH
- 44. CALDWELL METHOD • PAaxial 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 –WATERSMETHOD • 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 ethmoidalsinuses- OPEN MOUTHWATER’S • Parietocanthal projection • OPEN MOUTHWATERS • Position: OML 37 degree to cassette • MML not perpendicular • Mouth open • Central ray: : perpendicular- exit acanthion
- 49. • MAXILLARY SINUS •SPHENOIDAL SINUSES
- 50. ZYGOMATICARCH • 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 • STRUCTURE AND CONTOUR OFTHE ZYGOMATIC ARCH • SKULL AND FACIAL SKELETON • SOFTTISSUE
- 53. MAY METHOD • Tangentialprojection/ 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 ANDSTRUCTURE OF ZYGOMATIC ARCH • SOFTTISSUES
- 55. MANDIBLE • AXIOLATERAL OBLIQUEPROJECTION
- 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: headin 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 • SOFTTISSUES
- 59. Temporomandibular joint • APaxial projection • Axiolateral oblique projection
- 60. TEMPOROMANDIBULAR JOINT AP AXIALPROJECTION • Position : flex neck – OML is perpendicular to cassette • Central ray : 35 degree caudad , midway betweenTMJs, 7.5 cm above nasion
- 61. • Condyle • Ramusof mandible
- 62. TEMPEROMANDIBULAR JOINT -AXIOLATERAL OBLIQUEPROJECTION • 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 ANDZYGOMA • JAWS- HARMONIOUS CURVE • NOSE – SEPTUM • MAXILLARY SINUSES • TEMPOROMANDIBULAR JOINT AND MANDIBULAR ANGLE • DENTITION • SOFTTISSUES
- 66. PETROMASTOID • AXIOLATERAL (SCHULLER’SMETHOD) • 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. • MASTOIDANTRUM • INTERNALANDEXTERNALACOUSTIC MEATUS • PETROUS PYRAMID- SUPERIOR RIDGE, CITELLIANGLE, PNEUMATIZATION, SIGMOID SINUS • MASTOID PROCESS • TEMPOROMANDIBULAR JOINT – GLENOID FOSSA , ARTICULAR TUBERCLEAND MANDIBULAR CONDYLE • SOFTTISSUES
- 69. PETROMASTOID PORTION –TOWNE METHOD •AP Axial • Position: Supine/Upright, neck flexed • OML perpendicular to cassette • Central ray 300 caudad to OML
- 70. • DORSUM SELLA •ARCUATE EMINENCE • INTERNAL ACOUSTIC CANAL • LABYRINTH • MASTOID AIR CELLS
- 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. • MASTOID ANTRUM •MASTOID AIR CELLS • SUPERIMPOSED INTERNAL AND EXTERNAL ACOUSTIC MEATUSES • MANDIBULAR CONDYLE • MASTOID PROCESS • SOFTTISSUES
- 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 • PETROUSBONE • EXTERNAL ACOUSTIC MEATUS • INTERNAL ACOUSTIC CANAL • ARCUATE EMINENCE • MASTOID CELL AND MASTOID PROCESS • MANDIBULAR CONDYLE • SOFTTISSUES
- 75. Styloid process –CAHOONMETHOD • PA axial • Rest forehead on cassette • OML perpendicular to cassette • Central ray : nasion – 25 degree cephalad
- 76. • STYLOID PROCESS •RAMUS OFTHE MANDIBLE
- 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.
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