Radiography: Skull Projections & Positioning
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Questions and Answers

In the AP Axial Projection (Reverse Caldwell), what is the recommended central ray angle if the goal is to project the petrous pyramids into the lower third of the orbit?

  • 0 degrees
  • 15 degrees cephalad (correct)
  • 45 degrees cephalad
  • 15 degrees caudal

What positioning error is indicated if the distances from the lateral borders of the skull to the lateral borders of the orbits are unequal on an AP Axial Projection (Reverse Caldwell)?

  • Incorrect central ray angulation
  • Insufficient collimation
  • Excessive flexion of the neck
  • Rotation or tilt of the cranium (correct)

For the AP Axial (Towne Method), if the orbitomeatal line (OML) is used as a reference, what caudal angle should be applied to the central ray?

  • 37 degrees
  • 23 degrees
  • 45 degrees
  • 30 degrees (correct)

What is the entry point of the central ray for the AP Axial (Towne Method)?

<p>2.5 inches (6.3 cm) above the glabella (C)</p> Signup and view all the answers

In an AP Axial (Towne Method) radiograph, what anatomical structure should be aligned perpendicular to the midline of the image receptor (IR)?

<p>Midsagittal plane (MSP) (B)</p> Signup and view all the answers

Why is it important to center the MSP to the midline and ensure the OML is perpendicular to the IR in the AP Axial Projection (Reverse Caldwell)?

<p>To ensure symmetry and accurate visualization of structures (C)</p> Signup and view all the answers

How does the distance from the lateral margin of the orbit to the lateral margin of the temporal bone differ between the AP and PA projections in the AP Axial Projection (Reverse Crandall)?

<p>It measures less on the AP projection (B)</p> Signup and view all the answers

If the infraorbitomeatal line (IOML) is used for the AP Axial (Towne Method), what caudal angle of the central ray is required?

<p>37 degrees (A)</p> Signup and view all the answers

Which anatomical structures should ideally be superimposed in a correctly positioned lateral projection of the cranium?

<p>Orbital roofs and greater wings of the sphenoid (D)</p> Signup and view all the answers

What is the central ray (CR) angulation for a PA axial (Caldwell method) projection of the skull?

<p>15 degrees caudad (A)</p> Signup and view all the answers

In a PA (Posterior-Anterior) projection of the skull, which anatomical structures should fill the orbits?

<p>Petrous pyramids (D)</p> Signup and view all the answers

Which of the following is a primary evaluation criterion for a lateral skull radiograph regarding rotation?

<p>Superimposition of the orbital roofs (A)</p> Signup and view all the answers

During a PA axial (Caldwell) projection, if the petrous ridges are projected too high within the orbits, what adjustment should be made?

<p>Increase the central ray angle (D)</p> Signup and view all the answers

What is the recommended field size (in inches) for a PA axial (Caldwell Method) projection of the skull?

<p>10 x 12 (C)</p> Signup and view all the answers

For a PA skull radiograph, what is the correct positioning of the Orbitomeatal Line (OML) relative to the image receptor (IR)?

<p>Perpendicular to the IR (A)</p> Signup and view all the answers

Which of the following anatomical structures is best visualized in a lateral projection of the skull?

<p>Sella turcica (C)</p> Signup and view all the answers

In evaluating a PA axial Caldwell radiograph, what indicates that the patient's MSP (Midsagittal Plane) was properly aligned?

<p>Symmetric petrous ridges (A)</p> Signup and view all the answers

An AP axial (reverse Caldwell) projection may be performed when:

<p>Both A and C (C)</p> Signup and view all the answers

In an AP Axial (Towne Method) radiograph, what indicates correct positioning regarding the skull's rotation or tilt?

<p>Equal distances from lateral borders of skull to lateral margins of foramen magnum. (C)</p> Signup and view all the answers

Which anatomical structures are ideally visualized within the foramen magnum on a properly executed AP Axial (Towne Method) radiograph?

<p>Dorsum sellae and posterior clinoid processes. (A)</p> Signup and view all the answers

What is the correct positioning of the IOML (Infraorbitomeatal Line) for the SMV (Schüller Method) projection?

<p>Parallel with the IR. (C)</p> Signup and view all the answers

During an SMV projection, the central ray (CR) enters at which location?

<p>A point ¾ inch (1.9 cm) anterior to level of EAM. (D)</p> Signup and view all the answers

Which of the following anatomical structures is/are best visualized using the SMV (Schüller Method) projection?

<p>Foramina ovale and spinosum. (A)</p> Signup and view all the answers

In a properly positioned SMV radiograph, what indicates the absence of tilt?

<p>Symmetric petrosae. (C)</p> Signup and view all the answers

In a properly positioned SMV radiograph, what indicates the absence of rotation?

<p>Equal distances from the lateral borders of the skull to the mandibular condyles. (B)</p> Signup and view all the answers

For an SMV projection, what is the recommended collimation adjustment to ensure sufficient coverage while minimizing unnecessary radiation?

<p>Extend 1 inch beyond the shadow of the tip of the nose and 1 inch beyond the lateral borders. (C)</p> Signup and view all the answers

Which of the following indicates correct alignment of the IOML in the SMV projection?

<p>Mental protuberance superimposed over the anterior frontal bone. (B)</p> Signup and view all the answers

In the AP Axial (Towne Method), what is the significance of visualizing the petrous pyramids symmetrically?

<p>It indicates the absence of rotation of the skull. (A)</p> Signup and view all the answers

For a lateral projection of the cranium, which baseline should be positioned perpendicular to the image receptor (IR)?

<p>Interpupillary Line (B)</p> Signup and view all the answers

During an AP axial (Towne) projection of the cranium, if the Infraorbitomeatal Line (IOML) is positioned perpendicular to the IR, what is the correct central ray (CR) angulation?

<p>30 degrees caudad (D)</p> Signup and view all the answers

The Waters method for facial bones requires the patient to rest their head on their:

<p>Tip of extended chin (C)</p> Signup and view all the answers

Which of the following projections is best for demonstrating blowout fractures of the orbit?

<p>Modified Parietoacanthial (Modified Waters) (C)</p> Signup and view all the answers

What central ray (CR) angulation is required for a PA axial (Caldwell) projection to demonstrate the orbital rims?

<p>30 degrees caudad (D)</p> Signup and view all the answers

During a lateral projection of the nasal bones, where does the central ray (CR) enter?

<p>Bridge of the nose, 1 inch distal to nasion (C)</p> Signup and view all the answers

Which of the following is a key consideration when positioning a patient for a PA projection of the mandibular rami?

<p>Orbitomeatal line (OML) perpendicular to the IR (B)</p> Signup and view all the answers

What is the central ray (CR) angulation for the PA axial projection of the mandibular rami?

<p>20 to 25 degrees cephalad (C)</p> Signup and view all the answers

For a PA projection of the mandibular body, the anterior surface of the mandibular symphysis should be positioned how?

<p>Parallel to the IR (A)</p> Signup and view all the answers

During an axiolateral oblique projection of the mandible to demonstrate the body, how much should the head be rotated toward the IR?

<p>30 degrees (C)</p> Signup and view all the answers

What is the typical central ray (CR) angle used for an axiolateral projection of the mandible?

<p>25 degrees cephalad (C)</p> Signup and view all the answers

For a Submentovertical (SMV) projection of the mandible, the Infraorbitomeatal line (IOML) should be:

<p>Parallel to the IR (C)</p> Signup and view all the answers

What central ray (CR) angulation is used for an AP axial projection of the temporomandibular joints (TMJs)?

<p>35 degrees caudad (A)</p> Signup and view all the answers

In the modified Law method (axiolateral oblique) for temporomandibular joints (TMJs), how many degrees is the MSP of the head rotated toward the IR?

<p>15 degrees (D)</p> Signup and view all the answers

During an axiolateral projection of the TMJ, what is the central ray (CR) angulation?

<p>25-30 degrees caudad (D)</p> Signup and view all the answers

In an axiolateral oblique projection to demonstrate the mandibular body, how should the head be positioned?

<p>Rotated 45 degrees toward the IR (A)</p> Signup and view all the answers

For the parietoacanthial projection (Waters method), where does the central ray (CR) exit the patient?

<p>Acanthion (A)</p> Signup and view all the answers

Which of the following baseline positions is utilized in the parietoacanthial (Waters) method?

<p>OML—37 degrees from the plane of the IR (C)</p> Signup and view all the answers

Why is it important to use an upright position when imaging the sinuses?

<p>To demonstrate fluid levels (A)</p> Signup and view all the answers

What is the recommended SID when obtaining preoperative measurements of the sinuses using a lateral projection?

<p>72 inches (183 cm) (A)</p> Signup and view all the answers

What positioning adjustments are necessary when performing the PA axial (Caldwell) projection using the angled grid technique?

<p>Tilt the vertical Bucky down 15 degrees and rest the patient's forehead and nose on the device (C)</p> Signup and view all the answers

What is the primary disadvantage of using the vertical grid technique compared to the angled grid technique for the PA axial (Caldwell) projection?

<p>Increased object-to-image receptor distance (OID) (B)</p> Signup and view all the answers

What anatomical structure is of primary interest in the open-mouth modification of the parietoacanthial (Waters) projection?

<p>Sphenoid sinuses (D)</p> Signup and view all the answers

In the SMV projection of the sinuses, insufficient neck extension will cause what anatomical structure to superimpose the ethmoid sinuses?

<p>Mandible (D)</p> Signup and view all the answers

Which positioning error is indicated if the petrous pyramids are projected over the inferior portions of the maxillary sinuses in a parietoacanthial (Waters) projection?

<p>Insufficient neck extension (B)</p> Signup and view all the answers

What is the orientation needed to demonstrate all four sinus groups on a lateral projection?

<p>MSP parallel to the IR, IPL perpendicular to the IR. (A)</p> Signup and view all the answers

What is the central ray angle and its direction for a PA axial (Caldwell) projection of the sinuses?

<p>15 degrees caudad (D)</p> Signup and view all the answers

In the submentovertical (SMV) projection, what is the relationship between the infraorbitomeatal line (IOML) and the image receptor (IR)?

<p>Parallel (A)</p> Signup and view all the answers

What collimation adjustments should be made for a lateral projection of the sinuses to ensure proper coverage?

<p>Extend 1 inch beyond the tip of the nose, superiorly to 3 inches above the nasion, inferiorly to the occlusal plane, and posteriorly to the auricle. (D)</p> Signup and view all the answers

Which sinuses are best demonstrated in the Parietoacanthial projection (Waters method)?

<p>Maxillary sinuses (B)</p> Signup and view all the answers

What is the primary purpose of performing a metallic foreign body screening before an MRI of the orbits?

<p>To identify potential contraindications and prevent complications. (D)</p> Signup and view all the answers

In a lateral projection of the bony orbits, which anatomical landmark should be adjacent and centered to the image receptor (IR)?

<p>Outer canthus of the affected eye (C)</p> Signup and view all the answers

What is the correct positioning of the midsagittal plane (MSP) in relation to the image receptor (IR) for a lateral projection of the orbits?

<p>MSP parallel with the IR plane (D)</p> Signup and view all the answers

Why is it important to ensure that there is no rotation evident in a lateral projection radiograph of the orbits?

<p>To minimize the superimposition of orbital structures. (C)</p> Signup and view all the answers

What is the recommended central ray (CR) angulation for a PA axial projection of the orbits?

<p>30 degrees caudal (B)</p> Signup and view all the answers

In a PA axial projection, what anatomical structures should lie below the orbital shadows in the resulting radiograph if the positioning and angulation are correct?

<p>Petrous pyramids (D)</p> Signup and view all the answers

What is the primary reason for using a non-grid technique with very high resolution when imaging the orbits in the PA axial projection?

<p>To minimize magnification and eliminate possible artifacts (C)</p> Signup and view all the answers

In the Parietoacanthial (Modified Waters) projection, what angle should be formed between the orbitomeatal line (OML) and the image receptor (IR) plane?

<p>50-degree angle (D)</p> Signup and view all the answers

For the Parietoacanthial (Modified Waters) projection, where should the central ray (CR) enter the patient?

<p>Through the mid-orbits (C)</p> Signup and view all the answers

In assessing a Parietoacanthial (Modified Waters) projection, what is the primary indicator that the patient was properly positioned without rotation?

<p>Symmetric orbits (D)</p> Signup and view all the answers

Flashcards

Lateral Skull: Structures Shown

Superimposed halves of the cranium, sella turcica, anterior & posterior clinoid processes, and dorsum sellae.

Lateral Skull: Evaluation Criteria

Entire cranium without rotation/tilt, superimposed orbital roofs, mastoid regions and TMJs. Sella turcica in profile.

Caldwell Method: Patient Position

Erect or prone, MSP centered, forehead and nose on table/Bucky, OML perpendicular to IR.

PA (Caldwell): CR Angle

Perpendicular, exits nasion.

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PA Axial (Caldwell): CR Angle

15 degrees caudad, exits nasion.

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PA (Caldwell): Structures Shown

Orbits filled by petrous pyramids, frontal bone/sinuses, dorsum sellae visible.

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PA Axial (Caldwell): Structures Shown

Petrous ridges in lower 1/3 of orbits, anterior ethmoidal air cells, frontal bone/sinuses.

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Caldwell: Evaluation of Rotation/Tilt

Equal distances from lateral borders of skull to orbits, symmetric petrous ridges.

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PA Caldwell Criteria

Orbits filled by petrous ridges.

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AP Axial (Reverse Caldwell)

An AP projection with CR angled cephalad.

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AP Axial (Reverse Caldwell) Patient Position

Patient lies on their back with the MSP aligned to the midline. Ensure the MSP and OML are perpendicular to the IR.

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AP Axial (Reverse Caldwell) Central Ray

Perpendicular or 15 degrees cephalad, entering at the nasion.

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AP Axial (Reverse Caldwell) Structures Shown

The orbits appear magnified compared to a PA projection. The distance from the lateral margin of the orbit to the lateral margin of the temporal bone is smaller than on a PA projection.

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AP Axial (Reverse Caldwell) Evaluation Criteria: Symmetry

Equal distances from the lateral borders of the skull to the lateral borders of the orbits on both sides.

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AP Axial (Reverse Caldwell) Evaluation Criteria: Petrous Pyramids

Petrous pyramids should be in the lower third of the orbit with a cephalic CR angle, or filling the orbits with a 0 degree CR angle.

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AP Axial (Towne Method) Patient Position

Patient is supine or seated erect with the MSP perpendicular to the midline.

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AP Axial (Towne Method) Part Positioning

Flex the patient’s neck enough to place either OML or IOML perpendicular to the IR, centering the IR at or near the foramen magnum.

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AP Axial (Towne Method) Central Ray

Central ray enters 2.5 inches above the glabella, passing through the level of the EAM. Use a 30-degree caudal angle for OML or a 37-degree caudal angle for IOML.

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Light at Vertex & Sides

Ensures proper alignment and minimizes distortion in the AP Axial (Towne Method) projection.

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AP Axial Structures Shown

Symmetric petrous pyramids, posterior foramen magnum, dorsum sellae, occipital & parietal bones.

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AP Axial Evaluation

Assesses collimation, side marker, skull alignment, visualization of dorsum sellae, and bone/soft tissue detail.

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SMV Patient Positioning

Patient seated or elevated supine with MSP centered; neck extended to place IOML parallel to the IR.

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SMV Central Ray

CR is perpendicular to IOML, entering MSP of throat and passing through a point anterior to EAM.

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SMV Structures Shown

Symmetric petrosae/mastoids, foramina ovale/spinosum, sinuses, mandible, nasal septum, dens, occipital bone, maxillary sinuses.

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SMV Evaluation Criteria

Assess collimation, side marker, skull alignment, IOML parallelism, bony detail, and soft tissue.

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AP Axial Alignment

Equal distances from lateral borders of skull to lateral margins of foramen magnum; symmetric petrous pyramids.

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SMV IOML Parallel

Protuberance superimposed over anterior frontal bone; Mandibular condyles anterior to petrous pyramids.

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IOML Parallel to IR

IOML (Infraorbitomeatal Line) is parallel with the IR, Mental protuberance is superimposed over anterior frontal bone.

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Orbit Radiography Uses

Used to screen for metallic foreign bodies before MRI and evaluate bony orbit trauma.

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Lateral Orbit Position

Upright or recumbent anterior oblique position.

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Lateral Orbit Part Positioning

Outer canthus of affected eye adjacent and centered to IR, MSP parallel with IR plane, IPL perpendicular to IR plane and IOML perpendicular to front IR edge.

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Lateral Orbit Central Ray

Perpendicular through outer canthus.

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Lateral Orbit Evaluation Criteria

Entire orbit, superimposed orbital roofs (no rotation), close beam restriction, bony orbit and soft tissues.

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PA Axial Orbit Position

Upright or recumbent, forehead and nose on the IR.

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PA Axial Orbit Part Positioning

IR centered 3/4 inches (1.9 cm) distal to nasion, MSP and OML perpendicular to the IR plane.

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PA Axial Orbit Central Ray

Through center of the orbits with a 30-degree caudal angulation.

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PA Axial Orbit Evaluation Criteria

Entire orbit, petrous pyramids below orbital shadows, symmetric orbits (no rotation), close beam restriction, bony details and soft tissue.

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Modified Waters Orbit Positioning

IR centered at level of center of orbits, rest chin on IR holder, MSP perpendicular to IR plane, 50-degree angle between OML and IR plane.

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Well-collimated radiation field

Ensures optimum digital image quality and minimizes patient dose.

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Upright Position

Allows fluid levels to be visualized.

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CR for Lateral Sinuses

Horizontal and perpendicular to the IR, entering 1 inch posterior to the outer canthus.

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Lateral Sinuses: Structures Shown

All four sinus groups are visualized, especially the sphenoid.

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Lateral Sinuses: Evaluation Criteria

Sella turcica should be in profile, orbital roofs and mandibular rami superimposed.

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CR for PA Axial (Caldwell)

Horizontal, exiting at the nasion.

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PA Axial (Caldwell): Structures

Frontal and anterior ethmoid sinuses; petrous ridges in the lower third of the orbits.

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Patient Position: PA Axial (Caldwell)

Rest forehead and nose on the device, MSP and OML perpendicular to IR.

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PA Axial (Caldwell): Evaluation

Petrous ridges should lie in the lower third of the orbit.

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CR for Parietoacanthial (Waters)

Horizontal, exiting at the acanthion.

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Parietoacanthial (Waters): Structures

Maxillary sinuses with petrous pyramids inferior to the maxillary floor.

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Waters Method: OML angle

OML at 37 degrees from IR plane.

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Open Mouth Waters: Structures

Sphenoid sinuses projected through the open mouth; maxillary sinuses also seen.

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CR for SMV Projection

Horizontal and perpendicular to the IOML, entering MSP ¾ inch anterior to EAM.

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SMV Projection: Structures

Sphenoid and ethmoid sinuses.

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Parietoacanthial (Waters)

A cranial projection where the OML forms a 37-degree angle with the IR, and the CR is perpendicular to exit at the acanthion.

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Modified Waters

A Waters projection with less neck extension, OML forms a 55-degree angle with the image receptor.

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PA Axial (Caldwell)

Facial bone projection with forehead and nose on the table, OML perpendicular to IR. CR angled 15 degrees caudad, exiting the nasion.

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Caldwell for orbital rims

For the Caldwell projection: CR angled 30 degrees caudad to exit the nasion.

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Lateral Facial Bones

Head in lateral position with MSP parallel to the IR, IPL perpendicular; CR perpendicular to the zygomatic bone.

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Lateral Nasal Bones

Head position adjusted to place MSP parallel with the tabletop, IPL perpendicular. CR perpendicular to bridge of nose.

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PA - Mandibular Rami

Patient rests forehead and nose on the IR, OML and MSP perpendicular. CR perpendicular to exit at the acanthion.

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PA Axial - Mandibular Rami

Similar to PA, but CR angled 20-25 degrees cephalad, exiting the acanthion.

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PA - Mandibular Body

Patient rests nose and chin on the IR; AML nearly perpendicular to the IR. CR perpendicular at level of lips.

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PA Axial - Mandibular Body

Similar to PA, but CR angled 30 degrees cephalad, directed midway between the TMJs.

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Axiolateral Mandible

Goal to place the desired portion of the mandible parallel with the IR. CR angled 25 degrees cephalad through the region of interest.

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SMV - Mandible

Neck fully extended, head resting on vertex, IOML parallel with IR. CR perpendicular to IOML, midway between mandibular angles.

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AP Axial - TMJs

MSP perpendicular to IR, neck flexed to place OML perpendicular. CR angled 35 degrees caudad, midway between TMJs.

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Axiolateral - TMJs

Head in lateral position; MSP parallel, affected side closest to IR, and angled 25-30 degrees caudad, 0.5" anterior and 2" superior to upside EAM

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Axiolateral Oblique - TMJs

Cheek against grid device, rotate MSP 15 degrees toward IR, CR angled 15 degrees caudad through TMJ, modified Law method.

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