Podcast
Questions and Answers
What is the proper position for the Modified Waters projection?
What is the proper position for the Modified Waters projection?
In the Sweet Method, which structure is primarily targeted during the imaging process?
In the Sweet Method, which structure is primarily targeted during the imaging process?
What is the required angulation of the OML in the Reverse Waters method?
What is the required angulation of the OML in the Reverse Waters method?
Which projection utilizes a perpendicular CR directed to the Acanthion?
Which projection utilizes a perpendicular CR directed to the Acanthion?
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What is the key characteristic of the Towne View Method in terms of positioning?
What is the key characteristic of the Towne View Method in terms of positioning?
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What is the appropriate central ray (CR) angle for the Towne method?
What is the appropriate central ray (CR) angle for the Towne method?
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What is the central ray (CR) orientation for the Schuller/Pfeiffer Method?
What is the central ray (CR) orientation for the Schuller/Pfeiffer Method?
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In the Axiolateral Oblique Projection, how should the patient's head be oriented?
In the Axiolateral Oblique Projection, how should the patient's head be oriented?
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Which anatomical structure is best demonstrated with the Schuller Method?
Which anatomical structure is best demonstrated with the Schuller Method?
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Which projection provides a panoramic image of the mandible and TMJ?
Which projection provides a panoramic image of the mandible and TMJ?
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What is the recommended patient position for the Submentovertex Projection?
What is the recommended patient position for the Submentovertex Projection?
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In the Lysholm Method, what is the recommended patient position?
In the Lysholm Method, what is the recommended patient position?
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For the Valdini Method, what is the orientation of the central ray?
For the Valdini Method, what is the orientation of the central ray?
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Which of the following describes the purpose of the Caldwell Projection?
Which of the following describes the purpose of the Caldwell Projection?
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What angle is recommended when positioning for the Axiolateral Oblique Projection toward the ramus?
What angle is recommended when positioning for the Axiolateral Oblique Projection toward the ramus?
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Which sinuses are primarily illustrated in the Schuller Method?
Which sinuses are primarily illustrated in the Schuller Method?
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Which adjustment is recommended for muscular or hypersthenic patients during lateral projections?
Which adjustment is recommended for muscular or hypersthenic patients during lateral projections?
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What central ray positioning is used for the Towne View Method?
What central ray positioning is used for the Towne View Method?
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In the Verticosubmental Projection, how should the patient's chin be positioned?
In the Verticosubmental Projection, how should the patient's chin be positioned?
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What should be the position of the patient's IOML in the Lysholm Method?
What should be the position of the patient's IOML in the Lysholm Method?
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In a submentovertex projection, what is the relationship of the MSP to the IR?
In a submentovertex projection, what is the relationship of the MSP to the IR?
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What is the significance of filling the mouth with air during the Modified Towne Method?
What is the significance of filling the mouth with air during the Modified Towne Method?
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Which of the following is NOT a structure visualized by the Valdini Method?
Which of the following is NOT a structure visualized by the Valdini Method?
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In the closed-mouth position during the Towne Method, which teeth need to be in contact?
In the closed-mouth position during the Towne Method, which teeth need to be in contact?
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What is an essential feature of the Caldwell Projection?
What is an essential feature of the Caldwell Projection?
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What is the correct angulation of the central ray (CR) when using the Haas Method?
What is the correct angulation of the central ray (CR) when using the Haas Method?
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What anatomical structures are primarily visualized in the projection obtained with the Orbitoparietal Oblique?
What anatomical structures are primarily visualized in the projection obtained with the Orbitoparietal Oblique?
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In which position should the patient be placed for the PA Axial Projection?
In which position should the patient be placed for the PA Axial Projection?
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When performing the projection above the glabella, which orientation of the AML is mandated?
When performing the projection above the glabella, which orientation of the AML is mandated?
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What is the Recommended Positioning (RP) for the entrance of the central ray in the Haas Method?
What is the Recommended Positioning (RP) for the entrance of the central ray in the Haas Method?
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What is the main advantage of using the Sweet Method in imaging?
What is the main advantage of using the Sweet Method in imaging?
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Which projection best demonstrates the zygomatic bone and anterior wall of the maxillary sinus?
Which projection best demonstrates the zygomatic bone and anterior wall of the maxillary sinus?
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In the Reverse Waters Method, what is the primary angle of OML to the IR?
In the Reverse Waters Method, what is the primary angle of OML to the IR?
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What is the purpose of positioning the petrous ridges below the inferior border of orbits during imaging?
What is the purpose of positioning the petrous ridges below the inferior border of orbits during imaging?
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Which apparatus is essential for the Sweet Method?
Which apparatus is essential for the Sweet Method?
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Which anatomical structures are primarily demonstrated in the Caldwell Projection?
Which anatomical structures are primarily demonstrated in the Caldwell Projection?
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What is the central ray (CR) angle used in the Exaggerated Caldwell method?
What is the central ray (CR) angle used in the Exaggerated Caldwell method?
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In the Waters Method, what is the proper orientation of the OML with respect to the IR?
In the Waters Method, what is the proper orientation of the OML with respect to the IR?
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Which projection is utilized specifically for demonstrating medial or lateral displacement of fragments in fractures?
Which projection is utilized specifically for demonstrating medial or lateral displacement of fragments in fractures?
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What position is required for the patient during the Law Method PA Oblique Axial Projection?
What position is required for the patient during the Law Method PA Oblique Axial Projection?
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For the Tangential Projection, which structure is specifically targeted?
For the Tangential Projection, which structure is specifically targeted?
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What is the patient positioning for the Reverse Waters method?
What is the patient positioning for the Reverse Waters method?
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Which of the following describes the positioning of the head during the Initial positioning for the Waters Method?
Which of the following describes the positioning of the head during the Initial positioning for the Waters Method?
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What is the appropriate direction of the central ray (CR) for the Axiolateral Projection?
What is the appropriate direction of the central ray (CR) for the Axiolateral Projection?
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In the closed-mouth position, where does the condyle lie during the Axiolateral Projection?
In the closed-mouth position, where does the condyle lie during the Axiolateral Projection?
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Which method requires the patient's head to be in a true lateral position for the TMJ examination?
Which method requires the patient's head to be in a true lateral position for the TMJ examination?
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What is the proper rotation of the MSP for the Schuller Method?
What is the proper rotation of the MSP for the Schuller Method?
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For the lateral transfacial position, what is the orientation of the patient's chin?
For the lateral transfacial position, what is the orientation of the patient's chin?
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What structure is best demonstrated using the Schuller Method?
What structure is best demonstrated using the Schuller Method?
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In the opened-mouth position during the Axiolateral Projection, where do the condyles lie?
In the opened-mouth position during the Axiolateral Projection, where do the condyles lie?
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What is the recommended patient position for the Axiolateral Oblique projection?
What is the recommended patient position for the Axiolateral Oblique projection?
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Which of these structures is best visualized using the Schuller Method?
Which of these structures is best visualized using the Schuller Method?
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What is the appropriate central ray angulation for the Haas Method?
What is the appropriate central ray angulation for the Haas Method?
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In the Towne Method, what is the central ray reference point?
In the Towne Method, what is the central ray reference point?
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Which positioning is recommended for the Axiolateral positions?
Which positioning is recommended for the Axiolateral positions?
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What anatomical structures does the Valdini Method primarily illustrate?
What anatomical structures does the Valdini Method primarily illustrate?
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In the Henschen Method, what structure is primarily targeted?
In the Henschen Method, what structure is primarily targeted?
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What is a key factor in positioning for the Runstrom Recommendation?
What is a key factor in positioning for the Runstrom Recommendation?
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What is the positioning requirement for the Modified Towne Method?
What is the positioning requirement for the Modified Towne Method?
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Which projection uses a 30° caudad central ray angulation?
Which projection uses a 30° caudad central ray angulation?
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For which projection would a patient ideally be in a recumbent position?
For which projection would a patient ideally be in a recumbent position?
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In the submentovertex projection, what alignment is essential for the MSP?
In the submentovertex projection, what alignment is essential for the MSP?
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Which of the following is NOT a structure that can be visualized using the Schuller Method?
Which of the following is NOT a structure that can be visualized using the Schuller Method?
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What is the proper head position for imaging using the Henschen Method?
What is the proper head position for imaging using the Henschen Method?
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Which angulation is specific for the Lysholm/Runstrom II Method?
Which angulation is specific for the Lysholm/Runstrom II Method?
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What planes are required to be perpendicular in the Modified Waters method?
What planes are required to be perpendicular in the Modified Waters method?
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Which projection is best utilized to visualize the facial bones with less axial angulation?
Which projection is best utilized to visualize the facial bones with less axial angulation?
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In the Sweet Method, what does the apparatus specifically include?
In the Sweet Method, what does the apparatus specifically include?
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Which structure is best demonstrated in the Modified Waters projection?
Which structure is best demonstrated in the Modified Waters projection?
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What is the primary purpose of the Sweet Method in imaging?
What is the primary purpose of the Sweet Method in imaging?
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What is the central ray angle for the Caldwell Method when using an exaggerated angulation?
What is the central ray angle for the Caldwell Method when using an exaggerated angulation?
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In the Waters Method, what is the required angle of the OML relative to the IR?
In the Waters Method, what is the required angle of the OML relative to the IR?
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Which projection is described as providing visualization of the nasal bones with minimal superimposition?
Which projection is described as providing visualization of the nasal bones with minimal superimposition?
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What is the positioning recommendation for the patient's chin during the Tangential Projection?
What is the positioning recommendation for the patient's chin during the Tangential Projection?
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What should be the orientation of the patient's head for the PA Axial Projection?
What should be the orientation of the patient's head for the PA Axial Projection?
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Which method requires the patient to be in a prone position with MSP and MML perpendicular to the IR?
Which method requires the patient to be in a prone position with MSP and MML perpendicular to the IR?
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What anatomical structures does the Caldwell Projection primarily visualize?
What anatomical structures does the Caldwell Projection primarily visualize?
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What is the disadvantage of using the PA Axial Projection for patients?
What is the disadvantage of using the PA Axial Projection for patients?
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What is the required central ray (CR) angulation for the Axiolateral Projection?
What is the required central ray (CR) angulation for the Axiolateral Projection?
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In the opened-mouth position during the Axiolateral Projection, where do the condyles lie?
In the opened-mouth position during the Axiolateral Projection, where do the condyles lie?
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What is the correct positioning for the axiolateral projection using the double angulation method?
What is the correct positioning for the axiolateral projection using the double angulation method?
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What is the recommended position of the head for the Zaneli Method?
What is the recommended position of the head for the Zaneli Method?
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What is the central ray (CR) angle used in the Towne method for the OML?
What is the central ray (CR) angle used in the Towne method for the OML?
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In the Schuller Method, how should the patient's head be oriented relative to the IR?
In the Schuller Method, how should the patient's head be oriented relative to the IR?
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Which structures are better demonstrated when the central ray is perpendicular to the occlusal plane?
Which structures are better demonstrated when the central ray is perpendicular to the occlusal plane?
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In the PA tangential position, how should the patient's face be oriented?
In the PA tangential position, how should the patient's face be oriented?
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What aspect is evaluated by performing a lateral projection of the sinuses?
What aspect is evaluated by performing a lateral projection of the sinuses?
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What is the recommended patient position for the single angulation method?
What is the recommended patient position for the single angulation method?
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What structure should be seen free of superimposition in the axiolateral position?
What structure should be seen free of superimposition in the axiolateral position?
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Which method involves a patient position of true lateral with the chin elevated?
Which method involves a patient position of true lateral with the chin elevated?
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For a Schuller projection, where is the reference point (RP) for the entrance of the central ray situated?
For a Schuller projection, where is the reference point (RP) for the entrance of the central ray situated?
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What is the primary purpose of the part angulation method?
What is the primary purpose of the part angulation method?
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For the Law method, what is the central ray (CR) angle when targeting the TMJ?
For the Law method, what is the central ray (CR) angle when targeting the TMJ?
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In the Towne method, if the IOML is perpendicular to the IR, what is the required central ray (CR) angle?
In the Towne method, if the IOML is perpendicular to the IR, what is the required central ray (CR) angle?
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What is the required position for the Law Method?
What is the required position for the Law Method?
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Which structures are primarily visualized in the RHESE Method?
Which structures are primarily visualized in the RHESE Method?
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What is the central ray (CR) angle used for the Modified Hickey Method?
What is the central ray (CR) angle used for the Modified Hickey Method?
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In the positioning for the Law Method, what is the relationship of the neck to the imaging receptor?
In the positioning for the Law Method, what is the relationship of the neck to the imaging receptor?
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Which anatomical structure is not typically included in the images obtained using the RHESE Method?
Which anatomical structure is not typically included in the images obtained using the RHESE Method?
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What is the positioning of the patient’s head in the Modified Hickey Method during the AP Tangential position?
What is the positioning of the patient’s head in the Modified Hickey Method during the AP Tangential position?
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What is the orientation of the IOML during the Modified Hickey Method?
What is the orientation of the IOML during the Modified Hickey Method?
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Which projection utilizes a central ray angled 25-30 degrees cephalad from the uppermost gonion?
Which projection utilizes a central ray angled 25-30 degrees cephalad from the uppermost gonion?
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What is the recommended patient position for the PA projection of the skull?
What is the recommended patient position for the PA projection of the skull?
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Which line is described as being 7 degrees off between the OML and IOML?
Which line is described as being 7 degrees off between the OML and IOML?
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Which reference point is used for the AP projection of the skull?
Which reference point is used for the AP projection of the skull?
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What characteristic defines the successful PA projection of the skull with regards to the petrous pyramids?
What characteristic defines the successful PA projection of the skull with regards to the petrous pyramids?
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How does the Interpupillary line (IPL) relate to other skull planes during imaging?
How does the Interpupillary line (IPL) relate to other skull planes during imaging?
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What is the maximum angle of the OML to the IR during the Parietoacanthial projection?
What is the maximum angle of the OML to the IR during the Parietoacanthial projection?
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Which sinuses are best demonstrated using the Schuller method?
Which sinuses are best demonstrated using the Schuller method?
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In the Open-Mouth Waters Method, what should the patient be instructed to do during the exposure?
In the Open-Mouth Waters Method, what should the patient be instructed to do during the exposure?
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What is the required central ray (CR) orientation for the Axial Transoral Position?
What is the required central ray (CR) orientation for the Axial Transoral Position?
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During the Verticosubmental projection, what is the patient's position with respect to the IR?
During the Verticosubmental projection, what is the patient's position with respect to the IR?
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What is the central ray (CR) orientation when using the Stenvens Method?
What is the central ray (CR) orientation when using the Stenvens Method?
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In the Hirtz Method, where is the required projection point (RP) located?
In the Hirtz Method, where is the required projection point (RP) located?
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Which projection positions the patient's forehead, nose, and zygoma against the image receptor?
Which projection positions the patient's forehead, nose, and zygoma against the image receptor?
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What is the angulation of the IOML in the Axiolateral Oblique Projection?
What is the angulation of the IOML in the Axiolateral Oblique Projection?
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Which structures are visualized in the Axiolateral Oblique Projection?
Which structures are visualized in the Axiolateral Oblique Projection?
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What patient position is required for the Mayer Method?
What patient position is required for the Mayer Method?
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What is the direction of the central ray (CR) in the Reverse Stenvens Method?
What is the direction of the central ray (CR) in the Reverse Stenvens Method?
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In the Stenvens Method, what structures are best visualized?
In the Stenvens Method, what structures are best visualized?
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What type of fracture involves the floor of the orbit?
What type of fracture involves the floor of the orbit?
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Which fracture is characterized by a jagged and irregular shape?
Which fracture is characterized by a jagged and irregular shape?
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What is the general description of a Le Fort fracture?
What is the general description of a Le Fort fracture?
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Which type of fracture is caused by trauma to one side, affecting the opposite side of the structure?
Which type of fracture is caused by trauma to one side, affecting the opposite side of the structure?
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What anatomical structure is primarily involved in a Tripod fracture?
What anatomical structure is primarily involved in a Tripod fracture?
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In a depressed fracture, what is the primary outcome?
In a depressed fracture, what is the primary outcome?
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What condition involves inflammation of the mastoid air cells?
What condition involves inflammation of the mastoid air cells?
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What is the central ray angle for a True Caldwell projection?
What is the central ray angle for a True Caldwell projection?
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In the context of skull fractures, what does the term 'Paget’s Disease' refer to?
In the context of skull fractures, what does the term 'Paget’s Disease' refer to?
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Which projection is used to visualize the anterior and side walls of the cranium?
Which projection is used to visualize the anterior and side walls of the cranium?
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What is the central ray angle required for the Modified Lysholm method?
What is the central ray angle required for the Modified Lysholm method?
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Which structure is primarily visualized using the Hough method for the parieto-orbital oblique projection?
Which structure is primarily visualized using the Hough method for the parieto-orbital oblique projection?
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During a PA axial projection using the Caldwell method, which angle does the CR make with OML?
During a PA axial projection using the Caldwell method, which angle does the CR make with OML?
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In the Water method, what is the angle relationship of the OML to the IR?
In the Water method, what is the angle relationship of the OML to the IR?
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What position should the patient's chin be in during the Modified Waters method?
What position should the patient's chin be in during the Modified Waters method?
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What is the RP for the central ray entrance point in the Pfeiffer-Comberg method?
What is the RP for the central ray entrance point in the Pfeiffer-Comberg method?
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Which foreign body localization technique uses a lateral projection for imaging?
Which foreign body localization technique uses a lateral projection for imaging?
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What is the required angle for the CR in the PA axial projection for the Bertel method?
What is the required angle for the CR in the PA axial projection for the Bertel method?
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Which projection demonstrates the petrous pyramids lying below the orbital shadows?
Which projection demonstrates the petrous pyramids lying below the orbital shadows?
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What angle should the IOML be positioned for the Hough method?
What angle should the IOML be positioned for the Hough method?
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During the Alexander method, what is the angulation of the central ray?
During the Alexander method, what is the angulation of the central ray?
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Which projection is indicated for imaging of the inferior orbital fissures?
Which projection is indicated for imaging of the inferior orbital fissures?
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What is the positioning of the patient's head in the Vogt-Bone-Free position for lateral exposure?
What is the positioning of the patient's head in the Vogt-Bone-Free position for lateral exposure?
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In the Modified Waters method, what instruction should be given to the patient during imaging?
In the Modified Waters method, what instruction should be given to the patient during imaging?
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Study Notes
Skull Projections
-
Schuller/Pfeiffer Method
-
Submentovertical Projection (SMV)
- Patient Position: Supine or seated-upright, IOML parallel to IR, MSP perpendicular to IR, head resting on vertex, neck hyperextended
- Central Ray (CR): Perpendicular to IOML, MSP of throat between gonion (entrance)
- Structures Demonstrated: Foramen ovale & spinosum, symmetric petrosae, mastoid processes, carotid canals, sphenoidal & ethmoidal sinuses, mandible, bony nasal septum, dens of axis, occipital bone, maxillary sinus superimposed over the mandible, zygomatic arches, axial tomography of orbits, optic canals, ethmoid bone, maxillary sinuses & mastoid processes
-
Verticosubmental Projection
- Patient Position: Prone, chin fully hyperextended, MSP perpendicular to IR
- Central Ray (CR): Perpendicular to IOML
- Structures Demonstrated: Zygomatic arches free of superimposition
-
Submentovertical Projection (SMV)
-
Modified Towne Method (AP Axial Projection - Jug Handle View)
- Patient Position: Supine, OML/IOML & MSP perpendicular to IR
- Central Ray (CR): 30 degrees caudad (OML ┴); 37 degrees caudad (IOML ┴)
-
Lysholm Method (Axiolateral Method)
- Patient Position: Semiprone, MSP parallel to IR, IOML parallel to transverse axis of IR, IPL perpendicular to IR
- Central Ray (CR): 30-35 degrees caudad
- Structures Demonstrated: Oblique position of lateral aspect of cranial base closest to IR
-
Valdini Method (PA Axial Projection)
- Patient Position: Recumbent or seated-erect, upper frontal region of skull against IR, MSP perpendicular to IR, head acutely flexed, IOML 50 degrees/OML 50 degrees, line extending from inion to 0.5 cm distal to nasion form 28 degrees to CR
- Central Ray (CR): Perpendicular, inion (entrance), 0.5 cm distal to nasion (exit)
- Structures Demonstrated: Dorsum sellae, Internal Auditory Meatus (IAM), Labyrinth, External auditory meatus, Tymphanic cavity, Bony part of Eustachian tube, Dorsum sellae & posterior clinoid processes within or above shadow of foramen magnum, Tubeculum sellae, anterior clinoid processes
-
PA Axial Projection
- Patient Position: Prone, nose & chin against IR, AML & MSP perpendicular to IR, fill the mouth with air
- Central Ray (CR): 30 degrees cephalad
- Structures Demonstrated: Mandibular body, TMJs, condylar processes
-
Axiolateral Oblique Projection
- Patient Position: Seated/semiprone/semisupine, head in true lateral & IPL perpendicular to IR (ramus), head rotated 30 degrees toward IR (body), head rotated 45 degrees toward IR (symphysis), head rotated 10-15 degrees toward IR (general survey), mouth closed, neck extended
- Central Ray (CR): 25 degrees cephalad
- Structures Demonstrated: Mandibular body & TMJs
-
Panoramic Tomography/Pantomography/Rotational Tomography
- Technique employed to produced tomograms of curved surfaces
- Structures Demonstrated: Panoramic image of the entire mandible, TMJ, dental arches, distortion-free lateral image of the entire mandible, patients who sustained severe mandibular or TMJ trauma, general survey studies of dental abnormalities, adjuvant for pre-bone marrow transplant
Temporomandibular Joints (TMJ)
-
Schuller/Pfeiffer Method
-
Submentovertical Projection (SMV)
- Patient Position: Supine or seated-upright, IOML parallel to IR, MSP perpendicular to IR, head resting on vertex, neck hyperextended
- Central Ray (CR): Perpendicular to IOML
- Structures Demonstrated: Mandibular body, coronoid & condyloid processes of rami
-
Verticosubmental Projection
- Patient Position: Prone, chin fully hyperextended, IR against throat, MSP perpendicular to IR
- Central Ray (CR): Perpendicular to IOML
-
Submentovertical Projection (SMV)
-
Towne Method (AP Axial Projection)
- Patient Position: Supine, MSP & OML perpendicular to IR
- Closed-mouth Position: Posterior teeth in contact, not incisors. Rationale: prevents mandibular protrusion & condyles to be carried out of mandibular fossae
- Opened-mouth Position: Open as wide as possible, Mandible not protruded (jutted forward), Not perform in trauma patients
- Central Ray (CR): Perpendicular
- Structures Demonstrated: Orbits, maxillae & zygomatic arches, Petrous ridges below the maxillae, Blow out fractures
Nasal Bone
-
Lateral Projection
- Patient Position: Semiprone, MSP & IOML parallel to IR, IPL perpendicular to IR
- Central Ray (CR): Perpendicular
Additional Information
-
Sweet Method
- Used to determine the exact location of a foreign body using geometric calculations
- Uses a Sweet localizing device and a Sweet film pedestal
- Requires 1 projection: Lateral with 2 exposures
-
Reverse Waters Method (AP Axial Projection)
- Patient Position: Supine, MSP & MML perpendicular to IR, OML 37 degrees to IR, chin up
- Central Ray (CR): Perpendicular
- Structures Demonstrated: Zygomatic bone, anterior wall of maxillary sinus of side up
-
Modified Waters
- Patient Position: Prone, MSP & MML perpendicular to IR, OML 55 degrees to IR
- Central Ray (CR): Perpendicular
- Structures Demonstrated: Zygomatic bone, anterior wall of maxillary sinus of side up
Cranial Facial Projections
-
Distal to Nasion
-
Caldwell Method
-
PA Axial Projection
- Position: Prone; forehead & nose against IR; OML perpendicular to IR
- RP: Nasion
- CR: 15º caudad or 30º caudad (Exaggerated Caldwell)
-
SS: Orbital rims, maxillae, nasal septum, zygomatic bones & anterior nasal spine
- Petrous ridges at lower third of orbits (15º caudad)
- Petrous ridges below the inferior orbital margins (30º caudad)
- Orbital floors (30º caudad)
-
PA Axial Projection
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Waters Method
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Pariéto-Acānthial Projection
- Position: Prone; MSP & MML perpendicular to IR; OML 37º to IR; nose ¾ in.above glabella
- RP: Acanthion (exit)
- CR: Perpendicular
- SS: Nasal bones with minimal superimposition
- ER: Demonstration of any medial or lateral displacement of fragments in fractures
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Pariéto-Acānthial Projection
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Caldwell Method
Skull Projections
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Sinus Projections
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Lateral Projection
- Position: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR
- RP: ¾ in. (old) or ½ in. above nasion
- CR: 35° caudad
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SS: Condyles & neck of condylar processes
- Closed mouth: condyle lying in mandibular fossa
- Opened mouth: condyles lying inferior to articular tubercle
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Henschen, Schuller, & Lysholm Methods
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Axiolateral Positions
- Position: Semiprone; head in true lateral; MSP parallel to IR; IPL perpendicular to IR; IOML parallel to transverse axis of IR; auricles taped forward
- RP: Dependent EAM closest to IR
- CR: 15º caudad (Henschen/Cushing); 25º caudad (Schuller); 35º caudad (Lysholm/Runstrom II)
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SS: Mastoid & petrous portion
- Mastoid cells, mastoid antrum, IAM & EAM & tegmen tympani (Henschen)
- Tumors of acoustic nerve (Cushing)
- Pneumatic structures of mastoid process, mastoid antrum, tegmen tympani, IAM & EAM, sinus & dural plates & mastoid emissary when present (Schuller)
- Mastoid cells, matoid antrum, IAM & EAM, tegmen tympani, labyrinthine area & carotid canal (Lysholm/Runstrom II)
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Axiolateral Positions
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Towne Method
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AP Axial Projection
- Position: Supine; OML/IOML & MSP perpendicular to IR
- RP: MSP b/n EAMs
- CR: 30º caudad (OML ┴); 37º caudad (IOML ┴)
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SS: Petrosae above base of the skull
- IAM
- Arcuate eminences
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AP Axial Projection
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Schuller/Pfeiffer Method
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Submentovertical (Subbasal) Projection
- Position: Supine or Seated-upright (more comfortable); OML parallel to IR or CR perpendicular to OML (cannot fully extend the neck) or supraorbitomeatal line (SOML) parallel to IR; MSP perpendicular to IR; head rested on vertex; neck hyperextended
- RP: ¾ in.
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Submentovertical (Subbasal) Projection
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Lateral Projection
Other Projections
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Law Method
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PA Oblique Axial Projection
- Position: Semiprone; zygoma, nose & chin against IR; unaffected side against IR; OML perpendicular to IR; Center IR 2 in.above floor of maxillary sinuses
- CR: 30º caudad (OML ┴); 37º caudad (IOML ┴)
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SS: Sellar region
- Dorsum sellae, tuberculum sellae & anterior clinoid processes through occipital bone above shadow of foramen magnum (30º caudad)
- Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum (37º caudad)
- Symmetric petrous pyramid
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PA Oblique Axial Projection
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Rhése Method
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Orbitó-Pariétal Oblique Projection
- Position: Supine; affected orbit away from IR; AML perpendicular to IR; MSP 53º angle to IR
- RP: Inferior and lateral margin of uppermost orbit
- CR: Perpendicular
- SS: Orbits, maxillae & zygomatic arches
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Orbitó-Pariétal Oblique Projection
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Sweet Method
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Lateral Projection
- Position: 2 exposures
- SS: It determines the exact location of a foreign body by use of geometric calculations
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Lateral Projection
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Valdini Method
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PA Axial Projection
- Position: Recumbent or seated-erect (more comfortable); upper frontal region of skull against IR; MSP perpendicular to IR; head acutely flexed; IOML 50º/OML 50°; line extending from inion to 0.5 cm distal to nasion form 28º to CR
- RP: 0.5 cm distal to nasion (dorsum sellae); foramen magnum at or slightly above level of EAM (petrosae)
- CR: Perpendicular; inion (entrance); 0.5 cm distal to nasion (exit)
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SS:
- DILA: dorsum sellae; internal auditory meatus (IAM); labyrinth
- ETB: external auditory meatus; tymphanic cavity; bony part of Eustachian tube
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PA Axial Projection
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Modified Waters Method
- Position: Prone; MSP & MML perpendicular to IR; OML 55º to IR
- RP: Acanthion (exit)
- CR: Perpendicular
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SS: Facial bones w/ less axial angulation
- Petrous ridges below the inferior border of orbits
- Zygomatic bone
- Anterior wall of maxillary sinus of side up
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Haas Method
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PA Axial Projection
- Position: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR center 1 in.to nasion
- RP: Nasion
- CR: 25º cephalad
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SS: Symmetric axial frontal image of petrous portions projected above the base of the skull
- IAM
- Labyrinths
- Mastoid antrums
- Middle ears
- Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum
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PA Axial Projection
Distal to Nasion
- Acanthion is the exit point for this projection.
- Perpendicular central ray.
- Superior facial bones are imaged similarly to the Waters projection, but the image is magnified.
- Tangential projection.
- Extraoral film requires a prone positioning, with chin resting on sandbags and theMSP perpendicular to the IR.
- Intraoral film (Occlusal Film) requires a supine position with the head elevated. The MSP is perpendicular to the sponge and the GAL is parallel to the sponge and perpendicular to the film.
- Glabelloalveolar line is the reference point.
- Perpendicular central ray.
- Nasal Bones are imaged with minimal superimposition.
- Medial or lateral displacement of fragments in fractures can be visualized.
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Contraindications:
- Children or adults with short nasal bones.
- Concave face or protruding upper teeth.
Caldwell Method
- PA Axial projection.
- Prone positioning, with forehead and nose against the IR.
- OML is perpendicular to the IR.
- Nasion is the reference point.
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15° or 30° caudad angle for the central ray.
- 15° caudad: Petrous ridges at the lower third of the orbits.
- 30° caudad: Petrous ridges below the inferior orbital margins and orbital floors.
Law Method
- PA Oblique Axial.
- Semiprone positioning with the zygoma, nose, and chin against the IR, the unaffected side against the IR, and the OML perpendicular to the IR.
- Center the IR 2 inches above the floor of the maxillary sinuses.
- Two exposures are required.
Sweet Method
- Determines the exact location of a foreign body using geometric calculations.
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Apparatus:
- Sweet Localizing Device
- Sweet film pedestal
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One projection:
- Lateral: Two exposures
Waters (Parieto-Acanthial Projection)
- Prone positioning with the MSP and MML perpendicular to the IR.
- OML is 37° to the IR and the nose is 3/4 inch (1.9 cm) from the IR.
- Acanthion is the exit point.
- Perpendicular central ray.
- Best projection for facial bones.
- Orbits, maxillae, and zygomatic arches are imaged.
- Petrous ridges below the maxillae.
- Blowout Fractures can be visualized.
Modified Waters
- Prone positioning with the MSP & MML perpendicular to the IR.
- OML is 55° to the IR.
- Acanthion is the exit point.
- Perpendicular central ray.
- Zygomatic bones are imaged.
- Anterior wall of the maxillary sinus of the side up is visualized.
Reverse Waters
- AP Axial projection.
- Supine positioning, with the MSP & MML perpendicular to the IR.
- OML is 37° to the IR and the chin is up.
Nasal Bone
- Lateral projection.
- Semiprone positioning with the MSP & IOML parallel to the IR.
- IPL is perpendicular to the IR.
- Reference point: 3/4 inch (old) or 1/2 inch superior to the tip of the mastoid process.
- 15° caudad central ray.
- Mastoid process is free from superimposition and projected below the shadow of the occipital bone.
PA Tangential Position
- Prone positioning.
- IR is cranially inclined 15°.
- Tape auricles forward.
- Cheek against the IR.
- Face rotated away from the side of interest.
- MSP is 55° from the IR or 35° from vertical.
- IOML is perpendicular to the IR.
- Reference point: 1 inch superior to the tip of the mastoid process.
- 15° cephalad central ray.
- Mastoid process is free from superimposition and projected below the shadow of the occipital bone.
Towne Method
- AP Axial projection.
- Supine positioning with the OML/IOML and MSP perpendicular to the IR.
- Reference point: 2 inches above the glabella or 2.5 inches above nasion.
- 30° caudad (OML perpendicular) or 37° caudad (IOML perpendicular) central ray.
- Mandibular condyles and mandibular fossae of the temporal bones are imaged.
- Closed-mouth: The condyle lies in the mandibular fossa.
- Opened-mouth: The condyles lie inferior to the articular tubercle.
Axiolateral Projection
- Semiprone positioning with the head in a lateral position.
- IPL perpendicular to the IR.
- MSP parallel to the IR.
- Closed-mouth and opened-mouth positions.
- Reference point: 0.5 inch anterior and 2 inches superior to the upside EAM.
- 25-30° caudad central ray.
- TMJ anterior to the EAM is imaged.
- Closed-mouth: Condyle lies within the mandibular fossa.
- Opened-mouth: Condyles lie inferior to the articular tubercle.
Schuller Method
- Axiolateral oblique/lateral transcranial/axial transcranial projection.
- Semiprone positioning with MSP rotated 15° toward the IR.
- AML parallel to the transverse axis of the IR.
- Reference point: 1.5 inches anterior to the EAM (sella turcica).
- Mouth wide open.
- Acanthion is the reference point.
- Horizontal central ray.
- Sphenoidal sinuses projected through the open mouth.
- Petrous pyramids inferior to the floor of the maxillary sinus.
Zanelli Method
- Lateral transfacial position.
- Lateral recumbent positioning with the head in a true lateral position, resting on the parietal.
- MSP is 30° to IR.
- Uppermost gonion is the entrance point.
- Perpendicular central ray.
- TMJ is visualized.
Sinuses
- Cross and Flecker identified the value of the erect position to visualize fluid levels and differentiate fluid shadows from pathology.
Lateral Projection
- Perpendicular central ray.
- Sphenoidal sinuses are projected through the open mouth.
- Maxillary sinuses and nasal fossae visualized.
Rhese Method
- PA Oblique position.
- Seated erect positioning with zygoma, nose, and chin against the IR.
- AML perpendicular to the IR and MSP 53° from the IR.
- Upper parietal region is the reference point.
- Perpendicular central ray.
- Oblique image of the posterior and anterior ethmoidal sinuses.
- Frontal and sphenoidal sinuses visualized.
- Profile image of the optic canal is visualized.
Law Method
- PA Oblique position.
- Seated erect positioning with zygoma, nose, and chin against the IR.
- Neck is fully extended.
- Uppermost gonion is the reference point.
- 25-30° cephalad central ray.
- Relationship of the teeth to maxillary sinuses is visualized.
Mastoid
- Modified Hickey Method.
- AP Tangential position.
- Supine positioning with the auricles taped forward and the face rotated away from the side of interest.
- MSP is 55° from the IR or 35° from vertical.
- IOML perpendicular to the IR.
- IR caudally inclined 15°.
- Reference point: 1 inch.
- Sigmoid sinus, lateral portion of pars petrosa, tegmen tymphani, internal & external auditory meatuses, and the mastoid emissary vessel (when present) are visualized.
Skull Planes, Points & Lines
- Midsagittal Plane (MSP): Divides the skull into equal right and left halves.
- Interpupillary Line (IPL): Line drawn between the centers of the pupils.
- Acanthion: Point at the tip of the nasal spine.
- Outer Canthus: Lateral (outer) corner of the eye.
- Infraorbital Margin: Lower edge of the bony orbit.
- External Acoustic Meatus (EAM): Opening of the ear canal.
- Orbitalmeatal Line (OML): Line connecting the outer edge of the orbit to the EAM.
- Infraorbitomeatal Line (IOML)/Frankfort Line: Line connecting the infraorbital margin to the EAM.
- Acanthiomeatal Line (AML): Line connecting the acanthion to the EAM.
- Mentomeatal Line (MML): Line connecting the chin (menton) to the EAM.
- OML, IOML, and GML (Glabellomeatal Line): The angles between these lines are crucial for positioning during skull radiography.
Skull Pathology
- Basal Fracture: Fracture at the base of the skull.
- Blowout Fracture: Fracture of the floor of the orbit.
- Contre-Coup Fracture: Fracture on one side of a structure due to impact on the opposite side.
- Depressed Fracture: Fracture causing a portion of the skull to be pushed inwards.
- Le Fort Fracture: Bilateral horizontal fractures of the maxillae (upper jawbone).
- Linear Fracture: Irregular or jagged fracture of the skull.
- Tripod Fracture: Fracture involving the zygomatic arch, orbital floor/rim, and dislocation of the frontozygomatic suture.
- Mastoiditis: Inflammation of the mastoid antrum and air cells in the mastoid bone.
- Paget's Disease: Thickened, soft bone with a tendency for bowing and fractures.
- Sinusitis: Inflammation of one or more paranasal sinuses (air-filled cavities in the skull).
- TMJ Syndrome: Disorder of the temporomandibular joint (jaw joint).
Skull Radiographic Projections
- PA (Posteroanterior) Projection: Patient prone, MSP and OML perpendicular to the IR (image receptor).
- AP (Anteroposterior) Projection: Patient supine, MSP and OML perpendicular to the IR.
- Lateral Projection: Patient semiprone, MSP and IOML parallel to IR, IPL perpendicular to IR.
- Caldwell Method: PA axial projection.
- Waters Method: Parietoacanthial projection.
- Stenvers Method: Posterior profile position of the skull to view the petrous bone.
- Schuller Method: Verticosubmental projection to view the sphenoid sinuses.
- Mayer Method: Axiolateral oblique projection of the petrous bone.
- Modified Lysholm Method: Eccentric angle parieto-orbital oblique projection.
- Hough Method: Parieto-orbital oblique projection to view the sphenoid strut.
- Bertel Method: PA axial projection to view the inferior orbital fissures.
- Pfeiffer-Comberg Method: Utilizes a leaded contact lens to localize foreign bodies in the eye.
- Vogt-Bone-Free Position: Lateral and superoinferior projections used for detecting small or low-density foreign bodies in the eye.
- Parallax Method: Two projections (lateral) to determine if a foreign body is within the eye.
- Open-Mouth Waters Method: Modification of the Waters for better visualization of the sphenoid and ethmoid sinuses.
- Hirtz Method: Variation of the Open-Mouth Waters for better visualization of the petrous bone and mastoid structures.
Radiographic Projections for Specific Structures
- Petrous Pyramid: Best visualized with the Caldwell, PA axial, and Stenvers projections.
- Superior Orbital Fissure: Well visualized on the Caldwell PA axial projection at 15o caudal angle.
- Inferior Orbital Fissure: Best visualized with the Bertel Method, PA axial projection.
- Optic Canal (Foramen): Modified Lysholm Method, Hough Method, and PA projection with 10o cephalad angle.
- Foreign Body in the Eye: Lateral projection for initial check.
- Facial Bones: Lateral projection to visualize superimposed facial bones.
- Sphenoid and Ethmoid Sinuses: Waters method and Schuller method.
- Maxillary Sinuses: Waters method.
- Sella Turcica: Waters method, Open-Mouth Waters method, and Stenvers method.
- In addition to these projections, tomographic studies can be conducted to obtain detailed images of specific structures like the ears, jugular foramina, and rotundum foramina.*
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Description
This quiz covers detailed methods for skull projections including the Schuller/Pfeiffer method and the Modified Towne method. You will learn about patient positioning, central ray angles, and the anatomical structures demonstrated in each projection. Test your knowledge of radiographic techniques in skull imaging.
