Skull Projection 1 PDF

# Cranium ## Lateral Projection - **Position:** Seated/ Semi-prone - **Side of interest:** - closest to IR - head in true Lateral position - **Alignment:** - MSP // to IR - IOML // to IR - IPL 1 to IR - **Well demonstrate of:** - Sella turcica - **anterior & posterior of clinoid proce...

# Cranium ## Lateral Projection - **Position:** Seated/ Semi-prone - **Side of interest:** - closest to IR - head in true Lateral position - **Alignment:** - MSP // to IR - IOML // to IR - IPL 1 to IR - **Well demonstrate of:** - Sella turcica - **anterior & posterior of clinoid processes** - Dorsum sellae - Greater wings (sphenoid) - Parietal Penetrated - No overlap of cervical by mandible - **Superimposed:** - Orbital roofs - EAM - Mastoid Regions - TMJ ## **Crosstable/ Robinson/ Meares/ GOREC ** - **Position:** Dorsal Decub - **Alignment:** - affected near IR - MSP // IR - IPL L IR - **Demonstration of:** - Traumatic Sphenoid sinus effusion - FOR Basal FRACTURE ## Lateral Projection (Supine Lateral) - **Position:** Supine lateral - turn head toward side of side - **Alignment:** - MSP // to IR - IPL 1 to IR - **Support head Radiolucent Pad** - **Structure shown Same as Lateral Projection** ## PA Projection - **Position:** Prone - **Alignment:** - MSP I to IR - OML IIR - Rest Forehead - I nose IR - EAM equidistant to IR - **Exit:** Nasion - **Well demonstrate of:** - Frontal Bone - orbits filled w/ margins - Petrous pyramid - crista galli - Dorsum sellae - Sinuses - Frontal sinuses - posterior ethmoidal air cells ## PA Axial Projection (Caldwell Method) - **Position:** Prone - **Alignment:** - MSP I to IR - OML IIR - Rest Forehead - I nose IR - EAM equidistant to IR - **Exit:** - Nasion - **Well demonstrate of:** - Petrous Ridges - **to Lower 1/3 of ORBITs, upper 2/3 of ORBITS** - Sinuses - Frontal cinus - Anterior Ethmoidal sinuses ## Schüller Projection - **Angulation:** - 15° caudad - exit nasion - 25° caudad - exit nasion - 25 to 30° caudad - exit nasion - 20 to 25° caudad - exit midorbits - **Well demonstrate of:** - Rotundum Foramina - Superior Orbital fissure ## PA/PA Axial Projection (Lateral Decubitus) - **Position:** Lateral Decubitus - **PT who can't prone, PT w/ CERVICAL SPINAL INJURY** - **Body:** supine - **Head:** in True Lateral (Facing IR) - **Alignment:** - MSP I TO IR - OML I to IR - **PA:** 15 caudad- exit nasion ## True/Original Caldwell Method - **Position:** Prone - **Alignment:** - Rest Forehead I - nose IR - GML I IR - MSP IIR - **Angulation:** 23° caudad - exit nasion - **Same as PA axial** ## AP Projection - **Position:** Supine - **Alignment:** - MSP I IR - OML I IR - **Angulation:** I nasion - **Exit:** Nasion - **Well demonstrate of:** - PA image MAGNIFIED - Orbits are magnified ## AP Axial Projection - **Position:** Supine/upright - **Angulation:** - 15° cephalad - exit nasion - hypersthenic - seated/upright - **Well demonstrate of:** - Orbits are magnified - PA image MAGNIFIED ## AP Axial Projection (Towne Method) - **Position:** Supine - **Angulation:** - MSP I IR - OML LIR - 30° caudad - IOML LIR - 37° caudad - **Well demonstrate of:** - "SPDOP" - Symmetric Petrous Pyramid - Posterior (Foramen Magnum) - Posterior clinoid - Dorsum sellae (processes within foramen magnum) - Posterior (Parietal bone) ## Grashey Method (1912 cranium) - **Angulation :** 2 1/2" (6.3 cm) above slabella - Occipital bone ## Altschul & Towne Method (Chamberlain) - **Angulation:** - 40° caudad - strong depression of the chin - Chin depressed - CR to MSP - 3 in above eyebrows to the Foramen magnum - **Well demonstrate of:** Also use for TOMOGRAPHIC studies - ears - facial canal - Jugular foramina - Rotondum foramina ## Haas method (PA axial) - **Position:** Prone - **Alignment:** - MSP I IR - OML I IR - Rest on Forehead - I nose IR - Include vertex of skull - **Angulation:** - 25° cephalad - exit 1/2 in superior nasim - Haas method - 25° cephalad to OML - **Well demonstrate of:** - Sellar structure wlin Foramen Magnum for hypersthenic patients who can't do Towne projection - occipito-basal Occipital Region Cranium - Symmetric - Pars petrosa - Dorsum cellae - Posterior clinoid Process - w/in Foramen magnum - Entire Cranium ## Towne-Altschul-Grashey-Chamberlaine - **Position:** AP axial Projection - Lateral decubitus - **Angulation:** - 40 to 60° caudad - **Well demonstrate of:** - Entire Foramen magnum ## **Pathologic or trauma** - **Position:** - Semisupine - OML I to IR - **Angulation:** 30. caudad - **Well demonstrate of:** - For Pathologic conditim, trauma deformity, accentuated (dorsal kyphosis) ## PA axial Projection (Haas Method) - **Position:** Prone - **Alignment:** - MSP I IR - OML I IR - Rest on Forehead - I nose IR - Include vertex of skull - Center IR 3 in above sellar Regim - **Angulation:** 10° cephalad - **Well demonstrate of:** - 1/2 in below Inion - Dorsum & tuberculum sellae - GLabella - Posterior & Anterior Clinoid Processes - (through Frontal bone) above ethmoidal sinus - Hypersthenic pt Sellar structure w/in Foramen magnum ## Cranial Base - **Position:** supine - upright - IOML // to IR - CR 1 to 10ML - MSPI IR - Neck hyperextended - Rest Vertex on IR supine - increase intra-cranial pressure (dizzyness) - **Angulation:** - 10ML - Sella Turcica (3/4 anterior) to EAM - 6in gonion - **Well demonstrate of:** - Cranial Base Foramen ovale & spinosum - Symmetric petrosae mastoid Process - Carotid Canals - mandible - Bony nasal septum - Dens (axis) - occipital bont - Sinuses Sphenoidal & Ethmoidal maxillary sinus superimposed over mandible - axial Topography ORBITS - Optic canals - ethmoid bone - maxillary sinuses - mastoid process - zygomatic arches ## Verticosubmental (VSM) projection - **Position:** Prone - **Alignment:** - MSP I IR - Rest Fully extend chin on IR - **Angulation:** - 1 to 10 ML - 3/4 inch (1.9 cm) anterior to EAM - (Sella turcica) - **Well demonstrate of:** - Same as SMV: Distorted & magnified basal structure - Useful for: anterior cranial base Sphenoid sinuses - **Reduces magnification** - **Place throat on IR** ## Lysholm method (axiolateral projection) - **Position:** Semi-prone - **Alignment:** - MSP // IR - IOML // IR - IPL I IR - 30-35° caudad - 1 in distal to lower EAM - DILA (10ML 50°) IAM - ETB (OML 50°) EAM - **Well demonstrate of:** - Oblique position of Lateral of cranial base (closest IR) - Dorsum cellae - Labyrinth - Tympanic cavity - Bony pari (Eustachian) Tube - Mastoid Pneumatization ## Valdini method (PA axial Projection) - **Position:** - Recumbent/Upright - Rest upper Frontal skull on IR - Head a cutely Flexed - MSP I IR - nasion 28 IR - IOML 50° - auditory canals - -10ML 50° auditory canals · 1 0.5 distal to nasion - Foramen magnum - **Well demonstrate of:** - Labyrinths of Ears - Tympanic cavities - Bony pari (Eustachian) Tube - Above the foramen magnum shadow: - Dorsum sellae - P.clinoid process - Below Foramen M. shadow: - Tuberculum sallae - A clinoid Process ## Lateral Projection - **Position:** semi-prone / upright - head true Lateral - **Alignment:** - MSP // TO IR - 10ML // to IR - IPL I IR - **Angulation:** - 3/4 in (1.9cm) anterior - 3/4 in Posterior EAM - **Well demonstrate of:** - Lateral Projection Sellar Region (no distortion & Rotation) - superimposed anterior & Posterior clinoid processes - Sphenoid sinus - Dorsum sellae ## Towne method (APaxial Projection) - **Position:** Supine/upright - **Angulation:** - 37° caudad - 10ML - 30° caudad - 10ML - **Alignment:** - MSPI to IR - IOML I IR - OML I IR - **Well demonstrate of:** - 3in above Glabella - Sellar Region - Petrous pyramid - 37 caudad 10ML - Dorsum Sellal Posterior clinoid Processes w/in Foramen magnum - 30° caudad DML - Dorsum & tuberculum sellae - anterior clinoid processes - above Foramen magnum ## PA axial projection (Haas Method) - **Position:** Prone - **Alignment:** - MSP I IR - DML LIR - Rest Forehead - I nose IR - **Angulation:** - 10° cephalad - **Well demonstrate of:** - 1/2 inch below Inim - Dorsum & tuberculum sellae - GLabella - Posterior & Anterior Clinoid Processes - (through Frontal bone) above ethmoidal sinus - 25° cephalad to OML - Hypersthenic pt Sellar structure w/in Foramen magnum ## Optic canal & Foramen (Parieto orbital oblique Projection Rhese Method) - **Position:** - Semi-prone - affected orbit - 1 in superior - I posterior to TEA - closest to IR - Rest zygoma, nose & chin IR - AML I IR - MSP 53° to IR - **Well demonstrate of:** - Affected OPTIC canal & Foramen - (inferior & Lateral Q. of affected orbit) - Sinuses: - Frontal - Ethmoidal - Sphenoidal ### PAZAM - Position: Prone - Alignment: - Affected ORBIT IR - ZYNOCH - AML I IR - MSP 53° IR ## ORBITO-PARIETAL oblique proj (Rhese Method) - **Position:** - supine - affected orbit away IR - MSP 53° IR - AML I in - **Well demonstrate of:** - Inferior & Lateral Q. of uppermost Orbit - Optic canal & foramen - (inferior & Lateral Quadrant OF Orbit) ### Reverse Of Parieto orbital Oblique Proj. - **For pt who can't prone TOID** - **↑pt dose** ## Alexander Method (ORBITO- Parietal oblique projection) - **Position:** - Supine - AML I IR - MSP 40° IR - IR 15 From vertical - Affected orbit away IN - **Angulation:** - Inferior I Lateral margin of uppermost orbit - **Well demonstrate of:** - Optic canal & foramen ## Modified Lysholm Method (Eccentric Angle Parieto-Orbital Oblique Projection) - **Position:** - Prone - Rest Forehead & nose IR - IOML I IR - 20° caudad - 10ML I IR - 30° caudad - MSP 20° From vertical - **Angulation:** - inferior Root of lesser wing (sphenoid) - **Well demonstrate of:** - Affected OPTIC canal + Foramen - Orbit - anterior clinoid Process 20° - superior orbital Fissure 30° ## Sphenoid Strut - **Position:** - Prone - Supercilliary Ridge/ arch & Side of nose IR - IOML I IR - MSP 20° toward side of Interest (IR) - **Angulation:** - 7° caudad - **Well demonstrate of:** - affected orbit - unobstructed & undistorted image - Sphenoid strut - (lie b/n sphenoid Sinus & combined shadows of anterior clinoid processes & lesser wing of sphenoid) ## Superior Orbital Fissures - **Position:** - Prone - MSP LIR - Rest Forehead & nose IR - OML I IR - **Angulation:** - 20-25° caudad - **Well demonstrate of:** - Inferior margin Orbit - Petrous Ridge at / below inferior margin OF Orbits - Superior orbital fissure - elongated dark areas on medial orbits b/n greater wing & sphenoid - margins of superior orbital fissure (narrowed) - 15 caudad ## Inferior Orbital fissure (Bretel method PA axial Projection - **Position:** - Prone - MSPLIR - Forehead I nose IR - 10ML I IR - **Angulation:** - 20 - 25° nasion cephalad - 3 in (7.6 cm) below Inion - **Well demonstrate of:** - Inferior Orbital Fissure - Orbital fissure bln shadows of Pterygoid Lamina (sphenoid) & condylar Process (mandible) ## EYE/ORBIT (FOREIGN BODIES Localizatin Method) ### Vogt Bone-Free method - **Position:** - Eye straight - forward - 1st Look-upward-Vertical - 2nd Look-downward - 1st LOOK-Left- Horizontal - 2nd Look-Right - **Well demonstrate of:** - detect small/Low density foreign Particles in Anterior Segment of eyeball or eyelid - (use of periapical/ occlusal size dental film) ### Sweet method - **Well demonstrate of:** - For exact location Of Foreign body, - (w/ use of Geometric calculation) - **Requires device (2 markers For know positiml For measurement)** -Localizer device 8x10 film tunnel of the pedestal type - Lateral: 2 exposures: 1. 115-25° cephalad ### Pfeiffer-Comberg Method - **Well demonstrate af:** - Foreign body localized in Relation to the limbus - the corneoscleral Junction-waters-Horizontal Lateral - ト - Leaded contact lens Placed over the cornea. - 2 intraorbital & Intraocular - contact lens embedded around the periphery 4 lead markers spaced at 90° intervals - 1. Contact lens localization device 2. Pedestal type of Film holder ### Parallax Motion method - **Well demonstrate of:** - Determining the foreign body is located w/in the eyeball - Richard describes - 2 Lateral & 2 PA exposures w/ leyeball in different Position) - Anteriorly & intra ocular foreign bodies move w/ eyeball - Posteriorly - FB In extrinsic muscle - do not change positim - central intraocular FB ## For Image Quality - **Well demonstrate of:** - ↓ Geometric Unsharpness - 1010 - small Focal spot - ↓ SID - collimation - ↓ motion ↓ eyeball movements - **Well demonstrate of:** - 1. clean IR & screen ## EYE Preliminary Examinatim - **Well demonstrate of:** - Lateral projectims - PA projections - Bone-Free studies (waters)