Skull Projection 1 PDF
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Summary
This document provides detailed information on various skull projection methods, including lateral, PA, PA axial, and specific projections such as Caldwell, Schüller, Towne, and Haas. It covers patient positions, alignments, and indications for different imaging techniques, along with structures visualized in each projection, including orbital regions and sinus structures, as well as for conditions such as traumatic and pathologic.
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# 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)
