Procedures II: Chapter 11 - Skull positioning

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79 Terms

1
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For accurate air-fluid levels

Why is erect positioning preferred for sinuses?

2
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No AEC for sinuses

Can you use AEC for sinuses?

3
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If rotation is present, one is more in front of the other.

What do you look for in rotation?

4
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If tilt is present, one plate is higher than the other

What do you look for in tilt?

5
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  • Rami of mandible

  • Anterior + posterior clinoid processes

Vertical structures

What structures are seen when rotation is present?

6
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  • Body of mandible

  • Orbital plates

Horizontal structures

What structures are seen when tilt is present?

7
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Skull routines:

  1. PA or PA axial (caldwell)

  2. Lateral

  3. AP axial (Townes)

What are the routines for skull exam?

8
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Skull lines:

  • MSP perpendicular to IR

  • OML (30 degrees) or IOML (37 degrees) perpendicular to IR

What lines are used for AP axial projection of Towne’s method for skull?

<p>What <u>lines</u> are used for <strong>AP axial projection of Towne’s</strong> method for <strong>skull</strong>?</p>
9
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Skull positioning:

  • Pt is seated, back against the board

  • Tuck chin to OML

What is the positioning of AP axial projection of Towne’s method of skull?

<p>What is the <u>positioning</u> of <strong>AP axial projection of Towne’s</strong> method of <strong>skull</strong>?</p>
10
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Skull angle:

  • OML: 30 degrees caudad (60 degrees)

  • IOML: 37 degrees caudad (53 degrees)

What is the tube angle used for AP axial projection of Towne’s?

<p>What is the <u>tube angle</u> used for <strong>AP axial projection of Towne’s?</strong></p>
11
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Skull CR: 2.5 inches above glabella = hairline

What is the CR for AP axial projection of Towne’s for skull?

<p>What is the <u>CR</u> for <strong>AP axial projection of Towne’s </strong>for <strong>skull</strong>?</p>
12
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Skull demonstration:

  • Occipital bone

What is best demonstrated for AP axial projection of Towne’s method for skull?

<p>What is <u>best demonstrated</u> for <strong>AP axial projection of Towne’s</strong> method for <strong>skull</strong>?</p>
13
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Skull critique:

  • Dorsum sellae and posterior clinoid processes in the shadow of the foramen magnum

  • Petrous ridges are symmetrical

How do you critique radiograph of AP axial projection of Towne’s method for skull?

<p>How do you <u>critique</u> radiograph of <strong>AP axial projection of Towne’s</strong> method for <strong>skull</strong>?</p>
14
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Skull lines:

  • MSP parallel to IR (moving left to right)

  • IOML parallel to IR

  • IP perpendicular

What lines are used for RT and LT lateral method for skull?

<p>What <u>lines</u> are used for <strong>RT and LT lateral </strong>method for <strong>skull</strong>?</p>
15
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Skull positioning:

  • Shoulders obliqued

  • Head is close to the board “listening”

What is the positioning of RT and LT lateral method for skull?

<p>What is the <u>positioning</u> of <strong>RT and LT lateral </strong>method for <strong>skull</strong>?</p>
16
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Skull CR:

  • 2 inches above EAM

What is the CR for RT and LT lateral method for skull?

<p>What is the <u>CR</u> for <strong>RT and LT lateral </strong>method for <strong>skull</strong>?</p>
17
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Skull demonstration

  • Entire skull is visualized (Frontal + parietal + occipital + temporal)

  • Downside parietal bone

What is best demonstrated for RT and LT lateral method for skull?

<p>What is <u>best demonstrated</u> for <strong>RT and LT lateral </strong>method for <strong>skull</strong>?</p>
18
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Skull critique:

  • Sella turcica + anterior and posterior clinoid processes + orbital plates + rami of mandible are SUPERIMPOSED

How do you critique radiograph of RT and LT lateral method for skull?

<p>How do you <u>critique</u> radiograph of <strong>RT and LT lateral </strong>method for <strong>skull</strong>?</p>
19
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Skull lines:

  • MSP perpendicular

  • OML perpendicular

What lines are used for PA projection (axial + w/o angle) method for skull?

<p>What <u>lines</u> are used for <strong>PA projection (</strong><span style="color: green"><strong>axial + w/o angle</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
20
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Skull

  • Nose + forehead against the board

What is the positioning of PA projection (axial + w/o angle) method for skull?

<p>What is the <u>positioning</u> of <strong>PA projection (</strong><span style="color: green"><strong>axial + w/o angle</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
21
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Skull CR: Exit at Glabella

What is the CR for PA projection (0 degrees) method for skull?

<p>What is the <u>CR</u> for <strong>PA projection (</strong><span style="color: rgb(255, 0, 0)"><strong>0 degrees</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
22
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Skull: Frontal bone

  • Best general survey of cranial bone

What is best demonstrated for PA projection (axial + w/o angle) method for skull?

<p>What is <u>best demonstrated</u> for <strong>PA projection (</strong><span style="color: green"><strong>axial + w/o angle</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
23
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Skull:

  • Petrous pyramids filling the orbits

How do you critique radiograph of PA projection (0 degrees) method for skull?

<p>How do you <u>critique</u> radiograph of <strong>PA projection (</strong><span style="color: rgb(255, 0, 0)"><strong>0 degrees</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
24
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Skull CR: Exits at nasion

What is the CR for PA axial projection (Caldwell) method for skull?

<p>What is the <u>CR</u> for <strong>PA axial projection (</strong><span style="color: blue"><strong>Caldwell</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
25
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Skull:

  • Petrous pyramids are lower 1/3 of the orbit

How do you critique radiograph of PA axial projection (Caldwell) method for skull?

<p>How do you <u>critique</u> radiograph of <strong>PA axial projection (</strong><span style="color: blue"><strong>Caldwell</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
26
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Skull Caldwell angle:

  • 15 degrees caudad

What is the tube angle used for PA axial projection (Caldwell) method for skull?

<p>What is the <u>tube angle</u> used for <strong>PA axial projection (</strong><span style="color: blue"><strong>Caldwell</strong></span><strong>) </strong>method for <strong>skull</strong>?</p>
27
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Skull lines:

  • MSP perpendicular

  • IOML parallel to IR + perpendicular to CR

Special: What lines are used for Submentovertical (SMV) projection of skull?

<p>Special: What <u>lines</u> are used for <strong>Submentovertical (SMV) projection </strong>of skull?</p>
28
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Skull CR:

  • CR: 1.5 inches below mandibular symphysis

Special: What is the CR for Submentovertical (SMV) projection of skull?

<p>Special: What is the <u>CR</u> for <strong>Submentovertical (SMV) projection </strong>of skull?</p>
29
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Skull demonstration:

  • Floor of the cranium

Special: What is best demonstrated for Submentovertical (SMV) projection of skull?

<p>Special: What is <u>best demonstrated</u> for <strong>Submentovertical (SMV) projection </strong>of skull?</p>
30
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Skull critique:

  • Mandibular condyles anterior to petrous pyramids

Special: How do you critique radiograph of Submentovertical (SMV) projection of skull?

<p>Special: How do you <u>critique</u> radiograph of <strong>Submentovertical (SMV) projection </strong>of <strong>skull</strong>?</p>
31
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PA axial (Haas method)

Special: What is the reverse method of AP Axial Towne’s?

<p>Special: What is the reverse method of AP Axial Towne’s?</p>
32
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Skull tube angle:

  • 25 degrees cephalad

Special: What is the tube angle used for PA axial (Haas method) for skull?

<p>Special: What is the <u>tube angle</u> used for <strong>PA axial (Haas method) </strong>for <strong>skull</strong>?</p>
33
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Skull demonstration:

  • Occipital bone, petrous pyramids, and foramen magnum

  • Dorsum sellae and posterior clinoid processes visualized in the shadow of the foramen magnum

Special: What is best demonstrated for PA axial (Haas method) for skull?

<p>Special: What is <u>best demonstrated</u> for <strong>PA axial (Haas method) </strong>for <strong>skull</strong>?</p>
34
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Facial bone routines:

  1. Lateral

  2. PA axial (caldwell)

  3. Parietocanthial (waters)

What are the routines for facial bone?

35
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Facial bone lines:

  • MSP + IOML parallel to the IR

  • IP perpendicular to IR

What lines are used for RT and LT lateral for facial bone?

<p>What <u>lines</u> are used for <strong>RT and LT lateral </strong>for <strong>facial bone?</strong></p>
36
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Facial bone positioning:

  • Shoulders obliqued

  • Head is close to the board “listening”

What is the positioning of RT and LT lateral for facial bone?

<p>What is the <u>positioning</u> of <strong>RT and LT lateral </strong>for <strong>facial bone?</strong></p>
37
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Facial bone CR:

  • Halfway between outer canthus + EAM

What is the CR for RT and LT lateral for facial bone?

<p>What is the <u>CR</u> for <strong>RT and LT lateral </strong>for <strong>facial bone?</strong></p>
38
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Facial bone demonstration:

  • Downside facial bone

  • Mandible visible (no rotation)

What is best demonstrated for RT and LT lateral for facial bone?

<p>What is <u>best demonstrated</u> for <strong>RT and LT lateral </strong>for <strong>facial bone?</strong></p>
39
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Facial bone critique:

  • Tilt: Anterior and posterior clinoids + orbital plates

  • Rotation: Rami of mandible is superimposed

How do you critique radiograph of RT and LT lateral for facial bone?

<p>How do you <u>critique</u> radiograph of <strong>RT and LT lateral </strong>for <strong>facial bone?</strong></p>
40
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Facial bone lines:

  • MSP + MML perpendicular

What lines are used for Parietocanthial Projection: Waters method for facial bone?

<p>What <u>lines</u> are used for <strong>Parietocanthial Projection: Waters method </strong>for <strong>facial bone</strong>?</p>
41
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Facial bone positioning:

  • Chin on the board

What is the positioning of Parietocanthial Projection: Waters method for facial bone?

<p>What is the <u>positioning</u> of <strong>Parietocanthial Projection: Waters method </strong>for <strong>facial bone</strong>?</p>
42
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Facial bone CR:

  • CR - exits at acanthion

What is the CR for Parietocanthial Projection: Waters method for facial bone?

<p>What is the <u>CR</u> for <strong>Parietocanthial Projection: Waters method </strong>for <strong>facial bone</strong>?</p>
43
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Facial bone demonstration:

  • Best survey for facial bone

What is best demonstrated for Parietocanthial Projection: Waters method for facial bone?

<p>What is <u>best demonstrated</u> for <strong>Parietocanthial Projection: Waters method </strong>for <strong>facial bone</strong>? </p>
44
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Facial bone critique:

  • Petrous pyramid is below maxillary sinuses

How do you critique radiograph of Parietocanthial Projection: Waters method for facial bone?

<p>How do you <u>critique</u> radiograph of <strong>Parietocanthial Projection: Waters method </strong>for <strong>facial bone</strong>?</p>
45
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Facial bone lines:

  • MSP + OML perpendicular to IR

What lines are used for PA axial projection: Caldwell method for facial bone?

<p>What <u>lines</u> are used for <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>?</p>
46
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Facial bone positioning:

  • Nose + forehead on the board

What is the positioning of PA axial projection: Caldwell method for facial bone?

<p>What is the <u>positioning</u> of <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>?</p>
47
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Facial bone CR:

  • CR: exits at nasion

What is the CR for PA axial projection: Caldwell method for facial bone?

<p>What is the <u>CR</u> for <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>? </p>
48
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Facial bone tube angle:

  • CR: 15 degrees caudad

What is the tube angle used for PA axial projection: Caldwell method for facial bone?

<p>What is the <u>tube angle</u> used for <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>?</p>
49
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Facial bone demonstration:

  • Orbital rim/base, maxilla, zygoma, nasal
    septum, anterior nasal spine

What is best demonstrated for PA axial projection: Caldwell method for facial bone?

<p>What is <u>best demonstrated</u> for <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>?</p>
50
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Facial bone critique:

  • Petrous pyramids are in lower 1/3 of orbits

How do you critique radiograph of PA axial projection: Caldwell method for facial bone?

<p>How do you <u>critique</u> radiograph of <strong>PA axial projection: Caldwell method </strong>for <strong>facial bone</strong>?</p>
51
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Facial bone special lines:

  • LML + MSP perpendicular to IR

  • OML forms 55 degrees angle with IR

Special: What lines are used for Modified Parietocanthial projection: Modified waters method for facial bone?

<p>Special: What <u>lines</u> are used for <strong>Modified Parietocanthial projection: Modified waters method </strong>for <strong>facial bone</strong>?</p>
52
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Facial bone special positioning:

  • Chin and nose against the board

Special: What is the positioning of Modified Parietocanthial projection: Modified waters method for facial bone?

<p>Special: What is the <u>positioning</u> of <strong>Modified Parietocanthial projection: Modified waters method </strong>for <strong>facial bone</strong>?</p>
53
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Facial bone special CR:

  • CR: Exits at acanthion

Special: What is the CR for Modified Parietocanthial projection: Modified waters method for facial bone?

<p>Special: What is the <u>CR</u> for <strong>Modified Parietocanthial projection: Modified waters method </strong>for <strong>facial bone</strong>?</p>
54
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Facial bone special demonstration:

  • Orbital plates are NOT distorted

Special: What is best demonstrated for Modified Parietocanthial projection: Modified waters method for facial bone?

<p>Special: What is <u>best demonstrated</u> for <strong>Modified Parietocanthial projection: Modified waters method </strong>for <strong>facial bone</strong>?</p>
55
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Facial bone special critique:

  • Petrous pyramids in lower 1/3 of maxillary sinuses

Special: How do you critique radiograph of Modified Parietocanthial projection: Modified waters method for facial bone?

<p>Special: How do you <u>critique</u> radiograph of <strong>Modified Parietocanthial projection: Modified waters method </strong>for <strong>facial bone</strong>?</p>
56
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Sinus routines:

  1. Lateral

  2. PA Caldwell

  3. Parietocanthial (waters)

What are the routines for sinuses exam?

57
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Sinuses lines:

  • MSP + IOML parallel

  • IP perpendicular

What lines are used for RT and LT lateral for sinuses?

<p>What <u>lines</u> are used for <strong>RT and LT lateral </strong>for <strong>sinuses?</strong></p>
58
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Sinuses CR:

  • CR: Halfway between outer canthus + EAM

What is the CR for RT and LT lateral for sinuses?

<p>What is the <u>CR</u> for <strong>RT and LT lateral </strong>for <strong>sinuses?</strong></p>
59
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Sinuses demonstration:

  • All four sinuses demonstrated

What is best demonstrated for RT and LT lateral for sinuses?

<p>What is <u>best demonstrated</u> for <strong>RT and LT lateral </strong>for <strong>sinuses?</strong></p>
60
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Sinuses critique:

  • Sella in profile

  • Tilt: Anterior and posterior clinoids + orbital plates superimposed

  • Rotation: Rami of mandible superimposed

How do you critique radiograph of RT and LT lateral for sinuses?

<p>How do you <u>critique</u> radiograph of <strong>RT and LT lateral </strong>for <strong>sinuses?</strong></p>
61
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Sinuses lines:

  • MSP perpendicular

  • OML 15 degrees from horizontal

What lines are used for PA axial: Caldwell for sinuses?

<p>What <u>lines</u> are used for <strong>PA axial: Caldwell </strong>for <strong>sinuses?</strong></p>
62
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Sinuses positioning:

  • Nose + forehead against the board

What is the positioning of PA axial: Caldwell (no angle) for sinuses?

<p>What is the <u>positioning</u> of <strong>PA axial: Caldwell (no angle) </strong>for <strong>sinuses?</strong></p>
63
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Sinuses CR:

  • CR: exits at nasion

What is the CR for PA axial: Caldwell (no angle) for sinuses?

<p>What is the <u>CR</u> for <strong>PA axial: Caldwell (no angle) </strong>for <strong>sinuses?</strong></p>
64
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Sinuses demonstration:

  • Best demonstrated: Frontal sinuses + anterior ethmoid sinuses

What is best demonstrated for PA axial: Caldwell (no angle) for sinuses?

<p>What is <u>best demonstrated</u> for <strong>PA axial: Caldwell (no angle) </strong>for <strong>sinuses?</strong></p>
65
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Sinuses critique:

  • Petrous pyramid in lower 1/3 of orbit

How do you critique radiograph of PA axial: Caldwell (no angle) for sinuses?

<p>How do you <u>critique</u> radiograph of <strong>PA axial: Caldwell (no angle) </strong>for <strong>sinuses?</strong></p>
66
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Sinuses lines :

  • MML + MSP perpendicular

What lines are used for Parietocanthial projection: Waters method for sinuses?

<p>What <u>lines</u> are used for <strong>Parietocanthial projection: Waters method </strong>for <strong>sinuses?</strong></p>
67
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Sinuses CR:

  • CR: exits at acanthion

What is the CR for Parietocanthial projection: Waters method for sinuses?

<p>What is the <u>CR</u> for <strong>Parietocanthial projection: Waters method </strong>for <strong>sinuses?</strong></p>
68
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Sinuses demonstration:

  • Best demonstrated: Maxillary sinuses

What is best demonstrated for Parietocanthial projection: Waters method for sinuses?

<p>What is <u>best demonstrated</u> for <strong>Parietocanthial projection: Waters method </strong>for <strong>sinuses?</strong></p>
69
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Sinuses:

  • Critique: Petrous pyramids below maxillary sinuses

How do you critique radiograph of Parietocanthial projection: Waters method for sinuses?

<p>How do you <u>critique</u> radiograph of <strong>Parietocanthial projection: Waters method </strong>for <strong>sinuses?</strong></p>
70
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Sinuses special lines:

  • IOML parallel to IR

  • MSP perpendicular

Special: What lines are used for SMV for sinuses?

<p>Special: What <u>lines</u> are used for <strong>SMV </strong>for <strong>sinuses?</strong></p>
71
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Special sinuses positioning:

  • Back of head against the board

  • Raise chin (hyperextend neck if possible)

Special: What is the positioning of SMV for sinuses?

<p>Special: What is the <u>positioning</u> of <strong>SMV </strong>for <strong>sinuses?</strong></p>
72
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Special:

  • CR: directly perpendicular to IR

Special: What is the CR for SMV for sinuses?

<p>Special: What is the <u>CR</u> for <strong>SMV </strong>for <strong>sinuses?</strong></p>
73
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Sinuses special demonstration:

  • Sphenoid, ethmoid, maxillary sinuses

Special: What is best demonstrated for SMV for sinuses?

<p>Special: What is <u>best demonstrated</u> for <strong>SMV </strong>for <strong>sinuses?</strong></p>
74
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Sinuses special:

  • Critique: Mandibular condyles anterior to petrous pyramids

Special: How do you critique radiograph of SMV for sinuses?

<p>Special: How do you <u>critique</u> radiograph of <strong>SMV </strong>for <strong>sinuses?</strong></p>
75
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Sinuses special lines:

  • MML + MSP perpendicular

Special: What lines are used for Parietocanthial transoral projection: Open mouth waters method for sinuses?

<p>Special: What <u>lines</u> are used for <strong>Parietocanthial transoral projection: Open mouth waters method </strong>for <strong>sinuses?</strong></p>
76
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Sinuses special positioning:

  • Chin on the board

  • Extend neck

Special: What is the positioning of Parietocanthial transoral projection: Open mouth waters method for sinuses?

<p>Special: What is the <u>positioning</u> of <strong>Parietocanthial transoral projection: Open mouth waters method </strong>for <strong>sinuses?</strong></p>
77
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Sinuses special CR:

  • exit at acanthion

Special: What is the CR for Parietocanthial transoral projection: Open mouth waters method for sinuses?

<p>Special: What is the <u>CR</u> for <strong>Parietocanthial transoral projection: Open mouth waters method </strong>for <strong>sinuses?</strong></p>
78
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Sinuses special demonstration:

  • Maxillary, frontal, sphenoid sinuses

Special: What is best demonstrated for Parietocanthial transoral projection: Open mouth waters method for sinuses?

<p>Special: What is <u>best demonstrated</u> for <strong>Parietocanthial transoral projection: Open mouth waters method </strong>for <strong>sinuses?</strong></p>
79
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Sinuses special critique:

  • Petrous pyramids below maxillary sinuses

Special: How do you critique radiograph of Parietocanthial transoral projection: Open mouth waters method for sinuses?

<p>Special: How do you <u>critique</u> radiograph of <strong>Parietocanthial transoral projection: Open mouth waters method </strong>for <strong>sinuses?</strong></p>

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