Positioning of the Facial Bones

What is the technique for the lateral facial bones?

75 kVp @ 18-22 mAs

What is the technique for the waters method?

75 kVp @ 18-22 mAs

What is the technique for the modified waters method?

75 kVp @ 18-22 mAs

What is the technique for the Caldwell method of the facial bones?

75 kVp @ 18-22 mAs

What is the IR size/orientation for the lateral facial bones?

10 × 12 LW

What is the IR size/orientation for the waters method?

10 × 12 LW

What is the IR size/orientation for the modified waters method?

10 × 12 LW

What is the IR size/orientation for the Caldwell method of the facial bones?

10 × 12 LW

What is the SID for all facial bone views?

40 inch

What is the tube angle for the Caldwell method of the facial bones?

15 degrees caudad (75 on tube)

Where is the CR for the lateral facial bones?

To zygoma midway between outer canthus and EAM

Where is the CR for the waters method?

Exits the acanthion

Where is the CR for the modified waters method?

Exits the acanthion

Where is the CR for the Caldwell method of the facial bones?

Exits the nasion

How would you position for a lateral facial bone projection?

• IPL perpendicular to IR

• IOML perpendicular to front edge of IR/Bucky, IOML parallel to IR/Bucky

How would you position for a waters method?

• Rest chin on Bucky

• MML perpendicular to IR

• OML forms a 37 degree angle with the IR/Bucky

How would you position for a modified waters method?

• Rest chin and nose on the Bucky

• LML perpendicular to IR

• OML forms a 55 degree angle with the IR/Bucky

How would you position for a Caldwell method of the facial bones?

• Rest patients nose and forehead against upright Bucky

• OML perpendicular to IR/Bucky

• Ensure to check for rotation or tilt

Where is the marker for the lateral facial bones?

Anterior bottom corner

Where is the marker for the Caldwell method of the facial bones?

Bottom corner of IR

What is the breathing for all facial bone projections?

Suspend respiration

Do you shield for the facial bones?

Yes

Where is the side of interest for the lateral facial bones?

Closest to IR/Bucky

Where are the petrous ridges for the waters method?

Just below the maxillary sinuses

Where are the petrous ridges for the modified waters method?

Projected into the lower half of the maxillary sinuses

Where are the petrous ridges for the Caldwell method of the facial bones?

Projected in the lower third of the orbits

What is the only thing different about the waters method for the nasal bone?

You collimate down to at least an 8 × 10

What is the technique for the lateral nasal bones?

55 kVp @ 2.5-3.2 mAs

What is the technique for the super-inferior tangential (axial) nasal bones?

55 kVp @ 5-6.4 mAs

What is the IR size/orientation for the lateral nasal bones?

10 ×12

What is the IR size/orientation for the super-inferior tangential (axial) nasal bones?

10 ×12

For the nasal bones is it table top or in the Bucky?

Table top

Is there a tube angle for the super-inferior tangential (axial) nasal bones?

As needed to make sure the CR is parallel to GAL

Where is the CR for lateral nasal bones?

½ inferior to the nasion

Where is the CR for the super-inferior tangential (axial) projection of the nasal bones?

To nasion and make sure the the CR is parallel to the GAL

How would you position for the lateral nasal bones?

• Adjust head in true lateral

• IOML parallel to IR

• IOML is also perpendicular to the front edge of the IR

• IPL perpendicular to the IR/Bucky

How would you position for the superoinferior tangential (axial) nasal bones?

• IR is perpendicular to GAL (glabelloalveolar)

• CR must just skim glabella and anterior upper front teeth

Why would you do the lateral nasal bones upright?

To show air-fluid levels

What is the technique for the Rhese method of the optic foramina?

75 kVp @ 18-22 mAs

What is the IR size/orientation for the Rhese method of the optic foramina?

10 × 12

What is the collimation for the Rhese method of the optic foramina?

7 × 7

Where is the CR for the Rhese method of the optic foramina?

Centered to downside orbit

How would you position for the Rhese method of the optic foramina?

• 3-point landing (chin, cheek, and nose touching Bucky and eyeball on the crosshairs)

• Adjust head so that AML is perpendicular to IR

• Rotate head 37 degrees towards the affects side (angle formed between MSP and plane of IR measures 53 degrees)

What marker would you use for the Rhese method of the optic foramina?

If shooting right orbit, use right marker (on right side of IR)

If you have accurate positioning of the Rhese method, where is the optic foramen projected?

Into the lower outer quadrant of the orbit

What is the technique for the modified Towne method of the zygomatic arches?

75 kVp @ 24-32 mAs

What is the technique for the SMV projection for the zygomatic arches?

75 kVp @ 28-32 mAs

What is the technique for the oblique inferosuperior zygomatic arches?

60-65 kVp @ 6 mAs

What is the IR size/orientation for the modified Towne method?

10 ×12

What is the IR size/orientation for the SMV for the zygomatic arches?

10 × 12

What is the IR size/orientation for the oblique inferiosuperior for the zygomatic arches?

10 × 12

What is the collimation for the modified Towne method of the zygomatic arches?

Collimate to at least an 8 × 10

What is the collimation for the SMV of the zygomatic arches?

Collimate to at least an 8 × 10

What is the collimation for the oblique inferosuperior of the zygomatic arches?

Collimate down to a 8 × 8

How would you collimate for the waters method of the zygomatic arches?

Collimate to at least an 8 × 10

What is the tube angle for the modified Towne method of the zygomatic arches?

30 degrees caudal (60 on tube)

Where is the CR for the modified Towne method of the zygomatic arches?

1 inch above the glabella

Where is the CR for the SMV of the zygomatic arches?

1 ½ inches below to mandibular symphysis (midway between zygomatic arches)

Where is the CR for the oblique inferosuperior of the zygomatic arches?

To zygoma of interest (to skim the zygomatic arch)

How would you position for the modified Towne method of the zygomatic arches?

• Sit patient in chair, tuck chin

• OML perpendicular to IR

How would you position for the SMV of the zygomatic arches?

• Hyperextend neck, rest head on vertex of skull

• IOML is parallel to IR/Bucky

How would you position for the oblique inferosuperior of the zygomatic arches?

• 1st put them in an SMV, and line up the IOML parallel to IR/Bucky, rest head on vertex of skull

• 2nd rotate head/face 15 degrees towards side to be examined

• Next, tilt chin 15 degrees toward (zygoma) side of interest

What is different about the modified Towne method for the zygomatic arches compared to the one for the skull?

The CR is only 1 inch superior to glabella

What is important to note about the oblique inferosuperior of the zygomatic arches?

Lightly touch skin and do a fingertip shadow test (only one sided shot)

If you don’t get both zygomatic arches on the SMV, what other view do you have to do?

Tangential

What are the views done for the facial bones?

1. Lateral

2. Parietoacanthial (waters)

3. PA Caldwell

4. Modified waters

What are the views done for the nasal bones?

1. Lateral

2. Parietoacanthial (waters)

3. Superioinferior (axial)

What are the views done for the zygomatic arches?

1. SMV

2. Oblique inferiosuperior (tangential)

3. AP axial (modified towne)

4. Parietoacanthial (waters)

What are the views done for the optic foramina?

1. Parietoribital (Rhese)

2. Parietoacanthial (waters)

3. Modified waters