facial & nasal bones image critique & positioning notes!

views obtained for facial bones 3 views or more

1. parietocanthial waters

2. pa axial exaggerated caldwell

3. left lateral

4. smv

views obtained for eye/orbits foreign body

1. modified parietoacanthial waters

2. left lateral

views obtained for orbits 3 views or less

1. parietoacanthial waters

2. pa axial exaggerated caldwell

3. left lateral

orbits routine 4 views or more

1. parietoacanthial waters

2. pa axial exaggerated caldwell

3. left lateral

4. smv

parietoacanthial waters technique facial bones & nasal bones

85 kVp, 8 mAs, center cell

pa axial exaggerated caldwell technique

85 kVp, 7.1 mAs, center cell

left lateral technique facial bones

80 kVp, 3.2 mAs, center cell

smv technique

80 kVp, 8 mAs (NON AEC)

parietoacanthial waters facial bones overview

• 10×12 collimation

• PT PA

• MML perpendicular w/ IR (37 degrees)

• MSP perpendicular w/ IR

• central ray should exit acanthion

evaluation criteria of parietoacanthial waters facial bones

1. entire orbits & facial bones

2. no rotation/tilt demonstrated by:

• equal distance between skull & orbits

3. petrous ridges projected immediately below maxillary sinuses

PA axial exaggerated caldwell facial bones overview:

• 9×6 CW

• PT PA w/ OML perpendicular to IR

• central ray is 30 degrees caudad exiting through the infra-orbital rim

what view of facial bones demonstrates the orbital floor?

PA axial exaggerated caldwell

PA axial exaggerated caldwell facial bones evaluation criteria

1. no rotation/tilt demonstrated by:

• equal distance from skull & orbits

2. petrous ridges projected ON MAXILLARY SINUSES, below infraorbital margin

left lateral facial bone overview

• 8×10 LW

• MSP parallel to IR

• interpupillary line perpendicular to IR

• flex neck so IOML is perpendicular to IR

• central ray is at the point halfway between outer canthus & EAM (zygomatic prominence)

• LEFT MARKER ANTERIOR

left lateral facial bone evaluation criteria

1. all facial bones entirely w/ zygomatic in center

2. no rotation/tilt demonstrated by:

• almost perfectly superimposed mandibular rami

• superimposed orbital roofs

• sella turcica in profile

SMV facial bones overview:

• 12×10 CW

• pt AP w/ neck hyperextended so IOML is nearly parallel w/ IR

• rest head on its vertex

• MSP perpendicular w/ IR

• tube is perpendicular to IOML & centered through the gonion ¾” superior to EAM

what facial bone view demonstrates the zygomatic arcges?

SMV facial bones

SMV facial bones evaluation criteria

1. zygomatic arches free from overlying structures

2. no rotation/tilt demonstrated by:

• zygomatic arches symmetric w/o foreshortening

views for nasal bones

parietoacanthial waters, right & left laterals

nasal bone laterals technique

70 kVp, 2.5 mAs, non grid (non aec) use manual techniques

parietoacanthial waters nasal bone overview":

• 6×6

• hyperextend neck so OML forms 37 degree angle w/ IR

• MML perpendicular to IR

• MSP perpendicular to IR

• central ray should exit acanthion

parietoacanthial waters nasal bone purpose

nasal septum

parietoacanthial waters nasal bone evaluation criteria:

1. most of orbits & facial bones included (bony nasal septum is of main concern)

2. no rotation/tilt demonstrated by:

• equal distance between lateral border of skull & orbits

3. petrous ridges projected immediately below maxillary sinuses

right & left laterals nasal bones overview

• 4×4

• pt in anterior oblique

• MSP parallel to IR

• interpupillary line perpendicular to IR

• flex neck so IOML is perpendicular to IR

• tube perpendicular to bridge of nose & central ray is ½” distal to nasion

• mark side against & anterior

purpose of right & left laterals nasal bones

side closest to IR is demonstrated

right & left laterals nasal bones evaluation criteria

1. nasal bones, anterior nasal spine, frontonasal suture visualized

2. no rotation of nasal bones & soft tissue

what facial special view is good to demonstrate blow out fractures

modified parietoacanthial waters

what facial bone special view is this?

modified parietoacanthial waters

what is the routine facial/nasal bone for ARRT content specs?

pa axial caldwell

facial/nasal bone special view: PA axial caldwell

15 degrees caudad

petrous ridges in lower 1/3

what special view of the facial/nasal bone is this?

PA axial caldwell

what special view is this?

zygomatic arch special view (oblique inferosuperior tangential)

zygomatic arch special view (oblique inferosuperior tangential) what to do:

1. rotate MSP 15 degrees toward side being examined

2. then, tilt top of head 15 degrees away from side being examined

special view where orbits are free of superimposition of petrous pyramids

parietoacanthial waters orbits

what special view is this of the orbits?

parietoacanthial waters orbits

what special view is this of the orbits?

modified parietoacanthial waters

modified parietoacanthial waters

OML 50 degrees

what special view of the orbits is this?

pa axial caldwell

pa axial caldwell of orbits special view overivew

30 degrees caudad (exaggerated caldwell)

critique this parietoacanthial waters facial bone projection?

rotated towards the left → shorter side = PA

head is tilted to right

repeat

critique this parietoacanthial waters facial bone projection?

peterous ridges are in bottom half → chin needs to come up a little more

rotated toward left & tilt to right

repeat

critique this parietoacanthial waters facial bone projection?

petrous ridges are in sinuses → chin up

tilt towards right

rotation to left

repeat

critique this parietoacanthial waters facial bone projection?

petrous ridges are in lower maxillary sinuses

need chin up higher

repeat

critique this parietoacanthial waters facial bone projection?

rotated & tilted to left side

head is tilted way too far back → petrous ridges are in mandible & orbits are squished

repeat

critique this left lateral facial bone projection?

no sella turcica

rotation - to fix, rotate towards IR

tilt - away from IR

soft tissue over chin

repeat

critique this left lateral facial bone projection?

clip mandible - repeat

rotation & tilt

critique this left lateral facial bone projection?

slight tilt - orbital roofs

sella turcica is not in profile

might be clipping chin - very close

critique this left lateral facial bone projection?

no sella turcica

lots of rotation & tilt - repeat

critique this left lateral facial bone projection?

sella trucica is nice & crisp

slight rotation on roofs, but NOT reason for repeat

earring artifact - repeat reason

critique this PA axial exaggerated caldwell facial bone projection?

petrous rdiges are slightly too high → extend chin or angle tube more

tilt is to the left

minimal rotation to right

critique this PA axial exaggerated caldwell facial bone projection?

petrous ridges are not in sinuses → tuck chin or decrease tube angle

rotated to left slightly

repeat

critique this PA axial exaggerated caldwell facial bone projection?

petrous ridges below orbital rim

rotation is good

critique this PA axial exaggerated caldwell facial bone projection?

petrous ridges are too low → tuck chin or decrease angle

rotation to the left → shorter side

critique this PA axial exaggerated caldwell facial bone projection?

petrous ridges are too low → tuck chin or decrease tube angle

rotation & tilt to left

repeat

critique this SMV facial bone projection?

zygomatic arches are open & symetircal

all anatomy is on

good image

critique this SMV facial bone projection?

centering is too superior

left arch is the only one seen

right partieal is not on IR - tilt

critique this SMV facial bone projection?

zygomatic arches are open

symetrical all way around

good image

critique this SMV facial bone projection?

head is not back far enough → frontal bone on top

need to angle tube cephalad or extend chin up higher

need to collimate

critique this SMV facial bone projection?

don’t have left zygomatic arch → left side of the vertex is not on IR

rotation to the right → repeat

critique this SMV facial bone projection?

head needs to go back a lot → vertex is NOT touching IR

right partieal is not in contact w/ IR - repeat

critique this SMV facial bone projection?

nice open zygomatic arches

slightly rotation to right, but not enough to repeat

image is good

critique this parietoacanthial waters nasal bone projection?

off centered side to side

petrous ridges are in sinuses →extend chin more

repeat

critique this parietoacanthial waters nasal bone projection?

petrous ridges little high in sinuses, but not repeatable

rotation to left, tilt to right

critique this parietoacanthial waters nasal bone projection?

need to collimate

lots of rotation to the right

ridges are below = good

critique this parietoacanthial waters nasal bone projection?

nose ring is not in anatomy → good for this view

ridges in sinuses slightly → bring chin up

either rotated or off centered

critique this right & left lateral nasal bone projection?

good image

all anatomy is present

critique this right & left lateral nasal bone projection?

very close to nasal bone, but its on

centering is a bit superior, but all anatomy is on

good image

critique this right & left lateral nasal bone projection?

everything is on

rotation → in sinuses & orbits

orientation is wrong/wrong marker

critique this right & left lateral nasal bone projection?

bring marker out from skull - technially not in anatomy

rotation - seen in sinuses

artifact - repeat

what line should be perpendicular for the facial bones special views modified parietoacanthial waters?

LML perpendicular (petrous in maxillary)

MRI clearance

angle & centering for PA axial caldwell special view?

15 degrees caudad through nasion, OML perpendicular

if a pt cannot raise their chin enough to place MML perpendicular for a waters view, what can you do to allow petrous ridges below maxillary sinuses?

add a caudad tube angle to match the MML