W8 - Cranium

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15 Terms

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Skull radiography Usefulness

identifying skull fractures
locating entry and exit points for gunshot wounds
diagnosing multiple myeloma
diagnosing pituitary adenoma

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Skull routine projections

PA Skull
Lateral Skull
Towne (modified)

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Skull Morphology

Brachycephalic = short, broad head, width is 80% greater than the length
Mesocephalic = average head, width is 75-85% of the length
Dolichocephalic = long-narrow head, width is 75% less than the length

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Positioning - PA Skull

CR
CP
Structures Included
Resp
SID
PT Position

perp
CP, exits at the nasion
vertex to base of occiput and bilateral cortices; frontal, maxillary, posterior ethmoidal sinuses
suspend
SID = 122cm
erect no slouching, rest nose and forehead against bucky, OML perp to IR

<ul><li><p>perp</p></li><li><p>CP, exits at the nasion </p></li><li><p>vertex to base of occiput and bilateral cortices; frontal, maxillary, posterior ethmoidal sinuses </p></li><li><p>suspend</p></li><li><p>SID = 122cm</p></li><li><p>erect no slouching, rest nose and forehead against bucky, <strong>OML perp to IR</strong> </p></li></ul><p></p>

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Critique - PA Skull

F/E, OML Alignment

MAIN: petrous ridges are at supraorbital rim level and fill the orbits
anterior clinoid and dorsum sellae are superior to the ethmoid air cells

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Positioning - PA Axial (Caldwell)

15 caud or perp
exits at nasion
vertex to occiput base
122cm
suspend
OML perp to IR or, raise OML to form 15 angle to IR (TEA is at lower 1/3 orbits)

<ul><li><p>15 caud or perp</p></li><li><p>exits at nasion</p></li><li><p>vertex to occiput base</p></li><li><p>122cm</p></li><li><p>suspend</p></li><li><p>OML perp to IR or, raise OML to form 15 angle to IR (TEA is at lower 1/3 orbits)</p></li></ul><p></p>

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Critique - PA Axial (Caldwell)

MAIN Goal, F/E: petrous pyramids are projected into the lower 1/3 of the orbits
Tilt: supraorbital rims transversely aligned
Rotation: lateral border of the orbits equidistant to the lateral border of the cranium (rotation is towards the narrowed side)

<ul><li><p>MAIN Goal, F/E: petrous pyramids are projected into the lower 1/3 of the orbits</p></li><li><p>Tilt: supraorbital rims transversely aligned </p></li><li><p>Rotation: lateral border of the orbits equidistant to the lateral border of the cranium (rotation is towards the narrowed side)</p></li></ul><p></p>

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Positioning - AP Axial (Towne)

30 caud
2.5” above the glabella passing thru the EAM
vertex → occiput (?)
suspend
122cm
AP, OML perp to IR, skull vertex at the top collimation border

<ul><li><p>30 caud</p></li><li><p>2.5”  above the glabella passing thru the EAM</p></li><li><p>vertex → occiput (?)</p></li><li><p>suspend</p></li><li><p>122cm</p></li><li><p>AP, OML perp to IR, skull vertex at the top collimation border</p></li></ul><p></p>

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Positioning - AP Axial Modified Townes

25 caud, does not pass through EAM
midway between vertex and supraorbital rims
vertex → supraorbital rims *exclude eyes*

<ul><li><p>25 caud, does not pass through EAM</p></li><li><p>midway between vertex and supraorbital rims</p></li><li><p>vertex → supraorbital rims *exclude eyes* </p></li></ul><p></p>

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Critique - AP Axial (Towne)

BTP: dorsum sellae and clinoids visualized in the foramen magnum
- excessive = SI of the posterior arch of C1 over dorsum sellae
- insufficient = dorsum sellae seen superior to the foramen magnum
Tilt: nasal septum and sagittal suture // LA, petrous ridges // SA
Rotation: dorsum sellae equidistant to the lateral borders of the foramen magnum (rotation is towards the narrowed side)

<ul><li><p>BTP: dorsum sellae and clinoids visualized in the foramen magnum</p><ul><li><p>excessive = SI of the posterior arch of C1 over dorsum sellae</p></li><li><p>insufficient = dorsum sellae seen superior to the foramen magnum </p></li></ul></li><li><p>Tilt: nasal septum and sagittal suture // LA, petrous ridges // SA</p></li><li><p>Rotation: dorsum sellae equidistant to the lateral borders of the foramen magnum (rotation is towards the narrowed side)</p></li></ul><p></p>

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Positioning - LAT Skull

perp,
2” superior to EAM
entire cranium
suspend
122cm
erect: true lat, IOML // LA of IR, IPL perp to IR
recumbent: true lat with sponge
x-table: no OID, use sponge to raise posterior skull

<ul><li><p>perp, </p></li><li><p>2” superior to EAM</p></li><li><p>entire cranium</p></li><li><p>suspend</p></li><li><p>122cm</p></li><li><p>erect: true lat, IOML // LA of IR, IPL perp to IR</p></li><li><p>recumbent: true lat with sponge</p></li><li><p>x-table: no OID, use sponge to raise posterior skull</p></li></ul><p></p>

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Critique - LAT Skull

F/E: manibular rami SI anterior arch of C1
- excessive: posterior cranium SI on the posterior arch of C1
Tilt: separation of the orbital roofs inf/sup (sharper vs. duller)
Rotation: ant/post SI of EAM, mandibular rami, greater wings, cranial cortices

<ul><li><p>F/E: manibular rami SI anterior arch of C1</p><ul><li><p>excessive: posterior cranium SI on the posterior arch of C1</p></li></ul></li><li><p>Tilt: separation of the orbital roofs inf/sup (sharper vs. duller)</p></li><li><p>Rotation: ant/post SI of EAM, mandibular rami, greater wings, cranial cortices </p></li></ul><p></p>