skull imaging final
TRANSCRIPT
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Positions and Techniqueof Skull imaging
By Dr. Tamer Ahmed KamalProfessor of Radio diagnosis
Benha University
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SKULL Bones connected bysutures to protect brain
CALVARIUM= SKULL CAP Consists Of bones linked by sutures
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BONES OF CALVARIUM
FRONTAL
PARIETAL
OCCIPITAL
TEMPORAL
SPHENOID
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SUTURES
LAMBDOIDALSUTURE
SAGITTALSUTURE
CORONALSUTURE
LANDMARKS
LAMBDA - MIDPOINT OFLAMBDOIDALSUTURE
BREGMA - MIDPOINT OF CORONALSUTURE
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SURFACE ANATOMY AND REFERENCE POINTS
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Anterior Skull
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Anterior Skull
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PARA NASAL SINUSES
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Cranium
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Ventral Skull
Sphenoid bone
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Occipital Bone
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Lateral Skull
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Lateral Skull
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Internal Skull
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Internal Skull
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Indications for Skull x ray
• Head Injury with suspected penetrating injury.• Head injury when CT is not available.• Head injury with CSF or Blood loss via the
nose.• Head injury with major trauma.
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Basic skull projections
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The Routine views of the cranium are :
• PA skull (Caldwell)• Lateral skull • AP axial (Towne`s)
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SKULL PA
Patient PositionErect or Supine
Part Position Mid Sagittal plane perpendicular to midline of grid.
OML is perpendicular to the cassette.
Respiration Suspended respiration.Central Ray •PA :- perpendicular to cassette exiting nasion.
•Caldwell - Direct 15 degrees Cauded exiting nasion •Center Cassette to central ray.
NB If patient is obese a small radiolucent sponge may be needed under forehead.
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PA skull
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SKULL AP
Patient PositionPatient supine
Part Position Mid saggital plane perpendicular to cassette
Place arms by side or across the chest
Respiration Suspended respiration
Central Ray •AP :- perpendicular to cassette exiting nasion
•Axial :- Direct 15 degrees Cephalad
•Center Cassette to central ray
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SKULL LATRAL
Patient PositionSeated erect or semi prone
Part Position Mid saggital plane parallel to cassette
IOML is perpendicular to front edge of the cassette
Inter-pupillary line is perpendicular to cassette
Respiration Suspended respiration
•Direct Perpendicular Entering Two Inches Superior To EAM
•Center Cassette to central ray
Central Ray
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SKULL Lateral
Dorsal Decubitus
Patient Position Supine
Part Position
•Support head on sponge with site of interest closest to cassette
•Mid saggital - plane parallel
Inter-pupillary line is perpendicular to cassette
Respiration Suspended respiration
Central Ray
Direct horizontal and perpendicular entering two inches superior to EAM
Center Cassette to central ray
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SKULL Lateral
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Patient positionErect or supine
Part position
•Center mid saggital plane to mid line of grid device and adjust to be perpendicular
•Have patient flex Neck
•Place IOML perpendicular
•Place top of cassette at level of cranial vertex
Respiration Suspended respiration
Central ray
Direct through foramen Magnum with caudal angle 30 degree to 37 degree to IOML
Central ray enters approx 2.5 inches superior to glabella and passes through EAM
SKULL AP AXIAL- Towne method
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Patient PositionErect or prone
Part Position •Patient rest head over fore head and nose
•Place arms in comfortable position
•Adjust shoulders to lie in same transverse plane
•Adjust head to the mid sagittal plane
•OML is perpendicular to the cassette
Respiration Suspended respiration
Central Ray 25 degrees cephalad - entering 3.8 cm inferior to
external occipital protuberance
and exiting 3.8 cm superior to nasion
SKULL PA AXIAL- Hass method
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Seated Erect at Head unit or supine on elevated table support
•Patient extend head and rest on vertex •Center and adjust mid saggital plane perpendiculaar to cassette
•Adjust IOML parallel to plane of cassette if possible •immobilize head
Suspended respiration
•Direct through sella Turcica - perpendicular to IOML •Entering between angles of the mandible •Central ray passes through a point 1.9 cm anterior to level of EAM
Sub mento vertical- Schuller Method
Patient Position
Part Position
Respiration
Central Ray
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Patient Position Seated erect or semi prone
Part Position
•Center a point 1.8 cm superior and 1.8 cm anterior to EAM to cassette adjust mid sagittal plane parallel to cassette •inter pupillary line is perpendicular to cassette•IOML is perpendicular to front edge of cassette
Respiration Obtain radio graph through suspended respiration
Direct perpendicular entering 1.9 cm superior and 1.9 anterior to EAM to center of cassette Collimate the sphenoid bone
Sella Turcica - Lateral
Central Ray
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Patient PositionErect or semi prone
Part Position Center affected orbit to cassette
Have patient rest head on zygoma - nose and chin Adjust AML perpendicular to cassette
Rotate midsaggital plane 53 degrees from cassette
Respiration suspended respiration
Central Ray
•Direct perpendicular entering 2.5 cm superior and 2.5 cm posterior to elevated top of ear attachment •exiting orbit closest to cassette •Ensure colliminnation is extremely close •Center cassette to central ray
Optic canalREHSE Method
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Patient PositionErect or supine on elevated table
Part Position
Hyper-extended neck and have patient rest head on vetex
Center and adjust midsaggital plane perpendicular to cassette
Adjust IOML parallel with cassette
Respiration Suspended respiration
Central Ray
•Direct perpendicular to IOML entering midway between zygomatic arches
•Central ray enters approximately 1 inch posterior to outer canthi
Zygomatic arches
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Patient PositionErect or semi prome
•Position head in lateral ;position with affected side closest to cassette
•from true latral position , rotate midsaggital plane 15 degree toward cassette
•IOML is parallel to transverse axis of cassette
•interpupillary line is perpendicular to cassette
Respiration Suspended respiration
Central Ray
•Direct 15 degree caudal enetring approx 5 cm posterior and 5 cm superior to EAM •Farthest from Cassette
•Central ray exit 2.5 cm to EAM of affected side •Center cassette to center ray
Petro mastoid Bone
Axio-latral Oblique
Part Position
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Common positioning Errors
Tilt occurs when the interpupilary line is not at 90 to the film.
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Rotation occurs when the median Saggital plane is not parallel to the film
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Thank You