RADIOGRAPHIC POSITIONING 2
SKULL
SKULL AP
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in supine position, MSP centered to grid.
PART POSITION
OML is perpendicular to the IR.
Petrous pyramids should fill the orbits
CENTRAL RAY
Perpendicular to the nasion.
STRUCTURES SHOWN
Entire skull.
Symmetric petrous ridges.
Petrous pyramid fills the entire orbits.
BEST DEMONSTRATION
Best demonstrates the frontal and parietal bones
SKULL PA
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone position or erect.
PART POSITION
Rest patient's nose and forehead against table/bucky surface.
Flex neck, aligning OML perpendicular to midline of table/bucky to prevent head
rotation and/or tilt (EAMs same distance from table/bucky surface).
Center IR to CR.
Top of the image receptor is approx. 1 ½ inches (4cm) above the vertex of the skull.
CENTRAL RAY
Perpendicular to the receptor exiting at the nasion.
STRUCTURES SHOWN
Frontal bone
Crista galli
Internal auditory canals
Erontal and anterior ethmoid sinuses
Petrous ridges
Greater and lesser wings of sphenoid
Dorsum sellae
BEST DEMONSTRATION
Best demonstrates the frontal bone.
SKULL LATERAL
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone position or erect.
PART POSITION
MSP is parallel to IR.
IPL is perpendicular to IR.
IOML perpendicular to front edge of the cassette.
CENTRAL RAY
Perpendicular to 2 inches above EAM.
STRUCTURES SHOWN
Frontal bone
Parietal bone
Occipital bone
Temporal bone
Greater and lesser wings of sphenoid
Orbital roofs (plates)
Anterior and posterior clinoid processes
Clivus
Mandibular rami
Dorsum sellae
BEST DEMONSTRATION
Best demonstrates the parietal bone.
Crosstable or Shoot-Through Lateral Projection
Demonstrates traumatic sphenoid effusion which is an indication of a basal skull fracture.
SKULL AP AXIAL
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in supine position.
PART POSITION
MSP and OML perpendicular to the IR.
CENTRAL RAY
15 degrees cephalad
STRUCTURES SHOWN
Magnified orbits.
Reduced distance from the lateral margin of the temporal bone compared to PA
projection.
BEST DEMONSTRATION
Best demonstrates the ambot AHAHHAHAHAHH
SKULL AP AXIAL PROJECTION: SKULL SERIES
TOWNE’S/GRASHEY METHOD
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in supine position.
PART POSITION
Depress chin, bringing OML perpendicular to IR. For patients unable to flex the neck to this
extent, align IOML perpendicular to IR. Add radiolucent support under the head if needed.
Align MSP to CR and to midline of the grid or the table/imaging device surface.
Ensure that no head rotation or tilt exists.
Ensure that the vertex of the skull is within collimation field.
REFERENCE POINT
2.5 inches superior to the Glabella (at the level of the EAM).
CENTRAL RAY
Center at MSP 21 2 inches (6.5 cm) above the glabella to pass through the foramen magnum
at the level of the base of the occiput.
30° caudad to OML perpendicular to IR
37° caudad to IOML perpendicular to IR
40° - 60° caudad (to visualized the entire foramen magnum)
STRUCTURES SHOWN
Occipital bone
Posterior portion of parietal bone
Posterior portion of foramen magnum
Posterior clinoid process and dorsum sellae projected within foramen magnum.
Symmetric petrous pyramid
Mastoid
BEST DEMONSTRATION
Best demonstrates the occipital bone.
SKULL PA AXIAL PROJECTION: SKULL SERIES
HAAS METHOD
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone position.
PART POSITION
Rest patient’s nose and forehead against the table/imaging device surface.
Flex neck, bringing OML perpendicular to IR.
Align MSP to CR and to the midline of the grid or table/imaging device surface.
Ensure that no rotation or tilt exists (MSP perpendicular to IR)
REFERENCE POINT
Entrance: 1.5 inches inferior to the inion.
Exit: 1.5 inches superior to the nasion
CENTRAL RAY
25 degrees cephalad
STRUCTURES SHOWN
Occipital region
Posterior portion of foramen magnum
Posterior clinoid process and dorsum sellae projected within foramen magnum.
Symmetric petrous pyramid
Mastoid
BEST DEMONSTRATION
Best demonstrates the occipital bone with magnication.
Note:
Also called Reverse Towne’s Projection.
PA AXIAL PROJECTION
VALDINI METHOD
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in recumbent position or seated.
For patient’s comfort, they could be in seated (upright) position.
PART POSITION
Upper frontal region of the skull against the IR.
MSP perpendicular to the IR. Head acutely flexed; IOML 50 degrees/OML 50 degrees.
CENTRAL RAY
Perpendicular entering inion exiting .5 cm distal to nasion.
STRUCTURES SHOWN
For IOML (50 degrees):
o Dorsum sellae i
o Internal auditory meatus
o Labyrinth
For OML (50 degrees):
o External auditory meatus
o Tympanic cavity
o Bony part of eustachian tube
Dorsum sellae
Posterior clinoid process within or superior to the shadow of the
foramen magnum.
Tuberculum sellae, anterior clinoid, sella turcica inferior to the
shadow of the foramen magnum.
BEST DEMONSTRATION
Best demonstrates the not sure hhahhdhfh
SKULL PA AXIAL PROJECTION
CALDWELL’S METHOD
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone or in seated (upright) position.
PART POSITION
• Rest patient’s nose and forehead against table/imaging device surface.
Flex neck as needed to align OML perpendicular to IR.
Align MSP perpendicular to midline of the grid or table/imaging surface to prevent head
rotation or tilt.
Center IR to CR.
REFERENCE POINT
Nasion
CENTRAL RAY
Angle CR 15° caudad, and center to exit at nasion.
STRUCTURES SHOWN
Petrous pyramids are projected into the lower one-third of the orbits.
Supraorbital margin is visualized without superimposition.
Frontal and anterior ethmoidal air cells
Temporal fossae
Crista galli
BEST DEMONSTRATION
Best demonstrates alveolar ridge fractures.
General survey examination of the cranium.
VERTICOSUBMENTO (VSM) FULL BASAL
PROJECTION SCHULLER METHOD
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone position.
PART POSITION
Elbows flexed
Fully extended neck resting against the table
MSP perpendicular to the IR.
SKULL PA AXIAL PROJECTION
CALDWELL’S METHOD MODIFICATION
TECHNICAL FACTORS
Minimum SID—40 inches (102 cm)
IR size—24 × 30 cm (10 × 12 inches), lengthwise
Grid
Analog—70 to 80 kV range
Digital systems—80 to 85 kV range
Shield radiosensitive tissues outside region of interest.
Collimate on four sides to anatomy of interest.
PATIENT PREPARATION
Remove all metal, plastic, or other removable objects from the patient’s head. Take
radiograph with the patient in the erect or supine position.
PATIENT POSITION
Patient in prone or in seated (upright) position.
PART POSITION
Rest patient’s nose and forehead against table/imaging device surface.
REFERENCE POINT
Nasion
CENTRAL RAY
Original Caldwell’s Method:
o 23° caudad to nasion
20° to 25° caudad to mid-orbit
25° to 30° caudad
STRUCTURES SHOWN
Original Caldwell’s Method:
o
BEST DEMONSTRATION
Best demonstrates alveolar ridge fractures.
General survey examination of the cranium.