Skull - Lateral

[Link] upright or semi prone- if semi prone is used, have the patient rest on the
forearm and flex knee of the elevated side
[Link] sagittal _ parallel to the plane of IR, Interpupillary line__ perpendicular to
the IR, IOML perpendicular to the front edge of the IR and parallel to the long
axis of the IR
[Link]
4.2 inches(5 cm) above the EAM
 Skull - Lateral

[Link] criteria:-
1. Entire cranium without rotation or tilt
2. Superimposed of the orbital roof and greater wing of the sphenoid
3. Superimposed TMJs
4. Superimposed of mastoid regions and EAMs
5. Sella turcica seen
6. Radiographic penetration of the parietal region
7. NO over lap of the CS by mandible
 Skull - Lateral

• Evaluation Criteria:-
1. _____
2. _____
3. _____
4. _____
5. _____
6. _____ 2
7. _____ 5
6
3
4

7
 Modified Lateral

• Supine Lateral Position:-

1. Patient Position:-_(1)
2. Part Position:- Mid sagittal _, Interpupillary line__, IOML ___,
Support the opposite shoulder & hip , support the head over
radiolucent sponge
3. CR:- __2 in above IAM ___
4. CP:- _____

• Dorsal decubitus:-
1. Patient Position:-_(1)
2. Part Position:- Mid sagittal _, Interpupillary line__, IOML ___,
support the head over radiolucent sponge
3. CR:- _____
4. CP:- _____
Indication:- traumatic with sphenoid sinus effusion with base of the
skull #
 PA – PA Axial
1. Patient Position:- (1)
2. Part Position:- Mid sagittal,
3. CR:- _____
4. CP:- _____
 PA – PA Axial

• Structure Shown:-
– In PA zero degree, the orbits are filled by margins of petrus pyramids, the dorsum sellae is seen as
curved line extending b/w the orbits just above the ethemoidal air cells
– 10 degree, the petrus projected in the middle third of the orbits

– 15 degree caudally the petrus ridges projected into the lower third of the orbits .

– 20 degree the petrus projected below the inferior orbital margin

• Evaluation Criteria:
– Equal distance from lateral border of the skull to lateral border of the orbit in both side

– Symmetric petrus ridges

– Penetration of frontal bone without excessive density at lateral borders of skull.

 Reverse Caldwell position

may be indicated when:-

- patient unable to lie /sit prone e.g trauma to nose or C. spine trauma.
 AP & AP axial projection
1. Patient Position:-_(1)
2. Part Position:- Mid sagittal _, OML ___, Interpupillary line__
3. CR:- _____
4. CP:- _____
5. Structure shown : same as in PA
6. Orbit in the AP is magnified because the increase of the OID
AP Axial ( Towne view)
 AP Axial ( Towne view)

1. Patient Position:-_(1)
2. Part Position:- Mid sagittal _, OML ___, Interpupillary line__
3. CR:- _____
4. CP:- _____
5. Structure shown :
1. The sella Turcica & sphenoid bone is projected with in the foramen magnum
2. All occipital bone, posterior part parietal bone and the lambdoid suture should be shown
3. Zygoma may shown clear
 AP Axial ( Towne view)

1. The top of the cassette is adjacent to the vertex of the skull ensure the angulation does not
project the area of interest off image.

2. If the patient can't depress the chin to get the OML perpendicular increase the angulation

3. Over angulation the posterior arch of the atlas bone C1is visible within the foramen magnum
4. Use a Skull board if necessary, 10- 15- 20 degree
AP Axial ( Towne view)
 PA axial ( HASS)
• Is recommended for the obese, or other patient who cannot be adjusted correctly for the AP axial
(TOWNE)
• CR & CP:- 25 degree to 1.5 inches below the external occipital protuberance exit 1.5 inches
superior to the Nasion

MSP
2
OML 3
 Cranium Base- Submentovertical

• Patient Position:- supine or seated up right

• Part Position:-
– Supine raised the shoulder, neck hyper
extended to bring the vertex in contact
with the grid or table, EAM is
equidistant from the cassette, MSP At
1 5 right angle to the IR, OML is parallel to
IR
– Upright, sit at short distance from the
Bucky, neck hyperextend
2 6 • CR & CP:- CR at right angles to the IOML at
the midway b/w the EAM
7
3

8
4

9
 Sella Turcica

• Lateral Projection
– Collimated cone view additional to the cranium
– Same as lateral cranium except:- CP ¾ inch anterior & ¾ inch
superior to EAM
– Evaluation:-
• No rotation or distortion of the sella
• Superimposed anterior & posterior clinoid process
• Sella turcica centered on radiograph
• Collimated beam
 Sella Turcica- radiographic Anatomy

1. Anterior clinoid
process
2. Sephenoid sinus
3. Posterior clinoid
process
4. Dorsum sellae
5. Sella turcica
1 3

2
5
 optic canal & foramen

Plain radiography being replaced by CT

• Define a blowout fracture and state the projections that
will demonstrate them.
• may involve the orbital floor (most frequent), walls, or
roof. Usually due to a blunt blow from a relatively large
object, such as a fist, elbow, baseball bat, etc
Projections:
• Water’s or reverse
• CT
 (cont’d):

• This image confirms a blowout

fracture of the floor of the left orbit,
with herniation of orbital fat through
the defect.
• The inferior rectus is not directly
involved. Note also the blood
(air/fluid level) in the maxillary
antrum.
 Tripod fracture:
Three fractures involving :
• inferior orbital rim
• lateral orbital wall
• fracture/dislocation of
zygomatic arch.

Projections: Lateral; Caldwell (or

reverse Caldwell) & Water’s (or
reverse Water’s). CT/3D CT.
 Calcified lens
Evaluation of skull radiographs:
Look for:
1. Calcification
2. Sella turcica expansion/ erosion
3. Lysis (destruction) or sclerosis (hardening
of tissue).
4. Fracture
Calcification:
1. Calcification in skull radiography may indicate presence of tumour but normal variations
include calcification of :
a. Pineal gland (midline) (secretes melatonin – appetite, thirst) well seen in CT
(seen in PA & lateral projections.)
b. Falx cerebri (midline)
Calcification (cont’d):
c. Choroid plexus: (secretion
of CSF) -
In all ventricles; calcification
seen most often in body of
lateral ventricle.

Papilloma (benign tumour of

Ch. Plexus - over production
of CSF
Calcification (cont’d):
d. Carotid artery

1. Int. Carotid A.
2. Vertebral A.
3. Cavernous sinus
4. Carotid canal
[Link] cerebral A.
6. Posterior cerebral A.
Sella turcica expansion / erosion:
2. Two main reasons for erosion/ expansion of the sella turcica:
a. Pituitary tumor
 Sella erosion /expansion (cont’d):
b. Raised intracranial pressure (RIP or RICP). An increase in normal pressure :
a. increase in CSF pressure.
b. Lesions (tumour) or swelling within brain

b
 Osteolytic and ostesclerotic lesions

Lysis: the destruction of cells. e.g. Myeloma – a

malignant proliferation of plasma cells in bone
marrow.

Sclerosis: hardening of tissue. e.g. Pagets

disease – osteitis deformans - non-malignant
disease of old age; bones become enlarged &
softened;
4. Fracture

NB: tangential views might be necessary to demonstrate

the fracture.

Fracture – straight line Depressed fracture

• 1. Frontal sinus
2. Ethmoidal sinus
3. Sphenoidal sinus
4. Maxillary sinus
5. Anterior clinoid processes
6. Hypophyseal fossa
7. Posterior clinoid processes
8. Clivus
9. Great density of the petrous
part of the temporal bone
10. External acoustic meatus
11. Mastoid cells
12. Nasopharynx
13. Angle of mandible
14. Anterior arch of the atlas
15. Dens of axis
16. Posterior arch of the atlas
17. Internal occipital protuberance

• A. Coronal suture
B. Lambdoid suture
C. The grooves for the branches of
the middle meningeal vessels
• 1. Frontal sinus
2. Crista galli
3. Cribriform plate
4. Lesser wing of sphenoid
5. Superior orbital fissure
6. Superior border of
petrous part of temporal
bone
7. Dense shadow of
petrous part of temporal
bone
8. Perpendicular plate of
the ethmoid
9. Vomer
10. Maxillary sinus
11. Inferior concha
12. Ramus of mandible
13. Body of mandible