RADS

321

Final Study Guide

5-9-16

Test 1:
General Skull Guidelines

40 SID, 30 SID for sinuses (some may use 42-44) or 72 SID for some laterals
80-90 kVp
Large focal spot
Do PA skull, unless patient cant get PA
PA: Orbits are less magnified due to OID; also have less entrance skin dose to lenses of eyes
AP: Orbits magnified; increased entrance skin dose to lenses of eyes

Skull Positioning
PA Projection

10x12 LW


Grid
40 SID
80-90 kVp
Patient: prone, erect, or seated erect
Nose & forehead touching table/bucky
OML perpendicular
CR:
Exits nasion
Perpendicular:
Frontal Bone is of primary interest
OML perpendicular
Petrous ridges will fill orbits
15 Caudal: Caldwell Method
For general survey
OML perpendicular
Petrous ridges in lower thirds of orbits
20-25 Caudal:
Superior Orbital Fissures is of primary interest
OML perpendicular
30 Caudal:
Foramen Rotundum is of primary interest
OML perpendicular

RADS 321

Final Study Guide

5-9-16

PA Axial Projection: Caldwell Method

10x12 LW


Grid
40 SID
80-90 kVp
Patient: prone, erect, or seated erect
Nose & forehead touching table/bucky
OML perpendicular
CR: 15 Caudal
Exits nasion
Anterior Ethmoidal Cells of primary interest
Petrous pyramids lying in lower third of orbits
Reverse Caldwell: patient supine/erect, OML perpendicular; CR: 15 Cephalic & enters nasion

Lateral Projection (Right or Left)

10x12 CW


Grid
40 SID
80-90 kVp
Patient: prone, erect, or seated erect
IP line perpendicular
IOML perpendicular
CR:
Perpendicular
Enters 2 above EAM

RADS 321

Final Study Guide

5-9-16

AP Axial Projection: Towne Method

10x12 LW


Grid
40 SID
80-90 kVp
Patient: Supine, erect, or seated erect
OML perpendicular
If patient is unable to flex chin: IOML perpendicular, CR 37 Caudal entering 2.5 above EAM
CR:
30 Caudal
Enters 2.5 above Glabella
Exits Foramen Magnum
Petrous pyramids superior to mastoid air cells
Dorsum sellae & Posterior Clinoid Processes projected into Foramen Magnum
Trauma Towne: CR: 30 Caudal from OML & exits foramen magnum (CR will be more than 30)

PA Axial Projection: Haas Method or Reverse Towne Method

For hypersthenic patients

OML perpendicular
CR: 25 Cephalic
Exits 1.5 above Nasion

RADS 321

Final Study Guide

5-9-16

Submentovertical Projection- SMV

10x12 LW


Grid
40 SID
80-90 kVp
Patient: seated with vertex of head on IR
IOML parallel
CR:
Enters MSP between gonions at anterior to EAM
Perpendicular to IOML- no matter how positioned
To demonstrate the Zygomatic Arches- decrease 10 kVp

Sella Turcica Lateral Skull

8x10 LW


Grid
40 SID
65-70 kVp
Patient:
Seated erect or semi-prone
CR:
Perpendicular to sella turcica
Enters anterior & superior to EAM

RADS 321

Final Study Guide

5-9-16

SMV

PA Projection

RADS 321

PA/AP Projection
0 Caudal- Petrous Ridges fill orbits
Frontal bone is of primary interest

Final Study Guide

PA Axial
20-25 Caudal- Petrous Ridges below Orbits
Superior Orbital Fissures of primary interest

5-9-16

Caldwell Method: PA Axial
15 Caudal- Petrous Ridges bottom 1/3rd of Orbits
Anterior Ethmoidal Cells primary interest

Towne Method: AP Axial
30 Caudal- Petrous Ridges above Max. Sinuses
Foramen Rotundum of primary interest
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RADS 321

Final Study Guide

5-9-16

Lateral Skull

AP Axial: Towne Method

SMV for Zygomatic Arches

Sella Turcica Lateral

RADS 321

Final Study Guide

5-9-16

Anatomy of the Facial Bones

Each maxillary bone helps form 3 cavities of the face:

1. Oral- help form the roof of the mouth (along with the palatine bones)
2. Nasal- form part of the lateral wall & most of the floor of the nasal cavity
3. Orbital- forms part of the floor of the orbital cavities

RADS 321

Final Study Guide

5-9-16

Mental Foramen- 2 small holes on the body of the mandible on either side of the mentum
Coronoid Process- anterior process; thin & tapered; NO articulation
Condyloid Process- posterior; has head & neck portion; articulates with temporal bone at TMJ
Temporomandibular Joint- only diarthrodial joint of the skull; lies immediately anterior to EAM
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RADS 321

Final Study Guide

5-9-16

Test 2:
Facial Bones Positioning

Should be performed erect or decubitus to demonstrate fluid levels for possible bleeding into sinuses
Routine Series will always include Waters & Lateral

Lateral Projection

8x10 LW


Grid
40 SID
80-90 kVp
Patient: erect, seated erect, or semi-prone
IP line perpendicular
IOML perpendicular
Affected side down
CR:
Enters lateral surface of zygoma halfway between EAM & Outer Canthus
Center IR to zygoma

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RADS 321

Final Study Guide

5-9-16

Parietoacanthial Projection: Waters Method

8x10 or 10x12 LW

Grid
40 SID
80-90 kVp
Patient: erect, prone, or seated erect (Erect- air/fluid levels, deviated septum, & orbital fractures)
Rest head on tip of extended chin
OML should be 37 from the plane of the IR (nose usually off table)
MML perpendicular
CR:
Perpendicular to IR
Parallel to MML
Enters vertex
Exits Acanthion
Petrous Ridges immediately below maxillae

Modified Parietoacanthial Projection: Modified Waters

8x10 or 10x12 LW

Grid
40 SID
80-90 kVp
Patient: erect or prone
LML perpendicular
OML 55 from IR
CR:
Exits Acanthion
Petrous Ridges projected into lower half of maxillary sinuses
Done to show Blow-Out Fractures of the orbits & fractures of the orbital floor

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RADS 321

Final Study Guide

5-9-16

Acanthioparietal Axial Projection: Reverse Waters Method (Trauma)

10x12 LW


Grid
40 SID
80-90 kVp
Patient: supine
MML perpendicular
CR:
Enters at Acanthion
Exits vertex
Used when patient cant be placed in prone position
Trauma:
CR parallel to MML
If head cant be adjusted, place MML perpendicular to table with CR parallel to MML &
perpendicular to IR
Similar to Waters Method, only slightly magnified

PA Axial Projection: Caldwell Method

10x12 LW


Grid
40 SID
80-90 kVp
Patient: prone or seated
Rest forehead & nose on table/bucky
OML perpendicular
CR:
15 Caudal
Exit the Nasion

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RADS 321

Final Study Guide

5-9-16

AP/PA Projection

8x10 LW


Grid
40 SID
80-90 kVp
Patient: supine or prone
OML perpendicular
Forehead & nose resting on table
CR:
Enter tip of nose (to include entire mandible)
Exit tip of nose
Show entire mandible to supraorbital rims

Nasal Bones

Lateral Projection

8x10 CW (2 exposures)

Non-Grid
40 SID
65-75 kVp- Use finger technique
Small focal spot
Patient: semi-prone or seated erect
Head in true lateral
IP line perpendicular
Center nasion to the IR (mask other half)
CR:
Enter distal to the nasion
2 exposures made with face facing off the cassette
Both sides done for comparison

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RADS 321

Final Study Guide

5-9-16

Zygomatic Arches

Routine: SMV, Modified Towne, Waters, & Lateral (facial bones)

Optional: Tangential SMV (Axial Oblique); Tangential VSM (Axial Oblique)

Submentovertical (SMV) Projection: Schller Method

8x10 CW


Grid
70-80 kVp
Small Focal Spot
Patient: supine
IOML parallel
CR:
Perpendicular to IOML
Enter 1 posterior to Outer Canthus

AP Axial Projection: Modified Towne Method

8x10 CW


Grid
70-80 kVp
Patient: supine
OML parallel
CR:
30 Caudal (37 Caudal if using IOML)
Enters Glabella (1 superior to nasion)

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RADS 321

Final Study Guide

5-9-16

Tangential SMV Projection: AP Axial Oblique

8x10 CW


Grid
70-80 kVp
Patient: supine or seated erect
Vertex on bucky with chin up
IOML parallel
Rotate head 15 Toward AFFECTED side
CR:
Perpendicular to IOML
Pass through zygomatic arch

Mandible Positioning

Routine: PA, AP Axial, PA Axial, SMV, & Axiolateral Obliques

PA Projection (For best demonstration of mandible)

8x10 LW


Grid
80-90 kVp
Patient: prone or seated erect
Rest head on nose & forehead
OML perpendicular
CR:
Exit acanthion or tip of nose

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RADS 321

Final Study Guide

5-9-16

AP Axial Projection: Towne Method (Not in Book)

8x10 or 10x12 LW

80-90 kVp
Patient: supine
OML perpendicular
CR:
30 Caudal
8x10: Enters Acanthion
10x12: Enters Nasion

Grid

PA Axial Projection

8x10 LW


Grid
80-90 kVp
Patient: prone or seated erect
Rest forehead & nose against table/bucky
OML perpendicular
CR:
20-25 Cephalic
Exits Acanthion

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RADS 321

Final Study Guide

5-9-16

PA Axial Projection (Done Most Often)

8x10 LW


Grid
80-90 kVp
Patient: prone
Rest head on nose & chin
CR:
30 Cephalic
Enter midway between TMJs to exit tip of the nose

SMV Projection

8x10 LW


Grid
80-90 kVp
Patient: erect or supine
IOML parallel
CR:
Perpendicular to IOML
Enters midway between gonions

Axiolateral Oblique Projections

8x10 LW or CW


Grid
80-90 kVp
Patient: semi-supine, semi-prone, or seated erect
IP line perpendicular
Extend chin to prevent superimposition of C-spine
Ramus: head in true lateral
Body: chin 30 toward IR
Mentum: chin 45 toward IR
CR:
25 Cephalic
Enters mandibular region of interest

Actual Way: Patient: Lateral with head tilted toward body; CR: perpendicular to IR, enters below upper
gonion
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RADS 321

Final Study Guide

5-9-16

Temporomandibular Joint (TMJ) Positioning

Routine: AP Axial, Axiolateral: Schller Method or Axiolateral Oblique: Law Method

Always perform open & closed mouth projections- unless contraindicated (mark on IR)

AP Axial Projection

8x10 LW


Grid
80-90 kVp
Patient: supine or seated erect
OML perpendicular
CR:
35 Caudal
Enters 3 above Nasion (midway between TMJs)
Center IR just below level of TMJs

Axiolateral Projection: Schller Method

8x10 LW or CW


Grid
80-90 kVp
Patient: semi-prone
Affected side down
IP line perpendicular
IOML parallel
CR:
25-30 Caudal
Enters anterior & 2 superior to upper EAM
Exits TMJ closest to IR (will be higher TMJ on radiograph)

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RADS 321

Final Study Guide

5-9-16

Axiolateral Oblique Projection: Law Method

8x10 CW


Grid
80-90 kVp
Patient: erect or semi-prone
Rest side of head on table/bucky with affected side DOWN
IP line perpendicular
AML parallel
Rotate face 15 toward IR
CR:
15 Caudal
Exits TMJ closest to IR (1.5 superior to upper EAM)
Center to anterior to EAM

Anatomy of Sinuses

Maxillary- present at birth

Frontal- visible by age 6-7 (posterior to glabella between inner & outer tables of skull)
Sphenoid- visible by age 6-7 (located within body of sphenoid bone below sella turcica)
Ethmoid- develop during puberty (located on either side of nasion)

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RADS 321

Final Study Guide

5-9-16

Positioning of Paranasal Sinuses

Should be done with patient erect to demonstrate air/fluid levels & to differentiate between shadows
caused by fluid & those caused by pathologic conditions

Lateral Projection

8x10 LW


Grid
80-90 kVp
Patient: seated erect or semi-prone
Head in true lateral
Affected side closest to IR
CR:
Enters -1 posterior to Outer Canthus
Light should cover anterior face & just past EAM to 2 superior to Glabella

PA Axial Projection: Caldwell Method

8x10 LW


Grid
80-90 kVp
Patient: seated erect or prone
Rest head on tip of nose so OML forms 15 from CR
OML perpendicular if bucky tilts 15
CR:
Perpendicular
Exits Nasion
Tilt bucky 15 toward top of head with CR at 0 (best shows air/fluid levels)

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RADS 321

Final Study Guide

5-9-16

Parietoacanthial Projection: Waters Method

8x10 LW


80-90 kVp
Patient: seated erect or prone
Rest chin on bucky/table
IOML 37 from IR
MML perpendicular
CR:
Enters vertex
Exits Acanthion

Grid

Parietoacanthial Projection: Open Mouth Waters- Pirie Method

8x10 LW


Grid
80-90 kVp
Patient: seated erect or prone
Rest chin on bucky/table
OML 37 from IR
Open mouth & say Ahhh during exposure to immobilize tongue
CR:
Exits Acanthion
Sphenoid sinuses projected through the open mouth along with maxillary sinuses

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RADS 321

Final Study Guide

5-9-16

SMV Projection

8x10 LW


Grid
80-90 kVp
Patient: prone or seated erect
Vertex of head on IR with chin lifted
IOML parallel
CR:
Perpendicular to IOML- passing through sella turcica
Enters MSP at anterior to level of EAM
Sphenoidal sinus visualized with posterior ethmoidal air cells just below mentum

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RADS 321

Final Study Guide

5-9-16

Positioning of Orbits

Parietoorbital Oblique Projection: Rhese Method

8x10 CW


Grid or Non-Grid
80-90 kVp
Patient: seated erect or prone
Rest AFFECTED side on zygoma, nose, & chin (3-point stance)
AML perpendicular
MSP forms 53 angle with IR
CR:
Enters 1 superior & posterior to TEA
Exits dependent orbit
Optic foramen projected into lower outer quadrant of dependent orbit

Orbitoparietal Oblique Projection: Rhese Method

8x10 CW


Grid or Non-Grid
80-90 kVp
Patient: seated erect or supine
MSP 53 from IR
AML perpendicular
CR:
Enters uppermost orbit
Center IR to uppermost orbit

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RADS 321

Final Study Guide

5-9-16

Orbitoparietal Tangential Projection: Demonstrates Orbital Rim

8x10 CW


Grid or Non-Grid
80-90 kVp
Mark side UP
Patient: seated erect or supine
MSP forms 53 angle with IR
AML perpendicular to IR
CR:
Enters lateral margin of dependent orbital rim

Anatomy of Vertebral Column

Cervical & Lumbar Curvature- convex anteriorly; secondary/compensatory curves develop after birth
Pelvic & Thoracic Curvature- concave anteriorly; primary curves; present at birth
Lordosis- abnormal increase in anterior convexity; lumbar & cervical
Kyphosis- abnormal increase in anterior concavity; sacral & thoracic
Scoliosis- abnormal lateral curvature of vertebral column
Atlas- C-1
Axis- C-2

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RADS 321

Final Study Guide

5-9-16

Cervical Spine

Zygapophyseal Joints lie 90 from MSP & demonstrated on LATERAL projections

Intervertebral Foramina lie 45 from MSP & 15 inferior, demonstrated on OBLIQUE

Thoracic Spine

Zygapophyseal Joints lie 70-75 off MSP & demonstrated on OBLIQUE projections
Intervertebral Foramina lie at 90 & demonstrated in LATERAL projection

Lumbar Spine

Zygapophyseal Joints like 30-60 from MSP & demonstrated on OBLIQUE projections
Intervertebral Foramina demonstrated on LATERAL projection
Scottie Dog:
Neck- Pars Interarticularis
Ear- Superior Articular Process
Eye- Pedicle
Nose- Transverse Process
Front Leg- Inferior Articular Process

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RADS 321

Final Study Guide

Topographical Anatomy- Landmarks

5-9-16

Mastoid Tip- C-1

Gonion- C-2 - C-3
Adams Apple (Thyroid Cartilage)- C-5
Manubrial Notch- T-2 T-3 interspace
Sternal Angle- T-4 T-5 interspace
Xiphoid Tip- T-9/T-10
Inferior Costal Margin- L-2 L-3
Iliac Crest- L-4/L-5 Junction
Superior Symphysis Pubis- Coccyx & Greater Trochanters
ASIS- S-1 S-2

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RADS 321

Final Study Guide

5-9-16

C-Spine Positioning

With ER or trauma patients, perform Cross-Table Lateral projection FIRST

Remove any metallic objects from shoulders up, dentures, & hearing aids

AP Axial Projection

8x10 LW

85-95 kVp
Suspend respiration
Patient: supine or upright
Chin elevated
CR:
15-20 Cephalic
Enters C-4 at MSP

Grid

AP Projection: Open Mouth or Odontoid

8x10



Grid
85-95 kVp
Patient: supine or erect
Open mouth & say Ahhh
Line up upper occlusal plane to mastoid tip & perpendicular to IR
CR:
Perpendicular to midpoint of open mouth
Wagging Jaw- move mandible to blur it from superimposing C-1 & C-2

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RADS 321

Final Study Guide

5-9-16

Odontoid Process: Fuchs Method

8x10



Grid
85-95 kVp
Patient: supine or erect
Extend chin until mentum & mastoid process are vertical
MML perpendicular
CR:
Enters just distal to chin
With Cervical Collar: angle tube to be parallel to MML

PA Projection: Judd Method

8x10 CW


Grid
85-95 kVp
Patient: prone
Rest head on chin
OML 37 from IR
CR:
Enters just distal to level of gonions at MSP

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RADS 321

Final Study Guide

5-9-16

Lateral Projection

8x10 LW


Grid
60-72 SID (due to increased OID)
85-100 kVp
Suspend at end of Expiration
Patient: erect or seated lateral
Chin raised to prevent gonion superimposition
Head & body in true lateral
Top of light/IR at 1 above EAM or at TEA
Hold sandbags to lower shoulders
CR:
Enters C-4

Flexion & Extension Lateral Projections

8x10 LW


Grid
60-72 SID
85-95 kVp
Patient: erect or supine
Hyperflexion- tip of chin vertical; MML perpendicular to floor
Hyperextension- tip of chin horizontal; MML parallel to floor
CR:
Enters C-4

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RADS 321

Final Study Guide

5-9-16

Soft Tissue Neck

8x10 LW


Grid
60-72 SID
75-85 kVp (subtract 10 kVp from C-spine technique)
Demonstrates soft tissue structures of the neck (pharynx & larynx)
Suspend respiration on INSPIRATION
Patient: erect or recumbent
True lateral (Left or Right)
CR:
Center 1 below level of EAMs

AP Axial Oblique Projections: RPO/LPO

8x10 LW


Grid
60-72 SID
85-95 kVp
Patient: erect or recumbent
Rotate entire body into 45 oblique
Elevate chin
CR:
15-20 Caudal
Enters C-4
Will see Intervertebral Foramina FARTHEST from IR

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RADS 321

Final Study Guide

5-9-16

PA Axial Oblique Projections: RAO/LAO

8x10 LW


Grid or Non-Grid
60-72 SID
85-95 kVp
Patient: erect or recumbent
Rotate body 45
Elevate chin
CR:
15-20 Caudal
Enters C-4
Will see Intervertebral Foramina CLOSEST to IR

Trauma C-Spine

AP & Laterals- taken with collar in place

Odontoid- without movement; angle CR according to flexion of the head
Obliques- IR LW, placed on side opposite of affected intervertebral foramina with CR 15 Cephalic &
45 medial to enter the affected side

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RADS 321

Final Study Guide

5-9-16

RAO/LAO- Shows intervertebral foramina closest to IR- side down, CR goes through down side
Marker on posterior side
RPO/LPO- Shows intervertebral foramina farthest from IR- side up, CR goes up through farthest side
Marker on anterior side

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