Skull Positioning

RAD 124
Chapter 20
You might be an x-ray ‘tech’ if:
 Eating popcorn out of a clean emesis basis is
perfectly natural.
 You’ve ever had a patient with a nose ring,
tongue ring and 12 earrings say, “I’m afraid of
needles!”
 You believe a roll of tape can fix any problem!
 The question of the day is to B.E. or not to B.E.!
 You have copy x-rays of strange things that you
get out at parties.
Skull Topography:
Points, planes & abbreviations
 Midsagittal plane
 Interpupillary line
 Acanthion
 Outer canthus
 Infraorbital margin
 External acoustic meatus (EAM)
 Orbitomeatal line (OML)
 Infraorbital line (IOML)
 Acanthiomeatal line (AML)
 Glabelloalveolar line (GAL)
 Glabellomeatal line (GML)
 Mentomeatal line (MML)
 Skull Morphology
 Mesocephalic: typically shaped head where
petrous ridges project anteriorly & medially at
angle of 47 degrees from MSP
 Brachycephalic: Short from front to back
where petrous ridges lie at 54 degree angle
 Dolichocephalic: Long from front to back
where petrous ridges lie at 40 degree angle
 Technical considerations
 General body position: Upright or supine

 Hyposthenic or asthenic: elevate chest on pillow

 Hypersthenic: elevate top of head

 Cleanliness is important!
 Radiation Protection

 Use shields whenever possible

 Use proper collimation & proper instructions

to patient
 Review pg. 304-305
 Skull
 Standard views:

 Townes
 Both laterals
 Waters
 PA
AP Axial, Towne method: Pg. 316-319
 10 x 12, portrait
 Supine allows easier positioning but
upright OK
 MSP and OML perpendicular to IR
 Respiration: suspended
 CR: 30 degrees caudal entering 2 ½” above
glabella (or 37 degrees to IOML)
 Exposure index 2150: 80 kVp @ 40 mAs
Lateral, Pg. 306-307
 10 x 12, landscape
 Upright or prone
 MSP parallel to IR with IOML perpendicular to
front edge of cassette & parallel to long axis of
cassette. Interpupillary line perpendicular to IR
 Respiration: suspended
 CR: perpendicular, 2” superior to EAM
 Exposure index 2200: 15 mAs @ 75 kVp
Parietoacanthial projection
Waters method, Pg. 398-399
 10 x 12, portrait
 Upright or supine
 MSP perpendicular to cassette, chin on IR with
OML at 37 degree angle from plane of cassette
 Respiration: suspended
 CR: Perpendicular to IR exiting at acanthion
 Exposure index 1930: 30 mAs @ 75 kVP
 PA, Pg. 310-313
 10 x 12, portrait
 Upright or prone
 MSP perpendicular to cassette, forehead &
nose on IR with OML perpendicular to
cassette
 Respiration: suspended
 CR: perpendicular exiting nasion
 Exposure index 1910: 20 mAs @ 75 kVp
 Trauma Skull Radiography
 Patient usually supine; routine projections
include:

 AP
 Cross table laterals
 Acanthioparietal, Reverse Waters
 AP axial, Towne method
 AP, pg. 314-315

 OML perpendicular to IR
 CR perpendicular entering nasion OR parallel
to OML
 Structures seen are similar to PA, but orbits
considerably magnified
Cross Table Lateral, pg. 308-309

 After ruling out spinal injury, elevate head

in order to visualize posterior portion
 MSP parallel to IR, interpupillary line
perpendicular to cassette
 CR: perpendicular to IR 2” superior to
EAM
 Medical Humor
 A nurse caring for a woman from Kentucky
asked, “So, how’s your breakfast this
morning?” “It’s very good, except for the
Kentucky jelly. I can’t seem to get used to
the taste,” the patient replied. The nurse
asked to see the jelly and the woman
produced a foil packet labeled ….. …..
“KY Jelly”
Acanthioparietal projection
Reverse Waters method

 10 x 12, portrait
 Adjust CR parallel to MML
 CR enters acanthion
 AP Axial, Towne method
 10 x 12, portrait
 If IOML not perpendicular to IR:
 Measure from the perpendicular to the IOML
and then add 37 degrees
 Do not exceed 45 degrees
Non-Trauma Supplemental
Skull Radiographs

 PA axial, Haas method (pg. 322-323)

 Useful for obese, hypersthenic patients

 OML perpendicular to IR
 CR 25 degrees cephalic entering 1 ½” below
inion
Submentovertical projection
Schuller method, pg. 324-325

 10 x 12, portrait

 IOML parallel to IR

 CR perpendicular to IOML entering ¾”

anterior to EAM
Mastoid Positioning
 CT has virtually eliminated the need for
mastoid examinations
 Use proper radiation protection measures,
especially proper beam restriction
 Always examine mastoids bilaterally
 Tape the auricles of ear forward
 Use small focal spot with smallest possible
field size
Standard Projections
Bilateral Modified Law, Bilateral Stenvers method & Towne
method
 Axiolateral oblique projection, Modified Law
method, Pg. 328-329
 8 x 10, portrait
 Upright or prone with auricle of ear taped forward
 MSP of head parallel to IR with interpupillary line
perpendicular
 IOML parallel to IR with head rotated 15 degrees toward
IR
 Respiration suspended
 CR angled 15 degrees caudally entering 2” superior and
2” posterior to uppermost EAM
Mastoids – can't.
 Axiolateral oblique projection, Stenvers
method
 8 x 10, portrait
 Forehead, nose & cheek on IR with IOML parallel
to transverse axis of cassette
 Head rotated 45 degrees from plane of film
(mesocephalic)
 CR 12 degrees cephalic entering 3-4” posterior and
½” inferior to upside EAM
Mastoids – can't.
 AP axial projection, Towne method

 8 x 10, landscape
 Upright or supine (preferred)
 OML perpendicular to IR
 Respiration suspended
 CR angled 30 degrees caudal to OML entering 2
½” above nasion
 Orbits - Routine Projections:
Rhese method & Waters
 Parietoorbital oblique projection, Rhese method, pg.
336-337
 8 x 10 portrait
 Upright or prone
 Center affected orbit to IR with zygoma, nose & chin on
IR with AML perpendicular to plane of cassette
 Rotate head so that MSP forms 53 degree angle to plane
of cassette
 Respiration suspended
 CR: perpendicular entering 1” superior & 1” posterior to
upside TEA (CR exits orbit closest to IR)
Orbit – Con’t.
 Parietoorbital oblique projection, Rhese
method, pg. 334-335 – can't.
 Visualizes “on end” view of optic foramen
lying in inferior, lateral quadrant

 Lateral deviation indicates incorrect rotation of

head
 Longitudinal deviation indicates incorrect
angulation of AML
Orbits – can't.
 Parietoacanthial projection, Waters method

 Views orbital floor

 Eye
 Organ of vision consists of:
 Eyeball
 Optic nerve (connects eyeball to brain)
 Blood vessels
 Accessory organs (extrinsic muscles, lacrimal
apparatus and eyelids
 Eye
 Exposed part of eye is covered by a thin,
mucous membrane known as conjunctiva.
 Outer, supporting coat of the eyeball in its
posterior segment is called the sclera.
 Opaque, white sclera called the “white of the
eye”
 Cornea is in front of the iris (The center
point of the cornea referred to as the pupil.)
 Eye
 Retina: inner coat of the eyeball
 Composed of nervous tissue & millions of
receptor organs called rods and cones
 Important radiographically because they play a
role in your ability to see a fluoroscopic image
 Eye
 Projections for eye include a modified
waters method, Pg. 343
 OML forms an angle of 50 degrees with the
plane of the IR

 See Pg. 343

 Generally required prior to MR imaging to
rule out foreign body in the orbits.