Skull RAdiology

Skull & Vertebrae Radiology

dr. Fanani, Sp.Rad

An Introduction to the Axial Skeleton

Structures of Bones Articulations

Contacts with other bones

Landmarks (Bone Markings; Marks) Areas of muscle and ligament attachment

Foramina Openings for nerves and blood vessels

The Axial Skeleton

The axial skeleton Forms the longitudinal axis of the body Has 80 bones

The skull:– 8 cranial bones – 14 facial bones

Bones associated with the skull:– 6 auditory ossicles – the hyoid bone

The Axial Skeleton

The axial skeleton The vertebral column

24 vertebrae (singular = vertebra) The sacrum The coccyx

The thoracic cage 24 ribs The sternum

Peel-Away of Whole Axial Skeleton

The Axial Skeleton

Figure 7–1 The Axial Skeleton.

The Skull

The skull protects The brain Entrances to respiratory system Entrance to digestive system

The skull contains 22 bones 8 cranial bones:

Form the braincase or cranium 14 facial bones:

Protect and support entrances to digestive and respiratory tracts

The Skull

Figure 7–2 Cranial and Facial Subdivisions of the Skull.

The Skull

Figure 7–3a The Adult Skull.

The Skull

Figure 7–3b The Adult Skull.

The Skull

Figure 7–3c The Adult Skull.

The Skull

Figure 7–3d The Adult Skull.

The Skull

Figure 7–3e The Adult Skull.

Skull & Sinus Radiography

Skull Radiography can be easily done erect with the patient seated in a chair or often time standing. It is easier to check for rotation with the patient seated.Sinus studies should always be done erect to see air and fluid levels in the sinuses.Sinus views can also be used to evaluate the facial bone and orbits.

Skull & Sinus Radiography

All skull or sinus views should be taken using the small focal spot. This will provide the best possible geometric resolution.Skull films are taken on 10” x 12” regular speed cassettes.Sinus films are taken on 8” x 10” regular speed cassettes.

P-A Skull • Patient seated or

standing facing the Bucky.

• Nose and forehead touching the Bucky to get the canthomeatal line perpendicular to film.

P-A Skull • Horizontal CR: exit

through the glabella.• Vertical CR: mid-sagittal

plane• Center film to

horizontal CR• Collimation: slightly less

than film size.• Breathing Instructions:

Suspended respiration

P-A Skull • Make exposure and let

patient relax.• Note: If the patient is

done seated, place Bucky tray in the lower Bucky slot. This will allow the patient to get their legs under the Bucky.

P-A Skull Film• The entire skull should

be on the film.• There should be no

rotation.• The petrous ridges will

be superimposed with the orbits.

• To clear the ridges, the Caldwell view can be taken.

9.2 Chamberlain-Townes• The Townes Projection is

part of a routine skull series.

• The tube is angled to throw the anterior part of the skull away from the occipital region of the skull.

Chamberlain-Townes• Patient is seated facing

the tube.The chin is tucked into the chest until the canthomeatal line is perpendicular to film. A chair the allows some reclining will make this easier for the patient.

Chamberlain-Townes• Horizontal CR: Through

the EAM. The Horizontal CR will usually pass through the hair line.

• Vertical CR: mid-sagittal• Film centered to

horizontal CR• Collimation: slightly less

than film size or soft tissue of skull

Chamberlain-Townes• Breathing Instructions:

Suspended respiration• Make exposure• Let patient breathe and

Chamberlain-Townes Film• The entire skull and

especially the occipital region of the skull must be on the film.

• Structure seen include the foramen magnum, petrous ridges, IAC’s and TM Joints

• No rotation of skull

Skull Lateral• Patient seated of

standing facing the Bucky. Rotate the body into an oblique position.

• Turn skull so the affected side is next to the Bucky.

• The interpupillary line must be perpendicular to film and tube.

• Mid sagittal plane parallel to the film.

Skull Lateral Film

• Entire skull must be on the film.

• There should be no rotation of the skull, orbits and mandible ramus superimposed.

• The facial bones are sinuses will be dark (over exposed).

• Usually both lateral views are taken.

9.5 Base Posterior Skull• Routine skull view that

can be used to evaluate the upper cervical spine.

• Provides an axial view of C-1 and C-2 as well as the foramen magnum.

Base Posterior Skull Films

• The entire skull is visualized.

• The mandible and frontal region of skull are superimposed.

• With a bright light, the zygomatic arches can usually be seen.

Base Posterior Skull

• Assist patient get out of the position. Be very careful that the patient does not hit face on x-ray tube.

• The ability of the patient to lay back in the chair will make the view much easier for all concerned.

9.6 Schullers Projection• The Schullers

Projection can be used to evaluate the temporal mandibular joints and mastoid air cells and inner ear.

Schullers Protection for TMJ

• Patient is seated facing the Bucky. Head is turned to place the affected TMJ next to Bucky.

• Skull should be in a true lateral position. Align the TMJ to the center line of the Bucky.

• The vertical CR should be aligned with TMJ away from film.

Schullers Protection for TMJ

• Open and closed mouth view are taken of both TM joints.

• The TMJ closest to the Bucky will be the one seen at the center or top of the film.

• Accurate positioning is essential to being able to compare joints.

9.7 Caldwell Sinus Projection • The Caldwell Projection

will have the petrous ridges below the orbits.

• Positioning is exactly like the P-A skull with the exception of the use of a 15 degree caudal tube angle to lower the petrous ridges.

Caldwell Sinus Projection • Patient is seated facing

Bucky. Their legs should be under the Bucky. Get chair as close to the Bucky as possible.

• Ask patient to place their nose and forehead on center line of Bucky.

• Check for rotation.

9.8 Waters Projection Sinus• The most important view

for sinus problems or injury involving the maxilla or orbits.

• By taking the view erect, fluid levels within the maxillary sinuses can be seen.

Waters Projection Sinus• Patient is seated facing

the Bucky. Get the chair as close to the Bucky as possible. Patient may spread legs to get chair as close as possible. May also be taken standing.

• Mentomeatal line should be perpendicular to film with mouth closed.

Waters Projection Sinus Film• This is an example of the

open mouth waters view.• The facial bones and

sinuses should be on the film.

• There should be no rotation.

• The petrous ridges must be below the floor of the maxilla.

9.9 Sinus Lateral• The lateral view of the

sinuses and facial bones will under exposed for the skull.

• This view is very useful for seeing fluid levels in all of the sinuses.

Sinus Lateral• Patient is seated or

standing facing the Bucky. Turn patient toward the affected side. Turing the body will make it easier for the patient.

• Patient’s skull should be in a true lateral position. The interpupillary line perpendicular to film.

9.10 Basilar View of Sinuses• The base view of the

sinuses is positioned just like the base posterior view.

• The horizontal CR is moved to the center of the facial bones and sinuses.

• The positioning view demonstrates a patient that cannot extend their neck.

Basilar View of Sinuses• Position chair about 6” to

10” from Bucky. Patient seated facing the tube.

• Have patient lean back or recline in chair.

• Patient extend neck as far as possible until the inferior orbital-meatal line is parallel to film.

The Vertebral Column

Figure 7–16 The Vertebral Column.

Vertebrae The neck

Seven cervical vertebrae

The upper back 12 thoracic vertebrae Each articulates with one or more pair of ribs

The lower back Five lumbar vertebrae

Figure 7–17 Abnormal Curvatures of the Spine.

Figure 7–18a Vertebral Anatomy.

Figure 7–18c Vertebral Anatomy.

Figure 7–18 Vertebral Anatomy.

Vertebral Regions

Figure 7–19 The Cervical Vertebrae.

Vertebral Regions

The Cervical Vertebrae Transverse processes

Are fused to costal processes Which encircle transverse foramina (protect

arteries and veins)

Atlas (C1) Articulates with occipital condyles of skull Has no body or spinous process Has a large, round foramen within anterior and

posterior arches

Thoracic Spine

Lumbar Spine

Skull RAdiology

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