Skull RAdiology

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Skull & Vertebrae Radiologydr. Fanani, Sp.RadCopyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

An Introduction to the Axial SkeletonStructures of BonesArticulationsContacts with other bonesLandmarks (Bone Markings; Marks)Areas of muscle and ligament attachmentForaminaOpenings for nerves and blood vessels2Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

The Axial SkeletonThe axial skeletonForms the longitudinal axis of the bodyHas 80 bonesThe skull:8 cranial bones 14 facial bonesBones associated with the skull:6 auditory ossicles the hyoid bone

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The Axial SkeletonThe axial skeletonThe vertebral column24 vertebrae (singular = vertebra)The sacrum The coccyxThe thoracic cage24 ribs The sternum

Peel-Away of Whole Axial Skeleton4Copyright 2009 Pearson Education, Inc., publishing as Pearson Benjamin Cummings

The Axial SkeletonFigure 71 The Axial Skeleton.

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The SkullThe skull protectsThe brainEntrances to respiratory systemEntrance to digestive systemThe skull contains 22 bones8 cranial bones:Form the braincase or cranium 14 facial bones:Protect and support entrances to digestive and respiratory tracts

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The SkullFigure 72 Cranial and Facial Subdivisions of the Skull.

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The SkullFigure 73a The Adult Skull.

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The SkullFigure 73b The Adult Skull.

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The SkullFigure 73c The Adult Skull.

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The SkullFigure 73d The Adult Skull.

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The SkullFigure 73e The Adult Skull.

12Skull & Sinus RadiographySkull 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. 13Skull & Sinus RadiographyAll 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.1415P-A Skull Patient seated or standing facing the Bucky. Nose and forehead touching the Bucky to get the canthomeatal line perpendicular to film.

16P-A Skull Horizontal CR: exit through the glabella.Vertical CR: mid-sagittal planeCenter film to horizontal CRCollimation: slightly less than film size.Breathing Instructions: Suspended respiration

17P-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.

18P-A Skull FilmThe 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.

199.2 Chamberlain-TownesThe 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.

20Chamberlain-TownesPatient 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.

21Chamberlain-TownesHorizontal CR: Through the EAM. The Horizontal CR will usually pass through the hair line.Vertical CR: mid-sagittalFilm centered to horizontal CRCollimation: slightly less than film size or soft tissue of skull

22Chamberlain-TownesBreathing Instructions: Suspended respirationMake exposureLet patient breathe and relax

23Chamberlain-Townes FilmThe entire skull and especially the occipital region of the skull must be on the film.Structure seen include the foramen magnum, petrous ridges, IACs and TM JointsNo rotation of skull

24Skull LateralPatient 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.

25Skull Lateral FilmEntire 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.

269.5 Base Posterior SkullRoutine 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.

27Base Posterior Skull FilmsThe entire skull is visualized.The mandible and frontal region of skull are superimposed.With a bright light, the zygomatic arches can usually be seen.

28Base Posterior SkullAssist 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.

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

30Schullers Protection for TMJPatient 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.

31Schullers Protection for TMJOpen 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.

329.7 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.

33Caldwell 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.

349.8 Waters Projection SinusThe 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.

35Waters Projection SinusPatient 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.

36Waters Projection Sinus FilmThis 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.

379.9 Sinus LateralThe 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.

38Sinus LateralPatient is seated or standing facing the Bucky. Turn patient toward the affected side. Turing the body will make it easier for the patient. Patients skull should be in a true lateral position. The interpupillary line perpendicular to film.

399.10 Basilar View of SinusesThe 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.

40Basilar View of SinusesPosition 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.

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The Vertebral ColumnFigure 716 The Vertebral Column.

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The Vertebral ColumnVertebraeThe neckSeven cervical vertebraeThe upper back12 thoracic vertebraeEach articulates with one or more pair of ribsThe lower backFive lumbar vertebrae

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The Vertebral ColumnFigure 717 Abnormal Curvatures of the Spine.

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The Vertebral ColumnFigure 718a Vertebral Anatomy.

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The Vertebral ColumnFigure 718c Vertebral Anatomy.

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The Vertebral ColumnFigure 718 Vertebral Anatomy.

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Vertebral RegionsFigure 719 The Cervical Vertebrae.

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Vertebral RegionsThe Cervical VertebraeTransverse processesAre fused to costal processesWhich encircle transverse foramina (protect