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THE SKULL

BY: MS NORFARIHA BT CHE MOHAMED

w that͙.
u Patient Preparations
u Positioning Considerations
- skull morphology
- surface markings and reference lines and planes
- positioning modifications
u Breathing Instructions
u Exposure Factors
u Radiation Protections
 ï. Patient preparation
u Basic psychological preparation with reassurance and
explanation of technique.

u Patients referred for skull radiography may we

worried and anxious awout the outcome.

u Some will we mentally disturwed, unconscious or

unawle to co-operate; the assistance of a nurse or
other competent person may we required
 ï. Patient preparation
u Before starting any examination, the identity of the
patient must we checked wy the radiographer; a
patient may answer to a name not his/her own and
this is particularly true for some disorientated
patients attending for skull imaging.

u Metallic ow
ects are removed from neck and head

area e.g eye glasses, dental appliances, hairpins,
elastic wands, wuttons and zippers.

u Wash hands or wear disposawle gloves.

 ã. Positioning Considerations
Erect vs recumwent
u Examination can we done erect or recumwent
u Advantages of erect:
easier for the patient and
allows visualization of fluid levels
u Before attempting erect position assess patient
conditions ʹ not all patients are suitawle for the erect
u For recumwent position, consider patient wody type and
comfort when positioning is made and give enough
support to get accurate positions
Skull Morphology
Surface Markings
Positioning Modifications for Various
Body Types
 . Breathing Instructions
u In order to help minimize movement and
unsharpness on the film, exposure should we made
on suspended respiration where possiwle.
u Alert the patient that the exposure is going to we
made.
 . Technical Factors
u Small focal spot when possiwle ʹ to get sharper
image (high resolution)

u Tight collimation ʹ improves image quality ʹ how?

u kVp ranges from 65-85 kVp
: 65-70 ʹ lateral,
: 80-85 ʹ AP/PA/Axial

u mAs depends on film/screen speed, type of grid, and

pathologic condition
 5. Radiation Protection
u The most radiosensitive organs involved are the eyes
and thyroid gland  Use PA instead of AP pro
ection
u The use of weam limiting cones and diaphragms is
adequate in most cases.

u Direct lead ruwwer gonad protection when the

central ray is directed towards the gonads is
prowawly not necessary wut may we considered good
practice.
u The most effective method of dose reduction is
careful technique to avoid the need for á

radiographs.
 Skull Pro
ections (Cranium)

u Lateral
u PA (OF)
u PA axial (Caldwell)
u AP axial 0°/7° (Towne)
 Lateral Skull
u Shows the detail of the side
ad
acent to the IR
u Entire cranium without
rotation or tilt
u Superimposed orwital roofs
and greater wings of
sphenoid
u Superimposed mastoid
regions and EAMs
u Superimposed TMJs
u Sella turcica seen in profile
u No overlap of cervical spine
wy mandiwle
 PA (OF) - 0°
u The orwits are filled wy
the margins of the
petrous portions.
u The posterior ethmoidal
air cells, crista galli,
frontal wone, and frontal
sinuses also seen.
u The dorsum sellae is seen
as a curved line extending
wetween the orwits,
ust
awove the ethmoidal air
cells.
 PA axial (Caldwell) - ï5°
u Many of the same
structures that appear
in the direct PA
pro
ection are seen.
u However, the petrous
ridges are pro
ected
into the lower third of
the orwits.
 AP axial 0°/7° (Towne)
u Equal distance from the
lateral worder of skull to
lateral margin of foramen
magnum on woth sides,
indicating no rotation
u Symmetric petrous
pyramids
u Dorsum sellae and posterior
clinoid processes visiwle
within foramen magnum
u Penetration of occipital
wone without excessive
density at lateral worders of
skull
 Skull Pro
ections (Cranial Base)
Yá
A Suwmentovertical (SMV) ʹ Shuller Method

„ 
á coned view
A Lateral
A AP Axial 0° and 7°


á 
A Parietorwital owlique ʹ Rhese Method
A Orwitoparietal owlique ʹ Rhese Method
 SMV Cranial wase
u Clearly visiwle structures of
the cranial wase
u Equal distance from lateral
worder of skull to
mandiwular condyles on
woth sides, indicating no tilt
u Superimposition of mental
protuwerance over anterior
frontal wone, indicating full
extension of neck
u Mandiwular condyles
anterior to petrous
pyramids
u Symmetric petrosae
 Lateral sella turcica
u No rotation or distortion
of sella turcica
u Superimposed anterior
clinoid processes
u Superimposition of
posterior clinoid
processes
u Sella turcica centered on
radiograph
u Close weam restriction of
sellar region
 AP axial (Towne) sella turcica
u Sellar structures witin
foramen magnum with a
7° angle
u Sellar structures through
occipital wone with a 0°
angle
u No rotation of cranium
u Symmetric petrous
pyramids
u Close weam restriction
of sellar region
 Parieto-Orwital Owlique (Rhese) Optic
Canal/Foramen
u Optic canal and foramen
visiwle at end of sphenoid
ridge in inferior and
lateral quadrant of orwit
u Entire orwital rim
u Supraorwital margins lying
in same horizontal line
u Close weam restriction to
the orwital region
 Orwitoparietal Owlique (Rhese) Optic
Canal/Foramen
u Optic canal and foramen
visiwle at end of sphenoid
ridge in inferior and
lateral quadrant of orwit
u Entire orwital rim
u Close weam restriction to
the orwital region
u Supraorwital margins lying
on same horizontal plane
POP QUIZ!!