Transcript File

Skull- Special methods
Submento-vertical
• Remove any movable, radio- opaque material
from the patient's skull.
• Position of patient and cassette:
• The patient may be imaged erect or supine. If
the patient is unsteady, then a supine
technique is advisable.
• Supine:
• The patient’s shoulders are raised and the
neck is hyperextended to bring the vertex of
the skull in contact with the table.
• The head is adjusted to bring the external
auditory meatuses equidistant from the
cassette.
• The median sagittal plane should be at rightangles to the cassette along its midline.
• The IOML should be as near as possible
parallel to the cassette.
• Errect:
• The patient sits a short distance away from a
vertical Bucky.
• The neck is hyperextended to allow the head
to fall back until the vertex of the skull makes
contact with the centre of the vertical Bucky.
• The remainder of the positioning is as
described for the supine technique
Central Ray
• CR is perpendicular to infraorbitomeatal line
• Center at 2cm anterior to level of EAMs
(midway between angles of mandible)
Evaluation of the Image
• ID and anatomical markers must be present
and correct in the appropriate area of the film
• Optimal exposure should penetrate all the
bone structures and contrast should be low
enough to visualise fully the bone and soft
tissue structures.
The entire skull should be visualised
Signs of excellence
• The symmetrical structures should be projected
symmetrically about the midline. (condyles of the
mandible)
• The mandibular symphysis is superimposed with the
frontal bone
• the mandibular condyles anterior to the petrous
pyramids
• the foramen magnum should be projected almost
circular.
• No motion
• No tilt or rotation
SMV
PA axial projection (Haas method)
• An alternative view for patients who can’t flex
the neck (AP, towne view) but results in
magnification of the occipital bone. This view
can’t be used when the occipital bone is the
area of interest
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Patient in erect or prone position
Nose and forehead against the table
Flex neck until OML is perpendicular to the film
Midsagittal plane is perpendicular to the film (EAMs
at the same distance from the table)
Central ray
• 25 degree cephaled to OML
• CR: midsagittal plane at the level of EAM
Technical factors
• 24*30 cm
• 70-80 kVp
• SID: 100 cm
• Respiration: suspend respiration
Evaluation of the Image
• ID and anatomical markers must be present and
correct in the appropriate area of the film.
• Optimal exposure should penetrate all the bone
structures and contrast should be low enough to
visualise fully the bone and soft tissue structures
• The dorsum sella and posterior clinoid processes
should be projected in the almost circular foramen
magnum
• petrous ridge is projected above the mastoid
• The foramen magnum should be projected centrally
within the skull outline
Evaluation of the Image
• Equal distance from foramen magnum to the
lateral margin of the skull on both sides
• No motion: sharp bony margins
Haas method