Anusuya R.
Radiograher,
Department of Radiology,
MMCH &RI
The skull encloses and protects the brain and its related
structures.
The cranium is made up of 8 bones and the facial skeleton of 14
bones.
with the exception of the mandible all are immovable and joined
by sutures.
The most complex part is the base which contains numerous
foraminae for the passage of arteries, veins and cranial nerves.
1. Frontal bone
2. Mandible
3. Maxilla
4. Zygomatic
5. Greater wing of sphenoid
6. Inferior orbital fissure
7. Superior orbital fissure
8. Nasal bone
1. Frontal Bone
2. Mandible
3. Maxilla
4. Zygomatic
5. Greater wing of sphenoid
6. Parietal bone
7. Squamous temporal bone
8. Zygomatic arch
9. Mastoid process of temporal bone
10. Occipital.
1. Vertex
2. External Occipital Protuberance (E.O.P.)
3. External Auditory Meatus
4. Outer Canthus Of Eye.
5. Infra-orbital point
6. Nasion
7. Glabella
The Anthropological line
The Isometric “Baseline” which runs from the
inferior orbital margin to the upper border of the
external auditory meatus (EAM)
The Orbital-Meatal Line
The original “Baseline” which runs from the
Nasion through the outer canthus of the eye to
the centre of the external auditory meatus.
The Interpupillary line
The line connects the centres of the orbits
and is at 90 degree to the median sagittal
plane.
The Median Sagittal plane
A vertical plane dividing the skull into 2 symmetrical
right and left halves when viewed from the anterior
aspect.
The Anthropological plane
This plane splits the skull into upper and
lower halves passing along the anthropological baseline
lines.
The Auricular plane
This plane divides the skull into anterior
and posterior compartments along the
Auricular lines.
Rotation and tilt are the most common positioning errors.
A. Rotation occurs when
the median Sagittal plane
is not parallel to the film.
B. Tilt occurs when the
interpupillary line is not at
90° to the film.
Ensure that all radio opaque materials are removed from the area under
investigation. e.g. hair clips and hairpins.
Bunches of hair often produce artifacts and thus should be untied.
If the area of interest includes the mouth, then false teeth containing
metal and metal dental bridges should be removed.
The patient should be provided with a clear explanation.
Positioning of patient
The patient is seated facing the erect Bucky, so that the median sagittal
plane is coincident with the midline of the Bucky and is also perpendicular
to it.
The neck is flexed so that the orbito-meatal base line is perpendicular to the
Bucky. This can usually be achieved by ensuring that the nose and forehead
are in contact with the Bucky.
Centering of x-ray beam
The central ray is directed perpendicular to the Bucky along the median
sagittal plane.
It is important to ensure that the tube is centered to the middle of the
Bucky.
Positioning of patient
The technique used for this projections is similar to that employed for
the occipito-frontal projection, except that a caudal angulation is
applied.
A 20-degree caudal angulation will be employed.
Centering of x-ray beam
Ensure that the central ray is always centred to the middle of
the Bucky once the tube angulation has been applied.
Positioning of patient
The patient sits facing the erect Bucky and the head is then rotated, such
that the median sagittal plane is parallel to the Bucky.
The shoulders may be rotated slightly to allow the correct position to be
attained.
Position the cassette transversely in the erect Bucky, such that its upper
border is 5cm above the vertex of the skull.
Centering of x-ray beam
Centre midway between the glabella and the external occipital
protuberance to a point approximately 5cm superior to the external
auditory meatus.
Positioning of patient
The patient lies supine on a trolley or Bucky table, or with the posterior
aspect of the skull resting on a grid cassette.
The head is adjusted to bring the median sagittal plane at right-angles to
the film and coincident with its midline. In this position, the external
auditory meatuses are equidistant from the cassette.
The orbito-meatal baseline should be perpendicular to the cassette.
Centering of x-ray beam
The central ray is directed perpendicular to the cassette or Bucky along the
median sagittal plane.
Positioning of patient
The patient lies supine on a trolley or Bucky table, with the posterior aspect
of the skull resting on a grid cassette.
The head is adjusted to bring the median sagittal plane at right-angles to
the cassette and so it is coincident with its midline.
The orbito-meatal base line should be perpendicular to the film.
Centering of x-ray beam
The central ray is angled caudally so it makes an angle of 30 degrees to
the orbito-meatal plane.
Centre in the midline such that the beam passes midway between the
external auditory meatuses.
This is to a point approximately 5cm above the glabella
Positioning of patient
The patient’s shoulders are raised and the neck is hyper-extended to bring
the vertex of the skull in contact with the grid cassette or table.
The head is adjusted to bring the external auditory meatuses equidistant
from the cassette.
The median sagittal plane should be at right-angles to the cassette along
its midline.
The orbito-meatal plane should be as near as possible parallel to the
cassette.
Centering of x-ray beam
The central ray is directed at right-angles to the orbito-meatal plane and
centred midway between the external auditory meatuses.
Positioning of patient
The patient lies supine, with the head raised and immobilized on a non-opaque
skull pad. This will ensure that the occipital region is included on the final
image.
The head is adjusted, such that the median sagittal plane is perpendicular to the
table/trolley and the interorbital line isperpendicular to the cassette.
Support the grid cassette vertically against the lateral aspect of the head parallel
to the median sagittal plane, with its long edge 5cm above the vertex of the skull
Centering of x-ray beam
The horizontal central ray is directed parallel to the inter-orbital line, such
that it is at right-angles to the median sagittal plane.
Centre midway between the glabella and the external occipital
protuberance to a point approximately 5cm superior to the external
auditory meatus.
Position of patient and cassette
The patient sits facing the erect Bucky and the head is then rotated, such
that the median sagittal plane is parallel to the Bucky and the inter-
orbital line is perpendicular to the Bucky.
The shoulders may be rotated slightly to allow the correct position to be
attained. The patient may grip the Bucky for stability.
The head and Bucky heights are adjusted so that the centre of the Bucky
is 2.5 cm vertically above a point 2.5 cm along the baseline from the
external auditory meatus
Centering of the x-ray beam
A well-collimated beam is centered to a point 2.5 cm vertically above a point
2.5 cm along the baseline from the auditory meatus nearer the X-ray tube.
Position of patient and cassette
• The patient lies prone or, more commonly,
erect with the nose, cheek and chin of the side
being examined in contact with the Bucky or
cassette table.
• The centre of the orbit of the side under
examination should coincide with the centre of
the Bucky or cassette table.
• The median sagittal plane is adjusted to make
an angle of 35 degrees to the vertical (55
degrees to the table).
• The orbito-meatal base line is raised 35
degrees from the
horizontal.
Centering of the x-ray beam
With the beam collimated well, the horizontal
central ray should be centered to the middle of the
Bucky.
This is to a point 7.5 cm above and 7.5 cm behind
the uppermost external auditory meatus, so that
the central ray emerges from the centre of the
orbit in contact with the table.
A small lead side-marker can be placed above the
superior orbital margin 35°
Positioning of patient and cassette
• The patient’s shoulders are raised and the neck is
hyperextended to bring the vertex of the skull in
contact with the grid cassette or table.
• The head is adjusted to bring the external auditory
meatuses equidistant from the cassette.
• The median sagittal plane should be at right-
angles to the cassette along its midline.
• The orbito-meatal plane should be as near as
possible parallel to the cassette.
Centering of the X-ray beam
Using a well-collimated beam, the central ray is angled caudally so that it
makes an angle of 70 degrees to the orbitomeatal plane and centred in the
midline to pass midway between the external auditory meatuses.
Position of patient and cassette
The patient may be supine in the midline of the table or erect with their
back to an erect Bucky.
The head is adjusted to bring the external auditory meatuses equidistant
from the table, so that the median sagittal plane is at right-angles to, and
in the midline of, the table.
The chin is depressed so that the orbito-meatal line is at right-angles to
the table.
Centering of the x-ray beam
A caudal angulation is employed, such that it makes an angle of 35 degrees
to the orbito-meatal plane.
The beam is centred midway between the external auditory meatuses.
Collimate laterally to include the lateral margins of the skull and supra-
inferiorly to include the mastoid and petrous parts of the temporal bone.
The mastoid process can be palpated easily behind the ear.
Position of patient and cassette
The patient sits facing the erect Bucky. The head is then rotated, such that
the median sagittal plane is parallel to the Bucky and the inter-orbital
line is perpendicular to the Bucky.
The shoulders may be rotated slightly to allow the correct position to be
attained
The auricle of the ear adjacent to the table is folded forward to ensure
that its soft-tissue outline is not superimposed over the region of interest.
Position the mastoid process in the middle of the Bucky
centering of the X-ray beam
A 25-degree caudal angulation is employed and centered 5 cm above and
2.5 cm behind the external auditory meatus remote from the cassette.
Collimate to the area under examination.
Position of patient and cassette
The middle of the supra-orbital margin on the side being examined is
centered to the middle of the Bucky
The neck is flexed so that the nose and forehead are in contact with the
table and the orbito-meatal line is perpendicular to the table
From a position where the median sagittal plane is perpendicular to the
table, the head is rotated toward the side under examination, such that
the median sagittal plane is now at an angle of 45 degrees to the table.
This brings the petrous part of the temporal bone parallel to the cassette
The neck is extended so that the orbito-meatal line is raised five degrees
from horizontal
Centering of the x-ray beam
A 12-degree cephalad beam angulation is employed, i.e. at an angle of
seven degrees to the orbito-meatal plane, to separate the occiput from the
petrous bone
Centre midway between the external occipital protuberance and the
external auditory meatus furthest from the cassette
Collimate to the mastoid and petrous parts of the temporal bone under
examination.
