Chapter 11 A
The posterior aspect of the sella turcia is called the ______________.
dorsum sellae
Which of the auditory ossicles is considered the smallest?
Stapes
What is the total amount of bones in the cranium?
8
What is the average kV range for digital skull radiography?
80 to 90 kV
Which positioning line is placed perpendicular to the IR for the parietoacanthial projection?
Mentomeatal line (MML)
Which cranial bones form the upper lateral walls of he calvarium?
Right and left parietal bones
Which projection of the cranium produces an image of the frontal bone with little or no distortion?
0 degrees PA
How long is the average external accoustic meatus (EAM)?
1 inch
Where is the CR centered for an AP axial projection for the zygomatic arches?
1 inch superior to the glabella to pass through midarches (at level of gonion)
Which four cranial bones form the calvaria (skull cap)?
1- Frontal 2- Right Parietal 3- Left Parietal 4- Occipital
What are the four processes of the maxilla?
1- Frontal process 2- Zygomatic process 3- Alveolar process 4- Palatine process
Which two sensory functions occur within the inner ear?
1- Hearing 2- Equilibrium
What are two differences between the lateral projection of the cranium and the lateral projection for the facial bones?
1- IR is placed in portrait orientation for facial bones but landscape for the cranium 2- CR is centered to the zygoma for facial bones and 2 inches above EAM for the cranium
What are the four most commonly performed routine projections for the paranasal sinuses?
1- Lateral 2- PA Caldwell 3- Parietoacanthiomeatal (Waters method) 4- SMV
What are the three classification of the skull?
1- Mesocephalic- width between 75-80% of length 2- Brachycephalic- width ≥80% of length 3- Dolichocephalic- width <75% of length
What two things are important in order to demonstrated any possible air or fluid levels within the sinuses?
1- Perform all positions erect when possible 2- Use a horizontal x-ray beam
What are the three structures that form the nasal septum?
1- Perpendicular plate of ethmoid 2- Vomer 3- Septal cartilage
What are two reasons why projections of the facial bones are performed PA rather than AP when possible?
1- Reduces OID of facial bones 2- Reduces exposure to anterior facial bones and neck structures such as thyroid glands
Which four cranial bones form the floor of the cranium?
1- Right Temporal 2- Left Temporal 3- Sphenoid 4- Ethmoid
What are the five most common errors made during skull radiography? Which two are most common?
1- Rotation 2- Tilt 3- Excessive neck flexion 4- Excessive neck extension 5- Incorrect CR angulation **Rotation and tilt are the most common errors made during skull radiography
What are the three aspects of the temporal bones?
1- Squamous 2- Mastoid 3- Petrous
What is the total amount of facial bones?
14
To avoid angling the CR for the erect PA (axial) Caldwell sinus projection, the head should be adjusted to that the OML is _____________ degrees from horizontal.
15 degrees
Where is the CR centered for a lateral projection of the skull?
2 inches above the EAM
What central ray angle should be used for the PA axial (Haas method) projection of the cranium?
25 degrees cephalad
The axiolateral (Schuller method) projection for the TMJ requires a CR angle of ____________ degrees (caudad or cephalad).
25 to 30 degrees caudad
If the area of interest is the temporomandibular fossae, angle the CR _______________ to the OML for the AP axial (modified Towne) projection to reduce superimposition of the TM fossae and mastoid portions of the temporal bone.
40 degrees caudad
The frontal sinuses rarely become aerated before the age of __________.
6 years
What analog kV range should be used for sinus radiography?
70 to 85 kV
What digital kV range should be used for sinus radiography?
75 to 85 kV
What is the average kV range for analog skull radiography?
75 to 85 kV
Where does the CR exit for a PA axial (Haas method) projection of the skull? A- 1.5 inches superior to the nasion B- 3/4 inch anterior to the EAM C- 2.5 inches above glabella D- Level of nasion
A- 1.5 inches superior to the nasion
How much skull rotation (from lateral skull position) toward the IR is required with an axiolateral oblique projection for demonstrating each of the following? A- Body of the mandible: ____________________ B- Mentum region: _______________ C- Ramus region: ______________ D- General survey of the mandbile: ______________ E- What is the maximum CR angle needed for all of these projections?
A- 30 degrees B- 45 degrees C- 0 degrees, true lateral D- 10 to 15 degrees E- 25 degrees cephalad
(A) What CR angle is required for the AP axial projection of the mandible if the OML is placed perpendicular to the IR?(B) If the infraorbitomeatal (IOML) is perpendicular to IR, what CR angle is needed?
A- 35 degrees caudad B- 42 degrees caudad
There is a (A)______-degree difference between the orbitomeatal and infraorbitomeatal lines, and (B)_________ degrees between the orbitomeatal and glabellomeatal lines.
A- 7- to 8 degree B- 7 to 8 degrees
Which of the following clinical indications may require an increase in manual exposure factors?A- Advanced Paget's diseaseB- Metastatic neoplasmC- Multiple myelomaD- Basal skull fracture
A- Advanced Paget's disease
Which imaging modality is best to differentiate between an epidural and subdural hemorrhage? A- CT B- MRi C- Nuclear medicine D- PET
A- CT
Which of the following imaging modalities is the most common neuroimaging procedure performed for the cranium? A- CT B- Ultrasound C- MRI D- Nuclear medicine
A- CT
Which of the following radiographic appearances pertains to an acoustic neuroma? A- Expansion of the internal acoustic canal B- Bone destruction within the middle ear C- Increased density in the sinus D- Sinus mucosal thickening
A- Expansion of the internal acoustic canal
Match the following mandibular terms to the correct definition or description. Mandibular angle A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
A- Gonion
If the patient cannot flex the head adequately for the AP axial (Towne method) projection, the tecnologist could place the (A)__________ perpendicular to the IR and angle the central ray (B)________ degrees caudad.
A- IOML B- 37
Match each of the following sinus projections with the anatomy best seen. All four paranasal sinuses demonstrated A- Lateral B- Parietoacanthial C- PA axial (Caldwell) D- PA transoral E- SMV for sinuses
A- Lateral
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). Profile image of nasal bones and nasal septum A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
A- Lateral (nasal bones)
Bilateral horizontal fractures of the maxillae describe a ___________ fracture. A- Le Fort B- Blowout C- Tripod D- Contrecoup
A- Le Fort
(A) Which group of paranasal sinuses is best demonstrated with a parietoacanthial (Waters) projection? (B) The OML forms a _________-degree angle with the IR with this projection.
A- Maxillary B- 37 degree
Which of the following bones is not a facial bone? A- Middle nasal conchae B- Vomer C- Lacrimal bone D- Mandible
A- Middle nasal conchae
The axiolateral oblique projection of the TMJ is commonly referred to as the (A)_____________ method, which requires a (B)___________-degree head rotation from lateral and a (C)___________-degree caudad CR angle.
A- Modified Law B- 15- degree C- 15-degree
Match each of the following clinical indications for the temporal bone to the correct definition or description. New and abnormal growth A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
A- Neoplasia
When using a 30-degree caudad angle for the AP axial (Towne method) projection of the skull, which positioning line should be perpendicular to the IR? A- OML B- IOML C- GAL D- AML
A- OML
Match each of the following clinical indications to the correct definition or statement. Proliferative bony lesion of increased density A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
A- Osteoblasic neoplasm
What is the proper method name (A) and the common descriptive name (B) for the parieto-orbital oblique projections for the optic foramen?
A- Rhese method B- Three-point landing
Which of the facial bone openings is formed by a cleft between the greater and lesser wings of the sphenoid bone? A- Superior orbital fissure B- Optic foramen C- Maxillary nerve D- Trigeminal nerve
A- Superior orbital fissure
Match the following cranial landmarks and positioning lines with the correct definition. Corresponds to the level of the petrous ridge A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
A- TEA
The three aspects of the face that should be in contact with the head unit or tabletop when beginning positioning for the parieto-orbital oblique projection are the (A)_____________,_______________, and _______________. The final angle between the midsagittal plane and the IR should be (B)_______________, with the (C)_____________ line perpendicular to the IR. This places the optic foramen in the (D)__________ quadrant of the orbit.
A- cheek, nose, chin B- 53 degrees C- acanthiomeatal D- lower outer
The modified parietoacanthial (modified Waters) projection requires that the (A)_______________ line is perpendicular to the IR, which places the OML at a (B)____________-degree angle to the tabletop and IR.
A- lips-meatal B- 55- degree
For a parietoachantial (PA Waters) projection, the petrous ridges should be projected directly below the (A)_______________ and projected into the lower half of the maxillary sinuses or below the (B)___________ for a modified Waters projection
A- maxillary sinuses B- inferior orbital rims
The parietoacanthial (Waters) projection for the facial bones has the (A)____________ line perpendicular to the IR, which places the OML at a (B)_____________-degree angle to the table top and IR.
A- mentomeatal B- 37-degree
Central ray angles and degree of rotation stated for basic skull positions are based on the (A)__________________ (average) skull, which has an approximate angle of (B)________________ between the midsagittal plane and the long axis of the petrous bone
A- mesocephalic B- 47 degrees
A deviated nasal septum is most likely to occur at the junction between (A)_______________ and (B)__________________.
A- septal cartilage B- vomer
Small, irregular bones that sometimes develop in adult skull sutures are called (A) ___________________ bones and are most frequently found in the (B)_______________ suture.
A- sutural or wormian B- lambdoidal
From anterior to posterior, the cone-shaped orbits project upward at an angle of (A)________ degress and toward the midsagittal plane at an angle of (B)________ degrees.
A-30 degrees B- 37 degrees
Where does the CR exit for a parietoacanthial (Waters) projection of facial bones?
Acanthion
Which soft tissue landmark is found at the base of the anterior nasal spine?
Acanthion
Where should the CR exit for a PA axial projection of the mandible?
Acanthion (at lips for PA projection)
Which structure serves as an opening between the mastoid portion of the temporal bone and the middle ear?
Aditus
Situation: As part of a study of the zygomatic arches, the technologies attempts to perform the SMV position. Because of the size of the patient's shoulders, he is unable to flex his neck adequately to place the IOML parallel to the IR. What other options does the technologist have to produce an acceptable SMV projection?
Angle CR to place it perpendicular to the IOML. Angle the IR to maintain a perpendicular relationship between the CR and the IR. This will prevent distortion of the anatomy.
What is the older term for the maxillary sinuses?
Antrum of Highmore
What is the collective term for the small bones of the middle ear?
Auditory ossicles
Which structure makes up the cartilaginous external ear?
Auricle or pinna
Which projection of the mandible projects the opposite half of the mandible away from the side of interest?
Axiolateral oblique
What CR angle must be used to project the petrous bridges just below the orbital floor with the PA axial (Caldwell method) projection? A- None. CR is perpendicular. B- 30 degrees C- 20 degrees D- 45 degrees
B- 30 degrees
Which of the following imaging modalities best demonstrates otosclerosis? A- Nuclear medicine B- CT C- Conventional radiography D- Sonography
B- CT
Which skull positioning line is placed parallel to the plane of the IR for the SMV projection? A- OML B- IOML C- AML D- GML
B- IOML
Which of the following bones does not articulate with the zygomatic bone? A- Temporal B- Mandible C- Frontal D- Sphenoid
B- Mandible
Match the following mandibular terms to the correct definition or description. U-shaped notch A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
B- Mandibular notch
What is another term for the second cranial nerve? A- Olfactory nerve B- Optic nerve C- Maxillary nerve D- Trigeminal nerve
B- Optic nerve
The drainage pathway for the paranasal sinuses is called the: A- Uncinate process B- Ostiomeatal complex C- Paranasal meatus D- Lateral masses
B- Ostiomeatal complex
Match each of the following clinical indications for the temporal bone to the correct definition or description. Hereditary disease involving excessive bone formation of the middle ear A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
B- Ostosclerosis
Match each of the following sinus projections with the anatomy best seen. Best view o maxillary sinuses A- Lateral B- Parietoacanthial C- PA axial (Caldwell) D- PA transoral E- SMV for sinuses
B- Parietoacanthial
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). Inferior orbital rim, maxillae, nasal septum, nasal spine, zygomatic bone, and arches A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
B- Parietoacanthial projection
Match each of the following clinical indications to the correct definition or statement. A tumor that may produce erosion of the sella turcia A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
B- Pituitary adenoma
Which position is most often used when performing a CT study of the sinuses? A- Supine B- Prone C- Erect D- Supine with 20- degree oblique of skull from AP position
B- Prone
Which specific positioning error is present if the mandibular rami are not superimposed on a lateral skull radiograph? A- Tilt B- Rotation C- Overflexion of head and neck D- Incorrect CR angle
B- Rotation
Which projection/method of the TMJ requires that the skull be kept in a true lateral position? A- Modified Law B- Schuller C- Axiolateral oblique projection D- Modified Towne
B- Schuller
Match the following cranial landmarks and positioning lines with the correct definition. Corresponds to the highest level of the facial bone mass A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
B- Supraorbital groove
Which of the following imaging modalities is commonly performed on neonates with a possible intracranial hemorrhage? A- CT B- Ultrasound C- MRI D- Nuclear medicine
B- Ultrasound
Specifically, where are the frontal sinuses located?
Between the inner and outer tables of the skull, posterior to the glabella
What is the name of the fracture that results from a direct blow to the orbit leading to a disruption of the inferior orbital margin?
Blow-out fracture
Which of the following projections best demonstrates the foramen rotundum? A- SMV B- 25 to 30-degree AP axial C- 25 to 30-degree PA axial D- Lateral
C- 25 to 30-degree PA axial
Match each of the following clinical indications to the correct definition or statement. Fracture that may produce an air-fluid level in the sphenoid sinus A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
C- Basal skull fracture
Match the following mandibular terms to the correct definition or description. Horizontal portion of mandible A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis ment
C- Body
A properly positioned AP axial (Towne method) projection should place the dorsum sellae into the middle aspect of the: A- Orbitus B- Clivus C- Foramen magnum D- Anterior arch of C1
C- Foramen magnum
Match the following cranial landmarks and positioning lines with the correct definition. A line used in positioning to ensure that the skull is in a true lateral position A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
C- Interpupillary line
Which of the following projections best demonstrates the clivus in profile? A- AP axial B- 15-degree PA C- Lateral D- SMV
C- Lateral
Match each of the following clinical indications for the temporal bone to the correct definition or description. Bacterial infection of the mastoid process A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
C- Mastoiditis
Match each of the following sinus projections with the anatomy best seen. Best view of frontal and ethmoid sinuses A- Lateral B- Parietoacanthial C- PA axial (Caldwell) D- PA transoral E- SMV for sinuses
C- PA axial (Caldwell)
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). Optic foramen A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
C- Parieto-orbital oblique projection
Where is the CR centered for a lateral position for the facial bones? A- Outer canthus B- Acanthion C- Zygoma D- Nasion
C- Zygoma
An AP axial (Towne method) radiograph for the cranium demonstrates the dorsum sellae projected above, or superior to, the foramen magnum. The foramen magnum is distorted. Which positioning error(s) occured?
CR angled <37 degrees to the IOML or <30 degrees to the OML (would be caused by 30-degree angle to IOML). This error can be addressed with more flexion of the neck as well.
Situation: A patient comes to the radiology department with a possible tumor of the pituitary gland. Which radiographic projection of the cranium best demonstrates any bony involvement of the sella turcia?
Collimated, lateral projection of the sella turcia
Which aspect of the mandible is best visualized with an AP axial projection?
Condyloid process
What type of IR must be used with analogy orthopantomography?
Curved, nongrid cassette
Match each of the following clinical indications for the temporal bone to the correct definition or description. Benign tumor of the auditory nerve sheath A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
D- Acoustic neuroma
Match the following mandibular terms to the correct definition or description. Posterior process of the upper ramus A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
D- Condyloid process
Which of the following projections best demonstrates the sella turcia in profile? A- AP axial B- SMV C- 15-degree PA axial D- Lateral
D- Lateral
Match the following cranial landmarks and positioning lines with the correct definition. Located at the junction of the two nasal bones and the frontal bone A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
D- Nasion
Which of the following imaging modalities is most commonly performed to evaluate patients for Alzheimer disease? A- CT B- Ultrasound C- MRI D- Nuclear medicine
D- Nuclear medicine
Match each of the following sinus projections with the anatomy best seen. Sphenoid sinus in oral cavity A- Lateral B- Parietoacanthial C- PA axial (Caldwell) D- PA transoral E- SMV for sinuses
D- PA transoral
Match each of the following clinical indications to the correct definition or statement. Also known as osteitis deformans A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
D- Paget's disease
A lack of symmetry of the petrous ridges indicates which of the following problems with a radiograph o an AP axial projection? A- Tilt B- CR angle C- Flexion or extension D- Rotation
D- Rotation
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). Bilateral zygomatic arches A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
D- Submentovertical (SMV) projections
What is the major disadvantage of performing a straight PA projection for facial bones, with no CR angulation or neck extension, as compared with other PA facial bone projections?
Dense petrous pyramids superimpose the orbits, obscuring facial bone structures
What evidence on the Ap axial (Towne method) radiograph indicated whether the correct CR angle and correct head flexion were used?
Dorsum sellae and posterior clinoids should be projected into the forame magnum
Match the following mandibular terms to the correct definition or description. Bony process located anterior to mandibular notch A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
E- Coronoid process
Match the following cranial landmarks and positioning lines with the correct definition. Posterior angle of the jaw A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
E- Gonion
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). Floor of orbits (blowout fractures) A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
E- Modified Waters method
Match each of the following clinical indications to the correct definition or statement. Destructive lesion with irregular margins A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
E- Osteolytic neoplasm
Match each of the following clinical indications for the temporal bone to the correct definition or description. Growth arising from a mucous membrane A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
E- Polyp
Match each of the following sinus projections with the anatomy best seen. Inferosuperior view of sphenoid and ethmoid sinus A- Lateral B- Parietoacanthial C- PA axial (Caldwell) D- PA transoral E- SMV for sinuses
E- SMV for sinuses
Situation: A patient with a clincal history of acoustic neuroma comes to the radiology department. Which imaging modality or modalities can be performed for this type of pathology?
Either MRI or CT can be performed
What is the name of the notch that separates the orbital plates from each other?
Ethmoid notch
Which structure allows for communication between the nasopharynx and middle ear?
Eustachian (or auditory tube)
A radiograph o a 15-degree PA axial (Caldwell) projection of the cranium demonstrates that the petrous ridges are projected at the inferior orbital margin. Which position error(s) led to this radiographic outcome?
Excessive extension or excessive caudal CR angle--- projects the petrous ridges lower than expected (should be in the lower 1/3 of the orbit)
Situation: A radiograph of a superoinferior projection of the nasal bones shows that the glabella are superimposed over the nasal bones. What positioning error led to this radiographic outcome, and how can it be corrected during the repeat exposure?
Excessive flexion of the head and neck or incorrect CR angulation will project the glabella into the nasal bones. The CR must be parallel to the glabelloalveolar line (GAL)
Which specific positioning error is present if the petrous ridges are projected higher in the orbits than expected for a 15-degree PA axial projection?
Excessive flexion or insufficient CR angle
What must be done to prevent the ramus of the mandible from being superimposed over the cervical spine with an axiolateral oblique projection of the mandbile?
Extend the chin
Match each of the following clinical indications for the temporal bone to the correct definition or description. Benign, cystic mass or tumor of the middle ear A- Neoplasia B- Otosclerosis C- Mastoiditis D- Acoustic neuroma E- Polyp F- Cholesteatoma
F- Cholesteatoma
Match each of the following clinical indications to the correct definition or statement. Also called a "ping-pong" fracture A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
F- Depressed skull fracture
Match each of the following structures to the facial bone projection that best demonstrates the structure(s). View of single zygomatic arch A- Lateral (nasal bones) B- Parietoacanthial projection C- Parieto-orbital oblique projection D- Submentovertical (SMV) projections E- Modified Waters method F- Oblique inferosuperior projection
F- Oblique inferosuperior projection
Match the following mandibular terms to the correct definition or description. Vertical portion of mandible A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
F- Ramus
Match the following cranial landmarks and positioning lines with the correct definition. The small cartilaginous flap covering the ear opening A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
F- Tragus
T/F: An increase in kV of 25% to 30% (using manual techniques) is often required for the geriatric patient with advanced osteoporosis.
False
T/F: Secondary osteomyelitis is often caused by tumor invasion.
False
T/F: The semicircular canals include a closed system specific to the sense of hearing.
False
T/F: Facial bone studies should always be performed recumbent whenever possible.
False **Facial bone studies should always be performed erect whenever possible.
T/F: Nuclear medicine is not helpful in diagnosing occult facial bone fractures.
False **Nuclear medicine is helpful in diagnosing occult facial bone fractures.
T/F: The CR should be angled 20 to 25 degrees caudad for the PA axial projection of the mandible.
False **The CR should be angled 20 to 25 degrees cephalad for the PA axial projection of the mandible.
T/F: The older terms for the orbitomeatal line (OML) are Reid's base line and the anthropologic base line.
False **The older terms for the infraorbitomeatal line (IOML) are Reid's base line and the anthropologic base line..
T/F: The mastoid portion of the temporal bone is the densest of the three aspects of the temporal bone.
False **The petrous portion of the temporal bone is the densest of the three aspects of the temporal bone.
T/F: The oblique inferosuperior (tangential) projection for a unilateral zygomatic arch requires that the skull be rotated and tilted 15 degrees away from the affected side.
False ** The oblique inferosuperior (tangential) projection for a unilateral zygomatic arch requires that the skull be rotated and tilted 15 degrees toward the affected side.
T/F: The right and left nasal bones form the largest part of the nose.
False**Most of the nose is composed of cartilage
T/F: MRI is an excellent imaging modality for the detection of small metal foreign bodies in the eye.
False**Strong magnets in MRI prohibits this.
Which paranasal sinuses are best demonstrated with a PA (Caldwell) projection?
Frontal and anterior ethmoid
Which two cranial bones articulate with the maxilla?
Frontal and ethmoid
Which of the processes of the maxilla is considered most superior?
Frontal process
Match the following mandibular terms to the correct definition or description. Chin A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
G- Mentum
Match each of the following clinical indications to the correct definition or statement. A bone tumor that originates in the bone marrow A- Osteoblasic neoplasm B- Pituitary adenoma C- Basal skull fracture D- Paget's disease E- Osteolytic neoplasm F- Depressed skull fracture G- Multiple myeloma
G- Multiple myeloma
Match the following cranial landmarks and positioning lines with the correct definition. Lateral junction of the eyelid A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
G- Outer canthus
Where is the CR centered for an AP axial projection of the mandible?
Glabella
For the superoinferior projection of the nasal bones, the IR is placed perpendicular to the ___________________ line.
Glabelloalveolar (GAL)
Match the following cranial landmarks and positioning lines with the correct definition. A line between the glabella and alveolar process of the maxilla A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
H- Glabelloalveolar line
Match the following mandibular terms to the correct definition or description. Point of union between both halves of the mandible A- Gonion B- Mandibular notch C- Body D- Condyloid process E- Coronoid process F- Ramus G- Mentum H- Symphysis menti
H- Symphysis menti
Situation: A patient with a possible basal skull fracture enters the ER. No CT scanner is available. Which specific position may provide radiographic evidence of this fracture?
Horizontal beam (dorsal decubitus) lateral position----- will demonstrate a possible air-fluid level in the sphenoid sinus
Which facial bones form the posterior aspect of the hard palate?
Horizontal portion of the palatine bones
Which structures of the sphenoid bone help form part of the lateral walls of the nasal cavities?
Medial and lateral pterygoid processes
Match the following cranial landmarks and positioning lines with the correct definition. A line between the midlateral orbital margin and the EAM A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
I- OML
Where will the petrous ridges be projected with a 15-degree PA axial (Caldwell) projection of the cranium?
In the lower 1/3 of the orbits
Situation: A radiograph of a PA transoral projection shows that the sphenoid sinus is superimposed over the upper teeth and the nasal cavity. How must the position be modified to avoid this problem during the repeat exposure?
Increase extension of the head and neck to project the entire sphenoid sinus through the oral cavity.
Which of the auditory ossicles resembles a premolar tooth?
Incus
Which facial bone opening has the maxillary branch of the fifth cranial nerve passing through it?
Inferior orbital fissure
Which cranial line is placed parallel to the floor for orthopantomography of the mandible?
Infraorbitomeatal line (IOML)
What is the name of the passageway between the maxillary sinuses and the middle nasal meatus?
Infundibulum
What specific positioning error has been committed if both sides of the mandible are superimposed with an axiolateral oblique projection?
Insufficient cephalic CR angle or skull tilt
A radiograph of an SMV projection of the skull shows that the mandibular condyles are within the petrous bone. Which specific positioning error led to this problem?
Insufficient extension of the skull or CR was not perpendicular to the IOML
Situation: A radiograph of an axiolateral oblique projection of the mandible shows that the body of the mandible is severely foreshortened. The body of the mandible is the area of interest. What positioning error led to this radiographic outcome?
Insufficient rotation of the skull toward the IR. The skull should be rotated 30 degrees (from lateral position) toward the IR to prevent foreshortening of the body.
Which opening in the temporal bone serves as a passageway for nerves of hearing and equilibrium?
Internal accoustic meatus
Match the following cranial landmarks and positioning lines with the correct definition. A line between the infraorbital margin and the EAM A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
J- Infraorbitomeatal line (IOML)
Where are the petrous ridges located on a well-positioned parietoacanthial projection?
Just below the maxillary sinuses
Match the following cranial landmarks and positioning lines with the correct definition. A line between the mental point and the EAM A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
K- Mentomeatal line
Match the following cranial landmarks and positioning lines with the correct definition. A positioning line that is primarily used for the modified Waters projection A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
L- Lips-meatal line
Which facial bone is associated with the tear ducts?
Lacrimal bones
Which single projection for a paranasal sinus routine provides an image of all four sinus groups?
Lateral
Which specific aspect of the ethmoid bone contains the ethmoid sinuses?
Lateral masses or labyrinths
Which projection best demonstrates the sella turcia and dorsum sellae?
Lateral projection
Where should the CR exit for both the PA parietoacanthial (Waters) and the PA transoral (open-mouth Waters) projections?
Level of the acanthion
Match the following cranial landmarks and positioning lines with the correct definition. A smooth, slightly depressed area between the eyebrows A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
M- Glabella
Which of the auditory ossicles picks up sound vibrations from the tympanic membrane?
Malleus
What is the largest immovable bone of the face?
Maxilla
Situation: A patient with a possible blowout fracture of the right orbit enters the ER. In addition t the basic facial bone routine, what single projection would best demonstrate this type of injury?
Modified parietoacanthial (modified Waters method)
Match the following cranial landmarks and positioning lines with the correct definition. Corresponds to the highest "nuchal" line of the occipital bone A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
N- Inion
What device provides inherent collimation during an orthopantomographic procedure?
Narrow, vertical slit diaphragm
Where does the CR exit for a 15-degree PA axial (Caldwell) projection for the facial bones?
Nasion
A radiograph of an AP axial (Towne method) projection for the cranium shows that the mid- to lower mandible is cut off and not demonstrated. What should the technologist do?
No repeat exposure is required. Because of the elongation of the facial mass with the AP axial projection of the skull, cutting off aspects of the mandible is acceptable.
Situation: A radiograph of a parieto-orbital oblique (Rhese) projection shows that the optic foramen is located in the upper outer quadrant of the orbit. Is this an acceptable image for this projection? If not, what must be done to correct this problem during the repeat exposure?
No. Increase extension of the head and neck. The AML should be placed perpendicular to the IR to ensure that the optic foramen is open and is projected into the lower outer quadrant of the orbit.
Situation: A radiograph of a parietoacanthial (Waters) projection shows that the petrous ridges are projected within the maxillary sinuses. Is this an acceptable image? If not, what must be done to improve the image during the repeat exposure?
No. The petrous ridges should be projected just below the maxillary sinuses. The patients head needs to be extended mre.
Situation: A radiograph of a parietoacanthial projection (Waters method) shows that the petrous ridges are projected just below the maxillary sinuses. What positioning error (if any) is present?
None. The petrous ridges should be below the floors of the maxillary sinuses on a well-positioned parietoacanthial projection
Match the following cranial landmarks and positioning lines with the correct definition. The center point of the EAM A- TEA B- Supraorbital groove C- Interpupillary line D- Nasion E- Gonion F- Tragus G- Outer canthus H- Glabelloalveolar line I- OML J- Infraorbitomeatal line (IOML) K- Mentomeatal line L- Lips-meatal line M- Glabella N- Inion O- Auricular point
O- Auricular point
Which cranial bone contains the foramen magnum?
Occipital
What is the name of the oval processes found on the occipital bone that helps form the atlanto-occipital joint?
Occipital condyles
Which cranial bone is best demonstrated with an AP axial (Towne method) projection of the skull?
Occiptal
Which structure of the spehnoid bone allows for the passage of the optic nerve and is the actual opening into the orbit?
Optic foramen
Which aspect of the frontal bone forms the superior aspect of the orbit?
Orbital and horizontal portion
Which structures specifically are better visualized on the modified parietoacanthial (Waters) projection as compared with the basic Waters projection?
Orbital rims and orbital floors
Which cranial positioning line is placed perpendicular to the IR for a PA or PA axial projection of the mandible?
Orbitomeatal line (OML)
What facial bone structures are best seen with a parietoacanthial projection?
Orbits including infraorbital rims, bony nasal septum, maxillae, zygomatic bones & arches
Which imaging system provides a single, frontal perspective of the entire mandible?
Orthopantomography
What is the name of the small membrane that connects the middle to the inner ear?
Oval or vestibular window
A radiograph of an AP axial (Towne method) projection for the cranium shows that the posterior arch of C1 is projected within the foramen magnum. The dorsum sellae is superimposed on the posterior arch as well. What is (are) the positioning error(s)?
Overangulation of the CR or excessive flexion of neck
Situation: A patient comes to the radiology department with a clinical history of a deviated bony nasal septum. Which facial bone projections best demonstrates the degree of deviation? (More than one correct answer possible.)
PA, PA axial, and parietoacanthial projections will demonstrate a possible nasal septal deviation
Situation: A patient with a possible fracture of the nasal bones enters the ER. The physician is concerned about deviation of the bony nasal septum along with possible fracture of the nasal bones. What radiographic routine would be best for this situation?
Parietoacanthial and R and L lateral projections. The parietoacanthial (Waters method) or the option PA axial projections would demonstrate any possible septal deviation. The lateral projections would demonstrate any possible fracture of the nasal bones or anterior nasal spine. (The superoinferior tangential projection would provide an axial perspective but is considered an optional projection in most departments unless specifically requested.)
Situation: A patient with a possible fracture of the left zygomatic arch enters the ER. Neither the AP axial nor the SMV projection demonstrates the left side well. The radiologist is indecisive as to whether this zygomatic arch is fractured. What other projections can the technologist provide to better define this area?
Perform the oblique inferosuperior (tangential) projections. These projections are ideal to demonstrate a depressed fracture of the zygomatic arch. (Bilateral projections are generally taken for comparison.)
Which aspect of the temporal bone is considered to be the densest?
Petrous portion
Situation: A patient with a possible linear fracture of the right parietal bone enters the ER. Which single radiographic projection of the skull best demonstrates this fracture?
Right lateral projection of the skull
Excessive extension or excessive caudal CR angle--- projects the petrous ridges lower than expected (should be in the lower 1/3 of the orbit)
Rotation of the patient's face (skull) to the left
Situation: A radiograph of a lateral projection of the facial bones shows that the mandibular rami are not superimposed. What positioning error led to this radiographic outcome?
Rotation of the skull
Situation: A radiograph of a parietoacanthial (Waters) projection shows that the distance between the lateral margins of the orbits and the lateral aspect of the cranial cortex is not equal. What type of positioning error led to this radiographic outcome?
Rotation of the skull
Situation: A radiograph of a parietoacanthial projection shows that the distance between the midsagittal plane and the outer orbital margin is not equal. What positioning error is present on this radiograph?
Rotation of the skull
A radiograph of an AP axial (Towne method) projection of the cranium shows that the right petrous ridge is wider than the left side. Which specific positioning error is present on this radiograph?
Rotation of the skull present; rotation of patient's face toward left
What is the name of the small membrane found at the base of the cochlea (two terms possible)?
Round or cochlear window
For a patient with possible trauma, what must be determined before performing the submentovertical (SMV) projection of the skull?
Rule out any possible cervical fractures or subluxation
Which projection of the mandible demonstrates the entire mandible, including the coronoid and condyloid processes?
SMV projection
Situation: A patient comes to the radiology department for a skull series, but the patient cannot assume the correct position for either version of the AP axial (Towne method) projection because of a very short neck and severe spinal kyphosis. What can the technologist do to demonstrate the occipital bone?
Should perform the PA axial projection (Haas method)
A lateral skull radiograph demonstrates one mandibular ramus about 0.5 cm more anterior than the other. Which positioning error occured?
Skull rotation
A radiograph of a lateral projection of the skull shows that the orbital plates are not superimposed (one orbital plate is slightly superior to the other). Which specific positioning error led to this radiographic outcome?
Skull tilt
Which sinus is projected through the open mouth with a PA axial transoral projection?
Sphenoid sinus
Which sinuses are projected through the oral cavity with the PA axial transoral projection?
Sphenoid sinuses
Which paranasal sinuses are demonstrated with an SMV projection of the paranasal sinuses?
Sphenoid, ethmoid, and maxillary sinuses
Which term describes the superior rim of the orbit? (Include abbreviation also.)
Supraorbital Margin (SOM)
What is the name of the thin plate of bone that separates the mastoid air cells from the brain?
Tegmen tympani
Which small membrane marks the beginning of the middle ear?
Tempanic membrane (ear drum)
Situation: A patient comes to the radiology department to rule out a possible polyp within the sphenoid sinus. What routine and/or special projection provide the best overall assessment of the sinuses for this patient?
The PA transoral special projection in addition to the routine four sinuses projection series (lateral, PA Caldwell, parietoacanthial , and SMV)
Situation: A radiograph of a PA (Caldwell) projection for sinuses shows that the petrous ridges are projected into the lower half of the orbits and are obscuring the ethmoid sinuses. The technologis used a horizontal x-ray beam for the projection. The skull was positioned to place the OML at a 15-degree angle from the horizontal plane. What positioning modification is needed to correct this problem during the repeat exposure?
The head and neck need to be extended more to project the petrous ridges below the ethmoid sinuses
Situation: A lateral radiograph of the facial bones demonstrates that the bodies of the mandible are not superimposed; one is about 1 cm superior to the other. How would this be corrected during the repeat exposure?
The head was tilted. Ensure that the midsagittal plane is parallel to the IR.
Situation: A patient with a clinical history of sinusitis comes to the radiology department for a sinus study. The patient is quadriplegic a cannot be placed erect. Which single projection demonstrates any possible air-fluid levels in the sinuses?
The most diagnostic projection is the horizontal beam lateral projection to demonstrate any air-fluid levels
What is the one major difference in positioning between the parietoacanthial and the PA axial transoral projections?
The mouth (oral cavity) is open with the PA transoral projection
Situation: A radiograph of an SMV projection for the sinuses shoes that the distance between the mandibular condyles and lateral border of the skull is not equal. What positioning error is present on this radiograph?
Tilt of the skull
What positioning error has been committed if the EAMs are not superimposed with one of them more superior than the other on a lateral projection of the cranium?
Tilt of the skull
What is the major function of the eustachian tube?
To equalize the atmospheric pressure within the middle ear
Which external landmark corresponds with the level of the petrous ridge?
Top of ear attachment (TEA)
T/F: Both oblique inferosuperior (tangential) projections for the zygomatic arch are generally taken for comparison.
True
T/F: CT is ideal for facial bone studies because it allows for the visualization of bony structures as well as related soft tissues of the facial bones.
True
T/F: For a true PA projection of the mandibular body (if this is the area of interest), the AML should be perpendicular to the IR.
True
T/F: Lateral projections for the nasal bones generally are taken bilaterally for comparison.
True
T/F: MRI is the preferred imaging modality to study soft tissue changes and masses within the sinuses.
True
T/F: Most CT studies of the sinuses do not require use of contrast media.
True
T/F: The PA axial projection of the mandible produces an elongated view of the condyloid processes.
True
T/F: The common basic PA axial projection for the facial bones requires a 15-degree caudad angle of the CR, which projects the dense petrous ridges into the lower 1/3 of the orbits.
True
T/F: The mandibular condyles move anteriorly as the mouth is opened.
True
T/F: The modified Law method provides a bilateral and functional study of the TMJ.
True
T/F: Ultrasound exams of the maxillary sinuses to rule out sinusitis are possible.
True
Situation: A neonate has a clinical history of craniosynostosis. Because of the ages of the patient, the physician does not order a radiographic procedure of the cranium. What other imaging modality can be performed to evaluate the patient for this condition?
Ultrasound
What is the proper method name for the parietoacanthial projection of the facial bones?
Waters method
Situation: A radiograph of a 30-degree PA axial projection of the facial bones shows that the petrous ridges are projected at the level of the inferior orbital margins. Is this an acceptable image for this projection? If not, what must be done to improve the quality of the image during the repeat exposure?
Yes, this image is acceptable
Which specific facial bone structures (other than mandible) are best demonstrated with the submentovertical (SMV) projection if the correct exposure factors are used (soft tissue technique)?
Zygomatic arches
Which facial bones are sometimes called the "cheek bones"?
Zygomatic or malar bones
The purpose of the __________________, or ____________________, is to divide the nasal cavity into compartments and to circulate air coming into the nasal cavities.
conchae or turbinates
The small horizontal plate of the ethmoid is called the _________.
cribriform plate
A small prominence located on the squamous portion of the occipital bone is called the __________________.
external occipital protuberance (or inion)
Cranial sutures are classified as being ___________________ joints.
fibrous (synarthroidal)
If a patient cannot stand for the lateral projection of the paranasal sinuses, the projection should be take with ____________________.
horizontal x-ray beam
An infection of the teeth may travel upward and involve the ___________ sinus.
maxillary
Aligning the __________________ plane perpendicular to the IR prevents rotation of either a PA or an AP axial mandible.
midsagittal
The vertical plate of the ethmoid bone forming the upper portion of the bony nasal septum is the ___________.
perpendicular plate
A structure found in the middle of the sphenoid bone that surrounds the pituitary gland is the _________________.
sella turcia
A "free-floating" zygomatic bone is the frequent result of a ___________ fracture.
tripod
The long, narrow-shaped skull has an angle of approximately ____________ degrees between the midsagittal plane and the long axis of the petrous bone
±40
