Skull - Facial / Nasal/ Zygomatic Arches / Optic foramina / Mandible / TMJs / Sinuses, Mastoids

1)The orbits form a *30* degree *superior* angle from the OML 2) The orbits form a *37* degree *medial* angle in reference to the MSP

1)The orbits form a ___ degree _____ angle in refrence to the OML 2)The orbits form a ___ degree _____ angle in reference to the MSP

- *OML* or *IOML* perp to film - CR angled *30°(for OML)* or *37° (for IOML)* - CR to pass through *EAMs*

AP Axial (Towne) for Mastoids - ___ or ____ perp to film - CR angled ____ or ____ - CR to pass through _____

Condyloid processes and TM fossa

AP Axial - Modified Towne Method - TMJs Demonstrates?

AP Axial - Modified Towne Method - TMJs 1) Angle CR *35° caudad* from OML or *42° caudad* from IOML 2)CR to the level of TMJs, *ONE* inch *anterior* to EAM (Power point) 2.5) CR *3* inches superior to *Nasion* (Book)

AP Axial - Modified Towne Method - TMJs 1) Angle CR ___° ___ from OML or ___° ___ from IOML 2)CR to the level of ___, ___ inch ____ to EAM (Power point) 2.5) CR ___ inches superior to ____ (Book)

1)CR *35°* (OML) to *42°*(IOML) degrees *caudad* (BOOK) 1.5)CR *40* degrees *caudad* (Powerpoint) 2) CR centered to *glabella*

AP Axial Towne - Mandible 1)CR __ (OML) to __(IOML) degrees ___ (BOOK) 1.5)CR ____ degrees ____ (Powerpoint) 2) CR centered to _____

*45 °* rotation of pt head *45 ° caudad* angle CR Enters *3 inches* above *superciliary arch*

AP Axiolateral oblique Mayer Method ___ ° rotation of pt head ___ ° ____ angle CR Enters ___ inches above _________

1) if OML is perp to IR *30* degree *caudad* angle 2) if IOML is perp to IR *37* degree *caudad* angle 3) CR *1 inch superior to glabella*

AP axial projection: zygomatic arches Modified towne method. 1) if OML is perp to IR ____ degree _____ angle 2) if IOML is perp to IR ____ degree ____ angle 3) CR ?

Upright

All films for sinuses MUST be done _______

- PT is *PA* - Postion *IOML* perp to film - Then rotate head *45°* placing side of interest *closest* to the film - CR *12° cephalic* angle *3 - 4* inches *posterior* and *1/2* inch *inferior* to upside *EAM* -Shows *downside petrous bone* in profile

Axioanterior oblique (Stenvers) - PT is AP/PA? - Postion ____ line perp to film - Then rotate head ___ ° placing side of interest _____ to the film - CR ___° _____ angle ____ - ____ inches _____ and ____ inch(s) _____ to upside _____ -Shows _____ in profile

- Pt head is *True lateral (IPL perp to IR, IOML perp to front edge)* - CR is *25 - 30° caudad* angle - CR enters *1.5* inches *superior* & posterior to *upside EAM* - CR exits at *downside mastoid tip*

Axiolateral (Schuller) for Mastoids - Pt head is _____ - CR is ____ - ____° _____ angle - CR enters _____ inches ______ & _____ to ______ - CR exits at _________

TMJ nearest IR

Axiolateral - Modified Law Method - TMJs Demonstrates Which TMJ?

Axiolateral - Modified Law Method - TMJs 1) Prevent tilt by maintaining *IPL* perp to IR 2) Align *IOML* perp to front edge of IR 3)From lateral position, rotate face *toward* IR *15°* 4) *15° caudad, cented 1.5 inches superior to upside EAM* (to pass through downside TMJ)

Axiolateral - Modified Law Method - TMJs 1) Prevent tilt by maintaining ____ line perp to IR 2) Align _____ perp to front edge of IR 3)From lateral position, rotate face ____ IR ___° 4) CR??

1)Head in true lateral best demonstrates *ramus* 2)30° rotation toward IR best demonstrates *body* 3) 45° rotation best demonstrates *mentum*

Axiolateral Mandible (from the book) 1)Head in true lateral best demonstrates ______ (with 25° celphalic angle) 2)30° rotation toward IR best demonstrates _____ 3) 45° rotation best demonstrates ______

1)Head in true lateral use 25 degree cephalic angle 2)10-15° rotation towards film best demonstrates *ramus* 3)30° rotation toward IR best demonstrates *body* 4) 45° rotation best demonstrates *mentum*

Axiolateral Mandible (from the powerpoints) 1)Head in true lateral use ____ degree ____ angle 2)10-15° rotation towards film best demonstrates _____ 3)30° rotation toward IR best demonstrates _____ 4) 45° rotation best demonstrates ______

TMJ nearest IR Note: This projection results in greater elongation of the condyle compared with the modified law method

Axiolateral Projection - Schuller Method - TMJs Demonstrates

Axiolateral Projection - Schuller Method - TMJs 1) *IPL* perp to IR 2)*IOML* line perp to front edge of IR 3) *MSP* parallel to IR 4) CR 25° to 35° caudad, centered 1/2 inch anterior and 2 inches superior to upside EAM

Axiolateral Projection - Schuller Method - TMJs 1) ____ line perp to IR 2) ____ line perp to front edge of IR 3) ____ plane parallel to IR 4) CR ___° to ___° ____, centered _________

- Pt is *AP* with head rotated *45 °* - CR 12° caudad angle, enters *1 inch anterior* & *3/4 inch superior* to upside *EAM* shows *upside* petrous portion

Axiolateral oblique (Arcelin) ((reverse Stenvers)) - Pt is ___ with head rotated __ ° - CR ___° _____ angle, enters ___ inch _____ & ____ inch ____ to upside ____ shows _____ petrous portion FYI: More exposure to eye and more magnified petrous region

1/2 inch inferior to nasion

CR for lateral Nasal bones

- One table top w/detail for soft tissue - Second one darker for nasal spine

Describe the two laterals for nasal bones

1) MSP parallel 2) IPL perp to film 3) IOML perp to front edge of cassette 4) CR *zygoma (prominence of the cheek)*, half way between *outer canthus* & *EAM*

Facial Bones Lateral 1)MSP _____ to film 2)____ line perp to film 3)____ line perp to front of cassette 4)CR ______ , half way between ______ and _____

If positioned correctly the optic foramen will be projected into the *lower outer* quadrant of the orbit

If positioned correctly the optic foramen will be projected into the ______ quadrant of the orbit

37°

If the MML is perp to the film the OML forms this angle with the film

If you start from a PA prone position, you must rotate the patients head *37* degrees *toward* the affected side for the Parieto-Orbital Oblique Projection: (Rhese Method)

If you start from a PA prone position, you must rotate the patients head ____ degrees _____ the affected side for the Parieto-Orbital Oblique Projection: (Rhese Method)

5-6kVp

If you use a 5" cone you should add ___-___kVp

Lateral Sinus - *IPL* perp to IR - *IOML* perp to front edge of IR - CR directed *midway between outer canthus and EAM* - Best demostrates *all four paranasal* sinuses

Lateral Sinus - ____ line perp to IR - ____ line perp to front edge of IR - CR directed ___________________ - Best demostrates __________ sinuses

1)OML forms a *55°* degree angle with film 2) MML is *15°* degrees off of perpendicular line 3) *LML* line is perpendicular to IR 4) Chin is tucked and *nose* will be touching unit 5) CR exits *acanthion*

Modified Parietoacanthial (modified waters) 1)OML forms a _____ degree angle with film 2) MML is ___ degrees off of perpendicular line 3) ____ line is perpendicular to IR 4) Chin is tucked and _____ will be touching unit 5) CR exits ______

LML - orbital floors (plates)

Modified waters view demonstrates _____ perpendicular to IR

Frontal

Most anterior and superior sinus is the ________

1) *IOML* is parallel to film 2) Rotate head *15* degrees *toward* side to be examined 3) Also tilt chin *15* degrees *toward* side to be examined

Oblique inferosuperior projection: zygomatic arches 1) ____ line is parallel to film 2) Rotate head ___ degrees ____ side to be examined 3) Also tilt chin ____ degrees _____ side to be examined

Orbital rim / floor Maxillae Nasal septum Zygomatic bones Anterior nasal spine

PA (caldwell) best illustrates old monkeys need zoo activities

1)Nose and forehead 2)Oribitomeatal line perp to IR 3) 15° caudad to exit nasion 4) Petrous ridges found in lower 1/3 of orbits

PA Axial (caldwell) 1) What rests against IR? 2)_____ line is perp to IR 3) CR Angle and exits where? 4) Petrous ridges found?

1) CR angled *20-25* degrees *cephalic* 2) CR exits *acanthion* 3)Demonstates *proximal* rami, lateral body & elongates *condyloid processes*

PA Axial Mandible 1) CR angled ___ - ___ degrees _____ 2) CR exits _______ 3)Demonstates ______ rami, _____ body & elongates _______

- *OML 15°* from horizontal or tilt IR *15°* - Tube angle is *0°* - CR is *horizontal* centered to exit the *nasion* (remember pt must be erect and CR must be horizontal with floor to properly demonstrate air fluid levels)

PA Caldwell for Sinuses - ____ line ____° from horizontal or tilt IR ___° - Tube angle _____ - CR is ______ centered to exit the _____

PA Caldwell for Sinuses best demostrates *frontal* and *ethmoid*8 sinuses with the petrous ridges in *lower 1/3* of orbits

PA Caldwell for Sinuses best demonstrates ______ and _____ sinuses with the petrous ridges in ________ of orbits

1) *OML* perp to film 2) demonstrates *mandibular rami* and *lateral* portion of body 3) CR exits at *lips* and determines lateral deviations of mandible

PA Mandible 1) _____ line perp to film 2) demonstrates ______ and ______ portion of body 3) CR exits at ____ and determines _____ deviations of mandible

PA Transoral Waters is the same as a regular waters exit you need to have the pt *open mouth*. It also demonstrates the *sphenoid* sinus in the open mouth

PA Transoral Waters is the same as a regular waters exit you need to have the pt _______. It also demonstrates the _______ sinus in the open mouth

Chin, cheek, nose (three point landing)

Parieto-Orbital Oblique Projection: (Rhese Method) What part of the patient is touching the imaging surface?

1) MSP *53* degrees to film 2) *AML* perp to film 3) CR *perpendicular* to IR at the midportion of the *downside* orbit

Parieto-Orbital Oblique Projection: (Rhese Method) 1) MSP ____ degrees to film 2) ____ line perp to film 3) CR ______ to IR at the midportion of the ______ orbit

1) Perpendicular to unit (IR) 2) acanthion 3) PR below maxillary sinuses 4) Mentomeatal line

Parietoacanthial (Waters) 1)MSP is _____ to mid line of unit (IR) 2) CR exits _______ 3) petrous ridges are found below _______ 4) _____ line is perp to film

Parietoacanthial (Waters) for sinuses - *PA* - *MML* perp. to film - CR *horizontal* centered to exit *acanthion* - Best demonstrates *maxillary* sinuses - Petrous ridges are below *maxillary* sinuses

Parietoacanthial (Waters) for sinuses - AP or PA? - ____ line perp. to film - CR _______ centered to exit ______ - Best demonstrates _____ sinuses - Petrous ridges are below ______ sinuses

Inferior orbital rim Maxillae Nasal septum Zygomatic bones / arches Anterior nasal spine

Parietoacanthial (waters) demonstrates (Impatient monkeys need zoo activities)

Entire mandible and coronoid and condyloid processes

SMV Projection: Mandible Demonstrates

1)*IOML* is parallel to IR 2) CR is perpendicular to *IOML* 3)CR centered *1.5* inches inferior to *mandibular symphysis* (midway between angles (gonions))

SMV Projection: Mandible 1)_____ is parallel to IR 2) CR is perpendicular to ______ 3)CR centered ____ inches inferior to ______

- *IOML* parallel to IR - CR is perp to *IOML* directed midway *between the angles of mandible (gonions)* or *1.5-2 inches inferior to mandibular symphysis* - Demonstrates all sinuses except *frontal*

SMV for Sinuses - ____ line parallel to IR - CR is perp to ____ line directed ______ or ______ - Demonstrates all sinuses except ______

1) *Infraorbitomeatal line* is parallel to film 2) CR *1.5 inches* *inferior* mandibular symphysis, midway between *zygomatic arches*

Submentovertex for zygomatic arches 1) ____ line is parallel to film 2) CR _____ inches _____ mandibular symphysis, midway between _____

1) IR is perpendicular to *glabelloalveolar(GAL)* line 2) CR to *nasion* and angle as need to ensure it is parallel to *glabelloalveolar(GAL)* line

Superoinferior Axial - Nasal bones 1) IR is perpendicular to ____ line 2) CR to _____ and angle as need to ensure it is parallel to _____ line

Frontal and ethmoid

The _____ & _____ sinuses develop at 6-7 years old.

Axioposterior oblique (arcelin)

The opposite projection of the Axioanterior oblique (Stenvers) is the _________

Routine 1) Parieto-orbital (Rhese) 2)Parietoacanthial (Waters) Special 1)Modified parietoacanthial (modified waters) *Note* above is what the book says.... Monicas powerpoints says PA (caldwell) is routine as well

There are 2 Routine projections and 1 special projection for the Optic Foramina, what are they?

Basic 1) Lateral 2)Parietoacanthial (waters) Special 1) PA axial (caldwell) 2) Superoinferior Tangential (axial)

There are 2 basic projections and 2 special projections for the nasal bone routine. What are they?

Basic 1) Lateral 2) Parietoacanthial (waters) 3) PA axial (caldwell) Special 1) Modified waters

There are 3 Basic and one special projection for a facial bones routine, what are they?

1) SMV - Submentovertex 2) Oblique tangential 3) AP axial - modified towne method

There are 3 Routine projections for Zygomatic Arches, what are they?

Basic 1) Axiolateral 2)PA (or PA axial) 3)AP axial (Towne) Special 1) Submentovertex 2) Panorex

There are 3 basic and 2 special projections for a mandible routine, what are they?

Route 1)Axiolateral oblique (Law) 2)Axioanterior oblique (Stenvers) 3)AP axial (Towne) Special 1) Axiolateral (schuller) 2) Axioposterior oblique (arcelin) 3) AP axial oblique (mayer) 4) SMV

There are 3 routine and 4 special projections for the Mastoids. What are they?

Routine 1) PA Caldwell 2) Parietoacanthia (waters) 3) Later Special 1) Submentovertex (SMV) 2) Parietoacanthial transoral (open mouth waters)

There are 3 routine projections and 2 special projections for the paranasal sinuses. What are they?

CR *1/2* inch anterior to upside *EAM* 1) level of the *outer canthus* collimate tightly 2) *5* mm above first film 3) *5* mm below first film 4) adjust *fulcrum* to appropriate levels

Tomography for TMJs CR ___ inch _____ to upside ____ 1) level of the ______ collimate tightly 2) __ mm above first film 3) __ mm below first film 4) adjust _____ to appropriate levels

True

True or false - PA Axial (caldwell) for nasal bones has the same positioning, just need to cone?

True

True or false - Parietoacanthial (waters) for nasal bones has the same positioning, just need to cone?

True

True or false: Axiolateral Projection - Schuller Method - TMJs requires a true lateral position

TRUE

True or false: Some departmental protocols indicate that TMJ projections should be taken in both closed mouth and open mouth positions for comparison purposes

True

True or false: The Oblique inferosuperior projection: zygomatic arches has similar positioning to SMV

False: They are rarely symetrical

True or false: The frontal sinuses are symmetrical

True

True or false: the maxillary sinuses are present at birth?

1)AP axial - modified towns (Routine) 2) Axiolateral oblique (modified Law method) (Special in book, routine in PowerPoint) 3)Axiolateral (Schuller method)(Special in book, routine in PowerPoint) 4)Tomography(Special in book, routine in PowerPoint)

What 4 projections can be taken for TMJs

37°

What angle does the OML form with the IR for the Parietoacanthial (waters).

AP Axial - Towne Submentovertex (SMV)

What are the two routine views for Temporal Bones

nasal spine deviation

What does the parietoacanthial (waters) projection show when shooting for nasal bones?

IOML

Which line is parallel to the floor when performing orthopantomography - Panoramic tomography (Panorex) - Mandible

Modified parietoacanthial - modified waters

Which projection is best for "blow-out fractures of the orbits and shows petrous ridges projected into lower half of maxillary sinuses below inferior orbital rim?

Lateral

Which projection of the facial bones illustrates superimposed facial bones, greater wings of sphenoid, orbital roofs, sella tursica, zygoma, and mandible?

Superoinferior Tangential(axial)

Which projection of the nasal bones may use occulusal film?

Lateral

_______ is the only view that shows ALL sinuses

Ethmoid

_______ sinuses develop last

teens

all sinuses are fully developed in the late _____

below inferior orbital margin

if 30° caudad is used on PA Axial (caldwell) where will petrous ridges be?

sphenoid

most posterior & inferior sinus is the _______