radt 1542 skull radiography l.
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RADT 1542 SKULL RADIOGRAPHY. Wynn Harrison, Med, RT(R)(N). What a Bad Day!!!!. Section 1: The Cranium. New Words: HEMANGIOMA: tumor containing blood vessels and fibrous tissue TRAUMATIC PNEUMOCEPHALUS: injury causing gas/air in the extracranial cavity.

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radt 1542 skull radiography


Wynn Harrison, Med, RT(R)(N)

section 1 the cranium
Section 1: The Cranium
  • New Words:
  • HEMANGIOMA: tumor containing blood vessels and fibrous tissue
  • TRAUMATIC PNEUMOCEPHALUS: injury causing gas/air in the extracranial cavity
HYDROCEPHALUS: increased cerebrospinal fluid in the ventricles
  • PAGET’S DISEASE: overproduction of bone
  • CRANIOTOMY: Incision into the head
SUBDURAL HEMATOMA: Blood collected beneath the dura
  • TERATOMA: Congenital tumor containing 1+ embryonic germ layers (hair/teeth/skin may be present)
ENCEPHALITIS: Inflammation of the brain
  • GLIOMA: Primary tumor of the brain
  • MENINGIOMA: Slow growing benign tumor in the meninges
ACOUSTIC NEUROMA: Benign tumor involving hearing

CRANIO-PHARYNGIOMA: Benign tumor above the sella turcica

CONCUSSION: Impact injury

ANENCEPHALUS: Congenital absence of the brain
  • ACEPHALUS: Absence of head
  • MICROCEPHALIC: Small head
  • BURR HOLES: Holes bore into skull for pressure relief
positioning concerns
  • Some people don’t like to have their face touched
  • Wash your hands FIRST
  • CLEAN BUCKY or TABLE (and have them watch you)
  • Remember body habitus
    • The body is attached to the head!!!!
  • Composed of 22 Bones
    • Eight Cranial Bones
    • Fourteen Facial Bones
radiographic landmarks
Radiographic Landmarks
  • Glabella: Triangular area between and slightly superior to the eyebrows and above the bridge of the nose
  • Nasion: Depression at the bridge of the nose
    • Junction of the two nasal bones and the frontal bone
radiographic landmarks14
Radiographic Landmarks
  • Inner Canthus: Where the eyelids meet near the nose
  • Outer Canthus: Lateral junction of the eyelids
  • Acanthion: Midline point at the junction of the upper lip and the nasal septum. Point where the nose and the upper lip meet
radiographic landmarks15
Radiographic Landmarks
  • Gonion: Angle of the mandible (Jaw)
  • Mental Point: A triangular area projects forward as the chin (mentum). The center of the mentum is the mental point
radiographic landmarks16
Radiographic Landmarks
  • EAR
    • Auricle/Pinna: External portion of the ear. Large flap of ear made of cartilage
    • TEA: Top of the ear attachment. Superior attachment of the auricle. Level of the petrous ridge on each side
radiographic lines
Radiographic Lines
  • Radiographic lines are important to skull positioning
  • Certain lines are formed from anterior structures on the face and connect to the EAM
  • EAM: External acoustic (auditory) meatus, Opening of the external ear canal
radiographic landmarks18
Radiographic Landmarks
  • Eye
    • Supraorbital Margin (SOML): Superior rim of the bony orbit of the eye
    • Infraorbital Margin (IOML): Inferior rim of the bony orbit of the eye
    • Midlateral Orbital Margin: (OML) Portion of the lateral rim near the outer canthus of the eye
radiographic lines19
Radiographic Lines
  • Orbitomeatal Line(OML): Located between the outer canthus (midlateral orbital margin) and the EAM
  • Infraorbitomeatal Line(IOML): Formed by connecting the middle of the infraorbital margin to the EAM
radiographic planes
Radiographic Planes
  • Interpupillary Line (IPL):
    • A line connecting either the pupils or the outer canthi of the patient’s eyes
    • The IPL must be exactly perpendicular to the IR in a TRUE LATERAL position
radiographic landmark
Radiographic Landmark
  • Inion or EOP:
    • External occipital protuberance
    • Rise or bump along the midline of the lower back of the head near the junction of the head and neck
    • Extension of the IOML posteriorly approximates the location of the inion
radiographic landmark24
Radiographic Landmark
  • Vertex
    • Top portion of the head
sutures of the skull
Sutures of the Skull
  • Joints formed between the cranial bones are known as sutures
  • Fibrous connective tissue hold bones tightly together
  • Synarthrodial – Don’t permit movement
sutures of the skull26
Sutures of the Skull
  • Coronal Suture:
  • Sagittal Suture:
  • Lambdoidal Suture:
  • Squamosal Suture:
  • Temporomandibular Joint:
    • Only movable joints in the cranium
    • Formed by the mandibular fossa on each temporal bone with corresponding condyle of the mandible
Soft spots

Present at birth

Unossified connective tissue

Where three or more bones ajoin

Six Fontanels

Gradually replaced with bone

Allow for skull compression during birth

Most prominent are the anterior and posterior fontanels

Located on the anterior and posterior ends of the sagittal suture

Articulation between the frontal and both parietal bones at the anterior end of the sagittal suture is the bregma

Articulation between the occipital bone and both parietal bones at the posterior end is the lambda

Anterolateral (sphenoid) fontanel is the pterion

Posterolateral fontanel is the asterion

  • Skull Cap
  • Composed of four bones
    • Frontal bone
    • Right Parietal bone
    • Left Parietal bone
    • Occipital bone
cranial floor
Cranial Floor
  • Composed of four bones
    • Ethmoid bone
    • Sphenoid bone
    • Right Temporal bone
    • Left Temporal bone
skull morphology
Skull Morphology
  • Mesocephalic: Average shaped head, the petrous ridges lie at a 47 degree angle with the MSP
  • Brachycephalic: Short, broad, shallow head. Petrous ridges form a 54 degree angle with the MSP
  • Dolichocephalic: Long, narrow, deep head. Petrous ridges form a 40 degree angle with the MSP
sphenoid bone
Sphenoid Bone
  • Location and purpose
    • Midline of cranial floor
    • Anchor to hold the 8 cranial bones together
    • Articulates with all cranial bones
    • Forms the base of skull, small portion of each lateral wall, and posterior wall of each orbit
sphenoid bone42
Bat shaped



Paired lesser wings and greater wings

Pterygoid processes


Central portion of the bone

Between the ethmoid and occipital bones

Anterior surface forms posterior wall of nasal cavity

Body is hollow and enclosed with air – filled sphenoid sinuses

Sphenoid Bone
sphenoid bone43
Sphenoid Bone
  • Body of sphenoid
    • Sella Turcica
      • Saddle – shaped depression
      • Superior surface of the body
      • Houses pituitary gland
      • Sella turcica is localized for a radiographic exam by centering ¾ inches anterior and ¾ superior to the EAM on a lateral projection
body of sphenoid
Body of Sphenoid
  • Dorsum Sellae: is the posterior portion of the sella turcica
  • Posterior ClinoidProcesses: Extend superiorly from the lateral margin of the dorsum sellae
  • Optic Groove: Depression that runs horizontally across the body
  • Optic Chiasm: Formed by crossing of the optic nerves, situated in the optic groove
sphenoid bone45
Sphenoid Bone
  • Lesser Wings of the Sphenoid
    • Extends laterally and horizontally across the anterosuperior aspect of the body
    • Junction at the midline is the sphenoid ridge
    • Anterior clinoid processes extend from the posterior portion of each lesser wing
sphenoid bone46
Sphenoid Bone
  • Greater Wings of Sphenoid
    • Posterior to the lesser wings
    • Arise from the lateral surfaces of the body and extend outward
    • Openings on each greater wing serve as passageways for the nerves and blood vessels supplying the orbits and face
sphenoid bone48
Sphenoid Bone
  • Pterygoid Processes
    • Extensions of bone from under the sphenoid bone at the junction of the body and greater wings
    • Articulates anteriorly with the palatine bone and vomer
    • Comprised of two plates of bone fused together
    • Medial plate is called the pterygoid hamulus because it has a small hook – like process
temporal bones53
Named for the region around the temples


Below the parietal bone

Articulates with the greater wing of the sphenoid and the occipital bones

Contains 4 Regions





Temporal Bones
ap and pa projections
AP and PA projections
  • Petrous pyramids fill the orbit if there is no angulation
  • Petrous pyramid will lie in lower 1/3 of orbit with 15 degree angulation
  • if AP is it caudal or cephalic?
routine procedures ap view

OML and sagittal plane perpendicular to the cassette

Petrous pyramids fill

the orbits

ap axial townes
AP Axial (Townes)
  • OML = 30 degrees
  • IOML = 37 degrees
  • Posterior clinoids
  • HAAS is reverse Townes view
pa skull
PA Skull
  • OML = perpendicular to cassette
  • 0 degree angulation
  • Petrous pyramids fill the orbits
pa caldwell
PA Caldwell
  • Patient PA with 12 – 15 degree caudal angulation of CR
  • CR exits nasion
  • Petrous pyramids in bottom 1/3 of orbit
lateral skull
Lateral Skull
  • Interpupillary line perpendicular to cassette
  • Midsagittal plane parallel to cassette

(Look at patient body habitus)

submentovertex smv
Submentovertex (SMV)
  • IOML parallel to cassette
  • Midsagittal plane perpendicular to cassette
positioning errors
Positioning Errors

Rotation occurs when the median Saggital plane is not parallel to the film.