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SKULL and SINUSES
prepared by: Paula Nehme
Skull Positioning
Lines
Landmarks
SKULL
PA PROJECTION
PA AXIAL PROJECTION-CALDWELL
METHOD
Image receptor: (24 ×30 cm)
lengthwise
Position of patient
• Place the patient in a prone or
upright position.
• Center the midsagittal plane
of the patient to the midline of
the grid.
Rest the patient’s forehead and
nose on the table.
SKULL
PA PROJECTION
Position of part
• Adjust the flexion of the neck
so that the OML is perpendicular
to the IR. Align the midsagittal
plane perpendicular to the IR.
center the IR to the nasion.
Central ray
For the PA projection, when the
frontal bone is of primary interest,
direct the CR perpendicular to
exit the nasion.
SKULL
PA PROJECTION
• For the Caldwell method,
direct the CR to exit the nasion
at an angle of 15 degrees
caudad.
• Center the IR to the central ray.
SKULL
AP PROJECTION
AP Axial Projection
Position of patient and part:
Patient supine .
Ensure that the midsagittal
plane and the OML are
perpendicular to the IR.
AP axial skull with 15-degree cephalad
central ray.
SKULL
Central ray : Perpendicular or
directed to the nasion at an
angle 15 degrees cephalad .
Center IR to the central ray
AP skull with perpendicular central ray.
SKULL
LATERAL PROJECTION
R or L position
Image receptor:(24 ×30 cm)
crosswise
Position of patient
Place the patient in the
anterior oblique.
Position of part
Adjust the patient’s head so
that the midsagittal plane is
parallel to the IR.
Lateral skull, recumbent position
SKULL
LATERAL PROJECTION
Central ray
Perpendicular, entering (5
cm)superior to the EAM
Center the IR to the CR.
Paranasal
Sinuses
Paranasal Sinuses
LATERAL PROJECTION
R or L position
Image receptor:(18 ×24 cm)
Lengthwise
Position of patient: Patient erect.
with the body placed in the
RAO or LAO position. same
position that is used for the
lateral skull.
Lateral sinuses
Paranasal Sinuses
LATERAL PROJECTION
Position of part
adjust the head in a true
lateral position. The
midsagittal plane of the
head is parallel to the IR.
Central ray
Directed horizontal, enter
the patient’s head (1.3 to
2.5 cm) posterior to the
outer canthus.
Frontal and Anterior Ethmoidal
Sinuses
PA AXIAL PROJECTION
CALDWELL METHOD
Position of patient
• Seat the patient facing a
vertical grid device.
• Center the midsagittal plane
of the patient to the midline of
the grid.
Frontal and Anterior Ethmoidal
Sinuses
PA AXIAL PROJECTION
Position of part
extend the patient’s neck
slightly, rest the tip of the nose on
the grid device, and center the
nasion to the IR.
Position the patient’s head so
that the OML forms an angle of 15
degrees with the horizontal CR.
Central ray
Directed horizontal to exit the
nasion.
Maxillary Sinuses
PARIETOACANTHIAL
PROJECTION
WATERS METHOD
Position of patient
Patient seated or upright, facing
the vertical grid device.
Center the midsagittal plane of
the patient to the midline of the
grid
Parietoacanthial sinuses: Waters method
Maxillary Sinuses
WATERS METHOD
Position of part
Hyperextend the neck. Rest chin
against the vertical grid device.
Adjust the head so that the OML
forms an angle of 37 degrees with
the plane of the IR.
Center the IR to the acanthion
Central ray: Horizontal to the IR
and exiting the acanthion.
Facial Bones
PA Axial Projection
(Caldwell )
Central ray: 15 degrees
caudad to exit at nasion
Facial Bones
Parietoacanthial Projection
(Waters)
Central ray: Perpendicular
to the film exiting at the
acanthion
Facial Bones
Lateral Position
R or L Lateral
Central ray: perpendicular to
IR,entering at the zygoma
(prominence of the check)
Nasal Bones
Lateral Position
Central ray: Perpendicular to
the IR at a point1cm inferior
and posterior to the nasion.
