Orbits, Nasal
Bones
Mandible, TMJ
Orbits
Anatomy Refresher
Orbits
• Made up of 7 different bones
• 3 cranial bones: frontal, sphenoid, and ethmoid
• 4 facial bones: maxilla, zygoma, lacrimal, and palatine
• Cone-shaped, bony-walled cavities (bony sockets of the
eyeballs): each containing a roof, medial and lateral wall,
and floor
• Cone-shape forms a 37-degree angle with the MSP and 30-degrees
superior to OML
• Contain blood vessels and nerves that pass through
• Optic nerve for vision
Orbits
Projections
kVp range: 80-85
kVp
Orbits and Foreign Body
Localization
• Imaging of the orbits is often used for precise localization of a
foreign body in the eye, specifically for MRI clearance (metal
shrapnel, etc.) or for evaluating trauma to the bony orbits
• The highest possible spatial resolution is essential for this, as well
as optimal image quality
• This includes:
• Reducing geometric un-sharpness by minimizing OID and using a small focal spot
• Minimize secondary radiation (Scatter) by using close collimation
• Minimize possibility of artifacts that could mimic a foreign body by cleaning the
IR before imaging
Lateral Projection:
Positioning
• Position of patient: upright or
recumbent anterior oblique position
and place the outer canthus of affected
eye adjacent to and centered over
midpoint of IR
• Position of part: adjust patient’s head
to place MSP parallel and IPL
perpendicular to plane of IR. Adjust
neck flexion so that IOML is
perpendicular to IR
• Respiration: suspend/ stop breathing
• Central ray: perpendicular to outer
canthus
Lateral Projection:
Evaluation Criteria
• Entire orbits
• No rotation,
demonstrated by:
• Superimposed
orbital roofs
• Close beam restriction
(collimation) centered
to orbital region
• Bony orbit and soft
tissues of eye for
localization of foreign
bodies
PA Axial Projection:
Positioning
• Non-grid technique (very high resolution)
recommended to reduce magnification and
eliminate artifacts
• Position of patient: rest patient’s forehead
and nose on IR and center ½ in distal to
nasion
• Position of part: adjust patient’s head so
that MSP and OML are perpendicular to
plane of IR
• Respiration: suspend/ stop breathing
• Central ray: directed through the center of
orbits at a 30-degree caudal angle to
project petrous portions of temporal bones
below inferior margin of orbits
PA Axial Projection:
Evaluation Criteria
• Entire orbits
• Petrous pyramids lying below
orbital shadows
• No rotation or cranium,
demonstrated by:
• Symmetric visualization of
the orbits
• Close beam restriction
(collimation) centered to
orbital region
• Bony details of orbit and soft
tissues of the eye for
localization of foreign bodies
Parietoacanthial Projection:
Modified Waters Method
Positioning
• Position of patient: center IR to
level of center of orbits, rest
patient’s chin on IR and adjust
patient’s head so MSP is
perpendicular to plane of IR
• Position of part: adjust flexion of
patient’s neck so OML forms an
angle of 50-degrees with plane of IR
• Respiration: suspend/ stop
breathing
• Central ray: perpendicular through
mid-orbits
Parietoacanthial
Projection: Modified
Waters Method
Evaluation Criteria
• Entire orbits
• Petrous ridges lying well
below orbital shadows
• No rotation,
demonstrated by:
• Symmetric
visualization of orbits
• Close beam restriction
(collimation) to orbital
region
• Bony orbit and soft
tissues of the eye for
localization of foreign
bodies
Nasal Bones
Projections
kVp range: 55-65
kVp
Lateral Projection:
Positioning
• NONGRID TECHNIQUE: 55-65 kVp range
• Position of patient: in recumbent or upright anterior
oblique position, adjust rotation of body so MSP of
head can be placed horizontal
• Position of part: Adjust head so MSP is parallel with
tabletop and so IPL is perpendicular to tabletop,
adjust flexion of patient’s neck so IOML is parallel
with transverse axis of IR
• Respiration: suspend/ stop breathing
• Central ray: perpendicular to bridge of nose at a
point 1 in (2.5 cm) distal to nasion
• Collimation: adjust field to extend from glabella to 1
in (2.5 cm) inferior to acanthion and 1 in (2.5 cm)
beyond tip of the nose
• Structures shown: nasal bone and soft tissues of the
nose closer to IR
Lateral Projection:
Evaluation Criteria
• Evidence of proper
collimation and
presence of side
marker placed clear
of anatomy of interest
• Nasal bones, anterior
nasal spine and
frontonasal suture
• No rotation of nasal
ones and soft tissue
• soft tissue and bony
trabecular detail
Mandible
Anatomy Refresher
Mandible
Projections
kVp range: 75-85
kVp
PA Projection- Mandibular
Rami
Positioning
• Position of patient: place patient prone or seat
patient PA in front of upright bucky
• Position of part: rest patient’s forehead and
nose on IR, adjust so OML and MSP are
perpendicular to plane of IR
• Respiration: suspend/ stop breathing
• Central ray: perpendicular to exit acanthion
• Collimation: adjust field to extend 1 in (2.5 cm)
beyond the lateral sides, above the TMJs and
below the chin
• Structures shown: the mandibular body and
rami, central part of body not well shown
because of superimposed spine, this projection
used to show medial or lateral displacement of
fragments of fractures of the rami
PA Projection-
Mandibular Rami
Evaluation Criteria
• Evidence of proper
collimation and presence
of side marker placed clear
of anatomy of interest
• Entire mandible
• No rotation or tilt,
demonstrated by:
• Mandibular body and
rami symmetric on
each side
• MSP of head aligned
with long axis of
collimated field
• Soft tissue and bony
trabecular detail
PA Axial Projection-
Mandibular Rami
Positioning
• Position of patient: place patient in prone or
upright position in front of bucky
• Position of part: rest patient’s forehead and nose on
IR, adjust so OML and MSP is perpendicular to
plane of IR
• Respiration: suspend/ stop breathing
• Central ray: 20-25-degrees cephalad to exit at
acanthion
• Collimation: adjust radiation field to extend 1 in
(2.5 cm) beyond lateral sides, above TMJs and
below chin
• Structures shown: mandibular body and rami,
central part of body not well shown because of
superimposed spine, this projection used to show
medial or lateral displacement of fragments of
fractures of the rami
PA Axial Projection-
Mandibular Rami
Evaluation Criteria
• Evidence of proper collimation
and presence of side marker
placed clear of anatomy of interest
• Entire mandible
• No rotation or tilt, demonstrated
by:
• Mandibular body and rami
symmetrical on each side
• MSP of head aligned with long
axis of collimated field
• Condylar processes
• Soft tissue and bony trabecular
detail
PA Projection- Mandibular
Body
Positioning
• Position of patient: prone or upright in front
of bucky
• Position of part: Ensure MSP is centered to
midline of IR and rest head on nose and chin
so anterior surface of mandibular symphysis
is parallel with plane of IR, AML will be
nearly perpendicular to IR plane
• Respiration: suspend/ stop breathing
• Central ray: perpendicular to level of the lips
• Collimation: adjust field to extend 1in (2.5
cm) beyond lateral sides, above the TMJs
and below the chin
• Structures shown: mandibular body
PA Projection-
Mandibular Body
Evaluation Criteria
• Evidence of proper
collimation and presence
of side marker placed
clear of anatomy of
interest
• Entire mandible
• No rotation or tilt,
demonstrated by:
• Mandibular body
symmetric on each
side
• MSP of head aligned
with long axis of
collimated field
• Soft tissues and bony
trabecular detail
PA Axial Projection-
Mandibular Body
Positioning
• Position of patient: in prone or upright position
• Position of part: MSP of head centered to
midline of and perpendicular to IR, rest head
on the nose and chin so anterior surface of
mandibular symphysis is parallel with plane of
IR, AML nearly perpendicular to plane of IR
• Respiration: suspend/ stop breathing
• Central ray: directed midway between TMJs at
a 30-degree cephalad angle
• Collimation: adjust field to extend 1in (2.5 cm)
beyond lateral sides, above the TMJs and
below the chin
• Structures shown: mandibular body and TMJs
PA Axial Projection-
Mandibular Body
Evaluation Criteria
• Evidence of proper
collimation and presence
of side marker placed clear
of anatomy of interest
• Entire mandible
• TMJs just inferior to
mastoid process
• No rotation or tilt,
demonstrated by:
• Symmetric rami
• MSP of head aligned
with long axis of
collimated field
• Soft tissue and bony
trabecular detail
Mandible Axiolateral and Axiolateral
Oblique Projections
Positioning
• Position of patient: place patient in seated, semi-prone, or
semi-supine position
• Position of part: place patient’s head in lateral position
with IPL perpendicular to IR, mouth should be closed and
teeth together, extend patient’s neck enough so long axis
of mandibular body is parallel with the transverse axis of
IR to prevent superimposition of cervical spine
• **Positioning of part is dependent on desired portion of mandible
to be visualized in the image**
Mandible Axiolateral
and Axiolateral
Oblique Projections
Positioning
Positioning for ramus
of mandible: keep
patient’s head in a
true lateral position
Mandible
Axiolateral and
Axiolateral
Oblique
Projections
Positioning
Positioning for
body of
mandible: rotate
patient’s head
30-degrees
toward IR
Mandible
Axiolateral and
Axiolateral
Oblique
Projections
Positioning
Positioning for
symphysis of
mandible: rotate
patient’s head 45-
degrees toward
IR
Mandible Axiolateral
and Axiolateral Oblique
Projections
Positioning
Positioning semi-
supine axiolateral
oblique (body and
symphysis): angle CR
20-degrees cephalad
and head is tilted 10-
degrees so it is
resting on IR
Mandible Axiolateral and Axiolateral Oblique
Projections
Positioning
• Central ray: directed 25-degrees cephalad to pass
directly though the mandibular region of interest
• Collimation: adjust field to extend 1in (2.5 cm)
beyond the anterior and inferior skin shadows ad
above TMJs
• Structures shown: desired region of the mandible
positioned parallel to IR
Mandible Axiolateral and Axiolateral Oblique
Projections- Ramus and Body
Evaluation Criteria
• Evidence of proper collimation and presence of
side marker placed clear of anatomy of interest
• No overlap of ramus by opposite side of mandible
• No elongation or foreshortening of ramus or body
• No superimposition of ramus by cervical spine
• Soft tissue and bony trabecular detail
Mandibul
ar Body
Axiolatera
l Oblique
Projection
Mandibula
r Ramus
Axiolateral
Projection
Mandible Axiolateral and Axiolateral Oblique
Projections- Symphysis
Evaluation Criteria
• Evidence of proper collimation and presence of
side marker placed clear of anatomy of interest
• No overlap of mentum region by opposite side
of mandible
• No foreshortening of mentum region
• Soft tissue and bony trabecular detail
Mandibula
r
Symphysis
Axiolatera
l Oblique
Projection
Submentoverticle
(SMV) Projection-
Mandible
Positioning
• Position of patient: place patient upright in front
of bucky or in supine position, when supine
elevate shoulders on pillows to allow for
extension of the neck, center MSP to midline
• Position of part: with neck fully extended, rest
head on its vertex and adjust so MSP is vertical,
adjust so IOML is parallel with plane of IR
• Respiration: suspend/ stop breathing
• Central ray: perpendicular to IOML and
centered between midway between angles of the
mandible
• Collimation: adjust field to 1in (2.5 cm) beyond
lateral sides and above tip of nose
• Structures shown: SMV projection of mandibular
body showing coronoid processes of the rami
Submentoverticle
(SMV) Projection-
Mandible
Evaluation Criteria
• Evidence of proper collimation
and presence of side marker
placed clear of anatomy of
interest
• No rotation or tilt, demonstrated
by:
• Distance between lateral
border of skull and
mandible equal on both
sides
• MSP of head aligned to
long axis of collimated field
• Condyles of mandible anterior to
the pars petrosal
• Symphysis extending almost to
anterior border of face so
mandible is not foreshortened
• Soft tissue and bony trabecular
detail
Temporomandibular Joints
(TMJs)
Positioning
kVp range: 80-85
kVp
Temporomandibular
Articulations- AP Axial Projection
Positioning
• Position of patient: in supine or seated upright
with posterior skull in contact with bucky
• Position of part: adjust head so MSP is
perpendicular of plane of IR, flex patient’s neck
so OML is perpendicular to plane of IR
• Respiration: suspend/ stop breathing
• Central ray: 35-degrees caudad, centered midway
between TMJs and entering approx. 3 in(7.6 cm)
above the nasion (can expose one image with
mouth closed and one with mouth open)
• Collimation: adjust field to extend 1in (2.5 cm)
beyond lateral sides, superiorly to glabella, and
inferiorly to lips
• Structures shown: condyles of the mandible and
mandibular fossae of temporal bones
Supine Upright
Temporomandibular Articulations- AP Axial Projection
Positioning
Temporomandibular Articulations- AP Axial
Projection
Evaluation Criteria
• Evidence of proper collimation and presence of side
marker placed clear of anatomy of interest
• no rotation of head
• Minimal superimposition of petrosa on the condyle in the
closed-mouth examination
• Condyle and temporomandibular articulation below pars
petrosa in the open-mouth position
• Soft tissue and bony trabecular detail
Temporomandib
ular
Articulations- AP
Axial Projection
Closed Mouth
Temporomandib
ular
Articulations- AP
Axial Projection
Open Mouth
TMJ Axiolateral Projection
Positioning
• Position of patient: in semi-prone or seated upright before bucky
• If needed, place a mark on each cheek at a point ½ in (1.3 cm) anterior to EAM and 1 in (2.5
cm) inferior to EAM to localize the TMJ
• Position of part: center 0.5in (1.3 cm) anterior to EAM and place head in lateral
position with affected side closest to IR, adjust head so MSP is parallel with plane
of IR and IPL perpendicular to IR (unless contradicted, take one image with mouth
open and one with mouth closed)
• Respiration: suspend/ stop breathing
• Central ray: directed 25-30-degrees caudad and at ½in (1.3 cm) anterior and 2in (5
cm) superior to upside EAM
• Collimation: adjust field to extend 1in (2.5 cm) beyond anterior skin line, posterior
and inferior to TMJ
• Structures shown: TMJ when mouth is open and closed, both sides for comparison
Temporomandib
ular
Articulations-
Axiolateral
Closed Mouth
Temporomandi
bular
Articulations-
Axiolateral
Open Mouth
TMJ Axiolateral Projection
Evaluation Criteria
• Evidence of proper collimation and presence of side
marker placed clear of anatomy of interest
• TMJ anterior to EAM
• Condyle in mandibular fossa in the closed-mouth
examination
• Condyle inferior to articular tubercle in open-mouth
examination if patient is normal and able to open mouth
widely
• Soft tissue and bony trabecular detail
Temporomandibu
lar Articulations-
Axiolateral
Projection Closed
Mouth
Temporomandibu
lar Articulations-
Axiolateral
Projection Open
Mouth
TMJ Axiolateral Oblique
Projection
Positioning
• Position of patient: semi-prone or seated upright in front
of bucky, make one exposure with mouth closed and one
with mouth open (unless contraindicated) for comparison
• Position of part: center ½in (1.3 cm) anterior to EAM and
rest patient’s cheek on IR, rotate so MSP is 15-degrees
towards IR and IPL perpendicular to IR, adjust flexion of
neck so AML is parallel with transverse angle of IR
• Respiration: suspend/ stop breathing
• Central ray: 15-degrees caudad and exiting through TMJ
closest to IR, enters about 1in (3.8 cm) superior to upside
EAM
• Collimation: adjust field to extend from outer canthus to
posterior edge of auricle and from mid-parietal region to
inferior angle of auricle
• Structures shown: condyles and necks of mandible, also
shows the relationship between the mandibular fossae and
condyle, open-mouth position shows mandibular fossae
and inferior and anterior excursion of condyle, closed-
mouth position shows fractures of neck and condyle of
ramus
TMJ Axiolateral
Oblique Projection
Evaluation Criteria
• Evidence of proper
collimation and presence
of side marker placed
clear of anatomy of
interest
• Temporomandibular
articulation
• Condyle lying in the
mandibular fossa in the
closed-mouth examination
• Condyle lying inferior to
the articular tubercle in
the open-mouth
projection
• Soft tissue and bony
trabecular detail
