RADT 1542 SKULL RADIOGRAPHY Wynn Harrison, Med, RT(R)(N)

RADT 1542RADT 1542SKULL RADIOGRAPHYSKULL RADIOGRAPHY

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

What a Bad Day!!!!What a Bad Day!!!!

Section 1: The CraniumSection 1: The Cranium

New Words:New Words:

HEMANGIOMA: tumor containing blood HEMANGIOMA: tumor containing blood vessels and fibrous tissuevessels and fibrous tissue

TRAUMATIC PNEUMOCEPHALUS: TRAUMATIC PNEUMOCEPHALUS: injury causing gas/air in the extracranial injury causing gas/air in the extracranial cavitycavity

HYDROCEPHALUS: increased HYDROCEPHALUS: increased cerebrospinal fluid in the ventriclescerebrospinal fluid in the ventricles

PAGET’S DISEASE: overproduction of PAGET’S DISEASE: overproduction of bonebone

CRANIOTOMY: Incision into the headCRANIOTOMY: Incision into the head

SUBDURAL HEMATOMA: Blood SUBDURAL HEMATOMA: Blood collected beneath the duracollected beneath the dura

TERATOMA: Congenital tumor containing TERATOMA: Congenital tumor containing 1+ embryonic germ layers (hair/teeth/skin 1+ embryonic germ layers (hair/teeth/skin may be present)may be present)

ENCEPHALITIS: Inflammation of the ENCEPHALITIS: Inflammation of the brainbrain

GLIOMA: Primary tumor of the brainGLIOMA: Primary tumor of the brain

MENINGIOMA: Slow growing benign MENINGIOMA: Slow growing benign tumor in the meningestumor in the meninges

ACOUSTIC NEUROMA: Benign tumor ACOUSTIC NEUROMA: Benign tumor involving hearinginvolving hearing

CRANIO-PHARYNGIOMA: Benign tumor CRANIO-PHARYNGIOMA: Benign tumor above the sella turcicaabove the sella turcica

CONCUSSION: Impact injuryCONCUSSION: Impact injury

ANENCEPHALUS: Congenital absence of the ANENCEPHALUS: Congenital absence of the brainbrain

ACEPHALUS: Absence of headACEPHALUS: Absence of head

MICROCEPHALIC: Small headMICROCEPHALIC: Small head

BURR HOLES: Holes bore into skull for BURR HOLES: Holes bore into skull for pressure reliefpressure relief

Why Dogs Bite Their OwnersWhy Dogs Bite Their Owners

POSITIONING CONCERNSPOSITIONING CONCERNS

Some people don’t like to have their face Some people don’t like to have their face touchedtouched

Wash your hands FIRSTWash your hands FIRST CLEAN BUCKY or TABLE (and have them CLEAN BUCKY or TABLE (and have them

watch you)watch you) Remember body habitusRemember body habitus

The body is attached to the head!!!!The body is attached to the head!!!!

Lines/Landmarks/PlanesLines/Landmarks/Planes

Median saggitalMedian saggital CoronalCoronal

CompositionComposition

Composed of 22 Composed of 22 BonesBones Eight Cranial Bones Eight Cranial Bones Fourteen Facial BonesFourteen Facial Bones

Radiographic LandmarksRadiographic Landmarks

GlabellaGlabella: Triangular area : Triangular area between and slightly between and slightly superior to the eyebrows superior to the eyebrows and above the bridge of and above the bridge of the nosethe nose

NasionNasion: Depression at : Depression at the bridge of the nosethe bridge of the nose

Junction of the two nasal Junction of the two nasal bones and the frontal bonebones and the frontal bone

Radiographic LandmarksRadiographic Landmarks Inner CanthusInner Canthus: Where : Where

the eyelids meet near the the eyelids meet near the nosenose

Outer CanthusOuter Canthus: Lateral : Lateral junction of the eyelidsjunction of the eyelids

AcanthionAcanthion: Midline point : Midline point at the junction of the at the junction of the upper lip and the nasal upper lip and the nasal septum. Point where the septum. Point where the nose and the upper lip nose and the upper lip meetmeet


GonionGonion: Angle of the mandible (Jaw): Angle of the mandible (Jaw)

Mental PointMental Point: A triangular area projects : A triangular area projects forward as the chin (mentum). The center forward as the chin (mentum). The center of the mentum is the mental pointof the mentum is the mental point


EAREAR Auricle/Pinna:Auricle/Pinna:

External portion of the External portion of the ear. Large flap of ear ear. Large flap of ear made of cartilagemade of cartilage

TEATEA: Top of the ear : Top of the ear attachment. Superior attachment. Superior attachment of the attachment of the auricle. Level of the auricle. Level of the petrous ridge on each petrous ridge on each sideside

Radiographic LinesRadiographic Lines

Radiographic lines are Radiographic lines are important to skull important to skull positioningpositioning

Certain lines are formed Certain lines are formed from anterior structures from anterior structures on the face and connect on the face and connect to the EAMto the EAM

EAMEAM: External acoustic : External acoustic (auditory) meatus, (auditory) meatus, Opening of the external Opening of the external ear canalear canal


EyeEye Supraorbital Margin (SOML):Supraorbital Margin (SOML): Superior rim of Superior rim of

the bony orbit of the eyethe bony orbit of the eye

Infraorbital Margin (IOML):Infraorbital Margin (IOML): Inferior rim of the Inferior rim of the bony orbit of the eyebony orbit of the eye

Midlateral Orbital Margin:Midlateral Orbital Margin: (OML) Portion of (OML) Portion of the lateral rim near the outer canthus of the the lateral rim near the outer canthus of the eyeeye

Radiographic LinesRadiographic Lines

Orbitomeatal LineOrbitomeatal Line (OML):(OML): Located between Located between the outer canthus the outer canthus (midlateral orbital margin) (midlateral orbital margin) and the EAMand the EAM

Infraorbitomeatal LineInfraorbitomeatal Line (IOML):(IOML): Formed by Formed by connecting the middle of connecting the middle of the infraorbital margin to the infraorbital margin to the EAMthe EAM

Radiographic PlanesRadiographic Planes

Interpupillary Line Interpupillary Line (IPL): (IPL): A line connecting A line connecting

either the pupils or the either the pupils or the outer canthi of the outer canthi of the patient’s eyespatient’s eyes

The IPL must be The IPL must be exactly perpendicular exactly perpendicular to the IR in a TRUE to the IR in a TRUE LATERAL position LATERAL position

Talk about TOO MUCH RAIN~Talk about TOO MUCH RAIN~

Radiographic LandmarkRadiographic Landmark

Inion or EOPInion or EOP:: External occipital protuberanceExternal occipital protuberance Rise or bump along the midline of the lower Rise or bump along the midline of the lower

back of the head near the junction of the head back of the head near the junction of the head and neckand neck

Extension of the IOML posteriorly Extension of the IOML posteriorly approximates the location of the inionapproximates the location of the inion

Radiographic LandmarkRadiographic Landmark

VertexVertex Top portion of the Top portion of the

headhead

Sutures of the SkullSutures of the Skull

Joints formed Joints formed between the cranial between the cranial bones are known as bones are known as suturessutures

Fibrous connective Fibrous connective tissue hold bones tissue hold bones tightly togethertightly together

Synarthrodial – Don’t Synarthrodial – Don’t permit movementpermit movement

Sutures of the SkullSutures of the Skull

Coronal SutureCoronal Suture: :

Sagittal SutureSagittal Suture: :

Lambdoidal SutureLambdoidal Suture::

Squamosal SutureSquamosal Suture::

ArthrologyArthrology

Temporomandibular Joint:Temporomandibular Joint:

Only movable joints in the craniumOnly movable joints in the cranium

Formed by the mandibular fossa on each Formed by the mandibular fossa on each temporal bone with corresponding condyle of temporal bone with corresponding condyle of the mandiblethe mandible

FontanelsFontanels

Soft spotsSoft spots Present at birthPresent at birth Unossified connective Unossified connective

tissuetissue Where three or more Where three or more

bones ajoinbones ajoin Six FontanelsSix Fontanels Gradually replaced with Gradually replaced with

bonebone Allow for skull Allow for skull

compression during birthcompression during birth

Most prominent are the Most prominent are the anterior and posterior anterior and posterior fontanelsfontanels

Located on the anterior Located on the anterior and posterior ends of the and posterior ends of the sagittal suturesagittal suture

FontanelsFontanels

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

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

Anterolateral (sphenoid) Anterolateral (sphenoid) fontanel is the fontanel is the pterionpterion

Posterolateral fontanel is Posterolateral fontanel is the the asterionasterion

FontanelsFontanels

CalvariumCalvarium

Skull CapSkull Cap

Composed of four bonesComposed of four bones Frontal boneFrontal bone Right Parietal boneRight Parietal bone Left Parietal boneLeft Parietal bone Occipital boneOccipital bone

CalvariumCalvarium

Cranial FloorCranial Floor

Composed of four bonesComposed of four bones Ethmoid boneEthmoid bone Sphenoid boneSphenoid bone Right Temporal boneRight Temporal bone Left Temporal boneLeft Temporal bone

Cranial FloorCranial Floor

Skull MorphologySkull Morphology

MesocephalicMesocephalic: Average shaped head, the : Average shaped head, the petrous ridges lie at a 47 degree angle petrous ridges lie at a 47 degree angle with the MSPwith the MSP

BrachycephalicBrachycephalic: Short, broad, shallow : Short, broad, shallow head. Petrous ridges form a 54 degree head. Petrous ridges form a 54 degree angle with the MSPangle with the MSP

DolichocephalicDolichocephalic: Long, narrow, deep : Long, narrow, deep head. Petrous ridges form a 40 degree head. Petrous ridges form a 40 degree angle with the MSPangle with the MSP

Occipital BoneOccipital Bone

Sphenoid BoneSphenoid Bone

Location and Location and purposepurpose Midline of cranial floorMidline of cranial floor Anchor to hold the 8 Anchor to hold the 8

cranial bones togethercranial bones together Articulates with all Articulates with all

cranial bonescranial bones Forms the base of Forms the base of

skull, small portion of skull, small portion of each lateral wall, and each lateral wall, and posterior wall of each posterior wall of each orbitorbit


Bat shapedBat shaped CompositionComposition

BodyBody Paired lesser wings Paired lesser wings

and greater wingsand greater wings Pterygoid processesPterygoid processes

BodyBody Central portion of the Central portion of the

bonebone Between the ethmoid Between the ethmoid

and occipital bonesand occipital bones Anterior surface forms Anterior surface forms

posterior wall of nasal posterior wall of nasal cavitycavity

Body is hollow and Body is hollow and enclosed with air – enclosed with air – filled filled sphenoid sphenoid sinusessinuses


Body of sphenoidBody of sphenoid Sella TurcicaSella Turcica

• Saddle – shaped depressionSaddle – shaped depression• Superior surface of the bodySuperior surface of the body• Houses pituitary glandHouses pituitary gland• Sella turcica is localized for a radiographic Sella turcica is localized for a radiographic

exam by centering ¾ inches anterior and ¾ exam by centering ¾ inches anterior and ¾ superior to the EAM on a lateral projectionsuperior to the EAM on a lateral projection

Body of SphenoidBody of Sphenoid

Dorsum SellaeDorsum Sellae: is the posterior portion of : is the posterior portion of the sella turcicathe sella turcica

Posterior ClinoidPosterior Clinoid ProcessesProcesses: Extend : Extend superiorly from the lateral margin of the superiorly from the lateral margin of the dorsum sellaedorsum sellae

Optic GrooveOptic Groove: Depression that runs : Depression that runs horizontally across the bodyhorizontally across the body

Optic ChiasmOptic Chiasm: Formed by crossing of the : Formed by crossing of the optic nerves, situated in the optic grooveoptic nerves, situated in the optic groove


Lesser Wings of the SphenoidLesser Wings of the Sphenoid Extends laterally and horizontally across the Extends laterally and horizontally across the

anterosuperior aspect of the bodyanterosuperior aspect of the body Junction at the midline is the Junction at the midline is the sphenoid ridgesphenoid ridge Anterior clinoid processesAnterior clinoid processes extend from the extend from the

posterior portion of each lesser wingposterior portion of each lesser wing


Greater Wings of SphenoidGreater Wings of Sphenoid Posterior to the lesser wingsPosterior to the lesser wings Arise from the lateral surfaces of the body and Arise from the lateral surfaces of the body and

extend outwardextend outward Openings on each greater wing serve as Openings on each greater wing serve as

passageways for the nerves and blood passageways for the nerves and blood vessels supplying the orbits and facevessels supplying the orbits and face


Pterygoid ProcessesPterygoid Processes Extensions of bone from under the sphenoid Extensions of bone from under the sphenoid

bone at the junction of the body and greater bone at the junction of the body and greater wingswings

Articulates anteriorly with the Articulates anteriorly with the palatine bonepalatine bone and and vomervomer

Comprised of two plates of bone fused Comprised of two plates of bone fused togethertogether

Medial plate is called the Medial plate is called the pterygoid hamuluspterygoid hamulus because it has a small hook – like processbecause it has a small hook – like process

Sella Turcica Sphenoid BoneSella Turcica Sphenoid Bone

Temporal BonesTemporal Bones


Named for the region Named for the region around the templesaround the temples

LocationLocation Below the parietal Below the parietal

bonebone Articulates with the Articulates with the

greater wing of the greater wing of the sphenoid and the sphenoid and the occipital bonesoccipital bones

Contains 4 RegionsContains 4 Regions SquamousSquamous TympanicTympanic MastoidMastoid PetrousPetrous

Group Photo Anyone?Group Photo Anyone?

AP and PA projectionsAP and PA projections

Petrous pyramids fill the orbit if there is no Petrous pyramids fill the orbit if there is no angulationangulation

Petrous pyramid will lie in lower 1/3 of orbit Petrous pyramid will lie in lower 1/3 of orbit with 15 degree angulation with 15 degree angulation

if AP is it caudal or cephalic?if AP is it caudal or cephalic?

ROUTINE PROCEDURESROUTINE PROCEDURESAP ViewAP View

OML and sagittal OML and sagittal plane perpendicular plane perpendicular to the cassetteto the cassette

Petrous pyramids fillPetrous pyramids fill

the orbitsthe orbits

AP Axial (Townes)AP Axial (Townes)

OML = 30 degreesOML = 30 degrees IOML = 37 degreesIOML = 37 degrees

Posterior clinoidsPosterior clinoids

HAAS is reverse HAAS is reverse Townes viewTownes view

PA SkullPA Skull

OML = perpendicular OML = perpendicular to cassetteto cassette

0 degree angulation0 degree angulation

Petrous pyramids fill Petrous pyramids fill the orbitsthe orbits

PA CaldwellPA Caldwell

Patient PA with 12 – Patient PA with 12 – 15 degree caudal 15 degree caudal angulation of CRangulation of CR

CR exits nasionCR exits nasion

Petrous pyramids in Petrous pyramids in bottom 1/3 of orbitbottom 1/3 of orbit

Lateral SkullLateral Skull

Interpupillary line Interpupillary line perpendicular to perpendicular to cassettecassette

Midsagittal plane Midsagittal plane parallel to cassetteparallel to cassette

(Look at patient body (Look at patient body habitus)habitus)

Submentovertex (SMV)Submentovertex (SMV)

IOML parallel to IOML parallel to cassettecassette

Midsagittal plane Midsagittal plane perpendicular to perpendicular to cassettecassette

Positioning ErrorsPositioning Errors

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

Tilt occurs when the Tilt occurs when the interpupilary line is interpupilary line is not at 90 to the film not at 90 to the film

Trauma and PathologyTrauma and Pathology

Golf clubGolf club

Paget’s DiseasePaget’s Disease

Pituitary tumorPituitary tumor

Film critiqueFilm critique

Critical thinkingCritical thinking

RADT 1542 SKULL RADIOGRAPHY Wynn Harrison, Med, RT(R)(N)

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Transcript of RADT 1542 SKULL RADIOGRAPHY Wynn Harrison, Med, RT(R)(N)