What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

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Chapter 8

Skull, Facial Bones, and Paranasal Sinuses

• Cranial positioning lines

Cranium (Skull Series)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP axial (Towne method) and PA axial (Haas method) (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP axial critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA (0°) and PA (15° or 23°) Caldwell (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA Caldwell critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Submentovertex (SMV) (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 SMV critique

Trauma (Skull Series)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral trauma (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP 0°, AP 15°, and AP axial trauma (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral trauma critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP (0° and 15°) trauma critique

Facial Bones

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Parietoacanthial (Waters and modified Waters) (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Parietoacanthial critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA 15° Caldwell (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA axial 15° Caldwell critique

Trauma (Facial Bone Series)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral, acanthioparietal (reverse Waters and modified Waters) (S)

Optic Foramina

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Parieto-orbital oblique (Rhese method) (S)

Zygomatic Arches

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Submentovertex (SMV) (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Tangential (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 SMV and tangential critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP axial (modified Towne) (S)

Nasal Bones

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Superoinferior (axial) (S)

Mandible

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA and PA axial (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Axiolateral oblique (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Trauma axiolateral oblique (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA and axiolateral oblique critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 AP axial (mandible or TMJ) (R)

Temporomandibular Joints

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Axiolateral oblique (Law) (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Axiolateral (Schuller) (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Axiolateral (Law and Schuller) critique

Paranasal Sinuses

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 PA (Caldwell) (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Lateral and PA (Caldwell) critique

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Parietoacanthial (Waters) (R)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Submentovertex (SMV) (S)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?
 Waters and SMV critique

    (R) Routine, (S) Special

Cranial landmarks and positioning lines used in skull and facial bones positioning.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-1Positioning lines.

A Glabellomeatal line (GML)

B Orbitomeatal line (OML)

C Infraorbitomeatal line (IOML) (Reid’s base line, or “base line,” base of cranium)

D Acanthiomeatal line (AML)

E Lips-meatal line (LML) (used for modified Waters)

F Mentomeatal line (MML) (used for Waters)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-2Cranial landmarks.

AP (PA) Axial Skull*

AP Towne (or PA Haas Method)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

• 24 × 30 cm L.W. (10 × 12″)

• Grid

Position

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-3AP axial (Towne)—CR 30° caudad to OML.

• Seated erect, or supine, midsagittal plane aligned to CR and centerline, perpendicular to IR; no rotation or tilt

• Depress chin to bring OML or IOML perpendicular to IR.

• Center IR to projecting CR.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-4PA axial (Haas method), OML ⊥ CR 25° cephalad, through level of EAMs.

Central Ray:

• CR 30° caudal to OML; or 37° caudal to IOML

• CR to ≈2.5″ or 6 cm above glabella (through 2 cm or 0.75″ superior to level of EAMs)

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend during exposure.

Note:

PA Haas (p. 436 in text) is an alternate to AP Towne. Adjust head to bring OML ⊥ to IR.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

AP Axial

(Modified Towne Method)

Evaluation Criteria

Anatomy Demonstrated:

• Occipital bone, petrous pyramids, and foramen magnum

Position:

• Dorsum sellae within foramen magnum

• No rotation evident by symmetry of petrous pyramids

Exposure:

• Optimal density (brightness) and contrast to visualize occipital bone

• Sharp bony margins; no motion

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-5AP axial skull.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Lateral Skull*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

• 24 × 30 cm C.W. (10 × 12″)

• Grid

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-6Lateral skull.

Position

• Seated erect or semiprone on table

• No rotation or tilt, midsagittal plane parallel to IR, and IPL perpendicular to IR

• Adjust chin to place IOML parallel to upper and lower IR edges

• Center IR to CR.

Central Ray:

CR ⊥ to IR, ≈2″ (5 cm) superior to EAM

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend during exposure.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Lateral Skull

Evaluation Criteria

Anatomy Demonstrated:

• Superimposed cranial halves

• Entire sella turcica and dorsum sellae

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-7Lateral skull.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Position:

• No tilt, evident by superimposition of orbital plates (roofs)

• No rotation, evident by superimposition of greater wings of sphenoid and mandibular rami

Exposure:

• Optimal density (brightness) and contrast to visualize sellar structures

• Sharp bony margins; no motion

PA (0° and 15°) Caldwell Skull*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Note: Some departmental routines include a 0° PA to better demonstrate the frontal bone in addition to the 15° PA axial Caldwell.

• 24 × 30 cm L.W. (10 × 12″)

• Grid

Position

• Seated erect, or prone on table, head aligned to CR and centerline of IR

• With forehead and nose resting on tabletop, adjust head to place OML perpendicular to IR.

• No rotation or tilt, midsagittal plane perpendicular to IR

• Center IR to projected CR.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-8PA—0°.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-9PA axial—15° Caldwell.

Central Ray:

• PA 0°: CR ⊥ to IR, centered to exit at glabella

• PA axial (Caldwell): CR 15° caudad to OML, centered to exit at nasion (25°–30° best demonstrates orbital margins)

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend during exposure.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

PA (0°) and PA Axial Caldwell (15° Caudad)

Evaluation Criteria

Anatomy Demonstrated:

• PA 0°: Frontal bone and crista galli demonstrated without distortion

• PA axial 15°: Greater/lesser wings of sphenoid, frontal bone, and superior orbital fissures

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-10PA—0°.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Position:

• PA 0°: Petrous ridges at level of superior orbital margin. No rotation; equal distance between orbits and lateral skull

• PA axial 15°: Petrous ridges projected in lower ⅓ of orbits. No rotation; equal distance between orbits and lateral skull

Exposure:

• Optimal density (brightness) and contrast to visualize frontal bone and surrounding structures

• Sharp bony margins; no motion

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-11PA axial—15° Caldwell.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Submentovertex (SMV) Skull*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

• 24 × 30 cm L.W. (10 × 12″)

• Grid

• AEC optional

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-12SMV—CR ⊥ to IOML.

Position

• Seated erect or supine with head extended over end of table resting top of head against grid IR (may tilt table up slightly)

• Adjust IR and head to place IOML parallel to IR.

• Ensure no rotation or tilt.

• Center IR to CR.

Central Ray:

CR angled to be ⊥ to IOML, centered to 0.75″ (2 cm) anterior to level of EAMs (midpoint between angles of mandible)

Note:

If patient cannot extend head this far, adjust CR as needed to remain perpendicular to IOML.

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend during exposure.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Submentovertex (SMV) Skull

Evaluation Criteria

Anatomy Demonstrated:

• Base of skull, including mandible and occipital bone

• Foramen ovale and spinosum

Position:

• Mandibular condyles are anterior to the petrous bones

• No tilt; equal distance between mandibular condyles and lateral skull

• No rotation; MSP parallel to edge of radiograph

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-13 SMV.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Exposure:

• Optimal density and contrast (brightness) to visualize outline of foramen magnum

• Sharp bony margins; no motion

Lateral Trauma Skull*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Warning: Do NOT elevate or move patient’s head before cervical spine injuries have been ruled out.

• 24 × 30 cm C.W. (10 × 12″)

• Grid

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-14Lateral, with possible spinal injury.

Position

• Supine, without removing cervical collar if present

• With possible spinal injury, move patient to back edge of table and place IR about 1″ (2.5 cm) below tabletop and posterior skull (move floating tabletop forward).

• Center IR to horizontal beam CR (to include entire skull).

• Ensure no rotation or tilt.

Central Ray:

CR horizontal, ⊥ to IR, centered to ≈2″ (5 cm) superior to EAM

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend respiration.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

AP Trauma Skull Series*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Warning: With possible spine or severe head injuries, take all projections AP without moving head or without removing cervical collar if present.

• 24 × 30 cm L.W. (10 × 12″)

• Grid (Bucky)

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-15AP—0° to OML.CR—parallel to OML—centered to glabella

Position

• Patient carefully moved onto x-ray table in supine position

• All projections taken as is without moving head

SID:

40-44″ (102-113 cm)

Collimation:

On four sides to skull margins

Respiration:

Suspend during exposure, or take “as is.”

CR Angle and Centering

• As indicated under each photo

• IR centered to projected CR

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-16AP reverse Caldwell. CR—15° cephalad to OML—centered to nasion

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-17AP axial (Towne). CR—30° caudad to OML—centered to midpoint between EAMs

Lateral Trauma Skull

Evaluation Criteria

Anatomy Demonstrated:

• Superimposed cranial halves

• Entire sella turcica and dorsum sellae

Position:

• No rotation or tilt (see p. 229 for specific criteria)

Exposure:

• Optimal density (brightness) and contrast to visualize sellar structures

• Sharp bony margins; no motion

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-18Lateral trauma skull.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Trauma AP (0°) and AP Axial (15° Cephalad) Projections

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-19AP—0° to OML.

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Fig. 8-20AP axial (“reverse” Caldwell) (15° cephalad).

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

Evaluation Criteria

Anatomy Demonstrated:

• AP 0°: Frontal bone and crista galli demonstrated (magnified because of OID)

• AP axial 15°: Greater/lesser wings of sphenoid, frontal bone, and superior orbital fissures (magnified)

Position:

• AP 0°: Petrous ridges at level of superior orbital margin. No rotation; equal distance between orbits and lateral skull

• AP axial 15°: Petrous ridges projected in lower ⅓ of orbits. No rotation; equal distance between orbits and lateral skull

Exposure:

• Optimal density (brightness) and contrast to visualize frontal bone and surrounding structures

• Sharp bony margins; no motion

Facial Bones—Lateral*

What is the angle between the OML and the plane of the IR for the Parietoacanthial projection?

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