Skull Projections

SKULL AP PROJECTION
• Best demonstrate the
frontal and parietal
bones.
• Petrous pyramid fills
the orbit
• OML perpendicular to
the IR
• CR perpendicular to
nasion.
 SKULL PA AXIAL PROJECTION
CALDWELL’S METHOD

• Petrous pyramid in the

lower 1/3 of the orbits.
• Best demonstrate alveolar
ridge fractures.
• General survey examination
of the cranium.
• Prone
• Forehead and nose
• OML is perpendicular to IR
• MSP is perpendicular to
midline of the table.
• CR 15° caudad to nasion
 SKULL PA AXIAL PROJECTION
CALDWELL’S METHOD
CALDWELL’S METHOD MODIFICATION
ORIGINAL CALDWELL’S METHOD
• 23° caudad to nasion.
• Glabellomeatal Line (GML) perpendicular to IR
20° to 25° caudad to mid-orbit
• Demonstrate superior orbital fissures
25° - 30° Caudad
• Demonstrate rotundum foramina
• Petrous pyramid projected below the inferior orbital
margin.
 KULL AP AXIAL PROJECTION
AP Axial Projection
TOWNE’S/GRASHEY METHOD
• OML perpendicular to film RP: 2.5 in.(6 cm) above glabella
plane (chin depressed) • Best demonstrate the
• IOML perpendicular to film occipital bone
plane (Patient unable to flex • Posterior clinoid process
their neck). within the shadow of the
• CENTRAL RAY: foramen magnum.
1. 30° caudad to OML
perpendicular to IR
2. 37° caudad to IOML
perpendicular to IR
3. 40° - 60° caudad
• Foramen magnum and
jugular foramina.
SKULL PA AXIAL PROJECTION
HAAS METHOD
• Prone position • For hypersthenic or
• Forehead and nose kyphotic, obese and other
patients who cannot be
• OML perpendicular to IR
adjusted for AP axial
• CR 25° cephalad to 1.5 projection.
in. inferior to the inion and
exiting 1.5 in. above • Best demonstrate the
nasion. occipital bone with
magnification
• Also called Reverse
Towne’s projection
SKULL PA AXIAL PROJECTION
HAAS METHOD
 PA AXIAL PROJECTION
VALDINI METHOD
• Mastoid pneumatization
is shown in this position
• Alternative for Grashey
and Haas projection.
• Best demonstrate the
vestibulo-cochlear
region (the organ of
hearing)
SKULL LATERAL
• MSP is parallel to IR
• IPL is perpendicular to
IR
• IOML perpendicular to
front edge of the
cassette.
• CR perpendicular to 2
inches above EAM
• Best demonstrate the
parietal bones.
• Sella tursica and clivus
are demonstrated in
profile.
SKULL LATERAL
• Crosstable or
Shoot-Through
Lateral Projection
demonstrating
traumatic sphenoid
effusion which is an
indication of a basal
skull fracture.
 SUBMENTOVERTICAL (SMV) (FULL
BASAL PROJECTION) SCHULLER METHOD

• Head resting on vertex

• MSP is perpendicular to IR
• IOML is parallel to IR.
• CR to ¾ inch (2 cm)
anterior to level of EAMs
• Best demonstrate the
base of the skull
• Demonstrate the basilar
portion of the occipital
bone.
• Mandibular condyles
anterior to petrous
pyramids.
 VERTICOSUBMENTO
(FULL BASAL PROJECTION)
SCHULLER METHOD
• Distorted and magnified image
of the midbase due to
increase OID and angulation of
CR.
• Useful for studies of anterior
cranial base and sphenoid
sinuses.
• Best projection for foramen
ovale and spinosum.
• Alternative projection for
SMV projection.
• Mandibular condyles anterior
to petrous pyramids.
 AXIOLATERAL
LYSHOLM METHOD
• Head in lateral position.
• CR 30°-35° caudad exit
at a point 1 inch (2.5 cm)
distal to the lower EAM
• Alternative projection
for SMV projection for
patient who cannot
extend their neck.
• Oblique position of the
lateral base of the
cranium closest to the IR.
 SELLA TURSICA
LATERAL PROJECTION
Sella Tursica
• Turkish Saddle
Posterior Clinoid Process
• Small extensions superior to the
dorsum sellae.
Dorsum Sellae
• Back of the saddle
• Posterior wall of sella tursica.
Clivus
• Shallow depression just posterior
to the base of the dorsum sellae.
• Forms a base of support for the
pons portion of the brain.
 SELLA TURSICA
LATERAL PROJECTION
• CR perpendicular to ¾
inch anterior and ¾ inch
superior to EAM
• Best demonstrate the
sella tursica and clivus
in profile.
• Depression of the sella
tursica and dorsum sellae
is best seen in the lateral
projection.
 SELLA TURSICA AP AXIAL
TOWNE’S/GRASHEY METHOD
• 30° caudad - OML
perpendicular to IR
• 37° caudad - IOML
perpendicular to IR
• 2.5 inches (6 cm) above
glabella
30° Caudad
• Anterior clinoid process
directly above the foramen
magnum
37° Caudad
• Posterior clinoid process and
Dorsum Sellae projected into
the foramen magnum
 SELLA TURSICA PA AXIAL PROJECTION
HAAS METHOD
• 1) 25° cephalad to 1.5
inches inferior to the inion
and exiting 1.5 inches
above nasion
• 2) 10° cephalad
• This is an alternative
projection for
demonstrating the
dorsum sella, posterior
clinoid, foramen
magnum and petrous
ridge.
• Reverse Towne’s
projection
25° cephalad
• Dorsum sellae and
posterior clinoid
processes projected
within the shadow of the
foramen magnum.
10° cephalad
• Dorsum sellae is
projected above the
foramen magnum.
 PARANASAL SINUSES
• Large air-filled cavities
• Should be radiographed in erect/upright position. To
demonstrate the presence of air-fluid level.
• To differentiate between shadows caused by fluid and
those caused by other pathologic conditions.
• Patient must be in erect at least 5 minutes before taking
the examination.
• FEMS
• Frontal Sinuses - Frontal (cranial) bone
• Ethmoid - Ethmoid (cranial) bone
• Maxillary Sinuses - Maxillary (facial) bone
• Sphenoid - Sphenoid (cranial) bone
PARANASAL SINUSES
 PNS
LATERAL PROJECTION
• CR horizontally directed 1
inch posterior to outer
canthus.
• Best projection to
demonstrate all 4
sinuses.
• Demonstrate the
sphenoid sinus, which
is the primary
importance of this
projection.
 CALDWELL’S METHOD
• CR 15° caudad to nasion
• Best projection to
demonstrate the frontal
sinuses and anterior
ethmoidal sinuses.
• Petrous ridge are
projected into lower 1/3
of the orbits.
 PNS PARIETO ACANTHIAL PROJECTION
WATER’S METHOD

• Patient head is resting on • CR directed to acanthion.

chin.
• MML is perpendicular to
IR
• OML forms an angle of 37°
with the plane of the film.
• Tip of the nose ¾ inch
from the image receptor.
• Demonstrate any retention
cyst and possible nasal
deviation
• Best demonstrate the
maxillary sinuses above
the petrous ridge.
• Useful projection for
demonstrating the
foramen rotundum.
• Petrous pyramids below
the maxillary sinuses.
PNS PARIETO ACANTHIAL PROJECTION
WATER’S METHOD
PNS PARIETOACANTHIAL TRANS-ORAL PROJECTION
OPEN-MOUTH WATERS

• Demonstrate the
sphenoid sinuses
through the open
mouth.
• The open mouth
projection removes the
upper teeth from direct
superimposition of the
sphenoid.
 FACIAL BONES
LATERAL PROJECTION
• Zygoma is centered to
MLT
• CR perpendicular to mid-
zygoma (midway
between outer canthus
and EAM)
• Useful for
demonstrating
depressed fractures of
the frontal sinus.
• Superimposed
mandibular rami, orbital
roof
 FACIAL BONES
WATERS PROJECTION
• Demonstrate an axial
image of the facial bones.
• Best single projection
for demonstrating the
entire facial bone.
• Petrous ridge below the
maxillary sinus.
• Useful for demonstrating
fractures of the orbit and
fractures of the nasal
wings.
 FACIAL BONES
MODIFIED WATERS PROJECTION
• Prone position
• Patient head is resting on
chin and nose.
• LML is perpendicular to
table
• OML forms an angle of
55° with the film.
• CR Perpendicular to
acanthion
• Demonstrates facial
bones with less axial
angulation.
• Petrous ridges are
projected into lower-
half of the maxillary
sinuses.
• Best demonstrates a
more direct view of the
orbital rim as compared
with Waters projection.
 FACIAL BONES
MODIFIED WATERS PROJECTION
 NASAL BONE
LATERAL PROJECTION
(SOFT TISSUE LATERAL)
• CR perpendicular to ½
inch inferior to nasion
• Best position to
demonstrate non-
displaced linear
fractures of the nasal
bone.
• Soft tissue structure of
the nose.
• Nasal bones
• Nasofrontal suture
• Anterior nasal spine
 ZYGOMA
MAY METHOD
• Patient in prone position, • Single zygomatic arch
neck extended. free of superimposition.
• Rest chin on table • CR perpendicular to
• Rotate head away from IOML to 1 ½ inches
the side being posterior to outer
examined so that MSP canthus.
forms 15° then tilt head • Best projection for
15°. patients who have
• IOML as nearly parallel to depressed fractures or
IR flat cheekbones.
 ZYGOMA
MAY METHOD
 MASTOID AND TEMPORAL BONE
AP AXIAL PROJECTION
TOWNE’S/GRASHEY METHOD

• 30° caudad - OML

perpendicular to IR
• 37° caudad - IOML
perpendicular to IR
• 2.5 inches (6 cm)
above glabella
• Demonstrate the
petrosas above the
base of the skull.
 ORIGINAL LAW METHOD

• DOUBLE TUBE
ANGULATION
METHOD
• Head in lateral
position.
• 15° caudad and 15°
anteriorly to 2 inches
posterior and 2 inches
superior to the
uppermost EAM
 MODIFIED LAW
• Adjust head until MSP • This position
forms a 15° angle in demonstrates the
relation to the table. mastoid air cells and
• 15° caudad to 2 inches internal auditory canal
posterior and 2 inches of the side closest to IR
superior to the uppermost • Demonstrates an
EAM axiolateral perspective of
• Superimposed internal mastoid air cells closest
acoustic meatus (IAM) to film.
and external acoustic
meatus (EAM).
MODIFIED LAW
 STENVERS
• POSTERIOR PROFILE
POSITION
• Head resting on forehead,
nose and zygoma
• Downside or closest to IR
petrous bone in profile.
• 12° cephalad enters 3-4
inches posterior and 1 ½
inferior to upside EAM and
exits 1 inch anterior do
downside EAM
• MSP forms an angle of
45° in relation to table.
 ARCELIN
• ANTERIOR PROFILE
PROJECTION
• MSP forms an angle of
45° in relation to table.
• 10° caudad to 1 inch and
anterior and ¾ inch
superior to elevated EAM.
• Reverse Stenvers
projection.
• Upside or farthest from IR
petrous bone in profile.
• Useful with children and
adults who cannot be
placed in prone position.
 HENSCHEN
• 15° caudad To
dependent EAM
closest to IR

• Demonstration of
tumours of acoustic
nerve.
 SCHULLERS
• 25° caudad to
dependent EAM
closest to IR
• Demonstrate the
pneumatic structure
of the mastoid
process
 LYSHOLM
• 35° caudad to
dependent EAM
closest to IR
• Also referred as the
Runstrom II method
 MAYER
• MSP forms an angle of
45° in relation to table.
• 45° caudad to dependent
EAM (nearest IR)
• Demonstrate an end-on
view of downside
petrous portion.
• Axial oblique position
of the mastoid air cells
 SMV
• CR perpendicular to OML
centered to sagittal plane of
the throat at the level of the
EAMs.
• The goal of this projection is
to project the long axis of
the EAMs, tympanic cavities
and the osseus part of the
auditory (Eustachian) tubes
immediately behind the
mandibular condyles.
• Demonstrate the organ of
hearing within the petrosa.
 TMJ
SCHULLER METHOD
• Head in true lateral
position.
• CR 25°- 30° caudad to ½
inch anterior and 2 inches
superior to upside EAM
• This projection results
in more elongation of
the condyle as
compared with the
Modified Law method.
• TMJ closest to IR in the
open and closed mouth
position
 TMJ
MODIFIED LAW METHOD
• MSP 15° to IR.
• TMJ closest to IR in the
open and closed mouth
position
• Demonstrates
dislocations or small
fractures of the cortex
of the condyle
• 15°caudad to 1 ½ inches
anterior and 1 ½ inches
superior to upside EAM
TMJ
MODIFIED TOWNES METHOD
• 35° caudad – OML
perpendicular to IR
• 42° caudad - IOML
perpendicular to IR
• To 3 inches above the
nasion
• Axial image of the
condyloid process of the
mandible and mandibular
fossae of the temporal
bones.
 ORBITS PARIETO-ORBITAL OBLIQUE POSITION
RHESE METHOD

• Prone position • Demonstrate the OPTIC

• Rest the ZYGOMA, FORAMEN at the
NOSE and CHIN to the LOWER OUTER
table. QUADRANT.
• AML perpendicular to • Also known as the three-
the plane of the film. point landing method.
• MSP forms an angle 53°
with the plane of the
film.
ORBITS PARIETO-ORBITAL OBLIQUE POSITION
RHESE METHOD
 ORBITO-PARIETAL
OBLIQUE POSITION
• Patient in supine
position.
• AML perpendicular to
the plane of the film.
• MSP forms an angle 53°
with the plane of the
film.
• Reverse Rhese Method
• Demonstrate the OPTIC
FORAMEN at the
LOWER OUTER
QUADRANT.
 ORBITS
PA AXIAL PROJECTION
• Patient in prone position.
• Rest patient’s head on
FOREHEAD and NOSE
• CR 20°-25° caudad to
exit at the level of the
inferior margin of the
orbit.
• Best demonstrate the
superior orbital fissure.
 BERTEL METHOD
• Patient in prone
position
• Forehead and nose
resting on the table.
• CR 20°-25° cephalad
to exit at nasion.
• Best demonstrate
the inferior orbital
fissure
 MODIFIED PARIETOACANTHIAL
MODIFIED WATERS

• Prone position • Provides a more direct

• CHIN and NOSE resting on view of the entire orbital
the table rims than with Waters
• LML is perpendicular to projection.
IR • Also known as the
• OML forms an angle of Shallow Waters.
55° with the IR.
• PETROUS RIDGE
• CR perpendicular to projected into LOWER
acanthion. HALF of the
• Best demonstrates the MAXILLARY SINUS,
orbital floor.
below the Infraorbital
• Best projection for margin.
visualizing BLOWOUT
Fracture
MODIFIED PARIETOACANTHIAL
MODIFIED WATERS
 HOUGH METHOD
• Patient in prone position.
• MSP is turned 20°
toward the side being
examined.
• 7° caudad to exit affected
orbit.
• Good for visualizing
any deformity or lesion
of the strut bone.
 ORBITS
FOREIGH BODY LOCALIZATION
VOGT BONE-FREE
POSITIONS
• Made on standard
periapical or occlusal
size dental film.
 PARALLAX MOTION METHOD

Modified Waters Lateral projection

• 1st exposure patient is • 1st exposure is made
instructed to look to the looking cephalad
extreme right • 2nd exposure looking
• 2nd exposure extremely caudad
looking to the left
 SWEET METHOD
• This method of orbital
foreign body location
determines the exact
location of a foreign
body by the use of
geometric calculation.
 PFEIFFER-COMBERG METHOD

• A leaded contact lens is

placed directly over the
cornea, and intraorbital and
intraocular
• The contact lens embedded
around the periphery 4 lead
markers spaced at 90°
intervals.
• The apparatus designed
comprises:
• Contact lens localization
device
• Pedestal type of film holder
 MANDIBLE
PA PROJECTION
Forehead and nose Chin and nose
• Rami and lateral portion • Frontal view of the
of the body. body.
• CR perpendicular to tip of • For the mentum of the
nose. mandible.
• For general survey of the
mandible
• CR perpebdicular to lips

CR perpendicular to glabella
Demonstrates condylar process
 MANDIBLE
PA PROJECTION
Forehead and nose Chin and nose
• Mandibular Rami • Mandibular Body
• Mentum
 MANDIBLE
PA AXIAL PROJECTION
Forehead and nose Chin and nose
• Mandibular Body • Mandibular Body
• Mandibular Rami • TMJ
• CR 20°-25° cephalad to • 30° cephalad between
exit at acanthion. TMJs
• Well visualized • Mandibular body and
elongated view of the TMJs
head of the mandibular
condyles.
 MANDIBLE
PA AXIAL PROJECTION
Forehead and nose Chin and nose
 MANDIBLE
AXIOLATERAL PROJECTION

1. Head in true lateral position • 25° cephalad to pass

• RAMUS directly through the
mandibular region of
interest.
2. 10° to 15° rotation
• The goal of this
• GENERAL SURVEY projection is place the
desired portion of the
3. 30° rotation mandible parallel with
• BODY the IR.

4. 45° rotation
• SYMPHYSIS MENTI
 MANDIBLE
AXIOLATERAL PROJECTION
 MODIFIED TOWNE’S METHOD

CENTRAL RAY:
• 35° caudad to OML
• 42° caudad to IOML
• To 3 inches above the
nasion
• Axial image of the
condyloid process of the
mandible and mandibular
fossae of the temporal
bones.
 MANDIBLE
SUBMENTOVERTEX PROJECTION
• Head resting on vertex
• Perpendicular to IOML to
a point midway between
angles of mandible (1 ½ -
2 inches inferior to
mandibular symphysis)
• Demonstrate the
mandibular condyles
anterior to pars petrosa
• Demonstrate the
HORSE-SHOE SHAPED
mandible bone.