PARA NASAL SINUSES.

PNS
• Paranasal sinuses are air filled cavities within the bones of the skull
and have a communication with the nasal cavity.
• They appear of higher radiographic density than other tissues since
air offers little attenuation to the x-ray beam.
• If the sinuses are filled with fluid due to pathology this will lead to a
decrease in density.
• Frontal sinuses: paired
structures located within the
frontal
bone adjacent to the fronto-
nasal articulation. They are very
variable in size, and in some
individuals they may be absent
Ethmoid sinuses: a labyrinth of
small air spaces that collectively
form part of the medial wall of
the orbit and the upper
lateral walls of the nasal cavity.
• Sphenoid sinuses: structures that
lie immediately beneath
the sella turcica and posterior to the
ethmoid sinuses.
Maxillary sinuses (maxillary
antra): paired, pyramidal shaped
structures located within the
maxillary bone either
side of the nasal cavity. They are
the largest of the sinuses.
Clinical indications
• Inflammatory conditions; sinusitis, secondary osteomyelitis.
• Sinus polys and cysts.
Exposure factors
• A small focal spot for maximum detail.
• Short exposure time.
• SID 100CM
• IR size- (18×24)cm
• Grid /grid cassette.
• Analog 70 – 80 Kvp range (textbook of radiographic positioning)
• Digital 75- 90 Kvp range
Patient preparation
• Identify patient by name.
• Create rapport.
• Explain procedure to the patient.
• Instruct patient to remove radiopaque
materials from the head and neck.
• Armor the patient in a lead down to
protect the trunk from divergent rays.
• Position the patient.
• Collimate to area of interest and make
the exposure .
Radiation protection
• Dress patient in lead apron.
• Direct primary beam away from
the public.
• Close the door during the
exposure.
• Collimate only to include area of
interest.
• Use appropriate exposure
factors and proper positioning to
avoid double exposure.
OCCIPITAL MEATAL PROJECTION(PARIETOACANTHIAL
PROJECTION,WATERS METHOD.
• Patient is seated facing the vertical Bucky.
• Patients nose and chin are placed in the midline of the
vertical Bucky.
• Head is then adjusted to bring the occipital- meatal
baseline to 45⁰ to the vertical Bucky.
• The horizontal central line of the Bucky should be at the
lower orbital margin.
• Ensure that the median sagittal plane is at right angles
to the Bucky making the external auditory meatuses
equidistant.
• Instruct the patient to open the mouth during exposure.
(this projects the posterior part of the sphenoid sinuses through the mouth).
• Horizontal central ray is directed perpendicular to IR to exit at the acanthion.
Evaluation of image
• Petrous ridges must appear
below the floor of the maxillary
sinuses.
• Sphenoid sinuses visualized
through the open mouth.
• There should be no rotation.
(distance from the lateral orbital
wall to the outer skull margin
must be equidistant.)
 PA (CALDWELL METHOD). Frontal and ethmoid sinuses.
• Patient is seated facing vertical Bucky with
median sagittal plane coincident with midline of
vertical Bucky.
• Head is positioned so that orbital-meatal
baseline is raised 15⁰ to the horizontal.
• Ensure that the nasion is at the Centre of the
Bucky.
• Patient may place palms of each hand on either
side of the head or stability.
• Central ray is directed perpendicular to the
vertical Bucky so that it exits at the nasion.
Evaluation of image
• Frontal and ethmoid sinuses
should be included in the image.
• Petrous sinuses should be
projected just above the lower
orbital margin.
Lateral projection
• Patient sits/stands facing the Bucky
and the head is rotated so that the
median sagittal plane is parallel to the
midline of the vertical Bucky.
• Shoulder may be rotated slightly for
support.
• Bucky height is adjusted so that it’s
center is along the orbital meatal line.
• Direct horizontal beam to appoint
midway between the outer canthus
and external auditory meatus.
 Evaluation of image
• All four paranasal sinus
groups are demonstrated.
• Density and contrast should
be sufficient to demonstrate
sphenoid sinus through the
cranium.
• Sharp bony margins indicate
no motion.
Submentovertex projection
• Patient is standing or seated near the vertical
Bucky with the back facing the Bucky.
• Raise chin, hyperextend the neck until the
OML(orbital-meatal line) is parallel to the IR.
• Align MSP(median sagittal plane) perpendicular to
midline of the grid.
• Central ray is directed perpendicular to OML
midway between the mandibular angles at a
point 2 inches below the mandibular symphisis.
Evaluation of image
• Ethmoid ,maxillary sand
sphenoid sinuses are
demonstrated.
THANK YOU FOR LISTENING
• REFERENCES.
• TEXTBOOK OF RADIOGRAPHIC POSITIONING AND RELATED ANATOMY.
• CLARKS POSTIONING ON RADIOGRAPHY.12TH EDITION.