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

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Presentation on theme: "RADT 1542 SKULL RADIOGRAPHY Wynn Harrison, Med, RT(R)(N)"— Presentation transcript:

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

2 What a Bad Day!!!!

3 Section 1: The Cranium  New Words:  HEMANGIOMA: tumor containing blood vessels and fibrous tissue  TRAUMATIC PNEUMOCEPHALUS: injury causing gas/air in the extracranial cavity

4  HYDROCEPHALUS: increased cerebrospinal fluid in the ventricles  PAGET’S DISEASE: overproduction of bone  CRANIOTOMY: Incision into the head

5  SUBDURAL HEMATOMA: Blood collected beneath the dura  TERATOMA: Congenital tumor containing 1+ embryonic germ layers (hair/teeth/skin may be present)

6  ENCEPHALITIS: Inflammation of the brain  GLIOMA: Primary tumor of the brain  MENINGIOMA: Slow growing benign tumor in the meninges

7  ACOUSTIC NEUROMA: Benign tumor involving hearing  CRANIO-PHARYNGIOMA: Benign tumor above the sella turcica  CONCUSSION: Impact injury

8  ANENCEPHALUS: Congenital absence of the brain  ACEPHALUS: Absence of head  MICROCEPHALIC: Small head  BURR HOLES: Holes bore into skull for pressure relief

9 Why Dogs Bite Their Owners

10 POSITIONING CONCERNS  Some people don’t like to have their face touched  Wash your hands FIRST  CLEAN BUCKY or TABLE (and have them watch you)  Remember body habitus The body is attached to the head!!!! The body is attached to the head!!!!

11 Lines/Landmarks/Planes  Median saggital  Coronal

12 Composition  Composed of 22 Bones Eight Cranial Bones Eight Cranial Bones Fourteen Facial Bones Fourteen Facial Bones

13 Radiographic Landmarks  Glabella: Triangular area between and slightly superior to the eyebrows and above the bridge of the nose  Nasion: Depression at the bridge of the nose Junction of the two nasal bones and the frontal bone Junction of the two nasal bones and the frontal bone

14 Radiographic Landmarks  Inner Canthus: Where the eyelids meet near the nose  Outer Canthus: Lateral junction of the eyelids  Acanthion: Midline point at the junction of the upper lip and the nasal septum. Point where the nose and the upper lip meet

15 Radiographic Landmarks  Gonion: Angle of the mandible (Jaw)  Mental Point: A triangular area projects forward as the chin (mentum). The center of the mentum is the mental point

16 Radiographic Landmarks  EAR Auricle/Pinna: External portion of the ear. Large flap of ear made of cartilage Auricle/Pinna: External portion of the ear. Large flap of ear made of cartilage TEA: Top of the ear attachment. Superior attachment of the auricle. Level of the petrous ridge on each side TEA: Top of the ear attachment. Superior attachment of the auricle. Level of the petrous ridge on each side

17 Radiographic Lines  Radiographic lines are important to skull positioning  Certain lines are formed from anterior structures on the face and connect to the EAM  EAM: External acoustic (auditory) meatus, Opening of the external ear canal

18 Radiographic Landmarks  Eye Supraorbital Margin (SOML): Superior rim of the bony orbit of the eye Supraorbital Margin (SOML): Superior rim of the bony orbit of the eye Infraorbital Margin (IOML): Inferior rim of the bony orbit of the eye Infraorbital Margin (IOML): Inferior rim of the bony orbit of the eye Midlateral Orbital Margin: (OML) Portion of the lateral rim near the outer canthus of the eye Midlateral Orbital Margin: (OML) Portion of the lateral rim near the outer canthus of the eye

19 Radiographic Lines  Orbitomeatal Line (OML): Located between the outer canthus (midlateral orbital margin) and the EAM  Infraorbitomeatal Line (IOML): Formed by connecting the middle of the infraorbital margin to the EAM

20 Radiographic Planes  Interpupillary Line (IPL): A line connecting either the pupils or the outer canthi of the patient’s eyes A line connecting either the pupils or the outer canthi of the patient’s eyes The IPL must be exactly perpendicular to the IR in a TRUE LATERAL position The IPL must be exactly perpendicular to the IR in a TRUE LATERAL position

21 Talk about TOO MUCH RAIN~

22

23 Radiographic Landmark  Inion or EOP: External occipital protuberance External occipital protuberance Rise or bump along the midline of the lower back of the head near the junction of the head and neck Rise or bump along the midline of the lower back of the head near the junction of the head and neck Extension of the IOML posteriorly approximates the location of the inion Extension of the IOML posteriorly approximates the location of the inion

24 Radiographic Landmark  Vertex Top portion of the head Top portion of the head

25 Sutures of the Skull  Joints formed between the cranial bones are known as sutures  Fibrous connective tissue hold bones tightly together  Synarthrodial – Don’t permit movement

26 Sutures of the Skull  Coronal Suture:  Sagittal Suture:  Lambdoidal Suture:  Squamosal Suture:

27 Arthrology  Temporomandibular Joint: Only movable joints in the cranium Only movable joints in the cranium Formed by the mandibular fossa on each temporal bone with corresponding condyle of the mandible Formed by the mandibular fossa on each temporal bone with corresponding condyle of the mandible

28 Fontanels  Soft spots  Present at birth  Unossified connective tissue  Where three or more bones ajoin  Six Fontanels  Gradually replaced with bone  Allow for skull compression during birth  Most prominent are the anterior and posterior fontanels  Located on the anterior and posterior ends of the sagittal suture

29 Fontanels  Articulation between the frontal and both parietal bones at the anterior end of the sagittal suture is the bregma  Articulation between the occipital bone and both parietal bones at the posterior end is the lambda  Anterolateral (sphenoid) fontanel is the pterion  Posterolateral fontanel is the asterion

30 Fontanels

31 Fontanels

32 Fontanels

33 Calvarium  Skull Cap  Composed of four bones Frontal bone Frontal bone Right Parietal bone Right Parietal bone Left Parietal bone Left Parietal bone Occipital bone Occipital bone

34 Calvarium

35 Calvarium

36 Cranial Floor  Composed of four bones Ethmoid bone Ethmoid bone Sphenoid bone Sphenoid bone Right Temporal bone Right Temporal bone Left Temporal bone Left Temporal bone

37 Cranial Floor

38 Skull Morphology  Mesocephalic: Average shaped head, the petrous ridges lie at a 47 degree angle with the MSP  Brachycephalic: Short, broad, shallow head. Petrous ridges form a 54 degree angle with the MSP  Dolichocephalic: Long, narrow, deep head. Petrous ridges form a 40 degree angle with the MSP

39 Occipital Bone

40

41 Sphenoid Bone  Location and purpose Midline of cranial floor Midline of cranial floor Anchor to hold the 8 cranial bones together Anchor to hold the 8 cranial bones together Articulates with all cranial bones Articulates with all cranial bones Forms the base of skull, small portion of each lateral wall, and posterior wall of each orbit Forms the base of skull, small portion of each lateral wall, and posterior wall of each orbit

42 Sphenoid Bone  Bat shaped  Composition Body Body Paired lesser wings and greater wings Paired lesser wings and greater wings Pterygoid processes Pterygoid processes  Body Central portion of the bone Between the ethmoid and occipital bones Anterior surface forms posterior wall of nasal cavity Body is hollow and enclosed with air – filled sphenoid sinuses

43 Sphenoid Bone  Body of sphenoid Sella Turcica Sella 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 exam by centering ¾ inches anterior and ¾ superior to the EAM on a lateral projectionSella turcica is localized for a radiographic exam by centering ¾ inches anterior and ¾ superior to the EAM on a lateral projection

44 Body of Sphenoid  Dorsum Sellae: is the posterior portion of the sella turcica  Posterior Clinoid Processes: Extend superiorly from the lateral margin of the dorsum sellae  Optic Groove: Depression that runs horizontally across the body  Optic Chiasm: Formed by crossing of the optic nerves, situated in the optic groove

45 Sphenoid Bone  Lesser Wings of the Sphenoid Extends laterally and horizontally across the anterosuperior aspect of the body Extends laterally and horizontally across the anterosuperior aspect of the body Junction at the midline is the sphenoid ridge Junction at the midline is the sphenoid ridge Anterior clinoid processes extend from the posterior portion of each lesser wing Anterior clinoid processes extend from the posterior portion of each lesser wing

46 Sphenoid Bone  Greater Wings of Sphenoid Posterior to the lesser wings Posterior to the lesser wings Arise from the lateral surfaces of the body and extend outward Arise from the lateral surfaces of the body and extend outward Openings on each greater wing serve as passageways for the nerves and blood vessels supplying the orbits and face Openings on each greater wing serve as passageways for the nerves and blood vessels supplying the orbits and face

47 Sphenoid Bone

48  Pterygoid Processes Extensions of bone from under the sphenoid bone at the junction of the body and greater wings Extensions of bone from under the sphenoid bone at the junction of the body and greater wings Articulates anteriorly with the palatine bone and vomer Articulates anteriorly with the palatine bone and vomer Comprised of two plates of bone fused together Comprised of two plates of bone fused together Medial plate is called the pterygoid hamulus because it has a small hook – like process Medial plate is called the pterygoid hamulus because it has a small hook – like process

49 Sphenoid Bone

50

51 Sella Turcica Sphenoid Bone

52 Temporal Bones

53  Named for the region around the temples  Location Below the parietal bone Below the parietal bone Articulates with the greater wing of the sphenoid and the occipital bones Articulates with the greater wing of the sphenoid and the occipital bones  Contains 4 Regions Squamous Tympanic Mastoid Petrous

54 Temporal Bones

55

56

57 Group Photo Anyone?

58 AP and PA projections  Petrous pyramids fill the orbit if there is no angulation  Petrous pyramid will lie in lower 1/3 of orbit with 15 degree angulation  if AP is it caudal or cephalic?

59 ROUTINE PROCEDURES AP View OML and sagittal plane perpendicular to the cassette OML and sagittal plane perpendicular to the cassette Petrous pyramids fill Petrous pyramids fill the orbits the orbits

60 AP Axial (Townes) OML = 30 degrees OML = 30 degrees IOML = 37 degrees IOML = 37 degrees Posterior clinoids Posterior clinoids HAAS is reverse Townes view HAAS is reverse Townes view

61 PA Skull  OML = perpendicular to cassette  0 degree angulation  Petrous pyramids fill the orbits

62 PA Caldwell  Patient PA with 12 – 15 degree caudal angulation of CR  CR exits nasion  Petrous pyramids in bottom 1/3 of orbit

63 Lateral Skull  Interpupillary line perpendicular to cassette  Midsagittal plane parallel to cassette (Look at patient body habitus)

64 Submentovertex (SMV)  IOML parallel to cassette  Midsagittal plane perpendicular to cassette

65 Positioning Errors Rotation occurs when the median Saggital plane is not parallel to the film. Rotation occurs when the median Saggital plane is not parallel to the film.  

66

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

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70 Trauma and Pathology

71

72

73 Golf club Golf club

74 Paget’s Disease

75 Pituitary tumor

76 Film critique

77 Critical thinking


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