Chapter 11- Skull

-Which one of the following bones is not part of the floor of the cranium...

A. Temporal..
B. Ethmoid...
C. Occipital...
D. Sphenoid ANS- Occipital

-Which aspect of the frontal bone is thin-walled and forms the forehead ANS-
squamous

-What four cranial bones articulate with the frontal bone ANS- right parietal, left
parietal, sphenoid, and ethmoid

-Which structures are found at the widest aspect of the skull ANS- parietal tubercles
of two parietal bones

-What is the name of a prominent landmark (or bump) found on the external surface
of the occipital bone ANS- external occipital protuberance (inion)

-List the number of individual bones that articulate with the following cranial bones...

Parietal bone...
Occipital bone...
Temporal bone..
Sphenoid...and
Ethmoid ANS- 5 for parietal..
6 for occipital..
3 for temporal..
7 for sphenoid..and
2 for ethmoid

-What is the thickest and densest structure in the cranium ANS- petrous portion

-True or False: The hypophysis is another term for the pituitary gland ANS- True,
hypophysis cerebri

-True or False: The sphenoid bone articulates with all the other cranial bones ANS-
true

-The shallow depression just posterior to the base of the dorsum sellae and anterior
to the foramen magnum is the ANS- clivus

-What is the name of the paired collections of bone found inferior to the cribiform
plate that contain numerous air cells and help form the lateral walls of the nasal
cavity ANS- lateral labyrinth
-Which small section of the bone is located superior to the cribiform plate ANS-
crista galli

-What is the formal term for the left sphenoid fontanel in the adult ANS- left pterion

-What is the name of the cranial suture formed by the inferior junction of the parietals
to the temporal bones ANS- squamosal suture

-What are the two terms for the small, irregular bones found in the adult skull sutures
ANS- sutral, or wormian

-These following bones are within what structure....

pterygoid hamulus, anterior clinoid processes, foramen ovale, and sella turcica
ANS- sphenoid

-These following bones are within what structure....

glabella and supercilliary arch ANS- frontal

-These following bones are within what structure....

perpendicular plate, superior nasal conchae, and cribiform plate ANS- ethmoid

-These following bones are within what structure....

foramen magnum, lateral condylar portions, and inion ANS- occipital

-These following bones are within what structure....

zygomatic proces, EAM, and petrous ridge ANS- temporal

-Which one of the following skull classifications applies to a skull with an angle of 54
degree between the midsagittal plane and the long axis of the pars petrosa ANS-
brachycephalic

-Which of the preceding classifications is considered the average-shaped skull

ANS- mesocephalic

-What landmark corresponds to the highest level of the petrous ridge ANS- TEA

-What is also known as the large cartilaginous aspect of the external ear ANS-
pinna

-Reid's base line is an older term for ANS- IOML

-How much of a difference in degrees is there between the OML and IOML ANS- 7
to 8 degree difference
-Which one of the following positioning errors frequently results in a repeat exposure
of a cranial position...

A. Rotation..
B. Incorrect CR placement..
C. Slight flexion..
D. Slight extension ANS- rotation

-Bone tumor originating in the bone marrow ANS- multiple myeloma

-Fracture evident by sphenoid sinus effusion ANS- basal fracture

-Condition that begins with bony destruction followed by bony repair ANS- Paget's
disease

-Destructive lesion with irregular margins ANS- osteolytic neoplasm

-Fracture of the skull with jagged or irregular lucent line that lies at a right angle to
the axis of the bone ANS- linear fracture

-Tangential view may be helpful to determine extent or degree of this fracture ANS-
depressed fracture

-What clinical indication may require a decrease in manual exposure factors ANS-
multiple myeloma

-Which one of the imaging modalities may be used to examine a possible cranial
bleed caused by trauma ANS- CT

-Which one the imaging modalities provides an excellent distinction between normal
and abnormal ANS- MRI

-Which aspect of the temporal bone is considered to be the thinnest ANS-

squamous portion

-Which aspect of the temporal bone contains the organs of hearing and balance
ANS- petrous pyramid or pars petrous

-The correct term for the eardrum is the ANS- tympanic membrane

-Which one of the middle ear structures is considered to be the most lateral....

A. malleus....
B. Incus.....
C. Stapes.....
D. Oval window ANS- malleus

-Which structure helps equalize atmospheric pressure in the middle ear ANS-
eustachian tube
-What passes through the internal acoustic meatus ANS- facial nerve and vestibule
cochlear nerve

-The aditus is an opening between the _________ and the ________ portion of the
temporal bone ANS- epitympanic recess; mastoid

-An infection of the mastoid air cells, if untreated, can lead to a serious infection of
the brain called _____. ANS- mastoiditis

-Which auditory ossicle attaches to the oval window ANS- stapes

-The internal ear is divided into the osseous or bony labyrinth and the ________
labyrinth ANS- membranous

-What are the three divisions of the bony labyrinth of the inner ear ANS- cochlea,
vestibule, and semicircular canals

-A benign, cystlike mass of the middle ear is a(n) ANS- cholesteatoma

-True or False: Otosclerosis is a hereditary disease ANS- true

-Which two projections of the cranium project the dorsum sellae within the foramen
magnum ANS- AP axial Towne and PA axial Haas

-How much central ray angle is required for the AP axial projection Towne method
for skill with the IOML perpendicular to the image receptor.....

What is the central ray angle for this same projection with a perpendicular OML
ANS- 37 degree caudad...

30 degree caudad

-Where is the central ray centered for a lateral projection of the cranium ANS- 2
inches superior to EAM

-To prevent tilting of the skull for the lateral projection of the cranium, the _________
line is placed perpendicular to the IR ANS- interpupillary

-Where should the petrous ridges be located (on the image) for a well-positioned, 25
degree caudad PA axial Haas projection ANS- superior to mastoid processes and
symmetrical

-Where is the central ray centered for an SMV projection of the skull ANS- 1 1/2
inch inferior to mandibular symphysis

-Which positioning line is parallel to the IR for the SMV projection of the skull ANS-
IOML

-SITUATION: A radiograph of an AP axial projection for the cranium reveals that the
dorsum sellae is projected superior to the foramen magnum. What must be modified
during the repeat exposure to correct this problem ANS- increase CR angle
approximately 7 degree caudad

-SITUATION: A radiograph of a lateral projection of the cranium reveals that the

greater wings of sphenoid are not superimposed. What type of positioning error is
present on this radiograph ANS- rotation

-SITUATION: A radiograph of a 15 degree caudad PA axial projection of the cranium

reveals that the petrous ridge are at the level of the supraorbital margin. Without
changing the central ray angle, how must the head position be modified during the
repeat exposure to produce a more acceptable image ANS- increase extension of
the skull to place the OML perpendicular to the IR (will project ridges into lower 1/3 of
orbits)

-SITUATION: A patient with a possible basilar skull fracture enters the emergency
room. The physician wants a projection to demonstrate a possible sphenoid sinus
effusion. Which projection of the cranium is best for this situation ANS- Horizontal
beam (dorsal decubitus) lateral skull projection

-SITUATION: The same patient with the possible basilar skull fracture requires a
frontal projection of the skull. The physician wants the projection to demonstrate the
frontal bone and place the petrous ridges in the lower 1/3 of the orbits, but it has not
been determined whether the patient's cervical spine has been fractured, so the
patient cannot be moved from a supine position. What should the technologist do
ANS- perform the AP projection with a 15 degree cephalad CR angle to the OML

-SITUATION: A patient comes to the radiology department for a skull series.

Because of the size of the patient's shoulders, he is unable to flex his neck
sufficiently to place the OML perpendicular to the IR for the AP axial projection. His
head cannot be raised because of possible cervical trauma. What other options does
the technologist have to obtain an acceptable AP axial projection ANS- use IOML
instead and increase CR angle to an additional 7 degree caudad

-SITUATION: A radiograph of an AP axial Towne projection for cranium reveals that

the posterior arch of C1 and dorsum sellae are superimposed. Both are projected
into the foramen magnum. What modification is needed to correct this error present
on the initial radiograph ANS- decrease CR angle based on the skull line used,
OML 30 degree; IOML 37 degree

-SITUATION: A radiograph of a lateral skull demonstrates that the orbital plates

(roof) of the frontal bone are not superimposed. What is the positioning error present
on this radiograph ANS- tilt of the skull

-SITUATION: A radiograph of an AP axial Townes for cranium reveals that the left
petrous portion of the temporal bone is wider than the right. What is the specific
positioning error present on this radiograph ANS- rotation to the right

-SITUATION: A radiograph of a SMV projection of the cranium demonstrates that

mandibular condyles are projected into the petrous portion (pyramids) of the
temporal bone. How must the position be altered during the repeat exposure to
correct this error ANS- extend the skull further to place the IOML parallel to the IR

-The majority of the hard palate is formed by the ANS- palatine processes of the
maxilla

-Which of the following is not an aspect of the maxilla.

A. Frontal Process.
B. Body.
C. Zygomatic Process.
D. Ramus ANS- Ramus

-Which structure of the facial bone contains four processes ANS- Maxilla

-Which facial bone structure forms the lower, outer aspect of the orbit ANS-
zygomatic bone

-These facial bones lie just anterior and medial to the frontal process of maxilla
ANS- nasal bones

-This facial bone is the unpaired bone in the adult ANS- mandible

-These facial bones is located anteriorly in medial aspect of orbit ANS- lacrimal
bones

-This bone helps to mix air drawn into nasal cavity ANS- inferior nasal conchae

-These bone possess a vertical and horizontal portion ANS- palatine bones

-On average, how many separate cavities make up the frontal sinus? ANS- 2

-True or False: All of the paranasal sinuses are contained within cranial bones,
except the maxillary sinuses ANS- true

-True or False: All of the paranasal sinuses except the sphenoid communicate with
the nasal cavity ANS- false, all of the sinuses communicate with the nasal cavity

-True or False: In general, all the paranasal sinuses are fully developed by the age of
6 or 7 years ANS- False, fully developed in late teens (ethmoid develops last)

-True or False: The frontal sinuses are usually larger in men than in women ANS-
true

-Which aspect of the ethmoid bone contains the ethmoid air cells ANS- anterior,
middle and posterior collections

-The sphenoid sinus lies directly inferior to the ANS- sella turcica
-True or False: Ultrasound of the sphenoid sinus can be performed to rule out
sinusitis ANS- False, CT is used

-Which one of the following imaging modalities best demonstrates bony erosion of
the maxillary sinus resulting from acute sinusitis.

A. CT.
B. MRI.
C. Ultrasound.
D. Conventional radiography ANS- CT

-True or False: Facial bone studies should be performed erect whenever possible
ANS- True

-True or False: A Le Fort fracture produces a "free-floating" zygomatic bone ANS-

False (tripod fracture)

-Which frontal projection of the facial bones best visualizes the region of the maxilla
and orbits ANS- parietoacanthial Waters projection

-Which single projection of the facial bones best demonstrates any possible air-fluid
levels in the sinuses if the patient cannot stand or sit erect ANS- horizontal beam
lateral projection

-Which plane is placed parallel to the IR with a true lateral projection of the facial
bones ANS- midsagittal plane

-What is the angle between the OML and plane of image receptor with a
parietoacanthial Waters projection.

This places what positioning line perpendicular to the IR ANS- 37 degrees;

mentomeatal line

-The C R is centered to exit at the level of the _______ for a well-positioned

parietoacanthial projection ANS- acanthion

-The C R is centered to exit at the level of the _______ for a well-positioned 15

degree PA axial projection of the facial bones ANS- nasion

-Where are the petrous ridges projected for a properly positioned modified
parietoacanthial projection ANS- lower half of the maxillary sinuses

-True or False: The lateral projection of the nasal bones should be performed using a
small focal spot, low to medium kV (analog), and close collimation ANS- true

-True or False: The C R should be angled as needed to be parallel to the

glabellomeatal line for the superoinferior tangential projection of the nasal bones
ANS- true
-Which positioning line is placed perpendicular to the image receptor for a modified
parietoacanthial projection ANS- lips-meatal line

-Where is the C R centered for a lateral projection of the nasal bones ANS- 1/2 inch
inferior to the nasion

-Which positioning line, if placed parallel to the image receptor, ensures adequate
extension of the head for the submentovertex projection for zygomatic arches ANS-
IOML

-How much skull tilt and rotation are required for the oblique inferosuperior tangential
projection for zygomatic arches ANS- rotate head 15 degrees toward side
examined and 15 degrees tilt toward side of interest

-How much C R angle is required for the AP Axial projection of the zygomatic arches
if the IOML is placed perpendicular to the IR ANS- 37 degrees

-The proper method same for the "three-point landing" projection for the optic
foramen is the ANS- Rhese method

-Where should the optic foramen be located with a well-positioned parieto-orbital

oblique projection ANS- in the lower outer quadrant of the orbit

-What is the maximum amount of C R angulation that should be used for an

axiolateral oblique projection of the mandible ANS- 25 degrees

-What factor prevents superimposition of the ramus on the cervical spine for the
axiolateral oblique mandible projection ANS- extend chin

-How much skull rotation from lateral position toward the image receptor is required
for the axiolateral oblique projection specifically for the mentum ANS- 45 degrees

-How much C R angulation should be used for a PA axial projection of the mandible
ANS- 20 to 25 degree cephalad

-What structures are better defined when the C R angulation is increased from 35 to
40 degrees caudad for the AP axial projection of the mandible ANS- TM Fossae

-Where is the C R centered for an SMV projection of the mandible ANS- 1 1/2
inches inferior to mandibular symphysis

-During an orthopantomographic procedure, it is important to keep what positioning

line parallel to the floor ANS- IOML

-What C R angulation is used for the AP axial projection of the TMJ with the OML
perpendicular to the image receptor ANS- 35 degree caudad

-True or False: The modified Law method requires a tube angulation of 25 degree
caudad ANS- False, it is 15 degree caudad
-True or False: The Schuller method requires that the skull be placed in a true lateral
position ANS- True

-True or False: A grid is not required for the lateral projection of the nasal bones
ANS- True

-Where is the C R centered for a lateral projection of the paranasal sinuses ANS-
midway between outer canthus and EAM

-Why should a patient remain in an erect position for at least 5 minutes before sinus
radiography? ANS- to allow time for the thick, gel like fluid to be visualized

-Which routine projection is best for demonstrating the maxillary sinuses ANS-
parietoacanthial Water's method

-Why should a horizontal C R be used for the erect PA Caldwell projection for
sinuses rather than the usual 15 degree caudad angle ANS- To assess air fluid
levels accurately

-A radiograph of a 15 degree PA projection of the facial bones reveals that the

petrous ridges are projected at the level of the midorbital rims. What specific
positioning or CR angling error led to this radiographic outcome ANS- excessive
flexion or insufficient C R angle

-What positioning line should be perpendicular to the image receptor for the parieto-
orbital oblique Rhese method for optic foramina ANS- acanthomeatal line

-A radiograph of lateral position for sinuses reveals that the greater wings of the
sphenoid bone are not superimposed. What specific positioning error is present
ANS- rotation

-SITUATION: A patient with severe facial bone injuries comes into the emergency
room. The patient is wearing a cervical collar and cannot be moved. What type of
positioning routine should be performed for this situation ANS- Trauma horizontal
beam lateral, acanthioparietal reverse waters

-SITUATION: A superoinferior, tangential projection for the nasal bones was taken
with the following analog exposure factors: 8 X 10 inch IR crosswise, 85 kV, 13 mAs,
40 inch SID. The resultant radiograph was unsatisfactory because of the poor
visibility of the nasal bones. Which technical factors should be changed for the
repeat exposure ANS- kV is too high, analog needs to be 50 to 60 kV

-SITUATION: A patient with possible facial fractures, including a possible "blow-out"

fracture to the right orbit, was brought from the emergency room to the radiology
department. What special facial bone projection should be included with the basic
facial bone routine of a lateral, parietoacanthial Waters, and PA axial Caldwell
ANS- Modified Waters method

-SITUATION: A patient with a clinical history of secondary osteomyelitis comes to

the radiology department. Which imaging modalities or procedures can be performed
to demonstrate the extent of damage to the sinuses ANS- CT, lateral, Caldwell,
Waters, and SMV