SKULL SERIES

Routine
AP Projection CR perpendicular
to IR directed to
NASION

AP Axial TOWNE IR 10X12 CR 30 caudad to For skull Dorsum sellae shown within
inches LW OML fractures, the foramen magnum
CR 37 caudad to neoplastic
IOML processes, and Entire skull visualized
PAGET Disease
2 ½ inches
above
GLABELLA

AP Axial TOWNE

TRAUMA
Right Lateral IR 10X12 MSP Parallel For skull Entire skull visualized
inches CW Interpupillary fractures,
perpendicular neoplastic
CR 2 inches processes, and
superior to the PAGET Disease
EAM

Lateral IR 10X12 Horizontal beam Entire skull visualized

inches CW projection
TRAUMA

CR 15 caudad
PA axial Caldwell IR 10X12 exiting the For skull fractures Petrous ridges over lower
inches LW NASION (medial and 1/3 of orbits- 15 Caldwell
lateral
CR 20- 25 displacement)
caudad direct to neoplastic
mid orbits- for processes, and
visualization of PAGET Disease
superior orbital
fissures.

CR 25 to 30
caudad exit at
nasion –
rotundum
foramina

PA 0 IR 10X12 CR perpendicular Frontal Bone demonstrated

inches LW to IR to exit at Petrous ridges over supra
GLABELLA orbital margin
PA skull IR 10X12 CR perpendicular
TRAUMA inches LW to IR to exit at
GLABELLA

AP TRAUMA 0
IR 10X12 CR parallel to Entire skull visualized
inches LW OML, directed to
the GLABELLA

SMV- CR perpendicular Entire skull visualized

SCHULLER IR 10X12 to IR, directed 1
inches LW ½ inch inferior the Mandibular condyles
mandibular anterior to Petrous pyramids
symphysis

Vertico submental CR directed

projection- IR 10X12 through the Sella
SHULLER inches LW turcica
perpendicular to
IOML, passing to
a point ¼ of an
inch anterior to
the level of the
EAMS
 Similar to AP axial
PA Axial- HAAS IR 10X12 OML except,
inches LW perpendicular
Dorsum sellae
CR 25 appears
CEPHALAD to larger within
exit 1 ½ inch foramen
superior to magnum
NASION
Magnification of
occipital
bone evident

SELLA
TURCICA

Lateral 8x10 or CR ¾ inch (2cm) Sella Turcica and Clivus

10x12 ANTERIOR ¾ inch in profile
CW and (2cm) superior
to EAM Anterior and posterior
clinoid processes
superimposed

Greater and lesser wings

of sphenoid each
superimposed

30- dorsum and

AP Axial IOML Perpendicular tuberculum sellae,
anterior clinoid
CR 30 OR 37 processes through
CAUDAD, 1 ½ inch occipital bone above
(4cm) above level of the foramen
SUPERCILIARY magnum
ARCH at midsagittal
plane 37- dorsum sellae and
posterior clinoid
processes within the
foramen magnum
Facial Bones
and Paranasal
sinuses
*Erect position, air fluid Fractures and neoplastic or inflammatory
Lateral CR perpendicular, level shown processes of the facial bones, orbits, and
8x10 centered to mandible
LW ZYGOMA Zygomatic Bones
demonstrated

Parietoacanthial 8X10
WATERS OR MML perpendicular
10X12 to IR
LW
CR perpendicular to
IR to exit at
ACANTHION

Parietoacanthial – Petrous ridges projected in lower 1/3 of

8X10 LML perpendicular maxillary sinuses
Modified OR to IR
WATERS 10X12
LW OML 55 angle to IR
“SHALLOW
WATERS” CR perpendicular
exits at acanthion
 8X10
Acanthioparietal OR PX unable to do prone Facial Bones Demonstrated
10X12 position
REVERSE LW
WATERS

TRAUMA

PA Axial- 8X10 Fractures and

CALDWELL OR OML perpendicular Petrous ridges projected Neoplastic or inflammatory processes of
10X12 to IR into lower 1/3 of orbits the facial bones
LW
CR 15 Caudad
exits at NASION

NASAL BONE
ROUTINE
8x10 Nasal bone fractures
Lateral CW Interpupillary line
perpendicular to IR

CR perpendicular
centered to ½ inch
inferior to nasion
Superoinferior 8x10 IR perpendicular to Nasal bones Fractures of the NASAL BONE (medial
Tangential AXIAL CW GAL demonstrated lateral displacement)

CR parallel to GAL

Tangential CR parallel to Medial or lateral

glabello alveolar line displacement of
and perpendicular to fragments in fractures
image receptor demonstrated

ZYGOMATIC
ARCH ROUTINE
Fractures of Zygomatic arch
SMV- 8x10 CR perpendicular to Zygomatic arches Neoplastic or inflammatory processes
submentovertical /10x12 IOML demonstrated
Cheek bones CW
IOML is parallel to
IR

IOML parallel to IR Zygomatic arches

Oblique 8x10 demonstrated
Inferosuperior – CW Rotate and tilt skull
TANGENTIAL 15 toward affected
side

CR perpendicular to
IR and IOML

CR to arch of
interest
AP axial – 8x10 CR 30 to OML or Zygomatic arches Fractures and Neoplastic or
MODIFIED CW 37 to IOML Demonstrated inflammatory processes of zygomatic
TOWNE arch
1 inch superior to
glabella (to pass
through mid-arches)

Tangential- MAY Rotate midsagittal CR perpendicular to Demonstrates Zygomatic arch free of

METHOD plane 15 away from IOML and through the superimposition
the side being zygomatic arch to a
Can be done examined- Then tilt point 1 ½ inches Helpful for px with flat cheekbones or
prone the top of the head posterior to the outer who have depressed fractures.
away from the side canthus
being examined
15

OPTIC
FORAMINA

RHESE- Parieto- 8x10 MSP 53 to IR Optic foramen in lower Bony abnormalities of optic foramen
Orbital Oblique CW outer quadrant Lateral margins of orbits and foreign
AML Perpendicular bodies in the eye demonstrated
Bilateral taken for to IR
comparison
CR perpendicular
to downside Orbit

Orbitoparietal MSP forms a 53

Oblique – RHESE angle to the plane of
the IR

AML perpendicular
to the IR
 CR perpendicular
entering
uppermost orbit at
its inferior and
lateral quadrant
Parietoacanthial-
Modified waters CR perpendicular
through the mid-
orbits

Ask px to close eyes

and to hold them still
for exposure
PA Axial- CR center of orbits Petrous portions of the
CALDWELL at a CAUDAL temporal bones below
angulation of 30 the inferior margin of the
orbits demonstrated
Ask px to close eyes
and to hold them still
for exposure
Lateral- R+L CR perpendicular Projection showing foreign body as a white
position through the outer speck
Canthus

Ask px to look
straight ahead for
the exposure

PA axial BERTEL CR 20- 25 Each orbital floor and inferior orbital fissure
CEPHALAD and demonstrated between the shadows of the
exiting NASION lateral PTERYGOID lamina of the sphenoid
bone and the condylar process of the
CR entering midline mandible
3 inches below
external occipital
protuberance
MANDIBLE
Head in true lateral Methods to minimize Fractures and neoplastic or
Axiolateral position superimposition of inflammatory processes of mandible
Oblique demonstrates opposite mandibular
Ramus body: Both sides of mandible examined for
comparison
30 rotation Employ a combination tilt
towards IR on the head and CR
demonstrates body angle not to exceed 25.
(Example: Angle the CR
45 rotation 10 and add 15 of head
demonstrates tilt)
MENTUM
Employ 25 cephalad
10- 15 rotation angle toward the IR with
shows general NO head tilt.
survey of the
mandible

Horizontal Beam CR 25 Cephalad

TRAUMA and 5-10 posterior

PA and PA Axial OML perpendicular

8x10 or to IR
10x12
LW CR perpendicular to
exit at LIPS

Optional PA Axial:
CR 20-25
Cephalad to get a
better view of
Condyles (heads)
and neck.

AP Axial 8x10 or OML or IOML

10x12 perpendicular to IR
 LW
CR 35 (OML) to 42
(IOML) Caudad,
centered to Glabella

SMV mandible 8x10 or IOML parallel to IR

10x12
LW CR perpendicular
to IOML, directed
midway between
mandibular angles

Coronoid processes
Verticosubmental CR directed through easily visible on either
Projection the midsagittal plane image
and entering at the
level just posterior to Condyle and neck of
the outer canthi, condylar processes
perpendicular to better shown with greater
either the IOML or angle i.e., with the
the occlusal plane central ray at right angle
to the occlusal plane

TMJ- Temporo
Mandibular Joint
 OML perpendicular Mandibular condyles and Fractures and abnormal relationship of
Ap Axial 8x10 to IR mandibular fossae of the range of motion between condyle and TM
MODIFIED CW temporal bones fossa
TOWNE CR 35 caudad at demonstrated
level of TMJ which
is 2 inches anterior
to EAM and 3
inches superior to
nasion
Axiolateral
Oblique- 8x10 Rotate skull 15
MODIFIED LAW LW toward IR
METHOD
CR angled 15
Bilateral, caudad, directed 1
functional study ½ inch superior to
TMJ and fossa upside EAM

TMJ closest to IR
Axiolateral TMJ 8x10 True lateral in open demonstrated
SCHULLER LW and closed mouth
positions
Bilateral,
functional study CR angled 25-30
TMJ and fossa Caudad, entering ½
inch anterior and 2
inches superior to
Upside EAM

Inferosuperior Patient semi-prone

Transfacial or seated

IPL 10-15 from

vertical
 MSP 15

CR 30 Cephalad to
uppermost Gonion

SS-TMJ
Paranasal
Sinuses
Inflammatory All four sinuses demonstrated
Lateral 8x10 CR midway between conditions- sinusitis,
LW outer CANTHUS secondary
and EAM osteomyelitis

Sinus polyps or cysts

PA- Caldwell OML perpendicular Inflammatory

Sinuses 8x10 to IR 15 tilt conditions- sinusitis,
LW secondary
Horizontal CR, osteomyelitis
exiting at Nasion
Sinus polyps or cysts

Frontal and ethmoid sinuses

demonstrated

Petrous Ridges in lower 1/3 of orbits

 Maxillary sinuses
Parietoacanthial 8x10 or MML perpendicular demonstrated
WATERS 10x12 to IR
LW No rotation of cranium
CR horizontal to exit
at Acanthion Petrous ridges below
maxillary sinuses

SMV Sinuses 8x10 or IOML parallel to IR Mandibular condyles

10x12 anterior to petrous
LW Horizontal CR, ridges
between angles of
Mandible No rotation or tilt

PA Transoral 8x10 or MML perpendicular Sphenoidal sinuses

Waters 10x12 to IR projected including
LW maxillary sinuses
Open mouth CR horizontal to exit demonstrated
at ACANTHION

Open mouth

-Sphenoid sinus visualized

-Frontal and maxillary sinuses included
-Petrous ridges below maxillary sinuses
Temporal Bone

Axiolateral CR 15 Caudad and -Mastoid cells

Oblique 15 Anteriorly
ORIGINAL LAW -Lateral portion of the
METHOD It enters 2 inches petrous pyramid
posterior to and 2
Double tube inches above the -Super imposed
angulation uppermost EAM and internal acoustic
exits downside meatus (IAM) and EAM
mastoid process and when present the
mastoid emissary
Auricles of ears vessel demonstrated
folded forward
Axiolateral Rotate patients head Structures Shown:
Oblique toward the IR until
projection- midsagittal plane is -Mastoid cells
Modified LAW adjusted to an angle -Lateral portion of the
of 15 petrous pyramid
Single Tube
angulation CR 15 Caudad to -The superimposed
exit the DOWNSIDE IAM and EAM and
Tape each auricle mastoid tip 1 inch when present the
forward with posterior to EAM mastoid emissary
narrow strip vessel
adhesive tape The CR enters 2
inches posterior to
and 2 inches
superior to
uppermost EAM
-Mastoid cells
Axiolateral 15 Caudad to exit -Mastoid antrum
Projections- the EAM closest to -IAM and EAM
HENSCHEN IR demonstrated

Recommended for
demonstrating tumors of
the acoustic nerve
Axiolateral 25
Petromastoid -Pneumatic Structure
portion: of the mastoid process
SCHULLER
-Mastoid antrum

-IAM and EAM, the

sinus and sural plates

-When present the

mastoid emissary
vessel
Axiolateral 35 -Mastoid cells
Petromastoid -Mastoid antrum
portion: -EAM
LYSHOLM -Labyrinthine area
Aka Runstrom II -Carotid Canal
method demonstrated
Axiolateral CR directed 12
oblique – cephalad Profile image of the
STENVERS Petromastoid portion
method CR enters 3 to 4 closest to the IR
Posterior profile inches posterior and
½ inch inferior to the
upside EAM and
exits 1 inch anterior
to downside EAM

Axiolateral For children or adults

Oblique- CR 10 Caudad who can’t go into prone Exact revers of Stenvers method
ARCELIN or seated position
METHOD Petrous portion of the temporal bone
Anterior Profile This projection is exact farthest from IR demonstrated
opposite of stenvers
method and the
petromastoid portion is
more magnified

Axiolateral CR 45 Caudad to

Oblique- MAYER exit the EAM An axiolateral oblique
METHOD closest to IR projection of the
petrosa in the direction
of its long axis
demonstrated the EAM,
tympanic cavity and
ossicles, epitympanic
recess, aditus and
mastoid antrum closes
to the IR

AP Axial- CR 30 caudal to

TOWNE OML or 37 to IOML Petrosas projected
CR enters 2 ½ above the base of the
inches above the skull
nasion and passes Internal acoustic canals,
through at the level arcuate eminences,
of EAM labyrinths, mastoid
 antrums and middle ears
demonstrated

Dorsum sellae is seen

within the foramen
magnum

Submentovertical

Structures shown:
HIRTZ CR to a point
modification midway between Symmetric axial
and 1 inch anterior projection of the petrosas
to the EAMs at an demonstrate the mastoid
anterior angle of 5 processes, labyrinths,
EAM, tympanic cavities,
and acoustic ossicles
Styloid Processes

PA Axial CAHOON CR- Nasion at an Demonstrates a

angle of 25 symmetric image of
Cephalad the styloid processes
of the temporal
bones projected
within or just above
the maxillary sinuses

Submentovertical CR 1 inch distal to

Axial KEMP the mandibular
HARPER symphysis at a 20
posterior angle

The central ray

should be parallel to
a line passing
through or just distal
to the EAM

ERASO
MODIFICATION

Jugular Foramina
Axiolateral Oblique CR 12 Caudad to enter Method used to
MILLER METHOD 1 inch directly anterior delineate the
Anterior Profile to and ½ inch inferior to hypoglossal canal in a
the level of the EAM on patient with a
Hypoglossal Canal the side farthest from hypoglossal 12th cranial
the IR nerve tumor

MSP of the head 45

away from the side
being examined