CRANIUM AND SPINE

FILM ANALYSIS - PACEMAN

Prof Kanaga Kumari Chelliah

BODY PLANES & LANDMARKS

 MSP
 IOL
 Glabella
 Nasion
 Acanthion
 Angle or gonion.
 Mental point
 EAM
 inion
Radiography Positioning Lines
 GML
 IOML
 OML
 AML
 MML
 GAL
 Projections of the Skull
BASIC:
PA 0º
PA axial (Caldwell Method) 15º or 25º to 30º
Lateral
AP axial (Townes Method)

SPECIAL:
Submentovertex (SMV)
PA axial (Haas Method)
PA 0º
 Indication : skull #, neoplastic processes/ metastases,
paget’s disease.
 Patient prone or PA erect nose and forehead against
the bucky.
 Flex neck, align OML perpendicular to IR/table
 Ensure MSP perpendicular to table, check EAMs same
distance from table – to prevent head rotation, or tilt.
 Centre IR to CR
 CR: perpendicular to IR (parallel to OML) and is
centered to exit at glabella.
 Collimate to outer margin of skull
Petrous 0
• Distance from oblique orbital
line to the lateral cranial cortices
on each side are equal.
• Distance from crista galli to the
lateral cranial cortices on each
side are equal.
 Petrous ridge will fill the orbits
and superimposed with superior
orbital margins.
PA CALDWELL

 Patient prone or PA
erect nose and forehead
touching the bucky.
 MSP perpendicular to
table.
 OML perpendicular to
table.
 CR caudally 15 if OML
perpendicular.
 CALDWELL 15
 Cranium is demonstrated
without rotation.
 Distances from the lateral
orbital margin to the lateral
cranial cortices on both sides
are equal.
 Petrous ridges are
demonstrated through the
lower third of the orbits.?-15
 Superior orbital fissure are
demonstrated within the orbits.
 What is the indication the
degree between CR and OML
 Petrous Ridge
 0
 5
 10
 15
PA Cadwell 25 to 30
 TOWNES
MSP perpendicular to IR.

30 º caudad to OML

CR : 6 cm above glabella pass

through 2cm sup. to EAM
 TOWNE’S
 cranium is demonstrated
without rotation.
 distance from the posterior
clinoid process to the lateral
borders of the foreman magnum
on both sides are equal.
 mandibular necks to the lateral
cervical vertebrae on both sides
are equal,
 petrous ridges are symmetrical,
 dorsum sellea is centered within
the foramen magnum.
 TOWNE’S
 Correct CR and neck flexion/extension
 dorsum sellae in the foramen magnum.

 Under angulation –dorsum sellae projected

above the foramen magnum.

 Overangulation-project the anterior arch of C1

in the foramen magnum.
LATERAL

 MSP parallel to IR

 IOL perpendicular to
IR

 CR : Perpendicular 5cm
above EAM
 LATERAL
 cranium, facial bones,
sinuses, and nasal bones are
in a lateral position.

 sella turcica is demonstrated

in profile, and the orbital
roofs, mandibular rami,
greater wings of the
sphenoid, external acoustic
canals, zygomatic bones, and
cranial cortices are
superimposed.
 LATERAL
 posteroinferior occipital bone and
posterior arch of the atlas are free of
superimposition.

 an area 2 inches (5cm) superior to

the EAM is centered within the
collimated field.

 Outer cranial cortex is included

within the field.
SMV
 Position :Seated
 MSP perpendicular to
IR.
 IOML parallel to IR
 CR : perpendicular to
IOML
 2 cm ant to EAM
midway between angle
of mandible
 SUBMENTOVERTEX
 Equal distance bilaterally from mandibular
condyle to lateral edge of skull.

 Correct extension of neck.

 IOML and CR relationship-mandibular condyle

anterior to petrus pyramid.

 Frontal bone and mandibular symphysis

superimposed.
SUBMENTOVERTEX

 Inadequate angulation
 SMV

 Overangulation  Underangulation
PARIETOACANTHIAL (WATERS)
 Patient prone or erect.
 MSP at the midline.
 Hands by the side.
 Head extended and tip
of the chin rest on the
bucky.
 OML 37º to IR.
 MML perpendicular to
bucky.
 CR : perpendicular to
acanthion.
 WATERS (PARIETOACANTHIAL)
 cranium is demonstrated
without rotation.

 distances from the lateral

orbital margin to the lateral
cranial cortex

 distance from the bony

nasal septum to the lateral
cranial cortex on the both
sides are equal.
 WATERS (PARIETOACANTHIAL)
 petrous ridges are
demonstrated inferior to the
maxillary sinuses and extend
laterally from the posterior
maxillary alveolar process.

 bony nasal septum is aligned

with the long axis of the
collimated field, and the
infroorbital margins are
demonstrated on the same
horizontal plane.
 WATERS (PARIETOACANTHIAL)
 anterior nasal spine is at the
center of the collimated field.

 frontal and maxillary (and

sphenoid on the open-mouth
position) sinuses and the
lateral cranial cortices are
included within the field.
MODIFIED WATERS
(PARIETOACANTHIAL)

LESS FLEXION OF NECK

Projections (facial bones)

 Parietoacanthial (Waters method)

 PA 15° (Caldwell method)
 Lateral

Special projection
 Modified Parietoacanthial (modified Waters
method)
Lateral Facial Bones

 Lateral aspect of head (side of interest) againts

table.
 Adjust head into a true lateral position,(oblique
body for patient’s comfortable).
 MSP parallel to tabletop
 Interpupillary line perpendicular to IR
 External occipital protuberence and the
nasion/glabella are equidistant from the
tabletop.
 CR: midway between outer canthus and EAM
(zigoma)
 Collimation is essential
 NASAL BONES
 the nasal bones in profile are
centered within the collimated
field.

 Included within the field are the

nasal bones, with surrounding soft
tissue, anterior nasal spine of
maxilla

 anterior aspects of the cranial

cortices, orbital roofs, and
zygomatic bones.
 RHESE METHOD
 Optic canal is demonstrated on end,
and the optic foreman is open and
demonstrated in the lower half of the
orbit , adjacent to the lateral orbital
margin.

 Optic canal and foramen are centered

within the collimated field. Included
within the field are the optic canal and
foramen, lesser wing of sphenoid, and
orbital margins.
SPINE
 AP CERVICAL SPINE
 AP axial projection.
 Spinous processes are aligned with the
midline of the cervical bodies, the
mandibular angles and mastoid tips are
at equal distances.

 Articular pillars and pedicles are

symmetrically demonstrated lateral to
the cervical bodies.

 Distance from the vertebral column to

the sternal ends of the clavicles are
equal.
 AP CERVICAL SPINE
 Intervertebral disc spaces are open,
the vertebral bodies are
demonstrated without distortion and
each vertebra spinous is visualized at
the level of its inferior intervertebral
disc space.

 Third cervical vertebra is

demonstrated in its entirety and
posterior occiput and mandibular
mentum are superimposed.

 Occlusal plane to mastoid tip is

perpendicular to IR.
 AP CERVICAL SPINE
 CR : 15º to 20º cephalic to C4
(up margin of thyroid cartilage).

 SID : 100cm

 Q : Why do you angle the tube

 ATLAS AND AXIS
 Atlas and axis AP projection.

 Atlas is symmetrically seated on the

axis with the atlas lateral masses at
equal distances from the dens.

 The spinous process of the axis is

aligned with midline of the axis
body and the mandibular rami are
demonstrated at equal distances
from the lateral masses.
 LATERAL
 CV demonstrate a lateral
projection

 Rt and Lt articular pillars and

zygapophyseal joints of each
cervical vertebra are
superimposed.

 Spinous process demonstrated

in profile.
 OBLIQUE CERVICAL SPINE

 Ant oblique – interverterbral

foramina and pedicles on the
side closest to IR.
 Post oblique – intervertebral
foramina and pedicles on the
side farthest from IR.
 Over and under rotation will
obscure the intervertebral
foramina.
 What is the best
 projection?
Intervertebral foramina : R and L.
 zygapophyseal joints.
 transverse process.
 spinous process.
 AP THORACIC SPINE
 12 thoracic vertebra included.

 Spinous process in the midline.

 Distance between the spinous

process and lateral end of vertebra
equal on both sides.

 Wide exposure is seen on the image.

LATERAL THORACIC
 LATERAL THORACIC
 Ribs should be superimposed
posterior to indicate no rotation.

 Vertebra should be seen clearly

through rib and lung shadows.

 T12 & L1 included.

 Intervertebra foramina seen.

 Wide exposure is seen on the

image.
 OBLIQUE TV
 12 Thoracic Vertebra seen.

 Zygapophyseal articulations
closest to the IR seen on anterior
obliques.

 Zygapophyseal articulations
farthest to the IR seen on
posterior obliques.

 Wide exposure is seen on the

image.
AP LUMBAR VERTEBRA
 SI joint equidistant from
spinous process.
 Spinous process in
midlineof vertebral
column.
 R and L transverse
processes equal in length.
 Intervertebral -joint
should be open and
clearly visualized.
 T12 –sacrum seen
LATERAL LUMBAR
 LATERAL LUMBAR
 Intervertebral foramina

 L1 to L5 vertebral bodies.

 Intervertebral joint spaces

appear open.

 No rotation is indicated by
superimposed greater sciatic
notches and posterior
vertebral bodies.
 OBLIQUE LUMBAR SPINE
 Pedicle in the centre of
vertebra bodies.
 If pedicle is posterior,
patient is more than 45,
if pedicle is anterior
patient is less than 45.
 RPO shows the R
zygapophyseal joints.
 LPO -L
 RAO –L
 LAO- R
L5-S1
SACRUM
COCCYX
SCOLIOSIS

 Weight bearing AP/PA

 Lateral erect
 Foot of the convex side
elevated
 Right and Left bending
AP BENDING
FERGUSON WITH HIP ELEVATED
IMAGES FOR ANALYSIS