Intersting cases and spotters in skull xray
- 1. SKULL XRAY
- 2. Indications of skull radiograph • Metabolic bone diseases. • Multiple myeloma. • Infections and tumour affecting skull.
- 3. • Landmarks: 1. Outer canthus of the eye: the point where the upper and lower eyelids meet laterally. 2. Infra-orbital margin/point: the inferior rim of the orbit, with the point being located at its lowest point. 3. Nasion: the articulation between the nasal and frontal bones. 4. Glabella: a bony prominence found on the frontal bone immediately superior to the nasion. 5. Vertex: the highest point of the skull in the median sagittal plane. 6. External occipital protuberance (inion): a bony prominence found on the occipital bone, usually coincident with the median sagittal plane. 7. External auditory meatus: the opening within the ear that leads into the external auditory canal.
- 5. • Lines 1. Inter-orbital (inter-pupillary) line: joins the centre of the two orbits or the centre of the two pupils when the eyes are looking straight forward. 2. Infra-orbital line: joints the two infra-orbital points. 3. Anthropological baseline: passes from the infra-orbital point to the upper border of the external auditory meatus (also known as the Frankfurter line). 4. Orbito-meatal base line (radiographic baseline): extends from the outer canthus of the eye to the centre of the external auditory meatus. This line is angled approximately 10 degrees to the anthropological baseline.
- 7. • Planes • Median sagittal plane: divides the skull into right and left halves. Landmarks on this plane are the nasion anteriorly and the external occipital protuberance (inion) posteriorly. • Coronal planes: these are at right-angles to the median sagittal plane and divide the head into anterior and posterior parts. • Anthropological plane: a horizontal plane containing the two anthropological baselines and the infra-orbital line. It is an example of an axial plane. Axial planes are parallel with this plane. • Auricular plane: perpendicular to the anthropological plane. Passes through the centre of the two external auditory meatuses. It is an example of a coronal plane. • The median sagittal, anthropological and coronal planes are mutually at right-angles.
- 8. VIEWS • Basic views • Lateral view • Fronto occipital view ( A P view ) • Fronto occipital with 30 deg caudad ( TOWNE’S view) • Occipito frontal view ( P A view) • Occipito frontal with 15 deg caudad • ( CALDWELL’S view ) • Occipito mental view ( WATER’S view)
- 9. LATERAL VIEW • LATERAL (ERECT): Position of patient • Patient sits facing the IR and the head is then rotated, such that the median sagittal plane is parallel to IR and inter orbital line is perpendicular to it.
- 10. Central ray : • midway between the glabella and the external occipital protuberance to a point approx 5 cm superior to the external auditory meatus. Essential image characteristics : • The image should contain all cranial bones and the first cervical vertebra. • Should superimpose the floor of anterior cranial fossa and posterior cranial fossa. The sella turcica and clinoid processes should also be superimposed.
- 11. INDICATION • This projection is used to evaluate for skull fractures, in addition to neoplastic changes and Pagets disease . In the trauma setting lateral x ray may demonstrate air-fluid levels in the sphenoid sinus, an indication of basal skull fracture.
- 14. Lateral supine
- 15. INDICATION • This examination is able to assess for medial and lateral displacements of skull fractures, in addition to neoplastic changes and Paget disease.
- 16. Fronto occipital view Positioning : • Patient lies supine on a bucky table. Head is adjusted to bring the median sagittal plane at right angles to the film. • The external auditory meatuses are equidistance from the cassette • The orbito meatal baseline should be perpendicular to the cassette
- 17. Fronto occipital view Central ray : • Central ray is directed perpendicular to the cassette along the medial sagittal plane and throw nasion. • The field should be set to include the vertex of the skull superiorly and base of the occipital bone inferiorly.
- 19. Towne view
- 20. Towne’s view fronto occipital 30 deg caudad Positioning same as AP view Certral ray : • Its angled caudally so it makes 30 deg to the orbito meatal plane • Centre in the midline such that the beam passes midway between external auditory meatuses. This is a point approx 4 cm above the glabella
- 22. Essential image characteristics • the sella turcica is projected with in the foramen magnum. • Include all the occipital bone and posterior parts of parietal bone, and the lambdoidal suture should be visualized clearly.
- 24. • ADVANTAGES Occipital bone and posterior fossa space better evaluated than with a non angulated ap view, which would have more skull base and facial bone overlap Better than a conventional AP view for evaluating an occipital plagiocephaly involving the lambdoid suture May be a useful additional view for evaluating skull fractures .
- 25. Occipito frontal view Positioning of patient : • Patient is seated facing the erect bucky, so that the median sagittal plane is with the midline of the bucky and perpendicular to it. • Neck is flexed to bring orbito meatal line perpendicular to the bucky, this can be achieved by ensuring the nose and forehead are in contact with the bucky. Central ray : • Ray is directed perpendicular to the bucky along the median sagittal plane and at the level of nasion. • Image should include the vertex superiorly and base of occipital bone inferiorly
- 28. Caudal angulation : • OF 0 deg : the petrous ridges completely superimposed with orbit • OF 10 deg : the petrous ridges appears in the middle third of the orbit • OF 20 deg : the petrous ridges appears just below the inferior orbital margin.
- 29. Caldwell’s view occipito frontal with 15 deg caudad Positioning same as occipito frontal view Central ray : • Ray is directed perpendicular to the bucky alone the median sagittal plane. • The tube is rotated 15 deg caudal to the orbito meatal baseline
- 32. Water’s view
- 35. STENVER’S VIEW
Editor's Notes
- #39: METOPIC
- #40: CORONAL
- #41: COPPER BETAEN SKULL Inc impression of horal marking in Inners table Dd intra cranial masses Obstructive hydrocephalus Craniosynostosis
- #42: ENLARGED SELLA normal sella ap 5 – 16 mm, vertical 4 – 12 mm Dd . Empty Sella syndrome no erosion, no symptoms csf filled space Pituitary tumors Ich erosion + Craniopharyngioma
- #43: acromegaly
- #44: CONMAN - J shaped sella C: chronic hydrocephalus O: optic chiasm glioma, osteogenesis imperfecta N: neurofibromatosis type 1 M: mucopolysaccharidoses A: achondroplasia N: normal variant CONMAN C: chronic hydrocephalus O: optic chiasm glioma, osteogenesis imperfecta N: neurofibromatosis type 1 M: mucopolysaccharidoses A: achondroplasia N: normal variant CONMAN C: chronic hydrocephalus O: optic chiasm glioma, osteogenesis imperfecta N: neurofibromatosis type 1 M: mucopolysaccharidoses A: achondroplasia N: normal variant CONMAN C: chronic hydrocephalus O: optic chiasm glioma, osteogenesis imperfecta N: neurofibromatosis type 1 M: mucopolysaccharidoses A: achondroplasia N: normal variant
- #45: The cotton wool appearance is a plain film sign of Paget disease and results from thickened, disorganized trabeculae which lead to areas of sclerosis in a previously lucent area of bone, typically the skull. These sclerotic patches are poorly defined and fluffy.vstage 2
- #46: Tam o shanter skull diploma widening with platybadia
- #47: Osteoporosis circumscripta cranii well-defined areas of radiolucency, often large most commonly located in frontal and occipital bones affecting both inner and outer calvarial tables, with changes in outer table usually more extensive stage 1.
- #48: MM rain drop
- #49: Salt and pepper hpt due to erosion of trabecular bone
- #50: NB mets sutural widening
- #51: Eg punched out beveled lesion on skull geographic borders outer table more affected than inner table
- #66: ADENOID
- #69: NF1 BARE ORBIT SIGN absent innomimare line, greater wing of sphenoid dysplasia
- #70: STURGE WEBER SYNDROME Skull radiographs were historically useful and capable of identifying the gyriform calcification of the subcortical white matter although they no longer play a significant role in the diagnosis or management of this condition. The finding usually becomes evident between 2-7 years of age 2.