DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS Dr. Nur Hayati Jasmin 2 TOPIC Cranium & Facial Bones 9 Projections Image Analysis Case Study
DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS The course covers the image evaluation of the skull, facial bone, thorax, sternum, abdomen, pelvis, shoulder and hips girdle, spine and upper and lower extremities. Label the anatomy in selected radiograph. (C1,PLO1) Orally describe the selected radiograph according to film criteria. (A1, PLO3) Explain the main method obtained from literature to professionally decide the radiograph view based on pathology or abnormality. (A3, PLO7) Learning Objectives: "Radiographers can make mistakes, but professional radiographers are able to correct their mistakes by using careful and critical analytical process to determine exactly what went wrong" About The Author Dr. Nur Hayati Jasmin
AP or PA projection PA Axial (Caldwell) AP Axial (Towne) Lateral projection Cranium Mandible Premastoid portion Cranium Facial bones Sinuses 9PROJECTIONS Cranium Mandible Cranium Facial bones Sinuses Nasal bones
Submentovertex Waters projection Rhese projection Tangential projection Facial bones Sinuses Optical canal Foramen Nasal bones 9PROJECTIONS Cranium Mandible Sinuses Zygomatic arches
Stanvers projection 9PROJECTIONS Petromastoid portion
Thin Structure Thick Structure CONTRAST Thin Structure Thick Structure DENSITY Projection Posteroanterior (PA) or Anteroposterior (AP) Exposure Criteria Positioning Criteria BTP of Frontal Bone/ Mandibular rami BTP of Petrous ridges/ Dorsum Sellae SKULL BCo of Frontal Bone/ Mandibular rami BCO of Petrous ridges/ Dorsum Sellae Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. Petrous ridges superimpose supraorbital rims. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses Coronal suture Frontal bone Lateral cranial cortex Supraorbital rim Bony nasal septum Mastoid process Internal auditory canal Petrous ridge Anterior clinoid process Dorsum Crista galli 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
Thin Structure Thick Structure CONTRAST Thin Structure Thick Structure DENSITY Projection Posteroanterior (PA) or Anteroposterior (AP) Exposure Criteria Positioning Criteria BTP of Frontal Bone/ Mandibular rami BTP of Petrous ridges/ Dorsum Sellae SKULL BCo of Frontal Bone/ Mandibular rami BCO of Petrous ridges/ Dorsum Sellae Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. Petrous ridges superimpose supraorbital rims. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses
Thin Structure Thick Structure CONTRAST Thin Structure Thick Structure DENSITY Projection Posteroanterior (PA) or Anteroposterior (AP) Exposure Criteria Positioning Criteria BTP of Frontal Bone/ Mandibular rami BTP of Petrous ridges/ Dorsum Sellae SKULL BCo of Frontal Bone/ Mandibular rami BCO of Petrous ridges/ Dorsum Sellae
Projection Posteroanterior (PA) or Anteroposterior (AP) Rotation SKULL Evaluate distances between lateral cranial cortices and the oblique orbital lines Evaluate distances between lateral cranial cortices and crista galli Direction of rotation is the opposite of the side demonstrating greater distance. Analysis Correction The distance from the lateral orbital margins to the lateral cranial cortices and The distance from crista galli to the lateral cranial cortices on the right side are greater than the same distances on the left sides Rotate the patient's face toward the right side until the MSP is aligned perpendicular to the IR Analysis Correction Positioning Criteria Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. Petrous ridges superimpose supraorbital rims. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses
Projection Posteroanterior (PA) or Anteroposterior (AP) Positioning Criteria OML Alignment Analysis Correction Analysis Correction SKULL Evaluate relationship between the petrous ridges and supraorbital rim Correct alignment = Petrous ridges superimpose supraorbital rim Chin not adequately tucked = Petrous ridges inferior to supraorbital rim Chin tucked too much = Petrous ridges superior to supraorbital rim Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. Petrous ridges superimpose supraorbital rims. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses The petrous ridges are demonstrated superior to the supraorbital margins The internal acoustic meatus are obscured The patients's chin was tucked more than needed to position OML perpendicular to the Ir Extend the chin Moving chin away from the thorax until the OML is aligned perpendicular to the IR Move half the distance demonstrated between petrous ridges and the supraorbital margins
Thin Structure Thick Structure CONTRAST Thin Structure Thick Structure DENSITY Projection Posteroanterior (PA) 15/30 degree Caudal (Caldwell Method) Exposure Criteria Positioning Criteria BTP of Frontal Bone/ Mandibular rami BTP of Petrous ridges/ Dorsum Sellae SKULL BCo of Frontal Bone/ Mandibular rami BCO of Petrous ridges/ Dorsum Sellae Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. PA axial with 15°caudad Petrous pyramids are projected into the lower one third of the orbits Supraorbital margin is visualized without superimposition PA axial with 25°to 30°caudad Petrous pyramids are projected at or just below the IOM to allow visualization of the entire orbital margin Better visualization of superior orbital fissures, the foramen rotundrum, and the inferior orbital rim region. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses
Thin Structure Thick Structure CONTRAST Thin Structure Thick Structure DENSITY Projection Posteroanterior (PA) 15/30 degree Caudal (Caldwell Method) Exposure Criteria Positioning Criteria Analysis PA 15°caudad PA 30°caudad BTP of Frontal Bone/ Mandibular rami BTP of Petrous ridges/ Dorsum Sellae SKULL BCo of Frontal Bone/ Mandibular rami BCO of Petrous ridges/ Dorsum Sellae Distances from the oblique orbital lines to lateral cranial cortex equidistant. Distance from crista galli to lateral cranial cortex equidistant. Distance from mandibular rami to lateral cranial cortex equidistant. PA axial with 15°caudad Petrous pyramids are projected into the lower one third of the orbits Supraorbital margin is visualized without superimposition PA axial with 25°to 30°caudad Petrous pyramids are projected at or just below the IOM to allow visualization of the entire orbital margin Better visualization of superior orbital fissures, the foramen rotundrum, and the inferior orbital rim region. Dorsum sellae is at the c.c.f and includes outer cranial cortex, top of cranium and maxillary sinuses OML Alignment PA 15°caudad Evaluate relationship between the petrous ridges and supraorbital rim Correct alignment = Petrous ridges demonstrated horizontally through the lower third of the orbits Chin not adequately tucked = Petrous ridges inferior to infraorbital rim Chin tucked too much = Petrous ridges demonstrated in the upper half of the orbits
Projection Posteroanterior (PA) 15/30 degree Caudal (Caldwell Method) SKULL PA 0° PA 15°caudad PA 30°caudad
10% Reading 20% Listening 30% Visual 50% Visual & Listening 75% Discussion 80% Practical 95% Teaching