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Grand RoundsRobert P. Moskal BSc, DMDThe University of Illinois at ChicagoNovember 16, 1998
Radiographic Projections
Posteroanterior view (PA):general skull exam for disease, trauma, developmental abnormalities, assess mediolateral
dimensions of skull, and assymetriesSTRUCTURE: frontal & ethmoid sinus, nasal fossae, orbits, frontal bones mandible symphysis skull outline POSITION: -head centered and facing film- canthomeatal line parallel to floor (nose and forehead usually touching film)CENTRAL RAY: - XR beam parallel to canthomeatal line aiming at max central incisorsNote: (AP View) - XR from anterior to posterior
Lateral Skull (lateral cephalometric):general skull exam for disease, trauma, developmental abnormalities, assess facialproportions and assymetries,STRUCTURES: skull and soft tissue assessment paranasal structures and paired structures overlapped hard palatePOSITION: Left side of skull closest to film- canthomeatal line parallel to floor (in LAT CEPHFrankfurt Horizontal parallel to floor)CENTRAL RAY:- XR beam parallel to canthomeatal line or FH at 60" ( Note: filter anterior to better reveal soft tissue of face)
Occipitomental (37oWaters) View:variation of PA view
STRUCTURES: Maxillae, Orbits, Zygomatic archesMaxillary sinuses (air-fluid levels?) frontal & ethmoid sinuses, nasal cavity, zygomatico-frontal suture P
POSITION: - patient upright, prone- head centered & facing film with chin touching film- canthomeatal line 37
oto film
CENTRAL RAY: beam perpendicular to film, exiting at subnasale acanthion)
Modified Occipitomental View (55oWaters):modified "shallow" Waters view
STRUCTURES: Maxillae, Orbits, Zygomatic arches- less axial angulation, petrous ridges just below infraorbital rimsPOSITION - patient upright, prone or supine- head centered & facing film with chin touching film canthomeatal line 55
oto film
CENTRAL RAY: beam perpendicular to film, exiting at subnasale / acanthion)
Reverse Occipitomental View ( Reverse-Waters):STRUCTURES: same but increased magnification and is an AP viewPOSITION: head centered and film behind headinfraorbitomeatal line perpendicular to film (or canthomeatal lineperpendicular to film)CENTRAL RAY: 30 ocephalad to infraorbitomeatal line(37 degrees to canthomeatal line)
Tangential Nasal:(Intraoral or Extraoral)STRUCTURES: Nasal bones for medial or lateral displacement offragments in fracturesPOSITION: - supine with occlusal xray in teeth (Intraorally)- prone with chin extended and ray parallel to glabelloalveolar line(ext)- head centeredCENTRAL RAY: beam perpendicular to film & parallel to glabelloalveolar line
Lateral Nasal:STRUCTURES: Nasal bones, Rt and Lt.POSITION: supine/upright- canthomeatal lines parallel to floor
- film on side of interest or bilaterallyCENTRAL RAY: perpendicular to bridge of nose at 2cm distal to nasion- use close collimation for detail
Submento-vertex (SMV or "Jug-handles"):Aka. Tangential Zygomatic ArchSTRUCTURES: Zygomatic arches, base of skull, pterygoid plates,sphenoid sinus curvature of mandiblePOSITION:-supine, upright-extend neck with film behind head-Infraorbitomeatal line nearly parallel to filmCENTRAL RAY:perpendicular to infraorbitomeatal line and centered between
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zygomatic arches. It passes through coronal plane lying approx. 1" posterior toouter canthi. Decrease kVp to highlight thin, unobstructed zygomatic arches.
Submental Vertex:tangential images of unilateral zygomatic archesSTRUCTURES: Zygomatic arches (One isolated side)POSITION: supine/upright- infraorbitomeatal lines parallel as possible to film
- 15 degree top of head tilttoward examining sideCENTRAL RAY: perpendicular to infraorbitomeatal line and centered to zygomatic arch
Submental Vertex (Mays view):STRUCTURES: Zygomatic arches (One isolated side)POSITION: - prone or facing film- 15 degree tilt top of head away from examining sideCENTRAL RAY: perpendicular to infraorbitomeatal line, directed through arch
Townes View (30o):
tangential images of unilateral zygomatic arches, AP viewSTRUCTURES: Condyle, neck, ramusPOSITION: Upright or supine with film behind headcanthomeatal (FH) line perpendicular to film and parallel to floorCENTRAL RAY: from anterior, 30degrees coronal to FH or canthomeatal plane and directed towards condyles.
Modified Townes View(35o):
STRUCTURES: samePOSITION: sameCENTRAL RAY: anteroposteriorly, 35 degrees coronal to canthomeatal planeReverse-Townes View (PA):STRUCTURE: same as townesPOSITION: Prone or upright facing filmCanthomeatal line perpendicular to filmopen mouth as wide as possible, helps in visualization of TMJCENTRAL RAY:postero-anterior direction30
ocaudad to canthomeatal line
Lateral Oblique View:STRUCTURES: Rt & Lt Mandibular body, angle,ramus and condyleopposite condylar head and glenoid fossaPOSITION: upright, supine, film on side being studied extend neck so mandibular body is parallel to transverse axis of filmrotate head so mandibular body is parallel to plane of filmCENTRAL RAY: CR to enter slightly posterior to mandibular angle on the side farthest from the film at an angle ofaproximately 25 degrees cephalad to body/angle/ramus region on film side.Note:If appropriate density, can evaluate position of opposite TMJ in its fossa. Can aim CR more anteriorly along body to evaluateparasymphysis or posterosuperior at ramus
Intraoral Radiologic Projections
Maxillary Occlusal:STRUCTURES: Superoinferior projection of the roof of the mouth palatine processes of maxillae horizontal plates of palatinebone maxillary dental arch, anterior nosePOSITION: any comfortable position film placed intraorally and secured with teeth or fingerCENTRAL RAY: XR source from superior to inferior Perpendicular to film, centered on medial saggital plane & Coronal planepassing anterior to outer canthiMODIFICATIONS: central ray 60
ocaudad, directed to distal lower 1/3 of nose
Mandibular Occlusal:STRUCTURES: mandibular dental arch, anterior floor of the mouth symphysis and anterior mandibular body, sublingual
gland submandibular glandsPOSITION: any comfortable position with head extended film placed intraorally and secured with teeth or fingerCENTRAL RAY: XR source from inferior to superior Perpendicular to film, centered on medial saggital planeCoronal plane passing through second molarsMODIFICATIONS: Direct CR 55 degrees cephalad to tip of chin
Ordering OptionsMandibular Series: Rt & Lt Lateral ObliquesPA of mandible
Facial Series: PA headLateral Skull
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Waters ViewSubmentovertex(Jug-handles)
Mandible Maxilla / Midface CervicalTowne Modified Waters Flexion / ExtensionModified Towne Nasal Soft tissue neckTMJ Alexanders (orbital) ThoracicPanorex Panorex Lumbar
Occlusal Occlusal
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