SKULL

SKULL PLANES, POINTS & LINE

 Midsagittal plane (MSP) 11.) TMJ Syndrome
 Interpupillary line (IPL)  Dysfunction of the temporomandibular joint
 Acanthion
 Outer canthus A.) SKULL
 Infraorbital margin
 External acoustic meatus (EAM) PA PROJECTION
 Orbitalmeatal line (OML) PP: Prone; forehead & nose against IR; MSP &
OML perpendicular to IR
 Infraorbitomeatal line (IOML)/Frankpurt
RP: Nasion
Line
CR: Perpendicular
 Acanthiomeatal line (AML)
SS: Petrous pyramid completely filled the orbits;
 Mentomeatal line (MML)
frontal bone
 Between OML & IOML: 7o difference
 Between OML & GML: 8o difference
AP PROJECTION
PP: Supine; MSP & OML perpendicular to IR
PATHOLOGY
RP: Nasion
1. ) Basal Fx
CR: Perpendicular
 Fx located at the base of the skull SS: Same as PA, but the image is MAGNIFIED
2) Blowout Fx
 Fx of the floor of the orbit MODIFIED CALDWELL METHOD
3.) Contre-Coup Fx PA AXIAL PROJECTION
 Fx to one side of a structure caused by PP: Prone; forehead & nose against IR; OML
trauma to the other side perpendicular to IR; MSP perpendicular to IR
4.) Depressed Fx RP: Nasion
 Fx causing a portion of the skull to be CR: 15o caudad
depressed into the cranial cavity SS:
5.) Le Fort Fx -General Survey Examination:
 Bilateral horizontal fxs of the maxillae  Anterior & side walls of the cranium
6.) Linear Fx  Temporal fossae
 Irregular or jagged fx of the skull  Frontal sinuses & anterior ethmoid sinus
7.) Tripod Fx  Crista galli
 Fx of the zygomatic arch & orbital floor/rim  Upper 2/3 of orbits
& dislocation of the frontozygomatic suture  Petrous pyramid to lower 1/3 of orbit
8.) Mastoiditis -Superior orbital fissure/sphenoid fissure (20-25o
 Inflammation of mastoid antrum & air cells caudad) & foramen rotundum (25-30o caudad)
9.) Paget’s Disease
 Thick, soft bone marked by bowing fxs AP AXIAL PROJECTION
10.) Sinusitis PP: Supine; OML perpendicular to IR
 Inflammation of one or more of the RP: Nasion
paranasal sinuses CR: 15o cephalad
1
 SKULL

SS: Same as PA axial but orbits are magnified & SS:

the distance b/n lateral margin of orbits & temporal -“SPDOP”
bones are less on AP than PA  Symmetric petrous pyramid
 Posterior portion of foramen magnum
TRUE/ORIGINAL CALDWELL  Dorsum sellae & posterior clinoid process
PP: Prone; forehead & nose against IR; GML w/in shadow of foramen magnum
perpendicular to IR; MSP perpendicular to IR  Occipital bone
RP: Nasion  Posterior portion of parietal bone
CR: 23o caudad -Tomographic studies of ears, facial canal, jugular
SS: Same as above foramina & rotundum foramina
-Entire foramen magnum jugular foramina (40-60o
LATERAL PROJECTION caudad to OML)
PP: Semiprone; MSP & IOML parallel to IR; IPL -Posterior portion of cranial vault (CR ┴ to midway
perpendicular to IR b/n frontal tuberosities)
RP: 2 in. Above EAM or midway b/n inion &
glabella TOWNE/ALTSCHUL/GRASHEY/CHAMBER
CR: Perpendicular LAINE METHOD
SS: AP AXIAL PROJECTION
-General survey examination PP: Lateral decubitus; OML/IOML & MSP
 Sella turcica perpendicular to IR
 Anterior & posterior clinoid processes, RP: 2.5-3 in. above glabella
 Dorsum sellae CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
 Superimposed mandibular rami SS: Same as above
 Mastoid region ER: For patient w/ pathologic condition, trauma or
 EAM & TMJ deformity (strongly accentuated dorsal kyphosis)

CROSSTABLE LATERAL HAAS METHOD

PP: Dorsal decubitus (Robinson, Meares & Goree PA AXIAL PROJECTION
recommendation); MSP perpendicular to IR PP: Prone; MSP & OML perpendicular to IR;
RP: 2 in. Above EAM forehead & nose against the table; IR center 1 in. to
CR: Horizontal nasion
ER: For traumatic sphenoid sinus effusion (basal RP: 1.5 in. below inion (entrance); 1.5 in. superior
skull fx) to nasion (exit)
CR: 25o cephalad to OML
TOWNE/ALTSCHUL/GRASHEY/CHAMBER SS:
LAINE METHOD  Occipital bone
AP AXIAL PROJECTION  Symmetric petrous pyramid
PP: Supine; OML/IOML & MSP perpendicular to  Dorsum sellae & posterior clinoid processes
IR; w/in shadow of foramen magnum
RP: 2.5-3 in. above glabella ER: For obtaining image of sellar structures (DS &
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) PCP) w/in FM on hypersthenic & obese patient
2
 SKULL

SCHULLER/PFEIFFER METHOD LYSHOLM METHOD

SUBMENTOVERTICAL PROJECTION AXIOLATERAL METHOD
PP: Supine or Seated-upright (more comfortable); PP: Semiprone; MSP parallel to IR; IOML parallel
IOML parallel to IR; MSP perpendicular to IR; to transverse axis of IR; IPL perpendicular to IR
head rested on vertex; neck hyperextended RP: 1 in. distal to lower EAM (exit)
RP: ¾ in. anterior to EAM (sella turcica) CR: 30-35o caudad
CR: Perpendicular to IOML; MSP of throat b/n SS: Oblique position of lateral aspect of cranial
gonion (entrance) base closest to IR
SS: Cranial base ER: For patients who cannot extend their head
 Foramen ovale & spinosum (best enough for a satisfactory SMV projection
demonstrated)
 Symmetric petrosae VALDINI METHOD
 Mastoid processes PA AXIAL PROJECTION
 Carotid canals PP: Recumbent or seated-erect (more comfortable);
 Sphenoidal & ethmoidal sinuses upper frontal region of skull against IR; MSP
 Mandible perpendicular to IR; head acutely flexed; IOML
50o/OML 50o; line extending from inion to 0.5 cm
 Bony nasal septum
distal to nasion form 28o to CR
 Dens of axis
RP: 0.5 cm distal to nasion (dorsum sellae);
 Occipital bone
foramen magnum/slightly above level of EAM
 Maxillary sinus superimposed over the
(petrosae)
mandible
CR: Perpendicular; inion (entrance); 0.5 cm distal
 Zygomatic arches (well demonstrated if
to nasion (exit)
exposure factors are decreased)
SS:
 Axial tomography of orbits, optic canals,
 DILA (IOML 50o): Dorsum sellae; Internal
ethmoid bone, maxillary sinuses & mastoid
Auditory Meatus (IAM); LAbyrinth
processes
 ETB “EaT Bulaga” (OML 50o): External
auditory meatus; Tymphanic cavity; Bony
SCHULLER METHOD
part of Eustachian tube
VERTICOSUBMENTAL PROJECTION
 Dorsum sellae & posterior clinod processes
PP: Prone; chin fully hyperextended; MSP
within or above shadow of foramen magnum
perpendicular to IR
 Tubeculum sellae, anterior clinoid processes
RP: ¾ in. anterior to EAM (sella turcica)\
& sella turcica below shadow of foramen
CR: Perpendicular to IOML; MSP of throat b/n
magnum
gonion (entrance)
 Mastoid pneumatization
SS: Same as SMV
 Distorted & magnified basal structures
B.) SELLA TURCICA
 Useful for anterior cranial base &
sphenoidal sinuses
LATERAL PROJECTION
o IR in contact with the throat
PP: Semiprone; MSP & IOML parallel to IR; IPL
o Reduces magnification & distortion
perpendicular to IR
3
 SKULL

RP: ¾ in. anterior & ¾ in. superior to EAM SS: Dorsum sellae, tuberculum sellae, anterior &
CR: Perpendicular posterior clinoid processes through frontal bone
SS: Superimposed anterior & posterior clinoid above ethmoidal sinuses
processes; dorsum sellae
C.) OPTIC CANAL/FORAMEN
TOWNE METHOD
PP: Supine; OML/IOML & MSP perpendicular to RHESE METHOD
IR; PARIETO-ORBITAL OBLIQUE
RP: 2.5-3 in. above glabella PROJECTION
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) PP: Prone; affected orbit closest to IR; zygoma,
SS: Sellar region nose & chin against IR (3-pt Lower Landing); AML
 Dorsum sellae, tuberculum sellae & anterior perpendicular to IR; MSP 53o angle to IR
clinoid processes through occipital bone RP: Affected orbit closest to IR
above shadow of foramen magnum (30o CR: Perpendicular
caudad) SS: Optic canal/foramen (inferior & lateral quadrant
 Dorsum sellae & posterior clinoid processes of orbital shadow)
w/in shadow of foramen magnum (37o  PAZAM: Prone; Affected orbit against IR;
caudad) Zynoch; AML ┴; MSP 53o to IR
 Symmetric petrous pyramid
RHESE METHOD
HAAS METHOD ORBITO-PARIETAL OBLIQUE
PA AXIAL PROJECTION PROJECTION
PP: Prone; MSP & OML perpendicular to IR; PP: Supine; affected orbit away from IR; AML
forehead & nose against the table; IR center 1 in. to perpendicular to IR; MSP 53o angle to IR
nasion RP: Inferior and lateral margin of uppermost orbit
RP: 1.5 in. below inion (entrance); 1.5 in. superior CR: Perpendicular
to nasion (exit) SS: Magnified optic canal/foramen
CR: 25o cephalad to OML  Increased radiation dose to lens of eye
SS:
 Dorsum sellae & posterior clinoid processes ALEXANDER METHOD
w/in shadow of foramen magnum ORBITO-PARIETAL OBLIQUE
 Symmetric petrous pyramid PROJECTION
ER: For obtaining image of sellar structures (DS & PP: Erect/supine; IR 15o angle from vertical; MSP
PCP) w/in FM on hypersthenic & obese patients 40o to IR; AML perpendicular to IR
RP: Inferior and lateral margin of uppermost orbit
PA PROJECTION CR: Perpendicular
PP: Prone; forehead & nose against IR; MSP & SS: Optic canal/foramen
OML perpendicular to IR
RP: Glabella
CR: 10o cephalad

4
 SKULL

MODIFIED LYSHOLM METHOD  Well demonstrated at 15o caudal angle

ECCENTRIC ANGLE PARIETO-ORBITAL (Caldwell)
OBLIQUE PROJECTION  Petrous portions at or below the inferior
PP: Prone; forehead & nose against IR; IOML orbital margin
perpendicular to IR; MSP 20o from vertical;
RP: Affected orbit (exit) F.) INFERIOR ORBITAL FISSURES
CR: 20o caudad or 30o caudad
SS: Optic canal/foramen & anterior clinoid BERTEL METHOD
processes (20o); superior orbital fissure (30o) PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; IOML
D.) SPHENOID STRUT perpendicular to IR
-the inferior root of lesser wing of sphenoid RP: Nasion
bone- CR: 20-25o cephalad
SS: Inferior orbital fissures
HOUGH METHOD  b/n shadows of pterygoid process of
PARIETO-ORBITAL OBLIQUE sphenoid bone & mandibular ramus
PROJECTION  Anterior image of each orbital floor
PP: Prone; superciliary ridge/arch & side of the
nose against IR; IOML perpendicular to IR; MSP G.) EYE- FOREIGN BODY LOCALIZATION
20o from vertical; MSP 20o toward the side of
interest LATERAL PROJECTION
RP: Affected orbit (exit) PP: Semiprone; MSP parallel to IR; IPL
CR: 7o caudad perpendicular to IR; instruct patient to look straight
SS: Unobstructed & undistorted image of the ahead during exposure
sphenoid strut (lie b/n sphenoidal sinus & combined RP: Outer canthus
shadows of anterior clinoid processes & lesser wing CR: Perpendicular
of sphenoid bone) SS: Superimposed orbital roofs

E.) SUPERIOR ORBITAL/SPHENOID PA AXIAL PROJECTION

FISSURES PP: Prone; forehead & nose against IR; MSP &
OML perpendicular to IR; instruct patient to close
CALDWELL METHOD the eyes
PA AXIAL PROJECTION RP: Midorbits
PP: Prone; forehead & nose against IR; OML CR: 30o caudad
perpendicular to IR SS: Petrous pyramids lying below orbital shadows
RP: Nasion
CR: 20-25o caudad or 15o caudad MODIFIED WATERS METHOD
SS: Superior orbital fissures PARIETOACANTHIAL PROJECTION
 Lying on the medial side of orbits b/n PP: Prone; chin against IR; MSP perpendicular to
greater & lesser wings of sphenoid) IR; OML 50o to IR (new); OML 25-37o to IR (old);
instruct patient to close the eyes
5
 SKULL

RP: Midorbits  CR perpendicular

CR: Perpendicular  CR 15-25o cephalad
SS: Petrous pyramids lying well below orbital
shadows PFEIFFER-COMBERG METHOD
 A leaded contact lens is placed directly over
VOGT-BONE-FREE POSITION the cornea
 Taken to detect small or low density foreign  Apparatus:
particles located in the anterior segment of o Contact lens localization device
the eyeball/eyelids o Pedestal type of film holder
 2 Projections: lateral & superoinferior  2 Projections:
 2 Movements: o Waters Method:
o Vertical: 2 exposures (for lateral)  CR horizontal
 Look up as far as possible o Lateral:
 Look down as far as possible  CR perpendicular
o Horizontal: 2 exposures (for
superoinferior) H.) FACIAL BONE
 Look to extreme right
 Look to extreme left LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL
PARALLAX METHOD perpendicular to IR
 First described by Richards RP: Zygoma/malar bone
 It determines whether the foreign body is CR: Perpendicular
located within the eyeball requires no SS: Superimposed facial bones
special apparatus  Superimposed mandibular rami & orbital
 Not considered as precision localization roofs
procedure
 Widely used as preliminary check only WATERS METHOD
 2 Projections: PARIETO-ACANTHIAL PROJECTION
o Lateral: 2 exposures PP: Prone; MSP & MML perpendicular to IR;
OML 37o to IR; nose ¾ in. (1.9 cm) away from IR
o PA: 2 exposures RP: Acanthion (exit)
CR: Perpendicular
SWEET METHOD SS: Orbits, maxillae & zygomatic arches
 It determines the exact location of a foreign  Best projection for facial bones
body by use of a geometric calculations  Petrous ridges below the maxillae
 Apparatus:  Blow out fractures
o Sweet localizing device
o Sweet film pedestal MODIFIED WATERS
 1 Projection: PP: Prone; MSP & MML perpendicular to IR;
o Lateral: 2 exposures OML 55o to IR
RP: Acanthion (exit)
6
 SKULL

CR: Perpendicular  Zygomatic bone

SS: Facial bones w/ less axial angulation  Anterior wall of maxillary sinus of side up
 Petrous ridges below the inferior border of
orbits I.) NASAL BONE

REVERSE WATERS METHOD LATERAL PROJECTION

AP AXIAL PROJECTION PP: Semiprone; MSP & IOML parallel to IR; IPL
PP: Supine; MSP & MML perpendicular to IR; perpendicular to IR
OML 37o to IR; chin up RP: ¾ in. (old) or ½ in. (new) distal to nasion
RP: Acanthion (exit) CR: Perpendicular
CR: Perpendicular SS: Nasal bones of side down & soft tissue
SS: Superior facial bones; same as True/Original structures
Waters, but the image is MAGNIFIED
ER: For patient who cannot be placed in the prone TANGENTIAL PROJECTION
position PP:
 Extraoral Film (Cassette): prone; chin rested
CALDWELL METHOD on sandbags; chin fully extended; MSP &
PA AXIAL PROJECTION GAL perpendicular to IR
PP: Prone; forehead & nose against IR; OML  Intraoral Film (Occlusal Film): supine; head
perpendicular to IR elevated; MSP perpendicular to sponge;
RP: Nasion GAL parallel to sponge & perpendicular to
CR: 15o caudad or 30o caudad (Exaggerated film
Caldwell) RP: Glabelloalveolar line
SS: Orbital rims, maxillae, nasal septum, zygomatic CR: Perpendicular
bones & anterior nasal spine SS: Nasal bones with minimal superimposition
 Petrous ridges at lower third of orbits (15o ER: For demonstration of any medial or lateral
caudad) displacement of fragments in fractures
 Petrous ridges below the inferior orbital Contraindications:
margins (30o caudad)  Children or adults who have very short nasal
 Orbital floors (30o caudad) bones, concave face or protruding upper
teeth
LAW METHOD
PA OBLIQUE AXIAL PROJECTION WATERS METHOD
PP: Semiprone; zygoma, nose & chin against IR; PARIETO-ACANTHIAL PROJECTION
unaffected side against IR; OML perpendicular to PP: Prone; MSP & MML perpendicular to IR;
IR; Center IR 2 in. above floor of maxillary sinuses OML 37o to IR; nose ¾ in. (1.9 cm) away from IR
RP: Lower antrum RP: Acanthion (exit)
CR: 25-30o cephalad; posterior to gonion (entrance) CR: Perpendicular
SS: Floor & posterior wall of maxillary sinus ER: Displacement of bony nasal septum &
(antrum) of side down depressed fx of nasal wings
 External orbital wall
7
 SKULL

J.) ZYGOMATIC ARCHES SS: Bilateral symmetric zygomatic arches free of

superimposition
SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION K.) MANDIBLE
PP: Supine or Seated-upright (more comfortable);
IOML parallel to IR; MSP perpendicular to IR; PA PROJECTION
head rested on vertex; neck hyperextended PP: Prone; forehead & nose against IR; OML &
RP: 1 in. posterior to outer canthi MSP perpendicular to IR
CR: Perpendicular to IOML; MSP of throat b/n RP: Acanthion (exit)
gonion (entrance) CR: Perpendicular
SS: Best demonstrates bilateral symmetric SS: Mandibular rami
zygomatic arches ER: To demonstrate any medial or lateral
displacement of fragments in fractures of the rami
MODIFIED TITTERINGTON METHOD
PA AXIAL (SUPEROINFIOR) PROJECTION PA AXIAL PROJECTION
PP: Prone; nose & chin against IR; MSP PP: Prone; forehead & nose against IR; OML &
perpendicular to IR MSP perpendicular to IR
RP: Vertex midway b/n zygomatic arches RP: Acanthion (exit)
CR: 23-38o caudad CR: 20 or 25o cephalad
SS: Well shown zygomatic arches SS: Condylar processes; mandibular rami
ER: To demonstrate any medial or lateral
MAY METHOD displacement of fragments in fractures of the rami
TANGENTIAL PROJECTION
PP: Prone/seated; neck fully extended; IOML PA PROJECTION
parallel to IR; MSP rotated 15o toward the side of PP: Prone; nose & chin against IR; AML & MSP
interest; head tilted 15o perpendicular to IR
RP: Zygomatic arch at 1.5 in. posterior to outer RP: Level of lips
canthus CR: Perpendicular
CR: Perpendicular to IOML SS: Mandibular body
SS: Zygomatic arch free of superimposition
ER: Useful with patients who have depressed PA AXIAL PROJECTION
fractures or flat cheekbones PP: Prone; nose & chin against IR; AML & MSP
perpendicular to IR; fill the mouth with air to
MODIFIED TOWNE METHOD obtained better contrast around TMJs (Zanelli
AP AXIAL PROJECTION recommendation)
JUG HANDLE VIEW RP: Midway b/n TMJs
PP: Supine; OML/IOML & MSP perpendicular to CR: 30o cephalad
IR; SS: Mandibular body; TMJs; condylar processes
RP: Glabella (1 in. above nasion)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)

8
 SKULL

AXIOLATERAL OBLIQUE PROJECTION PANORAMIC TOMOGRAHY/

PP: Seated/semiprone/semisupine; head in true PANTOMOGRAPHY/ROTATIONAL
lateral & IPL perpendicular to IR (ramus); head TOMOGRAPHY
rotated 30o toward IR (body); head rotated 45o -technique employed to produced tomograms of
toward IR (symphysis); head rotated 10-15o toward curved surfaces-
IR (general survey); mouth closed; neck extended  Provides panoramic image of the entire
(prevent superimposition of cervical spine) mandible, TMJ, dental arches
RP: Mandibular region of interest  Provides distortion-free lateral image of the
CR: 25o cephalad entire mandible
SS: Mandibular body & TMJs  Patients who sustained severe mandibular or
ER: To place the desired portion of the mandible TMJ trauma
parallel with the IR  Useful for general survey studies of dental
Muscular/Hypersthenic Patients: MSP 15o & CR abnormalities
10o cephalad  Adjuvant for pre-bone marrow transplant
 To reduce the possibility of projecting
shoulder over the mandible L.) TEMPOROMANDIBULAR JOINTS

SCHULLER/PFEIFFER METHOD TOWNE METHOD

SUBMENTOVERTICAL PROJECTION AP AXIAL PROJECTION
PP: Supine or Seated-upright (more comfortable); PP: Supine; MSP & OML perpendicular to IR
IOML parallel to IR; MSP perpendicular to IR;  Closed-mouth Position: posterior teeth in
head rested on vertex; neck hyperextended contact not incisors
RP: Midway b/n gonions o Rationale: prevents mandibular
CR: Perpendicular to IOML protrusion & condyles to be carried
SS: Mandibular body; coronoid & condyloid out of mandibular fossae
processes of rami  Opened-mouth Position: open as wide as
possible
SCHULLER METHOD o Mandible not protruded (jutted
VERTICOSUBMENTAL PROJECTION forward)
PP: Prone; chin fully hyperextended; IR against o Not perform in trauma patients
throat; MSP perpendicular to IR RP: 3 in. above nasion
RP: Level just posterior to outer canthi CR: 35o caudad
CR: Perpendicular to IOML or occlusal plane SS: Mandibular condyles & mandibular fossae of
SS: Condyle & neck of condylar processes are temporal bones
better shown (CR ┴ occlusal plane)  Closed-mouth: condyle lying in mandibular
fossa
 Opened-mouth: condyles lying inferior to
articular tubercle

9
 SKULL

AXIOLATERAL PROJECTION SS: TMJ

PP: Semiprone; head in lateral position; IPL
perpendicular to IR; MSP parallel to IR; closed- ZANELLI METHOD
mouth & opened-mouth position LATERAL TRANSFACIAL POSITION
RP: 0.5 in. anterior & 2 in. superior to upside EAM PP: Lateral recumbent; head in true lateral; head
CR: 25-30o caudad resting on parietal region; MSP 30o to IR
SS: TMJ anterior to EAM RP: Uppermost gonion (entrance)
 Closed-mouth: condyle lying in mandibular CR: Perpendicular
fossa SS: TMJ
 Opened-mouth: condyles lying inferior to
articular tubercle M.) SINUSES
Cross & Flecker: pointed out the value of erect
SCHULLER METHOD position
AXIOLATERAL OBLIQUE/LATERAL  To demonstrate presence or absence of fluid
TRANSCRANIAL/AXIAL TRANSCRANIAL  To differentiate between shadows caused by
PROJECTION fluid & those caused by pathology
PP: Semiprone; MSP rotated 15o toward the IR;
AML parallel to transverse axis of IR; LATERAL PROJECTION
RP: 1.5 in. superior to upside EAM PP: Upright RAO/LAO or dorsal decubitus (can’t
CR: 15o caudad; TMJ of sidedown (exit) assume upright); head in true lateral; MSP parallel
SS: Condyles & neck of the mandible to IR; IPL perpendicular to IR; IOML parallel to
 Closed-mouth: fracture of the neck & transverse axis of IR;
condyle of ramus RP: 0.5-1 in. posterior to outer canthus
 Opened-mouth: mandibular fossa; inferior & CR: Perpendicular
anterior excursion of the condyle SS: All paranasal sinuses

INFEROSUPERIOR TRANSFACIAL PA PROJECTION

POSITION PP: Upright; forehead & nose against IR; MSP &
PP: Semiprone; head in true lateral; IPL 10-15o OML perpendicular to IR
from perpendicular; MSP 15o from IR RP: Nasion (┴); glabella (10o cephalad); midregion
RP: Uppermost gonion of maxillary sinuses (┴)
CR: 30o cephalad CR: Perpendicular; 10o cephalad; perpendicular
SS: TMJ SS:
 Posterior ethmoid sinuses inferior to cranial
ALBERS-SCHONBERG METHOD bones & superior to anterior ethmoid sinuses
LATERAL TRANSFACIAL POSITION (┴)
PP: Semiprone; head in true lateral; IPL  Sphenoidal sinuses through frontal bone &
perpendicular to IR; MSP parallel to IR; IOML superior to frontal & ethmoid sinuses
parallel to transverse axis of IR  Maxillary sinuses inferior to cranial base
RP: TMJ closes to IR (exit)
CR: 20o cephalad
10
 SKULL

CALDWELL METHOD SCHULLER METHOD

PA AXIAL PROJECTION SUBMENTOVERTICAL PROJECTION
PP: Upright PP: Upright; IOML parallel to IR; MSP
 Angle grid technique: nose & forehead perpendicular to IR; head rested on vertex; neck
against IR; IR tilted 15o; MSP & OML hyperextended
perpendicular to IR RP: ¾ in. anterior to EAM (sella turcica)
 Vertical grip technique: nose against IR; CR: Perpendicular to IOML; MSP of throat b/n
OML 15o from IR; sponge b/n forehead & gonion (entrance)
IR; MSP perpendicular to IR SS: Sphenoidal & ethmoidal sinuses
RP: Nasion  Anterior portion of the base of the skull
CR: Horizontal
SS: Frontal sinuses & anterior ethmoidal sinuses SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
WATERS METHOD PP: Seated-erect; chin fully hyperextended; MSP
PARIETOACANTHIAL PROJECTION perpendicular to IR
PP: Upright; neck hyperextended & rested against RP: ¾ in. anterior to EAM (sella turcica)
IR; OML 37o to IR; MML perpendicular to IR CR: Perpendicular to IOML; MSP of throat b/n
RP: Acanthion gonion (entrance)
CR: Horizontal SS: Sphenoidal sinuses
SS: Maxillary sinuses  Posterior ethmoidal sinuses
 Petrous pyramids inferior to floor of  Maxillary sinuses
maxillary sinus  Nasal fossae
 Foramen rotundum
 Distorted frontal & ethmoidal sinuses PIRIE METHOD
AXIAL TRANSORAL POSITION
OPEN-MOUTH WATERS METHOD PP: Upright (prone; nose & chin against IR; mouth
PARIETOACANTHIAL PROJECTION wide open; MSP perpendicular to IR; phonate “ah”
PP: Upright; neck hyperextended & rested against during exposure
IR; OML 37o to IR; MML perpendicular to IR; RP: ¾ in. anterior to EAM (sella turcica)
mouth wide open CR: Perpendicular
RP: Acanthion SS: Sphenoidal sinuses projected through open
CR: Horizontal mouth
SS: Sphenoidal sinuses projected through open  Maxillary sinuses
mouth  Nasal fossae
 Petrous pyramids inferior to floor of
maxillary sinus RHESE METHOD
ER: For the patients who cannot be placed in PA OBLIQUE POSITION
position for SMV PP: Seated-erect; zygoma, nose & chin against IR;
AML perpendicular to IR; MSP 53o from IR
RP: Upper parietal region
CR: Perpendicular
11
 SKULL

SS: Oblique image of posterior & anterior  Sigmoid sinus

ethmoidal sinuses  Lateral portion of pars petrosa
 Frontal & sphenoidal sinuses  Tegmen tymphani
 Profile image of the optic canal  Superimposed internal & external auditory
meatuses
LAW METHOD  Mastoid emissary vessel (when present)
PA OBLIQUE POSITION
PP: Seated-erect; zygoma, nose & chin against IR; MODIFIED HICKEY METHOD
neck fully extended AP TANGENTIAL POSITION
RP: Uppermost gonion PP: Supine; tape auricles forward; face rotated
CR: 25-30o cephalad away from side of interest; MSP 55o from IR or 35o
SS: Relationship of teeth to maxillary sinuses from vertical; IOML perpendicular to IR; IR
caudally inclined 15o
N.) MASTOID RP: 1 in. superior to tip of mastoid process
CR: 15o caudad
LAW METHOD SS: Mastoid process free of superimposition
AXIOLATERAL POSITION  Projected below the shadow of occipital
Double Angulation Method bone
PP: Prone; head in true lateral; tape auricle forward;
MSP & IOML parallel to IR; IPL perpendicular to PA TANGENTIAL POSITION
IR PP: Prone; IR cranially inclined 15o; tape auricles
RP: 2 in. posterior & 2 in. superior to uppermost forward; cheek against IR; face rotated away from
EAM side of interest; MSP 55o from IR or 35o from
CR: 15o caudad & 15o anterior vertical; IOML perpendicular to IR
Lange Recommendations: RP: 1 in. superior to tip of mastoid process
 25o caudad & 20o anterior CR: 15o cephalad
 Auricles taped forward SS: Mastoid process free of superimposition
Single Angulation Method  Projected below the shadow of occipital
PP: Prone; tape auricle forward; MSP rotated 15o bone
toward IR
RP: 2 in. posterior & 2 in. superior to uppermost TOWNE METHOD
EAM AP AXIAL PROJECTION
CR: 15o caudad PP: Supine; OML/IOML & MSP perpendicular to
Part Angulation Method IR;
PP: Prone; head rested on flat surface of cheek; RP: 2 in. above glabella or 2.5 in. above nasion
tape auricle forward; MSP rotated 15o towards IR; CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
IPL 15o from vertical SS:
RP: 2 in. posterior & 2 in. superior to uppermost  Internal auditory canals
EAM  Petrous portion of temporal bone
CR: ┴  Labyrinths
SS: Mastoid cells
12
 SKULL

 Mastoid antrum  Labyrinths

 Middle ears  Mastoid antrum
 Dorsum sellae w/in foramen magnum  Middle ears
 Dorsum sellae w/in shadow of foramen
HENSCHEN, SCHULLER, & LYSHOLM magnum
METHODS
AXIOLATERAL POSITIONS HAAS METHOD
PP: Semiprone; head in true lateral; MSP parallel to PA AXIAL PROJECTION
IR; IPL perpendicular to IR; IOML parallel to PP: Prone; MSP & OML perpendicular to IR;
transverse axis of IR; auricles taped forward forehead & nose against the table; IR center 1 in. to
RP: Dependent EAM closest to IR nasion
CR: 15o caudad (Henschen/Cushing); 25o caudad RP: Nasion
(Schuller); 35o caudad (Lysholm/Runstrom II) CR: 25o cephalad
SS: Mastoid & petrous portion SS: Symmetric axial frontal image of petrous
 Mastoid cells, mastoid antrum, IAM & portions projected above the base of the skull
EAM & tegmen tympani (Henschen)  IAM
 Tumors of the acoustic nerve (Cushing)  Labyrinths
 Pneumatic structures of mastoid process,  Mastoid antrums
mastoid antrum, tegmen tympani, IAM &  Middle ears
EAM, sinus & dural plates & mastoid  Dorsum sellae & posterior clinoid processes
emissary when present (Schuller) w/in shadow of foramen magnum
 Mastoid cells, matoid antrum, IAM & EAM, ER: For patients who cannot assume AP axial
tegmen tympani, labyrinthine area & carotid position
canal (Lysholm/Runstrom II)
Runstrom Recommendation: VALDINI METHOD
 Exposure made with open mouth PA AXIAL PROJECTION
 For visualization of petrous apex between PP: Recumbent or seated-erect (more comfortable);
anterior wall of EAM & mandibular condyle upper frontal region of skull against IR; MSP
perpendicular to IR; head acutely flexed; IOML
O.) PETROUS PORTION 50o/OML 50o; line extending from inion to 0.5 cm
distal to nasion form 28o to CR
TOWNE METHOD RP: 0.5 cm distal to nasion (dorsum sellae);
AP AXIAL PROJECTION foramen magnum at or slightly above level of EAM
PP: Supine; OML/IOML & MSP perpendicular to (petrosae)
IR; CR: Perpendicular; inion (entrance); 0.5 cm distal
RP: MSP b/n EAMs to nasion (exit)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴) SS:
SS: Petrosae above base of the skull  DILA (IOML 50o): Dorsum sellae; Internal
 IAM Auditory Meatus (IAM); LAbyrinth
 Arcuate eminences

13
 SKULL

 ETB “EaT Bulaga” (OML 50o): External  Mastoid antrum

auditory meatus; Tymphanic cavity; Bony Owen Modifications: cited by Pendergrass,
part of Eustachian tube Schaeffer & Hodes
 PP: MSP 40o to IR; IR & head angled 10o
SCHULLER/PFEIFFER METHOD caudally
SUBMENTOVERTICAL (SUBBASAL)  CR: 28o caudally
PROJECTION Owen Modifications: described by Etter & Cross
PP: Supine or Seated-upright (more comfortable);  PP: MSP 30o to IR
OML parallel to IR or CR perpendicular to OML  CR: 25-30o caudally
Owen Modifications: described by Compere
(cannot fully extend the neck) or supraorbitomeatal  PP: MSP 30-45o to IR
line (SOML) parallel to IR; MSP perpendicular to
IR; head rested on vertex; neck hyperextended  CR: 30o caudally
RP: ¾ in. anterior to EAM (sella turcica) Owen Modifications: used by Zizmor
CR: Perpendicular to OML at midway b/n EAMs or  PP: MSP 15o to IR
15-20o anteriorly at MSP of throat 1 in. anterior to
 CR: 35o caudally
EAMs
SS: Symmetric petrosae
STENVERS METHOD
 Mastoid processes
POSTERIOR PROFILE POSITION
 Labyrinths PP: Prone; forehead, nose & zygoma against IR (3-
 EAMs pt Upper Landing); IOML parallel to transverse axis
 Tympanic cavities of IR; face rotated away from side of interest; MSP
 Acoustic/auditory ossicles 45o to IR
Hirtz Method: RP: 1 in. anterior to EAM closest to IR (exit)
 RP: Midway b/n & 1 in. anterior to EAMs CR: 12o cephalad
 CR: 5o anteriorly SS: Pars petrosa closest to IR
 Petrous ridge
MAYER METHOD  Cellular structure of mastoid process
AXIOLATERAL OBLIQUE PROJECTION  Mastoid antrum
PP: Supine; auricles taped forward; outer side of IR  Area of tympanic cavity
elevated (reduces part-film distance); MSP 45o from  Labyrinth
IR; chin depressed; IOML parallel to IR
 IAM
RP: Dependent EAM
 Cellular structure of petrous apex
CR: 45o caudad
SS: Axial oblique of petrosa
ARCELIN METHOD
 Petrosa inferior to mastoid air cells
ANTERIOR PROFILE POSITION
 EAM REVERSE STENVERS METHOD
 Tympanic cavity & ossicles PP: Supine; IOML perpendicular to IR; face rotated
 Epitympanic recess (attic) away from side of interest; MSP 45o to IR
 Aditus

14
 SKULL

RP: 1 in. anterior & ¾ in. superior to EAM closest

to IR (exit)
CR: 10o caudad
SS: Magnified pars petrosa away from IR
ER: Useful with children & with adults who cannot
be position for Stenvers Method

MODIFIED LAW METHOD

AXIOLATERAL POSITION
Single Angulation Method
PP: Prone; taped auricle forward; Head rotated 15o
toward IR; MSP 15o
RP: 2 in. posterior & 2 in. superior to uppermost
EAM
CR: 15o caudad
SS:
 Mastoid cells
 Lateral portion of pars petrosa
 Superimposed IAM & EAM
 Mastoid emissary vessel (when present)

 THE END 
“BOARD EXAM is a matter of PREPARATION. If
you FAIL to prepare, you PREPARE to fail”
04/01/14

15