SKULL PLANES, POINTS & LINE

 Midsagittal plane (MSP)

 Interpupillary line (IPL)
 Acanthion
 Outer canthus
 Infraorbital margin
 External acoustic meatus (EAM)
 Orbitalmeatal line (OML)
 Infraorbitomeatal line (IOML)/Frankpurt Line
 Acanthiomeatal line (AML)
 Mentomeatal line (MML)
 Between OML & IOML: 7o difference
 Between OML & GML: 8o difference

PATHOLOGY
1. ) Basal Fx
 Fx located at the base of the skull
2) Blowout Fx
 Fx of the floor of the orbit
3.) Contre-Coup Fx
 Fx to one side of a structure caused by trauma to the other side
4.) Depressed Fx
 Fx causing a portion of the skull to be depressed into the cranial cavity
5.) Le Fort Fx
 Bilateral horizontal fxs of the maxillae
6.) Linear Fx
 Irregular or jagged fx of the skull
7.) Tripod Fx
 Fx of the zygomatic arch & orbital floor/rim & dislocation of the
frontozygomatic suture
8.) Mastoiditis
 Inflammation of mastoid antrum & air cells
9.) Paget’s Disease
 Thick, soft bone marked by bowing fxs
10.) Sinusitis
 Inflammation of one or more of the paranasal sinuses
11.) TMJ Syndrome
 Dysfunction of the temporomandibular joint
 A.) SKULL

PA PROJECTION
PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR
RP: Nasion
CR: Perpendicular
SS: Petrous pyramid completely filled the orbits; frontal bone

AP PROJECTION
PP: Supine; MSP & OML perpendicular to IR
RP: Nasion
CR: Perpendicular
SS: Same as PA, but the image walls is MAGNIFIED

MODIFIED CALDWELL METHOD

PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML perpendicular to IR; MSP
perpendicular to IR
RP: Nasion
CR: 15o caudad
SS: -General Survey Examination:
 Anterior & side of the cranium
 Temporal fossae
 Frontal sinuses & anterior ethmoid sinus
 Crista galli
 Upper 2/3 of orbits
 Petrous pyramid to lower 1/3 of orbit
-Superior orbital fissure/sphenoid fissure (20-25 o caudad) & foramen rotundum (25-
30o caudad)

AP AXIAL PROJECTION
PP: Supine; OML perpendicular to IR
RP: Nasion
CR: 15o cephalad
SS: Same as PA axial but orbits are magnified & the distance b/n lateral margin of
orbits & temporal bones are less on AP than PA

TRUE/ORIGINAL CALDWELL
PP: Prone; forehead & nose against IR; GML perpendicular to IR; MSP
perpendicular to IR
RP: Nasion
CR: 23o caudad
SS: Same as above
 LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR
RP: 2 in. Above EAM or midway b/n inion & glabella
CR: Perpendicular
SS: -General survey examination
 Sella turcica
 Anterior & posterior clinoid processes,
 Dorsum sellae
 Superimposed mandibular rami
 Mastoid region
 EAM & TMJ

CROSSTABLE LATERAL
PP: Dorsal decubitus (Robinson, Meares & Goree recommendation); MSP
perpendicular to IR
RP: 2 in. Above EAM
CR: Horizontal
ER: For traumatic sphenoid sinus effusion (basal skull fx)

TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE METHOD
AP AXIAL PROJECTION
PP: Supine; OML/IOML & MSP perpendicular to IR;
RP: 2.5-3 in. above glabella
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS: -“SPDOP”
 Symmetric petrous pyramid
 Posterior portion of foramen magnum
 Dorsum sellae & posterior clinoid process w/in shadow of foramen magnum
 Occipital bone
 Posterior portion of parietal bone
-Tomographic studies of ears, facial canal, jugular foramina & rotundum foramina
-Entire foramen magnum jugular foramina (40-60o caudad to OML)
-Posterior portion of cranial vault (CR ┴ to midway b/n frontal tuberosities)
TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE METHOD
AP AXIAL PROJECTION
PP: Lateral decubitus; OML/IOML & MSP perpendicular to IR
RP: 2.5-3 in. above glabella
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS: Same as above
ER: For patient w/ pathologic condition, trauma or deformity (strongly accentuated
dorsal kyphosis)
 HAAS METHOD
PA AXIAL PROJECTION
PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR
center 1 in. to nasion
RP: 1.5 in. below inion (entrance); 1.5 in. superior to nasion (exit)
CR: 25o cephalad to OML
SS:
 Occipital bone
 Symmetric petrous pyramid
 Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum
ER: For obtaining image of sellar structures (DS & PCP) w/in FM on hypersthenic &
obese patient
SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION
PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP
perpendicular to IR; head rested on vertex; neck hyperextended
RP: ¾ in. anterior to EAM (sella turcica)
CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance)
SS: Cranial base
 Foramen ovale & spinosum (best demonstrated)
 Symmetric petrosae
 Mastoid processes
 Carotid canals
 Sphenoidal & ethmoidal sinuses
 Mandible
 Bony nasal septum
 Dens of axis
 Occipital bone
 Maxillary sinus superimposed over the mandible
 Zygomatic arches (well demonstrated if exposure factors are decreased)
 Axial tomography of orbits, optic canals, ethmoid bone, maxillary sinuses &
mastoid processes

SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
PP: Prone; chin fully hyperextended; MSP perpendicular to IR
RP: ¾ in. anterior to EAM (sella turcica)\
CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance)
SS: Same as SMV
 Distorted & magnified basal structures
 Useful for anterior cranial base & sphenoidal sinuses
o IR in contact with the throat
 o Reduces magnification & distortion

LYSHOLM METHOD
AXIOLATERAL METHOD
PP: Semiprone; MSP parallel to IR; IOML parallel to transverse axis of IR; IPL
perpendicular to IR
RP: 1 in. distal to lower EAM (exit)
CR: 30-35o caudad
SS: Oblique position of lateral aspect of cranial base closest to IR
ER: For patients who cannot extend their head enough for a satisfactory SMV
projection

VALDINI METHOD
PA AXIAL PROJECTION
PP: Recumbent or seated-erect (more comfortable); upper frontal region of skull
against IR; MSP perpendicular to IR; head acutely flexed; IOML 50 o/OML 50o; line
extending from inion to 0.5 cm distal to nasion form 28o to CR
RP: 0.5 cm distal to nasion (dorsum sellae); foramen magnum/slightly above level of
EAM (petrosae)
CR: Perpendicular; inion (entrance); 0.5 cm distal to nasion (exit)
SS:
 DILA (IOML 50o): Dorsum sellae; Internal Auditory Meatus (IAM);
LAbyrinth
 ETB “EaT Bulaga” (OML 50o): External auditory meatus; Tymphanic cavity;
Bony part of Eustachian tube
 Dorsum sellae & posterior clinod processes within or above shadow of
foramen magnum
 Tubeculum sellae, anterior clinoid processes & sella turcica below shadow of
foramen magnum
 Mastoid pneumatization
 B.) SELLA TURCICA

LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR
RP: ¾ in. anterior & ¾ in. superior to EAM
CR: Perpendicular
SS: Superimposed anterior & posterior clinoid processes; dorsum sellae

TOWNE METHOD
PP: Supine; OML/IOML & MSP perpendicular to IR;
RP: 2.5-3 in. above glabella
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS: Sellar region
 Dorsum sellae, tuberculum sellae & anterior clinoid processes through
occipital bone above shadow of foramen magnum (30o caudad)
 Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum
(37o caudad)
 Symmetric petrous pyramid

HAAS METHOD
PA AXIAL PROJECTION
PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR
center 1 in. to nasion
RP: 1.5 in. below inion (entrance); 1.5 in. superior to nasion (exit)
CR: 25o cephalad to OML
SS:
 Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum
 Symmetric petrous pyramid
ER: For obtaining image of sellar structures (DS & PCP) w/in FM on hypersthenic &
obese patients

PA PROJECTION
PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR
RP: Glabella
CR: 10o cephalad
SS: Dorsum sellae, tuberculum sellae, anterior & posterior clinoid processes through
frontal bone above ethmoidal sinuses
 C.) OPTIC CANAL/FORAMEN

RHESE METHOD
PARIETO-ORBITAL OBLIQUE PROJECTION
PP: Prone; affected orbit closest to IR; zygoma, nose & chin against IR (3-pt Lower
Landing); AML perpendicular to IR; MSP 53o angle to IR
RP: Affected orbit closest to IR
CR: Perpendicular
SS: Optic canal/foramen (inferior & lateral quadrant of orbital shadow)
 PAZAM: Prone; Affected orbit against IR; Zynoch; AML ┴; MSP 53o to IR

RHESE METHOD
ORBITO-PARIETAL OBLIQUE PROJECTION
PP: Supine; affected orbit away from IR; AML perpendicular to IR; MSP 53 o angle to
IR
RP: Inferior and lateral margin of uppermost orbit CR: Perpendicular
SS: Magnified optic canal/foramen
 Increased radiation dose to lens of eye

ALEXANDER METHOD
ORBITO-PARIETAL OBLIQUE PROJECTION
PP: Erect/supine; IR 15o angle from vertical; MSP 40o to IR; AML perpendicular to
IR
RP: Inferior and lateral margin of uppermost orbit
CR: Perpendicular
SS: Optic canal/foramen

MODIFIED LYSHOLM METHOD

ECCENTRIC ANGLE PARIETO-ORBITAL OBLIQUE PROJECTION
PP: Prone; forehead & nose against IR; IOML perpendicular to IR; MSP 20 o from
vertical;
RP: Affected orbit (exit)
CR: 20o caudad or 30o caudad
SS: Optic canal/foramen & anterior clinoid processes (20 o); superior orbital fissure
(30o)
 D.) SPHENOID STRUT
-the inferior root of lesser wing of sphenoid bone-

HOUGH METHOD
PARIETO-ORBITAL OBLIQUE PROJECTION
PP: Prone; superciliary ridge/arch & side of the nose against IR; IOML perpendicular
to IR; MSP 20o from vertical; MSP 20o toward the side of interest
RP: Affected orbit (exit)
CR: 7o caudad
SS: Unobstructed & undistorted image of the sphenoid strut (lie b/n sphenoidal sinus
& combined shadows of anterior clinoid processes & lesser wing of sphenoid bone)

E.) SUPERIOR ORBITAL/SPHENOID FISSURES

CALDWELL METHOD
PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML perpendicular to IR
RP: Nasion
CR: 20-25o caudad or 15o caudad
SS: Superior orbital fissures
 Lying on the medial side of orbits b/n greater & lesser wings of sphenoid)
 Well demonstrated at 15o caudal angle (Caldwell)
 Petrous portions at or below the inferior orbital margin

F.) INFERIOR ORBITAL FISSURES

BERTEL METHOD
PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; IOML perpendicular to IR
RP: Nasion
CR: 20-25o cephalad
SS: Inferior orbital fissures
 b/n shadows of pterygoid process of sphenoid bone & mandibular ramus
 Anterior image of each orbital floor
 G.) EYE- FOREIGN BODY LOCALIZATION

LATERAL PROJECTION
PP: Semiprone; MSP parallel to IR; IPL perpendicular to IR; instruct patient to look
straight ahead during exposure
RP: Outer canthus
CR: Perpendicular
SS: Superimposed orbital roofs

PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; MSP & OML perpendicular to IR; instruct
patient to close the eyes
RP: Midorbits
CR: 30o caudad
SS: Petrous pyramids lying below orbital shadows

MODIFIED WATERS METHOD( closed eyes)

PARIETOACANTHIAL PROJECTION
PP: Prone; chin against IR; MSP perpendicular to IR; OML 50 o to IR (new); OML
25-37o to IR (old); instruct patient to close the eyes
RP: Midorbits
CR: Perpendicular
SS: Petrous pyramids lying well below orbital shadows
VOGT-BONE-FREE POSITION
 Taken to detect small or low density foreign particles located in the anterior
segment of the eyeball/eyelids
 2 Projections: lateral & superoinferior
 2 Movements:
o Vertical: 2 exposures (for lateral)
 Look up as far as possible
 Look down as far as possible
o Horizontal: 2 exposures (for superoinferior)
 Look to extreme right
 Look to extreme left

PARALLAX METHOD
 First described by Richards
 It determines whether the foreign body is located within the eyeball requires
no special apparatus
 Not considered as precision localization procedure
 Widely used as preliminary check only
 2 Projections:
o Lateral: 2 exposures
SWEET METHOD
 It determines the exact location of a foreign body by use of a geometric
calculations
 Apparatus:
o Sweet localizing device
o Sweet film pedestal
 1 Projection:
o Lateral: 2 exposures
 CR perpendicular
 CR 15-25o cephalad

PFEIFFER-COMBERG METHOD
 A leaded contact lens is placed directly over the cornea
 Apparatus:
o Contact lens localization device
o Pedestal type of film holder
 2 Projections:
o Waters Method:
 CR horizontal
o Lateral:
 CR perpendicular
 H.) FACIAL BONE

LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR
RP: Zygoma/malar bone
CR: Perpendicular
SS: Superimposed facial bones
 Superimposed mandibular rami & orbital roofs

WATERS METHOD
PARIETO-ACANTHIAL PROJECTION
PP: Prone; MSP & MML perpendicular to IR; OML 37o to IR; nose ¾ in. (1.9 cm)
away from IR
RP: Acanthion (exit)
CR: Perpendicular
SS: Orbits, maxillae & zygomatic arches
 Best projection for facial bones
 Petrous ridges below the maxillae
 Blow out fractures

MODIFIED WATERS
PP: Prone; MSP & MML perpendicular to IR; OML 55o to IR
RP: Acanthion (exit)
CR: Perpendicular
SS: Facial bones w/ less axial angulation
 Petrous ridges below the inferior border of orbits

REVERSE WATERS METHOD

AP AXIAL PROJECTION
PP: Supine; MSP & MML perpendicular to IR; OML 37o to IR; chin up
RP: Acanthion (exit)
CR: Perpendicular
SS: Superior facial bones; same as True Waters, but the image is MAGNIFIED
ER: For patient who cannot be placed in the prone position
CALDWELL METHOD
PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML perpendicular to IR
RP: Nasion
CR: 15o caudad or 30o caudad (Exaggerated Caldwell)
SS: Orbital rims, maxillae, nasal septum, zygomatic bones & anterior nasal spine
  Petrous ridges at lower third of orbits (15o caudad)
 Petrous ridges below the inferior orbital margins (30o caudad)
 Orbital floors (30o caudad)
LAW METHOD
PA OBLIQUE AXIAL PROJECTION
PP: Semiprone; zygoma, nose & chin against IR; unaffected side against IR; OML
perpendicular to IR; Center IR 2 in. above floor of maxillary sinuses
RP: Lower antrum
CR: 25-30o cephalad; posterior to gonion (entrance)
SS: Floor & posterior wall of maxillary sinus (antrum) of side down
 External orbital wall
 Zygomatic bone
 Anterior wall of maxillary sinus of side up
 I.) NASAL BONE

LATERAL PROJECTION
PP: Semiprone; MSP & IOML parallel to IR; IPL perpendicular to IR
RP: ¾ in. (old) or ½ in. (new) distal to nasion
CR: Perpendicular
SS: Nasal bones of side down & soft tissue structures

TANGENTIAL PROJECTION
PP:
 Extraoral Film (Cassette): prone; chin rested on sandbags; chin fully extended;
MSP & GAL perpendicular to IR
 Intraoral Film (Occlusal Film): supine; head elevated; MSP perpendicular to
sponge; GAL parallel to sponge & perpendicular to film
RP: Glabelloalveolar line
CR: Perpendicular
SS: Nasal bones with minimal superimposition
ER: For demonstration of any medial or lateral displacement of fragments in fractures
Contraindications:
 Children or adults who have very short nasal bones, concave face or
protruding upper teeth

WATERS METHOD
PARIETO-ACANTHIAL PROJECTION
PP: Prone; MSP & MML perpendicular to IR; OML 37o to IR; nose ¾ in. (1.9 cm)
away from IR
RP: Acanthion (exit)
CR: Perpendicular
ER: Displacement of bony nasal septum & depressed fx of nasal wings
 J.) ZYGOMATIC ARCHES

SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION
PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP
perpendicular to IR; head rested on vertex; neck hyperextended
RP: 1 in. posterior to outer canthi
CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance)
SS: Best demonstrates bilateral symmetric zygomatic arches

MODIFIED TITTERINGTON METHOD

PA AXIAL (SUPEROINFIOR) PROJECTION
PP: Prone; nose & chin against IR; MSP perpendicular to IR
RP: Vertex midway b/n zygomatic arches
CR: 23-38o caudad
SS: Well shown zygomatic arches

MAY METHOD
TANGENTIAL PROJECTION
PP: Prone/seated; neck fully extended; IOML parallel to IR; MSP rotated 15 o toward
the side of interest; head tilted 15o
RP: Zygomatic arch at 1.5 in. posterior to outer canthus
CR: Perpendicular to IOML
SS: Zygomatic arch free of superimposition
ER: Useful with patients who have depressed fractures or flat cheekbones

MODIFIED TOWNE METHOD

AP AXIAL PROJECTION
JUG HANDLE VIEW
PP: Supine; OML/IOML & MSP perpendicular to IR;
RP: Glabella (1 in. above nasion)
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS: Bilateral symmetric zygomatic arches free of superimposition
 K.) MANDIBLE

PA PROJECTION
PP: Prone; forehead & nose against IR; OML & MSP perpendicular to IR
RP: Acanthion (exit)
CR: Perpendicular
SS: Mandibular rami
ER: To demonstrate any medial or lateral displacement of fragments in fractures of
the rami

PA AXIAL PROJECTION
PP: Prone; forehead & nose against IR; OML & MSP perpendicular to IR
RP: Acanthion (exit)
CR: 20 or 25o cephalad
SS: Condylar processes; mandibular rami
ER: To demonstrate any medial or lateral displacement of fragments in fractures of
the rami

PA PROJECTION
PP: Prone; nose & chin against IR; AML & MSP perpendicular to IR
RP: Level of lips
CR: Perpendicular
SS: Mandibular body

PA AXIAL PROJECTION
PP: Prone; nose & chin against IR; AML & MSP perpendicular to IR; fill the mouth
with air to obtained better contrast around TMJs (Zanelli recommendation)
RP: Midway b/n TMJs
CR: 30o cephalad
SS: Mandibular body; TMJs; condylar processes

AXIOLATERAL OBLIQUE PROJECTION

PP: Seated/semiprone/semisupine; head in true lateral & IPL perpendicular to IR
(ramus); head rotated 30o toward IR (body); head rotated 45 o toward IR (symphysis);
head rotated 10-15o toward IR (general survey); mouth closed; neck extended (prevent
superimposition of cervical spine)
RP: Mandibular region of interest
CR: 25o cephalad
SS: Mandibular body & TMJs
ER: To place the desired portion of the mandible parallel with the IR
Muscular/Hypersthenic Patients: MSP 15o & CR 10o cephalad
  To reduce the possibility of projecting shoulder over the mandible

SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL PROJECTION
PP: Supine or Seated-upright (more comfortable); IOML parallel to IR; MSP
perpendicular to IR; head rested on vertex; neck hyperextended
RP: Midway b/n gonions
CR: Perpendicular to IOML
SS: Mandibular body; coronoid & condyloid processes of rami

SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
PP: Prone; chin fully hyperextended; IR against throat; MSP perpendicular to IR
RP: Level just posterior to outer canthi
CR: Perpendicular to IOML or occlusal plane
SS: Condyle & neck of condylar processes are better shown (CR ┴ occlusal plane)

PANORAMIC TOMOGRAHY/ PANTOMOGRAPHY/ROTATIONAL

TOMOGRAPHY
-technique employed to produced tomograms of curved surfaces-
 Provides panoramic image of the entire mandible, TMJ, dental arches
 Provides distortion-free lateral image of the entire mandible
 Patients who sustained severe mandibular or TMJ trauma
 Useful for general survey studies of dental abnormalities
 Adjuvant for pre-bone marrow transplant
 L.) TEMPOROMANDIBULAR JOINTS

TOWNE METHOD
AP AXIAL PROJECTION
PP: Supine; MSP & OML perpendicular to IR
 Closed-mouth Position: posterior teeth in contact not incisors
o Rationale: prevents mandibular protrusion & condyles to be carried
out of mandibular fossae
 Opened-mouth Position: open as wide as possible
o Mandible not protruded (jutted forward)
o Not perform in trauma patients
RP: 3 in. above nasion
CR: 35o caudad
SS: Mandibular condyles & mandibular fossae of temporal bones
 Closed-mouth: condyle lying in mandibular fossa
 Opened-mouth: condyles lying inferior to articular tubercle

AXIOLATERAL PROJECTION
PP: Semiprone; head in lateral position; IPL perpendicular to IR; MSP parallel to IR;
closed-mouth & opened-mouth position
RP: 0.5 in. anterior & 2 in. superior to upside EAM
CR: 25-30o caudad
SS: TMJ anterior to EAM
 Closed-mouth: condyle lying in mandibular fossa
 Opened-mouth: condyles lying inferior to articular tubercle

SCHULLER METHOD
AXIOLATERAL OBLIQUE/LATERAL TRANSCRANIAL/AXIAL
TRANSCRANIAL PROJECTION
PP: Semiprone; MSP rotated 15o toward the IR; AML parallel to transverse axis of
IR;
RP: 1.5 in. superior to upside EAM
CR: 15o caudad; TMJ of sidedown (exit)
SS: Condyles & neck of the mandible
 Closed-mouth: fracture of the neck & condyle of ramus
 Opened-mouth: mandibular fossa; inferior & anterior excursion of the condyle

INFEROSUPERIOR TRANSFACIAL POSITION

PP: Semiprone; head in true lateral; IPL 10-15o from perpendicular; MSP 15o from IR
RP: Uppermost gonion
CR: 30o cephalad
SS: TMJ

ALBERS-SCHONBERG METHOD
LATERAL TRANSFACIAL POSITION
PP: Semiprone; head in true lateral; IPL perpendicular to IR; MSP parallel to IR;
IOML parallel to transverse axis of IR
RP: TMJ closes to IR (exit)
CR: 20o cephalad
SS: TMJ

ZANELLI METHOD
LATERAL TRANSFACIAL POSITION
PP: Lateral recumbent; head in true lateral; head resting on parietal region; MSP 30 o
to IR
RP: Uppermost gonion (entrance)
CR: Perpendicular
SS: TMJ
 M.) SINUSES
Cross & Flecker: pointed out the value of erect position
 To demonstrate presence or absence of fluid
 To differentiate between shadows caused by fluid & those caused by
pathology

LATERAL PROJECTION
PP: Upright RAO/LAO or dorsal decubitus (can’t assume upright); head in true
lateral; MSP parallel to IR; IPL perpendicular to IR; IOML parallel to transverse axis
of IR;
RP: 0.5-1 in. posterior to outer canthus
CR: Perpendicular
SS: All paranasal sinuses

PA PROJECTION
PP: Upright; forehead & nose against IR; MSP & OML perpendicular to IR
RP: Nasion (┴); glabella (10o cephalad); midregion of maxillary sinuses (┴)
CR: Perpendicular; 10o cephalad; perpendicular
SS:
 Posterior ethmoid sinuses inferior to cranial bones & superior to anterior
ethmoid sinuses (┴)
 Sphenoidal sinuses through frontal bone & superior to frontal & ethmoid
sinuses
 Maxillary sinuses inferior to cranial base

CALDWELL METHOD
PA AXIAL PROJECTION
PP: Upright
 Angle grid technique: nose & forehead against IR; IR tilted 15 o; MSP &
OML perpendicular to IR
 Vertical grip technique: nose against IR; OML 15o from IR; sponge b/n
forehead & IR; MSP perpendicular to IR
RP: Nasion
CR: Horizontal
SS: Frontal sinuses & anterior ethmoidal sinuses
 WATERS METHOD
PARIETOACANTHIAL PROJECTION
PP: Upright; neck hyperextended & rested against IR; OML 37 o to IR; MML
perpendicular to IR
RP: Acanthion
CR: Horizontal
SS: Maxillary sinuses
 Petrous pyramids inferior to floor of maxillary sinus
 Foramen rotundum
Distorted frontal & ethmoidal sinuses

OPEN-MOUTH WATERS METHOD

PARIETOACANTHIAL PROJECTION
PP: Upright; neck hyperextended & rested against IR; OML 37 o to IR; MML
perpendicular to IR; mouth wide open
RP: Acanthion
CR: Horizontal
SS: Sphenoidal sinuses projected through open mouth
 Petrous pyramids inferior to floor of maxillary sinus
ER: For the patients who cannot be placed in position for SMV

SCHULLER METHOD
SUBMENTOVERTICAL PROJECTION
PP: Upright; IOML parallel to IR; MSP perpendicular to IR; head rested on vertex;
neck hyperextended
RP: ¾ in. anterior to EAM (sella turcica)
CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance)
SS: Sphenoidal & ethmoidal sinuses
 Anterior portion of the base of the skull

SCHULLER METHOD
VERTICOSUBMENTAL PROJECTION
PP: Seated-erect; chin fully hyperextended; MSP perpendicular to IR
RP: ¾ in. anterior to EAM (sella turcica)
CR: Perpendicular to IOML; MSP of throat b/n gonion (entrance)
SS: Sphenoidal sinuses
 Posterior ethmoidal sinuses
  Maxillary sinuses
 Nasal fossae

PIRIE METHOD
AXIAL TRANSORAL POSITION
PP: Upright (prone; nose & chin against IR; mouth wide open; MSP perpendicular to
IR; phonate “ah” during exposure
RP: ¾ in. anterior to EAM (sella turcica)
CR: Perpendicular
SS: Sphenoidal sinuses projected through open mouth
 Maxillary sinuses
 Nasal fossae

RHESE METHOD
PA OBLIQUE POSITION
PP: Seated-erect; zygoma, nose & chin against IR; AML perpendicular to IR; MSP
53o from IR
RP: Upper parietal region
CR: Perpendicular
SS: Oblique image of posterior & anterior ethmoidal sinuses
 Frontal & sphenoidal sinuses
 Profile image of the optic canal

LAW METHOD
PA OBLIQUE POSITION
PP: Seated-erect; zygoma, nose & chin against IR; neck fully extended
RP: Uppermost gonion
CR: 25-30o cephalad
SS: Relationship of teeth to maxillary sinuses
 N.) MASTOID

LAW METHOD
AXIOLATERAL POSITION
Double Angulation Method
PP: Prone; head in true lateral; tape auricle forward; MSP & IOML parallel to IR;
IPL perpendicular to IR
RP: 2 in. posterior & 2 in. superior to uppermost EAM
CR: 15o caudad & 15o anterior
Lange Recommendations:
 25o caudad & 20o anterior
 Auricles taped forward
Single Angulation Method
PP: Prone; tape auricle forward; MSP rotated 15o toward IR
RP: 2 in. posterior & 2 in. superior to uppermost EAM
CR: 15o caudad
Part Angulation Method
PP: Prone; head rested on flat surface of cheek; tape auricle forward; MSP rotated 15 o
towards IR; IPL 15o from vertical
RP: 2 in. posterior & 2 in. superior to uppermost EAM
CR: ┴
SS: Mastoid cells
 Sigmoid sinus
 Lateral portion of pars petrosa
 Tegmen tymphani
 Superimposed internal & external auditory meatuses
 Mastoid emissary vessel (when present)

MODIFIED HICKEY METHOD

AP TANGENTIAL POSITION
PP: Supine; tape auricles forward; face rotated away from side of interest; MSP 55 o
from IR or 35o from vertical; IOML perpendicular to IR; IR caudally inclined 15o
RP: 1 in. superior to tip of mastoid process
CR: 15o caudad
SS: Mastoid process free of superimposition
 Projected below the shadow of occipital bone
 PA TANGENTIAL POSITION
PP: Prone; IR cranially inclined 15 o; tape auricles forward; cheek against IR; face
rotated away from side of interest; MSP 55 o from IR or 35o from vertical; IOML
perpendicular to IR
RP: 1 in. superior to tip of mastoid process
CR: 15o cephalad
SS: Mastoid process free of superimposition
 Projected below the shadow of occipital bone

TOWNE METHOD
AP AXIAL PROJECTION
PP: Supine; OML/IOML & MSP perpendicular to IR;
RP: 2 in. above glabella or 2.5 in. above nasion
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS:
 Internal auditory canals
 Petrous portion of temporal bone
 Labyrinths
 Mastoid antrum
 Middle ears
 Dorsum sellae w/in foramen magnum

HENSCHEN, SCHULLER, & LYSHOLM METHODS

AXIOLATERAL POSITIONS
PP: Semiprone; head in true lateral; MSP parallel to IR; IPL perpendicular to IR;
IOML parallel to transverse axis of IR; auricles taped forward
RP: Dependent EAM closest to IR
CR: 15o caudad (Henschen/Cushing); 25o caudad (Schuller); 35o caudad
(Lysholm/Runstrom II)
SS: Mastoid & petrous portion
 Mastoid cells, mastoid antrum, IAM & EAM & tegmen tympani (Henschen)
 Tumors of the acoustic nerve (Cushing)
 Pneumatic structures of mastoid process, mastoid antrum, tegmen tympani,
IAM & EAM, sinus & dural plates & mastoid emissary when present
(Schuller)
 Mastoid cells, matoid antrum, IAM & EAM, tegmen tympani, labyrinthine
area & carotid canal (Lysholm/Runstrom II)
Runstrom Recommendation:
 Exposure made with open mouth
 For visualization of petrous apex between anterior wall of EAM & mandibular
condyle
 O.) PETROUS PORTION

TOWNE METHOD
AP AXIAL PROJECTION
PP: Supine; OML/IOML & MSP perpendicular to IR;
RP: MSP b/n EAMs
CR: 30o caudad (OML ┴); 37o caudad (IOML ┴)
SS: Petrosae above base of the skull
 IAM
 Arcuate eminences
 Labyrinths
 Mastoid antrum
 Middle ears
 Dorsum sellae w/in shadow of foramen magnum

HAAS METHOD
PA AXIAL PROJECTION
PP: Prone; MSP & OML perpendicular to IR; forehead & nose against the table; IR
center 1 in. to nasion
RP: Nasion
CR: 25o cephalad
SS: Symmetric axial frontal image of petrous portions projected above the base of the
skull
 IAM
 Labyrinths
 Mastoid antrums
 Middle ears
 Dorsum sellae & posterior clinoid processes w/in shadow of foramen magnum
ER: For patients who cannot assume AP axial position
VALDINI METHOD
PA AXIAL PROJECTION
PP: Recumbent or seated-erect (more comfortable); upper frontal region of skull
against IR; MSP perpendicular to IR; head acutely flexed; IOML 50 o/OML 50o; line
extending from inion to 0.5 cm distal to nasion form 28o to CR
RP: 0.5 cm distal to nasion (dorsum sellae); foramen magnum at or slightly above
level of EAM (petrosae)
CR: Perpendicular; inion (entrance); 0.5 cm distal to nasion (exit)
SS:
 DILA (IOML 50o): Dorsum sellae; Internal Auditory Meatus (IAM);
LAbyrinth
  ETB “EaT Bulaga” (OML 50o): External auditory meatus; Tymphanic cavity;
Bony part of Eustachian tube

SCHULLER/PFEIFFER METHOD
SUBMENTOVERTICAL (SUBBASAL) PROJECTION
PP: Supine or Seated-upright (more comfortable); OML parallel to IR or CR
perpendicular to OML (cannot fully extend the neck) or supraorbitomeatal line
(SOML) parallel to IR; MSP perpendicular to IR; head rested on vertex; neck
hyperextended
RP: ¾ in. anterior to EAM (sella turcica)
CR: Perpendicular to OML at midway b/n EAMs or 15-20 o anteriorly at MSP of
throat 1 in. anterior to EAMs
SS: Symmetric petrosae
 Mastoid processes
 Labyrinths
 EAMs
 Tympanic cavities
 Acoustic/auditory ossicles
Hirtz Method:
 RP: Midway b/n & 1 in. anterior to EAMs
 CR: 5o anteriorly

MAYER METHOD
AXIOLATERAL OBLIQUE PROJECTION
PP: Supine; auricles taped forward; outer side of IR elevated (reduces part-film
distance); MSP 45o from IR; chin depressed; IOML parallel to IR
RP: Dependent EAM
CR: 45o caudad
SS: Axial oblique of petrosa
 Petrosa inferior to mastoid air cells
 EAM
 Tympanic cavity & ossicles
 Epitympanic recess (attic)
 Aditus
 Mastoid antrum
Owen Modifications: cited by Pendergrass, Schaeffer & Hodes
 PP: MSP 40o to IR; IR & head angled 10o caudally
 CR: 28o caudally
Owen Modifications: described by Etter & Cross
 PP: MSP 30o to IR
 CR: 25-30o caudally
Owen Modifications: described by Compere
  PP: MSP 30-45o to IR
 CR: 30o caudally
Owen Modifications: used by Zizmor
 PP: MSP 15o to IR CR: 35o caudally
STENVERS METHOD
POSTERIOR PROFILE POSITION
PP: Prone; forehead, nose & zygoma against IR (3-pt Upper Landing); IOML parallel
to transverse axis of IR; face rotated away from side of interest; MSP 45o to IR
RP: 1 in. anterior to EAM closest to IR (exit)
CR: 12o cephalad
SS: Pars petrosa closest to IR
 Petrous ridge
 Cellular structure of mastoid process
 Mastoid antrum
 Area of tympanic cavity
 Labyrinth
 IAM
 Cellular structure of petrous apex

ARCELIN METHOD
ANTERIOR PROFILE POSITION
REVERSE STENVERS METHOD
PP: Supine; IOML perpendicular to IR; face rotated away from side of interest; MSP
45o to IR
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)