 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
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
Lateral Projection
 Patient position
 Position patient seated erect or
semiprone.
 Part position
 position midsagittal plane parallel to IR.
 IOML is perpendicular to front edge of IR.
 Interpupillary line is perpendicular to IR.
 Central Ray:
 Perpendicularly directed
 Reference point:
 2” superior to EAM- general survey
 ¾ inch superior and ¾ inch anterior to the
EA M- sella turcica
 Structure shown:
 sella turcica
 Patient position
 Position patient seated erect or
semiprone.
 Part position
 position midsagittal plane
parallel to IR.
 IOML is perpendicular to front
edge of IR.
 Interpupillary line is
perpendicular to IR.
 Central Ray:
 Perpendicularly directed
 Reference point:
 2” superior to EAM
 Structure shown:
 sella turcica
 Patient position
 Position patient seated erect or
semiprone.
 Part position
 Have patient rest head on forehead
and nose.
 Position midsagittal plane
perpendicular to midline of grid
device.
 OML is perpendicular to IR.

 Central Ray:
 PA: Perpendicularly directed

 Caldwell method: 15 degrees caudad

 Superior orbital fissures – 20 to 25

degrees caudad
 Foramen rotundum – 25 to 30 degrees
caudad
 Reference point:
 To exit nasion
 Patient position
 Position patient supine.
 Part position
 Position midsagittal plane and
OML perpendicular to midline
of grid device.
 Place arms at sides or across
chest.
 Central Ray:
 AP: Perpendicularly directed
 AP axial: 15 degrees cephalad
 Reference point:
 Nasion
 Patient position
 Position patient seated erect or supine.
 Part position
 Center midsagittal plane to midline of grid
device and adjust to make perpendicular.
 Have the patient’s neck flexed, and adjust
the OML perpendicular to IR.
 When the patient cannot flex neck, place
IOML perpendicular to IR and then increase
CR angulation 7 degrees
 Place top of IR at the level of cranial
vertex.
 Central Ray:
 30 degrees caudad to OML or 37 caudad
degrees to IOML.
 Foramen magnum and jugular foramina –
40 to 60 degrees
 Posterior portion of the cranial vault –
perpendicularly directed
 Respiration:
 Obtain radiograph during suspended
respiration.
 Reference point:
 2 and ½” superior to glabella and passes
through the level of EAM
 Symmetric view of the petrous pyramid
 Posterior portion of the foramen magnum
 Posterior clinoid processes within the shadow
of the foramen magnum and dorsum sellae
 Occipital bone
 Posterior portion of the parietal bones

 Remember: SPPOP
 Patient position
 Position patient seated erect or
prone.
 Part position
 Have the patient rest head on
forehead and nose.
 Place arms in comfortable
position.
 Adjust shoulders to lie in same
transverse plane.
 Adjust head so that MSP and OML
are perpendicular to IR.
 Central Ray:
 25 degrees cephalad
 Respiration:
 Obtain radiograph during
suspended respiration.
 Reference point:
 1 and ½” inferior to
external occipital
protruberance (inion) and
exiting 1 and ½” superior to
nasion.
 Dorsum sellae within the shadow of the
foramen magnum
 Occipital region of the cranium
 Symmetric view of the petrous pyramid
Submentovertical
projection
Schuller Method
 Patient position
 Position patient seated erect at head
unit or supine on elevated table
support.
 Part position
 Have the patient extend neck and
rest head on vertex.
 Center and adjust MSP perpendicular
to IR.
 Adjust IOML parallel to plane of IR if
possible.
 Central Ray:
 Perpendicularly directed
Submentovertical
projection
Schuller Method
 Respiration:
 Obtain radiograph during
suspended respiration.
 Reference point:
 Sella turcica perpendicular to
IOML entering between angles
of mandible.
 ¾” anterior to the level of
EAM
 Symmetric projection of the petrosae
 Mastoid processes
 Auditory tubes (eustachian tubes)
 Foramina ovale and spinosum- best shown
 Carotid canals
 Sphenoidal sinuses
 Mandible
 Maxillary sinuses
 Nasal septum
 Dens of the axis
 Atlas
 Patient position
 Position patient prone.
 Part position
 Rest the patient’s chin on the
table with neck fully extended.
 Position midsagittal plane
perpendicular to midline of grid
device.
 Place arms at sides
 Central Ray:
 Perpendicularly directed
 Reference point:
 Sella turcica
perpendicular to IOML
entering between
angles of mandible.
 ¾” anterior to the level
of EAM
 Structure shown:
 cranial base, sphenoidal
sinuses
Patient position
 Seated-erect or semiprone
Part position
 Center the EAM of the side being examined
to the midline of the table and adjust the
head in a true lateral position
 Extend neck and place the IOML parallel with
the transverse axis of the cassette
 Central ray
 1 inch (2.5 cm) distal to the lower EAM at an
angle of 30 to 35 degrees caudad
 An oblique position of the lateral aspect of
the base of the cranium closest to film is
demonstrated
 Lysholm is recommended for patients who
cannot extend their head enough for a
satisfactory submentovertical projection
 Patient position
 Seating position
 Part position
 Rest the patient’s upper frontal region of the
skull on the table and adjust it so that the MSP is
perpendicular to the midline of the grid
 IOML 50 degrees with IR for demonstration of
dorsum sellae, internal auditory canals and
labyrinths of the ear
 OML 50 degrees with the IR for demonstration of
the external auditory canals, tympanic cavities
and eustachian tubes
 Central ray
 CR perpendicular to IR
 Center to a point 0.5 cm distal to the nasion
for demonstration of dorsum sellae
 Center to the foramen magnum at or slightly
above the level of the EAM to demonstrate of
the petrosae
Lateral Projection
 Image Receptor: 8 x 10”
 Patient position:
 Patient is seated- upright or
semiprone.
 MSP parallel to the plane of the
IR
 Radiolucent sponge is required
for obese patients.
 Part position:
 MSP parallel to IR and IPL
perpendicular to IR
 IOML parallel with transverse
axis of the IR.
 Central Ray:
perpendicularly directed
 Reference point: ¾”
anterior and ¾” superior
to the EAM
 Structure shown:
 sella turcica region of the
cranium
AP Axial Projection
 Image Receptor: 8 x 10”
 Patient position:
 Patient is seated upright or
supine.
 Arms along side the body.

 Position of part:
 MSP perpendicular to the
midline of the grid device.
 IOML perpendicular to the
plane of the IR.
AP Axial Projection
 Central Ray:
 37 degrees caudal projects the
dorsum sellae and posterior clinoid
processes within the foramen
magnum.
 30 degrees caudal to IOML projects
the dorsum and tubercullum sellae
and anterior cliniod processes
through the occipital bone above the
level of the foramen magnum.
 Reference point:
 entering the upper forehead and
passing through the head at the level
of the EAM
 Structure shown:
 Sellar region and petrous pyramid
 Image Receptor: 8 x 10”
 Patient position:
 Patient prone or seated erect
 Arms in comfortable position.
 Part position
 Forehead and nose rested against
the VCH.
 OML perpendicular to IR.
 MSP perpendicular to IR.
 Central Ray:
 10 degrees cephalad
 Reference point:
 to exit glabella
 Structure shown:
 tuberculum sellae and clinoid
process
Parietoorbital Oblique
Projection
Rhese Method
 Image Receptor: 8 x 10”
 Patient position:
 Position patient seated erect or semiprone.
 Part position:
 Center affected orbit to IR
 Have patient rest head on zygoma, nose and
chin.
 Adjust AML perpendicular to IR
 Rotate MSP 53 degrees from IR.
 Central Ray:
 perpendicularly directed
 Reference point:
 1” superior and 1” posterior to elevated
TEA.
 Structure shown:
 optic canal, and optic foramen
 Image Receptor: 8 x 10”
 Patient position:
 Patient is seated-upright or supine
position
 Arms alongside the body

 Part position:
 Rotate head so that MSP forms an angle
of 53 degrees to the plane of the IR.
 AML perpendicular to IR.

 Central Ray:
 perpendicularly directed
 Reference point:
 enters the uppermost orbit at inferior
and lateral quadrant
 Structure shown:
 optic canal “on end” and optic foramen
PA Axial Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient is prone or seated-
upright
 Forearms along side the head
with elbows flexed.
 Part position:
 Patient’s forehead and nose
rested against the grid device
with MSP centered and
perpendicular to IR.
 OML perpendicular to IR.
PA Axial Projection
 Central Ray:
 directed at the angled 20-25
degrees caudad
 Reference point:
 exiting at the level of the
inferior margin of the orbit
 Structure shown:
 petrous portion temporal bone
PA Axial Projection
Bertel Method
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in prone or seated-upright.
 Patient’s arms alongside the body.
 Part position:
 Patient’s forehead and nose rested
against the VCH
 MSP perpendicular to IR.
 IOML perpendicular to IR
PA Axial Projection
Bertel Method

 Central Ray:
 Directed at 20-25 degrees cephalad
 Reference point:
 to enter approx. 3” below the external
occipital protruberance
 exiting to the nasion
 Structure shown:
 orbital floor, orbital fissure, pterygoid
lamina.
Lateral Projection
 Image Receptor: 8 x 10’’
 Patient position:
 Patient in semi-prone
 Part position:
 MSP parallel to the plane of the IR
 OML perpendicular to IR
 Central Ray:
 Perpendicular directed
 Reference point:
 through the outer canthus
 Structure shown:
 orbital region
 Note: instruct the patient to look straight
ahead for the exposure.
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient is seated erect or prone.
 Forehead and nose in contact with
the IR
 Arms along side the head
 Part position:
 OML perpendicular to IR
 Central Ray:
 30 degrees caudad
 Reference point:
 ¾” distal to the nasion through the
mid orbits.
 Instruct the patient to close the eyes and
to concentrate on holding them still for
the exposure.
Lateral projection
R or L position
 Image Receptor: 8 x 10’’

 Patient position:
 Patient in semiprone or obliquely seated
before a vertical grid device.
 Part position:
 MSP parallel to plane of the IR
 IPL perpendicular to IR
 Central Ray:
 Perpendicular Directed
 Reference point:
 Entering the lateral surface of the
zygomatic bone halfway bet. Outer
canthus and the EAM

 Structure shown:
 Bone of the face
Lateral Projection
 Image Receptor: 8 x 10’’
 Patient position:
 Patient in semiprone or seated position
before a VCH.
 Part position:
 Head in lateral position and MSP
parallel and IPL perpendicular to the
plane of the IR.
 Central Ray:
 perpendicularly directed
 Reference point:
 Lateral surface of the zygomatic bone
and halfway between the outer canthus
and the EAM
 Structure shown:
 Bony and Tissue structure
Parietoacanthial Projection
Water’s Method
 Image Receptor: 8 x 10’’
 Position of Patient:
 Patient is seated-erect or prone
 Arms along side the body
 Position of Part:
 rest the patient head on the tip of
the extend chin.
 OML must form 37 degrees in relation
to the plane of the IR.
 Average patient’s nose will be about
¾” away from the grid device.
 Central Ray:
 perpendicularly directed
 Reference point:
 exit to the acanthion
 Structure shown:
 orbit, maxillae and zygomatic arches.
 Image Receptor: 8 x 10’’
 Position of Patient:
 Patient is seated-erect or prone
 Arms along side the body
 Position of Part:
 rest the patient head on the tip of
the extend chin.
 OML must form 55 degrees in
relation to the plane of the IR.
 Central Ray:
 perpendicularly directed
 Reference point:
 exit to the acanthion
 Structure shown:
 orbit, maxillae and zygomatic
arches.
 Image Receptor: 8 x 10’’
 Patient Position:
 Patient in supine position
 Part position:
 The patient’s chin up, adjust the
extension of the neck so that the
OML forms a 37 degrees to the
plane of the IR.
 MML perpendicular to the IR
 Central Ray:
 Perpendicularly directed
 Reference point:
 enter the acanthion
 Structure shown:
 superior facial Bone
 Patient position
 Position patient seated erect or
semiprone.
 Part position
 Have patient rest head on forehead and
nose.
 Position midsagittal plane perpendicular
to midline of grid device.
 OML is perpendicular to IR.

 Central Ray:
 Caldwell method: 15 degrees caudad

 For the demonstration of orbital rims,

particularly the orbital floor, 30 degrees
caudal is used. (exaggerated Caldwell
method)
 Reference point:
 To exit nasion
Lateral Projection
R and L Position
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in semiprone position
 Part position:
 MSP parallel and IPL perpendicular to
the plane of the IR
 Support the mandible to prevent
rotation.
 Central Ray: perpendicular
directed to the bridge of the
nose.
 Reference point: ½ ’’ distal to
the nasion
 Structure shown:
 nasal bone, soft structure of the
bone.
Submentovertical
projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in seated-upright or supine
 Part position:
 Hyperextend the neck so that IOML is
nearly parallel with the IR
 Rest the head on its vertex.
 Central Ray:
 Perpendicularly directed to IOML
 Reference point:
 entering to the throat at the level of
1’’ posterior to the outer canthi.
 Structure shown: zygomatic arch
Tangential projection
 Image Receptor:
 8 x 10”
 Patient position:
 Patient is seated or supine.
 Part position:
 Seated:
 Neck hyperextended and head
resting on vertex.
 IOML parallel as possible to the plane
of the IR.
 Rotate the MSP approx. 15 degrees
toward the side being examine.
 Tilt the top of the head approx.15
degrees away from the side being
examine.
Tangential projection
 This rotation and tilt ensure that the
CR is tangent to the lateral surface of
the skull placing the zygomatic arch
onto the IR.
 Supine
 Head resting on the vertex
 IOML nearly parallel to IR
 Rotate and tilt 15 degrees towards the
side being examine.

 Central Ray:
 Perpendicular to the IOML.
 Reference point:
 1’’ posterior to outer canthus
 Structure shown:
 zygomatic arch
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient maybe seated upright
or prone.
 Part position:
 Completely extend the
patient’s neck so that the IOML
is as parallel with IR as
possible.
 Rotate the MSP approx. 15
degrees away from the side
being examined.
 Tilt the top of the head away
from the side being examined
approx.15 degrees.
 Central Ray:
 Perpendicular directed
 Reference point:
 1 ½” posterior to outer canthus
 Structure shown:
 patient who have depressed
fracture flat cheek bone
AP axial projection
Modified Towne method
 Image Receptor:
 8 x 10”
 Patient position:
 Patient seated-upright or supine.
 Center the center of the body to
the midline of VCH
 Part position:
 MSP center the VCH
 Chin slightly depressed so that
OML is perpendicular to IR.
 Central Ray:
 Directed to angle 30” caudad
AP axial projection
Modified Towne method

 37 degrees caudad for patients

who cannot flex neck.
 Reference point:
 1” above the nasion
 Structure shown:
 zygomatic arch
AP axial projection
 Image Receptor:
 2 ¼ x 3”
 Patient position:
 Patient seating at 1 edge of
the radiographic table.
 Elevate the film packet or IR
on a suitable support so that
the patient can extend the
neck and sustain the chin in a
horizontal plane.
 Central Ray:
 directed to 40-45 degrees
AP axial projection
 Reference point:
 to the mandibular symphysis
(midway between the lips and
the tip of the chin)
 Structure shown:
 mandibular symphysis,mental
foramina
PA projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect
or prone.
 Part position
 Have patient rest forehead
and nose on the grid device.
 Adjust head so that MSP is
perpendicular to IR.
 OML is perpendicular to IR.
PA projection

 Respiration:
 Obtain radiograph during
suspended respiration.
 Central Ray:
 perpendicular directed
 Reference point:
 exit to the acanthion
 Structure shown:
 mandibular body and rami
PA axial projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect or
prone.
 Part position:
 Position MSP perpendicular to IR
 OML is perpendicular to IR
 Have the patient head rest forehead
and nose on IR holder.
 Respiration:
 Obtain radiograph during suspended
respiration.
PA axial projection

 Central Ray:
 20 - 25 degrees cephalad
 Reference point:
 exiting acanthion
 Structure shown:
 mandibular rami
PA projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in prone position or
seated upright.
 Part position:
 Rest the head on nose and chin
so that the anterior surface of
the mandibular symphysis is
parallel to the plane of the IR.
 This places the AML nearly
perpendicular to the IR plane.
PA projection

 Central Ray:
 Perpendicularly directed.
 Reference point:
 to the level of the lips.
 Structure shown:
 Mandibular body
PA Axial Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in prone
position or seated
upright before a VCH.
 Part position:
 Rest the head on nose and
chin so that mandibular
symphysis will be placed
parallel to the plane of the
IR.
 MSP is perpendicular to the
plane of the IR.
PA Axial Projection

 Central Ray:
 30 degrees cephalad.
 Reference point:
 midway between TMJs.
 Structure shown:
 Mandibular body and TMJs.

 Mouth should be filled with air

Axiolateral oblique
projection
-the goal of this projection is to place the
desired portion of the mandible parallel to the
IR
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect,
semisupine, or semiprone.
 Part position:
 Place the head in lateral position
with interpupillary line perpendicular
to IR. Have patient close mouth and
keep teeth together.
 Cont…
Mandible

Axiolateral oblique
projection
 Extend neck enough that long axis of
mandibular body is parallel with the
transverse axis of IR, preventing
superimposition of cervical spine.
 If projection is being performed on
tabletop, position IR so that complete
body of mandible is positioned on IR.
 Adjust the rotation of the head so
that the area of interest is parallel to
IR as follows: 1) ramus: keep the head
in true lateral position; 2) body:
rotate head 30 degrees toward IR 3)
symphysis: rotate head 45 degrees
toward IR.
Axiolateral oblique
projection

 Central Ray:
 25 degrees cephalad
 Reference point:
 to pass through mandibular region
of interest.
 Structure shown:
 region of mandible of interest.
Submentovertical
Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in seated-upright or supine
 Part position:
 Hyperextend the neck so that IOML
is nearly parallel with the IR
 Rest the head on its vertex.
 Central Ray:
 Perpendicularly directed to IOML
 Reference point:
 entering to the throat at the level
of 1’’ posterior to the outer canthi.
 Structure shown:
 Shows coronoid and condyloid
processes of the rami.
 Patient position
 Position patient prone or
seated.
 Part position
 Rest the patient’s chin on the
table with neck fully
extended.
 Position midsagittal plane
perpendicular to midline of
grid device.
 IOML parallel to IR.
 Place arms at sides
 Central Ray:
 Perpendicularly directed
 Reference point:
 Through the MSP entering at the
level just posterior to the outer
canthi.
AP Axial Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in supine or seated-upright
position with the posterior aspect of
the skull in contact with the VCH.
 Central Ray:
 Directed 35 caudad
 Reference point:
 midway bet. TMJ’s, 3” above the
nasion
 Structure shown:
 condyles of mandible, mandibular
fossae of the temporal bone
 Image Receptor:
 8 x 10’’
 Patient position
 Position patient seated erect or
semiprone
 Part position
 Center a point ½” anterior to
EAM to IR.
 Rotate MSP 15 degrees toward
IR.
 Adjust AML parallel with the
transverse axis of IR
 IPL is perpendicular to IR.
 After first exposure with
patient’s mouth closed, do not
permit patient to move.
  Change IR, and ,make the 2nd
exposure with patient’s mouth
fully open.
 Central Ray:
 Perpendicularly directed at 25-
30˚
 Reference point:
 1” anterior and 2” superior to the
upside EAM
 Structure shown:
 TMJs in an open and closed
mouth.
 Image Receptor: 8 x 10’’
 Central Ray: 15 caudad
 Reference point: exits
through the TMJ closest,
about 1 ½” superior to the
upside EAM
 Structure shown: condyles
and neck of mandibles
Lateral Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect
 Part position:
 Adjust head to true lateral
position.
 MSP is parallel, and IPL is
perpendicular to IR
 Adjust IOML horizontal and
parallel with transverse axis of
the IR.
 Respiration
 Obtain radiograph during
suspended respiration.
Lateral Projection
 Central Ray:
 perpendicularly/ horizontally
directed
 Reference point:
 entering the pt. head to ½ to
1” posterior to the outer
cantus.
 Structure shown:
 paranasal sinuses
PA Axial Projection
Caldwell Method
 Image Receptor:
 8 x 10’’
 Patient position:
 Tilt vertical grid device down 15
degrees.
 Have patient rest head on
forehead and nose.
 Position MSP perpendicular to
midline of IR.
 OML is perpendicular to IR.
 This positioning places OML 15
degrees from horizontal central
ray.
PA Axial Projection
Caldwell Method
 Respiration:
 Obtain radiograph during
suspended respiration.
 Central Ray:
 Perpendicularly directed to the
plane of the IR.
 Reference point:
 To exit nasion
 Structure shown:
 frontal and anterior ethmoidal
sinuses.
Parietoacanthial Projection
Open and Closed mouth
Waters Method
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect.
 Part position:
 Center and adjust MSP
perpendicular to IR, and have
patient rest head on extended
neck.
 Adjust OML to form 37 degrees to
IR. MML is perpendicular to IR
Parietoacanthial Projection
Open and Closed mouth
Waters Method
 Center IR to acanthion.
 OPEN MOUTH OPTION:
 Have patient fully open mouth to
demonstrate the sphenoid and
maxillary sinuses.
 Central Ray:
 Horizontal and perpendicular to
IR.
 Reference point:
 exiting acanthion
 Structure shown:
 sphenoidal and maxillary sinuses
for an open mouth and maxillary
sinuses for a closed mouth.
Submventovertical
Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect at
head unit.
 Part position:
 Extend neck and have patient’s
head rest on vertex.
 Center and adjust MSP
perpendicular to IR.
 Adjust IOML parallel to IR.
Submientovertical
Projection
 Respiration:
 Obtain radiograph during
suspended respiration.
 Central Ray:
 Horizontal and perpendicular to
the IOML
 Reference point:
 ¾” anterior to the level of the
EAM
 Structure shown:
 Ethmoidal and Sphenoidal sinuses
PA Projection
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient on seated erect.
 Part position:
 For posterior ethmoidal sinuses:
 Center nasion to IR
 Patient’s head is resting on forehead and
nose against VCH
 OML is perpendicular to IR
 For sphenoidal sinuses:
 Center glabella to IR.
 Patient’s head is resting on forehead and
nose against VCH
 OML is perpendicular to IR
  For maxillary sinuses:
 Center IR midway between the infraorbital
margins and the acanthion.
 Patient’s head is resting on forehead and
nose against VCH
 OML is perpendicular to IR

 Central Ray:
 For posterior ethmoidal sinuses:
 Horizontal and perpendicular to IR
 For sphenoidal sinuses:
 10 degrees cephalad passing through the
sphenoidal sinuses.
 For maxillary sinuses:
 Horizontal and perpendicular to IR.
 Reference point:
 For posterior ethmoidal sinuses:
 To exit to the nasion
 For sphenoidal sinuses:
 To exit glabella
 For maxillary sinuses:
 Midway between infraorbital margins and
acanthion
 Structure shown:
 Ethmoidal, sphenoidal and maxillary
sinuses.
Axiolateral Oblique Projection
Original Law Method
Double-tube Angulation
 Image Receptor:
 8 x 10’’
 Patient position:
 Head in a true lateral
 IPL perpendicular to IR
 MSP and IOML parallel to the plane of IR.
 Central Ray:
 directed at the angle of 15 caudad and
15 anteriorly
Axiolateral Oblique Projection
Original Law Method
Double-tube Angulation
 Reference point:
 Enters approx. 2” to, and 2” above, the
upper most of external acoustic meatus
(EAM) and exits downside the mastoid
process.
 Structure shown:
 mastoid cells, the lateral portion of the
petrous pyramid and the superimposed
internal acoustic meatus (IAM)
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect or
semiprone.
 Part position:
 Position head in lateral position with
affected side closer to IR.
 From true lateral position, rotate MSP
15 degrees toward IR.
 IOML is parallel with the transverse
axis of IR
 IPL is perpendicular to IR
 Central Ray:
 perpendicularly directed at 15
degrees caudad
 Reference point:
 Enters 2” posterior and 2” superior to
EAM farthest from IR
 Exits 1” posterior to the EAM of the
affected side.
 Structure shown:
 mastoid cells, the lateral portion of
the petrous pyramid and the
superimposed internal acoustic
meatus (IAM) and external acoustic
meatus (EAM).
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in prone position or preferably, seated
before VCH.
 Part position
 Patient’s head in true lateral position
 MSP parallel to the plane of the IR
 IPL perpendicular to IR
 IOML parallel to the transverse axis of IR.
 Central Ray:
 Henschen Method – 15 caudad
 Schuller Method – 25 caudad
 Lysholm Method – 35 caudad
 Reference point:
 exits the EAM closest to IR.
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect or prone.
 Part position:
 Have patient rest head on forehead, nose, and
zygoma.
 Adjust IOML parallel to IR and MSP at 45
degrees.
 Central Ray:
 directed 12 degrees cephalad
 Reference point:
 Entering 3-4” posterior and ½” inferior to
upside EAM.
 Exiting 1” anterior to downside EAM.
 Structure shown:
 petromastoid portion in profile
 Image Receptor:
 8 x 10’’
 Patient position:
 Position patient seated erect or supine
centered to table.
 Part position:
 Rotate MSP 45 degrees away from side
being examined.
 Central Ray:
 directed 10 cephalad
 Reference point:
 1” anterior to the EAM and ¾ above it.
 Structure shown: petrous portion
 Image Receptor: 8 x 10’’
 Patient position:
 Patient in supine position or seated
laterally before VCH.
 Part position:
 Rotate head so that MSP will be 45 degrees
to the plane of IR, with side under study
closest to IR.
 Depressed patient’s chin to place IOML
parallel to the transverse axis of the IR.
 Central Ray:
 directed 45 caudad
 Reference point:
 exits to the EAM closest to IR
 Structure shown:
 tympanic cavity and ossicles
 Image Receptor:
 8 x 10’’
 Patient position
 Position patient seated erect or
supine.
 Part position
 Center midsagittal plane to midline
of grid device and adjust to make
perpendicular.
 Have the patient’s neck flexed, and
adjust the OML perpendicular to IR.
 When the patient cannot flex neck,
place IOML perpendicular to IR.
 Place top of IR at the level of
cranial vertex.
 Central Ray:
 30 degrees caudad to OML or 37
caudad degrees to IOML.
 Respiration:
 Obtain radiograph during suspended
respiration.
 Reference point:
 2 and ½” superior to nasion and
passes through the level of EAM
 Structure shown:
 internal acoustic canal, arcuate
eminenses, labyrinths, mastoid
anthrums, and middle ears.
PA Axial Projecton
Cahoon Method
 Image Receptor:
 8 x 10’’
 Patient position:
 Patient in seated-upright or prone position.
 Part position:
 Patient’s head resting on the forehead and
nose.
 MSP perpendicular to IR.
 OML perpendicular to IR.
 Central Ray:
 directed at angle of 25 cephalad
 Reference point:
 nasion
 Structure shown:
 styloid process
Submentovertical Axial
Projection
Kemp Harper Method and
Eraso Modification
 Image Receptor:
 8 x 10’’
 Patient position:
 Kemp Harper method
 For SMV axial projection, patient is in
supine or seated- upright position
 Trunk must be elevated.
 Eraso modification
 Same position
Submentovertical Axial
Projection
Kemp Harper Method and
Eraso Modification
 Part position:
 Kemp Harper method
 MSP of the body and head to the midline of
the grid.
 Patient’s head resting on vertex.
 OML parallel to the plane of IR.
 Eraso modification
 MSP of the body and head to the midline of
the grid.
 Patient’s head resting on vertex.
 OML place 25 degrees to IR
Submentovertical Axial
Projection
Kemp Harper Method and
Eraso Modification
 Central Ray:
 Kemp Harper method
 directed at 20 degrees
 Eraso modification
 Perpedicularly directed
 Reference point:
 Kemp Harper method
 1” distal to the mandibular
 Eraso modification
 2” distal to the mandibular
 Structure shown:
 Jugular foramina
Miller Method
 Image Receptor:
 8 x 10’’
 Central Ray:
 directed at angle of 12 degrees
caudad
 Reference point:
 1” directly anterior to and ½”
inferior to the level of EAM
 Structure shown:
mandibular condyle