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Skull views

Procedures 2 (cranial, facial, nasal, sinus, zygo, ect..)

QuestionAnswer
Towne method. Patient and part position? CR? Erect or supine. OML perpendicular to IR. CR 30 degrees caudal to OML, center at MSP 2.5 inches above glabella (to pass through foramen magnum)
Towne method. Patient is unable to flex neck to get OML perpindicular, what do you do? align IOML perp to IR. CR angled 37 degrees caudal (instead of OML and 30 degrees).
Towne/Haas, correct CR angle and proper neck flex/extension by... (2 things seen) dorsum sellae and posterior clinoids visualized in the foramen magnum
Underangulation of CR or insufficient flexion projects the dorsum sellae ____ to the foramen magnum. (Towne/Haas skull) superior
Towne/Haas skull. Overangulation of CR or excessive flexion has what appearance? posterior arch of C1 over the dorsum sellae
Lateral skull may show air fluid levels in what sinus? What is this a sign of? Sphenoid sinus. Sign of basal skull fracture if intracranial bleeding occurs
Lateral skull patient and part position? CR? MSP parallel to IR, IPL is perpendicular to IR! GAL parallel to front edge of IR. CR 2 inches superior to EAM or halfway between glabella and the inion for other skull morphologies
Anterior and Posterior separation of symmetric Vertical structures (such as EAM, greater wings..) indicate what on a lateral skull? Rotation. (superior and inferior separation of horizontal is tilt)
Superior and Inferior separation of Horizontal structures (such as orbital roofs and greater wings) indicate what on a lateral skull? Tilt. (anterior and posterior separation of vertical is rotation)
Caldwell skull and facial bones and sinus. Patient and part position? CR? Erect or Prone. OML perp to IR. CR 15 degrees caudal, centered to exit as nasion.
(Like caldwell but more angle..) PA axial skull with 25-30 degree angle allows better visualization of what 3 things? superior orbital fissures, foramen rotundum, and inferior orbital rim region.
Caldwell and PA skull. What sinuses are demonstrated? frontal and anterior ethmoid sinuses
What view/s show the superior orbital fissures within the orbits? PA axial with 25-30 caudal angle
What view are the petrous pyramids projected into the lower one third of the orbits? Caldwell
PA axial/caldwell. The distance between the right lateral orbit and lateral cranial cortex is greater than the left side, what way are they rotated? Left side
PA skull. Patient and part position? CR? prone, OML perp to IR. CR is perp and centered to exit at glabella.
What view is the posterior and anterior clinoids visualized just superior to ethmoid sinuses? And Petrous ridges fill the orbits? PA skull
What is the SMV projection for? And what does SMV stand for submentovortex. SMV is for pathology of inner temporal bone structures, skull base.
SMV skull. Patient and part position? CR? Erect or wheelchair. IOML is parallel to IR, head resting on vertex (like a headstand) If patient cant extend neck sufficiently, compensate by angling CR to remain perp to IOML & IR. Centered 1.5 inches inferior to mandibular symph. Or between gonions
Correct extension of neck on an SMV skull is indicated how mandibular mentum anterior to ethmoid sinuses
Alternative position for patients who cannot flex neck sufficiently for Towne? Haas
Haas method. Patient and part position, CR? OML perp to IR, CR angled 25 degrees cephalic TO OML. CR pass through level of EAM and exit 1.5 inches superior to nasion
*All cranial series has OML perp to IR except SMV (IOML is parallel) and Lateral
Lat facial bones. CR where? zygoma, midway between outer canthus and EAM
Waters facial bones. Patient position? CR? (same as nasal) MML is perp (OML FORMS A 37 DEGREE ANGLE TO IR!) CR perp to exit at acanthion.
Correct neck extension is demonstrated on facial bones waters view by? petrous ridges just inferior to maxillary sinuses
*** which position puts the OML at a 37 degree angle to the IR? Waters
If orbital floors are an area of interest, what should be done? (two options) Why? caldwell with 30 degree caudal angle to project petrous ridges below IOM. Or modified waters could be done with 55 degree OML to IR.
What view demonstrates the superior orbital rim and the anterior nasal spine?.. caldwell
Modified waters facial bones. Patient position and CR? LML perp (OML FORMS A 55 DEGREE ANGLE TO IR) CR perp exit at acanthion
Which projection would demonstrate the infraorbital rim?... Modified waters
Modified waters, where are the petrous ridges? Orbital floors? Petrous ridges are projected into lower half of maxillary sinuses below IOM. Orbital floors are perp to IR
kV range for nasal bones? 60-70
CR center for lat nasal bones? 1/2 inch below nasion
Superoinferior tangential (axial) nasal bones: CR to _____ and angle as needed to ensure that it is parallel to ____. Nasion, GAL
On superoinferior tangential (Axial) nasal bones: if you see alveolar ridge what is the issue? If you see too much glabella? alveolar ridge is too much extension, glabella is too much flexion (GLABELLA AND ALVEOLAR RIDGE NEED TO LINE UP! GAL!)
SMV zygomatic arches. ___ is parallel to IR. CR is centered where? IOML. CR perp to IR @ midway between arches, 1.5 inches below mandibular symph
How to tell if SMV of zygo arches is positioned correctly? (what is superimposed..) mandibular symphysis is superimposed on frontal bone
Oblique inferiosuperior (tangential) zygomatic arches. ___ is parallel to IR. How is patient positioned? CR where? IOML. head rotated 15 toward side of interest, chin tilted 15 toward side of interest. CR to zygo arch of interest (which is downside)
Oblique tangential zygo arches. Upside or downside is of interest? downside. (PT is rotated and tilted 15 degrees toward side of interest.. pt is on vertex..)
AP axial zygomatic arches (aka as modified townes) is the same as towne skull except you center @ ____ instead of 2.5 inches above glabella 1 inch above glabella (to pass through arches.. at level of gonion) (so OML or IOML is perp to IR and able 30 or 37 degrees caudal)
Oblique mandible. Head in true lateral best demonstrates what ramus
Oblique mandible. 30 degrees rotation best demonstrates what body
oblique mandible. 45 degrees rotation best demonstrates what mentum
oblique mandible. 10-15 rotation is best for general survey of mandible. (lat is for ramus, 30 is for body, 45 is for mentum)
Oblique mandible rotation and/CR angle should not exceed 25 degrees
PA mandible, ___ is perp to IR, CR @? OML, CR exit at junction of lips. (unless looking for true PA of the body.. then raise chin to bring AML perp)
PA mandible. If body is of interest what is changed to pt position? Instead of OML perp, raise chin so AML is perp
PA axial (optional from PA mandible) CR angle and exit? CR 20-25 cephalic, exit at acanthion
Mandible townes (AP). Patient position? CR angle and at? OML perp to IR (or IOML and add 7 degrees.) CR angle 35-42 degrees caudal to glabella.
What view/s is for condyloid processes of mandible and TM fossae? (AP axials...) Towne mandible or modified towne for TMJS
If area of interest is TM fossae, how much angle should be used on towne mandible projection? 40 caudal (reduces superimposition of TM fossae and mastoid portions of temporal bones)
SMV mandible. ___ is parallel to IR, CR @? IOML parallel, CR midway between angles of mandible (1.5 inches below mandibular symph)
AP axial (modified townes) TMJS is is the same as towne mandible, except instead of centering at glabella you center @ 3 inches above nasion
Axiolateral oblique TMJS is aka axiolateral TMJ is aka modified law method, schuller method
Axiolateral oblique TMJS (modified law): How to position patient? CR? start in lateral... then rotate face toward IR 15 degrees (this prevents superimposition of TMJS over eachother). CR 15 caudal 1.5 inches superior to upside EAM (to pass through downside TMJ)
How to tell if axiolateral oblique TMJS are open mouthed? Condyle moves to anterior margin of mandibular fossae
Axiolateral TMJ (schuller method) patient and CR ? True lateral, IPL/IOML is perp to IR. CR 25-30 caudal @ .5 inches anterior and 2 inches superior to upside EAM
Lateral sinuses, CR @ midway between outer canthus and EAM
Caldwell sinuses, Patient and part position? CR? Ideally, IR tilted 15 degrees with CR horizontal, placing OML perp to IR creates 15 degrees from horizontal. (to asses fluid levels).. otherwise just make sure pt extends head up slightly to put OML 15 degrees from horiz & use a PERP CR! CR exit @ nasion
Waters sinuses What is perp and CR where? exact same as waters facial bones. MML perp to IR and CR @ acanthion
Caldwell sinuses are exact same as Caldwell skull
*All SMV views are same CR and Position* What is the patient position and CR at? (What are the 4 SMV projections of?) IOML is parallel to IR, CR is perp to IOML @ midway between angles of mandible at level 1.5-2 inches below mandibular symphysis. (SMV of sinuses, mandible, zygo arches, and skull)
Good alternative to demonstrate the sphenoid sinuses for patients who cannot perform the SMV? Open mouth waters sinuses (parietoacanthial transoral)
open mouth waters of sinuses: ___ forms a 37 degree angle with IR (____ is perp when mouth is closed). CR to exit @ ____. OML, MML is perp with mouth closed, CR to exit at acanthion
Open mouth waters of sinuses, what is visualized through open mouth? sphenoid sinuses
SMV projections: what is parallel to IR? What is Perp to IR? CR angle? Centering? IOML parallel. CR and MSP are perpendicular. CR is perp to IOML/IR. CR @ 1.5-2 inches below mandibular symph
TOWNES projections: what is perp to IR? CR angle (for skull and zygo arches, and for mandible and TMJS? Centering for each? OML or IOML are perp to IR for all. SKULL and ZYGO CR 30-37 caudal, MANDIBLE and TMJS CR 35-42 caudal. Skull- 2.5 above glabella. Zygo- 1" above glabella. Mandible- @ glabella. TMJS- 3" above nasion
CALDWELL projections: what is perp to IR? CR angle? Centering? OML. CR 15 caudal. CR @ exit nasion. (Skull, facial bones, sinuses)
PA 0 degree projections: What is perp to IR? Centering? (mandible and skull) OML and CR perp to IR. SKULL: CR to exit at glabella. MANDIBLE: CR exit @ junction of lips
LATERAL projections: What is parallel to IR? What is perp to IR? CR angle? Centering? MSP and GAL are parallel. IPL and IOML and CR are perp. SKULL: CR 2" above EAM. NASAL: CR .5" below nasion. FACIAL BONES AND SINUSES: CR midway between outer canthus and EAM.
WATERS projections: What is perp to IR? CR angle? Centering? *different from modified* MML and CR are perp to IR. Facial, nasal, zygomatic, orbits, sinuses.. all exit @ acanthion. (*modified for facial bones and orbits is LML is perp*)
Created by: Zoest35