SKULL PLANES, POINTS & LINE ➢ RP: Nasion

➢ Midsagittal plane (MSP) ➢ CR: 15° caudad

➢ Interpupillary line (IPL) ➢ SS:
➢ Acanthion ✓ Frontal sinuses & anterior ethmoid sinus
➢ Outer canthus ✓ Anterior & side walls of the cranium
➢ Infraorbital margin ✓ Temporal fossae
➢ External acoustic meatus (EAM) ✓ Crista galli
➢ Orbitalmeatal line (OML) ✓ Upper 2/3 of orbits
➢ Infraorbitomeatal line (IOML)/Frankpurt Line ✓ Petrous pyramid to lower 1/3 of orbit
➢ Acanthiomeatal line (AML) ➢ Superior orbital fissure/sphenoid fissure (20-25° caudad) &
➢ Mentomeatal line (MML) foramen rotundum (25-30° caudad)
➢ Between OML & IOML: 7°difference
➢ Between OML & GML: 8° difference
PATHOLOGY
BASAL FX
➢ Fx located at the base of the skull
BLOWOUT FX
➢ Fx of the floor of the orbit
CONTRE-COUP FX
➢ Fx to one side of a structure caused by trauma to the other
side
DEPRESSED FX
➢ Fx causing a portion of the skull to be depressed into the AP AXIAL PROJECTION
cranial cavity ➢ PP: Supine; OML ⊥to IR
LE FORT FX ➢ RP: Nasion
➢ Bilateral horizontal fx of the maxillae ➢ CR: 15° cephalad
LINEAR FX ➢ SS: Same as PA axial but orbits are magnified & the
➢ Irregular or jagged fx of the skull distance b/n lateral margin of orbits & temporal bones are
TRIPOD FX less on AP than PA
➢ Fx of the zygomatic arch & orbital floor/rim & dislocation
of the frontozygomatic suture
MASTOIDITIS
➢ Inflammation of mastoid antrum & air cells
PAGET’S DISEASE
➢ Thick, soft bone marked by bowing fx
TRUE/ORIGINAL CALDWELL
SINUSITIS
➢ PP: Prone; forehead & nose against IR; GML ⊥to IR; MSP
➢ Inflammation of one or more of the paranasal sinuses
TMJ SYNDROME ⊥ to IR
➢ Dysfunction of the temporomandibular joint ➢ RP: Nasion
SKULL ➢ CR: 23° caudad
PA PROJECTION ➢ SS: Same as above
➢ PP: Prone; forehead & nose against IR; MSP & OML ⊥ to LATERAL PROJECTION
IR ➢ PP: Semi-prone; MSP & IOML // to IR; IPL ⊥ to IR
➢ RP: Nasion ➢ RP: 2 in. Above EAM or midway b/n inion & glabella
➢ CR: ⊥ ➢ CR: ⊥
➢ SS: Petrous pyramid completely filled the orbits; frontal ➢ SS:
bone ✓ Sella turcica
✓ Anterior & posterior clinoid processes,
✓ Dorsum sellae
✓ Superimposed mandibular rami
✓ Mastoid region
✓ EAM & TMJ
AP PROJECTION CROSSTABLE LATERAL
➢ PP: Supine; MSP & OML ⊥to IR ➢ PP: Dorsal decubitus (Robinson, Meares & Goree
➢ RP: Nasion recommendation); MSP ⊥to IR
➢ CR: ⊥ ➢ RP: 2 in. Above EAM
➢ SS: Same as PA, but the image is MAGNIFIED ➢ CR: Horizontal
➢ ER: For traumatic sphenoid sinus effusion (basal skull fx)
TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE
METHOD/ AP AXIAL PROJECTION
➢ PP: Supine; OML/IOML & MSP ⊥to IR;
MODIFIED CALDWELL METHOD/PA AXIAL PROJECTION ➢ RP: 2.5-3 in. above glabella
➢ PP: Prone; forehead & nose against IR; OML⊥ to IR; MSP ➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴)
⊥ to IR ➢ SS:
 ✓ Symmetric petrous pyramid ➢ ER: For obtaining image of sellar structures (DS & PCP)
✓ Posterior portion of foramen magnum w/in FM on hypersthenic & obese patient
✓ 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 (40-60° caudad
to OML)
➢ Posterior portion of cranial vault (CR ┴ to midway b/n
frontal tuberosities)

SCHULLER/PFEIFFER METHOD/SUBMENTOVERTICAL
PROJECTION
➢ PP: Supine or Seated-upright (more comfortable); IOML //
TOWNE/ALTSCHUL/GRASHEY/CHAMBERLAINE
to IR; MSP ┴ to IR; head rested on vertex; neck
METHOD/ AP AXIAL PROJECTION
hyperextended
➢ PP: Lateral decubitus; OML/IOML & MSP ┴ to IR
➢ RP: ¾ in. anterior to EAM (sella turcica)
➢ RP: 2.5-3 in. above glabella
➢ CR: ┴ to IOML; MSP of throat b/n gonion (entrance)
➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴)
➢ SS: Cranial base
➢ SS: Same as above
✓ Foramen ovale & spinosum (best demonstrated)
➢ ER: For patient w/ pathologic condition, trauma or
✓ Symmetric petrosae
deformity (strongly accentuated dorsal kyphosis)
✓ 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

HAAS METHOD/PA AXIAL PROJECTION

➢ PP: Prone; MSP & OML ┴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: 25° cephalad to OML
➢ SS:
✓ Dorsum sellae & posterior clinoid processes w/in
shadow of foramen magnum
✓ Occipital bone
✓ Symmetric petrous pyramid
 TOWNE METHOD
SCHULLER METHOD/ VERTICOSUBMENTAL
➢ PP: Supine; OML/IOML & MSP ┴ to IR;
PROJECTION
➢ RP: 2.5-3 in. above glabella
➢ PP: Prone; chin fully hyperextended; MSP ┴ to IR
➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴)
➢ RP: ¾ in. anterior to EAM (sella turcica)
➢ SS: Sellar region
➢ CR: ┴ to IOML; MSP of throat b/n gonion (entrance)
✓ Dorsum sellae, tuberculum sellae & anterior
➢ SS: Same as SMV
clinoid processes through occipital bone above
✓ Distorted & magnified basal structures
shadow of foramen magnum (30° caudad)
✓ Useful for anterior cranial base & sphenoidal
✓ Dorsum sellae & posterior clinoid processes w/in
sinuses
shadow of foramen magnum (37° caudad)
▪ IR in contact with the throat
✓ Symmetric petrous pyramid
▪ Reduces magnification & distortion

LYSHOLM METHOD/AXIOLATERAL METHOD

➢ PP: Semiprone; MSP // to IR; IOML parallel to transverse
axis of IR; IPL ┴ to IR
➢ RP: 1 in. distal to lower EAM (exit)
➢ CR: 30-35° caudad
➢ SS: Oblique position of lateral aspect of cranial base closest HAAS METHOD/ PA AXIAL PROJECTION
to IR ➢ PP: Prone; MSP & OML ┴ to IR; forehead & nose against
➢ ER: For patients who cannot extend their head enough for a the table; IR center 1 in. to nasion
satisfactory SMV projection ➢ RP: 1.5 in. below inion (entrance); 1.5 in. superior to
VALDINI METHOD/ PA AXIAL PROJECTION nasion (exit)
➢ PP: Recumbent or seated-erect (more comfortable); upper ➢ CR: 25° cephalad to OML
frontal region of skull against IR; MSP ┴ to IR; head ➢ SS:
acutely flexed; IOML 50°/OML 50°; line extending from ✓ Dorsum sellae & posterior clinoid processes w/in
inion to 0.5 cm distal to nasion form 28° to CR shadow of foramen magnum
➢ RP: 0.5 cm distal to nasion (dorsum sellae); foramen ✓ Symmetric petrous pyramid
magnum/slightly above level of EAM (petrosae) ➢ ER: For obtaining image of sellar structures (DS & PCP)
➢ CR: ┴; inion (entrance); 0.5 cm distal to nasion (exit) w/in FM on hypersthenic & obese patients
➢ SS: PA PROJECTION
✓ DILA (IOML 50°): Dorsum sellae; Internal ➢ PP: Prone; forehead & nose against IR; MSP & OML ┴to
Auditory Meatus (IAM); Labyrinth IR
✓ ETB “EaT Bulaga” (OML 50°): External ➢ RP: Glabella
auditory meatus; Tymphanic cavity; Bony part of ➢ CR: 10° cephalad
Eustachian tube ➢ SS: Dorsum sellae, tuberculum sellae, anterior & posterior
✓ Dorsum sellae & posterior clinod processes clinoid processes through frontal bone above ethmoidal
within or above shadow of foramen magnum sinuses
✓ Tubeculum sellae, anterior clinoid processes &
sella turcica below shadow of foramen magnum
✓ Mastoid pneumatization
SELLA TURCICA
LATERAL PROJECTION
➢ PP: Semiprone; MSP & IOML // to IR; IPL ┴ to IR
➢ RP: ¾ in. anterior & ¾ in. superior to EAM
OPTIC CANAL/FORAMEN
➢ CR: ┴
RHESE METHOD/PARIETO-ORBITAL OBLIQUE
➢ SS: Superimposed
PROJECTION
anterior & posterior
➢ PP: Prone; affected orbit closest to IR; zygoma, nose &
clinoid processes;
chin against IR (3-pt Lower Landing); AML ┴ to IR; MSP
dorsum sellae
53° angle to IR
 ➢ RP: Affected orbit closest to IR ➢ RP: Nasion
➢ CR: ┴ ➢ CR: 20-25° caudad or 15° caudad
➢ SS: Optic canal/foramen (inferior & lateral quadrant of ➢ SS: Superior orbital fissures
orbital shadow) ✓ Lying on the medial side of orbits b/n greater &
✓ PAZAM: Prone; Affected orbit against IR; lesser wings of sphenoid)
Zynoch; AML ┴; MSP 53° to IR ✓ Well demonstrated at 15° caudal angle
(Caldwell)
✓ Petrous portions at or below the inferior orbital
margin

INFERIOR ORBITAL FISSURES

BERTEL METHOD/ PA AXIAL PROJECTION
RHESE METHOD/ ORBITO-PARIETAL OBLIQUE ➢ PP: Prone; forehead & nose against IR; IOML ┴ to IR
PROJECTION ➢ RP: Nasion
➢ PP: Supine; affected orbit away from IR; AML ┴ to IR; ➢ CR: 20-25° cephalad
MSP 53° angle to IR ➢ SS: Inferior orbital fissures
➢ RP: Inferior and lateral margin of uppermost orbit CR: ┴ ✓ b/n shadows of pterygoid process of sphenoid
➢ SS: Magnified optic canal/foramen bone & mandibular ramus
✓ Increased radiation dose to lens of eye ✓ Anterior image of each orbital floor

ALEXANDER METHOD/ ORBITO-PARIETAL OBLIQUE

PROJECTION
➢ PP: Erect/supine; IR 15° angle from vertical; MSP 40° to
IR; AML ┴ to IR EYE- FOREIGN BODY LOCALIZATION
➢ RP: Inferior and lateral margin of uppermost orbit
➢ CR: ┴
➢ SS: Optic canal/foramen
MODIFIED LYSHOLM METHOD/ ECCENTRIC ANGLE
PARIETO-ORBITAL OBLIQUE PROJECTION
➢ PP: Prone; forehead & nose against IR; IOML ┴ to IR;
MSP 20° from vertical;
➢ RP: Affected orbit (exit)
➢ CR: 20° caudad or 30° caudad
➢ SS: Optic canal/foramen & anterior clinoid processes (20°);
superior orbital fissure (30°)
SPHENOID STRUT
HOUGH METHOD/ PARIETO-ORBITAL OBLIQUE
PROJECTION
➢ PP: Prone; superciliary ridge/arch & side of the nose
against IR; IOML ┴ to IR; MSP 20° from vertical; MSP
20° toward the side of interest
➢ RP: Affected orbit (exit)
➢ CR: 7° 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)
SUPERIOR ORBITAL/SPHENOID FISSURES LATERAL PROJECTION
CALDWELL METHOD/ PA AXIAL PROJECTION ➢ PP: Semiprone; MSP // to IR; IPL ┴ to IR; instruct patient
➢ PP: Prone; forehead & nose against IR; OML ┴ to IR to look straight ahead during exposure
 ➢ RP: Outer canthus SWEET METHOD
➢ CR: ┴ ➢ It determines the exact location of a foreign body by use of
➢ SS: Superimposed orbital roofs a geometric calculations
➢ Apparatus:
✓ Sweet localizing device
✓ Sweet film pedestal
➢ 1 Projection:
✓ Lateral: 2 exposures
▪ CR ┴
▪ CR 15-25° cephalad
PFEIFFER-COMBERG METHOD
PA AXIAL PROJECTION ➢ A leaded contact lens is placed directly over the cornea
➢ PP: Prone; forehead & nose against IR; MSP & OML ┴ to ➢ Apparatus:
IR; instruct patient ✓ Contact lens localization device
to close the eyes ✓ Pedestal type of film holder
➢ RP: Midorbits ➢ 2 Projections:
➢ CR: 30° caudad ✓ Waters Method:
➢ SS: Petrous ▪ CR horizontal
pyramids lying ✓ Lateral:
below orbital ▪ CR ┴
shadows FACIAL BONE
MODIFIED WATERS METHOD/ PARIETOACANTHIAL LATERAL PROJECTION
PROJECTION ➢ PP: Semiprone; MSP & IOML // to IR; IPL ┴ to IR
➢ PP: Prone; chin against IR; MSP ┴ to IR; OML 50° to IR ➢ RP: Zygoma/malar bone
(new); OML 25-37° to IR (old); instruct patient to close the ➢ CR: ┴
eyes ➢ SS: Superimposed facial bones
➢ RP: Midorbits ✓ Superimposed mandibular rami & orbital roofs
➢ CR: ┴
➢ 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: WATERS METHOD/PARIETO-ACANTHIAL PROJECTION
✓ Vertical: 2 exposures (for lateral) ➢ PP: Prone; MSP & MML ┴ to IR; OML 37° to IR; nose ¾
▪ Look up as far as possible in. (1.9 cm) away from IR
▪ Look down as far as possible ➢ RP: Acanthion (exit)
✓ Horizontal: 2 exposures (for superoinferior) ➢ CR: ┴
▪ Look to extreme right ➢ SS: Orbits, maxillae & zygomatic
▪ Look to extreme left arches
✓ Petrous ridges below
the maxillae
✓ Best projection for
facial bones
✓ Blow out fractures
MODIFIED WATERS
➢ PP: Prone; MSP & MML ┴ to IR; OML 55° to IR
PARALLAX METHOD ➢ RP: Acanthion (exit)
➢ First described by Richards ➢ CR: ┴
➢ It determines whether the foreign body is located within the ➢ SS: Facial bones w/ less axial angulation
eyeball requires no special apparatus ✓ Petrous ridges below the inferior border of orbits
➢ Not considered as precision localization procedure
➢ Widely used as preliminary check only
➢ 2 Projections:
✓ Lateral: 2 exposures
✓ PA: 2 exposures
 TANGENTIAL PROJECTION
➢ PP:
✓ Extraoral Film (Cassette): prone; chin rested on
sandbags; chin fully extended; MSP & GAL ┴ to
IR
✓ Intraoral Film (Occlusal Film): supine; head
elevated; MSP ┴ to sponge; GAL // to sponge &
┴ to film
➢ RP: Glabelloalveolar line
REVERSE WATERS METHOD/ AP AXIAL PROJECTION
➢ CR: ┴
➢ PP: Supine; MSP & MML ┴ to IR; OML 37° to IR; chin up
➢ SS: Nasal bones with minimal superimposition
➢ RP: Acanthion (exit)
➢ ER: For demonstration of any medial or lateral
➢ CR: ┴
displacement of fragments in fractures
➢ SS: Superior facial bones; same as True/Original Waters,
➢ Contraindications:
but the image is MAGNIFIED
✓ Children or adults who have very short nasal
➢ ER: For patient who cannot be placed in the prone position
bones, concave face or protruding upper teeth

CALDWELL METHOD/ PA AXIAL PROJECTION

➢ PP: Prone; forehead & nose against IR; OML ┴ to IR
➢ RP: Nasion WATERS METHOD/ PARIETO-ACANTHIAL PROJECTION
➢ CR: 15° caudad or 30° caudad (Exaggerated Caldwell) ➢ PP: Prone; MSP & MML ┴ to IR; OML 37° to IR; nose ¾
➢ SS: Orbital rims, maxillae, nasal septum, zygomatic bones in. (1.9 cm) away from IR
& anterior nasal spine ➢ RP: Acanthion (exit)
✓ Petrous ridges at lower third of orbits (15° ➢ CR: ┴
caudad) ➢ ER: Displacement of bony nasal septum & depressed fx of
✓ Orbital floors nasal wings
(30° caudad) ZYGOMATIC ARCHES
✓ Petrous ridges SCHULLER/PFEIFFER METHOD/ SUBMENTOVERTICAL
below the PROJECTION
inferior orbital ➢ PP: Supine or Seated-upright (more comfortable); IOML //
margins (30° to IR; MSP ┴ to IR; head rested on vertex; neck
caudad) hyperextended
➢ RP: 1 in. posterior to outer canthi
LAW METHOD/ PA OBLIQUE AXIAL PROJECTION ➢ CR: ┴ to IOML; MSP of throat b/n gonion (entrance)
➢ PP: Semiprone; zygoma, nose & chin against IR; ➢ SS: Best demonstrates bilateral symmetric zygomatic
unaffected side against IR; OML ┴ to IR; Center IR 2 in. arches
above floor of maxillary sinuses
➢ RP: Lower antrum
➢ CR: 25-30° cephalad; posterior to gonion (entrance)
➢ SS: Floor & posterior wall of maxillary sinus (antrum) of
side down
✓ External orbital wall
✓ Zygomatic bone
MODIFIED TITTERINGTON METHOD/ PA AXIAL
✓ Anterior wall of maxillary sinus of side up
(SUPEROINFIOR) PROJECTION
NASAL BONE
➢ PP: Prone; nose & chin against IR; MSP ┴ to IR
LATERAL PROJECTION
➢ RP: Vertex midway b/n zygomatic arches
➢ PP: Semiprone; MSP & IOML // to IR; IPL ┴ to IR
➢ CR: 23-38° caudad
➢ RP: ¾ in. (old) or ½ in. (new) distal to nasion
➢ SS: Well shown zygomatic arches
➢ CR: ┴
MAY METHOD/ TANGENTIAL PROJECTION
➢ SS: Nasal bones of side down & soft tissue structures
➢ PP: Prone/seated; neck fully extended; IOML // to IR; MSP
rotated 15° toward the side of interest; head tilted 15°
➢ RP: Zygomatic arch at 1.5 in. posterior to outer canthus
➢ CR: ┴ to IOML
➢ SS: Zygomatic arch free of superimposition
➢ ER: Useful with patients who have depressed fractures or
flat cheekbones
 PA AXIAL PROJECTION
➢ PP: Prone; nose & chin against IR; AML & MSP ┴ to IR;
fill the mouth with air to obtained better contrast around
TMJs (Zanelli recommendation)
➢ RP: Midway b/n TMJs
➢ CR: 30° cephalad
➢ SS: Mandibular body; TMJs; condylar processes

MODIFIED TOWNE METHOD/ AP AXIAL PROJECTION/

JUG HANDLE VIEW AXIOLATERAL/OBLIQUE PROJECTION
➢ PP: Supine; OML/IOML & MSP ┴ to IR; ➢ PP: Seated/semiprone/semisupine; head in true lateral &
➢ RP: Glabella (1 in. above nasion) IPL ┴ to IR (ramus); head rotated 30° toward IR (body);
➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴) head rotated 45° toward IR (symphysis); head rotated 10-
➢ SS: Bilateral symmetric zygomatic arches free of 15° toward IR (general survey); mouth closed; neck
superimposition extended (prevent superimposition of cervical spine)
➢ RP: Mandibular region of interest
➢ CR: 25° cephalad
➢ SS: Mandibular body & TMJs
➢ ER: To place the desired portion of the mandible parallel
with the IR
➢ Muscular/Hypersthenic Patients: MSP 15° & CR 10°
MANDIBLE cephalad
PA PROJECTION ✓ To reduce the possibility of projecting shoulder
➢ PP: Prone; forehead & nose against IR; OML & MSP ┴ to over the mandible
IR
➢ RP: Acanthion (exit)
➢ CR: ┴
➢ SS: Mandibular rami
➢ ER: To demonstrate
any medial or lateral
displacement of
fragments in fractures
of the rami
SCHULLER/PFEIFFER METHOD/SUBMENTOVERTICAL
PA AXIAL PROJECTION
PROJECTION
➢ PP: Prone; forehead & nose against IR; OML & MSP ┴to
➢ PP: Supine or Seated-upright (more comfortable); IOML //
IR
to IR; MSP ┴ to IR; head
➢ RP: Acanthion (exit)
rested on vertex; neck
➢ CR: 20° or 25° cephalad
hyperextended
➢ SS: Condylar processes; mandibular rami
➢ RP: Midway b/n gonions
➢ ER: To demonstrate any medial or lateral displacement of
➢ CR: ┴ to IOML
fragments in fractures of the rami
➢ SS: Mandibular body;
coronoid & condyloid
processes of rami

PA PROJECTION
➢ PP: Prone; nose & chin against IR; AML & MSP ┴ to IR SCHULLER METHOD/ VERTICOSUBMENTAL
➢ RP: Level of lips PROJECTION
➢ CR: ┴ ➢ PP: Prone; chin fully hyperextended; IR against throat;
➢ SS: Mandibular body MSP ┴ to IR
➢ RP: Level just posterior to outer canthi
➢ CR: ┴ 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 SCHULLER METHOD/ AXIOLATERAL
OBLIQUE/LATERAL TRANSCRANIAL/AXIAL
TRANSCRANIAL PROJECTION
➢ PP: Semi-prone; MSP rotated 15° toward the IR; AML // to
transverse axis of IR;
➢ RP: 1.5 in. superior to upside EAM
➢ CR: 15° 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
TEMPOROMANDIBULAR JOINTS
TOWNE METHOD/AP AXIAL PROJECTION
➢ PP: Supine; MSP & OML ┴ to IR
✓ Closed-mouth Position: posterior teeth in contact
not incisors
▪ Rationale: prevents mandibular
protrusion & condyles to be carried out
of mandibular fossae INFEROSUPERIOR TRANSFACIAL POSITION
✓ Opened-mouth Position: open as wide as possible ➢ PP: Semi-prone; head in true lateral; IPL 10-15° from┴;
▪ Mandible not protruded (jutted MSP 15 from IR
forward) ➢ RP: Uppermost gonion
▪ Not perform in trauma patients ➢ CR: 30° cephalad
➢ RP: 3 in. above nasion ➢ SS: TMJ
➢ CR: 35° caudad ALBERS-SCHONBERG METHOD/ LATERAL
➢ SS: Mandibular condyles & mandibular fossae of temporal TRANSFACIAL POSITION
bones ➢ PP: Semi-prone; head in true lateral; IPL ┴ to IR; MSP // to
✓ Closed-mouth: condyle lying in mandibular fossa IR; IOML // to transverse axis of IR
✓ Opened-mouth: condyles lying inferior to ➢ RP: TMJ closes to IR (exit)
articular tubercle ➢ CR: 20° cephalad
➢ SS: TMJ
ZANELLI METHOD/ LATERAL TRANSFACIAL POSITION
➢ PP: Lateral recumbent; head in true lateral; head resting on
parietal region; MSP 30° to IR
➢ RP: Uppermost gonion (entrance)
➢ CR: ┴
➢ SS: TMJ
SINUSES
AXIOLATERAL PROJECTION CROSS & FLECKER
➢ PP: Semiprone; head in lateral position; IPL ┴ to IR; MSP ➢ pointed out the value of erect position
// to IR; closed-mouth & opened-mouth position ➢ To demonstrate presence or absence of fluid
➢ RP: 0.5 in. anterior & 2 in. superior to upside EAM ➢ To differentiate between shadows caused by fluid & those
➢ CR: 25-30° caudad caused by pathology
➢ SS: TMJ anterior to EAM LATERAL PROJECTION
✓ Closed-mouth: condyle lying in mandibular fossa ➢ PP: Upright RAO/LAO or dorsal decubitus (can’t assume
✓ Opened-mouth: condyles lying inferior to upright); head in true lateral; MSP parallel to IR; IPL ┴ to
articular tubercle IR; IOML // to transverse axis of IR;
 ➢ RP: 0.5-1 in. posterior to outer canthus ➢ CR: Horizontal
➢ CR: ┴ ➢ SS: Sphenoidal sinuses
➢ SS: All paranasal sinuses projected through open
mouth
✓ Petrous pyramids
inferior to floor of
maxillary sinus
➢ ER: For the patients who
cannot be placed in position
PA PROJECTION for SMV
➢ PP: Upright; forehead & nose against IR; MSP & OML ┴ SCHULLER METHOD/SUBMENTOVERTICAL
to IR PROJECTION
➢ RP: Nasion (┴); glabella (10° cephalad); midregion of ➢ PP: Upright; IOML // to IR;
maxillary sinuses (┴) MSP ┴ to IR; head rested on
➢ CR: ┴; 10°cephalad vertex; neck hyperextended
➢ SS: ➢ RP: ¾ in. anterior to EAM
✓ Posterior ethmoid sinuses inferior to cranial (sella turcica)
bones & superior to anterior ethmoid sinuses (┴) ➢ CR: ┴ to IOML; MSP of throat
✓ Sphenoidal sinuses through frontal bone & b/n gonion (entrance)
superior to frontal & ethmoid sinuses ➢ SS: Sphenoidal & ethmoidal
✓ Maxillary sinuses inferior to cranial base sinuses
CALDWELL METHOD/ PA AXIAL PROJECTION ✓ portion of the base of
➢ PP: Upright the skull
✓ Angle grid technique: nose & forehead against SCHULLER METHOD/VERTICOSUBMENTAL
IR; IR tilted 15°; MSP & OML ┴to IR PROJECTION
✓ Vertical grip technique: nose against IR; OML ➢ PP: Seated-erect; chin fully hyperextended; MSP ┴to IR
15° from IR; sponge b/n forehead & IR; MSP ┴ ➢ RP: ¾ in. anterior to EAM (sella turcica)
to IR ➢ CR: ┴ to IOML; MSP of throat b/n gonion (entrance)
➢ RP: Nasion ➢ SS: Sphenoidal
➢ CR: Horizontal sinuses
➢ SS: Frontal sinuses & anterior ethmoidal sinuses ✓ Posterior
ethmoidal
sinuses
✓ Maxillary
sinuses
✓ Nasal fossae
PIRIE METHOD/ AXIAL TRANSORAL POSITION
➢ PP: Upright (prone; nose & chin against IR; mouth wide
open; MSP ┴ to IR; phonate “ah” during exposure
WATERS METHOD/ PARIETOACANTHIAL PROJECTION
➢ RP: ¾ in. anterior to EAM (sella turcica)
➢ PP: Upright; neck hyperextended & rested against IR;
➢ CR: ┴
OML 37° to IR; MML ┴ to IR
➢ SS: Sphenoidal sinuses projected through open mouth
➢ RP: Acanthion
✓ Maxillary sinuses
➢ CR: Horizontal
✓ Nasal fossae
➢ SS: Maxillary sinuses
RHESE METHOD/ PA OBLIQUE POSITION
✓ Petrous pyramids inferior to floor of maxillary
➢ PP: Seated-erect; zygoma, nose & chin against IR; AML ┴
sinus
to IR; MSP 53° from IR
✓ Foramen rotundum
➢ RP: Upper parietal region
✓ Distorted frontal & ethmoidal sinuses
➢ CR: ┴
➢ 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: 25-30° cephalad
➢ SS: Relationship of teeth to maxillary sinuses
OPEN-MOUTH WATERS METHOD/ PARIETOACANTHIAL MASTOID
PROJECTION LAW METHOD/ AXIOLATERAL POSITION
➢ PP: Upright; neck hyperextended & rested against IR; DOUBLE ANGULATION METHOD
OML 37° to IR; MML ┴to IR; mouth wide open ➢ PP: Prone; head in true lateral; tape auricle forward; MSP
➢ RP: Acanthion & IOML // to IR; IPL ┴ to IR
 ➢ RP: 2 in. posterior & 2 in. superior to uppermost EAM ✓ Mastoid cells, mastoid antrum, IAM & EAM &
➢ CR: 15° caudad & 15° anterior tegmen tympani (Henschen)
➢ Lange Recommendations: ✓ Tumors of the acoustic nerve (Cushing)
✓ 25° caudad & 20° anterior ✓ Pneumatic structures of mastoid process, mastoid
✓ Auricles taped forward antrum, tegmen tympani, IAM & EAM, sinus &
SINGLE ANGULATION METHOD dural plates & mastoid emissary when present
➢ PP: Prone; tape auricle (Schuller)
forward; MSP rotated ✓ Mastoid cells, matoid antrum, IAM & EAM,
15° toward IR tegmen tympani, labyrinthine area & carotid
➢ RP: 2 in. posterior & 2 canal (Lysholm/Runstrom II)
in. superior to ➢ Runstrom Recommendation:
uppermost EAM ✓ Exposure made with
➢ CR: 15° caudad open mouth
PART ANGULATION METHOD ✓ For visualization of
➢ PP: Prone; head rested on flat surface of cheek; tape auricle petrous apex
forward; MSP rotated 15° towards IR; IPL 15° from between anterior
vertical wall of EAM &
➢ RP: 2 in. posterior & 2 in. superior to uppermost EAM mandibular condyle
➢ CR: 15° caudad & 15° anterior
➢ SS: Mastoid cells PETROUS PORTION
✓ Sigmoid sinus TOWNE METHOD/AP AXIAL PROJECTION
✓ Lateral portion of pars petrosa ➢ PP: Supine; OML/IOML & MSP ┴ to IR;
✓ Tegmen tymphani ➢ RP: MSP b/n EAMs
✓ Superimposed internal & external auditory ➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴)
meatuses ➢ SS: Petrosae above base of the skull
✓ Mastoid emissary vessel (when present) ✓ IAM
MODIFIED HICKEY METHOD/ AP TANGENTIAL ✓ Arcuate eminences
POSITION ✓ Labyrinths
➢ PP: Supine; tape auricles forward; face rotated away from ✓ Mastoid antrum
side of interest; MSP 55° from IR or 35° from vertical; ✓ Middle ears
IOML ┴ to IR; IR caudally inclined 15° ✓ Dorsum sellae w/in shadow of foramen magnum
➢ RP: 1 in. superior to tip of mastoid process HAAS METHOD/PA AXIAL PROJECTION
➢ CR: 15° caudad ➢ PP: Prone; MSP & OML┴ to IR; forehead & nose against
➢ SS: Mastoid process free of superimposition the table; IR center 1 in. to nasion
✓ Projected below the shadow of occipital bone ➢ RP: Nasion
PA TANGENTIAL POSITION ➢ CR: 25° cephalad
➢ PP: Prone; IR cranially inclined 15°; tape auricles forward; ➢ SS: Symmetric axial frontal image of petrous portions
cheek against IR; face rotated away from side of interest; projected above the base of the skull
MSP 55° from IR or 35° from vertical; IOML ┴to IR ✓ IAM
➢ RP: 1 in. superior to tip of mastoid process ✓ Labyrinths
➢ CR: 15° cephalad ✓ Mastoid antrums
➢ SS: Mastoid process free of superimposition ✓ Middle ears
✓ Projected below the shadow of occipital bone ✓ Dorsum sellae & posterior clinoid processes w/in
TOWNE METHOD/AP AXIAL PROJECTION shadow of foramen magnum
➢ PP: Supine; OML/IOML & MSP ┴ to IR; ➢ ER: For patients who cannot assume AP axial position
➢ RP: 2 in. above glabella or 2.5 in. above nasion VALDINI METHOD/PA AXIAL PROJECTION
➢ CR: 30° caudad (OML ┴); 37° caudad (IOML ┴) ➢ PP: Recumbent or seated-erect (more comfortable); upper
➢ SS: frontal region of skull against IR; MSP ┴ to IR; head
✓ Internal auditory canal acutely flexed; IOML 50°/OML 50°; line extending from
✓ Petrous portion of temporal bone inion to 0.5 cm distal to nasion form 28 to CR
✓ Labyrinths ➢ RP: 0.5 cm distal to nasion (dorsum sellae); foramen
✓ Mastoid antrum magnum at or slightly above level of EAM (petrosae)
✓ Middle ears ➢ CR: ┴; inion (entrance); 0.5 cm distal to nasion (exit)
✓ Dorsum sellae w/in foramen magnum ➢ SS:
HENSCHEN, SCHULLER, & LYSHOLM METHODS/ ✓ DILA (IOML 50°): Dorsum sellae; Internal
AXIOLATERAL POSITIONS Auditory Meatus (IAM); LAbyrinth
➢ PP: Semiprone; head in true lateral; MSP // to IR; IPL ┴ to ✓ ETB “EaT Bulaga” (OML 50°): External
IR; IOML parallel to transverse axis of IR; auricles taped auditory meatus; Tymphanic cavity; Bony part of
forward Eustachian tube
➢ RP: Dependent EAM closest to IR SCHULLER/PFEIFFER METHOD/ SUBMENTOVERTICAL
➢ CR: 15° caudad (Henschen/Cushing); 25° caudad (SUBBASAL) PROJECTION
(Schuller); 35° caudad (Lysholm/Runstrom II) ➢ PP: Supine or Seated-upright (more comfortable); OML //
➢ SS: Mastoid & petrous portion to IR or CR ┴ to OML; (cannot fully extend the neck) or
 supraorbitomeatal line (SOML) parallel to IR; MSP ┴ to ✓ Mastoid antrum
IR; head rested on vertex; neck hyperextended ✓ Area of tympanic
➢ RP: ¾ in. anterior to EAM (sella turcica) cavity
➢ CR: ┴ to OML at midway b/n EAMs or 15-20° anteriorly ✓ Labyrinth
at MSP of throat 1 in. anterior to EAMs ✓ IAM
➢ SS: Symmetric petrosae ✓ Cellular structure
✓ Mastoid processes of petrous apex
✓ EAMs ARCELIN METHOD/ ANTERIOR PROFILE POSITION/
✓ Labyrinths REVERSE STENVERS METHOD
✓ Acoustic/auditory ossicles ➢ PP: Supine; IOML ┴to IR; face rotated away from side of
✓ Tympanic cavities interest; MSP 45° to IR
HIRTZ METHOD ➢ RP: 1 in. anterior & ¾ in. superior to EAM closest to IR
➢ RP: Midway b/n & 1 in. anterior to EAMs (exit)
➢ CR: 5° anteriorly ➢ CR: 10° caudad
MAYER METHOD/AXIOLATERAL OBLIQUE PROJECTION ➢ SS: Magnified pars
➢ PP: Supine; auricles taped forward; outer side of IR petrosa away from IR
elevated (reduces part-film distance); MSP 45 from IR; ➢ ER: Useful with children
chin depressed; IOML //to IR & with adults who cannot
➢ RP: Dependent EAM be position for Stenvers
➢ CR: 45° caudad Method
➢ SS: Axial oblique of petrosa MODIFIED LAW METHOD/ AXIOLATERAL POSITION
✓ Petrosa inferior to mastoid air cells SINGLE ANULATION METHOD
✓ EAM ➢ PP: Prone; taped auricle forward; Head rotated 15° toward
✓ Tympanic cavity & ossicles IR; MSP 15°
✓ Epitympanic recess (attic) ➢ RP: 2 in. posterior & 2 in. superior to uppermost EAM
✓ Aditus ➢ CR: 15° caudad
✓ Mastoid antrum ➢ SS:
OWEN MODIFICATIONS: ✓ Mastoid cells
PENDERGRASS, SCHAEFFER & HODES ✓ Lateral portion of pars petrosa
➢ PP: MSP 40° to IR; IR & head angled 10° caudally ✓ Superimposed IAM & EAM
➢ CR: 28° caudally ✓ Mastoid emissary vessel (when present)
ETTER & CROSS STYLOID PROCESS OF TEMPORAL BONE
➢ PP: MSP 30° to IR PA AXIAL PROJECTION/ CAHOON METHOD
➢ CR: 25-30° caudally ➢ PP: prone; forehead
COMPERE and nose; OML ┴
➢ PP: MSP 30-45° to IR ➢ CR: 25° cephalad
➢ CR: 30° caudally ➢ SS: styloid process of
ZIZMOR temporal bone
➢ PP: MSP 15° to IR
➢ CR: 35° caudally JUGULAR FORAMINA
SUBMENTOVERTICAL AXIAL PROJECTION/ KEMP
HARPER M ETHOD/ ERASO
MODIFICATION
➢ PP: OML is // to IR
➢ CR: 25° caudad
➢ ER: EAM
HYPOGLOSSAL CANAL
AXIOLATERAL OBLIQUE PROJECTION/ MILLER
METHOD
ANTERIOR PROFILE
STENVERS METHOD/ POSTERIOR PROFILE POSITION ➢ PP: supine position; head 45° away from the side being
➢ PP: Prone; forehead, nose & zygoma against IR (3-pt examined; OML // to IR
Upper Landing); IOML // to transverse axis of IR; face ➢ CR: 12° caudad; 1inch inferior of EAM
rotated away from side of interest; MSP 45° to IR ➢ SS: hypoglossal canal
➢ RP: 1 in. anterior to EAM closest to IR (exit)
➢ CR: 12° cephalad
➢ SS: Pars petrosa closest to IR
✓ Petrous ridge
✓ Cellular structure of mastoid process