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Clinical Indications: Skull fractures (medial and lateral displacement), neoplastic processes, and Paget's disease (a disease that disrupts the replacement of old bone tissue with new bone tissue)
Positioning:

Depress the chin until the orbitomeatal line (OML) is perpendicular to the IR

The infraorbitomeatal line (IOML) may be used instead of the OML for patients who are unable to flex the neck very well

Align the midsagittal plane (MSP) to the CR and to the midline of the grid

Ensure there is no rotation or tilt of the head

Include the entire skull within the collimation field

Central Ray

For the OML, angle the CR 30 degrees caudal

For the IOML, angle the CR 37 degrees caudal

The CR should be centered 2.5 inches above the glabella to pass through the foramen magnum

Anatomy Demonstrated

Occipital bone, petrous pyramids, and foramen magnum are demonstrated with the dorsum sellae and posterior clinoid processes visualized in the shadow of the foramen magnum

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Clinical Indications: Skull fractures, neoplastic processes, and Paget's disease
Positioning:

Place the head in a true lateral position, with the side of interest closes to the IR

The patient should be in a semiprone or erect position as needed for the comfort of the patient

Align the MSP parallel to the IR

Ensure there is no rotation or tilt of the head

Align the interpupillary line (IPL) perpendicular to the IR

Adjust the flexion of the patient's neck to align the IOML perpendicular to the front edge of the IR

Include the entire skull within the collimation field

Central Ray

Align the CR perpendicular to the IR

Center the CR 2 inches superior to the external acoustic meatus (EAM) or halfway between the glabella and the inion for other types of skull morphologies

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Entire cranium visualized and superimposed parietal bones of the cranium

The entire sella turcica, including the anterior and posterior clinoid processes and dorsum sellae, are also demonstrated

The sella turcica and clivus are demonstrated in profile

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Clinical Indications: Skull fractures, neoplastic processes, and Paget's disease
Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck as needed to align the OML perpendicular to the IR

Align the MSP perpendicular to the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 15 degrees caudal

Center the CR to exit at the nasion

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Frontal bone, greater and lesser sphenoid wings, superior orbital fissures, frontal and anterior ethmoid sinuses, supraorbital margins, and crista galli are all demonstrated

Petrous pyramids are projected into the lower 1/3 of the orbits

Supraorbital margin is visualized without superimposition

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Clinical Indications: Skull fractures (medial and lateral displacement), neoplastic processes, and Paget's disease
Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck to align the OML perpendicular to the IR

Align the MSP is perpendicular to the midline of the IR

Ensure there is no rotation or tilt

Central Ray

The CR is perpendicular to the IR

Center the CR to exit at the glabella

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Frontal bone, crista galli, internal auditory canals, frontal and anterior ethmoid sinuses, petrous ridges, greater and lesser wings of the sphenoid, and dorsum sellae are demonstrated

The petrous portion of the temporal bone fills the orbits with the petrous ridges at the level supraorbital margin

Posterior and anterior clinoid processes are visualized just superior to the ethmoid sinuses

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Clinical Indications:

Advanced bony pathology of the inner temporal bone structures (skull base)

Possible basal skull fracture

Positioning:

Raise the patient's chin and hyperextend the neck, if possible for the patient to do, until the IOML is parallel to the IR

Rest patient's head on vertex

Align the MSP perpendicular to the midline of the IR

Central Ray

The CR is perpendicular to the IOML

Center the CR 1.5 inch inferior to the mandibular symphysis or midway between the gonions

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Foramen ovale and spinosum, mandible, sphenoid and posterior ethmoid sinuses, mastoid processes, petrous ridges, hard palate, foramen magnum, and occipital bone are demonstrated

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This is an alternative position for patients who can't flex their neck sufficiently for the AP axial (Towne).
Clinical Indications:

Skull fractures (medial and lateral displacement), neoplastic processes, and Paget's disease

Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck until the OML is perpendicular to the IR

Align the MSP to the CR and to the midline of the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 25 degrees cephalic to the OML

Center the CR to the MSP and 1.5 inches inferior to the inion and exit 1.5 inches superior to the nasion

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Occipital bone, petrous pyramids, and the foramen magnum are demonstrated, with the dorsum sellae and posterior clinoid processes visualized in the shadow of the foramen magnum

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trauma cross table (horizontal beam) lateral

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trauma cross table (horizontal beam) lateral

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Cervical spine fractures and subluxations or dislocations must be ruled out before attempting to move the patient's head or neck.
Clinical Indications: Calvarial fractures, penetrating injuries, and radiopaque foreign bodies.
Positioning:
Patient will be lying supine

If the patient's head can be manipulated, carefully elevate skull onto a radiolucent sponge.

If you cannot manipulate the patient's head, move the patient to the edge of the table and place the IR at least 1 inch below the tabletop and occipital bone

Place the side of interest closest to the IR

Place the patient's head in a true lateral position by ensuring the MSP is parallel to the IR

Include the entire skull within the collimation field

Central Ray

A horizontal beam is directed perpendicular to the IR

Center the CR to a point 2 inches superior to the EAM

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Cervical spine fractures and subluxations or dislocations must be ruled out before attempting to move the patient's head or neck.
Clinical Indications: Calvarial fractures, penetrating injuries, and radiopaque foreign bodies.
Positioning:
Patient will be lying supine

Place IR in table bucky

Align the MSP perpendicular to the midline of the IR/grid

Center the IR to the CR

Central Ray

Angle the CR 15 degrees cephalic to the OML

Center the CR to the nasion

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Cervical spine fractures and subluxations or dislocations must be ruled out before attempting to move the patient's head or neck.
Clinical Indications: Calvarial fractures, penetrating injuries, and radiopaque foreign bodies.
Positioning:
Patient will be lying supine

Place IR in table bucky

Align the MSP perpendicular to the midline of the IR/grid

Center the IR to the CR

Central Ray

Angle the CR so it is parallel to the OML

If the patient is in a cervical collar, the CR is usually angled about 10 to 15 degrees caudal

Center the CR to the glabella

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Cervical spine fractures and subluxations or dislocations must be ruled out before attempting to move the patient's head or neck.
Clinical Indications: Calvarial fractures, penetrating injuries, and radiopaque foreign bodies.
Positioning:
Patient will be lying supine

Place IR in table bucky

Align the MSP perpendicular to the midline of the IR/grid

Center the IR to the CR

Central Ray

Angle the CR 30 degrees caudal to the OML or 37 degrees caudal to the IOML

Center the CR to pass midway between the EAMs and exiting the foramen magnum

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the facial bones, orbits, and mandible
Positioning:

Rest the lateral aspect of the patient's head against the table or upright wall bucky

The side of interest should be closest to the IR

Adjust the head into a true lateral position and oblique the patient's body as needed for their comfort

Align the MSP parallel to the IR

Ensure no rotation or tilt

Align the IPL perpendicular to the IR

Adjust the patient's chin to bring the IOML perpendicular to the front edge of the IR

Central Ray

Align the CR perpendicular to the IR

Center the CR to the zygoma (prominence of the cheek)

This is about midway between the outer canthus and the EAM

Center the IR to the CR

Collimate to include the entirety of the facial bones

Anatomy Demonstrated

The facial bones should be superimposed

The greater wings of the sphenoid, orbital roofs, sella turcica, zygoma, and mandible are demonstrated

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Clinical Indications: Fractures(particularly tripod and Le Fort fractures), neoplastic or inflammatory processes, and foreign bodies in the eye
Positioning:

Extend the patient's neck, resting their chin against the IR/grid

Adjust the patient's head until the MML is perpendicular to the plane of the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

IOMs, maxillae, nasal septum, zygomatic bones, zygomatic arches, and anterior nasal spine are demonstrated

Petrous ridges are demonstrated just inferior to the maxillary sinuses

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Clinical Indications: Fractures, neoplastic or inflammatory processes of the facial bones
Positioning:

Rest the patient's nose and forehead against the IR

Tuck the patient's chin bringing the OML perpendicular to the IR

Align the MSP perpendicular to the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 15 degrees caudal

Center the CR to exit at the nasion

Center the IR to the CR

Include the entirety of the facial bones within the collimation field

Anatomy Demonstrated

Orbital rim, maxillae, nasal septum, zygomatic bones, and anterior nasal spine are demonstrated

Petrous pyramids are projected into the lower 1/3 of the orbits

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Clinical Indications: Orbital fractures (ex: blowout), neoplastic or inflammatory processes, and foreign bodies in the eye
Positioning:

Extend the patient's neck, resting their chin and nose against the IR/grid

Adjust the patient's head until the lips meatal line (LML) is perpendicular to the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

Orbital floors (plates) are perpendicular to the IR which provides a less distorted view of the orbital rims than the Waters projection

Petrous ridges are demonstrated in the lower half of the maxillary sinuses

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Cervical spine fractures and subluxations or dislocations must be ruled out before attempting to move the patient's head or neck.
Clinical Indications: Fractures, penetrating injuries, and radiopaque foreign bodies
Positioning:
Patient will be lying supine

Place IR in table bucky

Align the MSP perpendicular to the midline of the IR/grid

Center the IR to the CR

Central Ray

Angle the CR cephalic as needed to be parallel to the mentomeatal line (MML)

Center the CR to the acanthion

Anatomy Demonstrated:

Facial bone structures and the maxillary region by projecting the maxilla and maxillary sinuses above the petrous ridges

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the mandible

Positioning:

Place the patient's head in a true lateral position

The side of interest should be closest to the IR

Have the patient close their mouth and bring their teeth together

Extend the patient's neck slightly to prevent superimposition of the gonion over the cervical spine

Rotate the patient's head toward the IR to place the mandibular area of interest parallel to the IR

The degree of rotation depends on which section of the mandible is of interest

The head in a true lateral best demonstrates the ramus

A 10 to 15 rotation best provides a general survey of the mandible

30 degree rotation toward the IR best demonstrates the body of the mandible

45 rotation best demonstrates the mentum

Central Ray

Direct the CR to exit mandibular region of interest

Center the IR to the CR

Anatomy Demonstrated

Remus, condyloid, and coronoid processes, body, and mentum of the mandible nearest the IR are demonstrated

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the mandible
Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck to align the OML perpendicular to the IR

Align the MSP is perpendicular to the midline of the IR

Ensure there is no rotation or tilt

Central Ray

Align the CR perpendicular to the IR

Center at the junction of the lips

Center the IR to the CR

Include the entire mandible within the collimation field

Anatomy Demonstrated

Mandibular rami and lateral portion of the body are visible

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the condyloid processes of the mandible
Positioning:

Rest the patient's posterior skull against the IR
Tuck the patient's chin until the OML is perpendicular to the IR

Align the MSP perpendicular to the midline of the IR

Ensure there is no rotation or tilt of the head

Include the entire mandible within the collimation field

Central Ray

Angle the CR 35 to 42 degrees caudal

Center the CR 1 inch superior to the glabella

Center the IR to the CR

Anatomy Demonstrated

Condyloid processes of the mandible and TOM fossae

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the mandible
Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck to align the OML perpendicular to the IR

Align the MSP is perpendicular to the midline of the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 20 to 25 degrees cephalic

Center the CR to exit at the acanthion

Center the IR to the CR

Include the entire mandible within the collimation field

Anatomy Demonstrated

Mandibular rami and lateral portion of the body are visible

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the mandible
Positioning:

Extend the patient's neck, resting their chin and nose against the IR/grid

Adjust the patient's head until the lips meatal line (LML) is perpendicular to the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entire mandible

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the mandible
Positioning:

Raise the patient's chin and hyperextend the neck, if possible for the patient to do, until the IOML is parallel to the IR

Rest patient's head on vertex of the skull

Align the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IOML and IR

Center the CR to a point midway between angles of the mandible or at a level 1.5 inches inferior to mandibular symphysis

Center the CR to the IR

Anatomy Demonstrated

Entire mandible and coronoid and condyloid processes are demonstrated

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Clinical Indications: Fractures of the zygomatic arch and neoplastic or inflammatory processes

Positioning:

Raise the patient's chin and hyperextend the neck, if possible for the patient to do, until the IOML is parallel to the IR

Rest patient's head on vertex of the skull

Align the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR

Center the CR midway between the zygomatic arches, at the level 1.5 iches inferior to the mandibular symphysis

Center the IR to the CR

IOML is parallel to the IR

Collimate to the outer margins of the zygomatic arches

Anatomy Demonstrated

Zygomatic arches are demonstrated laterally from each mandibular ramus

The mandibular ramus is superimposed on the frontal bone

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Clinical Indications: Fractures(particularly tripod and Le Fort fractures), neoplastic or inflammatory processes, and foreign bodies in the eye
Positioning:

Extend the patient's neck, resting their chin against the IR/grid

Adjust the patient's head until the MML is perpendicular to the plane of the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

IOMs, maxillae, nasal septum, zygomatic bones, zygomatic arches, and anterior nasal spine are demonstrated

Petrous ridges are demonstrated just inferior to the maxillary sinuses

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Clinical Indications: Fractures and neoplastic or inflammatory processes of the zygomatic arch
Positioning:

Rest the patient's posterior skull against the IR

Tuck the patient's chin until the OML (or IOML) is perpendicular to the IR

Align the MSP so it is perpendicular to the midline of the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 30 degrees caudal to the OML or 37 degrees caudal to the IOML

Center the CR 1 inch superior to the nasion at the level of the gonion

Center the IR to the CR

Anatomy Demonstrated

Bilateral zygomatic arches, free of superimposition, are demonstrated

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Clinical Indications: Fractures of the zygomatic arch, depressed zygomatic arches caused by trauma or skull morphology

Positioning:

Raise the patient's chin, hyperextending the neck until the IOML is parallel to the IR

Rest the patient's head on the vertex of the skull

Rotate the patient's head 15 degrees toward the side to be examined

Tilt the chin 15 degrees toward the side of interest

Central Ray

Align the CR perpendicular to the IR and IOML

Center the CR to the zygomatic arch of interest

Adjust the IR so it is parallel to the IOML and perpendicular to the CR

Anatomy Demonstrated

The single zygomatic arch, free of superimposition, is demonstrated

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Clinical Indications: Abnormal relationship or range of motion between the condyle and TM fossa
Positioning:

Prevent tilt by maintaining the IPL perpendicular to the IR

The MSP is parallel to the IR to start

Align the IOML perpendicular to the front edge of the IR

From the lateral position, rotate the patient's face 15 degrees toward the IR

Closed and open mouth projections are often taken to demonstrate range of motion of the TMJ

Central Ray

Angle the CR 15 degrees caudal

Center 1.5 inches superior to the upside of the EAM

Center the IR to the CR

Include entire TMJ in collimation

Anatomy Demonstrated

TMJ nearest the IR is visible

Closed mouth image demonstrates the condyle within the mandibular fossa

The condyle moves to the anterior margin of the mandibular fossa in the open mouth position

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Clinical Indications: Abnormal relationship or range of motion between the condyle and TM fossa
Positioning:

Adjust the patient's head into a true lateral position and move the patient's body in an oblique direction as needed for the patient's comfort

Align the IPL perpendicular to the IR

Align the MSP parallel with the IR

Position the IOML perpendicular to the front edge of the IR

Closed and open mouth projections are often taken to demonstrate the range of motion of the TMJ

Central Ray

Angle the CR 25 to 30 degrees caudal

Center the CR 1/2 inch anterior and 2 inches superior to the upside of the EAM

Center the IR to the projected TMJ

Anatomy Demonstrated

TMJ nearest to the IR is visible

Closed mouth image demonstrates the condyle within the mandibular fossa

The condyle moves to the anterior margin of the fossa in the open mouth position

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Clinical Indications: Abnormal relationship or range of motion between the condyle and TM fossa
Positioning:

Rest the patient's skull against hte IR

Tuck the patient's chin until the OML is perpendicular to the IR (or IOML)

Align the MSP to the midline of the IR

Ensure no rotation or tilt

Central Ray

Angle the CR 35 degrees caudal from the OML or 42 degrees caudal for the IOML

Center the CR 3 inches superior to the nasion

Center the IR to the CR

Anatomy Demonstrated

Condyloid processes of the mandible and TM fossae are demonstrated

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Positioning:

Extend the patient's neck, resting their chin against the IR/grid

Adjust the patient's head until the MML is perpendicular to the plane of the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

IOMs, maxillae, nasal septum, zygomatic bones, zygomatic arches, and anterior nasal spine are demonstrated

Petrous ridges are demonstrated just inferior to the maxillary sinuses

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Clinical Indications: Nasal bone fractures
Positioning:

Rest the lateral aspect of the patient's head against the IR

Position the nasal bones to the center of the IR

Adjust the patient's head into a true lateral position and oblique the patient's body as needed for their comfort

Align the MSP parallel with the IR

Ensure no rotation or tilt

Align the IPL perpendicular to the IR

Position the IOML perpendicular to the front edge of the IR

Central Ray

Align the CR perpendicular to the IR

Center the CR 1/2 inch inferior to the nasion

Anatomy Demonstrated

Nasal bones with soft tissue nasal structures, the frontonasal suture, and the anterior nasal spine are demonstrated

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Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck as needed to align the OML perpendicular to the IR

Align the MSP perpendicular to the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 15 degrees caudal

Center the CR to exit at the nasion

Center the IR to the CR

Include the entire skull within the collimation field

Anatomy Demonstrated

Frontal bone, greater and lesser sphenoid wings, superior orbital fissures, frontal and anterior ethmoid sinuses, supraorbital margins, and crista galli are all demonstrated

Petrous pyramids are projected into the lower 1/3 of the orbits

Supraorbital margin is visualized without superimposition

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Positioning:

Extend the patient's neck, resting their chin against the IR/grid

Adjust the patient's head until the MML is perpendicular to the plane of the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

Petrous ridges are demonstrated just inferior to the maxillary sinuses

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Positioning:

Place the head in a true lateral position, with the side of interest closes to the IR

The patient should be in a semiprone or erect position as needed for the comfort of the patient

Align the MSP parallel to the IR

Ensure there is no rotation or tilt of the head

Align the interpupillary line (IPL) perpendicular to the IR

Adjust the flexion of the patient's neck to align the IOML perpendicular to the front edge of the IR

Include the entire skull within the collimation field

Central Ray

Align the CR perpendicular to the IR

Center the CR 2 inches superior to the external acoustic meatus (EAM) or halfway between the glabella and the inion for other types of skull morphologies

Center the IR to the CR

Include the entire orbits within the collimation field

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Positioning:

Rest the patient's nose and forehead against the IR

Flex the patient's neck as needed to align the OML perpendicular to the IR

Align the MSP perpendicular to the IR

Ensure there is no rotation or tilt

Central Ray

Angle the CR 15 degrees caudal

Center the CR to exit at the nasion

Center the IR to the CR

Include the orbits within the collimation field

Anatomy Demonstrated

Petrous pyramids are projected into the lower 1/3 of the orbits

Supraorbital margin is visualized without superimposition

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Clinical Indications: Orbital fractures (ex: blowout), neoplastic or inflammatory processes, and foreign bodies in the eye
Positioning:

Extend the patient's neck, resting their chin and nose against the IR/grid

Adjust the patient's head until the lips meatal line (LML) is perpendicular to the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR perpendicular to the IR to exit at the acanthion

Center the IR to the CR

Collimate to include the entirety of the facial bones and orbits

Anatomy Demonstrated

Orbital floors (plates) are perpendicular to the IR which provides a less distorted view of the orbital rims than the Waters projection

Petrous ridges are demonstrated in the lower half of the maxillary sinuses

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Clinical Indications: Inflammatory conditions (sinusitis, secondary osteomyelitis) and sinus polyps or cysts
Positioning:

Rest the lateral aspect of the patient's head against the table or upright wall bucky

The side of interest should be closest to the IR

Adjust the head into a true lateral position and oblique the patient's body as needed for their comfort

Align the MSP parallel to the IR

Ensure no rotation or tilt

Align the IPL perpendicular to the IR

Central Ray

Align horizontal CR perpendicular to the IR

Center the CR to a point midway between the outer canthus and the EAM

Center the IR to the CR

Collimate to include the entirety of the sinuses

Anatomy Demonstrated

All four paranasal sinus groups are demonstrated

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Clinical Indications: Inflammatory conditions (sinusitis, secondary osteomyelitis) and sinus polyps or cysts
Positioning:

Place the patient's nose and forehead against the IR

Extend neck to elevate OML 15 degrees from horizontal

CR remains horizontal

Align the MSP perpendicular to midline of the IR

Ensure no rotation or tilt

Central Ray

Align the CR horizontal/parallel with the floor

Center the CR to exit at the nasion

Center the IR to the CR

Include the entirety of the sinuses within the collimation field

Anatomy Demonstrated

Frontal sinuses projected above the frontonasal suture are demonstrated

Petrous pyramids are projected into the lower 1/3 of the orbits

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Clinical Indications: Inflammatory conditions (sinusitis, secondary osteomyelitis) and sinus polyps and cysts
Positioning:

Extend the patient's neck placing the chin and nose against the IR

Adjust the head until the MML is perpendicular to the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Center the IR to the CR

Central Ray

Align horizontal CR perpendicular to the IR

Center the CR to exit at the acanthion

Collimate to include the entirety of the sinuses

Anatomy Demonstrated

Maxillary sinuses with the inferior aspect visualized free from superimposing alveolar processes and petrous ridges, the inferior orbital rim, and an oblique view of the frontal sinuses

Petrous ridges are demonstrated just inferior to the maxillary sinuses

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submentovertex (full basal), horizontal beam

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submentovertex (full basal), horizontal beam

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Clinical Indications: Inflammatory conditions (sinusitis, secondary osteomyelitis) and sinus polyps and cysts

Positioning:

Raise the patient's chin and hyperextend the neck, if possible for the patient to do, until the IOML is parallel to the IR

Rest patient's head on vertex of the skull

Align the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Central Ray

CR is directed perpendicular to the IOML

CR is centered midway between angles of the mandible

Center CR 1.5 to 2 inches inferior to the mandibular symphysis

Center the IR to the CR

Anatomy Demonstrated

Sphenoid sinuses, ethmoid sinuses, nasal fossae, and maxillary sinuses are demonstrated

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open mouth parietoacanthial (Waters), horizontal beam

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open mouth parietoacanthial (Waters), horizontal beam

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Clinical Indications: Inflammatory conditions (sinusitis, secondary osteomyelitis) and sinus polyps and cysts

Positioning:

Extend the patient's neck, placing their chin and nose against the IR

Adjust the patient's head until the OML forms a 37 degree angle with the IR

Position the MSP perpendicular to the midline of the IR

Ensure no rotation or tilt

Instruct the patient to open their mouth by instructing them to "drop their jaw without moving their head"

Central Ray

Align the horizontal CR perpendicular to the IR

Center the CR to exit at the acanthion

Collimate to the outer margins of the sinuses

Anatomy Demonstrated

Maxillary sinuses with the inferior aspect visualized, free from superimposing alveolar processes and petrous ridges, the inferior orbital rim, an oblique view of the frontal sinuses, and the sphenoid sinuses visualized through the open mouth

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Lampignano, J., & Kendrick, L. (2020). Bontrager's textbook of Radiographic positioning and related anatomy (9th ed.). Elsevier.