positioning of the sinuses, orbits and nasal bones

Question 1

routine protocol for orbits

Answer 1

• two 30 degree Caldwell images (exaggerated caldwell)
• lateral

always clean the detector or cassette first

Question 2

routine protocol for nasal bones

Answer 2

• waters (coned to nasal bones)
• lateral

Question 3

routine sinus protocol

Answer 3

• waters open mouth
• caldwell
• lateral

Question 4

exaggerated caldwell for orbits

(two projections)

Answer 4

• 30 degrees caudad, 110 SID
• two projections for this one, one with pt looking up and one with pt looking down
• pt facing detector (sitting on stool)
• OML lined up (corner of eye to EAM)
• (-) in line with eyes approx
• top of light: finger above eyebrows
• bottom of light: inferior orbital margin (most prominent bone under eye bag area, bottom of eye socket)
• put finger near to make sure what you want is included in the light
• up arrow, tell pt to look up
• now do the exact same again (tell pt to stay very still after you say the first beep)
• have the pt now looking down with a down arrow
• can stack the markers, one on top of the other so they both fit in the lightfield

** one projection is with their eyes looking up and an up arrow, then tell them to hold nice and still and beep, then second projection all you do now is tell them to hold very still and look down and mark it with a down arrow and “beep”

Question 5

(left) lateral for orbits

Answer 5

• 110 SID
• position head for IOML
• side to side: light all the way to EAM and just anterior to the eye
• (-) straight through the outer canthus
• top of light: superior orbital margin (eyebrows)
• bottom of light: inferior orbital margin (bone under eye bag)
• pts rotated so that their face is touching the detector and they are sitting on the stool (PA)
• marker in top corner at an angle
• check for tilt and rotation

Question 6

waters for nasal bones

Answer 6

• 110 SID
• (-) in middle of nose
• top of light: finger above eyebrows
• bottom of light: light to bottom of top lip (maxilla)
• side to side: collimate to sides of the nose (3 fingers wide)
• pt facing you to start and get lightfield set up
• now put marker in top corner of detector
• now have pt face the detector (now they are PA)
• corner of mouth to TEA
• make sure there is no rotation or tilt

Question 7

lateral for nasal bones

Answer 7

• use finger technique, 110 SID
• get pt rotated so their face is against the detector and their body is PA
• check for tilt and rotation
• top of light: finger above eyebrows
• bottom of light: to bottom of top lip (maxilla)
• outer lightfield: just past the outer canthus (side to side)
• marker in the top corner
• IOML perpendicular to the IR

Question 8

Caldwell for sinus

Answer 8

• 110 SID, 14x15 lightfield
• marker in bottom corner
• pt facing the IR (PA)
• tilt chin (two finger trick, start pt at OML and put finger in line with OML (middle finger) and put another finger on top of the middle finger and when pt tilts chin up to match line with finger then you have roughly the 15 degree head extension you need
• bottom of light: bottom of incisors (top teeth included to bottom of them)
• top of light: hairline
• wont see any light on the detector because coning is so small

Question 9

waters for sinus

Answer 9

• 110 SID, 14x15 lightfield
• marker in top corner at an angle
• tilt pts chin up corner of mouth to TEA
• top of light: eyebrows
• bottom of light: bottom of top incisors
• side to side: tiny bit of light on either side
• check for tilt and rotation
• (-) middle of nose
• hold side of pts head and tell them to drop their jaw without moving their head

Question 10

lateral for sinuses

Answer 10

• 110 SID, 13x15 lightfield
• pt rotated with face touching the detector (PA)
• IOML
• side to side: light through to EAM (aka EAM to everything anterior)
• bottom of light: to bottom of upper incisors
• top of light: just below hairline
• check for tilt and rotation
• marker in top corner
• can clip nose abit in this one
• barely any light on either side