RADIOGRAPHIC POSITIONING AND RADIOLOGIC PROCEDURES 2

MATRIX – PETROMASTOID

Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL OBLIQUE 8 X 10 inch Place the • Position the • MSP // to the 2” posterior Directed 15˚ Suspend none The axiolateral oblique projection The following should be clearly
PROJECTION either CW or patient in an head in a IR to, and 2” caudad first respiration demonstrates the mastoid cells, the demonstrated:
ORIGINAL LAW METHOD LW oblique body true lateral • IPL ⊥ to the above, the then 15˚ lateral portion of the petrous pyramids • Mastoid process closest to IR,
(Double tube Angulation) position (semi position. IR uppermost anteriorly the superimposed internal acoustic with air cells centered to IR
prone) • IOML // to external after. meatus (IAM) and EAM, and, when • Opposite mastoid process not
the acoustic present, the mastoid emissary vessel. superimposing but lying
transverse meatus inferior and slightly anterior to
axis of the IR (EAM) mastoid of interest
& exits the • Auricle of ear not
downside superimposing the mastoid
mastoid process
• Superimposition of IAM and
EAM
Folded Ear: • Temporomandibular joint
(TMJ) visible anterior to
mastoid process
• Close beam restriction to
mastoid region

Not Folded Ear:

 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL OBLIQUE 8 X 10 inch Place the • Rest head in • Rotate The CR Directed to the Suspend none The axiolateral oblique projection The following should be clearly
PROJECTION either CW or patient in a a lateral patient’s enters midpoint of the respiration demonstrates the mastoid cells, the demonstrated:
MODIFIED LAW METHOD LW seated or position with head towards approx 2 grid at an angle lateral portion of the petrous pyramid, • Mastoid process closest to IR,
(Single Tube Angulation) semiprone the affected the IR until inches of 15 ˚ caudad the superimposed IAM and EAM, and, with air cells centered to IR
position side closest MSP has 15 posterior to, to exit the when present, the mastoid emissary • Opposite mastoid process not
to the IR . degree and 2 inches downside vessel. superimposing but lying
angulation superior to, mastoid tip inferior and slightly anterior to
• IPL ⊥ to the the approx 1inch mastoid of interest
IR uppermost posterior to • Auricle of ear not
• IOML // to EAM the EAM superimposing the mastoid
the process
transverse • Superimposition of IAM and
axis of the IR EAM
• Temporomandibular joint
(TMJ) visible anterior to
mastoid process
• Close beam restriction to
mastoid region
 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL PROJECTION 8 X 10 inch Seated • Rest • IPL ⊥ to the exits the Henschen: Suspend none Henschen: The following should be clearly
HENSCHEN, SCHULLER & LYSHOLM either CW or upright of patient’s IR EAM closest 15˚ caudad respiration The Henschen 15 degree method demonstrated:
METHOD LW semiprone head in true • IOML and to the IR. demonstrates the mastoid cells, • Mastoid and petrous regions
position lateral MSP // to the Schuller: mastoid antrum IAM, and EAM. This in center of radiograph
Henschen: position. transverse 25˚ caudad LYSHOLM approach was recommended by • Mastoid air cells lying
axis of the IR Method: Henschen and later by Cushing for posterior to petrous region
Lysholm: Runstrom demonstrating tumors of the acoustic • TMJ lying anterior to petrous
35˚ caudad recommend nerve. region
ed that the
• Opposite mastoid and
exposures
petrous regions not
be made
superimposing side of
with the
mouth open interest and projecting to a
for more inferior location as CR
visualization angulation increases
of the • Close beam restriction to
Schuller: Schuller: mastoid petrous regions
petrous
The Schuller 25 degree method
apex
demonstrates the pneumatic
between the
structure of the mastoid process, the
anterior wall
mastoid antrum , the IAM and EAM,
of the EAM
and the the sinus and dural plates, and, when
mandibular present, the mastoid emissary vessel
condyle

Lysholm:
Lysholm:
The Lysholm 35 degree method,
sometimes referred to as the
Runstrom II method, demonstrates the
mastoid cells, mastoid antrum EAM,
labyrinthine area, and carotid canal
 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL OBLIQUE 8 X 10 inch Place the • Rest the • Adjust MSP The central Directed 12 Suspend none Shows a profile image of the The following should be clearly
PROJECTION either CW or patient in a patient's of head to ray enters degrees respiration petromastoid portion closest to the IR demonstrated:
STENVERS METHOD LW seated or head on the form 45- about cephalad When the patient is correctly • Petromastoid portion in
(Posterior Profile) semiprone forehead, degree 3 to 4” positioned, the petrous pyramid of profile Without distortion.
position nose, and angulation posterior interest is parallel with the plane of • Lateral border of skull to
cheek, with with the and 1”inch the IR The resultant image lateral border of orbit.
the side plane of the inferior to demonstrates the petrous ridge, the • Petrous ridge extended to a
being film the upside cellular structure of the mastoid point approximately two
examined • IOML // to EAM and process, the mastoid antrum the area thirds up lateral border of
the exits about of the tympanic cavity, the bony orbit.
closest to the
transverse 1” anterior labyrinth, the internal acoustic canal, • Mastoid process in profile
IR .
axis of the IR to the and the cellular structure of the below margin of cranium. (Air
downside petrous apex cells are not well visualized
EAM. when internal aspects of the
petrosa are properly exposed.)
• Posterior margin of
mandibular ramus
superimposing lateral border
of cervical column.
• Mandibular condyle projecting
over the atlas near the petrosa
• Close beam restriction to the
petrous pyramid and mastoid
region.

In patients with brachycephalic

(short front to back) skulls, the
petrous ridges form an angle of
approximately 54 degrees with
the MSP Patients with this skull
type require less than normal
rotation of the MSP to place the
petrous ridges parallel with the IR

In patients with dolichocephalic

(long front to back) skulls, the
petrous ridges form an angle of
approximately 40 degrees with
the midsagittal plane Patients
with this skull type require more
rotation of the midsagittal plane
to place the petrous ridge parallel
with the IR
 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL OBLIQUE 8 X 10 inch Place the • Rotate the • Rotate away The central ray Directed 10 Suspend none The anterior profile Arcelin method, The following should be clearly
PROJECTION either CW or patient in patient's face from side enters the degrees respiration the exact reverse of the Stenvers demonstrated:
ARCELIN METHOD LW supine away from being temporal area caudad method, demonstrates the petrous • Petromastoid portion in
(Anterior Profile) position the side examined, at a point portion of the temporal bone farthest profile.
Center body’s being MSP of head approximately 1 from the IR . • Lateral border of skull to
MSP to the to form 45- inch anterior to lateral border of orbit.
examined so
midline of degree the EAM and ½ • Petrous ridge lying
that the
the angulation inch above it. horizontally and at a point
radiographic midsagittal
plane forms with the approx 2/3 up the lateral
table. plane of the
an angle of border of orbit.
IR • Mastoid process in profile
45 degrees
• Adjust the below margin of cranium. (Air
with the
flexion of the cells are not well visualized
plane of the
patient's neck when petrous pyramid is
This is particularly useful in IR.
so that the properly exposed.)
children and in adults who cannot IOML is • Posterior surface of
be placed in the prone or seated perpendicular mandibular ramus parallel to
upright position for the Stenvers to the plane of lateral surface of cervical
method. This projection is the the IR. vertebrae.
exact opposite of the Stenvers • Mandibular condyle projected
method, and the petromastoid over the atlas near the
petrous pyramid.
portion is more magnified.
• Close beam restriction to
petrous pyramid and mastoid
In patients with brachycephalic region.
(short front to back) skulls, the
petrous ridges form an angle of
approximately 54 degrees with
the MSP. Patients with this skull
type require less than normal
rotation of the MSP to place the
petrous ridges parallel with the
IR.

In patients with dolichocephalic

(long front to back) skulls, the
petrous ridges form an angle of
approximately 40 degrees with
the midsagittal plane. Patients
with this skull type require more
rotation of the midsagittal plane
to place the petrous ridge parallel
with the IR
 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
AXIOLATERAL OBLIQUE 8 X 10 inch Seated • Rotate the • Depress chin Exits EAM 45 degrees Suspend none An axiolateral oblique projection of The following should be clearly
PROJECTION either CW or upright or head, so that so that IOML closest to the caudad respiration the petrosa in the direction of its long demonstrated:
MAYER METHOD LW Supine the MSP is // with the IR. axis demonstrates the EAM, tympanic • Petrosa inferior to mastoid air
position forms 45˚ to transverse cavity and ossicles epitympanic recess, cells
the plane of axis of the IR. aditus and mastoid antrum closest to • EAM visible adjacent and
the IR. (This the IR anterior to petrosa
places the • TMJ visible anterior to EAM
petrous • Auricle of ear not
pyramid of superimposing petrosa or
interest ┴ to mastoid air cells
the IR) • Close beam restriction to the
petrous region

The axiolateral oblique projection

or Mayer method was originally
described using a non-grid
technique. The original technique
has been modified to use a grid
for improved radiographic
quality.
AP AXIAL PROJECTION 8 X 10-inch Seated • Flex the • MSP & OML 2 inches OML: Suspend none This projection shows the petrosas The following should be clearly
TOWNE METHOD LW upright or patient’s ┴ to IR. above the 30 degrees respiration projected above the base of the skull. demonstrated:
Supine neck to place nasion and Caudad It demonstrates the internal acoustic • Entire petrous and mastoid
Position the OML ┴ passes canals, arcuate eminences, labyrinths, regions
to IR. through at the IOML: mastoid antrums, and middle ears. The • Distance from lateral border
Center body’s level of the 37 degrees dorsum sellae is seen within the of skull to lateral margin of
• Immobilize
MSP at the EAM Caudad foramen magnum. foramen magnum equal on
the head.
midline of the both sides.
table/VGCH
• Symmetric petrous pyramids
• Dorsum sellae visible within
foramen magnum
• Close beam restriction to the
When the patient's head cannot petrous & mastoid regions
be flexed to this extent, adjust it
to place the IOML perpendicular
to the IR and then compensate
with a 7 degree increase in the
caudal angulation of the central
ray.
 Radiographic View Film Size Body Part Position Localization Reference Central Ray Patient Immobilization Structure Shown Evaluation Criteria
Position Plane Point Instruction Device
PETROMASTOID
SUBMENTOVERTICAL PROJECTION 8 X 10 inch Seated • Center the • Rest the SMV: SMV: Suspend none A symmetric axial projection of the The following should be clearly
HIRTZ MODIFICATION either CW or upright or MSP of the patient's sagittal plane of Perpendicular respiration petrosas demonstrate the mastoid demonstrated:
LW Supine body to the head on the the throat at processes, labyrinths, EAM, tympanic • Mandibular condyles anterior
position (with midline of vertex, & the level HIRTZ: cavities, and acoustic ossicles to external acoustic canals
the trunk the grid. adjust it so of the EAMs Anterior angle and petrous pyramjds
elevated & that the MSP of 5 degrees • Organs of hearing within
• Rest the
knees is ┴ to the HIRTZ: petrosae
patient's
flexed to relax midline of CR to a point • Distance from lateral border
the abdominal head on the
vertex, & the grid. midway of skull to mandibular
muscles)
adjust it so • Position the between and 1 condyles equal on both sides
patient using inch (2.5 cm) • Symmetric petrosas
that the MSP
either of two anterior to the • Close beam restriction to the
is ┴ to the
basic EAMs at petrous region
midline of
approaches: an anterior
the grid. angle of 5˚
• (1) adjust the
extension of
the neck so
that the OML
is // with the
The goal of the basilar projection plane of the
for the petromastoid portion is to IR, or
project the long axis of the EAMs, • (2) when the
the tympanic cavities, and the neck cannot
osseous part of the auditory be fully
(eustachian) tubes immediately extended,
behind the mandibular condyles. angle the
Therefore, the central ray is central ray
anteriorly
projected perpendicular to the
until it is ┴ to
OML rather than the IOML, as in the OML
the submentovertical (SMV)
projection for the