RADIOGRAPHY

PENGINDERAAN
Moh.Zainuddin
SMF RADIOLOGI
RS DR SOEDARSO
 HEAD AND NECK RADIOLOGY
OBJECTIVES
1. Understand the how different imaging modalities
depict the head and neck anatomy
2.Realize how anatomic depiction of the head and Neck and
translate into clinical utility
3. Identify the anatomy of the orbit in different imaging planes
on MRI and CT
4. Identify the anatomy of the sinuses on CT and radiographs
5. Appreciate the complexity of the Temporal Bone
6. Be able to identify the main anatomical structures in the
neck on CT, MRI, and barium swallow
7. Use imaging to better understand the vascular Anatomy of
the neck
 IMAGING MODALITIES

• Radiographs (Xray)
– Include barium swallow
• Ultrasound
• Nuclear medicine
• Angiography
• Computed Tomography (CT)
– CT angiography
• Magnetic Resonance Imaging (MRI)
– MR angiography
 SKULL / MAXILLO-FACIAL
RADIOGRAPHS
• PA or AP
• Lateral
• Townes
• Waters (My favorite)
• Nasal bones
• Panorex
• Other special views
– Less used these days with CT
– Orbits, TM joints, Mandible, etc
1. Frontal sinus
2. Ethmoid sinus
3. Sphenoid sinus
4. Maxillary sinus
5. Anterior clinoid
6. Sella turcica
7. Posterior clinoid
8. Clivus
9. Petrous portion of temporal
bone
10. External acoustic meatus
11. Mastoid air cells
12. Nasopharynx
13. Angle of mandible
17. Internal occipital
protuberance A. Coronal suture
15. Odontoid process B. Lamdoid suture
14, 16. Ring of C1 C.Grooves of middle meningeal artery
Skull/Face – Lateral

FRONTAL BONE

CORONAL
SUTURE

PARIETAL BONE

LAMBDOID
SUTURE

SELLA TURCICA

TM JOINT
FRONTAL

SPHENOID

MAXILLARY

HARD PALETTE

PHARYNX
NASAL BONE LATERAL
FRAKTUR NASAL BONE
SKULL/ FACE-TOWNES
SKULL/ FACE-WATERS
PANOREX VIEW
 Specialized Imaging
• Temporal bone
– CT mostly because very fine bone detail so
important
• Sinuses
– Mostly CT, coronal plane very helpful
• Temporomandibular joint
– Mostly MRI, can do dynamic imaging
• Orbits
– CT or MRI used about equally
– Opthalmologists use ultrasound
TEMPORAL BONE
STENVERS VIEW
SCHULLER VIEW
 Temporal bone - CT

TRANSVERSE

Ossicles

Cochlea

Internal auditory canal

Semicircular canal

Petrous portion

Mastoid air cells

 Temporal bone - CT

CORONAL

Internal auditory
canal

Ossicles

Inner ear

Tympanic membrane

External au
CT INNER EAR
 PATOLOGI
• CONGENITAL
• TRAUMA
• INFLAMASI
• CHOLESTEATOMA
• NEOPLASMA
MASTOIDITIS
SCHULLER VIEW
 TOWNE VIEW
• ACOUTIC NEURINOMA
CHOLESTEATOM
PETROSUS BONE
 TOWNE VIEW
• ACOUTIC NEURINOMA
SINUS PARANASAL
SINUS PARANASAL
SINUS PARANASAL
 SINUS PARANASAL
1. PLAIN X RAY
2. CT
3. MRI
WATERS VIEW
LATERAL VIEW
AXIAL VIEW
CALDWELL VIEW
 PATOLOGI
• INFLAMASI DAN ALLERGI
• MUCOCELE
• CYST PARANASAL
• BENIGN TUMOR
– OSTEOMA
– FIBRO-OSSEOUS DISEASE
– JUVENIL ANGIOFIBROMA
• MALIGNANT TUMOR
 SINUSITIS
• Plain foto :
– Penebalan mucosa
– Air fluid level
– Radiopasitas memenuhi sinus
ACUT SINUSITIS
ETHMOIDITIS
RET.CYST
MUCOCELE
INVERTED PAPILLOMA
SQUAMOUS CELL CA
TRIPOD FRAKTUR
POLYP/RETENSION CYST
PANSINUSITIS
CHOANAL ATRESIA
ACUT SINUSITIS
THE ORBIT AND EYE
 TEHNIQUES
• PLAIN FILM
• USG
• CT
• MRI
• KONTRAS :
– ARETRIOGRAPHY CAROTIS
– DACRYOCYSTOGRAPY
 PLAIN FILM

1. SKULL AP/LAT
2. WATERS POSITION
3. TOWN
 USG
• Memakai transucer 10 MHz
• Operator dependent
• Praktis utk evaluasi segment posterior dari
bola mata.
• Relatif baik utk diagnostik str jaringan
dibanding CT
 CT DAN MRI
• Punya kemampuan untuk melihat dari
berbagai view (axial,coronal,sagital )
• Bisa menilai struktur vaskuler
• CT lebih baik menilai kondisi tulang dan
lesi yang mempunyai calsifikasi
• MRI lebih baik dalam menilai soft tissue
• CT modalitas terpilih untuk kasus Trauma
 Orbits – CT Transverse

Globe
LR=Lateral
MR ON
rectus
MR=Medial LR ES
rectus
ON=Optic
nerve
ES=Ethmoid
sinuses
 Orbits – MRI Coronal
LR=Lateral rectus

Orbital veins MR=Medial rectus

SR SO IR=Inferior rectus
LR SR=Superior rectus
OD MR
SO=Superior
IR oblique

OD=Optic disc
MS
IT
MS=Maxillary sinus

IT=Inferior turbinate
ORBITALCOMPARTEMENT
Orbital Floor Blowout Fracture

Blood

Blood
 Orbital Ultrasound

A-Anterior Chamber
I-Iris
L-Lens
CB-Ciliary Body
VB-Vitreous Body
CH-Choroid
S-Sclera
 PATOLOGY
• CONGINETAL ANOMALY
– MICROPHALMUS/ANOPHTALMUS
– BUPHTALMUS
• TUMOR
• KELAINAN VASKULER
• INFLAMASI
• TRAUMA
OPHTALMITIS
RETINAL DETACHMENT
TOTAL RETINAL DET
RETINOBLASTOMA
ORBITAL MENINGIOMA
CORPUS ALIENUM ORBITA
ORBITAL FLOOR FX