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Facial Bones and Paranasal Sinuses

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					Elsevier
                                                              Bontrager 7e
Document Information
Reference
Date                     July 21, 2011
Author                   NANCY DERRICO
Modified By
Instructional Designer
Module                   Facial Bones and Paranasal Sinuses




Bontrager 7e                             1 of 38
Document History
The following table states the build and revision history of the document:
 Version            Date               Modified by                           Reason
   1.0             7/11/08            Nancy Derrico         Templated




Global Engineering Notes
    




Bontrager 7e                                2 of 38
Module Outline
Module Title                        Facial Bones and Paranasal Sinuses
        Introduction ........................................................................................ 4
        1.1 Objectives ..................................................................................... 5
        1.2 Reading Assignment ................................................................... 6
        1.3 Anatomy and Pathology .............................................................. 9
        1.4 Positioning and Radiographic Analysis Considerations ....... 12
        2.1 Objectives ................................................................................... 14
        2.2 Reading Assignment ................................................................. 15
        2.3 Basic Projections and Positions of the Facial Bones and Paranasal Sinuses                                  17
        2.4 Advanced Study of the Facial Bones and Paranasal Sinuses19
        2.5 Lateral Projection for the Nasal Bones .................................... 21
        2.6 Parietoacanthial Projection for the Nasal Bones .................... 22
        2.7 Superoinferior Tangential Projection for the Nasal Bones.... 24
        2.8 SMV Projection for the Zygomatic Arches .............................. 26
        2.9 Oblique Inferosuperior Tangential Projection for the Zygomatic Arch                                   28
        2.10 Image Analysis of the Facial Bones and Paranasal Sinuses31
        2.11 Parietoacanthial Projection (Waters Method) for Sinuses ... 32
        2.12 Lateral Projection for Facial Bones ........................................ 34
        2.13 SMV Projection for the Mandible ............................................ 35
        2.14 Axiolateral Oblique Projection for the Body of the Mandible37




Bontrager 7e                                                3 of 38
Screen Number           1.

Screen Type         Introduction

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 1: Introduction to Radiography of the Facial Bones and Paranasal Sinuses

Screen Title        Introduction

On Screen Text      In Module 13 you will be learning about the facial bones and paranasal sinuses. Although there
                    are 14 facial bones, there are only a few, such as the nasal bones and mandible, that you will
                    radiograph specifically. Even so, it is important to know the anatomy and pathology of all the
                    facial bones as they contribute to the formation of the orbits and house some of the paranasal
                    sinuses. After you have completed Module 13, you should be familiar with the basic structures
                    and pathologic conditions of the facial bones and paranasal sinuses and be able to discuss and
                    demonstrate proper positioning and image analysis for each projection and position in the
                    module. As you progress through the module, be sure to have your text available for reference.
                    Click Next to continue.

On Screen Image

                             Source                Description          Alternate Text

                     http://coursewareob      Figure 1-1            Lateral Facial Bones
                     jects.elsevier.com/o
                     bjects/elr/Bontrager
                     6e/IC/jpg/Chapter13/
                     013057.jpg



Engineering Notes




Bontrager 7e                             4 of 38
Screen Number           2.

Screen Type         Section Objectives

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 1: Introduction to Radiography of the Facial Bones and Paranasal Sinuses

Screen Title        1.1 Objectives

On Screen Text      In this module, you will have an opportunity to self-assess your understanding of and ability to
                    apply what you have learned about the anatomy, pathology, and radiography of the facial bones
                    and paranasal sinuses. Upon completion of this section of the module, you should be able to:
                        1. Identify the basic structures of the facial bones and paranasal sinuses.
                        2. Differentiate among key types of pathologic conditions of the facial bones and
                           paranasal sinuses.
                        3. Determine which projections or positions will best demonstrate the structures of the
                           facial bones and paranasal sinuses.
                        4. Demonstrate proper positioning.
                        5. Analyze radiographic images.
                    Click Next to continue.

On Screen Image

                             Source                Description           Alternate Text

                     http://www.coursew       Figure 1-2             Student at computer
                     areobjects.com/obj
                     ects/bontrager6e_v
                     1/images/objectives
                     .jpg



Engineering Notes




Bontrager 7e                             5 of 38
Screen Number      3.

Screen Type     Reading Assignment

Module Title    Facial Bones and Paranasal Sinuses

Section Title   Section 1: Introduction to Radiography of the Facial Bones and Paranasal Sinuses

Screen Title    1.2 Reading Assignment




Bontrager 7e                         6 of 38
On Screen Text   Many of the facial bones are considered irregular. This means that they are uniquely shaped
                 with, oftentimes, multiple bony protuberances, surfaces, and foramina. As a result, thorough
                 radiographic examination requires projections from a minimum of two perspectives. While you
                 study the anatomy and pathology and positioning and radiographic analysis considerations for
                 the facial bones and paranasal sinuses, consider the questions asked below.
                 Readings from Bontrager's Textbook of Radiographic Positioning and Related Anatomy,
                  th
                 7 edition:

                              Read                                       Ask Yourself…

                  Chapter 13,                      1. What are the parts of the mandible? Of the maxilla?
                  "Radiographic                    2. Which facial and cranial bones comprise the orbit?
                  Anatomy," pp. XXX-XXX,
                  and “Pathologic                  3. What role does the zygoma play in the formation of the
                  Indications,” pp. XXX-XXX           zygomatic arch?
                                                   4. Which bony structures make up the TMJ?
                                                   5. What is the joint classification of the TMJ?
                                                   6. What names are given to the paranasal sinuses? Where
                                                      are they located?
                                                   7. Which anatomic areas are affected by blowout and
                                                      tripod fractures?
                                                   8. What are some signs and symptoms of TMJ syndrome?

                  Chapter 13,                      1. Which landmarks are used for positioning of the facial
                  “Radiographic                       bones and paranasal sinuses?
                  Positioning,” pp. XXX-           2. Why is the erect position preferred for radiography of the
                  XXX                                 facial bones and paranasal sinuses?
                                                   3. What are the typical kV ranges for radiography of the
                                                      facial bones and paranasal sinuses?
                                                   4. What is the IR size and orientation for radiographs of the
                                                      facial bones and paranasal sinuses?
                                                   5. Where should patient identification and side information
                                                      markers be placed?
                                                   6. What sort of diagnostic information for TMJ syndrome
                                                      can be gained from an MRI?
                                                   7. Which imaging plane is most often used for CT
                                                      evaluation of the paranasal sinuses?



                 Click Next to continue.




Bontrager 7e                          7 of 38
On Screen Image

                          Source                Description      Alternate Text

                    http://coursewareob    Figure 1-3         Textbook
                    jects.elsevier.com/o
                    bjects/bontrager7e_
                    v1/mod05/images/0
                    5s01l0202.jpg

Engineering Notes




Bontrager 7e                          8 of 38
                                  4.
         Screen Number

         Screen Type          Learning Activity

         Module Title         Facial Bones and Paranasal Sinuses

         Section Title        Section 1: Introduction to Radiography of the Facial Bones and Paranasal Sinuses

         Screen Title         1.3 Anatomy and Pathology
                              SELF-ASSESSMENT ACTIVITY
         Screen Icon

         On Screen Text       Relative to its size, the head with its many cranial and facial bones is one of the heaviest
                              structures of the human body. The air-filled sinus cavities “lighten” the weight of the head
                              but are also subject to infection. Air-fluid levels in the sinuses are an indication of
                              pathology and may be demonstrated on a radiograph when mucus or fluid collects in the
                              cavities.
                              After you have reviewed the anatomy and pathology of the facial bones and paranasal
                              sinuses, click each link to test your understanding.
                              Oblique Inferosuperior Tangential Projection for Zygoma
                              Axiolateral Projection for Mandibular Body
                              Axiolateral Projection for Mandibular Ramus
                              Lateral Projection for Sinuses
                              PA Projection for Sinuses
                              Parietoacanthial Projection for Sinuses
                              SMV Projection for Sinuses
                              Pathology of the Facial Bones and Paranasal Sinuses
                              Click Next to continue.

                          Identification - Oblique Inferosuperior Tangential Projection for Zygoma

         Pickup Source        http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_06_02.h
                              tm



                                 Identification - Axiolateral Projection for Mandibular Body

         Pickup Source        http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_06_04.h
                              tm



                                Identification - Axiolateral Projection for Mandibular Ramus

         Pickup Source        http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_06_05.h


Bontrager 7e                                9 of 38
                                     4.
         Screen Number
                                tm



                                          Identification - Lateral Projection for Sinuses

         Pickup Source          http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_07_01.h
                                tm



                                            Identification - PA Projection for Sinuses

         Pickup Source          http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_07_02.h
                                tm

         Developer: Please note this was formerly titled Ethmoidal Sinuses.

                                      Identification - Parietoacanthial Projection for Sinuses

         Pickup Source          http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_07_03.h
                                tm

         Developer: Please note this was formerly titled Maxillary Sinuses.

                                            Identification - SMV Projection for Sinuses

         Pickup Source          http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_07_04.h
                                tm

         Developer: Please note this was formerly titled Ethmoidal and Sphenoidal Sinuses.

                    Write It, Find It (Text) - Pathology of the Facial Bones and Paranasal Sinuses

     Instructions         ???

                                                  Bold the correct answer(s) in each question

     Question 1           A blowout fracture affects the orbital floor and may cause double vision or diplopia.

     Question 2           A tripod fracture affects the orbital process, maxillary process, and arch of the
                          zygoma.

     Question 3           Malocclusion is a symptom of TMJ syndrome.

     Question 4           A fracture that is caused by trauma to the opposite side is termed contrecoup.

     Question 5           Radiographic indications of sinusitis include mucosal thickening, air-fluid levels, and
                          opacification.




Bontrager 7e                                  10 of 38
     Question 6           Metallic foreign bodies of the eye appear as areas of decreased radiographic density
                          on a radiograph.

     Engineering          In questions 2 and 5, order of answer choices does not matter.
     Notes




      INSERT ANY NUMBER OF ENGINE TEMPLATE(S) HERE (Make sure cursor is in front of
      “INSERT”)

      Glossary Terms


      Notes



      On Screen Image

                                           Source                         Description               Alternate
                                                                                                       Text

                               http://coursewareobjects.els     Figure 1-4                       Paranasal
                               evier.com/objects/elr/Thibod                                      Sinuses
                               eau6e/IC/images/008009.jpg



      Engineering Notes       For onscreen image, please remove the letters A and B from the sides of the image.




Bontrager 7e                               11 of 38
                          5.
      Screen
      Number

      Screen Type     Learning Activity

      Module Title    Facial Bones And Paranasal Sinuses

      Section Title   Section 1: Introduction To Radiography Of The Facial Bones And Paranasal Sinuses
                      1.4 Positioning and Radiographic Analysis Considerations
      Screen Title
                      SELF-ASSESSMENT ACTIVITY
      Screen Icon

      On Screen       Fractures of the facial bones can be difficult to demonstrate on a radiograph. Careful placement
      Text            of the patient, CR, and IR are necessary to visualize blowout and tripod fractures, for example.
                      Perhaps even more challenging to image are fractures of the zygomatic arch. Understanding the
                      basic principles involved in radiography of the facial bones and paranasal sinuses is important to
                      obtaining diagnostic quality radiographs of these areas.
                      After you have reviewed the positioning and radiographic analysis considerations and alternative
                      modalities and procedures, click on the tab to evaluate your knowledge.
                      Positioning and Radiographic Analysis Considerations
                      Next, take the Section 1 Self-Assessment Quiz. The Self-Assessment Quiz will help you
                      prepare for the Module 13 Exam. After you have completed the Self-Assessment Quiz, continue
                      on to Section 2 Positioning and Image Analysis of the Facial Bones and Paranasal
                      Sinuses.

                                     True & False - {fill out the engine template below}

      Instructions    Click true or false for each statement. Be sure to answer all seven questions.

      Question 1

      Answer                         Answer Choices                                    Specific Feedback
      Choices and
                                (Bold the correct response)
      Specific
      Feedback
                      The erect position is preferred for                That is correct.
                      radiographs of the facial bones and
                      paranasal sinuses.

                      Radiographs of the paranasal sinuses are           That is not correct. A small focal spot size is
                      taken using a large focal spot size.               used for better image resolution.

                      Air-fluid levels are not accurately                That is correct.
                      demonstrated unless the CR is horizontal.

                      The radiation dose to the reproductive             That is correct.
                      organs during radiography of the facial
                      bones is so low it is not detectable.



Bontrager 7e                               12 of 38
                        5.
      Screen
      Number

                    The kV range for radiographs of the sinuses is     That is not correct. The kV range for
                    50 kV to 60 kV.                                    radiographs of the sinuses is 70 kV to 80 kV.

                    Damage to the articular disc in the TMJ fossa is   That is not correct. MRI is better for the
                    better evaluated using CT.                         evaluation of tissues.

                    The preferred patient position for CT scans to     That is not correct. The patient should be
                    evaluate the sinuses is the supine position.       placed in the prone position whenever
                                                                       possible.

      General
      Correct
      Feedback

      General
      Incorrect
      Feedback

      Engineering
      Notes




      INSERT ANY NUMBER OF ENGINE TEMPLATE(S) HERE (Make sure cursor is in front of “INSERT”)

      Glossary
      Terms

      Notes



      On Screen
      Image
                                 Source                          Description                       Alternate Text

                     http://coursewareobjects.els      Figure 1-5                         PA Axial Mandible
                     evier.com/objects/elr/Frank/
                     MerrillsAtlas11e/IC/images/0
                     21039.jpg



      Engineering
      Notes




Bontrager 7e                              13 of 38
Screen Number           1.

Screen Type         Section Objectives

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title        2.1 Objectives

On Screen Text      In this module you will have an opportunity to self-assess your understanding of and ability to
                    apply what you have learned about the projections and positions of the facial bones and
                    paranasal sinuses. Upon completion of this section of the module, you should be able to:
                        1. Identify the correct IR size and orientation.
                        2. Indicate appropriate patient and side identification marker placement.
                        3. Describe the CR direction and degree of angulation.
                        4. Identify the anatomic centering point for the CR.
                        5. Describe the proper patient position.
                        6. Identify the range of exposure factors that will produce a diagnostic quality radiograph.
                        7. Analyze images for anatomy, pathology, and diagnostic quality.
                    Click Next to continue.

On Screen Image

                             Source                 Description            Alternate Text

                     http://www.coursew       Figure 2-1               Student at computer
                     areobjects.com/obj
                     ects/bontrager6e_v
                     1/images/objectives
                     .jpg



Engineering Notes




Bontrager 7e                             14 of 38
Screen Number        2.

Screen Type      Reading Assignment

Module Title     Facial Bones and Paranasal Sinuses

Section Title    Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title     2.2 Reading Assignment

On Screen Text   There are many similarities between the projections and positions for the facial bones and
                 paranasal sinuses and those of the skull and cranial bones. There are some differences too,
                 however. Anatomic centering points, CR placement, and IR size are just a few. As you read,
                 note these variations and also consider the questions asked below.
                 Readings from Bontrager's Textbook of Radiographic Positioning and Related Anatomy,
                  th
                 7 edition:



                                    Read                                   Ask Yourself…

                  Chapter 13, "Basic and Special                  1. Which positioning lines are used
                  Projections," pp. XXX-XXX                          for the lateral, PA axial, and
                                                                     parietoacanthial projections of
                                                                     the facial bones?
                                                                  2. Which projections best
                                                                     demonstrate the nasal bones?
                                                                     The mandible?
                                                                  3. How do the SMV and oblique
                                                                     inferosuperior projections for the
                                                                     zygomatic arch differ?
                                                                  4. How is the patient positioned for
                                                                     the parietoorbital projection for
                                                                     optic foramen?
                                                                  5. What is the degree of patient
                                                                     rotation to demonstrate the
                                                                     mandibular body? The degree of
                                                                     CR angle?
                                                                  6. Why are two projections taken of
                                                                     the TMJ in the lateral position?
                                                                  7. How is the CR oriented for
                                                                     radiographs of the sinuses?



                 Click Next to continue.




Bontrager 7e                          15 of 38
On Screen Image

                          Source                 Description      Alternate Text

                    http://coursewareob    Figure 2-2          Textbook
                    jects.elsevier.com/o
                    bjects/bontrager7e_
                    v1/mod05/images/0
                    5s01l0202.jpg

Engineering Notes




Bontrager 7e                          16 of 38
                       3.
   Screen
   Number

   Screen Type     Learning Activity

   Module Title    Facial Bones and Paranasal Sinuses

   Section Title   Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses
                   2.3 Basic Projections and Positions of the Facial Bones and Paranasal Sinuses
   Screen Title
                   SELF-ASSESSMENT ACTIVITY
   Screen Icon

   On Screen       Do you notice the difference in appearance between the right and left maxillary sinuses in the
   Text            above image? The right side appears less dense due to pathology. If the pathologic cause was
                   fluid and a horizontal CR was used, you might see an air-fluid level. A horizontal x-ray beam
                   means that patient position must be adjusted instead of the CR. But what if the patient is unable
                   to flex or extend her neck? How might you compensate? Keep these and other important
                   positioning considerations in mind as you review the projections and positions of the facial bones
                   and paranasal sinuses. Then click each link to test your understanding.
                   Lateral Projection of the Nasal Bones
                   PA Projection of the Mandible
                   SMV Projection of the Mandible
                   Click Next to continue.

                             Image Analysis - Lateral Projection of the Nasal Bones

   Pickup Source   http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_11_02.htm



                                 Image Analysis - PA Projection of the Mandible

   Pickup Source   http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_11_04.htm



                                Image Analysis - SMV Projection of the Mandible

   Pickup Source   http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/popup/13_11_05.htm



   INSERT ANY NUMBER OF ENGINE TEMPLATE(S) HERE (Make sure cursor is in front of “INSERT”)

   Glossary
   Terms




Bontrager 7e                             17 of 38
   Notes



   On Screen
   Image
                             Source                     Description                Alternate Text

                  http://coursewareobjects.els   Figure 2-3                Parietoacanthial Projection of
                  evier.com/objects/elr/Frank/                             the Sinuses
                  MerrillsAtlas11e/IC/images/0
                  22017B.jpg



   Engineering   In the onscreen image, please remove the letter B from the side. Keep the R marker.
   Notes




Bontrager 7e                          18 of 38
   Screen Number           4.

   Screen Type         Content

   Module Title        Facial Bones and Paranasal Sinuses

   Section Title       Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses
                       2.4 Advanced Study of the Facial Bones and Paranasal Sinuses
   Screen Title

   On Screen Text      One of the most common jaw problems encountered by patients is a condition that is
                       sometimes called clicking jaw. While conventional radiography is used less and less for
                       evaluation of TMJ syndrome due to other, newer technologies, you may still be asked to take
                       radiographs of these joints. Other less common exams you may encounter include those for
                       the zygomatic arch and nasal bones.
                       The following activities will provide an opportunity for you to assess your knowledge of the
                       projections and positions of the facial bones and paranasal sinuses. Once you have reviewed
                       the advanced projections and positions of these structures, proceed to the next screens to
                       test your understanding.
                                Lateral Projection for the Nasal Bones (screen 5)
                                Parietoacanthial Projection for the Nasal Bones (screen 6)
                                Superoinferior Tangential Projection for the Nasal Bones (screen 7)
                                SMV Projection for the Zygomatic Arches (screen 8)
                                Oblique Inferosuperior Tangential Projection for the Zygomatic Arch (screen 9)
                       Click Next to continue.

   Glossary Terms

   On Screen Image

                                 Source                Description            Alternate Text

                        http://coursewareob       Figure 2-4              TMJ Open Mouth
                        jects.elsevier.com/o                              Patient Photograph
                        bjects/elr/Frank/Mer
                        rillsAtlas11e/IC/ima
                        ges/021061.jpg

   Animation/Slidesh
   ow/Audio/Video
                       {Insert media popup types here}



   Engineering Notes   For the onscreen image, please remove all lettering and indicators lines.
                       All of the activities on the following screens have been changed greatly. Please
                       use just the activities specified in the following screens; question text may have

Bontrager 7e                               19 of 38
   Screen Number      4.
                   changed from original activities but answer text is unchanged.




Bontrager 7e                       20 of 38
Screen Number           5.

Screen Type         Questions & Answers

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title        2.5 Lateral Projection for the Nasal Bones

On Screen Text      Image Analysis:
                    1. No rotation of nasal bones with bony and soft-tissue structures demonstrated
                    2. Anterior nasal spine and frontonasal suture demonstrated
                    After you have entered your response, click Submit and check your answer. Then click Next to
                    continue.

Glossary Terms

Questions &         {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                     Question                Why are right and left lateral projections required?

                     Answer Popup            Since there are two nasal bones, both lateral projections are taken to
                     Content                 rule out any subtle injury to either one of the nasal bones.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                      Alternate Text




On Screen Image

                              Source                      Description          Alternate Text

                     http://www.courseware                                    2 radiographs
                     objects.com/objects/b                                    of lateral
                     ontrager6e_v1/images/                                    projection of
                     module13/1310.jpg                                        nasal bones

Engineering Notes




Bontrager 7e                               21 of 38
Screen Number        6.

Screen Type      Questions & Answers

Module Title     Facial Bones and Paranasal Sinuses

Section Title    Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title     2.6 Parietoacanthial Projection for the Nasal Bones

On Screen Text   Image Analysis:
                 1. Distance between lateral border of skull and orbit is equal on each side
                 2. Petrous ridges are projected just inferior to the maxillary sinuses
                 After you have entered your responses, click Submit and check your answers. Then click Next
                 to continue.

Glossary Terms




Bontrager 7e                           22 of 38
Questions &         {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                     Question 1              What is the degree of angle between the IR and OML for the
                                             parietoacanthial projection?

                     Answer Popup            A 37° angle between the OML and plane of image receptor must be
                     Content                 formed for this projection.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                       Alternate Text

                                               http://www.courseware       Line drawing of parietoacanthial
                                               objects.com/objects/b       projection (table radiography)
                                               ontrager6e_v1/images/
                                               module13/1313.jpg



                     Question 2              Why should this projection be performed erect?

                     Answer Popup            Use of an erect position helps demonstrate any significant air-fluid
                     Content                 levels in the maxillary sinuses. Often, undetected facial trauma is first
                                             indicated by blood collecting in the maxillary sinuses.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                       Alternate Text




On Screen Image

                             Source                       Description          Alternate Text

                     http://www.courseware                                     Radiograph of
                     objects.com/objects/b                                     parietoacanthi
                     ontrager6e_v1/images/                                     al-Waters
                     module13/1314.jpg

Engineering Notes




Bontrager 7e                               23 of 38
Screen Number          7.

Screen Type        Questions & Answers

Module Title       Facial Bones and Paranasal Sinuses

Section Title      Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title       2.7 Superoinferior Tangential Projection for the Nasal Bones

On Screen Text     Image Analysis:
                   1. Nasal bones clearly demonstrated with minimal superimposition with the glabella or alveolar
                   ridge
                   2. No rotation of the nose
                   3. Soft tissue clearly demonstrated
                   After you have entered your response, click Submit and check your answer. Then click Next to
                   continue.

Glossary Terms

Questions &        {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                    Question 1              Why is it important to have the glabelloalveolar positioning line
                                            perpendicular to the IR?

                    Answer Popup            To prevent superimposition of the frontal bone or upper teeth upon the
                    Content                 nasal bones.

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                      Alternate Text




Bontrager 7e                              24 of 38
On Screen Image

                           Source              Description   Alternate Text

                    http://www.courseware                    2 radiographs
                    objects.com/objects/b                    of
                    ontrager6e_v1/images/                    superoinferior
                    module13/1317.jpg                        tangential
                                                             projection

Engineering Notes




Bontrager 7e                        25 of 38
Screen Number        8.

Screen Type      Questions & Answers

Module Title     Facial Bones and Paranasal Sinuses

Section Title    Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title     2.8 SMV Projection for the Zygomatic Arches

On Screen Text   Image Analysis:
                 1. Both zygomatic arches free from overlying structures
                 2. Both zygomatic arches symmetric and without foreshortening
                 3. No rotation of head
                 After you have entered your responses, click Submit and check your answers. Then click Next
                 to continue.

Glossary Terms




Bontrager 7e                          26 of 38
Questions &         {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                     Question 1              How does this projection differ from the cranial SMV projection?

                     Answer Popup            Since this projection only demonstrates the zygomatic arches rather
                     Content                 than the base of the cranium, exposure factors are greatly reduced.
                                             While the position itself is similar, the CR is centered 1 inch (2.5 cm)
                                             posterior to the outer canthi for the zygomatic arch projection.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                       Alternate Text

                                               http://www.courseware       SMV projection of zygomatic arches
                                               objects.com/objects/b
                                               ontrager6e_v1/images/
                                               module13/1320.jpg



                     Question 2              Must a radiographic grid be used for this projection?

                     Answer Popup            No. Since the zygomatic arches are thin and superficial to the skull, a
                     Content                 nongrid technique may be used, reducing patient dose further.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                       Alternate Text




On Screen Image

                             Source                       Description           Alternate Text

                     http://www.courseware                                     Radiograph of
                     objects.com/objects/b                                     SMV
                     ontrager6e_v1/images/
                     module13/1322.jpg

Engineering Notes




Bontrager 7e                               27 of 38
Screen Number        9.

Screen Type      Questions & Answers

Module Title     Facial Bones and Paranasal Sinuses

Section Title    Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title     2.9 Oblique Inferosuperior Tangential Projection for the Zygomatic Arch

On Screen Text   Image Analysis:
                 1. Zygomatic arch free of overlying structures
                 2. Zygomatic arch not overexposed
                 After you have entered your responses, click Submit and check your answers. Then click Next
                 to continue.

Glossary Terms




Bontrager 7e                          28 of 38
Questions &        {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                    Question 1              Describe how the head is positioned for this projection.

                    Answer Popup            The head and neck are extended, placing the IOML parallel to the IR.
                    Content                 The skull is rotated 15° toward and the chin is tilted 15° toward the
                                            side of interest.

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                        Alternate Text

                                              http://www.courseware      2 line drawings of tangential projection
                                              objects.com/objects/b      of zygomatic arches using upright
                                              ontrager6e_v1/images/      radiography and table radiography
                                              module13/1326.jpg



                    Question 2              What is the primary purpose of the 15° rotation and tilt?

                    Answer Popup            To prevent superimposition of the zygomatic arch upon the parietal
                    Content                 bone of the cranium

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                        Alternate Text




                    Question 3              How is the CR aligned for this projection?

                    Answer Popup            Perpendicular to the IOML and IR
                    Content

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                        Alternate Text




Bontrager 7e                              29 of 38
On Screen Image

                           Source              Description   Alternate Text

                    http://www.courseware                    Radiograph of
                    objects.com/objects/b                    oblique
                    ontrager6e_v1/images/                    inferosuperior
                    module13/1327.jpg                        tangential
                                                             projection

Engineering Notes




Bontrager 7e                        30 of 38
Screen Number            10.

Screen Type          Content

Module Title         Facial Bones and Paranasal Sinuses

Section Title        Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses
                     2.10 Image Analysis of the Facial Bones and Paranasal Sinuses
Screen Title

On Screen Text       In addition to taking radiographs, competent radiologic technologists are able to evaluate the
                     radiographic image for diagnostic quality. The following activities will provide an opportunity for
                     you to view and answer questions about a particular radiographic image. As you review the
                     images of the facial bones and paranasal sinuses, remember that they may possess multiple
                     positioning and technical errors. If you are uncertain about the projection or position in question
                     or the nature of the errors presented, refer to the textbook.
                              Parietoacanthial Projection (Waters Method) for Sinuses (screen 11)
                              Lateral Projection for Facial Bones (screen 12)
                              SMV Projection for the Mandible (screen 13)
                              Axiolateral Oblique Projection for the Body of the Mandible (screen 14)
                     Click Next to continue.

Glossary Terms

On Screen Image

                               Source                  Description           Alternate Text

                      http://coursewareob       Figure 2-5              Axiolateral Mandible
                      jects.elsevier.com/o
                      bjects/elr/Bontrager
                      6e/IC/jpg/Chapter13/
                      013090.jpg

Animation/Slidesho
w/Audio/Video
                     {Insert media popup types here}



Engineering Notes




Bontrager 7e                                31 of 38
Screen Number          11.

Screen Type         Questions & Answers

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title        2.11 Parietoacanthial Projection (Waters Method) for Sinuses

On Screen Text      After you have entered your response, click Submit and check your answer. Then click Next to
                    continue.




Glossary Terms

Questions &         {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                     Question                Identify the positioning error(s).

                     Answer Popup            The head is underflexed, placing the petrous pyramids into the
                     Content                 maxillary sinuses. The neck must be extended more to place them
                                             below the floor of the sinuses.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                        Alternate Text

                                               http://www.courseware        2 ills showing incorrect and correct
                                               objects.com/objects/b        radiographs of Parietoacanthial -
                                               ontrager6e_v1/images/        Waters method with excessive flexion
                                               module13/1340.jpg




On Screen Image

                             Source                       Description             Alternate Text

                     http://www.courseware                                        Parietoacanthi
                     objects.com/objects/b                                        al - Waters
                     ontrager6e_v1/images/                                        method with
                     module13/1339.jpg                                            excessive
                                                                                  flexion

Engineering Notes   This activity is based on
                    http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/screens/13_48.htm The

Bontrager 7e                               32 of 38
Screen Number      11.
                question wording is changed, but the answer text remains the same.




Bontrager 7e                        33 of 38
Screen Number          12.

Screen Type         Questions & Answers

Module Title        Facial Bones and Paranasal Sinuses

Section Title       Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title        2.12 Lateral Projection for Facial Bones

On Screen Text      After you have entered your response, click Submit and check your answer. Then click Next to
                    continue.




Glossary Terms

Questions &         {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                     Question                Identify the positioning error(s).

                     Answer Popup            The skull is tilted, evident by the poor superimposition of the orbital
                     Content                 roofs.

                     Answer Popup
                     Image(s) source(s):
                                                      Image Source                         Alternate Text

                                               http://www.courseware        2 ills showing incorrect and correct
                                               objects.com/objects/b        radiograph of Lateral facial bone
                                               ontrager6e_v1/images/        projection with excessive tilt
                                               module13/1342.jpg

On Screen Image

                             Source                       Description             Alternate Text

                     http://www.courseware                                        Lateral facial
                     objects.com/objects/b                                        bone
                     ontrager6e_v1/images/                                        projection with
                     module13/1341.jpg                                            excessive tilt

Engineering Notes   This activity is based on
                    http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/screens/13_49.htm The
                    question wording is changed, but the answer text remains the same.




Bontrager 7e                               34 of 38
Screen Number         13.

Screen Type        Questions & Answers

Module Title       Facial Bones and Paranasal Sinuses

Section Title      Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title       2.13 SMV Projection for the Mandible

On Screen Text     After you have entered your response, click Submit and check your answer. Then click Next to
                   continue.




Glossary Terms

Questions &        {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                    Question                Identify the positioning error(s).

                    Answer Popup            There is inadequate extension of the neck, evident by the condyles of
                    Content                 the mandible being projected into the pars petrosae. The IOML was
                                            not parallel to the plane of the IR and/or the CR was not perpendicular
                                            to the IOML.

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                        Alternate Text

                                              http://www.courseware        2 ills showing incorrect and correct
                                              objects.com/objects/b        radiograph of Submentovertical
                                              ontrager6e_v1/images/        projection of the mandible showing
                                              module13/1344.jpg            excessive flexion




On Screen Image

                            Source                       Description             Alternate Text

                    http://www.courseware                                        Submentoverti
                    objects.com/objects/b                                        cal projection
                    ontrager6e_v1/images/                                        of the
                    module13/1343.jpg                                            mandible
                                                                                 showing
                                                                                 excessive
                                                                                 flexion

Bontrager 7e                              35 of 38
Screen Number          13.

Engineering Notes   This activity is based on
                    http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/screens/13_50.htm The
                    question wording is changed, but the answer text remains the same.




Bontrager 7e                           36 of 38
Screen Number         14.

Screen Type        Questions & Answers

Module Title       Facial Bones and Paranasal Sinuses

Section Title      Section 2: Positioning and Image Analysis of the Facial Bones and Paranasal Sinuses

Screen Title       2.14 Axiolateral Oblique Projection for the Body of the Mandible

On Screen Text     After you have entered your response, click Submit and check your answer. Then, take the
                   Section 2 Self-Assessment Quiz. The Self-Assessment Quiz will help you prepare for the
                   Exam on Module 13 Sections 1 and 2. Remember, you can also return to the Section 1 Self-
                   Assessment Quiz for additional practice before taking the Module 13 Exam.




Glossary Terms

Questions &        {Insert additional questions & answers using the Insert Screens  Popups box}
Answers Popup(s)
                    Question                Identify the positioning error(s).

                    Answer Popup            Foreshortening of the body of the mandible due to not rotating the
                    Content                 patient’s head 30° toward the IR

                    Answer Popup
                    Image(s) source(s):
                                                     Image Source                        Alternate Text

                                              http://www.courseware        2 ills of correct and incorrect
                                              objects.com/objects/b        radiographs of Axiolateral oblique
                                              ontrager6e_v1/images/        projection for body of mandible showing
                                              module13/1346.jpg            foreshortening of body




On Screen Image

                            Source                       Description             Alternate Text

                    http://www.courseware                                        Axiolateral
                    objects.com/objects/b                                        oblique
                    ontrager6e_v1/images/                                        projection for
                    module13/1345.jpg                                            body of
                                                                                 mandible
                                                                                 showing
                                                                                 foreshortening
                                                                                 of body


Bontrager 7e                              37 of 38
Screen Number          14.

Engineering Notes   This activity is based on
                    http://www.coursewareobjects.com/objects/bontrager6e_v1/module13/screens/13_51.htm The
                    question wording is changed, but the answer text remains the same.




Bontrager 7e                           38 of 38

				
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