X-ray (X-ray) of the skull

The cranium in the human body performs a vital function. This bone structure is a protective shell of the brain, therefore it is distinguished by a certain strength. However, there are situations when the integrity of the skull, and, accordingly, the safety of brain tissue, may be at risk. Injuries, diseases and anomalies in the development of the cranium can directly threaten not only health, but also human life. Considering the peculiarities of the structure of the skull, as well as the density of its structure, the value of non-invasive methods for examining this bone structure cannot be overestimated. One of the most common and affordable diagnostic methods is a skull x-ray. It is her doctors who often prescribe as the first stage of the examination of the patient, preceding the more complex and expensive – computed and magnetic resonance imaging.

Как устроен череп, какие функции выполняет

The skull is part of the human skeleton. In fact, it forms the bone frame of the head.

This part of the skeleton has its own characteristics, for example, the growth and development of the bones of the skull occurs before a person reaches the age of 30-32 years. In addition, as a person grows older, the proportions of the ratio of the brain and facial sections change, the cartilages located between the bones of the base of the skull disappear, and the fontanelles (non-ossified sections of the cranial vault connecting its parts) overgrow.

The anatomical structure of the skull includes 23 bones, two sections – cerebral and facial, while the first significantly exceeds the second in volume.

In the front part of the cranium there are paired and unpaired bones: vomer, ethmoid and hyoid bones, lower jaw, lower nasal concha, upper jaw, nasal, palatine, zygomatic and lacrimal bones.

The brain part of the skull is divided into the vault and base, and is formed by the frontal, occipital, sphenoid, parietal and temporal bones. In the region of the crown there are parietal bones and parietal tubercles – characteristic convex parts of bone tissue. In the temporal bones are pyramidal processes containing the vestibular apparatus and auditory receptors.

All bones of the cranium are connected by sutures – immobile formations of a fibrous structure. The exception is the lower jaw – it is mobile, and is connected to the main part of the skull by ligaments and temporomandibular paired joints.

What is the skull for in the human body? First of all, it is a protective box for the brain. The skull is the bony frame of the head, it determines its shape. It can be argued that it is the protective function that is the main function of this bone structure.

In the region of the skull, there are the initial openings of the respiratory and digestive tract, as well as the human senses; facial muscles are attached to its bones, which, together with the bones, determine the facial features of a person.

Due to the mobility of the lower jaw, a person has the ability to perform chewing function. The bones of the skull are part of the speech apparatus, which makes it possible to communicate through articulate speech, and the bones of the jaws themselves are the base of the teeth.

The occipital bone of the brain part of the skull connects it to the spine, it has a hole for the transition of the brain into the spinal cord.

Дыхательная и речевая деятельность, поглощение пищи, работа почти всех органов чувств и головного мозга практически невозможны, если черепная коробка не может полноценно выполнять свои функции.

Что показывает рентгенография черепа, для чего её назначают

Распространённое заблуждение – мнение, что рентген головы предназначен для исследования мозга. На самом деле, этот метод диагностики более эффективен именно для изучения костей черепной коробки вместе с зубами.

Назначению проведения процедуры обычно предшествует обращение пациента к врачу с определенными жалобами. Терапевт, онколог, невролог, эндокринолог, окулист, хирург, отоларинголог – вот неполный перечень специалистов, которые могут направить пациента на это обследование.

The doctor issues a referral for an x-ray of the skull if the patient complains of the following symptoms:

• тремор верхних конечностей;
• persistent or recurrent headache;
• frequent dizziness;
• беспричинные кровотечения из носа;
• feeling of darkening in the eyes;
• decreased visual acuity and hearing;
• pain when chewing.

The purpose of the procedure is:

• establishment of a primary or verification of an existing diagnosis;
• development of tactics for conducting therapeutic measures;
• determination of the grounds for a surgical operation, radio- or chemotherapy;
• verification of the effectiveness of the treatment.

“What does a skull x-ray show?” – often the examined ask the doctor who ordered the x-ray, such a question.

A doctor of appropriate qualification can determine the presence of such pathologies and diseases of the bones of the skull from a high-quality image:

• who is
• остеопороза костной ткани;
• врождённых аномалий строения и деформаций черепа;
• мозговых грыж и опухолей гипофиза;
• hematoma;
• остеосклерозов;
• osteomas (benign tumors of the bone), meningiomas (benign tumors of the soft membranes of the brain), malignant tumors, metastases;
• fractures and their consequences;
• signs of intracranial hypertension and hypotension;
• consequences of inflammatory processes in the brain.

Indications and contraindications for the appointment of an x-ray of the skull

Due to the fact that the procedure is carried out using X-ray irradiation, it should be carried out only in the direction of the doctor, and only in cases where there is an objective need to obtain information about the state of the skull bones in this way.

Среди показаний к рентгену черепа:

• suspicion of traumatic brain injury (open or closed);
• tumor processes;
• possible developmental anomalies – congenital or acquired;
• патологии ЛОР-органов, например, носовых пазух;
• the presence of a number of symptoms with an unexplained etiology: impaired consciousness, dizziness, persistent severe headaches, symptoms of a hormonal disorder.

As for contraindications, they are associated with the dose of radiation received during the diagnostic process. For example, for pregnant women, especially in the first trimester, examination methods associated with the use of X-ray irradiation are not recommended at all. If possible, the doctor prescribes more gentle diagnostic methods for the fetus.

The second category of patients for whom skull radiography is prescribed with caution is children. Children’s age is not an absolute contraindication for the procedure, moreover, in some cases, an x-ray of the skull is an objective necessity, for example, if you need to confirm the doctor’s suspicions of congenital pathologies of bone development.

It is believed that modern X-ray machines during the diagnosis cannot significantly irradiate the child. Thus, the permissible dose of radiation per year for a person is no more than 50 microsieverts per year, and equipment for radiography “gives out” to the patient a dose of no more than 0,08 microsieverts per session. In this case, the problem is the fact that not every medical institution has at its disposal modern X-ray machines with dosed radiation, and in X-ray rooms, outdated equipment that has been in operation for more than a decade is more common. Nevertheless, sometimes it is simply impossible to refuse an x-ray of the baby’s skull. This diagnostic method is one of the most popular in pediatric neurosurgery, traumatology and neurology. In the presence of some indications, x-rays of the skull are performed even for newborn babies.

Requirements for preparation, the procedure for conducting x-rays of the skull

Этот вид рентгена не требует осуществления подготовительных мероприятий. До его проведения, доктор уточняет факт отсутствия беременности, если речь идёт о пациентке женского пола, объясняет, как именно будет проходить процедура, сколько снимков необходимо будет сделать, что требуется от обследуемого в процессе. Если процедура назначена ребёнку, родители готовят его к диагностике, доступно для малыша объясняют, как ему необходимо себя вести. Никаких ограничений по диете или количеству физических нагрузок перед обследованием врачи не устанавливают, если их не требует общее состояние пациента независимо от назначенной процедуры.

Before starting the diagnosis, the doctor asks the patient to remove all metal jewelry and accessories from the head and neck, as they can be reflected in the images in the form of additional blackouts, thereby distorting the results.

Image fixation can be carried out in different positions – the patient can lie down, sit or stand, depending on which area is being examined. The body of the subject is covered with a special protective apron with lead plates. The head, if necessary, can be fixed with special straps or rollers to ensure its complete immobility during the capture of the image. The doctor takes the required number of pictures. In the process, he can change the position and position of the patient.

Pictures can be taken in the following projections:

• axial;
• semi-axial;
• передне-задней;
• posterior-anterior;
• right side;
• left side.

There is also such a thing as radiography methods. It involves the implementation of fixing the image in special projections, allowing you to get an image of a specific area. For example, the methods according to Reza, Ginzburg and Golvin differ from each other, but they all provide an overview of the visual canals and the superior orbital fissure. Pictures according to Schüller, Mayer and Stanvers allow us to study the state of the temporal bones.

Most often, a doctor needs to make a diagnosis in two projections – anterior and one of the lateral. The whole procedure lasts no more than 5 minutes. It is absolutely painless, and the only atypical sensations that can occur because of it is a metallic taste in the mouth due to exposure to x-rays.

Types of X-rays of the skull

Given the complexity of the structure of the cranium, and the large number of bones that make it up, doctors distinguish two types of skull radiography:

• survey;
• sighting.

Обзорная рентгенография головы не имеет целью визуализировать какой-либо конкретный участок черепа. Её снимки показывают состояние костной структуры в целом.

Aiming radiography makes it possible to examine the state of a certain part of the skull:

• cheekbones;
• bone pyramid of the nose;
• upper or lower jaw;
• eye sockets;
• sphenoid bone;
• височно-нижнечелюстных суставов;
• сосцевидных отростков височных костей.

Снимки прицельной рентгенографии показывают наличие кальцификатов в костях, кровоизлияния и гематомы в конкретной части черепа, обызвествление частей опухолей, наличие патологической жидкости в придаточных пазухах носа, изменение размера костных элементов, связанное с акромегалией, нарушения в области турецкого седла, провоцирующие патологии гипофиза, переломы костей черепа, а также расположение инородных тел или очагов воспаления.

Peculiarities of radiography of the cranium in children

Для того, чтобы ребёнок не боялся непонятной и незнакомой процедуры, ему следует объяснить простыми и доступными словами, как проводится рентгенография, что этот процесс совсем не причиняет боли, что рядом могут находиться родители, поэтому причин для страха нет, и нужно просто слушаться доктора. Совсем маленьким детям разрешена соска-пустышка.

Ребёнка усаживают или укладывают, и аккуратно фиксируют, чтобы он не двигался. Все металлические заколки, украшения и аксессуары для волос нужно снять. Тело закрывают свинцовым фартуком, может дополнительно использоваться свинцовый воротник для защиты щитовидной железы.

After radiography, the baby should be given plenty of fluids – fruit drinks, teas, juices with pulp, milk and sour-milk drinks to neutralize the effect of the received radiation dose.

How are x-rays of the skull deciphered

Интерпретацией результатов занимается врач-рентгенолог. Проведя процесс сканирования черепной коробки во всех необходимых проекциях и укладках, доктор даёт расшифровку снимков, и составляет заключение обследования.

Examining the image recorded in the pictures, the doctor analyzes the size, shape, location and thickness of the bones of the skull, compares these data with normal values. The doctor is also interested in the vascular pattern, the condition of the cranial sutures and paranasal sinuses, and the general shape of the cranial vault.

The radiograph, in most cases, quite clearly shows the presence of fractures of the base or calvaria. However, for example, if the bones are of high density, it will be difficult to recognize a fracture on an x-ray.

Хорошо заметны на снимках врождённые патологии развития черепной коробки, остеопороз или увеличение размеров турецкого седла – отклонений, которые являются результатом хронически повышенного внутричерепного давления. Этот симптом может провоцировать увеличение размеров головного мозга, при этом он начинает давить на внутреннюю пластинку черепа, оставляя на ней так называемые пальцевые вдавления.

In the presence of osteomyelitis, the images show foci of calcification of the cranial bones. If chronic subdural hematoma is present, intracranial calcifications are seen on imaging.

Результаты обследования позволяют обнаружить обызвествлённые опухоли головного мозга, или объёмные образования по степени смещения обызвествлённого шишковидного тела по отношению к срединной плоскости черепа.

Multiple myeloma usually affects flat bones, including the bones of the skull. X-ray images can show different types of myeloma formations – focal, nodular, reticular, osteolytic, osteoporotic, or mixed. The most characteristic radiological symptom of multiple myelomas of the skull is the presence of sharp contours in each focus of the defect, and the similarity of the defect itself with a fossa or pothole in the bone structure. Myeloma is characterized by the fact that it usually does not manifest itself in isolation: if the lesion is found in the bones of the skull, a mandatory examination of the remaining bones of the skeleton is necessary.

The human cranium is a strong bone frame for the brain. In addition to the protective function, this bone structure also performs others, for example, it participates in the formation of human speech, in the process of breathing, chewing food, communication of the human body with the environment through the work of the sense organs.

Despite their strength, the bones and the cranial cavity are no less susceptible to diseases and injuries than other parts of the body, organs and bone formations. Timely and accurate diagnosis is one of the guarantees that dangerous disorders in the cranium will not lead to irreparable consequences for a person. The methods of diagnosing the condition of the skull include, among other things, radiography of the cranium. This method is considered less informative than, for example, magnetic resonance imaging, but it is the most accessible of all, since MRI scanners are not installed in every medical institution, and X-ray rooms are equipped in almost all clinics and hospitals.

X-ray examination of the skull reveals fractures, tumors, injuries, hematomas, developmental abnormalities, and other conditions of the skull that threaten a person, so that the attending physician is able to make a diagnosis and develop a treatment regimen.