Skull X-ray positioning
How to position for each of the 6 skull X-ray views: where the patient goes, where to centre, which receptor and distance to use, and what a good image looks like.
By the ScanFlo Editorial Team · Updated
In this section · X-ray positioning
- X-ray positioning guides
- Skull positioning
- Face & sinuses positioning
- Soft tissue neck positioning
- C-spine positioning
- Chest positioning
- Shoulder positioning
- Humerus positioning
- Elbow positioning
- Forearm positioning
- Wrist positioning
- Hand positioning
- T-spine positioning
- Abdomen positioning
- L-spine positioning
- Sacrum & SI joints positioning
- Pelvis positioning
- Hip positioning
- Femur positioning
- Knee positioning
- Tibia & fibula positioning
- Ankle positioning
- Foot positioning
X-ray positioning/Skull
The routine skull views are Skull lateral (horizontal beam) and Skull PA. Mastoid lateral (Schüller), Mastoids Towne's, Skull (occiput) Towne's and Skull AP come in when you need to answer a particular question, or when the patient can't manage a routine view. Each guide walks you through the set-up step by step, with a short video, exposure settings for different patient sizes and what a good image should show.
A radiographer is still checking these guides.
Routine views
Extra views
All views in this region
- Skull lateral (horizontal beam)
- Skull PA
- Mastoid lateral (Schüller)
- Mastoids Towne's
- Skull (occiput) Towne's
- Skull AP
Quick reference
Where to centre, how far and which receptor, for every skull view at a glance. Open a guide for the full set-up.
| Projection | Centre on | SID | Receptor | Breathing |
|---|---|---|---|---|
| Skull lateral (horizontal beam) | 2 cm above the external auditory meatus | 100 cm | 24×30 landscape, grid | No breathing instruction needed |
| Skull PA | the nasion | 100 cm | 24×30 portrait, grid | No breathing instruction needed |
| Mastoid lateral (Schüller) | 5 cm above the uppermost external auditory meatus | 100 cm | 18×24 portrait, grid | No breathing instruction needed |
| Mastoids Towne's | the midline between the external auditory meati | 100 cm | 18×24 landscape, grid | No breathing instruction needed |
| Skull (occiput) Towne's | 7–8 cm above the nasion on the midline | 100 cm | 24×30 portrait, grid | No breathing instruction needed |
| Skull AP | the nasion | 100 cm | 24×30 portrait, grid | No breathing instruction needed |
Mistakes that lead to repeats
- Double floor of the anterior fossa on the skull lateral (horizontal beam): make the interpupillary line vertical.
- Orbits asymmetric on the skull PA: check the mid-sagittal plane is perpendicular.
- Pinna over the air cells on the mastoid lateral (Schüller): fold the auricle forward.
- Asymmetric petrous ridges on the mastoids Towne's: check the mid-sagittal plane.
- Dorsum sellae above the foramen magnum on the skull (occiput) Towne's: tuck the chin and check 30° caudad.
- Head tilted on the skull AP: use a thin flat pad.
Common questions
- Which skull views are routine?
- Usually Skull lateral (horizontal beam) and Skull PA.
- What distance (SID) do skull X-rays use?
- 100 cm for every skull view here.
- Do skull X-rays need a grid?
- Yes, every view here is taken with a grid.
Try it in ScanFlo: the ScanFlo XR X-ray Room, coming soon, lets you set up every skull projection in a 3D room and score your positioning. See ScanFlo XR →