Central Nervous System| Indications,Preparation & Procedure (Skull X-Ray)

In this article, we will discuss procedures for the central nervous system (CNS) performed in a busy radiology department.

By the end of the article, you would be able to:

1. Procedure for the central nervous system
2. Preparation of the patients for each procedure
3. Indications of each procedure
4. Pre-procedure preparation of the patient
5. Post-procedure care

(Central Nervous System)

What is a skull X-Ray?

X-Ray skull is a radiographic image of the bones of the skull for diagnostic purposes. In this, bones of the skull, nasal sinuses can be visualized. At least 2 views AP/PA and lateral views have to be taken. PA view should be preferred over AP view because of less radiation to the eyes.

Indications for skull X-Ray (CNS):

1. Known or suspected trauma to the face of the cranium to reveal a fracture
2. Suspected increased intracranial pressure  revealed by abnormal marking-on the inside of the cranial vault
3. Suspected pituitary tumor revealed by increase size and erosion of the sellaturcica of cranial contents
4. Suspected acromegaly revealed by an enlarged mandible
5. Suspected tumor or inflammation involving the paranasal sinus
6. Suspected vascular abnormalities such as chronic subdural hematoma revealed by classification in brain tissue
7. Suspected perinatal injury or congenital defect involving the skull
8. For evaluation of abnormal calcification

Skull X-ray patient preparation

Patient teaching - explain to the patient or caregiver:

• About the purpose of the procedure
• The location where the procedure will take place and that a technician or radiologist will perform the procedure
• That the procedure takes about 5 to 10 minutes depending on X-Ray modern technique machines
• The foods, fluids, and medication or not restricted prior to procedure expect if advised by the clinician
• That no sedation or anesthetic is administered prior to the procedure
• That views may be taken with the patient in various position on the X-ray table or in X-ray
• That the area to be examined will be immobilized or the patient will be asked to remain still during the procedure
• That the procedure should not cause discomfort coma to expect possibly from lying on the heart table

Encourage questions and variablelization of concerns about the procedure appropriate to age and mental and emotional status. Use and atomic models and diagram to have the patient or caregiver understand the procedure. Use activity and demonstration kids for children depending on developmental level, to assist with explanations.

(Central Nervous System| Indication)

Physical preparation Skull X-ray (CNS)

• Obtain a history of known underlying medical condition or trauma and (for women) date of last menstrual period to determine the possibility of pregnancy
• Ensure that all dental prosthesis, jewelry, eyeglasses, or other metal objects such as hair clips are removed
• Provide Hospital gown to wear if needed
• Perform glucose testing of any drainages with test tape if it is cerebral fluid (validated by a positive test), report to the physician

Skull X-Ray Procedure:

The patient is placed on the X-ray table or seated in a chair; various views of the skull are taken with the patient repositioned and the head is stabilized with a headband, sandbags, or foam pads for each change of position. For posterior-anterior and basilar views, the patient is placed in a prone position; for anterior-posterior, axial (crown to chin) views, the patient is in the supine position, various degrees of neck flexion is used for different views.

The patient is requested to remain motionless while the X-ray is taken. The positions are maintained while the film is developed and checked in the event that more filming is needed. In the condition of trauma, before placing the patient in the various positions, confirm from the physician that the cervical spine is not injured.

Aftercare-(CNS, skull X-Ray)

Care and assessments following the procedure include assisting the patient from the X-ray table or chair. Perform neurologic checks and vital signs and compare them to baselines. If the patient is stable, helps him or her to remove the hospital gown and dress if needed. Return glasses, dentures, and jewelers to patients.