Adult skull

Following a head injury the imaging examination of choice is CT ¹^–⁹.

Plain film skull radiography (SXR) has in the main been abandoned⁶ or its use radically reduced as a first line imaging test both in children and in adults¹^–⁴.

A SXR is now limited to:

▪ where national or local guidelines indicate a role within a patient management algorithm;

▪ locations where imaging resources are limited and CT is not available.

If a SXR is obtained there are just three abnormal features to look for: linear fractures, depressed fractures, and a fluid level in the sphenoid sinus.

The standard radiographs

Radiographs comprising a standard SXR series:

▪ A Lateral obtained with a horizontal X-ray beam, and one additional view depending on the site of injury.

□ Trauma to the occipital bone
= Towne’s view.

□ Any other injury
= PA frontal view.

Abbreviations

CT, computed tomography; PA, posterior-anterior view; SXR, skull X-ray.

Following an apparently mild head injury requests for skull radiography (SXR) will occur very infrequently ¹^–⁹. Compelling evidence that CT should be the examination of choice was initially based on a meta-analysis of 20 head injury surveys⁷. SXR series may still be requested, perhaps in remote locations where imaging facilities are limited.