{"id":26485,"date":"2023-07-13T20:34:28","date_gmt":"2023-07-14T00:34:28","guid":{"rendered":"https:\/\/www.stepwards.com\/?page_id=26485"},"modified":"2025-03-21T21:58:49","modified_gmt":"2025-03-22T01:58:49","slug":"commonly-utilized-angiographic-projections-in-neurointerventional-radiology","status":"publish","type":"page","link":"https:\/\/www.stepwards.com\/?page_id=26485","title":{"rendered":"Commonly Utilized Angiographic Projections In Neurointerventional Radiology"},"content":{"rendered":"<div id=\"toc_container\" class=\"no_bullets\"><p class=\"toc_title\">Page Contents<\/p><ul class=\"toc_list\"><li><a href=\"#OVERVIEW\"><span class=\"toc_number toc_depth_1\">1<\/span> OVERVIEW<\/a><\/li><li><a href=\"#THE_RELATIONSHIP_BETWEEN_PROJECTIONS_AND_VASCULAR_APPEARANCE\"><span class=\"toc_number toc_depth_1\">2<\/span> THE RELATIONSHIP BETWEEN PROJECTIONS AND VASCULAR APPEARANCE<\/a><\/li><li><a href=\"#TOWNE8217S_VIEW\"><span class=\"toc_number toc_depth_1\">3<\/span> TOWNE&#8217;S VIEW<\/a><\/li><li><a href=\"#WATERS8217_VIEW\"><span class=\"toc_number toc_depth_1\">4<\/span> WATERS&#8217; VIEW<\/a><\/li><li><a href=\"#SCHULLER8217S_VIEW\"><span class=\"toc_number toc_depth_1\">5<\/span> SCHULLER&#8217;S VIEW<\/a><\/li><li><a href=\"#REVERSE_SCHULLER8217S_VIEW\"><span class=\"toc_number toc_depth_1\">6<\/span> REVERSE SCHULLER&#8217;S VIEW<\/a><\/li><\/ul><\/div>\n<h5><span id=\"OVERVIEW\"><span style=\"text-decoration: underline;\">OVERVIEW<\/span><\/span><\/h5>\n<p>Cerebral angiographic projections have a direct influence on visualization of key vascular anatomy during procedures. This page covers some common projections (and how they change the appearance of key vascular anatomy).<\/p>\n<h5><span id=\"THE_RELATIONSHIP_BETWEEN_PROJECTIONS_AND_VASCULAR_APPEARANCE\"><span style=\"text-decoration: underline;\">THE RELATIONSHIP BETWEEN PROJECTIONS AND VASCULAR APPEARANCE<\/span><\/span><\/h5>\n<p>As the C arm is moved around, the path of X-ray beams will move with it. A projection will ELONGATE a vessel (improving its visualization) if the path of X-ray beams are perpendicular to that vessel. Contrastingly a projection will SHORTEN a vessel (decreasing its visibility) if the X-ray beams are parallel to that vessel.<\/p>\n<figure id=\"attachment_26495\" aria-describedby=\"caption-attachment-26495\" style=\"width: 1149px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM.jpg\"><img loading=\"lazy\" class=\" wp-image-26495\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM.jpg\" alt=\"\" width=\"1159\" height=\"529\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM.jpg 2540w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM-300x137.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM-1024x467.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM-768x350.jpg 768w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM-1536x700.jpg 1536w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-6.10.41-PM-2048x934.jpg 2048w\" sizes=\"(max-width: 1159px) 100vw, 1159px\" \/><\/a><figcaption id=\"caption-attachment-26495\" class=\"wp-caption-text\">A cross section in this projection is in plane (Water&#8217;s projection) with the basilar (blue dashes above)<\/figcaption><\/figure>\n<p><b>In summary the angle of x-ray beams relative to a vessel changes its appearance: if the angle is perpendicular the vessel is ELONGATED, if the angle is parallel the vessel is SHORTENED.\u00a0<\/b><\/p>\n<h5><span id=\"TOWNE8217S_VIEW\"><span style=\"text-decoration: underline;\">TOWNE&#8217;S VIEW<\/span><\/span><\/h5>\n<p><b>The Townes projection is a common frontal projection: <\/b>The detector is angled up toward the vertex of the skull.<\/p>\n<figure id=\"attachment_26491\" aria-describedby=\"caption-attachment-26491\" style=\"width: 799px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM.jpg\"><img loading=\"lazy\" class=\" wp-image-26491\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM.jpg\" alt=\"\" width=\"809\" height=\"663\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM.jpg 1448w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM-300x246.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM-1024x840.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.20.18-AM-768x630.jpg 768w\" sizes=\"(max-width: 809px) 100vw, 809px\" \/><\/a><figcaption id=\"caption-attachment-26491\" class=\"wp-caption-text\">This is the Towne&#8217;s view.<\/figcaption><\/figure>\n<p><b>Here are the key features:<\/b><\/p>\n<ul>\n<li>Should see the IACs in the petrous bone but don\u2019t move indicator towards the point of seeing the foramen magnum.<\/li>\n<li>This puts the X-ray beam orthogonal to the PCOMS and PCAs<\/li>\n<li>This ELONGATES the PCOMs and PCAs<\/li>\n<li>Will conversely shorten the basilar artery<\/li>\n<\/ul>\n<h5><span id=\"WATERS8217_VIEW\"><span style=\"text-decoration: underline;\">WATERS&#8217; VIEW<\/span><\/span><\/h5>\n<p><b>The Water\u2019s projection is a common frontal projection: <\/b>The detector is angled down toward the patient\u2019s maxilla.<\/p>\n<figure id=\"attachment_26490\" aria-describedby=\"caption-attachment-26490\" style=\"width: 814px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM.jpg\"><img loading=\"lazy\" class=\" wp-image-26490\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM.jpg\" alt=\"\" width=\"824\" height=\"669\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM.jpg 1460w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM-300x244.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM-1024x832.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-06-27-at-10.22.42-AM-768x624.jpg 768w\" sizes=\"(max-width: 824px) 100vw, 824px\" \/><\/a><figcaption id=\"caption-attachment-26490\" class=\"wp-caption-text\">This is the Water&#8217;s projection.<\/figcaption><\/figure>\n<p><b>Here are the key features:<\/b><\/p>\n<ul>\n<li>Orbital roofs should be just off the top of the screen (depending on the mag).<\/li>\n<li>This puts the X-ray beam orthogonal to the basilar artery<\/li>\n<li>This ELONGATES the basilar artery as well as its branches<\/li>\n<\/ul>\n<h5><span id=\"SCHULLER8217S_VIEW\"><span style=\"text-decoration: underline;\">SCHULLER&#8217;S VIEW<\/span><\/span><\/h5>\n<p><b>The Schuller\u2019s projection is a common lateral projection:\u00a0<\/b>Angle detector to the shoulder of the side your catheter is on.<\/p>\n<figure id=\"attachment_26492\" aria-describedby=\"caption-attachment-26492\" style=\"width: 873px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM.jpg\"><img loading=\"lazy\" class=\" wp-image-26492\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM.jpg\" alt=\"\" width=\"883\" height=\"754\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM.jpg 1490w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM-300x256.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM-1024x874.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.14-PM-768x656.jpg 768w\" sizes=\"(max-width: 883px) 100vw, 883px\" \/><\/a><figcaption id=\"caption-attachment-26492\" class=\"wp-caption-text\">This is the Schuller&#8217;s projection (assuming the catheter is in the right internal carotid).<\/figcaption><\/figure>\n<p><b>Here are the key features:<\/b><\/p>\n<ul>\n<li>Elevates the M2, M3s, and M4s and separates them from the ACA.<\/li>\n<li>Shortens the M1 branch.<\/li>\n<li>Some PCA branches more visible<\/li>\n<\/ul>\n<h5><span id=\"REVERSE_SCHULLER8217S_VIEW\"><span style=\"text-decoration: underline;\">REVERSE SCHULLER&#8217;S VIEW<\/span><\/span><\/h5>\n<p><b>The reverse Schuller\u2019s projection is a common lateral projection: <\/b>Angle detector away from the shoulder of the side your catheter is on.<\/p>\n<figure id=\"attachment_26493\" aria-describedby=\"caption-attachment-26493\" style=\"width: 859px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM.jpg\"><img loading=\"lazy\" class=\" wp-image-26493\" src=\"http:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM.jpg\" alt=\"\" width=\"869\" height=\"736\" srcset=\"https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM.jpg 1470w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM-300x254.jpg 300w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM-1024x868.jpg 1024w, https:\/\/www.stepwards.com\/wp-content\/uploads\/2023\/07\/Screen-Shot-2023-07-13-at-5.47.47-PM-768x651.jpg 768w\" sizes=\"(max-width: 869px) 100vw, 869px\" \/><\/a><figcaption id=\"caption-attachment-26493\" class=\"wp-caption-text\">This is the reverse Schuller&#8217;s projection (assuming the catheter is in the right internal carotid).<\/figcaption><\/figure>\n<p><b>Here are the key features:<\/b><\/p>\n<ul>\n<li>Lowers the MCA branches.<\/li>\n<li>Puts the ACOM and A1 in plane.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Page Contents1 OVERVIEW2 THE RELATIONSHIP BETWEEN PROJECTIONS AND VASCULAR APPEARANCE3 TOWNE&#8217;S VIEW4 WATERS&#8217; VIEW5 SCHULLER&#8217;S VIEW6 REVERSE SCHULLER&#8217;S VIEW OVERVIEW Cerebral angiographic projections have a direct influence on visualization of key vascular anatomy during procedures. This page covers some common projections (and how they change the appearance of key vascular anatomy). THE RELATIONSHIP BETWEEN PROJECTIONS &#8230; <a title=\"Commonly Utilized Angiographic Projections In Neurointerventional Radiology\" class=\"read-more\" href=\"https:\/\/www.stepwards.com\/?page_id=26485\" aria-label=\"More on Commonly Utilized Angiographic Projections In Neurointerventional Radiology\">Read more<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":26349,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false},"jetpack_shortlink":"https:\/\/wp.me\/P71awf-6Tb","_links":{"self":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26485"}],"collection":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26485"}],"version-history":[{"count":5,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26485\/revisions"}],"predecessor-version":[{"id":26496,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26485\/revisions\/26496"}],"up":[{"embeddable":true,"href":"https:\/\/www.stepwards.com\/index.php?rest_route=\/wp\/v2\/pages\/26349"}],"wp:attachment":[{"href":"https:\/\/www.stepwards.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26485"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}