Temporal bone (modified Stenvers view)
Updates to Article Attributes
The modified Stenvers view is an oblique radiographic projection used to demonstrate the petrous temporal bone, IAMinternal acoustic meatus and bony labyrinth. It is performed as a posteroanterior (PA) projection to minimise radiation to the orbits. This view has succeeded the Stenvers view, which includes more of the mastoid air cells.
Indications
This view is primarily used to assess electrode placement following the insertion of a cochlear implant. Specifically, it assesses the:
- assesses the integrity, positioning, and depth of insertion of the electrodes 1
-
andis used as a baseline 2
The more electrodes in the cochlea the better. For the best hearing outcomes, a minimum of 15 intra-cochlear electrodes is required 1.
Patient position
- the patient is sitting upright or standing erect with the side of interest closer to the image detector or erect bucky
- position
IOMLinfraorbitomeatal line (IOML) (see Figure 1) perpendicular to the detector - rotate the patient's head 45° so that the cheek of the side of interest is close to the image detector
Technical factors
- posteroanterior oblique projection
-
centring point
- central ray has a 12° cephalic tilt
- midway between the external occipital protuberance and the
EAMexternal acoustic meatus of the unaffected side
-
collimation
- to include all petrous and mastoid parts of the temporal bone of the side of interest
-
orientation
- landscape
-
detector size
- 18 cm x 24 cm
-
exposure
- 75-80 kVp
- 20-25 mAs
-
SID
- 100 cm
-
grid
- yes (this can vary departmentally)
Image technical evaluation
The obliquity of the beam positions it in the plane of the superior semicircular canal. In a normally positioned cochlear implant (see cases), the electrodes should be medial to the point of cochleostomy, which is approximated by a line drawn (see Figure 2) downward vertically through the superior semicircular canal 3-4,4.
Practical points
- ensure tight collimation is used so that adequate penetration will allow for the visualisation of all intra-cochlear electrodes (i.e. dots in a circular configuration on the image)
- learning your skull positioning lines will make reading positioning guides a whole lot easier
-<p>The <strong>modified Stenvers view</strong> is an oblique radiographic projection used to demonstrate the <a href="/articles/petrous-part-of-temporal-bone">petrous temporal bone</a>, <a href="/articles/internal-acoustic-canal">IAM</a> and <a href="/articles/labyrinth-of-ethmoid-bone">bony labyrinth</a>. It is performed as a posteroanterior (PA) projection to minimise radiation to the orbits. This view has succeeded the <a href="/articles/temporal-bone-stenvers-view">Stenvers view</a>, which includes more of the <a href="/articles/mastoid-air-cells">mastoid air cells</a>.</p><h4>Indications</h4><p>This view is primarily used to assess electrode placement following the insertion of a <a href="/articles/cochlear-implant">cochlear implant</a>. Specifically, it assesses the:</p><ul>-<li>integrity, positioning, and depth of insertion of the electrodes <sup>1</sup>- +<p>The <strong>modified Stenvers view</strong> is an oblique radiographic projection used to demonstrate the <a href="/articles/petrous-part-of-temporal-bone">petrous temporal bone</a>, <a href="/articles/internal-acoustic-canal">internal acoustic meatus</a> and <a href="/articles/labyrinth-of-ethmoid-bone">bony labyrinth</a>. It is performed as a posteroanterior (PA) projection to minimise radiation to the orbits. This view has succeeded the <a href="/articles/temporal-bone-stenvers-view">Stenvers view</a>, which includes more of the <a href="/articles/mastoid-air-cells">mastoid air cells</a>.</p><h4>Indications</h4><p>This view is primarily used to assess electrode placement following the insertion of a <a href="/articles/cochlear-implant">cochlear implant</a>. Specifically, it:</p><ul>
- +<li>assesses the integrity, positioning, and depth of insertion of the electrodes <sup>1</sup>
-<li>and is used as a baseline <sup>2</sup>- +<li>is used as a baseline <sup>2</sup>
-<li>position IOML (see Figure 1) perpendicular to the detector</li>- +<li>position infraorbitomeatal line (IOML) (see Figure 1) perpendicular to the detector</li>
-<li>midway between the <a href="/articles/inion">external occipital protuberance</a> and the <a href="/articles/external-auditory-canal">EAM</a> of the unaffected side</li>- +<li>midway between the <a href="/articles/inion">external occipital protuberance</a> and the <a href="/articles/external-auditory-canal">external acoustic meatus</a> of the unaffected side</li>
-</ul><h4>Image technical evaluation</h4><p>The obliquity of the beam positions it in the plane of the <a href="/articles/superior-semicircular-canal-dehiscence-syndrome">superior semicircular canal</a>. In a normally positioned cochlear implant (see cases), the electrodes should be medial to the point of cochleostomy, which is approximated by a line drawn (see Figure 2) downward vertically through the superior semicircular canal <sup>3-4</sup>. </p><h4>Practical points</h4><ul>- +</ul><h4>Image technical evaluation</h4><p>The obliquity of the beam positions it in the plane of the <a href="/articles/superior-semicircular-canal-dehiscence-syndrome">superior semicircular canal</a>. In a normally positioned cochlear implant (see cases), the electrodes should be medial to the point of cochleostomy, which is approximated by a line drawn (see Figure 2) downward vertically through the superior semicircular canal <sup>3,4</sup>. </p><h4>Practical points</h4><ul>