On Saturday 18 May 2019 at Russell Strong Auditorium in PAH, over 120 registrants enjoyed some interesting and informative skull presentations.

The first speaker Amy Leung a paediatric physiotherapist shared her findings on Positional or Cranio-synostic “Odd shaped head” during Amy’s presentation she discussed the types of shapes she sees brachycephaly-  wider head, Plagiocephaly -left occiput flatter and scaphocepaly-right occiput flatter. Amy told us that these can be caused by premature fusion of the sutures and as the brain grows very quickly this can lead to complications. Amy stated that 1 in 3 babies can have these odd shaped heads, but often this can be preventable, the project Amy is working on has found that a major risk factor is the supine position where babies can be most at risk as they lie on their back for more than 12 hours a day and sleep on their back for more than 5 hours. Amy suggests for positional plagiocephaly the ABC strategy is best A-Active, B- Balanced Handling and C- Corrective strategies like on the tummy or side for some time.

Laura Gregory then gave us an Anatomy Update reminding us that the bones of the skull have sutures to allow them to be flexible enough to become small enough to progress through the birth canal. Laura reviewed the bony anatomy, the foramen and briefly structures located within the skull vault and face. Laura spoke about some of the research studies being done in Queensland where they have demonstrated much earlier suture closure than other international studies e.g. females at 13years and males at 16years.

Ultrasound Appearances of the Foetal Brain were shown to us by Donna Traves, scanning the foetal brain provides accurate measurements to assess morphology and anatomy. Donna explained how they scanned via the open fontanelles and took us through the normal and abnormal anatomy seen at three “slices” within the brain. It was so interesting to see how much detail is demonstrated at these early 16- and 20-week scans and the findings shown.

Lee Anderson shared his experiences in making HyperArc clinical within his department. Lee introduced us to this equipment via a short video demonstrating the way it moves and how comprehensively it can be used within the brain. It looked amazing and like something out of Transformers!  This system is a new solution to treat multiple brain metastases with high doses rather than treating the whole brain.

After an excellent morning tea Rhys Fitzgerald spoke about technical aspects and clinical comparisons to the HyperArc system. Rhys showed us the cases they have already treated and presented dose comparisons with DCAT and VMAT techniques. Although the hyperarc system allows excellent dosimetry in most cases, there are limitations to its use due to preset arc angles and quality assurance requirements for fields smaller than 2x2cm.

Donna MacGregor a lecturer in human anatomy and forensic anthropology shared with us a specific case  of a “missing skull  and hands”  this was a case from some years ago where good policework  and some excellent investigative work by Donna and her team using some modern and “old fashioned”  techniques  allowed them to  provide approximate age, sex  and  health issues  of their “torso”   to assist the police with their enquiries. The team used standard anthropological measurements of post cranial bones using 3D CT models from a masters student project and used length of humerus to provide stature so they were looking for a tall male, and by using validation of bone samples of sternal rib ends determined age. The other important factor used in conjunction with the anatomical findings was the trace of a specific drug requiring prescription narrowing the search down and finally locating the name of the missing person. In turn this allowed the police to arrest the person responsible.

We were introduced to Gamma Knife which allows treatment within the skull without surgery by Ryan Lusk. Ryan explained that they use 192 60CO   sources but that they have a half-life of 5-7 years meaning that with age of the sources longer doses are required to produce correct output.  To date, the majority of treatments have been neurosurgical rather than oncological.

Ryan explained that there are two planning workflows depending on whether the patient is treated in a frame or mask, and he briefly talked us through each one. Ryan then took us through a case study treating trigeminal neuralgia and demonstrated how effective this had been in a relatively short time.

Alex Hollingsworth took myself and some of my era of radiographers down memory lane with a brief history of early neuroradiology, he showed us air encephalograms, air ventriculograms  and also  took us through carotid angiograms  where the patient had a needle inserted directly into the  vessel with contrast hand injected by the radiologist and the radiographer  hand pulling the cassettes in AP and lateral position  what a  time we had with this system! Alex then showed us the “modern” Puck changer in action in a video and shared another video of the tomography unit demonstrating the elliptical movements. All of this making us realise we have come a long way into the future with CT and MRI making these examinations “archaic” thank goodness.

Our final speaker was Julianne Short who shared her experiences of Cranial Ultrasound showing us the three ways these examinations were performed via the three different fontanelles. Julianne demonstrated the anatomy best shown via each examination and gave us an idea of the reasons these examinations may be performed. Julianne completed her presentation with some interesting case studies.