positioning ch 9 anatomy

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PA oblique (RA) Sternum

10X12 Lengthwise 30" SID Place patient in RAO oblique 15-20 degrees CR enters patient on elevated side @ T7 1 inch lateral to MSP. (between spine and lateral border of scapula) Breathing: slow shallow breathing or for a short exposure, suspend at the end of expiration

Lateral Sternum

10X12 Lengthwise 72" SID Have patient place left side against grid, center sternum to center of grid. Have patient put hands behind and lock and roll shoulders back and push out chest CR enter lateral border of mid sternum Breathing: Suspended deep inspiration

AP lower

10X12 crosswise SID 40 lower border of IR at the level of illiac crests Suspend respiration at end of full expiration to elevate diaphragm

The bony thorax is formed by...

12 pairs of ribs, 12 thoracic vertebrae

How many parts compose the sternum

3

What is the approx length of the sternum in average adult

6 inches

PA oblique (Body rotation method)

6X8 collimation 10-15 degree of anterior with oblique position with the affected side closer to the IR: align sholders in same transverse plane Perpendicular to the SC joint closest to the IR, enters 1-2 inches lateral to the MSP at the level of T2-T3 (3 inches distal to vertebral prominence.

PA SC Joint...

6X8 collimation Patient prone with shoulders in the same plane, for bilateral have the patient rest head on chin and chin on table, for unilateral patient turns head toward affected side and rest cheek on table. CR enters patient at level of T3

PA Oblique (CR angulation method)

6X8 inches MSP perpendicular to IR From opposite side, angle 15 degrees toward MSP and SC of interest CR enters at 1-2 inches lateral of the MSP at level of T2-T3

The first sternocostal joint is considered ________ joint and is ________.

Cartilaginous synchondroses and immovable.

The head articulates with the vertebral body to form the ________ joints.

Constovertebral

____ articulations are found between the anterior extremities of the ribs and the costal cartilages

Costochondral

The tubercles articulate with the T spine to form the __________ joints.

Costotransverse joints

Interchondral 9-10th

Fibrous, syndesmosis, slightly moveable

Ribs 11 and 12 are termed...

Floating ribs, attach only to the vertebrae

What structures do costal tubercles articulate?

Head of the rib and the thoracic vertebral bodies

Typical rib consists of...

Head, neck, tubercle and body

The position of the diaphragm varies with body habitus: It is at a higher level in ___________ patients and at a lower level in_________ patients

Hypersthenic, Asthenic

The movement of the diaphragm is less in _______ patients and more in _________ patients.

Hypersthenic, Hyposthenic

___________joints are found between the costal cartilages of the sixth and seventh, seventh and eighth, and eighth and ninth ribs and are considered what kind of joints....

Interchondral, synovial gliding joints

costal groove

Located along the inferior and internal border of each rib is the ____, which contains costal arteries, veins, and nerves.

head, neck, tubercle, and body

a typical rib consists of a _____

cartilaginous synchondrosis is what type of joint

allows no movement

cervical ribs

articulate with the C7 vertebra but rarely attach to the sternum; they may be free or articulate or fuse with the 1st rib

Where is the sternal angle located?

at the junction of the manubrium and the sternal body

Sometimes it is helpful to use __________to mark the specific area of interest on the patient.

Nipple markers

sternum

breastbone; centered on the front of the thorax; flat bone; 6" long; manubrum, body, and xiphoid; supports the clavicles; provides rib attachment(costal cartilages) of the first 7 pair

Costochondral articulation are...

cartilaginous synchondroses and allow no movement.

Manubriosternal

cartilaginous, symphysis, slightly moveable

Costochondral 1st-10th ribs

cartilaginous, synchondroses, immovable

Sternocostal 1st Rib

cartilaginous, synchondroses, immovable

xiphisternal

cartilaginous, synchondroses, immovable

What is the purpose of turning the patients head toward affected side during a unilateral SC joint projection?

causes slight rotation of the vertebral column away from the sternum.

Shape of bony thorax

conical in shape narrow at top, posterior longer than anterior.

fracture

disruption of bone

Ribs 8-12 are called

false ribs, attached indirectly to the sternum

The interchondral articulation between the ninth and tenth ribs is what kind of joint...

fibrous syndesmosis and is only slightly movable.

intercostal spaces

spaces between the ribs

The only articulation between the upper limbs and trunk...

sternoclavicular joint

Inferior part of the sternum

xiphoid

Typical 5 View protocol for ribs...

PA CXR Both obliques (dependant upon whether the injury is on the anterior or posterior ribs to which obliques are done) AP/PA rib shot, dependant on area of interest AP lower ribs

Esential projections for the sternum are

PA oblique (RAO), and Lateral

SC joint projections...

PA, PA oblique (body rotation), PA oblique (CR angulation method)

What are the esential projections for the SC joints?

PA, PA oblique (central ray angulation), and PA obliqu (body rotation)

Uni Lat Oblique

SID 40 14X17 Lengthwise

AP/PA rib shot (Upper)

SID 40 14X17 crosswise

Bilateral Obliques

SID 72 14X17 Lengthwise

The second through seventh sternocostal joints are considered ________ joints and are ___________.

Synovial gliding joints, Freely moveable

Costotransverse 1st-10th ribs

Synovial, gliding, freely moveable

Costovertebral 1st-12th ribs

Synovial, gliding, freely moveable

Sternoclavicular joints are

Synovial, gliding, freely moveable

The xiphoid process is at the level of....

T10

Jugular notch lies at what level...

T2-T3 interspace

For the sc joint projection the CR should enter at the level of...

T3

Sternal angle lies at what level

T4-T5 interspace

The jug notch is found anterior to which precise location of the thoracic vertebral column?

The disk space of T2 and T3

take AP and lateral projections of the chest.

The first and usually the only requirement in the initial radiographic examination of a patient who has sustained severe TRAUMA to the rib cage is to ____ ; to check for injury to underlying structures by depressed rib fractures

fibrous syndesmosis

The interchondral articulation between the 9th and 10th ribs is a ____and is only slightly movable.

1½ inches (3.8 cm)

The respiratory movement of the diaphragm averages about ____ between deep inspiration and deep expiration.

Why should the patient be rotated into an oblique position instead of AP or PA?

To prevent superimposition of the sternum with spine

Which structures do costal tubercles articulate with?

Transverse process of the thoracic vertebrae

Ribs 1-7 are called

True Ribs, attached directly to the sternum

position in which they arrive in the radiology department.

Unless the change in position can be effected with a tilting radiographic table, patients with recent rib INJURY should be examined in the ____

supine, supine

When the body is placed in the ____position, the anterior ends of the ribs are displaced superiorly, laterally, and posteriorly. For this reason, the anterior ends of the ribs are less sharply visualized when the patient is radiographed in the ____ position.

interchondral joints

____ are found between the costal cartilages of the sixth and seventh, seventh and eighth, and eighth and ninth ribs; synovial gliding

costochondral

____ articulations are found at the anterior ends of the ribs and the costal cartilages; they are cartilaginous synchondroses and allowed no movement

recumbent

____ positions show air fluid levels in a decubitus technique

7th to the 12th rib

length decreases from the ____

1st to the 7th rib

length increases from the ____

lumbar ribs

less common than cervical ribs; can lend confusion of L1 vertebra

jugular notch

lies between T2 and T3 when upright; the top concave portion of the manubrium

Ribs are...

long, narrow curved bones

osteoporosis

loss of bone density

multiple myeloma

malignant neoplasm of plasma cells involving the bone marrow and causing destruction of bone

chondrosarcoma

malignant tumor arising from cartilage cells

The superior part of the sternum

manubrium

tumor

new tissue growth where cell proliferation is uncontrolled

floating ribs

rib pairs 11 and 12; they are attached to only vertebrae; do not have a neck or tubercular facets

false ribs

rib pairs 8 through 12

What condition of a patient requires more RAO rotation?

shallow chest

paget disease

thick, soft bone marked by bowing and fractures

upright, supine

to examine the ribs above the diaphragm, ____ positions are used and to examine the ribs below the diaphragm, ____ positions are used

What is the Functions of the bony thorax...

to protect the heart and lungs, Supports wall of pleural cavity and diaphragm, mad to vary the volume of thoracic cavity during respiration.

Why is the anterior oblique prefered

to reduce OID of the sternum

Why do we use RAO over LAO for the sternum?

to use the background density of the heart for better visualization of the sternum.

manubrium

top part of the sternum; quadrilateral; top of this part is the jugular notch

metastases

transfer of a cancerous lesion from one are to another

Ribs that articulate directly to the sternum

true ribs

Portion of the rib that articulates with the transverse process of the thoracic vertebrae

tubercle

If area of interest is at level of diaphragm...

two deep expirations

The position of the diaphragm changes considerably with the body position, reaching its lowest level when the body is _______ and its highest level when the body is ________.

upright, supine

What determines a true rib or a false rib

whether or not they are attached directly or indirectly to the sternum.

What level should the IR be placed for a sternum?

1 1/2" above jug notch

The respiratory movement of the diaphragm averages about image inches ______ between deep inspiration and deep expiration.

1 1/2"

T or F the ribs increase in thickness the closer they get to the vertebral column?

F

What part of the sternum articulates with the anterior ends of the first pair of ribs to form the sternocostal joints?

Manubrium

What part of the sternum supports the sternal ends of the clavicles?

Manubrium

The Sternum consist of which main parts

Manubrium, sternal body, and the xiphoid process

When the patient has trauma pain, what alternative sternum projection may be used?

Moore method or Modified prone position (25 degree angle)

PA CXR

kVp 110 SID 72 14X17 Lengthwise CR at T7 Light field 1 1/2 inches above relaxed shoulders Suspended respiration at end of full inspiration to elevate diaphragm

Deeper inspiration or expiration and greater depression or elevation of the diaphragm are achieved on the ________ respiratory movement than on the first.

Second

The articulations between the costal cartilages of the true ribs and the sternum are called ______ joints.

Sternocostal

The breastbone is also called the...

Sternum

The articulations between the tubercles of the ribs and the transverse processes of the vertebrae permit only ____________ and _____________ movements of the first six pairs.

Superior, inferior

the anterior ends of the ribs are less sharply visualized when the patient is radiographed in the ___________ position...

Supine

A ribs consists of which main parts...

head, neck, tuberacle, body, costal groove and angle

costotransverse joint

if a rib articulates with a transverse process, the joint is called ____ , and are synovial gliding articulations(first 6 pair only move up and down); where the costal tubercle and transverse process meet

osteopetrosis

increased density of atypically soft bone

osteomylelitis

inflammation of bone owing to a pyogenic infection

The spaces between ribs are referred to as...

intercostal spaces

The palpable concavity at the superior manubrial border...

jugular notch

Interchondral 6th-9th

synovial, gliding, freely moveable

Sternocostal 2nd-7th ribs

synovial, gliding, freely moveable

true ribs

the 1st 7 pair anteriorly attach to hyaline cartilage (costal cartilage)and to the sternum

sternocostal joint

the 1st rib and the sternum articulate at the ____; it is a cartilaginous synchondrosis joint; no movement;

left

the ___ side of the diaphragm is slightly lower

2nd through the 7th ribs

the ____ are sternocostal joints and considered synovial gliding joints; freely moveable

1st, 10th, 11th, and 12th ribs

the ____ each articulate with only one vertebral body

manubriosternal joint

the ____ is a cartilaginous symphysis joint and cartilaginous synchodrosis that allows little or no movement

xiphisternal joint

the ____ is similar to the 1st through 10th ribs in that they are cartilaginous synchondrosis joints and immovable

xiphoid process

the ____ is the distal and smallest part of the sternum; starts as cartilage and later ossifies; often deviates from the MSP; lies at T10; uselful in locating the superior part of the liver and inferior border of the heart

body

the ____ is the longest part of the sternum (4"); joins the manubrium at the sternal angle; has 6 lateral articulations to connect with rib pairs 2-6

12th rib

the ____ is the narrowest of the ribs

1st rib

the ____ is the shortest and broadest of the ribs

clavicular notch

the ____articulates with the sternal extremity of the clavicle; right below this lies the articulation for the 1st pair of ribs

3-5

the anterior end of a rib generally is located ____ inches BELOW the level of its head

to which location of the thoracic column does the sternal angle correspond?

the disk space between T4 and T5

vertebral and sternal

the ends of the ribs

Which pairs of ribs attach their costal cartilage to the lateral borders of the sternum?

the first seven pairs

sternal angle

the palpable point that joins the manubrium and sternum; where the articulation for the 2nd set of ribs are; lies between T4 and T5 when upright

bony thorax

the____supports the walls of the pleural cavity and diaphragm used in respiration; protects the heart and lungs; 12 pair of ribs, 12 thoracic vertebrae; conical

ribs

there are 12 pair of ____; corresponds to the thoracic vertebra to which it attaches; obliqued front and downward

no movement

there is____ on the 1st rib articulation


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