positioning ch 9 anatomy
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
