Bony Thorax- Sternum and Ribs
costotransverse joints are only found on ribs
1-10
how many degrees do you rotate for the anterior oblique of the SC joint
10 to 15 degrees
IR size for sternum
10 x 12
IR size for AP/PA ribs
14 x 17 crosswise
Sternum rotation for the RAO of a large barrel chested patient
15 degrees
Sternum rotation for the RAO of a thin chested thorax
20 degrees
The union of the 4 segments of the body of the sternum begins during puberty and may not be complete until about ______ years of age
25
The posterior or vertebral end of a rib is __________than the anterior or sternal end
3 to 5 inches higher
SID for sternum
40
length of the adult sternum
7 inches
Below the diaphragm standards for ribs
8 and below taken supine suspend on expiration medium kv
IR size for SC joint
8 x 10
Ribs routine projections
AP/PA bilateral or unilateral, oblique (axillary ribs) , and PA chest
The inferior rib (costal) angle also called the inferior costal margin corresponds to the level of
L2-L3
Malignant neoplasms spread to distant sites via blood and lymphatics. The ribs are a common site
Metastases
A localized or generalized infection of bone and marrow that can be associated with post operative complications of open heart surgery, which requires the sternum to be split. The most common cause is bacterial infection
Osteomyelitis
Sternoclavicular Joints routine projections
PA and oblique
Characterized by anterior protrusion of the lower sternum and xiphoid process. It is usually a benign condition but could lead to cardiopulmonary complications rarely
Pectus carinatum (pigeon breast)
Which projection best shows the sternum
RAO (right anterior oblique) (right front side touching IR)
Sternum routine projection
RAO and lateral
Joint type of sternoclavicular joints (between sternum and clavicles)
Synovial, diarthrodial, plane or gliding
The xiphoid process corresponds to the level of
T9- T10
What makes ribs 8, 9, and 10 unique?
They connect to the costocartilage of the 7th rib
Above the diaphragm standards for ribs
Upper nine taken erect suspend on inspiration lower kv
name the type of metastases that can be visualized with by a moth eaten appearance of bne resulting from the mix of destructive and blastic lesions
a combination of osteolytic and osteoblastic
The xiphoid process is made of carilage during infancy and youth and is not totally ossified until
age 40
Joint type first sternocostal joint (between first rib and sternum)
cartilaginous (synchondrosis), synarthrodial (immovable)
the ______ and the ________ of the first seven pairs of ribs connect directly to the sternum
clavicles cartilages
an oval articular facet on each side of the jugular notch where the clavicle articulates
clavicular notches
The anterior ribs unite with the sternum with the
costocartilage
where the tubercle of a rib and transverse process of the lower vertebrae articulate
costotransverse joint
Where the head of a rib articulates with two adjacent vertebral bodies
costovertebral joint
An anterior oblique of the SC joint (RAO or LAO) best demonstrates the joint on the
downside
No rotation of SC joints is shown by
equal distance of SC joints from vertebral column on both sides
Below each clavicular notch and SC (sternoclavicular joint) is a _______ for articulation with the carilage of the first rib
facet
ribs 8 through 12 are considered
false ribs
fractures of the ______ are often associated with injury to the underlying arteries or veins
first rib
The _______ are short and broad and are the most vertical of all the ribs
first ribs
This fracture of adjacent ribs in two or more places is caused by blunt trauma and is associated with underlying pulmonary injury can lead to instability of the chest wall
flail chest
Ribs 11 and 12 are called __________ because they do not possess costocartilage
floating ribs
The body of the rib extends laterally from the tubercle and then angles
forward and downward
Typically associated by blunt trauma and associated with underlying cardiac injury
fractures of the sternum
The vertebral end consists of the _____ which articulates with one or two thoracic vertebral bodies and a flattened _____
head neck
The uppermost border of the manubrium is called the _____, ________, ________ and corresponds to the level of
jugular notch, suprasternal, or manubrial notch T2-T3
SC joint radiograph should show
lateral manubrium, medial portion of clavicles
An LAo of the sc joint best demonstrates the
left sc joint
where do you center for a PA sc joint
level T2-T3 3 inches below the vertebra prominens
Where do you center for the anterior oblique of the SC joint
level of T2-T3 and 1 to 2 inches lateral towards upside
fractures to the _____ are associated with injurty to adjacent organst such as the spleen, liver, or kidney
lower ribs
the upper portion of the sternum, it is 2 inches long
manubrium
With osteoporosis in older patients the technique
must be decreased
breating technique for sternum
orthostatic technique (patient takes shallow breaths, usually don't tell them)
name the type of metastases that can be visualized with proleferative bony lesions of increased density
osteoblastic
name the type of metastases that can be visualized with destructive lesions with irregular margins
osteolytic
If the sternum appears into the auxillary on the RAO it is
over rotated
characterised by a depressed sternum, this condition rarely interferes with respiration but often is corrected surgically for cosmetic reasons
pectus excavatum (funnel chest)
An RAO of the SC joint best demonstrates the
right sc joint
Ribs have no rotation when
spinous process can be see in the middle of vertebrae
The second costocartilage connects to the sternum at the
sternal angle
Where the clavicular notch of the clavicle articulates with the manurium laterally
sternoclavicular joint (the only bony connection between each shoulder girdle and the bony thorax)
a thin narrow flat bone with three divisions
sternum
breathing technique for SC joint
suspend on expiration
Joint type of the first through tenth costochondral unions between cosotcartilage and ribs
synarthrodial, immovable
Joint type first to tenth costotransverse joints (between ribs and transverse processes of thoracic vertebrae)
synovial, diarthrodial, plane or gliding
Joint type first to twelth costovertebral joints (between heads of ribs and thoracic vertebrae)
synovial, diarthrodial, plane or gliding
Joint type second to seventh sternocostal joints (between second and seventh ribs and sternum)
synovial, diarthrodial, plane or gliding
Joint type sixth to ninth interchondral joints (between anterior sixth and ninth costal cartilages)
synovial, diarthrodial, plane or gliding
what is the most commonly fractured part of a rib
the auxillary
the longest part of the sternum, it is 4 inches long
the body
protects important organs of the respiratory system and vital structres within the mediastinum, such as the heart and great vessels
the bony thorax
The inside margin of each rib contains an artery, a vein and a nerve and is called _______-
the costal groove
Where the lower end of the manubrium joints the body of the sternum is called the _____________ and corresponds to the level of
the sternal angle or manubriosternal joint T4-T5
common site for marrow biopsy
the sternum
The bony thorax consists of
the sternum, 12 thoracic vertebrae, and 12 pairs of ribs
the ______________ connect directly to the body of the sternum
third through the seventh costocartilages
Any rib fracture may cause injury to the lung or cardiocascular structures
true
The first seven pairs of ribs are
true ribs
lateral to the neck of a rib is an elevated_______ that articulates with the ___________of a vertebra and allows for attachment of a ligament
tubercle transverse process
If the sternum appears close to the spine on the RAO or in the spine it is
under rotated
Which ribs would be displayed on a proper radiograph of ribs, upper and lower
upper ribs 1-9 lower ribs 8-12
How do you position the arms for an anterior oblique of the SC joint
upside arm in front of patient and downside arm behind the patient
Each rib has a _____ and a ______end, between the two ends is the ________
vertebral sternal shaft
The bony thorax is typically ______ at the lateral margins of the ____________
widest 8th or 9th ribs
The most inferior portion of the sternum is the
xiphoid process
