10 - Bony Thorax - Positions & Projections

Question 1

What are the Sternum Positions And Projections on the ARRT content specs?

Answer 1

a. Lateral
b. RAO

Question 2

What are the Sternoclavicular joint Positions And Projections on the ARRT content specs?

Answer 2

a. PA
b. LAO and RAO

Question 3

What are the Ribs Positions And Projections on the ARRT content specs?

Answer 3

a. AP and PA above and below diagram (AP/PA Bi/Unilateral)
b. anterior and posterior obliques

Question 4

RAO Position Sternum: Technical Factors

Answer 4

• SID 40”
• IR 10” x 12” portrait
• 3 to 4 second exposure if breathing technique used
• kVp 70-85

Question 5

RAO Position Sternum: Positioning

Answer 5

• Erect (preferred) or semiprone with slight rotation, right arm down by side, left arm up
• Oblique 15° - 20° RAO
• Long axis of sternum parallel to IR
• Top of IR 1.5 inches superior to jugular notch
• Breathing: Orthostatice
• Rotation Note: A deep chest requires less rotation to offset the sternum from the spine than an narrow chest. Determined by palpatating the sternum and spine to determine they are not superimposed
• LPO Adaptation: If the patient cannot lay down or rotate then angle the CR 15°-20° across right side.

Question 6

RAO Position Sternum: CR and Collimation

Answer 6

• CR perpendicular to IR
• CR centered on center of sternum midway between jugular notch and xiphoid, and 1 inch left of midline
• Long narrow colum to field of sternum

Question 7

RAO Position Sternum: Evaluation Criteria

Answer 7

• Sternum is visualised superimposed over heart
• Correct rotation when visualizing sternum alonside vertabral column with no superimposition
• Outline of sternum visualized through ribs with proper density and contrast
• Blurred edges if breathing used otherwise sharp edges
• Marker Visible

Question 8

R or L Lateral Sternum: Technical Factors

Answer 8

• SID “72” recommended, 40” minimum
• IR size 10” x 12”
• kVp 75-85

Question 9

R or L Lateral Sternum: Positioning

Answer 9

• Erect: standing lateral with shoulders drawn back
• Recumbent: lying on back, arms above head, shoulders back
• Top of IR 1.5” above jugular notch
• Align long axis of sternum to CR and midline of IR
• True lateral
• Large breasts may be drawn to the side and held by bandage if necessary
• Breathing: Suspended or Inspiration

Question 10

R or L Lateral Sternum: CR and Collimation

Answer 10

• Perpendicular to IR
• Directed toward center of sternum midway from jugular notch to xiphoid process
• Long narrow columiation to field of sternum
• Place marker

Question 11

R or L Lateral Sternum: Evaluation Criteria

Answer 11

• Full sternum with minimal soft tissue overlap
• no tation
• No superimposition of ribs
• Lower aspect not obsured by breasts on females
• Good density and contrast, no motion
• Marker visible

Question 12

PA Projection - Sternoclavicular Joints: Technical Factors

Answer 12

• SID 40”
• IR 8” x 10” landscape
• kVp 75-80

Question 13

PA Projection - Sternoclavicular Joints: Positioning

Answer 13

• Patient prone or Erect
• chin resting on radiolucent sponge when prone
• arms up beside head
• Respiration: Suspen on expiration

Question 14

PA Projection - Sternoclavicular Joints: CR and Collimation

Answer 14

• Perpendicular to IR
• Center on midsagittal plane at level of T2- T3, 3 inches distal to vertibral prominens
• Collimate to sternoclavicular joints, approximately 2” either side of spine

Question 15

PA Projection - Sternoclavicular Joints: Evaluation Criteria

Answer 15

• Bilateral right and left sternoclavicular joints
• Lateral aspects of manubrium visible through superimposing ribs and lungs
• No rotation
• Optimal density and contrast to vualize manubrium and it’s edges through superimposed ribs and lungs
• Marker visible

Question 16

RAO and LAO Sternoclavicular Joints: Technical Indicators

Answer 16

• SID 40”
• IR 8” x 10”
• kVp 75-85

Question 17

RAO and LAO Sternoclavicular Joints: Positioning

Answer 17

• Prone or erect with slight rotation 10° - 15°, Lift right for RAO, and left for LAO
• Alight center spinous process 1 to 2 inches lateral to CR midline
• Respiration: suspend on exhalation

Question 18

RAO and LAO Sternoclavicular Joints: CR and Collimations

Answer 18

• CR Perpendicular to T2 - T3, three inches distal to vertebral prominens
• 1” - 2” latteral to midsagittal plane
• Collimate to reigon of sternoclavicular joint
• Place Marker

Question 19

RAO and LAO Sternoclavicular Joints: Evaluation Criteria

Answer 19

• The manubrim, medial portion of clavicle and sternoclavicular joint are deomnstrated for the target side.
• Correct rotation demonstraits downside of joint with no superimposition of the vertebral column or manubrium
• Optimal density and and contrast to visualize joint through superimposed ribs and lungs
• Marker Visible

Question 20

AP Ribs Above Or Below Diaphram: Technical Factors

Answer 20

• SID 40” minimum, 72” preferred
• IR 14” x 17” landscape
• kVp 78-85

Question 21

AP Ribs Above Or Below Diaphram: Positioning

Answer 21

• Eretct is preferred for above diaphram and supine for below diaphram
• Align midsagittal to IR
• Raise chin or look strait ahead
• Rotae shoulders anteriorly
• No rotation of thorax and pelvis

Question 22

AP Ribs Above Or Below Diaphram: CR, Collimation, and Respiration

Answer 22

• Above: Centered to midsagittal and 3” to 4” below jugular notch
• Below: Centered to midsagittal and and midway between xiphoid process and lower rib margin
• Collimate to reigon of interest, that being larger for below-diaphram
• Respiration: Suspeded deep inspiration for upper. Suspended full expiration for lower
• Place Marker

Question 23

AP Ribs Above Or Below Diaphram: Evaluation Criteria

Answer 23

• Above: Ribs 1 through 9 visualized
• Below: Ribs 10 through 12 visualized at a minimum
• No rotation of thorax
• Collimated to area of interest
• Optinmal density and contrast
• Ribs visualized through lungs and heart shadow
• Marker Visible

Question 24

PA Bilateral Anterior Ribs: Technical Factors

Answer 24

• SID min 40”, ideal 72”
• IR 14” x 17” landscap or portrait if chest is narrow enough and at 72” SID
• kVp 75-85

Question 25

PA Bilateral Anterior Ribs: Positioning

Answer 25

- Erect preferred, prone if necessary - Arms down to side - Centerd to IR on midsagittal - Rotate shoulders anteriorly to remove scapulae from lung fields - No rotation of thorax

Question 26

PA Bilateral Anterior Ribs: CR, Collimation, Respiration

Answer 26

- CR perpendicular to IR - Centered on midsagittal plane at T7, 7" - 8" below vertabral prominence - Collimate to ribs reigon - Respiration: suspend on inspiration - Place Marker

Question 27

PA Bilateral Anterior Ribs: Evaluation Criteria

Answer 27

- Ribs 1 through 9 visualized above the diaphram - No rotation of thorax - Collimated to area of interest - Optimal density and contrast - Visualize ribs through lungs and heart

Question 28

AP projection of unilateral ribs: Technical Factors

Answer 28

- SID 40" - 14" x 17" portrait for above and below - kVp 75-85

Question 29

AP projection of unilateral ribs: Positioning

Answer 29

- Erect is preferred for above supine is preferred for below - Align left side of thorax to midline of IR - Raise chin to keep it from superimposing ribs - No rotation of thorax

Question 30

AP projection of unilateral ribs: CR, Collumation, Breathing

Answer 30

- CR perpendicular to IR - Above: Centered between midsagittal and later margin of thorax at a level 3" - 4" below jugular notch - Below: Centered between midsagittal and later margin of thorax and at a level midway between xiphoid process and lower rib margin - Align target side to CR and and to midline of IR - Collumate to reigon of interest - Respiration for Above: Suspend deep inspiration - Respiration for Below: Suspend on full expiration - Place Marker

Question 31

AP projection of unilateral ribs: Evaluation Criteria

Answer 31

- Above: Ribs 1 - 9 vizualized - Below: Ribs 10 -12 visualized at a minimum - No rotation - Optimal density and contrast to visualize ribs through lungs and heart shadows - Marker visible

Question 32

RPO LPO RAO LAO Axillary Ribs: Technical Factors

Answer 32

- SID 72", 40" min - 14" x17" landscape - kVp 75-85

Question 33

RPO LPO Axillary Ribs: Positioning (Not RAO, LAP)

Answer 33

- Erict is preferred for Above diaphragm and Supine is preferred for below - Position posterially to IR -Rotate patient 45° with affected side closest to IR rotating spine outward - Raise arm above shoulder of effected side and other side arm hangs down - If recumbent flex knee to help maintain position and support with sponges as needed - Aling IR to midway of effected side and ensure area of interest is not cut off

Question 34

RAO LAO Axillary Ribs: Positioning

Answer 34

- Erict is preferred for Above diaphragm and Supine is preferred for below - Position posterially to IR -Rotate patient 45° with affected side closest to IR rotating spine outward - Raise arm above shoulder of effected side and other side arm hangs down - If recumbent flex knee to help maintain position and support with sponges as needed - Aling IR to midway of effected side and ensure area of interest is not cut off

Question 35

RPO LPO RAO LAO Axillary Ribs: CR, Collimation, Breathing

Answer 35

- CR perpendicular to IR - Above: CR to level 3" or 4" below jugular notch for PO or 7" to 8" below vertebral prominens for AO - Below: CR level to midway between xiphoid process and lowe rib margin - Collimate to reigon of interest - Respiration for Above: Suspend on inspiration - Respiration for Below: Suspend on expiration - Place Marker

Question 36

RPO LPO RAO LAO Axillary Ribs: Evaluation Criteria

Answer 36

- Above: Ribs 1 - 9 should be included - Below: Ribs 10 - 12 min should be seen below diaphragm - no superimposition of ribs - ribs should be in profile with spine shifted away from area of interest - Optimal density and contrast to visualize ribs through lungs and heart shadow or through diaphragm - Marker visible