Chapter 10

Question 1

The act of respiration are created by the synchronous work of

Answer 1

muscles attached to the rib cage and atmospheric pressure

Question 2

The bony thorax also serves to protect important organs of the __ and vital structures within the __.

Answer 2

respiratory system & mediastinum, such as the heart and great vessels

Question 3

The bony thorax consists of the

Answer 3

sternum anteriorly, the thoracic vertebrae posteriorly, and the 12 pairs of ribs

Question 4

The adult sternum is a thin, narrow, flat bone with three divisions:

Answer 4

the manubrium, body, and xiphoid process

Question 5

The total length of the adult sternum is approximately

Answer 5

6 to 7 inches

Question 6

The sternum is composed of

Answer 6

highly vascular cancellous tissue (spongy bone) covered by a thin layer of compact bone.

Question 7

This vascular cancellous tissue allows for the sternum to be a common site for

Answer 7

marrow biopsy, where a needle is inserted under local anesthesia into the medullary cavity of the sternum to withdraw a sample of red bone marrow.

Question 8

superior portion of the sternum is the manubrium , which averages __ in length

Answer 8

2 inches (5 cm)

Question 9

widest portion of the sternum.

Answer 9

Manubrium

Question 10

The middle and longest part of the sternum is the __, which is about __ long

Answer 10

body & 4 inches (10 cm

Question 11

At birth, the body of the sternum is in __ separate segments.

Answer 11

4

Question 12

The union of these four segments begins during puberty and may not be complete until about the age of

Answer 12

25 years.

Question 13

The most inferior portion of the sternum is the

Answer 13

xiphoid (zi-foid) process

Question 14

xiphoid process is composed of cartilage during infancy and youth. It does not become completely ossified until about the age of

Answer 14

40 years.

Question 15

The first seven pairs of ribs are considered

Answer 15

true ribs

Question 16

True ribs are those ribs that connect directly to the sternum with a short piece of car-tilage, called

Answer 16

costal cartilage

Question 17

term __ applies to the last five pairs of ribs, numbered 8 through 12. Rib pairs 8 to 10 have costal cartilage that merges together and joins the costal cartilage of rib 7.

Answer 17

false ribs

Question 18

Rib pairs 11 and 12 do not have costal cartilage and therefore do not connect to the sternum. The term __ can be used to designate these two pairs of ribs.

Answer 18

floating ribs

Question 19

Each rib has two ends, a posterior or vertebral end, which articulates with the __ and an anterior or sternal end, which articulates with the __

Answer 19

thoracic vertebrae & costal cartilage

Question 20

The vertebral end consists of a __, which articulates with one or two thoracic vertebral bodies,

Answer 20

head

Question 21

Lateral to the neck is an elevated tubercle that articulates with the __ and allows for attachment of a ligament.

Answer 21

transverse process of a vertebra

Question 22

the inferior internal margin of each rib is the costal groove, which protects an

Answer 22

artery, a vein, and a nerve.

Question 23

posterior or vertebral end of a typical rib is 3 to 5 inches (8 to 13 cm) __ than the anterior or sternal end.

Answer 23

superior

Question 24

When counting the ribs in a thorax image, count the __ ribs to obtain the correct number of ribs above or below the diaphragm.

Answer 24

posterior

Question 25

What ribs are short, broad, and the most vertical of all the ribs and also have the sharpest curvature at the angle.

Answer 25

First ribs

Question 26

The bony thorax is typically widest at the lateral margins of the

Answer 26

eighth or ninth ribs.

Question 27

The jugular notch is at the level of.

Answer 27

T2-T3

Question 28

inferior end of the manubrium joins the body of the sternum to form a palpable anterior prominence, the

Answer 28

sternal angle

Question 29

The sternal angle is at the level of the Inteverebral disk space between

Answer 29

T4 and T5

Question 30

The xiphoid process corresponds to the level of.

Answer 30

T9-T10

Question 31

Inferior costal margin, the lowest margin of the bony thorax, corresponds to the level of

Answer 31

L2-L3

Question 32

Each clavicle articulates medially with the manubrium of the sternum at the clavicular notch to form the

Answer 32

sternoclavicular joint

Question 33

is the only bony connection between shoulder girdle and the bony thorax.

Answer 33

Sternoclavicular joint

Question 34

the first seven pairs of ribs connect anteriorly to the stenum through individual sections

Answer 34

costel cartilage

Question 35

The sternum has seven pair of __ located laterally along the manubrium and body to accept the costal cartilage.

Answer 35

facets, or depressions,

Question 36

The first pair of facets is located just below the

Answer 36

clavicular notch.

Question 37

The second costal cartilage connects to the sternum at the level of the

Answer 37

sternal angle.

Question 38

third through seventh costal cartilages connect

Answer 38

directly to the lateral body

Question 39

Ribs 8, 9, and 10 also possess costal cartilage, but these connect to the

Answer 39

costal cartilage of rib pair 7,

Question 40

costochondral union, or junc-tion, which is between the costal cartilage and the sternal end of a rib • Joint Classification: • Mobility Type: • Motion:

Answer 40

• Joint Classification: Unique. The cartilage and bone are bound together by the periosteum of the bone. • Mobility Type: Synarthrodial • Motion: No movement

Question 41

sternoclavicular joint, which occurs between a clavicle and the manubrium of the sternum and contains an articular capsule. • Joint Classification: • Mobility Type: • Motion:

Answer 41

• Joint Classification: Synovial • Mobility Type: Diarthrodial • Motion: Plane (gliding)

Question 42

sternocostal joint of the first rib. The costal cartilage of the first rib attaches directly to the manubrium with no synovial capsule, unlike the sternocostal joints of ribs 2 through 7 (see D and below). • Joint Classification: • Mobility Type: • Motion:

Answer 42

• Joint Classification: Cartilaginous • Mobility Type: Synchondrosis • Motion: No movement

Question 43

sternocostal joints typical of the second through seventh rib pairs between costal cartilage and sternum. • Joint Classification: • Mobility Type: • Movement:

Answer 43

• Joint Classification: Synovial • Mobility Type: Diarthrodial joints • Movement: No movement

Question 44

interchondral (endochondral) joints between the costal cartilages of the anterior sixth through ninth ribs. These are all interconnected by a long, thin, articular capsule lined by synovial membrane. • Joint type: • Mobility: • Movement:

Answer 44

• Joint type: Synovial • Mobility: Diarthrodial • Movement: Plane (gliding)

Question 45

The joints between the ribs and the vertebral column, the costotransverse joints (F) and the costovertebral joints (G), are Joint classification: Mobility type: Movement:

Answer 45

Joint classification: synovial joints with articular capsules lined by synovial membrane, Mobility type: diarthrodial Movement: plane or gliding motion,

Question 46

To demonstrate the sternum, the patient is rotated in a

Answer 46

15° to 20° right anterior oblique (RAO) position.

Question 47

(RAO) position allows for two important results when imaging the sternum

Answer 47

**First**, the sternum is shifted just to the left and away from the dense thoracic spine. **Second**, it superimposes the sternum over the heart

Question 48

A patient with a shallow or thin chest requires __ rotation than a patient with a deep chest to cast the sternum away from the thoracic spine.

Answer 48

more

Question 49

breathing technique, also referred to as an __, may be performed for the RAO of thé sternum.

Answer 49

orthostatic technique

Question 50

Sternoclavicular joint projections are typically best performed __ rather than __

Answer 50

PA rather than AP due to magnification and radiation to thyroid

Question 51

4 considerations for positioning ribs

Answer 51

1. The nature of the patient's complaint 2. The location of the rib pain or injury of ribs that are visualized through the diaphragm. 3. Whether the injury was caused by trauma to the thoracic cavity 4. Whether the patient is able to stand

Question 52

The upper __ generally represent the minimum number of ribs above the diaphragm on full inspiration,

Answer 52

nine posterior ribs

Question 53

Use of automatic exposure control (AEC) is or is not recommended?

Answer 53

Not! due to the lack of uniformity of tissue density within the bony thorax region.

Question 54

To demonstrate ribs above the diaphrag on the radiograph, the following actions are recommended:

Answer 54

1. **Erect** Gravity assists in lowering the diaphragm, deeper inspiration, 2. ** Suspend respiration and expose on deep inspiration if the patient is able**

Question 55

two-step process can be followed for ease in determining the necessary rib projections and patient positions.

Answer 55

1. AP vs PA: Select the projection that will place the area of interest closest to the image receptor. 2. Oblique ribs: After imaging the patient in previous step, rotate the patient 45° so that the spine moves away from the area of interest.

Question 56

patient who has trauma to the right anterior ribs. Two preferred projections would be

Answer 56

PA and left anterior oblique (LAO). The PA will place the site of injury closest to the image receptor, and the LAO will rotate the spinous process away from the site of trauma

Question 57

Some department protocols request the technologist tape a small metallic BB or some other small type of radiopaque marker over the site of injury before obtaining the images. This ensures that the

Answer 57

radiologist is aware of the location of the trauma or pathology as indicated by the patient.

Question 58

Departmental protocols also differ concerning the inclusion of a __ study as part of a rib examination.

Answer 58

chest

Question 59

history of rib injuries may require projections with inspiration/ expiration projections to assess for pneumothorax, hemothorax, pulmonary contu-Sion, or other chest pathology

Answer 59

erect PA and lateral of the chest

Question 60

Two primary concerns in pediatric radiography are patient

Answer 60

motion and safety.

Question 61

A __ help reduce patient motion.

Answer 61

short exposure time with optimal ma and kVp

Question 62

A breathing technique, as described in the sternum imaging, for pediatrics is

Answer 62

is not indicated for the young pediatric patient.

Question 63

can be used as a landmark to indicate the lower margin of the ribs.

Answer 63

The iliac crest or lower costal angle

Question 64

refers to a break in the structure or continuity of a bone.

Answer 64

fracture

Question 65

Rib fractures are most commonly caused by

Answer 65

trauma or underlying pathology.

Question 66

particular, fractures to the first rib are often associated with injury to the __, whereas fractures to the lower ribs (9 to 12) may be associated with injury to the

Answer 66

underlying arteries or veins spleen, liver, or kidney

Question 67

occurs when ribs are fractured in two or more places on multiple adjacent ribs, creating a segment of ribs that are unattached to the bony thorax.

Answer 67

Flail chest

Question 68

If flail chest injury is suspected, perform rib studies

Answer 68

**erect** if the patient's condition permits for best visualization.

Question 69

are conditions present from birth that may become more evident as a child ages.

Answer 69

Congenital anomalies

Question 70

This defect is characterized by anterior protrusion of the lower sternum and xiphoid process.

Answer 70

Pectus carinatum (pigeon breast):

Question 71

this deformity is characterized by a depressed sternum.

Answer 71

Pectus excavatum: Also referred to as funnel chest,

Question 72

Primary malignant neoplasms spread to distant sites via blood and lymphatics.

Answer 72

Metastases:

Question 73

-destructive lesions with irregular margins

Answer 73

Osteolytic

Question 74

-proliferative bony lesions of increased density

Answer 74

Osteoblastic

Question 75

-moth-eaten appearance of bone resulting from the mix of destructive and blastic lesions

Answer 75

Combination osteolytic and osteoblastic

Question 76

: This localized or generalized infection of bone and marrow can be associated with postoperative complications of open-heart surgery, which requires the sternum to be split.

Answer 76

Osteomyelitis

Question 77

Pectus carinatum (pigeon breast) Pectus excavatum (funnel chest) What positions

Answer 77

Routine chest and possible lateral sternum

Question 78

Exposure factors Osteolytic: Osteoblastic:

Answer 78

Osteolytic: decrease (-) Osteoblastic: increase (+)