Radiology Psotioning Chest Sternum And Ribs

Question 1

Sternum

Answer 1

12 pairs of ribs
12 thoracic vertebrae
Conical in shape

Question 2

Functions of bony thorax

Answer 2

*Protects heart and lungs
*Supports wall of pleural cavity and diaphragm
* made to vary the volume of thoracic cavity during respiration

Question 3

Anatomy of the sternum

Answer 3

Narrow flat bone

Approximately 6 inches long

Question 4

What are the 3 parts to the sternum

Answer 4

Manubrium
Body
Xiphoid process

Question 5

What does the sternum do

Answer 5

Supports clavicles at maunbrial angles

Provides attachment for costal cartilages of first seven pairs of ribs at lateral borders

Question 6

Palpable landmark
Lies at T2-T3 interspace

Answer 6

Manubrium

Question 7

Palpable
Lies at T4-T5 interspace

Answer 7

Sternal

Question 8

Palpable landmark
Distal smallest portion
Lies over T-10
Deviates from midline

Answer 8

Xiphoid process

Question 9

Not as hard as bone

Answer 9

Costal cartilage

Question 10

Long narrow curved bones

First is the shortest

Anterior ends lower than posterior ( vertebral) ends)

Increase in length from 1-7 then decrease to 12

Answer 10

Ribs

Question 11

False ribs

Answer 11

Pairs 8 to 12- attach indirectly to the sternum via costal cartilage

Question 12

True ribs

Answer 12

Pairs 1 to 7- attach directly to sternum

Question 13

Floating ribs

Answer 13

Pairs 11 and 12- attach only to the vertebrae

Question 14

Typical ribs consist of

Answer 14

Head
Neck
Tubercle
Body

Question 15

Costco=

Answer 15

Rib

Question 16

Vertebral=

Answer 16

Spine

Question 17

Transverse=

Answer 17

Joint

Question 18

What is recommend SID for PA oblique sternum

Answer 18

30 inches

Question 19

What is the recommend SID for lateral sternum to reduce magnification and distortion caused by increased OID

Answer 19

72 inches

Question 20

Essential projections of sternum

Answer 20

Pa oblique
Right anterior oblique (RAO) position

Collimated field size for both projections 10 X 12

Question 21

Essential projections of sternum

Answer 21

Lateral
> upright
> recumbent

Question 22

Patient position for oblique RAO recumbent

Answer 22

15-20 degrees
> Ensure shoulders and hips rotated equal amount
> long axis aligned to midline
> top of IR 1 1/2 inches above jugular notch
> entire sternum from jugular notch to tip of Xiphoid process
> sternum projected over the heart but free of superimposition from the thoracic spine

Question 23

How does your patient need to breath for a PA oblique sternumn

Answer 23

Slow shallow breaths during exposure

• you do this to blur out the lungs and show the bone more
• if short exposure time is used suspend breathing at the end of expiration (alternative to 1st technique)

Question 24

What position do you do in a lateral sternum

Answer 24

Upright or standing

• dorsal decubitus may be used to accommodate patient’s condition

Question 25

How do you set up the patient for a lateral sternum

Answer 25

Rotate shoulders posteriorly and lock hands behind back Center sternum to midline Line beam up at T7

Question 26

How to take the picture of a lateral sternum

Answer 26

Collimated field 10 X 12 Suspend respirations after deep inspiration SID at 72 inches- decreased magnification

Question 27

Essential projections for ribs

Answer 27

Pa- upper ,anterior ribs Ap- posterior ribs Ap oblique- axillary portion Pa oblique- axillary portion

Question 28

How to set up for Pa ribs

Answer 28

Put patient in upright position MSP centers to the grid at T7 Rest hands palms out on hips and roll shoulders forward If patient is prone, rest head on chin and adjust MSP to vertical

Question 29

How to breath for Pa ribs and collimation field

Answer 29

14 X 17 Respirations suspended at end of full inspiration ( depresses diaphragm)

Question 30

How to set up for Ap ribs

Answer 30

Patient upright for upper ribs to allow diaphragm to drop lower Msp centered to midline of grid at T7 Put patients hand behind head elbows up

Question 31

Ap and pa obliques positioning patient

Answer 31

45 degree angle RPO or LPO affected side close to IR Abduct and elevate arm of affected side Abduct opposite limp and rest hand on hip

Question 32

Collimation and breathing for Ap and Pa obliques

Answer 32

CR perpendicular to IR Collimation field 14 X 17 Respirations suspended at the end of deep inspiration for upper ribs Respirations suspended at the end of full expiration for lower ribs

Question 33

Recommend SID for chest

Answer 33

72 inches to minimize magnification of heart and increases recorded detail

Question 34

Essential projections for chest

Answer 34

PA Lateral PA oblique AP oblique AP Pa axial

Question 35

Pa chest position

Answer 35

Upright if possible to demonstrate air fluid levels and allow diaphragm to move to lowest position

Question 36

How to set up patient for Pa chest

Answer 36

MSP faces grid have beam at T7 Exposure should be made at the end of the second deep inspiration

Question 37

Lateral chest

Answer 37

Side placed closest to IR is side demonstrated in image. Left lateral is routinely used to minimize magnification of the heart.

Question 38

Lateral chest patient position

Answer 38

Patient upright if possible as same reasons as PA Shoulder should be in contact with grid Exposure made at the end of second deep inspiration

Question 39

AP and Pa oblique chest

Answer 39

Patient is an upright or recumbent Position their feet 45° LPO or RPO Perpendicular to IR Exposure made on second full inspiration CR enters 3 inches below jugular notch

Question 40

Ap chest

Answer 40

Patient is usually in upright Supine is used when patient is too ill for upright positions Top of IR 1 1/2 to 2 inches above shoulders

Question 41

AP axial chest Lordotic position (Lindblom position)

Answer 41

Patient in upright position face tube IR placed 3 inches above shoulder Feet 1 foot in front of grid

Question 42

Ap axial chest

Answer 42

When patient can’t tilt backwards you angle tube 15-20° cephalad

Question 43

Essential projections lungs and pleurae

Answer 43

Ap or Pa- right or left decubitus position Lateral- ventral or dorsal decubitus position

Question 44

Ap/Pa lateral decubitus position

Answer 44

Place patient on affected side to demonstrate fluid To demonstrate air place patient on non affected side Must be in position for five minutes for optimal pathology visualization

Question 45

Lateral ventral or dorsal decubitus position

Answer 45

Patient can be prone or supine body elevated 2-3 inches Top of IR at level of thyroid cartilage Patient should wait 5 minutes before exposure to allow fluid to settle or air to rise T7