Thoracic Cage

Question 1

mAs above diaphragm for oblique ribs

Answer 1

20

Question 2

mAs below diaphragm for oblique ribs

Answer 2

40

Question 3

If rib # is above xiphoid, what should patient respiration be?

Answer 3

Susp. Inspiration

Question 4

If rib # is below xiphoid, what should patient respiration be?

Answer 4

Susp. Expiration

Question 5

Marker placement for Rib projections

Answer 5

Top corner where the ribs curve away.

Question 6

Which side is used for sternum oblique and why?

Answer 6

RAO as is projects sternum into the ‘shadow’ of the heart, which allows for greater window width.

Question 7

In a Sternum oblique, if a patient is barrel chested then what has to occur to the obliquity?

Answer 7

Decrease obliquity.

Question 8

Can a breathing technique be used on a RAO sternum?

Answer 8

Yes, can help blur ribs.

Question 9

Why shouldnt AEC be used for lateral sternum?

Answer 9

Lungs in the field

Question 10

Why might a trial run be needed for a lateral sternum?

Answer 10

TO see how much the sternum moves during inspiration.

Question 11

FFD for lat sternum?

Answer 11

100 or 180 if air gap + magnification is an issue.

Question 12

Describe patient position for lateral sternum

Answer 12

True lat, arms held behind back, shoulders rolled back and chest out.

Question 13

Breathing for lateral sternum

Answer 13

susp inspiration

Question 14

What other modality is used instead of a PA SC joint and why?

Answer 14

CT or angio due to great vessels located in this region

Question 15

What is the difference between a serendipity projection and a AP SC projection

Answer 15

serendipity = AP with 40 cephalad angulation

Projects SC above clavicle.

Question 16

How is an oblique SC typically performed?

Answer 16

15 obliquity with arms at side.

Bilaterally.

Question 17

on a SC oblique RAO what is shown?

Answer 17

Left spinous process, Right SC joint

Question 18

FFD for lateral airways?

Answer 18

180

Question 19

kVP for lateral airways?

Answer 19

10

Question 20

Where to postion top of IR for lateral airways?

Answer 20

just below eye level

Question 21

Typical area for # on ribs?

Answer 21

Middle 1/3

Question 22

Most common MOI for rib #

Answer 22

Sagittal but sometimes coronal.

Question 23

Name of natural variance where sternum is ‘sunk’

Answer 23

Pectus excavatum

Question 24

How far are the ribs relative to sternum in a patient presenting with pectus excavatum?

Answer 24

1cm Ant to sternum

Question 25

what does EtoH stand for?

Answer 25

Ethyl Alcohol

Question 26

Questions to ask when a suspected FB has been ingested?

Answer 26

Localise pain What was it where was you where can you feel it where do you suspect they put it? How long?

Question 27

Whta is a flail segment and flail chest?

Answer 27

segment = 2 # TO SAME RIB CHEST = 3 OR MORE contiguous flail segments.

Question 28

Danger of flail chest/ segments.

Answer 28

Ribs move opposite way to healthy ribs. If patient inhales the segments move in instead of out. (TOWARDS LUNG)

Question 29

Typical MOI for flail chest/ segments

Answer 29

NAI or MVA with no airbag.

Question 30

What can a flail chest predispose a patient to ?

Answer 30

Pulmonary contusion (M/ bruise) Pneuomothorax Heamothorax

Question 31

Why is axial injuries uncommon with thorax pathologies?

Answer 31

Shoulder girdle + 1st rib protects thoracic cage from axial forces.

Question 32

Where are cervical ribs typically developed?

Answer 32

C7 and sometimes 6

Question 33

Cervical ribs

Answer 33

Fused to vertebral body, no costovertebral joint meaning no articulation or movement.

Question 34

Danger of cervical ribs

Answer 34

Arms above head can impinge neurovasculature (more the vasculature) Leads to thoracic outlet sydnrome

Question 35

Thoracic outlet syndrome

Answer 35

Cervical ribs + compression of vasculature of great vessels. ``` Pins and needles Mm. weakness Sub clavian Aa. compression Brachial plexus compression SWOLLEN ARM. ```

Question 36

Another name for pneumothorax

Answer 36

collapsed lung

Question 37

Pneumothorax MOI and radiographic appearance

Answer 37

Penetrative trauma: External = Knife Internal = Ribs Dead in air in pleural space causes 0 lung markings in the lung field.

Question 38

patients that typically have NAI rib #

Answer 38

Paediatric. typically crushing.

Question 39

if ribs are crushed then what is the orientation of ribs?

Answer 39

External .

Question 40

What can affect window density during sternal. projection? + how is it overcome?

Answer 40

breast tissue. tight collimation

Question 41

How can a sternal # affect the great vessels.

Answer 41

can cause retropulsion which can cause retrosternal heamotoma

Question 42

What can retropulsion with a sternal # cause?

Answer 42

Retrosternal heamotoma

Question 43

What is a retrosternal haemotoma??

Answer 43

Brusing, bloodclots, swelling and extrasitual blood pooling behind the sternum.

Question 44

Why is a lower kvp used for a airways projection

Answer 44

increased contrast.

Question 45

PAtient is a slobbering mess, where would the foreign body typically be?

Answer 45

epiglottis.

Question 46

if FB is at epiglottis- c4 then what projections to use?

Answer 46

Airway and Cxr +/- sternal oblique. incase the FB is SI by sternum.

Question 47

why is it better for a patient to dislocate SC joint superiorly?

Answer 47

Less chance of harming vasculature

Question 48

WHy is a post/ inf SC joint dislocation dangerous?

Answer 48

Inflammatory response can compress vasculature.

Question 49

MOI for SC dislocation ?

Answer 49

Handlebar to chest. large force over a small area.

Question 50

How is SC dislocation best managed in terms of projections?

Answer 50

Angio or CT Serendipity projection.