Bony Thorax- chapter 10

Manubrium, body, xiphoid process

List the three parts of the sternum

xiphoid process

What is the most distal aspect of the sternum?

sternal angle

What is the name of the palpable junction between the upper and mid-portion of the sternum?

Manubrium

which aspect of the sternum possesses the jugular notch?

a true rib attaches directly to the sternum with its own costocartilage

What distinguishes a true rib from a false rib?

A floating rib does not possess costocartilage

What distinguishes a floating rib from false rib?

True

The 5th rib is an example of ______ rib

Sternal angle

Which part of the sternum do the second ribs articulate?

Nerves, artery, and vein

List the structures that are found in the costal groove of each rib?

Sternoclavicular

Costovertebral joint

Eighth interchondral joint

Which joints are considered, diarthrodial/ plane (gliding)?

First sternocostal joint

Third costochondral union

Which joints are considered, synarthrodial/ immovable?

inspiration

medium kV 70-80

erect

list the correct positioning considerations for a study of the ribs above the diaphragm...

Breathing instructions:

KV range:

General body position:

40"

What is the minimum SID for sternum?

orthostatic- breathing technique

What breathing instruction should be used for RAO position of the sternum to maximize its visibility?

Area of interest closest to IR & rotate spine away from area of interest for axillary ribs

List two factors to consider when determining which specific projections to include in the rib routine

Pneumothorax, hemothorax, and pulmonary contusion

List three chest pathologic conditions that may result from a rib injury and may require that a PA and lateral chest projection be included with the rib routine

15-20 degrees

what is the range of body rotation for an RAO position for the sternum?

more obliquity

Does an anesthetic patient require a little more or a little less obliquity than a hypersthenic patient?

history of multiple myeloma

Nuclear medicine bone scans are not normally performed for which of the following conditions of the bony thorax?

possible fractures, osteoporosis, history of multiple myeloma, osteomyelitis

blunt trauma

pathology of the sternum is most commonly caused by:

bacterial infection

the most common cause of osteomyelitis

LPO

what other position can be used for the sternum if the patient cannot assume the recumbent RAO position?

Drawn back

how should the arms be positioned for an erect lateral projection of the sternum?

SC joints equal distance from midline of spine

which radiographic sign can be evaluated to determine whether rotation is present on a PA projection of the sternoclavicular joints?

10- 15 degrees

How much rotation of the thorax is required for the anterior oblique projection of the sternoclavicular joint?

midway between xiphoid process and lower rib margin

Where is the CR for AP, bilateral projection of the posterior ribs below the diaphragm?

70-80 kV

what range of kV for analog imaging should be used for ribs below the diaphragm?

LAO

Which of the following projections will best demonstrate the right axillary ribs?

over rotation of the sternum, larger patient requires 15 degree obliquity

A radiograph of RAO of sternum shows the width of the sternum is foreshortened and the sternum is shifted away from the spine and out of the heart shadow. the patient has a large barrel chest. the tech did a RAO with 20-25 degrees of rotation and used a breathing technique. what positioning error led to this outcome?

rotation of the upper body from a true lateral causes ribs to superimpose over the sternum

a radiograph of a lateral sternum shows that anterior ribs are superimposed over the sternum. which specific positioning error led to this outcome?

AP and RPO recumbent

suspend on expiration

patient with an injury to the right lower posterior ribs comes to the ER. she is unable to stand. list the positioning routine that would be performed for this patient

position:

breathing instructions:

PA and RAO recumbent

expose on inspiration

patient with an injury to the left upper anterior ribs comes to the ER. he is unable to stand, but can lie on his abdomen.

position:

breathing instructions:

10-15 degree RAO will show the R SC joint next to spine

A routine chest study shows a possible lesion near the right SC joint. A PA projection of the SC joint is taken, but the area of interest is superimposed over the spine. What specific position can be used to better demonstrate this region?

LPO and horizontal beam, lateral positions

patient is brought to the ER with multiple injuries because of a MVA. The patient can move but cannot stand or lie prone because of injuries. a sternum study is ordered. what position should be performed for this patient?

PA and lateral chest

patient comes to the ER with multiple rib fractures. The ER physician suspects a flail chest. The patient is able to stand and move. Beyond a rib series, what projection should be taken for this patient?

False

TRUE/FALSE: the automatic exposure control system is recommended for the RAO sternum projection if the center chamber is used.

False

TRUE/FALSE: orthostatic breathing technique is recommended for studies of the sternoclavicular joints.

PA & LAO, erect

A patient comes to the ER with a right, upper, anterior rib injury. A unilateral rib study is ordered. What are basic projections taken for this patient?

recumbent AP and LPO

A patient comes to the ER with a left, lower posterior rib injury. A unilateral rib study is ordered. The patient is unable to stand because multiple injuries. What are the basic projections taken for this patient?

RAO & lateral sternum (possible chest xray)

A patient comes in radiology with a clinical history of pectus excavatum. What positioning routine would best demonstrate the condition?

nuclear medicine bone scan

A patient comes to radiology with widespread metastases involving the bony thorax. Beyond radiographic studies, what other imaging modality demonstrates the extent of this condition?

body

What is the term for the long, middle aspect of the sternum?

40

The most distal aspect of the sternum does not ossify until a person is approximately _____years of age

6" or 15cm

The total sternum length on a average adult is about _______

T9-T10

A xiphoid process of the sternum is at the approximate level of the ________ vertebra

T4-5

The sternal angle is at the level of

manubriosternal joint

What is another term for the sternal angle?

sternoclavicular joint

What is the name of the joint that connects the upper limb to the bony thorax (the only bony connection between the bony thorax and upper limbs)?

costocartilage

What is the name of the section of cartilage that connects the anterior end of the rib to the sternum?

true ribs connect to the sternum by their own costocartilage. False ribs are connected to the sternum via the costocartilage of the 7th rib

what distinguishes a true rib from a false rib?

True

TRUE/FALSE: the 11th and 12th ribs are classified as false and floating ribs

False, its called anterior or sternal end

TRUE/FALSE: the anterior aspect of the ribs is classified the vertebral end

Tubercle

Which aspect of the ribs articulates with the transverse process of the thoracic vertebrae?

artery, vein and nerve

List the three structures found within the costal groove of each rib

1st-12th costovertebral joints

1st- 10th costotransverse joints

2nd- 7th sternocostal joints

6th- 9th interchondral joints

Which joints are known to be movable- diarthrodial (plane or gliding)

1st sternocostal

1st-10th costocondral unions

Which joints are known to be immovable- synarthrodial

9th and 10th intercondral joints between the cartilage

Which joints are known to be fibrous- syndesmosis

synovial

joints that are classified as diathrodial movement are classified as

True

TRUE/FALSE: it is virtually impossible to visualize the sternum with a direct PA or AP projection

False, less obliquity

TRUE/FALSE: a large deep chested (hypersthenic) patient requires more obliquity for a frontal view of the sternum as compared with a asthenic patient.

approximately 15 degrees

how much obliquity should be used for a hypersthenic (deep chested) patient?

Kv: 70-80

mA- low

exposure time: long, 3-4 seconds (orthostatic breathing technique)

list the recommended ranges for analog exposure factors as they apply to an oblique position of the sternum

kV range:

mA (low or high)

exposure time (short or long)

Blurs out the lung markings and ribs allowing the sternum to be more visualized

What is the advantage of performing an orthostatic breathing technique of the sternum?

increases patient dose, especially skin dose

What is the primary reason that a source image receptor distance (SID) of less than 40" should not be used for sternum radiography?

CT or nuclear medicine

What other imaging option is available to study the sternum if routine RAO and lateral radiographs do not provide sufficient information?

Recumbent

expiration

70-80 analog or 85+/- 5 digital

Preferred positioning factors to demonstrate an injury to the ribs found BELOW the diaphragm

General body position (erect or recumbent):

breathing instructions:

KV range

above

an injury to the region of the 8th or 9th rib requires the _____ (above or below) diaphragm technique

away from

To elongate and visualize the axillary aspect of the ribs properly, the patient's spine should be rotated (toward or away from) the area of interest?

PA and anterior obliques

Which projections (AP or PA and anterior or posterior oblique) should be performed for an injury to the anterior aspect of the ribs?

AP and RPO

Which two rib projections should be performed for an injury to the right posterior ribs?

taping a small metallic BB over site of injury

How can the site of injury be marked for a rib series?

erect PA and lateral chest

if the physician suspects a pneumothorax or hemothorax has occurred as a result of a rib fracture, which additional radiograph projections should be performed in addition to the routine ribs?

Flail chest

pulmonary injury caused by blunt trauma to two or more ribs

erect

if a flail chest injury is suspected, the technologist should perform rib study in which position?

irregular bony margins

osteolytic metastases of the ribs produce which of the following radiographic appearances?

pectus excavatum

Depressed sternum caused by congenital defect

osetoblastic

proliferative bony lesion of increased density

False

TRUE/FALSE: MRI provides a more diagnostic image of rib metastases as compared with a nuclear medicine scan

true

TRUE/FALSE: Patients can develop osteomyelitis as a postoperative complication following open heart surgery.

Jugular notch

Which bony landmark is most easily palpated on the obese patient for sternum and rib projections?

RAO because the sternum over the heart is better visualized

Which oblique position is preferred for a study of the sternum RAO or LPO? Why?

True- rotation more than 15-20 degrees causes distortion

TRUE/FALSE: the most common error for the oblique position of the sternum is over-rotation of the thorax

mid-sternum, midway between jugular notch and xiphoid process

Where is the CR centered for the oblique and lateral projections of the sternum?

LPO

What other position can be performed if the patient cannot assume a prone position for the oblique of the sternum?

60-72" because it reduces magnification

what is the recommended SID for a lateral sternum? Why?

The entire sternum should lie over the heart shadow and should be adjacent to the spine

What criteria applies to a radiograph for an evaluation of the oblique sternum?

T2-T3

Where is the CR centered for a PA of SC joints?

suspend on expiration

What type of breathing instructions should be provided to the patient for a PA projection of the SC joints?

10-15 degrees from PA position

how much rotation of the thorax is recommended for an anterior oblique of the SC joints?

LAO

Which specific oblique position best demonstrates the left SC joint adjacent to the spine?

A. nature of trauma or patient complaint

B. location of rib pain/injury

C. whether the injury was caused by trauma to the thoracic cavity

What are three points that should be included in the patient's history before a rib series?

3-4" below jugular notch, T7

Where is the CR centered for AP ribs above diaphragm?

RAO and LPO elongate the left axillary ribs

Which two specific oblique positions can be used to elongate the left axillary portion of the ribs?

PA and LAO elongate the right axillary ribs

Which two basic projections or positions should be performed for an injury to the right anterior ribs?

45 degrees

how much obliquity is required for an oblique projection of the axillary ribs?

72"

What is the recommended SID for bilateral lower rib study on an adult?

False- perform right lateral decub if pneumothorax is in the left thorax

TRUE/FALSE: A left lateral decubitus chest position (patient cannot stand) should be performed for a possible pneumothorax in the left thorax

True

TRUE/FALSE: the recommended kV range for a digital study of the unilateral, lower anterior ribs is 85+/- 5 kV

left axillary ribs

Which region of the ribs is best demonstrated with an RAO projection

True

TRUE/FALSE: A right lateral decubitus chest position ( patient cannot stand) should be performed for a possible hemothorax in the right thorax.