Week 2 - SC joints and Sternum - Critique

Q: What structures must be included in a PA oblique SC joint image?

The SC joint in question, manubrium, and medial clavicle ends

How do you know correct rotation is achieved in a PA oblique SC joint?

• The SC joint is open

• Positioned just anterior to the spinal column

• Free from vertebral body superimposition

• Very little distance between the spine and the SC joint of interest

How is flexion/extension assessed in a PA SC joint image?

Medial ends of the clavicles should be superimposed at T3–T4. If clavicles are too superior, the patient is extende

What structures should be included in a PA SC joint image?

Medial ends of the clavicles equidistant from the sternum and spinous process mid vertebral body

How is flexion/extension assessed in a PA SC joint image?

Medial ends of the clavicles should be superimposed at T3–T4. If clavicles are too superior, the patient is extended

Is this under or over rotated - OBL SC joint

Underrotated. Clavicle is still on the spine

OBL SC joint - what is this rotation like?

Correct rotation. SC joint open

OBL SC joint - is it over or under rotated?

Over rotated. Note the distance from the vertebral spine. The manubrium is starting to distort The SC joints are starting to narrow and too much distance from affected SC joint to spine

AP SC joint - is there any rotation?

Yes, there is rotation - LPO

Is this patient flexed or extended?

• patient extended - clavicles too superior

• Medial ends of the clavicle should be SI at level T3-T4

What structures must be included in a PA oblique (RAO) sternum?

Entire sternum from jugular notch to tip of xiphoid process.

How should the sternum appear in terms of rotation on a PA oblique sternum

The sternum should be adjacent to the spinal column and superimposed over the heart shadow.

At what vertebral level should the SC joints appear on a PA oblique sternum?

At the T3–T4 interspace.

What is seen with expiration in PA oblique sternum imaging?

Lung markings appear sharp.

What is seen with a breathing technique in PA oblique sternum imaging?

Lung markings appear blurred, but sternum outline is sharp.

What structures must be included in a lateral sternum?

Entire sternum: manubrium, body, and xiphoid.

How should the sternum be positioned in a lateral sternum?

Sternum in profile, no superimposition of shoulders, midsternum centered to image.

What indicates correct rotation in a lateral sternum?

Ribs do not superimpose across the sternum.

What indicates correct tilt in a lateral sternum?

Anterior ribs superimpose each other.

RAO - PA Oblique Sternum - Image labeled

Image labeled

Is the sternum visible in this image? RAO OBL Sternum

Sternum seen through the heart shadow

Is the sternum over or under rotated - LAO OBL

Sternum is over rotated, seen lateral to the heart shadow

Is the OBL Sternum over or under rotated?

Sternum is under rotated, sternum is still seen on spine

How is the image quality on this RAO OBL sternum?

• Sternum visible through thorax including blurred lung markings if breathing technique used

• Homogeneous density through entire sternum

• Boney trabeculation

• Cortical outline of entire sternum

• Visualize differences in densities of heart shadow, sternum, lung markings, bone types

Lateral sternum - Anatomy review

Lateral sternum - Anatomy review

Is there any tilt in this LAT sternum?

Yes, Tilt. Anterior ribs should SI each other.

Is there any rotation in this Lat sternum?

Yes, Rotation. Anterior ribs SI across the sternum