Thorax, chest and clavicle Projections

What are the routine projections for ribs

AP upper, AP oblique, AP lower, AP oblique lower

What IR is used on rib projections

Larger IR lengthwise for upper
Large IR crosswise for lower

What bucky is used for rib projections

Upright

What is the SID for rib projections

110DR, 100CR, 40 in

In an AP upper ribs the midcoronal plane should be...

Parallel to IR

What is the center of upper rib projections

Halfway between MSP and affected lateral rib at a level of T7

Where is T7

Halfway between jugular notch and xiphoid process

How is the arm positioned in an AP upper ribs

Abducted and internally rotated

Breathing instructions for an AP/AP oblique upper ribs

Full inspiration to depress diaphram

In an AP lower rib, the lower border of the IR should near the level of...

Iliac crests

How to center lower rib projections

Halfway between MSP and affected lateral rib at a level of T10

How is the arm position for an AP lower rib

Abducted

What are the breathing instructions for lower rib projections

Full expiration to elevate diaphram

How is the patient positioned for oblique rib projections

45' RPO or LPO, affected side closest to IR
Abduct arm of affected side

What articulations are demonstrated in both AP rib

Thoracic vertebrae-rib articulations

How should the medial clavicular end be positioned in both AP rib

Adjacent to lateral edge of vertebral column

How should the distance from the spinous process to the pedicles be in both AP rib

Equal on each side

How can we keep magnification to a minimum of the affected rib's in both AP ribs

If anterior rib is being projected then place patient prone or PA
If posterior rib is being projected then place patient supine or AP

How is the jaw and scapula demonstrated in upper AP ribs

Jaw and scapula out of lung field

How many posterior ribs are seen above the diaphragm in upper AP ribs

8

What posterior rib is at centre of exposure of upper AP ribs

7th

What is seen in upper AP rib projections

1-9 ribs and vertebral colomn

What are some positioning image analysis guidelines for an upper AP rib? (8)

• Rib magnification kept to a minimum
• Thoracic vertebrae-rib articulations demonstrated
• Medial clavicular end adjacent to lateral edge of vertebral column
• Distances from spinous processes to pedicles on each side (when seen) are equal
• Jaw and scapula out of lung field
• 8 posterior ribs seen above diaphragm
• 7 th posterior rib at center of exposure field
• Affected side's 1-9 ribs and vertebral column included

In an AP lower rib, how many posterior ribs are demonstrated

8-12th rib

What rib is at center in an AP lower rib

10th rib

What is seen an AP lower rib

Part of thoracic and lumbar vertebral column and 8-12th rib

What are some positioning image analysis guidelines for a lower AP rib? (7)

• Rib magnification kept to a minimum
• Thoracic vertebrae-rib articulations demonstrated
• Medial clavicular end adjacent to lateral edge of vertebral column
• Distances from spinous processes to pedicles on each side (when seen) are equal
• 8-12th posterior ribs demonstrated below the diaphragm
• 10th posterior rib at center of exposure field
• Part of thoracic and lumbar vertebral column and 8-12th ribs of affected side of patient included within exposure field

What are some positioning errors of the AP ribs (5)

•AP vs PA
•Rotation
•Scoliotic patient
•Scapula positioning
•Respiration

How can you tell if there was rotation towards the affected AP rib

• Medial clavicular end moves away from vertebral column
• Spinous processes of vertebrae move away from affected side
• Ribs elongated

How can you tell if there was rotation away from the affected AP rib

• Medial clavicular end superimposes vertebral column
• Spinous processes move toward affected side
• Ribs foreshortened

How is it important to be aware if a patient has scoliosis

the ribs and vertebral column will appear rotated even if they are positioned AP

What happens if the arm is not abducted and internally rotated in a rib projection

The scapula obscures the ribs

In upper AP ribs, inspiration is used because

The technique is lower since it does not need to penetrate the diaphragm
To see 1-8 ribs

In lower AP ribs, expiration is used because

The technique is higher to penetrate the diaphragm, but will over expose the ribs above the diaphragm
To see 8-12 ribs

Where is the inferior sternal body located in both AP oblique rib

Halfway between vertebral column and lateral rib surface

Describe the axillary ribs in both AP oblique ribs

Without foreshortening
At center of exposure field

Where is the anterior ribs located in both AP oblique ribs

At lateral edge

How many axillary ribs are demonstrated above the diaphragm in an AP upper oblique rib

8

What axillary rib is at center in an AP upper oblique rib

7th

What is seen in an AP upper oblique rib

1-10th axillary ribs, thoracic vertebral column

What are some positioning image analysis guidelines for an upper AP oblique rib? (7)

• Rib magnification kept to a minimum
• Inferior sternal body located halfway between vertebral column and lateral rib surface
• Axillary ribs demonstrated without foreshortening and located at center of exposure field
• Anterior ribs located at lateral edge
• 8 axillary ribs demonstrated above the diaphragm
• 7 th axillary rib at center of exposure field
• 1-10th axillary ribs of affected side and thoracic vertebral column included within exposure field

How many ribs are demonstrated below the diaphragm in an AP lower oblique rib

9-12th

Which rib is at center in an AP lower oblique rib

10th

What is seen in an AP lower oblique rib

Thoracic and lumbar vertebral column and 8-12 th axillary ribs

What are some positioning image analysis guidelines for a lower AP oblique rib? (7)

• Rib magnification kept to a minimum
• Inferior sternal body located halfway between vertebral column and lateral rib surface
• Axillary ribs demonstrated without foreshortening and located at center of exposure field
• Anterior ribs located at lateral edge
• 9-12th axillary ribs demonstrated below the diaphragm
• 10th axillary rub at center of exposure field
• Thoracic and lumbar vertebral column and 8-12th axillary ribs of affected side included within exposure field

What are some positioning errors of the AP oblique ribs

•Torso/chest rotation
•Respiration
•Scapula position

If the chest is incorrectly rotated away from affected side...

axillary ribs demonstrate increased foreshortening

How can you tell if there is insufficient chest and rib obliquity

• Sternum demonstrated closer to vertebral column (not halfway between vertebral column and lateral border of ribs)
• Axillary ribs foreshortened

How can you tell if there is excessive chest and rib obliquity

Sternum demonstrated closer to lateral border of ribs (not halfway between vertebral column and lateral border of ribs)

Why is RAO used for a PA oblique sternum

Use the heart as contrast

What is the obliquity for a PA oblique sternum

15-20'

What breathing instructions is used for a PA oblique sternum

Breathing motion-slow shallow breathes
Short exposure-expiration

Where does the CR enter in a PA oblique sternum

The elevated side at T7

What can you see in a PA oblique sternum projection

Entire sternum

What SID is used for a lateral sternum

180cm

How is the patient positioned in a lateral sternum

Upright with hands behind back and shoulders posteriorly rotated
R/L recumbent or dorsal decubitus with arms above head

In a lateral sternum the CR is __ to the sternum

Parallel entering the lateral border of the midsternum

What is the respiration for a lateral sternum

Deep inspiration

What is seen in a lateral sternum

entire sternum, superimposed SC joints, medial ends of clavicle

Why do we only image the upper ribs PA but not the lower

Magnification

In a PA rib how can we angle the CR to better see 7-9 rib

10-15 caudal

What is the respiration for a PA rib

Inspiration

How would a patient be positioned for a right PA oblique rib

45' with affected side away from the IR

What is the respiration for a PA oblique rib

Expiration-below
Inpiration-above

Where does the CR enter for a PA SC joint

Perp to IR and enteringT3

What is the breathing instructions for SC projections

Expiration

What is the patient position for a PA SC

Prone or upright with arms along the body

What is patient position for a right PA oblique SC

Affected side is adjacent to the IR

What is the range of obliquity of a PA oblique SC

10-15'

Where does the CR enter in a PA oblique SC

T2/3 crosswise
1-2 lateral from the midsag plane

What SID is used for an AP lordotic and AP axial chest

180

What is the patient position for a lordotic chest

Upright, AP, coronal plane is 15-20 from the vertical (leaning far back with shoulders on IR)

What is the patient position for an AP axial chest

Upright, hand on hips, shoulders back

What is the CR angle for an AP axial chest

15-20' cephalad

What is the breathing instruction for AP chest

2nd Inspiration

What structure can you see in AP lordotic and axial chest

Apices without the clavicle

For a neck soft tissue where do we center the IR if we are viewing the upper airway

At the laryngeal prominence

For a neck soft tissue were o we center the IR if we are viewing the larynx and superior mediastinum

Manubrium

What is the respiration for a soft tissue neck

Slow inspiration

What is seen during soft tissue radiographs

Foreign bodies, swelling, masses and fractures

Routine projections for the clavicle

AP and AP axial

What IR is used for clavicle projections?

Medium crosswise

What is the patient position for AP/axial clavicle projections

Upright
Arms along body

What is the CR angled for axial clavicle projections

15-30' cephalad

What are the breathing instructions for AP clavicle and why

Suspend at expiration
To make the image for uniform-dense image

What are the breathing instructions for Axial clavicle

Suspend at inspiration
To elevate and angle the clavicle

What is the collimation for clavicle projections

1.4 in above shoulder
1 in beyond medial clavicle
1 in beyond lateral shoulder

Routine projections for the chest

PA, lateral, AP lordotic

Routine projections of the neck/nasopharynx

AP, lateral

What are the breathing instructions for chest projections

Expose after 2 deep inspirations

When might you need to do chest projections with expiration

Pneumothorax (collapse lung due to air in cavity)
Foreign body
Atelectasis (collapse lung due to alveoli deflated)
Diaphragm movement

What is body habitus

How the internal organs are shaped, positioned, and movement

What are the 4 types of body habitus

Hypersthenic
Sthenic
Hyposthenic
asthenic

How would body habitus effect chest projections

Determines how to position the IR crosswise or lengthwise

Which body habitus has the shortest lung and widest upper body

Hypersthenic

Which body habitus is average

Sthenic

Which body habitus has the longest lungs and narrow upper body

Asthenic

Which body habitus has a similar build but longer lungs then sthenic

Hyposthenic