W3 - Ribs and Chests

AP vs. PA ribs

• AP = posterior upper and lower ribs

• PA = anterior upper ribs (only upper bc there are no lower anterior ribs)

Structures Included - AP Ribs

• upper = post. ribs 1-10

• lower = post. ribs 8-12

Critique - AP Ribs

• no rot’n or tilt

• scap off lung field

• correct resp

  • upper: full insp = 10 post. ribs seen above diaphragm

  • lower: full exp = 8-12 post. ribs below diaphragm

Positioning - AP Upper/Lower Ribs

• CP

• CR

• PT Position

• Respiration

• upper = T7, ISA, lower = between xiphi and LCM

• perp

• erect, roll shoulders to remove scapulae off lung field

• upper = insp, lower = exp

Structures Included - PA Ribs

post ribs 1-9

Critique Rotation - AP Upper/Lower OBL Ribs

• upper:

  • axillary ribs free of SI indicated by ant. ribs at lateral edge of rib cage (just SI lat. ribcage)

  • sternum approx. halfway between vertebral column and ant. ribs

• lower:

  • axillary ribs free of Si indicated by ant. ribs at lateral edge of rib cage (just SI lat. ribcage)

  • scottie dogs (pedicles mid VB)

AP vs. PA Rib OBLs

• AP = affected side is in contact

• PA = affected side is raised

Positioning - AP/PA OBL Ribs

• upper = T7, lower = midway xiphi and LCM

• perp

• erect, obl 45, abduct and roll affected arm 

Structures Included - Lordotic Chest

• entire lung field including clavs

• apical view: apices only

Critique - Lordotic Chest

• clavs are nearly horizontal and superior to the apices (acceptable to SI ribs 1-2), post. ribs nearly horizontal and SI ant. ribs

• no rot’n and tilt

Positioning - Lordotic Chest

• CP

• CR

• SID

• PT Position

• Respiration

• depends

• 15-20 ceph, or pt leans back

• 180cm

• pt is 30cm away from the board before and if leaning back

• inspiration

Structures Included - Decub Chest

• entire lung fields

• both lat. margins

Critique - Decub Chest

• Free of SI

  • arms flexed and abducted sup,

  • chin lifted

  • scaps rolled forward

• no rot’n

• Good Inspiration: ribs 9-10 above diaphragm

Positioning - Decub Chest

• T7

• HB

• 180cm

• pt lies on side for 5-8mins, torso elevated on sponge, arms raised and knees flexed

Purpose of Lordotic Chest

• to demonstrate the apices of the lungs

• to see some pathologies such as miliary TB, calcifications/masses beneath the clavicles

Purpose of LAT Decub Chest

to demonstrate air and/or fluid in the pleural cavity