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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
Rot’n:
SP midline
medial clav equidistant
scap off lung field
Positioning - AP Upper/Lower Ribs
CP
CR
PT Position
Respiration
upper = T7, lower = between xiphi and LCM
perp
erect, roll shoulders to remove scapulae off lung field
upper = insp, lower = exp
Respiration - AP Ribs
upper: full inspiration shows 1-10 post. ribs seen above diaphragm
lower: full expiration shows 8-12 post. ribs below diaphragm
deep insp vs. exp
deep insp = ribs flatten out → reduced OBL
deep exp = ribs become more angled
IQ - AP Ribs
ribs visible thru lung markings
bony trabs, cortical outline and ST seen
no noise
Structures Included - PA Ribs
post ribs 1-9
Structures Included - AP OBL Ribs
upper: 1-10 post. ribs, seen above diaphragm
lower: 8-12 post. ribs, seen below diaphragm
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
Tilt/BTB:
clavs are nearly horizontal and superior to the apices (acceptable to SI ribs 1-2)
post. ribs nearly horizontal and SI ant. ribs
Rot’n:
medial clavs equidistant
SP midline
lung fields equal width
Tilt:
ribs and clavs on the same transverse plane
spine // LA
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 leaning back
inspiration
IQ - Lordotic Chest
no motion
sharp outlines of diaphragm, heart and ribs
visible lung markings, esp in the upper/apical region
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
Rot’n:
clavs equidistant to spine
SP midline
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
IQ - Decub Chest
appropriate density diff to see air/fluid
cortical outline, ST vs. bone, lung markings
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