* BONY THORAX: RIBS *

What structures form the bony thorax?

Sternum, 12 pairs of ribs, and 12 thoracic vertebrae

What are the two primary functions of the bony thorax?

Protection of the heart and lungs; mechanical function for inhalation/exhalation

What is the most common reason for repeat rib x-rays?

Clipping the first rib

Which ribs are true ribs?

Ribs 1-7; directly attached to sternum via costal cartilage

Which ribs are false ribs?

Ribs 8-12; not directly attached to the sternum

Which ribs are floating ribs?

Ribs 11-12; only attach to vertebrae

What breathing is used for upper ribs?

Inspiration—pushes diaphragm down for better visualization

What breathing is used for lower ribs?

Expiration—pushes diaphragm up for uniform contrast

What are the two ends of a rib?

Vertebral end and sternal end

What is the posterior-anterior rib height difference?

Posterior ribs are 3-5 inches higher than anterior ribs

At which rib does rib length peak?

7th rib

Where is the bony thorax widest?

At ribs 8 and 9

Jugular notch corresponds to what level?

T2-T3

Sternal angle corresponds to what level?

T4-T5

Xiphoid corresponds to what level?

T9-T10

Inferior costal angle corresponds to what level?

L2-L3

Upper rib requirement?

At least 9 posterior ribs above diaphragm

Lower rib requirement?

Ribs 10-12 visualized below diaphragm

Posterior rib pain indicates what projection?

AP projection

Anterior rib pain indicates what projection?

PA projection

Posterior pain obliques?

LPO for left; RPO for right

Anterior pain obliques?

LAO for right; RAO for left ("PA Away")

CR for AP bilateral above diaphragm?

3-4 inches below jugular notch

CR for PA bilateral above diaphragm?

7-8 inches below vertebra prominens (T7)

CR for AP ribs below diaphragm?

Midway between xiphoid and lower rib margin

kVp range for all rib exams?

75-85 kVp

Patient position for upper ribs?

Erect

Patient position for lower ribs?

Supine

Unilateral ribs CR (AP)?

3-4 inches below jugular notch

Unilateral ribs CR (PA)?

7-8 inches below vertebra prominens

Oblique rib rotation?

45 degrees

Posterior obliques (RPO/LPO)?

Affected side closest to IR

Anterior obliques (RAO/LAO)?

Affected side away from IR ("PA Away")

Soft tissue signs for upper rib trauma?

Hematoma, air, pneumothorax, airway injury

Organs at risk with lower rib trauma?

Kidney, liver, spleen, diaphragm

What is hemothorax?

Blood in pleural cavity

What is pneumothorax?

Air in pleural cavity

Why abduct/internal rotate affected arm?

Move scapula laterally off ribs

What rib protocols may include?

Chest view included with ribs (e.g., "Ribs Right 2 view w/ Chest 1 view"