Positioning of the Ribs, Sternum, and SC Joints

What is the technique for the upper ribs?

65-70 kVp at 15-30 mAs

What is the technique for the lower ribs?

80-85 kVp and 15-30 mAs

When doing AP/PA or oblique ribs, where do you want the pain/injury?

Closest to the IR/Bucky

If the pain is anterior, what position do you do?

PA projection

If the pain is posterior, what position do you do?

AP projection

For oblique ribs if you have left-sided anterior pain what position do you do?

RAO projection

For oblique ribs if you have right-sided anterior pain, what position do you do?

LAO projection

For oblique ribs if you have ride-sided posterior pain, what position do you do?

RPO projection

For oblique ribs if you have left-sided posterior pain, what position do you do?

LPO projection

What size/orientation is the IR for the upper ribs (unilateral)?

14×17 lengthwise

What size/orientation is the IR for the lower ribs (bilateral)?

14×17 crosswise

Where is the CR for the AP/PA ribs?

T7

Where is the CR for the lower ribs?

Midway between xiphoid process and lower rib cage (bottom of film at crest)

How are the lower ribs always done?

Bilateral and AP

What is the SID for ribs?

40 SID

What is the breathing for above diaphragm ribs?

Full inspiration

What is the breathing for below diaphragm ribs?

Expiration

What may be required for rib injury to mark the site of injury?

BB marker

PA Ribs (unilateral) (above diaphragm) patient has left-sided anterior pain

• PA unilateral

• 14×17 LW

• CR to T7

• Have at least 1 ½ inches about the shoulder

• Roll shoulders forward to remove scapula from lungs

• Move patient not tube and cute in ½

• Collimate slightly side-to-side

• Full inspiration

AP Ribs (unilateral) (above diaphragm) patient has right-sided posterior pain

• AP unilateral

• 14×17 LW

• CR to T7

• Have 1 ½ inches of light field above the shoulder

• Move patient not tube and cut in ½

• Collimate slightly side-to-side

• Lift arms

• Full inspiration

RPO Oblique Ribs (unilateral) (above diaphragm) patient has right-sided posterior pain

• Rotate 45 degrees towards IR/Bucky

• CR to T7 (cute body in ½ check shadow and spine to make sure not clipping)

• Right arm up out of way, left arm is down to side

• Full inspiration

RAO/LAO Oblique Ribs (unilateral) (above diaphragm) patient has left-sided anterior pain

• Anterior pain= anterior interest away

• Spine must be out of the way of the ribs

AP Bilateral Lower Ribs (below diaphragm)

• 14×17 IR CW with 11×14 collimation

• May be done erect or recumbent

• Bottom of IR at crest

• CR is midway between xiphoid process and lower rib

• Abduct arms away from body

• Expiration

• Use P-tongue on 14” line holes

What is the technique for the RAO sternum?

70 kVp at 30-35 mAs

What is the technique for the lateral sternum?

70 kVp at 60-70 mAs

What is the IR size/orientation for the sternum?

10×12 LW

Where is the CR for the lateral sternum?

To mid sternum (T7) and 1 inch back from front of body

Where is the CR for the RAO sternum?

CR to mid sternum (midway between jugular notch and xiphoid process) and 1 inch left of midline

What is the SID for the RAO sternum?

40 inch

What is the SID for the lateral sternum?

72 inch

What is the breathing for the RAO sternum?

Shallow breaths (low mA, increase time)

What is the breathing for the lateral sternum?

Full inspiration

Left Lateral Sternum

• Have patient stick chest out, shoulders/arms drawn back

• 72 inch SID (reduces magnification)

• Full inspiration

• CR to mid sternum and 1 inch back from anterior surface

• Cock-the-box for tighter collimation

RAO Sternum

• 15-20 degree oblique (hyperstenic= 15 degrees, asthenic= 20 degrees)

• CR midway between jugular notch and xiphoid process and 1 inch left to the midline (top of IR 1 ½ inches above jugular notch)

• Be sure to rotate entire body

• Put sternum in middle of IR, put finger on sternum and ensure at crosshairs

• Orthostatic breathing

What is the technique for the SC joints?

70 kVp at 30 mAs

What is the IR size/orientation for the SC joints?

10×12 crosswise, collimate down to 7×7

Where is the CR for the PA SC joints?

Centered to jugular notch (level of T2/T3)

Where is the CR for the RAO/LAO SC joints?

• Rotate patient 10-15 degrees

• CR at jugular notch at level of T2/T3 and 1-2 inches lateral (towards upside)

What does the RAO SC joint demonstrate?

Right or downside SC joint

What marker should you use for the RAO SC joint?

Right marker

What does the LAO SC joint demonstrate?

Left or downside SC joint

What marker should you use for a LAO SC joint?

Left marker

What is the SID for the SC joints?

40 inch

What is the breathing for the SC joints?

Suspend respiration on expiration

PA projection SC Joint

• SC joints against the IR

• CR to jugular notch

• Arms up beside head or down by side

• True PA with no rotation of shoulders

LAO Position SC Joint

• Rotate patient slightly 10-15 degrees

• CR to jugular notch and 1-2 inches lateral (towards upside)

• LAO demonstrates downside or left SC joint

• Shoots through upside to see the downside

RAO position SC Joint

• Rotate patient slightly 10-15 degrees

• CR to jugular notch and 1-2 inches lateral (towards upside)

• RAO demonstrates downside or right SC joint

• Shoots through upside to see downside SC joint