Bony Thorax

What 2 bones make up the bony thorax?

ribs and sternum

What 3 bones make up the bony thorax?

ribs, sternum, and t-spine

How many pairs of ribs does a human have?

12 pairs (24 total)

How long is the average sternum?

6 inches

T/F: the sternum is an irregular bone

False, it is a flat bone

Where is the jugular notch located?

above the manubrium

What structure lies at T2-T3?

jugular notch

What structure lies at T4-T5?

sternal angle

Mid-sternum is at which vertebral level?

T7

What structure lies at T9-T10?

xiphoid tip

What structure lies at L2-L3?

inferior costal margin (bottom of the ribs)

What are the 2 secondary names for the body of the sternum?

corpus or gladiolus

What is the last piece of bone to ossify in the adult body?

Xiphoid process

How many pairs of anterior rib facets are on the sternum?

7

T/F: all ribs attach to the T-spine

True

Which ribs are considered true ribs?

1-7

Which ribs are considered false ribs?

8-12

Why are false ribs special?

they do not attach directly to the sternum

Which ribs are considered floating ribs?

11 and 12 (lack cartilage)

What are the secondary names for the jugular notch?

manubrial notch or suprasternal notch

Which rib is the thickest and most acutely curved?

1st

Which rib has the widest overall diameter?

8th

The anterior end of the rib is __ - __ inches lower/higher than the posterior end

3-5 inches lower

The head of the rib articulates with the ___ of the vertebra

body

The tubercle of the rib articulates with the ___ of the vertebra

transverse process

What part of the rib is considered the most curved portion, and what region is it found in the body?

the angle which is found in the axillary region

What is the cartilage called between the sternal end and the sternum?

costocartilage

What structure is on the inside of the ribs and helps with the passage of blood vessels and nerves?

costal groove

What is the opening at the top and the bottom of the rib cage called?

top - superior aperture

bottom - inferior aperture

What type of joint is the costovertebral and costotransverse joint?

diarthrodial - gliding

What is the joint between the rib and the cartilage that attaches it to the sternum called?

costochondral

What type of joint is the costochondral joint?

cartilaginous - synchondrosis

How much is the patient obliqued for an RAO sternum?

15-20 degrees

How much angle do you need for a hypersthenic patient getting an oblique sternum exam?

15 degrees

How much angle do you need for an asthenic patient getting an oblique sternum exam?

20 degrees

Compared to a chest x-rays, do you use a lower or higher kVp for ribs?

lower kVp

What is the respiration for an oblique sternum?

slow shallow breathing or suspend on expiration

What is the respiration for upper ribs?

suspend on full inspiration

What is the respiration for lower ribs?

suspend on expiration

An AP projection shows the anterior or posterior ribs best?

posterior

A PA projection shows the anterior or posterior ribs best?

anterior

If the patient is LPO, which ribs are shown best?

left posterior ribs

If the patient is in an LAO, which ribs are shown best?

right anterior ribs

If the patient is in an RAO, which ribs are shown best?

left anterior ribs

If the patient is RPO, which ribs are shown best?

right posterior ribs

Which position is this?

LAO or RPO

Which position is this?

RAO or LPO

How many degrees is the patient rotated for an oblique sternum?

15-20 degrees

Which positions are performed for a routine sternum?

• RAO

• Lateral

List all the x-rays that use a breathing technique

• lateral t-spine

• transthoracic humerus

• AP scapula

• RAO sternum

• Swimmers

Why do we rotate the patient to image the sternum?

to get the spine out of the way and place the sternum in the shadow of the heart

What modality is most common for sternal exams

CT

Where do you center for a RAO sternum?

T7 (inferior angle of the scapula)

What is respiration for an RAO sternum?

slow, shallow breathing

What is the SID for a RAO sternum?

40 in

What would the benefit be of reducing your SID when imaging the sternum?

it increases the space between the ribs using magnification to see the sternum better

What position is the patient in if there are getting a trauma lateral sternum?

dorsal decub

What is the SID for a lateral sternum?

72

Where do you center for a lateral sternum?

T7 as well as between the MCP and the anterior portion of the chest

What is the respiration for a lateral sternum and why?

suspend on full inspiration to create a retrosternal air pocket between the sternum and the heart

What is the position called that the patient must be in during a lateral sternal exam and explain what it looks like

retrosternal position - hands clasped behind the back with the shoulders rolled back

What does a routine SC joint exam consist of?

• PA

• RAO or LAO

T/F: PA SC joints must be performed on the table

true

How must the patient by lying on the table for a PA SC joint exam?

prone on the table with no pillow, their chin resting on the table, and their arms down by their side

Where do you center for a PA SC joint?

T2-T3 (jugular notch)

How do you find T2-T3 when the patient is prone?

2-3 inches below the vertebral prominence

What is the SID for a PA SC joint?

40

An RAO will show which SC joint?

right

An LAO will show which SC joint?

left

How much is the patient obliqued for an oblique SC joint?

10-15 degrees

AP oblique ribs are best used to see anterior/posterior ribs?

posterior

PA oblique ribs are best used to see anterior/posterior ribs?

anterior

When imaging upper ribs, should the patient be erect or recumbent?

erect (gravity pulls the diaphragm down)

What is respiration for upper ribs?

suspend on full inspiration

Where do you center for upper ribs?

T7

To know that you got a good upper rib x-ray, how many ribs should be visible?

1-10

If you are performing an upper rib exam and are unable to see 8,9, or 10, what can you do?

angle the tube 10-15 degrees caudal to move the diaphragm below the ribs

When performing lower ribs, the patient should be erect or recumbent?

recumbent

What is the respiration for lower ribs?

suspend on expiration

What orientation should the IR be when imaging the lower ribs?

Crosswise

What is the SID when imaging the lower ribs?

40

Where do you center for lower ribs?

T12

How do you find T12?

midway between the xiphoid tip and the inferior costal margin

Where should the light reach to when performing lower ribs?

the iliac crests

T/F: peristalsis is voluntary and can show up on an image

False, it is involuntary

If performing unilateral images of the ribs, where should you center?

between the MSP and the lateral edge of the body

A PA erect chest can be performed with a routine rib exam to check for ___ and ____

hemothorax and pneumothorax

Which position can replace the RAO sternum for the trauma patient who cannot lie prone or stand?

LPO

Which of the following technical considerations does not apply to a rib study for an injury to the left, upper anterior ribs?

• PA projection

• RAO projection for axillary ribs

• Erect position

• Exposure upon expiration

exposure upon expiration

Which of the following positions/technical considerations does not apply to a rib study for an injury to the right. lower posterior ribs?

• AP projection

• Recumbent

• Exposure upon expiration

• LPO projection

LPO projection