chapter 16

Anatomy of the Rib Cage

  • Ribs attach to the sternum via costal cartilage.

    • True Ribs: First seven ribs; attach directly to both the thoracic vertebrae at the back and to the sternum at the front.

    • False Ribs: Lower five ribs; do not attach directly to the thorax.

    • Note: The space near T12 means they do not completely surround the area.

    • Floating Ribs: Ribs eleven and twelve; lack any cartilage connection to the sternum.

Body Cavities

  • There are three primary body cavities:

    • Thoracic Cavity: Contains the right and left pleural cavities for the lungs and the mediastinum that houses the heart, blood vessels, trachea, esophagus, and thymus.

    • Abdominal Cavity

    • Pelvic Cavity

    • The diaphragm separates the thoracic cavity from the abdominopelvic cavity.

Thoracic Cavity Details

  • Lungs: The right lung has three lobes, while the left lung has two.

  • Importance of X-ray technique:

    • Reach the bottom for costophrenic angles during chest X-rays, which are crucial.

    • Look for lung markings; these appear as white patches indicating bronchioles and alveoli.

Abdominal Quadrants

  • The abdomen is divided into four quadrants:

    • Right Upper Quadrant

    • Left Upper Quadrant

    • Right Lower Quadrant

    • Left Lower Quadrant

  • Importance in clinical history:

    • Patients should be asked to localize abdominal pain, with emphasis on specific quadrants.

  • Detailed Regions of the Abdomen:

    • Nine regions: hypochondriac (upper), lumbar (middle), and iliac (lower).

    • Umbilical Region: Pain near the belly button.

    • Epigastric Region: Pain in stomach area.

Common Conditions and Pain Types

  • Kidney Stones: Flank pain is typically felt on the sides or lower back.

  • Abdominal pain history: Important questions include pain location, pregnancy chance, pain level, duration, and previous surgeries.

Body Habitus in Radiology

  • Four types of body habitus that affect positioning in X-rays:

    • Sthenic: Average body type, common organ placement.

    • Hyposthenic: Longer torso; organs in slightly altered positions.

    • Asthenic: Slimmer with longer torso; organs positioned lower.

    • Hypersthenic: Shorter torso; organs positioned higher.

  • Awareness during X-ray due to varied organ placements and body sizes.

X-Ray Preparations and Marking

  • Important to remove clothing and jewelry that can cause artifacts, especially for abdomen and chest X-rays.

  • Use appropriate markers (upright vs. supine) to specify positioning for X-rays.

  • Chest X-ray Technique:

    • PA (Posterior-Anterior) view is standard. Patient stands at 72 inches to minimize heart magnification.

    • Must include entire lung field and costophrenic angles in images.

Specific X-Rays and Techniques

Radiology Techniques

  • Lateral Chest X-ray:

    • Position patient with arms out to reduce shoulder rotation.

    • Aim for ribs to be superimposed for clear images.

    • Handle assists can stabilize patient arms.

  • Decubitus X-rays:

    • Show air-fluid levels in case of pleural effusion or other issues.

  • AP Axial (Lordotic Position) X-ray:

    • Patient leans back against the board; aimed at visualizing lung apices.

    • Useful for patients with kyphosis.

Abdominal Imaging Techniques

  • KUB (Kidneys, Ureter, and Bladder):

    • Focuses on kidneys, ureters, and bladder in one image.

  • AP Abdominal X-ray:

    • Investigates for air-fluid levels; done upright or supine depending on symptoms.

  • Decubitus Views for Abdomen:

    • Check for free air or fluid in the abdominal cavity.

  • Patient history is crucial, especially regarding previous surgeries or cancers, which may affect imaging interpretation.

Identifying Pathologies on X-Rays

  • Common conditions to recognize from X-rays include:

    • Atelectasis: Collapse of part of the lung.

    • Pneumothorax: Air in the chest cavity.

    • Pneumonia: Inflammation of the lungs.

    • Pleural Effusion: Fluid accumulation.

    • Congestive Heart Failure, Emphysema, Tuberculosis

  • Familiarization with textbook images for these conditions is recommended for accurate recognition during clinical practice.

Student Interaction and Assessment

  • Continuous check-ins for student understanding and queries throughout the session.

  • Emphasis on practical applications in clinical settings, noting that some topics might not be formally tested but are critical in practice.

Administrative Remarks

  • Regular assignment due dates noted, encouraging students needing assistance to reach out during office hours or via messages. Upcoming class topics were briefly outlined for student preparation.