Bony Thorax - Positioning

Question 1

T2/3

Answer 1

Manubrium

Question 2

T4/5

Answer 2

Sternal angle

Question 3

Where is the thorax at the widest diameter?

Answer 3

Rib 8/9

Question 4

L2/3

Answer 4

Lower costal margin

Question 5

What SID are rib projections done at? What are the exceptions?

Answer 5

100cm

180cm
Lateral sternum, AP bilateral ribs

Question 6

What projection is done for posterior ribs?

Answer 6

AP projection

Question 7

What projection is done for anterior ribs?

Answer 7

PA projection

Question 8

Why is it ideal for the patient to be upright for upper ribs?

Answer 8

Diaphragm descends to lowest position

Question 9

Why is it ideal for patient to be recumbent for lower ribs?

Answer 9

Recumbent allows diaphragm to ride to highest position

Question 10

What kv is used for ribs?

Answer 10

Low kv for high contrast
75-85 upper
80-90 lower

Question 11

What ribs should be demonstrated above the diaphragm in an upper rib projection?

Answer 11

1-9 above diaphragm

Question 12

Where should the CR be centered for upper ribs?

Answer 12

7-8” below vertebral prominens

Question 13

Where should the CR be crntered for lower ribs?

Answer 13

T9/10
Xiphoid process

Question 14

Resp suspended on inspiration

Answer 14

Upper

Question 15

Resp suspended on expiration

Answer 15

Lower

Question 16

What ribs are seen below the diaphragm on lower rib projection?

Answer 16

8/9-12 posterior ribs

Question 17

What is a posterior oblique position used for?

Answer 17

Posterior-lateral ribs
*oblique projection

Question 18

What is an anterior-oblique position used for?

Answer 18

Anterior lateral ribs injuries
*oblique projection

Question 19

In an AP oblique projection, what position will the patient be in?

Answer 19

RPO/LPO
*affected side closer to IR

Question 20

In a PA oblique projection, what ribs are being imaged?

Answer 20

Affected side away from IR
*RAO/RPO

Question 21

For a trauma situation, what projection is done?

Answer 21

PA chest

Question 22

What clinical indications might be on a requisition for a sternum?

Answer 22

Fracture
Congenital anomalies: pectus carinatum, pectus excavatum, Mets, osteomyelitis

Question 23

Anterior protrusion of the lower portion of the sternum

Answer 23

Pectus carinatum (pigeon breast)

Question 24

Depressed sternum, ribs in front of sternum

Answer 24

Pectus excavatum (funnel chest)

Question 25

What position is used for a PA oblique sternum?

Answer 25

RAO 15-20 degrees

Question 26

Where is the CR centered for an RAO sternum?

Answer 26

Enters elevated side (left) 1” lateral to MSP at level of T7

Question 27

What degree of rotation is used for an RAO sternum of a barrel chested patient?

Answer 27

15 degrees *less rotation - bigger chested

Question 28

What degree of rotation is used for a RAO sternum of a thin chested patient?

Answer 28

20 degrees *more rotation - smaller chested

Question 29

Why is a breathing technique used for RAO sternum projections?

Answer 29

To blur lungs and ribs *slow shallow breaths

Question 30

What kv is used for RAO sternum?

Answer 30

Low kv 70-80

Question 31

Why is an RAO position used for the oblique sternum?

Answer 31

Entire sternum is visualized within the heart shadow without vertebral superimposition

Question 32

T/F For a lateral sternum projection, the shoulders should be rolled posteriorly

Answer 32

True

Question 33

When should respiration be suspended for lateral sternum?

Answer 33

After inspiration

Question 34

What lateral position is usually used for a lateral sternum?

Answer 34

Left lateral

Question 35

What are the essential projections for SC joints?

Answer 35

PA Posterior oblique projection

Question 36

Where is the CR centered for PA SC joints?

Answer 36

MSP at T2/3 *3” distal to vertebral prominens

Question 37

When is respiration suspended for SC joints?

Answer 37

Expiration

Question 38

What position is the patient in for a posterior oblique SC joint projection?

Answer 38

10-15 degrees RAO/LAO position *affected side is closer to IR *both positions for bilateral

Question 39

Where is the CR centered for oblique SC joints?

Answer 39

T2/3 and 1-2” lateral toward the joint of interest *resp. Suspended on expiration