Ch 10- Bony Thorax Flashcards
1
Q
What does the bony thorax support?
A
The walls of the pleural cavity and diaphragm
2
Q
What does the bony thorax protect?
A
Heart and lungs
3
Q
What is the bony thorax formed by?
A
Sternum, 12 pairs of ribs and 12 thoracic vertebrae
4
Q
How is the bony thorax shaped?
A
Conical in shape, narrower above than below, narrower than deeper and longer posteriorly than anteriorly
5
Q
What is the sternum also known as?
A
The breastbone
6
Q
Where is the sternum located?
A
Centered over the midline of the anterior thorax
7
Q
What is the shape of the sternum?
A
Narrow, flat bone
8
Q
How long is the sternum?
A
6 inches in length
9
Q
What are the 3 parts of the sternum?
A
Manubrium, body and xiphoid process
10
Q
What is the function of the sternum?
A
Supports the clavicles and provides attachments to the costal cartilages of the first seven pairs of ribs
11
Q
What are the features of the manubrium?
A
It is the superior portion of the sternum and is quadrilateral in shape
12
Q
What is the widest portion of the sternum?
A
Manubrium
13
Q
What is the superior border of the manubrium called?
A
Jugular notch
14
Q
Where does the jugular notch lie when the body is upright?
A
Anterior to the interspace between the 2nd and 3rd thoracic vertebrae
15
Q
What part of the manubrium articulates with the sternal extremity of the clavicle?
A
Clavicular notch
16
Q
What is the longest part of the sternum?
A
Body
17
Q
Where does the body attach to the manubrium?
A
At the sternal angle, which is an obtuse angle
18
Q
Where does the sternal angle lie when the body is upright?
A
Anterior to the interspace between the 4th and 5th thoracic vertebrae
19
Q
What is the smallest part of the sternum?
A
Xiphoid process
20
Q
What is the xiphoid process made up of?
A
Cartilaginous in early life and ossifies in later life
21
Q
What are the features of the xiphoid process?
A
It is variable in shape and often deviates from the midline of the body
22
Q
Where does the xiphoid process lie in a normal thorax?
A
Lies over the tenth thoracic vertebrae
23
Q
What body parts can the xiphoid process help to identify?
A
The superior portion of the liver and inferior border of the heart
24
Q
How many pairs of ribs are there?
A
12 pairs which are numbered in correspondance to the thoracic vertebrae they attach to
25
What is the shape of the ribs?
Long, narrow and curved
26
What is the type/name of cartilage attached to the ribs?
Hyaline cartilage called costal cartilages
27
Which numbered ribs attach to the sternum?
1-7
28
Which numbered ribs attach to the costal cartilage of the 7th rib?
8-12
29
What are the first 7 ribs called and why?
True ribs because they attach directly to the sternum
30
What are the last 4 ribs called and why?
False ribs because they do not attach directly to the sternum
31
What are ribs 11 and 12 called?
Floating ribs because they're only attached to the vertebrae
32
What are the spaces between the ribs called?
Intercostal spaces
33
Which ribs are shortest and broadest?
First rib
34
How does the breadth or the ribs change as they move down the body?
They decrease in breadth
35
How does the length change as the ribs move down the body?
Length increases from 1-7 and gradually decreases from 8-12
36
What are the parts of the rib?
Head, flattened neck, tubercle and a body
37
What does the head of the ribs articulate with?
With the facets of the two adjacent vertebral bodies
38
What does the tubercle articulate with?
With the transverse process of the vertebrae
39
Which vertebrae do not have a neck or tubercle facet?
11th and 12th ribs
40
What are the two ends of the ribs called?
Vertebral end and the sternal end
41
What does the costal groove contain?
Nerves, arteries and vessels
42
How do the ribs articulate with the sternum?
Through costal cartilages
43
What is the name of the joint that articulates between the head of the rib and the body of the vertebrae?
Costovertebral joint
44
What is the name of the joint that articulates between the tubercle of the rib and the transverse process of the vertebrae?
Costotransverse joint
45
What is the name of the joint that connects the clavicle and the manubrium of the sternum?
Sternoclavicular joint
46
What is the name of the joint that connects the manubrium of the sternum and the first rib?
1st sternocostal joint
47
What is the name of the joint that connects the manubrium to the body of the sternum?
Manubriosternal joint
48
What are the 4 landmarks of the bony thorax?
T1, T2-3, T7 and T9-10
49
Where is T1 located?
2 inches above the jugular notch
50
Where is T2-3 located?
At the level of the jugular notch
51
Where is T7 located?
At the level of the inferior angle of the scapulae
52
Where is T9-10 located?
At the level of the xiphoid process
53
What are the two views used for Sternum?
- PA Oblique (RAO)
- Lateral (R&L)
54
What is the benefit of an oblique projection of the sternum?
Projects the sternum to the right of the thoracic vertebrae
55
Why is the RAO position a better oblique than the LAO?
It projects the sternum over the left T-spine and projects it over the heart to allow for a greater contrast
56
What breathing techniques should be used for sternal views?
Shallow breathing
57
What kVp techniques should be used for sternal views?
Low kVp to get better visibility
58
How long should the exposure time be for sternal views?
Exposure time should be long enough to cover several phases of shallow respiration
59
What can be done with pendulous breasts for sternal views?
Drawn to the side to prevent overlap and allow closer placement on the IR
60
Which IR should be used for PA Oblique Sternum - RAO?
10 x 12 lengthwise
61
What SID should be used for PA Oblique Sternum - RAO?
30 inches SID
62
What does the 30" SID achieve in aPA Oblique Sternum - RAO?
Blurs the posterior ribs
63
What is the postition of the patient in PA Oblique Sternum - RAO?
Patient in prone position and adjusted to right anterior oblique with left side up
64
What is the angle the body should be rotated in PA Oblique Sternum- RAO?
15-20 degrees
65
What does the degree of angulation for oblique sternum depend on?
The depth of the chest: deep chest require less rotation and shallow chest require more rotation
66
Where should the IR be placed in PA Oblique Sternum - RAO?
Top of IT placed 1.5 inches above the jugular notch
67
What are the breathing instructions for PA Oblique Sternum - RAO?
Slow, shallow breaths
68
What position should be used for trauma sternal views?
AP Oblique projection with LPO position
69
Where is the central ray placed for PA Oblique Sternum - RAO?
At the level of T7 and 1" lateral to the MSP on the elevated side
70
What anatomy is demonstrated in PA Oblique Sternum - RAO?
A slightly oblique projection of the sternum
71
What is the evaluation criteria for the PA Oblique Sternum - RAO?
- Entire sternum from jugular notch to tip of xiphoid process
- Good visibility of the sternum through the thorax
- Minimally rotated sternum and thorax
72
What demonstrates the minimal rotation of the sternum and thorax in PA Oblique-RAO?
- Sternum free from superimposition of T-spine
- No excessive rotation
- Lateral portion of the manubrium and SC joint free of superimposition of the vertebrae
- Sternum projected over the heart
73
Which IR should be used for Lateral Sternum?
10 x 12 lengthwise
74
What SID should be used for Lateral Sternum?
72 inches
75
What does the 72 inch SID do in the image?
Reduces magnification and distortion
76
How is the patient positioned in the Laternal Sternum?
Patient in the lateral position
77
How should the part be positioned for Lateral Sternum?
- Patient upright in true lateral with shoulder firmly against the grid
- Patient's hands locked behind their back or above their head
- Breasts drawn to the side if applicable
- Sternum placed in the center of the IR
78
Where should the IR be placed in Lateral Sternum?
1 1/2 inches above the jugular notch
79
What are the breathing techniques for Lateral Sternum?
Shallow breathing
80
What is the position of the central ray for Lateral Sternum?
Perpendicular to the IR at the level of T7 and entering the lateral border of the mid-sternum
81
What anatomy is demonstrated in Lateral Sternum?
A lateral image of the entire sternum showing superimposed SC joints
82
What is the Evaluation Criteria for Lateral Sternum?
- Sternum in its entirety
- Manubrium free from superimposition of soft tissue of shoulder
- Sternum free from superimposition of ribs
- Lower portion of sternum unabscured by breasts
83
What are features of the SC joints?
Diarthrodial joint
Saddle shapped
Synovial joint - gliding motion
84
What projections are used for the SC joints?
PA projection or Lateral when SC joints are of interest
85
Which IR should be used for PA SC joints?
10 x 12 lengthwise
86
What SID should be used for PA SC joints?
40" SID
87
What is the patient position of the PA SC joints?
Prone or upright with MSP centered to the midline of the grid
88
What is the general part position of the PA SC joints?
- IR centered at the level of the 3rd thoracic vertebrae (posterior to jugular notch)
- Arms along the side of the body with palms upward
- Shoulders in the same plane
89
What is the part position for a bilateral examination of the PA SC joints?
Patient head resting on chin and MSP vertical
90
What is the part position of the unilateral projection of the PA SC joints?
Patient's head turned to face the affected side with cheek resting on table
91
What does turning the head in a unilateral projection of PA SC joints?
Turning the head rotates the spine slightly away from teh side of intrest providing better visualization
92
What breathing techniques should be used for PA SC joints?
Respiration suspended at the end of expiration
93
Where is the central ray placed for PA SC joints?
Perpendicular to the IR at the level of T3
94
What anatomy is demonstrated in PA SC joints?
The SC joints and medial portions of the clavivle
95
What is the evaluation criteria for the PA SC joints?
- Both SC joints and the medial ends of the clavicle
- SC joints through the superimposing vertebral and rib shadows
- No rotation in bilateral exams
- Slight rotation in unilateral exams
96
What does a unilateral view of the PA SC joints provide?
A more open joint space on the side of interest
97
What considerations need to be addressed when taking rib x-rays?
- Position required to place the affected region parallel to the IR
- Whether the radiograph needs to include ribs above or below the diaphragm
98
What projection is used when the anterior portion of the ribs are affected?
PA projection with patient facing the IR
99
What projection is used when the posterior portion of the ribs are affected?
AP projection with the patient facing the tube
100
What projection is best used to show the axillar portion of the ribs?
Oblique projection
101
Which oblique positions allow for the ribs to clear from superimposition of the heart?
LAO or RPO positions
102
How should the kVp be adjusted when comparing ribs to chest?
Lower kVp
103
What breathing techniques are used for radiographs of the ribs?
Respiration suspended on inspiration for upper ribs
Respiration suspended on expiration for lower ribs
104
What size IR should be used for AP upper ribs?
14 x 17 inch lengthwise
105
What is the SID for AP upper ribs?
40" SID
106
What is the patient position for AP upper ribs?
Upright or recumbent facing the x-ray tube
107
What is the general part position for AP Upper ribs?
- IR projected 1.5" above the border of the shoulder
- Patient's hands moved up and away from the body to move scapula off the ribs
- Shoulders adjusted to lie in the same plane
108
What is the part position for AP upper ribs - bilateral?
MSP centered to the IR
109
What is the part position for AP upper ribs - unilateral?
Affected side centered to IR midway between MSP and lateral surface of the body
110
Where is the central ray positioned for AP Upper ribs?
Perpendicular to the IR at the level of T7 and either centered at MSP or midway between MSP and lateral border of body
111
What is the collimation for AP Upper ribs?
- 14 x 17 for bilateral ribs
- 1 inch beyond the MSP and lateral border of the body
112
What structures are demonstrated in AP Upper ribs?
Posterior ribs above the diaphragm
113
What is the evaluation criteria for AP upper ribs?
- Collimation and presence of side marker
- First through 10th posterior ribs
- Ribs visible through the lungs
114
What size IR should be used for AP lower ribs?
10 x 12 inches lengthwise
115
What SID should be used for AP lower ribs?
40" SID
116
What is the patient position for AP lower ribs?
Patient upright or recumbent facing the tube
117
What is the general part position for AP Lower ribs?
- IR adjusted so the lower edge is at the level of iliac crests
- Patient's shoulds adjusted to lie in the same plane
- Patient's hands moved up and away from the body
118
What is the part position for AP lower ribs - bilateral?
MSP centered to the midline of the grid
119
What is the part position for AP lower ribs - unilateral?
Affected side centered midway between the MSP and lateral surface of the body
120
What breathing technique should be used for AP lower ribs?
Suspended at full expiration to elevate the diaphragm
121
Where is the central ray placed for Ap lower ribs?
Perpendicular to the IR between the xiphoid process and lower ribs margin, either centered to MSP and midway between MSP and lateral border
122
What is the collimation for AP Lower ribs?
- 10 x 12 for bilateral ribs
- 1 inch beyond the MSP and lateral border of the body
123
What structures are demonstrated in AP Lower ribs?
Posterior ribs below the diaphragm
124
What is the evaluation criteria for AP lower ribs?
- Collimation and presence of side marker
- 8th through 12th posterior ribs
- Ribs visible through the abdomen
125
What is the patient position for AP Oblique ribs - RPO or LPO?
Upright or recumbent facing the xray tube
126
What is the part position for AP Oblique ribs - RPO or LPO?
- Body oblique 45 degrees with affected side closest to the IR
- Affected side centered midway between MSP and lateral surface of body
- IR placed 1.5" above the shoulders
127
What are the breathing techniques for AP Oblique Ribs - RPO or LPO?
Respiration suspended on inspiration for upper ribs and suspended on expiration for lower ribs
128
Where is the central ray for AP oblique ribs - RPO/LPO?
Perpendicular to the IR at the level of T7
129
What are the structures demonstrated in AP Oblique ribs - RPO/LPO?
The axillary portion of the ribs closest to the IR projected free of superimposition of the spine
130
What are the evaluation criteria for the AP Oblique ribs - RPO/LPO?
- Proper collimation and side marker
- Twice as much distance between the spine and lateral borders of ribs on affected side vs spine and lateral borders of ribs on unaffected side
- Axillary portion of ribs free from superimposition of thoracic spine
- 1st - 10th ribs above the diaphragm
- 8-12th ribs below the diaphragm
- Ribs visible through the lungs or abdomen
131
What is the patient position for PA Oblique ribs - RAO or LAO?
Upright or recumbent facing the IR
132
What is the part position for PA Oblique ribs - RAO or LAO?
- Body oblique 45 degrees with affected side away from the IR
- Affected side centered midway between MSP and lateral surface of body
- IR placed 1.5" above the shoulders
133
What are the breathing techniques for PA Oblique Ribs - RAO or LAO?
Respiration suspended on inspiration for upper ribs and suspended on expiration for lower ribs
134
Where is the central ray for PA oblique ribs - RAO/LAO?
Perpendicular to the IR at the level of T7
135
What are the structures demonstrated in PA Oblique ribs - RAO/LAO?
Axillary portion of the ribs farthest from the IR is projected free of superimposition with the thoracic spine
136
What is the evaluation criteria for PA Oblique Ribs - RAO/LAO?
▪ Approximately twice as much distance between the vertebral column and the lateral border of the ribs on the affected side as is present
on the unaffected side
▪ Axillary portion of the ribs free of superimposition with the thoracic spine
▪ First through tenth ribs visible above the diaphragm for upper ribs
▪ Eighth through twelfth ribs visible below the diaphragm for lower ribs
▪ Ribs visible through the lungs or abdomen according to the region examined
