Ch. 10 Bony Thorax - Sternum and Ribs Workbook Flashcards
what 3 structures make up the bony thorax
- sternum
- thoracic vertebrae
- 12 pairs of ribs
term for the long, middle aspect of the sternum
body
the most distal aspect of the sternum does not ossify until a person is about how old
40
the total sternum length on an average adult is about how long
7” (18 cm)
the xiphoid process of the sternum is at what approximate level
T9-T10
the sternal angle is at what level
T4-T5
what is another name for the sternal angle
manubriosternal joint
what is the name of the joint that connects the upper limb to the bony thorax (only bony connection between the bony thorax and upper limb)
sternoclavicular joint
what is the name of the section of cartilage that connects the anterior end of the rib to the sternum
costocartilage
T/F - the 11th and 12th ribs are classified as false and floating ribs
true
the anterior aspect of the ribs is called what
sternal end
the posterior aspect of the ribs is called what
vertebral end
which aspect of the ribs articulates with the transverse process of the thoracic vertebrae
tubercle
what are the 3 structures found within the costal groove of each rib
artery, vein, nerve
which end of the ribs is most superior
vertebral end
approximately how much difference in height is there between these two ends of the ribs
3-5”
which ribs articulate with the upper lateral aspect of the manubrium of the sternum
first ribs
the bony thorax is wider at the lateral margins in which ribs
8th and 9th
how many posterior ribs are shown above the diaphragm
10
what type of movement is the first sternocostal
synarthrodial
what type of movement is the 1st-12th costovertebral joints
diarthrodial - plane (gliding)
what type of movement is the 1st-10th costochondral unions
synarthrodial
what type of movement is the 1st-10th costotransverse joints
diarthrodial - plane (gliding)
what type of movement is the 2nd-7th sternocostal joints
diarthrodial - plane (gliding)
what type of movement is the 6th-9th interchondral joints
diarthrodial - plane (gliding)
what type of movement is the 9th and 10th interchondral joints
fibrous - syndesmosis
what are the joints that have diarthrodial movements classified as
synovial
what is unique about the true ribs
they attach to the sternum by their own costocartilage
what is unique about the floating ribs
they have no costocartilage
how much rotation should be used for the oblique position of the sternum for a large, deep-chested patient
15 degrees
what is the recommended kVp range for the oblique position of the sternum
70-85 kVp
what is the advantage of performing an orthostatic technique of radiography of the sternum
blur out the ribs and lung markings
what is the primary reason that a SID of less than 40” should not be used for sternum radiography
increases patient dose, especially skin dose
what other imaging option is available to study the sternum if routine RAO adn lateral radiographs do not provide sufficient information
CT or nuclear medicine
what is the general body position for an injury to the ribs found below the diaphragm
recumbent
what breathing instructions is used for an injury to the ribs found below the diaphragm
expiration
what is recommended kVp range for an injury to the ribs found below the diaphragm
75-85
an injury to the region of the 8th or 9th rib requires an above or below technique
above
to elongate and visualize the axillary aspect of the ribs properly, the patient’s spine should be rotated away or toward the area of interest
away from
which projections should be performed for an injury to the anterior aspect of the ribs
PA and anterior oblique
which two rib projections should be performed for an injury to the right posterior ribs
AP and RPO
how can the site of injury be marked for a rib series
taping a metal bb or other type of lead marker to mark site of pain
if the physician suspects a pneumothorax or hemothorax has occurred as a result of a rib fracture, which additional radiographic projection should be performed in addition to the routine rib projections
erect PA and lateral chest
a flail chest is define as what
pulmonary injury caused by blunt trauma to two or more ribs
if a flail chest injury is suspected, the tech should perform rib study in which position
erect
osteolytic metastases of the ribs produce which of the following radiographic appearances
irregular bony margins
what defines pectus excavatum
depressed sternum caused by congenital defect
a proliferative bony lesion of increased density is generally termed what
osteoblastic
which bony landmark is most easily palpated on the obese patient for sternum and rib projections
jugular notch
which oblique position is preferred for a study of the sternum and why
RAO to place the sternum over the heart
what is the most common error for oblique position of the sternum
over-rotation
where is CR for the oblique and lateral projections of the sternum
midway between jugular notch and xiphoid process
what other position can be performed if the patient cannot assume a prone position for the oblique position of the sternum
LPO
what is the recommended SID for a lateral projection of the sternum and why
60-72” to reduce magnification and compensate for the OID
what criteria apply to a radiograph for an evaluation of the oblique sternum
the entire sternum should lie over the heart shadow and should be adjacent to the spine
where is the CR centered for a PA projection of the sternoclavicular joints
level of T2-T3
what type of breathing instructions should be provided to the patient for a PA projection of the sternoclavicular jonts
suspend respiration on expiration
how much rotation of the thorax is recommended for an anterior oblique of the sternoclavicular joints
10-15 degrees from PA position
which specific oblique position best demonstrates the left sternoclavicular joint adjacent to the spine
LAO
what are the 3 points that must be included in the patient’s clinical history before a rib series
- nature of the trauma or patient complaint
- location of the rib pain or injury
- if the injury was caused by trauma to the thoracic cavity
where is CR centered for an AP projection of the ribs for an injury located above the diaphragm
3-4” below jugular notch (T7 level)
which two specific oblique positions can be used to elongate the left axillary portion of the ribs
RAO and LPO
which two basic projections or positions should be performed for an injury to the right anterior ribs
PA and LAO
how many degrees of rotation are required for an oblique projection of the axillary ribs
45 degrees
what is the recommended SID for a bilateral lower rib study on an adult
72”
what is the recommended kVp range for a study of the unilateral, upper anterior ribs
70-85 kVp
which region of the ribs is best demonstrated with an RAO projection
left axillary portion of the ribs
which chest position should be performed (pt. can’t stand) for a possible pneumothorax in the left thorax
right lateral decub chest
an RAO of the sternoclavicular joints projects with joint closest to the spine
right
to minimize the patient dose for an RAO projection of the sternum, the patients skin should be at least how far below the collimator
15” (40 cm)
which condition may require that a chest routine be included along with a study of the ribs
hemothorax
a radiograph of an RAO sternum shows part of the sternum is superimposed over the thoracic spine. Which specific positioning error is visible on this radiograph
under rotation
a radiograph of an RAO sternum shows the sternum is difficult to visualize because of excessive density. the following factors were used - 100 kVp, 25 mA, 3 seconds, 40” SID and bucky. which factors should be modified
lower the kVp to range of 70-85
a radiograph of an RAO sternum shows the sternum is poorly visualized because of excessive lung markings superimposed over the sternum. the following factors were used - 75 kVp, 200 mA, 1 second, 40” SID and bucky. what factors need to be altered
lower mA and increase time
a radiograph of a lateral projection of the sternum shows the patient’s breasts are obscuring the sternum. what can be done
ask pt to sperate them
repeat PA projections of the sternoclavicular joints do not clearly demonstrate them. what other imaging modality may produce a more diagnostic image
CT
a patient with trauma to the sternum and the left SC joint region enter the ER. in addition to the sternum routine, the physician asks for a specific projection to better demonstrate the left SC joint. what positioning routine would be used
15-20 degree RAO sternum with orthostatic breathing, lateral sternum taken on inspiration, and a 10-15 degree LAO of SC joint on inspiration
a patient enters the ER on a trauma board, due to condition of the patient, the physician orders a portable study of the sternum in the ER. what two projections of the sternum would be most diagnostic yet would minimize movement of the patient
LPO and horizontal beam lateral
a patient with trauma to the right upper anterior ribs enters the ER. he is able to sit in an erect position which positioning routine of the ribs should be performed
PA and LAO done erect and taken on inspiration
a patient with trauma to the left lower anterior ribs enters the ER. which positioning routine of the ribs should be performed
PA and RAO done recumbent and taken on expiration
an elderly patient comes to the department for a complete rib series with an emphasis on the posterior ribs. she has advanced osteoporosis and has difficulty moving and lying down. the physician wants both upper and lower ribs examined, what type of positions should be performed
AP and both obliques taken erect and with a lowered technique
a patient enters the ER with blunt trauma to the chest. he is restricted on a trauma board. the physician suspects a flail chest, beyond initial chest projections, what positioning routine would confirm the flail chest
limited rib series
