Chapter 10 Flashcards
The act of respiration are created by the synchronous work of
muscles attached to the rib cage and atmospheric pressure
The bony thorax also serves to protect important organs of the __ and vital structures within the __.
respiratory system & mediastinum, such as the heart and great vessels
The bony thorax consists of the
sternum anteriorly, the thoracic vertebrae posteriorly, and the 12 pairs of ribs
The adult sternum is a thin, narrow, flat bone with three divisions:
the manubrium, body, and xiphoid process
The total length of the adult sternum is approximately
6 to 7 inches
The sternum is composed of
highly vascular cancellous tissue (spongy bone) covered by a thin layer of compact bone.
This vascular cancellous tissue allows for the sternum to be a common site for
marrow biopsy, where a needle is inserted under local anesthesia into the medullary cavity of the sternum to withdraw a sample of red bone marrow.
superior portion of the sternum is the manubrium , which averages __ in length
2 inches (5 cm)
widest portion of the sternum.
Manubrium
The middle and longest part of the sternum is the __, which is about __ long
body & 4 inches (10 cm
At birth, the body of the sternum is in __ separate segments.
4
The union of these four segments begins during puberty and may not be complete until about the age of
25 years.
The most inferior portion of the sternum is the
xiphoid (zi-foid) process
xiphoid process is composed of cartilage during infancy and youth. It does not become completely ossified until about the age of
40 years.
The first seven pairs of ribs are considered
true ribs
True ribs are those ribs that connect directly to the sternum with a short piece of car-tilage, called
costal cartilage
term __ applies to the last five pairs of ribs, numbered 8 through 12. Rib pairs 8 to 10 have costal cartilage that merges together and joins the costal cartilage of rib 7.
false ribs
Rib pairs 11 and 12 do not have costal cartilage and therefore do not connect to the sternum. The term __ can be used to designate these two pairs of ribs.
floating ribs
Each rib has two ends, a posterior or vertebral end, which articulates with the __ and an anterior or sternal end, which articulates with the __
thoracic vertebrae & costal cartilage
The vertebral end consists of a __, which articulates with one or two thoracic vertebral bodies,
head
Lateral to the neck is an elevated tubercle that articulates with the __ and allows for attachment of a ligament.
transverse process of a vertebra
the inferior internal margin of each rib is the costal groove, which protects an
artery, a vein, and a nerve.
posterior or vertebral end of a typical rib is 3 to 5 inches (8 to 13 cm) __ than the anterior or sternal end.
superior
When counting the ribs in a thorax image, count the __ ribs to obtain the correct number of ribs above or below the diaphragm.
posterior
What ribs are short, broad, and the most vertical of all the ribs and also have the sharpest curvature at the angle.
First ribs
The bony thorax is typically widest at the lateral margins of the
eighth or ninth ribs.
The jugular notch is at the level of.
T2-T3
inferior end of the manubrium joins the body of the sternum to form a palpable anterior prominence, the
sternal angle
The sternal angle is at the level of the
Inteverebral disk space between
T4 and T5
The xiphoid process corresponds to the level of.
T9-T10
Inferior costal margin, the lowest margin of the bony thorax, corresponds to the level of
L2-L3
Each clavicle articulates medially with the manubrium of the sternum at the clavicular notch to form the
sternoclavicular joint
is the only bony connection between
shoulder girdle and the bony thorax.
Sternoclavicular joint
the first seven pairs of ribs connect anteriorly to the stenum through individual sections
costel cartilage
The sternum has seven pair of __ located laterally along the manubrium and body to accept the costal cartilage.
facets, or depressions,
The first pair of facets is located just below the
clavicular notch.
The second costal cartilage connects to the sternum at the level of the
sternal angle.
third through seventh costal cartilages connect
directly to the lateral body
Ribs 8, 9, and 10 also possess costal cartilage, but these connect to the
costal cartilage of rib pair 7,
costochondral union, or junc-tion, which is between the costal cartilage and the sternal end of a rib
• Joint Classification:
• Mobility Type:
• Motion:
• Joint Classification: Unique. The cartilage and bone are bound together by the periosteum of the bone.
• Mobility Type: Synarthrodial
• Motion: No movement
sternoclavicular joint, which occurs between a clavicle and the manubrium of the sternum and contains an articular capsule.
• Joint Classification:
• Mobility Type:
• Motion:
• Joint Classification: Synovial
• Mobility Type: Diarthrodial
• Motion: Plane (gliding)
sternocostal joint of the first rib. The costal cartilage of the first rib attaches directly to the manubrium with no synovial capsule, unlike the sternocostal joints of ribs 2 through 7 (see D and below).
• Joint Classification:
• Mobility Type:
• Motion:
• Joint Classification: Cartilaginous
• Mobility Type: Synchondrosis
• Motion: No movement
sternocostal joints typical of the second through seventh rib pairs between costal cartilage and sternum.
• Joint Classification:
• Mobility Type:
• Movement:
• Joint Classification: Synovial
• Mobility Type: Diarthrodial joints
• Movement: No movement
interchondral (endochondral) joints between the costal cartilages of the anterior sixth through ninth ribs. These are all interconnected by a long, thin, articular capsule lined by synovial membrane.
• Joint type:
• Mobility:
• Movement:
• Joint type: Synovial
• Mobility: Diarthrodial
• Movement: Plane (gliding)
The joints between the ribs and the vertebral column, the costotransverse joints (F) and the costovertebral joints (G), are
Joint classification:
Mobility type:
Movement:
Joint classification: synovial joints with articular capsules lined by synovial membrane,
Mobility type: diarthrodial
Movement: plane or gliding motion,
To demonstrate the sternum, the patient is rotated in a
15° to 20° right anterior oblique (RAO) position.
(RAO) position allows for two important results when imaging the sternum
First, the sternum is shifted just to the left and away from the dense thoracic spine. Second, it superimposes the sternum over the heart
A patient with a shallow or thin chest requires __ rotation than a patient with a deep chest to cast the sternum away from the thoracic spine.
more
breathing technique, also referred to as an __, may be performed for the RAO of thé sternum.
orthostatic technique
Sternoclavicular joint projections are typically best performed __
rather than __
PA rather than AP
due to magnification and radiation to thyroid
4 considerations for positioning ribs
- The nature of the patient’s complaint
- The location of the rib pain or injury
of ribs that are visualized through the diaphragm. - Whether the injury was caused by trauma to the thoracic cavity
- Whether the patient is able to stand
The upper __ generally represent the minimum number of ribs above the diaphragm on full inspiration,
nine posterior ribs
Use of automatic exposure control (AEC) is or is not recommended?
Not!
due to the lack of uniformity of tissue density within the bony thorax region.
To demonstrate ribs above the diaphrag on the radiograph, the following actions are recommended:
- Erect Gravity assists in lowering the diaphragm, deeper inspiration,
- ** Suspend respiration and expose on deep inspiration if the patient is able**
two-step process can be followed for ease in determining the necessary rib projections and patient positions.
- AP vs PA: Select the projection that will place the area of interest closest to the image receptor.
- Oblique ribs: After imaging the patient in previous step, rotate the patient 45° so that the spine moves away from the area of interest.
patient who has trauma to the right anterior ribs. Two preferred projections would be
PA and left anterior oblique (LAO). The PA will place the site of injury closest to the image receptor, and the LAO will rotate the spinous process away from the site of trauma
Some department protocols request the technologist tape a small metallic BB or some other small type of radiopaque marker over the site of injury before obtaining the images. This ensures that the
radiologist is aware of the location of the trauma or pathology as indicated by the patient.
Departmental protocols also differ concerning the inclusion of a __ study as part of a rib examination.
chest
history of rib injuries may require projections with inspiration/ expiration projections to assess for pneumothorax, hemothorax, pulmonary contu-Sion, or other chest pathology
erect PA and lateral of the chest
Two primary concerns in pediatric radiography are patient
motion and safety.
A __ help reduce patient motion.
short exposure time with optimal ma and kVp
A breathing technique, as described in the sternum imaging, for pediatrics is
is not indicated for the young pediatric patient.
can be used as a landmark to indicate the lower margin of the ribs.
The iliac crest or lower costal angle
refers to a break in the structure or continuity of a bone.
fracture
Rib fractures are most commonly caused by
trauma or underlying pathology.
particular, fractures to the first rib are often associated with injury to the __, whereas fractures to the lower ribs (9 to 12) may be associated with injury to the
underlying arteries or veins
spleen, liver, or kidney
occurs when ribs are fractured in two or more places on multiple adjacent ribs, creating a segment of ribs that are unattached to the bony thorax.
Flail chest
If flail chest injury is suspected, perform rib studies
erect if the patient’s condition permits for best visualization.
are conditions present from birth that may become more evident as a child ages.
Congenital anomalies
This defect is characterized by anterior protrusion of the lower sternum and xiphoid process.
Pectus carinatum (pigeon breast):
this deformity is characterized by a depressed sternum.
Pectus excavatum: Also referred to as funnel chest,
Primary malignant neoplasms spread to distant sites via blood and lymphatics.
Metastases:
-destructive lesions with irregular margins
Osteolytic
-proliferative bony lesions of increased density
Osteoblastic
-moth-eaten appearance of bone resulting from the mix of destructive and blastic lesions
Combination osteolytic and osteoblastic
: This localized or generalized infection of bone and marrow can be associated with postoperative complications of open-heart surgery, which requires the sternum to be split.
Osteomyelitis
Pectus carinatum (pigeon breast)
Pectus excavatum (funnel chest)
What positions
Routine chest and possible lateral sternum
Exposure factors
Osteolytic:
Osteoblastic:
Osteolytic: decrease (-)
Osteoblastic: increase (+)
