Lecture 1 - Ribs Sternum SC Joints Flashcards
What are some reasons that we would image the sternum?
- Fracture from blunt trauma
- . Fracture from CPR
What is the reason we would image the SC joint?
SC joint dislocation
What are some of the reasons that we would image the ribs?
- Direct complications of rib fractures (pneumothorax, hemothorax, contusions)
- Metastases
- Rib fractures themselves
What are metastases?
Cancer in the lungs (appear circular)
What is a pneumothorax?
What does it cause?
Air in the pleural space causing lung to collapse
What is a lung contusion?
Trauma to the lung that has caused bleeding in the alveolar capillaries without tear to the lung tissue
What type of body position is most comfortable for fracture patient
Erect position
Review sternum anatomy
Refer back to last semester notes
What body type is (A+C) and (B+D) representing?
A+C=hypersthenic
B+D=asthenic
Why do we image RAO for the sternum?
Why not LAO, AP/PA, or LPO?
- The sternum would be superimposed over the thoracic vertebrae if AP/PA
- RAO places the sternum over the homogenous density of the heart, so it prevents burn out as opposed to LAO
- RAO reduces OID compared to LPO (increases SR)
Is this image taken with or without a breathing technique?
Without breathing technique
For positioning the RAO sternum, how do you determine the obliquity?
Obliquity is 15-20 degrees
15 for hypersthenic
20 for asthenic
Textbook answer
In actuality, use 45 degrees
What should you see on an RAO sternum?
- Entire sternum from jugular notch to tip of Xiphoid process
- Blurred pulmonary markings with breathing technique
- Sternum projected over the heart and off the spine
What projection is this?
Sternum; RAO
Why do we use a 180cm OID for a lateral sternum?
To compensate for the increased OID/prevent magnification
When positioning a patient for a lateral sternum, should we position AP or lateral? Why?
Center lateral: Because with larger patients, if you centered AP, you could clip off part of the sternum
Why shoud we not use AEC for a lateral sternum?
Image will be underexposed and cause quantum mottle
List one thing that should have been done for this projection that the tech didnt do:
Tilt the collimator
What are the positives and negatives about this image of the sternum?
Positives: Good obliquity
Negatives: FOV too large, should have been windowed
Critique this image:
-FOV too large
-Should have been windowed
-They forgot the breathing technique
Which SC dislocation, (anterior, posterior) is more harmful?
Posterior dislocation-can be life threatening
How to you acess that there is no rotation in PA SC joint imaging?
-Spinous processes should be in the middle of trachea
-Compare spinous processes to the medial edge of the clavicle
What projection is this? Critique the image:
SC joints: PA
-Rotation is making image look like an RPO/LAO
How much should the patient be rotated for RAO/LAO SC Joints?
15-20 degrees
Textbook answer
In real life, use 45 degrees
What does an RAO SC joint projection demonstrate?
RAO demos Right SC joint (to the left of spine) – use R marker only face down
What does an LAO SC joint projection demonstrate?
LAO demos Left SC joint to the right of the spine – use L marker only face down
What projection is this?
LAO position of the x-ray image demonstrating the left SC joint
-Marker is incorrect
(Could be RPO, but we do not do that position)
What projection is this? Critique this image:
SC joints; RAO (dem. R joint)
-Perfect image
-Good FOV
-Can see spine
-Can see right SC joint clearly
What projection is this? Critique the image:
LAO
-Poor image
-Patient is not rotated enough (too shallow)
-Spine is over the joint space
What considerations should you make prior to imaging the ribs?
-Where the area of interest is;
a. Is it above or below diaphram?
b. Is it anterior or posterior?
Why do we image erect for upper ribs?
Gravity bring the diaphram lower in an upright position?
What are the benefits of imaging on a full inspiration?
-Moves diaphram down
-Decreases obliquity of ribs
What are the benefits of imaging on full expiration?
-Moves the diaphram up
-Increases obliquity of ribs
If the patient is experiencing pain in the anterior ribs, how would you image them?
AP
What type of respiration demonstrates all 10 ribs?
Full insipiration
Is this taken on inspiration or expiration?
Expiration
What projection is this? Critique the image:
Unilateral upper ribs
-Bad image;
a. Scapula is in the image (shoulders not rolled forward)
b. Patient rotated RAO (trachea is to the right of the spinous processes)
c. Can see the soft tissue of the arm
What projection is this? Is it a good or bad image? Why?
Bilateral lower ribs
Good image; it has ribs 8-12 included
What projection is this? Critique the image:
Bilateral lower ribs
-Bad image;
a. Image is acquired on inspiration
b. Body position erect
c. 8th rib is not included
What projection is this?
Unilateral lower ribs
(almost cut of the 8th rib)
What does a LPO/RAO body position for the oblique ribs demonstrate?
The left side
What does a RPO/LAO body position for the oblique ribs demonstrate?
The right side
What projection is this? Critique this image:
LPO/ RAO to demon. the L side
Positives: Demonstrates the axillary portion of ribs
Negatives: Taken during inspiration, over obliqued (ribs are over glenoid)
What is Dual Energy Chest/Ribs imaging?
What kVp do you use?
Some sites are using dual energy exposures (PA chest at 120 kVp and 60 kVp). The computer separates the soft tissue image from the bone image.
