Positioning Of Sternum, Ribs And SC Joints

Question 1

What will superimpose the sternum if we shoot straight AP or PA?

Answer 1

The spine

Question 2

For an AP projection, which body position would cause the sternum to be projection over the heart

Answer 2

-LPO/RAO

Question 3

For an AP projection, which patient body habitus would require more rotation of the MCP to move the sternum off the spine

Answer 3

Sthenic patient

Question 4

A _____ patient requires less rotation than a smaller one

Answer 4

Hypersthenic

Question 5

Routine sternum protocol

Answer 5

• PA oblique

- lateral

Question 6

Sternum PA oblique (RAO position)

Answer 6

• 110 SID
• the side that you are imaging is against the detector
• start with patient facing you
• 1 finger above jug notch top of light
• bottom of light at xiphoid (ask patient to tell you where ribs meet)
• center (-) in the middle of jug notch and xiphoid
• collimate from side to side to the SC joints (sternoclavicular)
• get pt to face detector with right side touching detector
• marker in bottom lateral (put marker before they turn to face detector)
• palpate jug notch and spinous process and turn them until sternum isn’t on spine (sternum projected off spine)
• put arm up rest on upper detector button remote
• center between medial border of scapula and spinous processes
• move pts whole body over to get them centered into the light (dont ever change obliquity just change left to right if (I) is not center)
• exhale and hold
• make sure tracking is on
• shielding
• lightfield will appear on left side but actually visualizing right side

Question 7

(Left) Lateral sternum

Answer 7

• 180 SID
• 18 X 24 light field
• finger width of light above jug notch (top of light)
• bottom of light at xiphoid (get pt to say where ribs meet)
• make pt buff out chest and reach shoulders back with hands locked behind back to make sure have enough light anteriorly to not clip sternum
• pt can relax chest
• tilt collimator to match breast bone (tilt towards face)
• take a breath in to check to make sure anatomy isn’t being clipped
• cone side to side just so you wont clip
• light should go back to the AC joints (near shoulder)
• marker in top of light
• expose on inspiration

Question 8

Routine rib protocol

Answer 8

• PA chest
• AP or PA projection
• 45 degree AP or PA oblique

Question 9

Breathing instructions for upper ribs (1-10)

Answer 9

Take on inspiration

Question 10

Breathing instructions for lower ribs (8-12)

Answer 10

Take on expiration

Question 11

AP/PA ribs (upper) ribs 1-10

Answer 11

• 110 SID
• 18 X 43 lightfield to start
• two fingers above jug notch top of light
• bottom of light at lower costal margin
• do half ribs at a time (either right or left)
• if ex doing right ribs then the edge of light cannot go farther than left SC joint
• arm needs to be placed on top of detector to move scapula off of ribs or for PA raise arm up on head
• right marker on bottom lateral
• take breath in and hold
• side to side AC to SC of side not doing (or slightly medial of the spine) or a little past spine to armpit area

Question 12

AP lower ribs (8-12)

Answer 12

• 110 SID
• 24 X 30 lightfield to start
• inferior angle of scapula to LCM
• imaging right side so light can’t go past left SC joint medially for ex
• marker on bottom lateral corner
• hold on exhalation
• only do half at a time (so right or left side)
• side to side a little past or at left SC joint if doing right side to armpit area or right AC joint

Question 13

Upper ribs 45 degree oblique (AP)

Answer 13

• 110 SID
• 18 X 43 lightfield to start
• side to side from sternum to AC joint
• put patient in 45 degree oblique (make sure everything is straight at in 45 degree angle)
• top of light two fingers above jug notch
• bottom of light LCM
• marker in top lateral
• arm against IR needs to be up with hand touching head
• hold on inhalation

Question 14

Upper ribs oblique (PA)

Answer 14

• PA AWAY
• 18 X 43 lightfield to start
• 110 SID
• put patient in 45 degree oblique
• put their arm up resting on top of detector
• top of light two fingers above jug notch
• bottom of light LCM
• edge of light medially a little past spinous processes
• center between spine and outer ribs (anterior curve of ribs) kind of in line with front of armpit
• front light will end just past anterior armpit
• hold on inhalation
• marker in top lateral

Question 15

45 degree for lower oblique ribs

Answer 15

• 110 SID
• 24 X 30 lightfield
• top of light inferior angle of scapula
• bottom of light LCM
• can do either AP or PA
• do one side at a time ex right or left
• make sure pt is in 45 degree oblique
• remember if doing PA it is away
• hold on exhalation
• marker in bottom lateral

Question 16

Routine protocol SC joints

Answer 16

• PA

- 15 degree PA oblique

Question 17

PA SC joints

Answer 17

• 110 SID
• 12 X 7 lightfield
• want light longer than wide
• side to side want a finger width of light on either side of SC joint
• center at jug notch
• top of light two fingers above jug notch
• two fingers width of light below SC joint for bottom of light
• center on MSP (I)
• now have pt face detector
• maker in top lateral (put it in place before pt faces detector)
• hold on expiration

Question 18

15 degree oblique PA SC joint

Answer 18

• 110 SID
• 12 X 7 lightfield
• center at jug notch
• two fingers of light above and below
• finger width of light on either side of SC joint
• marker in top lateral
• now have pt face detector
• oblique body 15 degrees
• palate both sides of SC joints and move pts whole body until they are centered in the light field
• center on MSP (I)
• hold on expiration
• rotate MCP until SC joints have been moved off of the spine to the side of the body farthest from the IR (ex in RAO position the joints are moved to the left of the spine)