Sternum, SC Joints and Ribs

Question 1

What are causes of sternum fractures?

Answer 1

from blunt trauma (eg. steering wheel - car crash) and CPR

Question 2

What are implications of a sternum fracture?

Answer 2

can lead to serious lung, heart or vascular injury

Question 3

What sport are SC joint locations common in?

Answer 3

wrestling

Question 4

What are complications of rib fractures?

Answer 4

pneumothorax, hemothorax or lung contusions

Question 5

What can cause rib fractures?

Answer 5

metastases and blunt trauma

Question 6

What are positioning considerations for sternum, sc joints and ribs?

Answer 6

patient changed from the waste up
erect position preferred and most comfortable for most fracture patients

Question 7

What is the level of the jugular notch?

Answer 7

T2-3

Question 8

What is the level of the Xiphoid process?

Answer 8

T10

Question 9

Sternum positions

Answer 9

RAO - sternum would be superimposed over thoracic vertebra is AP/PA
Lateral
Collimate to include above jugular notch and below diploid process

Question 10

Sternum RAO justification

Answer 10

preferred over LAO as it places sternum over the homogenous density of the heart (reducing burnout)
RAO preferred over LPO - less OID

Question 11

Sternum - RAO position

Answer 11

Wipe down Bucky
detector in portrait orientation
position and centre with patient AP
Oblique (15-20 test answer) 30-40 onto right side
CR - perpendicular
CP on raised side (left) 1-2’ left of midline and midway between judge notch and zippy
shield patient
shallow breathing technique to blur lung markings

Question 12

what implication does chest depth have on the positioning for RAO sternum?

Answer 12

deeper chests require less rotation than shallow chests

Question 13

breathing technique for RAO sternum?

Answer 13

use shallow breathing to blur lung markings
can suspend on expiration - not incorrect just not preferred as it does not demonstrate as well

Question 14

RAO sternum image

Answer 14

entire sternum from jugular notch to tip of xiphoid
blurred pulmonary markings
sternum projected over the heart and off the spine
SID 102

Question 15

Lateral Sternum Position

Answer 15

detector portrait
patent erect
roll shoulders back
SID 180
Centre between jugular notch and xiphoid
turn collimator to match sternum
CR - perpendicular
Suspend on full inspiration
Shielding
Do not use AEC

Question 16

SC joints positions

Answer 16

PA
RAO
LAO

Question 17

why is a posterior SC joint dislocation worse?

Answer 17

puts ate risk for damaging major important vessels like the carotid

Question 18

PA SC joint position

Answer 18

Wipe down Bucky
landscape detector
MSP to midline of bucky
SID 102
CR - perpendicular
CP - at jugular notch
suspend respiration on exhalation
Shielding
both markers face down

Question 19

RAO/LAO SC joint position

Answer 19

wipe down bucky
landscape detector
Pt. rotated 30-40
CP - at level of jugular notch 1-2” lateral to MSP on raised side (collimate to spinous process)
Suspend on expiration
RAO demonstrates right SC joint (to the left of the spine) use R marker only

Question 20

on an exam if it says “if hung correctly” what does that mean?

Answer 20

hung AP

Question 21

Rib positions

Answer 21

AP/PA
oblique

Question 22

What re the rib rules?

Answer 22

you must determine where the area of interest is
- above or below the diaphragm
- anterior or posterior

Question 23

Rib imaging

Answer 23

body position - diaphragm can move more inferiorly when erect
respiration
- full inspiration moves diaphragm down and decreases obliquity of the ribs - UPPER
- full expiration moves the diaphragm up and increases the obliquity of the ribs - LOWER - supine

Question 24

Upper ribs AP/PA position

Answer 24

1-10 minimum - more if you can
bilateral or unilateral
PA for anterior ribs
AP for posterior ribs
Roll shoulders forward with hands on hips
CR - perpendicular
include C7
CP - midline 3-4” below jugular notch
suspend on full inspiration
SID - 180

Question 25

Lower Ribs AP position

Answer 25

landscape if bilateral
patient supine
CR - perpendicular
CP - MSP between T8 (2” above xiphoid) and iliac crests
Suspend on expiration
SID 102

Question 26

Oblique upper ribs

Answer 26

axillary portion of the ribs demonstrated free of super imposition
LPO/RAO demonstrates left side
RPO/LAO demonstrates right side

Question 27

Oblique super ribs position

Answer 27

detector portrait
Include C7
include as many ribs as possible (1-10 necessary)
oblique patient 45
include from spine to past lateral border
suspend on inspiration
move humerus out of way