Sternum, SC Joints and Ribs Flashcards
What are causes of sternum fractures?
from blunt trauma (eg. steering wheel - car crash) and CPR
What are implications of a sternum fracture?
can lead to serious lung, heart or vascular injury
What sport are SC joint locations common in?
wrestling
What are complications of rib fractures?
pneumothorax, hemothorax or lung contusions
What can cause rib fractures?
metastases and blunt trauma
What are positioning considerations for sternum, sc joints and ribs?
patient changed from the waste up
erect position preferred and most comfortable for most fracture patients
What is the level of the jugular notch?
T2-3
What is the level of the Xiphoid process?
T10
Sternum positions
RAO - sternum would be superimposed over thoracic vertebra is AP/PA
Lateral
Collimate to include above jugular notch and below diploid process
Sternum RAO justification
preferred over LAO as it places sternum over the homogenous density of the heart (reducing burnout)
RAO preferred over LPO - less OID
Sternum - RAO position
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
what implication does chest depth have on the positioning for RAO sternum?
deeper chests require less rotation than shallow chests
breathing technique for RAO sternum?
use shallow breathing to blur lung markings
can suspend on expiration - not incorrect just not preferred as it does not demonstrate as well
RAO sternum image
entire sternum from jugular notch to tip of xiphoid
blurred pulmonary markings
sternum projected over the heart and off the spine
SID 102
Lateral Sternum Position
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
SC joints positions
PA
RAO
LAO
why is a posterior SC joint dislocation worse?
puts ate risk for damaging major important vessels like the carotid
PA SC joint position
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
RAO/LAO SC joint position
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
on an exam if it says “if hung correctly” what does that mean?
hung AP
Rib positions
AP/PA
oblique
What re the rib rules?
you must determine where the area of interest is
- above or below the diaphragm
- anterior or posterior
Rib imaging
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
Upper ribs AP/PA position
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
Lower Ribs AP position
landscape if bilateral
patient supine
CR - perpendicular
CP - MSP between T8 (2” above xiphoid) and iliac crests
Suspend on expiration
SID 102
Oblique upper ribs
axillary portion of the ribs demonstrated free of super imposition
LPO/RAO demonstrates left side
RPO/LAO demonstrates right side
Oblique super ribs position
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
