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bony thorax
bony thorax-sternum and ribs
| Question | Answer |
|---|---|
| List the 3 structures that make up the bony the bony thorax. | sternum, thoracic vertebra and 12 pairs of ribs |
| What is the term for the long, middle aspect of the sternum? | body |
| The most distal aspect of the sternum does not ossify until a person is approximately ___ years of age | 40 |
| The total sternum length on an average adult is about ____ inches (___cm). | 6 inches (15cm) |
| The xiphoid process of the sternum is at the approximate level of the ____ vertebra | T9 to 10 |
| The sternal angle is at the level of | T4 to 5 |
| What is another term for the sternal angle? | Manubriosternal joint |
| What is the name of the joint that connects the upper limb to the bony thorax (the only bony connection between the bony thorax and upper limb)? | Sternoclavicular joint |
| What is the name of the section of cartilage that connects the anterior end of the rib to the sternum? | Costicartilage |
| What distinguishes a true rib from a false rib? | true ribs connect to the sternum by their own costicartilage. False ribs are connected to the sternum via the costicartilage of the 7th rib. |
| True/False: the 11th and 12th ribs are classified as false and floating ribs | true |
| True/False: the anterior end of the ribs is called the vertebral end. | False (called the sternal end) |
| Which aspect of the ribs articulates with the transverse process of the thoracic vertebrae? | Tubercle |
| List the 3 structures found within the costal groove of each rib? | 1. Artery, 2. Vein, 3. Nerve |
| Which end of the ribs is most superior- the posterior vertebral ends or the anterior stenal ends? | Posterior vertebral ends |
| Approximately how much difference in height is there between these two ends of the ribs? | 3 to 5 inches (7.5 to 12.5 cm) |
| Which ribs articulate with the upper lateral aspect of the manubrium of the sternum? | 1st (anterior sternal end) |
| The bony thorax is widest at the lateral margins. | 8th and 9th |
| How many posterior ribs are shown above the diaphragm? | 11 |
| what movement type is 1st sternocostal | immovable- synarthrodial |
| what movement type is 1st through 12th costoverebral joints | movable - diarthrodial (plane or gliding) |
| what movement type is 1st through 10th costochaondral unions (between costicartilage and ribs) | immovable - synarthrodial |
| what movement type 1st through tenth costatransvertse joints (between ribs and transverse processes of T vertbrae | movable - diarthrodial (plane or gliding) |
| what movement type is 2nd through 7th joints (between 2nd and 7th ribs and sternum) | movable - diarthrodial (plane or gliding) |
| what movement type is 6th through 9th interchodral joints (between anterior 6th and 9th costal cartilage) | movable -diarthrodial (plane or gliding) |
| what movement type is 9th and 10th interchondral joints between the cartilage | fibrous - syndesmosis |
| The joints that have diarthrodial movement are classified as | synovial |
| what is unique about the True ribs (1 through 7) | Each rib attaches to the sternum by it own costicartilage |
| What is unique about Floating ribs (11 through 12) | They don't connect to anything anteriorly (thus the term "floating" ribs). |
| True/False: It is virtually impossible to visualize the sternum with a direct PA or anteroposterior (AP) projection. | True |
| True/False: A large, "deep-chested" (hyperstenic) patient requires more obliquity for a frontal view of the sternum as compared with a "thin-chested" (asthenic) patient. | False (less obliquity) |
| How much rotation should be used for the oblique position of a sternum for a large, "deep-chested" patient? | Approximately 15 degrees |
| List the recommended ranges for the following analog exposure factors as they apply to an oblique position of the sternum (orthostatic-breathing technique | kv range:65 to 70 kV (5 to 10 kV higher typically for digital systems) mA (low or high):low Exposure time (short or long): high (2 to 3 seconds) with orthostatic breathing technique. |
| What is the advantage of performing an orthostatic (breathing) technique for radiography of the sternum? | It blurs lung markings and ribs, which improves the visibility of the sternum |
| What is the primary reason that a source image receptor distance (SID) of less than 40 inches (102cm) should not be used for sternum radiography? | Increase in patient dose, especially skin dose |
| What other imaging option is available to study the sternum if routine RAO and lateral radiographs do not provide sufficient information? | CT or nuclear medicine |
| Identify the preferred positioning factors to demonstrate an injury to the ribs found below the diaphragm: | general body position: recumbent breathing instruction: expiration recommended kV range: medium kV range 70 to 80kV and 80 to 90 kV for digital systems |
| An injury to the region of the 8th or 9th rib requires the_____ diaphragm technique | above |
| The properly elongate and visualize the axillary aspect of the ribs, the patient's spine should be rotated ___ the area of interest. | Away from |
| Which two rib projections should be performed for an injury to the right posterior ribs? | AP and RPO (to shift spine away from area of interest) |
| Which projections should be performed for an injury to the anterior aspect of the ribs? | PA and anterior obliques (placing the area of interest closest to the IR is one recommended routine) |
| How can the site of injury be marked for a rib series? | By taping a small, metallic "BB" or other opaque marker over the site of injury |
| Which is preferred for a study of the sternum and why? | RAO; it places the sternum over the heart to provide a uniform background for added visibility of the sternum. |
| Where is the CR centered for the oblique and lateral projections of the sternum? | Midsternum (midway between jugular notch and xiphoid process) |
| What other position can be performed if the patient cannot assume a prone position for the RAO sternum? | LPO (oblique supine position) |
| What is the recommended SID for a lateral projection of the sternum? Why | 60 to 72 inches (152 to 183 cm); reduce magnification created by the long object image receptor distance (OID) |
| What criteria apply to a radiograph for an evaluation of the oblique sternum? | the entire sternum should lie over the heart shadow adjacent to the spine. |
| Where is the CR centered for a PA projection of the sternoclavicular joints? | Level of T2-T3 |
| What type of breathing instructions should be given to the patient for a PA projection of the sternoclavicular joints? | Suspend respiration on inspiration |
| How much rotation of the thorax is recommended for an anterior oblique of the sternoclavicular joints? | 10 to 15 from PA position |
| Which specific oblique position best demonstrates the left sternoclavicular joint adjacent to the spine? | LAO |
| What are the three points that must be included in the patient's clinical history before a rib series? | 1. the nature of the trauma or patient complaint, 2. the location of the rib pain or injury, 3. whether or not the patient has been coughing up blood |
| Where is the CR centered for an AP projection of the ribs for an injury located above the diaphragm? | 3 to 4 inches (8 to 10cm) below the jugular notch, level of T7 |
| Which two specific oblique positions can be used to elongate the left axillary portion of the ribs? | RAO or LPO elongates the left axillary ribs (and shifts the spine away from the injury site) |
| Which two basic projections or positions should be performed for an injury to the right anterior ribs? | PA and LAO (to elongate the right axillary rib region) |
| How many degrees of rotation are required for an oblique projection of the axillary ribs? | 45 degrees |
| What is the recommended SID for a bilateral lower rib study on a adult? | 72 inches (183cm) |
| True/False: An RAO of the SC joints projects the left joints closest to the spine | true |
| Which region of the ribs is best demonstrated with an RAO projection? | left anterior |
| True/False: An RAO of the SC joints projects the left joints closest to the spine. | False |
| To minimize patient dose for a RAO projection of the sternum, the patient's skin should be at least ___ below the collimator | 38 inches (97cm) |
| Which one of the following conditions may require a chest routine be included along with a study of the ribs? | Hemothorax |
| Bilateral ribs above diaphragm: | anatomy demonstrated: 9th through 10th ribs are cut off at left lateral margin part positioning: tilt of body toward projected ribs nos. 9 to 10 below collimation field |
| Oblique sternum | anatomy demonstrated: all pertinent anatomic structures included part positioning: sternum is over-rotated; sternum away from the spine and rotated beyond heart shadow and distorted |
| AP ribs below diaphragm | anatomy demonstrated: Right lower ribs cut off; only lower three air of ribs demonstrated, including diaphragm is too low from poor expiration Collimation and CR: IR should be placed crosswise to prevent lateral margins of ribs from being cut |
| Lateral sternum | anatomy demonstrated: lower aspect of sternum cut off |
| List the three parts of the sternum | manubrium, body, xiphoid process |
| What is the most distal aspect of the sternum? | Xiphoid process |
| What is the name of the palpable junction between the upper and midportion of the sternum? | Manubrium |
| What distinguishes a true rib form a false rib? | A true rib attaches directly to the sternum with its own costicartilag. |
| What distinguishes a floating rib form a false rib? | A floating rib does not possess costicartilage |
| The 5th rib is an example of a ___ | true rib |
| Which part of the sternum do the 2nd ribs articulate? | sternal angle |
| Which of the following structures is (are) found in the costal groove of each rib? | nerve, artery, vein |
| type of movement for costovertevral joint | Plane (gliding) - diarthodial |
| type of movement for sternoclavicular | Plane (gliding) - diarthodial |
| type of movement for 1st sternocostal joint | immovable- synarthrodial |
| type of movement for 8th interchondral joint | Plane (gliding) - diarthodial |
| type of movement for 3rd costochondral union | immovable- synarthrodial |
| List the correct positioning consideration for a study of the ribs above the diaphragm | a. breathing instructions: suspend inspiration b. kV range: 65 to 75 c. general body position: erecr |
| What is the minimum SID for radiography of the sternum? (note: This is a radiation safety concern) | 40 inches |
| What breathing instructions should be employed for a RAO position of the sternum to maximize visibility of it? | Orthostatic-breathing technique |
| List the two factors to be considered when determining which specific projections to include in the rib routine. | patient clinical history department protocol |
| What is the range of body rotation for an RAO position of the sternum? | 45 degrees |
| Does an asthenic patient require a little more or a little less obliquity than a hyperthenic patient? | little more |
| What other position can be used for the sternum if the patient cannot assume the recumbent RAO position? | LPO |
| how should the arms be positioned for an erect lateral projection of the sternum? | arms above the head |
| Which radiograph sign can be evaluated to determine whether rotation is present on a PA projection of the sternoclavcular joint? | by equal distance of sternoclavicular joints from vertebral column on both sides |
| How much rotation of the thorax is required for the anterior oblique projection of the sternoclavicular joints? | by bony margins |
| Where is the CR centered for an AP projection of the ribs below the diaphragm? | to level of xiphoid process |
| What range of kV for analog imaging should be used for ribs above the diaphragm? | 65 to 75 kV range analog 75 to 85 kV range digital |
| Which one of the following positions or projections will best demonstrate the right axillary ribs? | LAO and RPO |
Created by:
dcausey