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Ch. 10 Bony Thorax
Positioning
| Question | Answer |
|---|---|
| What is the main function of the bony thorax? | To serve as an expandable, bellows-like chamber, wherein the interior capacity expands & contracts during inspiration & expiration. |
| What does the bony thorax consist of? | The sternum anteriorly, the thoracic vertebra posteriorly, & the 12 pairs of ribs. |
| What is a common site for marrow biopsy? | Sternum |
| What type of bone is the adult sternum? | Thin, narrow, flat bone with 3 divisions |
| What is the total length of the adult sternum? | Approximately 7 inches |
| What is the upper portion of the sternum? | Manubrium |
| What is the longest part of the sternum? | The body, about 4 inches |
| What is the most inferior portion of the sternum? | The xiphoid process. |
| When is the xiphoid process usually totally ossified? | About the age of 40 years. |
| What is the easily palpable upper portion of the manubrium? | Jugular notch |
| What is another name for the jugular notch? | suprasternal or manubrial notch |
| What level is the jugular notch? | Level of T2-T3 |
| How is the sternal angle formed? | The lower end of the sternum joins the body of the sternum. |
| What level is the sternal angle? | T4 & T5 |
| What level is the xiphoid process? | T9-T10 |
| What level does the inferior rib (costal) angle correspond to? | L2-L3 |
| What is the sternoclavicular joint? | Where each clavicle articulates with the manubrium laterally at the clavicular notch on each side. |
| What is the only bony connection between each shoulder girdle & the bony thorax? | Sternoclavicular joint |
| What do the clavicles & cartilages of the 1st 7 pairs of ribs connect to? | the sternum |
| How do the anterior ribs unite with the sternum? | with a short piece of cartilage termed costocartilage |
| How do ribs 8, 9, & 10 connect to the sternum? | They connect to costocartilage 7, which then connects to the sternum. |
| How is each rib numbered? | According to the thoracic vertebra to which it attaches. |
| What are considered true ribs? | The first 7 pairs of ribs. |
| What does the term false ribs apply to? | The last five pairs of ribs; 8, 9, 10, 11, and 12 |
| Each rib has two ends, what are they called? | A posterior, or vertebral end, & an anterior or sternal end. |
| What is between the 2 ends of the rib? | Shaft, or body. |
| The vertebral end consists of a head, which articulates with what? | One or two thoracic vertebral bodies, and a flattened neck. |
| What is the angle of the rib? | The body extends laterally from the tubercle & then angles forward & downward. |
| *How much higher is the posterior or vertebral end of a typical rib than the anterior or sternal end? | 3 to 5 inches |
| What does the lower inside margin of each rib protect? | An artery, a vein, and a nerve |
| Describe the first ribs. | Short & broad & the most vertical of all ribs. |
| Where is the bony thorax typically widest? | At the lateral margins of the 8th or 9th ribs. |
| Where are costotransverse joints found? | On the 1st-10th ribs. The 11th & 12th ribs lack this joint. |
| Joint Classification: 1st-10th costochondral unions (b/w costocartilage & ribs.) | Unique type of union; synarthrodial (immovable) |
| Joint Classification: SC joints (b/w clavicles & sternum) | Synovial, diarthrodial, Plane (gliding) |
| Joint Classification: 1st sternocostal joint (b/w 1st rib & sternum) | Cartilaginous (synchodrosis); Synarthrodial (immovable) |
| Joint Classification: 2nd to 7th sternocostal joints; 6th to 9th interchondral joints; 1st to 10th costotransverse joints; 1st to 12th costovertebral joints. | Synovial; diarthrodial; Plane (gliding) |
| Why is the sternum difficult to radiograph? | Because of its thin bony cortex & position within the thorax. |
| The sternum is an anterior midline structure that is in the same plane as what? | Thoracic spine |
| Why is it almost impossible to see the sternum in a true AP or PA projection? | Because the thoracic spine is much denser. |
| How is the patient positioned to shift the sternum just to the left & into the heart shadow? | 15-20 degrees RAO |
| What is the degree of obliquity required dependent on? | The size of the thoracic cavity. |
| What technique may be used for radiographic exams of the sternum? | Breathing/orthostatic technique |
| What does an orthostatic technique require? | Lower kV (65+-5), a low mA, & a long exposure time, from 2-3 seconds. |
| What is a minimum SID for sternum radiography? | 40 inches |
| What does a complete clinical history include? | 1. The nature of the pt's complaint. 2. The location of the rib pain or injury. 3. Whether the injury was caused by trauma to the thoracic cavity. |
| What is the SID for all rib studies? | 40 inch SID |
| How to best demonstrate the above-diaphragm ribs. | 1. Pt erect. 2. Suspend respiration & take exposure on inspiration. 3. Select lower kV (65 to 75). |
| How to best demonstrate the below-diaphragm ribs. | 1. Pt recumbent. 2. Suspend respiration & expose on expiration. 3. Select a medium kV (70 to 80). |
| What projections should be selected? | Projections that will place the area of interest closest to the image receptor & rotate the spine away from the area of interest. |
| T or F: Some dept. protocols request that the tech tape a small metallic BB over the site of injury before obtaining the images. | True |
| What projections of the chest may be required to rule out possible pneumothorax, hemothorax, pulmonary contusion or other chest pathology? | erect PA & lateral chest |
| What are the 2 primary concerns in pediatric radiography? | Patient motion & safety |
| T or F: When possible, collimate to the involved region and reduce exposure to the thyroid gland? | True |
| What may geriatric patients require? | Additional assistance, time, and patience |
| What may be provided to the geriatric patient to provide comfort? | a radiolucent mattress or pad. |
| What is useful for visualizing pathology involving the sternum and/or SC joints without obstruction by overlying dense structures? | CT |
| What provides a sensitive diagnostic procedure for detection of skeletal pathologies of the thoracic cage? | Nuclear Medicine |
| Is it common for patients who are at risk or symptomatic for skeletal metastates to undergo a bone scan? | Yes |
| What is a fracture? | A break in the structure of a bone. |
| What are fractures to the first rib often associated with? | Injury to the underlying arteries or veins. |
| What are fractures to the lower ribs (8-12) associated with? | Injury to adjacent organs such as spleen, liver, or kidney. |
| What is a Flail Chest Fracture? | The fracture of adjacent ribs in 2 or more places that is caused by blunt trauma. Can lead to instability of the chest wall. |
| Describe a sternum fracture. | Typically caused by blunt trauma. Associated with underlying cardiac injury. |
| What is Pectus Carinatum (pigeon breast)? | The congenital defect is characterized by anterior protrusion of the lower sternum & xiphoid process. |
| What is Pectus Excavatum? | Funnel chest, this deformity is characterized by a depressed sternum. Rarely interferes with respiration but often is corrected surgically for cosmetic reasons. |
| What are metastases? | malignant neoplasms |
| Osteolystic metastases | destructive lesions with irregular margins |
| Osteoblastic metastases | proliferative bony lesions of increased density |
| Combination osteolytic & osteoblastic | moth-eaten appearance of bone resulting from the mix of destructive & blastic lesions |
| Osteomyelitis | Infection of bone; associated with postoperative complications; most common cause of osteomyelitis is a bacterial infection. |
| How much do you angle for a hypersthenic body type? | 15 degrees |
| How much do you angle for an asthenic/hyposthenic body type? | 20 degrees |
| Which oblique would you do for left posterior pain? | LPO |
| How much boy rotation & which joint is demonstrated on oblique SC joints? | Downside, 10-15 degrees |
| What is the analog kV range for AP ribs below the diaphragm? | 70-80 kV |
| Which positions will demonstrate the axillary portion of the ribs? | Oblique positions |
| Which ribs attach at the sternal angle? | 2nd Rib |
| What is the minimum number of ribs that must be demonstrated on the above diaphragm projection? | 1-10 |
| How to tell rotation on a PA projection of SC joints. | No rotation of patient, as demonstrated by equal distance of SC joints from vertical column on both sides. |
| What is the CR placement for PA SC joints? | Perpendicular; centered to T2-T3. or 3 inches distal to vertebra prominens. |
| For posterior pain, do we do AP or PA projections? | AP-above and AP-below |
| What projections do we do for Anterior pain? | PA above diaphragm & AP below diaphragm |
Created by:
Casinger2015