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Bony Thorax

SJC Zerbe Procedures Semester 2 Unit 3

What's it?That's it.
What is the function of the bony thorax? Protects heart and lungs - Supports pleural cavities and diaphragm
Is the bony thorax longer posteriorly or anteriorly? Longer posteriorly than anteriorly and wider than it is deep
What bone makes up the anterior portion of the bony thorax The sternum
How long is the sternum? It is a flat bone approximately 6” long
The sternum consists of what 3 portions? -Manubrium -Body or Gladiolus or Chorpus -Xyphoid process (ensiform)
What is the widest portion of the sternum? Manubrium
The jugular notch is level with: T2/T3
The sternal angle is level with: T4/T5
The xyphoid process is level with: T9/T10
Which ribs attach directly to the sternum via costal cartilage? 1-7
The costal cartilage of the 2nd ribs attach to what portion of the sternum? At the sternal angle attaching to both the manubrium and the sternal body at the manubriosternal joint
By what age is the xyphoid tip fully ossified? 40 years of age
Which ribs are considered to be true ribs and why? 1-7 -Because they attach directly to the sternum anteriorly via costal cartilage
Which ribs are considered to be false ribs and why? 8-12 -They do not attach directly to the sternum -8-10 costal cartilage attach to the costal cartilage of 7 -11 and 12 do not attach anteriorly at all (also called floating ribs)
Which pair of ribs are the shortest? 1st -They get larger gradually through to 7th pair (longest) -Then begin to decrease
Which pair of ribs are considered to be the broadest? 1st pair -Gradually decrease all the way to 12th pair
How are the anterior ribs positioned in comparison to the posterior ribs? Anterior ribs are 3 to 5” more inferior than the posterior ribs -Obliquity increases from 1 to 9 then decreases
What two joints are located at the vertebral or posterior ends of the ribs? Costovertebral joints: -Head of the rib and the body of the thoracic vertebrae at the facets and demifacets. —Costotransverse joints: -the transverse process and the tubercle of the rib (only thoracic vertebra 1-10 have facets for costotransverse joints.)
What is the name of the junction at the costal cartilage and the sternum? Sternocostal Joints
What is the junction of adjacent costal cartilage? Interchondral joint
What is the junction of the anterior ends of the ribs and the costal cartilage? Costochondral joint
What is the junction of the manubrium and the body of the sternum? Manubriosternal joint -Sternal angle
What joint is at the junction of the body of the sternum and the xyphoid process? Xyphisternal joint
Describe the movement of the ribs during deep inspiration? Anterior ends move: -Anteriorly -Superiorly -Laterally -Necks rotate inferiorly
Describe the movement of the ribs during deep expiration? Anterior ends move -Inferiorly -Posteriorly -Medially -Neck rotate superiorly
The bony thorax is made up of: Sternum, 12 thoracic vertebrae and the 12 pairs of ribs
The space between each of the ribs is called the: intercostal spaces
For which type of body habitus will the diaphragm be at the highest level in the body? hypersthenic
What is the distance of movement of the diaphragm between deep inspiration and deep expiration? 1½ inches
The easy palpable superior border of the manubrium is called the: jugular notch
The suprasternal, manubrial, or jugular notch all correspond to the level of: T2-3
The widest aspect of the thorax occurs at the level of: The eighth or ninth ribs -The boney thorax is Conical in shape -Narrower above than below -More wide than deep -Longer posteriorly than anteriorly
What is the name of the part of the rib that articulates with the thoracic vertebral body? Head -The Costovertebral is made up of the head of the rib to the vertebral body (1st -12th synovial gliding)
What are proper breathing instructions for the RAO sternum? Shallow breathing (long exposure) (BEST!!!) -Suspended expiration (short exposure)
What are the routine projections for the sternum? RAO and upright Lateral
What projections can be utilized for a trauma patient? LPO and x-table lateral (dorsal decubitus)
What is the recommended SID for the RAO sternum? 30” to blur out ribs and heart
What is the recommended SID for the lateral sternum? 72” to reduce magnification
What are the appropriate breathing instructions for the lateral sternum? Suspended inspiration
Where is the IR positioned for the RAO sternum? Long axis of the sternum parallel with the IR with the superior margin of the IR 1 ½” above the jugular notch
What is the CR location for the RAO sternum? perpendicular to IR level with T7 @1” to the left of the spine
How much is the patient obliqued for the RAO sternum? Just enough to separate the sternum and the spine (15-20 degrees) -Big barrel chest less -Thin patient more
What is demonstrated in the RAO projection of the sternum? Entire sternum from the manubrium to the xyphoid tip in a slight oblique projection -The sternum is projected over the heart
Where is the CR directed for the lateral sternum? Perpendicular to the IR entering the lateral border of the sternum midway between jugular notch and the xyphoid tip
Which plane should be parallel to the IR for the lateral projection of the sternum? MSP – parallel with the IR -MCP – perpendicular to the IR
Where is the IR positioned for the lateral projection of the sternum? Top of the IR 1 ½” above the jugular notch
What is the recommended patient position for the Lateral Sternum? ERECT
How are the arms positioned for the lateral sternum (upright) The hands should be clasped behind the back with the chest sticking out
How is the CR directed for the Upright Lateral Sternum? Perpendicular to the center of the IR and entering the lateral border of the mid-sternum
How is the CR directed for the PA SC Joints? Perpendicular to the center of the IR and entering T3 on midline
How is the patients head positioned for the PA projection of the sternoclavicular joints? Resting on the chin for bilateral -Turned toward the affected side if unilateral (will rotate the spine slightly to allow better visualization of the affected joint)
What are the appropriate breathing instructions for the projections of the sternoclavicular joints? Suspended expiration
How is the patient positioned for the PA oblique projections for the sternoclavicular joints? Upright or recumbent -RAO or LAO -10 to 15 degree oblique with the affected side closest to the IR
Where is the IR positioned for the PA oblique projections of the sternoclavicular joints? Affected (downside) joint to the midline with its center at the level of T2/T3 or jugular notch (3” below the vertebral prominens)
How is the CR directed for the PA oblique projection of the SC joints? Perpendicular -Level with T2/3 -1” TO 2” from spine toward the elevated side -CR will enter the back on the elevated side and exit the SC joint closest to the IR
Ribs above the diaphragm are best done in what position? Upright -Diaphragm will reach its lowest point
What is the best patient position to demonstrate below the diaphragm and why? Recumbent -Diaphragm will reach its highest point
For an injury of the anterior ribs what projections should be utilized? PA and PA Oblique projections -RAO for left anterior rib injury -LAO for right anterior ribs
For an injury of the posterior ribs what projections should be utilized? AP and AP oblique projections -LPO for left posterior rib injury -RPO for right posterior rib injury
Where is the IR positioned for the AP or PA projection of the ribs above the diaphragm? MSP centered to its midline with the top margin 1 ½” above the shoulders -If facility does unilateral: Affected side centered to the midline of the IR with its top margin 1 1/2” above the shoulders (do not AEC unilateral ribs)
Where is the CR directed for the AP/PA projection of the ribs above the diaphragm? perpendicular at the level of T7 on the MSP -If facility does unilateral: ½ way between midline and the lateral margin of the body
How should the Arms be positioned for the AP/PA ribs above the diaphragm? Like a AP/PA chest -Posterior hands on the back of the hips with the shoulders rolled forward -Moves the scapula laterally -Or they may be extended above the head
What are the recommended breathing instructions for ribs above the diaphragm? Suspended at the end of inspiration -For the hypersthenic patient – suspended at the end of second deep inspiration -Hypersthenic patient diaphragm is highest with the least amount of movement, 2nd inspiration will move diaphragm to lowest point.
What are the recommended breathing instructions for ribs below the diaphragm? Suspended at the end of expiration -Second expiration for the hyposthenic patient- Diaphragm is lowest for in the hyposthenic patient
How is the IR positioned for AP ribs below the diaphragm? Inferior margin of IR level with the iliac crest on Midsagittal plane -If facility does unilateral – affected side centered to the midline of the IR
Where is the CR directed for AP ribs below the diaphragm? Perpendicular to the IR level with a point midway between the xyphoid tip and lower rib cage on the MSP -If facility does unilateral: ½ way between MSP and lateral surface of the body
What is the recommended patient position for PA Oblique ribs Above the diaphragm – Upright -Below the diaphragm - recumbent
Where is the IR positioned for the LAO and RAO projection of the ribs? Center a plane midway between the midline and the lateral surface of the body (upside) to the midline of the grid and IR Above the diaphragm: -Top of the IR 1 1/2” above the shoulder -Below the diaphragm Bottom of the IR level with the iliac crest
Where is the IR positioned for the RPO and LPO projections of the ribs? Center affected side on a plane drawn midway between the MSP(spine) and lateral surface of the body to the midline of the IR and grid -Above the diaphragm -Top of IR 1 ½” above the relaxed shoulder -Below the diaphragm -Bottom of IR level with iliac crest
How is the CR directed for the RPO and LPO projection of the ribs? Perpendicular to the IR midway between the MSP (spine) and lateral surface of the body of the affected side (downside) -Above the diaphragm: T7 -Below the diaphragm: midway between the xyphoid tip and the lower rib cage
How is the CR projected for the RAO and LAO projection of the ribs? Perpendicular on a longitudinal plane midway between midline (spine) and the lateral surface of the body (upside) -Above the diaphragm: -Level with T7 -Below the diaphragm -Halfway between xyphoid and inferior rib margin
How much is the body rotated for oblique projections of the ribs? 45 degrees -Toward the affected side when AP oblique projection (RPO and LPO) -Away from the affected side when doing PA oblique projections (RAO and LAO)
Axillary ribs are best demonstrated in what position? 45 degree oblique
Why is the RAO sternum preferred to the LAO position? The RAO projects the sternum over the shadow of the heart -Bluring of the heart and more uniform density
Which position will best demonstrate the axillary portion of the left ribs? LPO or RAO
Which of the following conditions may occur with trauma to the ribs? Pneumothorax or Hemothorax
Which two projections should be taken for an injury to the right anterior upper ribs? PA and LAO
When performing the PA oblique projection (body rotation technique) of the sternoclavicular articulations, which of the joints would be demonstrated? the joint closest to the IR
Which ribs are demonstrated on an AP oblique projection? side closest to the IR -The side of interest in the AP oblique projection is the side closest to the IR. If the patient is having pain posteriorly on the left side, then the position should be the LPO
The sternoclavicular joints are best demonstrated with the patient PA and: In a slight oblique position, affected side adjacent to the image receptor. -To reduce OID SC joints should be done PA; A slight oblique of @ 15 degrees will open the joint closest to the IR. Positioning is similar to that of the oblique sternum.
Created by: paigeduh