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bony thorax
bontrager
| Question | Answer |
|---|---|
| What is the primary function of the bony thorax? | To serve as an expandable chamber for respiration and to protect vital organs. |
| What are the three divisions of the adult sternum? | The manubrium, body, and xiphoid process. |
| What is the average length of the adult sternum? | Approximately 6 to 7 inches (15 to 18 cm). |
| What type of tissue composes the sternum? | Highly vascular cancellous tissue covered by a thin layer of compact bone. |
| What is the manubrium? | The superior portion of the sternum, averaging 2 inches (5 cm) in length. |
| What is the body of the sternum? | The middle and longest part of the sternum, about 4 inches (10 cm) long. |
| What is the xiphoid process composed of during infancy? | Cartilage. |
| At what age does the xiphoid process typically become completely ossified? | About the age of 40 years. |
| How are the ribs numbered? | Sequentially starting at the first thoracic vertebra. |
| What are true ribs? | The first seven pairs of ribs that connect directly to the sternum. |
| What are false ribs? | The last five pairs of ribs (8-12) that do not connect directly to the sternum. |
| What are floating ribs? | Rib pairs 11 and 12 that do not have costal cartilage and do not connect to the sternum. |
| What is the costal cartilage? | The cartilage that connects the ribs to the sternum. |
| What is the angle of the rib? | The area where the rib curves anteriorly and inferiorly. |
| What is the costal groove? | The groove along the inferior internal margin of each rib that protects an artery, vein, and nerve. |
| What is the significance of the sternal angle? | It is a palpable anterior prominence used to locate other structures of the bony thorax. |
| At what vertebral level is the jugular notch located? | At the level of T2-T3. |
| What is the sternal angle's vertebral level in adults? | At the level of the intervertebral disk space between T4 and T5. |
| What is the relationship between the ribs and thoracic vertebrae? | Each rib pair is attached to a thoracic vertebra. |
| What is the typical appearance of the first rib? | Short, broad, and the most vertical of all the ribs. |
| How does the length of ribs change from the first to the twelfth pair? | They become progressively longer until the seventh rib, then shorter until the twelfth rib. |
| What is the purpose of the sternoclavicular joint? | It is the only bony connection between each shoulder girdle and the bony thorax. |
| What are the palpable landmarks of the bony thorax? | Jugular notch, sternal angle, and xiphoid process. |
| What is the average distance between the posterior and anterior ends of a typical rib? | The posterior end is 3 to 5 inches (8 to 13 cm) superior to the anterior end. |
| What is the importance of knowing the rib count in a thorax image? | To obtain the correct number of ribs above or below the diaphragm. |
| What happens to the body of the sternum during puberty? | The four segments begin to unite. |
| What is the role of the bony thorax in respiration? | It expands during inspiration and contracts during expiration. |
| What are the clinical indications for imaging the bony thorax? | To assess the sternum and ribs for injuries or abnormalities. |
| What imaging considerations are important for the sternum? | Positioning considerations for optimal visualization. |
| How do the first seven pairs of ribs connect to the sternum? | They connect anteriorly to the sternum through individual sections of costal cartilage. |
| Where are the facets located on the sternum for rib articulation? | The facets are located laterally along the manubrium and body of the sternum. |
| What is the significance of the sternal angle in rib anatomy? | The second costal cartilage connects to the sternum at the level of the sternal angle. |
| How do ribs 8, 9, and 10 connect to the sternum? | They connect to the costal cartilage of rib pair 7, which then connects to the sternum. |
| What type of joint is formed between the costal cartilage and the sternal end of ribs 1 to 10? | Costochondral unions, classified as synarthrodial with no movement. |
| What type of joint is the sternoclavicular joint? | It is a synovial joint classified as diarthrodial, allowing plane (gliding) motion. |
| How does the first sternocostal joint differ from the others? | The first sternocostal joint is cartilaginous (synchondrosis) and allows no movement. |
| What type of joints are the sternocostal joints for ribs 2 through 7? | They are synovial joints classified as diarthrodial, allowing no movement. |
| What is the classification of the interchondral joints between the sixth and ninth ribs? | They are synovial joints allowing plane (gliding) movement. |
| What type of joints are the costotransverse and costovertebral joints? | They are synovial joints allowing plane (gliding) motion and are classified as diarthrodial. |
| What is a challenge in radiographing the sternum? | The sternum's thin bony cortex and its position within the thorax make it difficult to visualize. |
| What positioning technique is used to visualize the sternum? | The patient is rotated in a 15° to 20° right anterior oblique (RAO) position. |
| Why is superimposing the sternum over the heart advantageous in radiography? | The dense heart provides a uniform background, improving the visibility of the sternum. |
| How does the size of the thoracic cavity affect the degree of rotation for sternum imaging? | A shallow or thin chest requires more rotation than a deep chest to cast the sternum away from the thoracic spine. |
| What kVp range is recommended for optimal contrast in sternum radiography? | A kVp range of 75 to 85 is recommended for adult sthenic patients. |
| What is the purpose of using a breathing technique during sternum radiography? | It blurs lung markings over the sternum while keeping the sternum sharp and well-defined. |
| What exposure factors are necessary for a successful breathing technique in sternum imaging? | A medium kVp range (75 to 85), low mA, and a long exposure time (3 to 4 seconds) are required. |
| What type of movement do the interchondral joints allow? | They allow a slight plane (gliding) type of movement. |
| What is the classification of the costovertebral joints? | They are classified as synovial joints allowing plane (gliding) motion. |
| What is the mobility type of the costochondral unions? | They are synarthrodial, meaning there is no movement. |
| What anatomical structure is located at the level of T9-T10? | The xiphoid process of the sternum. |
| What is the function of the costal groove on a rib? | It houses blood vessels and nerves. |
| How many pairs of ribs articulate with the sternum? | There are seven pairs of ribs that articulate with the sternum. |
| What is the classification of the joints between the heads of ribs and thoracic vertebrae? | They are synovial joints classified as diarthrodial. |
| What does the term 'diarthrodial' refer to in joint classification? | It refers to joints that allow free movement, typically synovial joints. |
| What is the primary challenge in obtaining a uniform radiographic appearance of the sternum? | The proximity of the lungs and mediastinum creates difficulty in achieving contrast. |
| What kVp range is optimal for rib imaging? | 75 to 85 kVp |
| What is the minimum source-image receptor distance (SID) for sternum radiography? | 40 inches (100 cm) |
| Why is a higher kVp used for imaging ribs over the heart area? | To obtain appropriate contrast necessary to visualize ribs through the heart shadow and lung fields. |
| What technique is recommended for taking radiographs of ribs below the diaphragm? | Take the radiographs with the patient recumbent and expose on expiration. |
| What is the purpose of tight collimation in sternum imaging? | To reduce scattered radiation and improve image contrast while reducing patient dose. |
| What breathing technique is used for successful rib imaging? | Shallow breathing with a long exposure time (3 to 4 seconds). |
| What should be the patient's skin distance from the collimator surface? | At least 15 inches (40 cm). |
| What is the effect of using a 72-inch SID for rib studies? | It minimizes magnification distortion, improves spatial resolution, and reduces skin dose. |
| What are the recommended actions for demonstrating ribs above the diaphragm? | Take radiographs erect, suspend respiration, and expose on deep inspiration. |
| What is the significance of the patient's clinical history in rib imaging? | It helps determine the specific projections needed for diagnostic radiographs. |
| What is the recommended projection for sternoclavicular joint imaging? | PA projection is preferred to reduce magnification distortion. |
| What should be done if the patient has trauma to the thoracic cavity? | Assess if the patient has difficulty breathing and obtain a complete clinical history. |
| What is the purpose of marking the site of injury before imaging? | To ensure the radiologist is aware of the trauma location. |
| What is the impact of using automatic exposure control (AEC) in rib imaging? | It is not recommended due to the lack of uniformity of tissue density. |
| What is the effect of patient position on diaphragm elevation during rib imaging? | Recumbent position elevates the diaphragm, reducing part thickness for better visualization. |
| What is the minimum number of ribs typically visualized above the diaphragm on full inspiration? | The upper nine posterior ribs. |
| What is the recommended rotation for imaging left posterior ribs? | Rotate the patient into the left posterior oblique (LPO) position. |
| What is the recommended kVp for imaging ribs below the diaphragm? | 75 to 85 kVp. |
| How does the position of the patient affect rib visualization? | Erect positions allow deeper inspiration and better visualization of ribs. |
| What should be done if the patient is unable to take a deep inspiration due to rib pain? | Only eight posterior ribs may be visualized above the diaphragm on inspiration. |
| What is the recommended technique for imaging ribs in patients with trauma? | Select projections that place the area of interest closest to the image receptor. |
| What is the effect of using a higher kVp for rib imaging? | It ensures proper penetration of dense abdominal structures surrounding the ribs. |
| What is the importance of the AP vs PA projection decision in rib imaging? | It determines which projection places the area of interest closest to the image receptor. |
| What should be done if the site of injury is over the heart area? | Use a higher kVp to visualize ribs through the heart shadow. |
| What is the main goal of collimation in radiographic imaging? | To improve image quality by reducing scatter and enhancing contrast. |
| What is the recommended patient position for rib imaging if they can stand? | Erect position to utilize gravity for diaphragm lowering. |
| What is the impact of using a low mA during exposure? | It is essential for achieving the desired image quality with shallow breathing. |
| What may trauma to the bony thorax result in? | Injury to the respiratory and/or cardiovascular system. |
| What imaging projections are recommended for patients with a history of rib injuries? | Erect PA and lateral projections of the chest with inspiration/expiration projections. |
| What imaging technique should be used if a patient cannot assume an erect position? | An image obtained with a horizontal beam with the patient in a decubitus position. |
| What are the two primary concerns in pediatric radiography? | Patient motion and safety. |
| What is important to achieve maximal trust and cooperation from pediatric patients? | A clear explanation of the procedure. |
| What techniques can help maintain pediatric patient cooperation? | Distraction techniques using toys or stuffed animals. |
| Why is immobilization important in pediatric radiography? | To achieve proper positioning and reduce patient motion. |
| What should be done if a pediatric patient must be held during imaging? | Provide a lead apron and/or gloves to the individual holding the patient. |
| What exposure factors may need adjustment for geriatric patients? | Decrease in mAs due to high incidence of osteoporosis. |
| What should be considered when imaging geriatric patients? | Sensory losses and the need for additional assistance and reassurance. |
| What is a common challenge when imaging bariatric patients? | Difficulty in palpating landmarks such as the xiphoid process and sternal angle. |
| What landmark is easiest to locate in bariatric patients for sternum and rib positioning? | The jugular notch. |
| What should be the maximum field size for sternum and rib projections? | 10 x 12 inches (24 x 30 cm). |
| What imaging technique should be used to reduce scatter radiation in bariatric patients? | Use a grid (bucky) for all procedures. |
| What is the ALARA principle in radiography? | As low as reasonably achievable in determining exposure factors. |
| What imaging modality provides sectional images of the bony thorax? | Computed Tomography (CT). |
| What does nuclear medicine provide for detecting skeletal pathologies? | Radionuclide bone scan. |
| What is a common cause of rib fractures? | Trauma or underlying pathology. |
| What is flail chest? | A condition where ribs are fractured in two or more places on multiple adjacent ribs, leading to chest wall instability. |
| What imaging position is recommended for rib studies if flail chest is suspected? | Erect position if the patient's condition permits. |
| What is the risk associated with rib fractures? | Injury to adjacent lung or cardiovascular structures. |
| What should be done to reduce radiation exposure to pediatric patients? | Use short exposure times with optimal mA and kVp. |
| What is the recommended approach for digital imaging of the bony thorax? | Follow guidelines for correct study selection, centering, collimation, and exposure factors. |
| What is the importance of using a radiolucent mattress during imaging? | To provide comfort to the patient in recumbent position. |
| What should be done to ensure comfort for geriatric patients during imaging? | Provide extra blankets to keep the patient warm. |
| What is the significance of the exposure indicator in digital imaging? | It helps determine whether a reduction in mAs is possible for future exposures. |
| What should be done if a patient has a history of rib injuries? | Perform imaging to assess for pneumothorax, hemothorax, or pulmonary contusion. |
| What imaging technique is recommended if a flail chest injury is suspected? | Perform rib studies erect for best visualization. |
| What is the typical cause of sternum fractures? | Blunt trauma, often associated with underlying cardiac injury. |
| What is pectus carinatum? | A congenital anomaly characterized by anterior protrusion of the lower sternum and xiphoid process. |
| What is pectus excavatum? | Also known as funnel chest, it is characterized by a depressed sternum. |
| Does pectus excavatum usually interfere with respiration? | No, it rarely interferes with respiration but is often corrected surgically for cosmetic reasons. |
| What are common sites for metastatic lesions in the body? | The ribs are common sites for metastatic lesions. |
| What are osteolytic lesions characterized by? | Irregular margins and decreased density. |
| What do osteoblastic lesions appear as? | Increased density in the bone. |
| What is a combination osteolytic and osteoblastic lesion? | A moth-eaten appearance of bone resulting from a mix of destructive and blastic lesions. |
| What is osteomyelitis? | A localized or generalized infection of bone and marrow, commonly caused by bacterial infection. |
| What is the most common radiographic examination for rib fractures? | AP (anterior-posterior) views. |
| What is the radiographic appearance of pectus excavatum? | Depressed sternum on routine chest radiographs. |
| What type of imaging is used for metastatic lesions of the sternum? | Routine radiographic views and nuclear medicine bone scans. |
| What is the recommended patient position for a RAO sternum view? | Oblique position, 15° to 20° right anterior oblique. |
| What is the purpose of using a breathing technique during sternum imaging? | To blur overlying vascular structures and improve image quality. |
| What is the minimum SID recommended for sternum imaging? | 40 inches (100 cm). |
| What is the recommended kVp range for sternum imaging? | 75-85 kVp. |
| What should be done if a patient cannot be positioned for an RAO view? | An oblique image may be obtained by angling the CR 15° to 20° across the right side. |
| What is the purpose of collimation in sternum imaging? | To limit the radiation exposure to the area of interest. |
| What is the evaluation criteria for a successful RAO sternum image? | Sternum visualized superimposed on heart shadow with no vertebral superimposition. |
| What is the appearance of osteomyelitis on radiographs? | Erosion of bony margins, dependent on the stage or severity of the disease. |
| What is the recommended exposure factor adjustment for rib fractures? | None required. |
| What is the clinical indication for performing a lateral view of the sternum? | Pathology of the sternum, including fractures and inflammatory processes. |
| What is the recommended field size for sternum imaging? | 10 x 12 inches (24 x 30 cm) or 14 x 14 inches (35 x 35 cm). |
| What should be done during the imaging of a patient with large breasts? | Use a wide bandage to hold them in position if necessary. |
| What is the importance of patient rotation in RAO sternum imaging? | To visualize the sternum alongside the vertebral column without superimposition. |
| What is the appearance of the sternum in a correctly positioned lateral view? | The sternum should be visualized with no rotation. |
| What is the significance of a shallow breathing technique in imaging? | It helps to minimize motion during the long exposure time. |
| What should be done to hold large breasts of female patients during radiography? | They may be drawn to the sides and held in position with a wide bandage if necessary. |
| What is the minimum SID for sternoclavicular joint imaging? | 40 inches (100 cm) is the minimum SID. |
| What is the recommended field size for sternoclavicular joint imaging? | 8 x 10 inches (18 x 24 cm), landscape. |
| What is the kVp range recommended for sternoclavicular joint imaging? | 75-85 kVp. |
| What patient position is required for PA projection of the sternoclavicular joints? | Patient should be prone with head straight and chin resting on a radiolucent positioning sponge. |
| What is the CR positioning for PA projection of the sternoclavicular joints? | CR perpendicular to IR, centered to midsagittal plane at the level of T2-T3. |
| What is the evaluation criterion for the anatomy demonstrated in sternoclavicular joint imaging? | Bilateral right and left sternoclavicular joints equidistant from the thoracic spine. |
| What indicates proper patient rotation in sternoclavicular joint imaging? | Equal distance of sternoclavicular joints from the vertebral column on both sides. |
| What is the purpose of the RAO position in imaging sternoclavicular joints? | Best visualizes the downside sternoclavicular joint. |
| What is the recommended respiration phase for imaging sternoclavicular joints? | Suspend on expiration. |
| What is the evaluation criterion for exposure in sternoclavicular joint imaging? | Optimal image receptor exposure and contrast to visualize the manubrium and medial portion of the clavicles. |
| What is the CR positioning for the AP projection of bilateral or unilateral posterior ribs? | CR perpendicular to IR at the level of T2-T3, 3 inches distal to vertebra prominens. |
| What is the recommended field size for posterior rib imaging? | 14 x 17 inches (35 x 43 cm), landscape or portrait for unilateral studies. |
| What is the evaluation criterion for the anatomy demonstrated in rib imaging above the diaphragm? | Ribs 1 through 9 should be visualized. |
| What should be done to prevent the chin from superimposing the upper ribs during rib imaging? | Raise the chin to look straight ahead. |
| What is the respiration phase for rib imaging above the diaphragm? | Suspend respiration on deep inspiration. |
| What is the evaluation criterion for exposure in rib imaging below the diaphragm? | Ribs 10 through 12 should be visualized. |
| What indicates no rotation in rib imaging? | Width of ribs is equidistant on both sides of the thoracic spine. |
| What is the purpose of using a 10° to 15° rotation in anterior oblique positions? | To rotate the SC joint across the spine to the opposite lung field. |
| What is the CR positioning for below diaphragm rib imaging? | CR perpendicular to IR, centered at a level midway between the xiphoid process and the lower rib margin. |
| What is the evaluation criterion for motion in rib imaging? | No motion, as demonstrated by sharp bony markings. |
| What should be done for unilateral rib studies to demonstrate specific trauma? | Center the side of interest to the center of the IR. |
| What is the evaluation criterion for optimal image receptor exposure in sternoclavicular joint imaging? | Visualize sternoclavicular joints through overlying ribs and lungs. |
| What is the purpose of the horizontal beam lateral position in sternum imaging? | To obtain lateral images with the patient in the supine position if necessary. |
| What is the anatomy demonstrated in the lateral sternum imaging? | Entire sternum with minimal overlap of soft tissues. |
| What is the recommended collimation for sternoclavicular joint imaging? | Collimate tightly to the region of the sternoclavicular joints. |
| What should be visualized in the lateral aspect of sternoclavicular joint imaging? | Lateral aspect of manubrium and medial portion of the clavicles. |
| Where should the CR be positioned for ribs above the diaphragm? | 3 to 4 inches below the jugular notch. |
| What is the recommended CR level for ribs below the diaphragm? | Midway between the xiphoid process and the lower rib margin. |
| What should be included in the collimation for rib imaging? | The ribs of the side of interest and the thoracic spine. |
| What is the patient position for a standard rib study? | Erect, facing the IR. |
| What is the recommended SID for rib imaging? | Minimum of 40 inches (100 cm). |
| What is the kVp range for rib imaging? | 75-85 kVp. |
| What is the purpose of rotating shoulders anteriorly during rib imaging? | To remove scapulae from lung fields. |
| When should respiration be suspended during rib imaging? | On inspiration for above-diaphragm ribs and on expiration for below-diaphragm ribs. |
| What is the purpose of performing a unilateral rib study? | To demonstrate specific trauma to the anterior ribs along one side of the thoracic cavity. |
| What anatomical structures should be visualized in a rib study above the diaphragm? | Ribs 1 through 9. |
| What anatomical structures should be visualized in a rib study below the diaphragm? | Ribs 10 through 12. |
| What is the optimal image receptor exposure for rib imaging? | To visualize ribs through the lungs and heart or through dense abdominal organs if below the diaphragm. |
| What is the positioning requirement for optimal visualization of axillary ribs? | An accurate 45° oblique position with the spine shifted away from the area of interest. |
| What should be done to ensure no motion is present in rib imaging? | Achieve sharp bony markings. |
| What is the significance of using a 72-inch SID in rib imaging? | It may allow the IR to be positioned in portrait orientation. |
| What is the recommended field size for rib imaging? | 14 x 17 inches (35 x 43 cm) or 14 x 14 inches (35 x 35 cm). |
| What should be done if the patient is recumbent during rib imaging? | Flex the knee of the elevated side to help maintain position. |
| What is the recommended patient position for axillary ribs imaging? | Erect, facing the x-ray tube, or supine if necessary. |
| What is the purpose of collimation in rib imaging? | To focus on the region of interest and minimize exposure to surrounding tissues. |
| What should be evaluated in radiographs for critique? | Essential anatomy, positioning errors, technical factors, collimation, and visibility of side markers. |
| What is the clinical indication for rib imaging? | Pathology of the ribs, including fractures and neoplastic processes. |
| What is the positioning error that can compromise image quality? | Improper alignment of the thorax to the midline of the IR. |
| What should be done to ensure the side of interest is not cut off in rib imaging? | Align the thorax to the midline of the IR. |
| What should be done if a well-collimated projection of the region of injury is required? | Take it on a smaller IR. |
| What is the importance of sharp bony markings in rib imaging? | They indicate no motion during the exposure. |
| What is the optimal patient arm position for axillary rib imaging? | Raise the elevated side arm above the head and extend the opposite arm down. |
| What is the purpose of using positioning sponges during rib imaging? | To support the thorax and maintain the required position. |
| What should be done to achieve optimal image receptor exposure? | Ensure proper alignment and collimation to visualize ribs clearly. |
| What is the significance of the 45° oblique position in rib imaging? | It demonstrates the axillary portion of the ribs not well seen on AP-PA projections. |
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