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RAD125 Boney Thorax
| Question | Answer |
|---|---|
| What makes up the boney thorax? | - Sternum - 12 pairs of ribs - 12 thoracic vertebrae - conical, narrow at top, longer posterior |
| Functions of boney thorax | - protects heart and lungs - supports wall of pleural cavity and diaphragm - made to vary the volume of thoracic cavity during respiration |
| Anatomy of sternum | - Centered on midline of anterior thorax - narrow, flat bone, ~6" long |
| Manubrium, re: sternum anatomy | - Has jugular notch at superior border -- palpable landmark, lies at T2-T3 interspace |
| Three parts of sternum | - manubrium - superior - body - xiphoid process - inferior |
| The sternum supports clavicles at what angles? | manubrial |
| The manubrium and clavical form what joint? | sternoclavicular |
| Sternum provides attachment for __________ at the first seven pairs of ribs at lateral border | costal cartilages |
| The body is the longest portion of the sternum and is joined to the manubrium where? | the sternal angle |
| The sternal angle is ____________ and lies at | palpable, T4-T5 interspace |
| The smallest portion of the sternum is the ______________, which lies over ________________ | xiphoid process, T10 |
| How many ribs are there and how are they numbered? | 12, superiorly to anteriorly, number corresponds to thoracic vertebra to which it attaches |
| Where do anterior ends of ribs lie? | Lower than posterior (vertebral) ends |
| rib lengths | increase from 1-7, then decrease to 12 |
| true ribs | pairs 1-7 attach directly to sternum |
| false ribs | pairs 8-10, attach indirectly to the sternum via costal cartilage |
| floating ribs | pairs 11 and 12, attach only to vertebrae |
| typical rib consists of | head, neck, tubercle, body |
| heads articulate with vertebral bodies and form ________ | costovertebral joints |
| tubercles articulate with | thoracic spine |
| thoracic spine transverse processes form ____________ | costotransverse joints |
| metastasis | transfer of a cancerous region from one to another |
| osteomyelitis | inflammation of bone due to pyogenic infection |
| osteopetrosis | increased density of a typically soft bone |
| paget disease | thick, soft, bone marked by bowing and fractures |
| chondrosarcoma | malignant tumor arising from cartilage cells |
| multiple myeloma | malignant neoplasm of plasma cells involving bone marrow and causing bone destruction |
| PA oblique sternum part positioning | RAO sternum, patient rotated 15-20 degrees |
| PA oblique sternum respiration | suspend respiration at the end of exhalation, OR shallow breathing technique |
| why use a shallow breathing technique? | to blur lungs |
| evidence of proper collimation PA oblique sternum | - from jugular notch to xiphoid process included - sternum projected over heart, but free of imposition from thoracic spine - minimally obliqued vertebrae to prevent excess rotation - exposure technique enough to show the sternum through the thorax |
| lateral sternum part positioning | left side against IR |
| lateral sternum evaluation criteria | - manubrium free of superimposition of soft tissue by shoulders - sternum free of superimposition by the ribs - lower portion of sternum unobstructed by breasts |
| SID for PA oblique sternum and lateral sternum | 30 inches for PA oblique sternum and 72 inches for lateral sternum |
| PA sternoclavicular joints, bilateral vs. unilateral | for bilateral, rest head on chin and adjust MSP of head to vertical for unilateral, turn head toward affected side and rest cheek on table |
| PA SC joints evaluation | - proper collimation - both SC joints and medial ends of clavicles - no rotation present for bilateral exam - slight rotation present on unilateral -exposure significant to demonstrate SC joints through superimposing vertebral and rib shadows |
| PA Oblique patient and part positioning | patient rotated 10-15 degrees toward side of interest |
| PA oblique SC joint body rotation method evaluation | - SC joint centered - manubrium and medial end of clavicle included - open SC joint space - SC joint of interest adjacent to vertebral column with minimum obliquity - sufficient exposure to demonstrate join through superimposing rib and lung fields |
| PA ribs evaluation | - 1st through 9th ribs in their entirety, with posterior portions lying above the diaphragm - in unilateral exam, ribs from opposite side are excluded - bony trabecular detail and surrounding soft tissues |
| AP Ribs Evaluation | - for ribs above diaphragm, 1st through 10th posterior ribs seen in entirety - for ribs below diaphragm, 8th through 12th posterior ribs viewed in entirety |
| respiration consideration upper vs. lower ribs | - respiration suspended at the end of deep inspiration for upper ribs - respiration suspended at the end of full expiration for lower ribs |
| AP/PA oblique ribs evaluation | - approx 2x distance between vertebral column and the lateral border of ribs on affected side - axillary portion of ribs free of superimposition with thoracic spine - 1st - 10th ribs visible above diaphragm for upper - 8th - 12th visible lower |
| flail chest (re: testing clues) | - adjacent ribs fractured in more than two places - paradoxical motion, life threatening |
| pathologic rib fracture | - fracture through diseased bone - minimal trauma, think cancer, osteoporosis |
| cervical rib | extra rib from C7 - above first rib, thoracic outlet syndrome |
| pectus excavatum | - depressed sternum - heart appears displaced left on PA |
| pectus carinatum | - protruding sternum - "pigeon chest" appearance |
| sternal fracture | - break in sternum - seatbelt injury |
| sternal dehiscence | seperation post sternotomy - post CABG patients |
| Paget disease | - abnormal bone remodeling - bone enlargement, thickening |
| osteoporosis | - loss of bone density - increased fracture risk |
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