Critique of the Sternum and Ribs

Chapter 9

Sternum (RAO)

Contrast & density to see jugular notch, manubrium, sternal body, & xiphoid process (60-70 kVp)This view rotates the sternum from behind the T-spine30 inch SID/ breathing technique/ 3 to 4 second exposure timeRotation 15-20 degrees, Sternum should be within heart shadowMidsternum in center of field

Sternum (lateral)

70 to 75 kVp

manubrium, sternal body & xiphoid process seen in profile with no superimposition of the anterior ribs over the sternum

Midsternum in center of field

Position getting patient in full inspiration

Ribs ( AP & PA)

65 to 70 kVp (upper)75 to 80 kVp (lower)When fractures occur, other pathology is closely looked for. Pneumothorax, emphysema, rupture of trachea, bronchus, or aortaFor lower pathology, kidney, liver, spleen or diaphragm damageFor anterior rib pain, do PA projection to place them closer to film/ and vice versa

AP or PA of Ribs above diaphragm

For AP & PA remove scapula from lung field

See 9 posterior ribs above diaphragm

7th posterior rib in center of field (halfway between jugular notch & xiphoid process)

Full inspiration

AP & PA of Ribs below diaphragm

9th – 12th posterior ribs seen below diaphragm

Use higher kVp to penetrate abdominal tissue

9th or 10th posterior rib in center of field halfway between sternum and xiphoid process

For hypersthenic patient with short, wide thorax, place lower border of cassette 2 inches above the crest, then center central ray to film

Ribs (anterior & posterior obliques)

65 to 70 kVp upper/ 75 to 80 kVp lower

Axillary rib detail is best in posterior oblique / axillary ribs closest to film and better view of sternum

Thorax rotated 45 degrees/ the inferior sternum is positioned halfway between the vertebral column and anterior ribs

Posterior & Anterior oblique Ribs above & below diaphragm

9 axillary ribs seen/ full inspiration

?7th axillary rib in center of field

Below: 9th – 12th axillary ribs seen expiration

9th or 10th axillary rib in center of field