Bontrager Chapter 10

Front 1

How many pairs of ribs are there?

Back 1

12

Front 2

What is the only bony connection between the shoulder girdle and the thorax?

Back 2

Sternoclavicular joint

Front 3

Which are the true ribs?

Back 3

Ribs 1 - 7
Each rib attaches directly to the sternum

Front 4

Which are the false ribs?

Back 4

Ribs 8 - 12

Front 5

Which are the 'floating' ribs

Back 5

11, 12

Front 6

What type of joint is the costochondral joints of ribs 1 - 10?

Back 6

Synarthrod1al

Front 7

What type of joint is the sternoclavicular joint?

Back 7

Diarthrodial

Front 8

What type of joints are the sternocostal joints?

Back 8

Diarthrodial

Front 9

What type of joints are the costovertebral joints?

Back 9

Diarthrodial

Front 10

The most distal part of the sternum does not fully ossify until age:

Back 10

40

Front 11

What 3 structures make up the bony thorax

Back 11

Sternum
Thoracic vertebrae
Ribs

Front 12

The average length of the adult sternum is:

Back 12

6"

Front 13

Why are ribs 8-12 called false ribs?

Back 13

The do not articulate directly with the sternum

Front 14

Which aspect of the rib articulates with the transverse process of the vertebra?

Back 14

Tubercle

Front 15

What 3 structures are in the costal groove?

Back 15

Nerve
Artery
Vein

Front 16

Which ends of the ribs are most superior?

Back 16

Posterior
About 3"

Front 17

Which rib(s) articulate with the manubrium?

Back 17

First

Front 18

The bony thorax is widest at:

Back 18

Ribs 8 & 9

Front 19

True/False
It is impossible to visualize the sternum with a PA projection.

Back 19

True

Front 20

True/False
A hyperesthenic patient requires more obliquity for a frontal view of the sternum as compared with an asthenic patient

Back 20

False
Less

Front 21

Why should a SID of less than 40" not be used for sternum radiography?

Back 21

Increased skin dose

Front 22

What is the advantage of using an orthostatic (breathing) technique for sternal radiography?

Back 22

Blur lung and rib markings

Front 23

Should a PA or AP projection be done for injury to the anterior ribs?

Back 23

PA

Front 24

What is a flail chest?

Back 24

Pulmonary injury caused be injury to two or more ribs

Front 25

What is pectus excavatum?

Back 25

Depressed sternum caused by a congenital defect

Front 26

What patient position is used to demonstrate the ribs below the diaphragm?

Back 26

Supine
Full exhalation

Front 27

Osteolytic lesions of the ribs usually appear as?

Back 27

Irregular bony margins

Front 28

A proliferative bony lesion of increased denisity is termed:
Osteoblastic
Osteoporotic
Osteolytic
Osteostenotic

Back 28

Osteoblastic

Front 29

True/False
The best imaging modality for metastatic lesion of the ribs is:

Back 29

NM

Front 30

Which is the preferred position for study of the sternum? (RAO or LAO)

Back 30

RAO
Puts heart behind sternum for better visibility

Front 31

Where is the CR centered for the oblique and lateral projections of the sternum?

Back 31

Midsternum

Front 32

What is the recommended SID for lateral projection of the sternum?

Back 32

60 - 72" for reduced magnification

Front 33

Where is the CR centered for a PA projection of the sternoclavicular joints

Back 33

Sternal notch
T2 - T3

Front 34

What breathing instructions are given to the patient for a PA projection of the sternoclavicular joint?

Back 34

Suspend on inspiration

Front 35

Pathology of the sternum is most commonly caused by:

Back 35

Trauma

Front 36

How much rotation of the thorax is recommended for an anterior oblique of the sternoclavicular joints

Back 36

10 - 15 degrees

Front 37

Which of the following criteria apply to a radiograph for an evaluation of the oblique sternum?
a. The entire sternum should be adjacent to the spine and heart shadow
b. The entire sternum should lie over the heart shadow and be adjacent to the spine
c. The left sternoclavicular joint should be adjacent to the spinal column
d. The second rib should lie directly over the manubrium of the sternum

Back 37

B
The entire sternum should lie over the heart shadow and be adjacent to the spine

Front 38

Where is the central ray located for a PA projection of the sternoclavicular joints?

Back 38

T2 - T3

Front 39

Which specific oblique position best demonstrates the left sternoclavicular joint adjacent to the spine?

Back 39

LAO

Front 40

What are the 3 points that must be included in the patient's clinical history before a rib series?

Back 40

Nature of the trauma
Location of the pain/injury
Coughing up of blood (hemoptysis)

Front 41

Where is the central ray centered for an AP projection of the ribs for an injury located above the diaphragm?

Back 41

T7
(3-4" below jugular notch)

Front 42

Which 2 specific oblique positions can be used to elongate the left axillary portion of the ribs?

Back 42

LPO, RAO

Front 43

Which 2 basic projections should be performed for an injury to the right anterior ribs?

Back 43

PA, LAO

Front 44

How many degrees of rotation are required for an oblique projection of the axillary ribs?

Back 44

45 degrees

Front 45

(T/F)
The recommended kV range for a digital study of the unilateral lower anterior ribs is 80 - 90.

Back 45

True

Front 46

To minimize patient dose for an RAO of the sternum, the patient's skin should be at least:
a. 40"
b. 72"
c. 38"
d 2"

Back 46

A
40"

Front 47

Which of the following conditions may require a chest routine be included along with a study of the ribs?
a. Pectus Excavatum
b. Hemothorax
c. Pectus carnatum
d. Osteomyelitis

Back 47

B
Hemothorax

Front 48

What is the level of the sternal angle?

Back 48

T4-T5

Front 49

How much rotation should be used for the oblique position of the sternum for a large patient?

Back 49

15 degrees

Front 50

Situation:
A radiograph of an RAO sternum reveals that part of the sternum is superimposed over the thoracic spine. Which specific positioning error is visible on this radiograph?

Back 50

Underrotation

Front 51

Situation:
A radiograph of a lateral projection of the sternum reveals that the patient's breast are obscuring the sternum. What can be done to minimize the breast artifact over the sternum?

Back 51

Have patient move breasts laterally and tape into position

Front 52

Situation:
A patient enters the emergency room on a backboard after being involved in a motor vehicle accident. Because of the condition of the patient, the physician orders a portable study of the sternum in the ER. Which two projections of the sternum would be most diagnostic yet minimize movement of the patient?

Back 52

LPO, Horizontal beam

Front 53

Situation:
A patient with trauma to the right upper anterior ribs enters the ER. He is able to sit in an erect position. Which positioning routine of the ribs should be performed?

Back 53

Erect PA and LAO

Front 54

Situation:
A patient with trauma to the left lower anterior ribs enters the ER. Which positioning routine of the ribs should be performed?

Back 54

Recumbent PA and RAO

Front 55

An elderly patinet comes to the radiology department for a complete rib series with an emphasis on the posterior ribs. She has advanced osteoporosis and has difficulty moving and lying down. Her physician wants both upper and lower ribs examined. What type of positions should be performed? How would you adjust technical factors for this patient?

Back 55

Erect with both full inspiration and expiration

Front 56

Situation:
A patient enters the ER with blunt trauma to the chest. He is restricted on a backboard. The ER physician suspects a flail chest. Beyond the initial chest projections, what positioning routine would confirm the diagnosis of flail chest?

Back 56

A limited rib series will indicate which ribs are fractured. The oblique positions may not be possible due to backboard.

Front 57

Situation:
A patient with trauma to the sternum and left sternoclavicular joint enters the ER. In addition to the sternum routine, the ER physician wants specific projections to better demonstrate the left SCJ. What would you use?

Back 57

15 - 20 degree RAO with orthostatic breathing
10 - 15 degree LAO with suspended breathing

Front 58

A radiograph of an RAO projection of the sternum reveals that the width of the sternum is foreshortened and the sternum is shifted away from the spine and out of the heart shadow. The patient has a large, "barrel" chest. The technologist performed the RAO with 20-25 degrees of rotation and used a breathing technique. Which positioning error led to this radiographic outcome?

Back 58

Overrotation.
Close to 15 degrees should be used

Front 59

A patient comes to the ER with a right, upper, anterior rib injury. A unilateral rib study is ordered. What are the basic projections taken for this patient?

Back 59

PA erect, LAO

Front 60

(T/F)
The automatic exposure control (AEC) system is recommended for sternum and rib routines if the center chamber is used.

Back 60

False

Front 61

(T/F)
An orthosttic breathing technique is recommended for studies of the SCJs.

Back 61

False

Front 62

A patient comes to radiology with widespread metastases involving the bony thorax. Beyond radiographic studies, what other imaging modality will demonstrate the extent of this condition?

Back 62

NM

Front 63

List 3 chest pathologic conditions that may result from a rib injury and may require AP and lateral chest projections included with the rib routine.

Back 63

Pneumothorax
Hemothorax
Flail chest

Front 64

For which of the following is NM studies usually NOT performed?
a. Fractures
b. Osteoporosis
c. Multiple myeloma
d. Osteomyelitis

Back 64

A
Fractures

Front 65

The most common cause of osteomyelitis is:

Back 65

Bacterial infection

Front 66

The 5th rib is an example of a:

Back 66

True rib