Chapter 11 - Bony Thorax

Front 1

Bony Thorax consists of:

Back 1

sternum anteriorly, the thoracic vertebrae posteriorly & 12 pair of ribs

Front 2

which bony thorax is a common site for red bone marrow?

Back 2

sternum

Front 3

The sternum is made of what type of bone?

Back 3

spongy bone

Front 4

Parts of the sternum:

Back 4

manubrium
body
ziphoid process

Front 5

The ziphoid process does not become totally ossified until about what age?

Back 5

40

Front 6

landmark:
*uppermost border of the manubrium

Back 6

jugular notch (suprasternal or manubrial notch)
**T2-T3**
(2-3" below vertebral prominence)

Front 7

The lower end of the manubrium joins the body of the sternum to form what angle and at what level?

Back 7

*sternal angle
**T4-T5**

Front 8

The xiphoid process is at what level?

Back 8

*T9-T10*

Front 9

The inferior rib (costal) angle corresponds to what level?

Back 9

*L2-L3*

Front 10

What joint of the clavicle that articulates w/the manubrium?

Back 10

Sternoclavicular joint (SC joint)

Front 11

SC joint seperation is the least common b/c:

Back 11

it is encapulated by fibrous cartilage

Front 12

What connects directly to the sternum?

Back 12

clavicle and 1-7 ribs by cartilage

Front 13

1-7 anterior ribs connects to the sternum by a short pcs of cartilage called:

Back 13

costocartilage

Front 14

Ribs 8,9,10 connect to ______ by costocartilage which then connects to the sternum.

Back 14

rib 7

Front 15

Ribs 1-7 are considered ____ ribs.

Back 15

true ribs

Front 16

Ribs 8,9,10,11,12 are considered ______.

Back 16

false ribs b/c they do not attached directly to the sternum.

Front 17

Ribs 11 & 12 are considered _____.

Back 17

floating ribs b/c they do not possess costocartilage.

Front 18

Ea. rib has 2 ends _______ & _______, and b/t the ends is the ____.

Back 18

*posterior (vertebral end - spine)
*anterior (sternal end - sternum)
*shaft (body)

Front 19

The vertebral end consists of a ______, which articulates w/one or two thoracic vertebral bodies, and a flattened neck.

Back 19

Head

Front 20

Lateral to the neck of the vertebral end is an elevated ______ that articulates w/the transverse process of the vertebra and allows for attachment of a ligament.

Back 20

Tubercle

Front 21

The body of a rib extends laterally from the tubercle and then angles forward and downward. The area of forward angulation is termed:

Back 21

"the angle of the rib"

Front 22

Posterior view of a rib.
Which end sits higher?

Back 22

vertebral end (posterior)

Front 23

True or False:
The lower inside margin of ea. rib protects an artery, a vein and a nerve; therefore, rib injures are very painful and may be associated w/substantial hemorrhage.

Back 23

True

Front 24

Which ribs is widest at the lateral margins?

Back 24

8-9 rib

Front 25

Costotransverse joints are classified as what type of movement?

Back 25

synovial/diarthrodial (gliding)

Front 26

What is the name of the joint b/t the ribs and vertebral column?

Back 26

Costotransverse joint

Front 27

positioning for the sternum:

Back 27

pt rotated in a 15-20 degree RAO to shift the sternum just to the left of the thoracic vertebrae and into the homogenous heart shadow

Front 28

Sternum technique:

Back 28

*15-20 degree RAO
*65-70 kV / 45 mAs
*pt. taking shallow breaths
*40" min. SID

Front 29

Rib technique: location depends on the trauma and pt. complaint
*Above diaphragm (upper 10 posterior ribs)
*Below diaphragm

Back 29

*Above - pt. erect, suspend respiration on inspiration & 65-70kV
*Below - pt. recumbent/supine, suspend respiration on expiration & 70-80 kV

Front 30

**ribs: place area of interest closest or furthest from IR?

Back 30

closest and rotate the spine away from the area

Front 31

rib positioning:
*pt. has a hx or trauma to the Left Posterior Ribs, what 2 projections are preferred?

Back 31

*straight AP
*LPO - left posterior oblique (will move the spinous processes away from the left side)

Front 32

rib positioning:
*pt. has a hx or trauma to the Right Anterior Ribs, what 2 projections are preferred?

Back 32

*straight PA (will place the site of injury closest to the IR)
*LAO - left anterior oblique (will rotate the spinous process away from the site of injury)

Front 33

You can mark the site of injury with a:

Back 33

metallic BB

Front 34

3 structures that make up the bony thorax?

Back 34

*sternum
*thoracic vertebra
*12 pair of ribs

Front 35

What is the term for the long, middle aspect of the sternum?

Back 35

body

Front 36

The most distal aspect of the sternum does not ossify until a person is approx. _____ years of age.

Back 36

40

Front 37

The xiphoid end of the sternum is at the approx. level of the ______ vertebra.

Back 37

T9-T10

Front 38

The total sternum length on an average adult is about ___ in.

Back 38

6" (15 cm)

Front 39

The sternal angle is at the level of ______.

Back 39

T4-T5

Front 40

What is the name of the joint that connects the upper limb to the body thorax?

Back 40

Sternoclavicular joint (SC joint)

Front 41

What is the name of the section of cartilage that connects the anterior end of the rib to the sternum?

Back 41

Costocartilage

Front 42

What distinguishes a true rib from a false rib?

Back 42

True ribs connect to the sternum by their own costocartilage. False ribs are connected to the sternum via the costacartilage of the 7th rib

Front 43

T or F:
The 11th and 12th ribs are classified as false and floating ribs.

Back 43

True

Front 44

T or F:
The anterior end of the ribs is called the vertebral end.

Back 44

False (called the sternal end)

Front 45

What aspect of the ribs articulates w/the transverse process of the thoracic vertebrae?

Back 45

Tubercle

Front 46

List the 3 structures found w/in the costal groove of each rib.

Back 46

*Artery
*Vein
*Nerve

Front 47

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**1st sternocostal?

Back 47

Immovable - synarthrodial

Front 48

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**1st - 12th costovertebral joints?

Back 48

Movable - diarthrodial

Front 49

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**1st - 10th costochondral unions (b/w costocartilage and ribs)?

Back 49

Immovable - synarthrodial

Front 50

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**1st - 10th costotransverse joints (b/t ribs and transverse processes of T vertebrae)?

Back 50

Movable - diarthrodial

Front 51

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**2nd - 7th sternocostal joints (b/t 2nd - 7th ribs & sternum)?

Back 51

Movable - diarthrodial

Front 52

Movement type:
*moveable - diarthrodial (plane or gliding)
*immoveable - synarthrodial
**6th - 10th interchondral joints (b/t anterior 6th - 10th costal cartilage)?

Back 52

Movable - diarthrodial

Front 53

Which end of the ribs is most superior?
Approx. how much difference in height is there b/t the 2 ends?

Back 53

Posterior vertebral ends
*3-5" (7.5-12.5cm)

Front 54

Which ribs articulate w/the upper lateral aspect of the manubrium of the sternum?

Back 54

1st (anterior sternal end)

Front 55

The bony thorax is widest at the lateral margins of which ribs?

Back 55

8th - 9th

Front 56

*True ribs =
*False ribs =
*Floating ribs =

Back 56

*1-7
*8-12
*11-12

Front 57

T or F:
It is virtually impossible to visualize the sternum w/a direct PA or AP projection.

Back 57

True

Front 58

T or F:
A large, "deep-chested" (hypersthenic) pt. requires more obliquity for a frontal view of the sternum as compared w/a "thin-chested" (asthenic) pt.

Back 58

False (less obliquirty)

Front 59

How much rotation should be used for the oblique position of the sternum for a large, deep-chested pt?

Back 59

~15 degrees

Front 60

Technique factors that apply to an oblique position of the sternum.
*kV
*mAs

Back 60

*65-70 kV
*45

Front 61

What is the advantage of performing a breathing technique for radiography of the sternum?

Back 61

It blurs lung markings and ribs, which improves the visibility of the sternum

Front 62

What is the primary reason that a SID of less than 40" should not be used for sternum radiography?

Back 62

Incr. in pt. dose, especially skin dose

Front 63

What other imaging option is available to study the sternum if routine RAO and lateral radiographs do not provide sufficient information?

Back 63

CT or nuclear med.

Front 64

Identify the preferred positioning factors to demonstrate an injury to the ribs found below the diaphragm:
*General body position:
*breathing instructions:
*kV range:

Back 64

*recumbent
*expiration
*70-80 kV

Front 65

An injury to the region of the 8th or 9th rib would require the _______ (above or below) diaphragm technique.

Back 65

Above

Front 66

To properly elongate and visualize the axillary aspect of the ribs, the pt's spine should be rotated ______ (toward or away from) the area of interest.

Back 66

Away from

Front 67

Which projection (AP or PA and anterior or posterior oblique) should be performed for an injury to the anterior aspect of the ribs?

Back 67

PA and anterior obliques (placing the the area of interest closest to the IR)

Front 68

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

Back 68

AP and RPO (to shift spine away from the area of interest)

Front 69

How can the site of injury be marked for a rib series?

Back 69

metallic BB

Front 70

If the Dr. suspects a pneumothorax or hemothorax has occurred as a result of a rib fx, which additional x-ray projection(s) should be performed in addition to the routine rib projections?

Back 70

Erect PA and lateral chest

Front 71

A flail chest is defined as:

Back 71

Pulmonary injury caused by blunt trauma to 2 or more ribs

Front 72

Osteolytic metastases of the ribs produce which of the following x-ray appearances?

Back 72

Irregular bony margins

Front 73

Which of the following definitions applies to pectus excavatum?

Back 73

Depressed sternum due to congenital defect

Front 74

A proliferative bony lesion of increased density is generally termed:

Back 74

osteoblastic

Front 75

T or F:
MRI provides a more diagnostic image of rib metastases as compared w/a nuclear medicine scan.

Back 75

False

Front 76

T or F:
Pt's can develop osteomyelitis as a postoperative complication following open heart surgery.

Back 76

True

Front 77

Which is preferred for a study of the sternum: RAO or LAO?
Why?

Back 77

RAO; it places the sternum over the heart to provide a uniform background for added visibility of the sternum.

Front 78

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

Back 78

midsternum (midway b/t jugular notch & xiphoid process)

Front 79

What other position can be performed if the pt. cannot assume a prone position for the RAO sternum?

Back 79

LPO (oblique supine position)

Front 80

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

Back 80

60-72"
*reduces magnification created by the long OID

Front 81

Which of the following criteria apply to the radiograph for an evaluation of the oblique sternum?

Back 81

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

Front 82

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

Back 82

level of T2-3

Front 83

What type of breathing instructions should be given to the pt. for a PA projection of the SC joints?

Back 83

suspend respiration on inspiration

Front 84

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

Back 84

10-15 degrees from PA position

Front 85

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

Back 85

LAO

Front 86

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

Back 86

*The nature of the trauma or pt. complaint
*The location of the rib pain or injury
*whether or not the pt. has been coughing up blood

Front 87

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

Back 87

3-4" (8-10cm) below the jugular notch, level T7

Front 88

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

Back 88

RAO or LPO elongates the left axiallary ribs (and shifts the spine away from the injury site)

Front 89

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

Back 89

PA and LAO (to elongate the right axiallary rib region)

Front 90

How many degrees of rotation are needed for a oblique projection of the axillary ribs?

Back 90

45 degrees

Front 91

T or F:
The thyroid dose for an anterior oblique rib projection is only about 5% of what it would be for a posterior oblique rib projection.

Back 91

False:
(only about 1/3 or 33%)

Front 92

T or F:
The breast dose for an anterior oblique rib projection is only about 5% of what it would be for a posterior oblique rib projection.

Back 92

True:
(a greater difference in breast dose exists for posterior vs. anterior rib projections than for thyroid doses b/c of the more anterior surface placement of the breasts compared w/the thyroid)

Front 93

T or F:
The amt. of gonadal dose given for rib projections is less than 1 mrad.

Back 93

True
(gonadal dose is so low that it is not listed on the dose charts for rib projections)

Front 94

To minimize pt. dose for a RAO projection of the sternum, the pt's skin should be at least _______ below the collimator.

Back 94

38" (15 cm)

Front 95

Which one of the following conditions may require a chest routine be included along w/a study of the ribs?

Back 95

hemothorax