Procedures Chapter 11 Bony Thorax

Front 1

Where should the top of the IR be for a lateral sternum?

Back 1

1 1/2 inches superior to the jugular notch

Front 2

Whats the level of the sternal angle?

Back 2

T4-T5

Front 3

The body is turned ___ to ___ degrees for oblique sternum with the ____ side down.

Back 3

15-20 degrees with the right side down (RAO).

Front 4

true ribs are ___ - ___ because they attach directly to the sternum by it's own costocartilage

Back 4

1 - 7

Front 5

false ribs are ___ to ___ because they do not attach directly to the sternum.

Back 5

8 - 12

Front 6

ribs __ and __ only attach to the vertebrae and are called floating ribs.

Back 6

11 and 12

Front 7

where is the CR for oblique sternum?

Back 7

midsternum, midway between jugular notch and xiphoid tip.

Front 8

The most inferior portion of the sternum?

Back 8

xiphoid

Front 9

The longest part of the sternum is the ___

Back 9

body

Front 10

what is the level of the jug notch?

Back 10

T2-T3

Front 11

Whats the breathing technique for oblique sternum

Back 11

gentle even breathing during exposure

Front 12

The heads of ribs articulate with ____ and form ____ joint

Back 12

vertebral body
costovertebral joint

Front 13

Tubercles of the rib articulate with ______ and form _____ joint

Back 13

T-spine transverse processes;
costotransverse

Front 14

Hypersthenic patient type has a ________ diaphragm

Back 14

higher positional

Front 15

CR for oblique sternum is _____ inch(es) left to the midline.

Back 15

1 inch

Front 16

The posterior end of a rib is the _______ end

Back 16

vertebral

Front 17

The anterior end of a rib is the ________ end

Back 17

sternal

Front 18

Hyposthenic patient has a ______________

Back 18

lower-positioned diaphragm

Front 19

how much is the body rotated for RAO/LAO sternoclavicular joints?

Back 19

10-15 degrees from PA

Front 20

For RAO/LAO sternoclavicular joints, where is the CR

Back 20

level of T2-T3, 3 inches distal to vertebra prominens, 1 to 2 inches lateral to midsagittal plane.

Front 21

Where is the CR for AP below diaphragm?

Back 21

midway between xiphoid process and lower ribs

Front 22

breathing technique for above the diaphragm is _______; breathing technique for below the diaphragm is __________

Back 22

inspiration ; expiration

Front 23

where is the CR for posterior oblique ribs

Back 23

midway between xiphoid process and iliac crest

Front 24

T/F

hypersthenic patient requires greater rotation of the sternum for RAO projection as compared to a sthenic patient

Back 24

False

Front 25

inside margin of the rib containing the blood vessels and nerves?

Back 25

costal groove

Front 26

T/F
anterior ends of the ribs do not attach directly to the sternum

Back 26

true

attach to costocartilage

Front 27

which position can replace the RAO sternum for the trauma patient who cannot lie prone or stand

Back 27

LPO

Front 28

T/F
The ideal general position for a study of the ribs below the diaphragm is recumbent

Back 28

True

Front 29

pulmonary injury caused by blunt trauma to two or more ribs

Back 29

flail chest

Front 30

Anterior protrusion of the lower sternum and xiphiod process

Back 30

Pectus carinatum (pigeon breast)

Front 31

pectus carinatum is a _________ anomaly

Back 31

congenital

Front 32

a depressed sternum due to a congenital defect

Back 32

pectus excavatum

Front 33

destructive lesions with irregular margins

Back 33

Osteolytic

Front 34

A proliferative bony lesion of increased density

Back 34

osteoblastic

Front 35

this can be post operative complication of open heart surgery since sternum is split for the surgery

Back 35

Osteomyelitis

Front 36

Localized infection of bone, and marrow.

Back 36

Osteomyelitis

Front 37

Label the above diagram

Back 37

A. costochondral union or junction
B. sternoclavicular joint
C. sternocostal joint
D. 4th sternocostal joint
E. continuous borders of the interchondral joints

Front 38

What kind of mobility type does the 1-10th costochondral unions (btw costocartilage and ribs) have?

Back 38

synarthrodial

Front 39

What is the mobility, movement, and classification of the sternoclavicular joints?

Back 39

Synovial
diarthrodial
plane (gliding)

Front 40

What classification and mobility type are the first sternocostal joints?

Back 40

cartilaginous
synarthrodial

Front 41

What classification, mobility type, and movement is do the 2nd-7th sternocostal joints have

Back 41

synovial
diarthrodial
plane (gliding)

Front 42

What classification, mobility type, and movement is do the 6th -10th interchondral joints have

Back 42

synovial
diarthrodial
plane (gliding)

Front 43

What classification, movement type, and mobility does the 1st -10th constotransverse joints have?

Back 43

synovial
diathrodial
plane (gliding)

Front 44

What classification, movement type, and mobility does the 1st -12th costovertebral joints have?

Back 44

synovial
diarthrodial
plane (gliding)

Front 45

A radiograph of an RAO sternum reveals that part of the sternum is superimposed over the Tspine. Which specific posistioning error is visible on this radiograph?

Back 45

underrotation of the PT

Front 46

A radiograph of an RAO sternum reveals that the sternum is poorly visualized because of excessive lung markings superimposed over the sternum. the following factors were used: 65kV, 200mA, 1 1/4- sec exposure, 40" SID, bucky, and 100 speed screens. which of these factors can be altered to increase the visibility of the sternum?

Back 46

increase the exposure time (and lower the mA) to allow for greater blurring of the lung markings

Front 47

A radiograph on an RAO sternum reveals that the sternum is difficult to visualize because of excessive density. the following factors were used: 75kV, 25 mA, 3sec exposure, 40" SID, bucky, and 100 speed screens. which one of these factors should be modified during the repeat exposure to produce a more diagnostic image>

Back 47

lower the kV to 65 for higher contrast and to prevent overpenetration of the sternum

Front 48

What classification, movement type, and mobility does the 1st -10th constotransverse joints have?

Back 48

synovial
diathrodial
plane (gliding)

Front 49

What classification, movement type, and mobility does the 1st -12th costovertebral joints have?

Back 49

synovial
diarthrodial
plane (gliding)

Front 50

A radiograph of an RAO sternum reveals that part of the sternum is superimposed over the Tspine. Which specific posistioning error is visible on this radiograph?

Back 50

underrotation of the PT

Front 51

A radiograph of an RAO sternum reveals that the sternum is poorly visualized because of excessive lung markings superimposed over the sternum. the following factors were used: 65kV, 200mA, 1 1/4- sec exposure, 40" SID, bucky, and 100 speed screens. which of these factors can be altered to increase the visibility of the sternum?

Back 51

increase the exposure time (and lower the mA) to allow for greater blurring of the lung markings

Front 52

A radiograph on an RAO sternum reveals that the sternum is difficult to visualize because of excessive density. the following factors were used: 75kV, 25 mA, 3sec exposure, 40" SID, bucky, and 100 speed screens. which one of these factors should be modified during the repeat exposure to produce a more diagnostic image>

Back 52

lower the kV to 65 for higher contrast and to prevent overpenetration of the sternum

Front 53

A radiograph of a lateral projection of the sternum reveals that the PTs breasts are obscuring the sternum. what can be done to minimize the breast artifact over the sternum'?

Back 53

have the pt bring the breasts to the side, hold them in position with a wide bandage

Front 54

repeat PA projections of the Sternoclavicular joints do not clearly demonstrate them. what other imaging modality may produce a more diagnostic image of these joints

Back 54

CT

Front 55

A pT with trauma to the sternum and the left sternoclavicular joint region enters the ER. in addition to the sternum routine, the ER physician asks for a specific projection to better demonstrate the left sternoclavicular joint. describe the positioning routine, including the breathing instructions that you would use.

Back 55

15-20 deg RAO sternum with breathing techinique
lateral sternum on inspiration
10-15deg LAO of sternoclavicular joint with suspended inspiration

Front 56

A radiograph of the upper ribs demonstrates that the diaphragm is superimposed over the 8th ribs, which is in the area of interest. the following factors were used for the inital exposure: 65kV, 400mA, 1/40th sec, 400 speed screens, grid, suspended respiration on expiration, erect posistion, 40" SID. which one of the factors can be modifies to increase the visibility of the area of interest

Back 56

suspend respiration during inspiration to move the diaphragm below the eigth ribs

Front 57

a pt enters the ER on a backboard after being involved in a motor vehicle accident. because of the condition of the pt 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 pt

Back 57

LPO and horizontal beam lateral projections.

Front 58

a pt 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 58

erect PA and LAO (or RPO) position with suspended inspiration

Front 59

a pt with trauma to the left lower anterior ribs enters the ER. which positioning routine of the ribs should be performed?

Back 59

recumbent PA (orAP if the PT can not assume prone position) and RAO (or LPO) positions with suspended expiration

Front 60

An elderly pt 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 the technical factors for this patient?

Back 60

bc of pt condition, it is best to perform all positions erect and initiate exposure on full inpiration for upper ribs and full expiration for lower ribs, (RPO and LPO) must be performed, it is recommended that kV (manual technique employed) for all projections be lowered because of the advanced osteoporosis

Front 61

a pt 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 a flail chest?

Back 61

a limited rib series will indicate which ribs are fractured (and whether this has led to flail chest) since the pt is restricted to a backboard, the oblique positions may not be possible

Front 62

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

Back 62

sternoclavicular joint

Front 63

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

Back 63

costocartilage

Front 64

Whats the difference between a true and false rib?

Back 64

true ribs connect to the sternum by their own costocartilage. False ribs are connected to the sternum via the costocartilage of the seventh rib.

Front 65

T/F the anterior end of the rib is called vertebral end

Back 65

False

sternal end

Front 66

List the three structures found within the costal groove of each rib?

Back 66

artery
vein
nerve

Front 67

Is the posterior vertebral end or the anterior sternal end most superior?

Back 67

posterior vertebral end is most superior

Front 68

How much difference in height is there between the posterior and anterior ends?

Back 68

3 to 5 inches

Front 69

Which ribs articulate with the upper lateral aspect of the manubrium of the sternum?

Back 69

1st anterior sternal end

Front 70

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

Back 70

8th or 9th

Front 71

How many posterior ribs are shown above the diaphragm?

Back 71

11

Front 72

Whats unique about true ribs 1-7

Back 72

each attaches to the sternum by its own costocartilage

Front 73

Whats unique about floating ribs 11-12

Back 73

they do not attach to anything anteriorly

Front 74

is it possible to view the sternum with a PA or AP projection?

Back 74

no

Front 75

An injury to the region of the eighth or ninth rib would require (above/below) diaphragm technique?

Back 75

above

Front 76

the head, neck, and tubercle are at the ______ end of the rib

Back 76

vertebral

Front 77

to best demonstrate the ribs below the diaphragm the tech should have the patient in a ______ position.

Back 77

recumbent

Front 78

for above the diaphragm a _____ kv from ___ to ___ should be used;
for below the diaphragm a ____ kv from ___ to ___ should be used.

Back 78

for above the diaphragm a low kv from 65 to 70 should be used;
for below the diaphragm a medium kv from 70 to 80 should be used.

Front 79

A patient has an injury to the right anterior ribs, which obl is best?

Back 79

LAO

Front 80

A patient has an injury to the left posterior ribs, which obl is best?

Back 80

LPO

Front 81

For AP ribs the area of interest is _____ to the IR (for a posterior rib injury)

Back 81

closest

Front 82

physician suspects rib injury caused pneumothorax or hemothorax, which additional projection should be done

Back 82

erect PA and lateral chest

Front 83

Is a high or low breathing technique required for obl sternum?

Back 83

high 3 to 4 seconds

Front 84

list the preferred positioning factors for ribs below diaphragm.

body position?
breathing ?
kv range?

Back 84

body: recumbent
breathing:expiration
kV range: medium 70 to 80

Front 85

Osteolytic Metastases of the ribs produce what type of radiographic appearance?

Back 85

irregular bony margins

Front 86

Why is RAO preferred for a study of the sternum

Back 86

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

Front 87

What other position can be preformed if patient cannot do RAO sternum prone?

Back 87

LPO supine

Front 88

Whats the breathing technique for PA SC joints?

Back 88

suspend respiration on inspiration

Front 89

Which position will best demonstrate the right sternoclavicular joint?

Back 89

RAO

Front 90

For RAO /LAO SC joints, the CR is at the level of T2 to T3, and 1 to 2 inches lateral to the (upside or downside)

Back 90

upside

Front 91

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

Back 91

3 to 4 inches below jug notch
level of T7

Front 92

Which obl positions elongate the left axillary portion of the ribs?

Back 92

RAO & LPO

Front 93

the patient thyroid and breast dose for PA SC joints is ______

Back 93

1 TO 5 mrad

Front 94

T/F the gonadal dose given for ribs projection is less than 1mrad

Back 94

true

Front 95

A patient who has a underlying pulmonary injury and suffers a blunt trauma to the chest may have ______ chest

Back 95

flail chest

Front 96

label

Back 96

Front 97

Back 97

Front 98

How much obliquity should a large barrel chested person get for RAO sternum

Back 98

15 degrees more is less

Front 99

How much obliquity should a thin thorax get for RAO sternum ?

Back 99

20 degrees

Front 100

What is the issue with this RAO sternum

Back 100

-under rotation
-right sternoclavicular joint not clear of vertebral column

Front 101

What is the issue with this RAO sternum

Back 101

-under rotation
-right sternoclavicular joint not clear of vertebral column

Front 102

What is the name of the palpable junction between the upper and midportion of the sternum

Back 102

sternal angle

Front 103

What distinguishes a floating rib from a false rib?

Back 103

floating ribs dont have cosotcartilage

Front 104

which part of the sternum do the second ribs articulate ?

Back 104

sternal angle

Front 105

pathology of the sternum is most likely due to : ______

Back 105

blunt trauma

Front 106

Whats the average breast dose range for each of the following projections:

posterior obl rib:

anterior obl rib:

Back 106

posterior obl: 66 mrad

anterior obl: 3mrad

Front 107

which of the following projections will best demonstrate the right axillary ribs?
LAO
LPO
RAO
PA

Back 107

LAO

Front 108

What can normally result when a hypersthenic patient is rotated more than 15 degrees for RAO sternum

Back 108

foreshortening along the width of the sternum and will shift the sternum away excessively from spine.

Front 109

AEC is generally is generally

(recommended/not recommended)

for rib routines due to the need for high contrast, optimum detail exposures.

Back 109

not recommended)

Front 110

T/F A breathing technique is recommended for studies of the sternoclavicular joints.

Back 110

False

suspended upon expiration