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Bony Thorax Tanya Nolan.

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Presentation on theme: "Bony Thorax Tanya Nolan."— Presentation transcript:

1 Bony Thorax Tanya Nolan

2 Bony Thorax Sternum 12 Ribs 12 Thoracic Vertebrae Function
Supports walls of pleural cavity & diaphragm Volume of cavity able to change during respiration Protects heart and lungs

3 Sternum Flat bone 6 in in length
Supports clavicles and provides attachment to 1st seven costal cartilages of ribs T2-T3 Sternal Angle T-10 Provides bony landmark for superior liver and inferior heart

4 12 Rib Pairs True Ribs False Ribs Floating Ribs Number Variation 1-7
Attached to the Sternum False Ribs 8-12 Do not attach directly to the sternum; attach to costal cartilage of 7th rib Floating Ribs 11 and 12 Attached only to the vertebrae Number Variation Cervical Ribs Articulate with C7 but rarely attach to sternum Lumbar Ribs Less Common

5 Ribs Angle Oblique plane slanting anteriorly and inferiorly
Anterior ends lies 3-5 inches below the level of the vertebral end. Angle increases from the rib 1-9 then decreases 9-12.

6 Ribs Vary in breadth and length
Facet on head articulates with vertebrae Trauma to ribs can damage these neurovascular structures, causing pain and hemorrhage. Rib fractures can cause a great deal of pain and hemorrhage because of the closely related neurovascular structures. Deeper inspiration will be attained if patient fully understands the importance of the expanding lungs. Vertebral End Costal Groove Sternal End Costal arteries, veins, and nerves

7 Erythropoiesis Production of red blood cells. Early Fetus
Mesodermal cells of yolk sac 3-4 Months to Adolescence Spleen, Liver, and Skeletal involvement Adulthood Vertebrae, Sternum, Pelvis, and Ribs Principal means of delivering oxygen to the body

8 Bony Thorax Articulations
8 Joints Sternoclavicular Costovertebral (1-12) Costotransverse (1-10) Costochondral (1-10) Sternocostal (1-7) Interchondral (6-10) Manubriosternal Xiphisternal

9 Sternoclavicular Only points of articulation between the upper limbs and the trunk Gliding Joints Permit free movement Manubriosternal Joint Xiphisternal Joint

10 Costovertebral and Costotranverse
Synovial Gliding Rib Head closely bound to the demifacets and 2 adjacent vertebral bodies Costotransverse Tubercle of rib articulates with transverse process of lower vertebra

11 Costochondral and Sternocostal
Cartilaginous Synchondosis No Movement Articulation between costal cartilages and true ribs Costochondral 1st Rib: Cartilaginous Synchondosis 2-7: Synovial Gliding Freely moveable Articulation between rib costal cartilages and sternum Sternocostal

12 Interchondral Between 6-9 Ribs Between 9-10 Ribs Synovial Gliding
Freely moveable Between 9-10 Ribs Fibrous Syndesmosis Slightly moveable

13 Manubriosternal & Xiphersternal
Cartilaginous Synchondrosis Little Movement Manubriosternal Joint Xiphisternal Joint

14 Respiratory Movement Quiet Respiration Deep Inspiration
Olique rib orientation changes little Deep Inspiration Degree of obliquity decreases Ribs carried anteriorly, superiorly, and laterally while necks are rotated inferiorly Deep Expiration Degree of obliquity increases Ribs carried inferiorly, posteriorly, and medially while the necks are rotated superiorly

15 Diaphram WHY? Ribs above diaphram best imaged through air filled lungs
Ribs below diaphram best imaged through upper abdomen Difference in penetration required for the 2 regions, even density required WHY?

16 Diaphram Location Changes with Body Position Repiratory Movement
Upright Lowest Supine Highest Anterior ends of ribs less sharply visualized in supine position Repiratory Movement 1 ½ inches between deep inspiration and deep expiration Less in hypersthenic More in hyposthenic Rib injury is very painful, and patients should be examined in the position in which they arrive in the radiology department

17 Oblique Projection of Sternum
Why must you do an oblique projection of the sternum versus an AP or PA projection? Degree of angulation depends on the depth of the chest Deep Chest Less angulation Shallow Chest More angulation Because sternum is directly anterior to the thoracic spine, AP and PA gives little useful diagnositic information.

18 Which Oblique Position???
RAO or LAO? Why? Answer: RAO Angulation of the body or the central ray to project the sternum to the right of the thoracic vertebrae clears the sternum of the vertebrae but superimposes it over the posterior ribs and the lung markings. If the sternum is projected to the left of the thoracic vertebrae it is also projected over the heart and other mediastinal structures which allows for use of the homogeneous density of the heart.

19 What technique? Why? Pulmonary structures, particularly in elderly persons and heavy smokers, can cast confusing markings over the sternum unless the motion of shallow breathing is used to eliminate them. Use breathing technique. If a breathing technique is not used, make sure exposure is made at the end of expiration to obtain a more uniform density

20 PA Oblique Projection (RAO) Sternum
Estimate body rotation by placing one hand on patient’s sternum and the other hand on the thoracic vertebrae to act as a guide Top of IR 1.5 inches above jugular notch Average body rotation is degrees

21 PA Oblique Projection (RAO, LPO) Sternum
Minimal rotation Sternum projected free from superimposition of the spine Sternum projected over the heart Answer: When the patient must stay supine (trauma) When would you use an LPO Position?

22 Lateral Projection (Upright) Sternum
Rotate patients hands posteriorly Lock hands behind back Film 24 x 30 cm lengthwise IR 1.5 inches above jugular notch Suspend deep inspiration

23 Lateral Projection (Supine) Sternum
Bring hands above head Film 24 x 30 cm lengthwise IR 1.5 inches above jugular notch Suspend deep inspiration

24 Lateral Projection Sternum

25 Pectus Excavatum Sunken or “caved in” chest
Most common congenital chest wall abnormality in children. Severity ranges from a moderate indentation to constriction of the internal organs. Sunken chest appears to be a problem with the sternum or ribs, but the problem is with the cartilage piece that connects each rib to the sternum. This costal cartilage connector is deformed, pushing the breastbone inward.

26 PA Projection Sternoclavicular Articulations
T3 (just posterior to jugular notch) Arms rest by side of patient with palms up Turn head toward affected side Rotates spine slightly away from side being examined Better visualization of lateral manubrium Suspend at end of expiration Use upright position when possible.

27 Sternoclavicular Articulations
Bilateral Unilateral No Rotation Slight Rotation

28 PA Oblique Projection (RAO, LAO) SC Joints
Rotate patient degrees CR perpendicular to SC Joint closest to the IR (T2-T3) You may also angle the tube 15 degrees toward the side of interest with the patient prone. S LAO: Left side of interest RAO: Right side of interest L R 15

29 PA Oblique Projection (RAO, LAO) SC Joints

30 Ribs Localize Point of Interest Anterior Ribs Posterior Ribs
PA Projection Posterior Ribs AP Projection Axillary Portion of Ribs Best demonstrated in oblique projection lateral projection results in superimposition of both sides

31 Respiration

32 Upper Anterior Ribs PA Projection
It may be useful to angle tube degrees caudad when demonstrating ribs 7-9 (depress diaphram) Do you use the same technique as you would for a chest x-ray?

33 Posterior Ribs: AP Projection
Ribs above diaphram 1.5 inches above shoulders Full Inspiration Ribs below diaphram Lower edge of IR at iliac crest Full Expiration

34 Posterior Ribs AP Projection

35 Axillary Ribs AP Oblique Projection (RPO, LPO)
45 degree Oblique Place affected side closest to the IR Center affected side midway between midsagittal plane and lateral surface Abduct arm of affected side and elevate to carry scapula away from rib cage

36 Axillary Ribs AP Oblique Projection (RPO, LPO)
2 x distance between vertebral column and lateral border affected side visualized Axillary ribs free of superimposition

37 Axillary Ribs PA Oblique Projection (RAO, LAO)
45 degree oblique 45 degree oblique Answer: Side up Which is the side of interest? Why?

38 Axillary Ribs PA Oblique Projection (RAO, LAO)



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