2 Bony Thorax Sternum 12 Ribs 12 Thoracic Vertebrae Function Supports walls of pleural cavity & diaphragmVolume of cavity able to change during respirationProtects heart and lungs
3 Sternum Flat bone 6 in in length Supports clavicles and provides attachment to 1st seven costal cartilages of ribsT2-T3Sternal AngleT-10Provides 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 SternumFalse Ribs8-12Do not attach directly to the sternum; attach to costal cartilage of 7th ribFloating Ribs11 and 12Attached only to the vertebraeNumber VariationCervical RibsArticulate with C7 but rarely attach to sternumLumbar RibsLess 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 vertebraeTrauma 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 EndCostal GrooveSternal EndCostal arteries, veins, and nerves
7 Erythropoiesis Production of red blood cells. Early Fetus Mesodermal cells of yolk sac3-4 Months to AdolescenceSpleen, Liver, and Skeletal involvementAdulthoodVertebrae, Sternum, Pelvis, and RibsPrincipal means of delivering oxygen to the body
9 SternoclavicularOnly points of articulation between the upper limbs and the trunkGliding JointsPermit free movementManubriosternalJointXiphisternalJoint
10 Costovertebral and Costotranverse Synovial GlidingRib Head closely bound to the demifacets and 2 adjacent vertebral bodiesCostotransverseTubercle of rib articulates with transverse process of lower vertebra
11 Costochondral and Sternocostal Cartilaginous SynchondosisNo MovementArticulation between costal cartilages and true ribsCostochondral1st Rib: Cartilaginous Synchondosis2-7: Synovial GlidingFreely moveableArticulation between rib costal cartilages and sternumSternocostal
12 Interchondral Between 6-9 Ribs Between 9-10 Ribs Synovial Gliding Freely moveableBetween 9-10 RibsFibrous SyndesmosisSlightly moveable
14 Respiratory Movement Quiet Respiration Deep Inspiration Olique rib orientation changes littleDeep InspirationDegree of obliquity decreasesRibs carried anteriorly, superiorly, and laterally while necks are rotated inferiorlyDeep ExpirationDegree of obliquity increasesRibs 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 abdomenDifference in penetration required for the 2 regions, even density requiredWHY?
16 Diaphram Location Changes with Body Position Repiratory Movement UprightLowestSupineHighestAnterior ends of ribs less sharply visualized in supine positionRepiratory Movement1 ½ inches between deep inspiration and deep expirationLess in hypersthenicMore in hyposthenicRib 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 chestDeep ChestLess angulationShallow ChestMore angulationBecause 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: RAOAngulation 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 guideTop of IR 1.5 inches above jugular notchAverage body rotation is degrees
21 PA Oblique Projection (RAO, LPO) Sternum Minimal rotationSternum projected free from superimposition of the spineSternum projected over the heartAnswer: When the patient must stay supine (trauma)When would you use an LPO Position?
22 Lateral Projection (Upright) Sternum Rotate patients hands posteriorlyLock hands behind backFilm 24 x 30 cm lengthwiseIR 1.5 inches above jugular notchSuspend deep inspiration
23 Lateral Projection (Supine) Sternum Bring hands above headFilm 24 x 30 cm lengthwiseIR 1.5 inches above jugular notchSuspend deep inspiration
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 upTurn head toward affected sideRotates spine slightly away from side being examinedBetter visualization of lateral manubriumSuspend at end of expirationUse upright position when possible.
28 PA Oblique Projection (RAO, LAO) SC Joints Rotate patient degreesCR 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.SLAO: Left side of interestRAO: Right side of interestLR15
30 Ribs Localize Point of Interest Anterior Ribs Posterior Ribs PA ProjectionPosterior RibsAP ProjectionAxillary Portion of RibsBest demonstrated in oblique projectionlateral projection results in superimposition of both sides
35 Axillary Ribs AP Oblique Projection (RPO, LPO) 45 degree ObliquePlace affected side closest to the IRCenter affected side midway between midsagittal plane and lateral surfaceAbduct 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 visualizedAxillary ribs free of superimposition
37 Axillary Ribs PA Oblique Projection (RAO, LAO) 45 degree oblique45 degree obliqueAnswer: Side upWhich is the sideof interest?Why?