Bony Thorax;
Sternum and Ribs
RAO of the sternum
Pathology: fractures and inflammation are demonstrated
Cassette size: 24*30 cm, lengthwise
Basic Patient Position
Erect (preferred) or semiprone
position with slight rotation, right
arm down by side, and left arm up.
Part Position
• Position patient oblique, 15° to 20°
toward the right side, RAO
• Align long axis of sternum to CR
and to midline of table/upright
Bucky.
• Place top of IR about 4 cm above
the jugular notch.
RAO of the sternum
CR
• Central ray (CR) perpendicular
to IR
• CR directed to center of sternum
(1 inch [2.5 cm] to left of midline
and midway between the jugular
notch and xiphoid process)
Breathing:
Breathing technique is preferred if patient can cooperate
or at suspended expiration
Example of using breathing technique: 30mA 1.0s 70 kVp
Radiographic anatomy
Evaluation of the Image
ID and anatomical markers must be present
and correct in the appropriate area of the
film.
Optimal exposure should penetrate all the
bone structures and contrast should be low
enough to visualise fully the bone and soft
tissue structures.
The complete structure of manubrium,
sternum and xiphisternum should be
projected just clear of the spine.
Lateral Projection: Sternum
Lat sternum (R or L)
Pathology: fractures and inflammation are demonstrated
Position
Erect with shoulders and
arms drawn back
Lat recumbent with arms
above the head and shoulders
kept back
Top of the cassette 4 cm
above the jugular notch
True lateral without any
rotation
Another Position
The patient stands erect median sagittal plane parallel to
the erect bucky, the hands are clasped together behind the
patients back, the patient projects the chest forward on
suspended inspiration.
Central Ray
The horizontal central ray is centered to the body of the
sternum immediately below the skin surface midway
between the sternal notch and xiphisternum
SID
150 to 180 cm to reduce the magnification
Evaluation of the Image
ID and anatomical markers must be present
and correct in the appropriate area of the
film.
Optimal exposure should penetrate all the
bone structures and contrast should be low
enough to visualize fully the bone and soft
tissue structures.
The complete structure of manubrium,
sternum and xiphisternum should be
projected just clear of ribs and in true lateral
position.
Radiohgrphic anatomy
PA PROJECTION:
STERNOCLAVICULAR JOINTS
Ribs
Rib fractures are the most common skeletal
injury in chest trauma, and occur in
approximately 50% of patients.
The first and most important projection in
rib trauma is a standard PA chest
radiograph to exclude lung and mediastinal
pathology. Fractures are often seen on this
projection.
PA Anterior Ribs: Above
Diaphragm
Patient Position
Erect preferred or prone if necessary, with
arms down to the side.
Part Position
• Align midsagittal plane to CR and to
midline of grid or table/upright Bucky.
• Rotate shoulders anteriorly to remove
scapulae from lung fields.
• Allow no rotation of thorax or pelvis.
CR
• CR perpendicular to IR, centered to T7
(7 to 8 inches [18 to 20 cm] below
vertebra prominens as for PA chest)
Respiration Suspend respiration on
inspiration.
PA Anterior Ribs: Above
Diaphragm
AP Posterior Ribs: Above or
Below Diaphragm
Patient Position
Erect position is preferred for above diaphragm if
patient’s condition allows and supine for below
diaphragm
Part Position
• Align midsagittal plane to CR and to midline of
grid or table/upright Bucky.
• Rotate shoulders anteriorly to remove scapulae from lung fields.
• Raise chin to prevent it from superimposing upper ribs; look
straight ahead.
• Allow no rotation of thorax or pelvis.
AP Posterior Ribs: Above or Below
Diaphragm
CR
Above diaphragm
• CR perpendicular to IR, centered to 3 or 4 inches (8 to 10 cm)
below jugular notch (level of T7)
• IR centered to level of CR (top of IR should be about 4 cm above
shoulders)
Below diaphragm
• CR perpendicular, centered to level of xiphoid process
• IR centered to CR (lower margin of IR at iliac crest)
Respiration Suspend respiration on inspiration for ribs above the
diaphragm and on expiration for ribs below the diaphragm.
AP Posterior Ribs: Above or
Below Diaphragm
RPO—injury to the right posterior ribs, above diaphragm
LPO—injury to le t posterior ribs, below diaphragm
LPO—below diaphragm
LPO—above diaphragm
RAO—injury to left anterior ribs
