Radiographic
Technique Bone of
Thorax and Sternum
Group 4
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Anatomy
1 Bony of thorax
The bony thorax is formed by the
sternum, 12 pairs of ribs, and 12
thoracic vertebrae.
Anatomy
2 Sternum
The sternum consists
of three main parts,
which are arranged
from above: Manubrium,
Body (gladiolus), Proc.
Xiphoid.
Sternum is a long flat bone that is located in the center of
the chest.
It is connected to the rib cage by means of cartilage and
forms the front of the rib cage, thereby helping to protect
the heart, lungs, and major blood vessels from injury.
Anatomy
1 Ribs / Costae
On the bony thorax there are 12
pairs of ribs. The 12 pairs of ribs
are numbered consecutively from
superiorly to inferiorly.
Ribs 1-7 are true ribs that attach
to the sternum costocartilage.
Ribs 8-12 are false ribs.
Ribs 11-12 are called floating ribs.
Radiographic Technique of
sternum
1. PA Oblique Projection RAO Position
2. PA Oblique Projection Moore Method (Modified Prone Position)
3. Lateral Projection (R or L)
PA Oblique Projection RAO Position
PA Oblique Projection RAO Position
a. Position of patient : b. Part Position :
- With the patient semiprone or - Position patient oblique, 15° to 20° toward
eret facing the IR, adjust the body the right side, RAO
into RAO position to use the heart - Align long axis of sternum to CR and to
for contrast as previously midline of table/ upright bucky.
described. - Place top of IR approximately 4 cm superior
- Have the patient support the to the jugular notch.
body on the forearm and flexed
knee, if recumbent.
- Erect position with slight
rotation, right arm down by side,
and left arm up.
PA Oblique Projection RAO Position
c. Central Point (CP) : g. Expository Factor
- Enters the elevated side of the kVp : 80
posterior thorax at the level of T7 and mAs :7
approximately 1 inch (2.5 cm) lateral to Respiration : When breathing
the midsagittal plane motion is to be used, instruct the
- CR directed to center of sternum (1 patient to take slow, shallow
inch [2.5 cm] to left of midline and breaths during the exposure. When
midway between the jugular notch and a short exposure time is to be
xiphoid process) used, instruct the patient to
d. Central Ray (CR) : Perpendicular to IR suspend breathing at the end of
e. FFD/SID : 102 cm expiration to minimize the visibility
f. IR size : 24 x 30 cm of the pulmonary vasculature.
PA Oblique Projection RAO Position
h. Radiographic Criteria
Result radiograph and anatomy • Sternum is visualized, superimposed on heart shadow
• Correct patient rotation is demonstrated by visualizing
sternum alongside vertebral column with no
superimposition by vertebrae.
• No distortion of sternum due to excessive rotation of
the thorax.
• Bony margins appear sharp, but lung markings are
blurred if breathing technique was used
• Minimally rotated sternum and thorax, as shown by the
following: Sternum projected just free of
superimposition from vertebral colum, Minimally
obliqued vertebrae to prevent excessive rotation of the
sternum, Lateral portion of manubrium and
sternoclavicular joint free of superimposition by the
vertebrae
PA Oblique Projection Moore Method
(Modified Prone Position)
PA Oblique Projection Moore Method
(Modified Prone Position)
a. Position of patient : b. Part Position :
Place the patient’s arms above the
Have the patient stand at the shoulders and the palms down on
side of the radiographic table the table. The arms act as a
directly in front of the Bucky
support for the side of the head
tray.
Ask the patient to bend at the Ensure that the patient is in a true
waist, and place the sternum in prone position and that the
the center of the table directly midsternal area is at the center of
over the previously positioned the radiographic table.
IR.
PA Oblique Projection Moore Method
(Modified Prone Position)
g. Expository Factor
c. Central Point (CP) :
kVp : 80
Enters at the level of T7 mAs :7
and approximately 2 Respiration : A shallow breathing technique
inches (5 cm) to the right produces the best results. Instruct the
of the spine. patient to take slow, shallow breaths during
d. Central Ray (CR) : the exposure. A low mA setting and an
Angled 25 degrees and exposure time of 1 to 3 seconds are
centered to the IR. recommended. When a low mA setting and
e. FFD/SID : 102 cm long exposure time cannot be employed,
f. IR size : 24 x 30 cm instruct the patient to suspend respiration
at the end of expiration to minimize the
visibility of the pulmonary vasculature.
PA Oblique Projection Moore Method
(Modified Prone Position)
Result radiograph and anatomy
h. Radiographic Criteria
• Image shown sternum from the jugular
notch to the tip of the xiphoid process
• Sternum projected free of
superimposition from the thoracic
spine
• Blurred pulmonary markings if a
breathing technique was used
• Exposure technique sufficient to
demonstrate the sternum through the
thorax
Lateral Projection (R or L)
Lateral Projection (R or L)
a. Position of patient : Place the patient in a lateral positionerect or recumbent. A dorsal
decubitus position may be used if needed because of the patient’s condition.
b. Part Position : b. Part Position :
- Erect - Lateral Recumbent
• Position patient standing or seated with • Position patient lying on side with arms up
shoulders and arms rawn back above head and keeping shoulders back
• Adjust the patient in a true lateral • Place top of IR 4 cm above the jugular notch.
position so that the broad surface of the • Align long axis of sternum to CR and midline
sternum is perpendicular to the plane of of grid or table/upright bucky.
the IR • Ensure a true lateral, with no rotation.
• Large breasts on female patients should • Rest the patient’s head on the arms or on a
be drawn to the sides and held in position pillow.
with a wide bandage so that their • Place a support under the lower thoracic
shadows do not obscure the lower portion region to position the long axis of the sternum
of the sternum. horizontally.
Lateral Projection (R or L)
c. Central Point (CP) : Entering the lateral border of the midsternum (midway
between the jugular notch and xiphoid process).
d. Central Ray (CR) : Center IR, Perpendicular to the center of the IR
e. FFD/SID : 60 – 70 inches (152 to 183 cm)
f. IR size : 24 x 30 cm
g. Expository Factor
kVp : 80
mAs : 20
Respiration : Suspend deep inspiration
Lateral Projection (R or L)
Result radiograph and anatomy h. Radiographic Criteria
• sternum shows the superimposed
sternoclavicular joints and medial ends
of the clavicles
• Manubrium free of superimposition by
the soft tissue of the shoulders
• Sternum free of superimposition by the
ribs
• Lower portion of the sternum
unobscured by the breasts of a female
patient (a second radiograph with
increased penetration may be
necessary)
Radiographic Technique of
Sternoclavicular Joints
PA Projection
Position of Patient Object Position
● Place the patient in the prone or ● Center the IR at the level of the
erect position. spinous process of the third
● Center the midsagittal plane of thoracic vertebra, which lies
the patient’s body to the midline posterior to the jugular notch.
of the grid. ● Place the patient’s arms along the
● Adapt the same procedure for sides of the body with the palms
use with a patient who is facing upward.
standing or seated pright. ● Adjust the shoulders to lie in the
● Pillow or head turned to one side, same transverse plane.
arms up beside head or down by ● For a bilateral examination, rest the
side patient’s head on the chin and
adjust it so that the midsagittal
plane is vertical.
PA Projection
PA Projection
centered to level of T2-T3, or 3 inches (7 cm)
CP distal to vertebra prominens/spinous
process of C7
CR Perpendicular to IR
FFD 102 cm
IR size 18 x 24 cm or 24 x 30 cm
80 kVp/ 7mAs (Suspend at the end
Expository Factor
expiration)
PA Projection
Criteria radiograph
• Radiograph shows the sternoclavicular joints
and the medial portions of the clavicles
• No rotation o patient, as demonstrated by
equal distance of sternoclavicular joints from
vertebral column on both sides.
• Optimal contrast and density (brightness) to
visualize the manubrium and medial portion of
the clavicles through superimposing ribs and
lungs.
• No motion, as indicated by sharp bony
margins.
PA Oblique Projection Body Rotation Method
(RAO or LAO)
Position of Patient Object Position
● Place the patient in a prone or • Patient rotated 10° to 15°, align and
center spinous process 1 to 2 inches
erect position with slight rotation
(3 to 5 cm) lateral (toward upside) to
(10° to 15°) of thorax with upside
CR and midline of grid or table/
elbow fexed and hand placed
upright bucky.
adjacent to head.
• Adjust the patient’s position to
center the joint to the midline of the
grid.
PA Oblique Projection Body Rotation
Method (RAO or LAO)
PA Oblique Projection
CP to level of T2 to T3, or 3 inches (7.5 cm)
distal to vertebra prominens, and 1 to 2
CP
inches (2.5 to 5 cm) lateral (toward upside) to
midsagittal plane
CR Perpendicular to IR
FFD 102 cm
IR size 18 x 24 cm
80 kVp/ 10 mAs (Suspend at the end
Expository Factor
expiration)
PA Oblique Projection Body Rotation
Method (RAO or LAO)
Criteria radiograph
• The manubrium, medial portion o clavicles, and
sternoclavicular joint are best demonstrated
on the downside
• The SC joint on the upside will be
oreshortened.
• Correct patient rotation demonstrates the
downside sternoclavicular joint visualized with
no superimposition o the vertebral column or
manubrium.
• Sternoclavicular joints through overlying ribs
and lungs.
PA Oblique Projection Central Ray Angulation
Method
Position of Patient Object Position
• Extend the patient’s arms along the
● Prone/erect
sides of the body with the palms of
● Place the patient in the prone
the hands facing upward.
position on a grid IR positioned
• Adjust the shoulders to lie in the
directly under the upper chest.
same transverse plane.
● Center the grid to the level of the
• Ask the patient to rest the head on
sternoclavicular joints.
the chin or to rotate the chin toward
● To avoid grid cutoff, place the
the side of the joint being
grid on the radiographic table with
radiographed
its long axis running perpendicular
to the long axis of the table.
PA Oblique Projection
CP should enter at the level of T2-3 (about 3
inches [7.6 cm] distal to the vertebral
CP prominens) and 1 to 2 inches (2.5 to 5 cm)
lateral to the midsagittal plane.
Direct to the midpoint of the IR at an angle of
CR
15 degrees toward the midsagittal plane
FFD 102 cm
IR size 18 x 24 cm or 24 x 30 cm
80 kVp/ 10 mAs (Suspend at the end
Expository Factor
expiration)
PA Oblique Projection
Criteria radiograph
• Sternoclavicular joint of interest in the center
of the radiograph, with the manubrium and the
medial end of the clavicle included
• Open sternoclavicular joint space
• Sternoclavicular joint of interest immediately
adjacent to the vertebral column with minimal
obliquity
• Exposure sufficient to demonstrate the
sternoclavicular joint through the
superimposingrib and lung fields
Radiographic
Technique of RIBS
PA Projection
Position of patient
• Position the patient either upright or recumbent, facing the IR.
• Because the diaphragm descends to its lowest level in the upright
position, use the standing or seated-upright position for
projections of the upper ribs when the patient’s condition permits.
The upright position is also valuable for showing fluid levels in the
chest.
PA Projection
Position of part
• Center the midsagittal plane of the patient’s body to the midline of the grid.
• Adjust the IR position to project approximately 1 1Τ2 inches (3.8 cm) above the upper
border of the shoulders. Less may be required for hypersthenic patients and for
those with very muscular shoulders.
• Rest the patient’s hands against the hips with the palms turned outward to rotate the
scapulae away from the rib cage.
• Adjust the shoulders to lie in the same transverse plane.
PA Projection
Position of part
• If the patient is prone, rest the head on the chin and adjust the midsagittal plane to be
vertical.
• To image affected ribs unilaterally, use 11 × 14 inch (28 × 35 cm) collimator size to
improve image quality.
• For hypersthenic patients with wide rib cages, it may be necessary to move the
patient laterally to include the entire lateral surface of the affected rib area on the
radiograph.
• Shield gonads.
• Respiration: Suspend at full inspiration to depress the diaphragm as much as
possible.
PA Projection
PA Oblique Projection
CP the central ray is at the level of T7
CR Perpendicular to the centre of IR
FFD 180 cm
IR size 14 x 17 inch (35 x 43 cm) lengthwise
Expository Factor 70-85 kVp / 32 mAs
PA Projection
The following should be clearly shown:
• Evidence of proper collimation
• First through ninth ribs in their entirety, with posterior
portions lying above the diaphragm
• First through seventh anterior ribs from both sides, in their
entirety and above the diaphragm
• In a unilateral examination, ribs from the opposite side
possibly not included in their entirety
• Ribs visible through the lungs with sufficient contras.
PA Projection
Evaluation Criteria
• The following should be clearly shown:
• Evidence of proper collimation
• First through ninth ribs in their entirety, with posterior portions lying above the
diaphragm
• First through seventh anterior ribs from both sides, in their entirety and above the
diaphragm
• In a unilateral examination, ribs from the opposite side possibly not included in their
entirety
• Ribs visible through the lungs with sufficient contras.
AP Projection
Position of patient
• Have the patient face the x-ray tube in either an upright or a
recumbent position.
• When the patient’s condition permits, use the upright position to
image ribs above the diaphragm and the supine position to image
ribs below the diaphragm to permit gravity to assist in moving the
patient’s diaphragm.
AP Projection
Position of part
Center the midsagittal plane of the patient’s body to the midline of the grid.
a. Ribs above diaphragm
b. Ribs below diaphragm
AP Projection
Ribs above diaphragm
• Place the IR lengthwise 1 1Τ2 inches (3.8 cm) above the upper border of the relaxed
shoulders.
• Rest the patient’s hands, palms outward, against the hips. This position moves the
scapula off the ribs. Alternatively, extend the arms to the vertical position with the
hands under the head (Fig. 9-33).
• Adjust the patient’s shoulders to lie in the same transverse plane, and rotate them
forward to draw the scapulae away from the rib cage.
• Shield gonads.
• Respiration: Suspend at full inspiration to depress the diaphragm.
AP Projection
Ribs above diaphragm
AP Projection
Ribs below diaphragm
• Place the IR crosswise in the Bucky tray, centred to a point halfway between the
xiphoid process and the lower rib margin. The lower edge of the IR will be near the
level of the iliac crests. This positioning ensures inclusion of the lower ribs because
of the divergent x-rays.
• Adjust the patient’s shoulders to lie in the same transverse plane.
• Place the patient’s arms in a comfortable position (Fig. 9-34).
• Shield gonads.
• Respiration: Suspend at full expiration to elevate the diaphragm.
AP Projection
Ribs below diaphragm
AP Projection
• Above diaphragm
CR to level 3 or 4 inches (8 to 10 cm) below jugular
notch (T7) or posterior oblique or 7 to 8 inches [18
to 20 cm] below vertebra prominens (T7) or
CP anterior oblique projections
• Below diaphragm
CR to level midway between xiphoid process and
lower rib margin (bottom o IR at about level o iliac
crest) the central ray is at the level of T7.
CR Perpendicular to the center of IR
FFD 180 cm
IR size 14 x 17 inchi (35 x 43 cm) lengthwise
Expository Factor 70-85 kVp / 32 mAs
AP Projection
The following should be clearly shown:
• Evidence of proper collimation
• For ribs above the diaphragm, first through tenth posterior ribs from both
sides in their entirety
• For ribs below the diaphragm, eighth through twelfth posterior ribs on both
sides in their entirety
• Ribs visible through the lungs or abdomen, according to the region examined
• In a unilateral examination, ribs from the opposite side possibly not included in
their entirety.
AP Oblique Projection RPO or LPO
Position of patient
• Examine the patient in the upright or recumbent position.
• Unless contraindicated by the patient’s condition, use the upright
position to image ribs above the diaphragm, and use the recumbent
position to image ribs below the diaphragm. Gravity assists by
moving the diaphragm.
AP Oblique Projection RPO or LPO
Position of part
• Position the patient’s body for a 45-degree AP oblique projection using the
RPO or LPO position. Place the affected side closest to the IR.
• Center the affected side on a longitudinal plane drawn midway between the
midsagittal plane and the lateral surface of the body.
• Position this plane to the midline of the grid.
• If the patient is in the recumbent position, support the elevated hip.
• Abduct the arm of the affected side, and elevate it to carry the scapula away
from the rib cage.
AP Oblique Projection RPO or LPO
Position of part
• Rest the patient’s hand on the head if the upright position is used (Fig. 9-37), or place the
hand under or above the head if the recumbent position is used (Fig. 9-38).
• Abduct the opposite limb with the hand on the hip.
• Center the IR with the top 1 1Τ2 inches (3.8 cm) above the upper border of the relaxed
shoulder to image ribs above the diaphragm or to a point halfway between the xiphoid
process and the lower rib margin to image ribs below the diaphragm.
• Shield gonads.
Respiration: Suspend at the end of full inspiration for ribs above the diaphragm and at the end
of deep expiration for ribs below the diaphragm.
AP Oblique Projection RPO or LPO
AP Oblique
CP The central ray is at the level of T7
CR Perpendicular to the centre of IR
FFD 180 cm
IR size 14 x 17 inchi (35 x 43 cm) lengthwise
Expository Factor 70-85 kVp / 32 mAs
PA Oblique Projection Body Rotation
Method (RAO or LAO)
Criteria radiograph
• Evidence of proper collimation
• Approximately twice as much distance
between the vertebral column and the lateral
border of the ribs on the affected side as is
present on the unaffected side
• Axillary portion of the ribs free of
superimposition with the thoracic spine
• First through tenth ribs visible above the
diaphragm for upper ribs
• Eighth through twelfth ribs visible below the
diaphragm for lower ribs
• Ribs visible through the lungs or abdomen
according to the region examined
PA Oblique Projection RAO or LAO Position
Position of patient
• Examine the patient in the upright or recumbent position.
• Unless contraindicated by the patient’s condition, use the upright
position to image ribs above the diaphragm and use the recumbent
position to image ribs below the diaphragm. Gravity assists by
moving the diaphragm.
PA Oblique Projection RAO or LAO Position
Position of part
• Position the body for a 45-degree PA oblique projection using the RAO or LAO position.
Place the affected side away from the IR (Fig. 9-40).
• If the recumbent position is used, have the patient rest on the forearm and flexed knee of
the elevated side (Fig. 9-41).
• Align the body so that a longitudinal plane drawn midway between the midline and the
lateral surface of the body side up is centered to the midline of the grid.
PA Oblique Projection RAO or LAO Position
Position of part
• Center IR with the top 1 1Τ2 inches (3.8 cm) above the upper border of the shoulder to
image ribs above the diaphragm or to a point halfway between the xiphoid process and
the lower rib margin to image ribs below the diaphragm.
• Shield gonads.
• Respiration: Suspend at the end of full expiration for ribs below the diaphragm and at the
end of full inspiration for ribs above the diaphragm.
PA Oblique Projection Body Rotation
Method (RAO or LAO)
PA Oblique
CP The central ray is at the level of T7
CR Perpendicular to the centre of IR
FFD 180 cm
IR size 14 x 17 inchi (35 x 43 cm) lengthwise
Expository Factor 70-85 kVp / 32 mAs
PA Oblique Projection Body Rotation
Method (RAO or LAO)
Criteria radiograph
• Evidence of proper collimation.
• Approximately twice as much distance
between the vertebral column and the lateral
border of the ribs on the affected side as is
present on the unaffected side
• Axillary portion of the ribs free of
superimposition with the thoracic spine
• First through tenth ribs visible above the
diaphragm for upper ribs
• Eighth through twelfth ribs visible below the
diaphragm for lower ribs
• Ribs visible through the lungs or abdomen
according to the region examine
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