Rib Radiography

1
Rib Radiography

• The region or area of injury or pain will
  determine the views taken.
• Anterior rib injury calls for P-A and anterior
  oblique views.Like the chest oblique, the
  affected side will be away from the film.
• Posterior rib injury calls for A-P and posterior
  oblique. The affected side is next to the Bucky.

2
Rib Radiography

• Anterior ribs are considered above the
  diaphragms. Breathing instructions will be full
  inspiration.
• Posterior ribs can be above or below the
  diaphragms. Above the diaphragms calls for deep
  inspiration. Below the diaphragms calls for full
  expiration.

3
Rib Radiography

• Ribs above the diaphragms should be taken erect.
• Ribs below the diaphragms can be taken erect but
  the diaphragms will move higher when taken
  recumbent.
• A small lead marker or BB taped to the area of
  tenderness can help in the interpretation of rib
  films.

4
A-P Upper Posterior Ribs

• Measure A-P at mid chest.
• Protection Half apron
• SID 40 Bucky
• No tube angle
• Film 14 x 17 regular I.D. up Portrait
• Marker Affected side.

5
A-P Upper Posterior Ribs

• Patient stands facing the tube. Place top of film
  two inches above the shoulder.
• Center horizontal central ray to film.
• Vertical central ray centered to the affected
  side unless patient is very small.

6
A-P Upper Posterior Ribs

• Collimation top to bottom less than film size.
• Collimation side to side skin of affected side.
• Instruction patient to roll shoulder forward and
  take a deep breath in and hold.
• Make exposure and let patient relax.

7
A-P Upper Posterior Ribs Film

• Must see the first rib for accurate counting .
• From thoracic spine to skin of affected side must
  be seen.
• With proper respiratory effort, should see down
  to 10th rib.

8
Upper Posterior Ribs Oblique

• Measure A-P at mid chest.
• Protection Half apron
• SID 40 Bucky
• No tube angle
• Film 14 x 17 regular I.D. up Portrait
• Marker Affected side.

9
Upper Posterior Ribs Oblique

• Patient stands facing the tube. Patient rotated
  45 degrees toward the affected side.
• Place top of film two inches above the shoulder.
• Center horizontal central ray to film.
• Vertical central ray centered to the affected
  side .

10
Upper Posterior Ribs Oblique

• Collimation top to bottom less than film size.
• Collimation side to side skin of affected side.
• Instruction patient to raise arm of the affected
  side and take a deep breath in and hold.
• Make exposure and let patient relax.

11
Upper Posterior Ribs Oblique Film

• Must see the first rib for accurate counting .
• From thoracic spine to skin of affected side must
  be seen.
• With proper respiratory effort, should see down
  to 10th rib.

12
P-A Upper Anterior Ribs

• Measure A-P at mid chest.
• Protection Half apron
• SID 40 Bucky
• No tube angle
• Film 14 x 17 regular I.D. up portrait
• Marker Affected side pronated

13
P-A Upper Anterior Ribs

• Patient stands facing the Bucky.
• Place top of film two inches above the shoulder.
• Center horizontal central ray to film.
• Vertical central ray centered to the affected
  side unless patient is very small.

14
P-A Upper Anterior Ribs

• Collimation top to bottom less than film size.
• Collimation side to side skin of affected side.
• Instruction patient to roll shoulders forward and
  take a deep breath in and hold.
• Make exposure and let patient relax.

15
P-A Upper Anterior Ribs Film

• Must see the first rib for accurate counting .
• From thoracic spine to skin of affected side must
  be seen.
• With proper respiratory effort, should see down
  to 10th rib.
• Scapula clear of ribs
• Note BB necklace

16
Upper Anterior Ribs Oblique

• Measure A-P at mid chest.
• Protection Half apron
• SID 40 Bucky
• No tube angle
• Film 14 x 17 regular I.D. up Portrait
• Marker Affected side pronated

17
Upper Anterior Ribs Oblique

• Patient stands facing the Bucky. The patients
  affected ribs are rotated 30 to 45 degrees away
  from the Bucky.
• The arm of the affected side is raised and rests
  on the top of the Bucky.
• Top of film placed two inches above the shoulder.

18
Upper Anterior Ribs Oblique

• Horizontal CR centered to film
• Vertical CR to the ribs of the affected side
• Collimation top to bottom slightly less than
  film size
• Collimation side to side ribs of the affected
  side and slightly less than film size.

19
Upper Anterior Ribs Oblique

• Ask patient to rest arm of the affected side on
  top of Bucky.
• Breathing Instructions Full inspiration
• Make the exposure and let patient breathe and
  relax.

20
Anterior Ribs Oblique Film

• Need to include first rib to accurately count
  from top to bottom.
• A BB can be taped on patient to note the area
  of injury.
• Must include the lateral soft tissues. Since the
  film is centered unilaterally, mark the affected
  side.

21
Lower Ribs A-P

• Measure A-P at mid chest or xiphoid
• Protection Half apron or bell on males
• SID 40 Bucky
• No tube angle
• Film 14 x 17 regular I.D. up Portrait

22
Lower Ribs A-P

• Patient standing facing tube or recumbent.
• Horizontal central ray at level of xiphoid
  process or place film two inches above iliac
  crest and center horizontal central ray to film.
• Vertical central ray to the affected side

23
Lower Ribs A-P

• On small patient vertical central ray is mid
  sagittal plane
• Collimation top to bottom slightly less than
  film size
• Collimation side to side to include all of the
  affected side or slightly less than film size.

24
Lower Ribs A-P

• Breathing instructions Take a breath in and
  blow it all out and hold it out. Full expiration
• Make exposure and let patient breathe and relax.

25
Lower Ribs A-P Film

• Should visualize the ribs below the diaphragms.
• Upper ribs will be over exposed (dark)
• Recumbent view will have diaphragms higher for
  better visualization of lower ribs.

26
Lower Ribs A-P Film

• Should visualize the ribs below the diaphragms.
• Upper ribs will be over exposed (dark)
• Recumbent view will have diaphragms higher for
  better visualization of lower ribs. Digital Image

27
Lower Ribs Oblique

• Measure A-P at mid chest or xiphoid process
• Protection half apron or bell on males
• SID 40 Bucky
• No tube angle
• Film 12 x 10 (large patient) Landscape or 10
  x 12 Portrait (small patient) with I.D. to spine.

28
Lower Ribs Oblique

• Patient stands facing tube. Turn patient 30 to 45
  toward the affected side.
• Patient may be recumbent and turned toward the
  affected side.
• Place bottom of film about two inches above the
  iliac crest

29
Lower Ribs Oblique

• Horizontal central ray entered to film.
• Vertical central ray centered to include all of
  the affected side.
• Collimation top to bottom slightly less than
  film size. Should include from 8th through 12th
  ribs of the affected side.

30
Lower Ribs Oblique

• Collimation side to side. to include from spine
  to chest wall of the affected side
• Breathing Instructions Take a breath in and
  blow it all the way out and hold it out.Full
  Expiration
• Make exposure and let patient relax.

31
Lower Ribs Oblique Film

• Should demonstrate from 8th through 12th ribs of
  the affected side.
• Must have 12th rib on film.

32
Lower Rib Oblique

• This Oblique was taken recumbent.
• For lower ribs, both the A-P and Oblique are best
  taken recumbent.

33
Lower Ribs Oblique Film

• This is the wrong oblique but it demonstrated a
  fracture. Sometimes you get lucky.
• When lower ribs fractures are seen, consider soft
  tissue damage to organs.

34
Sternum RAO

• Routine views are the RAO and Lateral
• If interest is the sternoclavicular joints, both
  oblique views are taken.
• Sternum radiographs have been replaced by Cat
  scans when available

35
Sternum RAO

• Measure A-P at mid chest
• Protection Half Apron
• SID 40 Bucky
• No tube angle
• Film 10 x 12 regular speed I.D. up Portrait

36
Sternum RAO

• Patient stands facing the Bucky. Turn patient
  into a 20 to 25 degrees RAO. The right shoulder
  should be touching the Bucky.
• Align the sternum with the centerline of the
  Bucky.

37
Sternum RAO

• Place top of film two inches above the
  sternoclavicular joint.
• Horizontal central ray centered to the film.
• Vertical central ray is established by centering
  sternum to Bucky center line.

38
Sternum RAO

• Collimation top to bottom Sternoclavicular
  joints to xiphoid process or slightly less than
  film size.
• Collimation side to side slightly less than film
  size.

39
Sternum RAO

• Breathing Instructions Deep inspiration. Some
  sources recommend expiration.
• Make exposure
• Tell patient to breathe and relax.
• Note left arm may be raised and rested on top of
  Bucky.

40
Sternum RAO Film

• Must include the entire sternum.
• The sternum should be just clear of the heart.
• Too much rotation will distort view.
• Both oblique views can be taken to study S C
  joints.

41
Sternum Lateral

• Measure Lateral at mid chest
• Protection Half Apron
• SID 40 Bucky
• No tube angle
• Film size 10 x 12 regular I.D. up Portrait

42
Sternum Lateral

• Patient in a lateral position with arms locked
  behind back.
• Make sure patient is as close to the Bucky as
  possible.
• Place top of film two inches above S.C. joints.

43
Sternum Lateral

• Horizontal central ray is centered to film.
• Vertical central ray through sternum. S.C. joints
  may be used as reference. Two to three inches
  anterior to mid coronal plane can also be used as
  reference.

44
Sternum Lateral

• Collimation top to bottom Sternoclavicular
  joints to xiphoid process
• Collimation side to side slightly less than film
  size
• Breathing Instructions Deep inspiration
• Make exposure and let patient breathe and relax

45
Sternum Lateral Film

• There should be no rotation of the patient.
• Must see from sternoclavicular joints to xiphoid
  process.
• Having shoulders pulled back is important for
  visualization of S C joints.

46
Rib Radiography

• The region or area of injury or pain will
  determine the views taken.
• Anterior rib injury calls for P-A and anterior
  oblique views.Like the chest oblique, the
  affected side will be away from the film.
• Posterior rib injury calls for A-P and posterior
  oblique. The affected side is next to the Bucky.

47
Rib Radiography

• Anterior ribs are considered above the
  diaphragms. Breathing instructions will be full
  inspiration.
• Posterior ribs can be above or below the
  diaphragms. Above the diaphragms calls for deep
  inspiration. Below the diaphragms calls for full
  expiration.

48
Rib Radiography

• Ribs above the diaphragms should be taken erect.
• Ribs below the diaphragms can be taken erect but
  the diaphragms will move higher when taken
  recumbent.
• A small lead marker or BB taped to the area of
  tenderness can help in the interpretation of rib
  films.

49
Sternum Radiography

• Routine views RAO and Lateral
• Shallow RAO only 20 to 25 Oblique
• For the Sternoclavicular Joints both RAO and LAO
  views with a straight P-A are taken.
• All views taken on inspiration.
• Low kVp is used for higher contrast.

50
Reading Assignment

• Read Chapters 6.1 through 6.18
• Be prepared to practice views in laboratory
• End of Lecture
• Return to Winter 2008 Index
• Return to PB-322 Home Page