Bony Thorax Sternum and Ribs

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

Bony Thorax Sternum and Ribs

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Bony Thorax;

Sternum and Ribs

 Pathology: fractures and inflammation are demonstrated

 ID and anatomical markers must be present

 Optimal exposure should penetrate all the

 The complete structure of manubrium,

Erect with shoulders and

 The patient stands erect median sagittal plane parallel to

 ID and anatomical markers must be present

 Optimal exposure should penetrate all the

 The complete structure of manubrium,

 Rib fractures are the most common skeletal

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