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What makes up the bony thorax?
- 12 pairs of ribs
- sternum
- 12 thoracic vertebrae
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What is the purpose/function of the bony thorax?
- supports the walls of the pleural cavity and diaphragm
- constructed so the volume of the thoracic cavity can be varied during respiration
- protects vital organs
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Is the clavicle part of the bony thorax?
no, it is part of the shoulder girdle.
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Describe four aspects of the general shape of the bony thorax:
- conical
- narrower on the upper end
- more wide than deep
- longer in the back than the front
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Describe the ribs' proximity to the iliac crest:
the posterior part of the ribs are about 1 1/2 inches from the top of the crest
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___________ ____________ are the spaces between the ribs.
intercostal spaces
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Major parts of the sternum:
- manubrium
- body/corpus/gladiolus
- xyphoid process/ensiform
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Describe the location of the sternum:
anterior; articulates with the clavicles and costal cartilages of the first 7 rib pairs.
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describe the shape of the manubrium:
wide and quadrilateral
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LABEL:
- A. clavicle/collar bone
- B. jugular notch/manubrial notch/suprasternal notch
- C. first rib cartilage
- D. sternoclavicular joint/ SC joint
- E. second rib cartilage
- F. manubrium
- G. sternal angle
- H. body/corpus/gladiolus
- I. intercostal space
- J. xiphoid tip/ensiform process
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What are the three major parts of the sternum?
- manubrium
- body/corpus/gladiolus
- xiphoid tip/ensiform process
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What lies on each side of the jugular notch for the attachment of the clavicles?
clavicular notches
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What are alternate names for and what is the general shape of the top of the manubrium?
- manubrial notch/jugular notch/suprasternal notch
- concave in shape
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what is directly below the clavicular notch?
a facet for the 1st rib to attach to
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What is the area where the manubrium joins the body of the sternum?
the sternal angle
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where does the 2nd costal cartilage attach?
the sternal angle
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where do ribs 3-7 attach?
the body of the sternum
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At what vertebral level is the manubrial notch?
T2-T3
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At what vertebral level is the sternal angle?
T4-T5
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At what vertebral level is the xiphoid process?
T10
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At what vertebral level is the lowest costal margin?
L2-L3
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Describe the location of the xiphoid process:
- lowest and smallest part of sternum
- can vary in shape and deviate from midline
- at the level of the lower portion of the heart
- at the level of the upper portion of the liver
- vertebral level of T10
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Describe some developmental aspects of the sternum:
- starts as four segments, but completes development at age 25
- xiphoid tip is cartilaginous at first, but ossifies by age 40
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Describe the dimensions and makeup of the sternum:
- sternum has red marrow inside (important in blood formation)
- body of sternum approx 4" long
- entire sternum approx 6" long
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How do ribs 8-10 attach?
they converge and attach indirectly to the sternum (they are false ribs)
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How do ribs 11-12 attach?
they have no cartilage and they do not attach. so they are both "false" ribs and "floating" ribs.
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What part of the bony thorax is the most anterior, in most people?
the sternal angle
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What attaches ribs 1-7 to the sternum?
hyaline cartilage, specifically the costal cartilage
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Describe the obliquity of the ribs:
- the vertebral (posterior) ends of the ribs are 3-5" higher than the sternal (anterior) ends of the ribs because the ribs slant downward.
- this obliquity increases from the 1st ribs to the 9th ribs, then decreases to the 12th ribs.
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Give some dimensional information about the ribs (2):
- the widest area of the ribs is around the 9th rib, then they decrease
- the ribs increase in length until the 7th ribs, then their length decreases
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Describe how the ribs line up with the thoracic vertebrae:
- the rib number corresponds with the thoracic vertebrae it articulates with anteriorly.
- each rib pair articulates with two vertebrae (anterior & posterior)
- ex. 2nd rib pair attaches to the upper part of T2 anteriorly and the lower part of T1 posteriorly at demifacets.
- this pattern continues for the rest of the ribs.
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Describe an anatomical anomaly that can occur with the number of ribs in the rib cage:
- there can be an extra set of ribs
- cervical ribs usually attach to C7 (important to document)
- lumbar ribs are usually very small and can be confused with a transverse process or can even look like a fracture
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Describe the 1st pair of ribs, as compared to the rest of the ribs:
they are the shortest, widest, and most vertical
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Name some anatomical details found on the typical rib:
- head
- flattened neck
- tubercle
- shaft
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What are some anatomical differences of the 11th and 12th ribs as compared to the rest of the rib pairs?
- there are no facets on the heads
- the 11th ribs have very small tubercles
- the 12th have very small or even no tubercles
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What do the head and the tubercle of the rib attach to?
- the head of the rib attaches to the vertebrae
- the tubercle of the rib attaches to the vertebral process
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Label:
- A.transverse process of vertebrae
- B. tubercle
- C. head
- D. body of vertebrae
- E. costochondral joint
- F. sternocostal joint
- G. costovertebral joint
- H. costotransverse joint
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What makes rib injuries particularly painful?
the shaft of each rib contains a nerve, an artery, and a vein, in the costal groove.
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LABEL:
- A. shaft
- B. angle
- C. tubercle
- D. neck
- E. head
- F. facet
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Which rib pair is the most narrow?
the 12th rib pair
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Describe the type of joints the SC joints are:
- synovial
- diarthrodial
- gliding type motion
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Where the cartilage of one rib articulates with the cartilage of another rib:
- interchondral joint
- where 7th, 8th, 9th, and 10th ribs all connect
- diarthrodic with gliding motion
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Where a rib articulates with costal cartilage:
- costochondral joint
- fibrous; synarthrodial; no movement
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Where the costal cartilage of a rib articulates with the sternum:
- sternocostal joint
- 1st rib is synarthrodic; no movement
- 2nd-7th are diarthrodic; synovial; gliding
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What does each rib pair attach to, anteriorly?
- ribs 1-7 attach directly to sternum (true)
- ribs 8-10 attach to the 7th rib pair by way of cartilage (false)
- ribs 11-12 do not attach but end in the musculature with no cartilage (false, floating)
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Label:
l:
- A. true ribs
- B. false ribs
- C. floating ribs
- D. clavicular notch
- E. costochondral joint
- F. sternocostal joint
- G. interchondral joint
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how does breathing affect rib obliquity?
- during inhalation, the ribs are slightly more horizontal (obliquity decreases)
- during exhalation, the ribs are slightly more vertical and move down (obliquity increases)
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Ideally, how should a patient be positioned for different rib x-rays, considering the effects of the diaphragm?
- Pt should be upright for upper ribs
- Pt should be supine for lower ribs
- this is because the diaphragm is lower when upright and higher when supine due to gravity
- *also, diaphragm movement is greater on 2nd inspiration/expiration
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What procedure should always accompany trauma rib xrays?
- a chest x-ray (PA and LAT)
- to better demonstrate the site and extent of injury, and also to better see possible injury to underlying structures
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What projections are normally taken of the sternum?
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Why is the RAO position utilized for the sternum instead of PA?
- it projects the sternum to the left of the spine without superimposition.
- this also makes use of the heart, which you can better visualize the sternum against than the lungs (as in an LAO position)
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describe the angle of the pt and the position of the CR for the RAO projection of the sternum:
- pt prone with left side elevated 15-20°
- CR at approx. T7 (½way between xiphoid and manubrium)
- CR at approx. 1" toward elevated side from midline
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What SID and breathing instructions should be used for the RAO projection of the sternum:
- SID: 30"
- breathing technique: shallow breaths, breathe normally (blurs out the posterior ribs and lung markings)
- increase exposure time to 1-2 seconds to aid the breathing technique (decrease mA, as low as 25)
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If a trauma patient cannot achieve the RAO position for a sternum image, what position should the tech use?
LPO, its opposite
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Does a deep chest require more or less rotation for an RAO projection of the sternum?
less rotation
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Name the image and position:
- LAO (PA oblique projection) of the sternum
- throws the sternum to the right over the posterior rib and lung markings
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Name the image and position:
- RAO (PA oblique projection) of the sternum
- throws the sternum to the left over the heart shadow
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Describe the SID, positioning, and breathing instructions for a lateral sternum projection:
- 72" SID (to reduce magnification and increase recorded detail)
- top of IR approx. 1½" above manubrial notch
- hands behind back, hands locked, shoulders back
- expose on inspiration
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Name image and position:
- lateral sternum
- entire sternum shown
- superimposed SC joints
- medial ends of clavicles
- no superimposition of spine
- good retrosternal space
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Name the image and position:
- lateral SC joints
- center to manubrial notch
- superimposed SC joints
- superimposed clavicles
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What projections are taken for the SC joints?
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Describe the PA projection of the SC joints:
- patient prone, arms down by sides (palms up, on table)
- bilateral: head rests on chin
- unilateral: turn face to affected side, cheek on table
- CR @ T3 (opposite manubrial notch)
- at least 48" SID if possible
- expose on expiration
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For the oblique projections of the SC joints, what angle is used?
- 10-15° RAO and LAO
- places the vertebrae behind the SC joint closest to the IR
- visualizes the side that is down
- turn face to side that is up
- center slightly off MSP toward up side
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Name the image and position:
- LAO position (PA oblique projection) of SC joint
- open SC space is closest to IR, along with clavicle and manubrium
- joint is projected in front of spine with very little obliquity
- suspended respiration
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When might additional rib pictures need to be taken?
if the first or last rib pair is injured
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For posterior oblique projections of the ribs, which side is better demonstrated?
the down side
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For anterior oblique projections of the ribs, which side is better demonstrated?
the up side (elevated side)
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Briefly describe body positioning for oblique ribs:
- 45° angle of patient
- center midway between MPS and lateral margin
- arm of affected side always goes up
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Name the image and position:
- Oblique Upper Rib Projection
- position is either LAO or RPO.
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When radiographing the upper ribs, what is done differently depending on if the injury is posterior or anterior?
- anterior rib injury = upper PA projection
- posterior rib injury = upper AP projection
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What is the reason for taking a lateral rib projection?
fluid and air levels
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What projections best demonstrates the axillary portion of the ribs?
- oblique projections:
- anterior obliques demonstrate anterior ribs
- posterior obliques demonstrate posterior ribs
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Which position demonstrates the left ribs clear of the heart?
LAO and RPO
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Where do you center for an AP or PA projection of the ribs?
T7 on the MSP
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Name a tip that can be used to better demonstrate ribs 7-9:
angle the tube 10-15° caudal
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Label:
- A. 9th rib - posterior
- B. 4th rib - anterior
- C. 7th rib - posterior
- D. 2nd rib - anterior
- E. 1st rib - posterior
- F. 1st rib - anterior
- G. 2nd rib - anterior
- H. 6th rib - posterior
- I. 4th rib - anterior
- J. 8th rib - posterior
- K. 5th rib - anterior
** #s A, E, F, & K are directly from powerpoint. the rest are student labeled. double-check for yourself, for mistakes.
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What ribs should be visualized in a proper upper ribs image?
- posterior ribs 1-9 above diaphragm
- anterior ribs 1-7 above diaphragm
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What are the breathing instructions for rib projections?
- upper ribs - expose on inspiration
- lower ribs - expose on expiration
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Where do you center for lower projections of the ribs?
- you put the bottom of the IR at the top of the crest.
- if you use crosswise, this puts the CR @ T12
- if you use lengthwise, this puts the CR @ T10
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Name the image and position:
- Upper Ribs
- AP (or possibly PA)
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Name the image and position:
- Lower Ribs
- AP (or possibly PA)
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Name the image and position:
- Oblique Lower Ribs
- LPO (or possibly RAO)
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Why is the position of the diaphragm for images of the ribs so important?
because of the need for different exposure techniques depending on its position
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Disruption of the continuity of the bone:
fracture
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Transfer of a cancerous lesion from one area to another:
metastases
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Inflammation of the bone due to a pyogenic infection"
- osteomyelitis
- usually resulting from a staph infection
- may not show up on xray in early stages
- can be demonstrated on a nuclear medicine scan
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Increased density of atypically soft bone:
osteopetrosis
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Loss of bone density:
osteoporosis
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Thick, soft bone marked by bowing and fractures:
Paget's disease
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New tissue growth where cell proliferation is uncontrolled:
tumor
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Malignant tumor arising from cartilage cells:
chondrosarcoma
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Malignant neoplasm of plasma cells involving the bone marrow and causing destruction of the bone:
MultipleMyeloma
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