Unit 1 (Bony Thorax)

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CoLinRadTechs
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216358
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Unit 1 (Bony Thorax)
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2013-04-28 14:52:47
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Procedures III
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Unit 1. Do not rely solely upon these cards. last revised fall2012.
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  1. What makes up the bony thorax?
    • 12 pairs of ribs
    • sternum
    • 12 thoracic vertebrae
  2. 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
  3. Is the clavicle part of the bony thorax?
    no, it is part of the shoulder girdle.
  4. 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
  5. 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
  6. ___________ ____________ are the spaces between the ribs.
    intercostal spaces
  7. Major parts of the sternum:
    • manubrium
    • body/corpus/gladiolus
    • xyphoid process/ensiform
  8. Describe the location of the sternum:
    anterior; articulates with the clavicles and costal cartilages of the first 7 rib pairs.
  9. describe the shape of the manubrium:
    wide and quadrilateral
  10. 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
  11. What are the three major parts of the sternum?
    • manubrium
    • body/corpus/gladiolus
    • xiphoid tip/ensiform process
  12. What lies on each side of the jugular notch for the attachment of the clavicles?
    clavicular notches
  13. 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
  14. what is directly below the clavicular notch?
    a facet for the 1st rib to attach to
  15. What is the area where the manubrium joins the body of the sternum?
    the sternal angle
  16. where does the 2nd costal cartilage attach?
    the sternal angle
  17. where do ribs 3-7 attach?
    the body of the sternum
  18. At what vertebral level is the manubrial notch?
    T2-T3
  19. At what vertebral level is the sternal angle?
    T4-T5
  20. At what vertebral level is the xiphoid process?
    T10
  21. At what vertebral level is the lowest costal margin?
    L2-L3
  22. 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
  23. 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
  24. 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
  25. How do ribs 8-10 attach?
    they converge and attach indirectly to the sternum (they are false ribs)
  26. How do ribs 11-12 attach?
    they have no cartilage and they do not attach. so they are both "false" ribs and "floating" ribs.
  27. What part of the bony thorax is the most anterior, in most people?
    the sternal angle
  28. What attaches ribs 1-7 to the sternum?
    hyaline cartilage, specifically the costal cartilage
  29. 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.
  30. 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
  31. 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.
  32. 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
  33. Describe the 1st pair of ribs, as compared to the rest of the ribs:
    they are the shortest, widest, and most vertical
  34. Name some anatomical details found on the typical rib:
    • head
    • flattened neck
    • tubercle
    • shaft
  35. 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
  36. 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
  37. 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
  38. What makes rib injuries particularly painful?
    the shaft of each rib contains a nerve, an artery, and a vein, in the costal groove.
  39. LABEL:
    • A. shaft
    • B. angle
    • C. tubercle
    • D. neck
    • E. head
    • F. facet
  40. Which rib pair is the most narrow?
    the 12th rib pair
  41. Describe the type of joints the SC joints are:
    • synovial
    • diarthrodial
    • gliding type motion
  42. 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
  43. Where a rib articulates with costal cartilage:
    • costochondral joint
    • fibrous; synarthrodial; no movement
  44. 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
  45. 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)
  46. Label:
    l:
    • A. true ribs
    • B. false ribs
    • C. floating ribs
    • D. clavicular notch
    • E. costochondral joint
    • F. sternocostal joint
    • G. interchondral joint
  47. 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)
  48. 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
  49. 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
  50. What projections are normally taken of the sternum?
    • RAO position
    • lateral
  51. 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)
  52. 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
  53. 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)
  54. If a trauma patient cannot achieve the RAO position for a sternum image, what position should the tech use?
    LPO, its opposite
  55. Does a deep chest require more or less rotation for an RAO projection of the sternum?
    less rotation
  56. 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
  57. Name the image and position:
    • RAO (PA oblique projection) of the sternum
    • throws the sternum to the left over the heart shadow
  58. 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
  59. Name image and position:
    • lateral sternum
    • entire sternum shown
    • superimposed SC joints
    • medial ends of clavicles
    • no superimposition of spine
    • good retrosternal space
  60. Name the image and position:
    • lateral SC joints
    • center to manubrial notch
    • superimposed SC joints
    • superimposed clavicles
  61. What projections are taken for the SC joints?
    • PA
    • both PA obliques
  62. 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
  63. 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
  64. 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
  65. When might additional rib pictures need to be taken?
    if the first or last rib pair is injured
  66. For posterior oblique projections of the ribs, which side is better demonstrated? 
    the down side
  67. For anterior oblique projections of the ribs, which side is better demonstrated?
    the up side (elevated side)
  68. 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
  69. Name the image and position:
    • Oblique Upper Rib Projection
    • position is either LAO or RPO.
  70. 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
  71. What is the reason for taking a lateral rib projection?
    fluid and air levels
  72. What projections best demonstrates the axillary portion of the ribs?
    • oblique projections:
    • anterior obliques demonstrate anterior ribs
    • posterior obliques demonstrate posterior ribs
  73. Which position demonstrates the left ribs clear of the heart?
    LAO and RPO
  74. Where do you center for an AP or PA projection of the ribs?
    T7 on the MSP
  75. Name a tip that can be used to better demonstrate ribs 7-9:
    angle the tube 10-15° caudal
  76. 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.
  77. What ribs should be visualized in a proper upper ribs image?
    • posterior ribs 1-9 above diaphragm
    • anterior ribs 1-7 above diaphragm
  78. What are the breathing instructions for rib projections?
    • upper ribs - expose on inspiration
    • lower ribs - expose on expiration
  79. 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
  80. Name the image and position:
    • Upper Ribs
    • AP (or possibly PA)
  81. Name the image and position:
    • Lower Ribs
    • AP (or possibly PA)
  82. Name the image and position:
    • Oblique Lower Ribs
    • LPO (or possibly RAO)
  83. 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
  84. Disruption of the continuity of the bone:
    fracture
  85. Transfer of a cancerous lesion from one area to another:
    metastases
  86. 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
  87. Increased density of atypically soft bone:
    osteopetrosis
  88. Loss of bone density:
    osteoporosis
  89. Thick, soft bone marked by bowing and fractures:
    Paget's disease
  90. New tissue growth where cell proliferation is uncontrolled:
    tumor
  91. Malignant tumor arising from cartilage cells:
    chondrosarcoma
  92. Malignant neoplasm of plasma cells involving the bone marrow and causing destruction of the bone:
    MultipleMyeloma

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