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120 Cards in this Set

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What is the most distal aspect of the sternum?
xiphoid process
What is the name of the palpable junction between the upper and midportion of the sternum?
sternal angle
What aspect of the sternum possesses the jugular notch?
manubrium
What distinguishes a true rib from a false rib?
attaches directly to the sternum with its own costocartilage
What distinguishes a floating rib from a false rib?
possesses no costocartilage
Which part of the sternum do the second ribs articular?
sternal angle
What structures are found in the costal groove of each rib?
nerve, artery, vein
Sternoclavicular joint
plane-diarthrodial
costovertebral joint
plane-diarthrodial
first sternocostal joint
immovable-synarthrodial
eighth interchondral joint
plane-diarthrodial
third costochondral union
immovable-synarthrodial
Breathing instructions for a study of the ribs above the diaphragm.
inspiration
kV range for a study of the ribs above the diaphragm.
65-70
What is the minimum SID for radiography of the sternum?
40
What breathing instructions should be employed for an RAO position of the sternum to maximize visibility of it?
breathing technique
List two factors to be considered when determining which specific projections to include in the rib routine as described in the textbook.
place area of interest closest to IR.
Rotate spine away from area of interest for axillary ribs
List two chest pathologic conditions that may result from a rib injury and may require a PA and lateral chest projections to be included with rib routine.
Pneumothorax, Hemothorax
What is the average degree of rotation for an RAO position of the sternum?
15-20
What degree of obliquity would be required for an RAO sternum?
20
For what condition of the bony thorax is nuclear medicine bone scans not normally performed?
history of multiple myeloma
Pathology of the sternum is most commonly due to:
blunt trauma
What is the average breast dose for a posterior oblique rib projection?
66
What is the average breast dose for an anterior oblique rib projection?
3
What other position can be used for the sternum if the patient cannot assume the recumbent RAO position?
LPO
How should the arms be positioned for an erect lateral projection of the sternum?
drawn back
Which radiographic sign can be evaluated to determine whether rotation is present on a PA projection of the sternoclavicular joints?
equal distance from midline of spine
How much rotation of the thorax is required for the anterior oblique projection of the sternoclavicular joint?
10-15
Where is the central ray centered for an AP projection of the ribs below the diaphragm?
midway between xiphoid process and lower rib cage
What kV range should be used for ribs above the diaphragm?
65-70
Which one of the following positions or projections will best demonstrate the right axillary ribs?
LAO
A radiograph of an RAO projection of the sternum reveals that the width of the sternum is foreshortened and the sternum is shifted away from the spine and out of the heart shadow. The patient has a large, "barrel" chest. The technologist performed the RAO with 20-25 degrees of rotation and used a breathing technique. Which positioning error led to this radiographic outcome?
overrotation.
close to 15 degrees should be used
A radiograph of a lateral sternum reveals that anterior ribs are superimposed over the sternum. Which specific positioning error led to this radiographic outcome?
rotation
A patient comes with an injury to the right lower posterior ribs comes to the ER. She is unable to stand. List the positioning routine that would be performed for this patient.
recumbent AP lower ribs, RPO, expiration
A patient with an injury to the left upper anterior ribs comes to the ER. He is unable to stand but can lie on his abdomen. List the positioning routine that would be used for this patient.
recumbent PA upper ribs, RPO, inspiration
A routine chest study reveals a possible lesion near the right sternoclavicular joint. A PA projection of the sternoclavicular joints is taken, but the area of interest is superimposed over the spine. What specific position can be used to better demonstrate this region?
RAO SC joint
A patient is brought into the ER with multiple injuries due to an MVA. The patient can move but cannot stand or lie prone because of his injuries. A sternum study is ordered. What positions should be performed for this patient?
LPO sternum, cross-table lateral sternum
A patient comes to the ER with multiple rib fractures. The ER physician suspects a flail chest. The patient is able to stand and move. Beyond a rib series, what projections should be taken for this patient?
PA and lateral chest
T/F: The automatic exposure control (AEC) system is recommended for sternum and rib routines if the center chamber is used.
False
T/F: A breathing technique is rnot recommended for studies of the sternoclavicular joints.
True
A patient comes to the ER with a right, upper, anterior rib injury. A unilateral rib study is ordered. What are the basic projections taken for this patient?
PA erect, LAO
A patient comes to radiology with a clinical history of pectus excavatum. What positioning routine would best demonstrate the condition?
RAO and lateral sternum, possibly a routine chest
A patient comes to radiology with widespread metastases involving the bony thorax. Beyond radiographic studies, what other imaging modality will demonstrate the extent of this condition?
nuclear medicine bone scan
A radiograph of an RAO sternum reveals that part of the sternum is superimposed over the thoracic spine. Which specific positioning error is visible on this radiograph?
underrotation
A radiograph of an RAO sternum reveals that the sternum is difficult to visualize because of excessive density. The following factors were used for this image: 75 kV, 25 mA, 3 second exposure, 40 in SID, Bucky, and 100 speed screens. Which one of the following factors should be modified during the repeat exposure to produce a more diagnostic image?
lower kV to 65
A radiograph of an RAO sternum reveals that the sternum is poorly visualized because of excessive lung markings superimposed over the sternum. The following factors were used: 65 kV, 200 mA, 1.25 sec exposure, 40 in SID, Bucky, 100 speed screens. Which of these factors can be altered to increase the visibility of the sternum?
2-3 second exposure needed
A radiograph of a lateral projection of the sternum reveals that the patient's breasts are obscuring the sternum. What can be done to minimize the breast artifact over the sternum?
draw breasts to sides
Repeat PA projections of the sternoclavicular joints do not clearly demonstrate them. What other imaging modality may produce a more diagnostic image of these joints?
CT
A patient with trauma to the sternum and the left sternoclavicular joint region enters the ER. In addition to the sternum routine, the ER physician asks for specific projection to better demonstrate the left sternoclavicular joint. Describe the positioning routine.
RAO sternum, lateral sternum, LAO of SC joint
A radiograph of the upper ribs demonstrates that the diaphragm is superimposed over the eighth ribs, which is in the area of interest. The following factors were used for the initial exposure: 65 kV, 400 mA, 1/40 sec exposure, 400 speed screen, grid, suspended expiration, erect position, 40 in SID. Which one of these factors can be modified to increase the visibility of the area of interest?
suspend on inspiration
A patient enters the ER on a backboard after being involved in an MVA. Because of the condition of the patient, the physician orders a portable study of the sternum in the ER. Which two projections of the sternum would be most diagnostic yet minimize movement of the patient?
LPO and cross-table lateral
A patient enters with trauma to the right upper anterior ribs enters the ER. He is able to sit in an erect position. Which positioning routine of the ribs should be performed?
erect PA and LAO both on inspiration
A patient with trauma to the left lower anterior ribs enters the ER. Which positioning routine of the ribs should be performed?
RAO and recumbent PA both on expiration
An elderly patient comes to the radiology department for a complete rib series with an emphasis on the posterior ribs. She has advanced osteoporosis and has difficulty moving and lying down. Her physician wants both upper and lower ribs examined. What type of positions should be performed?
AP, both obliques, all positions erect, upper ribs on inspiration, lower ribs on expiration, kV lowered for osteoporosis
A patient enters the ER with blunt trauma to the chest. He is restricted on a backboard. The ER physician suspects a flail chest. Beyond the initial chest projections, what positioning routine would confirm the diagnosis of the flail chest?
limited rib series. until released from backboard, no obliques can be performed
Which condition may require a chest routine to be included along with a study of the ribs?
hemothorax
List the three parts of the sternum.
manubrium, body, xiphoid process
List the three structures that make up the bony thorax.
sternum, thoracic vertebrae, 12 pairs of ribs
What is the term for the long, middle aspect of the sternum?
gladiolus
The most distal aspect of the sternum does not ossify until a person is approximately ___ years of age.
40
The total sternum length on an average adult is about __ inches (__ cm)
6, 15
The xiphoid end of the sternum is at the approximate level of T__ vertebra.
9-10
The sternal angle is at the level of T__.
4-5
What is the name of the joint that connects the upper limb to the bony thorax (the only bony connection between the bony thorax and upper limbs)?
sternoclavicular joint
What is the name of the section of cartilage that connects the anterior end of the rib to the sternum?
costal cartilage
What distinguishes a true rib?
directly connect to sternum with its own costocartilage
The eleventh and twelfth ribs are classified as ____ and ____.
false and floating
The anterior end of the rib is called the ______.
sternal end
Which aspect of the rib articulates with the transverse process of the thoracic vertebrae?
tubercle
Which end of the ribs is most superior?
posterior (vertebral) end
Approximately how much difference in height is there between these two ends of the ribs? ( answer in inches)
3-5
The bony thorax is widest at the lateral margins of which ribs?
8-9
How many posterior ribs are shown above the diaphragm?
9-10
Which ribs are classified as true ribs?
1-7
Which ribs are classified as false ribs?
8-12
Which ribs are classified as floating ribs?
11-12
What is unique about floating ribs?
do not connect anteriorly
A direct PA sternum is not possible because the sternum would be superimposed by what?
vertbral column
How much rotation should be used for the oblique position of the sternum for a large, "deep-chested" patient?
15
Ideal kV range for an RAO sternum (with breathing technique).
65-70
Ideal mA for RAO sternum (with breathing technique).
45
Ideal exposure time (in seconds) for an RAO sternum.
3-4
What is the advantage of performing a breathing technique for radiography of the sternum?
blurs posterior ribs and lung markings
What is the primary reason that an SID of less than 40 inches should not be used for sternum radiography?
increased patient dose
What other imaging option is available to study the sternum if routine RAO and lateral radiographs do not provide sufficient information?
CT or nuclear medicine
What is the general body position preferred to demonstrate ribs below the diaphragm?
recumbent
What breathing instructions are used to demonstrate ribs below the diaphragm?
expiration
What is the recommended kV range for below the diaphragm rib radiographs?
70-80
An injury to the region of the eighth or ninth rib would require the _____ the diaphragm technique.
above
To properly elongate and visualize the axillary aspect of the ribs, the patient's spine should be rotated_______ the area of interest.
away from
Which projections should be performed for an injury to the anterior aspect of the ribs?
PA, anterior oblique
Which two rib projections should be performed for an injury to the right posterior ribs?
AP and RPO
How ca nthe site of injury be marked for a rib series?
lead BB
If the physician suspects a pneumothorax or hemothorax has occurred as a result of a rib fracture, which additional radiographic projection(s) should be performed in addition to the routine rib projections?
erect PA and lateral chest
A pulmonary injury caused by blunt trauma to two or more ribs is:
flail chest
A radiographic appearance of irregular bony margins:
osteolytic metastases
Depressed sternum due to congenital defect:
pectus excavatum
Proliferative bony lesion of increases density
osteoblastic
Which modality provides a more diagnostic image of rib metastases?
nuclear medicine
Patients can develop _______ as a postoperative complication following open heart surgery.
osteomyelitis
A ____ is preferred for a study of the sternum to visualize the sternum in the heart shadow.
RAO
Where is the central ray centered for the oblique and lateral projections of the sternum?
1 in left of midline and midway between jugular notch and xiphoid process
What other position can be performed if the patient cannot assume a prone position for the RAO sternum?
LPO
what is the recommended SID for a lateral projection of the sternum?
72
Wgt do you increase the SId for a lateral sternum?
because of increases OID
Which of the following criteria apply to a radiography for an evaulation of the oblique sternum?
The entire sternum should lie over the hart shadow and be adjacent to the spine.
Where is the central ray centered for a PA projection of the sternoclavicular joints?
level of T2-3
What type of breathing instructions should be given to the patient for a PA projection of the SC joints?
suspend on inspiration
How much rotation of the thorax is recommended for an anterior oblique of the SC joints?
10-15
Which specific oblique position best demonstrates the left SC joint adjacent to the spine?
LAO
What are the three points that must be included in the patient's clinical history before a rib series?
nature of the patient's complaint, location of the rib pain or injury, whether the patient has been coughing up blood
Where is the central ray centered for an AP projection of the ribs for an injury located above the diaphragm?
3-4 inches below the jugular notch
Which two specific oblique positions can be used to elongate the left axillary portion of the ribs?
RAO, LPO
Which two basic projections or positions should be performed for an injury to the right anterior ribs?
PA, LAO
How many degrees of rotation are needed for an oblique projection of the axillary ribs?
45
Both the patient thyroid dose and the breast dose for a correctly collimated PA SC join projection are in the _____ mrad range.
1-5
The tyroid dose for an anterior oblique rib projection is about __% of what it would be for a posterior oblique rib projection.
33
The breast dose for an anterior oblique rib projection is about ___% of what it would be for a posterior oblique rib projection.
5
The amount of gonadal dose given for rib projections is less than __ mrad.
1
To minimize patient dose for a RAO projection of the sternum, the patient's skin should be at least _____in (15 cm) below the collimator.
38