RIBS STERNUM X RAY PROJECTIONS .

Its the basic anatomy and x-ray views about ribs and sternum. Which gives a clear image about positions of x ray projections

1. BASIC AND SUPPLEMENTARY PROJECTIONS OF RIBS KEVIN JOSE BMIT 2 nd Yr

2. The ribs are elastic arches of bone, which form a large part of the thoracic skeleton. They are twelve in number on either side; but this number may be increased by the development of a cervical or lumbar rib, or may be diminished to eleven. The first seven are connected behind with the vertebral column, and in front, through the intervention of the costal cartilages, with the sternum (Fig. 115); they are called true ribs. The remaining five are false ribs  ;  of these, the first three have their cartilages attached to the cartilage of the rib above vertebro-chondral the last two are free at their anterior extremities and are termed floating or vertebral ribs ANATOMY OF RIBS

3. PROJECTIONS UPPER RIBS BASIC Antero-posterior Cervical antero-posterior SUPPLEMENTARY Posterior-oblique LOWER RIBS BASIC A ntero-posterior SUPPLEMENTARY P osterior-oblique

4. INDICATIONS Pneumo thorax Hemothorax Rib fracture Pneumonia

5. ANTERO-POSTERIOR (UPPER RIBS) POSITION OF PATIENT The patient stand with the posterior aspect of the trunk against the vertical CR cassette. Alternatively the patient lies supine on the table The median sagital plane is adjusted at right angles to the image receptor The image receptor is centered to the junction of the medial and middle 1/3 of the clavicle

6. X RAY IMAGE OF ANTERIO-POSTERIOR

7. TECHNICAL FACTORS 1)COLLIMATION The collimated horizontal beam is directed perpendicular to the image receptor and centered over the junction of the medial and middle 1/3 of the clavicle 2)ORIENTATION Landscape 3)DETECTOR SIZE 18x24cm 4)EXPOSURE 50-60 kVp 1-5 mAs

8. CERVICAL ANTERO-POSTERIOR ( upper rib ) POSITION OF PATIENT The patient sits or stands with the posterior aspect of the trunk against a vertical CR cassette The median sagital plane should be at right angles to the image receptor and coincident with the midline of the table The CR cassette if selected is positioned transversely in the CR cassette tray and should be large enough to include the 5 th cervical and 5 th thoracic vertebrae

9. X RAY IMAGE OF C.ANTERO-POSTERIOR

10. TECHNICAL FACTORS 1)COLLIMATION The collimated beam is angled 10 degree cranially from the prependicular and centered towards the sternal notch. 2)ORIENTATION Portrait 3)DETECTOR SIZE 18x24cm 4) EXPOSURE 50-60 kVp 1-5 mAs

11. POSTERIOR OBLIQUE (upper ribs ) POSITION OF PATIENT Initially direct the collimated beam prependicular to the image receptor and towards the sternal angle The beam is then angled caudally so that the central ray coincides with the centre of the receptor.This centring assists in demonstrating the maximum number of ribs above the diaphragm Exposure made on arrested full inspiration will also assist in maximising the number of ribs demonstrated

12. X RAY IMAGE OF POSTERIOR OBLIQUE

13. TECHNICAL FACTORS 1)COLLIMATION Initially direct the collimated beam prependicular to the image receptor and toward the sternal angle The beam is then angled caudally so that the central ray coincides with the center of receptor. This centring assists in demonstrating the maximum number of ribs above the diaphragm Exposure made on arrested full inspiration will also assist in maximising the number of ribs demonstrated 2) ORIENTATIO Portrait 3)DETECTOR SIZE 18x24cm 4)EXPOSURE 50-60kVp 5-10 mAs

14. POSTERIOR OBLIQUE(lower rib) POSITION OF PATIENT The patient lies supine on the table or stands erect with the mid clavicular line of the slide under examination coincident with the midline of the bucky grid The trunk is rotated 45degree onto the side being examined with the raised side supported on non-opaque pads The hip and knees are flexed for comfort and to assist in maintaining patient position If selected the caudal edge of the cassette is positioned at a level just below the lower costal margin otherwise the DDR detector is positioned to include the area of interest with its centre coincident with the central beam

15. X RAY IMAGE OF POSTERIOR OBLIQUE(lower ribs)

16. TECHNICAL FACTORS 1)COLLIMATION The collimated vertical beam is centered to the midline of the anterior surface of patient at the level of the lower costal margin. From this position the central ray is then angled cranially to coincide with the centre of the image receptor Exposure is made on arrested full expiration 2)ORIENTATION Portrait 3)DETECTOR SIZE 18x24cm 4)EXPOSURE 50-60 kVp 5-10 mAs

17. ANTERO-POSTERIOR Position of patient The patient lies supine on the imaging couch with the median plane coincident with the midline of the couch The anterior superior iliac spines should be equidistant from the couch top Cassette is placed transversely in the bucky tray with its caudal edge positioned at a level just below the lower costal margin otherwise the DDR detector is positioned to include the area of interest with its centre coincident with central beam

18. X RAY IMAGE OF ANTERO POSTERIOR(lower rib)

19. TECHNICAL FACTORS 1)COLLIMATION The collimated vertical beam is centered in the midline at the level of the lower costal margin and then is angled cranially to coincide with the centre of the image receptor This centring assists in demonstrating the maximum number of ribs below the diaphragm Exposure made on full expiration will also assist in this objective 2)ORIENTATION Landscape 3)DETECTOR SIZE 18x24 4)EXPOSURE 50-60 kVp 5-10mAs

20. REFERANCE CLARKS POSITIONING RADIOGRAPHY