week 4 boney thorax positioning digital images

7/30/2019 Week 4 Boney Thorax Positioning Digital Images

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1

Rib Radiography

The region or area of injury or pain will

determine the views taken.

Anterior rib injury calls for P-A and anterior

oblique views.Like the chest oblique, the

affected side will be away from the film.

Posterior rib injury calls for A-P and

posterior oblique. The affected side is next

to the Bucky.


2/50

2

Rib Radiography

Anterior ribs are considered above the

diaphragms. Breathing instructions will be

full inspiration.

Posterior ribs can be above or below the

diaphragms. Abovethe diaphragms calls

fordeep inspiration. Belowthe

diaphragms calls forfull expiration.


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3

Rib Radiography

Ribs above the diaphragms should be

taken erect.

Ribs below the diaphragms can be taken

erect but the diaphragms will move higher

when taken recumbent.

A small lead marker or BB taped to the

area of tenderness can help in the

interpretation of rib films.


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4

A-P Upper Posterior Ribs

Measure:A-P at mid

chest.

Protection: Half apron

SID: 40 Bucky No tube angle

Film: 14 x 17 regular

I.D. up Portrait

Marker: Affected side.


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5


Patient stands facing the

tube. Place top of film two

inches above the

shoulder.

Center horizontal :

central ray to film.

Vertical central ray:

centered to the affected

side unless patient is verysmall.


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6


Collimation top to

bottom: less than film

size.

Collimation: side to

side: skin of affected

side.

Instruction patient to roll

shoulder forward and

take a deep breath in andhold.

Make exposure and let

patient relax.


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7

A-P Upper Posterior Ribs Film

Must see the first rib for

accurate counting .

From thoracic spine to

skin of affected side

must be seen.

With proper respiratory

effort, should see down

to 10th rib.


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8

Upper Posterior Ribs Oblique

Measure:A-P at mid

chest.




I.D. up Portrait

Marker: Affected side.


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9


Patient stands facingthe tube. Patient rotated

45 degrees toward the

affected side.

Place top of film twoinches above the

shoulder.

Center horizontal :




side .


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10


Collimation top tobottom: less than filmsize.

Collimation: side to

side: skin of affectedside.

Instruction patient toraise arm of theaffected side and take adeep breath in andhold.

Make exposure and letpatient relax.


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11

Upper Posterior Ribs Oblique Film


accurate counting .



must be seen.



to 10th rib.


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12

P-A Upper Anterior Ribs

Measure:A-P at mid

chest.




I.D. up portrait

Marker: Affected sidepronated


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13


Patient stands facing the

Bucky.

Place top of film two

inches above the

shoulder.

Center horizontal :




side unless patient is very

small.


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14


Collimation top to

bottom: less than film

size.

Collimation: side toside: skin of affected

side.

Instruction patient to

roll shoulders forward

and take a deep breath

in and hold.


patient relax.


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15

P-A Upper Anterior Ribs Film


accurate counting .



must be seen.



to 10th rib.

Scapula clear of ribs

Note BB & necklace


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16

Upper Anterior Ribs Oblique

Measure:A-P at mid

chest.




I.D. up Portrait

Marker: Affected sidepronated


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17


Patient stands facingthe Bucky. Thepatients affected ribsare rotated 30 to 45degrees away from

the Bucky. The arm of the

affected side is raisedand rests on the topof the Bucky.

Top of film placed twoinches above theshoulder.


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18


Horizontal CR:

centered to film

Vertical CR: to the ribs

of the affected side

Collimation top to

bottom: slightly less

than film size

Collimation side to

side: ribs of the affected

side and slightly less

than film size.


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19


Ask patient to rest arm of

the affected side on top of

Bucky.

Breathing Instructions:

Full inspiration

Make the exposure and

let patient breathe and

relax.


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20

Anterior Ribs Oblique Film

Need to include first rib to

accurately count from top

to bottom.

A BB can be taped on

patient to note the area of

injury.

Must include the lateral

soft tissues. Since the film

is centered unilaterally,mark the affected side.


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21

Lower Ribs A-P

Measure:A-P at mid

chest or xiphoid

Protection: Half

apron or bell onmales

SID: 40 Bucky

No tube angle Film: 14 x 17

regular I.D. up Portrait


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22

Lower Ribs A-P

Patient standing facing

tube or recumbent.

Horizontal central ray:

at level of xiphoid

process or place film two

inches above iliac crest

and center horizontal


Vertical central ray: tothe affected side


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23

Lower Ribs A-P

On small patient

vertical central ray is

mid sagittal plane

Collimation top to

bottom: slightly less

than film size

Collimation side to

side: to include all of the

affected side or slightlyless than film size.


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24

Lower Ribs A-P

Breathing instructions:

Take a breath in and

blow it all out and hold it

out. Full expiration


patient breathe and

relax.


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25

Lower Ribs A-P Film

Should visualize the

ribs below the

diaphragms.

Upper ribs will be over

exposed (dark)

Recumbent view will

have diaphragms

higher for better

visualization of lowerribs.


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26

Lower Ribs A-P Film

Should visualize the

ribs below the

diaphragms.

Upper ribs will be over

exposed (dark)

Recumbent view will

have diaphragms

higher for better

visualization of lowerribs. Digital Image


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27

Lower Ribs Oblique

Measure:A-P at mid

chest or xiphoid process

Protection: half apron or

bell on males

SID: 40 Bucky

No tube angle

Film: 12 x 10 (large

patient) Landscape or 10

x 12 Portrait (small

patient) with I.D. to spine.


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28

Lower Ribs Oblique

Patient stands facing

tube. Turn patient 30 to

45 toward the affected

side.

Patient may be

recumbent and turned

toward the affected side.

Place bottom of film

about two inches abovethe iliac crest


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29

Lower Ribs Oblique

Horizontal central ray

:entered to film.

Vertical central ray

centered to include all of

the affected side.

Collimation top to

bottom: slightly less than

film size. Should include

from 8th through 12th ribsof the affected side.


30/50

30

Lower Ribs Oblique

Collimation side to

side:. to include from

spine to chest wall of

the affected side

Breathing

Instructions: Take a

breath in and blow it all

the way out and hold it

out.Full Expiration


patient relax.


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31

Lower Ribs Oblique Film

Should

demonstrate

from 8th through

12th ribs of theaffected side.

Must have 12th

rib on film.


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32

Lower Rib Oblique

This Oblique was

taken recumbent.

For lower ribs, both

the A-P and Obliqueare best taken

recumbent.


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33

Lower Ribs Oblique Film

This is the wrong

oblique but it

demonstrated a

fracture. Sometimes

you get lucky. When lower ribs

fractures are seen,

consider soft tissue

damage to organs.


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34

Sternum RAO

Routine views are

the RAO and Lateral

If interest is the

sternoclavicularjoints, both oblique

views are taken.

Sternum

radiographs have

been replaced by

Cat scans when

available


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35

Sternum RAO

Measure:A-P at

mid chest

Protection: Half

Apron

SID: 40 Bucky

No tube angle

Film: 10 x 12

regular speed I.D.

up Portrait


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36

Sternum RAO

Patient stands

facing the Bucky.

Turn patient into a

20 to 25 degrees

RAO. The rightshoulder should be

touching the Bucky.

Align the sternum

with the centerlineof the Bucky.


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37

Sternum RAO


inches above the

sternoclavicular

joint.

Horizontal centralray: centered to the

film.


is established bycentering sternum

to Bucky center line.


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38

Sternum RAO

Collimation top to

bottom:

Sternoclavicular

joints to xiphoid

process or slightlyless than film size.

Collimation side to

side: slightly less

than film size.


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39

Sternum RAO

Breathing

Instructions: Deep

inspiration. Some

sources recommend

expiration. Make exposure

Tell patient to

breathe and relax.

Note: left arm may beraised and rested on

top of Bucky.


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40

Sternum RAO Film

Must include theentire sternum.

The sternum shouldbe just clear of theheart.

Too much rotationwill distort view.

Both oblique viewscan be taken tostudy S C joints.


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41

Sternum Lateral

Measure: Lateral at

mid chest

Protection: Half

Apron SID: 40 Bucky

No tube angle

Film size: 10 x 12regular I.D. up

Portrait


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42

Sternum Lateral

Patient in a lateral

position with arms

locked behind back.

Make sure patient isas close to the

Bucky as possible.


inches above S.C.

joints.


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43

Sternum Lateral

Horizontal central ray

is centered to film.


through sternum. S.C.

joints may be used asreference. Two to three

inches anterior to mid

coronal plane can also

be used as reference.


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44

Sternum Lateral

Collimation top tobottom:Sternoclavicular jointsto xiphoid process

Collimation side to

side: slightly less thanfilm size

BreathingInstructions: Deepinspiration

Make exposure and letpatient breathe andrelax


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45

Sternum Lateral Film

There should be no

rotation of the patient.

Must see from

sternoclavicular joints to

xiphoid process.

Having shoulders pulled

back is important for

visualization of S C

joints.


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46

Rib Radiography

The region or area of injury or pain will

determine the views taken.

Anterior rib injury calls for P-A and anterior

oblique views.Like the chest oblique, the

affected side will be away from the film.

Posterior rib injury calls for A-P and

posterior oblique. The affected side is nextto the Bucky.


47/50

47

Rib Radiography

Anterior ribs are considered above the

diaphragms. Breathing instructions will be

full inspiration.

Posterior ribs can be above or below the

diaphragms. Abovethe diaphragms calls

fordeep inspiration. Belowthe

diaphragms calls forfull expiration.


48/50

48

Rib Radiography

Ribs above the diaphragms should be

taken erect.

Ribs below the diaphragms can be taken

erect but the diaphragms will move higher

when taken recumbent.

A small lead marker or BB taped to the

area of tenderness can help in theinterpretation of rib films.


49/50

49

Sternum Radiography

Routine views: RAO and Lateral

Shallow RAO only 20 to 25 Oblique

For the Sternoclavicular Joints both RAO

and LAO views with a straight P-A are

taken.

All views taken on inspiration.

Low kVp is used for higher contrast.


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Reading Assignment

Read Chapters 6.1 through 6.18

Be prepared to practice views in laboratory

End of Lecture

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