1

PA -anterior side BEST SEEN AP -posterior side BEST SEEN

Ribs 2010- pt 2 VERSION 2POSITIOINING

TEXT VERSION -

PHOTOS HAVE BEEN REMOVED TO MAKE

PRESENTATION SMALLER

2• CLAVICLE

AP LT CLAVICLE - UPRIGHT• AXIAL LT CLAVICLE- UPRIGHT• AP RT CLAVICLE - SUPINE• AXIAL RT CLAVICLE- SUPINE

• A/C JOINTSA/C JTS – (BILATERAL) W/O WTS

• A/C JTS – (BILATERAL) WITH WTS• LT - A/C JTS - W/O WTS• LT - A/C JTS – WITH WTS

• SHOULDER (UPRIGHT OR SUPINE)• NON- TRAUMA• AP RT SHOULDER – INT ROT• AP RT SHOULDER – EXT ROT LT

SHOULDER – GRASHEY • TRAUMA• AP RT SHOULDER – NEUTRAL ROT• LT SHOULDER – TRANSTHORACIC

LAT• RT SHOULDER – SCAPULAR Y• SCAPULA (UPRIGHT OR SUPINE)• AP , LAT – RT SCAPULA

• RIBS – • (UPRIGHT OR SUPINE) UNILATERAL:• AP (RT) UPPER & LOWER RIBS • PA (RT) UPPER & LOWER RIBS • OBLIQUE – FOR (RT) AXILLARY UPPER

RIBS • OBLIQUE – FOR (RT) AXILLARY LOWER

RIBS • OBLIQUE – FOR (RT) POSTERIOR

UPPER RIBS (articulation to spine) • OBLIQUE – FOR (RT) POSTERIOR

LOWER RIBS (articulation to spine)

• BILATERAL:• AP BILATERAL UPPER RIBS • AP BILATERAL LOWER RIBS

• PA BILATERAL UPPER RIBS • PA BILATERAL LOWER RIBS

• RPO - BILATERAL UPPER RIBS • RPO BILATERAL LOWER RIBS • • LPO - BILATERAL UPPER RIBS • LPO BILATERAL LOWER RIBS

• STERNUM• RAO/LAO• Lateral Upright/ Supine / X-table

3

4 RIBS (Projections & Positions)

• AP

• OBLIQUES• LPO

• RPO

• (May also include PA CHEST for lungs)

• PA

• OBLIQUES• RAO

• LAO

Exam done : UNILATERAL or BILATERAL AD (above diaphram) & BD – (below diaphram)

5 BEST SEEN - RIBS

• AP - posterior ribs (AD/BD)

• PA - anterior ribs (AD/BD)

• OBLIQUES– RAO / LPO :

• LT axillary ribs + RT post rib art w/spine

– LAO / RPO • RT axillary ribs + LT post rib art w/spine

6UNIT 3 RT 122

TECHNIQUE CONSIDERATION

RIBS : UNILATERAL OR BILATERAL SHORT SCALE CONTRAST NEEDED

BONY DETAIL

• AD – above diaphram– 60 – 70 KVP – INSPIRATION

• BD – below diaphram– 70 KVP + 3-4 x more mAs (ABD)

• EXPIRATION

7 Routine: Bilateral RIBS

• AP or PA

• OBLIQUES• LPO (RAO)

• RPO (LAO) • (May also include PA CHEST for lungs)

↑ kVp for lungs (90-120)vs kVp bony ribs (60-80)

Must include : BOTH sides (RT & LT) TOP & Bottom (AD & BD)

8

PA for Chest or Bilat RIBS (AD)

9BILAT – AD (upright)

14 x 17 LW CW

Centering – same as CXR MSP + T 7

10

(AP) BILATERAL - AD

11 Deep Inspiration

Why?

12 INSPIRATION vs EXPIRATION

13Why do AP vs PA projection?

PA AP

14

BILAT (BD)

11X14 CW OR 14 x 17 CW Centering – (similar to upper ABD) MSP + L-1 (Bend of Rib)

Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

15

BILAT (BD)

11X14 CW OR 14 x 17 CW

16

OR Upright

17 SUPINE AP BILATERAL RIBS AD BD

18 AD – INSP BD - EXP

19 BILATERAL RIBS APAD & BDSame pt - routine

AD 14 x 17 LW 14 x 17 CW Centering – (similar to

upper ABD)

MSP + L-1 (Bend of Rib)

Top of light 1 – 2 “ above xyphoid

Bottom of light 1 – 2 “ below IC

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AD – INSP BD - EXP

21 BILAT – OBLIQUES – (AD) RPO LPO

CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)

& T7 (AD) 14x17 (LW or CW)

22

RPO LPO

23

RPO LPO

• RT AXILLARY RIBS• LT POST ARTICULATION TO

SPINE

• LT AXILLARY RIBS• RT POST ARTICULATION TO

SPINE

24 RPO LPO

25 If Taken “AP”Technique Used ?

Position? Demonstrates?What determines an adequate rotation?

26

Some of the challenges with RIBS >>>>>>>>>>>>>>

27 AP Bilat – OBLIQUE (AD)Position?

Demonstrates?

CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)

& T7 (AD)

CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)

& T7 (AD)

28 Projection PA AP Position LAO VS RPO

29 PA Bilat – OBLIQUE (AD)

Move both arms out of the way

This position not tested in lab

30

RAO (LOOKS THE SAME AS LPO)

BILATERAL OBLIQUE - AD

31

LAO VS RPO

32 BILATERAL OBLIQUES (BD)RPO LPO

CR ~ 2” lat to MSP (side up)& L1 (BD) 14x17 ( CW)

33BELOW THE DIAPHRAM

LPORPO

Technique needs improvement

34 Review :BILATERAL – LPOAD & BD

when positioning the patient – do same position (upper & lower)

Remember to change the tech ~ same kVp, go up 3 to 4 x in mas

35

LPO

36 Review BILATERAL – RPOAD & BD

when positioning the patient – do same position (upper & lower)

37

RPO

38

Routine: Unilateral RIBS

• AP or PA (area of injury)

• 1 or 2 OBLIQUES ex:

• RT RIBS• RPO for RT side (AD & BD)

• & LPO for RT side (AD & BD)

Focus is on RT side or LT side Top & Bottom (AD & BD)

39 UNILATERAL – RT RIBS( AP) AD & BD

when positioning the patient – do same position (upper & lower)

14 x 17 LW

CR ~ ½ way between MSP/MCP & T7 (AD) & L1 (BD)

11 X 14 CW

40 UNILATERAL – RT RIBS( AP) AD & BD

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AP UNILATERAL (LT RIBS)

AD BD

CR ~ ½ way between MSP/MCP & T7 (AD) L1 (BD)

42 UNILATERAL – LT RIBSAP AD BD

14 x 17 LW 14 x 17 cw

43 Unilateral - LT RIBS AD/BD

44 OBLIQUE Unilateral RIBS

1. AP or PA 2. AP OBLIQUES RT RIBS = RPO for RT side

(AD & BD) (“turn pt towards side that hurts”)

3. Additional oblique is • LPO for RT side (AD & BD)• And/or “cone down” with marker

45 UNILATERAL RibsDONE FOR ONE SIDE ONLY

• AP/PA – (? Injury on the back or front?)

•AP OBLIQUE – (ribs elongated)– side of problem turn toward the IR = axillary

•AP (OTHER) OBLIQUE – (ribs foreshortened)– side of problem turn away from the IR (see post art to spine and anterior portion of the rib best – they are superimposed)

–Keep your centering on the correct side of the injury

46UNILATERAL (LEFT RIBS) – AD

doing BOTH Obliques for one sideLPO –AXILLARY RPO –LT POST ART

“side down” ribs “side up” ribs

47

CR ~ ½ way between MSP/MCP (side down)

&~ T7 (AD)“frame with light”

top light 1”above shoulder lat side 1” lat to ribs

medial ~ 2 “ lat to msp (side up)bottom ~ 10th rib

48 Compare to RPO & LPO FOR ONE SIDERPO FOR RT SIDE LPO FOR LT SIDE

49 UNILATERAL (LEFT RIBS) – BOTH AD & BD LPO –AXILLARY

“side down” ribs

MSP + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

MSP + T7 Top of light 1” above shoulder Bottom of light ~ 10 rib

50

UNILAT – LEFT(LPO)

51

LPO/RAO – For LEFT Ribs

RAO

52 LPO for BD Lt axillary

53 Comparison of OBL – BDBILAT VS UNILAT

54 UNILATERAL – RT RIBS RPO AD RPO BD

(for the axillary portion of ribs)When positioning the patient – do same position (upper & lower)

55 UNILATERAL – RT RIBS RPO AD RPO BD

(for the axillary portion of ribs)

56 LAO/RPO for the RT RIBSUPSIDE = PA AWAY DOWNSIDE = AP TOWARD (SIDE OF PAIN)

57 UNILATERAL – RT RIBS LPO AD LPO BD

(for the posterior portion of ribs- articulation to spine) when positioning the patient – do same position (upper & lower)

Aka “side up” ribs

“extra view”

CR ~ ½ way between MSP/MCP (side up) &~ T7 (AD)“frame with light” top light 1”above shoulder lat side 1” lat to ribsmedial ~ 2 “ lat to msp bottom ~ 10th rib

CR ~ ½ way between MSP/MCP (side up) + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

58 UNILATERAL – RT RIBS LPO AD LPO BD

(for the posterior portion of ribs- articulation to spine)

59 OBLIQ - (LEFT RIBS) – ADRPO –LT POST ART

60 Position? Demonstrating?

AD BD

T7 or L 1

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End of Rib positioning

Review Part 3

Image Review