week 4 boney thorax positioning digital images
TRANSCRIPT
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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.
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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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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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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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A-P Upper Posterior Ribs
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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A-P Upper Posterior Ribs
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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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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Upper Posterior Ribs Oblique
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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Upper Posterior Ribs Oblique
Patient stands facingthe tube. Patient rotated
45 degrees toward the
affected side.
Place top of film twoinches above the
shoulder.
Center horizontal :
central ray to film.
Vertical central ray:
centered to the affected
side .
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Upper Posterior Ribs Oblique
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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Upper Posterior Ribs Oblique 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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P-A Upper Anterior 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 sidepronated
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P-A Upper Anterior Ribs
Patient stands facing the
Bucky.
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 very
small.
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P-A Upper Anterior Ribs
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.
Make exposure and let
patient relax.
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P-A Upper Anterior 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.
Scapula clear of ribs
Note BB & necklace
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Upper Anterior Ribs Oblique
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 sidepronated
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Upper Anterior Ribs Oblique
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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Upper Anterior Ribs Oblique
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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Upper Anterior Ribs Oblique
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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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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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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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
central ray to film.
Vertical central ray: tothe affected side
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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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Lower Ribs A-P
Breathing instructions:
Take a breath in and
blow it all out and hold it
out. Full expiration
Make exposure and let
patient breathe and
relax.
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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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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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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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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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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.
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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
Make exposure and let
patient relax.
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Lower Ribs Oblique Film
Should
demonstrate
from 8th through
12th ribs of theaffected side.
Must have 12th
rib on film.
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Lower Rib Oblique
This Oblique was
taken recumbent.
For lower ribs, both
the A-P and Obliqueare best taken
recumbent.
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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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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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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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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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Sternum RAO
Place top of film two
inches above the
sternoclavicular
joint.
Horizontal centralray: centered to the
film.
Vertical central ray
is established bycentering sternum
to Bucky center line.
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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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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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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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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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Sternum Lateral
Patient in a lateral
position with arms
locked behind back.
Make sure patient isas close to the
Bucky as possible.
Place top of film two
inches above S.C.
joints.
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Sternum Lateral
Horizontal central ray
is centered to film.
Vertical central ray
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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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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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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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.
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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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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.
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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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