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. Above the diaphragms calls for deep inspiration. Below the diaphragms calls for full expiration.

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.

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 very small.

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 and hold. 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.

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.

Upper Posterior Ribs Oblique

Patient stands facing the tube. Patient rotated 45 degrees toward the affected side. Place top of film two inches 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 to bottom: less than film size. Collimation: side to side: skin of affected side. Instruction patient to raise arm of the affected side and take a deep breath in and hold. Make exposure and let patient 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 side pronated

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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 to side: 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 side pronated

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Upper Anterior Ribs Oblique

Patient stands facing the Bucky. The patients affected ribs are rotated 30 to 45 degrees away from the Bucky. The arm of the affected side is raised and rests on the top of the Bucky. Top of film placed two inches above the shoulder.
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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 on males 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: to the 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 slightly less 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 lower ribs.

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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 lower ribs. 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 above the 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 ribs of 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 the affected 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 Oblique are 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 sternoclavicular joints, 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 right shoulder should be touching the Bucky. Align the sternum with the centerline of the Bucky.

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Sternum RAO
Place top of film two inches above the sternoclavicular joint. Horizontal central ray: centered to the film. Vertical central ray is established by centering sternum to Bucky center line.
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Sternum RAO
Collimation top to bottom: Sternoclavicular joints to xiphoid process or slightly less 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 be raised and rested on top of Bucky.
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Sternum RAO Film

Must include the entire sternum. The sternum should be just clear of the heart. Too much rotation will distort view. Both oblique views can be taken to study 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 12 regular I.D. up Portrait
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Sternum Lateral
Patient in a lateral position with arms locked behind back. Make sure patient is as 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 as reference. Two to three inches anterior to mid coronal plane can also be used as reference.

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Sternum Lateral
Collimation top to bottom: Sternoclavicular joints to xiphoid process Collimation side to side: slightly less than film size Breathing Instructions: Deep inspiration Make exposure and let patient breathe and relax
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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 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. Above the diaphragms calls for deep inspiration. Below the diaphragms calls for full 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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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 Return to Winter 2008 Index Return to PB-322 Home Page

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