Radiographic Technique - I

Prepared By:Ala’a Ali Tayem Abed.

Radiographic Positioning of

the Ribs, Sternum, and

Sternoclavicular Joint.

The Ribs, Sternum, and Sternoclavicular Joint X-Ray Positioning

PA Ribs

Cassette (IR) Size: 35 x 43 cm. Cassette Orientation: Landscape usually, but may be Portrait. Exposure: 65 kVp, 16 mAs. FFD / SID: 100cm. Central Ray: Perpendicular to the IR / Bucky. Centering Point: Directed to the midsagittal plane at the level of T7, or the inferior border of the scapula.Collimation:Shutter A: Open to approximately 5cm above the shoulder to include upper airway.Shutter B: Open to the level of the Acromioclavicular joints (AC joints) laterally. This will include the lung fields and ribs laterally. Markers: Superior and Lateral Marker orientation PA. Respiration: On Suspended Deep Inspiration.

Positioning: • Patient Erect, Standing or seated, facing the Bucky. • Patient's Chest touching the Bucky, relax their shoulders and rolled forward to touch the Bucky. • Adjust the height of the Bucky so that the upper border of the IR is 5cm above the shoulders. • Raise the chin and rest on or above the Bucky.

PA RIBS

Evaluation Criteria • No rotation as evidenced by:

1. The medial ends of the clavicles equidistant from the spine.

2. The clavicles are in the same horizontal plane.

• The Lungs fields are clear of the Scapulae. • The 1st though to 9th posterior ribs will be visualized above the diaphragm on full inspiration. • Posterior Ribs, 1 through to 8, Lungs Fields, Apices, Costophrenic Angles, Heart. • Shutter A: Open to show the First Rib Superiorly and the Diaphragm Inferiorly.• Shutter B: Open to show the Lung Fields and Ribs Laterally.

Ribs - PA

AP Ribs

Cassette (IR) Size: 35 x 43 cm. Cassette Orientation: Landscape usually, but may be Portrait. Exposure: 75 kVp, 30 mAs. FFD / SID: 100cm. Central Ray: Perpendicular to the IR / Bucky. Centering Point: • Directed to the midsagittal plane at the level of the midpoint between the Xiphoid process and the level of the lower costal margins. • Perpendicular to the IR. (Ensuring the level of the iliac crests is aligned with the inferior border of the IR will ensure the lower ribs will be included in the image).Collimation:Shutter A: Open to include the iliac crests inferiorlyShutter B: Open to include the lung fields and ribs laterally.Respiration: On Suspended Expiration.

Positioning: This View can be performed with the Patient either Erect or Supine. Position the patient so that their back is touching the Bucky. Arms relaxed and slightly Abducted from the Sides of the Thorax. Adjust the Lower Border of the IR so that it is at the Level of the Iliac Crests.

AP (Posterior Lower Ribs 9-12)

Evaluation Criteria • No Rotation of the Thorax.• The 8th though to 12th posterior ribs will be visualized below the diaphragm on expiration. • Posterior ribs 8 through to 12, costophrenic angles, diaphragm.• Shutter A: Open to show the iliac crests inferiorly. Shutter B: Open to show the lung fields and ribs laterally.

Ribs - Oblique (Posterior or Anterior Obliques).

Area Covered: • Upper Ribs: view shows Ribs 1 through to 10. • Lower Ribs: view shows Rib 8 through to 12. IR Size & Orientation: 35 x 43 cm, Portrait / Bucky.Exposure: • 66 kVp, 16 mAs for Upper Ribs. • 75 kVp, 30 mAs for Lower Ribs (to penetrate the Abdomen).FFD / SID: 100cm.Central Ray: Perpendicular to the IR.Collimation: • Shutter A: Open to include from the vertebral bodies to the lateral rib margin. • Shutter B: Open to the film size superiorly and inferiorly. Central Point:• Rotate Patient’s Body 45 degrees.• Directed to the centre of the IR, in line with the mid - clavicular line and Centre the top of IR 1.5 in (4 cm) above the patient's shoulder. (Upper Ribs). • Directed to the centre of the IR, to the point midway between the vertebral bodies and the lateral rib margins and so that the bottom of the IR is at the level of the Iliac Crest. (Lower Ribs).

Respiration: • Upper Ribs on Suspended Inspiration. • Lower Ribs on Suspended Expiration.

Positioning: Posterior Oblique view

• Position the patient so that their back is against the Bucky. • Rotate the patient so they are angled 45° with the affected side touching the Bucky. • Position the arm on the affected side so that it is away from the area of interest. • Align the mid-clavicular line of the side being imaged to the midline of the IR.

Anterior Oblique view

• Position the patient so that they are facing the Bucky. • Rotate the patient so they are angled 45° with the affected side away from the Bucky and the non affected side touching the Bucky. • Position the arm on the affected side so that is away from the area of interest. • Align the patient so that mid-clavicular line of the side being imaged (between the lateral rib margin and the spine) to the midline of the IR.

LAORAO

RPO LPO

Evaluation Criteria • Upper ribs: Ribs 1 through to approximately 10 may be seen above the diaphragm providing the image was taken while the patient suspended breathing on maximum inspiration. • Lower ribs: Ribs 12 through to approximately 8 may be seen below the diaphragm providing the image was taken while the patient suspended breathing on maximum expiration. • Upper Ribs: 1. Shutter A: Open to include the vertebral bodies to the lateral rib margin.2. Shutter B: Open to include the 1st rib at the top of the film. • Lower Ribs:1. Shutter A: Open to include the vertebral bodies to the lateral rib margin.2. Shutter B: Open to include the 12th rib on the bottom of the film.

RIBS - OBLIQUE VIEW

Sternum – PA Oblique (RAO)

IR Size & Orientation: 24 x 30 cm, Portrait, Bucky.Exposure: Breathing technique used,70 kVp,25 mA,3 seconds.FFD / SID: 100cm.Central Ray: Perpendicular to the IR.Centering Point: Mid sternum (mid way between the jugular notch and the Xiphoid process).Collimation: • Shutter A: Open to collimate to film size lengthwise, ensuring the jugular notch is included superiorly. • Shutter B: Open laterally to approximately 13 cm.Respiration: No suspension of breath - use the Breathing Technique to blur the lung markings. The exposure is taken while the patient is taking shallow breaths. Positioning: • Patient is Erect or Prone with chest touching the Bucky. • From this PA position, oblique the patient 15° in an Right Anterior Oblique (RAO) position, right shoulder touching the Bucky. • Centre the sternum to the IR.

Sternum – PA Oblique (RAO)

Sternum – PA Oblique (RAO)

Evaluation Criteria • Correct obliquity is demonstrated by

1. The sternum is seen along side the spine without superimposition of the vertebrae. 2. The sternum is seen through the heart shadow.

• Entire sternum from the jugular notch superiorly to the Xiphoid process inferiorly, and the Sternoclavicular joints are seen.

Sternum - LateralIR Size & Orientation: 24 x 30 cm, Portrait, Bucky.Exposure: 75 kVp, 25 mAs.FFD / SID: 100cm.Central Ray: Directed to the sternum, midway between the jugular notch and the Xiphoid process.Collimation: Shutter A: Open to the film lengthwise, ensuring the jugular notch is included superiorly.Shutter B: Open to include whole of sternum, collimate tightly. Respiration: On Suspended Inspiration. Positioning: • Patient erect, with either side touching the Bucky.• Have the patient bring their hands together behind their back and push their chest out.• Ensure the patient is not rotated and the sternum is in a true lateral position.

Sternum - LateralEvaluation Criteria • The patient is in lateral position as evidenced by no superimposition on the sternum by:

1. Humerus.2. Shoulders.3. Soft Tissue.4. Ribs

• The entire length of the sternum is seen in profile. Open to show the entire sternum from the jugular notch superiorly to the Xiphoid sternum inferiorly.

IR Size & Orientation: 18 x 24cm, Landscape, Bucky.Exposure: 65 kVp, 20 mAs.FFD / SID: 100cm.Central Ray: CR perpendicular to IR.Centering Point: centered to level of T2 to T3 (7cm distal to vertebral prominens).Respiration: suspended on expiration.Positioning: • Patient prone on table. • Cushion for patients head.• Ensure no rotation of shoulders. Can be performed erect againstthe vertical Bucky.

Sternoclavicular – PA

Sternoclavicular Joints - PA Both Joints• Both SCJ are demonstrated.

• Medial ends of the clavicle are equidistant from the Spinous processes of the thoracic vertebrae.• MSP perpendicular to IR, to make the medial ends of clavicle equidistant about the vertebral column.• Sharp image demonstrating joints either side of the vertebral column in contrast to the vertebrae, medial ends of the posterior ribs, soft tissue of the lungs and sternum.

Evaluation Criteria

IR Size & Orientation: 18 x 24cm, Landscape, Bucky.Exposure: 65 kVp, 25 mAs.FFD / SID: 100cm.Central Ray: CR perpendicular to IR.Centering Point: Centered to level of T2 to T3 (7cm distal to vertebral prominens), and 5cm lateral (toward upside) to midsagittal plane.Respiration: Suspended on Expiration.Positioning:• Patient prone on table. • Patients head on pillow.• Patient obliqued on the table 15°. Can be Performed Erect Against the Vertical Bucky.

Sternoclavicular – Oblique

Sternoclavicular Joints - PA Oblique

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