Projections

Sternum, Lateral

Patient Positioning and CR Location

Patient positioned upright with their left side against the IR. The patient’s arms are brought behind their back, with hands clasped, to push the chest forward.  The midsagittal plane should be parallel to the image receptor. The top of IR should be approximately 1.5 inches above the jugular notch, with the central ray directed midway between the jugular notch and the xiphoid process. 40 inch SID minimum, 72 inch SID preferred. Expose on full inspiration.

Evaluation Criteria

Entire sternum visualized without superimposition of ribs or arms. The image should demonstrate no rotation (the ribs are superimposed posterior to the sternum) and the sternum should form a clear anterior border.

Sternum, RAO

Patient Positioning and CR Location

Use a 40 inch SID or less. With the patient either upright or prone, rotate the patient into an RAO position, ensuring the right anterior chest wall is in contact with the IR. Roll the shoulders forward, bringing the sternum closer to the image receptor and minimizing superimposition. The top of IR should be approximately 1.5 inches above the jugular notch, with the central ray centered midway between the jugular notch and the xiphoid process, 1 inch to left of midline. Expose on full inspiration. Breathing technique can be used to blur the overlying ribs and lung markings, if patient can cooperate. 

Evaluation Criteria

Bony margins of the sternum appear sharp. (Lung markings will be blurred if breathing technique was used.) Entire sternum should be visualized in profile, superimposed over the heart shadow, with clear bony outlines and no superimposition from the spine or other structures. The entire sternum, from the jugular notch to the xiphoid process, should be visible.