Thorax and Abdomen
3 Ribs
Anatomy
Head of the rib, neck of the rib, tubercle, angle of the rib, body or shaft of the rib, sternal end of the rib, true ribs, false ribs, floating ribs, costocartilage, sternum, costal facets, manubrium, sternal angle, xiphoid process.
Projections
Ribs, PA or AP Upright, above the diaphragm
CR Location
Ribs, PA or AP, Above the Diaphragm – CR perpendicular to IR, centered to the midsagittal plane at a level 3 or 4 inches below jugular notch.
Evaluation Criteria
No motion, no rotation (sternoclavicular joints equidistant from spine), optimum exposure to visualize ribs through the heart shadow or abdominal organs without burning out the mid lung area when concerned with the upper ribs.
Hows & Whys of Rib Radiography
- What projection may be added to a rib series if the patient has been coughing up blood?
- PA chest.
- Why might you see fewer than ten pairs of ribs above the diaphragm when the patient takes in a deep breath?
- Rib injuries are painful and the patient may not be able to take in as full an inspiration.
- How do you decide whether to perform AP or PA ribs?
- The injured area should be closest to the image, so if the patient’s front ribs hurt, the PA projection is done; if their back ribs hurt, the AP projection is done.
- Why is it better to do upper ribs erect?
- It allows better inspiration, so the diaphragm drops lower and is usually more comfortable for the patient.
- Why is it better to do lower ribs with the patient lying down?
- This allows the diaphragm to rise to the highest position and flattens out the abdomen giving you a more uniform thickness to penetrate.
- How do you choose which oblique images to do?
- Select the projection that places the area of interest closest to the image and rotates the spine out of the way.
- What is often done to help the radiologist locate small rib fractures?
- A “BB” or other small marker is often taped to the site of injury.
- Why is the image receptor placed crosswise?
- The shorter SID (40 inches rather than 72 inches) gives greater magnification and can project the ribs off of lengthwise placed images.