PA -anterior side BEST SEEN AP -posterior side BEST SEEN

1. Ribs 2010- pt 2 VERSION 2POSITIOINING TEXT VERSION - PHOTOS HAVE BEEN REMOVED TO MAKE PRESENTATION SMALLER PA -anterior side BEST SEEN AP -posterior side BEST SEEN

2. CLAVICLEAP LT CLAVICLE - UPRIGHT AXIAL LT CLAVICLE- UPRIGHT AP RT CLAVICLE - SUPINE AXIAL RT CLAVICLE- SUPINE A/C JOINTSA/C JTS – (BILATERAL) W/O WTS A/C JTS – (BILATERAL) WITH WTS LT - A/C JTS - W/O WTS LT - A/C JTS – WITH WTS SHOULDER(UPRIGHT OR SUPINE) NON- TRAUMA AP RT SHOULDER – INT ROT AP RT SHOULDER – EXT ROT LT SHOULDER – GRASHEY TRAUMA AP RT SHOULDER – NEUTRAL ROT LT SHOULDER – TRANSTHORACIC LAT RT SHOULDER – SCAPULAR Y SCAPULA(UPRIGHT OR SUPINE) AP , LAT – RT SCAPULA RIBS – (UPRIGHT OR SUPINE) UNILATERAL: AP (RT) UPPER & LOWER RIBS PA (RT) UPPER & LOWER RIBS OBLIQUE – FOR (RT) AXILLARY UPPER RIBS OBLIQUE – FOR (RT) AXILLARY LOWER RIBS OBLIQUE – FOR (RT) POSTERIOR UPPER RIBS (articulation to spine) OBLIQUE – FOR (RT) POSTERIOR LOWER RIBS (articulation to spine) BILATERAL: AP BILATERAL UPPER RIBS AP BILATERAL LOWER RIBS PA BILATERAL UPPER RIBS PA BILATERAL LOWER RIBS RPO - BILATERAL UPPER RIBS RPO BILATERAL LOWER RIBS LPO - BILATERAL UPPER RIBS LPO BILATERAL LOWER RIBS STERNUM RAO/LAO Lateral Upright/ Supine / X-table

4. AP OBLIQUES LPO RPO (May also include PA CHEST for lungs) PA OBLIQUES RAO LAO RIBS (Projections & Positions) • Exam done : UNILATERAL or BILATERAL • AD (above diaphram) & BD – (below diaphram)

5. BEST SEEN - RIBS • AP - posterior ribs (AD/BD) • PA - anterior ribs (AD/BD) • OBLIQUES • RAO / LPO : • LT axillary ribs + RT post rib art w/spine • LAO / RPO • RT axillary ribs + LT post rib art w/spine

6. UNIT 3 RT 122TECHNIQUE CONSIDERATION RIBS : UNILATERAL OR BILATERAL SHORT SCALE CONTRAST NEEDED BONY DETAIL • AD – above diaphram • 60 – 70 KVP – INSPIRATION • BD – below diaphram • 70 KVP + 3-4 x more mAs (ABD) • EXPIRATION

7. Routine: Bilateral RIBS • Must include : BOTH sides (RT & LT) • TOP & Bottom (AD & BD) • AP or PA • OBLIQUES • LPO (RAO) • RPO (LAO) • (May also include PA CHEST for lungs) ↑ kVp for lungs (90-120)vs kVp bony ribs (60-80)

8. PA for Chest or Bilat RIBS (AD)

9. BILAT – AD (upright) 14 x 17 LW CW Centering – same as CXR MSP + T 7

10. (AP) BILATERAL - AD

11. Deep Inspiration Why?

12. INSPIRATION vs EXPIRATION

13. Why do AP vs PA projection? PA AP

14. BILAT (BD) 11X14 CW OR 14 x 17 CW Centering – (similar to upper ABD) MSP + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

15. BILAT (BD) 11X14 CW OR 14 x 17 CW

16. OR Upright

17. SUPINE AP BILATERAL RIBS AD BD

18. AD – INSP BD - EXP

19. BILATERAL RIBS APAD & BD Same pt - routine AD 14 x 17 LW 14 x 17 CW Centering – (similar to upper ABD) MSP + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

20. AD – INSP BD - EXP

21. BILAT – OBLIQUES – (AD) RPO LPO CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)& T7 (AD) 14x17 (LW or CW)

22. RPO LPO

23. RT AXILLARY RIBS LT POST ARTICULATION TO SPINE LT AXILLARY RIBS RT POST ARTICULATION TO SPINE RPO LPO

24. RPO LPO

25. If Taken “AP”Technique Used ? Position? Demonstrates?What determines an adequate rotation?

26. Some of the challenges with RIBS >>>>>>>>>>>>>>

27. AP Bilat – OBLIQUE (AD) Position? Demonstrates? CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)& T7 (AD) CR ~ ½ way between MSP/MCP (side up) or ~ 2” lat to MSP (side up)& T7 (AD)

28. Projection PA AP Position LAO VS RPO

29. PA Bilat – OBLIQUE (AD) Move both arms out of the way This position not tested in lab

30. RAO (LOOKS THE SAME AS LPO) BILATERAL OBLIQUE - AD

31. LAO VS RPO

32. BILATERAL OBLIQUES (BD)RPO LPO CR ~ 2” lat to MSP (side up)& L1 (BD) 14x17 ( CW)

33. BELOW THE DIAPHRAM LPO RPO Technique needs improvement

34. Review :BILATERAL – LPOAD & BDwhen positioning the patient – do same position (upper & lower) Remember to change the tech ~ same kVp, go up 3 to 4 x in mas

35. LPO

36. Review BILATERAL – RPOAD & BDwhen positioning the patient – do same position (upper & lower)

37. RPO

38. Routine: Unilateral RIBS Focus is on RT side or LT side Top & Bottom (AD & BD) • AP or PA (area of injury) • 1 or 2 OBLIQUES ex: • RT RIBS • RPO for RT side (AD & BD) • & LPO for RT side (AD & BD)

39. UNILATERAL – RT RIBS( AP) AD & BD when positioning the patient – do same position (upper & lower) 11 X 14 CW 14 x 17 LW CR ~ ½ way between MSP/MCP & T7 (AD) & L1 (BD)

40. UNILATERAL – RT RIBS( AP) AD & BD

41. AP UNILATERAL (LT RIBS) AD BD CR ~ ½ way between MSP/MCP & T7 (AD) L1 (BD)

42. UNILATERAL – LT RIBSAP AD BD 14 x 17 cw 14 x 17 LW

43. Unilateral - LT RIBS AD/BD

44. OBLIQUE Unilateral RIBS • AP or PA • AP OBLIQUES RT RIBS = RPO for RT side (AD & BD) (“turn pt towards side that hurts”) 3. Additional oblique is • LPO for RT side (AD & BD) • And/or “cone down” with marker

45. UNILATERAL Ribs DONE FOR ONE SIDE ONLY AP/PA (? Injury on the back or front?) AP OBLIQUE – (ribs elongated) side of problem turn toward the IR = axillary AP (OTHER) OBLIQUE – (ribs foreshortened) side of problem turn away from the IR (see post art to spine and anterior portion of the rib best – they are superimposed) Keep your centering on the correct side of the injury

46. UNILATERAL (LEFT RIBS) – ADdoing BOTH Obliques for one sideLPO –AXILLARY RPO –LT POST ART “side down” ribs “side up” ribs

47. CR ~ ½ way between MSP/MCP (side down) &~ T7 (AD)“frame with light” top light 1”above shoulder lat side 1” lat to ribsmedial ~ 2 “ lat to msp (side up)bottom ~ 10th rib

48. Compare to RPO & LPO FOR ONE SIDERPO FOR RT SIDE LPO FOR LT SIDE

49. UNILATERAL (LEFT RIBS) – BOTH AD & BD LPO –AXILLARY “side down” ribs MSP + T7 Top of light 1” above shoulder Bottom of light ~ 10 rib MSP + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC

50. UNILAT – LEFT(LPO)