Ribs and Sternum pt 2

Author: Jill Chagnon

All right to continue there are some unusual genetic anomalies that can happen with the ribs. Sometimes you have ribs that attach at C7 and occasionally you get... 10 percent of the time this can cause thoracic outlet syndrome. Which is some..

Causes nerve or vascular impingement at the thoracic outlet. Up at the superior top of the bony thorax. And this is the thoracic outlet there is the space between the base of the neck and the armpits. Not very often do you see cervical ribs. And only occasionally from there does it cause this thoracic outlet syndrome. There is a bifid rib which is on this image. I'm not gonna tell you where it is, but I want to see if you can find it. I'm gonna ask you about it on the quiz.

Where is the bifid rib? which rib has it? and usually unilateral and it's fairly uncommon but sometimes you'll see it. And it looks kinda like this. That's why I put that on there.

Sternum. So the sternum, you're probably, you know, if you ever see it. You maybe only see it once or twice in your career. But they're very difficult to get and get them right. So when you're positioning for the sternum, and usually 2 views, PA oblique, RAO position.

Ribs and Sternum pt 2

And you always its the RAO because it uses the shadow heart to help with visualizing the steinem a little bit better. You don't want to be too far oblique because you're trying to keep the the sternum relatively flat. So it's a very shallow oblique, fifteen to twenty degrees. The patient can be laying down or standing up either way. It's a very shallow oblique. So it's a good idea to when your positioning for these, to have been patient facing anteriorly so you can see where their sternum is.

And open your collimation so you're about an inch to an inch a half above the top of the jugular notch and below the xiphoid. Center along the long axis of the sternum. If you get your collimation open properly, then when you turn the patient around it'll be a lot easier just to line the sternum up with the midline of the image receptor.

Cuz it's hard to tell in the back if you're in exactly the right place. And the light field may look too small. So you typically, it tells you right here where to center if you're centering from the posterior. But I would say, have them start facing so you can see the part. And get your collimation just about right. Once you get it right and get them lined up against the image receptor, you bring your distance into thirty inches so just be sure you're at thirty inches before you line up the Collimation, cause you want your light field to be the right size. So as far as lining up on the on the posterior you want to be one inch lateral to the midsagittal plane at about T7. You know where you center for your chest X-rays.

Here is what the sternum looks like. Here's your anatomy. This is what your patient will look like. You know I don't think I've ever seen one that looks this good. You can see the scalloped edges were the ribs attach along the sternum, right along here. The xiphoid is pretty small. Right here.

It's just very little. And the manubrium. And the clavicle, the notch. So these are the things your going to name when you show me these views. One of the things that's a really important is to have a breathing technique and that shorter distance I don't know how the, uh, Jeff might do it the site or Jocelyn might do it at the site, but in the book, just so you know, it says thirty inch SID and that helps to blur out the ribs a little bit with a shallow breathing technique. Blur out the ribs a little bit and magnified those the sternum just a little bit. So this is a regular 40 inches with no breathing technique and this one is a shorter SID and the shallow breathing technique and you can see how much better you can see the sternum with this technique. So think about it.

It's you're not going to see them very often but I would give it a try. Because this ,is what I typically see, if even that clearly. It's very difficult to see the sternum in that view. So here's what you need to look for as far as evaluating your image. I'm not gonna read this to you. You can read it. But you want to be able to see it like on that last image. And next we're gonna look at the lateral sternum.

The lateral sternum is so much easier. The patient is upright or supine or on their side. You can do it any which way. You want to have 72 inches distance for this. That's gonna help because of your OID that you have. The sternum of course being the center chest and that's far enough away from the image receptor that you're going to need some more distance you account for that. One and a half inches collimation you want that IR above the jugular notch.

And that will help you center mid body and get your collimation open where it needs to be. So you can do fairly tight collimation. You... You can see how you can do these laying down too. You so you only need 10 by 12 film because, like I told you, this sternum itself, the whole sternum is only about six inches long.

So 10 by 12 should be plenty. And this is what your image will look like. Good collimation. You want to see all the way from the manubrium down to the xiphoid right there. That one was a little a little tight.

So you don't want to get it too tight. But you want to be able to see good detail on there so 72 inches because of the OID. So you can get better detail. The next slides go along with...with ribs. And the slides are a little upsetting and I apologize for that right now. I know maybe some of you are sensitive to this, but it's important that you see and be aware of what your responsibility is when it comes to abuse. Child abuse is what we're talking about.

This little baby, mom decided to smash her head with her foot so that's unfortunate. This little child has been clearly abused by the bruises you can see on her. 700,000 children a year are victims of maltreatment. It's just so disturbing and I'm sorry but you're gonna see it out at the sites and you need to be aware of what your responsibility is. Shaken baby syndrome this is where the ribs come in. Ribs get fractured when whoever's abusing the child, shakes the baby and they're gripping their ribs so tightly it fractures the ribs.

This is a two month old child, two months. It's just unfathomable to me and sometimes on the extremities you're gonna see spiral fractures. Or you're going to see clean breaks. And when a child that young injures itself, you may see a green stick fracture because the bones are made so much of cartilage. They're not solid calcium yet. So for a clean break and a spiral fracture that means that somebody twisted or bent a bone in half. So for the father to say that he heard a pop when he was changing the baby's diaper, somehow I don't I don't know.

This is only a three-month-old baby here. But that's clearly a spiral fracture of the femur. Over here on this child, , you can see the anterior ribs had fractures that are healing as well. So two months old and now has a second set of fractures on the opposite ribs. I think that child needs to be put somewhere where they're gonna be safe.

Now as a health care provider you are mandated by law to report any suspected abuse. All the site that you have that you are at will have a policy in place for reporting abuse and it's mandated by the federal government as well as state law. You can look at your policies in your sites and find out what is your responsibility. If you don't know what it is and you suspect abuse, whether it's an elder, or a child or a person with disabilities, or just someone you have an exam room who reports to you that they are being abused and that they need help, you need to get a supervisor radiologists if it's in the nighttime hours maybe an emergency department physician. Someone who knows how to report the situation. Because these people will know for sure what needs to be done. So sorry to end on that unhappy note, but it's a hard topic but you need to know what your responsibilities are along those lines. And we've all seen it.

Any of us who have been techs for any length of time, we've all seen it. You just do the best you can to take care of your patients and be someone who's good to that person who's not having the best luck in their life. So anyway here is a link to my favorite YouTube video. And it's been around for a long time so you probably seen it but it makes me laugh every time. So I want you guys that have a great spring break.

And try to relax and not think too much about school. Take some time for yourself because you need it to rejuvenate. So have a good week off.

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