PA -anterior side BEST SEEN AP -posterior side BEST SEEN
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Transcript of PA -anterior side BEST SEEN AP -posterior side BEST SEEN
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PA -anterior side BEST SEEN AP -posterior side BEST SEEN
Ribs 2010- pt 2 VERSION 2POSITIOINING
TEXT VERSION -
PHOTOS HAVE BEEN REMOVED TO MAKE
PRESENTATION SMALLER
2• CLAVICLE
AP 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
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4 RIBS (Projections & Positions)
• AP
• OBLIQUES• LPO
• RPO
• (May also include PA CHEST for lungs)
• PA
• OBLIQUES• RAO
• LAO
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
6UNIT 3 RT 122
TECHNIQUE 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
• 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)
Must include : BOTH sides (RT & LT) TOP & Bottom (AD & BD)
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PA for Chest or Bilat RIBS (AD)
9BILAT – AD (upright)
14 x 17 LW CW
Centering – same as CXR MSP + T 7
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(AP) BILATERAL - AD
11 Deep Inspiration
Why?
12 INSPIRATION vs EXPIRATION
13Why do AP vs PA projection?
PA AP
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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
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BILAT (BD)
11X14 CW OR 14 x 17 CW
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OR Upright
17 SUPINE AP BILATERAL RIBS AD BD
18 AD – INSP BD - EXP
19 BILATERAL RIBS APAD & BDSame 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
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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)
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RPO LPO
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RPO LPO
• RT AXILLARY RIBS• LT POST ARTICULATION TO
SPINE
• LT AXILLARY RIBS• RT POST ARTICULATION TO
SPINE
24 RPO LPO
25 If Taken “AP”Technique Used ?
Position? Demonstrates?What determines an adequate rotation?
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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
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RAO (LOOKS THE SAME AS LPO)
BILATERAL OBLIQUE - AD
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LAO VS RPO
32 BILATERAL OBLIQUES (BD)RPO LPO
CR ~ 2” lat to MSP (side up)& L1 (BD) 14x17 ( CW)
33BELOW THE DIAPHRAM
LPORPO
Technique needs improvement
34 Review :BILATERAL – LPOAD & BD
when positioning the patient – do same position (upper & lower)
Remember to change the tech ~ same kVp, go up 3 to 4 x in mas
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LPO
36 Review BILATERAL – RPOAD & BD
when positioning the patient – do same position (upper & lower)
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RPO
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Routine: Unilateral RIBS
• 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)
Focus is on RT side or LT side Top & Bottom (AD & BD)
39 UNILATERAL – RT RIBS( AP) AD & BD
when positioning the patient – do same position (upper & lower)
14 x 17 LW
CR ~ ½ way between MSP/MCP & T7 (AD) & L1 (BD)
11 X 14 CW
40 UNILATERAL – RT RIBS( AP) AD & BD
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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 LW 14 x 17 cw
43 Unilateral - LT RIBS AD/BD
44 OBLIQUE Unilateral RIBS
1. AP or PA 2. 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 RibsDONE 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
46UNILATERAL (LEFT RIBS) – AD
doing BOTH Obliques for one sideLPO –AXILLARY RPO –LT POST ART
“side down” ribs “side up” ribs
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CR ~ ½ way between MSP/MCP (side down)
&~ T7 (AD)“frame with light”
top light 1”above shoulder lat side 1” lat to ribs
medial ~ 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 + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC
MSP + T7 Top of light 1” above shoulder Bottom of light ~ 10 rib
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UNILAT – LEFT(LPO)
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LPO/RAO – For LEFT Ribs
RAO
52 LPO for BD Lt axillary
53 Comparison of OBL – BDBILAT VS UNILAT
54 UNILATERAL – RT RIBS RPO AD RPO BD
(for the axillary portion of ribs)When positioning the patient – do same position (upper & lower)
55 UNILATERAL – RT RIBS RPO AD RPO BD
(for the axillary portion of ribs)
56 LAO/RPO for the RT RIBSUPSIDE = PA AWAY DOWNSIDE = AP TOWARD (SIDE OF PAIN)
57 UNILATERAL – RT RIBS LPO AD LPO BD
(for the posterior portion of ribs- articulation to spine) when positioning the patient – do same position (upper & lower)
Aka “side up” ribs
“extra view”
CR ~ ½ way between MSP/MCP (side up) &~ T7 (AD)“frame with light” top light 1”above shoulder lat side 1” lat to ribsmedial ~ 2 “ lat to msp bottom ~ 10th rib
CR ~ ½ way between MSP/MCP (side up) + L-1 (Bend of Rib) Top of light 1 – 2 “ above xyphoid Bottom of light 1 – 2 “ below IC
58 UNILATERAL – RT RIBS LPO AD LPO BD
(for the posterior portion of ribs- articulation to spine)
59 OBLIQ - (LEFT RIBS) – ADRPO –LT POST ART
60 Position? Demonstrating?
AD BD
T7 or L 1
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End of Rib positioning
Review Part 3
Image Review