Ribs, sternum, SCJs, ACJs.

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ENCLOSE THE ORGANS
STERNUM (breast bone)
12 PAIR OF RIBS
12 THORACIC
VERTEBRA
ATTACH UPPER
EXTREMITY
2 CLAVICLES
2 SCAPULA
Posterior view



Bony Thorax (Anatomy)
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AP posterior ribs (upper and lower ribs) ( Basic)

A basic projection for pathology and fractures .

Film: 35 x 43 cm, crosswise.

For upper ribs: Patient erect (preferred), specially in case of trauma
to prevent lungs puncture by a fractured rib. Erect PA chest is also
recommended).
Lower ribs: Patient supine, shoulders rotated anteriorly to remove
scapula away from the lungs, chin raised to prevent superimposition
with upper ribs, patient looks straight ahead,
kV (65 75 for above diaphragm, 75 85 for below diaphragm),
FFD 100 cm, grid.

CP: Upper ribs (above diaphragm): To T7 (8 10 cm below the
jugular notch).
Lower ribs (below diaphragm): Midway between xiphoid
and lower rib cage.
CR: 90 to the film center.
For upper ribs: Exposure on the arrested
full inspiration.
For lower ribs: Exposure on the arrested
full expiration.
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RAO, RPO ribs (upper and lower ribs) ( Basic)

A basic projection for pathology, fractures
Film: 35 x 43 cm, lengthwise.
Upper ribs: Patient erect (preferred), specially in case of trauma to prevent
lungs puncture by a fractured rib. An erect PA chest also recommended.
Lower ribs: Patient supine, then rotated 45 posteriorly or interiorly.
PO: Affected side should be close to cassette.
AO: Affected side away from cassette, arm of elevated side raised above
head, opposite arm extended down away from thorax, kV 70 75 (above
diaphragm, 80 85 (below diaphragm).
CP: Upper ribs (above diaphragm): T7 (8-10 cm below jugular notch).
Lower ribs: (below diaphragm): Midway between xiphoid process and
lower rib cage.
CR: 90 to film center in each case.

AP/ AP Axial Clavicle B

For #s/ dislocations of the clavicle and Acromoiclavicular joint.

Patient supine or erect, arms at sides, chin raised, back of shoulder in
contact with the film or couch top.
Film: HD 24x30 cm.

CP: Mid-clavicle.
CR: AP: 90 horizontal. AP axial: 15- 30 cephalad.
Exposure on arrested inspiration.


AP ACROMIOCLAVICULAR JOINTS (ACJs) B

For #s/ joint separation. Done with /without stress weights (8 10
pounds, 10 15 for large adult patients), cassette crosswise.

Patient erect, back of shoulders against film, 2 films taken in the same
position (one with the weights, other without), film 2 above shoulders,
35x43 film.
CP: Midpoint between clavicles.
CR: 90 horizontal to film center.



For pathology of the sternum (fractures /other inflammatory
processes).

Patient erect with arms on sides, or: Semi prone and slightly
oblique (15 - 20, to the right side ) with the left arm up and the
right arm down by the side.

Film: HD 24x30 cm.

CP: Center of sternum (midway between jugular notch and the
xiphoid process).

CR: Horizontally 90 to film center, exposure on (normal)
quiet breathing, or else, during a suspended expiration.


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RAO sternum (Basic)

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RAO sternum (Basic)


For pathology of the sternum (#s, Subluxation, and other
inflammatory processes).

Patient erect (arms drawn to back), or in a lateral recumbent
(lying on the side, arms above the head), shoulders well back.

Film: HD 24x30 cm.

CP: Center of sternum (midway between jugular notch
and xiphoid process).

CR: 90 to film center, exposure during a suspended
inspiration.
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Lateral sternum (Basic)


For joint separation and pathology.

Patient prone, pillow for head which must be turned
to one side, arms up beside the head.
Film: HD 18x24 cm.

CP: At level of T2-T3.

CR: 90 to the film center, exposure done during
suspended expiration.
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PA bilateral sternoclavicular joints (SCJs) (Basic)

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CT sternoclavicular joints (SCJs)




Pelvis ,Hips and Sacroiliac joints




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Basic/ AP pelvis (bilateral hips)
Basic projection for #s and pathology. Shows pelvic girdle, L5, sacrum
and coccyx, femoral heads, neck and greater trochanters.

Patient supine, arms on sides or across chest, pillow under head, support
under knees, legs separated, long axis of feet and lower limb internally
rotated 15 to 20,sandbag between heels, feet taped together for
retention, exposure on the arrested respiration. 90 KVp is used to
reduce Gonadal dose. Gonadal shielding for males or females without
obscuring the essential anatomical parts, kV 85 95,FFD 102 cm, grid.
CR: Vertically 90 to film center.
CP: Midway between level of ASISs and symphysis pubis (5 cm
superior to the symphysis pubis).
Basic/ AP pelvis (bilateral hips)
1. Lateral part of the sacrum
2. Gas in colon
3. Ilium
4. Sacroiliac joint
5. Ischial spine
6. Superior ramus of pubis
7. Inferior ramus of pubis
8. Ischial tuberosity
9. Obturator foramen
10. Intertrochanteric crest
11. Pubic symphysis
12. Pubic tubercle
13. Lesser Trochanter
14. Neck of femur
15. Greater Trochanter
16. Head of femur
17. Acetabular fossa
18. Anterior inferior iliac spine
19. Anterior superior iliac spine
20. Posterior inferior iliac spine
21. Posterior superior iliac spine
22. Iliac crest
Basic / AP pelvis (frog-leg lateral)
Basic to show congenital hip dislocation in non-trauma patients. Shows
femoral heads, necks, trochanters, and the whole pelvis.
Patient supine, arms on the sides or across chest, pillow for head, support
under knee, ASISs should be equidistant from table top, both knees flexed
90, feet soles placed together, both femurs abducted 40 to 45 from
vertical, kV 75 80,FFD 100 cm
CR: 90 vertically to the film center.
CP: A point 1 inch (2.5 cm) above symphysis pubis.

Basic/ AP hip joint (unilateral)
A basic view (post-operative or follow-up) to show acetabulum, femoral head
and neck, the greater Trochanter.
Patient in semi-supine, arms by the side or over chest, the affected leg rotated
internally 15 to 20, kV 85 95, FFD 100 cm, with grid.
CR: 90 to film center.
CP: Mid femoral neck (2.5 cm medial to ASIS).
or inguinal crest ( where the leg bends)
Basic/ AP hip joint (unilateral)
1. Anterior superior iliac spine
2. Ilium
3. Anterior inferior iliac spine
4. Pelvic brim
5. Acetabular fossa
6. Head of femur
7. Fovea
8. Superior ramus of pubis
9. Obturator foramen
10. Inferior ramus of pubis
11. Pubic symphysis
12. Ischium
13. Lesser Trochanter
14. Intertrochanteric crest
15. Greater Trochanter
16. Neck of femur
Unilateral frog-leg hip (non-trauma)
A special (non-trauma) view for the hip joint and proximal femur.
Patient supine, pillow for head, affected knee and hip flexed (thigh 45) with
sole of the foot against the inside of the opposite leg (near the knee), affected
femoral neck centered to midline of film, kV 85 95, FFD 100 cm, with grid.
CR: 90 to film center.
CP: Mid femoral neck.
Unilateral frog-leg hip (non-trauma)
1. Greater Trochanter
2. Intertrochanteric crest
3. Lesser Trochanter
4. Neck of femur
5. Head of femur
6. Acetabular fossa
7. Superior ramus of pubis
8. Obturator foramen
9. Inferior ramus of pubis
10. Ischium
Axiolateral (Inferosuperior hip)
A lateral view for hip fractures and dislocations, (acetabulum and femoral
heads, and neck) when the patient is injured and can not move his leg. Can be
done on bed or stretcher.
Patient supine, pillow for the head, pelvis elevated 5 cm by supports under
pelvis, the affected leg elevated such that thigh is near vertical and outside the
radiation field, cassette placed in crease above iliac crest, such that it is parallel
to the femoral neck, leg rotated internally 15 to 20, kV 85 95, FFD 102 cm,
with grid..
CR: 90 to film center.
CP: Femoral neck.
AP axial sacroiliac joints
Basic view for fracture, dislocation, and Subluxation of the sacroiliac joints.
Patient supine, pillow for head, legs fully extended, with support under knees.
CR: 30 cephalic (males), and 35 cephalic (females) to film center.
CP: Midway between level of ASIS and symphysis pubis.
N.B. Urinary bladder should be emptied+ cleansing enema to exclude
gas and fecal matter.
RPO for left SI joint (upside)
RPO sacroiliac joint (left side up)
Basic view to show sacroiliac joints farthest from the film for fracture,
dislocation, and Subluxation.
Patient supine, a pillow for head, patient is turned 25 to 30 posterior oblique
(side of interest up), support under the elevated hip, elevated knee flexed,
Urinary bladder should be emptied, preferably + Cleaning enema
CR: 90 to film center.
CP: 1 inch (2.5 cm) medial to upside ASIS.
Good Luck