Ribs - AP Lower (9-12)

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Ribs - AP Lower (9-12) (See "Special Notes" below).
Area Covered	This view best shows the posterior ribs. It also shows the diaphragm.
Pathology shown	Pathologies of the ribs, particularly, fractures of the lower posterior ribs.
Radiographic Anatomy	Ribs radiographic anatomy
IR Size & Orientation	35 x 43 cm Landscape usually, but may be portrait depending on body habitus D.R. may cover 43 x 43 cm
Film / Screen Combination	Regular (CR and DR as recommended by manufacturer)
Bucky / Grid	Moving or Stationary Grid
Filter	No
Exposure	75 kVp 30 mAs
FFD / SID	100 cm
Central Ray	Directed to the midsaggital plane at the level of the midpoint between the xiphoid process and the level of the lower costal margins. Perpendicular to the IR (Ensuring the level of the iliac crests is aligned with the inferior border of the IR will ensure the lower ribs will be included in the image).
Collimation	Centre: At the midsaggital plane, at the level of the midpoint between the xiphoid process and the level of the lower costal margins Shutter A: Open to include the iliac crests inferiorly Shutter B: Open to include the lung fields and ribs laterally.
Markers	Inferior and Lateral Marker orientation AP
Shielding	Gonadal (check your department's policy guidelines)
Respiration	On suspended expiration This ensures the diapragm is as high as possible, allowing as many lower ribs as possible to be seen
Positioning	This view can be performed with the patient either erect or supine Position the patient so that their back is touching the bucky Centre the midsaggital plane of the patient to the midline of the IR Ensure the midsaggital plane is perpendicular to the IR, that is, the patient is not rotated Arms relaxed and slightly abducted from the sides of the thorax Adjust the lower border of the IR so that it is at the level of the iliac crests
Critique PACEMAN	Positioning No rotation of the thorax The 8th though to 12th posterior ribs will be visualised below the diaphragm on expiration. Area Covered Posterior ribs 8 through to 12, costophrenic angles, diaphragm Collimation Centre: Approximately, the 10th rib Shutter A: Open to show the iliac crests inferiorly Shutter B: Open to show the lung fields and ribs laterally Exposure There should be adequate exposure so that the ribs and thoracic vertebrae are seen faintly through the heart There is minimal patient motion demonstrated by sharp, clear cortical margins and bony trabucular markings of the ribs being demonstrated.
Special Notes	PA vs AP Rib views There are several factors that will determine whether a PA or an AP rib view is indicated for the X-ray examination. The following information should be considered - the patient's clinical history - the mechanism of injury - the region of the rib cage which is painful The cortical margins and bony trabeculation of the ribs closest to the IR/bucky will be sharper and clearer. Therefore, Anterior ribs are best shown on a PA view & Posterior ribs are best shown on an AP view.