Ribs - PA Chest

Radiographic Positioning

Adult

Other related pages of interest Applied Radiography Radiographic Anatomy Radiographic Protocols

Name of projection	Ribs - PA Chest. (See "Special Notes" below).
Area Covered	This view best shows the anterior ribs. It also shows the lung fields, mediastinal structures and diaphragm.
Pathology shown	Pathologies of the ribs, particularly, fractures of the anterior ribs. This view may also show related pathologies, such as a pneumothorax resulting from trauma to the ribs
Radiographic Anatomy	Chest 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	Decubitus filter for women with large breasts, particularly for non-digital imaging
Exposure	100 kVp 4mAs
FFD / SID	180cm
Central Ray	Directed to the midsaggital plane at the level of T7 Perpendicular to the IR
Collimation	Centre: T7, or the inferior border of the scapula Shutter A: Open to approximately 5cm above the shoulder to include upper airway Shutter B: Open to the level of the acromioclavicular joints (AC joints) laterally. This will include the lung fields and ribs laterally.
Markers	Superior and Lateral Marker orientation PA
Shielding	Gonadal (check your department's policy guidelines)
Respiration	On suspended deep inspiration This ensures the diapragm is as low as possible, allowing as many ribs as possible to be seen
Positioning	If the patient's condition allows, perform the views with the patient erect, standing or seated, facing the bucky Centre the midsaggital plane of the patient to the midline of the IR Bring the patient's chest so that it is touching the bucky Have the patient relax their shoulders and rolled forward to touch the bucky Adjust the height of the bucky so that the upper border of the IR is 5cm above the shoulders Raise the chin and rest on or above the bucky Clear the scapulae off the lung fields and ribs by getting the patient to either A. "Hug" the bucky by bringing the forearms behind the bucky (some buckys have purpose built handles for the patients to hold) OR B. Place the back of their hands against their lower hips
Critique PACEMAN	Positioning No rotation as evidenced by the medial ends of the clavicles equidistant from the spine the clavicles are in the same horizontal plane The lungs fields are clear of the scapulae The 10th anterior ribs will be visualised above the diaphragm on full inspiration. Note that fewer than the first 10 ribs will be seen if the patient is experiencing much pain and so therefore is less likely to take a deep breath. Less than 10 ribs are also seen when the patient is supine. Area Covered Anterior ribs, lungs fields, apices, costophrenic angles, heart Collimation Centre: T7 Thoracic vertebra Shutter A: Open to show the first rib superiorly and the diaphragm 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.