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XR Ribs

XRNo contrastChest
Indications
  • Rib pain/trauma
  • Suspected rib fracture
  • Suspected metastatic rib lesion
  • Localized chest wall pain
Patient prep
  • Remove radiopaque objects over thorax; gown
  • Mark/note painful area to tailor projection
Contrast
None / non-contrast
Technique
  • Tailor to area of injury (above vs below diaphragm) and anterior vs posterior ribs
  • Ribs ABOVE diaphragm: erect, suspended INSPIRATION
  • Ribs BELOW diaphragm: recumbent, suspended EXPIRATION
  • Posterior ribs: AP with affected side closest to IR; anterior ribs: PA
  • Oblique (RPO/LPO, 45 deg, affected side toward IR) to project axillary ribs free of spine
  • SID 40 inches; grid; kVp ~65-75 (below diaphragm) / lower for upper ribs
Series / Sequences
#Series / SequencePlaneNotes
1AP (or PA) ribsFrontalAP for posterior ribs (injury side to IR); PA for anterior ribs; breathing per location relative to diaphragm
2Oblique (anterior/posterior)Oblique45 deg, affected side toward IR; projects axillary portion of ribs away from spine
Key points
  • Include affected ribs above the diaphragm on inspiration; below the diaphragm on expiration
  • Always obtain a PA chest to exclude pneumothorax/hemothorax/effusion when trauma
  • Demonstrating an isolated rib fracture often does not change clinical management
References
• Lampignano JP, Kendrick LE. Bontrager's Handbook of Radiographic Positioning and Techniques. 10th ed. Elsevier; 2021 (rib projections).
• Rollins JH, Curtis T. Merrill's Atlas of Radiographic Positioning and Procedures. 16th ed. Vol 1, Ch 10: Bony Thorax. Elsevier; 2023.
• Radiopaedia: Ribs (PA view) and Ribs (AP view) link
Source: Researched — verify against your institution
‹ PreviousXR Chest Portable (AP)
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.