X-ray of the ribs

Among the numerous diagnostic studies, X-ray of the ribs occupies one of the leading places in terms of prevalence. Most often, the procedure is prescribed when a rib fracture is suspected. If multiple trauma is detected, the doctor may insist on performing a plain X-ray, which is necessary to obtain more objective and complete information about the damage. Plain X-ray shows the existing damage to the internal organs and the whole chest.

When X-rays of the ribs, the state of the bone mechanism is visualized, and the spine can be partially seen. The degree of ionizing radiation is not considered dangerous to human health, so X-rays can be considered a good alternative to ultrasound,  [1] computed and magnetic resonance imaging. [2]

Indications for the procedure

The thoracic skeletal frame is a reliable protection for the internal organs. An X-ray of the ribs is, in fact, the same X-ray of the chest, during which you can see not only bone structures, but also the heart, lungs, respiratory tract, and the spinal column. During the examination, the doctor may see damage or violation of the shape of the bones, or the development of any pathological process.

An X-ray of the ribs is necessary if a specialist suspects the presence of such diseases and conditions:

• traumatic chest injuries;
• violation of the integrity of the ribs;
• tumor processes in the organs of the chest;
• foreign bodies in the chest area;
• pulmonary pathology;
• bone tuberculosis;
• impaired bone formation, rickets;
• diseases of the spinal column;
• hernia of the diaphragm.

X-rays of the ribs are often prescribed not only as part of the diagnosis of the disease, but also to study the dynamics of pathology, and determine the treatment tactics. [3]

Preparation

Practically no preliminary preparation for the patient is required. The day before the scheduled study, it is advisable to exclude foods that cause increased gas formation in the intestines (peas, cabbage, carbonated drinks), since excess gases will raise the diaphragm, putting pressure on the lungs and ribs.

Immediately before the X-ray, the patient is asked to take off his outer clothing, undress to the waist. If there are any jewelry in the neck or chest area, then they must be removed. If a person has long hair, then they need to be gathered up: they should not fall into the image area.

Before starting the study, the patient should inform the radiologist about the pathologies suffered, surgical interventions on the chest organs, about the presence of foreign objects, implants in the area under study. Women must be sure to report pregnancy.

It is recommended to take all the medical documents that the doctor may need: the results of previous examinations, diagnoses, sheets with prescribed treatment, etc. All this can help the specialist decoding the radiograph to issue a more informative conclusion. [4]

Technique of the rib X-ray

In most cases, rib X-rays are performed in frontal and lateral projections. This approach allows you to assess the overall condition of the breast. If we are obviously talking about any part of the chest, then a targeted X-ray of the affected ribs is performed.

The patient undresses to the waist, presses his chest against the screen and inhales deeply (so that the chest expands), holds his breath. At the time of the expansion of the intercostal spaces, the costal contours become more distinct: it is then that the specialist takes a picture.

The position of the patient during the X-ray of the ribs can be different, depending on the area under study and the nature of the pathology. For example, when taking a direct posterior image, the person's lower ribs are placed horizontally on their backs. In this case, the midclavicular line of the diagnosed side should be located along the median longitudinal line of the couch. The upper limb is extended along the body, the legs are bent at the knees. On the frontal plane, the body should be parallel to the plane of the couch. This position allows you to clearly see the lower ribs, especially against the background of intense darkening of the liver. [5]

If it is necessary to perform a direct anterior image of the ribs, then the patient is placed on his stomach, a slight elevation is placed under his head, and his face is turned to the side opposite to that of the diagnosis. The arms should be extended along the body, the forearm and hands with the back of the body close to the table.

When performing a lateral image of the patient's ribs, they are placed on the diagnosed side, with the upper limbs raised and wound behind the head. The frontal plane of the body is parallel, and the sagittal plane is perpendicular to the plane of the couch.

To obtain an anterior oblique image, which is necessary to study the state of the anterolateral costal regions, a person is placed on the abdomen. The diagnosed half of the breast should fit snugly against the surface of the couch, and the opposite half should be slightly raised. The frontal plane of the body should intersect with the plane of the couch at an angle of 40-45 degrees. The upper limb from the side of the study is extended along the body, adjoining the back surface to the couch. The other arm is bent at the elbow, the palm rests on the table. The criterion for adequate placement is to obtain a clear image of the anterolateral parts of the ribs. [6]

To obtain a posterior oblique image, necessary to study the state of the posterolateral parts of the ribs, the patient is laid horizontally on his back, turning along the longitudinal axis of the body to the right or left (depending on which side to be examined), until the angle in the area of intersection of the frontal plane of the body and the plane of the couch reaches 40-45 degrees. Elevations can be placed under the back, pelvis, hip and knee. The upper limb from the examined side is extended along the body, and the other is retracted posteriorly, with an emphasis on the edge of the couch. 

In addition to an overview image in different projections, sometimes a sighting X-ray is required. To do this, they try to bring part of the rib with suspected pathology to the central or edge-forming position.

Contraindications to the procedure

We must not forget that there are contraindications to the X-ray of the ribs:

• the first trimester of pregnancy (or the entire period of pregnancy, depending on the situation);
• serious condition of the patient, various decompensated states;
• open pneumothorax, bleeding;
• mental disorders, inadequate behavior;
• sometimes obesity in the patient.

Most experts point out that there are, in principle, no absolute contraindications to performing an X-ray of the ribs, and for such categories of patients as pregnant women and children, the study should be carried out only if there are strict indications and if it is impossible to use other alternative diagnostic methods. [7], [8]

Normal performance

The structural elements that delimit the chest cavity consist of the chest skeleton, soft tissue, and the diaphragm. The boundaries of the chest cavity:

• ventral border - sternal segments;
• dorsal border - vertebral bodies and ribs;
• lateral borders - ribs, intercostal soft tissue, subcutaneous structure;
• the caudal border is the diaphragm.

The cranial thoracic region is bounded by the soft tissue of the ventral cervical region and the entrance to the rib cage.

During the diagnosis of these structures and organs, it is important to clearly assess the location of the pathological process. If necessary, additional x-rays should be taken from other views.

The X-ray of the fractured rib demonstrates the presence of objective signs - in particular, the fracture line, which is lighter than the bone in the image. It is also possible to change the bone structure, displacement of fragments. An indirect symptom can be a change in the adjacent soft tissues, which is also well visualized on the image - this is a darkening on the edge on X-ray, the disappearance of physiological enlightenment in the joints, thickening and thickening of the shadow of soft tissues, which is due to the formation of hematomas and edema. [9]

An X-ray of a rib fracture does not always show specific signs, therefore, the doctor often has to prescribe a computed tomography to the patient.

By such a violation as Lyushko's rib, they mean an abnormal development of the cartilage of the ribs, in which their anterior section is split. The violation is mainly one-sided, but it cannot be called a pathology, since it is not complicated by anything and does not in any way affect the quality of human life. [10]

Lushko's rib on X-ray looks like a dense formation, bifurcated in the front, usually localized near the sternum. The defect is found quite rarely (about 1% of cases).

Chondroma is a benign tumor that forms on the basis of mature cartilage tissue (mainly hyaline cartilage). The neoplasm grows and develops slowly, and is asymptomatic for a long time. The first signs begin to bother when the surrounding tissues are squeezed, when they spread to the pleura and the nerve fibers are damaged. In such situations, there is a deformation of the chest, the appearance of rib pain. A chondroma located on skeletal bones can be identified with a conventional X-ray. For example, if such a tumor is localized on the costal arch, then in the X-ray process it is possible to consider the focus of dysplasia and the cystic neoplasm itself. The chondroma of the ribs on X-ray against the background of soft tissues is invisible, since it is not radiopaque. Therefore, for other localizations of the tumor, diagnostic methods such as computed tomography, magnetic resonance imaging, as well as biopsy and microscope examination are used. [11]

Another congenital pathology - cervical ribs - is characterized by the presence of additional ribs in the cervical segment of the spinal column. The cervical ribs on the X-ray have the form of bony plates, symmetrically located on the sides of the spine. Normally, they are absent, and their detection allows us to speak of a developmental anomaly. Less often, such cervical elements are located only on one side.

X-ray numbering of ribs

The ribs are numbered from top to bottom: as they approach the pelvic region, these bones become softer and thinner.

The first rib is located near the clavicle, and the tenth is slightly below the xiphoid process. The body of the first seven costal pairs has a gradual transition into the cartilage tissue, then they are connected to the chest.

The first and strongest seven pairs of ribs are called true, and the eighth, ninth and tenth pair are called false ribs, since they have a cartilaginous connection between them. The eleventh and twelfth pairs are mobile, free, and are attached only on one side - to the spine.

The skeleton of an adult normally includes twelve costal pairs. It happens that in the course of development, a thirteenth pair is formed in a child, with localization at the level of the seventh or eighth cervical vertebra. Another rare anomaly is the formation of a single rudimentary rib in the cervical region.

Complications after the procedure

A certain danger is the X-ray of the ribs during pregnancy. The greatest likelihood of developing complications occurs in the first trimester - that is, the first 12 weeks of gestation. It is during this period that the future vital systems of the future baby are formed. [12] Therefore, the effect on the mother's body of a large number of X-rays can have various adverse consequences, depending on the period during which the study is carried out:

• the first 2 weeks of gestation: embryonic death, spontaneous abortion, ectopic implantation;
• 3-4 weeks: violations of the early stage of fetal development, spontaneous interruption;
• 5-6 weeks: improper development of the baby's glandular system, disorders in the formation of the immune, nervous, hematopoietic system;
• 7 week: development of disorders from the digestive system and metabolic processes;
• 8 week: pathology of the osteoarticular apparatus, the formation of the oral cavity;
• 9 week: the formation of disorders of the respiratory and reproductive system;
• 10-11 weeks: heart defects, dental disorders;
• 12 week: problems with the formation of immunity, with the work of the thyroid gland in the baby.

After 12 weeks, the negative effect of radiation on the fetus decreases. However, doctors strongly discourage x-rays from women without a valid indication. If possible, it is better to wait until the end of the pregnancy period, and only then carry out the diagnosis. [13]

If there is a rib injury or other problem in which it is impossible to use other diagnostic methods, and you cannot do without an X-ray, then the study is carried out, adhering to the following recommendations:

• women cover the pelvic and abdomen area with protective aprons and pads;
• inform the expectant mother about the possible consequences and complications.

Consequences after the procedure

The occurrence of negative consequences or complications after a rib X-ray procedure is extremely rare. If the patient has no contraindications to the study, and the X-ray itself is performed correctly, using special protective equipment, then adverse consequences can occur with an extremely low probability.

In general, the likelihood of side effects depends on the patient's individual radiosensitivity, on the amount and duration of the radiation received. Theoretically, reactions are possible:

• from the nervous system (increased irritability, headache, dizziness, sleep disturbance);
• from the digestive tract (nausea, vomiting, diarrhea, changes in appetite, dry mouth, the appearance of an unpleasant taste in the mouth);
• from the hematopoietic system (a decrease in the level of neutrophils and lymphocytes, monocytes, rarely - slight eosinophilia, thrombocytopenia).

Women are more at risk of complications during pregnancy.

Care after the procedure

There are no strict restrictions and specific recommendations regarding the care and regimen after the X-ray of the ribs. Some restrictions may be directly related to the trauma or pathology, in connection with which the radiography was ordered.

Some patients are worried about the radiation exposure that the patient's body receives during the diagnostic procedure. The most important thing for accelerating the elimination of radioactive substances from the body is adherence to the drinking regime with the use of at least 2 liters of water per day. In addition to water, it is allowed to drink freshly squeezed juices, fruit drinks, green tea. It is allowed to drink a little red dry wine. Grapes, pomegranates, nuts, and dairy products also have anti-radiation properties. Prunes, flaxseeds, nettle leaves are useful. It is advisable to include sour cream, cottage cheese, carrots, beets, buckwheat, seafood in the diet. But you should avoid products with preservatives, dyes, flavors and flavorings, as well as smoked meats and semi-finished products.

Rib X-rays are safe, although they are only done if indicated because they are associated with a certain amount of radiation exposure. The study is prescribed only if other diagnostic methods cannot provide enough information about the patient's condition. Do not be afraid of X-rays: if you follow all medical recommendations, then the diagnosis will not cause the development of negative manifestations and consequences in the body.