Ribs and sternum positioning

Above or below

Rib exams are split by the diaphragm. For ribs above the diaphragm, the patient is erect if possible and holds a full inspiration, which drops the diaphragm and shows the upper ribs against air-filled lungs. A lower, chest-like kVp keeps bone contrast. For ribs below the diaphragm, the patient is recumbent and holds a full expiration, which raises the diaphragm so the lower ribs sit over the abdomen. They need a higher, abdomen-like kVp. Upper ribs: CR to T7, top of the IR about 1.5 inches above the shoulders. Lower ribs: bottom of the IR at the iliac crest.