Sternum (oblique view)

The oblique sternum view a radiographic investigation of the entire sternum often complimenting the lateral sternum projection. 

Indications

The oblique view will show the sternal body in the AP plane, it is used to query fractures or infection ¹.

Patient position

• the patient is RAO facing the upright detector; the projection is performed RAO to project the sternum over the homogenous heart 
• RAO is 20-30 degrees larger patients require less rotation 

Technical factors

• posteroanterior right oblique projection
• respiration
  • suspended respiration or breathing technique if possible 
• centring point
  • midway between the jugular notch and the xiphoid process
  • dependent on rotation around 2.5-3.0 cm left of the midline
• collimation
  • laterally around 15 cm to include the body of the sternum 
  • superoinferiorly to include the jugular notch and the xiphoid process
• orientation
  • portrait
• detector size
  • 24 cm x 30 cm
• exposure
  • 65 – 75 kVp
  • 35 – 45 mAs
• SID
  • 100 cm
• grid
  • yes

Image technical evaluation

• the body of the sternum should be superimposed over the ribs and the heart shadow with  a clear bony outline 

Practical points

It is rare that this projection will be performed, therefore it is considered somewhat difficult due to the lack of practice. The key to achieving an optimal oblique sternum is: 

• tight collimation to avoid any unwanted scatter 
• taking the time to plan out the projection 
• always ensure you are performing it RAO (this is the optimal obliquity)

The projection can be performed in trauma situation (no spinal precautions) as an LPO supine projection. 

If spinal precautions are present it can be performed supine AP with a cross angle of 15-20 degrees and an aligned detector to ensure minimal elongation.