What types of X-ray views are available to image the sternum?

Sternum X-Ray Views

For sternum radiography, the standard imaging protocol includes a lateral view and an oblique view (typically right anterior oblique at 15-20 degrees), with the lateral view being the most essential for visualizing sternal fractures and pathology. 1

Standard Radiographic Views

Lateral View

• The lateral view is the primary projection for sternum imaging, obtained with the patient in a standing or recumbent position with the beam directed perpendicular to the sternum 1
• This view provides the best visualization of sternal fractures, anterior-posterior displacement, and overall sternal alignment 2
• The lateral projection demonstrates the manubrium, sternal body, and xiphoid process in profile 3

Oblique View (Right Anterior Oblique)

• The oblique view, typically performed as a right anterior oblique (RAO) at 15-20 degrees, projects the sternum away from the overlying thoracic spine and mediastinal structures 1
• This positioning reduces superimposition of the vertebral column and cardiac silhouette that obscures sternal detail on standard anteroposterior views 4
• The oblique projection is particularly useful for evaluating the sternoclavicular joints and detecting subtle cortical irregularities 3

Anteroposterior View (Limited Utility)

• Standard AP chest radiographs have significant limitations for sternum evaluation due to overlapping mediastinal structures, cardiac silhouette, and thoracic spine 5
• AP views alone are often inadequate for visualizing sternoclavicular joint dislocations and sternal pathology 5
• The sternum lies immediately behind the heart, making visualization on frontal projections particularly challenging 6

Specialized Views for Sternoclavicular Joint

Rockwood View

• The Rockwood view is an upright 30-degree angled caudad radiograph specifically designed to visualize the sternoclavicular region 5
• This specialized projection helps assess sternoclavicular joint dislocations by projecting the clavicular heads above the thoracic spine 5

Multiple View Protocol for Sternoclavicular Evaluation

• Initial evaluation of sternoclavicular joint pathology should include at least three views: AP views in internal and external rotation, plus an axillary or scapula-Y view 5
• This multi-view approach compensates for the anatomic complexity and overlapping structures in the sternoclavicular region 5

Important Clinical Considerations

Limitations of Plain Radiography

• Plain radiographs often show nonspecific findings in sternal abnormalities, with appearances ranging from benign to aggressive lesions 7
• Standard chest radiographs may miss sternal fractures entirely, particularly non-displaced fractures 2
• Radiographic findings alone cannot reliably distinguish between infection, neoplasm, and other pathologic conditions affecting the sternum 4, 7

When to Advance Beyond Plain Films

• CT is the preferred imaging modality when plain radiographs are inconclusive or for detailed evaluation of sternal pathology 4, 3
• CT demonstrates abnormalities better than conventional tomography, requires less time, and causes less patient discomfort 4
• Key CT features of sternal pathology include abnormal soft tissue mass, cortical destruction or irregularity, and abnormal bone attenuation 3
• Ultrasound can effectively diagnose sternal fractures in children as a radiation-free alternative, while also assessing for pericardial effusion 2
• MRI provides superior tissue characterization for differentiating benign from malignant lesions and evaluating soft tissue involvement 7

Patient Positioning Alternatives

• For ambulatory patients experiencing acute pain, a standing position technique can be utilized as an alternative to recumbent positioning 1
• This standing technique enables production of optimal radiographs while significantly increasing patient comfort during the examination 1