RAO Sternum X-Ray: Positioning Guide & Tips

Right Anterior Oblique (RAO) sternum X-rays, a specialized projection technique, primarily aids radiologists in visualizing the sternum, which the overlying structures often obscure in a standard anteroposterior (AP) view. Precise rao sternum x ray positioning minimizes superimposition of anatomical structures, such as the thoracic spine. Radiographers at institutions like the American College of Radiology (ACR) utilize specific guidelines to optimize image quality, helping physicians diagnose conditions like sternal fractures and metastases. Proper collimation and exposure parameters, managed effectively through digital radiography systems, play a crucial role in achieving diagnostic-quality images while adhering to ALARA (As Low As Reasonably Achievable) principles for radiation safety.

The sternum, or breastbone, is a vital, elongated, and flattened bone situated in the anterior midline of the thorax. It plays a crucial role in protecting underlying organs and providing attachment points for ribs and muscles.

Sternum: Anatomical Location and Function

Anatomically, the sternum is located in the anterior chest wall, directly anterior to the heart and major blood vessels.

It extends from the superior border of the manubrium to the inferior tip of the xiphoid process.

The sternum serves as a key component of the rib cage, protecting the heart, lungs, and great vessels from trauma. It also provides attachment points for the ribs via costal cartilage, as well as for muscles involved in respiration and upper limb movement.

The RAO Projection: A Radiographic Window

The Right Anterior Oblique (RAO) projection is a specialized radiographic technique employed to visualize the sternum free from superimposition of the spine.

This oblique projection rotates the patient, moving the sternum away from the vertebral column. The RAO provides a clearer view of the sternal body and manubrium, which can be obscured in a direct anteroposterior (AP) projection due to the overlying spinal structures.

Radiologic Technologist's Role: Precision and Care

The radiologic technologist bears significant responsibility in ensuring the quality and accuracy of the RAO sternum radiograph.

This includes precise patient positioning, selecting appropriate exposure factors, and adhering to strict radiation safety protocols.

Technologists must possess a thorough understanding of sternal anatomy and the principles of radiographic imaging.

This knowledge is essential to optimize visualization of the sternum while minimizing patient radiation exposure.

Clinical Indications: Identifying and Assessing Pathology

The RAO sternum projection is frequently used to assess various clinical conditions affecting the sternum.

These include:

• Sternal fractures, often resulting from blunt trauma to the chest.

• Sternoclavicular joint pathology, such as dislocations or arthritis.

• Evaluation of suspected sternal tumors or other bony lesions.

• Assessment of post-surgical changes following sternotomy.

• Investigating the source of localized sternal pain.

The RAO sternum radiograph plays a vital role in diagnosing and managing a range of sternal pathologies, contributing to optimal patient care.

Anatomical Foundations: Understanding the Sternum's Structure

The sternum, or breastbone, is a vital, elongated, and flattened bone situated in the anterior midline of the thorax. It plays a crucial role in protecting underlying organs and providing attachment points for ribs and muscles.

Understanding the anatomical structure of the sternum and its relationship to surrounding structures is paramount for precise radiographic positioning and accurate image interpretation. This section will explore the key anatomical components and their significance in the RAO sternum projection.

The Three Divisions of the Sternum

The sternum comprises three primary segments: the manubrium, the body (or gladiolus), and the xiphoid process. Each part presents unique characteristics and contributes to the overall functionality of the sternum.

The Manubrium

The manubrium is the superior segment of the sternum, roughly trapezoidal. It articulates with the clavicles at the clavicular notches and with the first pair of ribs. The jugular notch (suprasternal notch) is a palpable depression on its superior border, serving as a key anatomical landmark.

The Body (Gladiolus)

The body constitutes the major and the longest portion of the sternum. It articulates with the costal cartilages of ribs two through seven. These articulations facilitate respiratory movements and contribute to the structural integrity of the rib cage.

The Xiphoid Process

The xiphoid process is the smallest and most inferior segment of the sternum. It is cartilaginous in youth, gradually ossifying with age. Its shape is highly variable and it serves as an attachment point for several abdominal muscles.

Ribs and Clavicles as Positioning Landmarks

The ribs and clavicles provide essential reference points for positioning during sternal radiography. The symmetric articulation of the clavicles with the manubrium helps ensure the patient is not rotated, assuming no shoulder joint or clavicular pathology is present.

The ribs, particularly the upper ribs, act as indicators of the degree of obliquity achieved in the RAO projection. Proper visualization requires careful attention to the alignment and overlap of the ribs relative to the sternum.

The Thoracic Spine as a Reference

The thoracic spine, located posteriorly, serves as an indispensable reference for assessing patient alignment. In the RAO projection, the degree of sternal rotation can be indirectly evaluated by observing the position of the sternum relative to the vertebral column.

The Role of Costal Cartilage

Costal cartilage, which connects the ribs to the sternum, is partially radiolucent. However, they contribute significantly to visualizing appropriate rotation. The degree of overlap of the sternum with the heart and great vessels influences the technique selection and the diagnostic quality of the image.

Equipment Essentials: Tools of the Trade

In performing RAO sternum radiography, a variety of equipment and materials come into play. Each piece is essential for ensuring diagnostic image quality, procedural efficiency, and, most importantly, patient and operator safety. This section details the key tools of the trade, emphasizing their functionality and critical safety aspects.

The X-ray Machine and Radiographic Tube

The cornerstone of radiographic imaging is, of course, the X-ray machine. This sophisticated device houses the radiographic tube, the component responsible for generating X-rays.

Inside the tube, a high-voltage electrical current accelerates electrons toward a target material, typically tungsten. This interaction produces X-ray photons, which are then directed toward the patient. The technologist controls the quantity and quality of the X-ray beam through adjustable parameters like kVp (kilovoltage peak) and mAs (milliampere-seconds), which directly affect image contrast and patient dose.

Image Receptor (IR) Systems: DR vs. CR

Following X-ray beam transmission through the patient, the image must be captured using an Image Receptor (IR). Two primary types of systems are prevalent today: Digital Radiography (DR) and Computed Radiography (CR).

DR systems employ flat-panel detectors that directly convert X-ray energy into a digital image. This process is instantaneous, allowing for real-time image review and faster workflow.

CR systems, on the other hand, utilize photostimulable storage phosphor (PSP) plates. These plates store the X-ray energy, which is then released as light when scanned by a laser. This light is converted into a digital image. While CR offers advantages in terms of cost, DR generally provides superior image quality and efficiency.

Grids: Reducing Scatter Radiation

As X-rays pass through the patient, they interact with tissues, producing scatter radiation. This scatter degrades image quality by creating a hazy appearance and reducing contrast.

Grids are devices positioned between the patient and the IR, designed to absorb scatter radiation before it reaches the detector. They consist of thin lead strips interspersed with radiolucent material. By selectively absorbing off-axis photons (scatter), grids enhance image clarity, particularly in thicker body parts like the sternum.

Collimation: Beam Restriction for Image Quality and Patient Safety

Collimation refers to the process of restricting the size and shape of the X-ray beam. This is achieved using adjustable lead shutters within the X-ray tube housing.

Effective collimation serves two crucial purposes: it minimizes patient radiation dose by limiting exposure to only the area of interest and it reduces scatter radiation, further improving image quality.

Positioning Sponges and Aids: Ensuring Accurate Alignment

Accurate patient positioning is paramount for successful sternum radiography. Positioning sponges and aids are invaluable tools for achieving and maintaining the required RAO obliquity.

These tools come in various shapes and sizes and can be used to support the patient, elevate specific body parts, or ensure proper alignment of the sternum relative to the X-ray beam and image receptor.

Lead Markers: Essential Image Identification

Lead markers are small, radiopaque markers used to indicate the patient's left (L) or right (R) side on the radiograph. They are placed on the image receptor before exposure, providing essential anatomical orientation.

Proper use of lead markers is critical for accurate image interpretation and prevents potential errors in diagnosis or treatment planning.

Shielding: Prioritizing Radiation Protection

Radiation protection is a non-negotiable aspect of radiographic imaging. Lead aprons and gonadal shielding are essential protective devices worn by both the patient and the radiographer.

These shields are made of lead or lead-equivalent materials that effectively absorb X-rays, minimizing exposure to sensitive organs and tissues. Adherence to the ALARA (As Low As Reasonably Achievable) principle is paramount, ensuring that radiation doses are kept to the absolute minimum necessary for diagnostic imaging.

RAO Technique: A Step-by-Step Guide

Following the anatomical and equipment considerations, the practical application of the Right Anterior Oblique (RAO) technique for sternum radiography requires meticulous attention to detail. This section provides a comprehensive, step-by-step guide to performing the RAO projection, encompassing patient positioning, breathing instructions, exposure factor selection, and adherence to radiation safety principles. Each step is crucial for optimal image quality and minimizing patient dose.

Patient Positioning: Achieving the Optimal Oblique

The cornerstone of a successful RAO sternum radiograph lies in precise patient positioning. The patient is typically placed in the RAO position, rotated 15-20 degrees.

This oblique angle strategically projects the sternum away from the overlying vertebral column, improving its visualization. The degree of obliquity may need slight adjustment based on patient size and body habitus.

The patient's arms should be positioned out of the field of view. This usually means placing the arm closest to the image receptor (IR) extended and slightly elevated.

The other arm is typically positioned down by the patient's side or gently across the abdomen. Careful attention to arm placement ensures no unwanted shadows obscure the sternal region.

Source-to-Image Distance (SID): Standardizing the Geometry

Maintaining a consistent Source-to-Image Distance (SID) is essential for image quality and minimizing magnification. The standard SID for sternum radiography is typically 40 inches (102 cm).

This distance ensures adequate coverage of the sternum on the image receptor while minimizing geometric unsharpness. Deviations from the standard SID can affect image magnification and detail.

Central Ray (CR) Location and Angulation: Targeting the Sternum

Accurate CR placement is paramount for centering the sternum on the radiograph. The CR should be directed perpendicular to the center of the sternum.

Typically, this is approximately 1 inch lateral to the midline on the elevated side, at the level of T7 (approximately the midsternum). No tube angulation is typically required, although slight adjustments may be necessary based on patient anatomy.

Breathing Instructions and Patient Communication: Minimizing Motion

Effective patient communication is crucial to minimizing motion artifact.

The patient should be instructed to suspend respiration at the end of expiration. This reduces motion blurring caused by breathing.

Clear and concise instructions, along with encouragement, help the patient to cooperate and maintain the required position. Always explain the procedure to the patient and address any concerns they may have.

Exposure Factor Selection: Optimizing Image Quality

Selecting appropriate exposure factors (kVp and mAs) is vital for producing a diagnostic radiograph with adequate density and contrast.

Lower kVp values are generally preferred to enhance contrast and visualize subtle sternal fractures. The mAs should be adjusted to achieve optimal image density without overexposing the patient.

Automatic Exposure Control (AEC) is typically not recommended for RAO sternum radiography, as the varying tissue densities in the field can lead to inconsistent results.

Technique charts should be consulted and adjusted based on patient size, age, and clinical indication.

ALARA Principles and Radiation Protection: Prioritizing Safety

Adherence to the ALARA (As Low As Reasonably Achievable) principle is paramount in all radiographic procedures.

Strict collimation should be employed to minimize the irradiated area. Gonadal shielding should be used for all patients of reproductive age.

Lead aprons should be worn by all personnel remaining in the room during the exposure. Careful attention to technique and radiation protection practices ensures patient and staff safety.

Image Evaluation: Ensuring Quality and Accuracy

Following the detailed execution of the RAO sternum radiographic technique, a meticulous evaluation of the resulting image is paramount. This critical step ensures diagnostic accuracy and minimizes the need for repeat exposures. This section delves into the specific criteria for assessing image quality and identifying common artifacts, providing insights into their prevention and management.

Assessing Image Quality: Key Evaluation Criteria

The ideal RAO sternum radiograph demonstrates specific qualities related to anatomical visualization, density, and contrast. Each of these elements contributes to the overall diagnostic utility of the image.

Anatomical Visualization

The primary goal is to clearly visualize the sternum, free from significant superimposition by other structures.

• The sternum should be visible in its entirety, including the manubrium, body, and xiphoid process.
• The sternoclavicular joints should be demonstrated, providing context for sternal alignment.
• Optimal rotation will project the sternum away from the spine and heart, preventing overlap.
• The degree of obliquity can be assessed by noting the distance between the sternum and vertebral column.

Density and Contrast

Appropriate density and contrast are essential for differentiating between bony structures and soft tissues.

• Density refers to the overall blackness or whiteness of the image.
• The sternum should exhibit sufficient density to allow for clear visualization of trabecular patterns.
• Contrast refers to the difference in density between adjacent structures.
• Adequate contrast allows for the differentiation of cortical bone from medullary bone and subtle fractures.
• Too little contrast may obscure fine details.

Common Artifacts and Their Prevention

Artifacts can compromise image quality and potentially lead to misdiagnosis. Recognizing and preventing these artifacts is a crucial skill for radiologic technologists.

Motion Artifacts

Motion is a common cause of image blurring.

• Clearly instruct the patient to suspend respiration during the exposure.
• Use the shortest possible exposure time to minimize the impact of involuntary movement.

Positioning Artifacts

Inaccurate patient positioning can result in suboptimal visualization of the sternum.

• Ensure that the patient is rotated adequately to achieve the desired oblique projection.
• Verify that the central ray is properly aligned to the sternum.
• Carefully monitor patient positioning to avoid tilting or rotation during the procedure.

Equipment Artifacts

Malfunctioning or improperly maintained equipment can also introduce artifacts.

• Regularly inspect and calibrate the X-ray machine.
• Use clean and artifact-free image receptors.
• Check for collimator misalignment.

Scatter Radiation

• Collimate effectively to reduce the amount of scatter radiation reaching the image receptor.
• Use grids to absorb scatter radiation, particularly when imaging larger body parts.

Corrective Measures

When artifacts are present, corrective measures may be necessary.

• If motion is the cause, repeat the exposure with improved patient instruction and immobilization.
• If positioning is the issue, readjust the patient's position and repeat the exposure.
• If equipment malfunctions are suspected, report the issue to the appropriate personnel for repair or maintenance.
• When in doubt, consult with a senior technologist or radiologist for guidance.

Through diligent attention to image evaluation criteria and proactive artifact management, radiologic technologists can ensure that RAO sternum radiographs provide accurate and diagnostically valuable information.

Pathology and Clinical Significance: Identifying Abnormalities

[Image Evaluation: Ensuring Quality and Accuracy Following the detailed execution of the RAO sternum radiographic technique, a meticulous evaluation of the resulting image is paramount. This critical step ensures diagnostic accuracy and minimizes the need for repeat exposures. This section delves into the specific criteria for assessing image quality, then transitions into a discussion of pathology. This section will discuss the radiographic appearance of common pathologies affecting the sternum and the clinical significance of these findings.]

The RAO sternum projection plays a crucial role in identifying various pathologies affecting the sternum and surrounding structures. Accurate interpretation of radiographic findings is essential for appropriate patient management and treatment planning. Common indications include trauma assessment, evaluation of chest pain, and investigation of suspected sternal abnormalities.

Sternal Fractures: Radiographic Appearance and Clinical Implications

Sternal fractures are a common consequence of blunt trauma to the chest, often resulting from motor vehicle accidents or falls. Radiographically, sternal fractures may appear as:

• A distinct fracture line traversing the sternal body or manubrium.
• Displacement or angulation of the fracture fragments.
• Soft tissue swelling surrounding the fracture site.

It's imperative to carefully evaluate the RAO projection for subtle fractures that may be obscured by overlying structures. The presence of a sternal fracture can indicate the severity of the chest trauma and may be associated with underlying injuries, such as cardiac contusion or pulmonary complications.

Sternoclavicular Joint Dislocation/Separation

The sternoclavicular (SC) joint connects the clavicle to the sternum. Dislocations or separations can occur due to direct trauma or indirect forces applied to the shoulder.

Radiographic evaluation of SC joint injuries can be challenging due to overlapping structures, making the RAO projection a valuable supplementary view. Radiographic findings can include:

• Asymmetry of the SC joints compared to the contralateral side.
• Widening of the joint space indicating ligamentous injury.
• Displacement of the clavicle relative to the sternum.

Differentiating between anterior and posterior dislocations is crucial, as posterior dislocations can compromise vital mediastinal structures.

The Significance of Chest Pain

Chest pain is a common symptom that warrants radiographic evaluation of the sternum. While not all chest pain is indicative of sternal pathology, it is important to consider potential sternal involvement, especially in the context of trauma.

The RAO sternum projection can help identify fractures, dislocations, or other abnormalities that may be contributing to the patient's symptoms. It is essential to correlate radiographic findings with the patient's clinical history and physical examination findings to arrive at an accurate diagnosis.

Trauma: A Primary Indicator for Imaging

Trauma is a primary indication for RAO sternum radiography, particularly when there is suspicion of sternal injury.

The radiographic evaluation helps determine the extent and severity of the injury, guiding subsequent treatment decisions. In trauma cases, it is important to maintain a high index of suspicion for associated injuries, such as rib fractures, pneumothorax, or hemothorax. The RAO sternum projection should be interpreted in conjunction with other relevant imaging studies, such as chest X-rays or CT scans, to provide a comprehensive assessment of the patient's condition.

Professional Standards and Regulations: Maintaining Best Practices

[Pathology and Clinical Significance: Identifying Abnormalities [Image Evaluation: Ensuring Quality and Accuracy Following the detailed execution of the RAO sternum radiographic technique, a meticulous evaluation of the resulting image is paramount. This critical step ensures diagnostic accuracy and minimizes the need for repeat exposures. This section transitions to the broader framework of professional standards and regulations that govern the practice of radiography, ensuring patient safety, ethical conduct, and adherence to established guidelines.]

In the realm of medical imaging, radiographic examinations are not simply technical procedures, they are intricate processes governed by a complex web of professional standards and stringent regulations. These guidelines serve as the bedrock of responsible practice, ensuring patient safety, ethical conduct, and the delivery of high-quality diagnostic information. This section delineates the roles of various healthcare professionals, delves into ethical considerations, outlines relevant guidelines, and emphasizes adherence to radiation safety protocols.

Defining Roles and Responsibilities in Radiography

The radiographic process involves a collaborative effort from multiple healthcare professionals, each with distinct roles and responsibilities that contribute to optimal patient care and diagnostic accuracy.

The Radiologic Technologist: The Primary Imaging Professional

The radiologic technologist is at the forefront of the imaging procedure, directly interacting with the patient and skillfully executing the radiographic examination. Responsibilities include:

• Patient positioning and instruction.
• Selection of appropriate technical factors.
• Adherence to radiation safety protocols.
• Ensuring optimal image quality.
• Maintaining a professional and empathetic demeanor.

The Radiologist: The Diagnostic Expert

The radiologist is a physician specializing in the interpretation of medical images. Their role involves:

• Analyzing radiographic images to identify anatomical structures and potential abnormalities.
• Formulating a diagnostic impression based on the imaging findings.
• Communicating the findings to the referring physician in a timely and accurate manner.
• Providing expert consultation on imaging modalities and protocols.

The Referring Physician: The Clinical Context Provider

The referring physician initiates the radiographic examination by ordering the procedure based on the patient's clinical presentation and suspected diagnosis. Their responsibilities include:

• Providing relevant clinical information to the radiologist and technologist.
• Integrating the imaging findings with other clinical data to formulate a comprehensive treatment plan.
• Communicating the results of the imaging examination to the patient in an understandable manner.
• Managing patient care based on the collective information.

Ethical Considerations and Patient Care Practices

Beyond the technical aspects of radiography, ethical considerations and patient-centered care are paramount. Radiologic technologists must adhere to a code of ethics that prioritizes patient well-being, privacy, and autonomy.

• Patient Confidentiality: Maintaining the confidentiality of patient information is a fundamental ethical principle. Radiologic technologists must safeguard patient records and imaging data, adhering to privacy regulations such as HIPAA.
• Informed Consent: Obtaining informed consent from the patient before performing a radiographic examination is crucial. Patients have the right to understand the nature of the procedure, the potential risks and benefits, and the alternatives available.
• Patient Safety: Prioritizing patient safety is the paramount concern. Radiologic technologists must adhere to radiation safety protocols, minimize radiation exposure, and ensure a safe and comfortable environment for patients.
• Respect and Dignity: Treating patients with respect and dignity is essential. Radiologic technologists must be sensitive to patient needs, concerns, and cultural beliefs, providing compassionate and empathetic care.

Professional Guidelines from the ARRT

The American Registry of Radiologic Technologists (ARRT) is the leading credentialing organization for radiologic technologists in the United States. The ARRT establishes and maintains professional standards and guidelines for radiologic technologists, promoting competence, ethical conduct, and continuing education.

• ARRT Standards of Ethics: The ARRT Standards of Ethics outline the ethical principles and professional responsibilities that radiologic technologists must adhere to. These standards cover a wide range of topics, including patient care, confidentiality, integrity, and professional development.
• ARRT Rules of Ethics: The ARRT Rules of Ethics provide specific guidelines for ethical conduct in various situations. These rules help radiologic technologists navigate ethical dilemmas and make informed decisions that are in the best interest of patients.
• ARRT Continuing Education Requirements: The ARRT requires radiologic technologists to complete continuing education credits to maintain their certification. This ensures that technologists stay up-to-date with the latest advances in medical imaging and maintain their competence throughout their careers.

Adherence to Government Regulations and Hospital Protocols for Radiation Safety

Radiation safety is a critical aspect of radiography, and radiologic technologists must adhere to strict government regulations and hospital protocols to minimize radiation exposure to patients, themselves, and others.

• ALARA Principle: The ALARA (As Low As Reasonably Achievable) principle is the guiding principle of radiation safety. Radiologic technologists must strive to minimize radiation exposure by using appropriate collimation, shielding, and technical factors.
• Shielding: The use of lead aprons and gonadal shielding is essential to protect patients and healthcare workers from unnecessary radiation exposure.
• Personnel Monitoring: Radiologic technologists are required to wear personal radiation monitoring devices to track their radiation exposure levels.
• Equipment Calibration and Maintenance: Regular calibration and maintenance of radiographic equipment are crucial to ensure accurate radiation output and optimal image quality.
• Compliance with Regulations: Radiologic technologists must be knowledgeable about and compliant with all applicable federal, state, and local regulations regarding radiation safety. Hospital policies and procedures relating to radiation safety also need to be followed.

By understanding and adhering to these professional standards and regulations, radiologic technologists can ensure the delivery of safe, ethical, and high-quality radiographic examinations, contributing to improved patient outcomes and the advancement of medical care.

Procedure Locations: Accessing RAO Sternum Radiography

Following the detailed execution of the RAO sternum radiographic technique, a meticulous evaluation of the resulting image is paramount. This critical step ensures diagnostic accuracy and patient well-being. After understanding the process and its clinical applications, the next logical consideration is: where can one actually obtain this specific radiographic examination? Understanding the accessibility and variety of locations offering this procedure is vital for both patients and referring physicians.

Common Healthcare Facilities Offering Radiography

The RAO sternum radiograph is a standard diagnostic procedure, typically available in a range of healthcare settings. The specific choice of location often depends on factors such as the patient's insurance coverage, the urgency of the examination, and the availability of specialized equipment or expertise.

Hospitals, with their comprehensive imaging departments, are a primary source for RAO sternum radiography. They offer the advantage of being equipped to handle a wide range of medical needs, including emergency situations where sternal injuries may be suspected. Hospitals often have dedicated radiology departments staffed by experienced radiologic technologists and radiologists.

Outpatient clinics and specialized imaging centers represent another common avenue for obtaining this examination. These facilities often provide a more convenient and cost-effective option for patients who do not require the full spectrum of services offered by a hospital.

Imaging centers tend to focus specifically on diagnostic imaging, often boasting state-of-the-art equipment and a streamlined workflow. This can translate to shorter wait times and a more focused patient experience.

Factors Influencing Location Choice

Several factors can influence the selection of a particular facility for RAO sternum radiography.

The patient's insurance coverage plays a significant role, as some insurance plans may have preferred providers or require pre-authorization for certain imaging services.

The urgency of the examination is another important consideration. In cases of suspected acute trauma, a hospital emergency department may be the most appropriate choice for immediate evaluation.

The availability of specialized expertise can also be a factor, particularly in complex cases where the interpretation of the radiographic images may require the input of a radiologist with specific experience in musculoskeletal imaging.

The physician preference as well as the patient's may play a deciding role.

Ensuring Quality and Safety

Regardless of the location chosen, it is crucial to ensure that the facility adheres to established quality and safety standards. This includes using properly maintained equipment, employing qualified personnel, and implementing appropriate radiation protection measures.

Patients should feel empowered to inquire about the facility's accreditation and quality control procedures to ensure they receive the highest standard of care.

So, there you have it! Mastering the RAO sternum x-ray positioning takes practice, but with these tips and tricks, you'll be well on your way to capturing clear and diagnostic images. Keep practicing, stay confident, and you'll be a RAO sternum x-ray pro in no time!