{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T22:13:57Z","timestamp":1780352037970,"version":"3.54.1"},"reference-count":12,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,12,10]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>Over the last two decades, the clinical applications of diagnostic and interventional ultrasound have expanded rapidly. When analyzing the chest wall and thoracic region, ultrasound has previously been shown to reliably identify chest wall pathologies like rib fracture and slipping rib syndrome, as well as having fundamentally changed perioperative management and patient outcomes after the emergence of point-of-care ultrasound. In addition, ultrasound guidance has recently become more popular for multiple blocks in the field of regional anesthesia and pain medicine. In this technical report, we systematize an ultrasound-guided protocol for counting ribs and thoracic levels for both posterior and anterior approaches, which does not require level confirmation by fluoroscopy. With this protocol, we hope to create an effective educational resource to support physicians from any specialty background as they engage in point-of-care ultrasound applications in the thoracic region.<\/jats:p>","DOI":"10.1136\/rapm-2020-102050","type":"journal-article","created":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T15:20:11Z","timestamp":1609860011000},"page":"452-454","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Counting ribs and thoracic levels under ultrasound: a systematized technical protocol for both posterior and anterior approaches"],"prefix":"10.1136","volume":"46","author":[{"given":"Mark Friedrich B","family":"Hurdle","sequence":"first","affiliation":[{"name":"Department of Pain Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme","family":"Ferreira-Dos-Santos","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Central Lisbon University Hospital Centre, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raul","family":"Rosario-Concepcion","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura V","family":"Gil","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason S","family":"Eldrige","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4363-4794","authenticated-orcid":false,"given":"Steven R","family":"Clendenen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Jacksonville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,5]]},"reference":[{"key":"2025101113072830000_46.5.452.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmrj.2008.09.002"},{"key":"2025101113072830000_46.5.452.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/mus.26505","article-title":"Diagnostic and therapeutic musculoskeletal ultrasound applications of the shoulder","volume":"60","author":"Strakowski","year":"2019","journal-title":"Muscle Nerve"},{"key":"2025101113072830000_46.5.452.3","doi-asserted-by":"crossref","first-page":"197","DOI":"10.15557\/JoU.2017.0029","article-title":"Chest wall - underappreciated structure in sonography. 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