RADIOLOGI THORAX-ABDOMEN NORMAL

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RADIOLOGI THORAX-ABDOMEN NORMAL RADIOLOGI BLOK KDS I RADIOLOGI THORAX-ABDOMEN NORMAL

Tujuan Instruksional Umum Pada akhir praktikum mahasiswa diharapkan mampu : Mengidentifikasi anatomi radiologi (imaging) pada foto polos thorax normal. Mengidentifikasi anatomi radiologi (imaging) pada foto polos abdomen normal  

Tujuan Instruksional Khusus Pada akhir praktikum mahasiswa diharapkan mampu : Mengidentifikasi anatomi radiologi (imaging) pada foto polos thorax normal. Posisi Simetrisasi Inspirasi Kondisi  Mengidentifikasi anatomi radiologi (imaging) pada foto polos abdomen Organ-organ dalam rongga abdomen (dinding abdomen, hepar, renal out line, sistema tulang) Distribusi udara pada saluran pencernaan

THORAX NORMAL Anatomi thorax normal identik gambaran radiologi (Imaging Thorax normal). Mahasiswa harus sudah menguasai anatomi thorax (jantung-paru-vaskularisasi & organ-organ yang terlibat). Gambaran normal thorax kelainan

RIBS - HEART

Anatomi Paru-Paru

Anatomi Thorax, Lateral kiri

Anatomi Thorax, PA

Gambaran Thorax Normal Posisi Posteroanterior & Lateral Pada Foto thorax normal, hal-hal yang perlu diperhatikan adalah : Posisi Simetrisasi Inspirasi Kondisi

Gambaran Thorax Normal Hal-Hal yang Harus diperhatikan : Posisi Simetrisasi Inspirasi Kondisi

INTERPRETASI PA (berdiri) AP (berbaring) DASAR PENILAIAN : FAKTOR POSISI INTERPRETASI PA (berdiri) AP (berbaring) DASAR PENILAIAN : SCAPULA (DILUAR PARENKIM PARU) CLAVICULA (curam) UDARA FUNDUS GASTER (MEGENBLASE)

PA AP

AP versus PA The Effect of Magnification In a PA film, the heart is closer to the film and thus less magnified The standard chest x-ray is a PA film In an AP film, the heart is farther from the film and is more magnified Portable chest x-rays are almost always done AP

AP versus PA The Effect of Magnification AP portable film makes the heart look larger than it does… On this PA film done on the same patient an hour later

FAKTOR SIMETRISASI Jarak ujung clavicula dengan processus spinosus (simetris/tidak) CARA : JARAK YANG SAMA ANTARA PROCESSUS SPINOSUS KE SENDI STERNOKLAVIKULA KANAN DAN KIRI

Rotation If the spinous process of the vertebral body is equidistant from the medial ends of each clavicle, there is no rotation

If spinous process appears closer to the right clavicle (red arrow), the patient is rotated toward their own left side  If spinous process appears closer to the left clavicle (red arrow), the patient is rotated toward their own right side 

Pitfall Due to Marked Rotation Severe rotation may make the pulmonary arteries appear larger on the side farther from the film

FAKTOR INSPIRASI DASAR PENILAIAN : INTERPRETASI : PENAMPAKAN DIAFRAGMA PATOKAN : VT X / COSTA BELAKANG 10 /COSTA DEPAN 6 INTERPRETASI : CUKUP KURANG TERLALU DALAM

Inspiration About 10 posterior ribs visible is an excellent inspiration In many hospitalized patients 9 posterior ribs is an adequate inspiration

Anterior vs. Posterior Ribs Anterior ribs will be visible but are harder to see. They run more or less at a 45 degree angle downward toward the feet. Posterior ribs are those that are most apparent on the chest x-ray. They run more or less horizontally. How to tell the difference between the anterior and the posterior ribs

Ten posterior ribs showing is an excellent inspiration 10 Ten posterior ribs showing is an excellent inspiration

About 8 posterior ribs are showing Pitfall Due to Poor Inspiration About 8 posterior ribs are showing 8 Poor inspiration will crowd lung markings and make it appear as though the patient has airspace disease

About 8 posterior ribs are showing 9-10 posterior ribs are showing Same patient About 8 posterior ribs are showing 8 9-10 posterior ribs are showing 9 Better inspiration and the “disease” at the lung bases has cleared

KONDISI FOTO THORAX DINILAI DARI : INTERPRETASI : KONDISI PULMO KESELURUHAN (LUSENSI PARENKIM PARU) VERTEBRA THORAKALIS TAMPAK I-IV (< VT II KURANG, > VT VI KERAS) PROCESSUS SPINOSUS TAMPAK 3 ATAU 4 INTERPRETASI : KERAS (TERLALU HITAM/LUSENS) CUKUP KURANG (TERLALU PUTIH/OPAQUE)

kondisi You should be able to just see the thoracic spine through the heart.

TERPOTONG ATAU TIDAK DASAR PENILAIAN: SUPERIOR: TAMPAK VERTEBRA CERVIKALIS VI/VII INFERIOR: SINUS COSTOPHRENICUS DAN DIAFRAGMA SAMPING KANAN DAN KIRI: AXILLA TAMPAK

IDENTITAS LAYAK / TIDAK ? IDENTITAS SISI IDENTITAS REGISTRASI MARKER (L ATAU R) IDENTITAS REGISTRASI NAMA, UMUR, NO. REGISTER,TANGGAL FOTO LAYAK / TIDAK ?

Hal-hal yang harus diperhatikan dalam Pembacaan Foto Polos Thorax Jaringan lunak, tulang Corakan bronkhovaskuler Parenkim paru Keadaan hilus Sinus costofrenikus Diafragma Cor : CTR

SISTEMA TULANG DAN JARINGAN LUNAK LOKASI DAN GAMBARAN SISTEMA TULANG : COSTA, CLAVICULA SCAPULA LOKASI DAN GAMBARAN JARINGAN LUNAK MAMMAE, normal: sistem tulang intak

KEDUA APEKS PARU PENILAIAN : INTERPRETASI TENTUKAN LOKASI APEKS PARU GAMBARAN APEKS INTERPRETASI APEKS TENANG/ BERSIH APEKS TERDAPAT INFILTRAT ( UKURAN DAN BENTUK, DENSITAS)

TERDAPAT PENINGKATAN DENSITAS KEDUA APEKS PARU APEKS TENANG TERDAPAT PENINGKATAN DENSITAS DI APEKS KANAN

CORAKAN BRONKHOVASKULER CARA PENILAIAN BAGI PARU DARI TEPI MENJADI 3, LIHAT BAGIAN 1/3 LATERAL NORMAL : CORAKAN BRONKHOVASKULER TIDAK MELEBIHI 2/3 MEDIAL (1/3 LATERAL TAMPAK BERSIH) INTERPRETASI: NORMAL /MENINGKAT

CORAKAN BRONKHOVASKULER NORMAL MENINGKAT

PARENKIM PARU GAMBARAN PARENKIM PARU APABILA TERDAPAT INFILTRAT: TENTUKAN : LOKASI, UKURAN, JUMLAH, BENTUK

PARENKIM PARU

SINUS COSTOPHRENICUS INTERPRETASI LANCIP ATAU TUMPUL NORMAL : LANCIP BILA TUMPUL PASTIKAN ADA KELAINAN ATAU TERPOTONG

SINUS COSTOPHRENICUS TERPOTONG EFUSI PLEURA

Normal R costophrenic angle Blunted L costophrenic angle When 200-300cc of fluid accumulate in pleural space, the usually acute costophrenic angle (sulcus), as seen on the right in this person, becomes blunted (as seen on the left in this person)

DIAFRAGMA NORMAL : Kanan lebih tinggi dari kiri (jantung menekan) Selisih <3 cm)/ atau sebagai patokan tidak lebih dari 2 vertebra Licin

JANTUNG LOKASI BENTUK JANTUNG CTR : NORMAL < 0,5 UNTUK BERDIRI /PA

Cardio-thoracic Ratio One of the easiest observations to make is the cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage Cardio-thoracic Ratio CTR= (a+b) / c = < 50% a b c

Enlarged or not? Yes

Enlarged or not? Yes

Enlarged or not? No

Contoh Pembacaan Foto Thorax Normal Foto Thorax PA,errect,simetris, inspirasi dan kondisi cukup Tidak ada soft tissue swelling Sistema tulang intak tampak kedua apex paru tenang tampak corakan bronkhovaskuler di kedua lapangan paru normal sinus costophrenicus kanan-kiri lancip Diafragma kanan dan kiri licin Cor : CTR kurang dari 0,56 Kesan : Paru dan cor dalam batas normal  

Abdomen Normal Hal-hal yang harus diperhatikan pada Foto Polos Abdomen, adalah : Gambaran udara Usus Gambaran jaringan lunak (soft tissue) Gambaran organ-organ intra abdominal Hepar Lien Renal Tract Urinarius dan Genitalia

Gambaran Soft Tissue & Organ-organ Intra abdominal Preperitoneal fat line Psoas line Organ-organ Intra abdominal Hepar Lien Renal

FOTO POLOS ABDOMEN A Normal plain film of the abdomen. The lower margins of the posterior portion of the liver, the hepatic angle (H), and the lower part of the spleen (S) are delineated by a fat shadow. Both kidneys (K) and the psoas muscle shadows (arrowheads) are outlined by a fat shadow. The properitoneal fat stripe is also shown bilaterally (arrows). B Diagram of normal abdominal plain film.

Gambaran Foto Polos Abdomen

FOTO POLOS ABDOMEN Normal Gas Pattern Gas in stomach Gas in a few loops of small bowel D = 2.5 CM Gas in rectum or sigmoid ALMOST ALWAYS Normal Gas Pattern

FOTO POLOS ABDOMEN Always air/fluid level in stomach Erect Abdomen Always air/fluid level in stomach A few air/fluid levels in small bowel

Gambaran Udara usus

Gambaran Foto Polos Abdomen Neonatus udara di lambung (10-15 menit setelah kelahiran) udara di proksimal usus halus 30-60 menit setelah kelahiran udara di bagian distal usus halus  6 jam setelah kelahiran udara di colon dan rektum  24 jam setelah lahir. Gambaran soft tissue dan organ-organ intra abdominal minimal

Gambaran Udara pada usus halus (sentral) dan usus besar perifer (foto abdomen dengan kontras)  

Contoh Pembacaan Foto AbdomenNormal Foto Polos Abdomen, AP, Supine, kondisi cukup tampak preperitoneal fat line jelas Psoas line tegas dan simetris Renal out line jelas Tampak udara usus (+), tak tampak gambaran distensi usus Sistema tulang baik Kesan : Tak tampak kelainan pada abdomen