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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.

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Radiologi blok kds i

RADIOLOGI BLOK KDS I

RADIOLOGI

THORAX-ABDOMEN NORMAL


Tujuan instruksional umum
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
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

    • Posisi

    • Organ-organ dalam rongga abdomen (dinding abdomen, hepar, renal out line, sistema tulang)

    • Distribusi udara pada saluran pencernaan


Thorax normal
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






Gambaran thorax normal posisi posteroanterior lateral
Gambaran Thorax Normal Posisi Posteroanterior & Lateral

  • Pada Foto thorax normal, hal-hal yang perlu diperhatikan adalah :

  • Posisi

  • Simetrisasi

  • Inspirasi

  • Kondisi


Gambaran thorax normal
Gambaran Thorax Normal

Hal-Hal yang Harus diperhatikan :

  • Posisi

  • Simetrisasi

  • Inspirasi

  • Kondisi


Faktor posisi
FAKTOR POSISI

INTERPRETASI

  • PA (berdiri)

  • AP (berbaring)

    DASAR PENILAIAN :

  • SCAPULA (DILUAR PARENKIM PARU)

  • CLAVICULA (curam)

  • UDARA FUNDUS GASTER

    (MEGENBLASE)



AP versus PAThe 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 PAThe Effect of Magnification

AP portable film makes theheart look larger than it does…

On this PA film done on the same patient an hour later


Faktor simetrisasi
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 arrow), the patient is rotated toward their own left side

Severe rotation may make the pulmonary arteries appear larger on the side farther from the film


Faktor inspirasi
FAKTOR INSPIRASI arrow), the patient is rotated toward their own left side

DASAR PENILAIAN :

PENAMPAKAN DIAFRAGMA

PATOKAN :

VT X / COSTA BELAKANG 10 /COSTA DEPAN 6

INTERPRETASI :

  • CUKUP

  • KURANG

  • TERLALU DALAM


Inspiration arrow), the patient is rotated toward their own left side

  • About 10 posterior ribs visible is an excellent inspiration

  • In many hospitalized patients 9 posterior ribs is an adequate inspiration


Anterior vs. Posterior Ribs arrow), the patient is rotated toward their own left side

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


10 arrow), the patient is rotated toward their own left side

Ten posterior ribs showing is an excellent inspiration


8 arrow), the patient is rotated toward their own left side

About 8 posterior ribs are showing

Pitfall Due to Poor Inspiration

Poor inspiration will crowd lung markings and make it appear as though the patient has airspace disease


8 arrow), the patient is rotated toward their own left side

9

About 8 posterior ribs are showing

9-10 posterior ribs are showing

Same patient

Better inspiration and the “disease” at the lung bases has cleared


Kondisi foto thorax
KONDISI FOTO THORAX arrow), the patient is rotated toward their own left side

DINILAI DARI :

  • 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 arrow), the patient is rotated toward their own left side

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


Terpotong atau tidak
TERPOTONG ATAU TIDAK arrow), the patient is rotated toward their own left side

DASAR PENILAIAN:

  • SUPERIOR:

    TAMPAK VERTEBRA CERVIKALIS VI/VII

  • INFERIOR:

    SINUS COSTOPHRENICUS DAN DIAFRAGMA

  • SAMPING KANAN DAN KIRI:

    AXILLA TAMPAK


Identitas
IDENTITAS arrow), the patient is rotated toward their own left side

  • IDENTITAS SISI

    MARKER (L ATAU R)

  • IDENTITAS REGISTRASI

    NAMA, UMUR, NO. REGISTER,TANGGAL FOTO

    LAYAK / TIDAK ?


Hal hal yang harus diperhatikan dalam pembacaan foto polos thorax
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
SISTEMA TULANG DAN JARINGAN LUNAK Thorax

LOKASI DAN GAMBARAN SISTEMA TULANG :

  • COSTA,

  • CLAVICULA

  • SCAPULA

    LOKASI DAN GAMBARAN JARINGAN LUNAK

  • MAMMAE,

  • normal: sistem tulang intak


Kedua apeks paru
KEDUA APEKS PARU Thorax

PENILAIAN :

  • TENTUKAN LOKASI APEKS PARU

  • GAMBARAN APEKS

    INTERPRETASI

  • APEKS TENANG/ BERSIH

  • APEKS TERDAPAT INFILTRAT ( UKURAN DAN BENTUK, DENSITAS)


KEDUA APEKS PARU Thorax

APEKS TENANG

TERDAPAT PENINGKATAN DENSITAS

DI APEKS KANAN


Corakan bronkhovaskuler
CORAKAN ThoraxBRONKHOVASKULER

  • 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 bronkhovaskuler1
CORAKAN ThoraxBRONKHOVASKULER

NORMAL

MENINGKAT


Parenkim paru

GAMBARAN PARENKIM PARU Thorax

APABILA TERDAPAT INFILTRAT:

TENTUKAN :

LOKASI, UKURAN, JUMLAH, BENTUK

PARENKIM PARU



Sinus costophrenicus
SINUS COSTOPHRENICUS Thorax

INTERPRETASI

  • LANCIP ATAU TUMPUL

  • NORMAL : LANCIP

  • BILA TUMPUL PASTIKAN ADA KELAINAN ATAU TERPOTONG


SINUS COSTOPHRENICUS Thorax

TERPOTONG

EFUSI PLEURA


Normal R costophrenic angle Thorax

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
DIAFRAGMA Thorax

NORMAL :

  • Kanan lebih tinggi dari kiri (jantung menekan)

  • Selisih <3 cm)/ atau sebagai patokan tidak lebih dari 2 vertebra

  • Licin


Jantung
JANTUNG Thorax

LOKASI

BENTUK JANTUNG

CTR : NORMAL < 0,5 UNTUK BERDIRI /PA


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? cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

Yes


Enlarged or not? cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

Yes


Enlarged or not? cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

No


Contoh pembacaan foto thorax normal
Contoh Pembacaan cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cageFoto 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
Abdomen Normal cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

  • 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
Gambaran Soft Tissue & cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cageOrgan-organ Intra abdominal

  • Soft tissue

    • Preperitoneal fat line

    • Psoas line

  • Organ-organ Intra abdominal

    • Hepar

    • Lien

    • Renal


Foto polos abdomen
FOTO POLOS ABDOMEN cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

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
Gambaran Foto Polos Abdomen cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage


Foto polos abdomen1
FOTO POLOS ABDOMEN cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

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


Foto polos abdomen2
FOTO POLOS ABDOMEN cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

Always air/fluid level in stomach

A few air/fluid levels in small bowel

Erect Abdomen


Gambaran udara usus
Gambaran Udara usus cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage


Gambaran foto polos abdomen neonatus
Gambaran Foto Polos Abdomen Neonatus cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage

  • udara di lambung (10-15 menit setelah kelahiran)

  • udara di proksimal usushalus 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) cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cagedan usus besar perifer(foto abdomen dengan kontras)


Contoh pembacaan foto abdomennormal
Contoh Pembacaan cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cageFoto 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


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