pembacaan foto thorax
TRANSCRIPT
Weekly Medical Review 2K14Radiology of ChestOctober 2nd, 2014
Faculty of Medicine
Widya Mandala Catholic University
Surabaya
SIFAT Sinar-X
1. Tidak dapat diindera oleh kelima panca indera
2. Jalannya lurus
3. Tidak dipantulkan oleh cermin
4. Menembus dan dapat merusak jaringan tubuh.
5. Dapat mengubah emulsi film.
6. Pengaruh dalam tubuh bersifat kumulatif.
• Different tissues in our body absorb X-rays at different extents:• Bone- high absorption (white)• Tissue- somewhere in the middle absorption (grey)• Air and fat- low absorption (black)
FOTO THORAKS
Three Main Factors Determine the Technical Quality of the Radiograph
• Inspiration
• Penetration
• Rotation
Inspiration
• Sebaiknya dalam keadaan inspirasi penuh asesmen abnormalitas intrapulmoner
• Pada inspirasi penuh:
– Hemidiafragma memotong costa 6 di tengah
– Diafragma posterior setinggi costa 8 -10
– Diafragma anterior setinggi costa 5 – 6vv
Penetration
Pada radiografi thoraks yang dilakukan dengan baik:
• The lower thoracic vertebrae should be visible through the heart
• The bronchovascular structures behind the heart (trachea, aortic arch, pulmonary arteries, etc.) should be seen
Underexposure
In an underexposed chest radiograph, the cardiac shadow is opaque, with little or no visibility of the thoracic vertebrae.
The lungs may appear much denser and whiter, much as they might appear with infiltrates present.
Overexposure
With greater exposure of the chest radiograph, the heart becomes more radiolucent and the lungs become proportionately darker.
In an overexposed chest radiograph, the air-filled lung periphery becomes extremely radiolucent, and often gives the appearance of lacking lung tissue, as would be seen in a condition such as emphysema.
Rotation
Patient rotation can be assessed by observing the clavicular heads and determining whether they are equal distance from the spinous processes of the thoracic vertebral bodies.
Posisi Posterioranterior (PA)
• Merupakan posisi standar pada pencitraan thoraks rutin.
• Pasien berdiri dengan dada menghadap ke film.
• Bahu dirotasikan ke depan untuk dapat menyentuk film, memastikan bahwa scapula tidak menghalangi daerah paru.
• Biasanya dilakukan dengan pasien inspirasi penuh
• Film PA dibaca sebagai pasien berdiri di depan pembaca dan bagian kanan pasien berada pada bagian kiri pembaca
Lateral Position
• Pasien berdiri dengan bagian kiri di depan film dan kedua lengan diangkat ke atas.
• Dapat melihat bagian di belakang jantung dan diaphragmatic dome
• Is typically used in conjunction with a PA view of the same chest to help determine the three-dimensional position of organs or abnormal densities
Anteriorposterior (AP) Position
• Used when the patient is debilitated, immobilized, or unable to cooperate with the PA procedure
• The film is placed behind the patient’s back with the patient in a supine position
• Because the heart is a greater distance from the film, it with appear more magnified than in a PA
• The scapulae are usually visible in the lung fields because they are not rotated out of the view as they are in a PA
Lateral Decubitus Position
• The patient lies on either the right or left side rather than in the standing position as with a regular lateral radiograph
• The radiograph is labeled according to the side that is placed down (a left lateral decubitus radiograph would have the patient’s left side down against the film)
• Often useful in revealing a pleural effusion that cannot be easily observed in an upright view, since the effusion will collect in the dependent postion
Struktur Anatomi Thoraks
• Mediastinum dan Jantung
• Hilum
• Pulmo
• Diafragma (Diaphragmatic Dome)
• Pleura
• Tulang
• Jaringan Lunak
Jantung dan Mediastinum
• Trakea berada di tengah
• Arkus aorta dan Arteri Pulmonalis membentuk batas kiri dari mediastinum
• Tepi lateral Vena Cava Superior membentuk batas kanan jantung
• 2/3 jantung berada di sebelah kiri dari dada dan 1/3 di kanan
• C/T ratio <50%
Hilum
• Hilum Bronkus, arteri dan vena pulmonalis
• Hilum tidak simetris namun memiliki struktur utama yang sama
• Tinggi hilum dapat sama. Biasanya hilum kiri lebih tinggi.
• Densitas dan ukuran kedua hilum biasanya mirip
Pulmo
• Evaluasi lapangan tengah dan kedua hilus
• Evaluasi apeks hingga batas bawah (basal) paru. Bandingkan kanan-kiri seperti yang dilakukan dalam auskultasi
Diaphragm
• The left dome is normally slightly lower than the right due to elevation by the liver, located under the right hemidiaphragm.
• The costophrenic recesses are formed by the hemidiaphragms and the chest wall.
• On the PA radiograph, the costophrenic recess is seen only on each side where an angle is formed by the lateral chest wall and the dome of each hemidiaphragm (costophrenic angle).
Pleura
• The pleura and pleural spaces will only be visible when there is an abnormality present
• Common abnormalities seen with the pleura include pleural thickening, or fluid or air in the pleural space.
Bones
The bones visible in the chest radiograph include:
• Ribs
• Clavicles
• Scapulae
• Vertebrae
• Proximal humeri
The bones are useful as markers to assess patient rotation, adequacy of inspiration, and x-ray penetration.
EVALUASI FOTO THORAX LATERAL
1. Bayangan mediastinum:jantung dan aorta
2. Hilus paru dibentuk oleh arteri pulmonaris diatas dan vena pulmonaris dibawah.
3. Trachea dengan bifurcatio.
4. Anterior mediastinal clear space/retrosternal space.
5. Posterior mediastinal clear space/retrocardiac space.
X-foto thorax PA
bb
aa
b
Normal: a:b < 1/2
X-foto thorax PA
Atrium kanan
Aorta ascendens
Conus Aorticus
Conus Pumonalis
Aorta descendens
Ventrikel kiri
Ventrikel kanan
Hemidiaphragma kanan
Hemidiaphragma kiri
Gas dalam lambung
TracheaParu kanan
Paru kiri
Arcus Aorticus
THANK YOU
EVALUASI BOF/KUB
EVALUASI BOF/KUB
1.Menilai pola udara dalamusus-usus.
2.Besar dan contour kedua ginjal ,mengikutiperjalanan ureter kanan dan kiri.
3.Psoas shadow4.Flank area dan dinding abdomen
5.Tulang-tulang vertebra dan daerah pelvis