Interpretasi Rontgen Dada atau Foto Thoraks
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Materi Interpretasi Rontgen Dada atau Foto Thoraks Eri Yanuar
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Interpretasi Rontgen Dada atau Foto Thoraks
- 3. Tujuan Pembelajaran • Lima Opasiti Radiografi • Aspek Teknis Rontgen Dada • Interprestasi Rontgen Dada
- 5. Aspek Teknis
- 6. The Normal CXR Standard CXR biasa diambil: • PA – minimal magnification of the heart • Patient standing • Full inspiration 01 In ill patients, the CXR is usually taken: • AP – magnifies cardiac shadow • Often supine – diaphragms higher, lung volumes lower, pathology often obscured 02
- 10. PA vs AP PA view • Scapula is seen in periphery of thorax • Clavicles project over lung fields • Posterior ribs are distinct • Position of markers AP view • Scapulae are over lung fields • Clavicles are above the apex of lung fields • Anterior ribs are distinct • Position of markers
- 16. Expiratory CXR • Makes a pneumothorax appear relatively larger than on an inspiratory film • PTx may only visible on expiration film • When you see the word ‘expiration’ on a CXR you are almost certainly looking for a pneumothorax (especially in an exam!) • Expiratory film is also useful in kids when looking for air trapping due to an obstructing foreign body – lung on obstructed side remains expanded
- 17. Penetration With correct exposure you should barely see the intervertebral disc through the heart • If you see them very clearly the film is overpenetrated • If you do not see them it is underpenetrated
- 18. Penetration
- 19. Rotation
- 20. Not Centered
- 21. Pitfalls to Chest X-ray Interpretation • Poor inspiration • Over or under penetration • Rotation • Forgetting the path of the x-ray beam
- 23. Normal PA CXR
- 26. Trachea
- 32. Aortic Arch
- 33. Descending Aorta
- 37. Left Atrium
- 43. • Details • RIPE Image (Aspek Teknis) • Rotation – medial clavicle ends equidistant from spinous process • Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded? • Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane) • Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow. • Soft Tissues and Bones • Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density • Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses • Breast shadows • Calcification – great vessels, carotids
- 44. • Airway dan Mediastinum • Trachea – central or slightly to right lung as crosses aortic arch • Paratracheal/mediastinal masses or adenopathy • Carina & RMB/LMB • Mediastinal width <8cm on PA film • Aortic knob • Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum. • Check vessels, calcification. • Breathing • Lung fields • Pleura • Circulation system • Heart position • Aortic stripe
- 45. • Diaphragm • Hemidiaphragm levels – Right Lung higher than Left Lung (~2.5cm / 1 intercostal space) • Diaphragm shape/contour • Cardiophrenic and costophrenic angles – clear and sharp Gastric bubble / colonic air • Subdiaphragmatic air (pneumoperitoneum) • Extras • ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube • PPM, AIDC, metalwork
- 48. RIPE Images Rotation – medial clavicle ends equidistant from spinous process Inspiration – 5-6 anterior ribs in MCL or 8-10 posterior ribs above diaphragm, poor inspiration?, hyperexpanded? Picture – straight vs oblique, entire lung fields, scapulae outside lung fields, angulation (ie ’tilt’ in vertical plane) Exposure (Penetration) – IV disc spaces, spinous processes to ~T4, L) hemidiaphragm visible through cardiac shadow.
- 51. S – Soft tissues and bones Ribs, sternum, spine, clavicles – symmetry, fractures, dislocations, lytic lesions, density Soft tissues – looking for symmetry, swelling, loss of tissue planes, subcutaneous air, masses Breast shadows Calcification – great vessels, carotids
- 52. A – Airway & mediastinum Trachea – central or slightly to right lung as crosses aortic arch Paratracheal/mediastinal masses or adenopathy Carina & RMB/LMB Mediastinal width <8cm on PA film Aortic knob Hilum – T6-7 IV disc level, left hilum is usually higher (2cm) and squarer than the V-shaped right hilum. Check vessels, calcification.
- 53. Trachea
- 58. B – Breathing • Lung fields • Vascularity – to ~2cm of pleural surface (~3cm in apices), vessels in bases > apices • Pneumothorax – don’t forget apices • Lung field outlines – abnormal opacity/lucency, atelectasis, collapse, consolidation, bullae • Horizontal fissure on Right Lung • Pulmonary infiltrates – interstitial vs alveolar pattern • Coin lesions • Cavitary lesions
- 59. B – Breathing • Pleura • Pleural reflections • Pleural thickening
- 60. Anatomy
- 61. Lobes • Right upper lobe:
- 62. • Right middle lobe:
- 63. • Right lower lobe:
- 64. • Left lower lobe:
- 65. • Left upper lobe with Lingula:
- 66. Lingula:
- 69. Normal CTR
- 76. Left Atrium
- 77. Aortic Arch
- 78. Descending Aorta
- 83. Diaphragma Male
- 84. ??
- 90. TERIMA KASIH