Dasar CT Scan Toraks

1. Dasar Pemeriksaan
CT Scan Toraks
Penyaji : dr. Hetti Rusmini, M.Biomed
Pembimbing : dr. Tantri Dwi Kanya, Sp.Rad

2. Definisi
adalah teknik pemeriksaan
secara radiologi untuk
mendapatkan informasi
anatomis irisan crossectional
atau penampang aksial
thorax.

3. Indikasi

4. 1. allergy to iodine;
2. chronic renal and hepatic insufficiency;
3. hyperthyroidism;
4. myeloma disease;
5. bronchial asthma or severe diabetes mellitus.
Kontra Indikasi

5. Persiapan Pemeriksaan CT Scan Toraks
• Penderita melepaskan aksesoris seperti kalung, bra dan mengganti baju dengan baju
khusus pasien supaya tidak menyebabkan timbulnya artefak.
1. Persiapan Pasien
• Alat dan bahan untuk pemeriksaan CT-Scan thorax diantaranya: Pesawat CT-Scan,
Tabung oksigen, Media kontras, Alat-alat Suntik, Spuit, Kassa dan kapas, Alkohol
2. Persiapan alat dan bahan
• Penggunaan media kontras dalam pemeriksaan CT-Scan diperlukan untuk
menampakkan struktur-struktur anatomi tubuh seperti pembuluh darah dan organ-organ
lainnya dapat dibedakan dengan jelas.
3. Persiapan Media Kontras

6. 1. Posisi pasien :
• Supine diatas meja pemeriksaan dengan posisi kepala dekat dengan
gantry.
2. Posisi objek :
a. Mengatur pasien sehingga Mid Sagital Plane (MSP) tubuh sejajar
dengan lampu indicator longitudinal. Kedua tangan pasien di atas
kepala.
b. Memfiksasi lutut dengan menggunakan body clem.
c. Menjelaskan kepada pasien untuk inspirasi penuh dan tahan nafas
pada saat pemeriksaan berlangsung.
Teknik Pemeriksaan

7. Parameter pemeriksaan CT-Scan thorax

9. a. identifikasi anatomi pembuluh darah
b. penggambaran struktur non-vaskular yang berdekatan
c. meningkatkan deteksi dan karakterisasi lesi patologis
d. membantu penilaian struktur mediastinal, struktur pembuluh darah,
penyakit pleura kronis, massa paru-paru, dan diferensiasi parenkim
dari pleura atau koleksi pleura serta esofagus.
Peran Kontras pada CT Scan Toraks

10. 1. Jenis media kontras : media kontras dengan osmolaritas
rendah
2. Volume media kontras : 80 – 100 ml
3. Injeksi rata-rata (kecepatan) : 2 ml / detik
4. Waktu Scan : melakukan scanning pada saat 25 detik
setelah pemasukan awal media kontras (delay).
5. kanula 18 G yang ditempatkan dengan benar di fossa
ante cubital
Teknik injeksi intravena

12. 1. Diseksi aorta akut:
a. hematoma intramural, tanda awal, dapat dikaburkan
oleh kontras aorta yang padat.
2. Kebocoran esofagus kecil:
a. kontras oral yang bocor mungkin sulit dideteksi jika
i.v. kontras telah diberikan, karena dapat dikaburkan
oleh peningkatan pembuluh darah yang berdekatan.
Kondisi yang tidak membutuhkan kontras

13. 1. Menilai arsitektur paru-paru dan tidak melibatkan kontras i.v
2. Diperoleh irisan tipis yang tidak berdekatan, antara 1 dan 1,5
mm, mengambil sampel parenkim pada interval 10-15 mm.
3. Digunakan untuk menilai parenkim paru-paru untuk kondisi
seperti bronkiektasis, penyakit paru-paru interstitial, emfisema,
sarkoidosis, dan infeksi atipikal, misalnya, jamur atau TBC paru-
paru.
HRCT

14. Interpretasi CT Scan
Toraks
● Ulas lengkap tentang riwayat dan
pemeriksaan pasien.
● Periksa karakteristik pasien yang akan
ditinjau. Bandingkan dengan
pencitraan sebelumnya  membantu
diagnosis.
● Identifikasi orientasi gambar paru-
paru pada film (aksial, koronal dan
sagittal)
● Pendekatan sistematis  menilai
kelainan  identifikasi sesuai struktur
anatomi

15. Orientasi CT Scan Toraks

16. Struktur penting Radiografi Toraks

17. Radiografi pembuluh darah besar

20. Anatomi lengkungan aorta dan carina

25. Simulasi CT Scan Toraks Normal
Radiology Quiz 36676 | Radiopaedia.org

26. Patologi CT Scan

27. Consolidation of the left lung
parenchyma with air
bronchograms located within
and patchy ground glass
changes in the right lung.
Lung parenchyma and airways

28. Adult respiratory distress syndrome
with areas of parenchymal
consolidation (blue arrow) in the
dependent areas and ground glass
opacification (red arrow) in the non-
dependent areas.

29. demonstrated by the loss
in definition of
subsegmental and
segmental vessels, the
appearance of Kerley
lines, and pleural
effusions. Further,
oedema will migrate
centrally with progressive
blurring of vessels, first at
the lobar level and later at
the level of the hilum. At
this point, lung
radiolucency decreases
markedly, giving a ground
glass appearance
Pulmonary
oedema

30. Left upper lobe cavitating
lesion (red arrow)—
differentials would include
infective causes
(mycobacterium or
bacterial), septic
pulmonary emboli, or
malignancy.

31. Right endobronchial
intubation—the tracheal
tube is seen within the
right main bronchus
(red arrow).

32. Left pneumothorax with
mediastinal shift.
Pulmonary pleurae

33. Left anterior pneumothorax.

34. Pleural effusion (blue
arrow) noted within the
left pleural cavity

35. Split pleura sign—
contrast-enhanced CT
scan demonstrates
thickening of the visceral
(red arrow) and parietal
pleura (white arrow
heads) separated by fluid.
The split pleura sign is
seen mainly in empyema
but may also be seen in
haemothorax.

36. Pneumomediastinum—there is free
gas within the mediastinum as
highlighted by the arrows. This can
be from either intrathoracic air
(emanating from the trachea, major
bronchi, oesophagus, or pleural
space) or extrathoracic air
(originating from the head and neck
or the abdomen)
Mediastinum

37. Retrosternal goitre (red arrow)
causing significant tracheal
deviation (blue arrow).

38. Tracheo-oesophageal fistula
evidenced by the defect
highlighted (red arrow)

39. Saddle embolus noted within
the pulmonary bifurcation
Cardiovascular pathology

40. Embolus within the right
main pulmonary artery

41. Descending thoracic aortic
dissection with the true arterial
lumen highlighted by the red
arrow and the false lumen by
the blue arrow

42. Dilated right ventricle (red arrow)
with flattening of the
interventricular septum (blue
arrow) and compression of the left
ventricle (yellow arrow) indicating
right-sided volume or pressure
overload. This picture may be
seen in acute massive pulmonary
embolus

43. Large pericardial (red arrow) and
pleural effusions

44. Coronary artery
calcification—CT coronary
angiogram can be used as an
alternative to coronary
angiography. It is utilized in
those patients with a low risk
of coronary artery disease
and a low level of coronary
artery calcification,
measured using the CT
calcium score, within the
vessels

45. Large mediastinal haematoma (red
arrows) from a right-sided transverse
process fracture of the thoracic spine
and an associated right-sided
haemothorax in a trauma patient.
Trauma

46. Fractured right 9th rib (1),
haemopneumothorax (2), and
subcutaneous emphysema (3)

47. Lung contusions appear dense
and are usually peripheral, non-
segmental, and non-lobar. The
increased lung density seen in
the lung periphery is due to
haemorrhage and oedema

48. Left-sided traumatic
diaphragmatic defect with
herniation of the abdominal
contents into the thoracic
cavity and compression of
the left lung parenchyma.
There is also a right-sided
pneumothorax

49. 1. P Whiting, FRCA FFICM, N Singatullina, FRCA EDIC, JH Rosser, FRCA FFICM, Computed tomography of
the chest: I. Basic principles, BJA Education, Volume 15, Issue 6, December 2015, Pages 299–
304, https://doi.org/10.1093/bjaceaccp/mku063
2. JH Rosser, FRCA FFICM, N Singatullina, FRCA EDIC, P Whiting, FRCA FFICM, Computed tomography of
the chest—II: clinical applications, BJA Education, Volume 16, Issue 1, January 2016, Pages 15–
20, https://doi.org/10.1093/bjaceaccp/mkv007
REFERENSI

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questions?
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