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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

  1. 1. INTERPRESTASI RONTGEN DADA Eri Yanuar Akhmad B.S., S.Kep., Ns., M.N.Sc(I.C)
  2. 2. Gambaran Rontgen Dada
  3. 3. Tujuan Pembelajaran • Lima Opasiti Radiografi • Aspek Teknis Rontgen Dada • Interprestasi Rontgen Dada
  4. 4. Lima Opasiti Radiografi
  5. 5. Aspek Teknis
  6. 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
  7. 7. Kualitas Film PA or AP view. Upright/Erect or Supine Breath : Inspiration or Expiration X-ray penetration : Under- or Over- Rotation
  8. 8. PA AP Effect of projection on apparent heart size X-ray tube
  9. 9. PA AP Effect of projection on apparent heart size X-ray tube
  10. 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
  11. 11. Inspiration vs Expiration
  12. 12. Inspiration - 500mls air in pleural space, 2500mls in lung = 17% pneumothorax
  13. 13. Expiration - 500mls air in pleural space, 1500mls in lung = 25% pneumothorax • Pleural line displaced further inferiorly
  14. 14. 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
  15. 15. 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
  16. 16. Penetration
  17. 17. Rotation
  18. 18. Not Centered
  19. 19. Pitfalls to Chest X-ray Interpretation • Poor inspiration • Over or under penetration • Rotation • Forgetting the path of the x-ray beam
  20. 20. Normal CXR Anatomy
  21. 21. Normal PA CXR
  22. 22. Assessing for Rotation Spinous process should be equidistant from medial ends of both clavicles
  23. 23. Trachea
  24. 24. Left main bronchus
  25. 25. Right main bronchus
  26. 26. Carinal Angle (40-75 degrees)
  27. 27. Right pulmonary artery
  28. 28. Left pulmonary artery
  29. 29. Aortic Arch
  30. 30. Descending Aorta
  31. 31. Aortopulmonary Window
  32. 32. Right Heart Border = Right atrium
  33. 33. Left Heart Border = Left Ventricle
  34. 34. Left Atrium
  35. 35. Cardiothoracic Ratio (<50%)
  36. 36. Anterior Ribs - full inspiration 1 2 3 4 5 6
  37. 37. Gastric air bubble
  38. 38. STEP INTERPRESTASI RONTGEN DADA
  39. 39. • 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
  40. 40. • 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
  41. 41. • 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
  42. 42. D - Details Patient name, age / DOB, sex Type of film – PA or AP, erect or supine, correct L/R marker, inspiratory/expiratory series Date and time of study
  43. 43. 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.
  44. 44. Assessing for Rotation Spinous process should be equidistant from medial ends of both clavicles
  45. 45. Anterior Ribs - full inspiration 1 2 3 4 5 6
  46. 46. 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
  47. 47. 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.
  48. 48. Trachea
  49. 49. Left main bronchus
  50. 50. Right main bronchus
  51. 51. Carinal Angle (40-75 degrees)
  52. 52. Left mastectomy Beware of remaining nipple mimicking a nodule!
  53. 53. 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
  54. 54. B – Breathing • Pleura • Pleural reflections • Pleural thickening
  55. 55. Anatomy
  56. 56. Lobes • Right upper lobe:
  57. 57. • Right middle lobe:
  58. 58. • Right lower lobe:
  59. 59. • Left lower lobe:
  60. 60. • Left upper lobe with Lingula:
  61. 61. Lingula:
  62. 62. Left upper lobe - upper division:
  63. 63. Pulmonary oedema - cardiomegaly
  64. 64. Normal CTR
  65. 65. Tension pneumothorax
  66. 66. LUL collapse - trachea displaced to left left hilum elevated left hemidiaphragm elevated
  67. 67. C – Circulation Heart position –⅔ to left, ⅓ to right Heart size – measure cardiothoracic ratio on PA film (normal <0.5) Heart borders – R) border is R) atrium, L) border is L) ventricle & atrium Heart shape Aortic stripe
  68. 68. Cardiothoracic Ratio (<50%)
  69. 69. Right Heart Border = Right atrium
  70. 70. Left Heart Border = Left Ventricle
  71. 71. Left Atrium
  72. 72. Aortic Arch
  73. 73. Descending Aorta
  74. 74. Aortopulmonary Window
  75. 75. Left atrial enlargement in mitral stenosis - double right heart border, splayed carina
  76. 76. Sternotomy wires and aortic valve replacement
  77. 77. D – 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)
  78. 78. Diaphragma Male
  79. 79. ??
  80. 80. E – Extras ETT, CVP line, NG tube, PA catheters, ECG electrodes, PICC line, chest tube PPM, AIDC, metalwork
  81. 81. Posisi NGT normal
  82. 82. TERIMA KASIH

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