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Dasar Pemeriksaan
CT Scan Toraks
Penyaji : dr. Hetti Rusmini, M.Biomed
Pembimbing : dr. Tantri Dwi Kanya, Sp.Rad
Definisi
adalah teknik pemeriksaan
secara radiologi untuk
mendapatkan informasi
anatomis irisan crossectional
atau penampang aksial
thorax.
Indikasi
1. allergy to iodine;
2. chronic renal and hepatic insufficiency;
3. hyperthyroidism;
4. myeloma disease;
5. bronchial asthma or severe diabetes mellitus.
Kontra Indikasi
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
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
Parameter pemeriksaan CT-Scan thorax
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
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
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
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
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
Orientasi CT Scan Toraks
Struktur penting Radiografi Toraks
Radiografi pembuluh darah besar
Anatomi lengkungan aorta dan carina
Simulasi CT Scan Toraks Normal
Radiology Quiz 36676 | Radiopaedia.org
Patologi CT Scan
Consolidation of the left lung
parenchyma with air
bronchograms located within
and patchy ground glass
changes in the right lung.
Lung parenchyma and airways
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.
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
Left upper lobe cavitating
lesion (red arrow)—
differentials would include
infective causes
(mycobacterium or
bacterial), septic
pulmonary emboli, or
malignancy.
Right endobronchial
intubation—the tracheal
tube is seen within the
right main bronchus
(red arrow).
Left pneumothorax with
mediastinal shift.
Pulmonary pleurae
Left anterior pneumothorax.
Pleural effusion (blue
arrow) noted within the
left pleural cavity
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.
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
Retrosternal goitre (red arrow)
causing significant tracheal
deviation (blue arrow).
Tracheo-oesophageal fistula
evidenced by the defect
highlighted (red arrow)
Saddle embolus noted within
the pulmonary bifurcation
Cardiovascular pathology
Embolus within the right
main pulmonary artery
Descending thoracic aortic
dissection with the true arterial
lumen highlighted by the red
arrow and the false lumen by
the blue arrow
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
Large pericardial (red arrow) and
pleural effusions
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
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
Fractured right 9th rib (1),
haemopneumothorax (2), and
subcutaneous emphysema (3)
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
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
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
CREDITS: This presentation template was
created by Slidesgo, including icons by
Flaticon, infographics & images by Freepik
and illustrations by Stories
Thanks
Do you have any
questions?
hettirusmini@gmail.com
Please keep this slide for attribution

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Dasar CT Scan Toraks.pptx

  • 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.
  • 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
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  • 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
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  • 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
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  • 25. Simulasi CT Scan Toraks Normal Radiology Quiz 36676 | Radiopaedia.org
  • 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
  • 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
  • 50. CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, infographics & images by Freepik and illustrations by Stories Thanks Do you have any questions? hettirusmini@gmail.com Please keep this slide for attribution