Form C2
SIGNALEMENT
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PRESENT
STATUS
Animal Name :
Species :
BW :
kg
Age :
Yr
Sex :
M,
F
SM,
Rectal Temp.:
C
Resp. Rate :
Name:
Heart Rate :
Phone:
Mo Mentation:
SF
OWNER
Yes,
Address:
Ref. (sender):
No
RADIOGRAPHY PROCEDURES
Technical
Data:
Grid Factors:
Thick =
cm
FFD
cm
Yes,
No
12:1, kVP + 10
inchi
Beam
Setting:
=.
mAs =
.
Film
Sizes
Contras
Agents
Radiograph Positions
24 x
RBaSO4
Iodine
Double
Oblique
Ros-
VD
requmb
L-
40
contras
Caud
DV
requmb
LL
.
.
30
30 x
ORGANS/SYS
RADIOGRAPHIC DESCRIPTIONS
TEM
Kejelasan
Gambar diambil dengan nilai kVp dan mAs yang
kurang tepat sehingga batas antar organ tidak jelas
dan sulit diinterpretasikan.
ABNORMALIT
Y
Norm /
Abnrm
Posisi
Pertulangan
Norm /
Abnrm
Norm /
Abnrm
Abdomen
Pelvis
Hind
Extremity
..
..
b
c
a
Limpa
Norm /
Abnrm
Lambung
Norm /
Abnrm
Hati
Norm /
Abnrm
Ginjal
Norm /
Abnrm
Usus halus
Norm /
Abnrm
Usus besar
Norm /
Abnrm
Vesica Urinaria
Norm /
Abnrm
RADIOGRAPHIC DIAGNOSE:
Splenomegally, abdomen membesar akibat adanya massa radiopaque yaitu lipoma
Zona
4
Zona
1
Zona
2
Zona
3
Zona
5
Mahasiswa PPDH,
Dosen Radiologi