Form C2
SIGNALEMENT
Animal Name :
Species :
BW :
Sex :
M,
F Age :
SM, SF
PRESENT STATUS
Rectal Temp.:
C
kg Resp. Rate :
Yr Heart Rate :
Mo Mentation: Yes, No
OWNER
Name:
Address:
Phone:
Ref. (sender):
RADIOGRAPHY PROCEDURES
Technical Data: Grid Factors:
Thick = cm
FFD = cm
inchi
Yes,
24 x 30
30 x 40
.
Contras Agents
BaSO4
Iodine
Double contras
.
Radiograph Positions
Oblique
Ros-Caud
.
VD
R-requmb
DV
L-requmb
Radiographer: .. Signature: ..
RADIOGRAPHIC INTEPRETATIONS
REGIONS
Head
Neck
Fore Extremity
Thorax
Abdomen
Pelvis
ORGANS/SYSTEM
RADIOGRAPHIC DESCRIPTIONS
Kualitas
Pengambilan gambar dilakukan dengan nilai kVP dan mAs yang
tepat sehingga radiograf bisa diinterpretasikan.
Posisi
ABNORMALITY
Norm / Abnrm
Hind Extremity
..
..
Pertulangan
Ossa vertebrae
thoracalis
Os costae
Ossa vertebrae
lumbalis
Hati
Norm / Abnrm
Lambung
Ginjal
Limpa
Norm / Abnrm
Usus halus
Norm / Abnrm
Usus besar
Norm / Abnrm
Vesica urinaria
Norm / Abnrm
Zona 1
Zona 2
Zona 3
Zona 4
RADIOGRAPHIC DIAGNOSE:
Pneumoperitonium
Mahasiswa PPDH,
Dosen Radiologi