DASAR-DASAR

RESPIRASI

Bagian Radiologi
Universitas YARSI
Jakarta
POSISI
1. Postero-Anterior (PA)
2. Antero-Posterior (AP)
3. Lateral

Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
 TORAK PA
(Postero-Anterior)

- Merupakan posisi standar

- Posisi tubuh tegak
- Dada (anterior) menempel kaset film
- Sinar dari posterior
- Posisi lengan tolak pinggang agar os skapula diluar lapangan paru
- Inspirasi maksimal

Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
 TORAK AP
(Antero-Posterior)

- U/ keadaan umum lemah

- Posisi duduk atau ½ duduk atau
berbaring
- Kaset film berada di posterior
(punggung)
- Sinar berada di anterior (depan dada)
- Inspirasi maksimal Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
 TORAK LATERAL

- Dapat lateral kanan atau kiri

tergantung aspek yang akan dinilai
- Tujuan meminimalisasi efek
magnifikasi, menentukan posisi lesi,
konfirmasi lesi, cor analisa dll
- Bila obyek berada di kanan → lateral
kanan (sisi kanan menempel kaset)
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
5 densitas
- Radiolusen : udara

- Hiperlusen : gambaran udara bebas

- Intermediet : jaringan lunak : hepar,jantung,otot

- Opak : tulang, kalsifikasi

- Hiperadiopak : metal,kontras,marker

Balachandran. Interpretation of Chest Xray: An Ilustrated Companion. Jaypee. New

Delhi. 2014
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
Hostensen H. et al. The WHO manualof diagnostic imaging. Radiographic anatomy
and interpretation of the chest and the pulmonary system. Switzerland. 2006
Balachandran. Interpretation of Chest Xray: An Ilustrated Companion. Jaypee. New
Delhi. 2014
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
Hostensen H. et al. The WHO manualof diagnostic imaging. Radiographic anatomy
and interpretation of the chest and the pulmonary system. Switzerland. 2006
 RADIOANATOMI

- Sinar X menghitamkan kertas film (radiolusen)

- Jantung, tulang atau densitas padat akan menahan sinar X (radioopak)

Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys. 2010
 TORAK NORMAL

- Perhatikan label atau marker → sangat penting

terutama pada dekstrokardia atau situs
inversus
- Organ yang dinilai :
1. Jantung
2. Aorta
3. Mediastinum superior
4. Trachea
5. Hilus
6. Paru
7. Diafragma
8. Sinus kostofrenikus
9. Tulang
10. Jaringan lunak ekstra pulmonum
Corne J. et al. Chest X Ray Made Easy. 4th Edition. Edinburgh: Elsevier. 2016
 PROYEKSI ORGAN JANTUNG

- Posisi jantung proyeksi

agak diagonal
- Posisi ruang jantung
diagonal
- Batas jantung pada foto
torak
- Posisi vena cava, aorta
ascenden, arteri pulmonalis

At Ka At Ki

V Ka V Ki
Kartikheyan et al. 101 Chest X Ray Made Easy . Jaypee. New Delhi. 2007..
Proyeksi batas jantung

Kartikheyan et al. 101 Chest X Ray Made Easy . Jaypee. New Delhi. 2007..
 - Posisi arteri-vena
pulmonalis thd
bronchus dan proyeksi
foto polos
- Hilus kiri > kanan
- Ruang Mediastinum
- Ruang pleura

Singh H. 101 Chest X Ray Solutions . Jaypee. New Delhi. 2013.

 PROYEKSI ORGAN PARU

- Paru Kanan :
- 3 lobus → Superior, Medius, Inferior →
bronchus primer
- 10 Segmen ( 3, 2, 5 bronchus segmental )
- Paru Kiri :
- 2 lobus → Superior (+ lingula), Inferior
→ bronchus primer
- 8 segmen ( 2, 4, 2 bronchus segmental )

Collins J. et al. 101 Chest Radiology : The Essential . 2nd Edition. Lippincolt.
Philadelphia... 2008
- Sistim
Tracheobronchial :
Trachea → Bronchus
utama/primer
kanan/kiri →
Bronchus sekunder →
Bronchus tersier
(segmen) →
Bronchiolus (lobulus –
terminal –
respiratorik) →
Alveolus

- Pembagian unit paru :

Lobus → Segmen →
Lobulus → Acinus →
lobulus primer (16-40
alveolus)
Collins J. et al. 101 Chest Radiology : The Essential . 2nd Edition. Lippincolt.
Philadelphia... 2008
Torak lateral

Hostensen H. et al. The WHO manualof diagnostic imaging. Radiographic anatomy

and interpretation of the chest and the pulmonary system. Switzerland. 2006
- Hilus → arteri, vena
pulmonalis dan bronchus
utama
- Hilus kiri lebih tinggi dari
kanan Hostensen H. et al. The WHO manualof diagnostic imaging. Radiographic anatomy
and interpretation of the chest and the pulmonary system. Switzerland. 2006
 RADIOGRAFI TORAK
NORMAL

Syarat kondisi foto standard/Baik : Gambaran Torak normal :

1. Simetris 1. CTR < 50%
2. Kualitas baik 2. Aorta tidak melebar, tidak kalsifikasi
3. Inspirasi maksimal dan tidak elongasio
4. Skapula di luar paru 3. Mediastinum superior tak melebar
5. Identitas dan marker 4. Trachea di tengah
5. Hilus tak menebal, tak suram dan tak
melebar
6. Corakan bronchovaskular < 2/3 paru,
tak tampak infiltrat/ lesi
7. Diafragma licin
Balachandran. Interpretation of Chest Xray: An Ilustrated
Companion. Jaypee. New Delhi. 2014
8. Sinus kostofrenikus lancip
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: 9. Tulang intak
Amirsys. 2010
Hostensen H. et al. The WHO manualof diagnostic imaging. 10. Jaringan lunak ekstrapulmonum baik
Radiographic anatomy and interpretation of the chest and the
pulmonary system. Switzerland. 2006
 Kondisi foto
Syarat kondisi foto standard :
1. Simetris → proyeksi prosesus
spinosus berada tepat di tengah antara
caput clavicula
2. Kualitas baik → corpus vertebra
thorakalis IV masih samar terlihat
3. Inspirasi maksimal → costae 10
posterior atau ujung costae 6 anterior
berada di atas diafragma
4. Skapula di luar paru → proyeksi
tulang skapula berada di luar
lapangan paru
5. Identitas dan marker → nama,
tanggal, no dan L/R harus ada

Balachandran. Interpretation of Chest Xray: An Ilustrated

Companion. Jaypee. New Delhi. 2014
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas:
Amirsys. 2010
Hostensen H. et al. The WHO manualof diagnostic imaging.
Radiographic anatomy and interpretation of the chest and the
pulmonary system. Switzerland. 2006
 Gambaran Torak Normal

1. CTR < 50%

• Cardio-Toracic Index
• Diameter terjauh jantung
dibandingkan lebar torak Balachandran. Interpretation of Chest Xray: An Ilustrated
Companion. Jaypee. New Delhi. 2014
kardiomegali

Collins J. et al. 101 Chest Radiology : The Essential . 2nd Edition. Lippincolt.
Philadelphia... 2008
2. Aorta
• Tak melebar
- U/ mengukur diameter
arcus aorta (dilatasi (-),
aneurisma (-) dll )
- Diameter arcus aorta a
• Tak kalsifikasi
Aneurisma aorta

Balachandran. Interpretation of Chest Xray: An Ilustrated

Companion. Jaypee. New Delhi. 2014
Kalsifikasi aorta
3. Mediastinum Superior
- Tidak melebar → batas
mediastinum tidak melebihi
1/3 hemitorak
4. Trachea di tengah / midline
- Tidak deviasi ke kanan/kiri
o/k pendesakan (massa) atau
penarikan (atelektasis)

Balachandran. Interpretation of Chest Xray: An Ilustrated

Companion. Jaypee. New Delhi. 2014
Lymphoma Atelektasis

Balachandran. Interpretation of Chest Xray: An Ilustrated

Companion. Jaypee. New Delhi. 2014
5. Hilus
- Tak melebar dan menebal
Bisa karena limfadenopati
 6. Paru

- Bronchovaskuler → vaskuler →
dikotomi (bercabang)
- Corakan bronchovaskular < 2/3 lap
paru
- Tak tampak infiltrat
- Tak tampak lesi → nodul, corakan
meningkat, kranialisasi dll

Balachandran. Interpretation of Chest Xray: An Ilustrated

Companion. Jaypee. New Delhi. 2014
Vaskuler infiltrat nodul
Balachandran. Interpretation of Chest Xray: An Ilustrated
Companion. Jaypee. New Delhi. 2014
7. Diafragma
- Kanan > kiri
- < 1.5 tinggi corpus vert
- Licin → tidak suram
(bergerak)

Kartikheyan et al. 101 Chest X Ray Made Easy . Jaypee. New Delhi. 2007..
Elevasi diafragma hemithorax Elevasi diafragma hemithorax
kiri (eventerasi) kanan (Udara bebas sub
diafragma)

Kartikheyan et al. 101 Chest X Ray Made Easy . Jaypee. New Delhi. 2007..
8. Sinus kostofrenikus
- Sudut yang dibentuk oleh costae dan
diafragma
- Lancip
- Bila tumpul biasanya merupakan pertanda Balachandran. Interpretation of Chest Xray: An Ilustrated
Companion. Jaypee. New Delhi. 2014
adanya cairan di rongga pleura Corne J. et al. Chest X Ray Made Easy. 4th Edition. Edinburgh:
Elsevier. 2016
9. Tulang
- Costae, vertebra torakalis,
Calvicula dan Skapula
- Ada/tidak fraktur
- Ada/tidak skoliosis
- Struktur tulang →
osteoporosis / tidak
- Lesi blastik / lusen →
metastase ke tulang
10. Jaringan lunak
- Ketebalan
- Soft tissue mass (c/ tiroid
intratorakal, kgb aksila dll)
- Emfisema subkutis
 Daftar Pustaka

Balachandran. Interpretation of Chest Xray: An Ilustrated Companion.

Jaypee. New Delhi. 2014
Christenson et al. Diagnostic Imaging Chest. 2nd Edition. Texas: Amirsys.
2010.
Collins J. et al. 101 Chest Radiology : The Essential . 2 nd Edition.
Lippincolt. Philadelphia... 2008
Hostensen H. et al. The WHO manualof diagnostic imaging. Radiographic
anatomy and interpretation of the chest and the pulmonary system.
Switzerland. 2006.
Kartikheyan et al. 101 Chest X Ray Made Easy . Jaypee. New Delhi. 2007.
Singh H. 101 Chest X Ray Solutions . Jaypee. New Delhi. 2013.