Weekly Medical Review 2K14

Radiology of Chest
October 2nd, 2014

Faculty of Medicine
Widya Mandala Catholic University
Surabaya

SIFAT Sinar-X
1. Tidak dapat diindera oleh kelima panca indera
2. Jalannya lurus
3. Tidak dipantulkan oleh cermin
4. Menembus dan dapat merusak jaringan tubuh.
5. Dapat mengubah emulsi film.
6. Pengaruh dalam tubuh bersifat kumulatif.

 Different tissues in our body absorb X-rays at

different extents:
Bone- high absorption (white)
Tissue- somewhere in the middle absorption (grey)
Air and fat- low absorption (black)

FOTO THORAKS

Three Main Factors Determine the Technical Quality of

the Radiograph

Inspiration
Penetration
Rotation

Inspiration
Sebaiknya dalam keadaan inspirasi penuh
asesmen abnormalitas intrapulmoner
Pada inspirasi penuh:
Hemidiafragma memotong costa 6 di tengah
Diafragma posterior setinggi costa 8 -10
Diafragma anterior setinggi costa 5 6vv

Penetration
Pada radiografi thoraks yang dilakukan dengan
baik:
The lower thoracic vertebrae should be visible
through the heart
The bronchovascular structures behind the
heart (trachea, aortic arch, pulmonary arteries,
etc.) should be seen

Underexposure
In an underexposed chest radiograph, the cardiac
shadow is opaque, with little or no visibility of the
thoracic vertebrae.
The lungs may appear much denser and whiter,
much as they might appear with infiltrates
present.

Overexposure
With greater exposure of the chest radiograph,
the heart becomes more radiolucent and the
lungs become proportionately darker.
In an overexposed chest radiograph, the air-filled
lung periphery becomes extremely radiolucent,
and often gives the appearance of lacking lung
tissue, as would be seen in a condition such as
emphysema.

Rotation

Patient rotation can be assessed by observing the

clavicular heads and determining whether they
are equal distance from the spinous processes of
the thoracic vertebral bodies.

Posisi Posterioranterior (PA)

Merupakan posisi standar pada pencitraan thoraks
rutin.
Pasien berdiri dengan dada menghadap ke film.
Bahu dirotasikan ke depan untuk dapat menyentuk
film, memastikan bahwa scapula tidak menghalangi
daerah paru.
Biasanya dilakukan dengan pasien inspirasi penuh
Film PA dibaca sebagai pasien berdiri di depan
pembaca dan bagian kanan pasien berada pada
bagian kiri pembaca

Lateral Position
Pasien berdiri dengan bagian kiri di depan film
dan kedua lengan diangkat ke atas.
Dapat melihat bagian di belakang jantung dan
diaphragmatic dome
Is typically used in conjunction with a PA view of
the same chest to help determine the threedimensional position of organs or abnormal
densities

Anteriorposterior (AP) Position

Used when the patient is debilitated, immobilized,
or unable to cooperate with the PA procedure
The film is placed behind the patients back with
the patient in a supine position
Because the heart is a greater distance from the
film, it with appear more magnified than in a PA
The scapulae are usually visible in the lung fields
because they are not rotated out of the view as
they are in a PA

Lateral Decubitus Position

The patient lies on either the right or left side rather
than in the standing position as with a regular lateral
radiograph
The radiograph is labeled according to the side that
is placed down (a left lateral decubitus radiograph
would have the patients left side down against the
film)
Often useful in revealing a pleural effusion that
cannot be easily observed in an upright view, since
the effusion will collect in the dependent postion

Struktur Anatomi Thoraks

Mediastinum dan Jantung
Hilum
Pulmo
Diafragma (Diaphragmatic Dome)
Pleura
Tulang
Jaringan Lunak

Jantung dan Mediastinum

Trakea berada di tengah
Arkus aorta dan Arteri Pulmonalis membentuk
batas kiri dari mediastinum
Tepi lateral Vena Cava Superior membentuk
batas kanan jantung
2/3 jantung berada di sebelah kiri dari dada dan
1/3 di kanan
C/T ratio <50%

Hilum
Hilum Bronkus, arteri dan vena pulmonalis
Hilum tidak simetris namun memiliki struktur
utama yang sama
Tinggi hilum dapat sama. Biasanya hilum kiri
lebih tinggi.
Densitas dan ukuran kedua hilum biasanya
mirip

Pulmo
Evaluasi lapangan tengah dan kedua hilus
Evaluasi apeks hingga batas bawah (basal)
paru. Bandingkan kanan-kiri seperti yang
dilakukan dalam auskultasi

Diaphragm
The left dome is normally slightly lower than the
right due to elevation by the liver, located under
the right hemidiaphragm.
The costophrenic recesses are formed by the
hemidiaphragms and the chest wall.
On the PA radiograph, the costophrenic recess is
seen only on each side where an angle is formed
by the lateral chest wall and the dome of each
hemidiaphragm (costophrenic angle).

Pleura
The pleura and pleural spaces will only be
visible when there is an abnormality present
Common abnormalities seen with the pleura
include pleural thickening, or fluid or air in the
pleural space.

Bones
The bones visible in the chest radiograph include:
Ribs
Clavicles
Scapulae
Vertebrae
Proximal humeri

The bones are useful as markers to assess patient

rotation, adequacy of inspiration, and x-ray penetration.

EVALUASI FOTO THORAX LATERAL

1. Bayangan mediastinum:jantung dan aorta
2. Hilus paru dibentuk oleh arteri pulmonaris
diatas dan vena pulmonaris dibawah.
3. Trachea dengan bifurcatio.
4. Anterior mediastinal clear space/retrosternal
space.
5. Posterior mediastinal clear space/retrocardiac
space.

X-foto thorax PA

b
b
b
Normal: a:b < 1/2

Arcus Aorticus
Trachea
Paru kanan

Paru kiri
Conus Aorticus

Aorta
ascendens

Conus
Pumonalis
Aorta
descendens
Ventrikel kiri

Atrium kanan

Ventrikel
kanan
Hemidiaphragma
kanan
X-foto thorax PA

Hemidiaphragma
kiri

Gas dalam lambung

THANK

YOU

EVALUASI BOF/KUB

EVALUASI BOF/KUB
1.Menilai pola udara dalam
usus-usus.
2.Besar dan contour kedua ginjal
,mengikuti
perjalanan ureter kanan dan kiri.
3.Psoas shadow
4.Flank area dan dinding abdomen
5.Tulang-tulang vertebra dan daerah
pelvis