FOTO THORAKS

PROYEKSI foto thoraks

• Proyeksi PA
• Proyeksi lateral
• Proyeksi top lordotic
• Proyeksi lateral decubitus
 foto thoraks LAYAK BACA
1. Cek label
2. Cek exposure
3. Cek posisi
4. Cek inspirasi
5. Cek endorotasi sendi bahu
6. Cek seluruh lapang paru
 foto thoraks LAYAK BACA
 Nomor foto 1. Cek label
2. Cek exposure
 Nama 3. Cek posisi
 Jenis kelamin 4. Cek inspirasi
5. Cek endorotasi
 Tanggal sendi bahu
 Marker kanan/kiri 6. Cek seluruh
lapang paru
 CEK LABEL
 Nomor foto
 Nama
 Jenis kelamin
 Tanggal
 Marker kanan/kiri
 foto thoraks LAYAK BACA
 Over-exposurehitam 1. Cek label
2. Cek exposure
 Under-exposureterang 3. Cek posisi
4. Cek inspirasi
5. Cek endorotasi
sendi bahu
Dapat membedakan: 6. Cek seluruh
• Jaringan kerasputih lapang paru
• Jaringan lunakabu-abu
• Udarahitam

(Biasanya sampai corpus VTh-4)

DENSITAS
• Densitas cukup

• Over-exposure
 foto thoraks LAYAK BACA
1. Cek label
2. Cek exposure
3. Cek posisi
4. Cek inspirasi
5. Cek endorotasi
sendi bahu
 Posisi foto center 6. Cek seluruh
lapang paru

Perhatikan gap antara clavicula ka/ki

dengan corpus vertebra
 POSISI FOTO CENTER?

• Perhatikan gap antara clavikula ka/ki dengan korpus vertebra

 foto thoraks LAYAK BACA
 Inspirasi dalam 1. Cek label
2. Cek exposure
3. Cek posisi
Costa anterior VI-VII 4. Cek inspirasi
5. Cek endorotasi
sendi bahu
6. Cek seluruh
lapang paru
 foto thoraks LAYAK BACA
 Endorotasi sendi bahu 1. Cek label
2. Cek exposure
maksimal
3. Cek posisi
4. Cek inspirasi
Scapula tidak menutup lapang paru 5. Cek endorotasi
sendi bahu
6. Cek seluruh
lapang paru
 foto thoraks LAYAK BACA
 Seluruh lapang paru 1. Cek label
2. Cek exposure
3. Cek posisi
Lapang paru tidak terpotong 4. Cek inspirasi
5. Cek endorotasi
sendi bahu
6. Cek seluruh
lapang paru
Urutan Cara Pembacaan
 Urutan cara pembacaan
1. Kulit/ soft tissue.
2. Tulang dan persendian.
3. Trakea dan mediastinum.
4. Hilus.
5. Parenkim paru.
6. Bronchovaskular marking.
7. Diafragma.
8. Pleura.
9. Jantung.
FOTO NORMAL
 Jantung
 Besar jantung
 Bentuk jantung
 Silhouette jantung

• Besar jantungCTR <50%

• Bentuk jantungbuah pear
• Silhouette jantung
 BESAR
JANTUNG

CTR = a/b x 100%

Cardiomegali  CTR >50%
 Diafragma (7)

• Cembung
• Licin
• Kanan biasanya lebih tinggi
• Sudut costoprenikus tajam
• Diafragma kiri
normal
• Diafragma kanan:
sudut
kostophrenikus
tumpul
 Tulang
 Vertebra
 Clavicula
 Scapula
 Costa
Contoh Kasus
 TUBERCULOSIS
• Infiltrat
• Cavitas
• Fibrosis
• Kalsifikasi
 BRONKHITIS
• Peningkatan corakan bronkovasikuler
 PNEUMONIA
• Lung opacification
• Air bronchograms
• Lobar consolidation
 EFUSI PLEURA
• Sudut costoprenikus tumpul
• Fluid level
• Displacement of other structures
PERHATIKAN PERBEDAANNYA
 ATELECTASIS/COLLAPSE
1. Shadow of collapse
2. Elevation of the hemidiaphragm
3. Displacement of other structures
 OEDEM PULMONUM
• Widespread alveolar shadowing
• Alveolar oedema
• Cardiomegaly and pleural effusion bilateral
 PPOM
• Diafragma letak rendah, datar
• Bentuk jantung seperti tetesan air
• Hiperaerasi paru (luscent)
 PNEUMOTHORAK
• Corakan jaringan paru hilang
• Gambaran batas jaringan paru
mengumpul di hillus
• Displacement of other structures
FLUIDOPNEMOTHORAKS
 ABSES PARU
• Cavitas berkapsul tebal
• Terdapat gambaran air fluid level
MULTIPLE ABSES
MULTIPLE ABSES
MULTIPLE ABSES
 BRONKHIEKTASIS

• Gambaran sarang tawon/ Honey Comb Appearance

FIBROTIK PLEURA/SCHWARTE
TUMOR PARU
TUMOR PARU
TUMOR PARU
 Routine for Interpretation
• Develop a systematic approach and use it
consistently
1. Check label- name,date,time
2. Establish whether the film is PA or AP and Erect or
supine
3. Establish is patient is positioned correctly
4. Note if exposure (penetration ) and expansion of the
film is correct
5. Tubes and Lines
6. Heart and great vessels
7. Soft tissue/ bones
8. Lung tissue
 Different Views
• Anterior – Posterior (AP)
• Posterior – Anterior (PA)
• Lateral / Supine /Erect
• For patients who cannot get out of bed, a
portable chest x ray may be taken
Orientation
 Anterior/Posterior (AP)
• Most common x-ray in critical care setting
• AP-the x-rays penetrate through the front of the
patient on to the film
• Quality inferior to departmental film
• Anterior ribs are further away from the film,
making them look wider than P/A
• The heart will look bigger
• Scapulae sit over the lung fields
 Posterior / Anterior (PA)
• Taken in department
• PA- the x-rays penetrate through the back
of the patient on to the film
• Scapulae will not be overlaying the lung
fields
• Heart size can be assessed more easily
• Ribs at the back all lead into the spine
 Position
 Check label- name,date,time
 Establish whether the film is PA or
• Check that the film is AP and Erect or supine
centered  Establish is patient is
positioned correctly
• Gap between sternal  Note if exposure (penetration )
and expansion of the film is
ends of the clavicle correct
should be squarely over  Tubes and Lines
the vertebral column  Heart and great vessels
 Soft tissue/ bones
• Distortion effects will  Lung tissue
result
 Exposure
• When x-rays come into  Check label- name,date,time
 Establish whether the film is PA or
contact with photographic AP and Erect or supine
film chemical reaction  Establish is patient is positioned
occurs correctly
• Over exposure will  Note if exposure (penetration )
and expansion of the film is
darken film correct
• Under exposure will  Tubes and Lines
cause light film  Heart and great vessels
 Soft tissue/ bones
• Overexposure is  Lung tissue
necessary in some
instances
 Heart and Great Vessels
 Check label- name,date,time
• Size  Establish whether the film is PA or
• Shape AP and Erect or supine
 Establish is patient is positioned
• Silhouette correctly
 Note if exposure (penetration )
and expansion of the film is
correct
 Tubes and Lines
 Heart and great vessels
 Soft tissue/ bones
 Lung tissue
 Soft Tissue and Bones
 Check label- name,date,time
• Scapulae  Establish whether the film is PA or
• Clavicles AP and Erect or supine
 Establish is patient is positioned
• Humeri and shoulder correctly
 Note if exposure (penetration )
joint and expansion of the film is
correct
• Ribs  Tubes and Lines
 Heart and great vessels
• Spine  Soft tissue/ bones

• Breast  Lung tissue

• Chest wall
 Lung Fields
•  Check label- name,date,time
Trachea and carina
 Establish whether the film is PA or
• Right and left lung AP and Erect or supine
 Establish is patient is positioned
• Hilum correctly
• Apex  Note if exposure (penetration )
and expansion of the film is
• Lateral aspects correct
 Tubes and Lines
• Diaphragm  Heart and great vessels
• Air bronchogram sign  Soft tissue/ bones
 Lung tissue
• Kerley’s lines
 Trachea
• Usually visible as a a midline band of
lesser film density
• Note if midline or deviated
• Note if ant distortion or narrowing
• Trachea bifurcates at about level T5
(carina)
 Pulmonary Abnormalities
• Pulmonary oedema
• Pneumonia
• ARDS
• Aspiration
• Atelectasis
• Pleural effusion
• Chest trauma
 Pulmonary Oedema
• Bat wing distribution of H2O
• Pulmonary venous congestion
• Widespread alveolar shadowing
• Alveolar oedema
• Cardiomegaly and pleural effusion
 Pneumonia
• Hard to differentiate
• Lung opacification
• Air bronchograms
• Lobar consolidation
 .
•
.
 ARDS
• Usually diagnosed on clinical picture
• Wide range of findings
• Radiological signs seen between 24-36 hrs
after insult
• Classic findings
- Air bronchograms
- Increased lung opacification
-Enlargement of right ventricle and main
pulmonary arteries
 Atelectasis / Collapse
• Collapse refers to a lobe or entire lung
• Atelectasis affects smaller unit of the
lung
• Signs include
1. Shadow of collapse
2. Elevation of the hemidiaphragm
3. Displacement of other structures
 Pleural Effusion

• Blunted costophrenic angle

• Fluid level
• May be loculated
Pleural Effusion