interpretasi rontgen dada atau foto thoraks
TRANSCRIPT
INTERPRESTASIRONTGENDADAEriYanuarAkhmadB.S.,S.Kep.,Ns.,M.N.Sc(I.C)
GambaranRontgenDada
TujuanPembelajaran
• LimaOpasiti Radiografi• AspekTeknisRontgenDada• Interprestasi RontgenDada
Lima Opasiti Radiografi
Aspek Teknis
TheNormalCXR
StandardCXRbiasadiambil:• PA– minimalmagnificationoftheheart
• Patientstanding• Fullinspiration
01Inillpatients,theCXRisusuallytaken:• AP– magnifiescardiacshadow• Oftensupine– diaphragmshigher,lungvolumeslower,pathologyoftenobscured
02
KualitasFilm
PAorAPview.
Upright/ErectorSupine
Breath:InspirationorExpiration
X-raypenetration:Under- orOver-
Rotation
PA
AP
Effectofprojectiononapparentheartsize
X-raytube
PA
AP
Effectofprojectiononapparentheartsize
X-raytube
PAvsAP
PAview• Scapulaisseeninperipheryofthorax
• Claviclesprojectoverlungfields• Posteriorribsaredistinct• Positionofmarkers
APview• Scapulaeareoverlungfields• Claviclesareabovetheapexoflungfields
• Anteriorribsaredistinct• Positionofmarkers
Inspirationvs Expiration
Inspiration- 500mlsairinpleuralspace,2500mlsinlung=17%pneumothorax
Expiration- 500mlsairinpleuralspace,1500mlsinlung=25%pneumothorax• Pleurallinedisplacedfurtherinferiorly
ExpiratoryCXR
• Makesapneumothoraxappearrelatively largerthanonaninspiratoryfilm
• PTxmayonly visibleonexpirationfilm• Whenyouseetheword‘expiration’onaCXRyouarealmostcertainlylookingforapneumothorax(especiallyinanexam!)
• Expiratoryfilmisalsousefulinkidswhenlookingforairtrappingduetoanobstructingforeignbody– lungonobstructedsideremainsexpanded
PenetrationWithcorrectexposureyoushouldbarelyseethe
intervertebral discthroughtheheart
• Ifyouseethemveryclearlythefilmisoverpenetrated
• Ifyoudonotseethemitisunderpenetrated
Penetration
Rotation
NotCentered
PitfallstoChestX-rayInterpretation
• Poorinspiration• Overorunderpenetration• Rotation• Forgettingthepathofthex-raybeam
NormalCXRAnatomy
NormalPACXR
AssessingforRotation
Spinousprocessshouldbeequidistantfrommedialendsofbothclavicles
Trachea
Leftmainbronchus
Rightmainbronchus
CarinalAngle(40-75degrees)
Rightpulmonaryartery
Leftpulmonaryartery
AorticArch
DescendingAorta
AortopulmonaryWindow
RightHeartBorder=Rightatrium
LeftHeartBorder=LeftVentricle
LeftAtrium
CardiothoracicRatio(<50%)
AnteriorRibs- fullinspiration
1
2
3
4
5
6
Gastricairbubble
STEPINTERPRESTASIRONTGENDADA
• Details• RIPEImage(Aspek Teknis)
• Rotation– medialclavicleendsequidistantfromspinousprocess
• Inspiration– 5-6anteriorribsinMCLor8-10posteriorribsabovediaphragm,poorinspiration?,hyperexpanded?
• Picture– straightvsoblique,entirelungfields,scapulaeoutsidelungfields,angulation(ie ’tilt’inverticalplane)
• Exposure(Penetration)– IVdiscspaces,spinousprocessesto~T4,L)hemidiaphragm visiblethroughcardiacshadow.
• SoftTissuesandBones• Ribs,sternum,spine,clavicles– symmetry,fractures,dislocations,lyticlesions,density
• Softtissues– lookingforsymmetry,swelling,lossoftissueplanes,subcutaneousair,masses
• Breastshadows• Calcification– greatvessels,carotids
• Airwaydan Mediastinum• Trachea– centralorslightlytorightlungascrossesaorticarch
• Paratracheal/mediastinalmassesoradenopathy• Carina&RMB/LMB• Mediastinalwidth<8cmonPAfilm• Aorticknob• Hilum– T6-7IVdisclevel,lefthilumisusuallyhigher(2cm)andsquarerthantheV-shapedrighthilum.
• Checkvessels,calcification.
• Breathing• Lungfields• Pleura
• Circulationsystem• Heartposition• Aorticstripe
• Diaphragm• Hemidiaphragm levels– RightLunghigherthanLeftLung(~2.5cm/1intercostalspace)
• Diaphragmshape/contour• Cardiophrenic andcostophrenic angles– clearandsharpGastricbubble/colonicair
• Subdiaphragmatic air(pneumoperitoneum)
• Extras• ETT,CVPline,NGtube,PAcatheters,ECGelectrodes,PICCline,chesttube
• PPM,AIDC,metalwork
D- Details
Patientname,age/DOB,sex
Typeoffilm– PAorAP,erectorsupine,correctL/Rmarker,inspiratory/expiratoryseries
Dateandtimeofstudy
RIPEImages
Rotation– medialclavicleendsequidistantfromspinousprocess
Inspiration– 5-6anteriorribsinMCLor8-10posteriorribsabovediaphragm,poorinspiration?,hyperexpanded?
Picture– straightvsoblique,entirelungfields,scapulaeoutsidelungfields,angulation(ie ’tilt’inverticalplane)
Exposure(Penetration)– IVdiscspaces,spinousprocessesto~T4,L)hemidiaphragmvisiblethroughcardiacshadow.
AssessingforRotation
Spinousprocessshouldbeequidistantfrommedialendsofbothclavicles
AnteriorRibs- fullinspiration
1
2
3
4
5
6
S– Softtissuesandbones
Ribs,sternum,spine,clavicles–symmetry,fractures,dislocations,lyticlesions,density
Softtissues– lookingforsymmetry,swelling,lossoftissueplanes,subcutaneousair,masses
Breastshadows
Calcification– greatvessels,carotids
A– Airway&mediastinum
Trachea– centralorslightlytorightlungascrossesaorticarch
Paratracheal/mediastinalmassesoradenopathy
Carina&RMB/LMB
Mediastinalwidth<8cmonPAfilm
Aorticknob
Hilum– T6-7IVdisclevel,lefthilumisusuallyhigher(2cm)andsquarerthantheV-shapedrighthilum.
Checkvessels,calcification.
Trachea
Leftmainbronchus
Rightmainbronchus
CarinalAngle(40-75degrees)
LeftmastectomyBewareofremainingnipplemimickinganodule!
B– Breathing
• Lungfields• Vascularity– to~2cmofpleuralsurface(~3cminapices),vesselsinbases>apices
• Pneumothorax– don’tforgetapices• Lungfieldoutlines– abnormalopacity/lucency,atelectasis,collapse,consolidation,bullae
• HorizontalfissureonRightLung• Pulmonaryinfiltrates– interstitialvsalveolarpattern
• Coinlesions• Cavitary lesions
B– Breathing
• Pleura• Pleuralreflections• Pleuralthickening
Anatomy
Lobes• Right upper lobe:
• Right middle lobe:
• Right lower lobe:
• Left lower lobe:
• Left upper lobe with Lingula:
Lingula:
Leftupperlobe- upperdivision:
Pulmonaryoedema- cardiomegaly
NormalCTR
Tensionpneumothorax
LULcollapse-tracheadisplacedtoleftlefthilumelevatedlefthemidiaphragmelevated
C–Circulation
Heartposition–⅔toleft,⅓toright
Heartsize– measurecardiothoracicratioonPAfilm(normal<0.5)
Heartborders– R)borderisR)atrium,L)borderisL)ventricle&atrium
Heartshape
Aorticstripe
CardiothoracicRatio(<50%)
RightHeartBorder=Rightatrium
LeftHeartBorder=LeftVentricle
LeftAtrium
AorticArch
DescendingAorta
AortopulmonaryWindow
Leftatrialenlargementinmitralstenosis-doublerightheartborder,splayedcarina
Sternotomywiresandaorticvalvereplacement
D–Diaphragm
Hemidiaphragmlevels– RightLunghigherthanLeftLung(~2.5cm/1intercostalspace)
Diaphragmshape/contour
Cardiophrenicandcostophrenicangles–clearandsharp
Gastricbubble/colonicair
Subdiaphragmaticair(pneumoperitoneum)
DiaphragmaMale
??
E– Extras
ETT,CVPline,NGtube,PAcatheters,ECG
electrodes,PICCline,chesttube
PPM,AIDC,metalwork
PosisiNGTnormal
TERIMAKASIH