pemeriksaan radiologi thorax

Raymond Adiwicaksana

Chest X-Ray CT-scan USG

Foto PA Foto AP Foto lateral kiri Posisi lain

◦ Top lordotic◦ Recumbency◦ Oblique◦ Lateral decubitus◦ Expirasi maksimal

• Faktor kondisi– Kondisi pulmo– Kondisi costae

• Faktor inspirasi cukup– Cukupo– Kurang

• Posisi sesuai– Errect– supine

• Simetris

1. pulmo 2. hilum 3.jantung 4.mediastinum 5. diafragma 6. sudut costofrenik 7. trakea 8. tulang 9.jaringan lunak 10. area dibawah diafragma

Untuk mengukur jantung Mendeteksi pembesaran jantung CTR adalah perbandingan diameter

transversal jantung dengan diameter transversal rongga thorax

Ratio normal◦ 50%, untuk asia 55%◦ 60% pada neonatus

Kelemahan◦ Tidak bisa dipakai pada orang dengan letak

jantung mendatar atau vertikal◦ Orang dengan pericardium penuh lemak

Rumus◦ CTR = (a+b)/(c1+c2)

A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is a painless, noninvasive test. It creates precise pictures of the structures in your chest, such as your lungs. "Noninvasive" means that no surgery is done and no instruments are inserted into your body.

Lung imaging test Computed axial tomography (CAT) scan Helical CT scan (another name for spiral CT

scan)

The chest CT scan can: Provide more detailed pictures of your lungs

and other chest structures than a standard chest x ray

Find the exact location of a tumor or other problem

Show something that isn't visible on a chest x ray

Indikasi◦ Emboli paru◦ Emfisema◦ Hipertensi pulmonal◦ Ca paru◦ Sesak nafas dan sakit dada yang tidak diketahui

sebabnya Pemeriksaan ini tidak spesifik Kontraindikasi

Hipoksia berat dan kelainan jantung bawaan

Isotop99m Tc makrokoloid sebesar 2mCi intravena, memancarkan sinar gamma dengan energi 140keV

Tidak perlu persiapan Pemeriksaan

◦Siapkan preparat radiofarmaka◦Suntikkan perlahan sementara penderita ispirasi beberapa kali dalam posisi tidur terlentang◦Scanning paru dengan kamera gamma pada empat posisi depan, belakang, sisi kanan, dan kiri

Interpretasi◦ Myocardial perfusion imaging (MPI) offers a

method of visualizing blood flow to the heart by injection of a radioactive cardiac-specific tracer, ie, a cardiac imaging isotope. This improves the diagnostic accuracy of a cardiovascular stress test

◦ MPI offers the additional advantage of estimating left ventricular function.

Find the cause of unexplained chest pain or chest pain brought on by exercise.

Check for the location and amount of damage caused by a heart attack.

Identify coronary artery disease (CAD). Check to see that the heart is getting

enough blood after heart surgery or angioplasty.

Identify a congenital heart defect

1.Calcium-score screening heart scan2.Coronary CT angiography (CTA)3.Total body CT scan

Reasons for the procedure A chest ultrasound may used to assess

◦ the presence of excess fluid in the pleural space or other areas of the chest, especially when the amount of fluid is small.

◦ useful to determine the type of fluid, exudate (seen in inflammatory, cancerous, or infectious conditions) or transudate (fluid that has leaked from blood or lymph vessels for various reasons).

◦ It can also be used to evaluate the heart and its valves. When used for this purpose, the procedure is called an echocardiogram.

Chest ultrasound may be performed to guide a needle during thoracentesis (puncture of the chest wall for the removal of fluids) or biopsy.

to assess the movement of the diaphragm.

- john hopkins hospital -

absence of radiation, better portability, real-time imaging, the ability to perform dynamic imaging.

Ultrasound examination of the pleura is more sensitive than a plain chest radiograph at detecting the presence of pleural fluid and differentiating pleural fluid from lung consolidation. Compared with computed tomography (CT), pleural ultrasound has a 95 percent sensitivity for detection of pleural disease in patients with a “white out” on plain chest radiograph, but is slightly less sensitive in detecting small amounts of fluid

— Thoracic ultrasound is an operator dependent technology.

Ultrasound is not as good as CT imaging for evaluation of the underlying lung parenchyma in the setting of complex pleural and lung parenchymal disease. Ultrasound guidance is not as good as guidance by CT imaging for complicated interventional procedures, such as empyema drainage with a pigtail catheter or biopsy of pleural masses.

Bedside detection of pleural fluid when the plain chest radiograph shows a “white out”

Bedside detection of a pneumothorax Guidance for diagnostic and therapeutic

thoracentesis Guidance for placement of thoracostomy

tubes

There are many clinical indications for TUS but the most common is pleural effusion assessment.

TUS can diagnose inoperable pleural metastases,

allow safe day case pleural intervention, exclude significant pleural pathology not visible on CXR, triage further investigation.

- British Medical journal-