prinsip dasar usg
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kuliahTRANSCRIPT
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Prinsip Dasar Ultrasonografidan Teknik Pemeriksaan
Dr.H.Hasan Amin,Sp.Rad.
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Salah satu imaging Dx u/ pemeriksaan
alat-alat tubuh
- Bentuk
- Ukuran
- Gerakan
- Hubungan dengan jaringan sekitarnya
Menggunakan alat canggih gel.suara
frekuensi tinggi
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Apakah Ultrasound (US) itu?Gelombang suara dengan frekuensi
lebih dari 20.000 HzManusia bisa mendengar gelombang
suara yang berfrekuensi 20-20.000 HzUS yang dipakai untuk pemeriksaan
abdomen berkisar 3,5-5 MHz
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Bagaimana Gelombang US diproduksi?
Piezoelectric elementBila diberi arus listrik akan
menimbulkan gelombang US.Bila dikenai gelombang US
dapat menghasilkan arus listrik
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SEJARAH
Dimulai dgn penemuan efek “Piezo electric”
oleh Curie dkk (1880)
1st tehnik untuk radar
SONAR (Sound Navigation Ranging)
1939 untuk diagnosis batu empedu
Hasil kurang memuaskan
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Adakah penerapan gelombang US di luar bidang
medis?
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Produksi Citra US
Contoh pada detektor untuk ikan
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1974 Kossof dkk Gray scale
dapat menggambarkan detail struktur
tubuh
Di Indonesia awal ’80 USG
digunakan pemeriksaan organ dalam
rongga perut
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PRINSIP & CARA KERJA ALAT USG
Ultrasound Gel. Suara berfrek.tinggi (1-
10 MHz)
Dikecilkan oleh kristal-kristal yang
terdapat pada transducer efek piezo
electric
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Prinsip dasar Ultrasonografi seperti “echo”
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Transducer dirangsang o/ kristal bergetar
Suara ultra jaringan tubuh dipantulkan diterima
transducer
Impuls listrik mesin scanner
Dipergunakan dalam bentuk cahaya pada monitor
Dengan demikian bila transducer digambarkan
irisan-irisan pada bagian tubuh yang diinginkan
dilihat pada layar monitor
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Masing-masing jaringan tubuh
mempunyai “impedance acoustic”
Jaringan heterogen dan lunak hyperechoic/
echogenic
Jaringan homogen sedikit/sama sekali tidak ada
echo – Anechoic/ echofree
Misal : Kista
Ascites
Efusi pleura
Pembuluh darah
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Keuntungan pemeriksaan US
≠ kontraindikasi
Non invasif
Cepat dan aman
Nilai diagnostik cukup tinggi
Kurang/ tidak perlu persiapan khusus
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PENYULIT
Gelombang US tidak mampu menembus
bagian tertentu badan
70% gel. Suara yang mengenai tulang
dipantulkan
99% perbatasan rongga-rongga yang
mengandung gas dipantulkan
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PERSIAPAN
Tidak diperlukan persiapan khusus
Untuk pemeriksaan rongga perut bagian atas
misal Vesika felea puasa ± 6 jam
Untuk pemeriksaan kandungan dan daerah
pelvis buli-buli harus penuh
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Gambar Ultrasonografi
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Transducer / Probe
Frekuensi kecil besar
Penetrasi besar kecil
Resolusi kecil besar
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Transmisi US
Transmisi terjadi dengan baik dalam organ padat dan jaringan lunak.
Transimisi terhambat bila melalui organ berongga yang berisi udara seperti paru dan gastrointestinal
Tulang/metal tidak dapat mentransmisikan US
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Transmisi Gelombang Ultrasound
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Transmisi US
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Persiapan Penderita
PuasaBuli-buli penuhMedia kontak/ gel
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Puasa
6-8 jamMencegah kontraksi kandung empeduMencegah udara yang ikut tertelan
sewaktu makan.Tidak perlu puasa bila memeriksa:
hepar, lien, ginjal atau pada keadaan akut
Bila organ tertutup gas diulangi
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Buli-buli penuh
Khusus untuk memeriksa organ pelvis: ovarium, uterus, prostat dan buli-buli
Minum 1-2 jamMinum 1 liter Menahan kencingUntuk kehamilan Trimester III tidak
perlu
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Media Kontak/ Gel
Gel yang larut dalam airMencegah udara di antara transduser
dan permukaan kulitNama lain: Contact media/ coupling
media
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Kontrol Pernafasan
Bagian liver, lien dan ginjal yang tertutup kosta akan tampak pada waktu menarik nafas
Menahan nafas untuk mengurangi kekaburan sewaktu pengambilan gambar.
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Penyetelan skener
GAIN
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Teknik: Fanning
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Teknik: kompresi
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Midline Scan
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Teknik: Intercostal Scan (Right)
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Teknik: Longitudinal Scan
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Transverse Scan
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Teknik: subcostal
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Intercostal scan (Left)
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Oblique Scan
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Erect/Sitting Position
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Left Decubitus Position
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HEPAR Kelenjar terbesar di rongga perut sisi kanan atas
meluas kekiri melintasi linea mediana
Fossa sagitalis sinistra membagi hepar menjadi lobus dextra dan sinistra
Lobus dex.: segmen anterior et posterior
Lobus sin. Oleh lig.falciforme dibagi menjadi segmen medial et lateral
Untuk bedah hepar dibagi mjd 8 subsegmen
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HEPAR
Struktur echo hepar lebih hiperechoic dari ginjal
V. hepatica anechoic ke superior ke VCS
V. porta anechoic dinding lebih echogenic
Ukuran N lobus dextra 13 cm
Ukuran N lobus sinistra ± 10 cm
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LIEN
Organ di subphrenicus sinistra di regio
hipokondriaka kiri
Axis longitudinal sejajar costa X kiri
Ukuran normal 12 x 8 x 4 cm
Struktur echo homogen hampir sama dengan
echo struktur hepar tapi lebih halus dengan
permukaan rata
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VESIKA FELEA
Bentuk lonjong, anechoic, dinding tipis (tebal ± 3 mm)
Pemeriksaan USG pasien dipuasakan min. 6 jam
Normal:
- Aksis longitudinal 3,4 – 7,7 cm
- Aksis transversal 1,5 – 3,1 cm
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DUKTUS BILIARIS
Duktus biliaris intrahepatis : berjalan
mengikuti V.porta dan cabang-cabangnya
dengan Ø lumen normal 1,0 – 3,5 mm
Duktus biliaris extrahepatis : bangunan
tubuler, anechoic, mengikuti perjalanan VCI
Ø bagian proksimal normal 2,0-5,5 mm
Ø bagian distal normal 2,0-4,5 mm
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PANKREAS Kelenjar pencernaan & penghasil insulin terletak
retroperitoneal, melintang pada abdomen bagian atas
Panjang ± 15 cm tdd caput, corpus dan cauda
V.linealis berjalan transversal di posterior corpus pankreas
Tebal: caput 11-30 mm, corpus 4-20 mm, cauda 7-28 mm
Struktur echo homogen dengan permukaan rata, lebih hiperechoic dari hepar
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GINJAL
Letak :
Retroperitoneal posterior kanan dan kiri tulang belakang
- panjang 10-12 cm
- lebar 6 cm
- tebal 4-5 cm
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Tampak sebagai bangunan bulat panjang
dengan echo struktur :
- luar : hipoekhoik, homogen, permukaan
rata merupakan kortek
- Tengah : hiperekhoik, medula ginjal dgn
banyak vaskularisasi dan adanya sistem
pielokalices
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TEHNIK PEMERIKSAAN
Penderita tidur terlentang, miring ke kiri dan kanan
serta telungkup dengan irisan melintang dan
membujur
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TERIMA KASIH