PROCEDURE FOR EXAMINATION OF RADIOLOGY

THORAX CASES OF METASTASES LUNGS

CANCER IN INSTALLATION GENERAL HOSPITAL
REGIONAL RADIODIAGNOSTIC
DR. MOEWARDI SOLO

Scientific Paper Proposal

Compiled As a requirement for
Fulfilling Duty Scientific Writing Course

NAME : SHONIA GHINA ZAHARA

NIM : P1337430219137

Credit to Vidya Ristu Pujiastari

PROGRAM STUDI DIPLOMA IV TEKNIK RADIOLOGI

POLTEKKES KEMENKES SEMARANG
2020
 Abstract
Background: The thoracic cavity is bounded by the walls of thorax. One
of the diseases that occur in the thoracic cavity is metastases lungs cancer.
To fulfil the needs of enforcement, diagnose then performed through
complementary Radiology examination. Installation Radiodiagnostic Hospital
dr. Moewardi also have the same inspection procedures for radiological
examination of the thorax, but the standard of the hospital about positioning
of thorax examination is postero-anterior. The objective of this study is to find
out the reason why in the Installation Radiodiagnostic Hospital dr. Moewardi
using postero-anterior projection standard for radiological examination of the
thorax.
Material and Methods: This type of research is used in the preparation
of this Proposal Scientific Writing is descriptive qualitative research with case
study approach. The subjects were three technologists, a person
Radiological, one patient and one doctor sender. While the object is Thorax
examination procedure in cases of metastases lungs cancer in
Radiodiagnostic Installation Hospital Dr. Moewardi Solo will take in 16
September 2013 until 26 October 2013. Data’s will collect by observations of
the patients, interviewing the radiographer and radiologist, and
documentations of patient data from medical record.
Analysis Data: Analysis of the data used in the writing of this scientific
writing is descriptive analysis, observations and interviews made in the form
of the transcript, wholly selection of data to determine the categories and
based on objective research. After data reduction, coding is done to facilitate
the grouping of data in the information making it easy to analyze and
improve the validation of the data collected. After coding, the authors
conducted a technical assessment of the data with a quotation. Through the
discussion of the results of the research, the data are linked and compared
with the criteria and categories of existing.

Keyword: Thorax, Metastases Lungs Cancer.

 CHAPTER I
INTRODUCTION

1.1 Background of The Study

Thorax cavity is a cavity that is bounded by a wall of the thorax and
extends from the superior thoracic down to the inferior thoracic. The lower
part of the thorax cavity bounded by the diaphragm. In the thoracic cavity are
the lungss, heart, esophagus, and the thymus gland. In the thoracic cavity
there are three separate spaces, namely the pericardial cavity and the left
and right pleural cavity. The second space between the pleural cavity is
called by the name of mediastinum (Merrill’s, 2012).
Many pathologies that occur in the thorax, one of which is lungs cancer.
Lungs cancer is a primary malignant lungs tumor originating from the airway
or bronchial epithelium. The occurrence of cancer is characterized by cell
growth that is not normal, not limited, and damage normal tissue cells. To
diagnose lungs cancer in the thorax can be done using radiological
examination.
Radiodiagnostic Installation dr. Moewardi have the same inspection
procedures for radiological examination of the thorax, but the standard of the
hospital about positioning of thorax examination is postero-anterior, the
authors finally decided to lift the case into a Scientific Paper entitled
"Procedure for Examination of Radiology Thorax Cases of Metastases Lungs
Cancer in Installation General Hospital Regional Radiodiagnostic Dr.
Moewardi Solo".

1.2 The Problems of the Study

Why does postero-anterior projection thoracic examinations with maximum
inspiration and maximal expiration with cases of metastasesi lungs cancer in
Radiology Installation dr. Moewardi’s Hospital?

1.3 The Objective of the Study

In the thorax examination with cases of metastases lungs cancer and
suspicious weakness of the diaphragmatic nevrus, using postero-anterior
projection with maximum expiration and maximum inspiration such as
postero maximal air in the cavity at the peak becomes larger. In addition it is
higher than the density between the lungs and intrapleura air making it
easier to see pneumothorax, including the density of lungs tissue for
expansion but not increasing the density of the pneumothorax. Help
diagnose, the cause of the lungss is then relatively higher or denser than the
pneumothorax.

1.4 Benefits of The Study

1.4.1 For Institutions
Adding a standard reference on the examination of the thorax in
postero-anterior position in Radiodiagnostic Installation of dr. Moewardi
Solo’s Hospital.
1.4.2 For Readers
The research result can provide information about examination
standards thorax postero-anterior position in Radiodiagnostic
Installation of dr. Moewardi Solo’s Hospital.
1.4.3 For Writers
To add insight and experience of conducting research relating to
examination standards thorax postero-anterior position in
Radiodiagnostic Installation of dr. Moewardi Solo.
 CHAPTER II
LITERATURE REVIEW

Thorak or chest is an area of the body that lies between the neck and abdomen.
In front of and behind the thorak is flat and on the side is curved. Radiographic
anatomy of the thorax is divided into three, namely the chest frame, respiratory
system and mediastinum (Bontrager, 2001).
a. The chest frame is part of the skeletal system which protects respiratory
organs and blood circulation. The front of the chest frame is the sternum,
which consists of manubrium, body of sternum and xiphoid process. The
upper part of the chest frame consists of two clavicle that connect the
sternum with the two scapulas. Twelve pairs of ribs encircle the thorax and
twelve thoracic vertebrae in the back (Bontrager, 2001)
b. The respiratory system consists of body organs through which air enters
through the nose to the lungss. The respiratory system consists of pharynx,
larynx, trachea, bronchi, and lungss.
c. Trachea: Tubular fibrous muscular tube with a diameter of 2 cm and a length
of 11 cm. Composed of about 20 cartilage rings. Located as high as 6
cervical vertebrae to thoracic vertebrae 4-5. Some glands located around the
trachea are the thyroid gland, the parathyroid gland and the thymus gland
(Bontrager, 2001).
d. Bronchuspulmonary: Trachea splits into two main bronchi, these bronchus
branch off again before entering the lungss. In its journey exploring the
bronchhus-brocchus pulmonary lungss branching and a lot (Pearce, 2001).
The two brochus is the right bronchus and left bronchus.
Right Bronchus: Its size is bigger and shorter than the left bronchus. It is 2.5
cm long and 1.3 cm in diameter has an angle of 25⁰.
Left Bronchus: The diameter is smaller than the right bronchus but is longer.
The left bronchus is 5 mm long and 1.1 cm in diameter forming an angle of
37⁰. Carina is a branching bronchi, the bottom of the trachea before entering
the right and left bronchus. Its location is as high as thoracic vertebra 5,
commonly used for placement of ROI (region of interest) on CT scan of the
thorax (Bontrager, 2001).
e. Lungs organs are composed of parenchyma cells, like a sponge that is
lightweight and very elastic so that it allows the occurrence of respiratory
mechanisms (Bontrager, 2001).The function of the lungss is the exchange of
oxygen and carbon dioxide gas. In breathing through the lungss or external
breathing, oxygen is inhaled through the nose and mouth, when breathing,
oxygen enters through the trachea and bronchial tubes into the alveoli and
binds with blood in the pulmonary capillaries (Pearce, 2001).
1) Lungs lobe
Right lungss have three lobes namely the superior, middle and inferior lobes.
The three lobes are separated by two fissures. The left lungs consists of two
lobes namely the superior lobe (upper) and the inferior lobe (lower) both
separated by oblique fissures (Bontrager, 2001).
2) Pleura
The lungss are protected by a membrane called the pleura. The pleura
attached to the thorax and diaphragm wall is called the Pleural Parietalis. The
pleura attached to the lungss is called the pulmonary pleura or visceral
pleura. The cavity between the two pleura is called pleural cavity or pleural
cavity (Bontrager, 2001).
3) Hilum of the lungss.
Lungs lungs is formed by the following structure:
a) Pulmonary arteries, which drain blood without oxygen into the lungss to be
filled with oxygen,
b) Pulmonary veins which supply oxygenated blood from the lungss to the
heart.
c) Branched bronchus and branches to form bronchial trees are the main
airways.
d) Bronchial arteries come out of the aorta and drain blood into the lungs
tissue.
e) Bronchial veins drain some blood from the lungss to the superior vena
cava, and lymph vessels. The innervation of the lungss originates from the
vagus nerve and the sympathetic nerve (Pearce, 2001).
4) Mediastinum is the space in the middle of the chest cavity between the two
lungss. Important organs located in the mediastinum are the thymus gland,
heart and large blood vessels, esophagus and trachea (Bontrager, 2001).
 CHAPTER III
RESEARCH METHODOLOGY

3.1 The Kind of Research

This type of research is used in the preparation of this Proposal Scientific
Writing is descriptive qualitative research with case study approach.
3.2 Location and Time Data Collection
3.2.1 Location data collection writing Scientific Writing this is at
Radiodiagnostic Installation of dr. Moewardi Solo’s Hospital.
3.2.2 The time of data collection by the author that in 16 September 2013
until 26 Oktober 2013.
3.3 Subject and Object of Research
The subjects were three technologists, a Radiologist, one patient and one
doctor sender. While the object is Thorax examination procedure in cases of
metastases lungs cancer in Radiodiagnostic Installation of dr. Moewardi Solo’s
Hospital.
3.4 Data Collection
3.4.1 Observation
Thorax Radiography Techniques
1.a.Preparing Tool:
 X-ray equipment
 Cassette and film according to size, Usually using a size of
35x35
 Marker R / L
 Patient clothing
 Processing equipment
 Camera ID.
b. Patient Preparation
Thorax Examination there is no special preparation to provide
understanding to patients about the implementation that will be done,
so patients know what actions will be taken during the examination.
2. Radiography Techniques
    Anterior Posterior (PA)
Patient Position:
Stand or erect on the bucky stand or examination table.
Object Position:
 The chest is attached to the cassette.
 The chin is tilted in the middle of the cassette.
 MSP body in the middle of the cassette.
 The top edge of the cassette is ± 3-4 cm above the shoulder.
 Both the dorsum of the maximal endorotation, are placed on the
crista illiaca, the elbows are pushed until they are attached to the
cassette.
Beam Position:
 CR: perpendicular to the tape horizontally.
 CP: as high as Thoracal VII (in the inferior angle of the scapula).
 Exposure: second inspiration and hold your breath.
3.4.2 Interview
Radiographer: Good morning, Mrs. Siti. My name is Shonia, a
radiographer in this hospital. Before the examination let me check your
identity first. What’s your name?
Patient: My name is Siti Khadijah.
Radiographer: How old are you?
Patient: I’m 30 years old.
Radiographer: Where do you live?
Patient: I live in Tirto Agung Street, Pedalangan, Banyumanik,
Semarang.
Radiographer: Can I help you, Mrs?
Patient: My chest hurts.
Radiographer: Well, before the examination, please take off your brass
holder and your necklace.
Patient: I have done it.
Radiographer: Would you slip off your top things, please?
Patient: Yes, I would.
Radiographer: Please stand here and stick your chest over here. Put
your hands above your waist. Make your self comfortable. If you’re not
comfortable, please tell me.
Patient: I already feel comfortable.
Radiographer: After this, I will come out for a while, and you listen on
cue from me. Please hold back the movement.
Patient: Yes.
Radiographer: Inhale… exhale… inhale… hold! The inspection is over.
Please get dressed. Take your time, we are not in a hurry.
Patient: Yes miss, thank you.
Radiographer: Your welcome. Get well soon, Mrs.
Patient: Thank you.

3.4.3 Documentation
Doctor's Reading Results:
Examination of thorak PA:
• Clinical:Cancer metastases in the lungs and suspicion of
diaphragmatic nerve weakness
• COR: Normal shape and size
• Pulmo: Ultiple nodules of varying size in both lungs fields appear
• Sharp right and left costophrenic sinuses
• Normal right and left hemidiaphragma
• Trachea in the middle
• Good bone system
Conclusion:
Some nodules with varying sizes in both lungs fields can be a
pulmonum metastase process (a type of coarse nodule).
3.5 Processing and Analysis of Data
Analysis of the data used in the writing of this scientific writing is
descriptive analysis, observations and interviews made in the form of the
transcript, wholly selection of data to determine the categories and based on
objective research. After data reduction, coding is done to facilitate the
grouping of data in the information making it easy to analyze and improve the
validation of the data collected. After coding, the authors conducted a
technical assessment of the data with a quotation. Through the discussion of
the results of the research, the data are linked and compared with the criteria
and categories of existing.