CHAPTER I

Literature Review

1. THORACAL AND LUMBAL VERTEBRA ANATOMY

a) SPINAL ANATOMY

The vertebrae, consisting of 30 bones, are arranged one above and the other, forming a

spinal column. Each bone has a rather round hole, which when arranged according to the

correct rules forms a channel that surrounds the spinal nerve. Ligament and tendon

tissues hold the vertebrae bones in place and attach muscles to the spinal column.

b) THORACIC ANATOMY

Upper backbone has an important function in the human body including forming body

and supporting the upper body, to help movement, protection of the deep tissues of the

body. When standing the backbone helps to straighten the body and also helps the body's

movements when going extension or rotation.

c) LUMBAR ANATOMY

The lower back has an important function in the human body, given the structure,

movement and protection of body tissues. When standing, the lower back gather to
 support the upper body. When a person bends, extends, or is rotated at the waist, the

lower back helps support movement.

1. PATOFISIOLOGI VERTEBRA

a). Spina Bifida

Spina bifida is a congenital disease characterized by the spine and the membrane around

the bone marrow which is not properly closed.

2. EXAMINATION TECHNIQUES

1. Thoracolumbal AP/PA

1) Preparation of the tool :

a. X-ray Unit

b. Cassete 14x36 inch (35x90 cm) or 35x43 cm.

c. Grid

d. R/L Marker

e. Appron

2) Patient Position : Sit / Stand

3) Object Position : Adjust the MSP (Mid Sagittal Plane) of the patient's body

in the middle of the grid or bucky stand.

4) Central Ray (Ray Direction) :

a. Perpendicular to the cassette

b. Arrange the tapes with a lower limit of about 1.5 cm below the crista illiaca.

c. Arrange the cassette with the upper limit of the chin.

 d. Allow the patient's arm to hang casually next to the body. If the patient is sitting, flex

your elbows and place your hands on your lap.

e. There is no pelvic rotation.

5) Central Point ( Midpoint ) : Middle of Object (T11/T12)

6) FFD : 180-200 cm

7) Radiograph Criteria : The thoracal and lumbar vertebrae appear in the AP / PA position

2. Thoracolumbal Lateral

Tools preparation :

a. X-ray Unit

b. Cassete 14x36 inch (35x90 cm) or 35x43.

c. Grid.

d. R/L Marker

e. Appron

1) Patient Position : Stand

2) Object Position :

a. Set the mid coronal plane of the patient's body in the middle of the bucky stand (mid

axillary line)

b. Arrange the convex section to stick to the cassette

 c. Arrange the tapes with a lower limit of about 1.5 cm below the crista illiaca

d. Hands raised above the head.

3) Central Ray ( Ray direction ) : Perpendicular to the cassette

4) Central Point (Middle Point) : Middle of Object

5) FFD : 180-200 cm

6) Radiograph Criteria : Thoracal and lumbar vertebrae appear in the lateral

position.

(a) (b)

(a) Patient Position (b) Radiograph Result

3. Radiation Protection

A. Use an apron to protect a patient's body that is not

exposed to X-rays.

B. Give the patient direction so that the view is away from the source of the X-ray.

C. Arrange the collimator area as optimal as possible so that the object being examined is

in the irradiation.
 D. Invite unauthorized persons in the examination room to leave the room, if needed there

must be someone accompanying him to use the apron.

E. Avoiding repeating photos.

CHAPTER II

CASE PROFIL AND DISCUSSION

1. PROFIL

1) Patient Identity

Name: Mr. M.T.

Male gender

Age: 55 years old

RM Number: 290XXX

Inspection Date: August 12, 2019

Examination: Thoracolumbal AP / Lat

Disease History: -

Diagnosis: Low back pain

2) Patient History

On Saturday, August 12, 2019 came to the Radiology Installation of Pekalongan Palace

Hospital with a letter requesting photographs for an Thoracolumbal AP / Lat examination.

Patients present with complaints of pain in the lower waist.

2. VERTEBRA THORACOLUMBAL EXAMINATION PROCEDURE IN RADIOLOGY

INSTALLATION OF PEKALONGAN KRATON HOSPITAL

1. Preparation Patien

There is no specific preparation for the patient on thoracolumbar vertebra examination.

However, if there are metals or the like that can cause radiolucent / radio opaque (belts, coins,

cellphones, etc.) to be removed first.

2. Preparation Tools

 X ray Unit

Merk : Siemens

Type : Optitop 150/40/80hC-100

kV Maximum : 150 kV

mA Maximum : 800 mAs

Production year : 2015

 Film and Cassete size 35 cm x 43 cm

 Processing Unit : Computed Radiography

3. Thoracolumbal Examination Techniques

1. Thoracolumbal AP

1) Cassette Size: 35 cm x 43 cm

2) Position of the patient: The patient sleeps supine in the middle of the examination table

3) Object position: Center the sagittal plane mid-body to the middle of the cassette and

adjust the object. Put both hands on the side of the body. Both legs straight. Make sure

there are no pelvic / hip rotations.

 4) Central Ray (midpoint): Perpendicular to the cassette.

5) Central Point: 5cm below the Xyphideous Processus (L1 - L3), upper limit of C7 and

lower limit of L5

6) Radiograph Results

2. Thoracolumbal Lateral

1) Cassette Size: 35 cm x 43 cm

2) Position of the patient: The patient sleeps with the recumbent position in the middle of

the examination table.

3) Object position: Center the body's coronal plane to the center of the tape and adjust the

object. Put both hands on the head. Both legs are bent for fixation. Make sure there are no

pelvic / hip rotations.

4) Central Ray (midpoint): Perpendicular to the cassette.

5) Central Point (midpoint): 5cm above Crista Iliaca or (L1 - L3), upper limit of T1 and

lower limit of L5

6) Radiograph Results
 RADIATION PROTECTION

a. Radiation protection for patients

Radiation Protection Efforts for patients is to prevent the repetition of photographs, and

adjust the size of the collimation sufficiently, and adjust the exposure factor accordingly.

b. Radiation Protection For Officers

Radiation Protection Business for radiology officers is by taking cover behind a veil or being

outside the examination room when conducting an exhibition.

2. RESULT OF RADIOLOGICAL DOCTORS

a. Check Up result

Osteopenia Bone Structure

Straight Curve, Lightweight Wedge Corpus VTH12

Narrow Discus

Spur (+)

Listhesis (-)

Pedicles And Lamina Normal

Paravertebral Line Normsl.

b. Impression

Corpus V TH 1 Light Wedge.

3. DISCUSSION

In Radiology Installation of Pekalongan Palace Hospital Thoracolumbal Vertebra

Examination can be used to diagnose spinal abnormalities Low Back Pain.

 CHAPTER III

A. CONCLUSION

1. Examination of Thoracolumbal Vertebrae in Radiology Installation of Pekalongan

Palace Hospital using AP and Lateral projections. The AP projection is performed in the

Supine patient's position with the patient's sagittal area at the center of the examination

table because the patient has difficulty standing and pain in the lower back. Whereas

Lateral Projection is performed with the recumbent patient position with the patient's

coronal plane at the center of the examination table.

2. Thoracolumbal Vertebra Examination in Radiology Installation of Pekalongan Palace

Hospital is used to diagnose other than Scoliosis, one of which is Wedge

B. SUGGESTION

If the patient is able to stand up, it is better to take radiographs by standing.