CHEST XRAYS

TAMSIL SYAFIUDDIN
DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE
FAKULTAS KEDOKTERAN UISU
MEDAN 2013
TAMSIL SYAFIUDDIN
DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE
FAKULTAS KEDOKTERAN UISU
MEDAN 2013
CURRICULUM VITAE
N a m a : Prof.Dr.TAMSIL SYAFIUDDIN Sp.P (K)
Alamat : Jln.Karsa No F 1 Kompleks Eks KOWILHAN I
Sei.Agul Medan 20117
Jabatan : Guru Besar Tetap FK- UISU / Luar Biasa FK- USU
Penasehat Perhimpunan Dokter Paru Indonesia Pusat
Ketua Perhimpunan Dokter Paru Indonesia Cabang Sumut
Dewan Pembina Yayasan Asma Indonesia Wilayah Sumut
Ketua Departemen Pulmonologi dan Kedokteran Respirasi FK-UISU
Anggota Dewan Asma Nasional
Anggota Kolegium Perhimpunan Dokter Paru Indonesia Pusat
Anggota Pokja Asma Perhimpunan Dokter Paru Indonesia Pusat
Anggota Pokja PPOK Perhimpunan Dokter Paru Indonesia Pusat
Anggota Tim Akreditasi Pendidikan Spesialis Paru Nasional

Riwayat Pendidikan:
-Dokter Umum, FK-USU Medan,1979
-Dokter Spesialis I Paru, FK-UI Jakarta, 1990
-Dokter Spesialis II Paru, Konsultan Asma/PPOK, 1995

Pendidikan tambahan:
- Pelatihan Kanker Paru, TSUKAGUCHI Hospital, Kobe- Japan 1989
- Pelatihan PPOK, AMAGASAKI Hospital, Kobe- Japan 1990
- Pelatihan Respiratory Physiologi, JAPAN RESPIRATORY PHYSIOLOGIST
CLUB, Kyoto- Japan 1990
- Spirometry Training Course, Department of Respiratory Medicine,
National University Hospital Singapore, Singapore 1997

- Workshop of Bronchoscopy and Autofluorecent Bronchoscopy, RS Persahabatan
Jakarta, Jakarta September 2005

-Training of the new interventional technique of bronchosfiberscopy(Optical Coherence
Tommograhy) , Department of Thoracic Surgery, Tokyo Medical University Hospital,
Tokyo - Japan 2007
- Workshop of the new technique of bronchoscopy, Postgradute Medical Institute,
Singapore General Hospital, Singapore 2008
- Respiratory Masterclass Asthma and COPD, Singapore 2011
- Workshop on Medical Thoracoscopy, The American College of Chest Physicians-The
Indonesian Association of Pulmonologist, RS Persahabatan Jakarta, Jakarta November
1997

- Workshop on Reformation of Higer Education System,HEDS-JICA, Jakarta 1998

- Pulmonary Infections Course, Postgraduate Medical Institute, Singapore General Hospital,
Singapore 2001

- Bronchoscopy &Thoracoscopy Workshop, Postgraduate Medical Institute, Singapore
General Hospital, Singapore 2005
- Workshop on Transbronchial Lung Biopsy and Trasbronchial Needle Aspiration PDPI
Cabang Jakarta, RS Persahabatan Jakarta ,Jakarta 1997
- Workshop on Respiratory Physiology and Its Clinical Application, RS Pusat Angkatan
Darat Gatot Subroto Jakarta, Jakarta Juni 1997
CHEST XRAYS
TAMSIL SYAFIUDDIN
DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE
FAKULTAS KEDOKTERAN UISU
MEDAN 2013
TAMSIL SYAFIUDDIN
DEPARTMENT OF PULMONARY AND RESPIRATORY MEDICINE
FAKULTAS KEDOKTERAN UISU
MEDAN 2013
Contents:
Densities
Techniques
Anatomy
CXR Interpretation
Common Pathologies
Questions
Densities
The big two densities are:

(1) WHITE - Bone
(2) BLACK - Air

The others are:

(3) DARK GREY- Fat
(4) GREY- Soft tissue/water

And if anything Man-made is on the film, it is:

(5) BRIGHT WHITE - Man-made
Techniques - Projection
P-A (relation of x-ray beam to patient)
Techniques - Projection (continued)
A-P Supine/Erect
Technical quality
Projection: defined by the direction of the x-ray beam in relation to
the pt.

Portable (AP or Antero-posterior)
PA (Postero-anterior)
Technical quality
PA AP
Techniques - Projection (continued)
Lateral
Techniques - Projection (continued)
Lateral Decubitus
Techniques - Projection (continued)
Oblique
Orientation
Orientation
Rotation
Rotation (continued)
Penetration
Penetration
Inspiration/Expiration
Anatomy
Anatomy
Anatomy
Lobes
Right upper lobe:
Lobes (continued)
Right middle lobe:
Lobes (continued)
Left lower lobe:
Heart
1. Right border: Edge of (r) Atrium

2. Left border: (l) Left Ventricle + Left Atrium

3. Posterior border: Left Ventricle

4. Anterior border: Right Ventricle
Heart (continued)
Cardiac Silhouette
1. R Atrium
2. R Ventricle
3. Apex of L Ventricle
4. Superior Vena Cava
5. Inferior Vena Cava
6. Tricuspid Valve
7. Pulmonary Valve
8. Pulmonary Trunk
9. R PA 10. L PA
Heart (continued)
Mediastinum
Hilum
Made of:

1. Pulmonary Art.+Veins
2. The Bronchi

Left Hilus higher (max 1-2,5 cm)

Identical: size, shape, density
Hilum
Ribs
Heart
Size:
Heart
Size of heart

Size of individual
chambers of heart

Size of pulmonary
vessels

Evidence of stents, clips,
wires and valves

Outline of aorta and IVC
and SVC
Pathology
RUL pneumonia
RML pneumonia
RLL pneumonia
LUL pneumonia
LLL pneumonia
Consolidation on CT
The Enlarged Hila
Causes:

1. Adenopathies (neoplasia, infection)

2. Primary Tumor

3. Vascular

4. Sarcoidosis
Hilar m l
Hilar Lymphadenopathy - BL
Multiple Masses
Pleural Effusion
RUL collapse
LLL collapse
Pulmonary Fibrosis
?
Pneumothorax
TENSION PNEUMOTHORAX
Emphysema
Air under the diaphragm
Hiatus hernia
Miliary shadowing
Chest Tube, NG Tube, Pulm. artery cath
Dextrocardia
TUBERCULOSIS (CHEST)
TUBERCULOSIS (CHEST)
TUBERCULOSIS (CHEST)
LUNG ABCESS
GANGLIONNEUROBLASTOMA
THYMOMA
FIBROMATOSIS
RHEUMATOID LUNG
BRONCHIOLITIS OBLITERANS
ORGANIZING PNEUMONIA
PLEURAL EFFUSION
SARCOIDOSIS
FIBROMATOSIS
TERATOMA (MEDIASTINAL)
BRONCHOGENIC CYST
CAPLAN SYNDROME
PULMONARY OEDEMA (CARDIOGENIC)
Heart failure
PULMONARY OEDEMA (NONCARDIOGENIC)
PNEUMOCYSTIS PNEUMONIA
PULMONARY EMBOLISM
PULMONARY EMBOLISM (ANGIOGRAPHY)
PULMONARY METASTASES