INTERPRETASI DASAR

FOTO THORAKS

BASUKI RACHMAT
ICU Anak PJN HK Jakarta
 PURPOSES
Interpret any structures inside of thorax cavity
Interpret of bone and soft tissue of the chest
Interpret any devices in the thorax cavity
 PROJECTION VIEW
Posterior-Anterior (PA):
Standard view & most reliable technique
Erect films detect air under the diaphragm

Lateral view:
Done at the same time as the PA film
Helps localize infiltrates
For specific purposes

Anterior-posterior (AP):
Portable- patient is too ill to go to X-ray, usually patient is sitting
upright in bed
Poor quality but may be the best you can do
Remember- AP films may cause the mediastinum & heart to appear
larger than they are
Standard Radiographic
Positions
PA View
Standard Radiographic
Positions
AP View
 DENSITY
How deep of structures to absorp the x rays
Gas low density radiolucent black in
film structures with air inside airway, lung
Water more bright than gas radioopaque
white muscle, blood, vasculer
Fat more bright fat layer in the heart or
lung
Bone high density more radioopaque
vertebrae, ribs, coin, marker of any devices
 Five Radiographic Opacities

Air Fat Soft tissue Bone Metal

least opaque to most opaque

most lucent to least lucent
Black to White
RULES FOR BASIC INTERPRETATION
SYSTEMATIC READ THE LABEL ON THE
APPROACH CHEST FILM
IDENTITY ASSESS THE QUALITY OF
THE FILM
PROJECTION VIEW
CHECK THE STRUCTURES
SIDE MARKER
CONTRAST OR LOOK AT THE HEART AND
MAJOR VESSELS
BRIGHTNESS
SYMETRICALLY ASSESS THE AIRWAYS
ONE BY ONE ASSESS THE LUNG TISSUES
STRUCTURES LOOK FOR LINE & TUBE
PLACEMENT
FOTO YG BAIK
Simetris
Iga Posterior : 8-10
Iga Anterior : 6-8
Diafragma Flat
Vaskularisasi paru
terlihat
Inspirasi dalam
sudut costovertebra
~ 90
VASKULARISASI PARU
Normal CXR
Normal Thoracic Anatomy
JANTUNG
BATAS BATAS JANTUNG
BATAS BATAS JANTUNG
 CTR
(Cardio Thorasic Ratio)

M CTR =
a + b x 100%
c
a N = < 50%
b

c
Dextrocardi
SNOWMAN
Gambaran Seperti
boneka salju, VCS
besar, Segmen Po
dilatasi
Terjadi pada
peningkatan volume
jantung kanan
Contoh : Anomali total
drainase vena pulmonal
BOOT SHAPE
Gambaran seperti
sepatu boot, segmen
pulmonal lebih cekung
Terjadi karena
penurunan aliran darah
pulmonal
Co : ToF, PS
EGG SHAPE
Gambaran seperti telur,
batas kanan jantung
membesar, apeks
terangkat.
Terjadi karena
peningkatan beban
jantung kanan
Co : TGA
PARU
PLEURAL EFFUSION
Gambaran
Radiologis :
- Ada batas pleura,
gambaran pemb.
darah paru suram
atau hilang
- Sudut
costoprenikus
suram atau hilang
- Sela iga melebar
PLEURAL EFFUSION
PLEURAL EFFUSION
Gambaran Radiologis :
- Ada batas cairan yg
horizontal
- Sudut costoprenikus
suram atau hilang
- Pada efusi masif yg
mengenai satu paru
akan mendorong
struktur mediastinum ke
sisi yg berlawanan
PLEURAL EFFUSION
PULMONARY EDEMA
Gambaran
Radiologis :
- Cephalisasi
- Pelebaran hilus
tanda Bat-Wings
- Peningkatan
Opasitas lapangan
paru
- Bisa diikuti atau
tidak dengan
pembesaran
jantung
Pulmonary Edema
PNEUMOTHORAX
Gambaran Radiologis :
- Hiperlusensi paru
- Ada batas tegas pleura
- Tidak ada vaskularisasi
paru sebelah lateral
dari batas
- Diafragma pada sisi yg
sakit terdorong
kebawah
TENSION PNEUMOTHORAX
Gambaran
Radiologis :
- Area hiperlusensi yg
luas paru tampak
kolaps
- Trachea dan
mediastinum
terdorong kesisi yg
berlawanan
ATELEKTASIS
Gambaran Radiologis :
- Area opaq di lapangan
paru
- bisa mengenai satu
segmen, lobus atau satu
lapangan paru
- Trachea dan
mediastinum tertarik
kesisi yg sakit
- Sela iga pada bagian yg
kolaps lebih sempit
ATELEKTASIS
TB MILIER
Gambaran
Radiologis :
- Daerah hilus yang
melebar dan
meluas keseluruh
lapangan paru
- Peningkatan
opasitas dilapangan
paru .
EMFISEMA SUBCUTIS

Udara di
bawah kulit
densitas gas
di jarg lunak
diluar rongga
thoraks
ANEURYSMA AORTA

Pelebaran
mediastinum
daerah arkus
aorta
HIPERTENSI PULMONAL
LINES AND TUBE ON
CXR
Lines & Tubes on CXR
ETT : Sela iga 2 3,
diatas arkus aorta,
tepat dipertemuan
klavikula dengan
sternum

SG kateter : Sela
iga ke 5-6, Tips
kateter terletak di
1/3 hemithoraks
False Route CV Line
PERMANENT PACEMAKER
 Matur Nuwun

THANK YOU