RADIOLOGI

THORAX
RIBS - HEART
Anatomi Paru-Paru
Anatomi Thorax, Lateral
kiri
Anatomi Thorax, PA
Posisi Posteroanterior &
Lateral

Pada Foto thorax

normal, hal-hal
yang perlu
diperhatikan
adalah :
1. Posisi
2. Simetrisasi
3. Inspirasi
4. Kondisi
Gambaran Thorax Normal

Hal-Hal yang
Harus
diperhatikan :
1. Posisi
2. Simetrisasi
3. Inspirasi
4. Kondisi
 FAKTOR POSISI
INTERPRETASI
PA (berdiri)
AP (berbaring)

DASAR PENILAIAN :
1. SCAPULA (DILUAR PARENKIM PARU)
2. CLAVICULA (curam)
3. UDARA FUNDUS GASTER
(MEGENBLASE)
PA AP
 AP versus PA
The Effect of Magnification

In a PA film, the heart is closer to the film and thus less

magnified
The standard chest x-ray is a PA film
In an AP film, the heart is farther from the film and is
more magnified
Portable chest x-rays are almost always done AP
 AP versus PA
The Effect of Magnification

AP portable film makes the On this PA film done on

heart look larger than it the same patient an hour
does later
FAKTOR SIMETRISASI
Jarak ujung clavicula dengan
processus spinosus
(simetris/tidak)

CARA :
JARAK YANG SAMA ANTARA PROCESSUS
SPINOSUS KE SENDI STERNOKLAVIKULA
KANAN DAN KIRI
 Rotation

If the spinous
process of the
vertebral body is
equidistant from
the medial ends of
each clavicle, there
is no rotation
If spinous process appears closer to the right clavicle (red arrow), the
patient is rotated toward their own left side

If spinous process appears closer to the left clavicle (red arrow),

the patient is rotated toward their own right side
 Pitfall Due to Marked Rotation

Severe rotation may make the pulmonary arteries

appear larger on the side farther from the film
 FAKTOR INSPIRASI
DASAR PENILAIAN :
PENAMPAKAN DIAFRAGMA
PATOKAN :
VT X / COSTA BELAKANG 10 /COSTA DEPAN 6

INTERPRETASI :
CUKUP
KURANG
TERLALU DALAM
 Inspiration

About 10 posterior ribs visible is an

excellent inspiration
In many hospitalized patients 9 posterior
ribs is an adequate inspiration
 Anterior vs. Posterior Ribs

Anterior
ribs will be
Posterior
visible but
ribs are
are harder
those that
to see. They
are most
run more
apparent
or less at a
on the chest
45 degree
x-ray. They
angle
run more
How to tell the difference between downward
or less
the anterior and the posterior toward the
ribs
horizontally
 10

Ten posterior ribs showing is an excellent inspiration

 Pitfall Due to Poor Inspiration

About 8 posterior ribs are

showing
Poor inspiration will crowd lung markings and make it
appear as though the patient has airspace disease
Same patient

8 9

About 8 posterior ribs are 9-10 posterior ribs are

showing showing
Better inspiration and the disease
at the lung bases has cleared
 KONDISI FOTO THORAX
DINILAI DARI :
1. KONDISI PULMO KESELURUHAN (LUSENSI
PARENKIM PARU)
2. VERTEBRA THORAKALIS TAMPAK I-IV (< VT
II KURANG, > VT VI KERAS)
3. PROCESSUS SPINOSUS TAMPAK 3 ATAU 4

INTERPRETASI :
KERAS (TERLALU HITAM/LUSENS)
CUKUP
KURANG (TERLALU PUTIH/OPAQUE)
 kondisi

You should be
able to just see the
thoracic spine
through the heart.
TERPOTONG ATAU TIDAK
DASAR PENILAIAN:
SUPERIOR:
TAMPAK VERTEBRA CERVIKALIS VI/VII
INFERIOR:
SINUS COSTOPHRENICUS DAN DIAFRAGMA
SAMPING KANAN DAN KIRI:
AXILLA TAMPAK
 IDENTITAS
IDENTITAS SISI
MARKER (L ATAU R)

IDENTITAS REGISTRASI
NAMA, UMUR, NO. REGISTER,TANGGAL FOTO

LAYAK / TIDAK ?
 Hal-hal yang harus diperhatikan
dalam Pembacaan Foto Polos
Thorax

a. Jaringan lunak, tulang

b. Corakan bronkhovaskuler
c. Parenkim paru Keadaan hilus
d. Sinus costofrenikus
e. Diafragma
f. Cor : CTR
SISTEMA TULANG DAN
JARINGAN LUNAK
LOKASI DAN GAMBARAN SISTEMA TULANG :
COSTA,
CLAVICULA
SCAPULA
LOKASI DAN GAMBARAN JARINGAN LUNAK
MAMMAE,

normal: sistem tulang intak

 KEDUA APEKS PARU
PENILAIAN :
TENTUKAN LOKASI APEKS PARU
GAMBARAN APEKS

INTERPRETASI
APEKS TENANG/ BERSIH
APEKS TERDAPAT INFILTRAT ( UKURAN DAN
BENTUK, DENSITAS)
 KEDUA APEKS PARU

APEKS TENANG TERDAPAT PENINGKATAN DENSITAS

DI APEKS KANAN
 CORAKAN
BRONKHOVASKULER
CARA PENILAIAN
BAGI PARU DARI TEPI MENJADI 3, LIHAT BAGIAN 1/3 LATERAL

NORMAL :
CORAKAN BRONKHOVASKULER TIDAK MELEBIHI 2/3 MEDIAL
(1/3 LATERAL TAMPAK BERSIH)

INTERPRETASI:
NORMAL /MENINGKAT
 CORAKAN
BRONKHOVASKULER

NORMAL MENINGKAT
 PARENKIM PARU
GAMBARAN PARENKIM PARU

APABILA TERDAPAT INFILTRAT:

TENTUKAN :
LOKASI, UKURAN, JUMLAH, BENTUK
PARENKIM PARU
SINUS COSTOPHRENICUS
INTERPRETASI
LANCIP ATAU TUMPUL
NORMAL : LANCIP
BILA TUMPUL PASTIKAN ADA
KELAINAN ATAU TERPOTONG
 SINUS COSTOPHRENICUS

TERPOTONG EFUSI PLEURA

 Normal R costophrenic angleBlunted L costophrenic angle
When 200-300cc of fluid accumulate in pleural space, the
usually acute costophrenic angle (sulcus), as seen on the
right in this person, becomes blunted (as seen on the left in
this person)
 DIAFRAGMA
NORMAL :
Kanan lebih tinggi dari kiri (jantung
menekan)
Selisih <3 cm)/ atau sebagai patokan
tidak lebih dari 2 vertebra
Licin
 JANTUNG
LOKASI
BENTUK JANTUNG
CTR : NORMAL < 0,5 UNTUK
BERDIRI /PA
 One of the easiest observations
Cardio-thoracic to make is the cardio-thoracic
Ratio ratio which is the widest
diameter of the heart compared
to the widest internal diameter
of the rib cage
CTR= (a+b)
/c
= < 50%
a
b

c
Enlarged or not?

Yes
Enlarged or not?

Yes
Enlarged or not?

No
 Contoh Pembacaan
Foto Thorax Normal
Foto Thorax PA,errect,simetris, inspirasi dan
kondisi cukup
Tidak ada soft tissue swelling
Sistema tulang intak
tampak kedua apex paru tenang
tampak corakan bronkhovaskuler di kedua lapangan
paru normal
sinus costophrenicus kanan-kiri lancip
Diafragma kanan dan kiri licin
Cor : CTR kurang dari 0,56

Kesan : Paru dan cor dalam batas normal

Contoh Foto Thoraks

Klinis: sering
sesak napas dan
batuk, riwayat
merokok 2
bungkus/hari

Diagnosis?
Klinis:
pasien baru
saja
kecelakaan
dan
terhantam
stang
sepeda
motor

Diagnosis?
Klinis: post KLL
sepeda motor

Diagnosis?