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Imaging Interpretations

for Medical Students


Sianny Suryawati
Radiologist

Department of Radiology Medical Faculty


WIJAYA KUSUMA UNIVERSITY
CHEST
CHEST
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Goals of this lecture:
To confidently assess a chest
radiograph
To detect abnormalities, especially
those that are life threatening

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Normal Anatomy
Figure 1.
A=trachea,
B=carina,
C=right atrium,
D=aortic knuckle,
E=cardiophrenic angle,
F=left ventricle,
G=clavicle,
H=hemidiaphragm,
I=gastric air bubble,
J=hilar points,
K=rib, L=lung,
M=costophrenic angle,
N=breast shadow,
Lecture hand out March2011
O=thoracic spine
MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Chest X-Ray Views
Box 1. Technical aspects of a plain film
Name and agemake sure you have the correct patient. The age of
a patient will help you determine how likely you are to find a
particular pathologyfor example, cancer is not the most likely
diagnosis in a young patient.
SexDoes the image belong to a man or woman? The presence or
absence of breast shadows can help determine this.
OrientationIs the radiograph anterior-posterior (AP), or posterior-
anterior (PA)? PA films more accurately depict heart size than AP
films but require the patient to stand. An ill patient who is bed bound
would be more likely to have an AP film. Know your right from your
left and which way round the image is.
RotationIn a well centred image the medial ends of the clavicles
are equidistant from the spinous processes of the thoracic spine.
Rotation can obscure structures and accentuate differences in
attenuation between the lung fields.
PenetrationOver or under exposure of the film results in too little
or too much contrast, potentially at the expense of omitted detail or
exaggeration of normal features respectively.
InspirationPoor inspiration results in less air filling the lungs and
can imitate pathology, such as collapse or atelectasis in the lower
lobes.
Menentukan jantung

Inspirasi cukup, simetris


Cardio thoraxic ratio harus < 0,5 ( A/B )
Bila CTR > 0,5 PADA FOTO THORAX yang baik
cardiomegali
Evaluasi mediastinum
Evaluasi kompartemen mediastinal
Penting menentukan isi dari mediastinum
Ada 3 kompartemen:
Anterior mediastinum: anterior dari
pericardium dan trachea.
Middle mediastinum: antara anterior dan
posterior mediastinum.
Posterior mediastinum: posterior dari
pericardial surface.
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Formulating An Approach
One approach that is particularly favoured was
developed by the chest radiologist Benjamin
Felson. It is designed to target the least
interesting areas of the radiograph first,
before proceeding to analyse the more
important areasthe lungs and heart. This is to
lessen the chance of boring areas being
reviewed improperly. No gold standard system for
reviewing a chest radiograph exists, however.
Doctors use different methodsthe approach that
suits you most is acceptable as long as all areas
of the radiograph are reviewed and
commented on ( Box 2 ).
Box 2. Felsons system
Abdomen
Thorax
Mediastinum
Lungs (one side at a time)
Lungs (compare one against the other)

Aide memoire: Are There Many Lung


Lesions?
Case 1
Case 2
Case 3
Case 4
Case 5
Case 6
Case 7
Case 8
Case 9
Case 10
ABDOMINAL IMAGING
Banyak digunakan, seringkali untuk
pemeriksaan segera, mis dalam kasus
nyeri abdomen akut.
Indikasi, antara lain :
Kolik renal
Intestinal obstruction
Perforasi usus
Appendicitis
Intususepsi
Tertelan benda asing
BONE IMAGING
Plain Film
Primary imaging modality of
bone and joint imaging,
particularly in trauma

Advantages
fast
inexpensive
readily available
good for assessing bones and
joints
Plain Film
Primary imaging modality of
bone and joint imaging,
particularly in trauma

Disadvantages
uses ionising radiation (x rays)
limited information regarding
soft tissues

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
ABC-s
Evaluasi sistematik

a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
ABC-s
Evaluasi sistematik

a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Plain x-ray
Orthogonal Views (AP-Lat) for fractures

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Mal- alignment; joint dislocation
Spondylolisthesis
AC joint dislocation

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Sacro-coccygeal angulation- post trauma
NORMAL
ALIGNMENT
Scoliosis: Neutral + lateral bendings
Leg length discrepancy
ABC-s
Evaluasi sistematik

a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
BONE

Bentuk
Cortex
Medula
Trauma/
FRAKTUR
Fraktur

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Tipe Fraktur

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Arah garis fraktur

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
FRAKTUR INKOMPLET DAN
EPIPHYSEOLYSIS
Patah Tulang pada lempeng tulang yang masih
tumbuh: Epiphysiolysis
Klasifikasi menurut Salter & Harris

S A L T R
slipped above lower through ruined
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Trauma
lempeng
pertumbuhan

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Plain films post ORIF (open reduction
internal fixation)

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
After 2 months
Pins and wires Dislocated pins
Plain films- (healing) callus

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
3 years old with femur fracture
Any Questions?

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
ABC-s
Evaluasi sistematik

a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Catrilage: Joint narrowing
Catrilage: Joint narrowing + osteophyte / lipping
Example of applying ABCs
(A)Spndylolisthesis
(B)Spondylolysis
(C)Severe DDD-
degenerative
disc disease
ABC-s
Evaluasi sistematik

a.Alignment
b.Bone
c.Cartilage
d.Soft tissue
Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Swelling after DPT
injection
Imaging
Plain radiographs are usually the starting
point
Secondary imaging techniques have specific
advantages and disadvantages
A specific question is more likely to get you a
direct answer
When in doubt, ask a Radiologist

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
Communication

between
referring
physicians and
Radiologist is
most important

Lecture hand out March2011 MSK Imaging; Paulus Rahardjo, - MSK Consultant Radiologist
THANK YOU