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Subagia Santoso MD.
Medical FacultyPelita Harapan University
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Basic Conventional Imaging
We do conventional imaging s basic
Imaging : Black and white
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Contrast In Imaging
Black // white
Radio lucent // R Opaque
Hypo echoic // Hyper echoic
Hypo intens // Hyper intens
Lucent
Intermediate
Semi-Lucent
Semi-Opaque
Opaque
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Position photo processing
1. AP / PA
2. Right or Left lateral
2. Oblique , RAO , RPO , LAO and LPO
3. Tangensial : soft tissue4. Rekumben : prone or supine
5. Dekubitus : X ray horizontal direction
6. Semi erect : semi supine
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Photo position diagram
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Chest X Ray
The most important information in conventionalrespiratory imaging
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Ro Imaging Anatomi
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Mediastinum Borders of mediastinum:
Right : Right Lung
Left : Left Lung Anterior : Sternum
Posterior : Vertebrae
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Mediastinum structuresAnterior : Thymus, lymph node
Medial : Heart
Posterior : Oesophagus, Trachea
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Mediastinum abnormalities Pneumomediastinum
In patient with COPD, the air can out from alveolus intosurrounding broncovascular structures and finally entermediastinum through pulmonal hilum.
PA and lateral films show longitudinal lines andradioluscent bubles.
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Mediastinum abnormalities
Mediastinum mass Many variants of tumor origins from mediastinum.
To facilitate you in recognizing the possible mass arisesfrom mediastinum, so mediastinum is divided into 3
areas: Anterior : Upper level : tiromegaly, timoma, teratoma,
adenopathy, aneurysm.
Lower level : pericardium cyst, Morgagni hernia
Middle : bronchogenic cyst, hiatal hernia, esophageal
lesions, adenopathy and aneurysm. Posterior : neurogenic tumors, adenopathy, aneurysm
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Heart Normal anatomy of the heart;
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RA LA
RV LV
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Normal Cardiac Photo
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How to Measure Cardiac Size
Standard
method of
measuring CTRusing a
Posteroanterio
CXR.
CTR=(A+B)/C
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a b
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Normal Blood Pressure Increase Pulmonal Congestion
A. Pulmonal Hypertesion Post-Stenosis Pulmonal Blood Pressure Decrease
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Left Atrium Enlargement Left Ventricle Enlargement
Right Atrium Enlargement Right Ventricle Enlargement
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Pericardial effusion
Water bottle apperancein PA film is a spesificsign of pericardialeffusion.
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Coronary arterial disease Not so useful
But can help to detect the dilatation of heart andcongestion of the lung vessels.
We can see coronary heart disease w/ MSCT or heartcath.
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Left heart failure Left ventricular hyperthopy
Cardiomegaly sign
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Dilatation of superior lobes blood
vessels
Normally in erect position superior lobe vessels issmaller than inferior. And more peripher more sharp.
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Dilatation of superior lobes blood
vessels Increasing of flows
Etiology
Right to left shunt
Conditions that make Cardiac Outout increase eg anemia,tirotoksikosis
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Dilatation of superior lobes blood
vessels Congestion of Pulmonal Veins
Etiology
Mitral stenosis
Left heart failure
Atrial myxoma
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Interstitial oedema Pathopysiology
Interstitial oedema can occur due to consistent atrialpressure that make transudation. Transudate fluids flow
into interstitial space and interlobularis connectivetissue and make a line. The line that made is calledKerley line.
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Interstitial oedema
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Kerley lines
There are 3 types of Kerley lines
Type A : long, unbranched, and go to the hilum
Type B : short, tine, best showed at costophrenic angle Type C : soft, reticular form
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Kerley B Lines
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Interstitial oedema etiologies Pulmonal arterial hypertension
Etiology
COPD
Recurent pulmonal emboli
Post-stenosis dilatation
Reducing of flows
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Intra-alveolar oedema Is a continue from interstitial oedema. The fluids will
accumulate at alveolar space.
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