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The Basics
Ns. Deni Yasmara, M. Kep., Sp. Kep.MB
WHAT IS RADIOLOGY?
X-RAY
Discovered and named by
Dr. W. C. Rentgen at
University of Wrzburg,
1895
Awarded first Nobel prize
for physics, 1901
Did not patent invention
3
Spondilitis TB (??????)
RADIOLOGY TOOLS
X- RAY
ULTRASOUND
NUCLEAR MEDICINE
MAGNETIC RESONANCE
COMPUTED TOMOGRAPHY
Plain Radiographs
Widely available
Reproducible
Patient friendly
Inexpensive
Usually the indicated primary
imaging modality
Plain Radiographs
Standard protocols available
Consider the pathology in question
Image area of question, not the
vicinity
Plain Radiographs
- Obvious
Ultrasound
Reproducible in trained hands
Excellent for superficial soft tissue
elements including tendons and
muscle
Patient friendly
Small to moderate expense
Ultrasound
Routine exam room equipped with
adequate imaging devices
Superficial gel (standard or aseptic)
application with touch with
transducer
Usually static exam of architecture
+/- vascularity assessment
Potential for dynamic imaging
Ultrasound
Cranial
Cranial
Cauda
l
Calcaneu
s
Caudal
Proximal patellar
tendonitis
Jumpers Knee
Computed Tomography
Usually supine axial exam, with
some alternative positioning options
Can develop reformatted images
after exam for alternative views
Imaging time in seconds, rarely
minutes
Usually without IV or oral contrast
CT - Fractures
Scaphoid
fracture
CT - Dislocation
CT Bony anomalies
Midsubtalar
coalition
MRI
Usually performed with patient supine
Multiplanar imaging obtained without
changing position
One exam = one body part
Average exam time 45 minutes; most
patients cant last >2 hours
Strict guidelines for sedation
Optional contrast Rad usually decides
for body imaging
SPONDILITIS TB L3,4,5
MRI Trauma
Osteochondritis
dissecans
MRI Trauma
Femoral Neck
Fracture
MRI - Trauma
Tear vastus
medialis
Nuclear Scintigraphy
Most common = Bone Scan
Very sensitive for skeletal pathology
Mildly sensitive for soft tissue
pathology
Usually nonspecific as an isolated test
Mostly patient friendly; no significant
environmental exposure
Small-moderate expense
Nuclear Scintigraphy
Excellent for specific pathologies
Osteomyelitis
Metastases Not Multiple myeloma
Occult fracture
Reasonably reassuring
Normal is usually normal
Nuclear Scintigraphy
2nd MT stress
fracture
CONTRAST RADIOGRAPHY
Injection, ingestion, or other
placement of opaque material within
the body.
Improves visualization and tissue
separation.
Can demonstrate functional anatomy
and pathology.
46
ABC S APPROACH
A
ADEQUACY
Semua x-ray seharusnya memiliki
beberapa lapang pandang (views) :
Minimum 2 views AP dan Lateral
3 views jika memungkinkan
Beberapa tulang harus 4 views
ALIGNMENT
Normal x-ray seharusnya
mempunyai garis yang normal
Fractur dan dislokasi mungkin
mempengaruhi kesegarisan
BONES
Kaji tulang terhadap garis fraktur
dan penyimpangan lainnya
Kaji panjang dari tulang yang
seharusnya
CARTILAGE
Kaji jarak sendi diantara tulang
rawan (cartilage)
Curigai adanya cedera ligament
atau fraktur pada area di sekitar
sendi
SOFT TISSUE
Kaji terhadap adanya
pembengkakan soft tissue joint
effusions
Ini mungkin merupakan tanda dari
fraktur
BONE ANATOMY
Gambaran lokasi tulang yang abnormal
mengenai : Diaphysis,
metaphisis, atau
epiphisis.
BONE STRUCTURE
JOINT ANATOMY
DESCRIPTIVE TERM
Gambaran umum dapat digunakan
untuk menunjukan
ketidaknormalan.
SYSTEMATIC APPROACH
Cortical outline
Check cortical outline (white line) pada semua tulang yang
tampak
Telusuri garis tulang
Jangan hentikan penelusuran ketika menemukan satu
kejanggalan teruskan hingga penelusuran terakhir selesai.
Lihat adanya OSTEOPHITES
BOXER FRACTURE
Boxer fracture
Key Points :
2 views lebih baik dibanding 1
Cek semua foto yang ada
Bandingkan dengan yang sebelah atau sebelumnya (jika ada)
2 views
Clinical Information :
Twisting injury to left ankle
Patient tidak mampu menginjakkan kaki (Non Weight
Bearing )
Diagnosis :
Oblique fracture distal fibula of the ankle joint ( Weber B
Type)
Acromioclavicular joint
Acromioclavicular joint dapat diperiksa dengan x-ray standar
Loss of alignment inferior surfaces of the clavicle and acromion
mengindikasikan adanya kelainan (disruption) acromioclavicular
ligament pada sendi acromioclavicular (ACJ)
Jika
A
B
C
S
menggunakan ABCs, ;
Alignment : ada masalah alignment
Bone : garis fraktur 2,3,4
Cartilage : Fracture mid shaft metacarpals
Soft tissue : adanya pembengkakan
REFERENCES
Nilesh Patel (2008). BaSICS OF ORTHOPEDIC
RADIOLOGY
R M Freij (1996). Radiographic interpretation
by nurse practitioners. Emergency medical
journal. London.
THANK YOU