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Drh.Deni Noviana,Ph.DStaf Bagian Bedah dan Radiologi

Fakultas Kedokteran Hewan IPB

Email:deni@ipb.ac.id

http://deni.staff.ipb.ac.id/

istheuseofXraystoviewunseenorhardtoimageobjectsandisusedforbothmedicalandindustrialapplicationspp

isanXrayimageoftheinternalstructureofanobject.

isahealthcareprofessionalwhocreatesmedicalimagesofthebodytohelphealthcareprovidersdiagnoseandtreatillnessandinjury

a unit of measurement for ionizing radiationaunitofmeasurementforionizingradiationanalternativename

forXrays

Radiographmerupakan gambaran karya seni 2dimensi hasil dari suatu organ/struktur yangtadinya 3 dimensitadinya 3dimensi,

Gambaran 3dimensi dapat diimajinasikan darigambaran 2dimensi yangdiambil dengan sudutpandang yangtepat.

Imajinasi3dimensididapatkandenganmenggunakan hasil pengambilan 2 gambarmenggunakanhasilpengambilan2gambarstandarradiografi

Digantung pada iluminator dengan prosedur standardan pola tetap yangtelah ditentukan sebelumnya

Hasil pengambilan radiograf lateral,bagian kranialp g g , gdiletakkan di sisi kiri

Hasil pengambilan radiograf VD/DV,bagian kranialpasien di letakkan di atas,sedangkan bagian kiri pasiendiletakkan di kanan

Kondisi lingkungan yangtenang,pencahayaaniluminator yang cukup kurangi cahaya ruangan yangiluminator yangcukup,kurangi cahaya ruangan yangtidak perlu,fokuskan lesio organpada titik tertentu

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Setiap bayangan yangmuncul harus dievaluasidan dijelaskan,apakah:yBentukan normal anatomiyBentukan normalanatomiyPecahan/serpihan struktur dari struktur yangbertumpuk/superimposyArtefak dari kesalahan posisiyLesio pathologiyLesio pathologi

Contoh langkah interpretasi yangbaik dan benar

Contoh langkah interpretasi yangsalah

Berdasarkan arah datangnyasinar X,standarpandangyang

Gambar standar pandang padapengambilan foto sinarx , p g y g

umum dipakai untuk regioabdomen: Laterolateral (LL) Lateral Ventrodorsal (VD) Dorsoventral (DV) Decubitus lateral Decubitus lateral

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Evaluasi radiografik abdomenRasasakit pada regio abdominalGangguan gastrointestinalseperti anorexia,vomit,nauseaatau diarrhea.Gangguan traktus urinaria seperti hematuria,dysuria,strauria,perubahan frekuensi urineatau calculiVUatau ureter.Gangguan traktus genitaliaseperti dischargedarivulvaEvaluasi pada kebengkakan/masa abdomenEvaluasi distensi abdomen,tenesmus

RadiografiRadiografilaterallateralpadapadaregioabdomenregioabdomen::

Rightrecumbency lebih seringdigunakan, dapat memperlihatkanujung limpa

SStandartandarppandangandang1.1. LateralLateral

j g p Leftrecumbency memiliki

keunggulantersendiri yaitumembuatgasdalamlambungdapatberpindahkepylorusdanduodenum

Kakidepandiposisikansecranialmungkin,dankakibelakangsecaudal

2.2. VDVD

mungkin. Standar pandang lateraldengan

posisi hewan berdiri dan arah sinar Xhorizontal untuk deteksi cairandalam peritoneum.

3.3. DVDV

RadiografiRadiografiVD/DVVD/DVpadapadaregioabdomenregioabdomen::

VDlebih baik daripada DV DVcenderung menekan viscerayang

menyebabkan perpindahan organ

SStandartandarppandangandang1.1. LateralLateral

y p p g Posisi VDakan membantu

penyebaran luas normalorganorgandalam rongga abdomen

VDsulit dilakukan pada hewantraumapada pelvisatau kakibelakang ,karena tidak dapat

2.2. VDVD

dilakukan penarikan Kakidepandiposisikansecranial

mungkin,dankakibelakangsecaudalmungkin.

3.3. DVDV

Anjing:Pusatpenyinaran kirakira padat l t t khi d t h ttulang costaeterakhir dan pertengahanantaraumbilicusdantulangbelakanglumbalis.

Kucing:Pusatpenyinaran kirakira 2jari dibelakang tulang costaeterakhir danpertengahanantaraumbilicusdantulangp g gbelakanglumbalis.

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Protocol :

1. Appropriate cassette should be selected

2. Cranial boundaries entire diaphragm3. Caudal boundaries throchanter mayor femur4. Dorsal and ventral boundaries (lateral view)

soft tissue margins of the abdomensoft tissue margins of the abdomen.

5. Medial and lateral boundaries (DV or VD view)soft tissue margins of the abdomen

Posisi Radiografi LateralAbdomen

Posisi Radiografi VDAbdomen

Perbedaan kerapatan atau densityantara satuorgandengan organlainnya

Banyaknya lemak dalam abdomen Pergerakan pasien atau hewan selama

pemotretan

Ketebalan hewan

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Thegrossanatomyoftheabdomenarenotexactlythesamewithradiographicanatomy(ex:uterus)

Thinkabouttherelationshipsoforgans TheabdomendividedintofivezonesonlateralviewandfourzonesonVDview.

L3

Zone1

Zone3

Zone4

Zone5

Zone2

L 1

Zone1 Zone2

L1

Zone3

Zone4

L3Zone1 Liver(Right&caudate) Stomach(Fundus,body)

Zone1 Rightkidney Pancreas* Mesentericlymphnode* Spleen&rightadrenal*Zone2

Zone2

Liver Stomach(Body,pylorus) Pancreas* Gallbladder* Mesentericlymphnode*

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Zone1 Liver(Right) Stomach

P i l d dZone1 Zone2

Proximalduodenum Rightkidney Rightadrenalgland* Pancreas* Mesentericlymphnode* Gallbladder*Zone2 Liver(Left)

L1

Liver(Left) Stomach Spleen(Head) Leftadrenalgland*

L3 Spleen(Body,tail).

Small intestineZone1

Zone4

Zone5

Smallintestine Largeintestine Leftkidney Pancreas* Left ovary*

Zone2 Leftovary Uterus*

L1

Zone1 Zone2

Stomach* Smallintestine

Zone3

Largeintestine Leftkidney Pancreas* Rightandleftovaries*Ut ( i l

Zone4

Uterus(cranialhorns)*

Zone4

L3Zone4 Colon&Rectum Medialiliaclymph

Z 5

y pnodes*

UretersZone5 Urinarybladder Ureter

Zone3 Zone5 Uterus Prostategland

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Colon/rectum Ureter

Zone 3 Uterus Urinarybladder Medialiliaclymphnodes*

Prostate gland (M)*

L5

Zone3

Zone4

Prostategland(M) Rectallymphnode

Zone4

L3Zone5 Urinarybladder Ureter

Z 5

Ureter Uterus Prostategland(M)

Zone3 Zone5

Pemeriksaan radiografi lambung denganmenggunakan bahan kontras untuk

mengetahui struktur lambung

Bahan kontras dibagi 3macam :

1.1.BahanBahan KontrasKontras PositifPositif :BariumSulfat dan Iodium

2.2.BahanBahan KontrasKontras NegatifNegatif :Udara,Carbondioksida,Nitrit Oksida

3.3.DoubleDoubleKontrasKontras :Gabungan kontras positif dan negatif

Hewan dipuasakan selama1824jam

Hewan diberi obat sedasiacepromazine 0,1mg/kgBBIMdan dibius Ketamin 10%1520mg/kgBB (*opt)

Bahan kontras bariumsulfat30%10ml/kgBB dicampur/ bl ff (* )1/8tableteffervecent (*opt),dimasukkan ke lambungmelalui stomachtube.

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kVp :Lateral50,DVVD52mAs abdomen2.5 (Screen400)Pengambilan Xray:Pengambilan X ray:

Sebelum menit ke5dengan posisi leftlateraluntuk melihat cardiaclambung,

Pada menit ke10dengan posisi rightlateraldan DVuntuk pemeriksaan pyloruslambung,

Pada menit ke 20 dengan posisi VD Pada menit ke20dengan posisi VD Pada menit ke60dengan posisi VDdan LLateral.

BaSO4for0minute BaSO4for1minute

BaSO4for30minute BaSO4for60minute

Metode pemberian bahan kontras untukmenghasilkan struktur gambar ginjal yangjelasg g g j y g jBagian Pyelum ginjalMelalui VenaPerifer (V.Cephalica antibrachiiDorsalis,V.Saphena)atau VenaJugularis

Bahan kontras TriIodine(Iohexol)M l i di i l Meglumine diatrizoleSodiumdiatrizoat

Sifat:Soluble(terlarut)

1. Hewan di puasakan selama 1224jam

2. Hewan dibiusACP/Acepromazine,Dosis:0,020,1mg/kgBBIM/SC)+Ketamin10%,Dosis:1520mg/kgBB(*opt)

3 T h ik P k bd3. Tehnik Penekanan abdomen4. Penyuntikan IntraVena

Menggunakan IVCatether

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Iodinefor25minutesIodinefor15minutesIodinefor5minutes NegativeContrasDoubleContrasPositiveContras

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Largestglandinthebody. Softtissueopacityandliesinthecranialabdomen caudal the diaphragm and cranialabdomen,caudalthediaphragmandcranialstomach.

Dividedintofourlobes:left,right,caudateandquadrate.

Normalliversizeisemperical bothviewsmustbeused.

Positionofthestomach aidsinthedeterminationofliversize.

Axisstomachisparalleltotheribs. Caudal margin is enclosed within the rib cage Caudalmarginisenclosedwithintheribcageorveryclosetocostaemargin.

Dog Catg

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Hati

HatiHEPATOMEGALY MICROHEPATIANORMALLIVER

Associatedwithrightliverlobes. Softtissueopacity. Notnormallyvisualized. Changesmightbevisualized:mineralopacities,gasopacities

Normalsize:extremelyvariable. Indog>cat. Drugs such as barbiturate ACP generilized splenicDrugssuchasbarbiturate,ACP generilized splenic

enlargement. Proximalextremity(headofthespleen) connectedto

thegastricfundus. Proximalextremity(body) locatedintheleftdorsal

aspect(Lateralzone1/VDzone2). Distalextremity(tail) locatedintheventralabdomen,

highly variable locationhighlyvariablelocation. Radiographs:triangularsofttissueopacities remember

theexactsizeofspleenismuchlarger.

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Not visualized radiographically , except enlarged Ultrasound is excellent tool to evaluate. Medial iliac lymph nodes (ventral L6 in zone 4). Mesenteric lymph nodes (zone 3). Inguinal lymph nodes (ventral flank, outsideabdominal cavity)abdominal cavity).

Notvisualizedradiographically ,exceptenlarged.Ult d i f l t l t l t Ultrasoundismoreusefultooltoevaluate.

Therightlimbliesadjacentandcaudaltothecaudalmarginofstomach.

Theleftlimbliesmedialandadjacenttothedescendingduodenum.

Radiographicidentificationofpancreaticdiseaseisdifficult.

Locatedintheretroperitonealspace. CranialpoleoftheRKisoftendifficulttoCranial pole of the RK is often difficult tovisualize superimposedwiththeliver.

LKmorecaudalthanRK,anditslocationmorevariable.

Sizeindog:2.53.5timesthelengthofL2(rec:VD view)VDview).

Sizeini cat:2.43.0timesthelengthofL2(rec:VDview).

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R. KidneyR.KidneyL.Kidney

VU

GINJAL ANJING: 2,5-3,5 KALI PANJANG VERTEBRAE LUMBALIS KE-2 GINJAL KUCING: 2 KALI PANJANG VERTEBRAE LUMBALIS KE-2

Locatedintheretroperitonealspace. Notnormallyvisualizedonradiographs. Usingivcontrastmediummaxdiameter23mm.

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PRM

C

VU

AplikasiAplikasi IVP(intravenousIVP(intravenouspyelogrampyelogram))dengandengan bahanbahan kontraskontraspositifpositif terionisasiterionisasi preparatpreparat iodine,iodine,1515menitmenit..

PR

M

C

U

VU

AplikasiAplikasi IVP(intravenousIVP(intravenouspyelogrampyelogram))dengandenganbahanbahan kontraskontras positifpositif terionisasiterionisasi preparatpreparatiodine,5iodine,5menitmenit..

Thesizeishighlyvariable. Ifemptymaynotbevisible. Maybelocatedeithertotheleftortotherightofmidline,orcentered(VDview).

Male:comprisesthreeparts. Prostatic confinedtotheprostategland. Membranous extendsfromtheprostatetotheos penis.

Penile shorterincatthanindog. Female:theurethraisshorterandwider.

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Positif kontras cystogram dilkakukan dengan mengaplikasikan mediakontras secararetrogradeke dalam kantung kemih

Notvisualizedradiographically,exceptl denlarged

Normalprostatediameter:max2/3thewidthofthepelvicinletonVDview.

Normalprostateincatisnotvisible. Prostatic disease in the cat is very rare Prostaticdiseaseinthecatisveryrare.

Notvisualizedradiographically ,exceptl d idenlargedorgravid.

Stumpislocatedbetweenthebladderandcolon.

Gravid:fetalskeletonsbecomevisibe atday4545.

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Liescaudaltotheliverandcranialtotransversecolon.transversecolon.

Theaxisparalleltotheribs. Dog:pylorusisgenerallytotherightofmidline.

Cat:pylorusisgenerallyonmidlineorslightlypy g y g ytotheleftofmidline.

Thesizeandopacityisextremelyvariable.

Located at the mid abdomen

Dog : Normal SI should be no wider than thecentral portion of the body lumbarvertebrae and it should not exceed thediameter of twice the width of a rib.

Cat : Gas accumulation are typicaly lest thanCat : Gas accumulation are typicaly lest thanin normal dog.

Cecum : Located to the right of midline onVD i d i th t l bdVD view and in the central abdomenon lateral view.

Dog : It has a CShaped appereance.Cat Very small and usually not seenCat : Very small and usually not seen.

Ascending colon : Is to the right of midline.

Tranverse colon : At the hepatic flexure, theascending colon turns to the leftand continues across the midline tothe left.

Desending colon : At the splenic flexure theDesending colon : At the splenic flexure, thecolon turns caudaly and continues into the pelvic canal.

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Fundus

Caecum

P l

Duodenum ColonDesc

Pylorus

FundusPylorus

Asc.col

Tranv.col

desc.col

GINJAL

FUNDUS

COSTAE

KOLON

FEMUR

PYLORUSDUODENUM

USUSHALUS

ABDOMEN(120MENITKONTRASPOSITIF)

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