Saya dokter

dari UIN
SH , jakarta

Menajemen Dokter
Pemeriksaan
Radiologi
dalam Praktek Dokter
Umum di RS

o/ Ayat Rahayu
 Pada tahun 1895

Wilhelm Conrad Röntgen (27 Maret 1845 – 10 Februari 1923)

APA YANG ANDA PIKIRKAN ?

???
 Hubungan Dokter –Pasien
Pilihan “DEAL / NOT ” ???
• “Apa “
• “Siapa”
• “Dimana”
• “Kapan”
• “Bagaimana”
• “Mengapa”
 Pemeriksaan Radiologi
Sebagai Penunjang
• Klinis Diagnostik
• Terapi (follow up)
• Skrening
 Objek Penyakit
• Allergies •Hematology/Bloodwork
• Cancer/Tumors •Kidney and Urinary Problems
• Conditions of the •Orthopedic/Arthritis
Liver •Reproduction and Genetics
• Digestive System •Respiratory System
• Endocrinology and •Seizures and other Neurological
Metabolism Problems

• Eyes •Skin, Ears, and Coat

• Heart Disease and •Toxicology
Cardiology
 Jenis Pemeriksaan
Prinsip: Seluruh organ - dari kepala sampai kaki; dari
kulit sampai visera; dari jaringan lunak sampai keras;
dari cairan sampai padat; dari udara/gas sampai
cairan
Pendekatan-teknis ; Pilihan terbaik BY DOKTER
• Per –Sistem/ bidang Ilmu Penyakit
• Per – Operatif / Non Operatif
• Multi Organ/Penyakit
• Screening
Modalitas Imejing
 Plain Films
Uses ionizing radiation (X-ray) to generate image. Film exposed to radiation.
Resultant image reflects differences in density of structures through which
beam passed.
Examples
• CXR
• Plain films of abdomen
• Bones
Advantages
• Fast
• Relatively inexpensive
• Available everywhere
Disadvantages
• Uses radiation.
• Limited information regarding soft tissues
• Can't distinguish between soft tissues of similar consistency very well.
 Fluoroscopy
Real-time X-ray beam. Patient lies on table and moving X-ray beam is
used to watch structures at real-time. Contrast agents can be added
to delineate GI tract (e.g. barium).
Examples
• Barium enema
• Barium swallow
• Real-time visualization can see inside of gut, etc.
Advantages
• Real-time visualization can see inside of gut, etc.
• Relatively inexpensive
Disadvantages
• Can accumulate significant radiation exposures for patient and
doctors
 Angiography
Patient lies on a table. Moving, real-time X-ray beam paired with the
instillation of high density (iodine) contrast agents to see the size,
shape of blood vessels.
Advantages
• Allows specific evaluation of blood vessels to be performed.
• Therapeutic procedures can be done, making surgery unnecessary.
Disadvantages
• Can develop hefty radiation doses for doctor and patient.
• May experience nephrotoxicity to contrast.
• Also anaphylaxis.
• Blood product exposure.
• Invasive procedure with risks of bleeding and infection for patient.
• Relatively expensive.
 CT (Computed Tomography)Scan
Collimated X-ray beam used to image a patient in thin sections (thickness depends
upon body part imaged). Detectors surround patient. Computer generates image
based on different densities available after beam has traversed patient.
Example
• Metastatic Disease
Advantages
• Excellent soft tissue contrast and discrimination.
• Readily displayed.
• Facilitates clinical perusal.
• Allows deep structures to be visualized.
• Widely available.
• Can perform Interventional procedures using CT
Disadvantages
• Relatively expensive.
• Requires c ontrast enhancement with risks of nephrotoxicity and anaphylaxis.
• Some weight limitations
 Ultrasonografi(USG)
Use of high frequency sound waves to travel through human tissue, being reflected on traversing
interfaces. A transducer which emits high frequency sound is rubbed over the patient; based on
information which is returned to the transducer, an image is generated by the computer within the
machine.
Advantages
• Portable, inexpensive equipment
• Cheaper than other cross-sectional imaging techniques.
• Real-time.
• Can perform Interventional procedures.
• No radiation (good for children, pregnant patients).
• No contrast agents and their risks.
• Allows multi planar imaging.
• Good at deciding cystic vs solid.
• Doppler evaluation allows analysis of blood flow
Disadvantages
• Doesn't show function, only anatomy.
• Difficult with obese, immobile patients.
• Hard to see deep structures.
• Can't see through bone or air.
• Looks like weather map to untrained
 Magnetic Resonance Imaging (MRI)
Use of radio frequency pulses in a magnetic field. Hydrogen ions are moved and
deflected to generate image. Patient goes into long, thin tunnel while lying on
table.
Advantages
• No toxic contrast necessary.
• Allows multi-planar imaging
• Especially good for bones, CNS, joints
Disadvantages
• Expensive
• Claustrophobia, sometimes a big problem.
• Weight limit.
• Pacemakers, many medical supplies (IV's, O2 tanks) can't be put in magnetic field
safely. Limits patients and procedures which can be performed.
• Not available everywhere.
• Lengthy exams.
 Nuclear Medicine
Radioisotopes are injected into a patient and emit
rays of known energies. Cameras can collect
energy from the emitted beams, showing areas of
increased or decreased activity.
Advantages
• Excellent at delineating function
Disadvantages
• Weak anatomical analysis.
• Relatively expensive.
• Not good for Interventional procedures.
Using Various Modalities
 65 year old man with chest pain
• Diagnosis Acute Myocardial Infarction
• PLAIN FILM - CXR: to assess heart and lungs;
CHF
• ECHOCARDIOGRAPHY (US): chamber size,
vessels to heart, estimate ejection fraction
• CORONARY ANGIOGRAPHY: to assess blood
vessels - anything surgically correctable
 30 year old man with scrotal mass
• Diagnosis Testicular Cancer
• Ultrasound: To assess testis and mass
• CT: To look for retroperitoneal adenopathy
(that's where the disease spreads)
• CXR: To assess for metastatic disease to chest.
27 year old woman with R pap smear
• Diagnosis: Cervical Cancer
• Physical examination: To estimate extent of
disease
• CT Scan: To look for distant metastases (lung,
liver, bone), and to check for hydronephrosis.
Core Discipline Competency:
• Students will become familiarized with the variety of imaging modalities
available and the particular advantages and disadvantages of each imaging
tool.
• Students will learn the imaging features of specific disease processes and to
develop beginning skills in imaging interpretation.
• Students will learn direct radiologic - pathologic correlations for specific
disease processes and learn how to recognize the imaging features of the
disease processes presented.
• Students will develop a vocabulary to communicate the imaging findings
and their related disease process.
• Students will become familiarized as to how radiology as a medical specialty
relates to and contributes to clinical medicine.
Professional Competency:
• Students will demonstrate appropriate truthfulness, honesty and respect
for teaching faculty and peers. Demonstrate the ability to manage
confidential materials in a professional, confidential manner. Acknowledge
and honor the trust placed in student physicians/physicians. Demonstrate
professional behavior that is appropriate to the circumstance.
Apa yg telah ANDA pikirkan ?
•“Apa “
•“Siapa”
•“Dimana”
•“Kapan”
•“Bagaimana”
•“Mengapa”
 Alhamdulillah
???^><^
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