KULIAH PENGANTAR RADIOLOGI

dr. Indrastuti Normahayu

SpRad(K)
Dept. of Radiology FKUB
Saiful Anwar Hospital
MALANG
 Dep. Radiology / Dep.
Imaging
I. Radio Diagnostic / Diag.
Imaging
1. X Ray / Rontgen
a. Fluoroscopy
b. Radiography
- Plain Photo
- Contrast Photo
- C. T. Scan
- Tomography
2. Radioactive Scanning/Nuclear
Medicine

- Bone Scanning
- Cardiac Scanning
- Renal Scanning/ Renogram
- Thyroid Scanning
- Whole Body Sc. dsb
3. ULTRASOUND
a. Ultrasonography
Thyroid
- Abdomen
- Mammae dsb
- Cardiac
- Transvaginal, transrectal
- Endoscopic
b. Colour Doppler Ultrasonography
4. M R I
THERAPI
1. X Ray - Brachy
Therapy
Ray - External
Radiasi
a. Ortho Voltage
b. Medium Voltage
c. Mega Voltage
2. Radio Isotop - I 131
3. Ultra Sound -
Punctie,Guiding FNA
-ESW
L
 X Ray

1868 Wilhelm Conrad Roengent

Ionic ray
Cathode ray

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Spectrum Rays

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 Source of X Ray :

1. Artificial :
a. Radiology unit
b. Diode tube
c. Radio station
d. Radar macchine

2. Natural :
a. Cosmic
b. Earth
c. Radioactive material

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Cathode Electron mA
KV

Anode

Heat 99%
X Ray 1%

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X Ray :
1. Darkened film paper
2. Material penetrable
3. Unaffectable by lens or mirror
4. Ionated material and have biological effect
5. In the linier way
6. Same with light velocity
7. Fluorescensi & Fosforescensi
8. Effected by prisma

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 RADIOLOGY

The study of Imaging in

Medicine
Basic Knowledge:
1. Anatomy and
Physiology
2. Pathology
3. Patho Physiology
4. Clinical Situation

Macam macam Contras

X Ray:
1. Kontras (+)
- Memberi bayangan
radiopaque
2. Kontras (-)
- Memberi bayangan
radiolusent
3. Double kontras
- Kombnasi antara 1 & 2
4. Manfaat untuk menilai
- Fungsi suatu organ
Contras Photo
Manfaat :
Memberi informasi yang lebih
detail dari suatu organ /
bagian organ tertentu
Dipakai pada :
- X ray Conventional
- CT Scan
-MRI
-USG
Pemeriksaan dengan
Kontras

1. GI tract:
- Oesphagus photo
- UGI Photo/ Ba intake
- Ba In loop/Ba enema
- Lopograf
- Appendicogram
3. URINARY TRACT
- IVU
- Infusion urogaf
- RPG
- Cystograf
- Urethrograf
- Urethro cystograf
- Voiding urethrocystograf
- Double pole voiding
urethrocystograf
4. Genetalia :
- Bulbograf
- HSG
5. Vascular :
- Arteriograf
- Aortograf
- Phlebograf
- Spleento Portograf
6. System Lymphe:
- Lymphograf
Histerosalpingogram
Pengaruh Radiasi pada:
1. Sel - Dinding sel
- Inti sel
- Protoplasma
2. Jaringan
3. Organ
Klinis :
1. Kelainan acute
2. Kelainan chronis
CT Scan
CT Scan
 RADIO BIOLOGY

a. The effect of EM radiation on molecules is ionization

b. Higher energy increases ionization
c. Ionization is responsible for the biologic effects of
radiation on DNA and tissue
d. The major potential biology effect of EM radiation is:
- Carcinogenesis
- Genetic effect caused by gonadal irradiation
5. Tumors that are most likely to occur after
exposure to ionizing radiation

- Leukemia
- Thyroid tumors
- Breast tumors
- Lung tumors
- Skin tumors
The total dose required to
produce carcinogenesis
when multiple short
exposure are taken could
be about twice that
required to produce
carcinogenesis as a result
of a single dose
3 Natural Sources of
Radiation That are Un
Avoidable:

1. Cosmic radiation
2. Radiation on the
earth
3. Radon
Cathode Electron mA
KV

Anode

Heat 99%
X Ray 1%

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5 Factors That Affect the
Patient Dose in
Radiography :

1.Source to patient distance

2.Patient thicknes
3.Exposure time
4. Use of a Collimator
5. Use of on X Ray Scatter
reduction grid
Proteksi Radiasi

Ditunjukan kepada:
1. Penderita
2. Petugas Radiasi
3. Petugas yang jarang terkena
radiasi
4. Masyarakat umum
 Exposure of the
Radiologist to
Radiations Is Controlled
by

1. Increasing the examiners

distance from the beam
2. Decreasing the
fluoroscopy time
3. Shielding
 There is no absolute limit for
radiation to a patient undergoing on
imaging procedure
The rule is to follow the ALARA
principle, (ic , to use the dose that
is as Low as Reasonably
Achievable).
 RADIATION EXPOSURE

1. Primary radiation exposure

- Exposure to the site being examine

2. Secondary radiation exposure

- Exposure to the sites not being
examined also know as Scatter
5 Ways Of Reducing Primary Radiation:
1. Perform only the clinically relevant
studies
2. Reduce the need for repeated studies.
3. Reduce the number of films taken
4. Choose appropriate films and screens.
5. Use an appropriate projection
CARDIAC
IMAGE T1
 ULTRA SOUND

1. Bersifat = gelombang suara biasa.

2. Non Invasive
3. Dapat melihat gerakan gerakan
4. Membedakan densitas organ
5. Relatif tidak berbahaya
6. Tomografi
 NUCLEAR MEDICINE

Radioisotope
Gamma Camera
PET
SPECT
Used with the other diagnostic modality

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 ADVANTAGES
1. Diagnose Purpose to see :
a. Organ function : - ren
- hepar
- vascularisation
b. Anatomi/patologi disorder

2. Therapy
a. Tumor ablation therapy
b. Tumor metastase therapy
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ADVANTAGES :
1. High sensititity
2. Can see organ function

DISADVANTAGES
1. Radiation dangerous
2. Low spesifitas

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Figure 1.2 99mTc thyroid scan of a patient with toxic diffuse goitre (Graves
disease) showing diffusely increased uptake and visualization the pyramidal
lobe.

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Figura 1.5 99mTc thyroid scan (a) showing a large multinodular goitre with
retrosternal extension in a patient with pressure symptoms and stridor who was
unsuitable for surgery. Following treatment with 400 MBq 131I the pressure
symptoms improved (b) and after 400 MBq (c) the goitre was notably smaller.

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Figure 4.14 Neublastoma metastases. This case demonstrates mixed cold and hot
metastases of neuroblas. Cold photopenic lesion are present in the spine (a) and ribs
(b). Hypermetabolic lesion are present in the ribs and metaphyses of long bones (a).

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 BASIC RADIOTHERAPY AND
NURSING

dr. Indrastuti Normahayu SpRad (K)

RADIOLOGIC DEPARTMENT
Dr. SAIFUL ANWAR HOSPITAL MALANG

2013 56
 RADIOTHERAPY
DEFINITION : THERAPY
- RAY-IONIZATION/PARTIKEL
RADIATION : - PASSES MATTER, INTERACT WITH
MATERIAL, TRANSFERRING SOME/ALL ENERGY TO THE
ATOM OF THE MATERIAL
RADIATION ATOM NETRAL ION

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 Indication
Benign tumor
Malignant tumor ( Sarcoma,Carsinoma)
Time : (depend on clinical patient)
- Elective Radiation
- Cito Radiation
- Urgent Radiation

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 RADIATION
A. PHOTON
- GAMMA RAY X RAY

B. PARTICLE :
SINAR ALPHA (+)
SINAR BETA (-)
ELEKTRON (-)
NEUTRON (+/-)
PROTON (+)

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 RADIOTHERAPY MACHINE
A. SOURCE
- NATURAL GAMMA
ATOM HALF LIFE
* COBALT 60 5 6 TAHUN
* CECIUM 23 30 TAHUN
* RADIUM 1500-1600 TAHUN
* IRIDIUM 72 HARI
- GENERATOR :
* LINIAC
* BETATRON
* CICLOTRON
B. ENERGY
1. GRANZ RAY THERAPY
2. CONTACT THERAPY
3. ORTHO VOLT :
- SUPERFICIAL
- DEEP VOLTAGE
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ADVANTAGE MEGA VOLTAGE MACHINE
SHARP FIELD AREA
MINIMAL SCATTER RAY
MINIMAL SIDE EFFECT IN BONES AND TISSUE
HIGH PENETRA TE

RADIATION SOURCE :
CLOSE
OPEN

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PROCEDURE OF RADIATION
A. RADIATION EXTERNAL:
1. TELETERAPI
2. BRACHYTERAPI
CARA : - INTRA CAVITER/INTRALUMINAR
- INTER STITIEL/IMPLANT
- CONTACT
TECHNIK :
- CONVENSIONAL
- AFTERLOADING
DEPEND ON DOSE:
- L D R > 8 JAM
- M D R APROX. 40 MENIT
-HDR MINUTES

B. INTERNAL RADIATION
- PER ORAL J 131
- PARENTERAL POSPOR
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THE SUCCESFULL OF RADIATION
THERAPY DEPEND ON :

* CONTINUITY THERAPY
PATIENT CONDITION
PRECISE OF RADIATION AREA
STAGING
ETIOLOGY TUMOR (Ca,Sa)

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TECHNICAL
RADIATION
1. STATIONARY : - 1 AREA
- 2 AREA PLAN PARALEL
TANGENSIAL
- MULTIPLE

2. ROTATION : - FULL
- PARTIAL
DOSE:
-1 RAD = 1 cGy
-100 RAD = 1 Gy

PURPOSE :
RADICAL CURATIVE
PHALIATIVE RELIEVING THE SYMPTOM OF
CANCER
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 Principles of radiobiology :

EFFECTS OF IRRADIATION ON CELLS

1. MOLECULER
DAMAGE DNA : PRINCIPLE DEATH CELLS
- SINGLE/DOUBLE STRAND BREAK
- CHANGES BASES DNA
- CROSS LINKE DNA PROTEIN
2. CELLULER
- ABRASIO CHROMOSOM
- INHIBITE REPRODUCTION
- INHIBITE PROLIFERATIVE

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 PREPARING IRRADIATION
A. STAFF ADMINISTRATION
- PREPARING EQUIPMENT
- EXPLAINED ABOUT RADIATION TO FAMILY AND PATIENT
- COST
- INFORMCONCENT
B. NURSE
- EXPLAINED PREREQUISE IRRADIATION
- EXPLAINED PROHIBITION
- EXPLAINED ACUT/CHRONIC SIDE EFFECTS
- EXPLAINED ADDED IRRADIATION IF NEEDFUL

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C. PATIENT
1. GENERAL CONDITION, LAB.
2. SIDE EFFECTS
3. NURSE DURING IRRADIATION
- Radiation area forbid to contact with water
- if necessity mictie,defecation clean with minimal
water and perspire with soft and dry towel
- forbid to use zalep/cream
- radiation in Nasopharynx area :
* forbid to use denture
* no teeth caries
* Post pull out teeth > 2 minggu
* forbid eat hot food
* Gargling, to dry mouth
* Give anti fungi oral
* Dysphagia analgetica

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 - Radiation area of uterine :
* Radiation area forbid to contact of water
* Forbid coitus for 2 weeks post
radiation

4. Adviced :
* Consumtion of fruits, vegetable, milk good condition
* outpatient, better hospitalized

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5. Follow up patient
a. durante radiation
- Check every 5 x radiation
check : - Hb
- Leucosit
- Thrombosit
- general condition, complaint or occur of side
effects
b. after radiation
- 2 weeks after radiation
- 1 month later
- 3 months later
- 6 months later and continue every 6 months
3 bulan post radiation ,check PA laboratory to evaluate the tumor

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6. Side effect (+) :
Refer to :
- Surgery department
- Rehabilitation medicine
- Psychiatri
- Family

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 Irradiation performed :
PREOPERATION
POST OPERATIVE
DURANTE OPERATIVE
CITOSTATIKA (+)
* PRECHEMOTHERAPY
* CHEMOTHERAPY (+)
* POST CHEMO
IMUNOTHERAPY
SINGLE

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 CITO RADIASI
DEFINITION:
EXAMPLE:
- VENA CAVA SUPERIOR SYNDROME
- BLEEDING PROFUS
- HIGH SERUM CREATININ

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URGENT RADIATION

DEFINITION :
EXAMPLE :
- METASTASE VERTEBRAE
- JOINT SPACE NARROWING

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 SIDE EFFECT IRRADIATION
1. ACUT INFLAMASI
TIME 6 8 WEEKS
- GENERAL:
* RADIATION SIKCNESS
* DEPRESSED OF HEMOPOITIC S
* NAUSE, HEAD ACHE DLL
- LOKAL :
* ERYTHEMA
* DISKUAMASI
* MUCOSITIS
* IRITATION
* DRY MOUTH
* DISURIA, DLL
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2. CHRONIC : FIBROSIS IRREVERSIBLE
- TIME : > 8 WEEKS
- GENERAL :
* HEMATOLOGIC DISORDER
- LOCAL :
* PIGMENTATION
* ATROPHI
* TELEANGECTACIS
* ULCERASION
* FIBROSIS
* NECROSIS

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DOSE OF IRRADIATION DEPEND ON :
KINDS OF TUMOR
PURPOSE (RADICAL/PHALIATIVE)
TOLERANCE OF AROUND TISSUE
STAGING
PRE/POST OP

RADIATION PROTECTION:
1. MACHINE SPECIAL PROTECTION (+)
2. BUILDING : - THICKNESS
- PLUMBUM LAYER
- SPECIAL GLASS
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3. OPERATOR :
- APRON
- FILM BADGE
- AFTERLOADING
- HIGH CALORY ,HIGH PROTEIN

4. PASIENT
- BLOCK
- WHOLE ABDOMEN BLOCK HEPAR, REN
- WHOLE PELVIS BLOCK LIGAMENTUM INGUINALE
- NASOPHARYNX PLANPARALEL 4000 cGy
MEDULLA SPINALIS ,
BLOCK(+) ETC
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PREREQUSED IRRADIATION :

Hb 10 gram %
LEUKO 3000 10.000
THROMBOSIT 100.000 AMBULATORY
> 80.000 HOSPITALIZED

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