JRI (Jurnal Radiografer Indonesia)

The Teknik Pemeriksaan Dacryocystography Dengan Klinis Obstruksi Ductus Nasolacrimal

Raditya Faradina — 2023-12-06

Background: One examination using contrast media that is rarely encountered is the Dacryocystography examination. At one type A hospital in Jakarta only 34 examinations were carried out in 2019, while at another type A hospital this examination was not carried out at all. Dacryocystography examination is a radiological examination of the nasolacrimal system by filling the luminal canal with radiopaque contrast. This examination will not be visible well without using contrast. Based on the experience that the author found during practice at one of the type A hospitals in Jakarta, the Dacryocystography examination with clinical Nasolacrimal Ductus Obstruction only uses 1 (one) projection, namely AP (Anteroposterior). In contrast, according to Ballinger (2011), this examination uses 3 (three) projections—namely PA Caldwell, PA Waters, and Lateral.

Methods: This research is descriptive and qualitative in nature, namely by conducting observations, interviews, and documentation at the KIARA radiology installation, RSUPN Dr. Cipto Mangunkusumo. With 1 (one) sample, interviews with 3 (three) radiographers and 3 (three) radiology specialists. Dacryocystography technique: the patient without preparation is then taken on a plain AP photo, then contrast media is injected into the lacrimal punctum of both eyes of the patient and a post-contrast photo with AP projection. Then the patient's eyes are dripped with NaCl to reduce the concentration of the contrast medium.

Results: The results of the study showed that the Nasolacrimal Ductus was blocked because the contrast medium stopped at the location of the nasolacrimal duct blockage.

Conclusions: In the Dacryocystography examination with clinical Nasolacrimal Ductus Obstruction, contrast media is injected using a special syringe that has been modified in the form of a bent and blunt needle. For projections, only 1 projection is used, namely Antero Posterior (AP) for preliminary photos and post-contrast photos which will depict the image of the Nasolacrimal Ductus having obstruction or blockage.

Pelaksanaan Quality Control Pesawat Sinar X di Pelayanan Radiodiagnostik

Panji Nurcahyo — 2023-12-06

Background: Quality Control can be used as a monitoring of the reliability of X-Ray Unit during the validity period of the Conformity Test Certificate. During the use of X-ray Unit, there is the potential for damage to components during the validity period of the certificate of passing the Compliance Test. If the X-Ray Unit Reliability Test is only carried out during the Compliance Test, then if there is a decrease in the quality and safety of the X-ray Unit it cannot be immediately known. This has the potential to endanger patients, radiation workers and the public. In Banyumas Regency, there are 80 Radiation Source Utilization Permits spread across 34 radiodiagnostic installation. Preliminary studies show that not all radiodiagnostic installation carry out routine X-ray machine reliability tests according to the Keputusan Menteri Kesehatan Republik Indonesia Nomor 1250/Menkes/SK/XII/2009 Tentang Pedoman Kendali Mutu (Quality Control) Peralatan Radiodiagnostik.

Method: This research type is qualitative with survey of 20 radiodiagnostic installation using a questionnaire instrument. Quality control conducted periodically includes kVp accuracy test, linearity and reproducibility mA, exposure time accuracy test, tube leak test, collimator beam suitability test, collimator shutter efficiency test, collimator light strength test, HVL measurement, implementation of reject analysis program and availability and qualifications of quality control officers and availability of quality control equipment. Then the data will be grouped based on research objectives and presented descriptively.

Result: From the results of data collection, 1 hospital did not have a quality control officer and 4 hospitals had a quality control officer with an educational background of Diploma IV in Radiology Engineering without any Radiology Equipment Quality Control training. Meanwhile, 15 hospitals have quality control officers with an educational background in the Medical Physics Undergraduate Program and have attended training in Quality Control of Radiology Equipment. Of the 20 hospital radiology installations, there were 7 hospitals that did not carry out the Reject Analysis Program. This was done with the assumption that Digital Radiography had been used in both the CR and DR modalities. A number of 13 hospitals continued to carry out the Reject Analysis Program even though they had used Digital Radiography. Of the 20 hospital radiology installations, there are 6 hospitals that independently carry out X-ray unit testing within the framework of a quality control program. However, only 1 hospital conducts regular testing. Testing is also limited to the accuracy of the collimator field and the strong light of the collimator. Fourteen hospitals did not carry out a quality control program independently but only carried out an X-ray unit calibration test once a year which was carried out by BPFK and an X-ray unit distributor company.

Conclusion: The implementation of quality control of x-ray machines on a regular basis has not been carried out by all radiodiagnostic services, even though they already have quality control officers. One of the reasons is the availability of quality control equipment needed for testing and supervision of radiodiagnostic service management. The role of management of radiodiagnostic services is needed to overcome these problems.

Keyword : Quality Control Programe, Compliance Test, X-Ray Unit

Penegakan Diagnosa Nasopharynx Cancer (NPC) Dengan Radiografi Bone Survey Pediatric di RSUP Dr. Sardjito Yogyakarta

Asih Puji Utami — 2023-12-06

Background: Paediatric bone survey examination technique in nasopharyngeal cancer (NPC) at the Radiology Installation of Dr. Sardjito Yogyakarta only performed on the object of the AP projection and lateral head projection, thoracal, abdominal pelvis, femur, cruris, humerus and AP projection antebrachia. The purpose of this study is to determine the radiographic examination technique of paediatric bone surveys, the reasons for only focusing on the thoracic, the reasons for the number of objects being fewer than the opinion of Cohen et al (2021) and the reasons for using a lateral projection of the head

Methods: This research was a participatory observational with a case study approach at the Radiology Installation of. RSUP (Government General Hospital) Dr. Sardjito Yogyakarta. Three radiographers, two radiography specialists, and one radiology trainee served as the research subjects for this study, which used direct interviews, participatory observation, and documentation.

Results: The results of this study is the cervical was visible on the head photo and for the lumbar it was visible on the abdominal pelvis photo, the low validity of the bone survey and the low probability of bone metastases, and to expose the head laterally to the AP..

Conclusions: The authors suggest that patients are given an apron and it is preferable to use PET-CT Pediatric bone survey examination, namely head, thoracic, lumbosacral, pelvis, both femurs, both cruris, both humerus, and both antebrachii. There is no cervical examination because it can already be seen from the lateral head examination, because the bones of the head are flat bones. And the validity of BMD is <60%

Kasa Bedah Yang Tertinggal Setelah 1 tahun Tindakan Operasi: Studi Kasus Prosedur Pemeriksaan MRI Whole Abdomen Gossypiboma

Agi Febrian Trihadijaya — 2023-12-06

Background: A 30-year-old woman came to our radiology installation with complaints of radiating pain and abdominal cramps. It is known that this woman had undergone surgery for an ectopic pregnancy one year ago at another hospital, this research aims to know the whole abdomen MRI examination procedure with gossypiboma cases.

Methods: A qualitative research using a case study approach was carried out in March 2023 at Hermina Bekasi Hospital, with a sample of 1 Gossypiboma patient in the suprapubic area.

Results: Whole abdomen Magnetic Resonance Imaging (MRI) in radiology examination, found an inhomogeneous hypointense lesion on T1FSE to hyperintense inhomogene on disuprapubic T2FSE, benign suprapubic solid lesion with granula formation of 6.5x7.4x6.2 cm which is suspected to be surgical gauze left behind due to a history of ectopic pregnancy surgery 1 year ago. The lesion was removed by laparoscopic excision and the final diagnosis was gossypiboma.

Conclusions: Radiological imaging plays an important role in diagnosing Gossypiboma considering that this case is closely related to high legal implications and directly involves patient mortality and morbidity. Selection of examination modalities, examination procedures as well as accurate and careful reading of results is necessary.

Penatalaksanaan Radioterapi Melanoma Pedis Teknik 3D-CRT

Nida Hanifah — 2023-12-07

Background : Radioteraphy is one of the cancer treatment. Radiation techniques in Melanoma Pedis at MRCCC Siloam Semanggi Hospital can be done with 3 Dimensional Conformal Radiotherapy (3D-CRT) technique. The purpose this research is to evaluation the treatment of radiotherapy using the 3D-CRT techniques at MRCCC Siloam Hospital.

Method : The type of the research is used qualitative with a case study approarch of Melanoma Pedis using 3D-CRT technique in a 69 years old female with IV stage, curative therapy with fraksination 30x1.8 Gray (Gy).

Result : The treatment of radioteraphy to Melanoma Pedis with 3D-CRT technique was chosen taking into account the high stage of the cancer, the purpose of giving radiation that is curative, and none of Organ At Risk (OARs) must be protected.

Conclusions: The treatment of radiotherapy to Melanoma Pedis using 3D-CRT tecnique at MRCCC Siloam Semanggi Hospital is done through in several stages, such as : consulting a Radiation Oncologist at the Radiotherapy Polyclinic, do a simulation on the Computer Tomograpy (CT) simulator, calculated dose at Treatment Planning System (TPS), Process of geometry verification is done before the treatment and then continued with the process of treatment in the linac room

Pergeseran Verifikasi Geometri Kasus Kanker Payudara Teknik 3D-CRT menggunakan On Board Imager (OBI)

Sasa Herdiyani — 2023-12-06

Background: this research is one of the efforts to ensure the accuracy of the irradiation field in breast cancer cases with 3D-CRT technique by verifying the geometry using On Board Imager (OBI), therefore the dose received is exactly right on the target during the treatment and can reduce the impact that will be caused.

Methods: The type of this research is used qualitative research method, the study was undertaken starting from January up to May 2023 at a radiotherapy installation of one of Jakarta regional hospitals. As for the samples taken were 40 breast cancer patients, using primary data in the form of observation and interviews and secondary data is in the form of the patient’s data who had already completed the treatment..

Results: this research showed that there is a shift in the irradiation field that exceeds the tolerance limit at X, Y and Z coordinates, and this verification in 3-DCRT technique is accordingly carried out at multiples of 10 for each irradiation, which is precisely executed at the fractions of 1, 10 and 21.

Conclusions: showed that there is an excessive shift in the geometry verification carried out on the related samples to exceed the established tolerance limits (> 0.5 cm). This occurs due to several random errors such as the loss of markers in the patient's body or systematic errors due to mismatches between procedures during radiation planning and when radiation irradiation is carried out.

Analisis Dosis Radiasi Paru-Paru Pada Kanker Payudara Post Mastektomi Menggunakan Teknik Field in Field 3D CRT

Ni Putu Lia Andri Yantini — 2023-12-06

Background: Breast cancer is one of the leading causes of death worldwide and ranked first in Indonesia with 58,256 total cases. Radiotherapy with Field in Field 3D CRT technique is used as a method of post-mastectomy breast cancer treatment using ionizing radiation to stop the growth of cancer cells. The lungs are the most vulnerable organ exposed to radiation so that the radiation dose needs to be controlled. The purpose of this study was to analyze the lung radiation dose in the Field in Field 3D CRT technique with post-mastectomy breast cancer cases at the Radiotherapy Unit of Lavalette Hospital Malang.

Methods: This study is a quantitative study using retrospective data. The study population was all post mastectomy breast cancer patients who underwent radiotherapy irradiation in 2022 at the Radiotherapy Unit of Lavalette Hospital Malang. The sampling technique used was total sampling so that the sample of this study was 37 patients.

Results: The value of lung radiation dose in post-mastectomy breast cancer using Field in Field 3D CRT technique includes mean dose of ipsilateral lung of 1757.23 cGy, mean dose of contralateral lung of 76.19 cGy, V20 of ipsilateral lung of 35.7%, and V20 of contralateral lung of 0%. Based on the results of statistical tests that show that the p value <0.05, which means there is a significant difference in the radiation dose received by the ipsilateral lung and the QUANTEC dose standard.

Conclusions: The mean dose value of the ipsilateral lung in post-mastectomy breast cancer using the Field in Field 3D CRT technique has met the QUANTEC dose tolerance limit. However, the V20 value in post -mastectomy breast cancer using the Field in Field 3D CRT technique does not meet the QUANTEC dose tolerance limit. The reasearch summary and an extra tought (if any) must be well expressed in this section.

Literatur Review Teknik Pemeriksaan CT-Scan Kepala Klinis Cephalgia

Ria Saputri — 2023-12-06

Background: Cephalgia is pain around the head area. One of the diagnostic supporting modalities that can help establish the diagnosis of cephalgia is to perform a CT-scan. This study aims to determine the examination technique, the use of parameters and to determine the role of the use of contrast in CT-scan examination of the head with clinical cephalgia.

Methods: This research is a type of literature review research using descriptive qualitative research methods. This study uses 5 research journals that have been analyzed according to the research objectives.

Results: All journals reviewed have 3 journals that provide complete information regarding examination techniques including patient preparation, tool preparation, patient position and object position. The use of parameters in all major journals used includes scanogram, slice thickness, scan area, kV, mAs, FOV and window. There are 4 journals that provide information about the role of using contrast for CT-scan examination of the clinical head of cephalgia.

Conclusions: The cephalgia clinical head CT-scan technique includes preparing the patient by removing metal objects in the head area. The scan parameters used are the lateral cranium scanogram, slice thickness of 5 mm, scan area from maxillary sinus to vertex, kV 120, mAs 250, FOV 250 mm , and window brains. The use of contrast media is done when abnormalities are suspected, for example tumors, aneurysms and disorders due to infection such as meningitis or encephalitis because with contrast the location of the abnormality can be seen.

Prosedur Pemeriksaan MRI Pelvis Pada Kasus Kanker Serviks di Instalasi Radiologi RSUP Dr. Hasan Sadikin Bandung

Fatimah — 2023-12-06

Background: Cervical cancer is a carcinogenesis due to metaplastic process in squamocolumnar junctions. Based on the literature, DCE was not included in pelvic MRI protocol. However, at Radiology Department of RSUP Dr. Hasan Sadikin Bandung, pelvic MRI for cervical cancer cases utilized T1W VIBE sagittal dynamic sequence with DCE method. This research is aimed to perceive the procedure, the advantages and the disadvantages of T1W VIBE sagittal dynamic in pelvic MRI for cervical cancer cases.

Methods: This is qualitative research with case study approach. Data collection was accomplished in March-May 2023 at Radiology Department of RSUP Dr. Hasan Sadikin Bandung through observation, in-depth interview with radiographers, radiologist, and referring doctor, and documentation study. Interactive Analysis Model was utilized to analyze the data through data collection, coding, data display, and verification.

Results: The results showed, patient preparations started with screening, patients were instructued to change clothes to patient gowns and remove metal objects, IV-line insertions and intravaginal and intrarectal ultrasound gel injections. Pre-contrast sequences of Pelvic MRI were T1W TSE axial, coronal, sagittal; T2W HASTE axial, coronal, sagittal; T2W HASTE fat suppression sagittal, T2W TSE STIR coronal, DWI sagittal and post-contrast sequences were T1W VIBE sagittal dynamic, and T1W TSE fat suppression axial, sagittal dan coronal.

Conclusion: The advantages of T1W VIBE sagittal dynamic were its ability to determine cancer staging, lesion characteristic, tumor invasion to adjacent organs and likewise to detect fistulas. The disadvantages of this sequence were the long scan times, the risks of adverse reactions and the added cost from contrast media usage.

Penatalaksanaan Radioterapi Booster Elektron Pada Kasus Kanker Payudara

Zahra Faradisi — 2023-12-06

Background : Radioteraphy is one of the cancer treatment. Booster radiation in breast cancer aimed for eliminating microscopic tumor cells that may remain around the tumor bed. Electron beams are used in radiation boosters in cases of breast cancer because they provide an advantage in terms of uniformity of the target volume dose and in minimizing the dose to deeper tissues, namely the lungs and heart. Cancer has an irregular tumor shape and growth, in order to deliver the right dose to the tumor but still minimize the dose to at-risk organs, the electron beam irradiation field generated by Linac needs to be formed using individual electron blocks made based on calculation plans in the Treatment Planning System ( TPS).The purpose this research is to evaluation the treatment of radiotherapy using electron booster techniques at MRCCC Siloam Hospital

Method : The type of the research is used qualitative with a case study approach of breast cancer using electron booster technique in a 46 years old female, curative therapy with fractionation 8x2.5 Gray (Gy)

Result : The treatment of boost radiotherapy to breast cancer with electron booster technique was chosen to minimize radiation to lung and heart, the purpose of giving radiation that is curative

Conclusions: The treatment of radiotherapy electron booster for breast cancer in MRCCC Siloam Semanggi Hospital is done through in several stages, such as : consultation with Radiation Oncologist at the Radiotherapy Polyclinic, do a simulation on the Computer Tomograpy (CT) simulator, calculated dose and making the design of individual block at Treatment Planning System (TPS), making individual electron blocks using an autocutter in the mould room, Process of geometry verification is done before the treatment and then continued with the process of treatment in the linac room.