Oesophagus Maag Duodenum

JURUSAN TEKNIK RADIODIAGNOSTIK DAN

RADIOTERAPI
TR MAAG

Pengertian :
Adalah pemeriksaan secara radiografi
dengan menggunakan media kontras
(posisif dan negatif) untuk
menampakkan kelainan pada lambung.

Biasanya mrpk pemeriksaan satu paket

dengan Oesophagus dan Duodenum
(OMD = Oesopagus Maag Duodenum)
 INDIKASI PEMERIKSAAN
1. Bezoar  Undigested material thah become trapped in stomach (biasanya
berupa rambut, serat sayuran, atau bahan kayu)
• Tricobezoar : berupa rambut yang tertelan
• Phytobezoar : berupa serat sayuran atau biji
2. Divertikula : penonjolan keluar dr maag yg membentuk kantung (banyak
terjadi pd fundus)
3. Gastritis : radang pada dinding lambung (baik acut ataupun kronik)
4. Hematemesis : perdarahan
5. Neoplasma (tumor atau kanker)
6. Hernia hiatal : sebagian lambung tertarik ke atas diafragma krn esofagus yg
pendek atau melemahnya otot diafragma
7. Stenosis pylorus : penutupan atau penyempitan dr lumen pylorus
8. Ulcer/ulcus/tukak : Erosi/luka terbuka pd permukaan selaput lendir lambung
(krn cairan gaster, diet, rokok, bakteri)
9. Regurgitasi
KONTRA INDIKASI
• Persangkaan perforasi tdk boleh
menggunakan BaSO4  water soluble
kontras (Urografin, Iopamiro)

• Obstruksi usus besar

 Stomach
(Maag = Gaster = Lambung)

• Stomach, terletak diantara esophagus dan

usus halus, Merupakan bagian yang
mengalami pelebaran/dilatasi pada
alimentary canal.

• Stomach terdiri dr 4 bagian besar yaitu :

Cardiac, fundus, body atau corpus dan
pylorus.
Anatomi
 Anatomi
• Panjang 8-10 Inches
• Bentuk C
• Letakny dekat
dengan head of
pancreas
Anatomi Duodenum
• Bagian-bagian:
– The first (superior)
portion
– The second
(descending) portion
– The third
(horizontal) portion
– The fourth
(ascending) portion
Body Habitus
• Tipe dr body habitus memberikan efek yang
sangat besar terhadap lokasi organ pencernaan
pada rongga abdomen.
• Untuk keakuratan dan konsistensi posisi dr
organ pencernaan perlu diketahui karakteristik
dan klasifikasi dari body habitus.
• Terdapat 4 kelompok body habitus yaitu :
hypersthenic, sthenic, hyposthenic and
asthenic.
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 Persiapan alat dan bahan
• Pesawat sinar-X + • Obat emergensi : dexametason,
Flouroscopy delladryl, dll
• Film + kaset + grid • Media kontras barium sulfat
ukuran 24 X 30 cm, • Air minum
30 x 40 cm • Barium Encer (dg air hangat )
• Apron (BaSO4 : air = 1 : 4)
• Sarung tangan Pb • Kontras negatif  tablet
• Baju pasien efferfecent, natrium sulfas,
• Gelas dan sendok sprite dll
• Tissue
• Bengkok
• Baju pasien
• Marker
Persiapan Pasien
• Pasien diberi penjelasan tentang pemeriksaan yg akan
dilakukan  kooperatif
• 2 hari sebelum pemeriksaan pasien diet rendah serat
u’ mencegah pembentukan gas akibat fermentasi
• Lambung harus dlm kondisi kosong, u’ memastikan
lambung kosong dr makanan dan air pasien puasa 8 –
9 jam sebelum pemeriksaan
• Pasien tidak diperbolehkan mengkonsumsi obat-
obatan yg menggandung substansi radiopaque seperti
steroid, pil kontrasepsi dll
• Sebaiknya kolon bebas dr fecal material dan udara
bila perlu diberikan zat laxative
• Tidak boleh merokok (nicotine merangsang sekresi
saliva).
• Pasien diminta mengisi inform concent
 PROSEDUR SINGLE KONTRAST
1. Penjelasan pada pasien ttg prosedur Foto Polos abdomen
2. Dilakukan Persiapan pemeriksaan
3. Dibuat foto polos abdomen/dilakukan flouroskopi hepar,
dada dan abdomen
4. Pasien diberikan Media Kontras ± 1 gelas
5. Jika memungkinkan pasien dalam posisi berdiri, jika
pasien recumbent pasien minum dengan sedotan
6. Pasien diinstruksikan minum 2 – 3 teguk media kontras,
dilakukan manipulasi agar seluruh mukosa terlapisi diikuti
flouroskopi atau dibuat foto yg dibutuhkan.
7. Setelah melihat rugae pasien minum sisa barium u’
melihat pengisian penuh dan duodenum
8. Dg teknik fluoroskopi pasien dirotasi dan meja dp
disudutkan shg seluruh aspek oesophagus, lambung dan
duodenum terlihat
 PROYEKSI PEMOTRETAN
1. PA erect (film 30 x 40)  u’ melihat type dan posisi
lambung
2. Lateral erect  u’ melihat space retrogastric kiri
3. PA recumbent  u melihat gastroduodenal surface
4. PA Oblik (RAO)  u’ melihat pyloric canal dan
duodenal bulb
5. Right Lateral Decubitus  duodenal loop,
duodenojujunal junction dan retrograstric space
6. AP recumbent  melihat bagian fundus terutama pada
teknik double kontrast, rotasi lateral u’ melihat lesi pada
dinding anterior dan posterior, retogastric portion dr
jejunum dan illium
7. Variasi supine dg mengatur kepala lebih rendah 25o –
30o u melihat hernia hiatal dan 10o - 15o dan rotasi
pasien ke depan (sisi kanan dekat meja) u’ melihat u
melihat gastroesophageal junction juga untuk melihat
regurgitasi
 PROSEDUR DOUBLE KONTRAST
• Setelah minum media kontras positif, pasien
diberikan pil, bubuk carbonat dsb u menghasilkan
efek gas.
• Pasien diposisikan recumbent dan diinstruksikan u
berguling-guling 4 – 5 putaran shg seluruh mukosa
lambung terlapisi media kontras
• Dpt diberikan glucagon atau obat lain u mengurangi
kontraski lambung (lambung lebih relax)
• Dilakukan pengambilan foto dg proyeksi sesuai yang
diinginkan sama pada teknik single kontrast
• Bila menggunakan fluoroskopi diambil spot foto
pada daerah-daerah yang diinginkan
Projections of OMD
• Esophagram • Upper GI Series
(Barium swallow) Basic
Basic • RAO (recumbent)
• RAO (350 to 400) • PA (recumbent)
• Lateral • Right lateral
• AP (PA) (recumbent)
Special • LPO (recumbent)
• LAO • AP (recumbent)
 RAO Position : Upper GI Series
• Patient position : position patient recumbent, with the body
partially rotated into an RAO position; provide pillow for head.
• Part position : From a prone position, rotate 400 to 700, with
right anterior body against IR or table. Place right arm down
and left arm flexed at elbow and up by the patient’s head. Flex
left knee for support.
RAO Position : Upper GI Series
• Central Ray : Direct CR
perpendicular to IR.
– Sthenic type : center CR and
IR to duodenal bulb at level of
L2 (1 to 2 inches or 2,5 to 5 cm
above lower lateral rib margin),
midway between spine and
upside lateral border of
abdomen.
– Asthenic : center about 2
inches or 5 cm lower level of
L2.
– Hypersthenic : center about 2
inches or 5 cm above level of
L2 and nearer midline. Center
cassette to CR. Minimum SID
is 40 inches (100 cm)
• Collimation : collimate on four sides to outer margins of IR or to
area of interest on large IR.
• Respiration : suspend respiration and exposeon expiration.
Strctures shown : entire stomach and C-loop of
duodenum are visible
 PA Projection : Upper GI Series
• Patient position : position patient prone, with arms up
beside head; provide pillow
• Part position : Align midsagital plane to midline to CR and
to table. Ensure that the body is not rotated.
PA Projection : Upper GI Series
• Central Ray : Direct CR
perpendicular to IR.
– Sthenic type : center CR and IR
to level of pylorus and
duodenal bulb at level of L2 (1
to 2 inches or 2,5 to 5 cm above
lower lateral rib margin), and
about 1 inch (2.5 cm) left of the
vertebral column.
– Asthenic : center about 2 inches
or 5 cm below level of L2.
– Hypersthenic : center about 2
inches or 5 cm above level of
L2 and nearer midline. Center
cassette to CR. Minimum SID
is 40 inches (100 cm)
•Collimation : collimate on four sides to outer margins of IR
or to area of interest on large IR.
•Respiration : suspend respiration and expose on expiration.
•Strctures shown : entire stomach and duodenum are visible
 Right Lateral Position : Upper GI Series
• Patient position : position patient recumbent in a right-lateral
position. Provide pillow for head. Place arms up by the
patient’s head and flex knees.
• Part position : ensure that shoulders and hips are in a true
lateral position. Center IR at CR (botton of cassette about at
level of iliac crest)
 Right Lateral Position : Upper GI Series
• Central Ray : Direct CR
perpendicular to IR.
– Sthenic type : center CR and IR
to duodenal bulb at level of L1
(level of lower lateral margin of
the ribs) and 1 to 11/2 inches or
2,5 to 4 cm anterior to
midcoronal plane (near midway
between anterior border of
vertebra and the anterior
abdomen)
– Hypersthenic : center about 2
inches or 5 cm above L1.
– Asthenic : center about 2 inches
or 5 cm below [Link]
SID is 40 inches (100 cm)
Collimation : collimate on four sides to outer margins of IR or to
area of interest on large IR.
Respiration : suspend respiration and expose on expiration.
Strctures shown : entire stomach and duodenum are visible
 LPO Position : Upper GI Series
• Patient position : position patient recumbent, with the
body partially rotated into an LAO position; provide pillow
for head.
• Part position : rotate 300 to 600 from supine position, with
left posterior against IR or table. Flex right knee for
support. Extend left arm from body and raise arm right high
across chest to grasp end of table for support. Center IR at
CR Center IR at CR (botton of cassette about at level of
iliac crest)
LPO Position : Upper GI Series
• Central Ray : Direct CR
perpendicular to IR.
– Sthenic type : center CR and IR
to level of L1 (about midway
between xiphoid tip and lower
lateral margin of ribs), and
midway between midline of body
ang left lateral margin of
abdomen.
– Asthenic : center about 2 inches
or 5 cm below level of L2.
– Hypersthenic : center about 2
inches or 5 cm above level of L2
and nearer midline. Minimum
SID is 40 inches (100 cm)

Collimation : collimate on four sides to outer margins of IR or

to area of interest on large IR.
Respiration : suspend respiration and exposeon expiration.
Strctures shown : entire stomach and C-loop of
duodenum are visible
 AP Projection : Upper GI Series
• Patient position : position patient supine, arms at sides;
provide pillow for head
• Part position : Align midsagital plane to midline to
table. Ensure that the body is not rotated. Center cassette
to CR. (Cassette should be about at level of iliac crest)
• Alternative AP Trendelenberg  hiatal hernia (for a
stenic patient)
 AP Projection : Upper GI Series
• Central Ray : Direct CR
perpendicular to IR.
– Sthenic type : center CR and
IR to level of L1 (about
midway between xiphoid tip
and lower lateral margin of
ribs), midway between
midline and left-lateral margin
of abdomen.
– Hypersthenic : center about 1
inch or 2,5 cm above L1.
– Asthenic : center about 2
inches or 5 cm below and
nearer to midline Minimum
SID is 40 inches (100 cm)
•Collimation : collimate on four sides to outer margins of IR or to
area of interest on large IR.
•Respiration : suspend respiration and expose on expiration.
•Strctures shown : entire stomach and duodenum are visible.
Diafragma and lower lung fields are include for demonstration of
possible hiatal hernia.

AP Supine

AP Trendelenburg
PATHOLOGIC CONDITIONS
GASTRITIS

• Inflammation of the lining or mucosa of

the stomach.
• May develop in response to various
physiologic and environmental
conditions.
• ACUTE GASTRITIS: severe symptoms
of pain and discomfort.
• CHRONIC GASTRTITIS: intermittent
condition that may be brought on by
changed in diet, stress or life style.
• HELICOBACTER PYLORIC can cause
CHR. GS. That may lead to peptic ulcer
disease.
• Radiographic appearance: absence of
rugae folds, thin gastric wall or Speckled
appearance of the mucosa.
• PHLEGMONUS EMPHYSEMATOUS:
produces by bacteria.( Purulent
inflammation and infiltration of
connective tissue.[Link].
GASTRIC CARCINOMA

• Cancer of the stomach or

Neoplasms of stomach
• Pain is infrequently an early
symptom.
• Is rarely noted until the disease is
far advanced and thus a dismal
prognosis.
• Survival state rate 10%
• Most carcinomas occur in the distal
stomach and are ADENOMATOUS
in nature.
• Increase risk in patients with
Atrophic Gastric mucosa, as in
Pernicious Anemia.
HIATAL HERNIA

• Most frequent abnormality,

occurring in 50% of the population.
• Portion of the stomach lies within
the thoracic cavity going thru the
diaphragmatic opening.
• Changed intraabdominal or
intrathoracic pressure.
• Most hiatal hernias do not produce
symptoms and are clinically of no
importance.
• A sliding hernia produce a
radiographic sign called
SCHATZKE’S RING, which is a
ringlike constriction at the distal
esophagus.
PEPTIC ULCER

• Inflammatory process involving the

stomach and duodenum.
• It cause by the action of acid and the
enzymes pepsin secreted by the
stomach and occurs most
frenquently on the L.C.
• Small or shallow superficial
erosions to huge ulcers 
perforation.
• Major complications are
hemorrhage.
• Radiographic appearanceulcer
crater.
Hernia , Ulcer
 Gastritis

Obstruksi
Ulcer, 3 week after
formalin ingestion
 Hypotonic

Maglinant Lession
 A. Distal esophagus
B. Area of esophagogastric
juction
C. Lesser curvature of stomach
D. Angular notch of stomach
E. Pyloric portion of stomach
F. Pyloric valve or sphincter
G. Duodenal bulb of duodenum
H. Second (descending) portion
of duodenum
I. Body of stomach
J. Greater curvature of stomach
K. Gastric folds, or rugae of
stomach
PA Projection L. Fundus of stomach