INTERNATIONAL OF MULTIDISCIPLINARY: APPLIED BUSINESS AND EDUCATION RESEARCH Radiography of the Paranasal Sinus with Maxial Sinusitis in North Sumatra-Medan University Hospital

Paranasal sinus radiography is an appropriate method for showing abnormalities in the paranasal sinuses and showing abnormalities in suspected Maxillary Sinusitis. The purpose of this examination is to determine the location and location of sinusitis by obtaining an optimal picture with radiographic examination of the paranasal sinuses. This research was conducted at the Radiology Installation of the University of North Sumatra-Medan Hospital. Using a general X-ray unit with an aircraft capacity of 1100 mA in February 2022 - May 2022, with a qualitative descriptive research type. To show the an-atomical description and pathological abnormalities in the paranasal sinuses, especially maxillary sinuses, parietoacanthia (water's method) and lateral projections are used. The results of the examination showed that there was Sinusitis Maxillaris Sinistra and a suspected Sinusitis Ethmoidalis Sinistra.


Introduction
The paranasal sinuses are air-filled cavities lined by a mucous membrane that surrounds the nasal cavity. As for the paranasal sinuses divided into four groups according to the location of the bone, namely maxillary sinuses, frontal sinuses, ethmoidal sinuses and sinuses sphenoidalis. According to Cappello et al. (2018) Since The maxillary sinus is a pair of sinuses that has the largest structure located anteriorly and is part of the facial bone while the frontal sinuses are located between the inside and out-side of the skull, the ethmoidal sinuses are located within the ethmoid bone, and the sphenoidal sinuses are located in the sphenoid and posterior bones. The ethmoidal sinus is part of the cranium (Y. Jeon et al., 2021). The paranasal sinuses, according to Murata et al. (2019), have functions such as a sound resonance chamber, lighten head weight, help warm and humidify inhaled air, act as vibration dampers, and play a role in controlling the immune system. According to Little et al. (2018) the paranasal sinuses have several indications such as polyps and one of the most frequently encountered is sinusitis.
Based on data from the Ministry of Health of the Republic of Indonesia in 2003 (Idugboe et al., 2018), it was stated that nasal and sinus disease was ranked 25th out of 50 major disease patterns or about 102,817 outpatients in hospitals (Huang et al., 2019) . Sinusitis is an infection of the sinus mucosa and can be categorized as acute or chronic sinusitis. Patients with sinusitis will feel headache, pain, swelling around the infected sinus and accompanied by low-grade fever (Terlemez et al., 2019). To establish the diagnosis in patients with sinusitis can be done through radiological examination of the paranasal sinuses. In the examination of the paranasal sinuses , there are several projections used in the examination of the paranasal sinuses , namely, the postero anterior (PA) projection of the Caldwell method to show the frontal sinus , and the ethmoidal sinus from the anterior aspect (H.-G. . The second projection is lateral facebone to show the four sinuses from the lateral side (frontal sinus, maxillary sinus, ethmoid sinus and sphenoid sinus) . The third projection is the pariethoacanthial Water's Closed Mouth method to show the maxillary and frontal sinuses (Dave et al., 2020). In addition there are two additional projections in the examination of the paranasal sinuses, including the submentovertex projection to show the ethmoidal and sphenoidal sinuses. And the pariethoacanthial projection of the Water's Open Mouth method to show the maxillary sinus, frontal sinus and sphenoid sinus (Sheikh et al., 2018).
In accordance with the cases raised in the diagnosis of maxillary sinusitis, the authors will discuss more about the appropriate radiographic technique (Lim et al., 2022;Starkey & Mortman, 2019). In connection with the background of the problem and the scope of the radiography of the paranasal sinuses with suspected Maxillary Sinusitis, the authors formulate the problem that arises is "How are the efforts made to obtain the results of radiographs of the paranasal sinuses with the suspicion of optimal Maxillary Sinusitis? at the University of North Sumatra-Medan Hospital?" The purpose of this study was to find out how the process of examining the paranasal sinuses suspected of maxillary sinusitis at the University of North Sumatra-Medan Hospital (Kuwana et al., 2021). And the second is to find out the right radiographic technique to produce an optimal picture on radiographic examination of the paranasal sinuses suspected of maxillary sinusitis (Al Qahtani, 2019). And the third is to find out the results of the radiographic examination of the paranasal sinuses with a suspicion of maxillary sinusitis. And the last one can show the anatomy and abnormalities of the paranasal sinuses , especially with clinical maxillary sinusitis (Fenner et al., 2019).

Methods
Research on paranasal sinus radiography with cases of maxillary sinusitis uses qualitative research (Zhou et al., 2021). The data collection technique is based on the results of observations and interviews. Qualitative research techniques are research on descriptive research and tend to use analysis and the perspective of the subject is more highlighted. In this research, the theoretical basis is used as a guide so that the research focus is in accordance with the facts in the field and the theoretical basis is also useful for providing an overview of the research background and as a material for discussing research results (Shrestha et al., 2020).

Data collection technique
To obtain data correctly and accurately in the preparation of this paper, the author uses several methods such as the following. 1. Learning experience during lectures By applying the knowledge gained during lectures and clinical practice experience.

Observation
Namely, the author observed the radiographic examination of the paranasal sinuses carried out on patients at the Radiology Installation of the University of North Sumatra Hospital.

Documentation
Namely, the authors recorded and documented the course of examination of the IJMABER 1585 Volume 3 | Number 8 | August | 2022 paranasal sinuses with suspected maxillary sinusitis from the beginning of the examination until the examination was completed.

Interview
That is by doing to the patient's family in terms of the patient's illness. Conduct discussions and cooperation with radiographers, and consult with radiology specialists (Mori et al., 2021).

Result Analysis
The data collected is processed, then connected to the hypothesis and then get a conclusion (Serindere & Aktuna Belgin, 2020). In the results of the radiographic image of the paranasal sinuses with a suspicion of maxillary sinusitis using the basic projection, namely the parietoacanthia projection (Water's method) and lateral projection. The aircraft used is a PHILIPS brand general X-ray unit with a capacity of 1100 mA. Processing film using CR and the results are optimal.

Results and Discussion
The case selected by the author is a radiographic examination of the paranasal sinuses suspected of having maxillary sinusitis at the Radiology Installation of the University of North Sumatra Hospital. The following is the data taken: The radiographer officer reads the request letter for radiological examination to be carried out, especially a temporary clinical diagnosis from the sending doctor who requested a radiological examination of the Paranasal Sinus with cases of maxillary sinusitis which was carried out at the University Hospital of North Sumatra.

Patient Preparation
On examination of the paranasal sinuses with suspected maxillary sinusitis, there is no special preparation. However, prior to the examination, the radiographer must remove jewelry such as earrings, necklaces and other accessories in the head and neck area so as not to interfere with the results of the image and the radiographer must explain the examination procedure to the patient and/or his accompanying family.

Preparation of Tools and Materials
Before the radiographic examination is carried out, first the X-ray machine is heated so that the components on the X-ray machine can work optimally, then proceed with adjusting the shooting conditions. The X-ray unit used in this examination is a general Xray unit at the University of North Sumatra Hospital with the following specifications: X-Ray Before the inspection is carried out, the Xray machine is turned on by first controlling the incoming voltage to the PLN on the line voltage meter, adjusting the lighting conditions according to the object to be photographed. 1. X-ray film The size of the film used for this examination is a film measuring 24cm x 30cm with parietoacanthia (water's method) and lateral projections.

Cassette
The cassette used is the Carestream-Cassette and Screen PQ for CR brand with a size of 24 cm × 30 cm.

Marker
The marker (code) is made of Pb. For L code, patient name, examination date, gender. 4. Patient preparation.
In this examination, the patient does not do any special preparation, the patient only needs to remove the earrings and other accessories that are in the head and neck area. In this examination, a chair is required and the patient is placed in an upright position facing the bucky stand.

Position Setting
The projections made by the author are adjusted to the limitations described on the previous page, to perform an examination of the paranasal sinuses in a patient named Mr.
S with the suspicion of maxillary sinusitis, two projections were performed, namely the parietoacanthial (water's method) and lateral projections according to the patient's diagnostic needs.

Examination Technique
The projections used in this research are as follows:  The bones of the sinus wall are intact. No lytic, blastic or destructive lesions were seen.Septum of rice in the middle. The nasal conchae are not hypertrophied.

Conclusion
After doing a radiographic examination of the paranasal sinuses suspected of maxillary sinusitis at the University of North Sumatra Hospital, the authors provide the following conclusions and suggestions: In radiography of the paranasal sinuses with suspected maxillary sinusitis, good cooperation between the patient/patient's family and the radiographer is essential. The use of parietoacanthia (Water's method) and lateral projections have been able to show the patient's left maxillary sinusitis . On radiographic examination of the paranasal sinuses with suspicion of maxillary sinusitis at the Radiology installation of the University of North Sumatra Hospital using Computer Radiography , it can minimize photo repetition and the amount of radiation received by the patient.