ANTERIORPOSTERIOR 0 DEGREE SKULL ANTERIORPOSTERIOR 0 DEGREE SKULL ANTERIORPOSTERIOR 0 DEGREE SKULL Fracture of Skull
02 03 REFERENCES THE CONTENT: 06 LET’S PLAY A GAME! RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS RADIOGRAPHIC VIEW OF SKULL 01 ABOUT PATHOLOGY 04 05 REFLECTIVE ESSAY Page 01 Page 04 Page 06 Page 10 Page 11 Page 16
(The Skull | Anatomy and Physiology I, n.d.) Aof Skull natomy Ap Skul Lateral Skul (The Skull | Anatomy and Physiology I, n.d.)
PA Skul (The Skull | Anatomy and Physiology I, n.d.)
A skull fracture is any break in the cranial bone (skull). Most heal without intervention, but if there’s brain damage or surgery was needed, recovery can take weeks or months. (Ellis, 2023). The underlying cause of a skull fracture is a head trauma significant enough to break at least one bone. People with a skull fracture require treatment as soon as possible. The skull can break, or fracture, if it is subject to a direct and forceful impact. (Cadman, 2023). ABOUT PATHOLOGY What is skull fracture? The most common causes of skull fracture in adults are: A fall. Motor vehicle accident. Being hit with an object. Physical assault. Sports injury. Page 01 Causes of skull fracture: There are several types of skull fractures, including: Linear fracture: This is the most common type of skull fracture. It usually happens in the bone toward the top of your head, above your ears. So, this is a break in the bone that does not move the bone. Depressed fracture: A break in your skull that pushes part of the bone closer to your brain. A depressed fracture can involve multiple cracks and fragments. Basal (basilar) fracture: A break of the bones at the base of your skull. This includes the bones behind your face and the bones that are internal in your brain that you can’t see. Diastatic fracture: A separation of the cranial sutures, or the bands of tissue that connect the bones in your skull together. Combination or complex fractures: Fractures that may involve several of the above types or multiple areas of fractured bone. (Cleveland Clinic, 2023) Types of skull fracture:
Seizures Dizziness Confusion Headache Poor memory Unconscious Nausea & vomiting Very tired Bleeding from head Bruised under eye/ ear Swelling head The severity of symptoms can vary. They depend on how serious the injury is. The symptoms of a skull fracture can include: Page 02
A doctor may be able to diagnose a fracture by simply performing a physical examination of the head. However, it’s useful to diagnose the extent and exact nature of the damage. This requires more specific diagnostic tools. Doctors can use various imaging tests to get a clearer picture of the kind of fracture you have and how far it extends. X-rays, CTs, and MRIs are typical methods for imaging the body and can help your doctor diagnose skull fractures. An X-ray provides an image of the bone. An MRI takes an image of the bone and soft tissue. This allows your doctor to see both the skull fracture and the brain. The most common tool used is a CT or CAT scan. This test usually provides the clearest picture of the fracture and any damage to the brain because it produces a 3D image. (Ellis, 2023) Specific treatment for a fracture will be determined by the neurosurgeon, taking into account several factors, including: Patient’s age, overall health, and medical history Severity of the fracture Type of fracture The goal of skull fracture treatment is to control pain, promote healing, and prevent complications. For most skull fractures, which are linear fractures, surgical intervention is not needed. Instead, physicians prescribe medication to control pain and maintain close observation in the hospital. Surgery may be needed to repair compound fractures, comminuted fractures and some types of closed fractures, and also to stitch up any tears in the dura mater and scalp. Proper diagnosis is crucial to distinguish between skull fractures that need and do not need surgical treatment and thus to avoid potential complications. (Skull Fractures, 2021) TREATMENTS DIAGNOSING SKULL FRACTURES SKULL FRACTURES Page 03
NORMAL IMAGE APPEARANCES Sutures have a sawtooth appearance which distinguishes them from fractures which form smooth lines Normal skull anatomy as seen on X-ray. The occasional indications for post traumatic views of the skull. SKULL FRACTURE(Trauma X-ray - Axial Skeleton, n.d.) The black lines represent skull fractures These lines are too smooth to be sutures and do not branch like the vascular markings of the skull Page 04
The skull anteroposterior (AP) view is a non-angled radiograph of the skull. This view provides an overview of the entire skull rather than attempting to highlight any one region. This examination is able to assess for medial and lateral displacements of skull fractures, in addition to neoplastic changes and Paget disease. Note: As this view results in higher radiation dose to the radiosensitive lens of the eyes compared to the PA view, it should only be used in situations where the patient is unable to face the detector, like in trauma settings and patients with poor mobility.(Amanda ER, 2023) In the context of evaluating skull fractures, the AP projection is commonly used for several reasons: Visualization of Skull Anatomy: The AP projection allows for a clear visualization of the entire skull, including the frontal, parietal, occipital, and temporal bones. This comprehensive view is essential for assessing the extent and location of a skull fracture. 1. Assessment of Fracture Lines: By capturing the skull from an anterior to posterior direction, the AP projection helps in identifying and analyzing fracture lines. This is crucial for determining the severity and complexity of the fracture. 2. Comparison with the Contralateral Side: The AP projection enables a comparison of the affected side with the contralateral (opposite) side of the skull. This comparison helps in detecting any asymmetry or abnormality, aiding in the accurate diagnosis of a skull fracture. 3. Evaluation of Displacement or Misalignment: Skull fractures may lead to bone displacement or misalignment. The AP projection allows radiologists to assess whether there is any abnormal positioning of the skull bones, which can inform decisions about potential treatment options. 4. Convenience and Standard Practice: The AP projection is a standard imaging technique for evaluating skull fractures. It is a convenient and widely used method that provides valuable information to healthcare professionals. 5. Page 05 1.Position the Patient: The patient should be in a supine position with the midsagittal plane perpendicular to the image receptor. 2.Align the CR (Central Ray): Center the CR to the midpoint between the glabella and the external occipital protuberance. Direct the CR perpendicular to the image receptor. WHY AP 0 DEGREE SKULL PROJECTION IS SUITABLE TO RULE OUT THE PATHOLOGY?
1.AP: Position the patient in a upright AP projection. Adjust head rotation to align the midsagittal plane perpendicular to the IR. 2. Tuck the chin toward the chest until the OML is aligned perpendicular to the IR. 3. Instruct the patient to close the jaw, with teeth and lips placed together. 4. Adjust head tilting to align the midsagittal plane with the collimator’s longitudinal light line. 5. 6.Cranium: Center a perpendicular CR enter at the glabella. 7.Center the IR and grid to the CR. P A T I E N T P O S I T I O N I N G P A C E M A N (AP SKULL) IMAGE LABELING Coronal Suture Petrous Ridge Bony Nasal Septum Orbital Margins Lateral Cranial Cortex Dorsum sellae Crista Galli Frontal Bone Fracture Page 06
P O S I T I O N I N G If patient not adequately tuck the chin, the petrous ridge will be below the supraorbital rim. If patient tuck chin too much, the petrous ridge will be above the supraorbital rim. The petrous ridge is superimposed with superior orbital margins indicating the correct alignment of OML. The distance bilaterally from the oblique orbital to the lateral margin of the skull is equal, indicating no rotation. The petrous ridge at the left upwards and right downwards are not horizontal, indicates the patient is tilting upside. P O S I T I O N I N G A L I G N M E N T The alignment of X-ray tube and patient is correct because the centering point is equidistant with four border collimation. The alignment of X-ray tube & image receptor cannot be identify because there is no border of image receptor. The alignment of image receptor & patient cannot be identify because there is no border of image receptor. The good collimation of the AP skull at the superior border must include the entire skull, the inferior border at the maxilla and the lateral border including the lateral skin margins of the skull. C O L L I M A T I O N C O L L I M A T I O N This radiography is not adequate collimation. The center ray is correct which is at glabella. There is no four-sided collimation because the inferior border does not include the maxilla. Did you This is patient's positioning during AP SKULL Page 07 P A C E M A N
In conclusion, I reject this AP skull x-ray there is no patient name, ID and name of hospital. E X P O S U R E Normal range of exposure is 70-80 kVp and 8 mAs. The kVp is good because the cortical outline at the thick frontal bone can be seen and thin structure petrous ridge can be seen. The mAs is adequate because the bony trabecular pattern of thick frontal bone and thin structure petrous ridge can be seen. M A R K E R There is a marker which is L indicating the left of the skull area. The marker is not superimposed with important structures. A E S T H E T I C The film size used is 24 x 30 cm and the film orientation is lengthwise. No motion is indicated by a clear cortical outline and no artefact. There is a fracture of the skull at the frontal bone. The name of patient, the register number (RN) or ID of patient, date and the hospital name are not available. It should be located at the inferior of film. N A M E the patient is tilting upside Additional Info Conclusion This is the ultrasound for skull fracture the collimation is not adequate Page 08 P A C E M A N
All anatomical required demonstrated No Rotation : distance from oblique lorbital and lateral margins equal Tilting upside :both petrous ridge not horizontal Correct Alingment : petrous ridge superimposed superior orbital margins No artefact No motion Cassette in lenghthwise ( 24 x 30 xm ) PACEMAN POSITIONING alingment Xray tube and patient : correct, centered at OML Xray tube and image receptor : cannot be determined Image receptor and patient : cannot be determined AESTHETIC MARKER Anatomical part demonstrated Marker (L) appear name No patient’s name, id,date and hospital ‘s name collimation Superior border : entire skull Lateral border : lateral skin margins Inferior border : maxilla exposure CONTRAST: adequate (70-80 kVp) thin : structure petrous ridge thick : frontal bone DENSITY : adequate (8mAs) thin : structure petrous ridge thick : frontal bone Page 09
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Page 11 NURUL AZMINA BINTI ABDUL HADI 073239 In my short life, there are many experiences that could qualify as life-changing. Every new experience was, at one time or another, the first experience. For good or bad, each instance changed the course that my life has taken. Through this reflective essay, I would like to thank those who willing to help me especially for my group member to complete this portfolio together. During my journey as a part of writer and critical thinker, I can explore more and more into the world of knowledge that I never know before. I have fulfilled this goal by being able to identify how to form good writing that is easy to understand and meaningful to the reader. I can see clearly that the effective writing makes the information presented easier to understand. I hope that all the hard work with my team will pay off. This assignment was highly significant to the overall evaluation process of image critique. A skull fracture, according to (Ellis, 2023), is any break in the cranial bone (skull). Most heal without intervention, but if there’s brain damage or surgery was needed, recovery can take weeks or months. Further, according to (Cadman, 2023), the underlying cause of a skull fracture is a head trauma significant enough to break at least one bone. People with a skull fracture require treatment as soon as possible. The skull can break, or fracture, if it is subject to a direct and forceful impact. According to (What Is a Skull Fracture? | UC Health | Symptoms & Causes, n.d.), A skull fracture is a head injury where there is a break in the skull bone. As in the portfolio, the pathology tells the audience about the disease that might be caused by a force on the part of body. It discuss about the linear skull fracture. A linear fracture is a common or simple fracture that occurs after an eccident or force. So, this is a break in the bone that does not move the bone. For example, if it occur on a child, they should be watched closely in the hospital for a brief time. They can usually go back to normal activities in a few days. No treatment is usually needed. But, the parent should be more careful about doing any activities with the child. When meeting a patient with a skull fracture, I can further study the types of fractures and how to avoid the possibility of fracture. As a writer, I can improve my skills to learn more about the fracture of the skull. The challenge as the writer is that I need the guidance and support of any journal or book to refer all the content and make sure all point are delivered. So, I should do a lot of research about the fracture of skull to organize and document the work that leads to my privacy, such as signing my email to see the journal and need to pay for entering the website about the journal of specific fracture that I want. This can take more time to do the research and get the journal related. When doing the digital portfolio, it can be encounter technical issues such as the level of access to technology. For example, when accessing the website to do the research, it must use an internet connection, and when the connection is lost, my work delayed. Now, the weather is unpredictable like rain in the whole day , it will slow down the process of completing the portfolio. Expressing all the changes that this assignment is truly difficult because this is my first time do the portfolio. But, for several days I and my teammate spent together to finish this, I became a more knowledgeable to be a competent writer. I also discovered about myself as a learner that I can read the materials way in advance, just briefly skim over the text, and remember just about everything. As I thought, a closer reader was more beneficial. I also learned that working in a group really helps me find more information that I couldn't find. Same way as a radiographer, sometimes they must work in groups, such as in the operation theatre with a doctor's team. In addition, I am able to settle all of my part in this portfolio with my teammate in the given time. I also learned that looking at my own notes about what the lecturer teaches in a classroom in advance helped me a lot. By studying new techniques and researching other approaches, I now have a sturdy foundation and a robust writing arsenal for future endeavors.
Page 12 WAN NUR FATIN BINTI WAN MOHD ZAWAWI 071976 Along the path of being a student, our decision involves many things. Each event occurs for a reason, teaching us to be more mature and strong. For me, every decision that we make has an impact on our lives. I thank my teammates who helped me complete the portfolio by writing this reflective essay. There are many things that I went through while writing this portfolio. From scratch, until the portfolio is complete, we have poured all of our heart into making this portfolio. Each person's ideas, teamwork and creativity are shown in this portfolio. As one of the writers of this portfolio, I have learned new knowledge that I never knew and become more understanding of the topic. I hope the reader appreciates this portfolio and that our hard work will pay off. By writing this portfolio, I have achieved my goal of becoming an effective writer. I seek guidance from my lecturer and teammates to better understand content writing. The research and references help to create a better draft of the information. Understanding the content helps express the explanation in more simplified and accurate words. Showing the main point that each reader wants in simpler terms is not easy because not all studies have the same knowledge, which gives us a challenge and a chance to learn new knowledge. Due to that, I would also like to thank my lecturers because they would explain the information that helped us better understand and become more precise in writing the portfolio. The challenges of getting the information and pictures to complete the portfolio take work. A challenge that we encounter is that the concept of our X-ray image is challenging because the projection type has limited exposure to its kind of X-ray image. In my journey as a writer, this portfolio might not have all the details I gained during my writing. Every knowledge I have learned has a point to give me as a medical imaging student to understand better. Those who desire to know this topic get more understanding with the help of the explanation of our portfolio. With the portfolio being the reader's reference, they may know about the medical imaging world. Being a critical thinker is difficult, but writing this portfolio has been an enormous advantage that has helped me better understand my study. Researching while making the portfolio boosts my knowledge of my study. This portfolio also allows me to recall and improve my knowledge. Writing and completing the portfolio is more challenging than you think. My understanding and knowledge are lacking, and I need to understand the content to simplify. I almost messed up my group assignment due to my knowledge; it was the same for all my teamwork. Due to that, it was hard for us to complete this portfolio because not all references state all the information we needed. But, after all, my teammates and I have achieved our goal of completing this portfolio with the help of our lecturers which are Dr Nur Hayati.
Page 13 AINUR SHAFIKA BINTI WAHIB 073189 Embarking on the student journey is akin to navigating a labyrinth of decisions, each imbued with profound significance. Each twist and turn, a lesson shaping us into more resilient and mature individuals. As I reflect upon the completion of our portfolio, I am indebted to my teammates whose collective efforts breathe life into this document. The odyssey from inception to completion bears witness to the dedication we poured into this work.This portfolio is a testament to the amalgamation of diverse ideas, the synergy of teamwork, and the sparks of creativity that ignited its pages. As one of the contributors, I find myself richer in knowledge, having delved into realms previously unexplored. The hope lingers that our labor resonates with the reader, a silent recognition of the toil behind its creation. Becoming an effective writer was the beacon guiding my endeavors in this project. Seeking counsel from both lecturers and peers, I unraveled the intricacies of content writing. Research and references served as the bedrock, shaping the narrative into a coherent whole. Simplifying complex ideas became a challenge, a journey of acquiring new knowledge and refining my ability to articulate intricate concepts. Gratitude extends to the lecturers whose explanations brought clarity, fostering precision in our portrayal of medical imaging concepts. The challenges were formidable; the quest for information and images, a test of resilience. The enigmatic nature of our X-ray image concept, with its limited exposure in projection types, added an extra layer of complexity. Yet, in overcoming these obstacles, I discovered a reservoir of resilience within myself and my team. This portfolio is an incomplete tapestry of my writing journey. Every nugget of knowledge acquired holds a purpose, a beacon guiding me as a medical imaging student. It extends an invitation to those curious about the topic, offering a glimpse into the intricate world of medical imaging. Critical thinking, a skill indispensable yet elusive, found its ally in the creation of this portfolio. Researching and constructing its content became a crucible, refining my understanding of the subject matter. The portfolio, a repository of knowledge, becomes a tool for selfreflection and continuous improvement. The journey of writing and completing this portfolio unfurled a tapestry of challenges. My initial lack of understanding and knowledge posed hurdles, and the specter of failure loomed large during group assignments. The collaborative spirit prevailed, and with the invaluable guidance of our lecturers, led by Dr. Nur Hayati, we triumphed over adversity.
NURSHAFIKA HAISA BINTI ZAKARIA 072622 As I put up this portfolio, I go on a contemplative journey that captures my development on both a personal and professional level. I will consider the various obstacles that I faced, how finishing this portfolio has enhanced my knowledge and abilities to the assignment that I was given, and my difficulty. As I reflect upon the several weeks of work for this portfolio feel like I've accomplished something, even if I can't stop. This reflective learning is an essential element of effective performance in research. The writing I have done it portfolio helped me grow my writing and thinking skills. This assessment was crucial to the image criticism evaluation procedure as a whole. A skull fracture refers to a break or crack in one or more bones of the skull, which encases and protects the brain. Skull fractures can result from various causes. Including trauma, accidents, falls, or physical assaults. Some patient do not fell hurt when having a simple fracture but can be detected by the appearances of the skin. In a few cases, the child might have severed trauma due to abuse, so the disease is caused by a forced on the part of the body. Doctors may be able to diagnose a fracture by simply performing a physical examinations of the head with use various of imaging test. Skull fracture give a lot of symptoms such as site of injury, swelling and bruising. We need to be aware to prevent probability to get the skull fracture or injury. So, with this portfolio can help people to take action to avoid anything that lead to the skull injury. There are severe challenges that I need to face in order to complete this work. I have less resources or articles to make a reference. I used a lot of websites and journals from internet but there are not specific to AP skull and its fracture. So, I must do a lot of research about the fracture. Not only hard to find up to date research but also while doing this portfolio I have found many different opinions about the fracture skull and it make me confused to choose the right information. I also have bad internet connections, because of that this portfolio will slow down the process. I also need managing my time because of a lot assignment, test and time for revisions. Even it make me stress, but I handled it well and produce a good portfolio. Creating an effective portfolio requires careful planning and execution. There are many things that I learned in doing this portfolio. I can gain my knowledge and help me grow my writing and thinking skills, which keeps me open to new opportunities in life. It is because I need to make a lot of research, read a book and journals to understand about fracture and how to make the projection of AP 0 degree. In the future, there are many more skills I need to learn to ensure my reputation improves day by day. Page 14
Page 15 FARAH ELLYSA BINTI ROSLAN 074729 Embarking on various assignments throughout my academic journey has been a journey of self-discovery and intellectual growth. The portfolio is my new experience because I never done a portfolio before. I do find it quite interesting because each point presented its own set of challenges, pushing me to adapt, refine my skills, and delve deeper into this subject matter. I explored the multifaceted aspects of my experiences in completing my portfolio and the valuable lessons learned along the way. Looking back, I recall I always had a hard time making short notes, highlighting the only important points, and more. I used to think each word was important and that put me in difficulty every time I needed to do the assignments or any short notes. Incredibly, writing the portfolio taught me how to focus only on the important things and long sentences is actually can be changed into shorter ones. In light of this, writing the portfolio helped me become an effective writer and better thinking skills. On top of that, I have gained a deeper understanding of skull fractures. To define skull fracture is a medical term that refers to a break or crack in one or more bones of the skull. The skull, also known as the cranium is the bony structure that protects the brain. It consists of several bones, including the frontal bone, parietal bone, temporal bone, occipital bone, sphenoid bone, and ethmoid bone. A fracture in any of these bones is considered a skull fracture. It is considered dangerous because they pose a risk of causing severe and potentially life-threatening complications, primarily due to their proximity to the brain and the critical structures within the skull. It can cause brain injury, intracranial bleeding, infection risk, and more. Individuals with suspected skull fractures should seek immediate medical attention to assess the extent of the injury, manage complications, and prevent further harm to the brain and surrounding structures. I encountered significant obstacles to completing the portfolio. To collect the information about skull fractures and the projection chosen, I need to use a variety of sources like books, websites, journals, and articles. I struggled during the research because it was so hard to find an example of a skull radiograph image for Posterior-Anterior skull projection until I needed to change it into Anterior-Posterior skull projection with the guidance of my lecturer which is Dr. Hayati. Furthermore, for someone with a lack of technology skills, I need to learn how to make the slides more interesting by watching tutorials on TikTok, YouTube, and others. To sum up, at the bottom of my heart making a portfolio is not easy because it takes a long time to complete. Additionally. Making a timeline plan, creating a working outline, understanding the requirements, analyzing all the information, and staying organized are very important to create a great portfolio. It helps me to stay on track and prevent me make a mistake. On both sides of the coin, I love how great the portfolio turns out and I find this assignment quite interesting.
Ellis, M. E. (2023, April 20). Skull Fractures. Healthline. Retrieved from https://www.healthline.com/health/skull-fracture The Skull | Anatomy and Physiology I. Retrieved from https://courses.lumenlearning.com/suny-ap1/chapter/the-skull/ Cadman, B. (2023, July 24). How serious is a fractured skull? Retrieved from https://www.medicalnewstoday.com/articles/322871 Skull Fractures. (2021, July 21). Columbia Neurosurgery in New York City. Retrieved from https://www.neurosurgery.columbia.edu/patientcare/conditions/skull-fractures Weber, S. Review of Positioning Standards for the Skull and Facial Bones. Retrieved December 14, 2023, from https://wcec.info/blog3/wpcontent/uploads/2017/04/Review-of-Positioning-Standards-for-the-Skulland-Facial-Bones-1.pdf Skull - AP - wikiRadiography. Retrieved from http://www.wikiradiography.net/page/Skull_-_AP Skull Radiography, Skull AP view & Skull lateral view x-ray. Retrieved from https://www.youtube.com/watch?app=desktop&v=-RyR7mZj6YM Trauma X-ray - Axial skeleton. Retrieved December 15, 2023, from https://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/xray_trauma_spinal/x-ray_skull_fracture Murphy, A., & Morgan, M. (2015). Skull (AP view). Radiopaedia.org. Retrieved from https://doi.org/10.53347/rid-37219 Professional, C. C. M. (n.d.-c). Skull fracture. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/skull-fracture REFERENCES: Page 16
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