P O R T F O L I O DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS C O C C Y G O D Y N I A NUR NAQIYAH JALIL
ABOUT ME ABOUT ME ABOUT ME ABOUT ME ABOUT ME A B O U T M E ”Without continual growth and progress, such words as improvement, achievement and success have no meaning" - BENJAMIN FRANKLIN NUR NAQIYAH BINTI JALIL 065101 DIPLOMA IN RADIOGRAPHY DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
ACKNOWLEDGEMENT DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS I would l ike to thank my lecturer-in-charge, Dr. Nur Hayati binti Jasmin for guiding me throughout the course of this assignment. She was there to help me every step of the way, and her motivation is what helped me complete this assignment successful ly. I thank al l the teachers who helped me by providing the equipment that was necessary and vital , without which I would not have been able to work effectively on this assignment. I would also l ike to express my sincere gratitude to my friends and parents, who stood by me and encouraged me to work on this assignment.
C O N T E N T S C O N T E N T S ANATOMY OF SACRUM & COCCYX WHAT IS COCCYGODYNIA ? RADIOGRAPHIC VIEW OF COCCYGODYNIA RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS FUN TIME WITH GAMES REFLECTIVE ESSAY REFERENCES 1-2 3-4 5-8 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS 9-12 13-16 17-19 20
ANATOMY OF SACRUM & COCCYX 1 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
ANATOMY OF SACRUM AND COCCYX (A) (B) Figure 1 Anterior (A) and posterior (B) view of sacrum and coccyx Figure 2 Lateral view of sacrum and coccyx ANATOMY OF SACRUM AND COCCYX 2 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
WHAT IS COCCYGODYNIA ? 3 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS WHAT IS COCCYGODYNIA ?
Your coccyx (tailbone) is at the very bottom of your spine, and it consists of three to five fused vertebrae, shown in Figure 3. Despite its small size, the coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod—along with the ischial tuberosities—that provides weight-bearing support to a person in the seated position. COCCYGODYNIA Figure 3 Lateral radiograph of normal sacrum and coccyx Postascchini and Massobrio (1983) classified the variations in morphology of the coccyx into four different configurations : Type I: The coccyx is slightly curved forward, with its apex positioned downward Type II: The forward curvature of the coccyx is more exaggerated, with the apex positioned in a straightforward direction Type III: Sharp angulation of the coccyx forward Type IV: Subluxation of the coccyx at the sacrococcygeal or intercoccygeal joint “Coccygodynia” is the medical term for tailbone pain (“coccyx” = tailbone, “dynia” = pain). Simpson first introduced the term in 1859,1 but accounts of coccygeal pain date back to the 16th century.1-4 Despite the identification of chronic coccygeal pain hundreds of years ago, its treatment can be difficult and sometimes controversial because of the multifactorial nature of coccygeal pain. Many physiologic and psychological factors contribute to its etiology. Most cases of coccydynia resolve within weeks to months with or without conservative treatment, but for a few patients, the pain can become chronic and debilitating. Tailbone pain is common. It’s five times more likely to occur in women and people assigned female at birth (AFAB) than men and people assigned male at birth (AMAB). Adolescents and adults get it more often than children. Signs that you’ve injured your tailbone include pain and swelling, numbness or tingling, weakness in legs and bowel or bladder problems. Other related symptoms that may occur in people with tailbone pain include back pain, sciatica, sleep disorders, depression, anxiety. If you are having any of these symptoms, see a doctor right away. There are many reasons why you might develop tailbone pain. Possible tailbone pain causes include falls, repetitive strain injuries, pregnancy or childbirth, carrying extra weight and prolonged sitting. Dynamic radiographs, which are lateral standing and lateral sitting positions, are used to identify the fracture of coccyx. 4 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
RADIOGRAPHIC VIEW OF COCCYGODYNIA 5 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
Dynamic radiographs (sitting and standing): Dr. Maigne, in France, invented the idea of seated X-rays of the coccyx to see the coccyx position whi le the coccydynia patient was most symptomatic, which typical ly occurs whi le sitting. By comparing the coccyx position whi le sitting versus the position whi le standing, the cl inician can objectively measure the amount of change. These coccygeal movements are measured as changes in the coccygeal angle (amount of flexion) and luxation (amount of l isthesis at each of the coccygeal joints). These studies al low the classification of patients with coccydynia into groups based on coccygeal luxation and mobi l ity (hypomobi le, hypermobi le, and normal mobi l ity). The normal range of coccygeal mobi l ity is between 5 and 20 degrees. Thus, if sitting causes a change in the coccygeal angle of fewer than 5 degrees, this is hypomobi l ity. Conversely, if sitting changes the coccygeal angle by 20 degrees or more, this is hypermobi l ity. RADIOGRAPHIC VIEW 6 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS From the lateral radiographs, the examiner can assess the intercoccygeal angle, which is the measured angle between the first and last segment of the coccyx. It is used to assess the anterior angulation deformity of the coccyx. An increased intercoccygeal angle (increased forward angulation) has been reported as a possible etiology of coccydynia
RADIOGRAPHIC VIEW 7 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS LATERAL STANDING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Figure 4 Lateral radiographs in a 34-year-old woman with coccygodynia in the standing position The coccyx are showing a hypermobility sign which means the coccyx are bending upwards far more than normal The radiograph shows a 115° angle between the proximal and distal coccyx whi le standing The angulation of the broken coccyx start from Cy2 to Cy4 The radiograph shows anterior flexion of coccyx
RADIOGRAPHIC VIEW 8 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS LATERAL SITTING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Figure 5 Lateral radiographs in a 34-year-old woman with coccygodynia in the sitting position The coccyx are showing a hypermobility sign which means the coccyx are bending upwards far more than normal The radiograph shows a 81° angle between the proximal and distal coccyx whi le sitting The angulation of the broken coccyx start from Cy2 to Cy4 The radiograph shows more anterior flexion of coccyx in seated than standing position Anterior subluxation depicted on this seated radiograph
ACTS AS IF WHAT YOU DO MAKES A DIFFERENCE. IT DOES 9 DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS 10DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
Systematic radiographic technical evaluation is an important aspect to evaluative, effective radiography. It is the process of assessing a radiographic image to ensure it meets a high level of diagnostic standard. Two mnemonics are commonly used when assessing a radiographic image: DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS 11 PACEMAN IMAACREAP P A C E M A N - POSITIONING - - - - - - ALIGNMENT COLLIMATION EXPOSURE MARKER AESTHETIC NAME
ALIGNMENT Not aligned - the crossed l ines is not at the centering point (3.5inches posterior & 2inches inferior to elevated ASIS) Cannot be determined - doesn’t have four sided col l imation Cannot be determined - doesn’t have four sided col l imation 1.X-ray tube to patient 2.X-ray tube to image receptor 3.Image receptor to patient No marker - R/L anatomical marker that indicate right or left of the coccyx area No marker - standing or sitting anatomical marker DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS POSITIONING COLLIMATION MARKER include 5th sacral segment 4inches inferiorly to 4th coccygeal vertebrae include entire margin of coccyx posterior to skin margin Good collimation SUPERIOR BORDER INFERIOR BORDER ANTERIOR BORDER POSTERIOR BORDER No four-sided col l imation AESTHETIC Not aligned Have motion - evidenced by not adequate density and contrast of thin and thick structure No artifact Film size - 24 x 30 cm Film orientation - lengthwise NAME No patient’s name No patient’s RN or ID No date and hospital name 12EXPOSURE Thick structure Thin structure Thick structure Thin structure Not adequate contrast (kVp) - Bony cortical outl ine of coccyx vertebrae are not visual ized - Bony cortical outl ine of 5th sacral segment is not visual ized Not adequate density (mAs) - Bony trabecular pattern of coccyx vertebrae are not visual ized - Bony trabecular pattern of 5th sacral segment is not visual ized RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS Projection : Lateral Coccyx Standing Required anatomy is demonstrated ful ly (5th sacral segment, 1st through 4th coccygeal vertebrae, and inferior median sacral crest are included) Rotation - cannot be determined because the superimposition of greater sciatic notches cannot be seen
ALIGNMENT Not aligned - the crossed l ines is not at the centering point (3.5inches posterior & 2inches inferior to elevated ASIS) Cannot be determined - doesn’t have four sided col l imation Cannot be determined - doesn’t have four sided col l imation 1.X-ray tube to patient 2.X-ray tube to image receptor 3.Image receptor to patient No marker - R/L anatomical marker that indicate right or left of the coccyx area No marker - standing or sitting anatomical marker DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS POSITIONING COLLIMATION MARKER Projection : Lateral Coccyx Sitting Required anatomy is demonstrated ful ly (5th sacral segment, 1st through 4th coccygeal vertebrae, and inferior median sacral crest are included) Rotation - cannot be determined because the superimposition of greater sciatic notches cannot be seen include 5th sacral segment 4inches inferiorly to 4th coccygeal vertebrae include entire margin of coccyx posterior to skin margin Good collimation SUPERIOR BORDER INFERIOR BORDER ANTERIOR BORDER POSTERIOR BORDER No four-sided col l imation AESTHETIC Not aligned Have motion - evidenced by not adequate density and contrast of thin and thick structure No artifact Film size - 24 x 30 cm Film orientation - lengthwise NAME No patient’s name No patient’s RN or ID No date and hospital name 13EXPOSURE RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS Thick structure Thin structure Thick structure Thin structure Not adequate contrast (kVp) - Bony cortical outl ine of coccyx vertebrae are not visual ized - Bony cortical outl ine of 5th sacral segment is not visual ized Not adequate density (mAs) - Bony trabecular pattern of coccyx vertebrae are not visual ized - Bony trabecular pattern of 5th sacral segment is not visual ized
5 MINUTES BREAK TO REST YOUR MIND :) 14DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS
LET’S PLAY GAMES ! 15DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS LET’S PLAY GAMES !
16DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS WORD SEARCH HYPERMOBILITY SCIATIC FLEXION ROTATION SACRUM ANGULATION POSTERIOR FRACTURE INFERIOR COCCYX TILTING SUPERIOR COLLIMATION COCCYGODYNIA ANTERIOR FIND THE WORDS BELOW !
527 300 ENTER GAME CODE 17DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS QUIZIZZ SCAN THE QR CODE OR TO PLAY THIS QUIZ : JOINMYQUIZ.COM CLICK THIS LINK
REFLECTIVE ESSAY 18DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS REFLECTIVE ESSAY
REFLECTIVE ESSAY 19DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . As I sit down to reflect on my portfolio, I am intrigued by the insights it offers into my growth as both a writer and a critical thinker throughout my educational journey. This collection of my written work serves as a testament to the progress I have made, highlighting my strengths, weaknesses, and the areas in which I have excelled. First and foremost, my portfolio reveals my development as a writer. As I peruse the pieces, I notice a significant improvement in my ability to convey ideas clearly and cohesively. The early works showcase a more sporadic and disorganized writing style, suggesting a lack of structure and focus. However, as I progress through my academic journey, I can see a transition towards greater organization and coherence in my writing. This improvement is evident in the meticulous organization and logical flow of my more recent essays, demonstrating my ability to effectively communicate complex ideas and arguments. Furthermore, my portfolio highlights my growth as a critical thinker. When examining the earlier pieces, I can identify instances where my arguments lack depth and complexity. These earlier essays often lack critical analysis and instead rely on surface-level evaluations. As I move forward in my education, I can observe a subtle shift in my critical thinking skills. In my recent essays, I apply a more sophisticated approach, analyzing multiple perspectives, engaging with relevant literature, and offering nuanced arguments supported by evidence. This evolution in critical thinking exposes my willingness to challenge my initial assumptions and consider alternative viewpoints, enhancing the overall quality of my analytical work. Throughout this semester, I have had the opportunity to create a portfolio that showcases my growth and development as a student. As I reflect on the work I have included in my portfolio, I am reminded of the struggles, triumphs, and lessons learned throughout the semester. One of the most significant challenges I faced in this portfolio was selecting which pathology to include. As a student, I tend to be highly critical of my own work and often struggle to see its value. However, this portfolio forced me to confront this self-doubt and reflect on the progress I have made over the course of the semester. This reflection allowed me to recognize the growth I have achieved and reminded me of the importance of self-belief in achieving success.
REFLECTIVE ESSAY 20DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Overall, my portfolio provides an insightful glimpse into my growth as a writer and critical thinker throughout my educational journey. It paints a picture of a diligent and reflective student, willing to embrace challenges and continuously refine their skills. As I move forward, I intend to build upon the strengths highlighted in my portfolio, while actively addressing and improving upon the identified areas of weakness. With each new piece I add to my portfolio, I hope to witness further growth and development in my writing and critical thinking abilities. Additionally, my portfolio reveals my ability to engage in research and incorporate scholarly sources effectively. The earlier works often display a reliance on limited sources or general knowledge, indicating a lack of thorough research. However, as my education progresses, I become more adept at conducting research, locating credible sources, and skillfully integrating them into my writing. This heightened research ability allows me to develop well-informed arguments and substantiate my claims with evidence from reliable sources. While my portfolio demonstrates areas of growth and expertise, it also exposes areas where I can further refine my skills. One area that requires improvement is my ability to effectively address counterarguments. Although I make attempts to acknowledge opposing viewpoints, my earlier essays often fail to sufficiently engage with or refute these perspectives. By acknowledging this weakness, I am committed to developing stronger counterarguments, thus strengthening the overall persuasive power of my writing. Moreover, I recognize the need to enhance my ability to seamlessly transition between ideas and paragraphs. Although there has been progress, my portfolio shows instances of choppy transitions that hinder the flow of my writing. This weakness acts as a reminder to consciously work on crafting smoother transitions, ensuring a more cohesive and coherent writing style.
REFERENCES [1] C. C. M. Professional, “Tailbone pain (Coccydynia),” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/10436- coccydynia-tailbone-pain [2] “Coccygodynia (Coccydynia, coccalgia, tailbone pain),” Physiopedia. https://www.physiopedia.com/Coccygodynia_(Coccydynia,_Coccalgia,_Tail bone_Pain) [3]K. M. Robinson, “Tailbone pain (Coccydynia),” WebMD, Jun. 22, 2020. https://www.webmd.com/cancer/tailbone-paincoccydynia [4] A. Mabrouk, “Coccyx pain,” StatPearls - NCBI Bookshelf, May 01, 2023. https://www.ncbi.nlm.nih.gov/books/NBK563139/ [5] M. Hecht, “Everything you need to know about caring for a broken tailbone,” Healthline, Feb. 08, 2023. https://www.healthline.com/health/brokentailbone#diagnosis [6] A. Murphy, “Systematic radiographic technical evaluation (mnemonic),” Radiopaedia.org, Mar. 2018, doi: 10.53347/rid-59179. [7] M. Skalski, G. R. Matcuk, D. B. Patel, A. Tomasian, E. A. White, and J. S. Gross, “Imaging coccygeal trauma and coccydynia,” Radiographics, vol. 40, no. 4, pp. 1090–1106, Jul. 2020, doi: 10.1148/rg.2020190132. [8] A. A. Kabbani and F. Ebouda, “Coccydynia,” Radiopaedia.org, Oct. 2014, doi: 10.53347/rid-31409. [9] L. L.S., MD, C. G., T. R., and E. H., “Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain,” The Ochsner Journal, vol. 14, no. 1, season-01 2014. DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS 21
P O R T F O L I O DBR30903 RADIOGRAPHIC ANATOMY & IMAGE ANALYSIS C O C C Y G O D Y N I A