Musculoskeletal Imaging Studies Research Articles

Robust Multi-View Fracture Detection inthe Presence ofOther Abnormalities Using HAMIL-Net.

Foot and ankle fractures are the most common military health problem. Automated diagnosis can save time and personnel. It is crucial to distinguish fractures not only from normal healthy cases, but also robust against the presence of other orthopedic pathologies. Artificial intelligence (AI) deep learning has been shown to be promising. Previously, we have developed HAMIL-Net to automatically detect orthopedic injuries for upper extremity injuries. In this research, we investigated the performance of HAMIL-Net for detecting foot and ankle fractures in the presence of other abnormalities. HAMIL-Net is a novel deep neural network consisting of a hierarchical attention layer followed by a multiple-instance learning layer. The design allowed it to deal with imaging studies with multiple views. We used 148K musculoskeletal imaging studies for 51K Veterans at VA San Diego in the past 20 years to create datasets for this research. We annotated each study by a semi-automated pipeline leveraging radiology reports written by board-certified radiologists and extracting findings with a natural language processing tool and manually validated the annotations. HAMIL-Net can be trained with study-level, multiple-view examples, and detect foot and ankle fractures with a 0.87 area under the receiver operational curve, but the performance dropped when tested by cases including other abnormalities. By integrating a fracture specialized model with one that detecting a broad range of abnormalities, HAMIL-Net's accuracy of detecting any abnormality improved from 0.53 to 0.77 and F-score from 0.46 to 0.86. We also reported HAMIL-Net's performance under different study types including for young (age 18-35) patients. Automated fracture detection is promising but to be deployed in clinical use, presence of other abnormalities must be considered to deliver its full benefit. Our results with HAMIL-Net showed that considering other abnormalities improved fracture detection and allowed for incidental findings of other musculoskeletal abnormalities pertinent or superimposed on fractures.

Tips for Reporting Musculoskeletal Imaging Studies: Lessons Learned.

This paper is designed to be read by radiological trainees who are starting out with reporting musculoskeletal imaging studies. Based on the author's experience of over 25 years, it provides tips on how to report musculoskeletal imaging succinctly and effectively using a prose style report.

State variation in Medicaid and Medicare reimbursements in musculoskeletal radiology

BackgroundMedicaid reimbursements for physician services are determined by each state. However, how these reimbursements vary between states, and how these reimbursements vary in comparison to Medicare reimbursements is unknown for musculoskeletal radiology studies. ObjectiveTo evaluate the variability in Medicaid and Medicare physician reimbursements for musculoskeletal imaging studies between states. MethodsWe evaluated the Medicare and Medicaid physician reimbursements for the most commonly performed musculoskeletal radiology studies (15 radiographs and 10 MRIs) based on Medicare's 2017 National Summary Data File. Medicare and Medicaid reimbursements for these studies were compared by dollar difference (difference in reimbursement in dollars between Medicare and Medicaid). State-wide variability in these reimbursements was quantified by the coefficient of variation (COV) and by the dollar difference in reimbursement amounts. Medicaid and Medicare reimbursement rates were compared using a paired t-test, since the data was paired by state. ResultsThe mean Medicaid reimbursement rates were lower for musculoskeletal radiographs (p < 0.05) but higher for musculoskeletal MRI studies than the Medicare rates (p < 0.05). As hypothesized, there was variation in both Medicare and Medicaid imaging reimbursements between states, however, the variation was substantially higher for Medicaid reimbursements. We found the Medicare reimbursement COV between states was 0.07 for all imaging studies, whereas the Medicaid reimbursement COV between states varied from 0.23 to 0.55 for radiographs and from 0.31 to 0.45 for MRIs. DiscussionThe data show that there is mild, but constant variation across imaging studies in Medicare reimbursement for musculoskeletal imaging studies between states. However, there is more variation in the Medicaid reimbursements across imaging studies and between states. More appropriate reimbursement may increase access to care for Medicaid patients.

Evaluation of Audiovisual Reports to Enhance Traditional Emergency Musculoskeletal Radiology Reports.

Traditional radiology reports are narrative texts that include a description of imaging findings. Recent implementation of advanced reporting software allows for incorporation of annotated key images and hyperlinks directly into text reports, but these tools usually do not substitute in-person consultations with radiologists, especially in challenging cases. Use of on-demand audio/visual reports with screen capture software is an emerging technology, providing a more engaged imaging service. Our study evaluates a video reporting tool that utilizes PACS integrated screen capture software for musculoskeletal imaging studies in the emergency department. Our hypothesis is that referring orthopedic surgeons would find that recorded audio/video reports add value to conventional reports, may increase engagement with radiology staff, and also facilitate understanding of imaging findings from urgent musculoskeletal cases. Seven radiologists prepared a total of 47 audiovisual reports for 9 attending orthopedic surgeons from the emergency department. We applied two surveys to evaluate the experience of the referring physicians using audio/visual reports as a complementary material from the conventional text report. Positive responses were statistically significant in most questions including: if the clinical suspicion was answered in the video; willingness to use such technology in other cases; if the audiovisual report made the imaging findings more understandable than the traditional report; and if the audiovisual report is faster to understand than the traditional text report. Use of audiovisual reports in emergency musculoskeletal cases is a new approach to evaluate potentially challenging cases. These results support the potential of this technology to re-establish the radiologist's role as an essential member of patient care and also provide more engaging, precise, and personalized reports. Further studies could streamline these methods in order to minimize work redundancy with traditional text reporting or even evaluate acceptance of using only audiovisual radiology reports. Additionally, widespread adoption would require integration with the entire radiology workflow including non-urgent cases and other medical specialties.

Upper Limbs Trauma in Pediatrics.

A correct interpretation of musculoskeletal imaging studies of children requires an in-depth knowledge of normal skeletal growth and physiologic changes in growing bones. During childhood the growing bones are more prone to acute and chronic injuries because of the imbalance between osseous structures and tendons and ligaments, so physeal injuries are the most commonly encountered types of lesions. This review addresses acute and chronic injuries involving the upper extremities in the pediatric population. These injuries may be subtle to recognize or atypical. The radiologist has to choose the most appropriate technique that can best recognize the problem and establish the correct diagnosis, thus avoiding diagnostic errors and potential delayed complications.

Current Concepts in MRI of Focal and Diffuse Malignancy of Bone Marrow

Bone marrow is a ubiquitous component of musculoskeletal imaging studies. The ability to identify and characterize pathology accurately in the bone marrow can be challenging given the broad spectrum of imaging features of normal bone marrow. Knowledge regarding the ability to differentiate normal from abnormal marrow has been enhanced with MR imaging with numerous techniques available to aid in distinguishing benign from malignant lesions in the bone marrow. T1-weighted fast spin echo (FSE) and fluid-sensitive sequences, fat-saturated T2-weighted FSE, and short tau inversion recovery provide valuable tools for the evaluation of a focal bone marrow lesion. Gadolinium enhancement, chemical shift, diffusion-weighted, and MR spectroscopy imaging are additional tools available for focal bone marrow lesion evaluation. Whole-body MRI and fluorodeoxyglucose positron emission tomography-computed tomography have evolved to be useful studies for staging and monitoring of therapeutic response in whole-body imaging. The relative advantages and disadvantages of the whole-body techniques are reviewed for metastases, myeloma, and lymphoma.

Marrow: red, yellow and bad

Bone marrow is one of the largest and most dynamic tissues in the body, and it is well-depicted on conventional MRI sequences. However, often only perfunctory attention is paid to the bone marrow on musculoskeletal imaging studies, raising the risk of delayed or missed diagnoses. To guide appropriate recognition of normal variants and pathological processes involving the marrow compartment, this article describes and depicts the physiological spatiotemporal pattern of conversion of hematopoietic red marrow to fatty yellow marrow during childhood and adolescence, and the characteristic imaging findings of disorders involving marrow hyperplasia/reconversion, marrow infiltration/deposition and marrow depletion/failure.

Using Focused Missed-Case Conferences to Reduce Discrepancies in Musculoskeletal Studies Interpreted by Residents On Call

The purpose of this study is to determine whether focused missed-case conferences can significantly reduce the number of major discrepancies in musculoskeletal imaging studies interpreted by residents on call. A review of major discrepancies in musculoskeletal conventional radiography imaging studies interpreted by radiology residents and fellows on call from July 2008 to July 2009 revealed 31 common and important musculoskeletal injuries missed or misinterpreted at our institution. These missed cases were presented during focused missed-case conferences from July through October 2009. Only residents attended missed-case conferences. Over the 12 months before the missed-case conferences, there were 55 resident major discrepancies and 25 fellow major discrepancies, representing 31 common and important missed musculoskeletal injuries. Over the 12 months after the missed-case conferences, there were 18 resident major discrepancies and 21 fellow major discrepancies involving these injuries. This corresponds to a 67% reduction in the number of resident major discrepancies involving the 31 musculoskeletal injuries covered during the missed-case conferences (chi-square p < 0.001). The overall major discrepancy rate for all musculoskeletal conventional radiography studies was 1.19% for residents and 1.55% for fellows (not significant) before the missed-case conferences and 0.87% for residents and 1.46% for fellows (p < 0.05) after the missed-case conferences. During this time, fellows missed more musculoskeletal injuries related to the topics discussed during missed-case conferences (16) compared with residents (8) although fellows read significantly fewer studies overall. This accounted for 0.49% of the 0.59% difference between residents and fellows. Focused missed-case conferences are an effective educational intervention to significantly reduce the number of major discrepancies in radiology resident interpretation of musculoskeletal imaging studies on call.

Iliac Stress Fracture in a Male Collegiate Track Athlete

Iliac Stress Fracture in a Male Collegiate Track Athlete

The Perils of Protectionism

Are radiologists engaged in battles with other medical specialties over the turf of imaging? For example, is there a turf battle between radiology and cardiology over the use of computed tomography and magnetic resonance in the diagnosis of diseases of the heart and great vessels? Are interventional radiologists struggling with cardiologists and vascular surgeons over the use of endovascular stent devices in the treatment of arterial stenoses and aneurysms? Are orthopedic surgeons and rheumatologists encroaching on the territory of musculoskeletal radiologists by performing and interpreting their own musculoskeletal imaging studies?

Magnetic resonance imaging of knee menisci: Diagnostic interpretation and pitfalls

Magnetic resonance imaging (MRI) was recognized early on as a useful tool in the evaluation of patients with suspected internal derangement of the knee. The superb soft tissue contrast afforded by MRI provides clear visualization of the normal anatomic structures, as well as an accurate depiction of common pathological conditions and traumatic injuries of the knee. Both the capabilities and diagnostic accuracy of MRI of the knee have evolved rapidly over the past few years. Consequently, it continues to be one of the most frequently performed musculoskeletal imaging studies. With the exception of the physical examination, MRI has become the most important diagnostic tool to aid in the evaluation of the patient with suspected internal derangement of the knee. To gain the most benefit from this diagnostic tool, the orthopaedic surgeon must have a basic understanding of the imaging techniques and planes commonly used to evaluate the knee. In addition, it is important to possess a thorough knowledge of the appearance of the normal meniscus on MRI scans, the MRI criteria for meniscal tears, and the pitfalls that commonly mimic meniscal pathology. Finally, with an ever-increasing number of patients having undergone meniscal repair, a basic approach to interpreting MRI scans of the postoperative knee is essential.