Avulsion fracture of the tibial eminence in an adult with a unique mechanism of injury.

Tibial eminence avulsion fractures are not infrequent in the pediatric population; however, they are rare in the adult population. These injuries typically occur in skeletally immature patients between the ages of 8 and 14 years. We report the unique clinical history, imaging findings, and operative results of a 48-year-old female who presented with severe knee pain.

Reviewing CT Scout Images: Observations of an Expert Witness.

Objective: The purpose of this article is to share the views of an experienced expert witness in medical malpractice cases on the use of CT scout images.

Conclusion: The medical literature has resurrected issues regarding viewing of CT scout images. Scout images are an integral part of any CT examination and should be carefully reviewed for findings that may or may not be included in the FOV of the study.

CT-guided iliosacral screw placement.

Computed tomography (CT)-guided iliosacral screw placement for posttraumatic instability of that joint is a safe procedure that may be performed in a radiology department. CT guidance allows more accurate screw placement than traditional fluoroscopic imaging in the operating room. This article describes the technique for placing cannulated surgical screws percutaneously across the iliosacral joint in patients with unstable pelvic fractures using CT for guidance.

Radiology medical student education: an outcome-based survey of PGY-1 residents.

Rationale And Objectives: Postgraduate year (PGY)-1 residents are frequently required to order imaging studies and make preliminary interpretations on them. This study determines whether PGY-1 residents feel their radiology education in medical school sufficiently trained them for the clinical responsibilities of internship.

Materials And Methods: This multicenter, institutional review board-approved survey asked PGY-1 trainees three categories of questions: 1) extent of medical school training for ordering and interpreting imaging studies, 2) confidence levels in ordering appropriate imaging studies and making common/emergent diagnoses, and 3) rating the importance of radiologic interpretation by interns.

ACR appropriateness criteria(®) acute trauma to the knee.

There are more than 1 million visits to the ER annually in the United States for acute knee trauma. Many of these are twisting injuries in young patients who can walk and bear weight, and emergent radiography is not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographic studies ordered without missing a clinically significant fracture.

Understanding the US medical school requirements and medical students' attitudes about radiology rotations.

Rationale And Objectives: To learn what percentage of US medical schools require their students to complete rotations in radiology during the clinical years. A secondary goal was to survey students' opinions about radiology rotations.

Materials And Methods: Data were collected from 159 US medical schools from the Association of American Medical Colleges (AAMC) for allopathic medical schools, the American Association of Colleges of Osteopathic Medicine (AACOM) for osteopathic medical schools, and by e-mailing curriculum directors at US medical schools with a survey.

ACR Appropriateness Criteria® on acute shoulder pain.

The shoulder joint is a complex array of muscles, tendons, and capsuloligamentous structures that has the greatest freedom of motion of any joint in the body. Acute (<2 weeks) shoulder pain can be attributable to structures related to the glenohumeral articulation and joint capsule, rotator cuff, acromioclavicular joint, and scapula. The foundation for investigation of acute shoulder pain is radiography.

Radiologic evaluation of chronic neck pain.

For many years, there were no guidelines for evaluating patients with chronic neck pain. However, in the past 15 years, considerable research has led to recommendations regarding whiplash-associated disorders. This article summarizes the American College of Radiology Appropriateness Criteria for chronic neck pain.

ACR appropriateness criteria on metastatic bone disease.

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations.

Exclusion of cervical spine instability in patients with blunt trauma with normal multidetector CT (MDCT) and radiography.

The objective of the study was to determine if negative multidetector computed tomography (MDCT) and lateral radiography of the cervical spine effectively excludes patients with unstable cervical spine injuries. Over a period of 40 months, 6558 people were admitted to our trauma service with blunt injury and 447 (6.8%) were found to have cervical fractures.

ACR Appropriateness Criteria on suspected osteomyelitis in patients with diabetes mellitus.

Imaging of the diabetic foot is among the most challenging areas of radiology. The authors present a consensus of the suggested tests in several clinical scenarios, such as early neuropathy, soft-tissue swelling, skin ulcer, and suspected osteomyelitis. In most of these situations, magnetic resonance imaging (MRI) with or without contrast is the examination of choice.

ACR Appropriateness Criteria on suspected spine trauma.

The evaluation of patients with suspected spine trauma is controversial. This document addresses several pertinent issues: (1) which patients need imaging, (2) how much imaging is necessary, and (3) exactly what sort of imaging is to be performed. This subject is important, because conservative estimates indicate that more than 1 million blunt trauma patients, who have the potential for sustaining spine injuries, are seen annually in emergency departments in the United States.

Defining the relationship between rotator cuff injury and proximal humerus fractures.

The purpose of our study was to correlate radiographic characteristics with rotator cuff tendon injury on magnetic resonance imaging after fractures of the proximal humerus. We prospectively obtained magnetic resonance imaging on 30 patients with proximal humerus fractures after classifying each fracture radiographically using Neer and AO systems and determining the displacement of the greater tuberosity. Twelve patients (40.

CT-guided iliosacral screw placement: technique and clinical experience.

Objective: The purpose of this study was to describe the technique of and experience in using CT guidance for percutaneous iliosacral screw placement in patients with unstable pelvic fractures.

Conclusion: CT-guided iliosacral screw placement is a safe and accurate procedure that can be performed by radiologists in a radiology suite.

Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging?

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear.

Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis.

Objective: To examine the role of radiography in screening trauma patients with suspected injury to the cervical spine.

Subjects And Methods: Over a period of 2 years, 5172 people were admitted to our trauma service and 297 (5.4%) were found to have cervical fractures.

POEMS syndrome: radiographic appearance with MRI correlation.

POEMS syndrome is a rare disorder in which patients present with the hallmark signs of polyneuropathy, organomegaly, endocrinopathy, M protein and skin changes. Many other clinical findings are also often present, most notably osseous lesions. The MRI appearance of the bony lesions in POEMS syndrome has been described in five cases, four of which are in the non-English literature.

Controversies in cervical spine imaging in trauma patients.

The subject of cervical spine imaging for trauma patients has generated significant controversy over the past decade and a half. This review considers three aspects of this controversy. The first examines the indications for cervical imaging, focusing on the factors that determine whether trauma patients are at high or low risk for cervical injury.

Electrochemical corrosion of metal implants.

Objective: The objective of our study was to show the radiographic changes that result from electrochemical corrosion of implanted metal in the body.

Conclusion: Corrosion of metal implants is not rare. Radiologists should become familiar with the changes this process produces.

Controversies in cervical spine imaging in trauma patients.

No area of emergency radiology has generated as much discussion in recent years as the subject of cervical spine imaging for trauma patients. This review will be in three parts. The first will examine the indications for cervical imaging and will focus on those factors that make patients at high risk or low risk for cervical injury.

Fatigue fracture of the sacrum in an adolescent.

There are relatively few reports of sacral stress fractures in children. In adolescents, sacral stress fractures have been reported in patients involved in vigorous athletic activity. Recognition of these fractures is important to avoid unnecessary biopsy if the findings are confused with tumor or infection.

Correlation of joint fluid and internal derangement on knee MRI.

Objective: To test the hypothesis that in symptomatic patients, knees in which MRI examinations demonstrate no significant effusion will also be free of internal derangement.

Design And Patients: One hundred and fifteen knee MRI examinations performed between March 2002 and June 2002 at our institution were retrospectively reviewed, evaluating for both the presence of knee effusions and concurrent internal derangement. The amount of joint fluid was measured quantitatively by obtaining anteroposterior measurements in the midline and lateral aspects of the suprapatellar pouch using sagittal MR images.

MRI of tibialis anterior tendon rupture.

Ruptures of the tibialis anterior tendon are rare. We present the clinical histories and MRI findings of three recent male patients with tibialis anterior tendon rupture aged 58-67 years, all of whom presented with pain over the dorsum of the ankle. Two of the three patients presented with complete rupture showing discontinuity of the tendon, thickening of the retracted portion of the tendon, and excess fluid in the tendon sheath.