RESUMO
Retro-odontoid pseudotumor, or mass-like retro-odontoid soft tissue thickening, is an uncommon but important imaging finding that may be associated with rheumatoid arthritis, crystal deposition diseases, as well as non-inflammatory conditions such as cervical degenerative changes and mechanical alterations. Retro-odontoid pseudotumor is commonly associated with atlantoaxial microinstability or subluxation. MRI and CT have an important role in the detection and diagnosis of retro-odontoid pseudotumor. However, due to a wide range of imaging characteristics and ambiguous etiology, it is a frequently misunderstood entity. The purpose of this article is to review relevant anatomy of the craniocervical junction; describe various imaging appearances, pathophysiology and histology in both rheumatoid and non-rheumatoid etiologies; and discuss differential diagnosis of retro-odontoid pseudotumor in order to help guide clinical management.
Assuntos
Artrite Reumatoide/complicações , Articulação Atlantoaxial/diagnóstico por imagem , Luxações Articulares/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Processo Odontoide/diagnóstico por imagem , Doenças da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Humanos , Luxações Articulares/etiologia , Doenças da Coluna Vertebral/etiologiaRESUMO
Indications for hand surgeries include unremitting joint pain, deformity and stiffness, often secondary to arthritis. Several surgical options are available, including arthrodesis (fusion) and joint arthroplasty. Classically arthrodesis is performed in situations with poor bone stock and supporting soft tissues. Arthroplasty is reserved for patients and joints in which preservation of function is important and bone stock and soft tissue support are adequate. In this article we will review various techniques for arthrodesis and arthroplasty, their post-surgical imaging appearance, including key findings important to surgeons, and the findings that indicate post-surgical complications. Radiographs are the mainstay for postoperative evaluation and will be the focus of the imaging portions of this review. Advanced imaging modalities will be reviewed when applicable.
Assuntos
Artrite/diagnóstico por imagem , Artrite/cirurgia , Radiografia/métodos , Mãos/diagnóstico por imagem , Mãos/cirurgia , HumanosRESUMO
This article reviews evidence for performing various imaging studies in patients with total hip prostheses. Routine follow-up is generally performed with radiography. Radiographs are also usually the initial imaging modality for patients with symptoms related to the prosthesis. Following acute injury with pain, noncontrast CT may add information to radiographic examination regarding the presence and location of a fracture, component stability, and bone stock. Image-guided joint aspiration, noncontrast MRI, and white blood cell scan and sulfur colloid scan of the hip, are usually appropriate studies for patients suspected of having periprosthetic infection. For evaluation of component loosening, wear, and/or osteolysis, noncontrast CT or MRI are usually appropriate studies. Noncontrast MRI is usually appropriate for identifying adverse reaction to metal debris related to metal-on-metal articulations. For assessing patients after hip arthroplasty, who have trochanteric pain and nondiagnostic radiographs, ultrasound, or MRI are usually appropriate studies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Assuntos
Artroplastia de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Dor , Radiografia , Cintilografia , Sociedades Médicas , Estados UnidosRESUMO
Chronic foot pain is a frequent clinical complaint, which can significantly impact the quality of live in some individuals. These guidelines define best practices with regards to requisition of imaging studies based on specific clinical scenarios, which have been grouped into different variants. Each variant is accompanied by a brief description of the usefulness, advantages, and limitations of different imaging modalities. The present narrative is the result of an exhaustive assessment of the available literature and a thorough review process by a panel of experts on Musculoskeletal Imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Dor Crônica , Sociedades Médicas , Dor Crônica/diagnóstico por imagem , Diagnóstico por Imagem , Medicina Baseada em Evidências , Humanos , Estados UnidosRESUMO
OBJECTIVE: The purpose of our study was to investigate the efficacy of cross-table lateral knee radiography in the diagnosis of knee effusions compared with an MRI reference standard, to evaluate reader experience in effusion assessment, and to establish a new threshold for suprapatellar pouch measurement for the diagnosis of effusion. MATERIALS AND METHODS: First- and third-year radiology residents and an attending musculoskeletal radiologist retrospectively assessed 108 cross-table lateral knee radiographs for qualitative grading of joint fluid and quantitative measurement of the suprapatellar pouch. Qualitative and quantitative evaluation of ipsilateral knee MRI examinations performed within 1 week of radiography was performed by two attending musculoskeletal radiologists as a reference standard. RESULTS: Qualitative visual grading of cross-table lateral radiographs had a sensitivity of 90-92%, specificity of 39-54%, and accuracy of 69-76% for joint effusion. Extrapolating from previous work showing 4 mL of fluid distends the suprapatellar pouch to 4 mm on midline sagittal MRI, the corresponding measurement on cross-table lateral radiographs was predicted to be 7 mm. Using this new criterion of effusion, sensitivity, specificity, and accuracy compared with an MR midline sagittal reference standard were 76%, 83%, and 81%, respectively. Historical data for overhead lateral radiographs had a sensitivity of 78%, specificity of 80%, and accuracy of 79%. CONCLUSION: Qualitative visual assessment of cross-table lateral knee radiographs is highly sensitive for the detection of joint effusion. By performing quantitative evaluation with a new 7-mm criterion for suprapatellar pouch measurement, sensitivity, specificity, and accuracy are equivalent to that of overhead lateral radiography.
Assuntos
Exsudatos e Transudatos/citologia , Aumento da Imagem/métodos , Artropatias/diagnóstico , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética/métodos , Decúbito Dorsal , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Imaging evaluation of shoulder disorders should begin with radiographs. Several radiographic projections have been developed to best show areas affected by particular clinical disorders. This paper reviews the radiographic examinations that are used at our hospital for evaluating arthritis, impingement, trauma and instability. The techniques used to obtain each of these radiographs are briefly described to better understand the resulting images. An organized approach to assessment of these radiographs is delineated including evaluation of the ABCs (alignment, bone density, cartilage spaces and soft tissues). The expected radiographic findings in normal individuals and in patients with common abnormal conditions are reviewed.
Assuntos
Artropatias/diagnóstico por imagem , Luxação do Ombro/diagnóstico por imagem , Fraturas do Ombro/diagnóstico por imagem , Articulação do Ombro/diagnóstico por imagem , Ombro/diagnóstico por imagem , Humanos , RadiografiaRESUMO
Shoulder pain is one of the most common reasons for musculoskeletal-related physician visits. Imaging plays an important role in identifying the specific cause of atraumatic shoulder pain. This review is divided into two parts. The first part provides a general discussion of various imaging modalities (radiographs, arthrography, nuclear medicine, ultrasound, CT, and MRI) and their usefulness in evaluating atraumatic shoulder pain. The second part focuses on the most appropriate imaging algorithms for specific shoulder conditions including: rotator cuff disorders, labral tear/instability, bursitis, adhesive capsulitis, biceps tendon abnormalities, postoperative rotator cuff tears, and neurogenic pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Dor de Ombro/diagnóstico por imagem , Algoritmos , Diagnóstico Diferencial , Medicina Baseada em Evidências , Humanos , Dor de Ombro/etiologia , Sociedades Médicas , Estados UnidosRESUMO
Osteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of 20% within the first year. Dual x-ray absorptiometry (DXA) is the primary diagnostic modality by which to screen women >65 years of age and men >70 years of age for osteoporosis. In postmenopausal women <65 years of age with additional risk factors for fracture, DXA is recommended. Some patients with bone mineral density above the threshold for treatment may qualify for treatment on the basis of vertebral body fractures detected through a vertebral fracture assessment scan, a lateral spine equivalent generated from a commercial DXA machine. Quantitative CT is useful in patients with advanced degenerative bony changes in their spines. New technologies such as trabecular bone score represent an emerging role for qualitative assessment of bone in clinical practice. It is critical that both radiologists and referring providers consider osteoporosis in their patients, thereby reducing substantial morbidity, mortality, and cost to the health care system. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Osteoporose/diagnóstico por imagem , Idoso , Feminino , Fêmur/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Fatores de Risco , Fraturas da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
Infection of the musculoskeletal system is a common clinical problem. Differentiating soft tissue from osseous infection often determines the appropriate clinical therapeutic course. Radiographs are the recommend initial imaging examination, and although often not diagnostic in acute osteomyelitis, can provide anatomic evaluation and alternative diagnoses influencing subsequent imaging selection and interpretation. MRI with contrast is the examination of choice for the evaluation of suspected osteomyelitis, and MRI, CT, and ultrasound can all be useful in the diagnosis of soft tissue infection. CT or a labeled leukocyte scan and sulfur colloid marrow scan combination are alternative options if MRI is contraindicated or extensive artifact from metal is present. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Artrite Infecciosa/diagnóstico por imagem , Osteomielite/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Contraindicações de Procedimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Radiologia , Sociedades Médicas , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodos , Estados UnidosRESUMO
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Artralgia/diagnóstico por imagem , Artrite/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Extremidades/diagnóstico por imagem , Artralgia/etiologia , Artrite/complicações , Dor Crônica/etiologia , Humanos , Radiologia , Sociedades Médicas , Estados UnidosRESUMO
Inflammatory sacroiliitis or the seronegative axial spondyloarthropathies often presents as back pain or sacroiliac joint pain of more than 3-month duration with inflammatory symptoms and typically in patients younger than 45 years of age. Imaging plays an important role in diagnosis and disease monitoring. This article addresses the appropriate sequence of initial imaging for evaluation of a suspected spondyloarthropathy, the imaging follow-up of treatment response and the special considerations for imaging of trauma in patients with ankylosis of the spine. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Dor nas Costas/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Sacroileíte/diagnóstico por imagem , Espondiloartropatias/diagnóstico por imagem , Fatores Etários , Dor nas Costas/etiologia , Dor Crônica/etiologia , Diagnóstico por Imagem/métodos , Medicina Baseada em Evidências , Humanos , Radiologia , Sacroileíte/complicações , Sociedades Médicas , Espondiloartropatias/complicações , Estados UnidosRESUMO
Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in the United States and annual demand for primary TKA is expected to grow by 673% by 2030. The first part provides an overview of imaging modalities (radiographs, CT, MRI, ultrasound, and various nuclear medicine studies) and discusses their usefulness in the imaging evaluation of TKA. The second part focuses on evidence-based imaging and imaging-guided intervention algorithms for the workup of TKA and its complications, including routine follow-up, component wear, periprosthetic infection, aseptic loosening, granulomas/osteolysis, conventional and rotational instability, periprosthetic fracture, patellar complications, and a variety of periprosthetic soft tissue abnormalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Artroplastia do Joelho , Diagnóstico por Imagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Medicina Baseada em Evidências , Humanos , Sociedades Médicas , Estados UnidosRESUMO
Stress fractures, including both fatigue and insufficiency types, are frequently encountered in clinical practice as a source of pain in both athletes and patients with predisposing conditions. Radiography is the imaging modality of choice for baseline diagnosis. MRI has greatly improved our ability to diagnose radiographically occult stress fractures. Tc-99m bone scan and CT may also be useful as diagnostic tools. Although fatigue and insufficiency fractures can be self-limited and go onto healing even without diagnosis, there is usually value in initiating prompt therapeutic measures as incomplete stress fractures have the potential of progressing to completion and requiring more invasive treatment or delay in return to activity. This is particularly important in the setting of stress fractures of the femoral neck. Accuracy in the identification of these injuries is also relevant because the differential diagnosis includes entities that would otherwise be treated significantly different (ie, osteoid osteoma, osteomyelitis, and metastasis). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Fraturas de Estresse/diagnóstico por imagem , Sacro/lesões , Fraturas Ósseas , Humanos , Imageamento por Ressonância Magnética , Radiologia , Compostos Radiofarmacêuticos , Sacro/diagnóstico por imagem , Sociedades Médicas , Tecnécio , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia , Estados UnidosRESUMO
Chronic hip pain is a common clinical problem whose cause is often elucidated by imaging. The ACR Appropriateness Criteria for chronic hip pain define best practices of image ordering. Clinical scenarios are followed by the imaging choices and their appropriateness. The information is in ordered tables with an accompanying narrative explanation to guide physicians to order the right test. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Assuntos
Artralgia/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Articulação do Quadril/diagnóstico por imagem , Artralgia/etiologia , Dor Crônica/etiologia , Diagnóstico por Imagem/métodos , Humanos , Radiologia , Sociedades Médicas , Estados UnidosRESUMO
There has been a rapid increase in the number of shoulder arthroplasties, including partial or complete humeral head resurfacing, hemiarthroplasty, total shoulder arthroplasty, and reverse total shoulder arthroplasty, performed in the United States over the past two decades. Imaging can play an important role in diagnosing the complications that can occur in the setting of these shoulder arthroplasties. This review is divided into two parts. The first part provides a general discussion of various imaging modalities, comprising radiography, CT, MRI, ultrasound, and nuclear medicine, and their role in providing useful, treatment-guiding information. The second part focuses on the most appropriate imaging algorithms for shoulder arthroplasty complications such as aseptic loosening, infection, fracture, rotator cuff tendon tear, and nerve injury. The evidence-based ACR Appropriateness Criteria guidelines offered in this report were reached via an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (the RAND/UCLA Appropriateness Method and the Grading of Recommendations Assessment, Development, and Evaluation) for rating the appropriateness of imaging and treatment procedures for specific clinical scenarios. Further analysis and review of the guidelines were performed by a multidisciplinary expert panel. In those instances in which there was insufficient or equivocal data for recommending the appropriate imaging algorithm, expert opinion may have supplemented the available evidence.
Assuntos
Artroplastia do Ombro , Diagnóstico por Imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Algoritmos , Humanos , Estados UnidosRESUMO
Osteonecrosis of the hip (Legg-Calvé-Perthes) is a common disease, with 10,000-20,000 symptomatic cases annually in the United States. The disorder affects both adults and children and is most frequently associated with trauma and corticosteroid usage. The initial imaging evaluation of suspected hip osteonecrosis is done using radiography. MRI is the most sensitive and specific imaging modality for diagnosis of osteonecrosis of the hip. The clinical significance of hip osteonecrosis is dependent on its potential for articular collapse. The likelihood of articular collapse is significantly increased with involvement of greater than 30%-50% of the femoral head area, which is optimally evaluated by MRI, often in the sagittal plane. Contrast-enhanced MRI may be needed to detect early osteonecrosis of the hip in pediatric patients, revealing hypoperfusion. In patients with a contraindication for MRI, use of either CT or bone scintigraphy with SPECT (single-photon emission CT) are alternative radiologic methods of assessment. Imaging helps guide treatment, which may include core decompression, osteotomy, and ultimately, need for joint replacement. The ACR Appropriateness Criteria(®) are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Assuntos
Diagnóstico por Imagem , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Adulto , Criança , Humanos , Doença de Legg-Calve-Perthes/patologiaRESUMO
Appropriate imaging modalities for the follow-up of malignant or aggressive musculoskeletal tumors include radiography, MRI, CT, (18)F-2-fluoro-2-deoxy-D-glucose PET/CT, (99m)Tc bone scan, and ultrasound. Clinical scenarios reviewed include evaluation for metastatic disease to the lung in low- and high-risk patients, for osseous metastatic disease in asymptomatic and symptomatic patients, for local recurrence of osseous tumors with and without significant hardware present, and for local recurrence of soft tissue tumors. The timing for follow-up of pulmonary metastasis surveillance is also reviewed. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Assuntos
Assistência ao Convalescente/normas , Diagnóstico por Imagem/normas , Oncologia/normas , Doenças Musculoesqueléticas/diagnóstico por imagem , Neoplasias/diagnóstico por imagem , Radiologia/normas , Seguimentos , Humanos , Doenças Musculoesqueléticas/terapia , Neoplasias/terapia , Avaliação de Resultados em Cuidados de Saúde/normas , Prognóstico , Sociedades Médicas/normas , Resultado do Tratamento , Estados UnidosRESUMO
Advances in cancer care over the past decade have significantly changed treatment algorithms and life expectancies. Time from cancer diagnosis to death is rapidly increasing, as new, targeted therapies are developed, many prolonging life even in advanced disease. Tumors are now genotyped at diagnosis, allowing personalization of treatment. The FDA is continually approving new drugs that quickly become the standard of care for common tumors; the impact of these drugs and their side effects is monitored with imaging, and accurate interpretation of imaging studies has become essential as these patients live longer. Oncologists rely on radiologists to understand new patterns of treatment response and novel drug side effects that are associated with new drug classes, increasing the knowledge required for accurate image interpretation. These factors have led to the demand for dedicated cancer imaging training for radiologists, who can integrate findings throughout the body on various imaging modalities. In addition, we need to expand radiology's focus beyond diagnosis, staging, and restaging of tumors, and include education about the influence of genomics on tumor characterization and guidance for cancer care, the spectrum of treatment response, and the imaging characteristics of adverse events associated with various therapies. The time has come, therefore, to formally incorporate, as part of radiology residency, a distinct cancer imaging curriculum that is standardized, tested, and will allow the new generation of radiologists to effectively communicate with and assist their oncologic colleagues and optimally contribute to the care of patients with cancer.
Assuntos
Educação Médica/tendências , Oncologia/educação , Neoplasias/diagnóstico , Neoplasias/terapia , Radiologia/educação , Previsões , Genômica , HumanosRESUMO
Acute ankle injuries are frequently diagnosed and treated in emergency departments and outpatient clinics. Recent evidence-based clinical treatment guidelines and systematic review of economic analyses support the use of 3-view (anteroposterior, lateral, and mortise) radiographic evaluation of patients meeting the criteria of the Ottawa ankle rules. Cross-sectional imaging has a limited secondary role primarily as a tool for preoperative planning and as a problem-solving technique in patients with persistent symptoms and suspected of having occult fractures. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
Assuntos
Fraturas do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Guias de Prática Clínica como Assunto , Radiografia/normas , Radiologia/normas , Medicina Baseada em Evidências , Humanos , Estados UnidosRESUMO
More than 500,000 visits to the emergency room occur 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 radiographs are not required. Several clinical decision rules have been devised that can considerably reduce the number of radiographs ordered without missing a clinically significant fracture. Although a fracture is seen on only 5% of emergency department knee radiographs, 86% of knee fractures result from blunt trauma. In patients with a fall or twisting injury who have focal tenderness, effusion, or inability to bear weight, radiographs should be the first imaging study obtained. If the radiograph shows no fracture, MRI is best for evaluating for a suspected meniscus or ligament tear, or the injuries from a reduced patellar dislocation. Patients with a knee dislocation should undergo radiographs and an MRI, as well as an angiographic study such as a fluoroscopic, CT, or MR angiogram. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures, by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.