Proximal fibular physeal stress injury: a known entity in an unusual location.

In the skeletally immature patient, physeal stress injury is a common diagnosis in repetitive stress injury; in this case, we present an atypical location of physeal stress injury of the bilateral proximal fibulae. There are multiple well-documented diagnoses of physeal stress injury involving the shoulder, elbow, wrist and tibia, often considered when patients present with the typical history of intensive sports training and pain exacerbated by repetitive movements. However, isolated proximal fibular physeal stress injury is either unusual or under-recognized and underreported. Although less common, proximal fibular physeal stress injury should be among the diagnostic considerations in active adolescents complaining of lower extremity pain as failure to identify this entity can lead to delayed care and preventable potential long-term musculoskeletal effects.

Interactive Multimedia Reporting Technical Considerations: HIMSS-SIIM Collaborative White Paper.

Despite technological advances in the analysis of digital images for medical consultations, many health information systems lack the ability to correlate textual descriptions of image findings linked to the actual images. Images and reports often reside in separate silos in the medical record throughout the process of image viewing, report authoring, and report consumption. Forward-thinking centers and early adopters have created interactive reports with multimedia elements and embedded hyperlinks in reports that connect the narrative text with the related source images and measurements. Most of these solutions rely on proprietary single-vendor systems for viewing and reporting in the absence of any encompassing industry standards to facilitate interoperability with the electronic health record (EHR) and other systems. International standards have enabled the digitization of image acquisition, storage, viewing, and structured reporting. These provide the foundation to discuss enhanced reporting. Lessons learned in the digital transformation of radiology and pathology can serve as a basis for interactive multimedia reporting (IMR) across image-centric medical specialties. This paper describes the standard-based infrastructure and communications to fulfill recently defined clinical requirements through a consensus from an international workgroup of multidisciplinary medical specialists, informaticists, and industry participants. These efforts have led toward the development of an Integrating the Healthcare Enterprise (IHE) profile that will serve as a foundation for interoperable interactive multimedia reporting.

Multispecialty Enterprise Imaging Workgroup Consensus on Interactive Multimedia Reporting Current State and Road to the Future: HIMSS-SIIM Collaborative White Paper.

Diagnostic and evidential static image, video clip, and sound multimedia are captured during routine clinical care in cardiology, dermatology, ophthalmology, pathology, physiatry, radiation oncology, radiology, endoscopic procedural specialties, and other medical disciplines. Providers typically describe the multimedia findings in contemporaneous electronic health record clinical notes or associate a textual interpretative report. Visual communication aids commonly used to connect, synthesize, and supplement multimedia and descriptive text outside medicine remain technically challenging to integrate into patient care. Such beneficial interactive elements may include hyperlinks between text, multimedia elements, alphanumeric and geometric annotations, tables, graphs, timelines, diagrams, anatomic maps, and hyperlinks to external educational references that patients or provider consumers may find valuable. This HIMSS-SIIM Enterprise Imaging Community workgroup white paper outlines the current and desired clinical future state of interactive multimedia reporting (IMR). The workgroup adopted a consensus definition of IMR as "interactive medical documentation that combines clinical images, videos, sound, imaging metadata, and/or image annotations with text, typographic emphases, tables, graphs, event timelines, anatomic maps, hyperlinks, and/or educational resources to optimize communication between medical professionals, and between medical professionals and their patients." This white paper also serves as a precursor for future efforts toward solving technical issues impeding routine interactive multimedia report creation and ingestion into electronic health records.

Developing an Interactive Data Visualization Tool to Assess the Impact of Decision Support on Clinical Operations.

Due to mandates from recent legislation, clinical decision support (CDS) software is being adopted by radiology practices across the country. This software provides imaging study decision support for referring providers at the point of order entry. CDS systems produce a large volume of data, providing opportunities for research and quality improvement. In order to better visualize and analyze trends in this data, an interactive data visualization dashboard was created using a commercially available data visualization platform. Following the integration of a commercially available clinical decision support product into the electronic health record, a dashboard was created using a commercially available data visualization platform (Tableau, Seattle, WA). Data generated by the CDS were exported from the data warehouse, where they were stored, into the platform. This allowed for real-time visualization of the data generated by the decision support software. The creation of the dashboard allowed the output from the CDS platform to be more easily analyzed and facilitated hypothesis generation. Integrating data visualization tools into clinical decision support tools allows for easier data analysis and can streamline research and quality improvement efforts.

Skeletal development of the hand and wrist: digital bone age companion-a suitable alternative to the Greulich and Pyle atlas for bone age assessment?

PURPOSE: To assess reader performance and subjective workflow experience when reporting bone age studies with a digital bone age reference as compared to the Greulich and Pyle atlas (G&P). We hypothesized that pediatric radiologists would achieve equivalent results with each method while digital workflow would improve speed, experience, and reporting quality. MATERIALS AND METHODS: IRB approval was obtained for this HIPAA-compliant study. Two pediatric radiologists performed research interpretations of bone age studies randomized to either the digital (Digital Bone Age Companion, Oxford University Press) or G&P method, generating reports to mimic clinical workflow. Bone age standard selection, interpretation-reporting time, and user preferences were recorded. Reports were reviewed for typographical or speech recognition errors. Comparisons of agreement were conducted by way of Fisher's exact tests. Interpretation-reporting times were analyzed on the natural logarithmic scale via a linear mixed model and transformed to the geometric mean. Subjective workflow experience was compared with an exact binomial test. Report errors were compared via a paired random permutation test. RESULTS: There was no difference in bone age determination between atlases (p = 0.495). The interpretation-reporting time (p < 0.001) was significantly faster with the digital method. The faculty indicated preference for the digital atlas (p < 0.001). Signed reports had fewer errors with the digital atlas (p < 0.001). CONCLUSIONS: Bone age study interpretations performed with the digital method were similar to those performed with the Greulich and Pyle atlas. The digital atlas saved time, improved workflow experience, and reduced reporting errors relative to the Greulich and Pyle atlas when integrated into electronic workflow.

Impact of a Reading Priority Scoring System on the Prioritization of Examination Interpretations.

OBJECTIVE: Our institution implemented a read priority scoring system to combat the known limitations of traditional methods for the prioritization of examination interpretations by radiologists. We aimed to determine the impact on report turnaround time (RTAT) and RTAT variability. MATERIALS AND METHODS: On examination completion, technologists entered a read priority score (1-9) using provided definitions. We retrospectively reviewed the median RTAT and RTAT variability (i.e., interquartile range length) for radiology examinations (n = 615,541; 2011-2014). We used Spearman correlation coefficients to determine the relationships between read priority scores and the median RTAT and the RTAT variability by year. We compared median RTAT and RTAT variability between early (2011) versus late (2012-2014) adoption phases using distribution-free random permutation tests. RESULTS: Ranked correlations showed yearly improvement, leading to a near-perfect ranking of median RTAT (r = 0.98, p < 0.001) and a perfect ranking of RTAT variability (r = 1.00, p < 0.001) by nine levels of priority. Eight of the nine priority levels showed a reduction in median RTAT between the early and late phases, and the three most urgent levels--that is, 1, 2, and 3--improved by 23%, 5%, and 70% (all, p < 0.001), respectively. Only one priority level (4, defined as outpatient urgent [8% of studies]) showed significant worsening by 15% (p < 0.001). The three most urgent levels of priority also showed improvements in RTAT variability (61%, 17%, 71%, respectively; all, p < 0.01). Only the lowest level of priority (9) exhibited a significant worsening in RTAT variability by 9% (p < 0.01). CONCLUSION: A reading priority scoring system with defined clinical scenarios yielded desirable prioritization of examination interpretations by radiologists as evidenced by appropriate and improved stratification of RTATs and RTAT variability.

Prospective Evaluation of Agreement and Accuracy in the Diagnosis of Meniscal Tears: MR Arthrography a Short Time After Injection Versus CT Arthrography After a Moderate Delay.

OBJECTIVE: The purpose of this study was to compare the performance of direct CT arthrography performed after a moderate injection delay with that of MR arthrography performed soon after injection in the diagnosis of meniscal tears. SUBJECTS AND METHODS: Twenty-five patients underwent direct MR arthrography followed by same-day CT arthrography of the knee. Two blinded musculoskeletal radiologists independently reviewed the MR and CT arthrographic images for the presence of medial or lateral meniscal tears in the anterior horn, body, and posterior horn. Their readings were compared with a reference standard reading, which was based on post-MRI arthroscopic findings (n = 11) or the consensus opinion of two other musculoskeletal radiologists who simultaneously reviewed the paired CT and MR arthrographic examinations using all available clinical, surgical, and imaging information. The individual and combined radiologist agreements with the reference standard were calculated for each modality. RESULTS: Interreader agreement was 91% for MR arthrography and 85% for CT arthrography. The overall combined radiologist agreement with the reference standard was 91% for MR arthrography and 86% for CT arthrography (p = 0.03). For the two readers, the overall accuracy rates for diagnosing a meniscal tear were 82% and 88% with MR arthrography and 74% and 76% with CT arthrography. Only 50% (3/6) of surgically proven tears imbibed gadolinium. CONCLUSION: Although MR arthrography performed soon after the contrast injection had higher interreader agreement and greater accuracy, CT arthrography performed after a mean postinjection delay of 100 minutes was moderately accurate in the diagnosis of meniscal tears and can be used as an alternative procedure when MR arthrography cannot be completed.

Prevalence of asymptomatic chondrocalcinosis in the pelvis.

OBJECTIVE: To determine trends in incidentally detected age- and gender-associated chondrocalcinosis on pelvic CT. MATERIALS AND METHODS: Twenty patients of each gender at the center of each decade of life who underwent a CT scan of the pelvis performed 2009-2013 were identified and selected for a total of 400 pelvic CTs. Images were reviewed independently by two radiologists for the presence or absence of chondrocalcinosis within the pelvis. Patients with hip or low back pain, known CPPD arthropathy or any known predisposing condition, prior hip arthroplasty, or articular fracture were excluded. Logistic regression was used to predict the presence/absence of chondrocalcinosis as a function of patient age and gender. RESULTS: The presence/absence of chondrocalcinosis was found to be associated with patient age (p = 0.016) but not patient gender (p = 0.929). In the pelvis, chondrocalcinosis was most frequently identified at the pubic symphysis. Incidental chondrocalcinosis was not identified in any patients under 50 years of age. Chondrocalcinosis increased in frequency from 12.5 at 55 years of age to 27.5 % of patients 95 years of age. CONCLUSIONS: Chondrocalcinosis is common and more prevalent in late adulthood, occurs without a gender predilection, and is infrequently identified in patients younger than 50 years of age.

Presumed prepatellar fibrosis in collegiate wrestlers: imaging findings and clinical correlation.

Knee pain and injury are common complaints of athletes presenting to the orthopedic clinic. Wrestlers are no exception, and may present more commonly with anterior knee pain because of the nature of their sport. Morel-Lavallée lesions and prepatellar bursitis have been described in the prepatellar region of wrestlers. We report a distinctly different prepatellar finding on MRI, focally prominent and discrete fibrosis in three collegiate wrestlers. This characteristic appearance and clinical setting have already been repeated in our clinical practice; thus, other MRI readers are also likely to encounter this finding, which in our experience can be considered a "don't touch" lesion of no clinical significance.

MR arthrography: impact of steroids, local anesthetics, and iodinated contrast material on gadolinium signal intensity in phantoms at 1.5 and 3.0 T.

PURPOSE: To determine if gadolinium signal intensity at direct magnetic resonance (MR) arthrography is affected by the addition of steroids, anesthetics, or iodinated contrast material. MATERIALS AND METHODS: This study did not require approval by the institutional review board because no patients or patient data were involved. An in vitro study was performed to evaluate various concentrations of three gadolinium contrast agents (gadopentetate dimeglumine, gadobenate dimeglumine, and gadofosveset trisodium) diluted in either saline or iodinated contrast material (50% and full-strength iohexol 300). Three steroids (betamethasone, triamcinolone, and methylprednisolone) and three local anesthetics (lidocaine, ropivacaine, and bupivacaine) were added to solutions in clinical doses. T1-weighted fat-suppressed MR imaging sequences were performed in phantoms at 1.5 and 3.0 T. Signal intensities were measured. All experiments were repeated in full for a total of three replications each. The data were analyzed by using two-way factorial analysis of variance. RESULTS: Dilution of gadolinium into iohexol reduced the signal intensity in all samples compared with dilution in saline alone. Peak signal intensities were at 0.625 and 1.25 mmol/L of gadolinium in iohexol at both magnet strengths. At 1.5 T, the addition of steroids and anesthetics to the saline solutions had no impact on the signal intensity curves, with the peak signal intensity at gadolinium concentrations of 2.5 and 1.25 mmol/L. At 3.0 T, the addition of steroids and anesthetics had minimal effect on signal intensity curves, with the peak signal intensity at 1.25 mmol/L of gadolinium. CONCLUSION: The addition of steroids and/or anesthetics to gadolinium solutions for MR arthrography does not substantially impact signal intensity. When gadolinium is diluted into a 50% or greater strength of iohexol, the signal intensity curve shifts so that the maximum signal intensity is obtained with lower gadolinium concentrations (0.625-1.25 mmol/L).

Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes?

BACKGROUND: When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment. QUESTIONS/PURPOSES: We (1) compared MRI findings of medial ligament injuries between Schenck KDIIIM and KDIV injuries, (2) compared clinical outcomes and health-related quality of life as determined by Lysholm and Veterans Rand 36-Item Health Survey (VR-36) scores, respectively, of reconstructed KDIIIM and KDIV injured knees, and (3) determined reoperation rates of reconstructed KDIIIM and KDIV injured knees. METHODS: Over a 12-year period, we treated 65 patients with knee dislocations involving bicruciate ligament injury and concomitant medial ligament injuries, without or with posterolateral corner injuries (Schenck KDIIIM and KDIV, respectively); 57% were available for followup at a mean of 6.2 years (range, 1.1-11.6 years). These patients were contacted, and prospectively measured clinical outcomes scores (Lysholm and VR-36) were obtained and compared between subsets of patients. Preoperative MRIs (available for review on 49% of the patients) were rereviewed to characterize the medial ligament injuries. RESULTS: KDIIIM injuries more frequently had complete deep medial collateral ligament tears and posterior oblique ligament tears compared to KDIV injuries. KDIIIM knees had better Lysholm scores (88 versus 67, p = 0.027) and VR-36 scores (88 versus 70, p = 0.022) than KDIV knees. Female sex (Lysholm: 55 versus 85, p = 0.005; VR-36: 59 versus 85, p = 0.003) and an ultra-low-velocity mechanism (injury that occurs during activity of daily living in obese patients) (Lysholm: 55 versus 80-89, p = 0.002-0.013; VR-36: 60 versus 79-88, p = 0.001-0.017) were associated with worse outcomes. The overall reoperation rate was 28%, and the most common indication for reoperation was stiffness. CONCLUSIONS: Medial ligament injury is common in knee dislocations. Females who sustain these injuries and patients who have an ultra-low-velocity mechanism should be counseled at the time of injury about the likelihood of inferior outcomes. As ROM deficits are the most commonly encountered complication, postoperative rehabilitation should focus on early ROM exercises as stability and wound healing allow. Future prospective studies are needed to definitively determine whether operative or nonoperative management is appropriate for particular medial ligamentous injury patterns.

Extraosseous Gaucher cell deposition without adjacent bone involvement.

Extraosseous Gaucher cell deposits are a rare complication of Gaucher disease that can mimic malignancy. We describe a case of Gaucher cell deposition in the subcutaneous soft tissues overlying the lower thoracic spine in an 18-year-old woman with known type III Gaucher disease. This case is unique in the literature because this subcutaneous Gaucher mass was not associated with extension from underlying bone involvement or clear lymph node origin. It demonstrated no discernible continuity with the adjacent thoracic spinous processes, the cortices of which appeared intact. Although patients with Gaucher disease are at increased risk of malignancy, Gaucher cell deposition should remain a differential consideration for soft tissue masses with or without adjacent bone involvement in patients with known Gaucher disease.

MRI of transforaminal lumbar interbody fusion: imaging appearance with and without the use of human recombinant bone morphogenetic protein-2 (rhBMP-2).

PURPOSE: To describe the vertebral endplate and intervertebral disc space MRI appearance following TLIF, with and without the use of rhBMP-2, and to determine if the appearance is concerning for discitis/osteomyelitis. MATERIALS AND METHODS: After institutional review board approval, 116 TLIF assessments performed on 75 patients with rhBMP-2 were retrospectively and independently reviewed by five radiologists and compared to 73 TLIF assessments performed on 45 patients without rhBMP-2. MRIs were evaluated for endplate signal, disc space enhancement, disc space fluid, and abnormal paraspinal soft tissue. Endplate edema-like signal was reported when T1-weighted hypointensity, T2-weighted hyperintensity, and endplate enhancement were present. Subjective concern for discitis/osteomyelitis on MRI was graded on a five-point scale. Generalized estimating equation binomial regression model analysis was performed with findings correlated with rhBMP-2 use, TLIF level, graft type, and days between TLIF and MRI. RESULTS: The rhBMP-2 group demonstrated endplate edema-like signal (OR 5.66; 95% CI [1.58, 20.24], p = 0.008) and disc space enhancement (OR 2.40; 95% CI [1.20, 4.80], p = 0.013) more often after adjusting for the TLIF level, graft type, and the number of days following TLIF. Both groups had a similar temporal distribution for endplate edema-like signal but disc space enhancement peaked earlier in the rhBMP-2 group. Disc space fluid was only present in the rhBMP-2 group. Neither group demonstrated abnormal paraspinal soft tissue and discitis/osteomyelitis was not considered likely in any patient. CONCLUSIONS: Endplate edema-like signal and disc space enhancement were significantly more frequent and disc space enhancement developed more rapidly following TLIF when rhBMP-2 was utilized. The concern for discitis/osteomyelitis was similar and minimal in both groups.

Preliminary results of a novel single-stage cartilage restoration technique: particulated juvenile articular cartilage allograft for chondral defects of the patella.

PURPOSE: To evaluate outcomes and magnetic resonance imaging (MRI) findings after use of particulated juvenile cartilage for the treatment of focal Outerbridge grade 4 articular cartilage defects of the patella. METHODS: From 2007 to 2011, 16 patients (2 bilateral) underwent a novel single-stage articular cartilage restoration procedure using particulated juvenile articular cartilage allograft. We enrolled 15 knees (13 patients) in this study. The mean age at surgery was 26.4 ± 9.1 years, and the mean postoperative follow-up was 28.8 ± 10.2 months. A musculoskeletal radiologist evaluated each knee with postoperative MRI for the International Cartilage Repair Society cartilage repair assessment score, graft hypertrophy, bony changes around the graft, and percent fill of the defect. All patients also completed the Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee Subjective Knee Evaluation, and Kujala clinical outcome survey (scale, 0 to 100), as well as the Tegner activity scale and visual analog pain scale (scale, 0 to 10). RESULTS: The mean International Cartilage Repair Society cartilage repair assessment score on MRI was 8.0 ± 2.8, a nearly normal assessment. Of 15 knees, 11 (73%) were found to have normal or nearly normal cartilage repair. Three patients had mild graft hypertrophy whereas 2 had gross graft hypertrophy, 2 of whom required arthroscopic debridement because of symptoms. The mean fill of the defect at follow-up was 89% ± 19.6%, with 12 of 15 knees (80%) showing at least 90% defect coverage. The mean clinical outcome score at follow-up was 73.3 ± 17.6 for the International Knee Documentation Committee evaluation, and the mean scores for each subdomain of the Knee Injury and Osteoarthritis Outcome Score were as follows: 84.2 ± 14.2 for pain, 85.0 ± 12.3 for symptoms and stiffness, 88.9 ± 12.9 for activities of daily living, 62.0 ± 25.1 for sports and recreation, and 60.8 ± 28.6 for quality of life. The median score for the Kujala survey was 79 (range, 55 to 99). The median score on the Tegner activity scale was 5 (range, 3 to 9), and the mean score on the visual analog scale was 1.9 ± 1.4, indicating minimal pain. CONCLUSIONS: Preliminary results suggest that cartilage restoration using particulated juvenile articular cartilage allograft offers a viable option for patients with focal grade 4 articular cartilage defects of the patella.

Imaging Features of Intraosseous Schwannoma: A Case Series and Review of the Literature.

To characterize the imaging features of patients with pathologically confirmed intraosseous schwannoma (IOS), institutional pathology and imaging databases were searched for IOS cases over a period of 17 years. A musculoskeletal radiologist evaluated all imaging studies. Additionally, a literature search was performed to identify IOS cases that had imaging findings of at least two modalities. Six patients (one female, five males, mean age of 50 ± 14 years) with IOS were identified, with all lesions localized to the lumbosacral region. Radiographic imaging was available in four patients, while all patients underwent CT and MR imaging. Radiographs depicted lytic lesions, and CT depicted heterogeneous expansile lesions with centrally hypodense areas and peripheral sclerosis. All cases involved extra-osseous extension, producing a mass effect on adjacent soft tissues and nerve roots. On MRI, the neoplasms displayed iso- to- slightly- low signal intensity on T1-weighted images and hyperintense signal intensity on T2-weighted images with heterogeneous enhancement. The literature review resulted in 102 IOS cases, which to the best of our knowledge, is the largest review on IOS, and the imaging findings of the previously published cases were the same as our cases. IOSs are rare benign neoplasms that should be considered in the differential diagnosis of well-defined expansile lytic lesions with sclerotic borders. This is particularly important in middle-aged adults with mandibular, sacral, or vertebral body mass.

Can stress radiography of the knee help characterize posterolateral corner injury?

BACKGROUND: Conventional MRI is limited for characterizing the posterolateral corner of the knee due to the region's anatomic variability and complexity; further, MRI is a static study and cannot demonstrate pathologic laxity. Stress radiography may provide additional information about instability. QUESTIONS/PURPOSES: We therefore (1) correlated varus stress radiography with MRI findings, (2) compared opening in patients who underwent surgical posterolateral corner stabilization versus those who did not, and (3) determined whether stress radiography findings could supplement MRI for making treatment decisions. PATIENTS AND METHODS: We retrospectively studied 26 patients (27 knee injuries) and correlated lateral compartment opening on varus stress radiography with severity of posterolateral corner injury on MRI. We compared radiographic findings in 18 patients with complete injuries who underwent posterolateral corner stabilization with five who did not. RESULTS: A complete posterolateral corner injury on MRI was associated with an average of 18.6 mm (10.0-36.5 mm) of varus opening versus 12.8 mm (7.5-17.0 mm) in partial injuries. Opening in operative cases that underwent stabilization was 16.5 mm (11.0-36.5 mm) versus 11.0 mm (7.5-13.5 mm) for those that did not. Ten of 15 partial injuries underwent stabilization, for which the varus opening was 13.6 mm (11.0-17.0 mm). Average varus opening in partial injuries that did not undergo stabilization was 11.0 mm (7.5-13.5 mm). CONCLUSIONS: Varus stress radiography correlated to MRI findings for posterolateral corner injury. The injuries we treated with reconstruction were associated with increased varus opening. In patients with partial posterolateral corner injury on MRI, we used degree of opening on varus stress radiography to aid the decision for stabilization. LEVEL OF EVIDENCE: Level IV, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

Magnetic resonance imaging appearance of scurvy with gelatinous bone marrow transformation.

Scurvy is a lethal but treatable disease that is rare in industrialized countries. Caused by vitamin C deficiency, it is most prevalent in persons of low socioeconomic status and smokers. Low levels of circulating vitamin C result in poor collagen fiber formation that, in turn, leads to demineralized bones, microfractures, and poor healing. Here we report a case of scurvy in a 5-year-old boy with normal radiographs in whom initial concern for leukemia based upon magnetic resonance imaging and clinical presentation led to a bone marrow biopsy revealing gelatinous transformation.

Calcific myonecrosis of the upper extremity: case report.

Calcific myonecrosis is an uncommon late sequela of limb trauma that results in calcification and necrosis of damaged muscle. It almost exclusively occurs in the lower extremity. We present a second case of calcific myonecrosis in the upper extremity.

TeleResidents: Exploring the use of Resident Home Workstations During the COVID Pandemic.

RATIONALE AND OBJECTIVES: Since the beginning of the COVID-19 pandemic, numerous strategies have been proposed to allow for continued resident education while following social distancing guidelines. Diagnostic radiology is largely electronic work, allowing for relatively easy transition to telehealth. Our institution deployed home workstations to interested upper level radiology residents and fellows in order to maintain high volume workload and education, while complying with CDC social distancing and quarantine guidelines. MATERIALS AND METHODS: We deployed 28 home workstations with integrated PACS, electronic health record, and reporting system, supporting workflow that matched our on-site processes and allowing residents to work from home while on diagnostic rotations. Two months into the pilot, surveys were sent to trainees and faculty to assess satisfaction related to education, productivity, and wellness. A retrospective study count was performed for a sample of residents in order to assess productivity. RESULTS: Residents perceived their remote productivity as unchanged or better than at the hospital, while faculty were more likely to perceive it as decreased, however, objective results showed no difference. Education was largely considered worse or unchanged with very few regarding it as improved. Those utilizing shared-screen signout platforms rated education better than those utilizing voice/telephone communications only. Trainees expressed improvement in wellness and quality of life. CONCLUSION: Home workstations for trainees represent a feasible solution for implementing social distancing or even quarantine while maintaining operational productivity. There is the added benefit of scheduling flexibility, option to overcome space constraints, and improved quality of life.

The cartilage black line sign: an unexpected MRI appearance of deep cartilage fissuring in three patients.

Many patterns of cartilage signal anomalies have been described in the knee since the advent of magnetic resonance imaging (MRI). With the now widespread use of preoperative MRI, some of these anomalies have proven to represent true pathology, while others have been shown to be normal variants or artifacts at arthroscopy. We describe three patients with an MR cartilage abnormality, not previously illustrated in the literature, consisting of a thin dark signal line on T2-weighted imaging, oriented perpendicular to the plane of imaging. This aberration proved to represent a deep cartilage cleft at arthroscopy (two patients) and at CT arthrography (one patient). Such full thickness fissures are generally considered to have the opposite appearance, that of fluid signal intensity on T2-weighted images.