Battling fire and ice: remote guidance ultrasound to diagnose injury on the International Space Station and the ice rink.

BACKGROUND: National Aeronautical and Space and Administration (NASA) researchers have optimized training methods that allow minimally trained, non-physician operators to obtain diagnostic ultrasound (US) images for medical diagnosis including musculoskeletal injury. We hypothesize that these techniques could be expanded to non-expert operators including National Hockey League (NHL) and Olympic athletic trainers to diagnose musculoskeletal injuries in athletes. METHODS: NHL and Olympic athletic trainers received a brief course on musculoskeletal US. Remote guidance musculoskeletal examinations were conducted by athletic trainers, consisting of hockey groin hernia, knee, ankle, elbow, or shoulder evaluations. US images were transmitted to remote experts for interpretation. RESULTS: Groin, knee, ankle, elbow, or shoulder images were obtained on 32 athletes; all real-time US video stream and still capture images were considered adequate for diagnostic interpretation. CONCLUSIONS: This experience suggests that US can be expanded for use in locations without a high level of on-site expertise. A non-physician with minimal training can perform complex, diagnostic-quality examinations when directed by a remote-based expert.

Three-tesla imaging of the knee: initial experience.

PURPOSE: To assess 3-T imaging of the knee. MATERIALS AND METHODS: We reviewed 357 3-T magnetic resonance images of the knee obtained using a dedicated knee coil. From 58 patients who had arthroscopy we determined the sensitivity and specificity for anterior cruciate ligament (ACL) tear and medial and lateral meniscal tear. RESULTS: A chemical shift artifact showed prominently at 3 T even after improvements had been made by increasing the bandwidth. For complete ACL tear the sensitivity was 100% (95% confidence interval, CI, 75.30-100.00), and the specificity was 97.9% (95% CI 87.7-99.9). For the medial meniscus the sensitivity was 100.00% (95% CI 90.0-100.00), and the specificity was 83.3%(95% CI 66.6-95.3). For the lateral meniscus the sensitivity was 66.7% (95% CI 38.4-88.2), and the specificity was 97.6% (95% CI 87.1-99.9). CONCLUSIONS: In general 3-T imaging allows a favorable display of anatomy and pathology. The lateral meniscus was assessed to be weaker than the other anatomic structures. Three-tesla imaging allows increased signal-to-noise ratio, increased resolution, and faster scanning times.

Ultrasound for the early diagnosis of clinically suspected scaphoid fracture.

PURPOSE: To test the ability of ultrasound to diagnose clinically suspected occult scaphoid fractures. METHODS: Eighteen wrists in 18 patients with an average age of 35 years (range, 10-77 years) were seen in the emergency room, each with a single traumatic wrist injury, snuffbox tenderness, swelling, and a negative wrist x-ray result. They were evaluated in this prospective, blind, controlled study by physical examination, x-ray, and high-resolution ultrasound. One hand surgeon performed the examination, and ultrasounds were read by a musculoskeletal radiologist. Patients were immobilized in a thumb spica splint and then seen in the office 1 to 14 days after the emergency room visit, at which time a repeat physical examination, wrist x-ray, and the single investigative ultrasound were done using the opposite wrist as a control. All patients were immobilized and evaluated until symptoms resolved or x-ray showed scaphoid fracture site resorption or callus, in which case they were kept immobilized until healed. RESULTS: Ultrasound identified correctly 7 of 9 cases that were eventually positive for scaphoid fracture on plain x-ray. Ultrasound was read correctly as negative in 8 of 9 x-ray-negative cases; this was statistically significant. The 1 false-positive case had radioscaphoid arthrosis and radial wrist swelling. Sensitivity was 78% and specificity was 89%. The positive predictive value was 88% and negative predictive value was 80%. CONCLUSIONS: We recommend that high-frequency ultrasound be used to investigate occult suspected scaphoid fractures because of its ability to allow early diagnosis and to eliminate the need for a more invasive or expensive diagnostic test in most cases.

Ultrasonography of the Knee.

Musculoskeletal ultrasonography (MSUS) is a radiologic modality that can help in the evaluation of the knee and its lesions. Both soft tissue and surface bony structures can be sonographically visualized. The extra-articular structures of the knee can be evaluated, specifically the ligaments, bursae, and tendons. Collateral ligaments and the extensor mechanism, especially quadriceps and patellar tendons, are readily visualized. The diagnosis of a Baker's cyst and its complications is a common indication. The intra-articular structures of the knee, with proper maneuvers and transducers, can also be evaluated. The femoral condylar and patella cartilage can be examined for traumatic or degenerative lesions. The anterior and posterior cruciate ligaments can be partially visualized directly, or evaluated indirectly. Loose bodies are readily detectable whether intra-articular or extraneous in a Baker's cyst. Synovial disease can be characterized without the use of radiographic contrast. MSUS can be used as a screening, diagnostic or follow-up radiologic tool in the diseases of the knee.