Muscle injuries in athletics during the 2020 Tokyo Olympic Games: differences between heats and finals.

BACKGROUND: The aim of this study was to analyze muscle injuries and their related risk factors during the Athletics events of the 2020 Tokyo Olympic Games including the differences in muscle injury rates between heats and finals. METHODS: We included and analyzed in this study muscle injuries diagnosed by either magnetic resonance imaging, ultrasound, or physical examinations by at least two physicians, from Athletics athletes participating at the 2020 Tokyo Olympic Games. Data from electronic medical records, including sex, nationality, event, and the round (heat vs. final) during which the muscle injury occurred and the air temperature in the stadium, measured every five minutes during the competition were extracted. RESULTS: Among the 1631 athletes who competed, a total of 36 athletes (20 males and 16 females) were diagnosed with a muscle injury during the 2020 Tokyo Olympic Games. Among them, 24 occurred during heats (1.47 per 100 athletes) and 12 during finals (2.20 per 100 athletes) (P=0.25). Logistic regression analysis revealed that the geographic region of athletes' origin was a factor associated with muscle injury, with the highest muscle injury rate being in athletes from Africa (odds ratio [OR]=4.74, 95% confidence interval [CI]) = 1.75 to 12.82) and North America (OR=3.02, 95%CI=1.27 to 7.20). For male athletes, competing in finals was a risk factor to sustain a muscle injury (OR=2.55, 95%CI=1.01 to 6.45). CONCLUSIONS: During the 2020 Olympic Games, muscle injury rate was higher in finals than in heats, reaching statistical significance in male athletes.

Noteworthy performance of muscle injured para-athletes: A study of MRI-detected muscle injuries at the Tokyo 2020 Summer Paralympic Games.

BACKGROUND: To the best of our knowledge, no studies have attempted to correlate athletic performance with muscle injuries sustained during Paralympic Games. AIM: This study reports the incidence, anatomical location, anatomical site classification, and relationship between competition results and anatomical site classification in athletes who participated in the Paralympic Games. METHODS: All MRI images collected at the IPC polyclinic at the Tokyo 2020 Paralympic Games were reviewed to identify the presence and anatomical site of muscle injuries. The athletes' competition results were reviewed using IPC data sources. RESULTS: Twenty-six MRI-detected muscle injuries were observed in 16 male and 10 female athletes. Muscle injuries were most commonly observed during track and field events (n = 20) and in athletes with visual impairment (n = 12). Ten of the injuries involved the tendon. Twenty-one of injured athletes (81%) completed their competition, whereas 5 athletes did not. Eight athletes won medals in the Games. The anatomical site of muscle injury did not significantly impact the proportion of athletes who did not finish competition. CONCLUSION: Many athletes who sustained muscle injuries completed their competitions. No association was found between anatomical site classification and Paralympic athletes' performance in this study.

An evidence-based approach to artificial intelligence education for medical students: A systematic review.

The exponential growth of artificial intelligence (AI) in the last two decades has been recognized by many as an opportunity to improve the quality of patient care. However, medical education systems have been slow to adapt to the age of AI, resulting in a paucity of AI-specific education in medical schools. The purpose of this systematic review is to evaluate the current evidence-based recommendations for the inclusion of an AI education curriculum in undergraduate medicine. Six databases were searched from inception to April 23, 2022 for cross sectional and cohort studies of fair quality or higher on the Newcastle-Ottawa scale, systematic, scoping, and integrative reviews, randomized controlled trials, and Delphi studies about AI education in undergraduate medical programs. The search yielded 991 results, of which 27 met all the criteria and seven more were included using reference mining. Despite the limitations of a high degree of heterogeneity among the study types and a lack of follow-up studies evaluating the impacts of current AI strategies, a thematic analysis of the key AI principles identified six themes needed for a successful implementation of AI in medical school curricula. These themes include ethics, theory and application, communication, collaboration, quality improvement, and perception and attitude. The themes of ethics, theory and application, and communication were further divided into subthemes, including patient-centric and data-centric ethics; knowledge for practice and knowledge for communication; and communication for clinical decision-making, communication for implementation, and communication for knowledge dissemination. Based on the survey studies, medical professionals and students, who generally have a low baseline knowledge of AI, have been strong supporters of adding formal AI education into medical curricula, suggesting more research needs to be done to push this agenda forward.

Utilization of Imaging for Severe Injuries at the Beijing 2022 Winter Olympic Games.

Purpose: In order to better understand the imaging of severe trauma in sport, this study describes the imaging modalities utilized to image athletes who experienced severe traumatic injuries at the Beijing Winter Olympic Games 2022, the distribution of these modalities in relation to the sporting facilities, and the types of injuries imaged in each sport. Methods: This is a retrospective analysis with descriptive tables and figures, performed on a single population (athletes of the Beijing Winter Olympic Games 2022). Results: Of the 2871 athletes in the Beijing Winter Olympic Games, there were 40 athletes with severe injuries who underwent medical imaging. MRI was used more often than Radiography or CT. Athletes at venues without MRI on site had to be transferred to adjacent hospitals for care. Alpine and Freestyle skiing athletes experienced the majority of severe traumatic injuries at this Olympic Games, and the majority of injuries were to the lower limb. Conclusions: Access to medical imaging for severely injured athletes is a critical consideration in the organization of any sporting event. MRI in particular is highly utilized in this population.

T1Gd is reduced in bone marrow lesions overlying cartilage in the hip.

OBJECTIVE: Bone Marrow Lesions (BMLs) are areas in bone with high fluid signal on MRI associated with painful and progressive OA. While cartilage near BMLs in the knee has been shown to be degenerated, this relationship has not been investigated in the hip. RESEARCH QUESTION: is T1Gd lower in areas of cartilage overlying BMLs in the hip? DESIGN: 128 participants were recruited from a population-based study of hip pain in 20-49-year-olds. Proton-density weighted fat-suppressed and delayed Gadolinium Enhanced MR Imaging of Cartilage (dGEMRIC) images were acquired to locate BMLs and quantify hip cartilage health. BML and cartilage images were registered and cartilage was separated into BML overlying and surrounding regions. Mean T1Gd was measured in 32 participants with BMLs in both cartilage regions and in matched regions in 32 age- and sex-matched controls. Mean T1Gd in the overlying cartilage was compared using linear mixed-effects models between BML and control groups for acetabular and femoral BMLs, and between cystic and non-cystic BML groups. RESULTS: Mean T1Gd of overlying cartilage was lower in the BML group compared to the control group (acetabular: -105 ms; 95% CI: -175, -35; femoral: -8 ms; 95% CI: -141, 124). Mean T1Gd in overlying cartilage was lower in cystic compared to non-cystic BML subjects, but the confidence interval is too large to provide certainty in this difference (-3 [95% CI: -126, 121]). CONCLUSIONS: T1Gd is reduced in overlying cartilage in hips from a population-based sample of adults aged 20-49, which suggests BMLs are associated with local cartilage degeneration in hips.

The International Olympic Committee Venue Ultrasound Program: A Pilot Study From Tokyo 2020 Olympic Games.

ABSTRACT: The objective of this pilot investigation was to describe the novel use of venue ultrasound at the 2020 Tokyo Olympic Games. Portable laptop ultrasound machines were made available to cover seven Olympic sports at seven venues. The responses by both the National Olympic Committee personnel accompanying the medical room visits and by the examining physicians were recorded. Athletes were followed up until the end of the Olympic Games and the ultrasound diagnostic accuracy was evaluated. Fourteen athletes were evaluated using venue ultrasound and the recorded injuries included seven soft tissue, five osseous, and two nonmusculoskeletal injuries. From these, eight athletes were evaluated further by other imaging modalities, which indicated that the ultrasound provided an accurate diagnosis in all cases. All National Olympics Committee personnel reported increased diagnostic confidence and felt that venue ultrasound should be considered for future sports events. Furthermore, all evaluating physicians felt ultrasound was helpful in refining the diagnosis. The average years of sports ultrasound experience was 8.4 yrs and the average years of clinical sports medicine experience was 9.3 yrs among the physicians. In conclusion, the International Olympic Committee Venue Ultrasound Pilot Program showed promise in improving venue triaging, suggesting its role at future sports events.

Quantitative Assessment of Computed Tomography Energy Use and Cost Savings Through Overnight and Weekend Power Down in a Radiology Department.

Purpose: To assess energy and cost savings when a CT scanner is powered down during overnight non-operational times compared with the CT scanner left on full power or partial shutdown mode. Materials and Methods: Temporary portable power data loggers were placed on the power supply to the CT scanner to measure the energy consumption of the CT scanner in 3 power modes over 9 weeks: system ON (computer on, gantry on), computer ON (computer on/gantry off), and system shutdown (computer off/gantry off). Energy was separated into daily average consumption during normal operating hours and consumption after hours for three different day types: weekdays, Saturdays, and Sundays/Holidays. To estimate savings, the average after hours energy use per day during the system ON was compared to each of the two power saving modes. 95% confidence intervals were calculated for each mode and savings result. Results: Overnight and Sunday system shutdown compared to system ON mode is shown to save approximately 14 000 kWh over one year with a 95% confidence interval of (13 899 kWh, 14 464 kWh) as calculated by the electricity provider. Conclusion: Energy consumed by a CT scanner can be significantly reduced through system shutdown when the unit is non-operational, saving emissions and cost. In addition to cost and energy savings, this study emphasizes the importance of clinician leadership in convening interdisciplinary teams outside of usual healthcare silos to rethink how we purposefully use energy and reduce waste.

Knowledge and Perceptions of Competency-Based Medical Education in Diagnostic Radiology Post-Graduate Medical Education: Identifying Priorities and Developing a Framework for Professional Development Activities.

Introduction: We evaluated knowledge and perceptions of an established Competency-Based Medical Education (CBME) model developed by the Royal College of Physicians and Surgeons of Canada, Competence by Design (CBD), and identified evidence-informed priorities for professional development activities (PDAs). Materials and Methods: Teaching faculty and residents at a single, large diagnostic radiology post-graduate medical education (PGME) program were eligible to participate in this cross-sectional, survey-based study. Knowledge of CBD was evaluated through multiple choice questions (MCQs), which assessed participants' understanding of major principles and terms associated with CBD. Participants' perceptions of the anticipated impact of CBD on resident education and patient care were evaluated and priorities for PDAs were identified, which informed a framework for CBD PDAs. Results: Fifty faculty and residents participated. The faculty and resident response rates were 11.6% (n = 29/249) and 55.3% (n = 21/38), respectively. The mean ± standard deviation overall score on MCQs was 39.0% ± 20.4%. The majority of participants perceived the impact of CBD on resident education to be equivocal and to not impact patient care. Knowledge of CBD was not statistically significantly associated with participants' perceptions of the impact of CBD on either resident education or patient care (P > .05). Delivery of high-quality feedback was the greatest priority identified for PDAs. Discussion: Our results and proposed CBD PDAs framework may help to guide diagnostic radiology PGME programs in designing evidence-informed PDAs, which may meaningfully contribute to the successful implementation of CBD in diagnostic radiology PGME. As diagnostic radiology PGME programs throughout the world increasingly implement CBME models, evidence-informed PDAs will become of increasing importance.

Imaging-detected bone stress injuries at the Tokyo 2020 summer Olympics: epidemiology, injury onset, and competition withdrawal rate.

BACKGROUND: Prevention and early detection of injuries are essential in optimising sport participation and performance. The aim of this study is to investigate the epidemiology, athlete injury history, and competition withdrawal rate of imaging-detected bone stress injuries during the Tokyo 2020 Olympic Games. METHODS: We collected and analysed imaging and clinical information in athletes with bone stress injuries diagnosed in the Olympic Village polyclinic during the Games. Two physicians independently and retrospectively reviewed all imaging examinations of bone stress injuries. RESULTS: A total of 11,315 individual athletes from 206 National Olympic Committees competed at the Games, during which 567 MRIs and 352 X-rays were performed at the Olympic Village polyclinic. Radiology examinations revealed four stress fractures and 38 stress reactions in 29 athletes (median age 24 years, range 18-35 years). Of these, 72% of athletes (n = 21) had symptoms before entering the Olympic Village. Bone stress injuries were most common in women (55%), the lower extremities (66%), and track and field athletes (45%). Six athletes (21%) did not start or did not finish their competitions. CONCLUSIONS: This study revealed 42 imaging-detected bone stress injuries in the polyclinic of the Tokyo 2020 Olympic Village. The high proportion of athletes with symptoms before entering the village and the high proportion of competition withdrawals suggests the usefulness of an early MRI examination.

Review of Challenges to the Implementation of Competence by Design in Post-Graduate Medical Education: What Can Diagnostic Radiology Learn from the Experience of Other Specialty Disciplines?

Competence by Design (CBD) is a medical education initiative instituted by the Royal College of Physicians and Surgeons of Canada to improve the training of resident physicians in specialty disciplines. CBD integrates Competency Based Medical Education with traditional specialty discipline post-graduate medical education (PGME) training through the application of an organizational framework of competencies. Various specialty disciplines in Canada have transitioned to CBD since 2017 in a staggered approach. Diagnostic radiology PGME programs in Canada are expected to transition to CBD in 2022 for the incoming resident physician cohort. This article reviews potential challenges to the implementation of CBD in diagnostic radiology PGME programs and proposes evidence-informed targeted strategies and solutions to address these challenges. It is important for diagnostic radiology PGME programs to understand the challenges pertaining to the implementation of CBD so that they may be able to successfully implement this or similar medical education initiatives in their programs. Moreover, as radiology subspecialty PGME programs, such as nuclear medicine, interventional radiology, neuroradiology, and pediatric radiology, likewise transition to CBD and diagnostic radiology PGME programs internationally increasingly implement other Competency Based Medical Education models, the implications of the challenges pertaining to the implementation of CBD will further become of increasing importance.

Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage Values in Hips With Bone Marrow Lesions.

OBJECTIVE: Bone marrow lesions (BMLs) are associated with painful and progressive osteoarthritis (OA). Quantitative magnetic resonance imaging (MRI) has been used to study early cartilage degeneration in knees with BML, but similar work has not been done in hips. The purpose of this study was to compare mean delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) relaxation values (T1Gd) in hips with BML to hips without BML in a population-based study. Reduced T1Gd suggests depleted glycosaminoglycan. Our hypothesis was that mean T1Gd is lower in hips with BML compared to hips without BML. METHODS: Study participants (n = 128) were recruited from a cross-sectional population-based study of people ages 20-49 years with and without hip pain. dGEMRIC and proton density (PD)-weighted MRI scans of 1 hip from each participant were used for this analysis. BMLs were identified from PD-weighted fat-suppressed images. We applied a sampling-weighted linear regression model to determine the association of the presence of BMLs with mean cartilage T1Gd (significance: P < 0.05). The model was adjusted for age, sex, body mass index (BMI), hip pain, cam/pincer deformity, and physical activity. RESULTS: Thirty-two (25%) of the 128 participants had at least 1 BML. Subjects with at least 1 BML, compared to those without, had similar weighted characteristics of age, BMI, physical activity levels, and frequency of hip pain. Mean T1Gd was 75.25 msec lower (95% confidence interval -149.69, -0.81; P = 0.048) (9%) in the BML compared to the no-BML group. CONCLUSION: Our results suggest that hips with BMLs are associated with hip cartilage degeneration early in the OA disease process.