The changing psychiatry workforce in Australia: Still lacking in rural and remote regions.

INTRODUCTION: There is a long standing and worsening shortage of psychiatrists in Australia particularly in rural areas. The majority of psychiatrists work in major cities. OBJECTIVE: To identify recent trends in the Australian rural psychiatrist workforce compared with the metropolitan workforce. DESIGN: We descriptively analysed population-level data from the National Health Workforce Data Set (NHWDS), the Australian Institute of Health and Welfare (AIHW) and the Australian Bureau of Statistics (ABS). A descriptive analysis of the numbers (count) and gender of psychiatrists from 1995 to 2022 working in Australia was conducted. For the period 2013 to 2022, we analysed for rurality, gender, years' experience, hours worked, Medicare-subsidised services provided and proportions of Specialist International Medical Graduates (SIMG) by sex, with a focus on the rural workforce. For international comparison, psychiatrist numbers were obtained for other OECD countries. The number of psychiatrists working in Australia, as per NHWDS and AIHW, was quantified. We analysed trends in demographics, hours worked and rurality of psychiatrists working in Australia in a serial cross-sectional design. FINDINGS: Most psychiatrists are maldistributed to major cities, while outer regional and remote areas have few resident psychiatrists. Outer regional New South Wales (NSW) and South Australia (SA) have the lowest numbers of psychiatrists per capita. The full-time equivalent (FTE) of psychiatrists per 100 000 has increased from 12.6 in 2000 to 15.2 in 2022. However, the average hours worked by psychiatrists has declined. In total, available psychiatrist hours worked per 100 000 population has increased by 6.1% since the beginning of the millennium. DISCUSSION: Rural areas in NSW and SA have the greatest shortage of psychiatrists. Specialist International Medical Graduates and females (43% of the overall workforce) are the predominant workforce in rural areas. Although Medicare-subsidised services per 1000 people have increased in rural areas, they remain lower than for those living in major cities. CONCLUSION: There remains an acute shortage of psychiatrists in many regional and remote areas of Australia, with an increasing proportion of SIMGs and females working in these areas, in the context of future increased demand.

Perceptions of work-life balance and gender issues in private radiology in Australia.

INTRODUCTION: Women comprise almost 30% of practising clinical radiologists in Australia. Despite three-quarters of clinical radiologists working in private practice, there is limited research regarding the experience of female radiologists in private practice and issues surrounding work-life balance. The primary aim of this study was to identify gender issues within private radiology and investigate work-life balance, focusing on issues relevant for female practitioners. METHODS: Clinical radiologists working in private practice at five major Australian private radiology service providers were sent an email on behalf of the researchers, containing study information and a link to an online questionnaire. Descriptive statistics, chi-square analysis and Fisher's exact test were used. Binary logistic regression was used to determine odds ratios and 95% confidence intervals. Responses to short-answer questions were analysed manually and grouped into themes. RESULTS: There were consistent gender differences in perceptions of gender and its implication upon working and career progression in radiology private practice. There was near unanimous agreement that private radiologists should be able to work flexible/reduced working hours for a proportionate decrease in pay. Two themes with distinct gender differences related to pay equity and transparency. Key themes relating to work-life balance for private radiologists included workload, setting boundaries and flexibility of work hours in private radiology. CONCLUSION: This preliminary survey highlights areas related to work-life balance and gender issues relevant for female practitioners in private practice radiology in Australia that can be targeted for further investigation and improvement, namely pay equity and transparency, and part-time leadership opportunities.

Female representation in radiology subspecialty interest groups in Australia and New Zealand.

INTRODUCTION: Women comprise 31% of the Australian and New Zealand radiology workforce, and 35% of radiology trainees. To date, there has been no study of female representation within clinical radiology subspecialties in Australia and New Zealand. This study aims to quantify female representation among the clinical radiology subspecialty interest groups (SIGs) in Australia and New Zealand. METHODS: A list of SIGs was compiled using the Royal Australian and New Zealand College of Radiologists (RANZCR) website. The executive of each SIG or the RANZCR Standards committee was contacted with a request to provide the number of female versus male members for each subspecialty group and their executive. RESULTS: Six out of 10 SIGs reported a low proportion of female members; this was most pronounced for IRSA (interventional radiology; 7% women), AMSIG (musculoskeletal imaging; 13% women) and CCINR (interventional neuroradiology; 13% women). Female radiologists accounted for >50% of membership in four SIGs: OGSIG (obstetrics/gynaecology imaging; 87% women), BIG (breast imaging; 73% women), ARGANZ (abdominal imaging; 69% women) and ANZSTR (thoracic imaging; 69% women). Female executive representation ranged from 0% (IRSA (interventional radiology) and ANZSNR (neuroradiology)) to 100% (OGSIG (obstetrics/gynaecology imaging)). CONCLUSION: Female representation within the membership and representative leadership of some SIGs is well below parity and active initiatives to improve female representation should be considered.

Acute calcific periarthritis-a commonly misdiagnosed pathology.

Acute calcific periarthritis (ACP) is a self-limiting, monoarticular, peri-articular process of dystrophic mineral deposition and adjacent inflammation. Patients present with a sudden onset of pain, localised swelling, erythema, tenderness and restricted range of motion. Symptoms reduce in severity within 4-7 days and self resolve in 3-4 weeks. ACP is commonly misdiagnosed, in particular, as infective or inflammatory pathologies such as septic arthritis and gout. This condition has specific imaging findings which allows differentiation from other disorders when combined with the clinical presentation. Prompt diagnosis results in appropriate management and reduces the likelihood of unnecessary diagnostic and therapeutic procedures.

Imaging of Acute Capsuloligamentous Sports Injuries in the Ankle and Foot: Sports Imaging Series.

The ankle and foot are commonly injured during sporting activities. Clinical diagnosis can at times be challenging, due to the complex anatomy and multiple sites of potential injury. In the athlete, there is a reduced threshold for imaging to clarify diagnosis, guide prognosis, and treatment. Diagnostic imaging is also helpful in evaluating ongoing symptoms in the subacute or chronic setting. © RSNA, 2017.

Anterior cruciate ligament and intercondylar notch growth plateaus prior to cessation of longitudinal growth: an MRI observational study.

PURPOSE: Increasing numbers of children and adolescents are being treated for ACL tears. In order for surgeons to safely optimize treatment during ACL surgery, we must better understand ACL growth and intercondylar notch patterns in the skeletally immature knee. The aim of this study is to measure ACL and intercondylar notch volume in paediatric patients and observe how these volumes change as a function of age and gender. METHODS: Data were extracted from the picture archiving and communication systems (PACS) computer records. Sample consisted of 137 MRI knee examinations performed between January 2006 and July 2010 in patients aged 3-13. Subjects were grouped into 1-year age intervals. Patients with imaging reports including ACL tears, previous surgeries, congenital structural anomalies, or syndromes were excluded. RESULTS: Measures of ACL volume significantly increased with age (P < 0.001). A linear increase in ACL volume was observed until the age 10, with a mean increase in volume of 148 mm(3) per age group. ACL volume plateaued at 10 years, after which minimal increase in ACL volume was observed. Sex was not found to be a significant predictor of ACL volume in the multiple linear regression (P = 0.57). Similar to ACL volume, there was a significant increase in intercondylar notch volume with age with a mean increase of 835 mm(3) per age group (P < 0.0001). Intercondylar notch volume reached a plateau at age 10, after which a minimal increase in notch volume was observed in older groups. Female patients had notch volumes that were on average 892 + 259 mm(3) smaller than male patients who were in the same age group (P = 0.0006). CONCLUSION: The plateau in the growth of ACL and notch volume occurs at age 10, prior to the halt in longitudinal growth of boys and girls. Female patients have significantly smaller intercondylar notch volumes than their age-matched male counterparts, while no gender difference was seen in ACL volume. These results suggest that notch volume is an intrinsically sex-specific difference, which may contribute to the higher rate of ACL tears among females. These growth patterns are clinically relevant as it allows surgeons to better understand the anatomy, pathology, and risk factors related to ACL tears and its reconstruction. LEVEL OF EVIDENCE: Observational Study, Level IV.

Evaluation of the effect of zoom function on lesion detection by soft-copy reading of screening mammograms.

INTRODUCTION: This study aims to evaluate the effectiveness of zooming in improving screen-reader performance in reporting digital mammograms. METHOD: Two experiments were conducted. In the first experiment, 5 readers were asked to report 59 two-view bilateral mammograms retrospectively with zooming function turned off. The second session was similar to the first one except that zooming was enabled. The task of readers was to assess if the mammograms were normal or abnormal and rate the confidence levels for each of the lesion they detected. The reader performances were evaluated via case sensitivity, lesion sensitivity, specificity, receiver operating characteristics (ROC) area under the curve (AUC) and jackknife free-response receiver operating characteristics (JAFROC) figure of merit (FOM). RESULTS: There was no significant improvement in overall reader performance in detecting abnormalities in zooming condition compared with no zooming in terms of case sensitivity (96% and 87%, P = 0.285) or lesion sensitivity (88% and 81%, P = 0.224). However, differences in ROC AUC and JAFROC FOM (P ≤ 0.05) were found in two readers when they performed the test set with zooming function. CONCLUSION: The results suggested that the use of the zooming function did improve the performance of some readers in detecting abnormal cases.

Magnetic resonance imaging findings in symptomatic versus asymptomatic subjects following metal-on-metal hip resurfacing arthroplasty.

BACKGROUND: Although pseudotumors have been reported at the sites of well-functioning and painful metal-on-metal hip prostheses, there are no objective data on the magnitude of the adverse reaction. This observational study was performed to investigate the ability of modified magnetic resonance imaging (MRI) to detect and quantify adverse synovial responses in symptomatic and asymptomatic subjects following metal-on-metal hip resurfacing. We hypothesized that the magnitude of the synovial reactions would be greater in symptomatic patients. METHODS: Sixty-nine patients (seventy-four hips) with hip resurfacing were divided into three groups: asymptomatic (twenty-two hips), symptomatic with a mechanical cause (twenty), and unexplained pain (thirty-two). The volume of synovitis was calculated on MRI for all patients. RESULTS: Synovitis was detected in fifteen asymptomatic hips (68%), fifteen (75%) with symptoms with a mechanical causes, and twenty-five (78%) with unexplained pain. The mean volume (and standard deviation) of the synovitis in these groups was 5 ± 7 cm³, 10 ± 16 cm³, and 31 ± 47 cm³, respectively. The coefficient of repeatability between the examiners was 1.8 cm³ for measurement of synovitis. Of the thirteen subjects with revision arthroplasty, six had an adverse local tissue reaction. This subgroup had the highest volumes of synovitis on MRI. CONCLUSIONS: An adverse synovial reaction was detected on MRI in both symptomatic and asymptomatic subjects. We found a larger volume of synovitis in symptomatic patients; this increase reached significance only in the group with an adverse local tissue reaction. Synovial volume on MRI may be a valuable marker in the longitudinal assessment of asymptomatic patients with a metal-on-metal hip resurfacing and in identifying patients with adverse local tissue reaction.

Magnetic resonance imaging of the wrist: bone and cartilage injury.

Magnetic resonance imaging (MRI) is particularly useful for imaging the wrist due to its superior soft tissue contrast and ability to detect subtle bone marrow changes and occult fractures. A high field (1.5T or greater) strength, dedicated wrist coil, and high in-plane and through-plane resolution must be utilized to successfully visualize the relatively thin cartilage of the wrist. MRI can be used to detect occult carpal bone fractures, identify complications following scaphoid fractures, and assess for avascular necrosis in the setting in Kienböck's and Preiser's disease. MRI is useful to identify secondary soft tissue and chondral pathology in impaction/impingement syndromes. The use of an intermediate-echo time fast spin echo sequence allows for accurate assessment of articular cartilage, allowing evaluation of chondral wear in the setting of primary osteoarthritis and posttraumatic degenerative arthrosis. MRI is the most sensitive imaging modality for the detection of early inflammatory arthropathies and can detect synovitis, bone marrow edema, and early erosions in the setting of negative radiographs.

Lamellated hyperintense synovitis: potential MR imaging sign of an infected knee arthroplasty.

PURPOSE: To determine the sensitivity and specificity of lamellated hyperintense synovitis for infection following knee arthroplasty and to determine the inter- and intraobserver variability of this sign at magnetic resonance (MR) imaging. MATERIALS AND METHODS: The purpose of the retrospective case control study was approved by the hospital's institutional review board. MR images from 28 patients with proved infected total knee arthroplasty and 28 patients with noninfected arthroplasty were reviewed by two musculoskeletal radiologists for the presence of lamellated hyperintense synovitis. Cases were rereviewed 2 weeks later by each reader. The sensitivity and specificity were calculated with the initial reads. The κ statistic was used to assess inter- and intraobserver reliability. RESULTS: The sensitivity of lamellated hyperintense synovitis for infection was 0.86-0.92 (95% confidence interval [CI]: 0.75, 0.97) and the specificity was 0.85-0.87 (95% CI: 0.74, 0.94). There was almost perfect interobserver agreement (κ = 0.82; 95% CI: 0.72, 0.93; P < .001) and intraobserver agreement (for reader 1, κ = 0.89 [95% CI: 0.78, 1.00; P < .001] and for reader 2, κ = 0.89 [95% CI: 0.77, 1.00; P < .001]) in the classification of the synovial pattern. CONCLUSION: In this selected series of patients, the presence of lamellated hyperintense synovitis at MR imaging of knee arthroplasty had a high sensitivity and specificity for infection. This sign had high inter- and intraobserver reliability.

Clinical and MRI outcomes after platelet-rich plasma treatment for knee osteoarthritis.

The purpose of this study was to investigate whether platelet-rich plasma therapy for early knee osteoarthritis is associated with good clinical outcomes and a change in magnetic resonance imaging (MRI) structural appearances. The design was a prospective cohort study following patients 1 year after platelet-rich plasma therapy for knee osteoarthritis. Twenty-two patients were treated with platelet-rich plasma for early osteoarthritis, confirmed with a baseline MRI. Inclusion criteria were Kellgren grade 0-II with knee pain in patients aged 30 to 70 years. All the patients received a 6-mL platelet-rich plasma injection using the Cascade system. Fifteen subjects underwent clinical assessments at baseline, 1 week, and 1, 3, 6, and 12 months, and MRIs at 1 year. Pain scores significantly decreased, whereas functional and clinical scores increased at 6 months and 1 year from baseline. Qualitative MRIs demonstrated no change per compartment in at least 73% of cases at 1 year.

MRI findings in painful metal-on-metal hip arthroplasty.

OBJECTIVE: The objective of our study was to compare the frequency of osseous and soft-tissue abnormalities in patients presenting with hip pain after resurfacing arthroplasty and after total hip arthroplasty (THA), correlate the MRI findings with histologic results, and determine which MRI findings are predictive of aseptic lymphocytic vasculitis-associated lesions. MATERIALS AND METHODS: The MRI examinations of patients with metal-on-metal hip prostheses placed at resurfacing arthroplasty (n=31) or THA (n=29) were reviewed for osteolysis, synovitis, extracapsular disease, synovial pattern, and mode of decompression into adjacent bursae. Regional muscles and tendons were assessed for tendinosis, tear, atrophy, and edema. Histologic and operative findings were reviewed in 19 patients (20 hips) who underwent revision surgery. Chi-square tests were performed to detect differences between the resurfacing arthroplasty and THA groups. The Wilcoxon rank sum test was performed to detect differences in MRI findings in patients with and those without aseptic lymphocytic vasculitis-associated lesions. RESULTS: Synovitis was detected in 77.4% of resurfacing arthroplasty hips and 86.2% of THA hips. Extracapsular disease was present in 6.5% of resurfacing arthroplasty hips and 10.3% of THA hips. Osteolysis was detected in 9.7% of resurfacing arthroplasty hips and 24.1% of THA hips. There was no difference in the incidence of synovitis (p=0.51), osteolysis (p=0.17), or extracapsular disease (p=0.67) between the resurfacing arthroplasty and THA groups. Patients with aseptic lymphocytic vasculitis-associated lesions had higher volumes of synovitis (p=0.04) than patients without aseptic lymphocytic vasculitis-associated lesions. Extracapsular disease and muscle edema were seen only in patients with aseptic lymphocytic vasculitis-associated lesions. CONCLUSION: Synovitis is common in patients with metal-on-metal hip prostheses and occurs with a similar incidence after resurfacing arthroplasty and after THA; osteolysis and extracapsular disease are uncommon. The MRI signs most suggestive of aseptic lymphocytic vasculitis-associated lesions are high volumes of synovitis, extracapsular disease, and intramuscular edema.

Injuries of the elbow and the current treatment of tendon disease.

OBJECTIVE: Overuse and traumatic injuries of the elbow are common, occurring in both athletes and nonathletes. This article will discuss the commonly encountered soft-tissue and osseous pathologic abnormalities around the elbow and their imaging appearance on MRI and ultrasound. CONCLUSION: The current treatment of tendon disease of the elbow is reviewed, with a focus on platelet-rich plasma injection.

Magnetic resonance imaging of the postoperative hip.

Magnetic resonance imaging (MRI) is ideally suited to imaging the patient with painful hip arthroplasty due to its superior soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation. MRI is the most accurate imaging modality in the assessment of periprosthetic osteolysis and wear-induced synovitis, and can also assess regional tendons and neurovascular structures. This article discusses the technical aspects of MRI around metallic implants as well as the appearance of potential complications following hip arthroplasty, including osteolysis, wear-induced synovitis, infection, hemarthrosis, fracture, loosening, component displacement, heterotopic ossification, tendinopathy, and neurovascular impingement. The specific complication of metal hypersensitivity following metal-on-metal prostheses is reviewed.

Comparative analysis of 2- versus 3-dimensional sonography of the supraspinatus tendon.

OBJECTIVES: The purpose of this study was to determine the reliability in the analysis of images acquired using a dedicated 3-dimensional (3D) ultrasound transducer and conventional 2-dimensional (2D) images in the detection and characterization of supraspinatus tendon tears. METHODS: Images of the supraspinatus tendon in 42 patients who had undergone 2D and 3D sonography were classified by two readers independently as no tear, full-thickness tear, or partial-thickness tear. When present, the tear size and location were recorded. Inter- and intra-rater reliability for the two data sets were calculated. RESULTS: There was substantial agreement between the two readers in the classification of supraspinatus tendon tears on 2D images (κ = 0.79) but only moderate agreement on 3D images (κ = 0.48). There was moderate to substantial agreement in the classification of tears between the 2D and 3D images for both readers (reader 1, κ = 0.64; reader 2, κ= 0.54). The most common cause of a discordant result was the interpretation of a small hypoechoic region at the footprint as a partial tear on 3D images, compared to a normal appearance on 2D images. CONCLUSIONS: Use of a dedicated 3D ultrasound transducer has poorer inter- and intra-rater reliability for the assessment of supraspinatus tendon tears compared to 2D sonography because of the interpretation of small partial-thickness tears at the footprint on 3D images, a common region affected by anisotropy.

Posterior interosseous neuropathy: electrodiagnostic evaluation.

Electrodiagnostic studies are used to anatomically localize nerve injuries. These tests help differentiate between cervical radiculopathies, brachial plexopathies, and peripheral nerve injuries. They also help to identify or rule out other underlying neurological diseases and disorders. In this case report, a 22-year-old male swimmer presented with left finger extensor weakness following pull-up exercises. Left wrist extension remained intact. Electrodiagnostic testing revealed a severe but incomplete posterior interosseous neuropathy. Magnetic resonance imaging confirmed inflammation of the nerve in the forearm. Posterior interosseous neuropathy is an uncommon but well-studied condition. Typically, this condition presents with weakness in finger and thumb extension with preserved wrist extension as the extensor carpi radialis longus is innervated proximal to the site of nerve compression in most cases. It is important to understand the anatomic course and distribution of the radial nerve in order to make an accurate diagnosis. Once the anatomy is understood, electrodiagnostic testing may be used to identify the location of nerve injury and exclude other disorders.

MRI after arthroplasty: comparison of MAVRIC and conventional fast spin-echo techniques.

OBJECTIVE: The goal of this study was to evaluate the quality of images obtained with a prototype imaging technique, multiacquisition variable-resonance image combination (MAVRIC), compared with fast spin-echo (FSE) images in the evaluation of patients who have undergone hip, shoulder, or knee arthroplasty. MATERIALS AND METHODS: MRI with metal-artifact reduction FSE and MAVRIC sequences was performed in the care of 122 patients who had undergone 74 hip, 27 shoulder, and 21 knee arthroplasties. The FSE and MAVRIC images were subjectively graded for visualization of the synovium, prosthesis-bone interface, and hip abductors or supraspinatus tendon. The presence of synovitis, osteolysis, or supraspinatus tendon tear was recorded. RESULTS: Visualization of the synovium was significantly better on MAVRIC images than on FSE images of the hip (p < 0.0001), shoulder (p < 0.01), and knee (p < 0.01). Synovitis was detected only on the MAVRIC images of nine subjects (12%) who had undergone hip arthroplasty and five subjects (18%) who had undergone shoulder arthroplasty. Visualization of the periprosthetic bone was significantly better on MAVRIC images of the hip (p < 0.0001), shoulder (p < 0.0001), and knee (p < 0.01). Osteolysis was detected only on the MAVRIC images of 12 subjects (16%) who had undergone hip arthroplasty, six (22%) who had undergone shoulder arthroplasty, and five (24%) who had undergone knee arthroplasty. Visualization of the supraspinatus tendon was significantly better on MAVRIC images (p < 0.0001). Supraspinatus tendon tears in 12 subjects (44%) were detected only on MAVRIC images. CONCLUSION: MAVRIC complements the information on FSE images after arthroplasty and is a useful additional sequence, particularly when there is concern about synovitis, periprosthetic osteolysis, or the presence of a supraspinatus tendon tear.

Imaging of metal-on-metal hip resurfacing.

Conventional radiography is the primary imaging modality to evaluate the condition of hip resurfacing implants and the preferred method of assessing implant stability over time. Radiographs assess the angle of inclination of the femoral and acetabular components, implant stability, and femoral neck narrowing. Ultrasonography detects solid or soft tissue masses adjacent to the implant. Magnetic resonance imaging (MRI) detects osteolysis and complications in the periprosthetic soft tissues such as wear-induced synovitis, periprosthetic collections, neurovascular compression, and quality of the muscle and tendons of the rotator cuff of the hip. For pain after hip resurfacing, early use of optimized MRI is recommended.

Magnetic resonance imaging of cartilage repair techniques.

Magnetic resonance (MR) imaging offers a noninvasive method to assess cartilage repair, allowing objective evaluation of the repair tissue and insight into the natural history of cartilage repair procedures. MR imaging allows assessment of the percent fill, signal morphology of the repair tissue, subchondral bone and three-dimensional geometry of the joint. The information gained from MR imaging therefore plays a valuable role in patient follow-up after cartilage repair. This article discusses the MR imaging techniques available for the assessment of articular cartilage, including quantitative imaging techniques that allow assessment of cartilage biochemistry. The MR imaging appearance and assessment of microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft transplantation is reviewed.

Pictorial review: 'fishtail deformity' of the elbow.

Fishtail deformity of the elbow is characterised by a contour abnormality of the distal humerus, which develops when the lateral trochlear ossification centres fails to develop or resorbs. It is an uncommon complication usually following a distal humeral fracture in childhood. Whilst initially presumed to be a benign condition, long-term follow-up suggests that patients with fishtail deformity are prone to functional impairment, ongoing pain and the development of early osteoarthrosis. This paper reviews the imaging findings in fishtail deformity, the proposed aetiology and the potential long-term complications.