Current role and future applications of image-guided interventional procedures in musculoskeletal oncology - A narrative review

Background

Musculoskeletal (MSK) image-guided interventional procedures have been increasingly used in and remain crucial in the diagnosis and treatment of musculoskeletal tumours.

Aims

In this article, we aim to describe commonly performed interventional procedures in the subspeciality of MSK oncology drawing experience from our tertiary referral centre. Recent advances, emerging techniques and future applications of image-guided interventional procedures in the field of MSK oncology are highlighted.

Material and methods

A retrospective search using the keyword 'musculoskeletal system', 'neoplasms', 'biopsy', and 'interventional radiology' was performed at our tertiary care oncology orthopaedic referral centre radiology database. The radiology images were collected from our Picture Archiving and Communication System (PACS) and Radiology Information System (RIS). Electronic Patient Records, histopathology laboratory records and patient characteristics were collaborated to generate this narrative experience at our centre.

Results

Image-guided interventional procedures have been utilised in a spectrum of primary and secondary MSK tumours. Current applications include diagnosis of bone and soft tissue MSK neoplastic lesions with biopsies, thermal, cryotherapy and Radiofrequency ablations and augmentation procedures.

Conclusion

Musculoskeletal (MSK) image-guided interventions have increasing applications in the diagnosis, management, treatment and monitoring of patients with MSK tumours. The emergence of newer imaging technologies with enhanced skills of interventional radiologists will allow a range of therapeutic MSK interventions in both effective control of primary lesions and palliative care of metastatic lesions.

Imaging in international sporting event: experience from the Birmingham Commonwealth Games 2022

AIM

To explain the design and delivery of diagnostic imaging and image-guided intervention services for an international games. The authors share their experiences from the Birmingham Commonwealth Games 2022.

MATERIALS AND METHODS

A retrospective analysis was undertaken of anonymised data from the Zillion, Easyvision (RIS and PACS), and Encounter platforms for image viewing, interpretation and reporting during the Games. The data collected included age and gender, type of sport, nature of the injury, and imaging findings with diagnoses.

RESULTS

The number of individuals who had radiological investigations at the Birmingham Commonwealth Games was 518 and the vast majority of them were athletes (90 %). The average age of athletes who had imaging was 28 years and that of non-athletes who accessed imaging services was 46.4 years with male predominance. Magnetic resonance imaging was the most frequently used imaging technique and the lower limb was the most frequently imaged body part. Athletes playing netball and beach volleyball had the highest percentage of injuries.

CONCLUSION

The authors share their experience from the Birmingham Commonwealth Games 2022 regarding the nuances and challenges in radiology service provision for an international sports event that would be helpful for musculoskeletal radiologists in the design and delivery of similar international events in the future.

Musculoskeletal Computed Tomography: How to Add Value When Reporting Adult Upper Limb Trauma

ABSTRACT

There is increasing reliance on computed tomography to evaluate fractures and dislocations following routine evaluation with plain radiography, critical in preoperative planning; computed tomography can provide multiplanar reformats and 3-dimensional volume-rendered imaging, providing a better global assessment for the orthopedic surgeon. The radiologist plays a critical role in appropriately reformatting the raw axial images to illustrate best the findings that will help determine further management. In addition, the radiologist must succinctly report the pertinent findings that will have the most significant bearing on treatment, assisting the surgeon in deciding between nonoperative and operative management. The radiologist should also carefully review imaging to look for ancillary findings in the setting of trauma beyond the bones and joints, including the lungs and rib cage when visualized.In this review article, we will systematically describe key features for fractures of the scapula, proximal humerus, distal humerus, radial head and neck, olecranon, coronoid process through a case-based approach, and distal radius. Although there are numerous detailed classification systems for each of these fractures, we aim to focus on the core descriptors that underpin these classification systems. The goal is to provide the radiologist with a checklist of critical structures they must assess and findings that they should mention in their report, emphasizing those descriptors that influence patient management.

Calcaneocuboid capsuloligamentous soft-tissue entrapment: a rare cause of acquired equinovarus deformity

Acquired equinovarus deformity is rare, with most cases related to congenital disorders such as clubfoot. We describe a unique case of traumatic capsuloligamentous soft-tissue entrapment within the calcaneocuboid joint in a 13-year-old girl, causing an acquired equinovarus deformity. This required surgical exploration and joint fixation. Assessing soft-tissue entrapment on magnetic resonance imaging can be beneficial as a potential cause of an acquired post-traumatic non-reducible foot deformity in children. We discuss the intricate capsuloligamentous structures that reinforce the calcaneocuboid joint and highlight the importance of interrogating such structures in the context of inversion injuries to the ankle.

Entrapped Malecot catheter removal: Our experience

Some surgeons use a Malecot catheter for drainage of intra-abdominal or mediastinal collections. These tubes are usually removed after 2-3 weeks. If left later, they may become entrapped due to the ingrowing of tissue, and fibrosis within the flower-like tip of the Malecot's catheter. Its removal then needs careful manipulation to prevent organ damage. We present our experience in ensuring the safe removal of such entrapped Malecot's catheters in liver abscess patients.

Calcific Enthesopathy of the Superior Extensor Retinaculum - An Unusual Cause of Medial Ankle Pain

AIM OF THE STUDY

Ankle pain can present a clinical dilemma to the foot and ankle surgeons, with a multitude of entities to which the symptoms could potentially be attributed. Enthesopathy around the ankle joint could be due to overuse, injury, inflammation or infection. Calcific ligamentous enthesopathy around the ankle is a well-recognised condition with a spectrum of causes.

CASE DESCRIPTION

To our knowledge, a clinically symptomatic presentation of calcific enthesopathy specifically affecting the entheses of the superior extensor retinaculum has not been described in the literature. We report the first case of symptomatic calcific enthesopathy of the superior extensor retinaculum in a healthy young female, and highlight the role of radiological interventions in its diagnosis. The condition was managed successfully by ultrasound-guided barbotage.

CONCLUSIONS

Calcific enthesopathy of the attachment of the superior extensor retinaculum is a rare condition that should be considered in the differential diagnosis of patients with medial ankle pain.

Calcific Enthesopathy of the Superior Extensor Retinaculum - An Unusual Cause of Medial Ankle Pain

AIM OF THE STUDY

Ankle pain can present a clinical dilemma to the foot and ankle surgeons, with a multitude of entities to which the symptoms could potentially be attributed. Enthesopathy around the ankle joint could be due to overuse, injury, inflammation or infection. Calcific ligamentous enthesopathy around the ankle is a well-recognised condition with a spectrum of causes.

CASE DESCRIPTION

To our knowledge, a clinically symptomatic presentation of calcific enthesopathy specifically affecting the entheses of the superior extensor retinaculum has not been described in the literature. We report the first case of symptomatic calcific enthesopathy of the superior extensor retinaculum in a healthy young female, and highlight the role of radiological interventions in its diagnosis. The condition was managed successfully by ultrasound-guided barbotage.

CONCLUSIONS

Calcific enthesopathy of the attachment of the superior extensor retinaculum is a rare condition that should be considered in the differential diagnosis of patients with medial ankle pain.

A Radiologists' Guide to En Bloc Resection of Primary Tumors in the Spine: What Does the Surgeon Want to Know?

En bloc resection in the spine is performed for both primary and metastatic bone lesions and has been proven to lengthen disease-free survival and decrease the likelihood of local recurrence. It is a complex procedure, which requires a thorough multi-disciplinary approach. This article will discuss the role of the radiologist in characterizing the underlying tumor pathology, staging the tumor and helping to predict possible intraoperative challenges for en bloc resection of primary bone lesions. The postoperative appearances and complications following en bloc resection in the spine will be considered in subsequent articles.

MRI imaging of soft tissues tumours and tumour like lesions-SLAM approach

Imaging is vital in characterising and delineating the extent of soft tissue tumours and there is abundant literature on this. A simplified approach is required to characterise the lesions on MR and we describe a simplified street-smart approach called SLAM (signal, location, age, multiplicity and matrix).

A guide to assessing post-operative complications following en bloc spinal resection

En-bloc resection of spinal tumours is a complex procedure with significant morbidity and mortality. The extensive resection leaves a large soft tissue and osseous defect requiring reconstruction. Following en-bloc resection, there may be complications relating to both the removal of the tumour and the subsequent reconstruction. This paper outlines the imaging appearances of the frequently encountered complications in our experience. The primary aim is to improve the confidence of the radiologist when reporting imaging following spinal en-bloc resection, however we believe this is also useful for the spinal and orthopaedic surgeons in assessing the patients following en block resection.

COVID-19 pandemic and medical education

COVID-19 has had significant impact on medical students and medical education. In this article, we discuss the effect on medical education and general well-being based on survey and measures to mitigate the same.

Spinal collision lesions

Collision lesions are rare neoplasms often described in the hepatobiliary system, genitourinary system and adrenal glands. Vertebral haemangiomas (VH) are the most common lesions involving the vertebral bodies. VHs are usually asymptomatic and considered as "Do not touch" lesions. Rarely they can be symptomatic. Imaging findings of typical and atypical haemangiomas, variant forms of haemangioma such as aggressive haemangiomas are well known. Collision lesions involving VHs are extremely rare. This article presents a series of cases with collision lesions of the vertebral body involving VHs.

ADVANCES IN KNOWLEDGE

This Case series demonstrates the various collision lesions in spinal haemangioma.

Iliotibial band enthesopathy: an unusual cause of lateral knee pain post total knee replacement

Iliotibial band (ITB) pathology is one of the main causes of lateral knee pain. The enthesopathy of the ITB at its insertion post total knee replacement (TKR) is a rare cause of lateral knee pain. We describe a series of cases of ITB enthesopathy with sonographic findings and management.

Impact of the COVID-19 pandemic on radiologists

COVID-19 pandemic is one of the biggest crises faced by health-care systems in the recent times. The aim of this study was to assess the impact of the COVID-19 pandemic on radiology workflow, working pattern, training and continuing professional development (CPD) activities, as well as personal well-being of the radiologists during the pandemic. Material and Methods: Questionnaire designed to gather the opinions regarding the impact of the COVID-19 pandemic was distributed to radiologists throughout the world in electronic format. Anonymized responses were obtained and analyzed. Two hundred radiologists, working in 17 different countries, responded to our questionnaire. Majority of the respondents were from India (72.8%) and 70% of the them were in the age group of 25–45 years. About 80% of respondents felt that they were well protected or moderately well protected in terms of the personal protective equipment (PPE), however, most of them felt that the use of PPE had affected their ability to work. Similar number of radiologists felt that there was significant reduction in the radiology workload. More than half of the respondents felt that their working patterns were altered by the pandemic with drastic impact on teaching, CPD activities, and personal well-being. COVID-19 pandemic has had profound impact on the radiologists all over the world. Learning from the experiences of the first wave should be used to provide innovative solutions to some of the challenges posed to provide better radiology services, training, and improve the well-being of radiologists if we encounter a similar situation in the future. COVID-19 pandemic had significant impact on radiologists. Radiologists felt that they were well or moderately well protected with PPEs; however, PPEs affected their ability to work. Radiology workflow was significantly reduced in the pandemic with more radiologists working from home. COVID-19 pandemic had deleterious effect on radiologist’s well-being, education, and CPD activities.

Machine-learned approximations to Density Functional Theory Hamiltonians

Large scale Density Functional Theory (DFT) based electronic structure calculations are highly time consuming and scale poorly with system size. While semi-empirical approximations to DFT result in a reduction in computational time versus ab initio DFT, creating such approximations involves significant manual intervention and is highly inefficient for high-throughput electronic structure screening calculations. In this letter, we propose the use of machine-learning for prediction of DFT Hamiltonians. Using suitable representations of atomic neighborhoods and Kernel Ridge Regression, we show that an accurate and transferable prediction of DFT Hamiltonians for a variety of material environments can be achieved. Electronic structure properties such as ballistic transmission and band structure computed using predicted Hamiltonians compare accurately with their DFT counterparts. The method is independent of the specifics of the DFT basis or material system used and can easily be automated and scaled for predicting Hamiltonians of any material system of interest.

Comparison of thermophilic and mesophilic one-stage, batch, high-solids anaerobic digestion

The concept of starting up a batch, high-solids anaerobic digester by simply flooding the bed with a pH-buffer solution was tested using a mixture of vegetable waste and wood chips as feedstock at mesophilic (38 degrees C) and thermophilic (55 degrees C) conditions. At both temperatures stable and balanced methanogenesis was rapidly established within four days and was sustained until substrate was exhausted. Methanogenesis was more rapidly initiated in the thermophilic digester than in the mesophilic digester. Acetic, propionic and butyric acids accumulated in the leachate of both digesters during the start-up of digestion of uninoculated batch of waste. Thereafter all acids were degraded; which was quicker in the thermophilic digester. The accumulation and degradation of these acids was slower in the mesophilic digester. These studies showed that inoculum for carrying out thermophilic and mesophilic anaerobic digestion is readily available within the waste and its activity for complete mineralization of organic matter can be enhanced and sustained by providing adequate alkalinity. By employing a process in which anaerobic digestion of subsequent batches of waste was carried out by flooding with leachate drained from the digestion of a previous batch of waste, the volatile organic acid accumulation was maintained low and 95% of the methane yield potential of the waste was produced in 11 days under thermophilic conditions as opposed to 27 days under mesophilic conditions.