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Physicians Update

 
Spring 2010

Improvements to Imaging Technology Benefit Ortho Patients

03/01/2010

PhyUpdate-Spring2010 Ortho ImagingState-of-the-art imaging technology has expanded options for orthopaedic patients while providing a clearer picture of their condition. “Imaging is the cornerstone for confirming diagnoses that we suspect on physical findings,” says Leanne Seeger, M.D., chief of musculoskeletal imaging in the UCLA Department of Radiology. “Obviously, patients want to know what’s wrong with them, and with the tools we now have we are able to be much more definitive in what we can tell them.”

Magnetic resonance imaging has long been an invaluable modality for orthopaedic abnormalities that require more than the initial radiograph. But UCLA radiologists now have access to higherstrength magnets for the majority of orthopaedic MRI studies. These 3-Tesla magnets provide twice the field strength of conventional 1.5-Tesla scanners. “This has revolutionized musculoskeletal imaging,” Dr. Seeger says. “Whether it’s cartilage pathology in the joints, rotator cuff tears, meniscus tears or anything else, the detail of the scans is far superior to what it was with the 1.5-Tesla scans.”

In addition to the vastly improved image resolution, the ability of the new MRI equipment to perform scans in less time than it took using the previous systems has improved patient compliance. Because patients are in for a shorter time period, there is less discomfort and motion that could compromise the image, Dr. Seeger explains. The comfort factor is enhanced by the larger gantries in UCLA’s 3-Tesla machines, reducing the claustrophobic effect that has troubled many patients and plagued compliance efforts in the past.

While MRI continues to be the mainstay for diagnosing complex orthopaedic injuries, UCLA has increasingly relied on musculoskeletal ultrasound as either an MRI complement or a substitute when MRI is contraindicated. Musculoskeletal ultrasound has been widely used overseas for many years, but has only recently begun to gain favor in the United States, particularly as a way to diagnose soft-tissue pathology. UCLA radiologist Kambiz Motamedi, M.D., notes that unlike MRI, ultrasound allows for direct interaction between the physician or technologist and the patient. “We’re able to tailor the examination to patient symptoms,” he explains. Moreover, ultrasound facilitates dynamic imaging. “When the patient tells us about a certain symptom when he moves his elbow, we can have him reproduce that motion and view the structures in action,” Dr. Motamedi says. Ultrasound is also being used for patients who can’t undergo an MRI, whether it’s because they are claustrophobic or because they have a medical condition or device such as a pacemaker that makes them ineligible for the modality.

The newest-generation 64-channel computerized tomography (CT) scanners are able to provide radiologists with faster, higher-resolution scans and virtually eliminate motion artifact as a concern, Dr. Seeger notes. UCLA is also one of only two centers in Southern California that is using CT-guided thermal ablation for certain bone tumors. With CT as the guide, radiologists work PhyUpdate-Spring2010 3T image of the Kneewith orthopaedists to apply thermal energy through a probe and rid patients of osteoid osteoma, a benign lesion most common in adolescents and young adults. “This tumor can be very painful and debilitating,” Dr. Motamedi says. “Previously, it required surgery and a recovery time of several weeks, but with thermal ablation we can burn it through a skin incision of a few millimeters in an outpatient procedure, and patients are back to normal activities within 24 to 48 hours.”

UCLA has taken steps to make the images more accessible to referring physicians. Offering Web access to their patients’ studies not only ensures that referring physicians are able to see them in a more timely manner, but it also allows them to view the report produced by the radiologist and confer with experts remotely while both are looking at the image at the same time, explains Ric McGill, business development liaison for UCLA’s Department of Radiology.

In an effort to educate interested physicians about the state-of-the-art imaging, McGill notes, the department has been holding a “Lunch and Learn” series on various topics, as well as a community dinner series for continuing medical education (CME) credit. “There are more and better options available than ever before for orthopaedic imaging, and we invite physicians to contact us if they need to consult about the possibilities,” Dr. Motamedi says. “The technology seems to improve almost daily.”





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