Faculty Bibliography

A standardized guideline and scoring system are recommended for the imaging evaluation of musculoskeletal infections on MR imaging. The Musculoskeletal Infection Reporting and Data System (MSKI-RADS) is a recently developed and validated classification system using MR imaging that can be used to classify the severity and extent of musculoskeletal infections, improve radiology-pathology concordance, and outline the corresponding management recommendations. This review article explains MSKI-RADS and discusses the different elements of this system in detail with a review of pertinent literature so that the readers can apply it in their practices. The work outlines the technical considerations for optimal MR imaging for evaluating various musculoskeletal infectious lesions, details the severity scales with examples of various conditions that fall under each class, and outlines related patient management recommendations. The readers can learn about the MSKI-RADS classification system and apply the gained information from this article to improve MRI interpretations in their practice and increase the effectiveness of their multidisciplinary communications. This standardized system will also allow longitudinal data collection and tracking for future research purposes. CRITICAL RELEVANCE STATEMENT: MSKI-RADS is a recently developed and validated MRI-based guideline for musculoskeletal infections in extremities. A comprehensive understanding of these classifications can facilitate improved standardized diagnostic reporting of musculoskeletal infections on MRI and better patient outcomes. KEY POINTS: Current terminology for describing musculoskeletal infections on MRI is nonspecific, resulting in confusing diagnostic reports. A standardized guideline and scoring system are critical for improving diagnostic reporting of musculoskeletal infections on MRI. MSKI-RADS is a recently developed and validated MRI-based guideline that can be used to characterize musculoskeletal infections in extremities. MSKI-RADS is a meaningful tool that facilitates improvements in standardized reporting and treatment protocols, multidisciplinary communications, and longitudinal data collection.

BACKGROUND:The objective of this study was to survey a cross-section of US female orthopaedic surgeons evaluating their education and attitudes on radiation safety and adherence to safety recommendations. METHODS:An online survey was distributed to female orthopaedic surgery faculty through the Forum, a society for women in orthopaedic surgery, and through internal institutional education networks (residency and fellowship programs). The first component of the survey gathered demographic information including practice setting, US state, and years in practice. The second component was a 10-question knowledge assessment. The third component captured personal experiences among respondents including satisfaction with radiation safety training, radiation safety practices, and level of concern regarding exposure risk. Responses from 66 participants from differing geographic locations were collected using Research Electronic Data Capture. RESULTS:Sixty-six female orthopaedic surgeons from 21 states completed the survey. Regular dosimeter usage was reported by 24.2% of respondents, and 36.4% of respondents reported always having well-fitted radiation protective equipment provided. The majority (56.1%) stated that they worry about the risks of radiation to their health. Regarding their radiation safety training, 60.6% of respondents rated their training as unsatisfactory or extremely unsatisfactory, and 90.9% of respondents stated that they think training efforts for radiation safety can improve. CONCLUSIONS:Female orthopaedic surgeons demonstrated an inadequate knowledge of adherence to radiation safety protocols and the majority expressed concern with long-term radiation exposure, particularly regarding health and pregnancy risk. To enhance radiation safety awareness and adherence among female orthopaedic surgeons, strategies should be tailored to this demographic, fostering confidence in their knowledge of radiation exposure and bolstering safety measures.

PURPOSE/OBJECTIVE:To evaluate the safety and efficacy of genicular artery embolization and its longitudinal effects on biomarkers implicated in knee osteoarthritis (KOA) pathogenesis.. MATERIALS AND METHODS/METHODS:This is a prospective, single-arm clinical trial of patients with symptomatic KOA resistant to conservative therapy for greater than 3 months. Twenty-five patients who underwent GAE using 250-μm microspheres were included. Patient reported outcome measures were evaluated at baseline and 1-, 3-, and 12-months following GAE. Blood samples were collected for biomarker analysis. Magnetic resonance imaging was obtained at baseline and 3 months post GAE. The primary endpoint was the clinical success rate at 12 months. Baseline and follow-up outcomes were analyzed using the Wilcoxon matched-pairs signed-rank test. RESULTS:The technical success was 100%, with no significant adverse events. The clinical success rate was 62%. The mean VAS pain score for the target knee decreased by 48.5% at 1 month, 50.8% at 3 months, and 55.4% at 12 months (p < .001). WOMAC pain scores improved by 39.6% at 1 month, 50.1% at 3 months, and 43.7% at 12 months (p < .001). There was a statistically significant decrease in the serum levels of vascular endothelial growth factor (VEGF) and Interleukin-1 receptor antagonist (IL-1Ra) at 12 months. The remaining biomarkers showed no significant change. CONCLUSIONS:GAE is a safe treatment for symptomatic KOA, providing clinically significant pain relief for a subset of patients. The observed reductions in serum VEGF and IL-1Ra levels following GAE may contribute to local pain relief and decreased inflammation in the knee joints.

PURPOSE/OBJECTIVE:To assess whether an Artificial Intelligence (AI) translation of a magnetic resonance imaging (MRI) report improved patient understanding of the information presented in the radiology report and to evaluate patient preferences for these translations over traditional radiology reports. METHODS:Patients presenting to an orthopedic surgery clinic were prospectively enrolled and randomized into two groups. The "standard MRI group" received a traditional MRI report written by a radiologist of a multi-ligament knee injury, while the "AI group" received an AI- translated version of the same report, generated using ChatGPT 4. All patients completed a standardized quiz to assess comprehension of their respective reports. Following the quiz, participants were provided with both reports and asked to rate their preferences between the two. Demographic information including age, sex, race, education level, area deprivation index, and previous orthopedic history was collected from all patients. RESULTS:A total of 64 patients (32 in each group) with an average age of 51.9 ± 15.5 years were enrolled and randomized. No significant differences in demographics were identified between the two groups. Patients in the AI group scored 20% higher than those in the standard MRI group on the comprehension quiz (74.7% vs 54.7%, p<.001). 87.5% of patients preferred the AI translation while 4.7% preferred the standard version. Patients rated the AI translation as significantly clearer than the standard (4.5/5 vs. 2.2/5, p<.001), although they had less trust in the AI translation compared to the standard report (4.1/5 vs 4.5/5, p=.003). A higher education level was predictive of comprehension. CONCLUSION/CONCLUSIONS:AI-translated MRI reports significantly improved patient comprehension and were preferred for their clarity, despite lower trust levels compared to standard radiology reports. CLINICAL RELEVANCE/CONCLUSIONS:AI-translated MRI reports have the potential to enhance patient understanding of radiologic findings in orthopedic care. However, given the low quality and low level of trust in AI-generated content observed in this study, physician oversight remains essential to ensure accuracy and sustain patient confidence.

BACKGROUND:The goal of this study was to utilize preoperative computed-tomography(CT) scans to identify differences in the Hounsfield units(HU) of the acromion in patients who did and did not develop a postoperative acromial and scapular-spine fracture(ASF) after primary reverse total shoulder arthroplasty (rTSA). METHODS:A retrospective analysis was performed at a single institution. All patients undergoing a rTSA with either a 135° neck/shaft angle(NSA) humeral inlay design combined with a lateralized center-of-rotation(COR) glenosphere or a 145° NSA onlay combined with a medialized COR glenosphere design between 2011-2021 with a minimum follow-up of 24-months were included. Demographic characteristics and clinical outcome metric scores were recorded. Preoperative CT scans were analyzed to obtain acromion trabecular bone density measurements in HU in each zone of the scapula based on the Levy classification. Radiographic parameters were evaluated to determine their association with ASF. RESULTS:In total 263-patients were included, 140-patients with a 135° NSA humeral-inlay design;123-patients with a 145° NSA humeral-onlay design. There were no significant differences in baseline demographics between cohorts. The rate of ASF was 6.4%(9/140) for the 135° NSA-inlay-design versus 2.4%(3/123) in the 145° NSA-onlay design. In the non-fracture cohort there was a linear increase in bone density from zone-1(173.9HU)→zone-3(396.5HU)(lateral→medial). In the fracture cohort there was a decrease in bone density from zone-1(282.6HU)→zone-3(154.5HU). Measuring preoperative bone density in all Levy specific fracture-zones resulted in an AUC of 0.96 correlating to excellent predictive value. A threshold cutoff of 99.9 resulted in a sensitivity of 91.6% and specificity of 75.3%. A HU of 99.9 in any of the three-zones resulted in OR 5.1(p<0.0001) for sustaining an ASF postoperatively. A threshold of<50HU was associated with an 8-times higher-likelihood of developing a fracture in that specific zone. Greater than 5° of superior tilt in combination with ≥24mm of distalization was associated with an OR 6.4(p=0.0004) of sustaining an ASF. CONCLUSION/CONCLUSIONS:The current study demonstrates an accurate method of measuring HU at each of the described Levy fracture zones with excellent predictability of patients who are at risk of an ASF following rTSA. Additionally, we found that a HU threshold of <50 HU at any of the three Levy zones was associated with a nearly 8 times higher likelihood of developing a fracture in that specific zone. Lastly, we found that >5° of superior tilt in combination with ≥24mm of distalization was associated with 6.4 times higher likelihood of sustaining an ASF agnostic to prosthesis design.

Diversity, equity, and inclusion (DEI) is important for delivering high-quality, culturally competent care and ensuring equal access to resources and opportunities in healthcare. However, the implementation of DEI has been met with unique challenges and successes across the globe. The International Skeletal Society (ISS), a multidisciplinary musculoskeletal society, made a conscious effort to promote DEI. This article discusses advantages and controversies of DEI approaches, DEI initiatives implemented by the ISS, and experiences of the ISS DEI committee members from their respective continents. The ISS DEI committee implemented educational webinars with expert panel discussions, revising membership criteria and policies for enhancing inclusiveness, advising on programing and speakers for the annual meeting, and fostering mentorship. From a global perspective, in North America, DEI has improved health outcomes and patient care, but anti-DEI legislation has posed significant challenges. Europe relies on international recruitment but faces challenges in staff retention. South America's cultural diversity necessitates culturally sensitive approaches, but discussions about DEI are scarce, and gender inequalities persist in leadership. In Africa, DEI principles are underdeveloped, with limited engagement among stakeholders. In Asia, DEI is emerging, with more women being appointed to faculty positions and leadership roles in academic societies. The implementation of meaningful DEI initiatives requires long-term institutional buy-in and the global participation and commitment of employees and institutional leaders at all levels.

OBJECTIVE:To determine inter-reader reliability and diagnostic accuracy of MSKI-RADS among early-career radiologists with different experience levels. MATERIALS AND METHODS/METHODS:This is a retrospective multicenter study of MRIs of proven musculoskeletal (MSK) infections. MSKI-RADS categories included: 0-incomplete imaging, I-negative for infection, II-superficial soft tissue infection, III-deeper soft tissue infection, IV-possible osteomyelitis (OM), V-highly suggestive of OM, VI-known OM, and NOS-nonspecific bony lesions unrelated to infection. There were 22 readers from 9 institutions with 1-8 years of radiology experience, including radiology residents, MSK radiology clinical fellows, and junior MSK attendings. After initial training with expert readers, a dataset of 210 cases across a spectrum of extremity infections from a single institution was evaluated. The readers recorded the following for each case: MSKI-RADS score, final qualitative diagnosis, and confidence levels for both. Inter-reader agreements (ICC) and accuracy were obtained. RESULTS:Among 210 cases, there were 17 negative, 32 superficial soft tissue infections, 39 deeper soft tissue infections, 24 possible OM, 41 highly suggestive of OM, 18 known OM, and 39 NOS cases. A moderate inter-reader agreement was seen for 22 readers (ICC: 0.57 (CI = 0.52, 0.67)). The average true positive rates for non-infectious cases (I and NOS), soft tissue infection (II and III), and bony infection (IV and V) were 70% (95% CI: 67-73%), 66% (95% CI: 63-68%), and 82% (95% CI: 80-84%), respectively. Average true positive rates for classes V and VI were 80% (95% CI: 77-82%) and 86% (95% CI: 82-89%), respectively. Overall, MSKI-RADS reader accuracy was 66 ± 10%, higher than the qualitative diagnosis accuracy of 59 ± 11% (p < 0.05). Average confidence levels for MSKI-RADS score and final qualitative diagnosis were 3.56 ± 0.91 and 3.52 ± 0.92, respectively (p > 0.05). CONCLUSION/CONCLUSIONS:MSKI-RADS is an accurate and reliable MRI-based classification system for the diagnosis of a spectrum of musculoskeletal infections among early-career radiologists, like expert readers. KEY POINTS/CONCLUSIONS:Question What is the inter-reader reliability and diagnostic accuracy of the musculoskeletal infection reporting and data system (MSKI-RADS) among early-career radiologists with different experience levels? Findings Overall reader accuracy using MSKI-RADS was significantly higher than the accuracy for final qualitative diagnoses, like the results of the initial validation study with expert readers. Clinical relevance MSKI-RADS is valid and reliable for diagnosis and grading of a spectrum of extremity musculoskeletal infections for early career radiologists of different experience levels, like expert readers.