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Pattern Recognition in Musculoskeletal Imaging Using Artificial Intelligence

Gorelik, Natalia; Chong, Jaron; Lin, Dana J
Artificial intelligence (AI) has the potential to affect every step of the radiology workflow, but the AI application that has received the most press in recent years is image interpretation, with numerous articles describing how AI can help detect and characterize abnormalities as well as monitor disease response. Many AI-based image interpretation tasks for musculoskeletal (MSK) pathologies have been studied, including the diagnosis of bone tumors, detection of osseous metastases, assessment of bone age, identification of fractures, and detection and grading of osteoarthritis. This article explores the applications of AI for image interpretation of MSK pathologies.
PMID: 31991451
ISSN: 1098-898x
CID: 4294122

Anteroposterior Radiograph of the Ankle with Cross-Sectional Imaging Correlation

Lin, Dana J; Alaia, Erin F; Rossi, Ignacio Martín; Zember, Jonathan; Rosenberg, Zehava Sadka
The focus of this article is to illustrate various pathologic entities and variants, heralding disease about the ankle, based on scrutiny of AP radiographs of the ankle, with correlative findings on cross-sectional imaging. Many of these entities can only be detected on the AP ankle radiograph and, if not recognized, may lead to delayed diagnosis and persistent morbidity to the patient. However, a vigilant radiologist, equipped with the knowledge of the characteristic appearance and typical locations of the imaging findings, should be able to make the crucial initial diagnosis and surmise additional findings to be confirmed on cross-sectional imaging.
PMID: 31575401
ISSN: 1557-9786
CID: 4115642

Artificial Intelligence in Musculoskeletal Imaging: Current Status and Future Directions

Gyftopoulos, Soterios; Lin, Dana; Knoll, Florian; Doshi, Ankur M; Rodrigues, Tatiane Cantarelli; Recht, Michael P
OBJECTIVE. The objective of this article is to show how artificial intelligence (AI) has impacted different components of the imaging value chain thus far as well as to describe its potential future uses. CONCLUSION. The use of AI has the potential to greatly enhance every component of the imaging value chain. From assessing the appropriateness of imaging orders to helping predict patients at risk for fracture, AI can increase the value that musculoskeletal imagers provide to their patients and to referring clinicians by improving image quality, patient centricity, imaging efficiency, and diagnostic accuracy.
PMID: 31166761
ISSN: 1546-3141
CID: 3917862

Ulnar Collateral Ligament Insertional Injuries in Pediatric Overhead Athletes: Are MRI Findings Predictive of Symptoms or Need for Surgery?

Lin, Dana J; Kazam, Jonathan K; Ahmed, Firas S; Wong, Tony T
OBJECTIVE:The purpose of this study was to determine whether ulnar collateral ligament (UCL) insertion below the articular margin (so-called T sign) exists in the pediatric population and whether MRI features can be used to identify insertional UCL injuries in overhead athletes that are symptomatic or require surgery. MATERIALS AND METHODS/METHODS:Retrospective review of elbow MR images of patients younger than 21 years from 2011 to 2017 yielded 26 control subjects who were not overhead athletes and 97 overhead athletes. According to the clinical diagnosis, 50 of the overhead athletes had symptoms. Two radiologists evaluated the UCL for thickness, abnormal insertional signal intensity, insertion distance, and adjacent marrow or soft-tissue edema. Insertion distance was defined as the coronal length of any T sign measured from the articular margin. RESULTS:Mean insertion distance was greater in overhead athletes than in control subjects (1.42 vs 0.23 mm, p = 0.001) but not significantly different in athletes with symptoms compared with those without symptoms or in those who underwent operative treatment compared with those who did not. Mean UCL thickness was greater in overhead athletes than in control subjects (2.64 vs 1.74 mm, p < 0.0001), athletes with than those without symptoms (2.84 vs 2.41 mm, p = 0.005), and athletes who did versus those who did not undergo operative treatment (3.40 vs 2.73 mm, p = 0.011). Marrow (p = 0.002) and soft-tissue (p = 0.016) edema were found more frequently in athletes with symptoms. ROC analysis of UCL thickness and insertion distance as predictors of symptoms showed AUCs of 0.69 and 0.49, respectively. CONCLUSION/CONCLUSIONS:The T sign is likely not an anatomic variation but is a poor predictor of symptoms and need for surgery. Soft-tissue and marrow edema are more frequently seen in overhead athletes with symptomatic injuries and can aid in the diagnosis of clinically relevant injury.
PMID: 30699009
ISSN: 1546-3141
CID: 3626722

Shoulder Injuries in the Overhead-Throwing Athlete: Epidemiology, Mechanisms of Injury, and Imaging Findings

Lin, Dana J; Wong, Tony T; Kazam, Jonathan K
The unparalleled velocity achieved by overhead throwers subjects the shoulder to extreme forces, resulting in both adaptive changes and pathologic findings that can be detected at imaging. A key biomechanical principle of throwing is achieving maximum external rotation, which initially leads to adaptive changes that may result in a pathologic cascade of injuries. In addition to the well-established concepts of glenohumeral internal rotation deficit and internal impingement, osseous and soft-tissue injuries of the shoulder unique to overhead athletes are illustrated. The epidemiology and biomechanics of throwing injuries are reviewed, and examples from the authors' institutional experience with competitive, collegiate, and professional baseball players are provided to demonstrate the constellation of unique imaging findings seen in overhead throwing athletes. Given the widespread popularity of baseball, and other sports relying on overhead throwing motions at all playing levels from recreational to professional, it is important for radiologists in various practice settings to be familiar with the special mechanisms, locations, and types of shoulder injuries seen in the overhead throwing population. © RSNA, 2018.
PMID: 29356641
ISSN: 1527-1315
CID: 3372832

Adventures and Misadventures in Plastic Surgery and Soft-Tissue Implants

Lin, Dana J; Wong, Tony T; Ciavarra, Gina A; Kazam, Jonathan K
Soft-tissue augmentation and implants are increasingly seen by the radiologist as more techniques emerge for a variety of indications and locations. Some surgical and implant procedures are performed for purely cosmetic reasons in otherwise healthy patients seeking to improve their body image, and some are performed for reconstruction after cancer or other chronic illnesses. Abdominoplasty, liposuction, and autologous fat grafting can be performed for abdominal and gluteal contouring. Injection of liquid injectable silicone has historically been fraught with legal issues, although it continues to be used for augmentation in a variety of anatomic locations. Newer solid silicone implants have revolutionized cosmetic and reconstructive muscular contouring. Subdermal implants placed by nonmedical professionals are relatively new and unrecognized within the medical establishment, although such implants have been described in the popular culture. Perhaps the most rapidly increasing segment of cosmetic procedures, however, is minimally invasive cosmesis in the form of soft-tissue fillers in the hands and face. Finally, the major principles of breast augmentation and penile implants are also reviewed. Regardless of the location and the type of implant, complications of plastic surgery and soft-tissue implants can generally be classified into the following categories: seroma, hematoma, infection, migration, vascular or nerve compression, fibrosis, foreign-body reaction, and rupture or breakdown. Key concepts include knowing the appropriate anatomic location and the normal postoperative appearance so that complications can be properly detected. A broad range of approved, off-label, and illicit plastic surgical and implant procedures are described and their complications illustrated with cases with classic imaging findings. (c)RSNA, 2017.
PMID: 29131778
ISSN: 1527-1323
CID: 2784692

Elbow Injuries in Pediatric Overhead Athletes

Wong, Tony T; Lin, Dana J; Ayyala, Rama S; Kazam, Jonathan K
OBJECTIVE:The purpose of this article is to discuss common elbow injuries found in pediatric athletes who participate in sports that entail overhead movements with focus on mechanism, clinical features, imaging appearance, and treatment options. CONCLUSION/CONCLUSIONS:Elbow injuries are commonly seen in pediatric overhead athletes and have been on the rise owing to the increased participation in and demand of youth sports. Imaging plays a critical role in identifying the type and severity of injury, which helps to determine appropriate treatment options.
PMID: 28796550
ISSN: 1546-3141
CID: 3372822

Elbow Injuries in Adult Overhead Athletes

Wong, Tony T; Lin, Dana J; Ayyala, Rama S; Kazam, Jonathan K
OBJECTIVE:The purpose of this article is to review common elbow injuries found in overhead athletes with focus on mechanism, clinical features, imaging appearance, and treatment options. CONCLUSION/CONCLUSIONS:The overhead throwing motion subjects the elbow to a variety of complex forces, which places both osseous and soft-tissue structures at high risk for injury.
PMID: 28095019
ISSN: 1546-3141
CID: 3372812

Shoulder Arthroplasty, from Indications to Complications: What the Radiologist Needs to Know

Lin, Dana J; Wong, Tony T; Kazam, Jonathan K
The replaced shoulder is increasingly encountered by the radiologist, both on a dedicated and incidental basis, in this era of the growing population of aging patients wishing to preserve their mobility and function. Knowledge of the normal biomechanics of the glenohumeral joint-particularly the function of the rotator cuff and the unique relationship of the humeral head to the glenoid-is essential for understanding the need for shoulder replacement and its subsequent complications, because the intent of shoulder arthroplasty is to approximate the normal joint as closely as possible. The most common indications for shoulder arthroplasty are osteoarthritis, inflammatory arthritis, proximal humerus fractures, irreparable rotator cuff tears, rotator cuff arthropathy, and avascular necrosis of the humeral head. Knowledge of the key imaging features of these indications helps facilitate a correlative understanding between the initial diagnosis and the choice of which type of arthroplasty is used-total shoulder arthroplasty, reverse total shoulder arthroplasty, or partial joint replacement (humeral head resurfacing arthroplasty or hemiarthroplasty). The preoperative requirements and usual postoperative appearance of each arthroplasty type are summarized, as well as the complications of shoulder arthroplasty, including those unique to or closely associated with each type of arthroplasty and those that can be encountered with any type of shoulder arthroplasty.
PMID: 26761537
ISSN: 1527-1323
CID: 3372802

Radiology ExamWeb: development and implementation of a national web-based examination system for medical students in radiology

Lewis, Petra J; Chen, Jim Y; Lin, Dana J; McNulty, Nancy J
RATIONALE AND OBJECTIVES/OBJECTIVE:Faculty are often limited in time, knowledge, and resources to develop efficient, effective, and valid computer-based examinations to evaluate students. Our purpose was to develop a web-based pool of standardized National Board of Medical Examiners (NBME)-format, peer-reviewed, and peer-tested questions based on the Alliance of Medical Student Educators in Radiology (AMSER) National Medical Student Curriculum to evaluate the radiologic knowledge of medical students. MATERIALS AND METHODS/METHODS:Members of the AMSER Electronics Committee submitted questions they had written for their institutions and later developed a 113-question standardized examination. Questions were edited by 24 subspeciality editors and then further edited by the authors to NBME recommendations. Software was developed using commercially available software (www.ExamWeb.com) with extensive modifications and additions following initial deployment. Students take examinations online and receive their scores immediately. Items were validated by identifying those answered >30 times and analyzing the following: number of times deployed, number of times correctly answered, distractor-specific breakdown, difficulty level (P), and point biserial coefficient (rbi). RESULTS:Radiology ExamWeb (REW) is available online with 3500 registered students from 65 institutions and 1800 active questions. Instructors can create examinations or use "shared examinations" made by another instructor but enabled for other institutions to administer or modify. More than 300 shared examinations have been developed. The AMSER curriculum was converted into database format and crosschecked with question items to ensure that the question pool adequately covered the spectrum of the curriculum. An AMSER standardized examination has been developed and deployed within REW. CONCLUSIONS:REW has provided medical student educators with the means to evaluate students in a systematic way, using a nationally edited and regularly reviewed web-based process.
PMID: 23452473
ISSN: 1878-4046
CID: 3372852