The musculoskeletal radiology section deals with imaging of bone and joint abnormalities, including orthopedic, rheumatologic and traumatic conditions. Conventional radiographs (X-rays) have been the mainstay of diagnosis in this field since their discovery in the late 1800’s. Another tried and true technique, fluoroscopy, enables us to directly observe motion or guide the placement of needles and treatment devices into areas needing intervention.
Much has changed in recent years in our capability to study the anatomy and function of bones, joints, muscles and the tissues that support them. We refer to these newer modalities as “advanced imaging techniques” and they include computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound. CT gives a highly detailed picture of the anatomy of bone and the resulting changes due to a variety of pathologic conditions such as injury (fracture), infection or tumor. MRI has revolutionized the diagnosis of bone and soft tissue conditions with its detailed depiction of anatomy and highly accurate detection of abnormalities. At UC Davis Health System, we have state of the art equipment, including the new high field (“3 T”), conventional high-field magnetic imagers as well as an open MRI unit for those needing more room during the procedure (i.e. large or claustrophobic patients).
We also utilize ultrasound to study the anatomy and function of the soft tissue surrounding bones and joints, helping us to directly observe function as the patient moves in a real-time setting and to characterize masses for appropriate treatment. We can use all of these techniques to guide biopsy (getting a sample of tissue or fluid) or treatment via a percutaneous approach (entering the body through the skin under a local anesthetic) to avoid the need for hospitalization, general anesthesia and surgery in many conditions. In this manner, painful joints can sampled for fluid abnormalities, be injected with therapeutic agents, or tested to make sure that the pain is actually coming from that joint and not “referred pain” from another source.
The choice of one or more of these techniques depends on the patient’s condition, and is generally initiated by the primary care provider or surgical specialist. We usually start with regular X-rays to give an overview of the problem. The advanced imaging techniques may follow depending on the condition and often involve consultation between the clinical physician and the radiologist to decide which of these studies might provide the answer as quickly as possible. These studies may be complementary and more than one may be necessary to provide the full answer. It is our job as musculoskeletal radiologists to make sure that the appropriate study is ordered, taking into consideration the clinical problem as well as the safety and special needs of each patient. At times the study initially ordered may be modified or changed to another exam entirely depending on these factors.
The publicity surrounding these new “miracles” of modern science sometimes creates unrealistic expectations on the part of some patients. These exams do not eliminate the need for tissue samples or biopsy in most cases: the pathologist still has the final say in such cases. We may hear about a celebrity or professional athlete having an MRI and expect that this study might be the answer to all musculoskeletal conditions. Each case is different and the study is chosen is dependent on many factors unique to each patient. Likewise, the results of the study, taken out of the context of the patient’s history, physical findings, previous surgery, medication, etc. can be misleading, prompting most radiologists to encourage that patients obtain and discuss the results with the person who knows their medical situation best-their referring physician.
These “high-tech” studies can be confusing and intimidating. Our physicians and staff are all eager to answer any questions and make the experience as comfortable as possible for each patient.
Musculoskeletal radiology faculty
John Hunter, M.D.
Adam Greenspan, M.D.
Eva Escobedo, M.D.
Robert Boutin M.D.