IMAGING AND IMAGE- GUIDED THERAPY IN SPORTS MEDICINE
PART I – MODALITIES
DR AMIT LAKKARAJU AND DR PHILIP O’CONNOR
INTRODUCTION Imaging sports injuries has become an integral part of sports medicine. The increased sophistication and sensitivity of the technology involved in imaging now allows increasingly early identification of pathology. Appropriate imaging therefore complements clinical diagnosis and may benefit the outcome for the patient (1). Paradoxically, the sensitivity of imaging techniques is increasing which means that asymptomatic incidental pathology is also being identified more and more often. Therefore, a thorough clinical examination remains the cornerstone of accurate diagnosis and it is important to consider carefully how imaging will influence further management (1,2). The two parts of this article cover the indications for imaging, the various imaging modalities and their application in the diagnosis of sports injuries, and concludes with a brief description of the image-guided therapies that can be offered.
GUIDELINES FOR REQUESTING INVESTIGATIONS Imaging of sports injuries is a useful adjunct to a thorough clinical examination, but as mentioned above there is the potential for imaging to highlight incidental abnormalities that may have no clinical relevance to the patient’s symptoms. Appreciating these potential “red herrings” is an important part of imaging in sports medicine. Imaging can provide additional information and aid management but it needs to be appropriately indicated. We present eight basic principles for getting the most out of radiological investigations (1–3). Box 1 gives a summary of these eight principles.
Understanding the meaning of the results The sports clinician should understand the relevance of a radiological diagnosis and be able to correlate the results with
Limited accessibility to imaging hinders the ability to diagnose and to deliver your athlete’s treatment or rehabilitation, but even when there is good access to imaging resources, how appropriate are the investigations that the injured athlete undergoes? The two articles in this series describe the increasing role of imaging in sports medicine today. The first part is a comprehensive review of the imaging modalities currently available to the health professional and the second part (to be published in the April 2010 issue) summarises how these different imaging technologies are applied to both the diagnosis and delivery of image- guided therapies for sports injuries.
BOX 1: EIGHT PRINCIPLES FOR REQUESTING INVESTIGATIONS
1. Understand the meaning of the results
2. Consider the suitability, timing and accuracy of the investigation 3. Influence management 4. Communicate clinical details 5. Consider the quality of the examination
6. Develop close working relationships with the investigators 7. Explain the investigation to the patient
8. Consider use the of ionising radiation and the associated risks.
TECHNOLOGY MEANS PATHOLOGY CAN BE IDENTIFIED MUCH EARLIER
THE INCREASED SOPHISTICATION AND SENSITIVITY OF IMAGING