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To determine imaging utilization and expenditures among an underserved population at a student-run free clinic. This was a retrospective review of billing records for all radiology studies performed over a 4-year period at a student-run free clinic supervised by physician faculty. All imaging services were outsourced through either direct payment by the clinic to a local imaging group or through in-kind donations. Radiology studies were grouped by modality and diagnostic category. Data were analyzed to determine overall and average imaging utilization and expenditures. Across the 4-year study period, 413 radiology studies were performed with a yearly average of 103 (SD = 16). During this time, 192 (46%) ultrasounds, 123 (30%) radiographic studies, 40 (10%) MRIs, 37 (9%) CTs, 8 (2%) interventional procedures, and 5 (1%) nuclear imaging studies were obtained. Overall, expenditures were $157,888 with a yearly average of $39,472 (SD = $1982). In-kind donations accounted for $138,508 (88%) of expenditures. Across the 4-year study period, utilization increased by 15% with less than 1% increase in expenditures. Ultrasound was the most common imaging modality used. Overall imaging utilization was considerably less than that of published data in an ambulatory setting. [ABSTRACT FROM AUTHOR]

Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students. [ABSTRACT FROM AUTHOR]

Intramuscular myxomas are benign soft-tissue tumors, characterized by bland spindle-shaped cells and fibroblasts within an abundant mucoid matrix on histologic examination. Classically, these are slowly enlarging masses which may occasionally cause pain, paresthesia, and muscle weakness secondary to mass effect. We present an interesting phenomenon of two histologically confirmed cases of intramuscular myxomas that exhibited size and enhancement changes on follow-up imaging after image-guided biopsy. To our knowledge, this is the first report to describe size and enhancement changes of intramuscular myxomas after biopsy. [ABSTRACT FROM AUTHOR]

This means that having a resident fail the Core Exam is possible for any radiology residency program, including larger "top-tier" academic centers as well as smaller community-based programs. In some instances, residents who do not pass the examination may choose not to retake the examination (or at least during residency), but many have eventually passed on their second attempt (particularly those who repeat the examination when extenuating circumstances have improved). 27, 2020, 269-273 7 A.S. Shetty, J.R. Grajo, S. Decker, ABR Core examination preparation: results of a survey of fourth-year radiology residents who took the 2013 examination. [Extracted from the article]

Abstract: Purpose: We sought to retrospectively compare the accuracy of a three-dimensional fat-suppressed, fast spin-echo sequences acquired in the sagittal plane, with multiplanar reconstructions to that of two-dimensional fat-suppressed, fast spin echo sequences acquired in three planes on a 3T MR system for the evaluation of articular cartilage in the knee. Materials and methods: Our study group consisted of all patients (N =34) that underwent 3T MR imaging of the knee at our institution with subsequent arthroscopy over an 18-month period. There were 21 males and 13 females with an average age of 36 years. MR images were reviewed by 3 musculoskeletal radiologists, blinded to operative results. 3D and 2D sequences were reviewed at different sittings separated by 4 weeks to prevent bias. Six cartilage surfaces were evaluated both with MR imaging and arthroscopically with a modified Noyes scoring system and arthroscopic results were used as the gold standard. Sensitivity, specificity, and accuracy were calculated for each reader along with Fleiss Kappa assessment agreement between the readers. Accuracies for each articular surface were compared using a difference in proportions test with a 95% confidence interval and statistical significance was calculated using a Fisher''s Exact Test. Results: Two hundred and four articular surfaces were evaluated and 49 articular cartilage lesions were present at arthroscopy. For the patellofemoral surfaces, the sensitivity, specificity, and accuracy were 76.5%, 83%, and 78.2% for the 3D sequences and were 82.3%, 76%, and 82% respectively for the 2D sequences. For the medial compartment surfaces, the sensitivity, specificity, and accuracy were 81.1%, 65.1%, and 78.5% for the 3D sequences and were 82.5%, 48%, and 76.7% respectively for the 2D sequences. For the lateral compartment surfaces, the sensitivity, specificity, and accuracy were 89.3%, 39%, and 79.5% for the 3D sequences and were 94.7%, 18.8%, and 79.5% respectively for the 2D sequences. The accuracies were not significantly different between 3D and 2D sequences. Fleiss Kappa agreement values for the assessment of inter-observer agreement ranged from substantial for the patella and medial femur to moderate for the trochlea and fair for the medial tibia and lateral compartment. Conclusion: There was no significant difference in accuracy for the evaluation of articular cartilage of a single three-dimensional, fast spin echo sequence with multi-planar reformatted images vs. two-dimensional, fast spin echo sequences acquired in all three imaging planes in the knee. [Copyright &y& Elsevier]

Hip dislocations are emergently reduced to decrease the chance of avascular necrosis of the femoral head. However, in some situations, the dislocation may be irreducible by a closed technique. Rarely, the fractured femoral head may become perched on an intact acetabulum, leading to an irreducible fracture-dislocation. This rare type of irreducible fracture-dislocation demonstrates unique physical and associated radiographic findings. These fractures are important to recognize early, as attempts at closed reduction can lead to femoral neck fractures. [ABSTRACT FROM AUTHOR]

Melorheostosis is a rare non-hereditary sclerosing bone dysplasia which predominantly affects the appendicular skeleton. Although melorheostosis is typically recognized as an osseous lesion, associated soft-tissue components have been reported. Advanced imaging with MRI may allow for more complete evaluation of these soft tissue components; however, there is little information regarding their MRI characteristics which may lead to confusion with malignant processes. We present a case of melorheostosis in a 32-year-old woman with an associated paraarticular enhancing soft tissue mass and emphasize discriminating this from soft tissue sarcoma. • Meloheostosis is a rare bone dysplasia which may also cause associated soft tissue changes. • MRI appearance of the soft tissue component is variable and depends on the histologic constituents. • This report emphasizes an enhancing soft tissue component which can mimic sarcoma. • Knowledge of the variable appearance can prevent misdiagnosis and unnecessary workup. [ABSTRACT FROM AUTHOR]

Marrow enhancement mimicking sclerotic osseous disease, or the so-called transient "pseudolesion," has frequently been described in vertebral bodies supplied by collateral basivertebral venous flow in the setting of central venous obstruction. Pseudolesions involving the sternum are much rarer and have only been described in the setting of malignant central venous obstruction. We report a case of an incidental manubrial pseudolesion on contrast-enhanced CT prompting further investigation for thoracic outlet syndrome. [ABSTRACT FROM AUTHOR]

Mallet injury is associated with variable degrees of extensor hallucis longus tendon tearing, ultimately leading to the well-known mallet toe deformity; this entity, commonly described at the lesser toes and fingers, has rarely been reported at the hallux. We present a surgically proven case of mallet hallux injury with radiographic and magnetic resonance imaging assessment and review the literature, including clinical and radiological findings, along with basic treatment concepts. • Mallet toe deformity is characterized by flexion at the distal interphalangeal joint in the sagittal plane • MHI is typically caused by forced hyperflexion damaging the extensor hallucis longus tendon at or about its insertion • Clinical/radiological findings vary based on degree of injury, with the classic mallet deformity being the final stage. • No consensus on treatment: conservative and operative (closed reduction and open repair) treatments have been described [ABSTRACT FROM AUTHOR]

Fat embolism in the subarachnoid space has a unique pathophysiology and clinical picture when compared to fat embolism syndrome. Lipid deposits in the subarachnoid space—most commonly the sequela of dermoid rupture in the neuraxis—can cause an inflammatory reaction leading to irritation of nearby neurovascular structures. Herein, we report the only case in the United States, to our knowledge, of a patient diagnosed with subarachnoid fat emboli secondary to sacral fracture who initially presented with a normal head CT and subsequently developed visual changes. • Fat embolism in the subarachnoid space has unique pathophysiology and symptoms. • Subarachnoid fat embolism with visual changes as presenting symptom • Lipid deposits in subarachnoid space can irritate nearby neurovascular structures. [ABSTRACT FROM AUTHOR]

Osteochondromas, the most common benign bone tumor, are typically asymptomatic and discovered incidentally by imaging. Most frequently, osteochondromas occur at the metaphyses of long bones, and rarely involve the head and neck. We report the first case of a symptomatic osteochondroma of the temporal styloid process causing facial nerve paralysis. • Osteochondromas, the most common benign bone tumor, are typically asymptomatic and discovered incidentally by imaging. • These lesions typically occur at the metaphyses of long bones, and rarely involve the head and neck. • We report the first case of a symptomatic osteochondroma of the temporal styloid process causing facial nerve paralysis. [ABSTRACT FROM AUTHOR]

Objective: Calcium hydroxyapatite depositional disease (HADD) is usually asymptomatic and self-limiting; however, when there is an associated inflammatory process or HADD occurs in an unusual location, it may mimic trauma, infection, or neoplasm. The purpose of this article is to review the imaging features of HADD and how to distinguish it from more worrisome entities that can have similar appearances.Conclusion: An understanding of the presentations of HADD is important to allow early and confident diagnosis. In particular, familiarity with presentations that resemble more ominous pathologies is essential to avoid costly and time-consuming workup or intervention. [ABSTRACT FROM AUTHOR]