Calf injuries in professional football: Treat the patient or the scan? – A case study

ObjectiveTo describe a case of a professional football player with significant imaging findings despite a rather innocuous clinical presentation with gradual onset of calf pain and who was able to continue training and playing with minor medical intervention. To discuss some of the limitations of existing muscle injury grading systems and their potential to cover the full range of injury presentations for calf injuries.DesignCase report.SettingA professional football player was assessed by physical examination, clinical testing and imaging (MRI) after a gradual onset of a calf injury. After returning to training and competition, a follow-up of his symptoms was performed with regular ultrasound imaging assessments.ParticipantA professional football player (35 years, 1.90 m, 88 kg) male, African, striker, playing in the Professional Arabian Gulf League.ConclusionThe discordance between the clinical presentation and the imaging findings resulted in a challenging situation regarding the decision of whether to allow the player to train and compete. In addition, existing muscle injury grading systems do not seem to cover the full range of injuries seen in clinical practice.     

Why do girls sustain more anterior cruciate ligament injuries than boys?: a review of the changes in estrogen and musculoskeletal structure and function during puberty

Sport is the leading cause of injury among adolescents and girls incur more non-contact anterior cruciate ligament (ACL) ruptures than boys, with this gender disparity in injury incidence apparent from the onset of puberty. Although the mechanisms for this gender disparity in ACL injuries are relatively unknown, hormonal, anatomical and biomechanical factors have been implicated. Puberty is associated with rapid skeletal growth and hormonal influx, both of which are thought to contribute to alterations in ACL metabolic and mechanical properties, as well as changes in lower limb strength and flexibility, ultimately influencing landing technique. Therefore, the aim of this review is to explain (i) the effects of changes in estrogen levels on the metabolic and mechanical properties of the ACL; (ii) changes in musculoskeletal structure and function that occur during puberty, including changes in knee laxity, and lower limb flexibility and strength; and (iii) how these hormonal and musculoskeletal changes impact upon the landing technique displayed by pubescent girls. Despite evidence confirming estrogen receptors on the ACL, there are still conflicting results as to how estrogen affects the mechanical properties of the ACL, particularly during puberty. However, during this time of rapid growth and hormonal influx, unlike their male counterparts, girls do not display an accelerated muscle strength spurt and the development of their hamstring muscle strength appears to lag behind that of their quadriceps. Throughout puberty, girls also display an increase in knee valgus when landing, which is not evident in boys. Therefore, it is plausible that this lack of a defined strength spurt, particularly of the hamstring muscles, combined with the hormonal effects of estrogen in girls, may contribute to a more 'risky' lower limb alignment during landing, in turn, contributing to a greater risk of ACL injury. There is, however, a paucity of longitudinal studies specifically examining the lower limb musculoskeletal structural and functional changes experienced by girls throughout puberty, as well as how these changes are related to estrogen fluctuations characteristic of puberty and their effects on landing biomechanics. Therefore, further research is recommended to provide greater insight as to why pubescent girls are at an increased risk of non-contact ACL injuries during sport compared with boys. Such information will allow the development of evidence-based training programmes aimed at teaching girls to land more safely and with greater control of their lower limbs in an attempt to reduce the incidence of ACL ruptures during puberty.     

CAD systems for mammography: a real opportunity? A review of the literature

The introduction of systems for automated reading in mammography has been proposed to improve the sensitivity [computer-aided detection (CADe) systems] and, more recently, the specificity [computer-aided diagnosis (CADi) systems] of the test. Only CADe systems have been approved by the U.S. Food and Drug Administration (FDA) and are used in current practice. These systems are still under discussion. Several studies have demonstrated that they are beneficial to inexperienced readers and that, through comparison with the computer, radiologists are led to improve their performance. However, there is still considerable variation among different studies in the level of benefit deriving from CAD. Therefore the role of these systems in clinical practice is still debated, and their real contribution to the overall management of the diagnostic process is not yet clear.     

Sudden cardiac death in young athletes: time for a Nordic approach in screening?

In 2005, the European Society of Cardiology published recommendations for cardiovascular screening in athletes. Discussion on whether screening is beneficial is ongoing. Recently, the first prospective results on effectiveness of screening in preventing sudden deaths were published from Italy. The results were supportive of screening, but did not provide conclusive evidence. Our suggestion for a Nordic approach on this issue is a directed cardiovascular examination initially involving elite athletes, because this is feasible with respect to the Nordic health care systems and the organization and logistics of elite competitive sports, but also because of the negative aspects of screening large populations. This directed cardiovascular examination would include personal and family history, clinical examination, and electrocardiography (ECG). Further examinations should thereafter be carried out in athletes with suggestive findings in the initial evaluation. The directed cardiovascular examination should be voluntary. It should be conducted at least once, with information on alarming symptoms (syncope, chest pain or dizziness during exercise) and heredity (sudden cardiac death or hereditary heart disease in near relatives) stressed to the athlete as indications for necessary check-ups in the future. The examination would also provide the athlete with an ECG recording, which is valuable as a reference at a later time.     

Lung abscess in a professional rugby player: an illustration of overtraining syndrome?

As in other endurance sports, the intensity of training sessions and the pace of competition has significantly increased since rugby union became a professional sport. The case history is presented of a professional rugby player who was diagnosed with septicaemia and a lung abscess following an infected wound to the ear. The symptoms only resolved after a large dose of antibiotics and 3 months of rest. It is hypothesised that this may be an example of overtraining syndrome, but complementary blood analyses would be necessary to confirm this. The case underlines the importance of clinically assessing the individual capacity of players to recover, in order to prevent overtraining and to maintain a high level of performance during the whole season.     

Are pancreatic IPMN volumes measured on MRI images more reproducible than diameters? An assessment in a large single-institution cohort

Objectives

To assess reproducibility of volume and diameter measurement of intraductal papillary mucinous neoplasms (IPMNs) on MRI images.

Methods

Three readers measured the diameters and volumes of 164 IPMNs on axial T2-weighted images and coronal thin-slice navigator heavily T2-weighted images using manual and semiautomatic techniques. Interobserver reproducibility and variability were assessed.

Results

Interobserver intraclass correlation coefficients (ICCs) for the largest diameter measured using manual and semiautomatic techniques were 0.979 and 0.909 in the axial plane, and 0.969 and 0.961 in the coronal plane, respectively. Interobserver ICCs for the volume measurements were 0.973 and 0.970 in axial and coronal planes, respectively. The highest intraobserver reproducibility was noted for coronal manual measurements (ICC 0.981) followed by axial manual measurements (ICC 0.969). For the diameter measurements, Bland-Altman analysis revealed the lowest interobserver variability for manual axial measurements with an average range of 95% limits of agreement (LOA) of 0.68 cm. Axial and coronal volume measurements showed similar 95% LOA ranges (8.9 cm³ and 9.4 cm³, respectively).

Conclusions

Volume and diameter measurements on axial and coronal images show good interobserver and intraobserver reproducibility. The single largest diameter measured manually on axial images showed the highest reproducibility and lowest variability. The 95% LOA may help define reproducible size changes in these lesions using measurements from different readers.

Key Points

? MRI measurements by different radiologists can be used for IPMN follow-up. ? Both diameter and volume measurements demonstrate excellent interobserver and intraobserver reproducibility. ? Manual axial measurements show the highest interobserver reproducibility in determining size. ? Axial and coronal volume measurements show similar limits of agreement. ? Manual axial measurements show the lowest variability in agreement range.

     

The efficacy of an iterative “sequence of prevention” approach to injury prevention by a multidisciplinary team in professional rugby union

Objectives

Due to the complex systems nature of injuries, the responsibility for injury risk management cannot lie solely within a single domain of professional practice. Interdisciplinary collaboration between technical/tactical coaches, strength and conditioning coaches, team doctors, physical therapists and sport scientists is likely to have a meaningful impact on injury risk. This study describes the application and efficacy of a multidisciplinary approach to reducing team injury risk in professional rugby union.

Complicated IVC anomalies: Are they more common than we thought? An experience of 100 MDCT venography examinations

Objective

The aim of this study was to monitor the incidence of complicated inferior vena cava (IVC) anomalies and evaluate the role of Multidetector Computed Tomographic Venography (MDCTV) in diagnosis and assessment of associated venous collaterals, lower limb deep venous thrombosis (DVT) or varicose veins (VV).

Is there a role for professional supervision in supporting the professional and personal wellbeing of the sonographic workforce? A literature review

ObjectivesThe sonographer workforce in the UK is under pressure due to chronic staff shortages and increased service demands. The Health and Care Professions Council and the Society of Radiographers both advocate for the use of professional supervision to support wellbeing and development, however the use of professional supervision is not widespread within the sonographer workforce. The aim of this literature review was to explore the evidence around the use of professional supervision and how this could support sonographer wellbeing.Key findingsProfessional supervision was found to be of importance for providing emotional support which can lead to increased job satisfaction, lower levels of burnout and subsequently impact on retention of the workforce. Professional supervision supported personal development and therefore increased quality of patient care, allowing professionals to discuss evidence-based care, policies and practice development through reflection.Whilst important for emotional and professional support, this review found that there are conflicting pressures which can impact the effectiveness of supervision including the supervisory relationship itself and time and organisational pressures. Demands on the workforce made a significant impact on the availability of quality clinical supervision.ConclusionProfessional supervision has an important role in supporting the sonography workforce and enable increased wellbeing and emotional support. There are clear benefits to undertaking professional supervision to support the workforce however there are competing demands which may affect the effectiveness of professional supervision.Implications for practiceThere is limited international research on the use of professional supervision in the radiographer and sonographer workforce. There are clear benefits for supporting professional wellbeing and development under a structured professional supervision framework however within the United Kingdom there is a significant gap in the literature where further research is required.     

Determination of splenomegaly by CT: is there a place for a single measurement?

OBJECTIVE: Our objective was to determine if there is a single parameter that can be used as a marker of splenomegaly using CT. MATERIALS AND METHODS: Splenic length, width, and thickness were measured in 249 CT scans and multidimensional indexes were obtained from the multiplication of these measurements. Volume was calculated by summing the volumes of multiple contiguous scans. The relationship of the spleen to the left liver lobe and inferior third of the left kidney was also evaluated. Linear equations were obtained to correlate each measurement to the splenic volume. RESULTS: The unidimensional measurements with best correlation to volume were splenic length (r = 0.81, p < 0.01) and width (r = 0.804, p < 0.01). Correlation was better for the multidimensional indexes (r = 0.95, p < 0.01). Using a previously described upper limit of normality for splenic volume of 314.5 cm3 in the linear regression equation obtained, a maximum spleen length of 9.76 cm was the upper limit of normality. The relation of the lowest point of the spleen to the inferior third of the kidney also showed that if the spleen reached or extended below this portion of the kidney, it could be used as evidence of splenomegaly (p < 0.005), although it had a low sensitivity. CONCLUSION: Splenic length and multidimensional indexes correlate well with splenic CT volume. A splenic length of 9.76 cm can be used to accurately diagnose splenomegaly and can replace multiple-measurement, time-consuming methods in the clinical routine.     

Non-invasive determination of frontal plane lower limb alignment using motion capture technique – An alternative for full-length radiographs in young patients treated by a temporary hemiepiphysiodesis?

BackgroundMultiple full-length standing anteroposterior radiographs are common practice to quantify the mechanical axis angle (MAA) in young patients with lower limb malalignment in the frontal plane treated with a temporary hemiepiphysiodesis.Research questionIs it possible to predict the MAA measured with gold-standard radiographs from a non-invasive method using the marker-based motion capture technique in a standing position and has an increased body mass index (BMI) a negative effect on this prediction?MethodsForty-six children and adolescents with valgus or varus malalignment of the knee were measured several times during the treatment period. In total 175 data sets were evaluated in this prospective study. BMI was included into the linear mixed effect regression to detect the influence of this variable on the prediction model. Bland and Altman plots were obtained to examine methods’ agreement.ResultsThe X-ray-based MAA highly correlated (r = 0.808, p < 0.001) with the marker-based MAA. The association between measurements was stronger in patients with a BMI < 25 (r = 0.881, p < 0.001) than in patients with a BMI ≥ 25 (r = 0.747, p < 0.001). The Bland and Altman plots illustrated a better agreement between both methods for patients with a BMI < 25 (bias of 0.7°) than for patients with a BMI ≥ 25 (bias of 3.7°).SignificanceDetermination of frontal plane lower limb alignment using motion capture technique is an alternative method to assess the MAA non-invasively. The approach is therefore relevant for clinical and scientific use when cumulative radiation dosage becomes a problem or when radiation may be prohibited (e.g. healthy control group). A higher BMI overestimates the valgus malalignment in the motion capture method which may result from excess body tissue and the difficulty in palpating bony landmarks on the skin.     

Nonoperative management of traumatic splenic injuries: is there a role for proximal splenic artery embolization?

OBJECTIVE: The objective of our study was to evaluate our experience with transcatheter proximal (i.e., main) splenic artery embolization (TPSAE) in the nonsurgical management of patients with grade III-V splenic injuries, according to the American Association for the Surgery of Trauma (AAST) guidelines, and patients with splenic injuries associated with CT evidence of active contrast extravasation or blush (or cases meeting both criteria). MATERIALS AND METHODS: The records of patients with traumatic splenic injuries admitted during a 52-month period were retrospectively reviewed for patient age and sex, mechanism of injury, injury severity score (ISS), RBC transfusion requirements, AAST splenic injury CT grade, presence of active contrast extravasation or blush on CT examination, and amount of hemoperitoneum on CT examination. Demographics, CT findings, transfusion requirements, and outcome were compared using the Student's t test or chi-square test in patients undergoing standard nonoperative management and nonoperative management TPSAE-that is, TPSAE followed by nonoperative management. RESULTS: Of the 79 identified patients with splenic trauma, 67 were managed nonoperatively. Thirty-seven patients (28 men, nine women; mean age, 40 years; mean ISS, 28.8) underwent nonoperative management TPSAE and 30 patients (27 men, three women; mean age, 37 years; mean ISS, 25.1) underwent nonoperative management. Age, sex, and ISS were not significantly different between the two groups. TPSAE was always technically feasible. Splenic injuries were significantly more severe in the nonoperative management TPSAE group than in the nonoperative management group with respect to the mean splenic injury AAST CT grade (3.7 vs 2, respectively; p < 0.0001), active contrast extravasation or blush (38% [14/37] vs 3% [1/30], respectively; p = 0.0005), and hemoperitoneum grade (1.6 vs 0.8, respectively; p = 0.0006). Secondary splenectomy rate was lower in the nonoperative management TPSAE group (2.7% [1/37] vs 10% [3/30]). No procedure-related complications were encountered during early and delayed clinical follow-up. CONCLUSION: TPSAE is a feasible and safe adjunct to observation in the nonoperative management of severe traumatic splenic injuries. The secondary splenectomy rate using nonoperative management TPSAE (2.7%) is among the lowest reported despite a selection of severe injuries.     

Creation of a Forensic Pathology Biobank in Switzerland: which issues and research opportunities?

A biobank is a collection of biological material associated with health database. The field of biobanking has significantly developed over the past 30 years. Research based on biobank material gives access to data of a large number of people and can often significantly accelerate the understanding of disease and improve the quality of care. In the University Center of Legal Medicine Lausanne-Geneva, samples collected during autopsies are used for forensic investigations. The legal and ethical framework to use these samples for research is often complex and confused, which is unfortunate given the potential of these biospecimens. Indeed, forensic samples are valuable for research because they originate in part from young (including pediatrics cases) and healthy people who are poorly represented in worldwide institutional biobanks. In this context at the beginning of the year 2019, the Forensic Pathology Biobank was created. Creation of a forensic pathology biobank is the best way to standardize local conservation practices and improve personal data management, thus providing a very valuable biological material for scientific projects. Its development gives rise to many questions about technical standards, ethical and legal issues but also many research opportunities.