bluuebunny/crossref_metadata_2025 huggingface dataset:
Foreign Bodies
Authors: Porrino Jack , Wyatt Alvin R.
Published: June 2019

Chapter 29 discusses foreign bodies and trauma. An object that originates from outside the body is by definition considered a foreign body. The retained foreign body can occur in a variety of clinical settings, such as motor vehicle accident, explosion, or gunshot injury and is a common presenting complaint in the acute care setting. Although radiography is often obtained as the first line of imaging in the diagnostic workup of soft tissue foreign bodies, some object compositions, such as wood and plastic, are radiolucent. In this scenario, US is an excellent imaging modality in identifying a retained soft tissue foreign body and can also assist in its removal. Management of the superficial foreign body is typically uneventful, however, the deeply penetrating foreign body may require a more intricate surgical procedure because of proximity of adjacent vital structures.
Rheumatoid Arthritis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 30 discusses rheumatoid arthritis (RA), which is the most common inflammatory arthritis and increases in incidence with age. Radiographs of the hand and feet are the primary imaging modality used for diagnosis and assessing response to treatment. The characteristic marginal erosions of the hands and feet of chronic disease are virtually diagnostic of RA. Ultrasound and MRI are highly sensitive and specific for the articular changes of RA. MRI is the only modality proven to identify bone marrow edema (BME), which is characteristic of early RA and predictive of future erosions. Early RA diagnosis and treatment with disease-modifying antirheumatic drugs (DMARDs) has resulted in a trend toward less severe imaging findings, fewer physical limitations and improved outcomes.
Juvenile Idiopathic Arthritis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 31 discusses juvenile idiopathic arthritis (JIA), which is a heterogeneous disease of joint inflammation. Initial radiographic evaluation is useful for excluding other diseases. Radiographs are sensitive to late findings of JIA, but not early changes of JIA. The monitoring of chronic disease, however, relies on modalities that do not result in ionizing radiation and are more sensitive to changes in the skeletally immature patient. MRI and US are both safe imaging techniques, which can detect inflammation in joints that are not well evaluated by radiography and can better classify the disease. US can also be useful for guiding intraarticular injections.
Reactive Arthritis
Authors: Hoover Kevin B.
Published: June 2019

Chapter 34 discusses reactive arthritis (ReA), which is a seronegative spondyloarthropathy (SpA) usually of younger patients. ReA is a postinfectious SpA. ReA is a SpA suspected in younger patients, especially those 25-30 years old, with inflammatory back pain, oligoarthritis, and extraarticular symptoms following infection, usually gastrointestinal or genitourinary. It more commonly involves the peripheral than the axial skeleton, especially the lower extremity. Sacroiliac joint involvement is also common. The Assessment of SpA International Society (ASAS) classification criteria are useful in diagnosing ReA and distinguishing it from other SpA. Peripheral disease is first evaluated by radiography, but MRI is the gold standard for identifying active disease.
Gout
Authors: Vossen Josephina A.
Published: June 2019

Chapter 35 discusses gout, a metabolic disorder in which hyperuricemia leads to deposition of monosodium urate (MSU) crystals in soft tissues and joints. Gout is the most common crystalline type of arthropathy in the United States. Gout is considered to have 4 phases, characterized by asymptomatic hyperuricemia, recurrent attacks of acute arthritis, intercritical gout and chronic tophaceous gout. Radiography is generally used in the initial evaluation of gouty arthritis. Characteristic of gout are well-defined, punched-out erosions with overhanging edges, with late preservation of the joint space, lack of periarticular osteopenia, asymmetrical involvement, and soft tissue nodules that may calcify.
Calcium Pyrophosphate Dihydrate Deposition Disease
Authors: Vossen Josephina A.
Published: June 2019

Chapter 36 discusses calcium pyrophosphate dihydrate deposition (CPPD) disease. CPPD disease is a common crystalline type of arthropathy in the United States, most often seen in middle-aged and elderly patients. Characteristics of CPPD disease include an acute and chronic inflammatory arthropathy. CPPD is associated with a range of clinical syndromes, which have been given various names, based on the most prominent clinical symptoms or radiographic findings. Conventional radiography is the main diagnostic tool for CPPD. Classic radiologic findings include chondrocalcinosis of the hyaline cartilage and fibrocartilage of the knee, the triangular fibrocartilage complex of the wrist, the symphysis pubis, and the acetabular labrum of the hip.
Polymyositis and Dermatomyositis
Authors: Vossen Josephina A.
Published: June 2019

Chapter 42 discusses polymyositis and dermatomyositis, which are idiopathic inflammatory myopathies characterized by muscle inflammation, proximal muscle weakness, and elevated muscle enzymes. Idiopathic inflammatory myopathies represent a heterogeneous group of muscle diseases. Diagnosis is based on clinical examination, muscle enzyme laboratory values, electromyography (EMG), and muscle biopsy. MRI is the most important imaging modality used in diagnosis and management. Radiographs and CT may detect calcinosis. Treatment is primarily by immune suppression.
Mixed Connective Tissue Disease
Authors: Vossen Josephina A.
Published: June 2019

Chapter 43 discusses mixed connective tissue disease (MCTD), which is a complex disease with overlapping features of systemic sclerosis, systemic lupus erythematosus, and polymyositis. MCTD is rare and more common in women than in men, characterized by the presence of high titers of a distinctive autoantibody, called anti-U1 ribonucleoprotein (RNP). Arthritis and myositis are common features. Radiographs are standard in the initial evaluation of symptomatic extremities. Ultrasound is useful to evaluate multiple joints. MRI is especially sensitive in detection of myositis. Medical therapy is targeted to specific organ involvement and extent of disease activity. There are large variations in clinical features, response to therapy, and outcomes.
Imaging of Erosive Osteoarthritis
Authors: Hayashi Daichi , Guermazi Ali , Roemer Frank W.
Published: June 2019

Chapter 45 discusses imaging of erosive osteoarthritis (EOA), a severe phenotype of osteoarthritis (OA) characterized by erosions and superimposed synovitis, most typically seen in women in the interphalangeal (IP) joints of the hand. Radiography is the primary imaging modality used in the diagnosis of EOA. EOA is distinguished from non-EOA based on the presence of erosions on radiography. US and MRI can be useful in detecting erosions, joint effusion, and active synovitis that may precede radiographic changes. The most common differential diagnosis of EOA is psoriatic arthritis (PsA), which exhibits additional characteristic imaging features such as bony proliferations and periostitis.
Malignant Chondroid Matrix Bone Tumors
Authors: Levine Benjamin D. , Seeger Leanne L.
Published: June 2019

Chapter 55 discusses malignant chondroid matrix bone tumors. Chondrosarcoma is a malignant bone tumor of cartilage origin. It represents the third most common primary malignant bone tumor, after multiple myeloma and osteosarcoma. Conventional intramedullary chondrosarcoma is its most common subtype, with rarer subtypes that include clear cell, mesenchymal, dedifferentiated, and periosteal chondrosarcoma. Secondary chondrosarcoma represents a lesion that arises in a preexisting benign chondroid lesion (enchondroma or osteochondroma). Chondrosarcomas demonstrate some specific imaging features that can improve diagnostic accuracy and help guide clinical management. Histological grade of central chondrosarcoma usually dictates surgical management. As with other sarcomas, outcome of chondrosarcoma depends on histological grade, surgical margins, and staging.
Malignant Fibrous Lesions of the Bone
Authors: Song Albert
Published: June 2019

Chapter 57 discusses malignant fibrous lesions of the bone. In the most recent edition of the World Health Organization (WHO) Classification of Tumors of Soft Tissue and Bone, undifferentiated high-grade pleomorphic sarcoma, previously named malignant fibrous histiocytoma (MFH), and fibrosarcoma are the 2 main malignant fibrous matrix tumors of bone. There is considerable imaging and histologic overlap between these 2 entities and their subtypes. Malignant fibrous lesions of bone universally require treatment. Despite variable histologic aggressiveness, these lesions are usually diagnosed when large and have a poor survival prognosis. This chapter will review demographics, multimodality imaging features, differentials diagnoses, and clinical management of the malignant fibrous bone tumors.
Benign Soft Tissue Masses
Authors: Blount Kevin J.
Published: June 2019

Chapter 65 discusses benign soft tissue masses, which are much more common than malignant lesions; however, there can be overlap between these categories, and some lesions have features that are indeterminate. In many cases, the clinical presentation is not clearly diagnostic, and patients with soft tissue lesions require additional evaluation with imaging and biopsy. Radiography, MRI, and US serve complementary roles in the workup of soft tissue masses, with MRI providing the most comprehensive evaluation in most cases. Although imaging sometimes cannot confirm a definitive diagnosis, the imaging appearance plays an important role in the workup of soft tissue masses and tumorlike conditions. The most important features to evaluate are the internal architecture of the lesion, defining the anatomic location of the lesion, and assessing the relationship of the soft tissue lesion to surrounding vital structures.
Pigmented Villonodular Synovitis
Authors: Mar Winnie A.
Published: June 2019

Chapter 68 on pigmented villonodular synovitis (PVNS) reviews the clinical features, pathology, and imaging characteristics of PVNS. Epidemiology and treatment are briefly discussed. Diffuse intraarticular PVNS, localized intraarticular PVNS, and localized extraarticular PVNS, also referred to as giant cell tumor of the tendon sheath, are discussed. PVNS is considered to be a benign neoplastic disorder. Joints, tendon sheaths, and bursae may be involved. The knee is the most common location of the intraarticular form. The characteristic MRI finding is low signal intensity synovial proliferation or mass with blooming from susceptibility artifact on gradient echo images, secondary to the presence of hemosiderin.
Bone Marrow Conversion and Reconversion
Authors: Hoover Kevin B.
Published: June 2019

Chapter 75 discusses bone marrow conversion and reconversion. The bone marrow is one of the largest organs in the body and it changes in composition throughout life. There is a normal conversion of hematopoietic bone marrow to fatty marrow with age. Various stressors or diseases can cause a reversal of this process or marrow reconversion. Marrow reconversion is often incidentally detected on MRI. Its imaging characteristics are important to distinguish from pathologic marrow infiltrative processes. Characteristic locations of marrow reconversion and the presence of focal or microscopic fat on MRI are useful features, but biopsy may still be required to exclude malignancy. Treatment is specific to the underlying disorder.
Lymphoproliferative and Myeloproliferative Disorders
Authors: Hoover Kevin B.
Published: June 2019

Chapter 78 discusses lymphoproliferative and myeloproliferative disorders, which are a disparate group of premalignant and malignant neoplasms originating in or metastasizing to the bone marrow. Included in this group of disorders is primary myelofibrosis, systemic mastocytosis, leukemia, and lymphoma. Because these tend to involve the marrow more often than the cortex, they are best detected by MRI and nuclear imaging techniques, including FDG-PET and CT. Distinguishing the disorders by imaging is often difficult because of the overlap in imaging findings. Imaging is beneficial to guide biopsy, which is crucial in diagnosis, and to assess treatment response.
Parathyroid Diseases and Renal Osteodystrophy
Authors: Hoover Kevin B.
Published: June 2019

Chapter 82 discusses parathyroid diseases and renal osteodystrophy. Parathyroid disease disrupts calcium homeostasis with systemic effects including abnormal bone metabolism. Secondary hyperparathyroidism, caused by chronic kidney disease, is the most common parathyroid disease. Diagnosis is primarily based on serum calcium, phosphate, and parathyroid hormone levels rather than imaging. However, there are characteristic findings that may suggest the diagnosis of parathyroid disease. Resorption of bone is the most important radiographic finding in primary hyperparathyroidism. Increase in bone density is the most specific radiographic and DXA finding in hypoparathyroidism. Treatment is dependent on disease, for example, parathyroidectomy is standard treatment for hyperparathyroidism, whereas hypoparathyroidism is treated with calcium supplementation.
Osteomyelitis of the Long and Flat Bones
Authors: Shikhare Sumer N. , Peh Wilfred C. G.
Published: June 2019

Chapter 86 highlights the imaging manifestations of osteomyelitis (OM) involving the long and flat bones. OM refers to inflammation of the bone and bone marrow caused by underlying infection, classically bacterial. Long and flat bone OM can occur either because of hematogenous spread, direct inoculation or from a contiguous source of infection. The severity depends on the factors such as organism isolated, pathogenesis, extent of bone involvement, duration of infection, and host factors such as age and immune status. Imaging plays a crucial role in the early diagnosis of OM with MRI being the modality of choice. Both acute and chronic forms of OM are still a big challenge to treat, even in the era of advanced antibiotics and new surgical techniques. Imaging helps in early diagnosis, which in turn helps to initiate early treatment.
Tuberculosis
Authors: Arkun Remide
Published: June 2019

Chapter 89 reviews musculoskeletal tuberculosis (TB), which is an infectious disease caused by Mycobacterium tuberculosis. Extrapulmonary TB is seen in 20% of all TB cases. Musculoskeletal TB accounts for 1-3% of tuberculous infections. The most common musculoskeletal presentation is TB spondylitis followed by TB infectious arthritis, osteomyelitis, tenosynovitis, bursitis, and Poncet disease. Hematogenous dissemination of the organism from a visceral primary focus (lungs, kidneys, lymph nodes) to the musculoskeletal system is the most common pathway, but lymphatic spread or direct inoculation can also occur. Clinical findings are variable. Generally patients have low-grade fevers, night sweets, weight loss, anorexia, and malaise. Although radiography should be the initial imaging modality in evaluation of disease, MRI is the best modality in evaluation of musculoskeletal TB.
Fungal and Higher Bacterial Infections
Authors: Arkun Remide
Published: June 2019

Chapter 91 reviews fungal and higher bacterial ınfections. Fungal bone infections are rare disorders, and incidence of these diseases is related to geographic distribution, ethnic and nutritional factors, and occupation. Immunocompromise and traveling can lead to increased incidence. Similar to fungal infections, Actinomycosis and Nocardiosis, which are rare gram-positive filamentous bacterial infections, cause chronic, slowly progressive granulomatous disease. These are a group of chronic disorders, and delayed diagnosis is common although radiographs, CT, bone scan, and MRI are useful for characterization of pathologic changes. Diagnosis is possible with a high index of clinical suspicion, but aspiration or biopsy is necessary for definitive diagnosis.
Brucellosis
Authors: Arkun Remide
Published: June 2019

Chapter 92 reviews musculoskeletal brucellosis. Brucellosis is a zoonosis of worldwide distribution that is caused by small, gram-negative, nonencapsulated coccobacilli of the genus Brucella. This infection involves granulomatous reaction of the reticuloendothelial system. Musculoskeletal involvement is variable and occurs in 10-85% of patients with brucellosis. Musculoskeletal infection may manifest as sacroiliitis, spondylitis/spondylodiscitis, arthritis, bursitis, tenosynovitis, and osteomyelitis. The spine and sacroiliac joints are the most common locations. In musculoskeletal brucellosis, evaluation usually begins with radiography. MRI and CT are more sensitive and are used to evaluate the extent of disease. Brucellosis should be included in the differential diagnosis of a patient with arthralgia or symptoms of musculoskeletal system disorders, especially in endemic areas.
Cat Scratch Disease
Authors: Arkun Remide
Published: June 2019

Chapter 94 reviews cat scratch disease, which is an infection caused by Bartonella henselae, a gram-negative intracellular Bacillus, which causes granulomatous inflammation of the tissues. There is usually a history of exposure to cats, and cat scratch, bite or licking. The disease is characterized by chronic lymphadenopathy in children and adolescents. In immunocompromised patients, severe systemic disease or other atypical manifestations may develop, including osteomyelitis together with ipsilateral lymphadenopathy. A history of cat exposure, polymerase chain reaction (PCR), and other serologic tests are helpful in diagnosis and complement imaging findings. Tissue sampling of lymph nodes or bones reveals granulomatous infection.
Melioidosis
Authors: Arkun Remide
Published: June 2019

Chapter 95 reviews musculoskeletal manifestations of melioidosis, which is a frequently fatal infection caused by the gram-negative bacillus Burkholderia pseudomallei. Melioidosis is present in tropical regions, mainly in Southeast Asia and northern Australia. Musculoskeletal infection is usually seen as a part of multiorgan involvement, but localized musculoskeletal involvement may occur. The most common form is septic arthritis, followed by osteomyelitis, pyomyositis, and soft tissue abscess. The infection is usually chronic and relapsing. Evaluation usually begins with radiography. Imaging findings in musculoskeletal melioidosis are nonspecific and may mimic other infections. A definitive diagnosis is made by positive culture of the organism from blood or infected organs.
Musculoskeletal Echinococcosis (Hydatid Disease)
Authors: Arkun Remide
Published: June 2019

Chapter 96 reviews musculoskeletal echinococcosis (hydatid disease). Human echinococcosis is a parasitic disease caused by tapeworms of the genus Echinococcus. It is a zoonotic infection with widespread infestation in the Mediterranean region, Central Asia, South America, southern Europe, and Australia. Humans are infected secondarily by ingestion of contaminated food or water. The disease can be seen even in nonendemic areas. Although hydatid disease can develop in almost any part of the body, it is most commonly found in the liver and lung. Musculoskeletal involvement is rare and reported in 1-4% of cases. Evaluation usually begins with radiography. The radiologic appearance of musculoskeletal echinococcosis mimics tumors and other inflammatory conditions.
Shoulder Arthrography
Authors: DelGiudice Matthew
Published: June 2019

Chapter 98 describes indications, technique, and imaging findings of shoulder arthrography. Shoulder arthrography is commonly performed in routine clinical practice for MR arthrography (MRA), typically in younger patients. The main indications include evaluation of shoulder instability and postoperative rotator cuff. Other indications include fluoroscopic guidance for therapeutic injections or therapy for adhesive capsulitis. CT arthrography (CTA) may also be performed for evaluation of total shoulder arthroplasty (TSA) loosening and conversion from anatomic to reverse TSA. Contrast should be easy to inject and disperse throughout the joint. Abnormal communication between the glenohumeral joint and subacromial-subdeltoid and subcoracoid bursae is diagnostic of a full-thickness rotator cuff tear unless the contrast is accidentally injected into the bursa. However, in the setting of prior rotator cuff repair, contrast may extend into the bursa even in the absence of re-tear because the cuff is not watertight. Contrast extension into the glenoid labral substance is diagnostic of labral tear.
Elbow Arthrography
Authors: DelGiudice Matthew
Published: June 2019

Chapter 99 describes indications, technique, and imaging findings of elbow arthrography. Elbow arthrography is selectively performed for MR arthrography (MRA), typically in younger patients for evaluation of ligamentous (ulnar or radial collateral ligaments) injuries and osteochondral lesions. Indications also include therapeutic injections. The posterior transtriceps approach is preferred when the clinical concern is for radial collateral ligament injury. Contrast should easily inject and disperse throughout the joint. Contrast opacifies the anterior (coronoid), posterior (olecranon), and periradial (annular) recesses, which are easily depicted on lateral radiograph. Complications are rare but include infection and bleeding.
Hip Arthrography
Authors: DelGiudice Matthew
Published: June 2019

Chapter 101 describes the indications, technique, and imaging findings of hip arthrography. Hip arthrography is selectively performed in routine clinical practice for MRA, typically in younger patients. Indications include hip pain thought to be caused by acetabular labral injury, femoroacetabular impingement syndromes, as well as therapeutic steroid injections. Contrast should easily inject and disperse throughout the joint away from the needle, opacifying the femoral head and neck recesses and outlining the zona orbicularis. The technique can also be used for arthrocentesis with suspected infection, but contrast should not be injected. Contrast extension into the acetabular labral substance may be occasionally depicted on the standard arthrography images. However, it is nowadays evaluated by MRA or sometimes CTA. Complications include infection, bleeding (especially if arterial puncture), and femoral nerve injury.
Ankle Arthrography
Authors: DelGiudice Matthew
Published: June 2019

Chapter 103 describes the indications, technique, and imaging findings of ankle arthrography. Ankle arthrography is selectively performed in clinical practice for MRA. It is typically performed in younger patients. The main indication is the evaluation of the talar dome for stability of osteochondral lesions. Contrast undermines the unstable osteochondral lesions. Extravasation of the contrast through the lateral or medial joint capsule is consistent with ligamentous tear. Filling defects within the intraarticular contrast relate to joint bodies or synovitis. Complications are rare but can include infection, bleeding, and nerve injury.
Internal Derangement of the Shoulder
Authors: Brandel David , Gandikota Girish
Published: June 2019

Chapter 104 details the use of routine MRI and MRA to visualize the shoulder, identify normal anatomic variations, and diagnose common abnormalities, particularly those that are relevant to the general radiologist or radiology trainee. Although evaluation of the shoulder begins with radiography, when injury to the soft tissues is suspected, MRI offers numerous advantages. An emphasis will be placed on pathology of the rotator cuff and glenoid labrum, given their high prevalence and importance in patient management. Lesions of the biceps pulley and long head of biceps tendon will also be reviewed. Finally, the spectrum of findings related to muscle denervation will be discussed.
Internal Derangement of the Wrist and Hand
Authors: Karantanas Apostolos H.
Published: June 2019

Chapter 106 discusses the normal MRI anatomy and imaging findings of the major and common disorders leading to internal derangements of the wrist and hand including osteonecrosis (ON) of the scaphoid and lunate bones, tendon and ligamentous injuries, and common nerve entrapment syndromes. The anatomy of the wrist and hand is complex. A wide spectrum of traumatic, inflammatory, and degenerative conditions affects the wrist and hand. High-resolution MRI of the wrist and hand and MRA of the wrist provide excellent evaluation of the osseous and soft tissue structures and in many instances represent the study of choice. Radiography, CT, arthrography, CTA, and diagnostic US represent the alternative and/or complementary imaging methods in the evaluation of these structures.
Internal Derangement of the Ankle and Foot
Authors: Bancroft Laura W.
Published: June 2019

Chapter 109 discusses MRI of the ankle and foot internal derangements, namely tendon and ligament tears, osteochondral defects, and miscellaneous. Tenosynovitis may be detected anywhere in the ankle and foot, except along the Achilles tendon where a tendon sheath is absent and there is a paratenon. Tendinosis and tendon tears occur most commonly in the Achilles, posterior tibial, and peroneal tendons. Peroneal tendons may subluxate or dislocate anteriorly with superior peroneal retinacular disruption or may become transposed with intrasheath dislocations. The anterior talofibular ligament is the most commonly torn ankle ligament caused by inversion injuries. Calcaneofibular ligament tears may occur in conjunction with an anterior talofibular ligament tear. MRI is helpful in differentiating stable from unstable talar dome osteochondral defects, because of high spatial resolution of the articular cartilage and underlying bone.
Internal Derangement of the Temporomandibular Joints
Authors: Vossen Josephina A.
Published: June 2019

Chapter 110 provides a systematic approach to the imaging techniques and interpretation of the temporomandibular joint (TMJ). The most common TMJ conditions and treatment options are discussed. The TMJ plays a crucial role in mastication, jaw mobility, and verbal and emotional expression. Temporomandibular disorders (TMDs) include several entities that can lead to orofacial pain symptoms. Common symptoms include jaw pain, jaw dysfunction, earache, headache, and facial pain. Multiple risk factors have been implicated, including trauma, anatomical factors, pathophysiological factors, and psychosocial factors. TMJ dysfunction is best evaluated with MRI. Internal derangement is the most common TMJ disorder, followed by degenerative joint disease.
Developmental Hip Dysplasia
Authors: Gilbertson-Dahdal Dorothy L.
Published: June 2019

Chapter 112 focuses on developmental dysplasia of the hip, which includes a spectrum of abnormalities ranging from a stable hip with a mildly dysplastic acetabulum to complete hip dislocation. Pathophysiology, clinical findings, and screening studies are explored. The pathophysiology is multifactorial including mechanical, genetic and hormonal factors. Imaging strategies, findings, and treatment options are also discussed. Screening US, which is the imaging modality of choice, is performed on infants with predisposing risk factors. Outcome is quite variable with many cases resolving spontaneously without treatment whereas others stabilize with acetabular dysplasia. Treatment options include immobilization and surgery. MRI is used for problem solving in postoperative patients.
Scoliosis
Authors: Gilbertson-Dahdal Dorothy L.
Published: June 2019

Chapter 113 discusses scoliosis. The chapter focuses on the definition of scoliosis, causes, and imaging strategy. Imaging findings and treatment options are also discussed. Scoliosis consists of the presence of one or more lateral and rotatory curves of the spine. Scoliosis can be acquired or it can be congenital and associated with numerous other anomalies including vertebral anomalies. Degenerative scoliosis also occurs secondary to degenerative s or facet disease in elderly adults. Radiography should be the primary study with MRI indicated if underlying osseous or neurologic pathology is suspected. Progression depends on the magnitude of scoliosis and skeletal maturity. Treatment options include observation, bracing, or surgery.
Osteonecroses and Osteochondroses
Authors: Mar Winnie A.
Published: June 2019

Chapter 115, entitled “Osteonecroses and Osteochondroses,” discusses the pathophysiology, clinical findings, imaging findings, and treatment of osteonecrosis (ON) of bone, including epiphyseal ON and bone infarcts. It also discusses the osteochondroses including Legg–Calvé-Perthes, osteochondritis dissecans, Blount, Panner, Osgood-Schlatter, Sinding-Larsen-Johansson, and Köhler diseases and Freiberg infraction. ON occurs from an ischemic insult to bone with subsequent death of the hematopoietic, osteoblastic, osteoclastic, and fat cells. Osteochondroses comprise a variety of diseases involving epiphyses or apophyses in children with epiphyseal or apophyseal fragmentation and increased sclerosis. Initial evaluation for ON and osteochondrosis is typically with radiographs. MRI is the study of choice when radiographic findings are not diagnostic.
Medication-Induced Musculoskeletal Changes
Authors: Mar Winnie A.
Published: June 2019

Chapter 117 discusses common medication-induced changes of the musculoskeletal system. The effect of corticosteroids on the musculoskeletal system, including osteoporosis and osteonecrosis, is discussed. Corticosteroids decrease osteoblastic activity, stimulate bone resorption, and decrease intestinal absorption of calcium. Complications of bisphosphonate therapy such as atypical femoral fractures and osteonecrosis of the jaw are reviewed. Myopathies and tendon pathologies are briefly discussed, as well as bony changes potentially seen with long-term voriconazole treatment. For osteoporosis, DXA scan is the gold standard, whereas radiography is usually the first imaging modality performed in patients on voriconazole therapy who present with pain.
An Introduction to Musculoskeletal Ultrasound
Authors: Griffith James F.
Published: June 2019

Musculoskeletal ultrasound is incredibly helpful in the assessment of musculoskeletal conditions, particularly those of soft tissue and joint. It very much helps to compliment other imaging modalities such as radiographs, CT and MRI. This chapter introduces the benefits and practicalities of musculoskeletal ultrasound as well as outlining the ultrasound appearances of commonly encountered normal structures and common pathological entities.
Imaging Artifacts in Musculoskeletal Ultrasound
Authors: Gimber Lana H.
Published: June 2019

Chapter 119 discusses imaging artifacts in musculoskeletal US. Artifacts may be produced with B-mode grayscale and Doppler US imaging. These artifacts occur when the US beam deviates from ideal physical beam assumptions. It is important for radiologists to have an understanding of these artifacts so as to distinguish them from pathology. Side lobe, beam-width, posterior acoustic enhancement and shadowing, posterior reverberation, ring down, comet-tail, mirror image, anisotropy, refraction, and speed displacement artifacts are seen with grayscale imaging. Background noise, mirror image, aliasing, twinkle, transducer pressure, motion, and blooming artifacts are seen with Doppler imaging. Understanding of US artifacts is crucial to avoid mistaking artifacts for true pathology.
Ultrasound of the Elbow
Authors: Yablon Corrie M.
Published: June 2019

Chapter 121 discusses US of the elbow, which is an important imaging modality for the evaluation of elbow pain, providing soft tissue resolution superior to MRI. Soft tissue injury of the elbow is usually caused by repetitive motion and chronic overuse. The most common indications for elbow US examination are joint effusion, tendon and ligament pathology, olecranon bursitis, and ulnar nerve entrapment. The distal biceps tendon, triceps tendon, and common extensor and common flexor tendons are easily evaluated with US. Dynamic evaluation can determine between partial- and full-thickness radial and ulnar collateral ligament tears. US easily identifies joint effusions and olecranon bursitis. Furthermore, US can be used to guide interventions about the elbow.
Ultrasound of the Peripheral Nerves
Authors: Martinoli Carlo , Airaldi Sonia , Zaottini Federico
Published: June 2019

The most common disorders affecting peripheral nerves that are amenable to US examination are illustrated in Chapter 126, including compressive neuropathies, polyneuropathies, nerve injuries, tumors, and tumorlike lesions. There is an expanding evidence base to support the use of high-resolution US as an imaging tool to evaluate the peripheral nervous system. However, the highly operator-dependent nature and level of technical expertise required to perform an adequate US assessment of peripheral neuropathies means that appropriate training and an in-depth knowledge of anatomy and clinical findings are required. A careful US approach with thorough understanding of soft tissue planes and extensive familiarity with anatomy are prerequisites for obtaining reliable information regarding these types of examinations.
Ultrasound of the Rheumatologic Diseases
Authors: Lopez-Ben Robert
Published: June 2019

Chapter 127 discusses US scanning for rheumatologic diseases. US is increasingly being used in patients with rheumatologic diseases for initial diagnostic evaluation and to objectively monitor disease course and treatment response. US findings of synovitis and erosive disease can help identify and monitor inflammatory arthritis, in particular rheumatoid arthritis (RA), with greater sensitivity and specificity than radiography. Evaluation of target joints for the different rheumatologic diseases helps expedite the examinations. US findings of enthesopathy may help differentiate psoriatic and reactive arthritis from RA. The US findings associated with gout and calcium pyrophosphate deposition disease (CPPD) arthropathy can also help in differentiating these entities from other inflammatory arthritides.
Basic physics
Authors: Venables Karen
Published: June 2019

Chapter 2 discusses the basic physics of external beam therapy, and addresses the fact that distribution of radiation within the patient will be affected by many factors. These include the energy and modality of the beam, the density of the tissue and the use of beam modification. The apparent distribution will also be affected by the accuracy of the algorithm used in the planning system.
Proton therapy
Authors: MacKay Ranald , Aitkenhead Adam
Published: June 2019

Chapter 4 discusses proton therapy and includes discussion on proton interactions, the proton advantage, treatment planning, treatment delivery (scattered beams and scanned beams), plan robustness, adaption, a clinical case example, radiobiological effect of proton therapy, and proton range in the patient.
Breast radiotherapy
Authors: Coles Charlotte , Brunt Murray , Kirby Anna , Lightowlers Sara , Twyman Nicola
Published: June 2019

Chapter 5 discusses breast radiotherapy and includes discussion on the evidence-based rationale for radiotherapy, including adjuvant loco-regional radiotherapy and other indications, adverse effects of breast and lymphatic radiotherapy, pre-planning procedures, radiotherapy planning, treatment and verification, and patient assessment and follow-up.
Radiotherapy for thoracic tumours
Authors: Franks Kevin , McDonald Fiona , Hanna Gerard G
Published: June 2019

Chapter 6 discusses radiotherapy for thoracic tumours and includes discussion on lung cancer. The chapter covers assessment of patients with lung cancer for radical radiotherapy, patient positioning for radical radiotherapy for lung cancer, tumour motion, target delineation, organs at risk, implementation on the treatment machine, treatment verification , radical treatment of non-small cell lung cancer, radical treatment for small cell lung cancer, and palliative thoracic treatment for lung cancer. It also covers mesothelioma (including current indications for radiotherapy, patient positioning, target delineation, planning, and dose prescription) and thymic tumours (including current indications for radiotherapy, radical treatment, and palliative radiotherapy).
Squamous cell carcinoma of the anus
Authors: Glynne-Jones Rob , Harrison Mark
Published: June 2019

Chapter 9 discusses squamous cell carcinoma of the anus and includes discussion on specific Phase III trials that establish chemoradiotherapy as the treatment of choice, radiotherapy dose, brachytherapy, radical primary treatment, postoperative adjuvant treatment, supportive care during radiotherapy, palliative treatment, therapeutic assessment and follow-up, and current and future research.
Prostate cancer
Authors: Benjamin Linus , Tree Alison , Dearnaley David
Published: June 2019

Chapter 10 discusses prostate cancer and includes discussion on indications including radical radiotherapy to prostate ± seminal vesicles, pelvic radiotherapy, post-prostatectomy radiotherapy, palliative radiotherapy to prostate ± pelvis, palliative radiotherapy to metastases, and breast bud radiotherapy for the prevention or treatment of gynaecomastia, radical radiotherapy planning, target volume definition , dose distribution, implementation, verification, dose prescription, toxicity and care during treatment, the role of hormonal therapy in combination with radical radiotherapy, treatment outcome, and future developments.
Testis
Authors: Hoskin Peter
Published: June 2019

Chapter 12 discusses the role of radiotherapy in testicular cancer and how it is becoming less prominent. The mainstay of treatment is radical orchidectomy and, where there is a risk of metastatic disease, combination chemotherapy. Radiotherapy may be indicated in the following situations: 1) stage I and IIa testicular seminoma delivering prophylactic para-aortic lymph nodes irradiation, and 2) palliative treatment in the management of chemotherapy resistant disease.
Penis
Authors: Hoskin Peter
Published: June 2019

Chapter 13 discusses carcinoma of the penis t. Management may be by primary surgery, either total amputation or partial amputation with reconstruction, or primary radiotherapy. Primary radiotherapy is indicated for those patients with T1 and T2 tumours <4 cm in diameter, particularly in those unfit for surgery, those with locally advanced disease and fixed inguinal lymph nodes, and for patients in whom surgical treatment may require total amputation and where they choose to have organ preservation by radiotherapy as an alternative. No randomized trial comparison is available to give accurate figures for the relative efficacy of either treatment. Brachytherapy is an alternative means of delivering high-dose radiotherapy to the penis and may be considered where there is local expertise for this instead of external beam treatment.
Uterus: Endometrium and Cervix
Authors: Powell Melanie , Taylor Alexandra
Published: June 2019

Chapter 14 discusses carcinoma of the uterus (the endometrium and cervix), including discussion on anatomy, cervical cancer, uterine cancer, pelvic and para-aortic nodal irradiation, palliative treatment, and management of patients undergoing pelvic radiotherapy.
Lymphomas
Authors: Tsang Richard W , Gospodarowicz Mary K , Hoskin Peter
Published: June 2019

Chapter 16 discusses lymphomas, including discussion on nodal and extranodal non-Hodgkin lymphoma, and Hodgkin lymphoma. , treatment of early and late stage lymphomas, radiation therapy volume and dose, and planning techniques. It includes skin lymphomas and total body electron treatment, toxicity after radiotherapy for lymphoma, and second malignancies.
Skin cancer
Authors: Corner Carie , Tharmalingam Hannah , Hoskin Peter
Published: June 2019

Chapter 19 discusses skin tumours. Volume definition based principally upon clinical examination is described. Treated pro cipally uses single applied beams using low-energy X-rays or electrons with clinical verification. The three major histological groups are squamous cell carcinoma, basal cell carcinoma, and malignant melanoma, with a fourth comprised of the rarer entities of adnexal tumours and Merkel cell tumours.
Sarcomas of soft tissue and bone
Authors: Wylie James
Published: June 2019

Chapter 20 covers sarcomas of soft tissue and bone and includes discussion of radiotherapy for soft tissue sarcomas (including indications for radiotherapy, essential investigations for planning radiotherapy, patient preparation, planning imaging required for target definition, target definition, dose fractionation, and critical organs and tolerance doses,including the sites forearm, hands and feet, retroperitoneum, chest wall, and spinal/para-spinal), particular histologies (angiosarcoma and fibromatosis), particular radiotherapy techniques, and palliative treatment (including cerebral and lung secondaries),
Principles of paediatric radiation oncology
Authors: Mandeville Henry C
Published: June 2019

Chapter 21 discusses principles of paediatric radiation oncology including discussion on proton therapy for paediatric tumours, intensity-modulated radiotherapy, radiotherapy quality assurance, toxicity of radiotherapy for children, chemotherapy and radiotherapy interactions, leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma, neuroblastoma, Wilms’ tumour, rhabdomyosarcoma, Ewing’s sarcoma, osteosarcoma, central nervous system tumours, and high-grade glioma.
Radiotherapy planning for metastatic disease
Authors: Hoskin Peter
Published: June 2019

Chapter 22 discusses radiotherapy planning for metastatic disease, predominantly for patients with bone metastasis, spinal cord compression, and brain metastasis. The techniques for such treatments are specific to this indication rather than the primary tumour site.
Globalization and urbanization
Authors: Darmansjah Debby , Kalra Gurvinder , Bhugra Dinesh
Published: June 2019

More than 50% of world’s population lives in the cities that are bustling with possibilities. Growth in these cities is mainly associated with the change in their demographic and geographical situations. Globalization has contributed further to movement of people and resources creating tensions and overpopulation in some parts and reduction in others. It is inevitable that overpopulation and urbanization leading to overcrowding have been shown to have negative consequences on people’s physical and mental health. Numerous efforts have been made through governmental policies and non-governmental organization (NGO) involvement in order to promote healthy cities between policymakers, healthcare professionals, and community members.
Neuroscience of mental illness in the city
Authors: Golembiewski Jan
Published: June 2019

The urban environment appears to be causal for psychosis – specifically in the way it is percieved. The Ecological Model of Perception is an excellent model for understanding the aetiology of urban psychosis, because it asserts that recognition does not commence a cognitive process, but, instead, that recognition occurs only once behaviours have already been directly triggered by the action opportunities that are embodied within objects—especially action opportunities that are designed, and are therefore ubiquitous in cities. This chapter traces key neural differences between urban and rural populations to explain this ecological phenomenon with the Ecological Hypothesis for Schizophrenia, which details how these behaviours become symptomatic. The chapter provides insight for those who are responsible for the built environment. It also draws attention of the mental health professionals to work together with city planners to provide a better understanding of various issues.
Cross-cultural contact: psychosis and the city in modern life
Authors: Zhang Shuo , Bhavsar Vishal , Bhugra Dinesh
Published: June 2019

In the modern globalized world with rapid industrialization and urbanization the city has once again become the focus of modern social, economic and political life. Urban spaces and places have been the focus of research by many disciplines, including epidemiology, sociology, anthropology, and urban studies. In this chapter, the authors outline the importance and the role of culture in urban mental health employing various historical, sociological, and epidemiological contexts. The authors point out that modern multicultural approaches in viewing the metropolis can be conceptualized as a global hub of migration. This therefore becomes a place where individuals encounter the other and various boundaries between spaces and residence, and between wellness and illness, intersect. Acculturation to the urban places may take some time and the authors propose that the psychological process of acculturation is a useful beginning in terms of unpicking and understanding the phenomenology of identity formation and cross-cultural contact. The chapter traces the historical development of the city in parallel to the literature on psychosis and the city in developed and developing contexts, before critically examining the role of culture in informing our explanatory and interpretive frameworks of psychosis epidemiology.
Common mental disorders in cities
Authors: Chaturvedi Santosh K. , Manjunatha Narayana
Published: June 2019

Common mental disorder (CMDs) are the most common psychiatric disorders in the general population, as well as at primary care. They include a triad of three illnesses—depression, anxiety disorders, and somatoform disorders. Global data suggest that the urban population exceeded the rural population in 2007. Cities provide an opportunity for economic growth and comparatively better healthcare facilities. However, what is worrisome is the increased vulnerability for many illnesses, especially CMDs. This chapter reviews the noteworthy literature about CMDs in cities across the world and discusses some of best practices in treating CMDs in various cities.
Work, worklessness, and mental health
Authors: Boardman Jed , Craig Tom K. J.
Published: June 2019

The association between unemployment and mental disorders is complex. Some of the strongest evidence for the causal impact of losing employment on mental health comes from studies carried out during and in the years following national and international financial crises and economic recession. Mental health problems can also lead to unemployment and, once unemployed, people suffering from these conditions have difficulty finding and sustaining employment. It was taken for granted that people with disabilities associated with enduring mental health problem required a lengthy period of re-training before job seeking. More recently, this ‘train then place’ approach has been turned on its head, starting first with job placement and following this with ongoing support to both employee and employer. Research has now shown the latter to be the more effective approach across several countries albeit tempered by factors such as the state of the wider economy and availability of welfare support.