American Journal of Roentgenology最新文献

A growing shortage of breast radiologists has hindered timely access to diagnostic breast imaging services, particularly in rural and underserved areas. Radiologist burnout is exacerbating these workforce challenges. This Clinical Perspective, drawing on the experiences of radiologists from diverse practice backgrounds, explores the implementation of a remote diagnostic breast imaging service as a sustainable strategy to address these gaps. Although remote diagnostic breast imaging was historically considered challenging due to the need for direct patient interaction, advances in teleradiology technology, development of communication infrastructures, and acceptance of telehealth, have enabled effective delivery of diagnostic breast imaging in remote settings with preserved quality and patient experience. We outline key components for successful implementation, including practice leadership that promotes a culture of change, optimization of patient selection criteria, integrated information technology (IT) systems, and systems for real-time communication with technologists and patients. A multidisciplinary team-spanning radiologists, technologists, IT professionals, and support staff-is critical to ensuring clinical quality, regulatory compliance, and operational efficiency. For practices seeking to expand service capacity, reach geographically distant populations, or mitigate burnout of its radiologist members, remote diagnostic breast imaging offers a practical and forward-looking solution.

BACKGROUND. The lateral meniscal oblique radial tear (LMORT) is a recently described, biomechanically important tear pattern associated with anterior cruciate ligament (ACL) injury. OBJECTIVE. The purposes of this study were to assess the utility of MRI for distinguishing LMORT lesions from other posterior lateral meniscal tears in patients undergoing primary ACL reconstruction, using an arthroscopic reference standard, and to assess potential independent predictors of LMORT lesions on MRI. METHODS. An arthroscopic database of 568 ACL reconstructions (December 2022-December 2023) included 140 lateral meniscal posterior horn or posterior root tears meeting the inclusion criteria. An orthopedic surgeon, blinded to the original arthroscopic report, reviewed the arthroscopic images for LMORT presence and type. Three musculoskeletal radiologists, also blinded to the original arthroscopic report, independently reviewed posterior lateral meniscal tears for LMORT presence, lesion type based on treatment, the presence of a meniscofemoral ligament tear, presence of meniscal extrusion, and presence of the "meniscal sail" sign. Sensitivity and specificity were calculated for each reader, and the kappa coefficient assessed interreader agreement. Univariate regression analysis assessed for independent imaging predictors of LMORT lesions using a p value of less than .05. RESULTS. Arthroscopic review identified 51 LMORT lesions (9.0% of ACL reconstructions, 36.4% of lateral meniscal posterior tears; 19 female patients, 32 male patients; mean age, 28.1 years; age range, 14-50 years). MRI had a sensitivity of 76.5-80.4% and specificity of 54.9-88.2% for all LMORT lesions, with moderate to substantial interreader agreement (0.443-0.747). MRI showed a higher sensitivity for the classification of LMORT type 3 and 4 lesions (82.6-91.3%) than for the classification of type 1 (12.5-25.0%) or type 2 (0-27.3%) lesions. Lateral meniscal extrusion was an independent predictor of LMORT presence (p = .049). CONCLUSION. MRI can be used to distinguish LMORT lesions from other posterior lateral meniscal tears, and lateral meniscal extrusion may serve as a useful feature in the identification of LMORT lesions on MRI. CLINICAL IMPACT. The LMORT lesion is a biomechanically important meniscal tear pattern that should be included in the MRI search pattern of patients with ACL tears.