Autumn 2023 MSK Special Interest Group Meeting
Agenda
Agenda
Scoliosis imaging protocols Pathways • Scaphoid • CES myelogram Educational cases AOB
Minutes
MSK SIG Autumn 2023 - Minutes
Attendance
James Baren, Conrad Nel, David Howarth, Gillian Barber, Lisa Field, Martin Hampshire, Jo Sharratt, Kelly Robinson, Scott Raine, Manjusha Salins
Scoliosis Protocols
• Standing radiographs can be performed for children at any age who are able to stand, however the majority of imaging will be done at LTHT following spinal team assessment
• Scoliosis MRI should not be performed prior to surgical review
• MRI can be performed locally, but the majority of imaging will normally be performed in LTHT
• Scoliosis MR protocol: o T1 sag cervical o T2 TSE coronal thoracolumbar o T1 SE coronal thoracolumbar o T2 space coronal thoracolumbar
Scaphoid pathway
• LTHT has seen the number of scaphoid MRI requests escalate following conversion from bone scan to MRI as 2nd line imaging
• MidYorks: 2nd line imaging CT after 2 radiographs showing no fracture. Only a small proportion of patients have MRI after this
• Harrogate: 2nd line MRI after 2 radiographs
• Harrogate use streamlined MR protocol with coronal STIR/T1 only. Perhaps this is something to consider for other Trusts performing MRI as second line imaging
• LTHT planning on auditing referrals for MR scaphoid (JB)
CT myelograms for suspected CES
• CT myelograms should not be performed prior to spinal surgical review for patients with suspected cauda equina syndrome who are unable to have MRI. CT myelogram is not a substitute for spinal surgical assessment
• CT myelogram can be performed locally in selected outpatients following spinal surgical review if local teams feel able to support this
Educational case
• Dr Salins presented a case of failed reverse total shoulder replacement.
• Learning point was to always check prior imaging and seek advice if you are unfamiliar with an implant
AOB
• MidYorks (CN/DH) to trial limited sag T2 to exclude CES in patients repeatedly presenting to the Emergency Department, as per national pathway. CN/DH to share any published data or clinical guidelines before discussing at the next meeting.
• Link to spinal surgery CES GIRFT pathway:
• Please share any thoughts about what should/should not be included in the meeting moving forwards to be beneficial for all
• Provisional date and time for next meeting: Wednesday 7th February 2024 (12-1pm)
If you have any queries or suggestions, please contact Dr James Baren (James.baren@nhs.net) and cc the YIC (yorkshireimagingcollaborative@nhs.net)