2024 Winter MSK SIG meeting

07 February 2024 12:00 — 13:00 (1 hour)

Agenda

Agenda

1. Limited T2 Sagittal sequence for Cauda Equina Syndrome 2. MR Arthrography after the discontinuation of Magnevist 3. MSK Ultrasound waiting times 4. AOB

Minutes

Attendance: James Baren, Daniel Fascia, Pankaj Nagatode, Martin Hampshire, Lisa Field, Amy Richards, Richard (Guest), Gill Barber, Richard Packer

Key Discussion Points

1. Implementation details of Limited T2 sagittal imaging protocol for cauda equina syndrome

Discussion around topic, and Dan Fascia mentioned 2 years of experience using the protocol in Harrogate. James Baren asked to provide the implementation of the protocol for group sharing (Appendix 1). A similar protocol has been implemented in Mid Yorkshire hospitals although it was pointed out that they have a step requiring scan time review by a radiologist which was felt unrealistic and rate limiting. Dan Fascia suggested this needs to be done by the radiographer after acquiring the limited T2 sagittal scan, and based on the availability of a prior fully reported MLSPN during the last 3-years.

2. MR Arthrography in the advent of Magnevist being discontinued

  • Key point: Use high resolution joint specific MR protocols wherever possible instead of arthro (hip, wrist, ankle all commonplace. Shoulder less so)

  • Other products are available in pre-prepared format

  • Saline arthrography has growth in interest. It is an old technique but works well if pitfalls are avoided. Scan protocol should be adapted to use PD/PDFS to take advantage of the water weighting. T1FS sequences have no role. A narrower ‘scanning window’ has been documented historically of time to scan within 1hr of saline injection which was lower than the window of 2hrs with Gadolinium present.

  • Pankaj will share with us his pilot study on saline MRA - we are not only interested in image quality (expected to be fine), but user experience and pitfalls.

3. MSKUS waiting times

  • Leeds experiencing increased waiting times due to surge in demand, needing to outsource
  • Not vetting and protocolling USS causes poor list quality and insurmountable, uncontrolled demand
  • Vetting and protocolling feels like wasted time: consider improving request pathways, forms, digital tools to implement decision trees for referrers

No AOB

Appendix 1: Harrogate Cauda Equina MRI protocol

  • A patient has had a standard complete MR spine protocol within the last 3-years
  • Same patient presents with suspected CES based on clinical assessment in ED. GP and outpatient assessments are not accepted and must attend for assessment. This is because if CES is discovered, the infrastructure to instigate rapid care does not exist in these areas and result delivery is also harder.
  • Clinical assessment in ED: history and examination, bladder scan to stratify scan urgency
  • MR protocol: T2 sagittal only images acquired and reviewed during scan by MR radioghrapher.
  • Any abnnormal finding results in progress to axial T2 imaging across abnormal area
  • Scans are reported throughout on-call period 7-days a week
  • No automatic wider field scanning if the scan is normal
  • Digital critical alert delivered in accordance with RCR critical alerting guidance in the event of a positive scan finding
  • Recommendation line applied when ‘repeat visits’ are observed: “Further MRI scanning for the same indication is not likely to yield additional information. Please refer this patient to the MSK Spine Service for further care”