27 September 2023 12:00 — 13:00 (1 hour)

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:

https://gettingitrightfirsttime.co.uk/wp-content/uploads/2023/03/National-Suspected-Cauda-Equina-Pathway-February-2023-FINAL-V2.pdf

• 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)