AN EVENING RECOGNIZING EXCELLENCE IN MUSCULOSKELETAL MEDICINE

At HSS’s premier fundraising event recognizing physicians and philanthropists making an impact in the field of musculoskeletal medicine, Mr. Griffin was presented with the 2024 HSS Tribute Dinner Award by Robert K. Steel, Co-Chair of the HSS Board of Directors. Dr. Haas was presented with the HSS Lifetime Achievement Award by baseball legend Bernie Williams, and Dr. Potter was presented with the HSS Lifetime Achievement Award by Chase Coleman, founder of Tiger Global and an HSS Trustee.

The evening, which featured a musical performance by five-time Grammy Award-winner Jon Batiste, was attended by over 750 guests and raised more than $5 million for patient care, research and medical education.

“The Lifetime Achievement Award is our highest recognition for an outstanding healthcare leader at HSS,” said Douglas E. Padgett, MD, Surgeon-In-Chief and Medical Director. “Both Drs. Haas and Potter exemplify the qualities that make HSS unique: their unwavering dedication to providing the highest quality of care; consistent efforts to advance the science in their respective fields; and their leadership in developing new techniques, technologies and treatment advances that have transformed the lives of patients around the world.”

An Extraordinary GIFT

With the new transformational gift from Mr. Griffin announced at the event, HSS will establish the Kenneth C. Griffin Research Accelerator to accelerate the pace of innovative research to help millions of people regain their mobility and quality of life. Mr. Griffin’s donation will advance work to better personalize treatment to the unique clinical needs of each patient and will also support construction of the HSS Kellen Tower, a new headquarters for joint replacement surgery and global destination for the treatment of complex orthopedic problems that is expected to open in 2025.

“We are privileged to honor Ken with the Tribute Dinner Award and to have his incredible support,” said Bryan T. Kelly, MD, MBA, President and CEO at HSS. “As one of the country’s foremost philanthropists, Ken has demonstrated outstanding leadership in his efforts to improve quality and access to healthcare. His support of cutting-edge research drives progress in science and medicine that will have a global impact.”

Joint pain affects more than 80 million adults in the United States, with nearly 1 in 2 people experiencing chronic pain in the knee. HSS performs more than 12,000 hip and knee replacement surgeries annually, more than any other hospital in the United States. The breadth of expertise and high patient volume uniquely position HSS to drive innovative investigations for joint disease so that patients can achieve the mobility and function they desire, with results that will last a lifetime.

“The extraordinary scientists, physicians, and healthcare professionals at the Hospital for Special Surgery lead the world in the research and treatment of orthopedic care,” said Mr. Griffin. “I am proud to support HSS in its broad impact that stretches from helping elite athletes get back on the field to enabling seniors to actively engage with their grandchildren. The research and innovation at HSS is changing the lives of people around the world.”

Mr. Griffin has previously supported vital investigations in knee replacement surgery and precision medicine, as well as the expansion of facilities for care and research at HSS.

“We are deeply grateful for Ken’s remarkable generosity. This gift will help us establish how to personalize every aspect of knee replacement surgery for maximum benefit,” said Dr. Haas.

“Ken’s generous contribution and partnership will have significant impact in creating the best environment for joint replacement care at HSS and in shaping the standards of care globally,” said Mr. Steel.

Through the HSS Innovation Institute, HSS and MARS will collaborate to advance musculoskeletal imaging and diagnosis, including evaluation of specific aspects of the MARS 5x120 Extremity Scanner and potential co-development of new scanning technologies and systems.

The MARS 5x120 Extremity scanner is based on detector technology that was initially developed as part of ongoing particle physics research at the European Laboratory for Particle Physics (CERN), where the Higgs Boson was discovered. The MediPix3 detector technology previously enabled MARS’s development of the world’s first commercial (2010) photon counting 3-D color x-ray, producing high contrast images of bone detail and assessment of bone density at a fracture site at a significantly reduced radiation dose compared to traditional CT. The MARS 5x120 Extremity scanner is designed as a “point-of-care” system, intended for use in clinical office and ambulatory settings, addressing clinical needs such as pre- and post-surgical planning, assessment of fracture healing, and identification of implant complications.

HSS Department of Radiology and Imaging Chairperson Hollis Potter, MD is enthusiastic about the HSS- MARS collaboration: “Our team looks forward to collaborating with MARS to assess the technology and pursue other new applications and development opportunities. We see this type of imaging modality and detector technology as the next evolution in CT scanners; as HSS physicians and innovators, our goal of continuously improving patient care and outcomes includes identifying and pursuing new technologies, as well as developing partnerships that leverage HSS’s expertise and innovative spirit with cutting-edge industry advancements to drive innovation.”

“We’re pleased that a world-class clinical organization like HSS sees the potential for the MARS CT scanning technology,” says MARS CEO Mark Figgitt. “Given their substantial experience and expertise in the field of musculoskeletal health, including the volume of orthopedic surgeries performed there, we are confident that HSS is the right partner to help us evaluate and develop our technology and clinical applications. We believe this will be a true collaboration where the complimentary expertise of both organizations come together to improve clinical care and lower costs.”

Michael Campbell, Spokesperson for the Medipix3 collaboration at CERN, said, “it is great to see the efforts of CERN and the Medipix3 Collaboration playing a pivotal role in bringing innovations in medical imaging for the benefit of the global medical community”.

 About MARS Bioimaging Limited

MARS Bioimaging was launched in 2007 by father and son team Professor Phil Butler, then Head of the New Zealand CERN research group, and his son Professor Anthony Butler, a clinical radiologist and Director of Radiology at the University of Otago, Christchurch. MARS was formed to commercialize the ground breaking MARS technology and bring photon counting CT to the clinic. To achieve this the company brought together an interdisciplinary research and development team of physicists, radiologists, engineers, computer scientists, orthopaedic and other surgeons, mathematicians, biologists, and cancer researchers. MARS systems are based on next generation x-ray detectors (Medipix3RX) developed under the Medipix3 collaboration hosted by CERN, and other partners, including the University of Canterbury (UC). In association with UC and University of Otago, Christchurch (UOC), MARS now has a team working on developing new preclinical and clinical applications for photon-counting technology. This includes, but is not limited to, bone and joint health, cancer, cardiovascular disease, and infectious disease. MARS has established itself as the world’s leading research and development group in spectral molecular imaging and to-date has delivered the world’s first commercial pre-clinical spectral CT scanner (MARS Microlab 5X120), as well as a compact human system for upper extremity evaluation (MARS Extremity 5X120). 

MARS’s technology and company have received several awards, including: HealthTech Award for Best Translational Project in HealthTech Week; Supreme Small Enterprise in the Champion Canterbury Awards; and Best Health and Science Innovation and Best Emerging Innovation at the NZ Innovation Awards.

The study, published yesterday in Clinical Orthopaedics and Related Research, is the first to evaluate the presence and risk of local tissue complications after hip replacements made of different materials in patients, including those who are asymptomatic. Previous studies have been limited to metal-on-metal implants.

Hip replacement parts are made of plastic, ceramic, metal or a combination of these materials. The components move against each other and wear down slowly through regular use. Small wear particles can break free from the hip replacement material over time and damage local joint tissues. MRI is a non-invasive imaging technique that uses a large magnet and radiofrequency energy to produce digital images without the use of ionizing radiation. MRI is often used in orthopedics to visualize the soft tissues around total hip replacements that are affected by the small wear particles.

“We found that patients can be completely asymptomatic and have high-functioning hip scores while harboring reactions that could start to destroy the soft tissues around the hip,” said Hollis G. Potter, MD, chairman of the Department of Radiology and Imaging and the Coleman Chair in MRI Research at HSS and the study’s senior author. “This finding is important because tissue reactions typically worsen over time. Delayed detection results in unnecessary pain, longer and more complicated revision operations and more challenging recoveries.”

Matthew F. Koff PhD, the lead study author said, “The study also indicates that MRI is clinically useful for patients who receive a ceramic-on-polyethylene or metal-on-polyethylene implant, in addition to patients who received a hip resurfacing arthroplasty.”

Drs. Potter and Koff and HSS colleagues prospectively evaluated 206 patients (243 hip replacements) at least one year after having hip resurfacing arthroplasty or total hip replacement. The researchers examined the volume of joint tissue reaction using MRI images, levels of metal particles in the blood and patients' responses on a survey called the Hip Disability and Osteoarthritis Outcome Score annually over the course of 3 years. The researchers compared results for patients who received hip resurfacing arthroplasty (HRA) with patients who received ceramic-on-polyethylene and metal-on-polyethylene total hip replacements.

During the study, MRI identified adverse local tissue reactions in 25 percent of patients who had hip resurfacing arthroplasty. This finding was surprising, since these patients reported symptoms similar to or less severe than patients with ceramic-on-polyethylene and metal-on-polyethylene total hip replacements implants. Patients who received hip resurfacing arthroplasty had a significantly larger volume of joint tissue reaction on MRI, a nearly five-times-higher risk of having tissue complications than patients who had a ceramic-on-polyethylene total hip replacement. Metal ion levels were inconsistently elevated in the patients with these reactions.

“By sharing our findings, we hope physicians will start incorporating MRIs into patient assessments, leading to earlier detection of issues and better outcomes for patients,” Dr. Potter said. “Widespread use of MRI to assess soft tissue damage may also help identify patterns that could ultimately improve implant design in the future.”

The system, called the Sectra Digital Pathology Solution, lets HSS pathologists scan and upload slides into a single repository where others in the care team — from orthopedic surgeons and radiologists to rheumatologists and endocrinologists — can view them, along with radiologic images that also are housed in the system. This facilitates access for specialists from across HSS to share and discuss tissue samples in real time, making care more efficient and improving clinicians’ ability to diagnose and treat their patients. Additionally, HSS clinicians and others in the care team can review the digital slides individually, simultaneously or slides shared by other hospitals to consult on complex cases.

“HSS is the first hospital in the United States to have successfully integrated a high-resolution digital scanner [Leica] with the pathology Laboratory Information System [Epic/Beaker] and the enterprise-wide PACS [Sectra] in a way that allows pathologists to use digital images for primary diagnosis,” said Thomas W. Bauer, MD, PhD, pathologist-in-chief at HSS, who led the digital pathology initiative.

Allowing surgeons, radiologists, and other physicians to view high-resolution digital images of scanned microscope slides can significantly improve patient care, Dr. Bauer said. “Access to digital pathology images, side by side with radiology images on the same enterprise-wide PACS, enables correlation between different types of studies and promotes efficient discussion about complicated cases.”

In addition, instantly viewing digital images from previous procedures will be much easier than retrieving old microscope slides from long-term storage for re-review, he added.

“The implications of the move to digital pathology are significant for patients everywhere,” Dr. Bauer said. For example, because HSS pathologists are experts in musculoskeletal pathology, they frequently receive cases for consultation from other hospitals.

“Receiving digital images electronically from hospitals with their own scanners will facilitate consultative review, and has the potential to greatly reduce turnaround time,” he added.

“Digital pathology is the natural next step in the digital transformation of healthcare,” said Douglas N. Mintz, MD, a radiologist at HSS who specializes in musculoskeletal imaging and who was instrumental in developing the platform with Dr. Bauer. “We can compare what we see on an image with what was seen on biopsy. It also facilitates the correlation between radiology and pathology, which is particularly important in the diagnosis and treatment of musculoskeletal neoplasms.”

Array of High-Tech Tools

“The scanned images are extremely high quality and, when used in combination with the Leica scanner and Sectra viewer, are considered by the FDA to be equivalent to conventional microscopy for making a primary diagnosis,” explained Dr. Bauer.

HSS, ranked #1 in the world for Orthopedics by Newsweek and has been ranked #1 in the United States for orthopedics for 11 consecutive years by U.S. News & World Report, began its digital pathology initiative in 2017, and started working with Sectra technology in 2018, when it was still in the development phase. Initially, the goal was to use the system in a limited fashion, for particularly challenging cases in which clinicians had questions about pathology reports. But the COVID-19 pandemic prompted the FDA to grant the company emergency use authorization for its imaging platform, allowing HSS to speed up its transition to digital pathology.

"It is gratifying to see our vision of Integrated Diagnostics come to fruition after a long software development and integration journey," said Inderpal Kohli, assistant vice president, IT Clinical Applications at HSS. In addition to other benefits, the solution offers HSS clinicians a familiar user interface and workflows, enabling ease of use and broader adoption across the enterprise.

Beyond patient care, digital pathology will also have an immediate impact on student and resident education, both at HSS, where the technology already is being used to help trainees, and elsewhere.

“We and other hospitals anticipate incorporating digital pathology into a variety of educational conferences available online, in which residents and fellows learn from more senior faculty by reviewing digital images,” Dr. Bauer said. “As other hospitals convert their systems to digital imaging, they will be able to better take advantage of the expertise of the faculty at HSS and other centers of excellence, thereby promoting physician education and improving the care of patients around the world.”

The condition is characterized by sudden pain in the shoulder and upper arm, often so intense that many people go the emergency room. It tends to strike young, otherwise healthy adults, usually on one side of their body. For many, it happens suddenly with no known cause. The pain usually subsides within two or three weeks and is followed by muscle atrophy and severe weakness.

Twenty-nine-year old Lucy Schwartzman is participating in the HSS study. She clearly remembers the day in April of this year when she was struck by severe pain in her right shoulder that radiated into her neck and down her arm to her elbow. After a few weeks, the extreme pain improved, but she started to experience another problem. “Three weeks in, I went to fill up my water container and realized I couldn’t move my arm; I couldn’t reach forward,” she recalls. “I felt like my upper arm was paralyzed.” Ms. Schwartzman says she still can’t move her arm above her elbow, and it has affected her ability to perform basic activities, such as putting on a jacket or washing her hair.

“Patients experience damage to the peripheral nerves that control movement in the shoulders and arms,” explains Darryl Sneag, MD, director, Peripheral Nerve, MRI, at HSS and principal investigator. “In our study, we will use magnetic resonance neurography to obtain high resolution images of those nerves. Our goal is to discover biomarkers to detect and monitor PTS. We will also use ultrasound imaging and check patients’ blood for inflammatory markers.”

Parsonage-Turner Syndrome is named for Drs. Maurice Parsonage and John Aldren Turner, who described 136 cases in the Lancet medical journal in 1948. The disease is also called neuralgic amyotrophy or brachial neuritis.

Although the exact cause is not known, it is believed PTS may arise following a viral or bacterial infection, an injury, surgery, strenuous exercise or a medical procedure. There is no cure or specific treatment, although doctors usually prescribe pain medication, steroids and physical therapy to help relieve symptoms. Sometimes patients receive intravenous immunoglobulin.

Although an estimated 80 to 90 percent of people eventually recover and regain function of their arm, it could take several years. Full strength may not return for some patients, and a certain number will continue to experience mild pain.

The discovery of a biomarker for PTS could pave the way for clinical trials to determine which treatment works best and open the possibility of finding new treatments down the road, according to Dr. Sneag.

“Our research aims to understand if imaging and serologic findings in PTS can serve as reliable, noninvasive markers of motor and functional recovery,” he notes. “In addition to facilitating clinical trials of possible treatments, early identification of the nerves affected by PTS could assist in determining if surgery could help patients.”

Previous PTS research by Dr. Sneag and colleagues identified a specific abnormality in brachial plexus branches and other peripheral nerves. “Using high-resolution MR neurography and ultrasound techniques, we have routinely identified one or more hourglass-like constrictions of nerves in patients with Parsonage-Turner Syndrome and have detected denervation changes in muscles they supply,” he explains. “The constrictions actually make the nerve look like an hourglass on the digital image. We perform almost 100 MR neurography cases monthly at HSS and have not seen this in any other nerve condition, so we believe these constrictions are unique to PTS.”

Patients enrolled in the new HSS study will have imaging tests at their initial consultation and at follow-up intervals of three, six and nine months. Dr. Sneag and colleagues hypothesize that a greater number of or more severe constrictions in affected nerves will correlate with worse muscle function and lower patient-reported outcome scores at each time interval. The MRI findings will be correlated with standard electromyography (EMG) tests that measure muscle function and the nerves that control them.

Using imaging to zero in on hourglass-like constrictions in affected nerves also aids in surgical planning, according to Dr. Sneag. “Images obtained by magnetic resonance neurography can enable surgeons to do a very targeted surgery. Instead of exploring the entire nerve in an arm, the images can pinpoint the location of the constriction,” he says. “Think of a coaxial cable. When you cut it, you see a cross section of multiple fibers. In a damaged nerve, constrictions may not involve the entire nerve, but just one or more fibers within the nerve. With MRN showing the exact location of the constriction, the surgeon wouldn’t have to spend hours opening and exploring the nerve to find it.”

The National Center for Advancing Translational Sciences of the NIH awarded the $275,000 grant for the HSS study, which is expected to take two years. Investigators are recruiting patients 18 and older who have been diagnosed with Parsonage-Turner Syndrome. Anyone interested in participating is invited to email Sophie Queler at quelers@hss.edu or call (646) 714-6242 for more information.

Harry “Tate” Greditzer, IV, MD, radiologist at HSS and avid surfer himself, launched a study to determine the kinds of orthopedic injuries a recreational surfer might sustain and how often he or she required surgery. “The primary purpose of the study was to characterize MRI patterns of acute surfing-related injury at HSS, an urban musculoskeletal hospital,” Dr. Greditzer said. “Secondarily, the purpose was to report the proportion of those injuries that required orthopedic surgical intervention.”

Dr. Greditzer and colleagues found that shoulder injuries were the most common, followed by knee injuries. In the study, 17% of patients needed surgery for any type of surfing injury. The research was published online in the journal Sports Health on November 5.

The investigators noted that previous surfing studies from different regions of the world have described the incidence of injuries along with the type, location, and severity, but the results have been highly variable. Most prior studies have also utilized imaging modalities that are readily available in an emergency setting, but did not focus on high resolution soft tissue imaging modalities such as MRI, as in the HSS study.

HSS investigators conducted a retrospective review of medical records to identify patients with surfing-related injuries who came to HSS for treatment between January 1, 2009 and August 1, 2018. The researchers analyzed the data and reported on the body part injured, diagnosis, and surgical versus nonsurgical treatment.

The search yielded 109 patients with surfing-related injuries who had MRIs. A total of 90 patients came to HSS within six months of their injury and were included in the final analysis. The median age was 36, with patients ranging in age from 12 to 66. Three-quarters of the patients were male.

Acute surfing injuries were diagnosed with an MRI in 72% of study patients. The following injuries were reported:

• Shoulder: 46% of surfing injuries
• Knee: 28%
• Foot or ankle: 9%
• Spine: 6%
• Elbow: 6%
• Other (rib fracture; muscle strain or muscle laceration): 5%

“Although prior studies have shown that injuries related to surfing are primarily found in the head or lower extremities, our study found upper extremity injuries to be more common,” said Peter D. Fabricant, MD, MPH, pediatric orthopedic surgeon at HSS and study author. “The majority of upper extremity injuries occurred at the shoulder with anterior shoulder dislocation being the most common diagnosis. Of the presenting knee injuries, a torn medial collateral ligament was the most frequent.”

Only 17% of all the surfing injuries required surgery at HSS. This percentage may overestimate the number of surfing injuries in general that require surgery, the study authors noted. Tertiary care referral centers such as HSS tend to see a greater proportion of serious injuries requiring surgery.

The study authors noted that the overall diagnostic quality provided by MRI helps to elucidate the most serious soft tissue surfing injuries. However, the exclusive use of this imaging modality for diagnosis was a limitation of the study, as it would not account for other musculoskeletal surfing injuries that do not require an MRI.

“When compared to other extreme sports, surfing seems relatively safe,” said Dr. Greditzer. “However, it’s important to keep in mind that our study looked at recreational surfers. We did not include professional surfers, so the patients in our study were not able to generate as much speed, get barreled, or launch into the air like a professional or amateur can, where the potential for injury is much higher.”

Dr. Greditzer, who has been surfing for more than 20 years, commented on injury prevention for beginning surfers. He says being a good swimmer is the most important attribute for anyone thinking of taking up the sport. He also recommends that beginners take a few lessons to learn the basics and use a soft foam surfboard to start.

The lower-dose imaging technology is now available at HSS Westchester in White Plains, New York. The other imaging systems are at the main hospital campus in Manhattan, including one at the Lerner Children’s Pavilion.

“Many of our pediatric patients who are treated for scoliosis need x-rays several times a year. We take every safety precaution with all imaging tests, and the low-dose system is another way we can meet the needs of our patients and provide high quality care,” noted Dr. Roger Widmann, chief of Pediatric Orthopedic Surgery at HSS.

“Parents of our Westchester and Connecticut patients have been willing to travel one or two hours to our Manhattan location for the low-dose x-rays,” he added. “The new imaging system at HSS Westchester will make it more convenient for these families.”

Vera Scavone, who lives in Armonk in Westchester County, was pleased to hear that the lower-dose imaging system is now available in White Plains. Dr. Widmann successfully treated her daughter, Grace, for scoliosis, and the new location will be more convenient for any future spine x-rays she may need.

Ms. Scavone learned about low-dose x-rays for the first time two years ago when Grace became Dr. Widmann’s patient at age 15. “I definitely felt better, since Grace needed a lot of x-rays,” recalls Ms. Scavone, who traveled to HSS in Manhattan each time x-rays were needed. “It’s absolutely reassuring for parents to know that the dosage of radiation is minimized.”

“Our goal is to provide high quality patient care. Lower-dose x-ray imaging and other cutting edge technologies enable us to do this,” said Dr. John A. Carrino, vice chairman of the Department of Radiology and Imaging at HSS.

When choosing an imaging modality to make a diagnosis and plan treatment, physicians must balance the need for accurate measurements with the need to minimize radiation, Dr. Carrino explains. This concept, known as ALARA (as low as reasonably achievable), is particularly important in children. Physicians at HSS seek to ensure that the lowest amount of radiation is used to produce images based on the patient’s size and the diagnostic task at hand.

The lower-dose imaging facility is open to anyone who has a prescription for x-rays from his or her physician. One does not need to be a patient of an HSS doctor. Lower-dose imaging is most often used for patients who have scoliosis. The system is not used to diagnose a broken bone; regular x-rays remain the gold standard if a fracture is suspected.

In addition to scoliosis, the lower-dose system is used to assess leg length discrepancies in children. These patients generally require frequent imaging tests to monitor growth, plan for surgery and determine the effectiveness of treatment. A previous study at HSS found that the lower-dose imaging system performed as well as a conventional CT scan to assess leg length.

“HSS was an early adopter in using the low-dose imaging technology and is the only hospital in the U.S. with four units,” notes Christopher Smith, administrative director of Radiology & Imaging at HSS. “The advanced imaging system is the only one available in Westchester County and the Lower Hudson Valley Region.”

Although originally acquired primarily for imaging exams in pediatric patients at HSS, the system is being used increasingly by orthopedic surgeons treating adults who need a hip or knee replacement or spine surgery. The system provides 3D frontal and side weight-bearing images that aid in pre-surgical planning.

The test takes about 25 seconds. Patients must be capable of standing still in the spacious unit and able to follow directions from an x-ray technologist. The lower-dose x-rays are generally covered by insurance.

Dr. Miller writes that while both are excellent for evaluating patients, each modality has different strengths so it’s best to determine which is most appropriate for each case.

"At the HSS Stamford facility at Chelsea Piers, patients can be assured that they are getting the same world-quality MR imaging and sonography that they would if they traveled to the main campus in New York City. Integration of our imaging modalities allows HSS radiologists and clinicians access to patient’s studies, regardless of which HSS facility in which it was performed," explains Dr. Miller.

Read the full article at DailyVoice.com.

The articles include interviews with Joel M. Press, MD, physiatrist-in-chief at HSS; Richard J. Herzog, MD, FACR, director of Spinal Imaging at HSS; Chad M. Craig, MD, medical director of HSS Spine; Ellen M. Soffin, MD, PhD, spine anesthesiologist at HSS; Todd J. Albert, MD, surgeon-in-chief at HSS; Mary-Ellen Zullo, PA; Andrew Koo, PA; and Catherine H. MacLean, MD, PhD, chief value medical officer at HSS.

Becker's reports that the HSS spine model functions because of the collaboration between medical practitioners and systems all working together to ensure each patient is being treated safely and effectively. 

Read the full articles at BeckersSpineReview.com - Part One and Part Two.

Dr. Sneag explains that peripheral nerve imaging is somewhat of a biomarker and can help treat complex conditions such as Parsonage-Turner Syndrome. "Biomarkers that can identify specific diseases and place patients into categories can better direct treatment. We want to know precisely what we are treating. An objective diagnosis through imaging can also help with longitudinal monitoring to see how nerves improve, or don't improve, over time."

When looking at the growing subfield of MR neurology, Dr. Carrino explains that not all readers are created equal. "There are specialized protocols we use at HSS that require interaction with other multidisciplinary providers for optimal outcomes. This involves understanding imaging and understanding the disease process—that specific interaction is key. I would advise pain providers to seek out professionals who really know how to image the peripheral nerves rather than sending patients to the closest or most convenient location, which may not result in the most accurate information."

Read the full article at PracticalPainManagement.com. This also appears in Volume 18, Issue #9.

She writes that the benefit of MRI following cartilage repair is to provide an objective assessment of the biologic integration of the tissue, as well as any host-mediated response. 

"It is not uncommon that objective outcome variables do not correlate with more subjective patient-reported outcome measures (PROMs)," she explains. The discordance between clinical (subjective) and imaging (objective) results is often a result of individuals who report good function and limited symptoms despite the presence of suboptimal graft appearance on imaging.

Read the full perspective at Healio.com.

"Reducing health care-related radiation exposure is a metaphorical cornerstone in medical ethics and the standards exhibited in the Hippocratic Oath. While incidental exposure from x-rays has minimal to no patient risk, there are patient populations, such as adolescent idiopathic scoliosis patients, that may receive serial x-rays for many years," said Smith.

"At HSS, we see dose reductions equal to approximately 50 percent of comparable digital x-rays. EOS also offers a microdose feature that can further reduce patient exposure to near-background levels, which HSS will be exploring to offer for some patient cohorts," he added.

This article appeared in the September 2018 print issue.

According to Theodore T. Miller, MD, FACR, chief of the division of Ultrasound in the Department of Radiology & Imaging at HSS, explains that ultrasonography has been shown to have no deleterious effects.

"The risk of any ultrasound guided procedure would be the same as any other time you are sticking a needle into somebody," Dr. Miller says. "You always have to do it with a sterile technique so that you do not introduce an infection to the patient."

Read the full article at Healio.com/Orthopedics. This also appears in the August 2018 print edition.