Musculoskeletal Imaging – A Survival Manual

This is a really comprehensive textbook that is written as a clinical survival manual and reference tool for any healthcare professional involved in image interpretation. It is an excellent guide for trainees learning pattern recognition and expanding their image knowledge base in preparation for reporting images. There is also a checklist approach to assessing certain images and confidently approaching an examination.

The book has a very straightforward layout that is easy to navigate, with some excellent nuggets of knowledge and advice for the reader. It is written in a very novel way, almost mirroring an army survival guide, and in the first chapter the authors have used the acronym SURVIVAL, relating it to recommendations in musculoskeletal imaging and interpretation. I do wonder if instead of I = improvise as the authors suggest, it should have been I = intuition, which is more fitting and developed with experience and knowledge. As a reporter I do like the ethos of ‘own your mistakes, learn from your mistakes.’ This will resonate with all reporters as they do not intentionally mean to make an error and it is important to turn this situation into a positive learning outcome and an opportunity for personal reflection. I really liked the key points throughout the book; tips and tricks that are really useful for trainees. There are interactive sections at the end of each chapter – ‘after action review’ –  where the reader can perform a test to assess their new knowledge.

There are some slight errors in the abbreviation list at the beginning of the textbook, for example the abbreviation for carpal tunnel syndrome is included three times and others are also included multiple times. This is obviously just an error.  

The sections on each anatomical area are clearly set out, with excellent images and explanations of the image findings. An additional feature is that when the reader places the cursor over the image a full detailed description of the image pops up. Just a note that in the UK it is not standard practice to perform x-rays of the cervical spine in trauma scenarios and CT is the initial image of choice, as per NICE guidelines.

I really liked the headline ‘The coracoid is the lighthouse of the shoulder’ in the shoulder chapter and I will be using this when teaching students reviewing images for dislocation. The only point I would stress about the content in the shoulder chapter is that we do not use comparison views in the UK routinely. In the scaphoid section in the UK, we commonly use CT as a follow-up imaging method if the x-rays are normal, and we do not widely use MRI. We always stipulate a PA view with full ulnar deviation to fully visualise the scaphoid.

On page 38 there is a nice illustration of the importance and necessity of orthogonal views. The red flags mentioned numerous times regarding the presence of a joint effusion at the elbow is a good recommendation. Figure 3.32 clearly demonstrates elevation of the posterior and anterior fat pads indicative of a joint effusion and the fracture. The hip and pelvis section provides good advice on the use of CT and MRI if the patient is still experiencing pain and x-ray imaging has demonstrated no bony injury. There is also a good section in this chapter on atypical femoral fractures due to long-term bisphosphonate treatments and how to deal with this unusual presentation.

The book provides additional advice about normal variants versus true pathology, including the base of the fifth metatarsal in children and the common appearance of the apophysis at this site. There is also advice on being confident in assessing normal variants of the patella such as bipartite versus a true fracture. These are two areas in clinical practice that do cause false positives and are therefore good examples of the pitfalls of normal variants. The authors make reference to the merchant view of the patella and its application in practice; it is worth noting that in the UK this is more commonly known as the skyline patella view.

The later sections are focused on other challenging pathology including infection, bone tumours, metabolic disease, arthritis and other inflammatory arthropathies. These are areas that are often a challenge, particularly acute versus chronic infection. The cases in the test at the end of the bone lesions section were really testing, with a great variation of pathology, demonstrating the importance of using the geography and location of the lesion when arriving at a diagnosis.

While most of the images are of excellent quality there are a few that are quite pixelated. There is a nice, easy to follow checklist highlighting the typical appearances of inflammatory arthritis and the manifestations on imaging, including the distribution and symmetry of the disease. This is a good and useful diagnostic aid to use while reporting these kinds of images. To summarise, this is a really good clinical practical guide to have when reporting MSK images; is an aid in arriving at a diagnosis; and helps to build a list of differentials. The images are mainly of excellent quality and clearly labelled with the added functionality for the reader of accessing extra information when placing the cursor over the image. I really like the survival guide arrangement of the text and the key take-home messages in each section. Over and Out.

To purchase this title at our discounted rate email: katherine@radmagazine.com.