A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

SSR white paper: guidelines for utilization and performance of direct MR arthrography

OBJECTIVE

Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion.

MATERIALS AND METHODS

The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations.

RESULTS

Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus.

CONCLUSION

Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

Efficacy of an intensive 2-week musculoskeletal anatomy course in a medical education setting

There is little consistency in student contact hours and teaching activities used in medical curriculums across North America, and controversy exists regarding the most efficient or effective way to teach musculoskeletal (MSK) anatomy in medical school. The purpose of this investigation was to retrospectively examine academic performance and levels of course satisfaction among first year medical students who had completed an intensive 2-week MSK anatomy course during the pre-clerkship portion of their Association of Faculties of Medicine in Canada accredited undergraduate medical program. Course data from formative and summative student evaluations, as well as end-of-course satisfaction surveys were analyzed for a homogenous group of 549 first-year medical students over a 5-year period. Data indicated that student's academic performance on both formative and summative evaluations for the 2-week MSK anatomy course were consistently high, and not significantly different from the results for other system-based 1^st year anatomy courses delivered over longer durations. Likert data from end-of-course surveys also suggested that student feedback regarding the course was overwhelmingly positive, and that the 2-week MSK anatomy course had the highest level of overall satisfaction when compared to all other first-year anatomy courses. These results can be used to help in the design and implementation of MSK anatomy courses within medical curriculums, and contribute to a growing body of literature which is focused on examining the effect of curricular design on MSK anatomy learning in a medical education setting.