What abnormality is demonstrated on this MR image of the head of a healthy individual?

What was his occupation?

Case 79 - Figure 1

Findings

This is a coronal T1 weighted image from an MR examination.

There is distortion of the image along the scalp of this patient, indicating the presence of ferromagnetic material causing susceptibility artefact due to distortion of the local magnetic field.

Case 79 - Figure 1

Diagnosis

Susceptibility artefact – Metallic foreign bodies

Discussion

The patient was a welder. Although he was unaware of their presence, small metal fragments had become embedded in his hair or scalp during his work. Certain hair products that contain iron may produce a similar appearance. Mascara may have a similar effect, distorting images of the orbits.

Identify the abnormality on these films.

Case 87 - Figure 2

Case 87 - Figure 1

Case 87 - Figure 2

Case 87 - Figure 1

Diagnosis

Supracondylar process

Discussion

The supracondylar process is a normal variant present in between 0.5 and 1% of subjects. It is the origin of a fibrous band that extends to the medial epicondyle at the elbow joint, and thus points towards the joint. This helps distinguish it from an exostosis (osteochondroma) which tends to point away from the joint. The median nerve and artery pass beneath the band, and in a small minority it may cause compressive symptoms.

Clinical Radiology Annual Scientific Meeting 2013

Monday 9-Wednesday 11 September 2013
The Barbican, Silk Street, London

The Clinical Radiology Annual Scientific Meeting (CRASM) is a major national conference providing high-quality education and learning and leading edge research presentations on radiology, training seminars, concurrent sessions and workshops attracting consultant radiologists, trainees and other professional groups.

The CRASM updates delegates on matters relevant to their practice and informs and educates on the latest technological developments. Programme streams include:

Cardiac imaging I Paediatric MSK I Service delivery I Chest radiology I MSK – hip I Pelvic imaging IIT and Informatics I Colorectal and neuro-oncological malignancy I Dementia I Head & Neck IObesity I

Registration will open for the CRASM 2013 in December. 

The CRASM 2013 features:

• Full three-day meeting centred around CPD presentations
• State-of-the-art presentations by expert speakers
• Five streams of lectures and workshops, giving a wide choice of topics for delegates
• Keynote lectures
• Proffered Papers sessions
• The 2012 Blue Skies Lecture
• Scientific and audit poster exhibitions
• Industry Forum
• The Royal College of Radiologists’ Annual General Meeting

The packed 3-day programme ensures there is something for everyone.

There are many opportunities to network and exchange ideas with fellow delegates – over 600 radiology professionals are expected to attend.

As always, this will be different from any other conference you attend this year  – we look forward to seeing you there!

The Barbican, Silk Street, London, EC2Y 8DS

Update from Borders General Hospital

The Department

Nestled below the beautiful Eildon hills, BGH continues to punch above its weight reminding us of much that is good in small hospitals. The radiology department remains a modest yet glittering jewel! A one year old 128 slice CT and 1.5T MRI just about cope with spiralling cross sectional requirements although as ever there are not enough hours in the day. The department remains well equipped and staffed by a do anything brand of radiographer with wide role extension.

The A Team

Currently we stand at 6 full time consultants with a further three sessions from the not yet fully-retired David Hardwick. We are lucky that our broad skills base allows us to practice a wide variety of radiology on site although we do not offer PET-CT and our interventional work is limited.

Luis Ferrando (Hannibal) is clinical lead, slavish workhorse and MRI guru. Sadly Luis is working too hard and is no longer club champion at the best golf course in the Borders. He assures us this is a temporary blip. Luis leads by example although trying to do more work than him is likely to damage your health. His management style is relaxed and owes much to his next door neighbour Hamish McRitchie (the Face) who continues as associate medical director, national PACS lead and many other things besides. Hamish still has a significant clinical impact reporting much of the work that no one else wants. It is not clear when he finds time to do all this reporting, however I think it was a master stroke by Luis to install a camp bed in his office, although the TPN and catheter are perhaps a step too far.

John Reid (Murdock) continues to lambast and entertain while providing the definitive cardiovascular opinion in this hospital and other places besides. Befitting his polymath nature, John’s clinical meetings are likely to feature discussion of astronomy, Roman history and the nature of Saharan sand and might even cover some radiology if all else fails. John provides much of our interventional work, which is just as well as the road toEdinburghis a long one if you are exsanguinating. John also spends a day a week at the CRIC, a University research centre in the car park of the new Royal Infirmary, What he does there is anyone’s guess but he tells us most of it is legal.

Andrew Pearson (B.A. Baracus) continues to divine the dots combining nuclear medicine with general radiology as well as running the Borders osteoporosis service. Apparently the Borders have the best record inScotlandfor identifying patient at risk of osteoporotic fracture. This must be due to Andrew as I need a dictionary even to spell osteoporosis.

The lonely, dark back corridor of the department is home to Rachel Thomson (Melinda) and Simon McGurk (Colonel Lynch) in adjoining offices. They are like Yin and Yang, he Yin, she Yang. Rachel quietly goes about her work combining a prodigious workload with never-ending home renovation. She is currently planning a family extension which will further increase her burden. Her colleagues feel an appropriate gift following the birth of her child would be a PACS unit in one of her outbuildings. Rachel is strangely resistant. Fortunately for everyone, Simon McGurk only spends 3 days a week in the Borders spending the other two at RHSC inEdinburgh. Dr McGurk professes a paediatric sub-specialisation although evidence of this is in short supply.

The Future

Although currently fully staffed, vacancies are likely in this department within the next 2 or 3 years. While we have room for all comers, your interventional desires are unlikely to be met at the BGH. As ever an ARSAC licence and a sense of humour will always be welcome. If you are ever passing, feel free to drop in, coffee time is 10.30!

Update from Crosshouse Hospital

The radiologist complement consists of 9 full time Consultant Radiologists

We have a busy department with near 100,000 examinations per year. The main department has 8 rooms including CT (Siemens Sensation 64) and MRI (Siemens Avanto1.5T).  A recent linkedUSextension has now expanded to 4 rooms (all Toshiba) with a further 2 roomed DR suite linked directly with A&E.

Consultants in post are Dr. Morag McMillan, Dr Elspeth Lindsay (Director Breast Screening), Dr David Rawlings (Clinical Lead), Dr Mike Dean, Dr Sudhakar Unnam, Dr Shahid Rasul, Dr Bindu Kumar, Dr Bappa Sarkar and Dr Calum Nicolson. We are one radiology directorate with our colleagues inAyrHospital, Dr Stephen Cooper presently presiding as Clinical Director.

Our retired colleague, Dr Pat Crumlish still has a variable part time sessional commitment, carefully structured around his golfing activities.

Consultant recruitment has improved over last few years with Dr Bindu Kumar joining us in 2011 and in 2012 we successfully recruited Dr Bappa Sarkar and Dr Calum Nicholson.

The department was also supported until recently by two South African Locum posts. Both these posts terminate this year due to work permit and visa issues but local recruitment has compensated for this to a degree.

We utilise the National Carestream RIS and PACS and run a paperless department. While presently relying on Carestream RISWEB for electronic requesting it is hoped to integrate electronic requesting directly into the new hospital wide Patient Management System (PMS) very shortly while at the same time keeping our sceptical clinical colleagues on board.

The major burden for radiologists at present is the heavy CT workload. With the rapid scanner throughput and extended day working exceeding the reporting capabilities of the most efficient of radiologists, we now have two radiologists covering CT reporting during most of the week.

A new MRI scanner in 2011 found a home in the old film file room and promised increased throughput and efficiency. However the increased range of sequences and new indications seems to leave the service as pressurised as before.

A new mammography room and further office space are planned for this year.

Skill mix continues with sonographers, Barium radiographers and reporting radiographers taking on much of the work previously done by radiologists.

Outsourcing plain film reporting remains one area we would like to see reduced, and we would hope with further recruitment to achieve this soon.

Our department has received positive feedback from trainees largely due to enthusiastic teaching of Dr Unnam. This has certainly aided recruitment and hopefully will continue to do so over the next year.

The SRS 2013 spring meeting will be held on Friday 7th of June at the Royal College of Physicians and Surgeons in Glasgow. Please put the date in your diaries. I hope you will be able to attend.

Dr Kingsley Nwafor (Monkland’s Hospital) is the local organiser.

The programme is excellent and will include national and international speakers on a wide range of topics.

The programme and registration form will follow shortly.

CME points have been applied for.

Regards

David A Ritchie
SRS committee

Update

You can now find the event details here. Look forward to seeing you there!

SRS Spring Meeting, 2013

Location

This event is taking place at:

The Royal College of Physicians and Surgeons of Glasgow
232-242 St Vincent Street,
Glasgow G2 5RJ

Tel:  0141 221 6072

Directions can be found here: http://www.rcpsg.ac.uk/en/the-college/about-us/location.aspx

The RCPSG is located in the centre of Glasgow on St Vincent Street and is easily accessible by rail from Queen Street and Central stations.

Glasgow airport is about 15 – 20 minutes by taxi.

Programme

Download the programme here:

SRS Spring Meeting 2013 Programme

Enquiries

Please send any enquiries about the event to:

Dr Kingsley Nwafor,
Consultant Radiologist,
Monklands Hospital,
Airdrie.

Tel: 01236 712166

Booking

Please download the booking form below:

Booking_Form_SRS_Jun_2013

and return it to:

Dr Maggie Brooks,
Consultant Radiologist,
Lorn & Islands Hospital,
Oban. PA34 4HH

We are now announcing our next Edinburgh level 2 cardiac CT course, taking place in April.

Monday 15th – Friday 19th April, 2013
8:30am – 5:00pm

Course Outline

The course offers lectures and hands-on experience in the interpretation of 150 contrast enhanced CT coronary angiograms as well as multiple non-contrast coronary calcium scans. Live recorded cases of 25 CT scans will be shown. Cases will be reviewed on Vitrea workstations (maximum 2 delegates per workstation).

The course meets the requirements for level II accreditation as defined by the British Society of Cardiac Imaging and the Society of Cardiovascular Computed Tomography

Topics covered include:

1: Optimal imaging: practical physics and imaging protocols – how to acquire the optimal study

at the lowest radiation dose?

2: Optimal use of viewing workstations

3: Cardiac anatomy

4: Systematic evaluation and interpretation of cardiac and non-cardiac findings

5: Imaging of ischaemic heart disease with multimodality correlation

6: Coronary artery anomalies

7: Imaging of coronary artery bypass graft disease and coronary stents

8: Imaging of valvular disease and cardiac failure

9: Cardiac tumours

10: Congenital heart diseases

11. Electrophysiology and TAVI planning

12: Non-cardiac findings

More Information and Booking

Download the Cardiac CT Course Spec here, and download the course flyer here: Cardiac CT Course Flyer.

For more information, or to book a place, please contact:

Sharon Douglas, Education Assistant, Wellcome Trust Clinical Research Facility,
Western General Hospital, Edinburgh, EH4 2XU

Tel: 0131 537 3355

E-mail: wtcrf.education@ed.ac.uk

https://www.crts.org.uk/Local/Lists/Courses.aspx

Dear Colleague,

Following on from our successful SBTR educational meeting on jan 16th, Wednesday afternoon we have decided to have another.

Time: Wednesday June 26th 2013, 2 – 4.30pm

Location: Radiology Seminar Room, Gartnavel General Hospital.

The meeting is open to Consultant Radiologists and not trainees.

I would appreciate an early reply.

I am hoping that Dr Elaine MacDuff (Pathologist) and Mr Mike Jane (Surgeon) will attend again.

The programme will be much the same as last time with 2 hour long sessions reviewing the imaging findings along with relevant clinical, pathological and management data.

Free lunch from 1.15 – 2.00pm and coffee break at half time (sponsored by Scottish Sarcoma Society).

There is no cost for the meeting.

The RCR should award 2 Cat 1 CMEs for the meeting and you can pick up your certificates on the day.

Parking will be in Gartnavel Car Park in the visitors car park – parking up to 4 hours is free.

The Parking attendant wants to know how many will require parking as he may need to designate a reserved area.

Could you ley me know if you need parking and also confirm your attendance, please?

If you are interested, can you please reply to

David.Ritchie@nhs.net

Regards
David Ritchie, Nigel Raby, organisers

Click below to see the 2011 AGM Minutes

AGM 2011 Minutes

The BNMS 41^st Annual Meeting was set on the waterfront of the beautiful seaside town of Brighton. A stroll along the promenade was a welcome calm before the action packed day which lay ahead. One look at the number of pages in the thick colourful programme was an indicator of the vast scope of topics to be covered in this bi-annual meeting. The meeting was spread across three days and the venue split across four main areas; three large lecture halls for presentations from every field of Nuclear Medicine conceivable, from specialty specific talks to advice on setting up your own NM department. The final area was a large central hall for sponsors, poster presentations and interactive live demonstrations.

My knowledge of Nuclear Medicine before this meeting was at the very least limited and I knew that at times I would feel out of my depth, but following a two week taster in this field I was keen to explore and build on this knowledge. Fresh from my FRCR Part 1 examination in Physics, I was able to appreciate the concepts behind Nuclear Imaging and in part understand the advances being described in SPECT and PET imaging. I joined the morning of lectures in the main hall, finding it hard to narrow down the number of talks I wished to attend, and sat through short punchy lectures in general topics such as bone scintigraphy – the main workhorse of NM imaging, before moving on to one of the smaller theatres where the topic of presentation became more specialty specific. On my particular day of attendance the talks given were focussed on Neurology and it was fascinating to see how NM was helping in the understanding of debilitating illnesses such as epilepsy and dementia. I was surprised to see the number of non-radiological clinicians and health professionals present at the meeting and was impressed at their depth and understanding of imaging in their own fields.  

Between the morning and afternoon line-ups, there was the opportunity to present my own poster to a panel of honorary judges. During my attachment to the NM Department at the Western General Hospital I came across a rare extra-osseous finding on bone scintigraphy in a 68 year old man with a history of prostate cancer and a rising PSA. Following isotope injection, the scan revealed traumatic uptake in the right rib as well as degenerate uptake in the lumbar spine. However in addition, unusual asymmetric activity was noted in the left forearm, hand and fingers (glove distribution). Further imaging revealed no abnormality on plain film or cross section and the patient reported no pain in this area. Differentials for a painless hot arm were investigated and we came across a rare finding coined the “glove phenomenon” caused by partially arterialised isotope injection. We felt this was an important cause to highlight as incorrect interpretation could have devastating effects on patient management. In addition it was important to repeat imaging in such cases using a different site of injection to confirm and rule out any underlying metastatic disease hidden by this effect. I had an interesting discussion with the judges about their own personal experiences of this imaging artefact, which has also been described in other NM studies such as PET FDG, renal and myocardial perfusion imaging. The competition was tough, with over 80 posters covering every aspect of NM. I am proud to say we were one of three posters from Scotland invited to the event. I would love to see this number increase in the years to come and would encourage anyone with an interest or even a curiosity in NM to attend future events. I hope to return as a senior trainee following more experience and training to contribute once again.

Nuclear Medicine is an area of radiology quite unlike anything else. The huge advances in PET imaging, in particular, has already revolutionised cancer staging and management. Judging the topics of discussion at this year’s meeting I believe there are huge advances yet to come, with molecular imaging just around the corner. This is an exciting and promising field that I would invite any trainee of any level to become involved.

 Sarah Eljamel

ST1 Radiology
Western General Hospital
Edinburgh
NHS Lothian

With generous support from the Scottish Radiological Society I was privileged to attend the 51st Annual Meeting for the American Society of Neuroradiology (ASNR) in San Diego, USA. The conference ran from the 18th to 23rd of May 2013. ASNR provides one of the world’s largest dedicated neuroradiology meetings; all facets of neuroradiology and head and neck imaging are covered. As an aspiring neuroradiologist, the meeting provided me with an invaluable learning experience. Some particular highlights for me included a lively three session debate tackling current controversies in neuroimaging (e.g. the Liberation Procedure), a special session discussing current theories on how the brain thinks and as part of the trainee stream, a very informative session simplifying some of the trickier areas of reporting such as the post therapy neck.

An integral part of the trip for me was the opportunity to present some of my ongoing research data. As a registered MD student with the University of Edinburgh, I am currently analysing imaging data from a large randomised controlled trial that investigated IV thrombolysis in acute ischaemic stroke (The Third International Stroke Trial – IST-3). I was excited to present my early results within the stroke imaging stream of the meeting. It was very helpful to discuss my findings with a large assembled international audience, although 6 minutes is not very long when you are on the podium! I received some interesting questions from the audience and afterwards discussed ideas with other researchers.

The conference was held in the San Diego Convention Center, a huge sprawling complex right on the waterfront and in the heart of downtown. The adjacent Gas Lamp District is the cultural heart of San Diego and a great place to wind down after a long day at conference! On the final day, the closing reception was held on the upper deck of the USS Midway, a decommissioned aircraft carrier that looms large over the bay and was most recently active during the Gulf war.

Overall, my trip to San Diego was extremely worthwhile. I would certainly recommend the conference to others, especially those with a neuro interest.

Finally, I would like to thank all those at the SRS for helping to make this possible for me.

Grant Mair

5th July 2013

The Autumn Meeting & AGM 2013 will take place this Autumn in Aberdeen. Details as follows:

Date:
Friday 15th November

Location:
The Suttie Centre,
Aberdeen Royal Infirmary,
Foresterhill 

Please find attached the programme and the invitation from the local organiser, Dr Steven Yule.  

Details of the Junior Forum meeting on Thursday 14th November are also attached.

To Book Click here

Any questions or queries please e-mail Dawn Younie at d.younie@abdn.ac.uk .

SRS Autumn Meeting Programme 2013 

Autumn Meeting Invitation

SRS Junior Forum Aberdeen 2013

BIR Scottish Branch Meeting:  Recent advances in diagnostic imaging

Date:  14 February 2014

Time:  08:30 - Registration & Refreshments

Venue:  Royal College of Physicians and Surgeons, Glasgow

CPD:  5 Credits (applied for)

Click here for more details BIR Event

Clinical Fellow in Thoracic and Non-Invasive Cardiac Radiology

£31,838 – £47,175         

Clinical Research Imaging Centre

This post is to enable a Clinical Fellow, equivalent to a senior specialist registrar in Radiology or a post CCT radiologist, to undertake one year advanced training in thoracic and non-invasive cardiac radiology based at Clinical Research Imaging Centre (Little France campus). Consideration will also be given to suitable candidates who wish to undertake a longer period of training to gain a higher academic qualification such as an MD or PhD. Overseas doctors specialising in this area are eligible to apply.

You will have a fundamental knowledge of all aspects of general radiology with broad experience and a sound clinical background. MBBS or equivalent registered with GMC FRCR. A post-graduate qualification such as MRCP, FRCS etc is desirable.

Placement on the AMN2 salary scale will be dependent upon experience. You must be eligible to hold an honorary registrar contract with NHS Lothian. Additional on-call supplement will be available depending on the call rota, and will be furnished by the South East Scotland training scheme.

This post is available on a fixed term basis for a two-year fellowship, renewable annually and has been approved for a period of up to three years initially.

Prospective candidates wishing to discuss the appointment or visit should, in the first instance, please contact Ms Clair Holden, PA to Professor van Beek tel: 0131 242 7762 or email: clair.holden@ed.ac.uk.

Click here for Job Particulars

Click here for AGM Minutes 2012

I am very grateful to the SRS for assisting with funding towards my recent visit to Boston, Massachusetts, as part of my final year training in diagnostic neuroradiology.  I was able to attend the Harvard MRI/CT Update course and spend a week in the neuroradiology department of the Brigham and Women’s Hospital.       

The Harvard MRI/CT Update course is well-respected for good reason and was certainly an intense experience – talks began at ten past seven every morning and continued till 5pm, with excellent speakers from local hospitals, HarvardMedicalSchool and guest experts from around the world. Mornings began with a fantastic presentation of interesting cases relevant to that session. Lectures then covered a broad range of related topics, always covering the latest technologies and uses for advanced forms of imaging. Speakers included Dr Hugh Curtin, the author of the ‘bible’ of Head & Neck imaging, who shared some practical approaches to temporal bone imaging and somehow made complex middle ear imaging seem relatively straightforward. Neuroradiology talks included research and clinical applications for perfusion imaging, spectroscopy, tractography and functional MRI and I was able to see all these being put to use in my second week at the BWH.

 Boston has a higher ratio of doctors to people than any other city in the world and the resources to match. This was put to good use earlier in the year after the terrorist bombings at the close of the Boston marathon, as victims (and bombers) were taken to some of the six Level 1 trauma centres within a two mile radius of the event. The Longwood medical area, the site of the BWH, seems like a small city, containing numerous different hospitals, many interconnected, including a specialist children’s hospital and the world-renowned Dana-Farber Cancer Institute. While the neuroradiologists wait for the opening of the new 10-storey neurosciences building, currently in construction, imaging is split up around the hospital site. I counted 18 MRI scanners being used for adult imaging, the majority of which are 3T.

 The huge difference in their practice is volume – scans are happening all around the hospital, all the time. At least two MRI scanners are in full use 24 hours a day, easily accessible to patients presenting to the Emergency Department. They have 9 neuroradiology fellows to run the on call rota.  Follow up scans were more frequent, with cancer patients attending on average every six weeks. To cope with the volume of patients attending, I was interested to see that the vast Cancer Institute operates a ‘tagging’ system – every patient entering the building is given a key tag, so they can always be located, presumably to help multiple appointments run smoothly. Luckily doctors seem to have escaped this as yet.

 Techniques such as functional MRI, spectroscopy, tractography and perfusion imaging are close to routine examinations in the BWH, certainly for all tumour patients. Currently in Edinburgh, these are used on relatively rare occasions for specific patients and take some organisation. It was really useful for me to see cases where these were used for problem solving, helping with the radiological differential diagnosis and planning treatment. In Edinburgh, I’ve been involved in some of the functional MRI being carried out, mostly still at the research level and it was useful to see their methods for performing fMRIs, for clinical and research purposes. I also got a brief glimpse of their 7T mouse MR scanner, and some of the imaged brains, although they’re not on to fMRI yet… I was also taken to see their AMIGO operative suite, set up for intra-operative angiography, MRI, CT and PET.

 Other aspects of their work seemed reassuringly familiar. I attended multidisciplinary meetings for epilepsy and neuro-oncology, with a similar range of challenging cases discussed as found in my own tertiary referral centre. Most of their actual structural imaging examinations looked much the same as those I’m used to, with a few differences of specific protocols used.

 I was in Boston during the recent government shutdown, triggered by disagreements over the introduction of healthcare reforms and got an interesting insight into the US approach to healthcare from a Grand Rounds radiology lecture by a visiting governmental speaker. Doctors are aware that cutbacks will be necessary in response to the economic downturn and there is early evidence that imaging volume is being affected. The radiology discussion centred on the worrying lack of evidence available for the benefits of imaging, in terms of costs and health, particularly regarding its volume and frequency. This highlighted one of the many differences between US healthcare and our own nationalised system, where much more evidence for new techniques must be accumulated before they are introduced.

 I was glad to return to the NHS, but it was fascinating to see a part of what can be done in such a large, well-resourced centre, where the distances between current research and clinical applications are being ever narrowed. I was lucky to be looked after while I was there by Dr Srini Mukundan, who combines clinical neuroradiology with a teaching post at HarvardMedicalSchool and an active research interest in imaging techniqes and contrast agents.  He also showed me some of the history attached to the site, including the original office of the neurosurgery pioneer Harvey Cushing and the skull of Phineas Gage, who amazingly survived an iron rod being driven through his frontal lobes in the 1840s.

 This has been a really useful and interesting experience for me and I’m very grateful to the SRS for its support.

The BIR Event :  Optimisation in CT

Venue:    The Royal Society of Edinburgh

Date:   18 June 2014

Time:  09:30

CPD:  5 Credits (applied for)

Click here for full details……Optimisation in CT Programme