Thursday, November 5, 2015

Pediatric Imaging Services at the Young Athlete Center

by Eric Eutsler, MD
Pediatric Musculoskeletal Radiologist
           High quality medical imaging is crucial to any orthopedic practice. At the Young Athlete Center, our imaging technologists and radiologists work closely with the orthopedic doctors to optimize the imaging tests that are performed. The Young Athlete Center is staffed every weekday by a pediatric radiologist from the Mallinckrodt Institute of Radiology (which is part of Washington University). We have on-site x-ray, ultrasound, and MRI available at the Children’s Specialty Care Center in West County.

            X-rays are primarily used to evaluate bones. When a sports-related injury occurs, an x-ray is almost always the first imaging test that is obtained. X-rays use ionizing radiation (photons) to take an image of the injured body part. It is important to limit radiation exposure in all patients, but especially in young patients whose bodies are still growing. At the Young Athlete Center, our carefully calibrated x-ray equipment ensures that our patients’ x-rays are obtained at the lowest radiation dose possible while still maintaining excellent image quality.

An X-ray of the forearm demonstrating fractures of the radius and ulna

            Ultrasound is primarily used to evaluate the soft tissues. This type of imaging uses sound waves to generate a picture, and there is no ionizing radiation involved. It is especially helpful for looking at the superficial soft tissues (close to the skin), such as certain muscles, tendons, and ligaments, as well as other “lumps and bumps” related to acute or chronic injuries.
An ultrasound image showing the normal patellar tendon which is close to the skin surface and connects the kneecap (or patella, arrow) to the tibia (curved arrow)

            Magnetic Resonance Imaging (or ‘MRI’) can be used to evaluate both the bones and soft tissues, including structures deep inside joints. MRI pictures are created using a powerful magnet, and no ionizing radiation is involved. Most MRI examinations for sports injuries do not require injection of contrast material (no needles!). However, a special type of MRI called an MR Arthrogram (or ‘MRA’) does help diagnose many types of sports injuries, including labral tears of the shoulder, ulnar collateral ligament tears of the elbow, various ligament injuries of the wrist, and labral tears of the hip. In this procedure, our pediatric musculoskeletal radiologist Dr. Eric Eutsler uses pulses of low-dose x-rays to guide a needle into the joint and fills the joint with contrast fluid. After that, the patient is immediately escorted down the hall to our state-of-the-art MRI machine and an MRI is performed. The Young Athlete Center currently offers appointments for MR arthrograms every Wednesday at the Children’s Specialty Care Center in West County, and will offer MR arthrogram appointments at St. Louis Children’s Hospital in the near future.

An MR image of the knee demonstrating the anterior cruciate ligament (or 'ACL', arrow)

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