Stellar course offers chance to bone up

April 1, 2007

When I started in radiology, near the end of the Jurassic Period, musculoskeletal radiology did not exist. Skeletal radiology was a popular field, but we had no way to image musculos. Like everything in radiology, this subspecialty has been changed by CT and MRI.

When I started in radiology, near the end of the Jurassic Period, musculoskeletal radiology did not exist. Skeletal radiology was a popular field, but we had no way to image musculos. Like everything in radiology, this subspecialty has been changed by CT and MRI.

Skeletal radiology has always been one of our bread and butter fields. Since the onslaught of CT and MRI, it has also become our meat and potatoes. While most CTs are not ordered for MSK problems, they all contain MSK structures. As we all know, if it's on the image, it is yours.

MR exams are more focused, but MSK is still a big slice of the pie. If you include spine studies, an area both MSK radiologists and neuroradiologists like to claim, the percentage of MSK MRs in our hospital tops 50%.

Given the importance of the field in my practice, I try to keep abreast of it. Of course, I try to do this in every area of radiology, thereby falling short in all of them. This is the curse of the general radiologist. Still, over the years, I have listened to a lot of MSK lectures and attended many courses.

As a rule, I attend only courses with four hours of classes a day and a major form of recreation within spitting distance. One of my partners strongly recommended the visiting fellowship in MSK MRI at Duke University, however, and in a moment of weakness, I decided to go. Having gone to Davidson College, I knew Duke was one of the better second-tier schools in North Carolina, so I expected the course to be good. It was terrific.

As those of you who have been reading this column for the a while have probably surmised, I am not a very complex guy. I like things simple, straightforward, humorous, and honest. This course was all of those things.

The course, and the Duke MSK imaging department, are run by Dr. Clyde Helms. He clearly sets the tone and style of both, and he has all the qualities I like. The course consists of four full days of lectures. At the end of each day, we moved from the classroom to the radiology department to participate in the "afternoon rollout" session. There, Helms and the available staff, residents, and fellows would discuss the day's cases.

I liked a lot of things about this course. Helms gave about a third of the lectures, which is its major strength. He is a gifted teacher. The rest of the faculty were also very good, and their mix of styles kept the course interesting.

The afternoon rollout was particularly helpful. The cases were interesting, and the discussion reinforced what we had heard in lectures all day. But more than that, I liked the openness and intellectual honesty of the whole session. These folks question the same findings and debate the same hard issues I ask myself at the viewbox every day. Misery loves company, and so does indecision.

As with many courses I have attended, I constantly found myself asking, "How many times have I missed that finding?" When I got home, I had our office manager pull the last 25 MSK MRIs I had dictated and reviewed them on PACS. I did not pick up any gross errors, which means I'm either unteachable, consistent, or not quite as dumb as I feared. But I did find a lot of important subtle and associated findings, enough that I dictated four addenda to my initial reports. Plus, I felt a lot better reading them.

Helms and Dr. Nancy Majors have developed a cottage industry teaching MSK radiology courses around the world. I suspect you would not go wrong by attending any of them. I know the visiting fellowship at Duke is well worth the money.

Dr. Tipler is a private-practice radiologist in Staunton, VA. He can be reached by fax at 540/332-4491 or by e-mail at btipler@medicaltees.com.