Area of the Research
Medical imaging refers to the systems and practices used to produce images of parts of the human body for medical purposes with the aim of disclosing, diagnosing, or studying a particular disease. It entails the study of ordinary body anatomy and functioning. Procedures involved in medical imaging are usually understood as pathology.
Several medical imaging techniques exist, and this paper will focus on ultrasonography, Magnetic Resonance Imaging (MRI) and plain radiography. Ultra Sonography is an imaging technique that is based on ultra sound and is used for envisaging subcutaneous body parts especially joints and muscles. Frequencies used in this imaging technique range from 2 to 18 MHz’s.
Magnetic Resonance Imaging is a therapeutic imaging procedure used in radiology to envisage internal body parts that are detailed. It utilizes nuclear magnetic resonance to picture nuclei of molecules in the human body. It offers exceptional comparisons between distinct body tissues, and this makes MRI to be tremendously constructive in medical imaging. Ionizing radiation is absent in MRI.
Plain Radiography entails the creation of two-dimensional descriptions of the parts of the human body via x-ray radiations. Well-trained health experts specialising in the use of radiographic machines usually perform this radiography. It is the key stone of the contemporary medical imaging and is used to view almost all parts and organs of the human body.
The most crucial sections of medical centers and infirmaries are found in the medical imaging sector. This is where examinations on imaging are carried out. Joints are found where any two bones convene. They allow the skeleton to move since, in their absence, it would be impossible for human beings to move.
Synovial joints have a fluid known as the synovial fluid. These are the main joints in the body, and the fluid permits the joints to move about liberally and reduce friction. Synovial joints are the majority in the human body and include pivot, ellipsoidal, hinge, saddle, ball and socket joint and finally the gliding joint. Ball and socket joint usually moves in all ways and is supported by the ligaments.
An example is the joints found in the shoulders. This joint consists of muscles, bones, ligaments and many fibers. Shoulders concentrate on military actions and allow for freedom in movement. Joints in the shoulders must be movable enough for the broad range of arm and hand activities. The joints also make the shoulder firm enough to allow for activities such as lifting and pulling.
It is difficult to determine the exact pathological crisis with a single imaging modality due to the intricacy of the shoulder joints. The information available on soft tissues is also insufficient if passed through plane radiography, though it provides constructive details about the bone. Ultra Sonography (US) and Ultrasound are some of the imaging techniques, which are accurate, economical, and valuable. Several limitations have also been discovered in these two methods.
Plane tomography is similar to computed tomography although it does not offer specific information on the diminutive body parts especially the soft tissues. This can be overwhelmed by the induction of a contrast medium, exactly inside the joint. The most effective and accurate imaging modality for detecting pathological issues in the shoulder joint is the Magnetic Resonance Imaging (MRI). This imaging modality is, however, not recommended in patients with serious contradictions.
Research shows that MRI is the best compared to Ultra Sonography (US). Efficiency of this MRI was tested in a different study, and the results showed that it is not a sufficient tool especially for patients with an excruciating shoulder. This is because it does not appropriately envisage the pathological variations in the patient’s shoulders.
A different study shows that MRI is of limited use in the identification of arthritis of the joints. This study also asserts that plain radiography would be effective to develop a diagnosis and treatment plan for ordinary shoulder difficulties. This entails the complete description and physical inspection of the shoulder. The paramount imaging modality that is useful, can offer sufficient information, and fulfils the needs of the patient in the shoulder joints has, therefore, not yet been established. This paper will aim at determining which of these two imaging techniques for the shoulder joint (MRI and US) is the best.
Methods of bibliography Compilation
A bibliography of shoulder imaging was first compiled with relevant articles found in electronic journal database and other medical websites. Information on shoulder imaging was first obtained from distinct databases.
Results obtained were skimmed and scanned. More research was done by reading relevant materials on the shoulder and imaging modalities. This included abstract reading and use of the word web to identify some useful books on the research topic as well as some useful medical sites with detailed information on shoulder imaging. All relevant references were finally fixed in the bibliography section.
Selection of the five Most Important References
The presence of a large number of references permitted abstracts of the selected articles to be read through to identify the most useful ones providing clear ideas to the next step of the research topic. Recent articles conveying most aspects of the research topic were selected.
Experience gained during the process
Gathering large amounts of information was not easy and involved lots of effort to achieve the projects aim. During the research process, I gained wide knowledge on shoulder imaging. I also learnt how to obtain the relevant research sources and skim quickly through the abstracts to get an overall view of the research topic.
Significant five articles
This section outlines the most prestigious five articles. The order in which the articles are presented does not relate to their order of importance.
Article #1
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
Article summary
The author in the first part of this article gives an overview of five distinct imaging modalities of the shoulder during pain. He states some of the common pathologies of this joint and identifies the four most common parts of the shoulder exposed to this pathology. In addition, the author identifies the radiological techniques used to demonstrate this pathology. He asserts that conventional radiography is tremendously crucial in showing any bone abnormalities although it does not provide useful information when it comes to the soft tissues.
He provides the criteria used to carry out an ultrasound examination of the shoulder and mentions its advantages over other examinations. He further talks of the usefulness of Arthography when used together with a CT-scan. In the modalities final section, the author concludes by stating that MRI technology is the best technique used in demonstrating the shoulder joint and all its constituents. According to the author, this technique offers high-quality imagery.
In the second part of this article, the author mentions four different shoulder pathologies, the first one being Impingement Syndrome. This is caused by the trap of the supraspinatus tendon, subachromial-subdeltoidbursa and biceps tendon located between the humeral head and the coraco-acromial arch. According to the author, acromion plays a dominant role in this situation, and there are some different causes of this syndrome. The author makes a comparison between plain radiographs, ultrasound, and MRI. He concludes that MRI and Ultrasound are better compared to plain radiograph.
The second shoulder pathology according to the author is Rotator cuff tears, which might be caused by different etiologies. The author provides many studies that have dealt with this pathology and gives the results of using MRI and US to diagnose it. He further adds that both MRI and Ultrasound would provide useful information about it. The third pathological syndrome of the shoulder mentioned in this article is Biceps tenosynovitis Both MRI and ultrasound have the ability to display this pathology. The last pathological problem of the shoulder joint stated in this article is Instability.
At the end of the article, the author proves that many MRI studies have occurred and have demonstrated this disorder compared to the other imaging modalities. He concludes the article by claiming that MRI is the best imaging modality used to demonstrate shoulder joint complications.
Article significance
This article is of utmost importance due to the useful information it provides on shoulder pathology. It gives a comparison between different imaging modalities based on previous studies and ends by suggesting the best modality, which can show the shoulder in different cases of pathology. This research is focused on shoulder imaging and this article states that MRI and Ultrasound are the best imaging modalities compared to plain radiography and CT. The large number of references in this article is quite significant.
Article #2
Blanchard, T. K., P. W. Bearcroft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder Problems: a randomized study. The European Journal of Radiology 30 (1):5-10.
Article summary
This article concentrates on a study assessing the attitude of medical scientists towards Arthrography and MRI as imaging modalities of the shoulder. The study took one year to be complete and involved 51 patients who were referred to a rheumatology clinic to diagnose the rotator cuff problems in their shoulders.
The clinicians according to this article split this group into two, 29 for MRI investigation, and 24 for arthrography. MRI investigations were held under 0.5 T or 1.5 T machines while arthrography was done through conventional methods. After necessary examinations, the patients were sent back to the
referred clinic to continue their treatment or to be followed up in the future. The researchers used questionnaires, which were sent together with the imaging reports to evaluate patient satisfaction towards MRI and arthrography.
Compared to the primary diagnosis, which had been done in the centers, MRI and arthrography results were similar to the presaging diagnosis. The article discusses the impact of these two imaging modalities. It confirms that clinicians’ diagnostic confidence when using MRI is more beneficial than arthrography.
According to the authors, Ultra Sound results are not accurate since Ultra Sound depends on the operator skills. According to them, MRI changes the treatment managements of some patients making them more vulnerable to surgery to solve their shoulder joint problems. This is different from arthrography, which shows the same result to the pre-imaging diagnosis. The authors in this article highlight the advantages of MRI and its ability to give a clear view of the examined organ.
They also show the importance of Arthrography in identifying some pathological problems of the shoulder joint though it lacks technological advancements as compared to MRI. They conclude their article by stating that arthrography can play a very pivotal role in demonstrating a full thickness rotator cuff tendon and getting a better visualization.
Article significance
This article has been found significant in this research topic due to its useful information on two imaging methods of the shoulder, that is, MRI and arthrography. The authors of this article concentrate on this two techniques due to their capabilities in diagnosing problems of the shoulder joint. The article at some point talks of the importance of arthrography due to its dependence on the contrast media, which is usually injected inside the joint.
However, this article still proposes that MRI is the best imaging modality since it gives a wide range of multi-planner images by using technology that reflects on the clinicians’ decisions. This supports the hypothesis of this project that MRI is the best method for shoulder imaging.
Article #3
Middleton, William D., 1, William T. Payne, 1, Sharlene A. Teefey, 1, Charles F. Hildebolt, 1, David A. Rubin, 1, Ken Yamaguchi, and 2. 2004. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction. Am. J. Roentgenol 138 (5):1449-1452.
Article summary
The main purpose of the study in this article is to determine the imaging modality preferred by patients with shoulder complications. The article determines whether such patients prefer ultrasound or MRI. These two imaging modalities are used to evaluate shoulder pain complications though with varying technological degrees. This study involved a hundred and thirty patients, and was conducted between the period December 1998 and April 2001. The patients were subjected to both imaging modalities after which they were requested to fill out a Satisfactory Survey form. Ultrasound examinations were first performed followed by MRI.
During ultrasound exam, the arm of every patient was moved in many directions to visualize the whole shoulder girdle components like rotator cuff and tendons. In MRI exams, the shoulders were examined via the use of different imaging planes. Six patients were, however, excluded from the study because they got 12 contraindications towards MRI. In this survey, researchers concentrated on whether the modality exam would cause or seize pain to the shoulder.
In patients where this caused pain, then the patients were asked to grade the level of the pain and how long it took it to end. They were also asked whether they would do the test again and which imaging modality among the two they would prefer. Thirty-nine patients who were examined through ultrasound reported strong pain in the shoulder with nineteen patients reporting that the pain was during the exam period. For MRI exam, thirty-two patients reported pain or discomfort during the exam.
Overall, patients reported that MRI exam took exceedingly long time compared to ultrasound examination. Most patients were excited about the ultrasound investigation. Seven patients reported that they were not happy with MRI exams with most of them reporting that they were satisfied with it. The article concludes by asserting that most patients prefer ultrasound exams rather than MRI in shoulder examination.
Article significance
This article was found significant in this study. It provides the results of a study conducted on patients with shoulder complications, which is the main point of this research project. The study conducted in this article is tremendously significant to this research topic since it allows for patient opinion, which is indispensable in determining the best imaging modality. The study could have, however, provided better results if patient number was high due to accuracy and rationality. The study shows that MRI and ultrasound are the best imaging modalities dealing with shoulder joint.
Article #4
Cheng-Yen Changa, c, Su-Fang Wanga, Hong-Jen Chioua,c, Hsiao-Li Mab,c, and Ying- Chou Suna, Hong-Dar Wua,c. 2002. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears journal of clinical imaging 26 (1):50-54.
Article summary
This article provides the results of a study conducted between July 1996 to October 2000. Four hundred and twenty-two patients were used to evaluate diagnosis ability by using Ultrasound and MRI to demonstrate full-thickness rotator cuff tears. Researchers divided the patients into two groups according to time. It was optional for the patients to undergo surgery to proof the diagnosis.
During Ultrasound investigation, the arm of every patient was moved in different directions while performing different imaging planes like vertical and oblique. MRI investigations were done using 1.5 T MRI systems. Experienced radiologists did reports in the musculoskeletal system. There was a different diagnosis criterion for both groups during ultrasound exams. A 5- year experienced technician performed first group diagnosis while a 10-year experienced radiologist performed diagnosis for the second group.
This was done to help in evaluating the findings. The results of this study show that the full thickness rotator cuff tears in some patients cannot be detected by using Ultrasound or MRI. Surgical action showed tears for some patients, which have not been detected in both modalities.
According to this article, both ultrasound and MRI have many advantages for patients. These include the fact that both are non-radioactive, non-evasive to patients and offer multi-planar shoulder images. Ultrasound examination is, however, more economic, time saving, and fast compared to MRI which is highly operator-dependent, more expensive and slow. Authors in this article emphasize on the fact that Ultrasound investigates full-thickness rotator cuff tears depending on the operator experience.
They add that Ultrasound exam can be considered as the imaging modality of choice for screening especially in the presence of an expert. MRI, on the other hand, is the second option for clinicians planning to perform shoulder examinations after rotator cuff tear is diagnosed by Ultra Sound. Authors in this article conclude by straining the fact that in circumstances where an expert in ultrasound is unavailable, then MRI should be performed to show full-thickness rotator cuff tears due to its high technology.
Article significance
This article was considered significant in this research topic since it provides useful information about the ability of both Ultrasound and MRI imaging modalities in demonstrating shoulder complications. It presents a comparison on the ability of both imaging modalities and conditions required to have perfect and clear investigation results.
In addition, the article stresses the point that MRI is the best imaging modality in depicting shoulder problems. It, however, gives some disadvantages of this modality compared to ultrasound, which is accepted, by most patients. This article thus provides further knowledge about MRI’s and ultrasound capabilities in showing problems of the shoulder girdle.
Article #5
Shahabpour, M., M. Kichouh, E. Laridon, J. L. Gielen, and J. De Mey. 2008. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. The European Journal of Radiology 65 (2):194-200.
Article summary
This article is a brief summary of literature reviews from many medical sources and evaluates the capability of different imaging modalities in identifying certain pathological problems in the shoulder and elbow. This article is divided into two sections, and my interest based on the research topic is on the shoulder section. Many articles as well as previous studies concentrate on the shoulder joint.
According to the article, occult fractures, articular structures and soft tissues of the shoulder, including tendons, ligaments, muscles, and capsulolabral structures can be perfectly demonstrated by MRI modality. There is an outstanding example in this study article, which shows the problem of full-thickness rotator cuff tears and the ability of normal MRI investigation to show it.
Ten of the studies in this article show that most clinicians prefer using conventional MRI pulse sequences as opposed to fat-suppressed MRI. Literature review explained that MR arthrography is accurate in showing the problems of the shoulder especially during contrast medium injection to the joint. Ultrasound investigations studies formed part of the literature and provided useful information about this modality and its ability to show shoulder problems. The article states that CT scan investigation that follows arthrography is useful to show rotator cuff tears and is strongly used for patients who have contraindications toward MRI.
Ultrasound, according to this article, is an accurate imaging modality to demonstrate rotator cuff tears though it requires the presence of an experienced operator. In case of shoulder instability, the article emphasizes on two imaging modalities with MR arthrography being the best method. The article further asserts that with the presence of any contraindication toward MRI machine, CT arthrography is useful and gives remarkably satisfactory results.
In terms of conventional radiography, the article states that a special radiographic position for the shoulder should be incorporated to show a full view of the joint. The article concludes by saying that MRI and Ultrasound could be used to detect rotator cuff tears and MR arthrography as well as CT arthrography could detect labrum tears.
Article significance
This article is one of the best five articles that was considered beneficial to the research topic. It is extremely useful for this research topic since it deals with many studies involving the shoulder and elbow joint. The largest part of this study focuses on the shoulder, and the article provides supportive information to add to the researcher’s knowledge. This is reflected in the research project.
However, the quality of the study conducted in this article would have been more accurate if more previous studies were included. It is, however, well equipped with enough details on the shoulder joint, which is highly required in this research.
Bibliography
Blanchard, T. K., P. W. Bear croft, A. Maibaum, B. L. Hazelman, S. Sharma, and A. K. Dixon. 1999. Magnetic resonance imaging or arthrography for shoulder problems: a randomized study. European Journal of Radiology 30 (1):5-10.
Cheng-Yen Changa, c, Su-Fang Wanga,c,*, Hong-Jen Chioua,c, Hsiao-Li Mab,c,, and c Ying- Chou Suna, Hong-Dar Wua,c. 2002. Comparison of shoulder ultrasound and MR imaging in diagnosing full-thickness rotator cuff tears. journal of clinical imaging 26 (1):50-54.
King, Leonard J., and Jeremiah C. Healy. 1999. Imaging of the painful shoulder. Manual Therapy 4 (1):11-18.
Levine, Harry. 2010. Medical Imaging. Westport: Roundhouse Publishers.
Middleton, William D., 1, William T. Payne, 1, Sharlene A. Tee fey, 1, Charles F. Hilde bolt, 1, David A. Rubin, 1, Ken Yamaguchi. 2004. Sonography and MRI of the Shoulder: Comparison of Patient Satisfaction. Am. J. Roentgen 138 (5):1449-1452.
Shahabpour, M., M. Kichouh, E. Laridon, J. L. Gielen, and J. De Mey. 2008. The effectiveness of diagnostic imaging methods for the assessment of soft tissue and articular disorders of the shoulder and elbow. European Journal of Radiology 65 (2):194-200.