Diagnostic and Interventional Radiology

Istituto Ortopedico Galeazzi

key figures 

CLINICAL SERVICES:

  • Orthopaedic and general imaging examinations
  • Ultrasound-guided diagnostic and interventional procedures
  • Evaluation of all the spectrum of muscle, tendon, nerve and joint disorders
  • Abdominal, thyroid, and soft tissue imaging evaluation
  • Evaluation of bone density

The Unit of Diagnostic and Interventional Radiology of Istituto Ortopedico Galeazzi Research Hospital is a highly specialised tertiary referral centre for musculoskeletal radiology imaging. In 2017, the Unit has performed about 131,000 imaging and therapeutic procedures. We routinely see all aspects of musculoskeletal pathology, with more than 95% of examinations related to the field of musculoskeletal imaging. The radiology department consists of 12 board-certified radiologists with expertise in all subspecialties of musculoskeletal radiology. Exams are performed by trained and qualified radiographers, with special competences in MRI imaging.

treatmentS

Magnetic Resonance Arthrography

Magnetic resonance imaging is the most comprehensive imaging tool in the evaluation of joints and the surrounding tissues. However, in some cases, a more accurate analysis is needed. Magnetic resonance arthrography (MRA) consists in the injection of contrast agents in the joint space – mainly the shoulder, the wrist, and the hip – with the two-fold purpose of distending the joint space and making the intra-articular structures more visible. The injection is performed using ultrasound guidance, which allows for a quick and precise targeting of the joint space without the use of ionizing radiations. MRA is usually requested before surgery, to have a more comprehensive evaluation of the area to treat. At the Unit, approximately 200 MRAs are performed per year.

EOS imaging

Conventional radiography is usually the first imaging examination performed in patients with orthopaedic conditions. For the spine and the lower limbs, this exam is of even greater importance, as it is very panoramic and provides crucial information about deformities. Even when performed well, the spine and the lower limbs radiographies suffer from deformation, which does not allow performing precise measurements. At the Unit, the EOS system is used, which is an advanced radiographic scanner able to obtain spine and lower limbs radiographies without any deformation. What’s also important is that, this system provides a remarkably lower radiation dose to patients, also enabling to perform 3D measurements when needed.

Minimally invasive interventional procedures and pain control treatments

Radiology plays a crucial role not only in the diagnosis of orthopaedic conditions, but also in their treatment. In fact, imaging can be used as a guidance to perform minimally invasive therapeutic procedures in the musculoskeletal system. This implies that the radiologist can monitor continuously, through images, very small tools in the body of the patient used to perform minimally invasive procedures. Most of these procedures are performed under local anaesthesia, do not require hospitalization, and in most cases allow patients to restart their working activity on the following day.

The list of the main interventional procedures performed at the Unit are:

  • Ultrasound-guided percutaneous irrigation of calcific tendinopathy
  • Ultrasound-guided treatment of tendinopathies (such as lateral epicondylitis, Achilles tendinopathy, etc.)
  • Ultrasound-guided treatment of plantar fasciitis
  • Ultrasound-guided injections of platelet-rich plasma (PRP) and other growth factors for regenerative purposes in cooperation with the REGAIN centre of our Institute
  • Ultrasound-guided intra-articular injection of therapeutic agents (hyaluronic acid, steroids)
  • Ultrasound-guided biopsies of soft tissue lesions
  • Bone biopsies under CT guidance
  • Spine injections for pain control

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENt

The Radiology Department service has fully integrated PACS and RIS system and consists of:

  • Four conventional radiography systems performing both orthopaedic and general examinations
  • Sixty-four-slice computed tomography scanner performing both diagnostic and interventional procedures
  • Two 1.5T high-field magnetic resonance scanners, performing all diagnostic study related to orthopaedic conditions, including magnetic resonance arthrography for a better assessment of the joint space and its structures
  • Ultrasound for the evaluation of all the spectrum of muscle, tendon, nerve and joint disorders, as well as to guide interventional procedures. In addition, we perform general ultrasound studies for abdominal, thyroid and soft tissue evaluation
  • Bone densitometry, for a precise and accurate evaluation of bone density with qualified radiographers and fully equipped scanner
  • EOS, which consists in a stereotactic, low-dose radiographic system used to perform standing radiographs of the spine, pelvis, and lower limbs without deformation