Health Concerns for Paris Olympics (2): Diagnostic Imaging Techniques Explained

Introduction

As the alarming number of injuries involving athletes like gymnast Simone Biles during the Paris 2024 Olympic event continues to rise, the question of how to provide timely medical assistance to athletes at the point of care again captivates the world’s attention.

After learning the extensive use of MSKUS in diagnosing and managing musculoskeletal conditions in the previous discussion, this follow-up chapter will examine the strengths and limitations of major diagnostic imaging techniques, including X-ray, CT scans, MRI scans, and ultrasound scans. Discover how these technologies are improving athlete care and performance, especially the transformative effects of portable ultrasound scanners in sports medicine.

In-Hospital Diagnostic Imaging Techniques

1. X-rays

X-rays utilize electromagnetic radiation to produce images of the body’s internal structures. They are typically carried out at the Department of Radiology in the hospital. To create a radiograph, a patient is positioned between an X-ray source and detector, allowing X-rays to pass through the body and be absorbed at varying levels based on the radiological density, which depends on the tissue’s density and atomic number. For example, bones appear whiter on X-rays because they contain calcium, which absorbs X-rays more readily than less dense tissues like fat, muscle, and air-filled cavities, which appear in shades of gray.

X-rays can be used to examine most areas of the body, and the most familiar use of X-rays is checking for fractures (broken bones)^[1]and large areas such as the thorax and enterocoelia. X-ray scans are relatively quick and painless. However, a limitation of X-rays is that they expose patients to ionizing radiation.

2. CT scans

CT scans utilize a combination of X-rays and computer technology to create detailed cross-sectional images of the body. The CT scanning machine rotates on an axis and takes various 2D images of an individual’s body from multiple angles. Then, the computer will place all the cross-sectional images together on its screen, resulting in a 3D image of the body’s inside.

CT scans are often used to diagnose severe injuries of the chest, head, spine, or abdomen, particularly fractures^[2]. It will usually take 10-20 minutes to take a CT scan, and several days to receive the imaging result. Patients may have a contrast dye injection or liquid intake for a clearer image of certain body structures^[2]. CT scans will expose patients to higher levels of radiation compared to X-rays.

Radiation Dose Comparisons of X-ray and CT Scans^[3]

3. MRI scans

MRI scans use a magnetic field and radio waves to generate detailed images of the body’s soft tissues. Unlike X-rays or CT scans, there’s no radiation involved in MRI scans, making them a safer option for repeated imaging studies. It is the gold standard for most soft tissue injuries, including muscles, tendons, ligaments, and cartilage, and it is also the most sensitive for bony stress injuries compared to other imaging techniques that may only show bone structures^[4]. When sports injury causes abnormalities of the spinal cord or the brain, it is also recommended to take an MRI scan.

MRI scans tend to be more expensive and time-consuming than X-rays or CT scans, and the MRI scanner will make loud tapping noises at certain times. Depending on the size of the area being scanned and how many images are taken, the whole procedure will take 15 to 90 minutes.

Notably, the wait time for patients from an appointment to an MRI service is usually long, with wait times generally ranging from 65 to 105 days^[5]. Timothy McAdams, MD, president of the NFL Physicians Society and head team physician for the San Francisco 49ers, explained that after every NFL game, it seems that at least four or five players from each team need an MRI exam to determine the extent of suspected injuries. However, even for athletes who get injured and need emergency diagnosis, the players have to be scheduled for an MRI at the nearest hospital, and, often, the appointment is for the next day or so. Cincinnati is the only team in the NFL that has an MRI onsite at its stadium, Paycor Stadium^[6]. But Doctor McAdams confessed that having an MRI at the stadium isn’t especially helpful when it comes to return-to-play decisions, because by the time the MRI is completed and the results are read, there may not be much time left in the game^[6].

Cincinnati Bengals Are Lone NFL Team with An MRI Facility at Their Stadium

4. Arthroscopy

Arthroscopy is a minimally invasive surgical procedure that involves making small incisions in the joint capsule and ligament. Through these incisions, a fiber-optic camera, known as an arthroscope, is inserted to visualize the inside of the joint. This allows surgeons to diagnose and treat various joint conditions, such as torn cartilage, damaged joint lining, torn ligaments, damage to the knee cap (patella), and arthritis. Arthroscopy can be performed on multiple joints, including the hands, wrists, knees, and elbows. While complications from arthroscopy are rare, they can be serious, including blood clots and infections.

One of the significant advantages of arthroscopy over traditional open surgery is that it is less invasive, leading to quicker recovery times, less pain, and minimal scarring for patients. In many cases, patients are discharged the same day as the procedure, and the recovery time can range from 1 to 6 weeks, depending on the extent of the surgery and the patient’s overall health^[7].

On a more individual note, Eli Manning, an American former football quarterback, underwent arthroscopic surgery on his left ankle in 2014. Remarkably, he was able to run again about six weeks after the procedure^[8]. Despite initial concerns that this injury could end his career, Manning continued to play for another five seasons until his retirement in 2019. His successful recovery highlights the effectiveness of arthroscopy in treating joint injuries and enabling professional athletes to return to their sports.

5. Ultrasound

Ultrasound scanner utilizes high-frequency sound waves to produce images of the body’s internal organs and tissues. Compared with the stationary-type scans above, ultrasound features the ability to capture the movement of musculoskeletal components allowing for structure examinations at rest and in motion.

Traditional console-based ultrasound machines have become highly advanced and are now proficiently used for diagnosing musculoskeletal (MSK)^[9]. These machines offer detailed imaging capabilities that allow healthcare professionals to accurately assess and diagnose a variety of MSK conditions, such as muscle tears, tendon injuries, ligament tears, and joint abnormalities. Furthermore, ultrasound is more cost-effective and often becomes the target of cost-cutting in the imaging department. An article by Parker et al., published in 2008, indicates that the substitution of MSK ultrasound for MSK MRI, when appropriate, would lead to savings to Medicare of more than $6.9 billion in the period from 2006 to 2020^[10].

However, the above-mentioned imaging techniques still leave the major challenge in sports medicine unsolved, namely the need for more accessible and immediate imaging solutions, while dealing with the high costs and bulkiness of traditional scanners, along with ongoing staffing and maintenance expenses.

Portable ultrasound machines are innovative products that have revolutionized diagnostic imaging techniques, especially in sports medicine. These compact devices offer the same diagnostic capabilities as traditional ultrasound machines but with the added benefit of cost-effectiveness and mobility. They can be used in various settings, including remote or rural areas, emergency rooms, and even at venues. This flexibility allows for quicker diagnoses and more immediate care, making portable ultrasound machines an invaluable tool in sports medicine and modern healthcare.

Comparative Overview and Summary Table

Check the picture below to compare different imaging techniques including X-rays, CT scans, PET scans (showing cell reaction to a radiotracer that may indicate cancerous areas[11]), MRI scans, and MRA (one type of MRI scan focusing on blood vessels).

Additionally, a summary table is provided for quick comparison.

Brian Imaging Comparison under Different Diagnostic Imaging Techniques

Comparison Table of Different Diagnostic Imaging Techniques

At-Spot Musculoskeletal Ultrasound Diagnosis

In sports medicine, portable ultrasound machines are increasingly adopted to provide athletes and medical professionals with immediate access to essential imaging technology. Explore the unparalleled advantages of at-spot portable ultrasound machines like Viatom Uprobe-C, paving the way to elevate approaches to sports health and performance.

1. Wireless, handheld portability for flexible move

Wireless, handheld ultrasound machines offer unparalleled convenience for sports medicine professionals. Compared to traditional console-based ultrasound systems that occupy a specialty office[12] and demand power supply and complex wires, portable ultrasound machines like Viatom Uprobe-C offer greater flexibility and accessibility. Viatom Uprobe-C is comparable in weight to an apple^[13], making them compact and portable for use in various locations, whether in a sports field or the gym. Athletes no longer need to wait for appointments or transport themselves to imaging facilities. Instead, they can receive instant evaluations during training sessions and competitions.

This ability to conduct immediate assessments on-site is crucial in situations such as suspected muscle tears, joint sprains, or tendon injuries. For instance, a football player with a potential hamstring tear can receive an instant diagnosis, helping coaches and trainers quickly determine whether they can continue playing or need immediate medical attention. Similarly, a basketball player experiencing knee pain may require rapid evaluation to rule out ligament injuries.

Furthermore, portable ultrasound machines are bringing substantial benefits to remote management and teleconferencing. Their wireless data transmission capabilities facilitate real-time sharing of diagnostic images, providing essential references during interdisciplinary collaboration and remote consultations among athletes, team coaches, and medical professionals. This technology also allows experts to assist less experienced practitioners with complex scans, offering immediate feedback that enhances remote education opportunities in ultrasound healthcare.

portable ultrasound and teleconferencing

2. Multi-head capability for whole-body imaging

Portable ultrasound machines like Viatom Uprobe-C are equipped with multiple interchangeable heads, such as linear array probes and convex array probes. The linear array probe is ideal for imaging superficial structures like tendons, ligaments, and muscles, providing high-resolution images that are essential for diagnosing sprains, strains, and muscle tears. On the other hand, the convex array probe is better suited for deeper structures, such as abdominal organs, offering a broader field of view. This versatility allows sports medicine practitioners to use a single device to assess various parts of the body, from superficial injuries to deeper internal issues.

Portable Ultrasound Probe Switch — Diagram of Sound Waves Emitted by Different Probes

color Doppler — Ultrasound Images Using Convex Array Probe of Viatom

Liver and kidneys — Ultrasound Images Using Convex Array Probe of Viatom

3. High-resolution multi-modal imaging

Portable ultrasound machines like Viatom Uprobe-C are at the forefront of modern diagnostic technology, featuring high-resolution multi-modal imaging that significantly enhances the precision and effectiveness of medical examinations. With its versatile display modes, Uprobe-C provides clinicians with a comprehensive set of insights into assessing a wide range of musculoskeletal and other conditions. For example, B-mode provides standard grayscale images, which are useful for general assessments of tissue structure[14]. M-mode or “motion” mode is a one-dimensional view of all reflectors, therefore its temporal and axial resolution is remarkably high. It is able to evaluate motion and timing and can document tissue movement in a still image when the recording of a video clip is not feasible[15]. Doppler mode assesses vascular patency and organ perfusion, which is essential for evaluating blood flow, and helps to identify issues like blood clots or reduced circulation^[16]. The ability to switch between these modes enhances diagnostic accuracy and provides a comprehensive view of the patient’s condition.

Uprobe-C excels in image quality not just through its diverse display modes but also by incorporating sophisticated image adjustment features. Adjustments such as BGain, TGC (Time Gain Compensation), and DYN (Dynamic Range) optimize image clarity and contrast, ensuring that subtle anatomical details are easily discernible. The Focus, Depth, and Harmonic settings allow for customized imaging tailored to specific clinical needs, enhancing resolution and depth perception. Moreover, the Denoise feature minimizes unwanted artifacts, ensuring that the images presented are as clear and accurate as possible^[17].

More Application of Musculoskeletal Ultrasound in Sports Medicine

The Treatment of Musculoskeletal Diseases market is anticipated to achieve a remarkable revenue of US$183.20bn by 2024 and is forecasted to expand to US$211.40bn by 2029[18]. In this evolving landscape, portable ultrasound machines will become increasingly influential in sports medicine and the broader healthcare industry with the following two extended scenarios.

1. Routine health check

Regular use of ultrasound in routine checks can significantly enhance the overall health and longevity of an athlete’s career. Acting like another “stethoscope” for physicians, musculoskeletal ultrasound is an essential tool in sports medicine for routine health status checks. During a routine check, an ultrasound can detect early signs of tendonitis in a runner’s Achilles tendon or identify minor tears in a tennis player’s rotator cuff right after training.

By equipping a portable musculoskeletal ultrasound machine and utilizing it as part of the healthcare routine, team doctors can catch potential musculoskeletal issues early and tailor training programs to individual needs. This proactive approach not only helps in preventing serious injuries but also ensures athletes maintain peak performance levels.

2. Treatment and rehabilitation management

Ultrasound machines play a crucial role as treatment and rehabilitation assistants, offering precise and effective treatment advice. One concrete example of ultrasound in treatment assistance is its extensive use in guiding injections, aspirations, and biopsies. It is proven that the accuracy of ultrasound-guided injections is superior to that of landmark-guided injections regardless of anatomic locations[19]. Taking corticosteroids as an example, ultrasound-guided corticosteroid injections can be administered directly into inflamed joints or tendon sheaths, such as the player’s shoulder or knee, to reduce pain and inflammation without deviating^[20]. Moreover, evidence also shows that less experienced providers can be more accurate with ultrasound guidance, potentially affecting the future of medical education^[19].

Portable ultrasound machines allow clinicians to monitor real-time tissue healing and adjust rehabilitation protocols accordingly. This capability ensures that treatments are tailored to the specific needs of each athlete. By incorporating portable ultrasound machines into rehabilitation programs, sports medicine practitioners can deliver more personalized and effective care, ultimately speeding up recovery times and helping athletes return to their sport safely and efficiently.

Final Words

Ultrasound, the non-invasive and painless diagnostic imaging technique, has the advantages of being radiation-free, quickly accessible, relatively inexpensive, and highly accurate in experienced hands^[21]. Portable ultrasound scanners like the Viatom Uprobe-C enable immediate assessment and management of musculoskeletal injuries, allowing healthcare professionals to quickly identify issues on-site and administer timely treatment. This alignment of advanced technology and sports medicine illustrates the ongoing commitment to athlete performance and well-being at all levels of competition.

References:

[1] X-ray – NHS (2022)

https://www.nhs.uk/conditions/x-ray